ABSTRACT
BACKGROUND: Limited information exists on the influence of demographics, tumor characteristics, and treatment on survival in cutaneous pleomorphic sarcoma (CPS). OBJECTIVE: To describe incidence rates and prognostic factors affecting survival in CPS. METHODS: National Cancer Institute's Surveillance, Epidemiology, and End Results data (1972-2013) was analyzed for 2423 patients with CPS diagnoses. RESULTS: The age-adjusted incidence rate was 0.152 cases/100,000 person-years and was 4.5-fold higher in male than female patients. Male sex, white race, and increasing age >40 years were significantly associated with decreased overall survival. Head and neck tumors, tumors >15 mm, and tumors with grade III or IV histology were associated with significantly decreased survival. Surgical excision had a survival benefit compared with no treatment. Radiation therapy did not provide a survival benefit. Patients with localized disease had the greatest survival followed by regional and distant disease. LIMITATIONS: Surveillance, Epidemiology, and End Results data might not be reflective of all CPS patients. Recurrences, restaging, or other nonmortality events over time were not tracked. CONCLUSION: Tumor size, grade, sex, age at diagnosis, and race appear to influence survival as prognostic factors in CPS. Surgical tumor extirpation provides a survival benefit over no treatment whereas primary or adjuvant radiation does not provide a survival benefit.
Subject(s)
Neoplasm Recurrence, Local/epidemiology , Sarcoma/mortality , Sarcoma/therapy , Skin Neoplasms/mortality , Skin Neoplasms/therapy , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Cryosurgery/statistics & numerical data , Female , Humans , Kaplan-Meier Estimate , Laser Therapy/statistics & numerical data , Male , Middle Aged , Mohs Surgery/statistics & numerical data , Neoadjuvant Therapy/methods , Neoadjuvant Therapy/statistics & numerical data , Neoplasm Grading , Neoplasm Recurrence, Local/prevention & control , Prognosis , Radiotherapy, Adjuvant/statistics & numerical data , Risk Factors , SEER Program/statistics & numerical data , Sarcoma/diagnosis , Sarcoma/pathology , Sex Factors , Skin/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Tumor Burden , United States/epidemiology , Young AdultABSTRACT
Actinic vascular lesions tend to be stenotic-occlusive lesions. In this article, we present 2 exceptional cases of pseudoaneurysms caused by radionecrosis of the supra-aortic trunks. Both patients were treated by a retrograde carotid approach and deployment of a self-expanding covered stent. Proper exclusion of the pseudoaneurysm was attained in both cases; the first patient remained asymptomatic 12 months later; the second patient died of mediastinitis. Compared with conventional surgery, endovascular management is a viable, less invasive alternative in select patients, especially in life-threatening cases.
Subject(s)
Aneurysm, False/therapy , Brachiocephalic Trunk , Endovascular Procedures/instrumentation , Radiation Injuries/therapy , Stents , Vascular System Injuries/therapy , Aged , Aneurysm, False/diagnosis , Aneurysm, False/etiology , Brachiocephalic Trunk/diagnostic imaging , Brachiocephalic Trunk/injuries , Brachiocephalic Trunk/radiation effects , Endovascular Procedures/adverse effects , Fatal Outcome , Female , Humans , Mediastinitis/microbiology , Necrosis , Patient Selection , Prosthesis Design , Radiation Injuries/diagnosis , Radiation Injuries/etiology , Radiotherapy/adverse effects , Risk Factors , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Vascular System Injuries/diagnosis , Vascular System Injuries/etiologyABSTRACT
Here, we report a case of multidrug-resistant tuberculosis (TB) presenting as a solitary splenic mass in a 60-year-old immunocompetent patient. Splenic TB is unusual and, when present, is usually associated with disseminated disease in immunocompromised patients. A high level of suspicion is required for diagnosis, and, as occurred in our case, it may be an unexpected finding following surgery. Diagnosis was made by polymerase chain reaction, which showed the presence of Mycobacterium tuberculosis DNA. Interestingly, rifampicin- and isoniazid-resistant genes were detected in our analysis. Splenic TB diagnosis and treatment are reviewed.
