Plastic surgery for giant metastatic endometrioid adenocarcinoma in the abdominal wall: A case report and review of literature.

BACKGROUND: Endometrial cancer (EC) is a common gynecological malignancy, but metastasis to the abdominal wall is extremely rare. Therefore, an appropriate treatment approach for large metastatic lesions with infection remains a great challenge. CASE SUMMARY: We report the case of a 65-year-old woman who developed abdominal metastasis of endometrioid adenocarcinoma, as defined by International Obstetrics and Gynecology stage II, in which the lesion was complicated by infection. A right hemicolectomy was performed for colon metastasis in relation to her initial gynecological cancer 3 years ago. When admitted to our department, a complete resection of the giant abdominal wall lesion was performed, and a Bard composite mesh was used to reconstruct the abdominal wall. A local flap was used to close the resultant large defect in the external covering of the abdomen. The patient underwent chemotherapy following cytoreductive surgery. Pathology revealed metastasis of EC, and molecular subtyping showed copy number high of TP53 mutation, implying a poor prognosis. CONCLUSION: When EC patients develop giant abdominal wall metastasis, a plastic surgeon should be included before contemplating resection of tumors.

[An analysis of prognostic factors for malignant fibrous histiocytoma of bone].

OBJECTIVE: To study the risk factors related to the survival rate, recurrence and metastasis of malignant fibrous histiocytoma of bone. METHODS: From July 1997 and July 2010, 56 patients with malignant fibrous histiocytoma of bone were treated. Univariate and multivariate analysis were performed to determine the probable risk factors including gender, age, tumor location, tumor size and so on. RESULTS: Forty-four cases were followed up ranged from 2 weeks to 78 months (medium 33.3). The 5-year overall survival rate was 50.1%, local recurrence rate 40.9% with a median time of 12 months (3 to 60 months) and metastatic rate 27.5% (11/40) with a median time of 6.5 months (2 to 23 months). Univariate analysis indicated that gender, condition of presentation (primary case or recurrence case), tumor location, surgical margin and surgical stage were significantly related to survival rate (P < 0.05), and tumor location and surgical margin were related to local recurrence rate (P < 0.05), and important vessel or nerve invasion was related to metastatic rate (P < 0.05). Multivariate analysis showed that surgical margin and surgical stage were independent risk factors for survival rate, of which surgical margin was the independent risk factor for recurrence rate. CONCLUSIONS: Surgical margin and surgical stage are independent risk factors for survival rate, of which surgical margin is the independent risk factor for recurrence rate.

[Analysis of therapeutic strategies and prognostic factors of malignant fibrous histiocytoma of soft tissue].

OBJECTIVE: To assess the therapeutic strategies and risk factors of malignant fibrous histiocytoma of soft tissue. METHODS: The 78 cases with malignant fibrous histiocytoma of soft tissue treated at Muscular Skeletal Tumor Center of People's Hospital, Peking University from December 1999 and October 2010 were retrospected. Univariate and multivariate analyses were performed to determine the probable risk factors including sex, age, tumor location, tumor size and so on. RESULTS: All 60 cases were followed up ranged from 6 to 131 months (medium 35.5 months). The 1-, 3-, 5-year overall survival rate was 84.9%, 72.9% and 56.9% respectively. Local recurrence rate is 33.3% (20 cases) with a median time of 11.5 months (1 to 72 months) and metastatic rate is 15.0% (9 cases) with a median time of 7 months (1 to 26 months). Univariate analysis indicated that condition of presentation (primary case or recurrence case), tumor size and surgical margin were significantly related to survival rate (all P < 0.05, Kaplan-Meier Log-rank test), surgical margin and radiotherapy related to local recurrence rate (P value were 0.000 and 0.039 respectively), and surgical margin related to metastatic rate. Multivariate analysis showed that surgical margin was independent risk factors for survival rate (P = 0.002, OR = 5.753, 95%CI 1.904 - 17.386) and local recurrence rate (P = 0.000, RR = 0.044, 95%CI 0.010 - 0.188). CONCLUSIONS: Surgical margin was independent risk factors for survival rate and local recurrence rate. Comprehensive therapy of surgery followed by radiotherapy can improve survival rate, reduce local recurrence rate.

[Diagnosis and treatment of osteoid osteoma].

OBJECTIVE: To study the clinical features and surgical treatment of osteoid osteoma and improve the diagnostic therapeutic level. METHODS: Clinical data of 35 patients (25 males and 10 females) with osteoid osteoma diagnosed and treated between January 1997 to October 2009 were retrospectively reviewed. The average age was 21 years (ranged, 6 to 49 years). The average interval time between onset of symptoms and diagnosis was 12 months (ranged, 1 to 24 months). The most common sites were the tibia (13 patients) and the femurs (7 patients). The most common presenting complaints for patients with osteoid osteoma was pain which usually responded to NSAIDs and was generally more severe at night. The imaging manifestations revealed a circular or oval nidus. All the patients underwent surgical treatment. The tumors were treated with curettage or excision with autograft or allograft in 19 patients, simple surgical resection in 9 patients, curettage or excision with autograft or allograft and fixation in 7 patients. RESULT: The mean follow-up period was 49 months (ranged,2 months to 12 years). The symptom of pain disappeared after operation. There were no evidence of recurrence. Tibial pathological fracture happened in one patient 4 months postoperatively, and the patient got healing after plate-screw internal fixation. One patient with sinus formation 5 years postoperatively got wound healing after sinus resection, intramedullary nail removal and debridement. CONCLUSION: According to the typical clinical presentation, radiographic findings, the diagnosis of osteoid osteoma is not difficult. Once the diagnosis is confirmed, the operation should be carried out as early as possible to relieve the symptoms, improve the quality of life and prevent long-term complications.