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1.
Surgery ; 175(5): 1402-1407, 2024 May.
Article in English | MEDLINE | ID: mdl-38423892

ABSTRACT

BACKGROUND: Racial and ethnic disparities have been observed in the multidisciplinary management of pancreatic ductal adenocarcinoma. Intraductal papillary mucinous neoplasm is the most common identifiable precursor to pancreatic ductal adenocarcinoma, where early surgical intervention before the development of an invasive intraductal papillary mucinous neoplasm improves survival. The association of race/ethnicity with the risk of identifying invasive intraductal papillary mucinous neoplasms during resection has not been previously defined. METHODS: The American College of Surgeons National Quality Improvement Program targeted pancreatectomy database (2014-2021) was queried for patients with race/ethnicity data who underwent resection of an intraductal papillary mucinous neoplasm. Backward Wald logistic regression modeling (P ≤ 0.05 for entry; P > .10 for removal) was used to identify independent predictors of invasion. RESULTS: A total of 4,505 cases of resected intraductal papillary mucinous neoplasms were identified, with 923 (20.5%) demonstrating invasive intraductal papillary mucinous neoplasms. The cohort of individuals other than non-Hispanic Whites were significantly more likely to have invasive intraductal papillary mucinous neoplasms (White, 19.9%; Black, 24.2%; Asian, 23.7%; Hispanic, 22.6%; P = .026). Such disparity could not be explained by greater comorbidity, as non-White patients were significantly younger (age <65 years: 41.7% vs 33.2%, P < .001) and had better physical status (American Society of Anesthesiologists score ≤2: 28.8% vs 25.2%, P = .053). After controlling for clinicodemographic variables, being an individual of race/ethnicity other than White was independently associated with higher odds of invasive intraductal papillary mucinous neoplasms (odds ratio, 1.280; 95% confidence interval, 1.046-1.566; P = .017). No differences in postoperative morbidity were observed. CONCLUSION: In a national cohort of patients with resected intraductal papillary mucinous neoplasms, individuals who identified as being of race/ethnicity other than White were significantly more likely to have invasive intraductal papillary mucinous neoplasms during surgical resection.


Subject(s)
Carcinoma, Pancreatic Ductal , Neoplasms, Cystic, Mucinous, and Serous , Pancreatic Neoplasms , Humans , United States/epidemiology , Aged , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/pathology , Pancreatectomy , Pancreatic Ducts/surgery , Neoplasms, Cystic, Mucinous, and Serous/surgery , Neoplasm Invasiveness , Retrospective Studies
2.
Pancreas ; 53(3): e280-e287, 2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38277399

ABSTRACT

OBJECTIVES: Most patients with intraductal papillary mucinous neoplasms (IPMNs) are diagnosed with a solitary lesion; however, the presence of skip lesions, not appreciable on imaging, has been described. Postoperatively, these missed lesions can continue to grow and potentially become cancerous. Intraoperative pancreatoscopy (IOP) may facilitate detection of such skip lesions in the remnant gland. The aim of this scoping review was to appraise the evidence on the role of IOP in the surgical management of IPMNs. MATERIALS AND METHODS: Studies reporting on the use of IOP during IPMN surgery were identified through searches of the PubMed, Embase, and Scopus databases. Data extracted included IOP findings, surgical plan modifications, and patient outcomes. The primary outcome of interest was the utility of IOP in surgical decision making. RESULTS: Ten studies reporting on the use of IOP for IPMNs were identified, representing 147 patients. A total of 46 skip lesions were identified by IOP. Overall, surgical plans were altered in 37% of patients who underwent IOP. No IOP-related complications were reported. CONCLUSIONS: The current literature suggests a potential role of integration of IOP into the management of patients with IPMNs. This tool is safe and feasible and can result in changes in surgical decision making.


Subject(s)
Carcinoma, Pancreatic Ductal , Neoplasms, Cystic, Mucinous, and Serous , Pancreatic Neoplasms , Humans , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/surgery , Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging , Neoplasms, Cystic, Mucinous, and Serous/surgery , Carcinoma, Pancreatic Ductal/diagnostic imaging , Carcinoma, Pancreatic Ductal/surgery , Carcinoma, Pancreatic Ductal/pathology , Retrospective Studies
3.
Pancreas ; 52(5): e288-e292, 2023 May 01.
Article in English | MEDLINE | ID: mdl-37922344

ABSTRACT

OBJECTIVE: We aimed to elucidate the feasibility of surveillance of patients with mucinous cystic neoplasm (MCN). METHODS: We performed a retrospective, multi-institutional study of 328 patients who underwent surgery for MCN at 18 Japanese institutions. Patients with MCN were divided into an immediate surgery group and a surveillance group, which underwent surgery after surveillance. RESULTS: The median surveillance period until surgery in the surveillance group was 27 months (range, 7-165 months). Compared with the immediate surgery group, the surveillance group showed smaller tumor diameter (46 vs 50 mm, P = 0.01), more frequent laparoscopic approach (58% vs 37%, P < 0.01), and less frequent malignancy (7% vs 15%, P = 0.03). The new appearance of mural nodules and elevation of serum tumor markers were associated with malignancy in the surveillance group. Two patients in the surveillance group experienced postoperative recurrence, although there was no significant difference in recurrence or disease-free survival between the two groups. In the surveillance group, the 1-, 5-, and 10-year cumulative incidence rates of malignant MCN were 0.8%, 5.6%, and 36.5%, respectively. CONCLUSION: As the risk of progression to malignant MCNs increases over the long term, MCNs should be resected rather than subjected to unnecessary surveillance.


Subject(s)
Neoplasms, Cystic, Mucinous, and Serous , Pancreatic Neoplasms , Humans , Retrospective Studies , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/pathology , East Asian People , Feasibility Studies , Pancreas/pathology , Neoplasms, Cystic, Mucinous, and Serous/surgery , Neoplasms, Cystic, Mucinous, and Serous/pathology , Pancreatic Hormones
4.
Gastrointest Endosc Clin N Am ; 33(4): 867-877, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37709417

ABSTRACT

During the past two decades, there has been a significant evolution in endoscopic interventions in pancreatic cystic neoplasms (PCNs), ranging from diagnostic intervention (endoscopic ultrasound-guided through-the-needle biopsy [EUS-TTNB]) to therapeutic intervention (endoscopic ultrasound-guided pancreatic cystic ablation [EUS-PCA]). They have received attention as alternatives to conventional diagnostic and therapeutic modalities. EUS-TTNB can categorize PCN types accurately by providing histologic diagnoses that conventional diagnostic modalities cannot provide. As pancreatectomy entails high morbidities, EUS-PCA can be performed safely to treat PCNs in patients who refuse surgery or have high surgical risks.


Subject(s)
Neoplasms, Cystic, Mucinous, and Serous , Pancreatic Neoplasms , Humans , Pancreas , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/surgery , Endoscopy , Pancreatectomy , Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging , Neoplasms, Cystic, Mucinous, and Serous/surgery
5.
J Obstet Gynaecol Res ; 49(12): 2975-2978, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37771102

ABSTRACT

Low-grade appendiceal mucinous neoplasm (LAMN) is a rare epithelial malignancy of the appendix. If it perforates the abdominal cavity, it can cause a serious clinical syndrome called pseudomyxoma peritonei. In the present case, we laparoscopically removed a LAMN encountered during risk-reducing salpingo-oophorectomy (RRSO). The patient was a 53-year-old woman who was diagnosed with hereditary breast and ovarian cancer syndrome. RRSO was planned, and magnetic resonance imaging revealed a large cystic tumor in the right lower abdomen. We expected an ovarian cyst; however, it was a primary tumor of the appendix. Partial cecal resection was performed laparoscopically by a surgical oncologist. The pathological diagnosis was LAMN. Gynecologists may encounter this disease incidentally. Mucinous appendiceal neoplasm (MAN) may be encountered during RRSO. If a right lower abdominal mass is found near a normal ovary preoperatively, gynecologists should consider MAN as well as paraovarian cyst.


Subject(s)
Appendiceal Neoplasms , Laparoscopy , Neoplasms, Cystic, Mucinous, and Serous , Peritoneal Neoplasms , Pseudomyxoma Peritonei , Female , Humans , Middle Aged , Appendiceal Neoplasms/surgery , Appendiceal Neoplasms/pathology , Salpingo-oophorectomy , Peritoneal Neoplasms/pathology , Pseudomyxoma Peritonei/pathology , Pseudomyxoma Peritonei/surgery , Neoplasms, Cystic, Mucinous, and Serous/surgery
6.
World J Gastroenterol ; 29(20): 3119-3132, 2023 May 28.
Article in English | MEDLINE | ID: mdl-37346158

ABSTRACT

BACKGROUND: Pancreatic mucinous cystic neoplasms (MCNs) represent one of the precursor lesions of pancreatic ductal adenocarcinoma, and their detection has been facilitated by advances in preoperative imaging. Due primarily to the rarity of MCNs, however, there is limited knowledge regarding the prognostic variables and high-risk factors for malignant transformation. A more comprehensive and nuanced approach is necessary to fill this gap and provide a basis for improved treatment decisions and patient outcomes. AIM: To investigate the high-risk factors associated with malignant MCNs and to explore the prognostic factors of MCN with associated invasive carcinoma (MCN-AIC). METHODS: All cases of resected MCNs from a single high-volume institution between January 2012 and January 2022 were retrospectively reviewed. Only cases with ovarian-type stroma verified by progesterone receptor staining were included. Preoperative features, histological findings and postoperative course were documented. Multivariate logistic regression was employed to investigate variables related to malignancy. Survival analysis was performed using the Kaplan-Meier curve, and the prognostic factors were assessed to evaluate the postoperative course of patients with MCN-AIC. RESULTS: Among the 48 patients, 36 had benign MCNs, and 12 had malignant MCNs (1 high-grade atypical hyperplasia and 11 MCN-AIC). Age, tumour size, presence of solid components or mural nodules and pancreatic duct dilatation were identified as independent risk factors associated with malignancy. The follow-up period ranged from 12 mo to 120 mo, with a median overall survival of 58.2 mo. Only three patients with MCN-AIC died, and the 5-year survival rate was 70.1%. All 11 cases of MCN-AIC were stage I, and extracapsular invasion was identified as a prognostic factor for poorer outcomes. CONCLUSION: The risk factors independently associated with malignant transformation of MCNs included age, tumour size, presence of solid components or mural nodules, and pancreatic duct dilatation. Our study also revealed that encapsulated invasion was a favourable prognostic factor in MCN-AIC patients.


Subject(s)
Carcinoma, Pancreatic Ductal , Neoplasms, Cystic, Mucinous, and Serous , Pancreatic Neoplasms , Receptors, Progesterone , Humans , Carcinoma, Pancreatic Ductal/epidemiology , Carcinoma, Pancreatic Ductal/pathology , Carcinoma, Pancreatic Ductal/surgery , East Asian People , Neoplasms, Cystic, Mucinous, and Serous/epidemiology , Neoplasms, Cystic, Mucinous, and Serous/pathology , Neoplasms, Cystic, Mucinous, and Serous/surgery , Pancreatic Neoplasms/epidemiology , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Prognosis , Retrospective Studies
7.
Gynecol Oncol ; 175: 8-14, 2023 08.
Article in English | MEDLINE | ID: mdl-37267674

ABSTRACT

OBJECTIVES: We sought to compare outcomes between minimally invasive surgery (MIS) and laparotomy in patients with clinical stage I uterine serous carcinoma (USC). METHODS: Patients who underwent surgery for newly diagnosed USC between 11/1/1993 and 12/31/2017 were retrospectively identified and assigned to either the MIS cohort or the laparotomy cohort. Patients with conversion to laparotomy were analyzed with the MIS cohort. Chi-square and Mann-Whitney tests were used to compare categorical and continuous variables, respectively. Kaplan-Meier curves were used to estimate survival and compared using the log-rank test. RESULTS: In total, 391 patients met inclusion criteria; 242 underwent MIS (35% non-robotic and 65% robotic-assisted laparoscopies) and 149 underwent laparotomy. Age, BMI, stage, and washings status did not differ between cohorts. Patients who underwent MIS were less likely to have lymphovascular space invasion (LVSI; 35.1% vs 48.3%), had fewer nodes removed (median, 9 vs 15), and lower rates of paraaortic nodal dissection (44.6% vs 65.1%). Rates of adjuvant therapy did not differ between cohorts. Median follow-up times were 63.0 months (MIS cohort) vs 71.0 months (laparotomy cohort; P = .04). Five-year PFS rates were 58.7% (MIS) vs 59.8% (laparotomy; P = .1). Five-year OS rates were 65.2% (MIS) compared to 63.5% (laparotomy; P = .2). On multivariable analysis, higher stage, deep myometrial invasion, and positive washings were associated with decreased PFS. Age ≥ 65 years, higher stage, LVSI, and positive washings were associated with shorter OS. CONCLUSIONS: MIS does not compromise outcomes in patients with newly diagnosed USC and should be offered to these patients to minimize surgical morbidity.


Subject(s)
Laparoscopy , Neoplasms, Cystic, Mucinous, and Serous , Robotic Surgical Procedures , Uterine Cervical Neoplasms , Neoplasms, Cystic, Mucinous, and Serous/surgery , Laparoscopy/methods , Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Uterine Cervical Neoplasms/surgery , Treatment Outcome
8.
Gastrointest Endosc Clin N Am ; 33(3): 655-677, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37245941

ABSTRACT

Historically, the management of pancreatic cystic neoplasms (PCN) has been operative. Early intervention for premalignant lesions, including intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN), offers an opportunity to prevent pancreatic cancer-with potential decrement to patients' short-term and long-term health. The operations performed have remained fundamentally the same, with most patients undergoing pancreatoduodenectomy or distal pancreatectomy using oncologic principles. The role of parenchymal-sparing resection and total pancreatectomy remains controversial. We review innovations in the surgical management of PCN, focusing on the evolution of evidence-based guidelines, short-term and long-term outcomes, and individualized risk-benefit assessment.


Subject(s)
Neoplasms, Cystic, Mucinous, and Serous , Pancreatectomy , Pancreatic Intraductal Neoplasms , Pancreatic Neoplasms , Neoplasms, Cystic, Mucinous, and Serous/pathology , Neoplasms, Cystic, Mucinous, and Serous/surgery , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Pancreatectomy/trends , Clinical Decision-Making , Patient-Centered Care , Humans , Pancreatic Intraductal Neoplasms/pathology , Pancreatic Intraductal Neoplasms/surgery
9.
HPB (Oxford) ; 25(7): 747-757, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37003852

ABSTRACT

BACKGROUND: Mucinous Cystic Neoplasms (MCN) of the pancreas are premalignant cysts for which current guidelines support pancreatic resection. The primary aim of this systematic review and meta-analysis is to define the pooled rate of malignancy for MCN. METHODS: A systematic review of eligible studies published between 2000 and 2021 was performed on PubMed and Embase. Primary outcome was rate of malignancy. Data regarding high-risk features, including cyst size and mural nodules, were collected and analyzed. RESULTS: A total of 40 studies and 3292 patients with resected MCN were included in the final analysis. The pooled rate of malignancy was 16.1% (95%CI 13.1-19.0). The rate of malignant MCN in studies published before 2012 was significantly higher than that of studies published after recent guidelines were published (21.0% vs 14.9%, p < 0.001). Malignant MCN were larger than benign (mean difference 25.9 mm 95%CI 14.50-37.43, p < 0.001) with a direct correlation between size and presence of malignant MCN (R2 = 0.28, p = 0.020). A SROC identified a threshold of 65 mm to be associated with the diagnosis of malignant MCN. Presence of mural nodules was associated with the diagnosis of a malignant MCN (OR = 4.34, 95%CI 3.00-6.29, p < 0.001). CONCLUSION: Whereas guidelines recommend resection of all MCN, the rate of malignancy in resected MCN is 16%, implying that surveillance has a role in most cases, and that surgical selection criteria are warranted. Size and presence of mural nodules are significantly associated with an increased risk of malignant degeneration, small MCN and without mural nodules can be considered for surveillance.


Subject(s)
Neoplasms, Cystic, Mucinous, and Serous , Pancreatic Neoplasms , Precancerous Conditions , Humans , Pancreatic Neoplasms/pathology , Pancreas/pathology , Neoplasms, Cystic, Mucinous, and Serous/surgery , Neoplasms, Cystic, Mucinous, and Serous/pathology , Precancerous Conditions/pathology , Risk Factors , Retrospective Studies
10.
Pancreatology ; 23(3): 258-265, 2023 Apr.
Article in English | MEDLINE | ID: mdl-36906508

ABSTRACT

BACKGROUND: The ideal surveillance strategy after partial pancreatectomy for non-invasive IPMN remains undefined and existing guidelines provide conflicting recommendations. The present study was developed in anticipation of the joint meeting of the International Association of Pancreatology (IAP) and the Japan Pancreas Society (JPS) held in Kyoto in July 2022. METHODS: An international team of experts developed the four clinical questions (CQ) to operationalize issues pertaining to surveillance of patients in this context. A systematic review was designed following the PRISMA guidelines and registered in PROSPERO. The search strategy was executed in PubMed/Medline (Ovid), Embase, the Cochrane Library and Web of Science databases. Four investigators individually extracted data from the selected studies and drafted recommendations for each CQ. These were subsequently discussed and agreed upon that the IAP/JPS meeting. RESULTS: From a total of 1098 studies identified through the initial search, 41 studies were included in the review and informed the recommendations. No studies providing level one data were identified in this systematic review, all studies included were cohort or case-control studies. CONCLUSIONS: There is a lack of level 1 data addressing the issue of surveillance of patients following partial pancreatectomy for non-invasive IPMN. The definition of remnant pancreatic lesion in this setting is largely heterogeneous across all studies evaluated. Herein we propose an inclusive definition of remnant pancreatic lesions to guide future prospective efforts for reporting the natural history and long-term outcomes of these patients.


Subject(s)
Carcinoma, Pancreatic Ductal , Neoplasms, Cystic, Mucinous, and Serous , Pancreatic Intraductal Neoplasms , Pancreatic Neoplasms , Humans , Carcinoma, Pancreatic Ductal/pathology , Pancreatic Intraductal Neoplasms/surgery , Pancreatic Intraductal Neoplasms/pathology , Pancreatic Neoplasms/pathology , Pancreatectomy/adverse effects , Retrospective Studies , Neoplasms, Cystic, Mucinous, and Serous/surgery
12.
J Surg Oncol ; 127(6): 1019-1027, 2023 May.
Article in English | MEDLINE | ID: mdl-36825427

ABSTRACT

BACKGROUND: Incomplete cytoreduction for mucinous appendiceal neoplasms is often required to temporarily alleviate symptoms. The surgical technology for this intervention may be complex and result in extensive morbidity and even mortality. Knowledgeable patient selection for this surgery is mandatory. METHODS: A database was used to identify patients who had palliative surgery that included total abdominal colectomy (TAC). Clinical- and treatment-related variables were assessed for their impact on overall survival. RESULTS: Seventy-eight patients had an incomplete cytoreductive surgery (CRS) that included a TAC. The median survival was 2.5 years and the median follow-up was 2 years. Patients with symptoms of abdominal distention and ascites showed a reduced prognosis (p = 0.0254). The low-grade appendiceal mucinous neoplasms (LAMN) and mucinous appendiceal adenocarcinoma intermediate type (MACA-Int) grouped together showed a prolonged survival (p = 0.0003). MACA with positive lymph nodes showed a reduced survival (p = 0.0009) when compared to MACA patients without positive lymph nodes. A peritoneal cancer index of 1-30 versus >30 and completeness of cytoreduction score of 2 versus 3 were not significant. CONCLUSION: TAC with end ileostomy was used as a treatment option to provide palliation of patients having an incomplete CRS for appendiceal mucinous neoplasms. With LAMN or MACA-Int, median survival was 5.0 years. The surgery can be performed with a morbidity of 9.0% and mortality of 2.6%. Although not considered a palliative option in the past, these data suggest TAC may be used with acceptable results in this group of patients.


Subject(s)
Adenocarcinoma, Mucinous , Appendiceal Neoplasms , Hyperthermia, Induced , Neoplasms, Cystic, Mucinous, and Serous , Peritoneal Neoplasms , Humans , Appendiceal Neoplasms/pathology , Peritoneal Neoplasms/secondary , Peritoneum/surgery , Neoplasms, Cystic, Mucinous, and Serous/surgery , Adenocarcinoma, Mucinous/surgery , Colectomy , Cytoreduction Surgical Procedures/methods , Hyperthermia, Induced/methods , Survival Rate , Retrospective Studies
13.
Am J Surg ; 225(4): 630-638, 2023 04.
Article in English | MEDLINE | ID: mdl-36424200

ABSTRACT

INTRODUCTION: Mucinous cystic neoplasms (MCN) are mucin-producing epithelial cell tumors of pancreas. They consist of an ovarian-type stroma expressing estrogen and progesterone receptors. Pregnancy-associated MCNs are presumed to be larger in size and more aggressive without any concrete evidence. OBJECTIVE: and Data Sources: Systematic review of published literature using PubMed and Google Scholar databases. Original articles including case reports and series published between 1970&2021 were included wherein MCN was diagnosed during pregnancy/within one-year post-partum. Thirty-three publications having 36 cases, adding one of our own patient were analyzed in this review. RESULT: Median age at presentation was 32 years. Only three (9%) patients were asymptomatic. Mean size of MCN was 135 mm. Ten patients (27%) reported an increase in size during pregnancy. Most tumors involved body and tail of pancreas (60%). Distal pancreatectomy with splenectomy was the most common resection performed (57%). No foetal mortality was reported to date. CONCLUSION: Pregnancy may cause a rapid increase in size of MCN. Decision-making is more complex and needs a fine balance between optimal oncological and obstetric outcomes.


Subject(s)
Cystadenocarcinoma, Mucinous , Neoplasms, Cystic, Mucinous, and Serous , Pancreatic Neoplasms , Female , Pregnancy , Humans , Adult , Pancreatic Neoplasms/pathology , Neoplasms, Cystic, Mucinous, and Serous/surgery , Pancreas/surgery , Pancreatectomy , Epithelial Cells/pathology , Cystadenocarcinoma, Mucinous/surgery
14.
Int J Surg Pathol ; 31(5): 646-650, 2023 Aug.
Article in English | MEDLINE | ID: mdl-35946118

ABSTRACT

Isolated metastases from non-gynecological cancers to the fallopian tube are rare. Recent literature suggests that mucosal alterations of the fallopian tube should be considered primary tubal lesions. This has led to a paradigm shift in the classification of ovarian tumors with studies proposing tubal origin for these tumors, and clinicians advocating distal salpingectomy to decrease rates of ovarian cancer. This is based on the theory that sole presence of tubal mucosal disease is evidence of tubal origin. We present two patients with isolated mucosal metastases to the fallopian tube from appendiceal tumors. Two 36- and 72-year-old women presented with adnexal masses. Both had a history of right hemicolectomy for low-grade appendiceal mucinous neoplasms. The tubes in both cases were distended with mucin. Microscopic examination showed multifocal low-grade mucinous epithelium with papillations and tufting, interspersed by normal tubal epithelium. The mucinous epithelium was diffusely positive for keratin 20 and CDX2, focally positive for keratin 7, and negative for ER and PAX8 in both cases. Ovaries showed acellular mucin pools. Based on morphology and immunohistochemical features, it is likely that these tumors are of primary appendiceal origin metastatic to fallopian tube mucosa. These cases are unique in that no other organs were involved by metastases raising the possibility of an in-situ lesion or benign tubal mucinous metaplasia. These cases bring up an important point that mucosal metastasis can occur and question the current practice of assigning primary origin of a tumor to the fallopian tube in the presence of "intraepithelial" tumor.


Subject(s)
Appendiceal Neoplasms , Carcinoma in Situ , Fallopian Tube Neoplasms , Neoplasms, Cystic, Mucinous, and Serous , Neoplasms, Glandular and Epithelial , Ovarian Neoplasms , Humans , Female , Adult , Middle Aged , Aged , Fallopian Tubes/pathology , Fallopian Tube Neoplasms/pathology , Appendiceal Neoplasms/surgery , Appendiceal Neoplasms/pathology , Ovarian Neoplasms/pathology , Neoplasms, Glandular and Epithelial/pathology , Mucous Membrane/pathology , Carcinoma in Situ/pathology , Neoplasms, Cystic, Mucinous, and Serous/surgery , Neoplasms, Cystic, Mucinous, and Serous/pathology , Mucins
16.
Diagn Pathol ; 17(1): 37, 2022 Apr 14.
Article in English | MEDLINE | ID: mdl-35422044

ABSTRACT

The occurrence of endocrine cell micronests in ovarian tumors is rarely reported. To our knowledge, there are only three prior cases reported to date: one occurring in an ovarian mucinous cystadenoma, one in an ovarian mucinous cystadenofibroma, and another in an ovarian mucinous carcinoma with a predominant borderline component. This is a 27-year-old woman that presented with a one-month history of abdominal pain and fullness. Imaging studies revealed a large multiloculated cystic and solid mass measuring 23 cm occupying the majority of the pelvis and abdomen concerning for a primary ovarian malignancy. The patient underwent a right salpingo-oophorectomy with appendectomy. Histologic sections from the ovary showed a multiloculated, cystic and focally solid mass lined by gastrointestinal-type mucinous epithelium with variable degrees of proliferation accounting for greater than 10% of the tumor. In addition to the mucinous epithelial component, there were several foci of bland, monotonous epithelioid cells arranged in solid nests with focal tubular/acinar formation within the fibrous septa and mucinous epithelium. Immunohistochemical studies showed that these cells were positive for cytokeratin, EMA, and synaptophysin, while negative for inhibin. The Ki-67 proliferation index was low (<1%). The presence of endocrine cell nests associated with an ovarian mucinous neoplasm is a rare phenomenon. Whether this represents preservation of endocrine cells in the context of epithelial degeneration or an independent neoplastic component is unclear. Progression related to this endocrine cell proliferation is unlikely and the recognition of this phenomenon holds more diagnostic value than prognostic significance, as it could be confused with microinvasion or sex cord stromal elements.


Subject(s)
Cystadenoma, Mucinous , Endocrine Cells , Neoplasms, Cystic, Mucinous, and Serous , Ovarian Neoplasms , Adult , Cystadenoma, Mucinous/diagnosis , Cystadenoma, Mucinous/pathology , Endocrine Cells/pathology , Female , Humans , Neoplasms, Cystic, Mucinous, and Serous/diagnosis , Neoplasms, Cystic, Mucinous, and Serous/surgery , Ovarian Neoplasms/pathology
17.
Rev. argent. cir ; 114(1): 51-57, mar. 2022. graf
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1376376

ABSTRACT

RESUMEN Las neoplasias mucinosas apendiculares son infrecuentes y se clasifican en neoplasias mucinosas de bajo grado, de alto grado y adenocarcinoma mucinoso. Se consideran precursoras del pseudomixoma peritoneal, caracterizado por la acumulación de mucina dentro de la cavidad abdominal. Informamos tres casos de neoplasia mucinosa apendicular de bajo grado, dos varones y una mujer, que presentaron dolor abdominal agudo, diagnosticados preoperatoriamente mediante tomografía y que fueron manejados con un abordaje laparoscópico (apendicectomía, resección parcial de ciego y colectomía derecha, respectivamente). Los tres casos tuvieron una buena evolución posoperatoria y no hubo complicaciones. Se concluye que las neoplasias mucinosas apendiculares son raras y no tienen una presentación clínica específica. El abordaje laparoscópico es una opción segura y factible. La frecuencia y la duración del seguimiento de estos pacientes es motivo de controversia.


ABSTRACT Appendiceal mucinous neoplasms are rare and are classified in low-grade mucinous neoplasm, high-grade mucinous neoplasm and mucinous adenocarcinoma. They are considered precursors of pseudomyxoma peritonei, characterized by the accumulation of mucin within the abdominal cavity. We report three cases of low-grade appendiceal mucinous neoplasm, two men and one woman, who presented with acute abdominal pain. The diagnoses were made preoperatively by computed tomography scan and the tumors were managed through laparoscopic approach (appendectomy, partial resection of the cecum and right colectomy, respectively). The three patients evolved with favorable postoperative outcome without complications. Appendiceal mucinous neoplasms are rare without specific clinical presentation. The laparoscopic approach is a safe and feasible option. The frequency and duration of surveillance in these patients are still controversial.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Appendiceal Neoplasms/surgery , Neoplasms, Cystic, Mucinous, and Serous/surgery , Mucocele/surgery , Appendectomy , Laparoscopy , Colectomy , Neoplasms, Cystic, Mucinous, and Serous/pathology , Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging
18.
Eur J Surg Oncol ; 48(1): 275-282, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34753619

ABSTRACT

BACKGROUND: Lymphadenectomy is debated in patients with ovarian cancer. The aim of our study was to evaluate the impact of lymphadenectomy in patients with high-grade serous ovarian cancer receiving neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). METHODS: A retrospective, unicentric study including all patients undergoing NACT and IDS was carried out from 2005 to 2018. Patients with and without lymphadenectomy were compared in terms of recurrence free survival (RFS), overall survival (OS), and complication rates. RESULTS: We included 203 patients. Of these, 133 had a lymphadenectomy (65.5%) and 77 had involved nodes (57.9%). Patients without a lymphadenectomy were older, had a more extensive disease and less complete CRS. No differences were noted between the lymphadenectomy and no lymphadenectomy group concerning 2-year RFS (47.4% and 48.6%, p = 0.87, respectively) and 5-year OS (63.2% versus 58.6%, p = 0.41, respectively). Post-operative complications tended to be more frequent in the lymphadenectomy group (18.57% versus 31.58%, p = 0.09). In patients with a lymphadenectomy, survival was significantly altered if the nodes were involved (positive nodes: 2-year RFS 42.5% and 5-year OS 49.4%, negative nodes: 2-year RFS 60.7% and 5-year OS 82.2%, p = 0.03 and p < 0.001, respectively). CONCLUSION: Lymphadenectomy during IDS does not improve survival and increases post-operative complications.


Subject(s)
Carcinoma, Ovarian Epithelial/surgery , Cytoreduction Surgical Procedures/methods , Lymph Node Excision/methods , Neoplasms, Cystic, Mucinous, and Serous/surgery , Ovarian Neoplasms/surgery , Postoperative Complications/epidemiology , Aged , Antineoplastic Agents/therapeutic use , Carcinoma, Ovarian Epithelial/pathology , Disease-Free Survival , Female , Humans , Middle Aged , Neoadjuvant Therapy , Neoplasms, Cystic, Mucinous, and Serous/pathology , Ovarian Neoplasms/pathology , Retrospective Studies , Risk Assessment , Survival Rate
19.
Eur J Surg Oncol ; 48(1): 268-274, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34753617

ABSTRACT

OBJECTIVE: To evaluate factors impacting survival outcomes in patients with uterine serous carcinoma (USC). METHODS: Data of consecutive patients diagnosed with USC undergoing surgery between 2000 and 2020 at Fondazione IRCCS Istituto Nazionale Tumori of Milan (Italy) were reviewed. Progression-free (PFS) and overall survival (OS) outcomes were evaluated using Kaplan-Meier and Cox proportional hazard models. RESULTS: Records of 147 consecutive patients meeting the inclusion criteria were analyzed. Stage distribution was: 67 (45.6%) patients with early-stage with uterine confined disease and 80 (54.4%) with advanced stages disease. Minimally invasive surgery was performed in 43 patients (29.5%). The median follow-up period was 78.6 months (IQ range = 35.7-117.3 months). The overall recurrence rate was 41% (60 patients): 19/67 patients (28.4%) with early-stage disease and 41/80 patients (51.3%) with advanced stage. The 5-year PFS rate was 35.0% (95% confidence interval [CI]: 27.5-44.7%). In multivariate analysis, age, BMI, depth of myometrial invasion, cytology, and optimal cytoreduction with postoperative residual tumor absent significantly impacted on PFS. The 5-year OS rates were 46.5% (95% CI: 38.1-56.8). The result of multivariate analysis showed that there was significant difference in OS based only on optimal cytoreduction and accuracy of retroperitoneal surgery. CONCLUSIONS: In apparent early-stage USC, peritoneal and retroperitoneal staging allows to identify patients with disease harboring outside the uterus. Optimal cytoreduction is the most significant prognostic factor. Further collaborative studies are warranted in order to improve outcomes of USC patients.


Subject(s)
Carcinoma/surgery , Endometrial Neoplasms/surgery , Hysterectomy , Lymph Node Excision , Neoplasms, Cystic, Mucinous, and Serous/surgery , Adult , Aged , Carcinoma/pathology , Cytoreduction Surgical Procedures , Endometrial Neoplasms/pathology , Female , Humans , Kaplan-Meier Estimate , Lymph Nodes , Middle Aged , Myometrium/pathology , Neoplasm Invasiveness , Neoplasm Staging , Neoplasm, Residual , Neoplasms, Cystic, Mucinous, and Serous/pathology , Peritoneal Neoplasms/secondary , Positron Emission Tomography Computed Tomography , Progression-Free Survival , Proportional Hazards Models , Retroperitoneal Neoplasms/secondary , Sentinel Lymph Node Biopsy , Tertiary Care Centers
20.
Gynecol Oncol ; 164(2): 333-340, 2022 02.
Article in English | MEDLINE | ID: mdl-34895897

ABSTRACT

OBJECTIVE: Practice guidelines advocating for regionalization of endometrial cancer surgery to gynecologic oncologists practicing in designated gynecologic oncology centres were published in Ontario in June 2013. Our objectives were to determine whether this policy affected surgical wait times, and whether longer wait time to surgery is a predictor of survival in high grade endometrial cancer patients. METHODS: This was a population-based retrospective cohort study, which included patients diagnosed with high-grade non-endometrioid endometrial cancer who had a hysterectomy between 2003 and 2017. Multivariable Cox proportional hazards regression with a spline function was used to model the relationship between surgical wait time and overall survival (OS). RESULTS: We identified 3518 patients who underwent hysterectomy for high-grade non-endometrioid endometrial cancer. Patients who had surgery with a gynecologic oncologist had a median surgical wait time from diagnosis to hysterectomy of 53 days compared to 57 days pre-regionalization (p = 0.0007), and from first gynecologic oncology consultation to hysterectomy of 29 days compared to 32 days pre-regionalization (p = 0.0006). Survival was inferior for patients who had surgery within 14 days of diagnosis (HR death 2.7 for 1-7 days, 95% CI 1.61-4.51, and HR death 1.96 for 8-14 days, 95% CI 1.50-2.57), reflective of disease severity. Decreased survival occurred with surgical wait times of more than 45 days from the patient's first gynecologic oncology appointment (HR death 1.19 for 46-60 days, 95% CI 1.04-1.36, and HR death 1.42 for 61-75 days, 95% CI 1.11-1.83). CONCLUSIONS: Regionalization of surgery for high-grade endometrial cancer has not had an impact on surgical wait times. Patients who have surgery more than 45 days after surgical consultation have reduced survival.


Subject(s)
Adenocarcinoma/surgery , Carcinosarcoma/surgery , Endometrial Neoplasms/surgery , Hysterectomy/statistics & numerical data , Neoplasms, Cystic, Mucinous, and Serous/surgery , Time-to-Treatment/statistics & numerical data , Adenocarcinoma/pathology , Aged , Carcinosarcoma/pathology , Endometrial Neoplasms/pathology , Female , Humans , Middle Aged , Multivariate Analysis , Neoplasm Grading , Neoplasm Staging , Neoplasms, Cystic, Mucinous, and Serous/pathology , Ontario , Proportional Hazards Models , Survival Rate
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