Pleomorphic hyalinizing angiectatic tumor of the mesorectum: a rare case and review of literature

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare tumor of uncertain tissue origin. Although it has been classified as a benign tumor under the WHO classification, it is locally aggressive, and multiple recurrences have been reported. PHAT commonly involves the lower extremities; however, various unusual sites of origin have been reported. We present the case of a 30-year-old female with dysmenorrhea, who presented a presacral mass on imaging. The core biopsy confirmed the diagnosis of PHAT. She underwent laparotomy and excision. Histopathology confirmed the presence of a tumor comprised of aggregates of ectatic vessels with perivascular hyalinization. An immunohistochemical study showed diffuse CD34 positivity, but S100, MDM2, and smooth muscle actin negativity. After surgical procedures, the patient is disease free as at the 12-month follow-up. Only 120 cases have been published in the English literature to date. Our study is only the third case of PHAT arising from the pelvis to be reported. Though considered to be a rare condition, the diagnosis of PHAT should always be considered in the differential diagnosis of well-defined hypervascular soft tissue mass in the pelvis. The typical histopathological findings along with immunohistochemistry should clinch the diagnosis.

Complications and cost analysis of hemipelvectomy for the treatment of pelvic tumors / Complicações e análise de custo da hemipelvectomia para o tratamento de tumores da pelve

ABSTRACT Objective: Hemipelvectomy is a complex surgery with a high complication rate. Here, we aimed to identify factors related to the onset of complications and calculate their impacts on hospital costs. Methods: We evaluated 31 consecutive patients who underwent hemipelvectomy between 1999 and 2015. We assessed the clinical and radiographic data to determine the patients' demographic factors, tumor and surgical characteristics, and complications. The individual hospital stays and financial balances were assessed up to 6 months following the index surgery. Results: The overall complication rate was 61% (19/31). Infection was the most prevalent complication (36%). Immediate postoperative death occurred in 5/31 patients (16%); another 5 (16%) died after hospital discharge due to disease progression. Histological grade, previous surgery, and previous radiotherapy were not associated with complications or infection. Acetabular resections, bone reconstruction, and longer operative times were associated with infection, whereas older age, pelvic organ involvement, and comorbidities were associated with immediate postoperative death. Complications and infection were associated with 4.8- and 5.9-fold increases in hospital costs, respectively. Conclusions: Acetabular resection and bone reconstruction are important factors that increase short-term complication rates, infection rates, and hospital costs. Mortality was associated with older age and adjacent pelvic tumor progression. Level of Evidence: IV, case series.

RESUMO Objetivo: Hemipelvectomia é uma cirurgia complexa associada a alta taxa de complicações. O objetivo foi identificar fatores relacionados a complicações e calcular o impacto sobre os custos hospitalares. Métodos: Avaliamos 31 pacientes consecutivos submetidos à hemipelvectomia entre 1999 e 2015. Analisamos dados clínicos e radiográficos para determinar variáveis demográficas, características do tumor e cirurgia, e complicações. A internação hospitalar individual e o balanço financeiro foram calculados até seis meses após a cirurgia principal. Resultados: A taxa de complicações foi de 61% (19/31). Infecção foi a complicação mais frequente (36%). Morte pós-operatória precoce foi observada em 5/31 pacientes (16%) e outros cinco (16%) morreram após alta hospitalar devido à progressão da doença. Grau histológico, cirurgia e radioterapias prévias não estiveram associadas com complicações ou infecções. Ressecções acetabulares, reconstruções ósseas e maiores tempos cirúrgicos estiveram associados com infecções, enquanto que mais idade, envolvimento de orgão pélvico e comorbidades estiveram associados com morte precoce. Complicações e infecções apresentaram aumento de 4,8-, e 5.9-vezes nos custos hospitalres. Conclusões: Ressecções acetabulares e reconstrução óssea são fatores importantes que aumentam as complicações, infecções e custos hospitalares. Mortalidade está associada com maior idade e progressão tumoral intrapélvica. Nível de Evidência IV, Série de casos.

Current research progress on pelvic insufficiency fractures after radiotherapy for pelvic neoplasms / 中华放射肿瘤学杂志

Pelvic insufficiency fractures ( PIF) is a vital complication after radiotherapy for pelvic neoplasms. It often leads to intractable pain and limited activity and is likely to be misdiagnosed as bone metastases and improperly treated. MRI is a common method for the diagnosis and differential diagnosis of PIF. The optimal approach to prevent PIF is to correctly identify the high-risk population and provide drug intervention when necessary. The low bone density state serves as a pivotal predictor at the beginning of radiotherapy. Reasonable selection of irradiation dose in pelvic lymphatic drainage area and minimizing the dose of pelvic bone probably reduce the incidence of PIF after radiotherapy.

Dose-volume restriction analysis based on ≥grade Ⅱ marrow suppression in radiotherapy for pelvic cancer / 中华放射肿瘤学杂志

Objective@#To investigate the correlation between bone marrow suppression and the dose volume analysis of pelvic bone and provide reference for defining the parameters of bone volume-dose restriction during pelvic radiotherapy.@*Methods@#A retrospective analysis of 102 cases of cervical cancer, 53 cases of rectal cancer and 34 cases of prostate cancer in People′s Hospital of Xinjiang Uygur Autonomous Region from January 2013 to April 2016 was performed. All patients received pelvic irradiation at a dose of 50.0-50.4Gy, and a boost of 10-24 Gy was given for different types of tumors or tumor beds. Concurrent chemotherapy was carried out in patients with cervical cancer and colorectal cancer, and endocrine therapy was given to prostate cancer patients during radiotherapy. The parameters including the target bone volume, V10, V20, V30, V40, V50, and the grade of bone marrow suppression according to RTOG grading scale within 3 months after radiotherapy or 6 months post-radiotherapy were evaluated. The correlation between the irradiation bone volume and the grade of bone marrow suppression was assessed by univariate analysis. The relationship between the grade of bone marrow suppression and age, chemotherapy and radiotherapy dose was further analyzed by multivariate analysis.@*Results@#In patients with cervical, rectal and prostate cancer, the overall incidence rate of early bone marrow suppression was 77.5%, 79.2% and 70.6%, and 65.7%, 62.3% and 35.3% for ≥grade 2 bone marrow suppression, respectively. Late-stage bone marrow suppression occurred in 11 patients, grade Ⅱ in 7 cases, and the incidence rate of ≥grade 2 bone marrow suppression was 3.7%. The target bone volume in the cervical, rectal and prostate cancer groups was (746.30±27.84) cm3, (736.15±28.72) cm3 and (740.70±35.08) cm3(P=0.023), respectively. Univariate and multivariate analyses revealed that V10, V20, V30, V40 and CV10, CV20, CV30, CV40 were not significantly correlated with the grading of bone marrow suppression (all P>0.05), whereas V50 and CV50 were significantly correlated with bone marrow suppression (both P<0.05). ROC curve analysis demonstrated that V50=72.33 cm3 and CV50=9.42% were the diagnostic cut-off values for ≥grade 2 bone marrow suppression.@*Conclusions@#The incidence of bone marrow suppression is relatively high in pelvic radiotherapy, which is correlated with the irradiation bone volume and dose in the target area. At a total dose of 50 Gy, the incidence of ≥grade 2 bone marrow suppression is not associated with ≤V40 or absolute volume. Besides, it is not correlated with dose boost or whether chemotherapy is delivered, whereas it is associated with V50 and absolute volume. V50=10.23% and CV50=72.33 cm3 are the cut-off values for the incidence of ≥grade 2 bone marrow suppression.

Research progress in effect of pelvic bone marrow-sparing intensity-modulated radiotherapy on hematologic toxicity in pelvic tumor patients after concurrent chemoradiotherapy / 中华放射肿瘤学杂志

Concurrent chemoradiotherapy can improve the survival rate in patients with advanced pelvic tumors.However,it also increases the incidence of hematologic toxicity and other adverse events.Patients cannot tolerate these adverse events and discontinue the therapy.Pelvic bone marrow-sparing intensity-modulated radiotherapy (PBMS-IMRT) possesses obvious advantages in reducing the radiation dose and volume of the pelvic bone marrow.In this article,comparison between PBMS-IMRT and other irradiation therapies,correlation between dosimetric parameters and hematologic toxicity and imaging methods with precise delineation of the active bone marrow were reviewed.

A customized vacuum cushion for immobilization in the radiotherapy of pelvic malignancies / 中华放射医学与防护杂志

Objective To evaluate the performance of a customized vacuum-form body immobilization method in the radiotherapy of pelvic malignancies by comparing it with conventional approaches, thus to improve immobilization accuracy in the radiotherapy of pelvic malignancies. Methods A total of 66 patients with pelvic malignancies were enrolled in this study. These patients were divided into three groups according to three immobilization approaches: radiotherapy board ( Group N ) , conventional vacuum cushion ( Group V ) , and a customized vacuum cushion specifically for pelvic immobilization ( Group New-V) . Setup deviations of these immobilizations were comparatively evaluated by translational and rotational errors during intra-fractional measurements. Results The average translational setup errors in vertical(x), longitudinal(y), lateral(z) and rotational error r were (0. 35 ± 0. 37), (0. 21 ± 0. 22), (0. 29 ± 0. 28) cm and (0. 70 ± 0. 65)° for Group New-V; (0. 44 ± 0. 43), (0. 31 ± 0. 62), (0. 45 ± 0. 60) cm and (1. 25 ± 1. 00)° for Group N; (0. 38 ± 0. 36), (0. 27 ± 0. 25), (0. 32 ± 0. 29) cm and (1. 09 ± 0. 77)° for Group V, respectively. Significant differences were observed in r direction among these three method (F=7. 859,P <0. 05). Group New-V with customized cushion showed the least standard deviations in four directions and the least setup error in r direction compared with the other two method (F=3. 166,P<0. 05). Reconstructed dose distribution based on the isocenter shift result ed from setup errors revealed that Group New-V showed the least deviations in the minimum and mean dose and of the planning target volume (PTV) before and after isocenter shift(F=8. 018, P<0. 05). Conclusions The customized vacuum cushion provided best immobilization and dosimetric advantage. It helps to optimize the immobilization accuracy and improve the clinic outcome potentially.

Pelvic serous carcinoma of female:a clinicopathogical analysis of 20 cases / 临床与实验病理学杂志

Purpose To study the clinicopathological and immunohistochemical features, carcinogenesis and differential diagnosis of female pelvic serous carcinoma. Methods The clinical data, macroscopic and microscopic features and immunostaining results of 20 patients with pelvic serous carcinoma were studied, and some associated literatures were reviewed. Results 20 cases of PSC aged from 23 to 87, with the mean age being 58. 9. PSC may occur in fallopian tube, ovary and peritoneum, while they were referred to hospital because of abdominal distention, abdominal pain or pelvic mass. The tumor often invasive pelvic organs diffusely when they were diag-nosed, so, the primary site were difficultly determined. Usually, the primary focus of serous carcinoma of fallopian tube is small and easily planted in pelvic. The patients with ovarian serous carcinoma or peritoneal serous carcinoma had serous tubal intraepithelial car-cinoma at the mean time. Conclusions The tubal epithelial cells may be the major source of PSC. About the specimen of PSC, we need check the fallopian tube carefully to determine the primary site, and make differential diagnosis with peritoneal malignant mesothe-lioma and metastatic carcinoma from other sites than pelvic when it diffusely invasive peritoneum.

Aggressive Angiomyxoma Pelvis Presenting As An Ovarian Tumor With Vault Prolapse.

Angiomyxoma is a rare tumor arising from the pelvis. Preoperative diagnosis and treatment may be difficult. We report a case of aggressive angiomyxoma pelvis that presented as vault prolapse and was misdiagnosed as ovarian tumor. Conclusion: As surgery is the main treatment, preoperative diagnosis and assessment of extent of the tumor for planning surgery cannot be overemphasized.

Cone-beam CT scanning in study of setup margin for pelvic carcinoma irradiation / 中华放射肿瘤学杂志

Objective To analyze setup errors for irradiation of pelvic carcinoma by online conebeam CT (CBCT) scanning and to calculate the external margins from clinical target volume (CTV) to planning target volume (PTV) in treatment planning. Methods Twelve patients with rectal or prostate cancer were enrolled in this study. Translational errors (x,y,z) and rotational errors (u,v,w) were obtained by using CBCT in radiotherapy. Results The set-up errors were gathered from 229 sets of CBCT in 12patients. The systemic ± random errors on x,y,z, u,v and w axes were (0.49 ± 1.18) mm, (-0. 11 ±3.45) mm, (-2. 00 ± 1.59) mm, 1.14°±0. 67°, 0. 42°±O. 94°and -0. 32°±±0. 68°, respectively. Setup errors in the left-right, anterior-posterior, and superior-inferior directions were 4. 6 mm, 12. 5 mm, and 6. 2 mm, respectively. Conclusions Set-up errors were unavoidable in pelvic carcinoma irradiation. To minimize the influence of set-up errors, we suggest a PTV margin of 5 mm, 15 mm and 10 mm in the leftright, anterior-posterior and superior-inferior directions, respectively.

A case of myxoid malignant fibrous histiocytoma in the pelvic cavity / 부인종양

Malignant fibrous histiocytoma (MFH) is the most frequent malignant soft tissue tumor in adults. A primary MFH occurs most commonly in the extremities and the trunk, but rarely in the pelvic cavity. We report a case of malignant fibrous histiocytoma of the unknown origin in the pelvic cavity with a review of the literature. The neoplasm occurred in the pelvic cavity of 53-year-old female who complained of enlarging nontender mass in the lower abdomen. The final diagnosis was based on the pathological report of the surgical specimen.

Application of magnetic resonance imaging in diagnosis and treatment of pelvic neoplasms / 上海第二医科大学学报

Objective To study the value of magnetic resonance imaging(MRI) in the diagnosis and treatment of pelvic neoplasms. Methods The patients who were suspected of malignant pelvic neoplasms were performed MRI.The surgical approach was determined according to the MRI results.The MRI results were compared with operation findings and pathological reports. Results The MRI results were consistent with operation findings and pathological reports in 22 cases highly suspected of pelvic neoplasms and 15 cases with abnormal endometrial echo.Therapeutic regimen was designed for 5 cases with uterine cervix cancer according to MRI stages,and favourable surgical curative effects were obtained. Conclusion MRI provides a reliable guideline for surgical approach and may improve the outcomes.

Pharmacokinetics of cisplatin during pelvic isolated perfusion with the balloon occlusion technique in dogs / 介入放射学杂志

Objective To demonstrate the pharmacokinetic characters of cisplatin in isolated prefusion of dog pelvic.Methods Pelvic isolated perfusion with the balloon occlusion was performed in 11 dogs.Blood samples of perfusion and non-perfusion regions were assayed for platinum using atomic absorption spectrophotometer.Pharmacokinetic characters of cisplatin were analized. Results C_(pel max) 30.3 ?g/ml,and C_(sys max) 4.8 ?g/ml,and AUC_(pel 0～25min) 330 ?g/ml?min were observed in perfusion area.AUC_(sys 0～25min) in non-perfusion area was 56 ?g/ml?min. Conclusions Balloon catheter-mediated pelvic I-P has favorable pharmacokinetic characters for chemotherapeutics and therefore should be an alternative method to treat pelvic neoplasma.