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Cronin AJ, Pancholi R, Kumar M. Iatrogenic donor site seeding in head and neck carcinoma: A case report. Advances in Oral and Maxillofacial Surgery 2022; 8:100321. [DOI: 10.1016/j.adoms.2022.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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LiBrizzi CL, Rao SS, Wang KY, Levin AS, Morris CD. Survey of sarcoma surgery principles among orthopaedic oncologists. Surg Oncol 2022; 42:101782. [DOI: 10.1016/j.suronc.2022.101782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/26/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
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LiBrizzi CL, Rao SS, Tuffaha SH, Levin AS, Gross JM, Morris CD. Iatrogenic Metastasis of Soft-tissue Sarcoma at the Donor Flap Site: Case Report and Proposed Surgical Oncologic Techniques. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202112000-00005. [PMID: 34860749 DOI: 10.5435/jaaosglobal-d-21-00208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
An 81-year-old woman with multiply recurrent undifferentiated pleomorphic sarcoma of the foot underwent wide excision and reconstruction with an anterolateral thigh free flap. Six years postoperatively, she developed biopsy-proven recurrence within the harvest site. No other sites of disease were detected on staging workup. The flap site recurrence was attributed to iatrogenic implantation at the time of harvesting. Iatrogenic metastases are thought to be caused by tumor implantation, which may be attributable to cross-contamination from instrumentation and surgical techniques. In the present article, we highlight preventive techniques and oncologic surgical principles intended to reduce the likelihood of iatrogenic metastasis. Increased awareness by all members of the surgical team may prevent this unfortunate complication.
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Affiliation(s)
- Christa L LiBrizzi
- From the Division of Orthopaedic Oncology (Dr. LiBrizzi, Dr. Rao, Dr. Levin, and Dr. Morris), Department of Orthopaedic Surgery, Department of Plastic and Reconstructive Surgery (Dr. Tuffaha), and the Department of Pathology (Dr. Gross), The Johns Hopkins University School of Medicine, Baltimore MD
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Sidhu DS, Gull T, Skinner OT. Influence of intraoperative closed glove exchange on glove contamination during clean soft tissue surgeries. Vet Surg 2021; 50:1510-1517. [PMID: 34286868 DOI: 10.1111/vsu.13688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/10/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the influence of intraoperative glove exchange on glove contamination during clean soft tissue surgery. STUDY DESIGN Prospective clinical study. SAMPLE POPULATION Two hundred pairs of gloves and gowns from 50 clean soft tissue surgeries. METHODS Gloves and gown cuffs were cultured from the primary surgeon and first assistant using a standardized protocol. Cultures were taken from outer surface of both gown cuffs prior to surgery and after gloves were removed at the end of surgery; gloves were cultured prior to surgery, at end of surgery and after a new pair was donned after closed glove exchange. Cultures were evaluated for colony-forming units after 72 h of inoculation. RESULTS Bacterial contamination was documented in 41 of the 50 surgeries (82%). The most common species cultured was Streptocococcus spp. There was no difference (p = .719) in the bacterial contamination rate of gown cuffs prior to surgery (10%; 20/200) compared to after surgery (9.5%; 19/200). The bacterial contamination rate for gloves was 10.5% (21/200) prior to surgery, 19.5% (39/196) after surgery, and 11% (22/200) after regloving. Gloves cultured following surgery were significantly more contaminated than gloves cultured preoperatively (p = .010) or gloves cultured following regloving (p = .018). CONCLUSION Glove exchange did not increase bacterial contamination of gloves during the clean soft tissue surgeries tested here. CLINICAL SIGNIFICANCE The outside of the gown cuff does not seem to represent a major source of contamination during clean procedures. This study does not provide evidence to support a change in current practices for intraoperative closed glove exchange.
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Affiliation(s)
- Deepinder S Sidhu
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
| | - Tamara Gull
- Veterinary Medical Diagnostic Lab, University of Missouri, Columbia, Missouri, USA
| | - Owen T Skinner
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
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Carroll AM, Kim KG, Walters ET, Phillips BK, Singh B, Dekker PK, Steinberg JS, Attinger CE, Kim PJ, Evans KK. Glove and instrument changing to prevent bacterial contamination in infected wound debridement and closure procedures: A prospective observational study. Int Wound J 2021; 18:664-669. [PMID: 33955150 PMCID: PMC8450785 DOI: 10.1111/iwj.13568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/28/2022] Open
Abstract
Many surgeons use a single table of instruments for both excisional debridement and coverage/closure of infected wounds. This study investigates the effectiveness of a two-table set-up of sterile instruments, in addition to glove exchange, to reduce instrument cross-contamination during these procedures. This is a prospective, single-site, institutional review board-approved observational study of surgical debridements of infected wounds over a 17-month period. Two separate sterile surgical tables were used for each case: Table A for initial wound debridement (debridement set-up) and Table B for wound coverage/closure (clean set-up). Swabs of each table and its respective instruments were taken after debridement but prior to coverage/closure. The primary outcome of interest was bacterial growth at 48 hours. There were 72 surgical cases included in this study. Culture results of Table A demonstrated bacterial growth in 23 of 72 (32%) cases at 48 hours compared with 5of 72 (7%) from Table B (P = .001). These data suggest that there is significant bacterial contamination of surgical instruments used for debridement of infected wounds. Use of a two-table set-up reduced instrument cross-contamination by 78%, suggesting avoidable re-contamination of the wound.
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Affiliation(s)
| | - Kevin G Kim
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Elliot T Walters
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Brian K Phillips
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Brinder Singh
- MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Paige K Dekker
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - John S Steinberg
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Christopher E Attinger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Paul J Kim
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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Kuhar HN, Shay A, Revenaugh PC, Stenson K, Tajudeen BA, Smith R, Gattuso P, Al-Khudari S. Cytopathologic assessment of gloves and instruments after major head and neck surgery. Am J Otolaryngol 2021; 42:102876. [PMID: 33482564 DOI: 10.1016/j.amjoto.2020.102876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/27/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the potential for cancer cells to be transferred between anatomic sites via instruments and other materials. MATERIALS AND METHODS Pilot prospective study from April 2018-January 2019 at Rush University Medical Center. Glove and instrument washings were collected from 18 high-risk head and neck cancer resection cases (36 samples total). Each case maintained at least one of the following features in addition to a diagnosis of squamous cell carcinoma or sarcoma: palliative/salvage surgery, positive margins, extensive tumor burden, and/or extra capsular extension (ECE). Surgical gloves and four main instruments were placed through washings for blind cytological assessment (2 samples/case). RESULTS 18 patients undergoing surgical tumor resection for biopsy-proven squamous cell carcinoma with at least one of the aforementioned characteristics were included. 26.7% of cases had ECE, 40.0% had positive final margins and 46.7% had close final margins. Tumor locations included: oral cavity (10), neck (4), parotid gland (2), and skin (2). Malignant cells were isolated on glove washings in 1 case (5.5%). No malignant cells were isolated from instrument washings. The single case of malignant cells on glove washings occurred in a recurrent, invasive squamous cell carcinoma of the scalp with intracranial extension. Anucleated squamous cells likely from surgeon skin were isolated from 94.4% of washings. Squamous cells were differentiated from mature cells by the absence of nuclei. CONCLUSIONS Malignant squamous cells can be isolated from surgical glove washings, supporting the practice of changing of gloves after gross tumor resection during major head and neck cancer resections.
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Oh C, Ording J, Kent PM. The Risk of Tumor Contamination Associated With Thoracic Instrumentation in Patients With Osteosarcoma: 2 Case Reports and a Literature Review. J Pediatr Hematol Oncol 2021; 43:e207-11. [PMID: 32205783 DOI: 10.1097/MPH.0000000000001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/30/2020] [Indexed: 11/26/2022]
Abstract
Orthopedic surgeons are well aware of tumor contamination at the site of initial biopsy in osteosarcoma. However, tumor contamination in patients with osteosarcoma associated with thoracic instrumentation is not well described. The authors summarize 2 reported cases in addition to the 2 cases at their institution of this phenomenon. Knowledge of tumor contamination and preventative measures against tumor contamination is sparse in the literature, especially pertaining to patients with osteosarcoma undergoing thoracic instrumentation. In this report, the authors hope to increase awareness of these cases and suggest preventative measures to mitigate against tumor contamination in patients with osteosarcoma. The authors report that the median time between thoracic instrumentation and the visible detection of tumor migration to local sites was 5 months. They conclude that tumor contamination associated with thoracic instrumentation is characterized by patients with multiple sites of relapse and aggressive, fatal disease.
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Tiengo C, Sonda R, Messana F, Masciopinto G, Trovarelli G, Berizzi A, Ruggeri P, Bassetto F. Risk of translocated soft-tissue sarcoma recurrence using perforator propeller flap: Case report and literature review. SAGE Open Med Case Rep 2020; 8:2050313X20970021. [PMID: 33224498 PMCID: PMC7649883 DOI: 10.1177/2050313x20970021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/09/2020] [Indexed: 11/15/2022] Open
Abstract
Tumor seeding after intra-abdominal and head and neck cancer surgery is a well-known entity. The risk of disseminating cancerous cells during surgery is also described for soft-tissue sarcoma of the extremities. Nonetheless, after reconstructive surgery using flaps, the risk of recurrence at the donor site is extremely rare. Up to this date, the literature describes only three cases, but none of them reported a translocated recurrence after a reconstruction with a propeller flap. Here, we report a case of high-grade pleomorphic sarcoma of the knee, which recurred at the proximal edge of a propeller flap 28 months after the first excision surgery. The reasons for such local recurrences are not clear and previous works have advocated different theories: direct contamination by tumor cells, physical manipulation of the tumor and creation of surgical wounds with tumor supportive properties. Although these particular cases of recurrence are exceedingly rare, certain precautionary meticulous surgical techniques and a thorough preoperative planning are pivotal to avoid the contamination of "clean" areas during the first excision surgery.
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Affiliation(s)
- Cesare Tiengo
- Clinic of Plastic Reconstructive and Aesthetic Surgery, Padova University Hospital, Padova, Italy
| | - Regina Sonda
- Clinic of Plastic Reconstructive and Aesthetic Surgery, Padova University Hospital, Padova, Italy
| | - Francesco Messana
- Clinic of Plastic Reconstructive and Aesthetic Surgery, Padova University Hospital, Padova, Italy
| | - Giuseppe Masciopinto
- Clinic of Plastic Reconstructive and Aesthetic Surgery, Padova University Hospital, Padova, Italy
| | - Giulia Trovarelli
- Department of Orthopedics and Orthopedic Oncology, Padova University Hospital, Padova, Italy
| | - Antonio Berizzi
- Department of Orthopedics and Orthopedic Oncology, Padova University Hospital, Padova, Italy
| | - Pietro Ruggeri
- Department of Orthopedics and Orthopedic Oncology, Padova University Hospital, Padova, Italy
| | - Franco Bassetto
- Clinic of Plastic Reconstructive and Aesthetic Surgery, Padova University Hospital, Padova, Italy
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Caudill AR, Newman A, Davison SP. Precaution Costs: The Presumption of Breast Cancer Seeding and Its Impact on Surgical Expenditure. Plast Reconstr Surg Glob Open 2020; 8:e2903. [PMID: 32766056 DOI: 10.1097/GOX.0000000000002903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022]
Abstract
As healthcare costs continue to rise at unsustainable rates (at an average rate of 5.5% a year), expenses without measurable outcomes need review.1 In reconstructive surgery, empiric change of instruments between oncologic and reconstructive segments of surgery is one such practice. Breast surgery for ductal carcinoma in situ (DCIS), prophylaxis, and partial extirpation has little possible increase in seeding or implantation risk based on the literature. With undue extrapolation from higher risk cancers (such as ovarian), preventative practices of changing out trays, re-gloving, re-gowning, re-preparing, and re-draping between phases persist in operating rooms across the country. From real case costs, the additional expense of 2 surgical setups in the United States is conservatively estimated at $1232 per case, or over $125 million per year for this theoretical risk. Using implantation risk for core breast biopsies as a denominator, this cost is $1.65–$5.8 million per potential recurrence. This is an unacceptably high cost for hypothetical recurrence risk reduction, especially one that does not impact survival outcomes.
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Gresham E, Don Parsa F. Iatrogenic Implantation of Cancer Cells During Surgery. Hawaii J Health Soc Welf 2020; 79:4-6. [PMID: 31967105 PMCID: PMC6969391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the late 1800s, the concept of iatrogenic implantation of cancer cells during surgery was put forth. The most dramatic example is a recurrence in a donor graft site, which is often distant to the primary site of excision. This eliminates the possibility of incomplete removal as the etiology of recurrence. However, in addition to direct transplantation to the graft site via gloves or instruments, several other possibilities exist, including de novo lesions of squamous cell carcinoma in the graft, as well as systemic metastases. This article reviews 15 published case reports of cancer recurrence in graft donor sites in which the authors considered seeding via gloves or instruments. Viewing these cases in the context of a 2018 study demonstrates the varying opinions of surgeons on the possibility of cancer seeding. This article strongly advises the changing of gloves and instruments following resection of any suspicious or established cancerous tumors.
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Affiliation(s)
- Eric Gresham
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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Berger-Richardson D, Xu RS, Gladdy RA, McCart JA, Govindarajan A, Swallow CJ. Glove and instrument changing to prevent tumour seeding in cancer surgery: a survey of surgeons' beliefs and practices. ACTA ACUST UNITED AC 2018; 25:e200-e208. [PMID: 29962846 DOI: 10.3747/co.25.3924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Some surgeons change gloves and instruments after the extirpative phase of cancer surgery with the intent of reducing the risk of local and wound recurrence. Although this practice is conceptually appealing, the evidence that gloves or instruments act as vectors of cancer-cell seeding in the clinical setting is weak. To determine the potential effect of further investigation of this question, we surveyed the practices and beliefs of a broad spectrum of surgeons who operate on cancer patients. Methods Using a modified Dillman approach, a survey was mailed to all 945 general surgeons listed in the College of Physicians and Surgeons of Ontario public registry. The survey consisted of multiple-choice and free-text response questions. Responses were tabulated and grouped into themes, including specific intraoperative events and surgeon training. Predictive variables were analyzed by chi-square test. Results Of 459 surveys returned (adjusted response rate: 46%), 351 met the inclusion criteria for retention. Of those respondents, 52% reported that they change gloves during cancer resections with the intent of decreasing the risk of tumour seeding, and 40%, that they change instruments for that purpose. The proportion of respondents indicating that they take measures to protect the wound was 73% for laparoscopic cancer resections and 31% for open resections. Training and years in practice predicted some of the foregoing behaviours. The most commonly cited basis for adopting specific strategies to prevent tumour seeding was "gut feeling," followed by clinical training. Most respondents believe that it is possible or probable that surgical gloves or instruments harbour malignant cells, but that a cancer recurrence proceeding from that situation is unlikely. Conclusions There is no consensus on how gloves and instruments should be handled in cancer operations. Further investigation is warranted.
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Affiliation(s)
- D Berger-Richardson
- Division of General Surgery, Department of Surgery, University of Toronto.,Institute of Medical Science, University of Toronto.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System; and
| | - R S Xu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System; and
| | - R A Gladdy
- Division of General Surgery, Department of Surgery, University of Toronto.,Institute of Medical Science, University of Toronto.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System; and
| | - J A McCart
- Division of General Surgery, Department of Surgery, University of Toronto.,Institute of Medical Science, University of Toronto.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System; and
| | - A Govindarajan
- Division of General Surgery, Department of Surgery, University of Toronto.,Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON
| | - C J Swallow
- Division of General Surgery, Department of Surgery, University of Toronto.,Institute of Medical Science, University of Toronto.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System; and
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Fernandes Cabral DT, Zenonos GA, Fernandez-Miranda JC, Wang EW, Gardner PA. Iatrogenic seeding of skull base chordoma following endoscopic endonasal surgery. J Neurosurg 2017; 129:947-953. [PMID: 29271711 DOI: 10.3171/2017.6.jns17111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Iatrogenic tumor seeding after open surgery for chordoma has been well described in the literature. The incidence and particularities related to endoscopic endonasal surgery (EES) have not been defined. METHODS The authors retrospectively reviewed their experience with EES for clival chordoma, focusing on cases with iatrogenic seeding. The clinical, radiographic, pathological, and molecular characterization data were reviewed. RESULTS Among 173 EESs performed for clival chordomas at the authors' institution between April 2003 and May 2016, 2 cases complicated by iatrogenic seeding (incidence 1.15%) were identified. The first case was a 10-year-old boy, who presented 21 months after an EES for a multiply recurrent clival chordoma with a recurrence along the left inferior turbinate, distinct from a right petrous apex recurrence. Both appeared as a T2-hypertintense, T1-isointense, and heterogeneously enhancing lesion on MRI. Resection of the inferior turbinate recurrence and debulking of the petrous recurrence were both performed via a purely endoscopic endonasal approach. Unfortunately, the child died 2 years later due progression of disease at the primary site, but with no sign of progression at the seeded site. The second patient was a 79-year-old man with an MRI-incompatible pacemaker who presented 19 months after EES for his clival chordoma with a mass involving the floor of the left nasal cavity that was causing an oro-antral fistula. On CT imaging, this appeared as a homogeneously contrast-enhancing mass eroding the hard palate inferiorly, the nasal septum superiorly, and the nasal process of the maxilla, with extension into the subcutaneous tissue. This was also treated endoscopically (combined transnasal-transoral approach) with resection of the mass, and repair of the fistula by using a palatal and left lateral wall rotational flap. Adjuvant hypofractionated stereotactic CyberKnife radiotherapy was administered using 35 Gy in 5 fractions. No recurrence was appreciated endoscopically or on imaging at the patient's last follow-up, 12 months after this last procedure. In both cases, pathological investigation of the original tumors revealed a fairly aggressive biology with 1p36 deletions, and high Ki-67 levels (10%-15%, and > 20%, respectively). The procedures were performed by a team of right-handed surgeons (otolaryngology and neurosurgery), using a 4-handed technique (in which the endoscope and suction are typically passed through the right nostril, and other instruments are passed through the left nostril without visualization). CONCLUSIONS Although uncommon, iatrogenic seeding occurs during EES for clival chordomas, probably because of decreased visualization during tumor removal combined with mucosal trauma and exposure of subepithelial elements (either inadvertently or because of mucosal flaps). In addition, tumors with more aggressive biology (1p36 deletions, elevated Ki-67, or both) are probably at a higher risk and require increased vigilance on surveillance imaging and endoscopy. Further prospective studies are warranted to evaluate the authors' proposed strategies for decreasing the incidence of iatrogenic seeding after EES for chordomas.
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Affiliation(s)
| | | | | | - Eric W Wang
- 2Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Esteller E, Agüero A, Martel M, López M, Quer M, León X. Stomal recurrence in head and neck cancer patients with temporary tracheostomy. Auris Nasus Larynx 2014; 41:467-70. [DOI: 10.1016/j.anl.2014.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/04/2014] [Accepted: 02/07/2014] [Indexed: 11/29/2022]
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Park HR, Min JH, Huh KH, Yi WJ, Heo MS, Lee SS, Cho YA. Distant metastasis of intraosseous dentinogenic ghost cell tumour to the donor site of a bone graft. Dentomaxillofac Radiol 2013; 42:20120172. [PMID: 23420853 DOI: 10.1259/dmfr.20120172] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A dentinogenic ghost cell tumour (DGCT) is an extremely rare odontogenic tumour which is considered as a solid, neoplastic variant of calcifying odontogenic cyst. Intraosseous DGCTs are more aggressive than extraosseous DGCTs and have a high propensity for local recurrence. This report describes a case of a diagnosis of recurrent DGCT at the primary site and a distant donor site. A 25-year-old female patient visited a dental hospital for a complaint of facial swelling for the previous month. Incisional biopsy was performed and the specimen was diagnosed as DGCT. Partial mandibulectomy for tumour resection and iliac bone graft was performed. 2 years later, the tumour recurred on the mandible and iliac bone. The recurrent lesion on the donor site was diagnosed as metastasized DGCT. This report highlights the possibility of distant metastasis occurring at a graft donor site.
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Affiliation(s)
- H-R Park
- Department of Oral and Maxillofacial Radiology, Seoul National University, Seoul, Republic of Korea
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Affiliation(s)
- Benvon Moran
- Department of Dermatology, St. James's Hospital, Dublin, Ireland
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Bater M, Puxeddu R, Brennan P. Use of an adhesive dressing to minimize tumour seeding from ulcerative cutaneous squamous carcinomas. Br J Oral Maxillofac Surg 2008; 46:422. [DOI: 10.1016/j.bjoms.2007.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2007] [Indexed: 11/28/2022]
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Affiliation(s)
- A Koitschev
- Universitäts-Hals-Nasen-Ohren-Klinik, 72076, Tübingen.
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Affiliation(s)
- Frank Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Building 25, Suite 191, Orange, CA 92868-3201, USA
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Abdel-Wanis MES, Tsuchiya H, Kawahara N, Tomita K. Tumor growth potential after tumoral and instrumental contamination: an in-vivo comparative study of T-saw, Gigli saw, and scalpel. J Orthop Sci 2002; 6:424-9. [PMID: 11845352 DOI: 10.1007/s007760170009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2001] [Accepted: 04/16/2001] [Indexed: 10/27/2022]
Abstract
In the field of spinal tumors, intralesional tumor cutting is sometimes inevitable. The purpose of this study was to compare the potential for tumor growth after intralesional cutting by T-saw, Gigli saw, and scalpel. Tumors, prepared by the subcutaneous injection of human HT 1080 fibrosarcoma cells in nude mice, were harvested and cut with a T-saw, Gigli saw, or scalpel. A 3-cm wound was created in the skin on the back in another group of nude mice. The cut surface of the tumor was rubbed for 10 s against the subcutaneous tissue in this second group of nude mice. In the same manner, the instrument used for tumor cutting was rubbed against the subcutaneous tissue in the 3-cm wound in the back of a third group of nude mice for 10 s. Other instruments used for tumor cutting were immediately washed in culture medium, and the total number of tumor cells was counted. Tumor blocks and single-cell suspensions prepared from tumor tissues of the same weight were inoculated and injected into a fourth group of nude mice. The incidence of tumor growth after the rubbing of the subcutaneous tissue with the tumor surface cut with a T-saw, Gigli saw, and scalpel was 16.7%, 50.0%, and 33.3%, respectively. The corresponding figures after the rubbing of the subcutaneous tissue with a T-saw, Gigli saw, and scalpel was 16.7%, 33.3%, and 33.3%, respectively. The mean numbers of tumor cells attached to the T-saw, Gigli saw, and scalpel were 1.88 x 105, 5.02 x 105, and 4.92 x 105, respectively. Finally, the incidence of tumor growth after the inoculation of tumor blocks and single-cell suspensions was 100% and 77.8%, respectively. These findings show that tumor recurrence is less likely after intralesional tumor cutting with a T-saw than after such cutting with a Gigli saw or scalpel.
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Affiliation(s)
- M el-S Abdel-Wanis
- Orthopaedic Department, Faculty of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan
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Abstract
AIM To demonstrate the ability of extremity soft tissue sarcomas (STSs) to implant into tissues exposed during surgery. METHODS We use two cases to illustrate that wounds created during surgery for STSs, including donor sites for skin grafts, pedicled and free flaps and blood vessels used in reconstruction, should be regarded as potential sites of quasi-local recurrence. CONCLUSIONS This report reinforces the need for meticulous surgical technique and planning of procedures to avoid contamination of clean areas that might not be included in adjuvant radiotherapy fields. The cases also highlight the pivotal importance of the correct initial management of these uncommon tumours.
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Affiliation(s)
- T M Hughes
- Melanoma and Sarcoma Unit, Royal Marsden Hospital NHS Trust, London, UK
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