Benign Tumor Recurrence Research Articles

Clinical, paraclinical and therapeutic factors implicated in the recurrence of benign jaw tumors in three tertiary hospitals in Yaounde

IntroductionBenign jaw tumors or tumor-like swellings of the jaws can be classified as odontogenic or non-odontogenic. The type of surgery undertaken or the histological typing of the tumor could be the cause of the recurrence of these tumors. Our objective was to determine clinical and paraclinical features implicated in or that signal the recurrence of benign tumors. Material and methodsWe carried out a case control study during the period from January 2010 to April 2020 in the units of Stomatology and maxillofacial surgery, radiology and pathology units of Yaoundé University Teaching Hospital, Yaoundé Central Hospital and Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital. Participants who had been operated for a benign jaw tumor were included in this study. For the statistical analysis: the significant threshold was set at 0.05 that is all p values less than 0.05 were considered statistically significant. ResultsWe retained 89 study participants with a recurrence rate of 7.51%. In our study, we had 61.8% females and 38.2% males with a sex ratio of 0.62. The localization at the level of the angle and ramus of the mandible, tooth preservation, type of anesthesia, radiological tumor aspect and histomorphology (ameloblastic fibroma and osteoma) were statistically significant for recurrence. ConclusionThe recurrence of jaw tumors is associated with several clinical and paraclinical factors. These factors can help predict recurrences and hence reduce the complications associated with late treatment plan.

АНАЛИЗ ПРИЧИН РЕЦИДИВОВ ДОБРОКАЧЕСТВЕННЫХ ОПУХОЛЕЙ СЛЮННЫХ ЖЕЛЕЗ

<p>Among cancer tumors of the parotid gland is 1-2%. In this paper we present and analyze statistical data to determine the most frequent causes of recurrence of benign tumors of the salivary glands, the recommendations for patients and physicians, the examination algorithm.</p>

Tumors and Pseudotumors of the Orbit and their Surgical Removal

Purpose: To determine the share of malign and benign formations of the orbit and to select their optimum surgical intervention. Design: Retrospective observation of a case series. Methods and subjects: The authors evaluated a set of 100 tumors and pseudotumors in 93 patients who were operated on at the Central Military Hospital over the period of 13 years (1982-1994). The average age of patients (56 men and 37 women) was 45 years. Results: 59 primary orbital tumors, 41 secondary tumors, no metastases observed. There were 27 malign tumors. Most of the 29 benign neoplasms were meningeomas (10) and hemangiomas (9). The rest of the tumors of the orbit (12) were operated for granulomas (4), pseudocholesteatomas (3) and dermoid cysts (3), papilloma of the paranasal sinuses (1) and epidermoid cyst of the orbit (1). There were 32 muco- and pyoceles of frontal sinuses and ethmoid cells. We applied the following surgical methods: anterior and lateral orbitotomy, exenteration and extended exenteration of the orbit, rhinologic surgical techniques, partial and complete transcranial orbitotomy and a combination of several surgical methods. Seven patients operated for malignant neoplasm survived five years after the operation (25.9%). There are no reports on five other operated patients. Recurrence of benign tumors was found three times (10.3%), and once (8.3%) for the rest of tumors. As far as muco- and pyoceles are concerned, no recurrence has been ascertained. Conclusion: Our set comprised 59 primary orbital tumors, 41 secondary tumors and, metastases were not found. Successful surgical treatment of tumors and pseudotumors of the orbit lies in the exact diagnosis, the choice of convenient surgical methods and appropriate interdisciplinary cooperation. With regard to the small recurrence rate in all tumors and to the time of survival in malign neoplasms, the therapeutic methods we used can be considered as useful and contributing. died of another disease two years after the operation mentioned above and there are no reports on two others. Postoperational irradiation was applied in 5 patients (i.e. half of the total number only). The reasons were as follows: actinotherapy was contraindicated in four cases and one case was not considered as suitable. This decision proved correct as the last mentioned patient has been living for six years since the operation without any recurrence. Carcinomas of the nose and paranasal sinuses were treated surgically in 8 cases. Six of them were living for more than three years, two for more than 5 years. This group of malign tumors will be discussed in more details hereinafter. In four cases, the eye bulb was deviated before the surgery. Adenoid cystic carcinoma of the lacrimal gland caused deviation of the eye in all three cases. In all cases of adenoid cystic carcinomas of the lacrimal gland, exenteration of the orbit followed by irradiation was performed in all patients.

Repeated Transanal Endoscopic Microsurgery Is Feasible and Safe

The benefits of transanal endoscopic microsurgery (TEM) for the excision of benign and low-grade malignant lesions in the low and middle rectum are well recognized. This study examined the feasibility and safety of a repeated TEM procedure. Patients who underwent a repeat TEM for excision of rectal lesions, either for involved resection margins or for local recurrence, between the years 2000 and 2010, were identified. Rectal lesion characteristics were retrieved. Mean operative times, length of hospital stay, and intra- and postoperative complications were compared between primary and repeated procedures. The postoperative histopathology reports were reviewed, and the adequacy of resection was determined. All patients completed a questionnaire based on the Wexner score for anal sphincter function evaluation. Fourteen patients (3 female, 11 male) underwent a repeat TEM operation during the study period. All procedures were completed endoscopically. Indications for repeated TEM were involved margins in 12 patients and recurrence of benign tumor in 2. Mean operative time, mean length of hospital stay, and rate of postoperative complications were similar for primary and repeated TEM procedures (62.5 ± 17 versus 55 ± 23 minutes, P=.181; 1.7 ± 1.3 versus 1.7 ± 1.12 days, P=.99; and 35.7% versus 21.4%, P=.66, respectively). The Wexner score was comparable at baseline and after the first and the second TEM procedures (1.5 ± 2.3, 1.5 ± 2.3, and 3.3 ± 3.1, respectively; P=.188). No cases of fecal incontinence following a repeat TEM were documented. Repeated TEM is feasible and safe and may be appropriate for selected patients.

Patterns in neurosurgical adverse events: intracranial neoplasm surgery

Neurosurgery is a high-risk specialty currently undertaking the pursuit of systematic approaches to measuring and improving outcomes. As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in cranial tumor resection concerning the frequency of adverse events in practice, their patterns, and current methods of reducing the occurrence of these events. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice. The authors performed a PubMed search using search terms "intracranial neoplasm," "cerebral tumor," "cerebral meningioma," "glioma," and "complications" or "adverse events." Only papers that specifically discussed the relevant complication rates were included. Papers were chosen to maximize the range of rates of occurrence for the reported adverse events. Review of the tumor neurosurgery literature showed that documented overall complication rates ranged from 9% to 40%, with overall mortality rates of 1.5%-16%. There was a wide range of types of adverse events overall. Deep venous thromboembolism (DVT) was the most common adverse event, with a reported incidence of 3%-26%. The presence of new or worsened neurological deficit was the second most common adverse event found in this review, with reported rates ranging from 0% for the series of meningioma cases with the lowest reported rate to 20% as the highest reported rate for treatment of eloquent glioma. Benign tumor recurrence was found to be a commonly reported adverse event following surgery for intracranial neoplasms. Rates varied depending on tumor type, tumor location, patient demographics, surgical technique, the surgeon's level of experience, degree of specialization, and changes in technology, but these effects remain unmeasured. The incidence on our review ranged from 2% for convexity meningiomas to 36% for basal meningiomas. Other relatively common complications were dural closure-related complications (1%-24%), postoperative peritumoral edema (2%-10%), early postoperative seizure (1%-12%), medical complications (6%-7%), wound infection (0%-4%), surgery-related hematoma (1%-2%), and wrong-site surgery. Strategies to minimize risk of these events were evaluated. Prophylactic techniques for DVT have been widely demonstrated and confirmed, but adherence remains unstudied. The use of image guidance, intraoperative functional mapping, and real-time intraoperative MRI guidance can allow surgeons to maximize resection while preserving neurological function. Whether the extent of resection significantly correlates with improved overall outcomes remains controversial. A significant proportion of adverse events in intracranial neoplasm surgery may be avoidable by use of practices to encourage use of standardized protocols for DVT, seizure, and infection prophylaxis; intraoperative navigation among other steps; improved teamwork and communication; and concentrated volume and specialization. Systematic efforts to bundle such strategies may significantly improve patient outcomes.

Transanal endoscopic microsurgery for rectal tumors: the St. Mary’s experience

Background The aim of this study is to describe a single institution’s experience in the use of transanal endoscopic microsurgery for rectal tumors. Methods Between 1996 and 2005, transanal endoscopic microsurgery was performed in 76 patients. The histologic diagnosis was adenoma in 48 and adenocarcinoma in 28 patients. Results Clear resection margins were achieved in 71 of 74 patients (95.9%). Overall morbidity was 18.9% because 14 patients developed minor (10 patients) or major complications (4 patients). During the follow-up, benign tumor recurrence was detected in 3 patients (6.3%). The recurrence rates among patients with T1, T2, and T3 malignant tumors were 7.1%, 42.8%, and 66.6%, respectively. Comments Transanal endoscopic microsurgery is a safe and feasible technique with low incomplete excision rates and may be the preferred method in patients with benign rectal tumors. Its role in the management of malignant tumors should be limited to selected patients with T1 lesions.

Partial parotidectomies: morbidity and benign tumor recurrence rates in a series of 94 cases.

Review the methods available for parotidectomy. Describe the technique of partial parotidectomy assisted by evoked electromyographic nerve location and the expected morbidity and benign and low-grade cancer tumor recurrence rates from this modified procedure. From 1983 to 1999 the author performed or assisted in 94 parotidectomies (79 partial), all done by a single specialty group and all using evoked electromyographic nerve location. The cases were surveyed by reviewing all the hospital and office records on these cases and tabulating the type and extent of surgery, pathology, postoperative problems recorded, and long-term follow-up. Partial parotidectomy was elected in those cases of benign and low-grade malignant disease in which adequate tumor removal required a less than complete lobectomy or total parotidectomy. Heavy reliance was placed on proactive nerve location by an evoked electromyographic device with dissecting/stimulating hemostat. A retrospective review focusing on these cases was performed based on the patient charts and their continued documentation by the practice. In 79 partial parotidectomies there were no documented facial nerve injuries and one incidence of recurrence of a benign mixed tumor and an acinic cell carcinoma, respectively. Partial parotidectomy has the advantages of reduced risk to the facial nerve, reduced operating time, possible outpatient surgery, and no apparent risk of increased recurrence of benign tumors.

Transanal endoscopic microsurgery: experience with 75 rectal neoplasms.

The aim of this study was to describe a single institution's experience with transanal endoscopic microsurgery in patients with benign and malignant rectal tumors. Between January 1992 and April 1998, 75 patients with a mean follow up of 38 months, underwent transanal endoscopic microsurgery excision of benign (46) or malignant (29) rectal tumors, located 3 to 18 cm from the dentate line. A total of 3 of 46 (6.5 percent) patients with benign tumors underwent conversion to radical surgery owing to tumor size. During the follow-up period, benign tumor recurrence was observed in four (9 percent) patients, three of whom were managed by repeat transanal endoscopic microsurgery, whereas one required radical surgery. Histologic staging of malignant tumors was T1 (10), T2 (10), and T3 (9). Seven patients with either inadequate resection margins or T3 tumors were complimented with radical surgery. Of the remaining 22 patients, 11 received adjuvant radiation therapy whereas 11 had no further treatment. Four (18 percent) had recurrent disease, which was managed by repeat transanal endoscopic microsurgery in two, radical surgery in one, and laser ablation in one. No cancer-related deaths were observed during the follow-up period. There was one operative mortality in a cardiac-crippled patient. Postoperative complications were mainly of a minor character and included fever, urinary retention, and bleeding; none of which required reintervention. Rectourethral fistula developed in one patient who underwent repeat transanal endoscopic microsurgery excision for a T3 malignancy. Fecal soiling was transient in three patients and persisted in two. Transanal endoscopic microsurgery excision is a safe and precise technique that is well tolerated even in high operative risk patients. Transanal endoscopic microsurgery may become a procedure of choice for benign rectal tumors and selected early malignant neoplasms.

Local drug delivery system using ceramics: vacuum method for impregnating a chemotherapeutic agent into a porous hydroxyapatite block.

We performed an experimental study on a new drug delivery system that employs a porous hydroxyapatite block (HAb) (composition: Ca10(PO4)6(OH)2)) to conduct sustained release of a chemotherapeutic agent. To confirm penetration of the agent into the HAb (2 cm3), an aqueous solution containing eosin dye was used at various vacuum pressures. To estimate the storage capacity of the HAb, blocks were weighed before and after being impregnated with the aqueous dye solutions, and the capacity of the block was calculated from the increase in weight after vacuum. In this slow-release study using vacuum, the anti-cancer drug methotrexate (MTX) was used in vitro. Four HAb (1 cm3) containing different concentrations of MTX, ranging from 1.22 to 2.38 mg per block, were studied. All were found to release the drug, maintaining a mean concentration of 0.22 to 0.32 microg/ml even after twelve days. This concentration is high enough to be effective against tumor cells. The results suggest that HAb impregnated with a chemotherapeutic agent using a simple vacuum system may serve as a valuable new method of administering local chemotherapy, primarily when used as a strut graft for bone defects. This new drug delivery system can also be used as an adjuvant material in extended curettage, which can also discourage recurrence of benign tumors without any risk of systemic toxicity.

Clinical analysis of eight cases treated with lateral skull base surgery

Eight cases were treated by lateral skull base surgery. Three benign tumors (2: paraganglioma, 1: neurinoma) originated from parapharyngeal space and infiltrated into jugular foramen, and five malignant tumors (3: squamous cell carcinoma, 1: adenoid cystic carcinoma, 1: rhabdomyosarcoma) involved the skull base. Preoperative magnetic resonance imaging gives information as to whether tumors invaded to cranial bone or not, and also permits deciding surgical procedures. Surgical management of mandibular bone was performed in five cases for complete tumor resection and sufficient surgical view; hemimandibulectomy was carried out in four malignant cases, who simultaneously underwent radical neck dissection, and one benign case underwent mandiblotomy. Ligation of sigmoid sinus was carried out in four cases (1; benign, 3; malignant) to control bleeding from large vessels. The skull base was reconstructed with myocutaneous flaps which were fixed by fibrin tissue adhesive. No significant surgical complications were not noted. There were no recurrence of benign tumor during 8-13 years follow up period. Malignant tumors, except one (rhabdomyosarcoma), had no local recurrence during follow up period (4 months-2 years). We emphasize that the progress in preoperative assessment, as well as in reconstructive surgical techniques, will assure more adequate indication of lateral skull surgery for malignant tumors.

Human liver tumors in relation to steroidal usage.

Since 1973 a number of investigators have reported an association between liver neoplasia and steroid usage. Through referral material we have examined the histology of over 250 cases of hepatic neoplasia, most in patients receiving steroid medications. The majority have been benign, predominantly focal nodular hyperplasia (55%) and hepatocellular adenoma (39%). The average age was 31.4 years; 83% had significant steroid exposure with an average duration of 71 months for focal nodular hyperplasia and 79.6 months for hepatocellular adenoma. The type of estrogenic agent was predominantly mestranol; however, during the period mestranol was the most frequently used synthetic steroid. A distinct clinical entity of life threatening hemorrhage from the lesion occurred in 31% of patients with hepatocellular adenoma and 9% of patients with focal nodular hyperplasia. Recurrence of benign tumors has occurred in some patients who continued using steroids and regression has been observed in patients who had incomplete tumor removal but discontinued steroid medication. Medial and intimal vascular changes have been present in a large number of the benign tumors. The relationship of these vascular changes to oncogenesis is unclear, but similar lesions have been described in the peripheral vasculature associated with steroid administration. A number of hepatocellular carcinomas have also been seen. Of significance is the young age of these patients and lack of abnormal histology in adjacent nonneoplastic liver. A striking number of the malignant hepatocellular tumors have been of the uncommon type described as "eosinophilic hepatocellular carcinoma with lamellar fibrosis." The epidemiology of liver lesions within this series is difficult to assess, since the material has been referred from very diverse locations.

Multifocal benign chondroblastomas: Report of a case

Benign chondroblastoma is an unusual solitary bone tumor occurring usually in the second decade in a long bone. The tumor is often sited on epiphyseal cartilages. Very few examples of malignant variants have been documented, although local recurrence of benign tumors is not unusual. We wish to report a patient who developed two chondroblastomas in two distinct anatomical sites (tibia and calcaneus) over the space of seven years, with no clinical or histological features of malignant disease.