Metastatic osteosarcoma to the breast: a rare case.

Osteosarcoma is the most common malignant bone neoplasia and metastasizes mainly to the lung. Breast metastasis is an extremely rare event and poorly reported in the literature. We present a case of a 51-year-old patient, with a past surgical history of thigh osteosarcoma presented metastasis to the right breast and lung. She underwent the metastasis resection and later abandoned the treatment. Metastasis of osteosarcoma to the breast is an extremely rare event, but this diagnosis should be considered when meeting patients with a large breast nodule and a past history of osteosarcoma.

Quando se deve preservar o(s) ovário(s) na cirurgia radical para câncer do colo do útero? / When should the ovary be preserved in the uterine cervical cancer during the radical hysterectomy?

Objetivo: Realizou-se uma revisão da literatura sobre a preservação dos ovários em pacientes na pré-menopausa e com câncer do colo do útero em estádios iniciais que se submeteram à histerectomia radical. Métodos: Foi feita uma busca de estudos na língua inglesa na base de dados Pubmed e em português na base Lilacs utilizando-se as palavras uterine cervical neoplasm, hysterectomy and ovarian neoplasms . Dos artigos encontrados, foram lidos todos os resumos e aqueles artigos que abordavam a preservação dos ovários durante a histerectomia radical para tratamento do câncer do colo do útero foram obtidos. Excluíram-se os relatos de casos e série com menos de 20 casos avaliados. Resultados: Foram encontrados 312 artigos em língua inglesa e um em português. Destes, foram selecionados 16 que avaliaram a preservação ovariana durante a histerectomia radical para tratamento do câncer do colo do útero em estádios iniciais. Nenhum estudo randomizado foi encontrado; todos eram série de casos avaliados prospectiva ou retrospectivamente. No total, 1.305 pacientes foram avaliadas. A taxa de manutenção da função ovariana foi de 76,7%, a reoperação por lesões ovarianas benignas ocorreu em 3,9% dos casos e a taxa de ocorrência de metástase ovariana foi de 0,2%. O fator associado à perda da função ovariana foi a realização de radioterapia externa. Adenocarcinoma esteve associado à maior taxa de metástase ovariana. Conclusão: Os ovários podem ser preservados em pacientes com câncer do colo do útero inicial durante a histerectomia radical se a histologia do tumor for carcinoma epidermoide e não apresentar doença extracervical

Abstract Objective: A review of the literature on ovarian preservation in premenopausal patients with early-stage uterine cervical cancer undergoing radical hysterectomy was conducted. Methods: A search for studies in English on the Pubmed database and written in Portuguese on the Lilacs database was carried out using the words ?uterine cervical neoplasm?, ?hysterectomy? and ?ovarian neoplasms?. All abstracts from the articles found were read and the articles that discussed ovarian preservation at the time of radical hysterectomy for the treatment of uterine cervical carcinoma were obtained. Case reports and series with less than 20 cases evaluated were excluded. Results: Three hundred and twelve (312) articles published in English in addition to one article published in the Portuguese idiom were found. Of these, 16 articles that examined ovarian preservation at the time of hysterectomy for the treatment of early-stage uterine cervical cancer were selected. No randomized studies were found. All studies were case series prospectively or retrospectively evaluated. A total of 1,305 patients were evaluated. Maintenance of ovarian function occurred in 76.7% of women, reoperation due to benign ovarian lesions was performed in 3,9% of cases and metastases rate was of 0,2%. The factor associated with loss of ovarian function was the performance of external radiation therapy. Adenocarcinoma was associated with a higher rate of ovarian metastasis. Conclusion: The ovaries may be preserved in patients with early-stage uterine cervical cancer at the time of radical hysterectomy if tumor histology shows squamous cell carcinoma of the cervix and when there is no sign of extracervical disease

Prevalence of prognostic factors for cancer of the uterine cervix after radical hysterectomy.

CONTEXT AND OBJECTIVE: Cancer of the uterine cervix is still very common in Brazil. It is important to evaluate factors that influence its prognosis. The aim here was to analyze the prevalence of prognostic anatomoclinical factors among patients with carcinoma of the uterine cervix undergoing radical hysterectomy. DESIGN AND SETTING: Cross-sectional study on 301 patients with invasive carcinoma of the uterine cervix who underwent Level III Piver-Rutledge hysterectomy surgery at São Marcos Hospital. METHODS: The following variables were analyzed: age, histological type, degree of differentiation, invasion of lymphatic, vascular and perineural space, lymph node metastasis, distance to nearest margin, tumor invasion depth, vaginal cuff size, largest diameter of the tumor, presence of necrosis and surgical margin involvement. Descriptive statistics, multiple regression analysis, Kaplan-Meier survival curves and the log-rank test were performed. A significance level of 5% was used. RESULTS: The mean age was 48.27 years. The following were not important for the prognosis, in relation to survival analysis: degree of differentiation and tumor invasion depth; presence of lymphatic, blood and perineural invasions; distance to nearest margin; and vaginal cuff size. Tumor size (P < 0.036), presence of lymph node metastasis (P < 0.0004), necrosis (P < 0.05) and surgical margin involvement (P < 0.0015) presented impacts on survival. The overall survival with 98 months of follow-up was 88.35%. CONCLUSION: The most prevalent prognostic factors were the presence of lymph node metastasis, tumor size and surgical margin involvement.

[Post-radiotherapy pelvic exenteration in relapsed cervical cancer: experience of a tertiary health service in the northeast of Brazil]. / Exenteração pélvica para câncer do colo uterino recidivado pós-radioterapia: experiência de um centro terciário do Nordeste brasileiro.

PURPOSE: to analyze complications, morbidity, mortality and survival rate in a group of patients with cervical cancer with central pelvic relapse after primary radiotherapy treatment. METHODS: retrospective study of a series of 16 cases of pelvic exenteration after primary radiotherapy treatment. Descriptive statistics, survival curve through Kaplan-Meier's method, and regression analysis to evaluate prognosis were performed. RESULTS: sixteen patients have undergone pelvic exenteration. Epidermoid carcinoma, IIb stage and undifferentiated grade were the most frequent conditions. Post-operatory tumor relapse occurred in half the cases. Eleven patients presented peri or post-surgical complications, the most frequent being pelvic infection, that of the surgical wound, and urinary fistulae. Global survival rate was 64.3%, with average follow-up of 11 months. Regression analysis did not detect any significant prognosis factor for the patient survival. CONCLUSIONS: the survival rate was 64.3%. No particular factor associated to poor prognosis has been found in the present series of cases.

Exenteração pélvica para câncer do colo uterino recidivado pós-radioterapia: experiência de um centro terciário do Nordeste brasileiro / Post-radiotherapy pelvic exenteration in relapsed cervical cancer: experience of a tertiary health service in the northeast of Brazil

OBJETIVO: analisar complicações, morbidade, mortalidade e sobrevida num grupo de pacientes com câncer de colo uterino com recidiva pélvica central submetidas à exenteração pélvica pós-tratamento primário com radioterapia. MÉTODOS: estudo retrospectivo de uma série de 16 casos de exenteração pélvica pós-tratamento primário com radioterapia. Foi realizada estatística descritiva, curva de sobrevida pelo método de Kaplan-Meier e análise de regressão linear múltipla para avaliar fatores prognósticos. RESULTADOS: dezesseis pacientes foram submetidas à exenteração pélvica. O carcinoma epidermoide, o estádio IIb e o grau indiferenciado foram as condições mais frequentes. A recidiva tumoral pós-operatória ocorreu na metade dos casos. Onze pacientes apresentaram complicações perioperatórias ou pós-operatórias e as mais frequentes foram infecções pélvica e da ferida operatória e fístulas urinárias. A sobrevida global foi de 64,3 por cento, com um seguimento mediano de 11 meses. A análise de regressão linear múltipla não revelou fatores prognósticos significativos na sobrevida das pacientes. CONCLUSÕES: a taxa de sobrevida foi de 64,3 por cento. Nenhum fator associado a pior prognóstico foi encontrado nesta série.

PURPOSE: to analyze complications, morbidity, mortality and survival rate in a group of patients with cervical cancer with central pelvic relapse after primary radiotherapy treatment. METHODS: retrospective study of a series of 16 cases of pelvic exenteration after primary radiotherapy treatment. Descriptive statistics, survival curve through Kaplan-Meier's method, and regression analysis to evaluate prognosis were performed. RESULTS: sixteen patients have undergone pelvic exenteration. Epidermoid carcinoma, IIb stage and undifferentiated grade were the most frequent conditions. Post-operatory tumor relapse occurred in half the cases. Eleven patients presented peri or post-surgical complications, the most frequent being pelvic infection, that of the surgical wound, and urinary fistulae. Global survival rate was 64.3 percent, with average follow-up of 11 months. Regression analysis did not detect any significant prognosis factor for the patient survival. CONCLUSIONS: the survival rate was 64.3 percent. No particular factor associated to poor prognosis has been found in the present series of cases.

Prevalence of prognostic factors for cancer of the uterine cervix after radical hysterectomy / Prevalência de fatores prognósticos em câncer de colo uterino após histerectomia radical

CONTEXT AND OBJECTIVE: Cancer of the uterine cervix is still very common in Brazil. It is important to evaluate factors that influence its prognosis. The aim here was to analyze the prevalence of prognostic anatomoclinical factors among patients with carcinoma of the uterine cervix undergoing radical hysterectomy. DESIGN AND SETTING: Cross-sectional study on 301 patients with invasive carcinoma of the uterine cervix who underwent Level III Piver-Rutledge hysterectomy surgery at São Marcos Hospital. METHODS: The following variables were analyzed: age, histological type, degree of differentiation, invasion of lymphatic, vascular and perineural space, lymph node metastasis, distance to nearest margin, tumor invasion depth, vaginal cuff size, largest diameter of the tumor, presence of necrosis and surgical margin involvement. Descriptive statistics, multiple regression analysis, Kaplan-Meier survival curves and the log-rank test were performed. A significance level of 5 percent was used. RESULTS: The mean age was 48.27 years. The following were not important for the prognosis, in relation to survival analysis: degree of differentiation and tumor invasion depth; presence of lymphatic, blood and perineural invasions; distance to nearest margin; and vaginal cuff size. Tumor size (P < 0.036), presence of lymph node metastasis (P < 0.0004), necrosis (P < 0.05) and surgical margin involvement (P < 0.0015) presented impacts on survival. The overall survival with 98 months of follow-up was 88.35 percent. CONCLUSION: The most prevalent prognostic factors were the presence of lymph node metastasis, tumor size and surgical margin involvement.

CONTEXTO E OBJETIVO: O câncer do colo do útero é ainda muito frequente no Brasil, sendo importante avaliar os fatores que influenciam no seu prognóstico. O objetivo é analisar a prevalência dos fatores prognósticos anatomoclínicos em pacientes com carcinoma do colo uterino submetidas a histerectomia radical. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo de 301 pacientes com carcinoma invasivo de colo uterino submetidas a histerectomia radical nível III de Piver-Rutledge no Hospital São Marcos. MÉTODOS: Analisaram-se as variáveis: idade, tipo histológico, grau de diferenciação, invasão do espaço linfático, vascular e perineural, metástase linfonodal, distância da margem mais próxima, profundidade de invasão do tumor, tamanho do manguito vaginal, maior diâmetro do tumor, presença de necrose, comprometimento de margens cirúrgicas. Realizou-se estatística descritiva, análise de regressão múltipla, curva de sobrevida pelo método de Kaplan-Meier e teste log rank. Adotou-se índice de significância de 5 por cento. RESULTADOS: A idade média foi de 48,27 anos. A análise da sobrevida em relação ao grau de diferenciação e profundidade de invasão do tumor, à presença de invasões linfática, sanguínea e perineural, à distância da margem mais próxima e ao tamanho do manguito vaginal não foram importantes no prognóstico. O tamanho do tumor (P < 0,036), presença de metástase linfonodal (P < 0,0004), necrose (P < 0,05) e comprometimento de margens cirúrgicas (P < 0,0015) apresentaram impacto na sobrevida. A sobrevida global com um acompanhamento de 98 meses foi de 88,35 por cento. CONCLUSÃO: Os fatores prognósticos mais prevalentes foram a presença de metástase linfonodal, o tamanho do tumor, a presença de necrose e o comprometimento das margens cirúrgicas.

Changes in pulse oximetry after patent blue dye injection into the uterine cervix.

BACKGROUND: To evaluate changes in pulse oximetry readings in patients with cervical carcinoma after the injection of patent blue dye into the uterine cervix for sentinel lymph node detection. METHODS: Fifty-six patients underwent radical hysterectomy and bilateral pelvic lymphadenectomy for the treatment of International Federation of Gynecology and Obstetrics stage I or II cervical cancer. Four milliliters of patent blue dye were injected into the cervix. On the eve of surgery, all patients also received an injection of Dextran 500 labeled with technetium 99 m (Tc-99 m Dextran, 600 to 800 muCi) into the cervix and subsequently underwent pelvic lymphoscintigraphy. RESULTS: Of the 56 patients, 1 (1.79%) had an anaphylactic reaction, and in 13 (23.22%), pulse oximetry readings were <96%. The lowest median pulse oximetry reading in these patients was 87%. Pulse oximetry readings began to decrease between 2 and 10 minutes after patent blue dye injection into the cervix and lasted for approximately 5 minutes. No changes in blood pressure, heart rate, or electrocardiogram were found during the period in which this alteration was recorded by the pulse oximeter. CONCLUSION: The decrease in pulse oximetry readings after patent blue dye injection into the cervix was associated with larger tumors and tumors that surrounded the external cervical os.

Metástase vaginal como manifestação inicial de carcinoma de células renais / Vaginal metastasis as initial manifestation of renal cell carcinoma

A ocorrência de metástases de carcinoma de células renais para a vagina é rara. Ocorre principalmente em mulheres na pós-menopausa e o principal fator prognóstico é se essa metástase apresenta-se ou não isolada. Poucos casos foram relatados na literatura mundial e a maioria destes envolve metástases originadas no rim esquerdo. Os autores apresentam um caso de metástase vaginal de carcinoma de células renais em uma paciente de 53 anos de idade cuja apresentação clínica inicial foi de uma massa pediculada com bordas irregulares na parede posterior da vagina. Realizou-se a retirada cirúrgica da lesão que revelou tratar-se de adenocarcinoma de células claras. A ultrasonografia abdominal evidenciou presença de massa incidental no rim esquerdo e foi realizada a nefrectomia deste rim. O estudo imunoistoquímico realizado demonstrou tratar de lesão neoplásica primária do rim com metástase para a vagina. A paciente, então, recebeu radioterapia adjuvante na vagina e na pelve. Após oito meses do início do tratamento, realizou-se imunoterapia com interferon 2 devido ao aparecimento de metástase também para ofígado. A paciente encontra-se viva 17 meses após a cirurgia.