Giant Tumor Research Articles

Giant Supratentorial Brain Tumors in Children: Functional Outcome and Progression-Free Survival Analysis

Introduction: This study aimed to identify factors affecting progression-free survival (PFS) in pediatric patients with giant supratentorial brain tumors (GSBTs) treated with surgical excision. The secondary aim was to analyze how these same factors affected the functional outcome in the long term. Methods: We performed a retrospective, analytical, single-center cohort study. We included all pediatric patients with GSBT between January 2014 and June 2018. Patients were followed for a minimum of 24 months for the PFS and overall survival (OS) analysis. Functional status score (FSS) was used to assess the functional outcome. Results: We included 27 patients with GSBT, the median age was six (range 2–12), and eleven patients had a grade IV tumor. The 24-month PFS and OS were 51.85% and 74.04%, respectively. A PFS-ending event or treatment failure occurred in 13 patients. We found that patients with postoperative FFS >16 have a worse PFS than patients with a postoperative FSS <15 (HR 4.51; p = 0.03). Patients with more than three surgeries had worse PFS than patients with one or two procedures (HR 11.39; p = 0.004). High-grade tumors were associated with worse PFS than low-grade tumors (HR 1.55; p = 0.04). Finally, patients with CNS infections had worse PFS than patients without that complication (HR 2.70; p = 0.04). Conclusions: GSBTs in pediatric patients are complex lesions that require multidisciplinary management. Surgical management and quality of life should be considered when choosing the best treatment. Factors influencing long-term PFS were high-grade histopathology, the need for three or more surgeries, postoperative FSS >16, and CNS infections.

Navigating the learning curve with large and giant tumors: Initial experience with endoscopic endonasal transphenoidal resection of PitNETs

BackgroundThe endoscopic endonasal approach (EEA) has progressively become the preferred choice of surgical intervention for PitNETs. However, the adoption in Sub-Saharan Africa has been low. We report our initial experience with the utility of the EEA in PitNETs particularly in large and giant tumors despite limited resources. MethodsThe study was over a 73-month period at the University College Hospital, Ibadan, Nigeria. Pre and post-operative clinical, imaging and neuro-ophthalmological findings were documented. Perioperative and postoperative outcomes were recorded. We compared the outcomes between the early 23 and later 22 patients. Data were analyzed using descriptive statistics, student’s t test, Mann-Whitney U test and Chi square test at α = 0.05. ResultsThere were 45 patients; 25(55.6%) were males. Mean age was 49.9 ± 13.4 years. Visual symptoms predominated with 12(26%) blind in at least one eye. Median tumor volume was 20.9 cm3 and mean tumor diameter was 4.09 ± 0.89 cm. 31(68.9%) had gross or near total excision. Vision improved in 31(68.9%). There were 2 procedure related mortality from CSF leak/meningitis.The mean of the tumor diameter of the earlier patients was less than that of the latter (3.84 vs 4.40 cm, p = 0.04,). The latter group also had more gross or near total resections (26.8% versus 41.5%) but this was not statistically significant. There was no difference in postoperative complications. ConclusionsEEA remains a veritable option for PitNETs, including for large and huge tumors, even within resource challenged environments, with acceptable limits of complications.

Imatinib use in the management of a patient with Doege-Potter syndrome.

Doege-Potter syndromeis a paraneoplastic syndrome characterized by nonislet cell tumor hypoglycemia due to a solitary fibrous tumor, which produces insulin-like growth factor II. In this report, we present the case of a 67-year-old male with recurrent and refractory hypoglycemia due to DPS successfully treated with imatinib. He initially presented with neuroglycopenic symptoms and dyspnea secondary to a giant tumor in the left hemithorax, which was totally resected. During follow-up, 7 years later, he presented with thoracoabdominal tumor recurrence associated with severe hypoglycemia and underwent subtotal tumor resection, with a subsequent improvement of symptoms. The following year, he had a recurrence of his intra-abdominal tumor, which was unresectable, associated with severe hypoglycemia refractory to dextrose infusion and corticosteroids, thus receiving imatinib with a favorable response. The clinical presentation, diagnostic approach, progression of the disease, and response to treatment with imatinib in the management of a patient with large, recurrent, and unresectable mesenchymal tumors with insulin-like growth factor-2 secretion causing hypoglycemiahighlight the importance of this case report. Doege-Potter syndrome (DPS) is a rare cause of tumoral hypoglycemia of non-pancreatic origin. Some malignant or benignant neoplasms have ectopic secretion of insulin-like growth factor-2. Total surgical removal is the principal treatment in patients with DPS. Tyrosine kinase inhibitors management in DPS may contribute to improved tumor control in patients with unresectable tumors and severe hypoglycemia.

Giant intra-abdominal and retroperitoneal desmoid tumor

Desmoid tumors are extremely rare. They represent 3% of all soft tissue tumors. Giant desmoid tumors are rarely reported in the literature and are a challenge in their therapeutic management. The radiological evaluation of extension allowed to delimit its extension in depth and its limits of exeresis. In our case, the tumor was surgically resected with simple postoperative care. This case illustrates the difficulties of managing this entity given its large size.

Giant Tumor of the Thigh Type Epithelioid Sarcoma of the Soft Tissues: A Rare Case with Literature Review

Giant Tumor of the Thigh Type Epithelioid Sarcoma of the Soft Tissues: A Rare Case with Literature Review

Efficacy and safety of an Aron Alpha method in managing giant ovarian tumors

BackgroundGiant malignant tumors have an increased risk of intraoperative rupture, which might lead to a worse disease condition and tumor recurrence. We performed a clinical study on patients with a giant ovarian mass who underwent laparoscopy combined with an Aron Alpha method. MethodsThis retrospective clinical study spanned from January 2016 to September 2022 and included 23 patients with giant ovarian tumors treated with an Aron Alpha method. ResultsThe mean age of the subjects was 47.6 ± 17.8 years, mean tumor diameter 20.4 ± 5.8 cm, mean surgical duration 87.2 ± 33.1 min, and mean hemorrhage volume 94.1 ± 92.2 mL. No patient experienced intraoperative tumor rupture or surgery-related symptoms. Histopathology of excised samples revealed serous cyst adenoma and mucinous cystadenoma, mucinous cystadenoma of borderline malignancy and mature cystic teratoma, and endometriotic cyst adenoma in 6, 4, and 3 patients, respectively. The mean hospitalization period was 6.0 ± 1.2 days, and the hospitalization period was not extended in any subject. ConclusionThe Aron Alpha method allows tumor resection without capsular rupture and is a useful, minimally invasive surgical method for resecting giant ovarian tumors in which malignancy cannot be ruled out.

Giant basal cell carcinoma of the scalp: rotation advancement flap as a successful dermatosurgical approach.

Giant keratinocyte tumors, in particular basal cell carcinomas of the scalp area, are a serious challenge for dermatosurgeons, oncologists, and maxillofacial and reconstructive surgeons. The scalp area is limited in terms of skin mobility, and its elasticity decreases with age. The size of the tumors in this area and the degree of infiltration of the underlying tissues are important for the therapeutic choice, from surgical removal, waiting for granulations to form, and placing a split skin mesh graft (at a later stage) to performing complex rotational/transpositional or advancement flaps. Achieving an optimal aesthetic result is often the consequence of interventions carried out or based on the decisions of multidisciplinary teams. Alternatives, such as radiotherapy and targeted therapy with vismodegib, could be administered both preoperatively and postoperatively or as first-line therapy, depending on the tumor board decisions. We present the case of a 69-year-old female patient with a histopathologically proven preoperative giant basal cell carcinoma of the scalp that did not infiltrate the tabula externa. A preoperative ultrasound was performed to preserve the feeding flap arteries. Surgical treatment under general anesthesia was planned and subsequently carried out. During surgery, the surgical resection lines were in close proximity to the arterial vessels, but they remained preserved and ensured a subsequently unproblematic healing process. After the application of the rotational advancement flap technique under general anesthesia, an optimal cosmetic effect was achieved.

Gamma Knife Stereotactic Radiosurgery for Giant Intracranial Tumors - A Series of 70 Patients.

Surgery remains the primary option in large intracranial tumors, but significant number of patients may not be amenable for surgery. We explored the role of stereotactic radiosurgery as an alternative to external beam radiation therapy (EBRT) in such patients. Our study objective was to assess the clinicoradiological outcomes of large intracranial tumors (volume ≥20 cm3) managed with gamma knife radiosurgery (GKRS). This was a single-center, retrospective study conducted from January 2012 to December 2019. Patients with intracranial tumor volume ≥20 cm3 who received GKRS and had a minimum of 12 months of follow-up were included. Clinical, radiological, and radiosurgical details and clinicoradiological outcomes of the patients were obtained and analyzed. Seventy patients who had a pre-GKRS tumor volume ≥20 cm3 with >12 months of follow-up were included. The mean age of the patients was 41.9 ± 13.6 (range 11-75) years. Majority (97.1%) received GKRS in a single fraction. Mean pretreatment target volume was 31.9 ± 15.1 cm3. At a mean follow-up of 34.2 ± 17.1 months, tumor control was achieved in 91.4% (n = 64) of the patients. Adverse radiation effects were observed in 11 (15.7%) patients, but were symptomatic in only one (1.4%) patient. The present series defines "large intracranial lesions" for GKRS and demonstrates excellent radiological and clinical outcomes in these patients. GKRS may be considered as the primary option in such large intracranial lesions in which surgery carries significant risk based on patient-related factors.

The anesthetic management and the role of extracorporeal membrane oxygenation for giant mediastinal tumor surgery.

Mediastinal tumors are a remarkably diverse category. They include malignant and benign forms with different rates of disease progression and tissue invasion. Anesthesiologists may encounter significant difficulties in managing patients with giant mediastinal tumors due to the non-negligible occurrence of severe cardiorespiratory collapse. Respiratory complications ensue from the compression of the airways induced by the mediastinal mass: the compressive effects may be exacerbated by positioning or anesthesia induction. Furthermore, the compression or invasion of major vessels may elicit acute cardiovascular collapse. The specter of sudden cardiorespiratory deterioration should lead the anesthesiologist to careful planning: acknowledging clinical and radiological signs that may presage an increased risk of life-threatening complications is of pivotal importance. This review aims to present a strategy for treating patients with mediastinal masses, starting with the pathophysiological elements and moving through preoperative care, intraoperative behavior, and the recovery period. We will also focus on respiratory and cardiovascular issues, emphasizing the need for extracorporeal membrane oxygenation (ECMO) as a rescue and crucial component of the anesthesia strategy. Understanding the physiological alterations after anesthesia induction can aid in identifying and treating potential problems. In addition, we attempted to offer insight into multimodal anesthesia and analgesia management: we emphasize the importance of a thorough preoperative assessment and the need for reviewing extracorporeal support not just a resuscitative strategy but as an integrated component of the perioperative care.

EVALUATION OF THE MICROSURGERY RESULTS FOR ACOUSTIC NEUROMA USING AN INTRAOPERATIVE NERVE MONITORING SYSTEM

Objectives: To evaluate the results of microsurgery for acoustic neuroma using an intraoperative nerve monitoring system. Subjects and methods: Cross-sectional, retrospective, and prospective description of 74 patients with acoustic neuroma who were microsurgically treated in Viet Duc University Hospital from October 2016 to March 2018. Results: Women (58.11%) were more predominant than men (41.89%). The age mean was 50.41% ± 9.43 years. There was no significant difference between the tumor location on the right and left side (54.41 compared to 45.59%). There were 40 patients with large tumors (54.05%), giant tumors in 20 patients (27.02%), and 14 patients (18.92%) with small tumors &lt; 2.5cm. Postoperative magnetic resonance examinations were indicated for 100% of patients, in which 78.37% full of tumors were taken out and 21.63% were taken almost tumors. The rate of intact facial nerve was 93.3%. The damage rate of the facial nerve was about 20.28%. The most complications were cerebral edema, bleeding, hydrocephalus, death and meningitis (5.4%; 4.05%; 4.05%; 2.7%, and 1.35%, respectively). The recovery of the function of the VII nerve, grade I, II according to House-Brackmann was 79.72%. Conclusion: Neurosurgical intervention remains the main step in the effective management of vestibular schwannomas. Using a continuous monitoring system for the facial nerve in surgery for vestibular schwannoma has reduced the rate of post-operative facial nerve paralysis.

Giant benign tumor of the sacrum - A case report

Introduction: A benign sacral tumor is a rare disease, especially with a giant tumor. We will present the clinical examination, imaging diagnosing images, and our experience in this case. Case presentation: We report a 25-year-old female with a massive sacral tumor, which had been developing for ten years. Clinical examination showed a 210 × 150 × 210mm mass originating from S2 into the sacrum with organ displacement. The biopsy confirmed that was a benign tumor. The surgery was performed with the anterior and posterior approach to remove the tumor and preserve sacroiliac joints. After 18 months, her recovery was smooth. However, she still presented irreversible damages to the bladder and rectal sphincter functions. Conclusion: En block resection of the giant benign sacral tumor with the anterior and posterior approaches is only administrated for a massive and complicated mass, which can only be performed in hospitals with advanced operating departments, anesthesiology, and aggressive supportive care.

Giant gastric stromal tumor with predominant cystic formation misdiagnosed as gastric cyst under endoscopic ultrasonography and fine-needle aspiration.

A 78-year-old man was admitted owing to 10 days of abdominal pain. He had a history of coronary heart disease, diabetes mellitus, and hypertension. Laboratory results, including tumor markers, blood amylase, and lipase, were unremarkable. During physical examination, a mass was palpated in the left upper abdomen (from the left costal arch to the umbilicus), which had an indistinct boundary and was poorly mobile. Esophagogastroduodenoscopy revealed a bulge in the gastric fundus with an unremarkable mucosa ([Fig. 1]). Computerized tomography revealed a huge abdominal cystic mass (23.3 × 14 × 22 cm), which had an indistinct boundary with the stomach ([Fig. 2]), and distinct boundaries with adjacent organs such as the liver, pancreas, etc. Endoscopic ultrasonography revealed a hypoechoic cystic lesion with scarred hyperechoic strip, and fine-needle aspiration was performed ([Video 1]). A rapid on-site evaluation was unremarkable. The cystic fluid analysis revealed a negative stringing test, normal amylase and lipase, slightly elevated CA125 and ferroprotein, with normal CEA, CA199, and AFP. Cell block and immunocytochemistry were also undiagnosed. Surgical resection was performed ([Fig. 3]), and 3000-mL cystic fluids were aspirated intraoperatively. Postoperative histology showed a spindle cell tumor ([Fig. 4]) with necrosis and cystic degeneration, and immunohistochemical results showed positive staining of CD117, DOG1 ([Fig. 5]), and CD34, with negative staining of SMA, S100, and Ki-67 index of 25 %, and mitoschisis of 8/50 HPF. Therefore, the final diagnosis was a high-risk gastrointestinal stromal tumor (GIST). He refused imatinib treatment and died within 2 years.

A Rare Case of Neglected Giant Basal Cell Carcinoma in a Nurse-Case Report and Literature Review.

Basal cell carcinoma (BCC) is the most common skin cancer in the fair-skinned adult population over 50 years of age and the incidence is rising. Generally, BCC has an indolent course, low mortality and a good prognosis due to low rates of metastasis. Giant basal cell carcinoma is a rare reported oncological entity which accounts for 0.5% to 1% of all cases of BCC and has a diameter larger than 5cm. Basosquamous carcinoma is a rare high-risk type of BCC with clinical and histopathological features of both BCC and squamous cell carcinoma. A 61-year-old female presented to our clinic for a giant bleeding tumor located under her left breast. She initially noted the tumor almost 15 years ago. Although the patient was a nurse, she was afraid to seek medical advice until an episode of significant bleeding. At presentation the tumor was a 15/7cm in size, was invading the underlying structures and had a central ulceration. The margins of the tumoral plaque had several nodules and pearly structures suggesting the possible clinical diagnosis of BCC.

Replantation of solitary kidney in a patient with giant primary retroperitoneal sarcoma

Background. Surgery for non-organ malignant retroperitoneal tumors poses a serious challenge. Long-term asymptomatic course of the disease leads to a delayed diagnosis, when tumors can reach massive size with potential involvement of adjacent organs and critical structures. In most cases, nephrectomy is often required during resection of retroperitoneal sarcomas. Recently, there has been growing interest in nephronsaving surgery for large retroperitoneal tumors.Description of the clinical case. A 70-year-old patient was admitted to Irkutsk Regional Cancer Center with right-sided giant primary retroperitoneal tumor and grade 1 hydronephrosis of solitary right kidney. The patient underwent extended resection of primary retroperitoneal tumor with right-sided hemicolectomy and nephradrenalectomy. Extracorporeal resection of the solitary kidney was then performed. After obtaining negative kidney smears (imprints), the kidney was replanted in the pool of right iliac vessels. No complications were observed in the postoperative period. Histopathology examination revealed was welldifferentiated liposarcoma. On follow-up examination 38 months after surgery, there were no signs of local tumor recurrence, and renal function was satisfactory.Conclusion. Extracorporeal resection of the kidney with heterotopic replantation is an effective nephron-saving method in surgery for primary retroperitoneal sarcomas. The patient’s solitary kidney with primary retroperitoneal sarcoma is an absolute indication for kidney’s saving, including the use of transplant technologies.

A Rare Case of a Giant Tumor of Sebaceous Glands in the Posterior Chest Wall

Sebaceous gland carcinoma is a rare and aggressive tumor that accounts for less than 1% of all cutaneous malignancies. It is classified as intraocular and extraocular and is rarely found in the chest wall. Imaging tests such as Computed Tomography and Magnetic Resonance help to identify the location, size, and evaluation of the involvement of adjacent structures. The treatment is surgical excision, and diagnosis is confirmed postoperatively by the immunohistochemical analysis.

Clinical analysis of 5-year survival and recurrence in giant retroperitoneal liposarcoma after surgery.

Clinical analysis of 5-year survival and recurrence in giant retroperitoneal liposarcoma after surgery.

Clinical effect of surgical resection on primary malignant and invasive bone tumours of the proximal fibula.

There is no unified surgical plan for fibular proximal malignant tumours; therefore, the present study retrospectively analysed the medical records of 19 patients with primary malignant and invasive tumours in the proximal fibula and discussed the postoperative oncological results, complications and postoperative functions of limb salvage surgery. According to pathological classification, there were 10 osteosarcoma cases, 3 chondrosarcoma cases, 2 invasive giant cell osteosarcoma tumour cases, 1 epithelioid sarcoma case, 1 leiomyosarcoma case, 1 fibrosarcoma case and 1 lymphoma case. According to the Enneking instalment, IB stage was found in 2 cases, IIA in 2 cases and IIB in 15 cases. A total of 3 patients underwent Malawer I resection, and 16 patients underwent Malawer II resection. The follow-up period was 11-174 months, with an average of 76.58 months. Local recurrence occurred in three patients and distant metastasis in seven patients; 4 patients succumbed and 15 survived. After biceps femoris tendon reconstruction and lateral collateral ligament insertion, 18 patients had good knee stability. The Musculoskeletal Tumour Society scale ranged between 23 and 29 points, with an average of 27.26 points; the Lysholm Knee Score was 65-84 points, with an average of 83 points. After the resection of proximal fibula primary and invasive tumours, the biceps femoris tendon and lateral collateral ligament insertion point was reconstructed. The data show that this technique can effectively reconstruct stability and restore knee function.

High-grade B-cell lymphoma with MYC and BCL2 rearrangements with abundant multinucleated giant tumor cells.

High-grade B-cell lymphoma with MYC and BCL2 rearrangements with abundant multinucleated giant tumor cells.

Giant gastric myxoid epithelioid gastrointestinal stromal tumor.

A 45-year-old woman presented to the gastrointestinal surgical department with a 2-month history of enlarging abdominal mass. Physical examination revealed an abdominal tumor of approximately 30.0 cm in diameter. Endoscopic ultrasonography showed an extraluminal growing tumor arising from the muscular layer of the gastric wall. Abdominal contrast-enhanced CT revealed a giant cystic-solid tumor originated from the big curved side of gastric corpus, which was considered as a plexiform fibromyxoma of the stomach (Fig. 1A and B).

Giant borderline mucinouscystadenoma in a woman of 46 years-old. Clinical case

Introduction. Ovarian cysts more than 10 cm in dimension are labeled as giant ovarian cysts. Mucinous cystadenomas have the potential to grow into huge mass and rarely remain undiagnosed till they become giant ovarian cysts, they are incidentally found on routine physical examination. Mucinous tumors constitute of benign 75%, borderline 10% and malignant lesions 15%. Giant ovarian tumors generally pose risk due to their location and pressure effects on surrounding structures. Clinical case. A 46-year-old female patient who comes to the consultation because presents a progressive increase in volume of the abdominal region of more than two years of evolution. She presents with dyspnea, low back pain on walking and constipation. An MRI of the abdomen is requested where the abdominal and pelvic cavity is found occupied by a multilocular tumor measuring 297 x 340 x 198 mm, with thin and fine walls, some with internal septa, the signal intensity within the cystic lesions is variable within the different sequences made, but with characteristics of liquid content; with contrast medium applications there is diffuse reinforcement of the wall of the lesions without observing undulations or papillary projections. Unaltered uterus; the anatomical delimitation of both ovaries is not possible due to the characteristics and size of the lesion. Laboratory studies: were normal. Alterated antigens. Exploratory laparotomy + salpingo-oophorectomy bilateral are performed. A transoperative study of the tumor was carried out, which reported: borderline seromucinous cystadenoma, measuring 44 x 36 x 30 cm and weighing 10,170 kg. Discussion. The differential diagnoses of benign ovarian cysts include dermoid cysts, Brenner cysts, and mucinous cysts. Dermoid cysts are sac-like growths on ovaries containing fat, hair, and other tissue types. Brenner cysts are found incidentally and are solid outgrowths on the ovarian surface. Of all the ovarian tumors, mucinous cystadenomas account for 15-20%. These tumors arise from the ovarian surface epithelium and have smooth inner and outer thin walls.