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Zhang N, He J, Maithel SK, Poultsides G, Rocha F, Weber S, Fields R, Idrees K, Cho C, Lv Y, Zhang XF, Pawlik TM. Accuracy and Prognostic Impact of Nodal Status on Preoperative Imaging for Management of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study. Ann Surg Oncol 2024; 31:2882-2891. [PMID: 38097878 DOI: 10.1245/s10434-023-14758-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/25/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND We sought to define the accuracy of preoperative imaging to detect lymph node metastasis (LNM) among patients with pancreatic neuroendocrine tumors (pNETs), as well as characterize the impact of preoperative imaging nodal status on survival. METHODS Patients who underwent curative-intent resection for pNETs between 2000 and 2020 were identified from eight centers. Sensitivity and specificity of computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)-CT, and OctreoScan for LNM were evaluated. The impact of preoperative lymph node status on lymphadenectomy (LND), as well as overall and recurrence-free survival was defined. RESULTS Among 852 patients, 235 (27.6%) individuals had LNM on final histologic examination (hN1). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 12.4%, 98.1%, 71.8%, and 74.4% for CT, 6.3%, 100%, 100%, and 80.1% for MRI, 9.5%, 100%, 100%, and 58.7% for PET, 11.3%, 97.5%, 66.7%, and 70.8% for OctreoScan, respectively. Among patients with any combination of these imaging modalities, overall sensitivity, specificity, PPV, and NPV was 14.9%, 97.9%, 72.9%, and 75.1%, respectively. Preoperative N1 on imaging (iN1) was associated with a higher number of LND (iN1 13 vs. iN0 9, p = 0.003) and a higher frequency of final hN1 versus preoperative iN0 (iN1 72.9% vs. iN0 24.9%, p < 0.001). Preoperative iN1 was associated with a higher risk of recurrence versus preoperative iN0 (median recurrence-free survival, iN1→hN1 47.5 vs. iN0→hN1 92.7 months, p = 0.05). CONCLUSIONS Only 4% of patients with LNM on final pathologic examine had preoperative imaging that was suspicious for LNM. Traditional imaging modalities had low sensitivity to determine nodal status among patients with pNETs.
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Affiliation(s)
- Nan Zhang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin He
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - Flavio Rocha
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Sharon Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ryan Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, WI, USA
| | - Kamran Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Cliff Cho
- Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Yi Lv
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Zhang Y, Shang K, Li J, Sun M, Gu X. Operative treatment of pulmonary primitive neuroectodermal tumor: a case report and literature review. J Cardiothorac Surg 2024; 19:109. [PMID: 38443970 PMCID: PMC10913649 DOI: 10.1186/s13019-024-02563-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Pulmonary primitive neuroectodermal tumor (PNET), a member of the Ewing sarcoma family of tumors, is a rare malignancy that is associated with a grim prognosis. To date, fewer than 30 cases of pulmonary PNET have been reported. In this case report, we present the clinical details of a 12-year-old girl with pulmonary PNET who underwent surgical treatment. We also conducted an analysis and summary of other relevant studies and the surgical outcomes. CASE PRESENTATION In May 2018, a 12-year-old girl was admitted with symptoms of cough and blood-tinged phlegm. A computed tomography scan revealed a large mass, measuring 12.9 cm × 8.1 cm, in the right middle and lower lungs. A percutaneous lung biopsy confirmed poorly differentiated tumor cells with a nested growth pattern. Immunohistochemical staining demonstrated positive expression of CD99, CD56, Vimentin, and Synaptophysin. The patient was diagnosed with pulmonary PNET. Following three cycles of neoadjuvant chemotherapy, a substantial reduction in tumor volume was observed. Subsequently, the patient underwent a surgical procedure involving pneumonectomy and partial resection of the left atrium with the assistance of cardiopulmonary bypass. The patient was discharged 37 days after surgery. During a three-year follow-up period, she exhibited no signs of tumor recurrence and has successfully returned to school. CONCLUSIONS This case highlights the successful management of an advanced PNET with neoadjuvant chemotherapy, pneumonectomy, and partial resection of the left atrium employing cardiopulmonary bypass. The patient remained disease-free after three years. Our analysis of surgically treated cases indicates that neoadjuvant chemotherapy can contribute to improved prognoses for PNET patients. It is crucial to emphasize that complete surgical excision remains the cornerstone of treatment, underscoring the importance of surgeons considering radical surgical approaches whenever feasible for patients with pulmonary PNETs.
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Affiliation(s)
- Yiyuan Zhang
- Department of Thoracic surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Ke Shang
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jialin Li
- Department of Thoracic surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Mengyao Sun
- Department of Cardial Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Xiaoying Gu
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, 130021, China.
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Amini N, Demyan L, Shah M, Standring O, Gazzara E, Lad N, Deperalta DK, Weiss M, Deutsch G. Decreasing utilization of surgical interventions amongst patients with pancreatic neuroendocrine tumor with liver metastases. Am J Surg 2024; 227:77-84. [PMID: 37798150 DOI: 10.1016/j.amjsurg.2023.09.035] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Since 2013, North American Neuroendocrine Tumor Society (NANETS) consensus-guidelines have endorsed consideration of surgical intervention for pancreatic- neuroendocrine tumors (PNET) with liver metastases. METHODS Patients with non-functional PNET with liver only metastases from 2010 to 2019 were identified from the National Cancer Database. RESULTS 34.7% underwent surgical intervention (13% PNET resection, 2.1% surgical management of liver metastases (SMLM), 19.5% PNET resection + SMLM). In multivariable analysis, government insurance, year of diagnosis>2013, increasing primary tumor size were associated with lower rate of surgical intervention. Receiving treatment at an academic center (OR 3.59, 95%CI 1.81-7.11; P < 0.001) or integrated cancer network (OR 3.21, 95%CI 1.57-6.54; P = 0.001) was associated with a higher rate of surgical intervention. The overall rate of surgical intervention decreased from 45.7% in 2010 to 23.0% in 2019. CONCLUSION Despite guideline recommendations and the suggested survival benefits, only one-third of patients underwent surgical intervention, potentially influenced by the rising utilization of systemic therapy in the past decade.
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Affiliation(s)
- Neda Amini
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Lyudmyla Demyan
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Manav Shah
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA
| | - Oliver Standring
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Emma Gazzara
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Neha Lad
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Danielle K Deperalta
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA; Northwell Health Cancer Institute, 1111 Marcus Avenue, Lake Success, NY, 11042, USA; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA
| | - Matthew Weiss
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA; Northwell Health Cancer Institute, 1111 Marcus Avenue, Lake Success, NY, 11042, USA; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA
| | - Gary Deutsch
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA; Northwell Health Cancer Institute, 1111 Marcus Avenue, Lake Success, NY, 11042, USA; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA.
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Irfan A, Gleason F, Reddy S, Heslin MJ, Rose JB. Resection Versus Observation for Small (≤2 cm) Pancreatic Neuroendocrine Tumors. Am Surg 2023; 89:4675-4680. [PMID: 36134675 DOI: 10.1177/00031348221129501] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We hypothesized that those patients with pancreatic neuroendocrine tumors (pNETs) ≤2 cm managed nonoperatively would have comparable disease progression to individuals undergoing an operation. METHODS Patients diagnosed with nonfunctional pNETs ≤ 2 cm who were evaluated at a single comprehensive cancer center from 2010 to 2017 were selected from a cancer registry database. Clinicopathologic variables were obtained via retrospective chart review. Primary outcomes were overall and disease specific survival. Variables were compared between the 2 groups using chi-square and independent t-test. RESULTS Fifty-two individuals had tumors ≤2 cm, of whom 75% had an operation, while 25% were observed. Each treatment arm had similar distributions of gender, race, and tumor location. The most common operation was distal pancreatectomy (n = 29) followed by pancreatoduodenectomy (n = 6). Nine patients had grade III postoperative complications and 4 had grade IV under Clavien-Dindo classification. The observation group was noted to have a mean disease progression interval of 80.9 months, while those who underwent an operation had a mean disease progression interval of 94.6 months (P = .246). CONCLUSIONS Overall disease progression in patients with pNETs ≤ 2 cm without evidence of metastasis at the time of presentation is not different between those who underwent operation compared to those observed.
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Affiliation(s)
- Ahmer Irfan
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Frank Gleason
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sushanth Reddy
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Martin J Heslin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Bart Rose
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Itoi T, Kutara K, Mitsui I, Akashi N, Kanda T, Sugimoto K, Shimizu Y, Yamazoe K. Magnetic resonance imaging findings of the primitive neuroectodermal tumour in lumbosacral spinal cord in a cat. Vet Med Sci 2023; 9:2399-2403. [PMID: 37742085 PMCID: PMC10650244 DOI: 10.1002/vms3.1283] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023] Open
Abstract
A 5-year-old, castrated, male domestic short-haired cat presented with neurological deficits in the pelvic limbs, back pain and dysuria. Magnetic resonance imaging showed a mass lesion caudal to the L4 vertebrae. In addition, suspected haemorrhage was observed at the cranial aspect of the mass. There was no evidence to support the presence of extravertebral intrusion or vertebral body, osteolysis. Dorsal laminectomy and durotomy were performed to debulk the intraspinal mass. Histopathological and immunohistochemical assessment revealed a primitive neuroectodermal tumour (PNET). To our knowledge, this is the first report to describe the clinical and pathological features and imaging diagnosis of intraspinal PNET without extraspinal invasion in a cat.
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Affiliation(s)
- Takamasa Itoi
- Faculty of Veterinary MedicineOkayama University of ScienceImabariEhimeJapan
| | - Kenji Kutara
- Faculty of Veterinary MedicineOkayama University of ScienceImabariEhimeJapan
| | - Ikki Mitsui
- Faculty of Veterinary MedicineOkayama University of ScienceImabariEhimeJapan
| | - Natsuki Akashi
- Faculty of Veterinary MedicineOkayama University of ScienceImabariEhimeJapan
| | - Teppei Kanda
- Faculty of Veterinary MedicineOkayama University of ScienceImabariEhimeJapan
| | - Keisuke Sugimoto
- Faculty of Veterinary MedicineOkayama University of ScienceImabariEhimeJapan
| | - Yuki Shimizu
- Faculty of Veterinary MedicineOkayama University of ScienceImabariEhimeJapan
| | - Kazuaki Yamazoe
- Faculty of Veterinary MedicineOkayama University of ScienceImabariEhimeJapan
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Zhang C, Niu W, Xu Y, Lu Y, Huang L, Li S, Jiang X, Wu J. Multivisceral resection of nonfunctional pancreatic neuroendocrine neoplasm with nearby organ invasion: a case report. Front Endocrinol (Lausanne) 2023; 14:1236685. [PMID: 37822595 PMCID: PMC10562619 DOI: 10.3389/fendo.2023.1236685] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
Pancreatic neuroendocrine neoplasms (pNENs) are relatively rare epithelial malignancies originating from pancreatic neuroendocrine cells, pathologically classified into well-differentiated pancreatic neuroendocrine tumors (pNETs) and poorly-differentiated pancreatic neuroendocrine carcinoma (pNECs). Although they also fall under the category of pNENs, the almost entirely distinct biological characteristics and survival prognosis have caused debate among surgeons when it comes to the development of surgical intervention options, particularly for locally advanced G3 pNETs and pNECs. We present a case of 66-year-old male with nonfunctional G3 pNET, invasion of five nearby pancreatic organs and type II liver metastases. The patient achieved good outcomes after undergoing multivisceral resection and postoperative adjuvant chemotherapy. This finding helps surgeons better understand locally advanced pNENs, formulate treatment decisions systematically and confidently, and balance patient benefits and risks of surgery.
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Affiliation(s)
| | | | | | | | | | | | - Xinwei Jiang
- Department of Hepatobiliary Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, China
| | - Jianwu Wu
- Department of Hepatobiliary Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, China
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Gangi A, Ferrone CR. What Is the Role of Lymph Node Resections in Small Islet Tumors? Adv Surg 2023; 57:47-58. [PMID: 37536861 DOI: 10.1016/j.yasu.2023.06.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Well-differentiated nonfunctional pancreatic neuroendocrine tumors are often indolent neoplasms without lymph node (LN) metastasis at diagnosis. Patients with PNETs that are functional or >2 cm should have surgical resection as per the standard of care. However, in appropriately selected patients with NF PNETs <2 cm who are at low risk of LN metastasis, the extent of surgery and lymphadenectomy could be limited.
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Affiliation(s)
- Alexandra Gangi
- Gastrointestinal Tumor Program, Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard North Tower, Suite 8215, Los Angeles, CA 90048, USA.
| | - Cristina R Ferrone
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard North Tower, Suite 8215, Los Angeles, CA 90048, USA
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Chopde A, Gupta A, Chaudhari V, Parghane R, Basu S, Ostwal V, Ramaswamy A, Puranik A, Shrikhande SV, Bhandare MS. Prognostic predictors for recurrence following curative resection in grade I/II pancreatic neuroendocrine tumours. Langenbecks Arch Surg 2023; 408:204. [PMID: 37212896 DOI: 10.1007/s00423-023-02943-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Pancreatic neuroendocrine tumours (pNETs) have an excellent long-term survival after resection, but are associated with a high recurrence rate. Identification of prognostic factors affecting recurrences would enable identifying subgroup of patients at higher risk of recurrences, who may benefit from more aggressive treatment. METHODS A retrospective analysis of prospectively maintained database of patients undergoing pancreatectomy with curative intent for grade I and II pNETs between July 2007 and June 2021 was performed. Perioperative and long-term outcomes were analysed. RESULTS A total of 68 resected patients of pNETs were included in this analysis. Fifty-two patients (76.47%) underwent pancreaticoduodenectomy, 10 (14.7%) patients had distal pancreatectomy, and 2 (2.9%) patients underwent median pancreatectomy, while enucleation was performed in 4 patients (5.8%). The overall major morbidity (Clavien-Dindo III/IV) and mortality rates were 33.82% and 2.94%, respectively. At a median follow-up period of 48 months, 22 (32.35%) patients had disease recurrence. The 5-year overall survival and 5-year recurrence-free survival (RFS) rates were 90.2% and 60.8%, respectively. While OS was unaffected by different prognostic factors, multivariate analysis showed that lymph node involvement, Ki-67 index ≥5%, and presence of perineural invasion (PNI) were independently associated with recurrence. CONCLUSIONS While surgical resection gives excellent overall survival in grade I/II pNETs, lymph node positivity, higher Ki-67 index, and PNI are associated with a high risk for recurrence. Patients with these characteristics should be stratified as high risk and evaluated for more intensive follow-up and aggressive treatment strategies in future prospective studies.
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Affiliation(s)
- Amit Chopde
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Homi bhabha National Institute, Mumbai, India
| | - Amit Gupta
- Department of Surgical Oncology, Cancer Care, Gujrat, Surat, 395002, India
| | - Vikram Chaudhari
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Homi bhabha National Institute, Mumbai, India
| | - Rahul Parghane
- Homi bhabha National Institute, Mumbai, India
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, Maharashtra, India
| | - Sandip Basu
- Homi bhabha National Institute, Mumbai, India
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, Maharashtra, India
| | - Vikas Ostwal
- Homi bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anant Ramaswamy
- Homi bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ameya Puranik
- Homi bhabha National Institute, Mumbai, India
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shailesh V Shrikhande
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Homi bhabha National Institute, Mumbai, India
| | - Manish S Bhandare
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
- Homi bhabha National Institute, Mumbai, India.
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Bolm L, Nebbia M, Wei AC, Zureikat AH, Fernández-del Castillo C, Zheng J, Pulvirenti A, Javed AA, Sekigami Y, Petruch N, Qadan M, Lillemoe KD, He J, Ferrone CR. Long-term Outcomes of Parenchyma-sparing and Oncologic Resections in Patients With Nonfunctional Pancreatic Neuroendocrine Tumors <3 cm in a Large Multicenter Cohort. Ann Surg 2022; 276:522-531. [PMID: 35758433 PMCID: PMC9388557 DOI: 10.1097/sla.0000000000005559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The role of parenchyma-sparing resections (PSR) and lymph node dissection in small (<3 cm) nonfunctional pancreatic neuroendocrine tumors (PNET) is unlikely to be studied in a prospective randomized clinical trial. By combining data from 4 high-volume pancreatic centers we compared postoperative and long-term outcomes of patients who underwent PSR with patients who underwent oncologic resections. METHODS Retrospective review of prospectively collected clinicopathologic data of patients who underwent pancreatectomy between 2000 and 2021 was collected from 4 high-volume institutions. PSR and lymph node-sparing resections (enucleation and central pancreatectomy) were compared to those who underwent oncologic resections with lymphadenectomy (pancreaticoduodenectomy, distal pancreatectomy). Statistical testing was performed using χ 2 test and t test, survival estimates with Kaplan-Meier method and multivariate analysis using Cox proportional hazard model. RESULTS Of 810 patients with small sporadic nonfunctional PNETs, 121 (14.9%) had enucleations, 100 (12.3%) had central pancreatectomies, and 589 (72.7%) patients underwent oncologic resections. The median age was 59 years and 48.2% were female with a median tumor size of 2.5 cm. After case-control matching for tumor size, 221 patients were selected in each group. Patients with PSR were more likely to undergo minimally invasive operations (32.6% vs 13.6%, P <0.001), had less intraoperative blood loss (358 vs 511 ml, P <0.001) and had shorter operative times (180 vs 330 minutes, P <0.001) than patients undergoing oncologic resections. While the mean number of lymph nodes harvested was lower for PSR (n=1.4 vs n=9.9, P <0.001), the mean number of positive lymph nodes was equivalent to oncologic resections (n=1.1 vs n=0.9, P =0.808). Although the rate of all postoperative complications was similar for PSR and oncologic resections (38.5% vs 48.2%, P =0.090), it was higher for central pancreatectomies (38.5% vs 56.6%, P =0.003). Long-term median disease-free survival (190.5 vs 195.2 months, P =0.506) and overall survival (197.9 vs 192.6 months, P =0.372) were comparable. Of the 810 patients 136 (16.7%) had no lymph nodes resected. These patients experienced less blood loss, shorter operations ( P <0.001), and lower postoperative complication rates as compared to patients who had lymphadenectomies (39.7% vs 56.9%, P =0.008). Median disease-free survival (197.1 vs 191.9 months, P =0.837) and overall survival (200 vs 195.1 months, P =0.827) were similar for patients with no lymph nodes resected and patients with negative lymph nodes (N0) after lymphadenectomy. CONCLUSION In small <3 cm nonfunctional PNETs, PSRs and lymph node-sparing resections are associated with lower blood loss, shorter operative times, and lower complication rates when compared to oncologic resections, and have similar long-term oncologic outcomes.
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Affiliation(s)
- Louisa Bolm
- (1) Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Martina Nebbia
- (1) Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Alice C. Wei
- (2) Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amer H. Zureikat
- (3) Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Jian Zheng
- (3) Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Ammar A. Javed
- (4) Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Yurie Sekigami
- (1) Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Natalie Petruch
- (1) Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Motaz Qadan
- (1) Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Keith D. Lillemoe
- (1) Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jin He
- (4) Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Cristina R. Ferrone
- (1) Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Zhang Z, Wang F, Li Z, Ye Z, Zhuo Q, Xu W, Liu W, Liu M, Fan G, Qin Y, Zhang Y, Chen X, Yu X, Xu X, Ji S. Value of lymphadenectomy in patients with surgically resected pancreatic neuroendocrine tumors. BMC Surg 2022; 22:160. [PMID: 35538535 PMCID: PMC9088076 DOI: 10.1186/s12893-022-01595-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although some factors that predict the prognosis in pancreatic neuroendocrine tumor (pNET) have been confirmed, the predictive value of lymph node metastasis (LNM) in the prognosis of pNETs remains conflicting and it is not clear whether regional lymphadenectomy should be performed in all grades of tumors. METHODS We included pNET patients undergoing surgery in Shanghai pancreatic cancer institute (SHPCI). The risk factors for survival were investigated by the Kaplan-Meier method and Cox regression model. We evaluated the predictors of LNM using Logistic regression. RESULTS For 206 patients in the SHPCI series, LNM was an independent prognostic factor for entire cohort suggested by multivariate Cox regression analysis. LNM (P = 0.002) predicted poorer overall survival (OS) in grade 2/3 cohort, but there is no significant association between LNM and OS in grade 1 cohort. Grade (P < 0.001) and size (P = 0.049) predicted LNM in entire cohort. Grade (P = 0.002) predicted LNM while regardless of size in grade 2/3 cohort. CONCLUSIONS Based on our own retrospective data obtained from a single center series, LNM seems to be associated with poorer outcome for patients with grade 2/3 and/or grade 1 > 4 cm tumors. On the other way, LNM was seems to be not associated with prognosis in patients with grade 1 tumors less than 4 cm. Moreover, tumor grade and tumor size seem to act as independent predictors of LNM. Thus, regional lymphadenectomy should be performed in grade 2/3 patients but was not mandatory in grade 1 tumors < 4 cm. It is reasonable to perform functional sparing surgery for grade 1 patients or propose a clinical-radiological monitoring.
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Affiliation(s)
- Zheng Zhang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Fei Wang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Zheng Li
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Zeng Ye
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Qifeng Zhuo
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Wenyan Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Wensheng Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Mengqi Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Guixiong Fan
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Yi Qin
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Yue Zhang
- The First People's Hospital of Changzhou, Changzhou City, Jiangsu Province, People's Republic of China
| | - Xuemin Chen
- The First People's Hospital of Changzhou, Changzhou City, Jiangsu Province, People's Republic of China
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China.
| | - Xiaowu Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China.
| | - Shunrong Ji
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People's Republic of China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
- Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China.
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11
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Rehman O, Narang S, Nayyar S, Aggarwal P. Unusual case of intraocular medulloepithelioma in an adult male. Rom J Ophthalmol 2021; 65:296-299. [PMID: 35036657 PMCID: PMC8697787 DOI: 10.22336/rjo.2021.61] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 11/18/2022] Open
Abstract
Medulloepithelioma is a rare tumor of the eye, arising from the posterior segment. This embryonic tumor is mostly seen in children and is very rare in adult population. This case report presents the case of a 39-year-old Indian male, who had gradual vision loss over 4 years in his left eye with new onset of pain. He was referred to our center in view of secondary cataract and intraocular mass. Vision in right eye was 20/ 20 while left eye had no light perception at presentation. Ocular examination of the left eye revealed shallow anterior chamber, florid iris neovascularization, raised intraocular pressure and cataractous lens. B-scan ultrasonography showed a heterogenous mass filling the entire globe. MRI scan confirmed the finding, showing a mass hyper-intense to vitreous. No invasion of optic nerve or sclera was observed. Left eye enucleation with PMMA implant placement was performed and histopathology confirmed the diagnosis of benign teratoid medulloepithelioma. At the time of submission of this report, the patient was still under follow-up and had no detectable metastases at 15 months follow-up. This report highlights a very rare case of embryonic tumor in adult male, which could be managed successfully with a high index of suspicion and timely intervention.
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Affiliation(s)
- Obaidur Rehman
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Subina Narang
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Shifali Nayyar
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Phiza Aggarwal
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
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Abstract
RATIONALE Primitive neuroectodermal tumor (PNET) of the urinary bladder is a highly aggressive tumor with high local recurrence and distant metastasis rates in cases of incomplete excision. We report a case of a young female patient, in whom early laparoscopic radical cystectomy combined with standard lymph node dissection and a modified vincristine, doxorubicin hydrochloride, and cyclophosphamide (VAC) chemotherapy regimen was controversial. Because PNET of the urinary bladder is a rare malignancy, the standard treatment regimen has not yet been established. It is not clear whether surgery combined with postoperative chemotherapy for PNET patients may be superior to surgery alone on long term survival. PATIENT CONCERNS The patient was a 45-year-old Chinese woman who complained of lower urinary tract symptoms, including urgency, frequency, and difficulty in urination, for 2 months. DIAGNOSES PNET. INTERVENTIONS The patient underwent laparoscopic radical cystectomy and standard lymph node dissection, combined with modified VAC chemotherapy regimens. OUTCOMES After undergoing radical surgery in 2018, the patient completed 6 courses of adjuvant chemotherapy. Abdominal and thorax computed tomography scanning was performed 3, 6, 9, and 12 months after the surgery was completely free of tumor. The patient is still alive with no signs of recurrent disease 2 years after diagnosis. LESSONS Radical surgery and standard lymphadenectomy combined with adjuvant chemotherapy may be essential to improve the prognosis of PNET of the urinary bladder.
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Affiliation(s)
- Liang Gao
- Department of Urology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University
| | - Wenjie Xie
- Department of Urology, the First Affiliated Hospital of Nanchang University
| | - Kun Li
- Department of Urology, Jiujiang No.1 People's Hospital
| | - Gaomin Huang
- Department of Urology, the First Affiliated Hospital of Nanchang University
| | - Yuanhai Ji
- Department of Urology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University
| | - Yangkang Ou
- Department of Urology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University
| | - Jie Chen
- Department of Urology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University
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13
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Maker AV, Tran TB, Coburn N, Fong ZV, Cardona K, Newell P, Morris-Stiff G, Chavin K, Mansour J. Does attending a Delphi consensus conference impact surgeon attitudes? Survey results from the Americas HepatoPancreatoBiliary Association consensus conference on small asymptomatic pancreatic neuroendocrine tumors. HPB (Oxford) 2019; 21:524-530. [PMID: 30442562 DOI: 10.1016/j.hpb.2018.10.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Management of asymptomatic small well-differentiated (panNET) <2 cm remains controversial. A consensus conference was held on this topic. The impact of attending the conference and participating in the audience response survey on surgeon's clinical approach to pancreatic neuroendocrine tumors was assessed. METHODS Audience members were surveyed using a smartphone real-time response system at the beginning and end of the conference. RESULTS The majority of 75 attendees underwent fellowship training, and 30% had >10 years experience as attending surgeons. Previously published consensus statements on the topic were considered insufficient to guide surgical practice by 82% of attendees, and over 96% desired additional data. After review of the data, consensus statements, and decision-making process, a significant number of participants changed their opinions regarding indications for tissue biopsy (p = 0.001), size thresholds for excision (p = 0.002), and regional lymph node dissection (p = 0.002) independent of whether a consensus was reached by the content-expert panel. CONCLUSIONS This represented the first Delphi process consensus on the topic, and the survey confirmed the topic as well-chosen and timely. Attendees changed opinions on management of panNET regardless of whether formal consensus was reached. Therefore, statements of consensus combined with presentation of literature and live discussion served to impact attendees' approach to this disease.
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Affiliation(s)
- Ajay V Maker
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
| | - Thuy B Tran
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, USA
| | - Zhi V Fong
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Philippa Newell
- Department of Surgery, Providence Portland Medical Center, Portland, OR, USA
| | | | - Kenneth Chavin
- Department of Surgery, University Hospitals, Cleveland, OH, USA
| | - John Mansour
- Department of Surgery, UT Southwestern, Dallas, TX, USA
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14
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Abstract
RATIONALE Intracranial medulloepitheliomas are extremely rare and highly malignant. Intraventricular medulloepitheliomas are even rarely reported, and little is known about the clinical features. PATIENT CONCERNS In this article, we report two cases of intracranial medulloepitheliomas. In the first patient, a one-month old boy, the tumor was located in in right lateral ventricle, which was the first report of such location of this disease; in the second patient, an eleven-month old girl, the tumor was in right cerebellopontine angle. DIAGNOSES Both patients were diagnosed as medulloepithelioma by pathologists. INTERVENTIONS Both patients underwent craniotomy to resect the lesion totally. OUTCOMES The boy underwent chemotherapy after operation and was alive 3 months after operation. The girl died 6 months after operation, despite aggressive adjuvant chemotherapy. LESSONS Surgical resection is safe and effective to prolong patient survival. However, despite aggressive adjuvant therapy, prognosis of medulloepithelioma remains poor, and further study is needed to improve treatment of this rare disease.
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Affiliation(s)
| | - Ni Chen
- Department of Pathology, West China Hospital of Sichuan University
| | - Yan Ju
- Department of Neurosurgery
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15
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De Nola R, Di Naro E, Schonauer LM, Lucarelli G, Battaglia M, Fiore MG, Mastrolia SA, Loverro G. Clinical management of a unique case of PNET of the uterus during pregnancy, and review of the literature. Medicine (Baltimore) 2018; 97:e9505. [PMID: 29480840 PMCID: PMC5943895 DOI: 10.1097/md.0000000000009505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE PNETs (primitive neuroectodermal tumors) are a family of highly malignant neoplasms characterized by small round cells of neuroepithelial origin. They usually involve bone and soft tissues, and have a higher incidence in childhood. PATIENT CONCERNS In this case report, we describe the obstetric and oncological outcome of a huge mass diagnosed as a leiomyoma in a 39-year-old pregnant woman who complained of low back pain, dysuria, and urinary frequency at 22 weeks of gestation. DIAGNOSES During the 25th week of pregnancy, the patient was referred to our hospital at night with severe anemia and suspected hemoperitoneum. She underwent an emergency caesarean section, delivering a female fetus weighing 400 g, with an Apgar score of 7 at 1 minute and 9 at 5 minutes. INTERVENTION During surgery, we found a huge uterine sarcoma-like metastatic tumor, invading the pelvic peritoneum and parametria bilaterally; the adnexae seemed disease-free. We performed a type B radical hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, omentectomy, appendectomy, and excision of a bulky lymph node. Seven days after delivery, staging computed tomography (CT) scan demonstrated a large lombo-aortic lymph node compressing the left renal vein and we completed debulking with a second surgery, including diaphragmatic peritonectomy and excision of a huge lymph node by lombo-aortic lymphadenectomy, requiring partial reconstruction of an infiltrated renal vein. OUTCOME Ten days after the second surgery, echo-color Doppler showed a regular microcirculation in the left kidney. The patient was discharged after 10 days, and the baby after 1 month, both in good health.Histological examination revealed a uterine body cPNET (central primitive neuroectodermal tumor) orienting the clinical management toward chemotherapy with cisplatin and etoposide. LESSONS PNETs are aggressive neoplasms, usually diagnosed at an advanced stage. Due to their low incidence, universally accepted guidelines are still unavailable. Radical surgery leaving no macroscopic residual disease is mandatory in advanced stages. A good fertility-sparing procedure can be performed only in young women at early stages of disease, when the wish for childbearing is not yet fulfilled.
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Affiliation(s)
- Rosalba De Nola
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Edoardo Di Naro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Luca Maria Schonauer
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | | | | | - Giuseppe Loverro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
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16
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Abstract
RATIONALE Primary spinal primitive neuroectodermal tumors (PNETs) are highly malignant tumors, which are extremely rare entities and primary intramedullary PNETs are extremely rare. Till now, only 24 cases of primary intramedullary PNET have been reported. PATIENT CONCERNS A 26-year-old male presented with progressive low back and lower limb pain for 1 month. DIAGNOSES Based on MRI and histopathological findings, he was diagnosed with primary intramedullary PNET. INTERVENTIONS The patient was treated two times with microsurgical resections. OUTCOMES Follow-up visit at 14 months after the first surgery showed that the patient is neurologically intact and free of disease. LESSONS PNETs should be considered in the differential diagnosis of an intramedullary spinal cord tumor manifesting as progressive neurological deterioration.
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Affiliation(s)
| | - Fuyou Guo
- Department of Neurosurgery
- Department of Neurosurgery, Key Laboratory of Neurosurgical Diseases, The First Affiliated Hospital of Zhengzhou University, ZhengZhou, HeNan Province, PR China
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17
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Liu C, Cui LG, Wang HL. Renal Ewing's sarcoma/primitive neuroectodermal tumor: a case report and literature review. Beijing Da Xue Xue Bao Yi Xue Ban 2017; 49:919-923. [PMID: 29045981] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ewing's sarcoma/primitive neuroectodermal tumor (EWS/PNET) in the kidney is a rare but high-grade malignant tumor that affects predominantly elder children and adolescents. Patients mostly present with nonspecific symptoms such as abdominal pain and gross hematuria. Since EWS/PNET has a rapid clinical progression with early metastasis and death, it is essential to make an accurate and early diagnosis. Once diagnosed, multimodality treatment, including radical surgery combined with adjuvant chemotherapy, and radiotherapy if necessary, is recommended. Unfortunately, there are no characteristic signsthat have been described in ultrasonography or any other imaging modalities so far. The diagnosis of EWS/PNET is now based on a classical histological and immunohistochemical investigation complemented by a demonstration of specific chromosomal changes. Strong immunoreactivity to CD99 is ubiquitous, and t(11;22) translocation is seen in approximately 90% of EWS/PNET. Herein, we report a patient with such condition. The patient was a young woman, and she presented with sudden right flank pain clinically. Ultrasonography revealed a large heterogeneous mass in the lower pole of her right kidney. The tumor compressed the renal pelvis and led to upper pole caliectasis. Color Doppler demonstrated blood flow with a pulsatile arterialized waveform within the mass. The patient received radical nephrectomy with right renal vein and vena cava thrombectomy. A search for other sites of tumor involvement yielded negative results. And six cycles of chemotherapy were sequentially performed. The diagnosis of EWS/PNET was confirmed based on primitive small round cell histology and characteristic immunohistochemical results. She was still alive with no evidence of recurrence five years after initial diagnosis. We would like to point out that ultrasound is still a useful method for initial assessment, and ultrasound-guided fine needle aspiration may play an important role in determining preoperative diagnosis.
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Affiliation(s)
- C Liu
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - L G Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - H L Wang
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
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18
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Chen S, Idrees M, Lin J, Wu HH. Fine-Needle Aspiration of Metastatic Central Type Primitive Neuroectodermal Tumors in Patients with a Germ Cell Tumor. Acta Cytol 2017; 61:409-417. [PMID: 28554176 DOI: 10.1159/000476025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Central type primitive neuroectodermal tumors (PNET) are some of the most frequent somatic type tumors derived from germ cell tumors and can metastasize. We studied the cytomorphological features of metastatic central type PNET by fine-needle aspiration (FNA). MATERIALS AND METHODS A computerized search of our laboratory information system was performed for the 9-year period from 2005 through 2014 to identify all cytology cases in which a diagnosis of metastatic central type PNET had been rendered. A total of 5 FNA cases were collected and direct smears were reexamined. RESULTS All patients had a history of testicular or ovarian germ cell tumors. Direct smears displayed single and clusters of atypical round to oval cells with scant to moderate cytoplasm. Abundant naked nuclei were present in Diff-Quik-stained smears with mild to marked crushed artifacts and nuclear molding. Tumor cells showed fine granular chromatin, nuclear size variation (up to 1:3), and one or more small nucleoli. Pseudorosettes (Homer Wright-like rosette) were noticed in 1 case. Tumor cells were commonly positive for synaptophysin. CONCLUSION Metastatic PNET can be reliably diagnosed by FNA. Differential diagnoses include Ewing sarcoma/peripheral PNET, alveolar rhabdomyosarcoma, neuroblastoma, etc. It is important to be familiar with this entity to avoid diagnostic pitfalls.
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Affiliation(s)
- Shaoxiong Chen
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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19
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Ramanathan S, Vora T, Gulia A, Mahajan A, Desai S. Pulmonary cement embolism in a child following total elbow replacement for primitive neuroectodermal tumour (PNET) of the humerus. Skeletal Radiol 2017; 46:715-718. [PMID: 28233027 DOI: 10.1007/s00256-017-2602-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/31/2017] [Accepted: 02/08/2017] [Indexed: 02/05/2023]
Abstract
Pulmonary bone cement embolism (PCE) is an uncommon event occurring after implantation of polymethylmethacrylate (PMMA) in orthopaedic surgeries involving adult patients, more so in the elderly. Its incidence in the paediatric population is extremely rare. We herein describe a case of PCE in a 15-year-old girl, 9 days after she underwent total elbow replacement with PMMA placement for a primitive neuroectodermal tumour (PNET) of the distal humerus. This report describes the occurrence of a common post-operative complication of bone cement embolism in an uncommon scenario of total elbow replacement for a bone tumour in a child, which masqueraded initially as acute pneumonitis.
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Affiliation(s)
- Subramaniam Ramanathan
- Department of Medical Oncology (Paediatric), Tata Memorial Hospital, Dr. E. Borges Road Parel, Mumbai, 400012, India.
| | - Tushar Vora
- Department of Medical Oncology (Paediatric), Tata Memorial Hospital, Dr. E. Borges Road Parel, Mumbai, 400012, India
| | - Ashish Gulia
- Department of Surgical Oncology (Orthopaedic), Tata Memorial Hospital, Mumbai, India
| | - Abhishek Mahajan
- Department of Radio-Diagnosis, Tata Memorial Hospital, Mumbai, India
| | - Subhash Desai
- Department of Radio-Diagnosis, Tata Memorial Hospital, Mumbai, India
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20
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Weber F. [Importance of tumor size for pancreatic neuroendocrine tumors]. Chirurg 2016; 87:1077. [PMID: 27752726 DOI: 10.1007/s00104-016-0315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- F Weber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
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21
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Yuan LL, Tang XB, Liu T, Zhang J, Gong XH, Liu P, Wang DZ. [Temporal-parietal medulloepithelioma: report of a case]. Zhonghua Bing Li Xue Za Zhi 2013; 42:706-707. [PMID: 24433740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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22
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Aydin MV, Sen O, Ozel S, Kayaselcuk F, Caner H, Altinors N. Primary primitive neuroectodermal tumor within the spinal epidural space: report of a case and review of the literature. Neurol Res 2013; 26:774-7. [PMID: 15494121 DOI: 10.1179/016164104225014111] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Primary intraspinal primitive neuroectodermal tumors (PNETs) are rare tumors and a have poor prognosis. In reviews of the literature, it is seen that primary intraspinal PNETs may arise at all levels of the spine and may be intramedullary, intradural-extramedullary, or epidural. Spinal epidural location of PNET is extremely rare and out of 22 cases of primary spinal PNETs reported to date, only two were epidural. Tumors within the epidural space of the spinal canal are most often metastatic neoplasms from different primary sites. Here we report a case of primary extradural PNET located in the thoracic spine in a 16-year-old boy and review the relevant literature.
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Affiliation(s)
- M Volkan Aydin
- Department of Neurosurgery, Medical Faculty, Baskent University, Adana, Turkey.
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23
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Pancucci G, Simal-Julian JA, Plaza-Ramirez E, García-Marcos R, Mayordomo-Aranda E, Botella-Asunción C. Primary extraosseous intradural spinal Ewing's sarcoma: report of two cases. Acta Neurochir (Wien) 2013; 155:1229-34. [PMID: 23686630 DOI: 10.1007/s00701-013-1739-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 03/13/2013] [Accepted: 04/22/2013] [Indexed: 12/11/2022]
Abstract
Two cases of primary extraosseous intradural spinal Ewing's sarcoma are reported with a review of the current literature. This rare neoplasm shares features with cerebral primitive neuroectodermal tumors, complicating a correct diagnosis. Gross total resection seems to be the main treatment, although adjuvant therapies could improve the prognosis. In case 1, a 56-year-old man presented with cauda equina syndrome. MRI showed an intradural tumor from L4 to S2. An emergency laminectomy was performed with gross total resection of a hemorrhagic tumor, followed by adjuvant treatment. In the second case, a 25-year-old female developed leg and lumbar pain. MRI study identified a homogeneously enhancing intradural mass at the L2-L3 level. A laminoplasty was performed, followed by tumor resection; no adjuvant treatment was administered afterwards. Immunohistochemical workup confirmed the diagnosis of Ewing's sarcoma in both cases.
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Affiliation(s)
- Giovanni Pancucci
- Department of Neurological Surgery, Hospital Universitario La Fe, Área Administrativa 5E, c/Bulevar Sur, s/n, 46026, Valencia, Spain.
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Ryzhova MV, Kushel' IV, Zheludkova OG, Shishkina LV, Panina TN, Melikian AG, Zemlianskiĭ MI, Lemeneva NV. Are the medulloepithelioma, ependymoblastoma and embryonal tumor with multilayered rosettes the same entity? Zh Vopr Neirokhir Im N N Burdenko 2013; 77:51-55. [PMID: 24558755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medulloepithelioma is a rare malignant tumor arising in cerebral hemispheres. Microscopically, medulloepithelioma is characterized by epithelial structures that mimic the embryonic neural tube. Immunohistochemical analysis revealed that tumor cells are immunopositive for LIN28A and fluorescence in situ hybridization showed an amplification of a miRNA cluster at 19q13.42. Presence of these both aberrations suggesting that medulloepithelioma, ependymoblastoma and embryonal tumor with multilayered rosettes are the same entity.
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MESH Headings
- Brain Neoplasms/classification
- Brain Neoplasms/genetics
- Brain Neoplasms/metabolism
- Brain Neoplasms/pathology
- Brain Neoplasms/surgery
- Chromosomes, Human, Pair 19/genetics
- Chromosomes, Human, Pair 19/metabolism
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Ependymoma/classification
- Ependymoma/genetics
- Ependymoma/metabolism
- Ependymoma/pathology
- Ependymoma/surgery
- Humans
- Infant
- Male
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Neoplasms, Germ Cell and Embryonal/classification
- Neoplasms, Germ Cell and Embryonal/genetics
- Neoplasms, Germ Cell and Embryonal/metabolism
- Neoplasms, Germ Cell and Embryonal/pathology
- Neoplasms, Germ Cell and Embryonal/surgery
- Nerve Tissue Proteins/genetics
- Nerve Tissue Proteins/metabolism
- Neuroectodermal Tumors, Primitive/classification
- Neuroectodermal Tumors, Primitive/genetics
- Neuroectodermal Tumors, Primitive/metabolism
- Neuroectodermal Tumors, Primitive/pathology
- Neuroectodermal Tumors, Primitive/surgery
- RNA-Binding Proteins
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Xu N, Jin MS, Chen L, Wang CX, Sun ST, Shi AP. Renal primitive malignant tumor with endocrine activity. Med Princ Pract 2013; 22:200-3. [PMID: 22964717 PMCID: PMC5586721 DOI: 10.1159/000342194] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 07/22/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a hypertensive and systematically pigmented female with primitive neuroectodermal tumors. CLINICAL PRESENTATION AND INTERVENTION A female patient presented with a complaint of right flank pain. She had a right renal space-occupying lesion, underwent right radical nephrectomy, and returned to normotensive postoperatively. The pathological examination identified typical primitive neuroectodermal tumor histology. During a 60-month follow-up period, she remained normotensive and demonstrated normal renal and adrenal functions. CONCLUSION Early diagnosis and definitive surgery led to the patient's long-term survival.
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Affiliation(s)
- Ning Xu
- Department of Urology, Jilin University First Hospital, Changchun, China
| | - Mei-Shan Jin
- Department of Pathology, Jilin University First Hospital, Changchun, China
| | - Liang Chen
- Department of Radiology, Jilin University First Hospital, Changchun, China
| | - Chun-Xi Wang
- Department of Urology, Jilin University First Hospital, Changchun, China
| | - Shou-Tian Sun
- Department of Urology, Jilin University First Hospital, Changchun, China
| | - Ai-Ping Shi
- Department of General Surgery, Jilin University First Hospital, Changchun, China
- *Dr. Ai-Ping Shi, Department of General Surgery, Jilin University First Hospital, 71 Xinmin Blvd, Changchun 130021 (China), Tel. +86 431 8878 2284, E-Mail
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Tortorelli AP, Alfieri S, Sanchez AM, Rosa F, Doglietto GB. Image of the month. PNET of the pancreas. Arch Surg 2012; 147:1063-4. [PMID: 23165620 DOI: 10.1001/archsurg.2011.1620b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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27
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Cortnum S, Laursen RJ. Fluorescence-guided resection of gliomas. Dan Med J 2012; 59:A4460. [PMID: 22849976] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Malignant gliomas remain associated with a poor prognosis despite both surgical treatment and radiochemotherapy.Previous studies have shown that complete resection of contrast-enhancing tumours is achieved in less than 20-30% of patients. 5-aminolevulinic acid (5-ALA) is a pro-drug that leads to accumulation of fluorescent protoporphyrins in malignant gliomas. The fluorescence can be visualized intraoperatively by use of a modified microscope. The Department of Neurosurgery at Aalborg Hospital has recently adopted this new technique as the first centre in Denmark. Our preliminary results are presented as a retrospective case series. MATERIAL AND METHODS All patients who had undergone 5-ALA fluorescence-guided surgery due to suspected malignant glioma were included. Patients received a standard preoperative dose of Gliolan. All patients had a postoperative cerebral magnetic resonance imaging scan done within 72 hours to determine their postoperative resection status. RESULTS To date, 13 patients have undergone fluorescence-guided surgery. Total resection was achieved in 54-70% of the patients depending on the inclusion criteria. Total or near total resection was achieved in 92% of patients. CONCLUSION The small numbers in our case series do not allow for direct comparison to be made, but show that our results on postoperative resection status fall within the range reported in other studies on the efficacy of 5-ALA. The literature offers mounting evidence in support of the role of aggressive cytoreductive surgery in patients with malignant gliomas. FUNDING not relevant. TRIAL REGISTRATION not relevant.
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Affiliation(s)
- Søren Cortnum
- Department of Neurosurgery, Aarhus University Hospital, Aalborg Hospital, Denmark.
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Li Z, Ye Z, Zhang M. Functional and oncological outcomes after total claviculectomy for primary malignancy. Acta Orthop Belg 2012; 78:170-174. [PMID: 22696985] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Primary malignancies of the clavicle are very rare, and scarce data are available regarding the functional and oncologic outcome after total claviculectomy. This is a retrospective review of 9 patients with primary clavicular malignancy, between 2000 and 2010, treated with total claviculectomy. There were 5 females and 4 males with a mean age of 29 years (range, 16 to 56). After a mean follow-up period of 46 months (range, 24-102 months) all patients were alive and without local recurrence or metastases. Patients had almost a full range of motion without pain, without significant functional deficit. The mean Constant-Murley score (best possible score = 100) improved from 26 to 79 (p < 0.001), while the VAS for pain improved from 8.7 to 2.4 (p < 0.001). Therefore, total claviculectomy may be a useful salvage procedure for primary clavicular malignancy.
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Affiliation(s)
- Zhaoxu Li
- Department of Orthopaedics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
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Sobieniecka A, Jurkiewicz E, Czech-Kowalska J, Bekiesińska-Figatowska M, Grajkowska W, Dembowska-Bagińska B, Brożyna A, Dobrzańska A, Perek D, Nowak K, Pakuła-Kościesza I, Malczyk K. Congenital intramedullary spinal cord tumours: a report of two cases. Med Wieku Rozwoj 2011; 15:458-461. [PMID: 22516701] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present two different cases of congenital intramedullary tumours, one of a patient in whom treatment was started without pathological confirmation of a malignant tumour and the other of a primitive neuroectodermal tumour. Magnetic resonance imaging is the most useful tool in the diagnosis of malignant intramedullary tumours and differentiation from other types of spinal cord lesions.
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Affiliation(s)
- Anna Sobieniecka
- Department of Diagnostic Imaging, The Children's Memorial Health Institute, Warszawa
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von Bueren AO, Warmuth-Metz M, Schlegel PG, Soerensen N, Krauss J, Roggendorf W, Pietsch T, Feiden W, Graf N, Pohl F, Flentje M, Kuehl J, Rutkowski S. Late complete remission of supratentorial primitive neuroectodermal tumor (CNS-PNET) after multiple relapses. Pediatr Blood Cancer 2011; 56:503-5. [PMID: 21113945 DOI: 10.1002/pbc.22914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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31
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Milović IS, Stajević MS, Sehić IN. Costovertebral rib disarticulation and pleurectomy in Askin's tumor: a mandatory approach to radical surgery in children? Case report and guiedelines to surgical treatment. Acta Chir Iugosl 2011; 58:103-106. [PMID: 22519201] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The case report of Askin's tumor in a 16-year-old girl is focused on the still debatable surgical contg roversy in the treatment of PNET tumor, i.e., whether disarticulation of involved rib at the costovertabral joint should be accepted as the mandatory surgical procedure. It was concluded that the procedure, if feasible, may offer better prognosis of PNET because progression-free survival rate of patients without costovertebral junction involvement reported in multicenter studies was statistically significantly better than in patients in whom PNET has involved the costovertebral junction or bone metastases were present at the diagnosis. The cartilage is a natural barrier for tumor spread and this property should be augmented by radical surgery. Disarticulation of involved rib or ribs and pleurectomy should be routinely performed if the surgery is contemplated with proper timing between the cycles of induction chemotherapy.
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Ozlen F, Gunduz A, Asan Z, Tanriverdi T, Ozkara C, Yeni N, Yalcinkaya C, Ozyurt E, Uzan M. Dysembryoplastic neuroepithelial tumors and gangliogliomas: clinical results of 52 patients. Acta Neurochir (Wien) 2010; 152:1661-71. [PMID: 20526635 DOI: 10.1007/s00701-010-0696-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [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: 03/30/2010] [Accepted: 05/18/2010] [Indexed: 12/14/2022]
Abstract
PURPOSE Dysembryoplastic neuroepithelial tumors (DNET) and gangliogliomas (GG) are generally associated with epilepsy in young patients. Presurgical work-up and postsurgical results vary from center to center. Seizures are commonly focal with secondary generalization, and surgical treatment is often effective. METHODS Twenty-eight patients with DNET and 24 patients with GG were eligible for this retrospective study. The authors present clinical, radiological, and pathological characteristics and seizure outcome of 52 patients histopathologically diagnosed with either a DNET or a GG. RESULTS Characteristically the majority of the tumors showed hypointensity on T(1)-weighted images and increased signal intensity on both T(2)-weighted and FLAIR images. At the last follow-up (mean 54.3 months), overall favorable seizure outcome was 94.2% (n = 49). Twenty-six (92.8%) patients with DNET and 21 (87.5%) patients with GG were seizure free. Complete drug withdrawal was achieved in 26 (50%) patients. Shorter duration of epilepsy (p = 0.02), absence of status epilepticus (p = 0.01), absence of edema on MRI (p = 0.03), absence of seizure within the first month of surgery (p = 0.002), and total resection (p = 0.00001) were associated with favorable outcome with respect to seizure. CONCLUSIONS Our results indicate that a prompt diagnosis and total resection with additional adjacent structures or cortices when feasible are associated with a high epilepsy cure rate. Not only children but also adults benefit from surgical treatment. Although radiological features of DNETs or GGs are helpful, no definitive differences were found between the two types of tumors. Thus, clinical, radiological, and histopathological findings have to be considered together.
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Affiliation(s)
- Fatma Ozlen
- Department of Neurosurgery, Istanbul University, Turkey
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34
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Cabrera-Meirás F, Duque-Ruiz G, Martínez-Silva VM, Leiva-Galvis O. [Primitive neuroectodermical tumour of the kidney: Case report]. Actas Urol Esp 2010; 34:730-732. [PMID: 20800039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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35
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Korshunov A, Remke M, Gessi M, Ryzhova M, Hielscher T, Witt H, Tobias V, Buccoliero AM, Sardi I, Gardiman MP, Bonnin J, Scheithauer B, Kulozik AE, Witt O, Mork S, von Deimling A, Wiestler OD, Giangaspero F, Rosenblum M, Pietsch T, Lichter P, Pfister SM. Focal genomic amplification at 19q13.42 comprises a powerful diagnostic marker for embryonal tumors with ependymoblastic rosettes. Acta Neuropathol 2010; 120:253-60. [PMID: 20407781 DOI: 10.1007/s00401-010-0688-8] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [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: 03/16/2010] [Revised: 04/08/2010] [Accepted: 04/11/2010] [Indexed: 11/25/2022]
Abstract
Ependymoblastoma (EBL) and embryonal tumor with abundant neuropil and true rosettes (ETANTR) are very aggressive embryonal neoplasms characterized by the presence of ependymoblastic multilayered rosettes typically occurring in children below 6 years of age. It has not been established whether these two tumors really comprise distinct entities. Earlier, using array-CGH, we identified a unique focal amplification at 19q13.42 in a case of ETANTR. In the present study, we investigated this locus by fluorescence in situ hybridization in 41 tumors, which had morphologically been diagnosed as EBL or ETANTR. Strikingly, FISH analysis revealed 19q13.42 amplifications in 37/40 samples (93%). Among tumors harboring the amplification, 19 samples were identified as ETANTR and 18 as EBL. The three remaining tumors showed a polysomy of chromosome 19. Analysis of recurrent/metastatic tumors (n = 7) showed that the proportion of nuclei carrying the amplification was increased (up to 80-100% of nuclei) in comparison to the corresponding primary tumors. In conclusion, we have identified a hallmark cytogenetic aberration occurring in virtually all embryonal brain tumors with ependymoblastic rosettes suggesting that ETANTR and EBL comprise a single biological entity. FISH analysis of the 19q13.42 locus is a very promising diagnostic tool to identify a subset of primitive neuroectodermal tumors with distinct morphology, biology, and clinical behavior.
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MESH Headings
- Child, Preschool
- Chromosomes, Human, Pair 19/genetics
- Female
- Humans
- In Situ Hybridization, Fluorescence/methods
- Infant
- Male
- Neoplasms, Germ Cell and Embryonal/diagnosis
- Neoplasms, Germ Cell and Embryonal/genetics
- Neoplasms, Germ Cell and Embryonal/mortality
- Neoplasms, Germ Cell and Embryonal/surgery
- Neuroectodermal Tumors, Primitive/diagnosis
- Neuroectodermal Tumors, Primitive/genetics
- Neuroectodermal Tumors, Primitive/mortality
- Neuroectodermal Tumors, Primitive/surgery
- Survival Analysis
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Duan XH, Ban XH, Liu B, Zhong XM, Guo RM, Zhang F, Liang BL, Shen J. Intraspinal primitive neuroectodermal tumor: imaging findings in six cases. Eur J Radiol 2010; 80:426-31. [PMID: 20591597 DOI: 10.1016/j.ejrad.2010.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [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: 04/13/2010] [Revised: 05/30/2010] [Accepted: 06/02/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE To retrospectively review CT and MRI findings in a series of six intraspinal primitive neuroectoderal tumors and to find out their radiological features. METHODS CT and MRI of six patients with surgically and pathologically proved intraspinal primitive neuroectoderal tumor were retrospectively reviewed. The tumor location, morphological features, signal intensity, calcification, contrast enhancement characteristics, involvement of paraspinal soft tissues and adjacent bony structures were assessed. RESULTS Of six patients, four had extradural lesions and two had intradural, extramedullary lesions. Most lesions were well defined and manifested heterogeneous iso- or hypo-intense signal on T1-weighted imaging and hyper-intense signal on T2-weighted imaging and moderate attenuation on CT, and were heterogeneously enhanced after contrast enhancement. The lesion extending through the intervertebral foramen with a large paraspinal soft tissue mass formed was found in four patients and vertebral bone involvement was seen in four patients. CONCLUSIONS Although imaging findings are not specific of intraspinal primitive neuroectoderal tumor, this diagnosis could be suggested when MR imaging depicts an intradural, extramedullary or extradural large well-circumscribed mass which extends out from intervertebral foramen and invades paraspinal soft tissues or vertebral bones in a young patient.
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Affiliation(s)
- Xiao-Hui Duan
- Department of Radiology, The Second Affiliated Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
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López JI, Pomposo-Gaztelu I. [Surgical pathology of epilepsy]. Rev Neurol 2010; 50:616-622. [PMID: 20473838] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The surgical treatment of refractory epilepsy represents a large step forward in the quality of life and survival of many patients, particularly for those whose pathology is located in the temporal lobe. AIM To concentrate the basic histological aspects of an extremely varied, although generally little known, genuinely neural pathology into one single review work. DEVELOPMENT The causes of refractory epilepsy with a genuinely neurohistological foundation can be either malformative or neoplastic. The former include cortical dysplasias and hippocampal sclerosis, while the latter involve the so-called glioneuronal tumours (dysembryoplastic neuroepithelial tumour, ganglioglioma) and some glial cell-related tumours. CONCLUSIONS There is a group of disorders that are intrinsic to cerebral development and primary brain tumours which are closely related to epilepsy. Surgery applied to these processes cures epilepsy in a high percentage of cases that are resistant to pharmacological treatment.
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Affiliation(s)
- José Ignacio López
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Universidad del País Vasco, Baracaldo, Vizcaya, España.
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Gurkanlar D, Korkmaz E, Gurler IE, Gokhan G, Kazan S. Multilevel primary intraspinal PNETs in an infant associated with hydrocephalus. Turk Neurosurg 2010; 20:82-85. [PMID: 20066629] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PNETs of the spinal cord are aggressive and local recurrence and/or leptomeningeal spread is common. Primary spinal PNETs are extremely rare and most cases involving the spinal cord are drop metastases from primary intracranial tumors by cerebrospinal fluid. Herewith, we present a 40-day-old infant with multilevel primary spinal PNET at Th12-L1 and L5-S1 levels associated with hydrocephalus occurring nearly 15 days after the operation. According to our knowledge this is probably the first case harboring all these pathologies. Multilevel primary intraspinal PNET in an infant is even rarer and can be associated with hydrocephalus that occurs during the postoperative period.
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Affiliation(s)
- Doga Gurkanlar
- Başkent University, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey.
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Reina J, Plasencia V, Ferres F. [Consecutive infections by different types and subtypes of influenza virus in the same epidemic season]. Enferm Infecc Microbiol Clin 2009; 28:257-8. [PMID: 19664856 DOI: 10.1016/j.eimc.2009.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 03/23/2009] [Accepted: 03/23/2009] [Indexed: 11/18/2022]
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Topp SG, McManaman JF, Bloom DC. Peripheral primitive neuroectodermal tumour of the anterior tongue in a newborn. J Otolaryngol Head Neck Surg 2009; 38:E56-E60. [PMID: 19442356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Shelby G Topp
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia 23708, USA.
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Doi H, Ichikawa S, Hiraoka A, Ichiryu M, Nakahara H, Ochi H, Tanabe A, Kodama A, Hasebe A, Miyamoto Y, Ninomiya T, Horiike N, Takamura K, Kawasaki H, Kameoka C, Kan M, Doi S, Soga Y, Tamura H, Maeda T, Asaki A, Seno S, Iguchi H, Hasegawa T. Primitive neuroectodermal tumor of the pancreas. Intern Med 2009; 48:329-33. [PMID: 19252356 DOI: 10.2169/internalmedicine.48.1484] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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] [Indexed: 11/06/2022] Open
Abstract
The primitive neuroectodermal tumor (PNET) of the pancreas, a member of Ewing's sarcoma family of tumors, is extremely rare. We treated a 37-year-old Japanese man who had a solitary pancreatic tumor 40 mm in diameter and multiple hepatic tumors with surgical resection. The PNET was positive for CD99 on immunohistochemical staining. Fluorescence in situ hybridization (FISH) was also performed, which revealed a Ewing sarcoma breakpoint region 1 (EWSR1) 22q12 rearrangement. According to the Japan-Ewing protocol, chemotherapy with Ifomide (ifosfamide), etoposide, vincristine, and cyclophosphamide was given after surgery. To the best of our knowledge, to date 13 PNET cases have been reported with a mean age for all patients of 19.3 years old. Surgical resection was performed in most cases and some patients received postoperative chemotherapy. The clinicopathologic characteristics and management of this extremely rare disease are also discussed.
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Affiliation(s)
- Hirokazu Doi
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama
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Cary KC, Sundaram CP. Primitive neuroectodermal tumor of the kidney with level II inferior vena cava involvement. Can J Urol 2008; 15:4431-4432. [PMID: 19046499] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Primitive neuroectodermal tumor of renal origin, PNET, is extraordinarily rare and often lethal. Here we present a case of renal PNET managed successfully by radical nephrectomy, caval thrombectomy and retroperitoneal node dissection.
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Affiliation(s)
- K Clint Cary
- Department of Urology, Indiana University, Indianapolis, Indiana 46202, USA
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Oishi H, Matsumura Y, Ishida I, Sado T, Hoshikawa Y, Kondo T, Tachi M. [Sternal resection and chest wall reconstruction for primitive neuroectodermal tumor of the sternum]. Kyobu Geka 2008; 61:836-840. [PMID: 18788370] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Primitive neuroectodermal tumor of the sternum is rare. A 59-year-old woman referred to our department with anterior chest pain and a tumor in the sternum. The patient was diagnosed as primitive neuroectodermal tumor of the sternum by core biopsy of the lesion. She received 2 cycles of preoperative chemotherapy with vincristine, doxorubicin, cyclophosphamide, ifosfamide, etoposide. She underwent a total sternectomy with resection of adjacent bilateral costal cartilages and sternal ends of the clavicles. The skeletal defect of chest wall was reconstructed by polypropylene mesh-resin sandwich. The myocutaneus defect was reconstructed by the pedicled latissimus dorsi myocutaneus flap and the bilateral breast flaps. The postoperative course was uneventful and adjuvant radiotherapy was started 6 weeks after the operation. She died of distant metastases 3 months after the operation, although this patient was free from local recurrence.
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Affiliation(s)
- H Oishi
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
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Fangusaro JR, Jubran RF, Allen J, Gardner S, Dunkel IJ, Rosenblum M, Atlas MP, Gonzalez-Gomez I, Miller D, Finlay JL. Brainstem primitive neuroectodermal tumors (bstPNET): results of treatment with intensive induction chemotherapy followed by consolidative chemotherapy with autologous hematopoietic cell rescue. Pediatr Blood Cancer 2008; 50:715-7. [PMID: 17009232 DOI: 10.1002/pbc.21032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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] [Indexed: 11/06/2022]
Abstract
We have evaluated the response rate and survival utilizing intensified chemotherapy followed by myeloablative chemotherapy with autologous hematopoietic cell rescue (AuHCR) and adjuvant radiation therapy in six young children with newly diagnosed brainstem primitive neuroectodermal tumors (bstPNET). Following maximum surgical resection of the tumor, patients received high dose induction chemotherapy including vincristine, cisplatin, cyclophosphamide, and etoposide. Eligible patients received a single cycle of myeloablative chemotherapy followed by AuHCR. Two patients survive at least 32 months with stable disease. This approach provides an alternative for young patients with bstPNET who in prior reports have had a uniformly fatal prognosis.
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Affiliation(s)
- Jason R Fangusaro
- The Children's Hospital Los Angeles, New York University Medical Center, Memorial Sloan-Kettering Cancer Center, and Schneider Children's Hospital, USA.
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Abstract
A 20-month-old boy presented with precocious puberty due to a Leydig cell tumor, and at the age of 6 years with a primitive neuroectodermal brain-tumor (PNET). A novel splice site mutation of the TP53-gene, likely to be associated with a nonfunctional protein, was found in the proband, his father and younger sister, but only the proband has so far developed malignancy. The clinical phenotype in the boy is suggestive of Li-Fraumeni syndrome, but the family does not strictly conform to the canonical definition.
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Affiliation(s)
- Chalotte W Stecher
- Department of Pediatrics, Skejby Hospital, Aarhus University, Aarhus, Denmark
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Fangusaro J, Finlay J, Sposto R, Ji L, Saly M, Zacharoulis S, Asgharzadeh S, Abromowitch M, Olshefski R, Halpern S, Dubowy R, Comito M, Diez B, Kellie S, Hukin J, Rosenblum M, Dunkel I, Miller DC, Allen J, Gardner S. Intensive chemotherapy followed by consolidative myeloablative chemotherapy with autologous hematopoietic cell rescue (AuHCR) in young children with newly diagnosed supratentorial primitive neuroectodermal tumors (sPNETs): report of the Head Start I and II experience. Pediatr Blood Cancer 2008; 50:312-8. [PMID: 17668858 DOI: 10.1002/pbc.21307] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [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] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children with newly diagnosed supratentorial primitive neuroectodermal tumors (sPNET) have poor outcomes compared to medulloblastoma patients, despite similar treatments. In an effort to improve overall survival (OS) and event-free survival (EFS) and to decrease radiation exposure, the Head Start (HS) protocols treated children with newly diagnosed sPNET utilizing intensified induction chemotherapy (ICHT) followed by consolidation with myeloablative chemotherapy and autologous hematopoietic cell rescue (AuHCR). PROCEDURES Between 1991 and 2002, 43 children with sPNET were prospectively treated on two serial studies (HS I and II). After maximal safe surgical resection, patients on HS I and patients with localized disease on HS II were treated with five cycles of ICHT (vincristine, cisplatin, cyclophosphamide, and etoposide). Patients on HS II with disseminated disease received high-dose methotrexate during ICHT. If the disease remained stable or in response, patients received a single cycle of high-dose myeloablative chemotherapy followed by AuHCR. RESULTS Five-year EFS and OS were 39% (95%CI: 24%, 53%) and 49 (95%CI: 33%, 62%), respectively. Non-pineal sPNET patients faired significantly better than those patients with pineal sPNETs. Metastasis at diagnosis, age, and extent of resection were not significant prognostic factors. Sixty percent of survivors (12 of 20) are alive without exposure to radiation therapy. CONCLUSIONS ICHT followed by AuHCR in young patients with newly diagnosed sPNET appears to not only provide an improved EFS and OS for patients who typically have a poor prognosis, but also it successfully permitted deferral and elimination of radiation therapy in a significant proportion of patients.
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Affiliation(s)
- Jason Fangusaro
- Children's Hospital Los Angeles, Los Angeles, California, USA.
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Bauer R, Dobesberger J, Unterhofer C, Unterberger I, Walser G, Bauer G, Trinka E, Ortler M. Outcome of adult patients with temporal lobe tumours and medically refractory focal epilepsy. Acta Neurochir (Wien) 2007; 149:1211-6; discussion 1216-7. [PMID: 17940725 DOI: 10.1007/s00701-007-1366-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [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: 06/28/2006] [Accepted: 06/22/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tumours are a well-recognized cause of medically intractable epilepsies. Tumours represent the primary pathology in 10%-30% of patients undergoing surgical treatment for chronic epilepsy. This study examines the surgical and epileptological outcome of adults with temporal lobe tumoural epilepsy treated within a comprehensive epilepsy surgery programme. METHODS Between 1999 and 2004, 99 consecutive patients have been operated for intractable temporal lobe epilepsy (TLE). Among these, 14 adult patients exhibited temporal lobe neoplasms associated with TLE. Every patient underwent a comprehensive presurgical evaluation including video-EEG monitoring, MRI, interictal PET scan, ictal SPECT and neuropsychological testing. Surgical strategies were determined in an interdisciplinary seizure conference and tailored to the findings of the presurgical evaluation. All patients were available for follow up at regular intervals after 3, 6, 12 months and yearly thereafter. Epileptological outcome was classified according to Engel [10] and the ILAE (International League Against Epilepsy)/systems [33]. FINDINGS The surgical procedures performed were temporal lobe resection in 3 patients, extended lesionectomy in 4 and extended lesionectomy with resection of the temporomesial structures in 7. One patient with an astrocytoma grade III underwent a second and third operation for recurrent disease. Histological results: Astrocytoma 5 patients, ganglioglioma/gangliocytoma 5, oligodendroglioma 2, ependymoma 1 and dysembryoplastic neuroepithelial tumour (DNET) 1. Postoperative follow-up was performed after 12-74 months (mean 31). The outcome according to the Engel classification indicated class IA in 9 patients, class IC in 3, and 1 each in classes IIIA and IVA. Epileptological outcome according to the ILAE classification indicated class 1 (12 patients) and class 4 (2 patients). Surgical mortality was zero and mild permanent neurological deficits due to surgery were seen in 2 patients. Postoperatively 3 patients showed a homonymous quadrantanopia. CONCLUSIONS Patients with drug resistant epilepsy and temporal lobe tumours should undergo evaluation in dedicated epilepsy surgery programmes.
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Affiliation(s)
- R Bauer
- Clinical Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria.
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Kanaya H, Hirabayashi H, Tanigaito Y, Baba K. Ewing's sarcoma/primitive neuroectodermal tumour of the mandible: report of a rare case and review of the literature. ACTA ACUST UNITED AC 2007; 36:E15-8. [PMID: 17711755 DOI: 10.2310/7070.2006.0150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
MESH Headings
- Adult
- Cell Proliferation
- Humans
- Male
- Mandibular Neoplasms/diagnostic imaging
- Mandibular Neoplasms/pathology
- Mandibular Neoplasms/radiotherapy
- Mandibular Neoplasms/surgery
- Neuroectodermal Tumors, Primitive/diagnostic imaging
- Neuroectodermal Tumors, Primitive/pathology
- Neuroectodermal Tumors, Primitive/radiotherapy
- Neuroectodermal Tumors, Primitive/surgery
- Prognosis
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Ewing/diagnostic imaging
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/radiotherapy
- Sarcoma, Ewing/surgery
- Tomography, X-Ray Computed
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Affiliation(s)
- Hiroaki Kanaya
- Department of Otorhinolaryngology and Bronchoesophagology, Dokkyo University School of Medicine, Tochigi, Japan.
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Abstract
BACKGROUND In this report, we describe a young woman with a nasal cavity paraganglioma with malignant transformation. METHODS AND RESULTS A 23-year-old woman presented with frequent right-sided epistaxis. Physical examination revealed a pedunculated mass originating from the right superior turbinate and filling the posterior nasal cavity. The endoscopically removed mass was composed of a reddish anterior portion and a white, flesh-looking posterior portion, the latter comprising the majority of the tumor. Histologically, the anterior portion showed a paraganglioma and the posterior portion showed a separate malignant lesion simulating Ewing's sarcoma/PNET. She underwent wide endoscopic excision including the site of tumor origin and has been followed up for 3 years without any evidence of disease recurrence. CONCLUSION This is a rare case of nasal cavity paraganglioma that had transformed into a malignant tumor.
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Affiliation(s)
- Hong-Ryul Jin
- Department of Otorhinolaryngology, Seoul National University Boramae Hospital, 425 Dongjak-gu, Shindaebang-dong, Seoul, South Korea.
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