Correlation between pelvic relapses of rectal cancer after radical and R0 resection: A regression model-based analysis / 中华胃肠外科杂志

Objective: To propose a new staging system for presacral recurrence of rectal cancer and explore the factors influencing radical resection of such recurrences based on this staging system. Methods: In this retrospective observational study, clinical data of 51 patients with presacral recurrence of rectal cancer who had undergone surgical treatment in the Department of Gastrointestinal Surgery, Peking University People's Hospital between January 2008 and September 2022 were collected. Inclusion criteria were as follows: (1) primary rectal cancer without distant metastasis that had been radically resected; (2) pre-sacral recurrence of rectal cancer confirmed by multi-disciplinary team assessment based on CT, MRI, positron emission tomography, physical examination, surgical exploration, and pathological examination of biopsy tissue in some cases; and (3) complete inpatient, outpatient and follow-up data. The patients were allocated to radical resection and non-radical resection groups according to postoperative pathological findings. The study included: (1) classification of pre-sacral recurrence of rectal cancer according to its anatomical characteristics as follows: Type I: no involvement of the sacrum; Type II: involvement of the low sacrum, but no other sites; Type III: involvement of the high sacrum, but no other sites; and Type IV: involvement of the sacrum and other sites. (2) Assessment of postoperative presacral recurrence, overall survival from surgery to recurrence, and duration of disease-free survival. (3) Analysis of factors affecting radical resection of pre-sacral recurrence of rectal cancer. Non-normally distributed measures are expressed as median (range). The Mann-Whitney U test was used for comparison between groups. Results: The median follow-up was 25 (2-96) months with a 100% follow-up rate. The rate of metachronic distant metastasis was significantly lower in the radical resection than in the non-radical resection group (24.1% [7/29] vs. 54.5% [12/22], χ2=8.333, P=0.026). Postoperative disease-free survival was longer in the radical resection group (32.7 months [3.0-63.0] vs. 16.1 [1.0-41.0], Z=8.907, P=0.005). Overall survival was longer in the radical resection group (39.2 [3.0-66.0] months vs. 28.1 [1.0-52.0] months, Z=1.042, P=0.354). According to univariate analysis, age, sex, distance between the tumor and anal verge, primary tumor pT stage, and primary tumor grading were not associated with achieving R0 resection of presacral recurrences of rectal cancer (all P>0.05), whereas primary tumor pN stage, anatomic staging of presacral recurrence, and procedure for managing presacral recurrence were associated with rate of R0 resection (all P<0.05). According to multifactorial analysis, the pathological stage of the primary tumor pN1-2 (OR=3.506, 95% CI: 1.089-11.291, P=0.035), type of procedure (transabdominal resection: OR=29.250, 95% CI: 2.789 - 306.811, P=0.005; combined abdominal perineal resection: OR=26.000, 95% CI: 2.219-304.702, P=0.009), and anatomical stage of presacral recurrence (Type III: OR=16.000, 95% CI: 1.542 - 166.305, P = 0.020; type IV: OR= 36.667, 95% CI: 3.261 - 412.258, P = 0.004) were all independent risk factors for achieving radical resection of anterior sacral recurrence after rectal cancer surgery. Conclusion: Stage of presacral recurrences of rectal cancer is an independent predictor of achieving R0 resection. It is possible to predict whether radical resection can be achieved on the basis of the patient's medical history.

Hemofilia adquirida como manifestación inicial de recidiva de adenocarcinoma colorrectal / Acquired hemophilia as the initial manifestation of colorectal cancer's recurrence

Resumen Presentamos el caso de un varón de 86 años con un hematoma espontáneo en el músculo ilíaco izquierdo y diagnóstico previo de cáncer de colon en 1998 (estadio pT3N0M0), tratado quirúrgicamente mediante colectomía transversal, considerado en remisión completa. Tras realización de estudios complementarios se demostró la presencia de autoanticuerpos inhibidores del Factor VIII que confirmaron el diagnóstico de hemofilia adquirida. Durante el ingreso el paciente presentó un sangrado digestivo bajo que conllevó al descubrimiento de recidiva del adenocarcinoma colorrectal tratado previamente. Respondió de forma favorable a la terapia inicial con corticoides sistémicos y el complejo coagulante anti inhibidor que incluye el Factor VII activado [FEIBA].

Abstract We report the case of an 86-year-old man presenting with a spontaneous hematoma in the left iliac muscle and previous diagnosis of colon cancer in 1998 (stage pT3N0M0) treated with transverse colectomy and considered in complete remission. After a complete study, it was possible to identify the presence of Factor VIII inhibitors antibodies that confirmed the presence of acquired hemophilia. During hospitalization the patient presented a lower gastrointestinal bleeding leading to the diagnosis of recurrence of a previously treated colorectal adenocarcinoma. He responded to initial therapy with systemic corticoids and anti-inhibitory coagulant complex which includes activated VII Factor [FEIBA].

PSA density of the lesion: a mathematical formula that uses clinical and pathological data to predict biochemical recurrence in prostate cancer patients / Densidade de PSA da lesão: uma fórmula matemática baseada em dados clínicos e patológicos para prever a recidiva bioquímica em pacientes com câncer de próstata

ABSTRACT A main challenge in the clinical management of prostate cancer is to identify which tumor is aggressive and needs invasive treatment. Thus, being able to predict which cancer will progress to biochemical recurrence is a great strategy to stratify prostate cancer patients. With that in mind, we created a mathematical formula that takes into account the patients clinical and pathological data resulting in a quantitative variable, called PSA density of the lesion, which has the potential to predict biochemical recurrence. To test if our variable is able to predict biochemical recurrence, we use a cohort of 219 prostate cancer patients, associating our new variable and classic parameters of prostate cancer with biochemical recurrence. Total PSA, lesion weight, volume and classic PSA density were positively associated with biochemical recurrence (p<0.05). ISUP score was also associated with biochemical recurrence in both biopsy and surgical specimen (p<0.001). The increase of PSA density of the lesion was significantly associated with the biochemical recurrence (p=0.03). Variables derived from the formula, PSA 15% and PSA 152, were also positive associated with the biochemical recurrence (p=0.01 and p=0.002 respectively). Logistic regression analysis shows that classic PSA density, PSA density of the lesion and total PSA, together, can explain up to 13% of cases of biochemical recurrence. PSA density of the lesion alone would have the ability to explain up to 7% of cases of biochemical recurrence. In conclusion, this new mathematical approach could be a useful tool to predict disease recurrence in prostate cancer.

RESUMO Um dos principais desafios no manejo clínico do câncer de próstata é identificar qual tumor é agressivo e precisa de tratamento invasivo. Assim, ser capaz de prever qual irá progredir para recorrência bioquímica é uma ótima estratégia para estratificar pacientes com câncer de próstata. Pensando nisso, criamos uma fórmula matemática que leva em consideração os dados clínicos e patológicos resultando em uma variável quantitativa, denominada densidade de PSA da lesão, que tem potencial para predizer recidiva bioquímica. Para testar se nossa variável é capaz de predizer recorrência bioquímica, usamos uma coorte de 219 pacientes com câncer de próstata, associando nossas variáveis e parâmetros clássicos como a recorrência bioquímica. PSA total, peso da lesão, volume e densidade de PSA clássico foram associados com recorrência bioquímica (p<0,05). O escore ISUP também foi associado à recorrência bioquímica na biópsia e na amostra cirúrgica (p<0,001). O aumento da densidade do PSA da lesão foi significativamente associado à recidiva bioquímica (p=0,03). As variáveis ??derivadas da fórmula, PSA 15% e PSA 152, também foram associadas positivamente à recorrência bioquímica (p=0,01 e p=0,002 respectivamente). A análise de regressão logística mostra que a densidade do PSA clássico, do PSA da lesão e PSA total, juntos, podem explicar até 13% dos casos de recorrência. A densidade de PSA da lesão por si só poderia explicar até 7% dos casos de recorrência. Em conclusão, esta nova abordagem matemática pode ser uma ferramenta útil para prever a recorrência da doença no câncer de próstata.

Desmoplastic small round cell tumor of the ovary: A case report with a new modality of treatment and review of the literature

Abstract Objective Desmoplastic small round cell tumor (DSRCT) is a rare intraabdominal neoplasm that grows along serosal surfaces and is primarily found in young men. To Keywords date, only 16 cases of ovarian DSRCT have been previously reported in women in the English literature, and no large population-based studies on this topic exist. Case Report We report the case of a 19-year-old virgo with unremarkable past medical history, initially presented with abdominal fullness. After being treated with the optimal treatment modality (primary and secondary surgical debulking, unique chemotherapy, protocol and adjuvant radiotherapy), the patient has remained without tumor disease for 40 months. Conclusion Although the best therapy for patients with DSRCT has yet to be determined, combining complete surgical resection, adjuvant chemotherapy, and radiotherapy is required to prolong survival and to achieve proper quality of life.

Tumor de células gigantes en cúbito de paciente postrauma / Giant cell tumor in ulna of trauma patient

RESUMEN Introducción: Los tumores de células gigantes pueden originarse en el tejido óseo, sinovial o cualquier otro tejido blando. Se caracterizan por su rápido crecimiento. A pesar de ser comúnmente benignos, si se dejan evolucionar sin tratamiento, hay riesgo de que en su proceso de crecimiento destruyan el tejido adyacente y afecten la funcionalidad, estructura y apariencia de la zona anatómica afectada. Objetivo: Describir el curso clínico y manejo terapéutico de un paciente con tumor de células gigantes en el antebrazo. Caso clínico: Se presenta paciente masculino de 28 años, que se le diagnosticó tumoración ósea en tercio distal del cúbito, y a quien, por su voluntad de no atenderse, no se le realizó el abordaje y manejo quirúrgico. Un año después, regresó al servicio de urgencias. Tenía mayor volumen en las dimensiones tumorales, con cambios a nivel del tercio distal del cúbito, lesiones de patrón lítico, pérdida de la cortical, con reacción perióstica, bordes mal definidos y afectación de tejidos blandos circundantes. Se diagnóstico probable tumor de células gigantes. El manejo quirúrgico permitió la conservación del antebrazo, pero a un año de su intervención quirúrgica, dada la probabilidad de recidiva, su pronóstico permanece incierto. Conclusiones: La velocidad de crecimiento de los tumores de células gigantes amerita decisiones oportunas, dado que el tiempo que transcurre previo al tratamiento puede, como en el presente caso, traducirse en un crecimiento destructivo de los tejidos adyacentes. A más de un año de la cirugía, el pronóstico del paciente es incierto, pues la probabilidad de recidiva permanece latente(AU)

ABSTRACT Introduction: Giant cell tumors can originate in bone, synovial, or any other soft tissue. They are characterized by their rapid growth. Despite being commonly benign, if they are allowed to evolve without treatment, they may destroy adjacent tissue, in its growth process, affecting the functionality, structure and appearance of the affected anatomical area. Objective: To describe the clinical course and therapeutic management of a patient with a giant cell tumor in the forearm. Clinical case: We report the case of a 28-year-old male patient, who was diagnosed with a bone mass in the distal third of the ulna. This patient desired not to undergo surgical management. A year later, he returned to the emergency room. the tumor had greater dimensions, changes at the level of the distal third of ulna, lytic pattern lesions, loss of the cortex, periosteal reaction, poorly defined edges and involvement of surrounding soft tissues. Giant cell tumor was the probable diagnosis. Surgical management allowed the forearm preservation, but one year after surgery, the prognosis remains uncertain, given the probability of recurrence. Conclusions: The growth rate of giant cell tumors merits timely decisions, since the time that elapses prior to treatment can, as in the present case, translate into destructive growth of adjacent tissues. More than a year after surgery, the prognosis is uncertain for this patient, as the probability of recurrence remains latent(AU)

RÉSUMÉ Introduction: Les tumeurs à cellules géantes peuvent être localisées au niveau du tissu osseux, du tissu synovial ou d'un autre tissu mou quelconque. Elles sont caractérisées par une croissance rapide. Malgré leur classique bénignité, si elles évoluent sans traitement, elles risquent de détruire le tissu adjacent et d'altérer la fonction, la structure et l'apparence de la région affectée lors du processus de croissance. Objectif: Décrire l'évolution clinique et la prise en charge thérapeutique d'un patient atteint de tumeur à cellules géantes au niveau de l'avant-bras. Cas clinique: Un patient âgé de 28 ans, diagnostiqué d'une tumeur osseuse au niveau du tiers distal du cubitus, sans abord ni traitement chirurgical dû à son refus de soin, est présenté. Un an après, il est rentré au service d'urgence. La tumeur avait grandi, et présentait des changements au niveau du tiers distal du cubitus, des lésions lytiques, une perte osseuse corticale, une réaction périostée, des bords mal définis, et un dommage des tissus mous environnants. Une probable tumeur à cellules géantes a été diagnostiquée. Le traitement chirurgical a permis la conservation de l'avant-bras, mais un an après l'intervention, son pronostic reste incertain, étant donnée la probabilité de récidive. Conclusions: La rapide croissance des tumeurs exige des décisions opportunes, car le temps parcouru avant le traitement peut se traduire -comme dans ce cas- par une atteinte destructive des tissus adjacents. Plus d'un an après la chirurgie, le pronostic du patient reste incertain, parce que la probabilité de récidive est encore latente(AU)

Positive surgical margins are predictors of local recurrence in conservative kidney surgery for pT1 tumors

ABSTRACT Objectives: The clinical significance of positive surgical margin (PSM) after a Nephron Sparing Surgery (NSS) is controversial. The aim of this study is to evaluate the association between PSM and the risk of disease recurrence in patients with pT1 kidney tumors who underwent NSS. Materials and Methods: Retrospective cohort study. A total of 314 patients submitted to a NSS due to stage pT1 renal tumor between January 2010 and June 2015 were included. Recurrence-free survival was estimated. The Cox model was used to adjust the tumor size, histological grade, pathological stage, age, surgical margins and type of approach. Results: Overall PSM was 6.3% (n=22). Recurrence was evidenced in 9.1% (n=2) of patients with PSM and 3.5% (n=10) for the group of negative surgical margin (NSM). The estimated local recurrence-free survival rate at 3 years was 96.4% (95% CI 91.9 to 100) for the NSM group and 87.8% (95% CI 71.9 to 100) for PSM group (p=0.02) with no difference in metastasis-free survival. The PSM and pathological high grade (Fuhrman grade III or IV) were independent predictors of local recurrence in the multivariate analysis (HR 12.9, 95%CI 1.8-94, p=0.011 / HR 38.3, 95%CI 3.1-467, p=0.004 respectively). Fuhrman grade proved to be predictor of distant recurrence (HR 8.1, 95%CI 1.6-39.7, p=0.011). Conclusions: The PSM in pT1 renal tumors showed to have higher risk of local recurrence and thus, worse oncological prognosis.

Tissue-based molecular markers in upper tract urothelial carcinoma and their prognostic implications

ABSTRACT Upper tract urothelial carcinoma (UTUC) is a rare and aggressive disease that is associated with high rates of recurrence and death. Radical nephroureterectomy (RNU) with excision of the bladder cuff is considered the standard of care for high-risk UTUC, whereas kidney-sparing techniques can be indicated for select patients with low-risk disease. There is a significant lack of clinical and pathological prognostic factors for stratifying patients with regard to making treatment decisions. Incorporation of tissue-based molecular markers into prognostic tools could help accurately stratify patients for clinical decision-making in this heterogeneous disease. Although the number of studies on tissue-based markers in UTUC has risen dramatically in the past several years—many of which are based on single centers and small cohorts, with a low level of evidence—many discrepancies remain between their results. Nevertheless, certain biomarkers are promising tools, necessitating prospective multi-institution studies to validate their function.

Evaluation of the p16 and Ki-67 Biomarkers as Predictors of the Recurrence of Premalignant Cervical Cancer Lesions after LEEP Conization / Avaliação dos biomarcadores p16 e Ki-67 como preditores de recidivas de lesões pré-cancerígenas do colo do útero após conização por cirurgia de alta frequência

Abstract Objective To evaluate the expressions of biomarkers p16 and Ki-67 in low-grade (LG) or high-grade (HG) lesions, and to relate them to risk factors and the recurrence of these lesions. Methods A retrospective case-control study of 86 patients with LG and HG lesions who underwent a loop electrosurgical excision procedure (LEEP) between 1999 and 2004. The control group was composed of 69 women with no recurrence, and the study group, of 17 patients with recurrence. All patients were followed-up over a two-year period after surgery, and screened every six months, including cytology and colposcopy. Biopsy samples collected from LEEP were submitted to immunohistochemical analysis for p16 and Ki-67. The statistical analysis was performed using the Statistical Package for the Social Sciences software (SPSS, IBM-SPSS, Inc., Chicago, IL, US), with a significant p < 0.05. Results The biomarkers p16 and Ki-67, separately or combined, showed no relation to recurrence on the total analysis. However, evaluating specifically HG lesions, the positive expression (2+ and 3 + ) of p16/Ki-67 was associated with recurrence (0.010). In addition, p16 isolated was also more expressive in HG lesions (2+ and 3 + , p= 0.018), but it was unrelated to recurrence. Conclusion Proteins p16 and Ki-67, both isolated and combined, are not reliable primary markers for the recurrence of cervical lesions in the majority of LG lesions. However, analyzing only the group with prior diagnosis of HG lesions, the expressions of p16 and of p16/Ki-67 were associated with recurrence, and they may be useful in monitoring these cases.

Resumo Objetivo Avaliar as positividades dos biomarcadores p16 e Ki-67 em lesões de baixo grau (BG) ou de alto grau (AG), e relacioná-las com os fatores de risco e com a recidiva dessas lesões. Métodos Estudo retrospectivo caso-controle, com 86 pacientes com lesões de BG e AG, submetidas à conização por cirurgia de alta frequência entre 1999 e 2004. O grupo de controle foi constituído de 69 mulheres sem recidivas, e o grupo de estudo, de 17 pacientes que recidivaram. Todas as pacientes foram acompanhadas durante dois anos após a cirurgia, com controle a cada seis meses, incluindo citologia e colposcopia. As peças provenientes de cirurgia de alta frequência (CAF) foram submetidas a imunohistoquímica para p16 e Ki-67. A análise estatística foi realizada com o programa Statistical Package for the Social Sciences (SPSS, IBM-SPSS, Inc., Chicago, IL, EUA), com p significante quando < 0,05. Resultados Isoladamente ou em conjunto, p16 e Ki-67 não se relacionaram com as recidivas quando analisados na totalidade dos casos. Entretanto, avaliando especificamente as lesões de AG, a positividade (2+ e 3 + ) do conjunto p16/Ki-67 foi relacionada com recidiva (0,010). No mais, p16, isoladamente, foi também mais expresso nas lesões de AG (2+ e 3 + , p= 0,018), mas sem relação com recidiva. Conclusão Quando testadas na totalidade dos casos, as proteínas p16 e Ki-67, separadas ou em conjunto, se mostraram ineficientes como marcadores primários de recidiva de lesões precursoras. Entretanto, quando avaliadas somente no grupo diagnóstico prévio de lesão de AG, as expressões das proteínas p16 e p16/Ki-67 têm relação com a recidiva, e podem ser úteis no acompanhamento desses casos.

Long-Term Outcome and Surveillance Colonoscopy after Successful Endoscopic Treatment of Large Sessile Colorectal Polyps

PURPOSE: Although there is a consensus about the need for surveillance colonoscopy after endoscopic resection, the interval remains controversial for large sessile colorectal polyps. The aim of this study was to evaluate the long-term outcome and the adequate surveillance colonoscopy interval required for sessile and flat colorectal polyps larger than 20 mm. MATERIALS AND METHODS: A total of 204 patients with large sessile and flat polyps who received endoscopic treatment from May 2005 to November 2011 in a tertiary referral center were included. RESULTS: The mean age was 65.1 years and 62.7% of the patients were male. The mean follow-up duration was 44.2 months and the median tumor size was 25 mm. One hundred and ten patients (53.9%) received a short interval surveillance colonoscopy (median interval of 6.3 months with range of 1-11 months) and 94 patients (46.1%) received a long interval surveillance colonoscopy (median interval of 13.6 months with range of 12-66 months). There were 14 patients (6.9%) who had local recurrence at the surveillance colonoscopy. Using multivariate regression analysis, a polyp size greater than 40 mm was shown to be independent risk factor for local recurrence. However, piecemeal resection and surveillance colonoscopy interval did not significantly influence local recurrence. CONCLUSION: Endoscopic treatment of large sessile colorectal polyps shows a favorable long-term outcome. Further prospective study is mandatory to define an adequate interval of surveillance colonoscopy.

Details of recurrence sites after definitive radiation therapy for cervical cancer / 부인종양

OBJECTIVE: This is a retrospective study aimed at clarifying the details of recurrence patterns and sites in patients with cervical cancer treated with definitive radiation therapy (RT). METHODS: Data were analyzed from consecutive patients, admitted to the University of Tokyo Hospital (Tokyo, Japan) between 2001 and 2013, who had received definitive RT, with or without chemotherapy, for International Federation of Gynecology and Obstetrics stages IB-IVA cervical cancer. RESULTS: One hundred and thirty-seven patients formed the patient cohort. The median follow-up period for surviving patients was 57.0 months. A complete response was achieved in 121 patients (88%). Of these, 36 (30%) developed a cancer recurrence during follow-up. The first sites of recurrence were located in intra-RT fields in nine, outside RT fields in 20, and both in seven patients. In the intra-RT field group, all patients showed a local recurrence, while no one experienced an isolated pelvic lymph node (PLN) recurrence. In the outside RT field group, the most frequent site of recurrence was lung (60%), and three-quarters of patients were free from intra-RT field recurrence until the last follow-up. Of the entire cohort, including 48 PLN-positive patients, only seven patients (5.1%) developed PLN persistence or recurrence, all in the common iliac, internal iliac, and/or obturator nodes, and all with another synchronous relapse. CONCLUSION: Local disease was a major type of intra-RT field recurrence, while PLN control was favorable even in initially PLN-positive patients. The predominance of outside RT field recurrence alone highlights issues concerning distant control, including the intensity enhancement of systematic therapy.

Síntomas de miastenia grave en un paciente con antecedente de timectomía por timoma invasor / Symptoms of myasthenia gravis in a patient with a history of thymectomy for invasive thymoma

Introducción. La miastenia grave es una enfermedad autoinmunitaria mediada por anticuerpos. Entre 10 y 15 % de quienes la padecen tienen timoma y su presencia se asocia con una mayor gravedad de los síntomas, crisis miasténicas y fracaso del tratamiento de primera línea. La timectomía se recomienda en pacientes jóvenes con miastenia grave generalizada y en todos los pacientes con timoma. Caso clínico. Se presenta el caso de una mujer de 43 años que, en el 2005, presentó una primera crisis miasténica asociada con un timoma invasor que se trató con timectomía y radioterapia. Durante los siguientes tres años, presentó síntomas graves y dos crisis más, que obligaron a suministrarle respiración mecánica asistida e inmunoglobulina. Al cabo del tratamiento, no se evidenciaron signos de recurrencia en las tomografías de tórax con contraste. Entre el 2009 y el 2012, la gravedad de los síntomas fue menor. En el 2013, estos se exacerbaron y una resonancia magnética de tórax con contraste reveló una lesión en el mediastino anterior, ya observada en el 2011, sugestiva de tejido residual o fibrosis. Se inició el tratamiento usual con inmunoglobulina y se hizo una tomografía por emisión de positrones cuyos resultados no fueron concluyentes, por lo que se llevó a cabo una nueva resección y se constató que no había recurrencia del tumor. Conclusiones. Los pacientes con miastenia grave y aquellos con timoma asociado, deben someterse a la timectomía como parte del tratamiento. Sin embargo, la exacerbación de los síntomas o su reaparición después del procedimiento no necesariamente implica una nueva alteración en el timo.

Introduction: Myasthenia gravis is an antibody-mediated autoimmune disease. Approximately 10-15% of patients present with a thymoma, the presence of which is associated with greater severity of symptoms, myasthenic crisis, and irresponsiveness to front-line therapy. A thymectomy is recommended in young patients with generalized myasthenia gravis and in all patients presenting with thymoma. Clinical case: The patient was a 43-year-old woman, who first showed symptoms of myasthenic crisis in 2005 and presented with invasive thymoma managed with thymectomy and radiotherapy. In the subsequent three years, the patient presented with severe symptoms and two myasthenic crises that required mechanical ventilation and immunoglobulin treatment. Contrast chest computed tomography examinations showed no recurrence. Between 2009 and 2012, the patient experienced decreased symptom severity. In 2013, the patient presented with an exacerbation of symptoms; a contrast chest magnetic resonance scan showed a lesion in the anterior mediastinum, previously observed in 2011, suggestive of residual tissue as opposed to fibrosis. Regular management was started with immunoglobulins; a positron emission tomography scan was inconclusive, requiring a new resection, which showed no evidence of tumor recurrence. Conclusions: Patients with myasthenia gravis and those with myasthenia-related thymoma both share thymectomy as an element of treatment. However, following the procedure, exacerbation or reappearance of symptoms does not necessarily represent new alterations in the thymus.

Imaging Surveillance of Patients with Breast Cancer after Primary Treatment: Current Recommendations

Women who have been treated for breast cancer are at risk for second breast cancers, such as ipsilateral recurrence or contralateral metachronous breast cancer. As the number of breast cancer survivors increases, interest in patient management and surveillance after treatment has also increased. However, post-treatment surveillance programs for patients with breast cancer have not been firmly established. In this review, we focus on the imaging modalities that have been used in post-treatment surveillance for patients with breast cancer, such as mammography, ultrasonography, magnetic resonance imaging, and positron emission tomography, the effectiveness of each modality for detecting recurrence, and how they can be applied to manage patients.

Risk Factors for Recurrent High-Risk Polyps after the Removal of High-Risk Polyps at Initial Colonoscopy

PURPOSE: Colonoscopic polypectomy and surveillance are important to prevent colorectal cancer and identify additional relative risk factors for adequate surveillance. In this study, we evaluated risk factors related to recurrent high-risk polyps during the surveillance of patients with high-risk polyps. MATERIALS AND METHODS: We included 434 patients who had high-risk polyps (adenoma > or =10 mm, > or =3 adenomas, villous histology, or high-grade dysplasia) on the baseline colonoscopy and underwent at least one surveillance colonoscopy from 2005 to 2011 at Severance Hospital. Data regarding patient characteristics, bowel preparation and polyp size, location, number, and pathological diagnosis were retrospectively collected from medical records. Patients with recurrent high-risk polyps were compared with patients with low-risk or no polyps during surveillance. RESULTS: Patients were predominantly male (77.4%), with a mean age of 61.0+/-8.6 years and mean follow-up of 1.5+/-0.8 years. High-risk polyps recurred during surveillance colonoscopy in 51 (11.8%) patients. Results of multivariate analysis showed that male gender, poor bowel preparation, and a larger number of adenomas were independent risk factors for recurrent high-risk polyps (p=0.047, 0.01, and <0.001, respectively). Compared with high-risk polyps found during initial colonoscopy, high-risk polyps on surveillance colonoscopy had higher proportions of small adenomas, low-risk pathology, and fewer adenomas overall, but there was no difference in location. CONCLUSION: Male patients and those with poor bowel preparation for colonoscopy or higher numbers of adenomas were more likely to experience recurrent high-risk polyps.

Multiparametric magnetic resonance imaging for prostate cancer: A review and update for urologists

Recently, imaging of prostate cancer has greatly advanced since the introduction of multiparametric magnetic resonance imaging (mpMRI). mpMRI consists of T2-weighted sequences combined with several functional sequences including diffusion-weighted imaging, dynamic contrast-enhanced imaging, and/or magnetic resonance spectroscopy imaging. Interest has been growing in mpMRI because no single MRI sequence adequately detects and characterizes prostate cancer. During the last decade, the role of mpMRI has been expanded in prostate cancer detection, staging, and targeting or guiding prostate biopsy. Recently, mpMRI has been used to assess prostate cancer aggressiveness and to identify anteriorly located tumors before and during active surveillance. Moreover, recent studies have reported that mpMRI is a reliable imaging modality for detecting local recurrence after radical prostatectomy or external beam radiation therapy. In this regard, some urologic clinical practice guidelines recommended the use of mpMRI in the diagnosis and management of prostate cancer. Because mpMRI is the evolving reference standard imaging modality for prostate cancer, urologists should acquire cutting-edge knowledge about mpMRI. In this article, we review the literature on the use of mpMRI in urologic practice and provide a brief description of techniques. More specifically, we state the role of mpMRI in prostate biopsy, active surveillance, high-risk prostate cancer, and detection of recurrence after radical prostatectomy.

Presença de sintomas no momento do diagnóstico da recorrência do câncer do colo do útero está relacionada com pior prognóstico? / Recurrent cervical cancer: symptoms at diagnosis are related to a worse prognosis?

OBJETIVO: Aval iar as características clínicas e implicações prognósticas de pacientes portadores de recidiva de câncer do colo do útero. MÉTODOS: Por meio de revisão de prontuários foram avaliados todos os casos de câncer do colo do útero nos estádios IA a IVA que iniciaram acompanhamento em um hospital especializado da região Sudeste do Brasil de 2007 a 2009. Os episódios de recidiva foram categorizados conforme a localização da doença e foram coletadas informações sobre o tipo de tratamento e a sobrevida dessas pacientes. A casuística foi caracterizada por meio da estatística descritiva e as análises de associação foram realizadas pelo teste exato de Fisher. RESULTADOS: Dentre 469 prontuários selecionados foram identificados 50 casos de recidiva, sendo 31 sintomáticos no momento do diagnóstico da recorrência (62%) e 19 assintomáticos (38%). Dentre as mulheres com sintomas, oito solicitaram antecipação da consulta previamente agendada por apresentarem queixas clínicas. Pacientes com sintomas no momento do diagnóstico da recorrência apresentaram tendência a menores taxas de sobrevida global em dois anos em relação às pacientes assintomáticas (39,4 versus 67,6%) (p=0,081). Nenhuma portadora de recorrência a distância recebeu tratamento com intensão curativa, mas recebeu tratamento cirúrgico ou radioterápico visando remissão completa da doença. As mulheres que solicitaram antecipação da consulta por apresentarem sintomas tiveram significativa redução na taxa de sobrevida global em dois anos após a recorrência (0 versus 60,4%; p<0,001) em relação àquelas que compareceram à consulta na data agendada e nenhuma paciente desse grupo foi submetida a tratamento ...

PURPOSE: The aim of this study was to evaluate the clinical features and prognostic implications of patients with recurrent cervical cancer. METHODS: By reviewing the medical records we evaluated all patients with cervical cancer at stages IA to IVA who started treatment at a specialized hospital in the Southeast region of Brazil from 2007 to 2009. Recurrence episodes were categorized according to location of disease and information was collected regarding the type of treatment and survival of these patients. The sample was characterized by descriptive statistics and association analyses were performed using Fisher's exact test. RESULTS: Fifty cases of recurrence were identified among 469 selected records, with 31 patients being symptomatic at diagnosis of recurrence (62%); and 19 being asymptomatic (38%). Among women with symptoms, eight requested anticipation of the previously scheduled appointment because of the presence of clinical complaints. Patients with symptoms at the diagnosis of recurrence had lower rates of overall two-year survival (39.4 versus 67.6%) (p=0.081). None of the patients with recurrence at distance received curative intent treatment, but all received surgical treatment or radiotherapy aiming at full remission of the disease. Women who requested anticipation of the appointment because of the presence of symptoms had a significant reduction of overall two-year survival after recurrence (0 versus 60.4%; p<0.001) compared to those who attended the consultation on the scheduled date, and none of them received curative intent treatment. As expected, the patients who underwent palliative treatment with the main objective of improving quality of life and increasing survival but with no perspective of cure had a significant reduction in overall survival compared to those who were treated with curative intent (76.7 versus 35.4%; p<0.001). CONCLUSION: The benefit of detecting asymptomatic recurrence of cervical ...

Recaída extramedular de leucemia linfocítica aguda: reporte de un caso / Extramedullary relapse of acute linfoblastic leukemia: report of a case

El síndrome de vena cava superior (SVCS), considerado una emergencia, requiere tratamiento inmediato, por lo que el diagnóstico etiológico es esencial antes de decidir una conducta terapéutica. El manejo del SVCS consiste en el alivio de los síntomas y de la enfermedad subyacente. Los tratamientos tienen el objetivo de restituir el flujo sanguíneo. Se presenta un paciente de 5 años de edad, masculino, con antecedente de LLA tipo B. Su estado oncohematológico era remisión total y, en febrero de 2013, consultó por síndrome de dificultad respiratoria (SDR) de rápida evolución y edema facial, que progresó en 24 h. Se realizó angio TC de tórax y vasos de cuello, que evidenció tejido pseudonodular que comprime VCS. Se realiza biopsia endocavitaria de urgencia, que informa infiltración difusa Knfroproliferativa. Tratamiento quimioterápico, con buena evolución y egreso hospitalario. El SVCS es una emergencia oncológica que requiere diagnóstico oportuno y tratamiento inmediato a fin de mejorar los resultados.

The superior vena cava syndrome (SVCS) is considered an emergency and requires immediate treatment; therefore, the etiologic diagnosis is essential before deciding on its implementation. The management of SVCS consists on the relief of symptoms and treatment of the underlying disease, aiming to restore the blood flow. We present a 5 years old boy with a history of B-cell ALL. His oncologic state was that of complete remission. In February 2013 he consulted for respiratory distress syndrome (RDS) of rapid evolution, and facial edema which progressed within 24 hours. CT chest and neck angiography was performed, showing pseudo nodular tissue compressing the SVC. Emergency endocavitary biopsy reported diffuse lymphoproliferative infiltration Chemotherapy is administered, with good results and hospital discharge. The SVCS is an oncologic emergency that requires prompt diagnosis and immediate treatment in order to improve results.

Usefulness of Urine Cytology as a Routine Work-up in the Detection of Recurrence in Patients With Prior Non-Muscle-Invasive Bladder Cancer: Practicality and Cost-Effectiveness

PURPOSE: To investigate the usefulness of urine cytology in the detection of tumor recurrence in terms of practicality and cost-effectiveness. MATERIALS AND METHODS: We retrospectively analyzed 393 patients who underwent transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) from January 2010 to June 2013. All patients underwent cystoscopy, urine cytology, urinalysis, and computed tomography (CT) at 3 and 6 months after TURBT. In 62 cases, abnormal bladder lesions were identified on cystoscopy within 6 months. Suspicious lesions were confirmed pathologically by TURBT or biopsy. Patients were grouped by modalities: group I, urine cytology; group II, CT; group III, urinalysis; group IV, urine cytology plus CT; group V, urine cytology plus urinalysis; group VI, CT plus urinalysis; group VII, combination of all three modalities. Each group was compared by cost per cancer detected. RESULTS: Forty-nine patients were confirmed to have tumor recurrence and 13 patients were confirmed to have inflammation by pathology. The overall tumor recurrence rate was 12.5% (49/393) and recurrent cases were revealed as NMIBC. Sensitivity in group I (24.5%) was lower than in group II (55.1%, p=0.001) and group III (57.1%, p<0.001). However, in group VII (77.6%), the sensitivity was statistically similar to that of group VI (75.5%, p=0.872). Under the Korean insurance system, total cost per cancer detected for group VII was almost double that of group VI (p=0.041). CONCLUSIONS: Routine urine cytology may not be useful for follow-up of bladder cancer in terms of practicality and cost-effectiveness. Application of urine cytology needs to be adjusted according to each patient.

Is a Preoperative Assessment of the Early Recurrence of Pancreatic Cancer Possible after Complete Surgical Resection?

BACKGROUND/AIMS: The prognosis of pancreatic adenocarcinoma (PAC) is poor. The serum carbohydrate antigen 19-9 (CA 19-9) level has been identified as a prognostic indicator of recurrence and reduced overall survival. The aim of this study was to identify preoperative prognostic factors and to create a prognostic model able to assess the early recurrence risk for patients with resectable PAC. METHODS: A series of 177 patients with PAC treated surgically at the St. Andrea Hospital of Rome between January 2003 and December 2011 were reviewed retrospectively. Univariate and multivariate analyses were utilized to identify preoperative prognostic indicators. RESULTS: A preoperative CA 19-9 level >228 U/mL, tumor size >3.1 cm, and the presence of pathological preoperative lymph nodes statistically correlated with early recurrence. Together, these three factors predicted the possibility of an early recurrence with 90.4% accuracy. The combination of these three preoperative conditions was identified as an independent parameter for early recurrence based on multivariate analysis (p=0.0314; hazard ratio, 3.9811; 95% confidence interval, 1.1745 to 15.3245). CONCLUSIONS: PAC patient candidates for surgical resection should undergo an assessment of early recurrence risk to avoid unnecessary and ineffective resection and to identify patients for whom palliative or alternative treatment may be the treatment of choice.