1
|
Annicchiarico A, Montali F, Baldinu M, Casali L, Virgilio E, Costi R. Leiomyosarcoma of the rectum: A systematic review of recent literature. J Surg Oncol 2024; 129:365-380. [PMID: 37814590 DOI: 10.1002/jso.27481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
Leiomyosarcomas (LMSs) are rare tumors originating from the muscular layer. We performed a literature review of cases of confirmed rectal leiomyosarcomas (rLMSs) to clarify the history of such an infrequent tumor arising at such an uncommon location. In this research local recurrence was related to poorly differentiated rLMS and no other association between recurrence and any criteria was found. Concerning overall survival (OS), rLMS patients developing recurrence presented shorter longevity compared with the group without.
Collapse
Affiliation(s)
- Alfredo Annicchiarico
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Filippo Montali
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Manuel Baldinu
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lorenzo Casali
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Edoardo Virgilio
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Renato Costi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| |
Collapse
|
2
|
Shilo Yaacobi D, Bekhor EY, Khalifa M, Sandler TE, Issa N. Trans-anal endoscopic microsurgery for non- adenomatous rectal lesions. World J Gastrointest Surg 2023; 15:2406-2412. [PMID: 38111779 PMCID: PMC10725552 DOI: 10.4240/wjgs.v15.i11.2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/29/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Trans-anal endoscopic microsurgery (TEM) enables a good visualization of the surgical field and is considered the method of choice for excision of adenomas and early T1 rectal cancer. The rectum and retro-rectal space might be the origin of uncommon neoplasms, benign and aggressive, certain require radical trans-abdominal surgery, while others can be treated by a less aggressive approach. In this study we report outcomes in patients undergoing TEM for rare and non-adenomatous rectal and retro-rectal lesions over a period of 11 years. AIM To report outcomes in patients undergoing TEM for rare and non-adenomatous rectal and retro-rectal lesions over a period of 11 years. METHODS Between January 2008 to December 2019 a retrospective analysis was completed for all patients who underwent TEM for non-adenomatous rectal lesion or retro-rectal mass in our institution. Patients were discharged once diet was well tolerated and no complications were identified. They were evaluated at 3 wk post operatively, then at 3-mo intervals for the first 2 years and every 6 mo depending on the nature of the final pathology. Clinical examination and rectoscopy were performed during each of the follow-up visits. RESULTS Out of 198 patients who underwent TEM during the study period, 18 had non-adenomatous rectal or retro-rectal lesions. Mean age was 47 years. The mean size of the lesions was 2.9 mm, with a mean distance from the anal margin of 7.9 cm. Mean surgical time was 97.8 min. There were no intra-operative neither late post-operative complications. Mean length of stay was 2.5 d. Mean patient follow-up duration was 42 mo. CONCLUSION TEM allows for reduced morbidity given its minimally invasive nature. Surgeons should be familiar with the technique but careful patient selection should be considered. It can be used safely for uncommon rectal and selected retro-rectal lesions without compromising outcomes. We believe that it should be reasonably considered as one of the surgical methods when treating rare lesions.
Collapse
Affiliation(s)
- Dafna Shilo Yaacobi
- Department of Plastic Surgery and Burns, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Eliahu Y Bekhor
- Department of Surgery, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Muhammad Khalifa
- Department of Surgery, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Tal E Sandler
- Department of Anesthesiology, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Nidal Issa
- Department of Surgery, Rabin Medical Center, Petah Tikva 4941492, Israel
| |
Collapse
|
3
|
Bennassi A, Souhail H, Lo Cicero A, Durigova A, Salati E. Leiomyosarcoma of the lower rectum managed by radiotherapy and surgery: A case report and review of literature. Cancer Radiother 2023; 27:235-239. [PMID: 37095055 DOI: 10.1016/j.canrad.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/10/2022] [Accepted: 10/21/2022] [Indexed: 04/26/2023]
Abstract
Rectal leiomyosarcoma is a very rare entity. Surgery is the main treatment, but the place of radiation therapy remains unclear. A 67-year-old woman was referred for a few-weeks' history of bleeding and anal pain intensified during defecation. Pelvic magnetic resonance imaging (MRI) showed a rectal lesion and biopsies revealed a leiomyosarcoma of the lower rectum. She was free of metastasis on computed tomography imaging. The patient refused radical surgery. After discussion by a multidisciplinary team, the patient received pre-operative long-course radiotherapy followed by surgery. The tumor was treated with 50Gy delivered in 25 fractions, within 5 weeks. The aim of radiotherapy was local control, allowing organ-preservation. Four weeks after radiation therapy, organ-preservation surgery could be performed. She had no adjuvant treatment. At 38-months follow-up, she had no local recurrence. However, distant recurrence (lung, liver, and bone) was detected 38 months after the resection and was managed by intra-venous doxorubicin 60mg/m2 and dacarbazine 800mg/m2 every 3 weeks. The patient was in a stable condition for nearly 8 months. The patient died 4 years and 3 months after the diagnosis.
Collapse
Affiliation(s)
- A Bennassi
- Department of radio-oncology, centre hospitalier universitaire Vaudois, 46, rue du Bugnon, 1011 Lausanne, Switzerland.
| | - H Souhail
- Department of radio-oncology, centre hospitalier universitaire Vaudois, 46, rue du Bugnon, 1011 Lausanne, Switzerland
| | - A Lo Cicero
- Department of oncology, 20, route du Vieux Séquoia, 1847 Rennaz, Switzerland
| | - A Durigova
- Department of oncology, 20, route du Vieux Séquoia, 1847 Rennaz, Switzerland
| | - E Salati
- Department of oncology, 20, route du Vieux Séquoia, 1847 Rennaz, Switzerland
| |
Collapse
|
4
|
Freund MR, Emile SH, Horesh N, Garoufalia Z, Gefen R, Wexner SD. The importance of surgical resection in the management of rectal sarcoma: A national cancer database analysis of 133 cases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:647-654. [PMID: 36756950 DOI: 10.1016/j.ejso.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/05/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE Rectal sarcomas (RS) are rare malignant tumors with a very poor prognosis. This study aimed to assess the characteristics, treatment, and outcomes of RS in the United States. METHODS This study was a retrospective analysis of the National Cancer Database (NCDB) from 2004 to 2019 of patients with a diagnosis of RS. The main outcome measures were overall survival (OS) and its predictors. RESULTS 133 RS patients (39.1% female) with a mean age of 65.7 ± 15.6 years were included in the study. Mean tumor size was 6.1 ± 3 cm. The crude OS rate was 22.5% and median survival duration was 10.1 (IQR: 3.2-21) months. Factors associated with an improved OS on were private insurance (HR = 0.23, p = 0.001) and undergoing surgery (HR 0.23, p < 0.001), Factors associated with poor survival were age (HR 1.02, p = 0.005), male sex (HR 2.27, p = 0.001), Charlson score of 3 (HR 5.17, p = 0.003), and positive resection margins (HR: 2.64, p = 0.01). Multivariate Cox regression analysis revealed that male sex (HR 2.16, p = 0.04) and positive resection margins (HR 2.31, p = 0.03) were predictors of poor survival whereas surgery was an independent predictor of improved OS (HR 0.321, p < 0.001) CONCLUSIONS: RS is a very rare rectal malignancy with an even poorer prognosis than previously reported. However, undergoing surgery with curative intent while obtaining negative margins may confer better OS.
Collapse
Affiliation(s)
- Michael R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura, Egypt
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
| |
Collapse
|
5
|
Traumatic divergent dislocation of the elbow in the adults. INTERNATIONAL ORTHOPAEDICS 2023; 47:847-859. [PMID: 36622400 PMCID: PMC9931842 DOI: 10.1007/s00264-022-05679-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/14/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE This retrospective study aimed to investigate the clinical outcomes of DDE in adults. METHODS From September 2010 to March 2020, adult patients with traumatic DDEs admitted to Beijing Chaoyang Hospital and Beijing Jishuitan Hospital were included in this study. Each patient underwent operative or conservative treatment during hospitalization. The clinical and radiological examinations were followed up. The primary outcomes included the Mayo Modified Wrist Score (MMWS), the Mayo Elbow Performance Score (MEPS), the Broberg and Morrey functional index, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the Visual Analogue Scale (VAS) score that were performed. Post-operative complications and secondary surgery details were also collected. RESULTS Of the fourteen patients, clinical and radiographic results were reviewed at a mean of 53.2 months (18 to 110 months) postoperatively. There were 11 men and three women with an average age of 31.5 years (17 to 51 years). At the final follow-up, the average MMWS, MEPS, Broberg and Morrey functional index, and DASH scores were 91.4 points, 93.4 points, 92.6 points, and 10.7 points. The mean VAS at rest and during activities was 0.4 and 1.7 points. Two patients required a secondary procedure due to radial malalignment and elbow contracture, respectively. In addition, two patients were found degeneration. CONCLUSIONS Within the context of high-energy DDE combined with simultaneous upper limb injuries, our study recommended obtaining the mechanical benefit of the forearm ring with concentric elbow stability. Despite the various and complicated traumatic patterns of DDE, great clinical results could be acquired based on adequate surgical treatments and early rehabilitation training.
Collapse
|
6
|
Yong ZZ, Wong JSM, Teo MCC, Chia CS, Ong CAJ, Farid M, Tan GHC. Neoadjuvant tyrosine kinase inhibitors in rectal gastrointestinal stromal tumours: a provision for enhanced oncological and functional outcomes. Int J Clin Oncol 2021; 26:913-921. [PMID: 33528660 PMCID: PMC8055628 DOI: 10.1007/s10147-021-01867-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/01/2021] [Indexed: 11/04/2022]
Abstract
Background The role of tyrosine kinase inhibitors (TKI) in the neoadjuvant setting and the optimal duration of therapy remains poorly defined. As such, we aim to evaluate the impact of neoadjuvant TKI on oncological and functional outcomes in our cohort of patients with rectal GISTs. Methods A retrospective analysis of 36 consecutive patients who underwent treatment for rectal GIST at the National Cancer Centre Singapore from February 1996 to October 2017 was analysed. Surgical, recurrence and survival outcomes between the groups who underwent neoadjuvant therapy and those who underwent upfront surgery were compared. Results Patients who received neoadjuvant treatment had significantly larger tumours (median size 7.1 vs. 6.0 cm, p = 0.04) and lower mitotic count (> 10 per 50 HPF, 14 vs. 70%, p = 0.03) when compared with the non-neoadjuvant group. With TKI pre-treatment (median duration 8.8 months), majority of patients (82%) achieved at least partial response to the therapy coupled with a significant downsizing effect of up to 39% (median size of 7.1–3.6 cm), resulting in similar rates of sphincter-sparing surgery (75 vs. 76%, p = 0.94) when compared with the non-neoadjuvant group. In general, neoadjuvant group had lower rates of local recurrence (0 vs. 69%, p = 0.04) and higher overall survival (7.4 vs. 5.7 years, p = 0.03) as compared to the non-neoadjuvant group. Conclusions Neoadjuvant TKI has the benefit of downsizing unresectable rectal GIST to benefit from sphincter-sparing procedure and also confers protection against local recurrence and improves overall survival.
Collapse
Affiliation(s)
- Zachary Zihui Yong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Melissa Ching Ching Teo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.,SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.,SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.,SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.,Institute of Molecular and Cell Biology, A*STAR Research Entities, 61 Biopolis Drive, Singapore, 138673, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Grace Hwei Ching Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore. .,SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| |
Collapse
|
7
|
Nassif MO, Habib RA, Almarzouki LZ, Trabulsi NH. Systematic review of anorectal leiomyosarcoma: Current challenges and recent advances. World J Gastrointest Surg 2019; 11:334-341. [PMID: 31523383 PMCID: PMC6715585 DOI: 10.4240/wjgs.v11.i8.334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/10/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The anorectal leiomyosarcoma (LMS) is an aggressive malignant neoplasm. Owing to the rarity of LMSs, an optimal treatment modality has yet to be determined.
AIM To collect all published data on anorectal LMS characteristics, explore current treatment options, and review recent cases of postradiation LMS.
METHODS A literature search of the PubMed electronic database was conducted using the MeSH terms “rectal neoplasms”, “anus neoplasms” and “gastrointestinal neoplasms” combined with “leiomyosarcoma”. The search was limited to English language and human studies. All available case reports and case series of anal or rectal LMSs that were published from the beginning of January 1996 to May 2017 were included if the diagnosis of LMS had been confirmed by histopathologic examination. Data were analyzed using simple statistics (mean, median, and standard deviation). Independent sample t-test was used to compare means for continuous variables.
RESULTS A total of 27 articles reporting on 51 cases of anorectal LMS were identified. Among these cases, 11.7% had undergone previous pelvic radiotherapy (developing LMS at 13-35 years afterwards). Anorectal LMS affected the rectum in 92.2% of the cases, and no sex-based predominance was observed. Surgical resection with negative margins remains the mainstay of treatment, which can be accomplished with wide local excision or radical resection. The local recurrence rate was higher among cases who received wide local excision (30%), as compared to radical resection (20%); however, the overall rate of metastasis was 51.61% regardless of the treatment approach. The use of neoadjuvant radiation lowers the risk of local recurrence compared to adjuvant radiotherapy, and facilitates R0 resection of the tumor. Cases treated with adjuvant chemotherapy showed better rates of distant recurrence and overall survival. Nonetheless, multidisciplinary team discussion is necessary to determine the optimal management plan whilst considering patient- and disease-related factors.
CONCLUSION A multidisciplinary team approach, considering the underlying patient- and disease- related factors, is necessary for optimal management of these complex tumors.
Collapse
Affiliation(s)
- Mohammed O Nassif
- Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Razan A Habib
- Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Luai Z Almarzouki
- Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Nora H Trabulsi
- Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| |
Collapse
|
8
|
Cooper CR, Scully BF, Lee-Kong S. Colorectal sarcoma: more than a gastrointestinal stromal tumor. Transl Gastroenterol Hepatol 2018; 3:42. [PMID: 30148227 DOI: 10.21037/tgh.2018.07.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/06/2018] [Indexed: 01/05/2023] Open
Abstract
Primary colorectal sarcomas have been defined as a rare and diverse group of mesenchymal cancers distinct from gastrointestinal stromal tumors (GISTs). Primary colorectal sarcomas have been recognized as a distinct entity from GISTs due to the dramatically worse prognosis these sarcomas carry. Also, primary colorectal sarcomas when compared to the more common colorectal adenocarcinoma, demonstrate more aggressive biology, present at a younger age and carry worse outcomes. At this time, surgery remains the mainstay of treatment and adjuvant chemotherapy has an unclear role in treatment of primary colorectal sarcoma. This paper attempts to review the available data regarding primary colorectal sarcomas.
Collapse
Affiliation(s)
- C Randall Cooper
- Department of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA
| | - Brendan F Scully
- Department of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA
| | - Steven Lee-Kong
- Department of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
9
|
Outcomes of Primary Colorectal Sarcoma: A National Cancer Data Base (NCDB) Review. J Gastrointest Surg 2017; 21:560-568. [PMID: 28097468 DOI: 10.1007/s11605-016-3347-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/21/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Primary colorectal sarcomas are a rare entity with anecdotally poor outcomes. We sought to inform surgeons, oncologists, and researchers of the characteristics and outcomes of these understudied and difficult-to-manage tumors. METHODS The National Cancer Data Base (NCDB) was queried for patients with pathologically confirmed primary sarcoma of the colon or rectum (1998-2012). Gastrointestinal stromal tumors were excluded. Unadjusted overall survival was reported using the Kaplan-Meier method. Patients with colorectal adenocarcinoma were used as a comparison cohort. RESULTS Four hundred thirty-three patients with primary colorectal sarcoma were identified (57.5% leiomyosarcoma subtype). Median age was 63 [inter-quartile range 52, 75] years with 23.1% between the ages of 18 and 50 and 48.7% female. Majority of sarcomas were located in the colon (70.7%). When compared to 696,902 patients with adenocarcinoma, sarcoma patients were younger, had larger tumors, were more likely node negative and rectal in location, and higher grade (all p < 0.001), while sex, race, and comorbidity score were similar (all p > 0.05). Overall survival was lower at 5 years in patients with sarcoma (43.8%) than adenocarcinoma (52.3%, p < 0.001). CONCLUSION Primary colorectal sarcomas are rare and present at a younger age and higher grade than adenocarcinoma of the colon and rectum. Survival is significantly worse compared to adenocarcinoma patients.
Collapse
|
10
|
Ortenzi M, Ghiselli R, Cappelletti Trombettoni MM, Cardinali L, Guerrieri M. Transanal endoscopic microsurgery as optimal option in treatment of rare rectal lesions: A single centre experience. World J Gastrointest Endosc 2016; 8:623-627. [PMID: 27668073 PMCID: PMC5027033 DOI: 10.4253/wjge.v8.i17.623] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/02/2016] [Accepted: 07/13/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To analyze the outcomes of transanal endoscopic microsurgery (TEM) in the treatment of rare rectal condition like mesenchymal tumors, condylomas, endometriosis and melanoma.
METHODS We retrospectively reviewed a twenty-three years database. Fifty-two patients were enrolled in this study. The lesions were considered suitable for TEM if they were within 20 cm from the anus. All of them underwent an accurate preoperative workup consisting in clinical examination, total colonoscopy with biopsies, endoscopic ultrasonography, and pelvic computerized tomography or pelvic magnetic resonance imaging. Operative time, intraoperative complications, rate of conversion, tumor size, postoperative morbidity, mortality, the length of hospital stay, local and distant recurrence were analyzed.
RESULTS Among the 1328 patients treated by TEM in our department, the 52 patients with rectal abnormalities other than adenoma or adenocarcinoma represented 4.4%. There were 30 males (57.7%) and 22 females (42.3%). Mean age was 55 years (median = 60, range = 24-78). This series included 14 (26.9%) gastrointestinal stromal tumors, 21 neuroendocrine tumors (40.4%), 1 ganglioneuroma (1.9%), 2 solitary ulcers in the rectum (3.8%), 6 cases of rectal endometriosis (11.5%), 6 cases of rectal condylomatosis (11.5%) and 2 rectal melanomas (3.8%). Mean lesion diameter was 2.7 cm (median: 4, range: 0.4-8). Mean distance from the anal verge was 9.5 cm (median: 10, range: 4-15). One patient operated for rectal melanoma developed distant metastases and died two years after the operation. We experienced 2 local recurrences (3.8%) with an overall survival equal to 97.6% (95%CI: 95%-99%) at the end of follow-up and a disease free survival of 98% (95%CI: 96%-99%).
CONCLUSION We could conclude that TEM is an important therapeutical option for rectal rare conditions.
Collapse
|
11
|
Sahli N, Khmou M, Khalil J, Elmajjaoui S, El Khannoussi B, Kebdani T, Elkacemi H, Benjaafar N. Unusual evolution of leiomyosarcoma of the rectum: a case report and review of the literature. J Med Case Rep 2016; 10:249. [PMID: 27633779 PMCID: PMC5025574 DOI: 10.1186/s13256-016-1047-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/29/2016] [Indexed: 01/01/2023] Open
Abstract
Background Leiomyosarcoma of the rectum is a rare entity that comprises less than 0.1 % of all rectal malignancies. Given the uncommon nature of this tumor and the controversy about its treatment we report one case and review the literature in an attempt to report a particular evolution and to discuss the most appropriate treatment. Case presentation This case report describes the presentation of leiomyosarcoma of the rectum. A 30-year-old man from the north of Morocco presented with rectorrhagia and constipation. On physical examination we found a mass in his rectum approximately 6 cm from his anal margin. Pelvic magnetic resonance imaging showed a rectal mass with a parietal attachment that invaded the fascia and his perirectal tissue. Before any treatment he defecated spontaneously the tumor. On histopathological examination a diagnosis of leiomyosarcoma was made. An anterior resection of his rectum was performed with adjuvant radiotherapy at a dose of 50 Gy. After 1 year of surveillance, he has not presented any clinical symptoms and pelvic magnetic resonance imaging was normal. Unfortunately, histological analysis of a superficial biopsy of a rectal leiomyosarcoma may not be reflective of the entire tumor mass, and a diagnosis is based essentially on postoperative pathological examination. The optimal treatment modality in patients with rectal leiomyosarcomas is controversial. Prognosis is also poor; tumor size, histological grade, mitotic index, and local staging are the most known prognosis factors. Conclusion The prognosis of rectal leiomyosarcoma is poor; more investigations are necessary to understand the progression of these tumors and to define an optimal treatment modality.
Collapse
Affiliation(s)
- N Sahli
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco.
| | - M Khmou
- Department of Pathology, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - J Khalil
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - S Elmajjaoui
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - B El Khannoussi
- Department of Pathology, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - T Kebdani
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - H Elkacemi
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - N Benjaafar
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| |
Collapse
|
12
|
Faraj W, El-Kehdy J, Nounou GE, Deeba S, Fakih H, Jabbour M, Haydar A, El Naaj AA, Abou-Alfa GK, O'Reilly EM, Shamseddine A, Khalife M, Mukherji D. Liver resection for metastatic colorectal leiomyosarcoma: a single center experience. J Gastrointest Oncol 2015; 6:E70-6. [PMID: 26487954 DOI: 10.3978/j.issn.2078-6891.2015.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Leiomyosarcoma arising in the colorectum is a rare malignancy of the smooth muscles accounting for less than 1% of gastrointestinal tumors. Surgery remains the most accepted modality for the treatment of this entity however management of liver metastases remains controversial. METHODS & RESULTS From 1998 to 2009, five patients diagnosed with primary leiomyosarcoma of colorectal origin with metastatic liver disease, underwent liver resections at the American University of Beirut Medical Center. The median overall survival was 47 months (range, 7-135 months). CONCLUSIONS Leiomyosarcoma of colorectal origin with liver metastasis is a very rare entity. Long-term survival can be achieved after surgical resection and should be considered for all patients.
Collapse
Affiliation(s)
- Walid Faraj
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jessica El-Kehdy
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ghina El Nounou
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Samer Deeba
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Hawraa Fakih
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Mark Jabbour
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ali Haydar
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Abdallah Abou El Naaj
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ghassan K Abou-Alfa
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Eileen M O'Reilly
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ali Shamseddine
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Mohamad Khalife
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Deborah Mukherji
- 1 Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, 2 Department of Surgery, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon ; 5 Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
13
|
Oruc MT, Mayır B, Bılecık T, Sakar A, Erinekci AR. Rectal leiomyosarcoma, late complication of pelvic radiotherapy. Int J Colorectal Dis 2015; 30:571-2. [PMID: 25296708 DOI: 10.1007/s00384-014-2020-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Mehmet Tahir Oruc
- Department of General Surgery, Antalya Training and Research Hospital, Gursu mah. Altinkum Konaklari. 344 sokak 2. Kisim E2, Antalya, Turkey
| | | | | | | | | |
Collapse
|
14
|
|
15
|
Huynh TK, Meeus P, Cassier P, Bouché O, Lardière-Deguelte S, Adenis A, André T, Mancini J, Collard O, Montemurro M, Bompas E, Rios M, Isambert N, Cupissol D, Blay JY, Duffaud F. Primary localized rectal/pararectal gastrointestinal stromal tumors: results of surgical and multimodal therapy from the French Sarcoma group. BMC Cancer 2014; 14:156. [PMID: 24597959 PMCID: PMC3975725 DOI: 10.1186/1471-2407-14-156] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 02/21/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Rectal and pararectal gastrointestinal stromal tumors (GISTs) are rare. The optimal management strategy for primary localized GISTs remains poorly defined. METHODS We conducted a retrospective analysis of 41 patients with localized rectal or pararectal GISTs treated between 1991 and 2011 in 13 French Sarcoma Group centers. RESULTS Of 12 patients who received preoperative imatinib therapy for a median duration of 7 (2-12) months, 8 experienced a partial response, 3 had stable disease, and 1 had a complete response. Thirty and 11 patients underwent function-sparing conservative surgery and abdominoperineal resection, respectively. Tumor resections were mostly R0 and R1 in 35 patients. Tumor rupture occurred in 12 patients. Eleven patients received postoperative imatinib with a median follow-up of 59 (2.4-186) months. The median time to disease relapse was 36 (9.8-62) months. The 5-year overall survival rate was 86.5%. Twenty patients developed local recurrence after surgery alone, two developed recurrence after resection combined with preoperative and/or postoperative imatinib, and eight developed metastases. In univariate analysis, the mitotic index (≤5) and tumor size (≤5 cm) were associated with a significantly decreased risk of local relapse. Perioperative imatinib was associated with a significantly reduced risk of overall relapse and local relapse. CONCLUSIONS Perioperative imatinib therapy was associated with improved disease-free survival. Preoperative imatinib was effective. Tumor shrinkage has a clear benefit for local excision in terms of feasibility and function preservation. Given the complexity of rectal GISTs, referral of patients with this rare disease to expert centers to undergo a multidisciplinary approach is recommended.
Collapse
Affiliation(s)
- Thanh-Khoa Huynh
- Service d’Oncologie Médicale, CHU Timone, AP-HM, Marseille, and Aix-Marseille Université, Marseille, France
- Service d’Oncologie Médicale Adulte, CHU Timone, AP-HM, 264 rue Saint Pierre, 13385 Marseille, France
| | - Pierre Meeus
- Service de Chirurgie, Centre Léon Bérard, Lyon, France
| | | | - Olivier Bouché
- Service d’Oncologie Digestive, CHU Robert Debré, Reims, France
| | | | - Antoine Adenis
- Service d’Oncologie Médicale, Centre Oscar Lambret, Lille, France
| | - Thierry André
- Service d’Oncologie Médicale, Hôpital St Antoine, Assistance Publique–Hôpitaux de Paris and Université Pierre & Marie Curie (UPMC), Paris, France
| | - Julien Mancini
- Service de Santé Publique et d’Information Médicale, Unité de Biostatistique, CHU Timone, APHM, Marseille, and Aix-Marseille Université, Marseille, France
| | - Olivier Collard
- Service d’Oncologie Médicale, CLCC, Institut de Cancérologie Lucien Neuwirth, Saint-Etienne, France
| | | | | | - Maria Rios
- Service d’Oncologie Médicale, Centre Alexis Vautrin, Vandoeuvre les, Nancy, France
| | - Nicolas Isambert
- Service d’Oncologie Médicale, Centre George François Leclerc, Dijon, France
| | - Didier Cupissol
- Service d’Oncologie Médicale, Centre Valdorelle, Montpellier, France
| | - Jean-Yves Blay
- Service d’Oncologie Médicale, Centre Léon Bérard, Lyon, France
| | - Florence Duffaud
- Service d’Oncologie Médicale, CHU Timone, AP-HM, Marseille, and Aix-Marseille Université, Marseille, France
| |
Collapse
|
16
|
Ouh YT, Hong JH, Min KJ, So KA, Lee JK. Leiomyosarcoma of the rectum mimicking primary ovarian carcinoma: a case report. J Ovarian Res 2013; 6:27. [PMID: 23587096 PMCID: PMC3637498 DOI: 10.1186/1757-2215-6-27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/11/2013] [Indexed: 12/17/2022] Open
Abstract
Leiomyosarcoma of the rectum is a very rare mesenchymal tumor. Because of its rarity, its diagnosis, treatment, and pathology often present challenges to the clinician. The characteristics of this tumor, such as its anatomical location, heterogeneous solid features on imaging, and nonspecific lower gastrointestinal tract symptoms, can be confused with those of primary ovarian carcinoma. Here, we report the case of a 52-year-old-woman presenting with a low abdominal mass that was later pathologically confirmed to be a rectal leiomyosarcoma. The findings of preoperative ultrasonography, pelvic magnetic resonance imaging, and abdominopelvic computed tomography were suggestive of a malignant pelvic mass, most likely a primary ovarian carcinoma. The patient underwent explorative laparotomy, and intraoperative frozen examination revealed a sarcoma originating from the gastrointestinal tract. Low anterior resection and supracervical hysterectomy with bilateral salpingo-oophorectomy were performed. The patient’s postoperative course was uneventful, and adjuvant chemotherapy is currently being administered.
Collapse
Affiliation(s)
- Yung-Taek Ouh
- Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University, Seoul 152-703, Republic of Korea.
| | | | | | | | | |
Collapse
|
17
|
Clinicopathological features and prognostic factors of rectal gastrointestinal stromal tumors. J Gastrointest Surg 2013; 17:793-8. [PMID: 23288714 DOI: 10.1007/s11605-012-2086-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 11/12/2012] [Indexed: 01/31/2023]
Abstract
AIM Rectal gastrointestinal stromal tumor (GIST) was a rare disease. This study sought to summarize clinicopathological features and prognostic factors of rectal GISTs. METHODS Clinicopathological characteristics and prognostic factors of rectal GISTs were investigated by reviewing patients undergoing curative resection at the Fudan University Shanghai Cancer Center between 1986 and 2010. RESULTS Twenty-one patients, 15 male and 6 female, were included. The mean age of onset was 51 years. The most common initial presentation was hematochezia (7 cases). Eleven patients underwent radical resection, and the other 10 received local resection. No lymph node metastases were identified. All cases were positive for CD117. Seventeen patients were classified as high National Institutes of Health (NIH) risk category. The 5-year disease-free survival (DFS) and overall survival were 33 and 46 %, respectively. Fifteen cases had recurrence postoperatively. Both univariate and multivariate analyses demonstrated the NIH risk category (p = 0.028) and hematochezia symptom (p = 0.014) were independent prognostic factors of the DFS of patients. CONCLUSIONS Hematochezia was the most common initial symptom. Over 50 % of patients received radical surgery. More than 80 % of patients were at high NIH risk of recurrence. Hematochezia symptom and high NIH risk category indicated poor prognosis of rectal GISTs.
Collapse
|
18
|
Nassif MO, Trabulsi NH, Bullard Dunn KM, Nahal A, Meguerditchian AN. Soft tissue tumors of the anorectum: rare, complex and misunderstood. J Gastrointest Oncol 2013; 4:82-94. [PMID: 23450454 DOI: 10.3978/j.issn.2078-6891.2012.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 08/27/2012] [Indexed: 12/28/2022] Open
Abstract
Anorectal soft tissue tumors are uncommon and often present both diagnostic and therapeutic challenges. Although many of these tumors are identified with imaging performed for unrelated reasons, most present with nonspecific symptoms that can lead to a delay in diagnosis. Historically, radical surgery (abdominoperineal resection) has been the mainstay of treatment for both benign and malignant anorectal soft tissue tumors. However, a lack of proven benefit in benign disease along with changes in technology has called this practice into question. In addition, the role of radiation and/or chemotherapy remains controversial. In this manuscript, we review the history and current status of anorectal soft tissue tumor management, with a particular focus on challenges in optimizing survival.
Collapse
Affiliation(s)
- Mohammed O Nassif
- Division of Experimental Surgery, McGill University, 845 Sherbrooke Street West Montreal, Quebec, Canada H3A 2T5; ; Department of Surgery, King Abdulaziz University, P.O. Box 80205, Zip Code 21589, Jeddah, Saudi Arabia
| | | | | | | | | |
Collapse
|
19
|
The Role of Neoadjuvant Imatinib Mesylate Therapy in Sphincter-Preserving Procedures for Anorectal Gastrointestinal Stromal Tumor. Am J Clin Oncol 2011; 34:314-6. [DOI: 10.1097/coc.0b013e3181dea970] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Lima MA, Pozzobon BHZ, Fonseca MFM, Horta SHC, Formiga GJS. Leiomiossarcoma perineal: relato de caso e revisão da literatura. ACTA ACUST UNITED AC 2010. [DOI: 10.1590/s0101-98802010000300012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lemiossarcomas são neoplasias malignas que se originam no músculo liso. Quando presentes na região perineal são agressivos e o tratamento cirúrgico mais adequado ainda não está bem definido. Os autores relatam o caso de uma paciente jovem, sexo feminino, com sintomatologia de nodulação perineal há oito meses. Ao exame físico apresentava abaulamento em região perineal esquerda, onde palpava-se massa fibroelástica de aproximadamente 10 cm de diâmetro. Ressonância nuclear magnética mostrava volumosa formação sólida de contornos regulares em região perineal à esquerda sem sinais de infiltração perilesional. O tratamento realizado foi a excisão com margens amplas. A paciente encontra-se em acompanhamento ambulatorial, sem sinais de recidiva local.
Collapse
|
21
|
Thalheimer L, Richmond B, Lohan J. Leiomyosarcoma of the Anal Canal: Case Report and Review of the Literature. Am Surg 2008. [DOI: 10.1177/000313480807400118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A rare case of a leiomyosarcoma of the anal canal is presented. A 68-year-old male presented with painful defecation and rectal bleeding. Endorectal ultrasound revealed a mass invading both sphincters (T4 lesion), and extending 6 cm into the anal canal. Colonoscopy revealed an ulcerated area in the anal canal, of which biopsies revealed high-grade leiomyosarcoma–only the eighteenth such case at the time of this submission. The details of the case and teaching images are presented in detail, as is a comprehensive review of the relevant literature.
Collapse
Affiliation(s)
- Liza Thalheimer
- West Virginia University School of Medicine, Morgantown, West Virginia and
| | - Bryan Richmond
- Department of Surgery, West Virginia University, Charleston Division, Charleston, West Virginia
| | - Jay Lohan
- Department of Surgery, West Virginia University, Charleston Division, Charleston, West Virginia
| |
Collapse
|
22
|
Baik SH, Kim NK, Lee CH, Lee KY, Sohn SK, Cho CH, Kim H, Pyo HR, Rha SY, Chung HC. Gastrointestinal stromal tumor of the rectum: an analysis of seven cases. Surg Today 2007; 37:455-9. [PMID: 17522761 DOI: 10.1007/s00595-006-3424-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 10/24/2006] [Indexed: 01/11/2023]
Abstract
PURPOSE Gastrointestinal stromal tumors (GISTs) rarely originate in the rectum. We investigated the clinicopathologic characteristics of rectal GISTs. METHODS We analyzed the medical records of seven patients who underwent surgery for GIST of the rectum between 1998 and 2003. RESULTS There were two men and five women with a median age of 55 years (range, 41-72 years) at the time of diagnosis. The median follow-up period was 23 months (range, 7-75 months). The chief symptoms were hematochezia, constipation, and anal pain. All patients underwent curative resection; in the form of abdominoperineal resection in five patients, transanal excision in one, and Hartmann's operation with prostatectomy in one. The median tumor size was 6.6 cm (range, 1-12 cm). Four patients received adjuvant radiation therapy. Local recurrence developed in two patients; 54 months and 23 months after surgery, respectively. CONCLUSION The common symptoms of rectal GIST were the same as those of other rectal tumors. Curative surgical resection should be done, but further studies are necessary to investigate better adjuvant treatment strategies for patients with rectal GISTs.
Collapse
Affiliation(s)
- Seung Hyuk Baik
- Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-ku, 120-752, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Cuffy M, Abir F, Longo WE. Management of Less Common Tumors of the Colon, Rectum, and Anus. Clin Colorectal Cancer 2006; 5:327-37. [PMID: 16512991 DOI: 10.3816/ccc.2006.n.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The majority of colorectal and anal malignancies are adenocarcinomas and squamous cell cancers, respectively. Despite the predominance of these neoplasms in these locations, rare histiotypes of the colon, rectum, and anus do occur. These histotypes include but are not limited to lymphoma, melanoma, diffuse cavernous hemangioma, and sarcomas, such as leiomyosarcoma or Kaposi's sarcoma. These tumors often present challenges to clinicians with respect to diagnosis, staging, management, and pathology because of their unfamiliarity. A Medline search using "colon," "rectum,""anus," "lymphoma," "melanoma," "diffuse cavernous hemangioma," "squamous cell carcinoma," "carcinoid," "sarcoma," "leiomyosarcoma," "Kaposi's sarcoma," "Paget's disease," "Bowen's disease," and "basal cell carcinoma" as key words was performed as well as a cross-referencing of the bibliography cited in each work. Rare tumors of the colon, rectum, and anus present diagnostic and management dilemmas for clinicians. Because of their infrequency and poor prognosis, the optimal management of these tumors is controversial. For some histotypes, such as squamous cell carcinoma and carcinoids of the rectum, treatment depends on location and size of the tumor. For uncommon anal lesions, such as Bowen's disease, Paget's disease, and basal cell carcinoma, wide local excision (WLE) with negative margins is the standard of care. For other lesions such as anorectal melanoma or leiomyosarcoma, abdominal perineal resection versus WLE is still being debated. Because the optimal treatment of these tumors is still unclear, we recommend a multidisciplinary approach including a surgeon, primary care physician, medical oncologist, radiation oncologist, and pathologist to offer the patient the best outcome.
Collapse
Affiliation(s)
- Madison Cuffy
- Yale University School of Medicine, Department of Surgery, New Haven, CT 06520-8062, USA
| | | | | |
Collapse
|
24
|
Changchien CR, Wu MC, Tasi WS, Tang R, Chiang JM, Chen JS, Huang SF, Wang JY, Yeh CY. Evaluation of prognosis for malignant rectal gastrointestinal stromal tumor by clinical parameters and immunohistochemical staining. Dis Colon Rectum 2004; 47:1922-9. [PMID: 15622586 DOI: 10.1007/s10350-004-0687-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study was to identify associated prognostic factors influencing the outcome of curative resection of rectal gastrointestinal stromal tumor. PATIENTS AND METHODS Diagnostic immunohistochemical staining with CD34, CD117, S-100, desmin, and muscle-specific actin was performed in 46 consecutive patients with previously diagnosed rectal leiomyosarcoma who underwent curative resection from 1979 to 1999. CD44, Bcl-2, P53, and Ki-67 staining were performed on tumors rediagnosed as gastrointestinal stromal tumor for the prognostic evaluation. RESULTS There were 42 (91.3 percent) patients with rectal gastrointestinal stromal tumor (18 females and 24 males; mean age, 58.4 years). Twenty-nine patients underwent radical surgical resections, such as abdominoperineal resection or low anterior resection, whereas the other 13 patients underwent wide local excision, such as transrectal excision or Kraske's operation. Sixteen tumors were classified as high-grade gastrointestinal stromal tumors, and 26 as low-grade. No tumor had a positive P53 stain. Twenty-seven patients (64.3 percent) developed recurrence or metastasis postoperatively (median follow-up, 52 months). The one-year, two-year, and five-year disease-free survival rates were 90.2 percent, 76.7 percent, and 43.9 percent, respectively. Of these patients with recurrence, subsequent resections in 12 patients with local recurrence, transarterial tumor embolism or STI-571 chemotherapies in 3 patients with distant mestastases were performed. The one-year, two-year, and five-year overall survival rates were 97.4 percent, 94.3 percent, and 83.7 percent, respectively. Bcl-2 (P = 0.007) and histologic grade (P = 0.05) in disease-free survival analysis and age < 50 years (P = 0.03) and tumor size > 5 cm (P = 0.02) in overall survival analysis were independent prognostic factors. The group with wide local excision had a higher local recurrence rate than that of the radical resection group (77 percent vs. 31 percent, P = 0.006), despite smaller tumors (4.5 vs. 7.2 cm, P = 0.05). There was no difference in the incidence of distant metastasis between the two groups. CONCLUSION Younger age (< 50 years), higher histologic tumor grade, positive Bcl-2 status, and larger tumors (> 5 cm) were factors associated with significantly poorer prognoses for rectal gastrointestinal stromal tumor. Radical resection was superior to wide local excision in the prevention of local recurrence, but not that of distant metastases.
Collapse
|
25
|
Campos FG, Leite AF, Araújo SEA, Atuí FC, Seid V, Habr-Gama A, Kiss DR, Gama-Rodrigues J. Anorectal leiomyomas: report of two cases with different anatomical patterns and literature review. ACTA ACUST UNITED AC 2004; 59:296-301. [PMID: 15543403 DOI: 10.1590/s0041-87812004000500013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Gastrointestinal mesenchymal tumors comprise a rare group of gastrointestinal tract wall tumors that have long been a source of confusion and controversy, especially in terms of pathological classification, preoperative diagnosis, management strategies, and prognosis. This report describes the clinical manifestations and management of 2 rectal leiomyomas and reviews the pertinent literature. Case 1: A 44-year-old woman was admitted reporting a nodule in the right para-anal region for the previous 2 years. At proctological examination, a 4-cm diameter fibrous mass situated in the para-anal region that produced an arch under the smooth muscle on the right rectal wall just above the anorectal ring was noted. Computed tomography and magnetic resonance imaging of the abdomen and pelvis showed the lesion and detected no other abnormalities. Surgical treatment consisted of wide local resection of the tumor through a para-anal incision, with no attempts to perform lymphadenectomy. Case 2: A 40-year-old male patient was admitted reporting constant anal pain for 4 months. He presented a 3-cm submucosal nodule at the anterior rectal wall just above the dentate line. After 2 inconclusive preoperative biopsies, transanal resection of the tumor was performed. Histological analysis of the specimen showed a benign leiomyoma. A review of the literature is presented, emphasizing some clinical and therapeutic aspects of this unusual rectal tumor.
Collapse
Affiliation(s)
- Fábio Guilherme Campos
- Department of Gastroenterology, Coloproctology Unit, Hospital das Clínicas, Faculty of Medicine, University of São Paulo - São Paulo/SP, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Rossi CR, Mocellin S, Mencarelli R, Foletto M, Pilati P, Nitti D, Lise M. Gastrointestinal stromal tumors: from a surgical to a molecular approach. Int J Cancer 2003; 107:171-6. [PMID: 12949790 DOI: 10.1002/ijc.11374] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. These tumors span a wide clinical spectrum from benign to malignant and have long been recognized for their nearly absolute resistance to chemotherapy and radiation treatment. We reviewed the worldwide experience on GIST diagnosis, prognosis and treatment and describe our own series. PubMed was searched for references using the terms gastrointestinal stromal tumor, GIST and gastrointestinal sarcoma. Recent reports were given emphasis because GIST is a novel clinical entity and older published work on gastrointestinal sarcomas might be contaminated with other histologic tumor types. At present, surgery is the standard treatment for primary resectable GIST. To increase the activity of conventional chemotherapeutic agents, locoregional therapies are being implemented in the clinical setting. A major breakthrough is the development of a new class of anticancer agents targeting tumor-specific molecular abnormalities. Preliminary results on administration of imatinib mesylate, a signal transduction inhibitor, are particularly encouraging, showing potent activity of this drug against metastatic GIST. Molecular targeting of the critical pathogenetic mechanism underlying GIST might not only revolutionize the strategy to treat locally advanced and metastatic GIST but also improve disease control after macroscopically radical surgery.
Collapse
Affiliation(s)
- Carlo Riccardo Rossi
- Department of Oncologic and Surgical Sciences, University of Padua, Padua, Italy.
| | | | | | | | | | | | | |
Collapse
|
27
|
Randleman CD, Wolff BG, Dozois RR, Spencer RJ, Weiland LH, Ilstrup DM. Leiomyosarcoma of the rectum and anus. A series of 22 cases. Int J Colorectal Dis 2001; 4:91-6. [PMID: 2746135 DOI: 10.1007/bf01646866] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Twenty-two patients with leiomyosarcoma of the rectum (n = 19) or the anus (n = 3) were treated surgically at the Mayo Clinic from 1950 through 1985. The majority of tumors occurred in men (1.4:1.0) during the sixth and seventh decades of life. Fifty-nine percent of the patients had symptoms including, most commonly, change in bowel habit, bleeding, and pain. Wide local excision was performed in 10 patients, whereas a more radical surgical procedure, including abdominoperineal resection (n = 8), pelvic exenteration (n = 2), and low anterior resection (n = 1), were performed in 11 patients. One tumor was unresectable. The overall survival until death from disease was 90% at 1 year, 74% at 5 years, and 51% at 10 years postoperatively. The percentage of patients free of disease at 1, 5, and 10 years postoperatively was 85, 62, and 40, respectively. Wide local resection was not superior to a more radical surgical approach in preventing tumor recurrence or improving survival. Lesions less than 2.5 cm and confined to the bowel wall can be treated by wide local excision, whereas larger or more extensive tumors should be treated by a more radical surgical approach.
Collapse
Affiliation(s)
- C D Randleman
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
Gastrointestinal stromal tumour (GIST) has been immunohistochemically defined as the tumour lacking differentiation towards either leiomyomatous tumour or schwannoma. We report a 75-year-old man who underwent an abdominoperineal resection of a large submucosal tumour of the rectum. The excised specimen was revealed to be an elastic soft tumour, 8 x 7 x 6 cm in size, which histologically consisted of spindle-shaped cells without nuclear atypia. The mitotic count was fewer than 2 per 10 high-power fields. The tumour cells were positive for staining of CD34 and c-kit protein, while the lesions were negative for alpha-smooth muscle actin, HHF-35, neuron-specific enolase, and S-100 protein. The diagnosis of GIST was confirmed by immunohistochemical examination of the tumour. From these findings, the present case is thought to be potentially malignant, and a long-term follow-up observation is needed for the case.
Collapse
Affiliation(s)
- Y Shibata
- Department of Surgery, Hokushu Central Hospital, Takanosu, Akita, Japan.
| | | | | | | |
Collapse
|
29
|
Yeh CY, Chen HH, Tang R, Tasi WS, Lin PY, Wang JY. Surgical outcome after curative resection of rectal leiomyosarcoma. Dis Colon Rectum 2000; 43:1517-21. [PMID: 11089585 DOI: 10.1007/bf02236730] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study is to present the prognosis and possible associated prognostic factors after curative resection of rectal leiomyosarcoma. METHODS From 1979 to 1996 our hospital saw 40 patients with rectal leiomyosarcoma, including 19 females, who did not have metastasis initially and received curative resection and regular postoperative follow-up. RESULTS The mean age of the 40 patients was 58.7 years. Anal bleeding and perianal pain were the two most common symptoms at initial diagnosis. Twenty-nine patients received a radical surgical resection, such as abdominoperineal resection or low anterior resection; the other 11 patients received a wide local excision, such as transrectal excision or Kraske's operation. Sixteen tumors were classified as high-grade leiomyosarcoma, and 23 as low grade. Nineteen patients (48 percent) developed recurrence or metastasis postoperatively (median follow-up, 35 months). The overall and disease-free (1-year, 3-year, and 5-year) survival rates were 97, 90, and 75 percent and 90, 59, and 46 percent, respectively. In univariate analysis, younger group (<50 years, n = 9, P = 0.033) and high-grade leiomyosarcoma (P = 0.043) showed poorer prognosis in the disease-free survival curve. In the multivariate Cox model, gender, tumor size, tumor location, and operation type did not significantly affect disease-free survival, whereas histologic grade (P = 0.037) and age divided by a level of 50 years (P = 0.009) were shown to be independent factors. There was a strong trend toward higher local recurrence rate for the wide local excision group than for the radical resection group (55 vs. 24 percent, P = 0.067) despite the wide local excision group being composed of smaller tumors (5.1 vs. 7.5 cm, P = 0.069). There was no difference in the incidence of distant metastasis between the two groups with different operation types. The metastasis rates of the wide local excision and radical resection groups were 27 and 38 percent, respectively. CONCLUSION A younger age (<50 years) and a high histologic grade of tumor were the two most significant poor prognostic factors for rectal leiomyosarcoma. Radical resection may be superior to wide local excision in the prevention of local recurrence but not distant metastasis.
Collapse
Affiliation(s)
- C Y Yeh
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
30
|
Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 2000; 7:705-12. [PMID: 11034250 DOI: 10.1007/s10434-000-0705-6] [Citation(s) in RCA: 307] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastrointestinal stromal tumors (GIST) are rare tumors of the gastrointestinal (GI) tract that arise from primitive mesenchymal cells. GISTs occur throughout the GI tract but are usually located in the stomach and small intestine. The majority of GISTs are immunohistochemically positive for c-kit protein (CD 117) and CD34. GISTs express a heterogeneous clinical course not easily predicted by standard pathological means. The most important prognostic factors are size > 5 cm, tumor necrosis, infiltration and metastasis to other sites, mitotic count > 1-5 per 10 high-powered fields, and most recently, mutation in the c-kit gene. Surgical resection remains the mainstay of treatment, as chemotherapy and radiation are ineffective. Long-term follow-up is imperative, as recurrence rates are high.
Collapse
Affiliation(s)
- I Pidhorecky
- Department of Surgical Oncology, Roswell Park Cancer Institute, State University of New York at Buffalo 14263, USA
| | | | | | | |
Collapse
|
31
|
Lee SH, Ha HK, Byun JY, Kim AY, Cho KS, Lee YR, Park HW, Kim PN, Lee MG, Auh YH. Radiological features of leiomyomatous tumors of the colon and rectum. J Comput Assist Tomogr 2000; 24:407-12. [PMID: 10864076 DOI: 10.1097/00004728-200005000-00009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the radiological features of 12 pathologically proven cases of colorectal leiomyomatous tumors. METHOD A retrospective analysis of radiologic findings was performed in 12 patients with pathologically proven colorectal leiomyomatous tumors (2 leiomyomas and 10 leiomyosarcomas). Available radiologic studies included abdominal CT scans in 11 patients, double contrast barium studies in 4, and pelvic MRI in 1. On imaging, we evaluated the size, tumor margin (smooth or lobulated), morphologic appearance, growth patterns (endocolic, exocolic, or combined), contrast enhancement patterns, presence or absence of calcification within the tumors, and metastasis. RESULTS The involved tumor sites were the colon in 2 patients and the rectum in 10. The mean tumor size was 7.9 cm (range 2-15 cm): It was 3.5 cm in leiomyomas and 8.8 cm in leiomyosarcomas. On imaging studies, the tumor margin was smooth in three patients and lobulated in nine, with endocolic growth in one, exocolic in four, and combined in the remaining seven. Eight of the 12 tumors showed varying degrees of internal necrosis with heterogeneous contrast enhancement. Dystrophic calcification was noted in five patients. Metastasis was seen in the liver in three patients at the time of initial diagnosis, and lymphadenopathy was noted in two patients (paraaortic space in one and perirectal space in two). CONCLUSION Although rare, the diagnosis of leiomyomatous tumor may be suggested especially when the tumor occurring in the colorectum shows exocolic growth or calcification with varying degree of internal necrosis.
Collapse
Affiliation(s)
- S H Lee
- Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Grann A, Paty PB, Guillem JG, Cohen AM, Minsky BD. Sphincter preservation of leiomyosarcoma of the rectum and anus with local excision and brachytherapy. Dis Colon Rectum 1999; 42:1296-9. [PMID: 10528767 DOI: 10.1007/bf02234218] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to determine the outcome of patients with leiomyosarcoma of the rectum or anus treated with local excision and brachytherapy. METHODS Eight patients with leiomyosarcoma of the rectum (7 patients) or anus (1 patient) were treated with a transanal excision followed by a temporary iridium-192 interstitial implant to 4,500 cGy. Median tumor size was 4.2 (range, 1.5-5) cm. Margins were positive in six patients, negative in one patient, and close in one patient. RESULTS With a median follow-up of 53 months, median survival time was 53 months and the three-year actuarial survival rate was 71 percent. The cumulative incidence of failure as a component of failure for local was 25 percent (2/8), for abdominal was 0 percent (0/8), and for distant was 25 percent (2/8). Four patients eligible for functional analysis all had excellent sphincter function (1-2 bowel movements per day, no soilage). CONCLUSION In selected patients the use of conservative surgery followed by brachytherapy is a reasonable alternative to an abdominoperineal resection. However, more experience and longer follow-up are needed before this approach can be recommended routinely.
Collapse
Affiliation(s)
- A Grann
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | | | | | | |
Collapse
|
33
|
Hsieh JS, Huang CJ, Wang JY, Huang TJ. Benefits of endorectal ultrasound for management of smooth-muscle tumor of the rectum: report of three cases. Dis Colon Rectum 1999; 42:1085-8. [PMID: 10458136 DOI: 10.1007/bf02236709] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Smooth-muscle tumor of the rectum is rare, and the therapeutic strategy is still controversial. Endorectal ultrasound was used to evaluate three patients with smooth-muscle tumor of the rectum. Endorectal ultrasound demonstrated a homogenous hypoechoic tumor without invasion to the perirectal tissue in two patients. The tumor was 5 cm in diameter in one patient and 4 cm in diameter in the other patient, and they were excised locally. Their histologic types were leiomyoma and leiomyosarcoma. The third patient had a recurrent leiomyosarcoma. Proctosigmoidoscopy found a linear lesion with ulcerated mucosa on the rectal wall. Endorectal ultrasound observed a hypoechoic solid tumor of 3.5 cm x 1 cm, which involved the mucosal, submucosal, and muscle layers of the rectal wall. Disruption of the first hypoechoic layer was identified. Abdominoperineal resection was performed. Endorectal ultrasound follow-up revealed no evidence of recurrence in any of these patients. Endorectal ultrasound can help to define the extent of disease and may be a useful adjunct in deciding about the appropriate surgical procedure in these diseases.
Collapse
Affiliation(s)
- J S Hsieh
- Department of Surgery, Kaohsiung Medical College, Taiwan
| | | | | | | |
Collapse
|
34
|
Luna-Pérez P, Rodríguez DF, Luján L, Alvarado I, Kelly J, Rojas ME, Labastida S, González JL. Colorectal sarcoma: analysis of failure patterns. J Surg Oncol 1998; 69:36-40. [PMID: 9762889 DOI: 10.1002/(sici)1096-9098(199809)69:1<36::aid-jso7>3.0.co;2-l] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Colorectal sarcomas (CRS) are rare and their treatment remains controversial, especially for those located in the rectum. The aim of this paper is to evaluate our experience, with special emphasis on the failure pattern after surgical therapy alone or combined with postoperative radiotherapy. MATERIALS AND METHODS The medical records and histological slides of 13 CRS patients treated between 1986 and 1996 were reviewed retrospectively. RESULTS The patients included eight males and five females, with a median age of 54 years; nine of their primary tumors were located in the rectum, and four in the colon. The histologies were leiomyosarcoma in nine cases and malignant fibrous histiocytoma in four cases. Surgical treatment consisted of anatomical colectomy (four); local excision (three); abdominoperineal resection (APR)(two); low anterior resection (LAR)(two); LAR en bloc with the prostate (one), and total pelvic exenteration (one). One operative death occurred. The median size of the tumors was 8 cm (range, 5-40). The tumors were graded as low, three, and high, ten. The median follow-up was 24 months. Eight patients in the overall group developed recurrences as follows: local, three; local and distant, three, and distant, two. Five out of nine patients with rectal sarcoma received adjuvant postoperative radiotherapy (PRT). Local recurrence occurred in 20% (1/5) of those who received PRT, and in 100% (3/3) of those who did not. The overall 5-year survival was 40%, and the 5-year survival for patients with low-grade tumors was 66%, as compared with 22% for those with high-grade tumors. CONCLUSIONS The patterns of failure in CRS are combined in both local and distant sites. However, our results suggest that in rectal sarcoma, the use of surgery + PRT may reduce the local recurrence rate; in selected patients, it may allow for anal sphincter preservation.
Collapse
Affiliation(s)
- P Luna-Pérez
- Surgical Oncology Department, Oncology Hospital, Mexican Social Security Institute, México City.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
A 47-yr-old man with history of metastatic low-grade rectal leiomyosarcoma presented with progressive protrusion of his left eye due to an enlarging orbital mass. The differential diagnosis included tumor metastasis or orbital infection due to an unknown infectious agent. Diagnostic fine-needle aspiration (FNA) of the orbit was performed on an urgent basis to institute proper therapy and to save the patient's eyesight. Cytomorphologic examination of the material demonstrated a spindle-cell neoplasm consistent with metastatic leiomyosarcoma. It is a rare event for leiomyosarcoma to occur in the orbit. On our review of the literature, the cytology of primary orbital leiomyosarcoma on FNA has only been reported once. To our knowledge, this is the first report of the FNA cytomorphology of metastatic leiomyosarcoma to the orbit.
Collapse
Affiliation(s)
- R Logrono
- Wisconsin State Laboratory of Hygiene, Madison, USA
| | | | | | | |
Collapse
|
36
|
Abstract
PURPOSE Perineal sarcomas are rare tumors that are typically of an extensive nature by the time of diagnosis. In this article, two case reports are followed by a brief review of different types of sarcomas that may occur in the perineal and perirectal region. STUDY PATIENTS This study consists of two cases that are representative of the many types of perineal/perirectal sarcomas. PRINCIPLE CONCLUSIONS Perineal and perirectal sarcomas are generally of poor prognosis mainly because of delayed diagnosis. Computed tomography and magnetic resonance imaging can be extremely useful to help assess these tumors. It is well known that the most important criterion for diagnosing leiomyosarcomas appears to be the presence of mitotic activity. Anorectal stromal tumors having five or more mitoses per 50 high powered fields are considered to be malignant. The mainstay of treatment is surgical excision with wide margins. Currently, chemotherapeutic and radiotherapy trials are under way.
Collapse
Affiliation(s)
- K J Kessler
- Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio, USA
| | | | | |
Collapse
|
37
|
Conlon KC, Casper ES, Brennan MF. Primary gastrointestinal sarcomas: analysis of prognostic variables. Ann Surg Oncol 1995; 2:26-31. [PMID: 7834450 DOI: 10.1007/bf02303698] [Citation(s) in RCA: 114] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Primary gastrointestinal sarcomas are uncommon, and the clinicopathological determinants of survival remain unclear. In order to correlate clinical presentation, pathological assessment, and treatment with outcome, we have analyzed our institution's recent experience with these tumors. METHODS Records of adult patients admitted to our institution between July 1982 and December 1991 were reviewed. RESULTS During this period, 38 adult patients (> 16 years of age) were admitted to our institution with a primary gastrointestinal sarcoma. They accounted for 2% of all adult sarcoma admissions during that period. The study population was composed of 26 men and 12 women. Ages ranged from 29 to 82 years (mean 59). Disease was localized to the primary site in 30 patients (81%). The stomach was the most frequent site of disease (20 cases). The small bowel was affected in nine cases (five duodenum, four jejunum) and the large bowel in nine cases (two colon, seven rectum). Ninety-two percent of patients were symptomatic at presentation. A complete resection was performed in 27 cases, incomplete resection in seven cases, and biopsy only in the remaining three patients. Nine patients received doxorubicin-based chemotherapy. Leiomyosarcoma (n = 35) was the predominant histological diagnosis. Twenty-six tumors were classified as high grade (68%) and 12 as low grade (32%). Overall actuarial 5-year survival was 28% (median follow-up 26 months). Weight loss (p = 0.02) and pain at presentation (p = 0.05) were adverse prognostic factors. Histological grade (p = 0.0002), completeness/extent of surgical resection (p = 0.005), or small bowel primary site were significant determinants of overall survival. The resection of contiguous organs did not affect survival if the primary tumor was completely excised (p = 0.422). Age, race, sex, presentation (prior surgery), tumor size, or adjuvant therapy were not significant prognostic factors. Recurrence was noted in 44% after complete resection, and mean time to recurrence was 9 months (median 7, range < 1-37). Hepatic metastases (42%) and local recurrence (42%) were the predominant sites of initial failure. For patients with a complete resection, grade was the major prognostic determinant (5-year survival: high grade/complete resection 18% vs. low grade/complete resection 72%, p = 0.002). CONCLUSION The prognosis of gastrointestinal sarcomas is poor. Complete surgical excision is the optimal therapy. However, our results suggest that surgery alone is inadequate for high-grade tumors. We believe that these patients should be considered candidates for investigational adjuvant therapies.
Collapse
Affiliation(s)
- K C Conlon
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
| | | | | |
Collapse
|
38
|
Wolf O, Glaser F, Kuntz C, Lehnert T. Endorectal ultrasound and leiomyosarcoma of the rectum. THE CLINICAL INVESTIGATOR 1994; 72:381-4. [PMID: 8086772 DOI: 10.1007/bf00252832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Leiomyosarcomas of the rectum are uncommon neoplasms accounting for fewer than 1% of all malignancies of the colon and rectum. Approximately 215 cases have been described in the literature. Distinction from leiomyoma is often difficult, but regarding dignity is important. The case reported is that of a 68-year-old man in whom a 2.2-cm rectal mass covered by mucosa was diagnosed by rectoscopy and endorectal ultrasound. After treatment by wide local excision the histological specimen revealed a low-grade, highly differentiated leiomyosarcoma. Due to the lack of a large series of this disease, there is disagreement over the therapeutic strategy. At the moment a selective treatment approach seems to be the most frequently advocated. Large tumors and those extending beyond the rectal wall are treated by radical surgical resection. Leiomyosarcomas less than 2.5 cm in size and confined to the bowel wall can be treated by wide local excision. Endosonography can provide exact assessment of tumor size and expansion and is of great value in selecting the appropriate treatment.
Collapse
Affiliation(s)
- O Wolf
- Chirurgische Universitätsklinik Heidelberg, Germany
| | | | | | | |
Collapse
|
39
|
Tjandra JJ, Antoniuk PM, Webb B, Petras RE, Fazio VW. Leiomyosarcoma of the rectum and anal canal. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1993; 63:703-9. [PMID: 8363480 DOI: 10.1111/j.1445-2197.1993.tb00495.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Leiomyosarcoma of the rectum and anal canal is rare and the optimal treatment is not clear. Eight patients with isolated anorectal leiomyosarcoma treated surgically were reviewed. The age ranged from 44 to 76 years (median 63 years) and the follow up ranged from 6 months to 4.5 years (median 2 years). All patients were symptomatic at presentation. All tumours involved the muscularis propria of the low and/or mid-rectum with three tumours also involving the anal sphincters. The tumour size ranged from 1.2 to 10 cm (median 4 cm). Mucosal involvement occurred in only three patients and there was no lymph node involvement. All showed microscopic infiltration at the advancing border, despite macroscopic circumscription. Only one patient was thought to have a tumour sufficiently small (3 cm) and localized on clinical and intrarectal ultrasound examinations (UST2N0) to be suitable for wide local excision. That patient remained tumour-free after 2 years. The remaining patients (88%) were treated by abdomino-perineal resection. The disease free interval in this latter group ranged from 3 months to 4.5 years. All recurrences were detected within 15 months of surgery and the mean interval from detection of recurrence to death was 9 months. Using a histological grading system that included tumour differentiation, mitotic count and amount of necrosis, high grade sarcomas were associated with a worse prognosis. Other factors associated with a poor outcome included large tumour size (> 6-7 cm) and prior incomplete local excision.
Collapse
Affiliation(s)
- J J Tjandra
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195
| | | | | | | | | |
Collapse
|
40
|
Abstract
A case report of a woman with perineal leiomyosarcoma who was cured by combination chemotherapy is presented, and the literature on chemotherapy of soft tissue is reviewed.
Collapse
Affiliation(s)
- I Stornes
- Department of Oncology, University Hospital of Aarhus, Denmark
| | | | | |
Collapse
|
41
|
Abstract
Perineal leiomyosarcomas are rare aggressive tumors for which the therapy remains to be defined. These tumors may be extensively infiltrating and therapy may require radical surgery. The problems encountered in treating these tumors are similar to those for retroperitoneal sarcomas. Namely, delay in diagnosis, lack of distinct anatomic boundaries, and close proximity to and encroachment on multiple organs prevents resection with adequate surgical margins. We discuss the current literature and present our management of perineal leiomyosarcomas.
Collapse
Affiliation(s)
- J P Rice
- Department of General Surgery, National Naval Medical Center, Bethesda, Maryland
| | | | | | | | | |
Collapse
|