RESUMO
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.
Assuntos
Recidiva Local de Neoplasia/epidemiologia , Sarcoma/mortalidade , Sarcoma/terapia , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criocirurgia/estatística & dados numéricos , Feminino , Humanos , Estimativa de Kaplan-Meier , Terapia a Laser/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/estatística & dados numéricos , Terapia Neoadjuvante/métodos , Terapia Neoadjuvante/estatística & dados numéricos , Gradação de Tumores , Recidiva Local de Neoplasia/prevenção & controle , Prognóstico , Radioterapia Adjuvante/estatística & dados numéricos , Fatores de Risco , Programa de SEER/estatística & dados numéricos , Sarcoma/diagnóstico , Sarcoma/patologia , Fatores Sexuais , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Carga Tumoral , Estados Unidos/epidemiologia , Adulto JovemRESUMO
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.
Assuntos
Falso Aneurisma/terapia , Tronco Braquiocefálico , Procedimentos Endovasculares/instrumentação , Lesões por Radiação/terapia , Stents , Lesões do Sistema Vascular/terapia , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/lesões , Tronco Braquiocefálico/efeitos da radiação , Procedimentos Endovasculares/efeitos adversos , Evolução Fatal , Feminino , Humanos , Mediastinite/microbiologia , Necrose , Seleção de Pacientes , Desenho de Prótese , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Radioterapia/efeitos adversos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologiaRESUMO
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.
