RESUMO
Background: Rectal cancer is a public health priority. Primary objectives of this study were to evaluate the quality of care for non-metastatic rectal cancer using process and outcome indicators. Delay of management, length of stay and readmission rate, sphincter preservation, morbidity, number of examined lymph nodes, mortality, overall and disease-free survivals were evaluated. Secondary objectives were to estimate the relationship between possible predictive parameters for (1) anastomotic leakage (logistic regression), (2) overall or disease-free survivals (cox regression).Methods: We performed a retrospective study on 312 consecutive patients diagnosed with primary rectal cancer between 2016 and 2019. We focused on the 163 patients treated by surgery for non-metastatic cancer.Results: The treatment began within 33 days (range 0-264) after incidence, resection rate was 67%. Digestive continuity rate in lower, middle and upper rectum was 30%, 87% and 96%. Median of 14 lymph nodes (range 1-46) was analyzed. Length of stay and readmission rate were 11 days (range 3-56) and 4%, respectively. Within 90 postoperative days, clinical anastomotic leakage occurred in 9.2% of cases, major morbidity rate was 17%, mortality 1.2%. Multivariate analysis revealed that stoma decreased the risk of anastomotic leakage [hazard ratio: 0.16; 95% confidence intervals: 0.04-0.63; p = 0.008]. The 5-year overall survival after surgery was 85 ± 4%, disease-free survival 83 ± 4%. Patients with major complications, male gender and R1/R2 resection margin had a poorer prognosis.Conclusion: This work showed encouraging results in rectal cancer treatment in our institution, our results were in line with recommendations at the time.
RESUMO
Fatty liver disease is a common condition that rarely occurs on a multifocal mode. In this form, the differential diagnosis with hepatic carcinomatosis is not obvious, especially when a neoplastic condition coexists. Radiologically, MRI can almost systematically differentiate these two entities. However, concerning metabolic imaging with [18F]FDG PET/CT it is important to keep in mind that a multifocal hepatic steatosis may appear hypermetabolic in rare cases. By mimicking a typical presentation of metastatic carcinomatosis, it may lead to a false positive result. Here we report the case of a 73-year-old woman with a recent diagnosis of colorectal cancer. As part of the initial assessment, a MRI of the liver is performed and shows multiple lesions described as multifocal steatosis. A [18F]FDG PET/CT subsequently describes the same liver lesions but assimilates them to colorectal metastatic carcinomatosis. Due to this mismatch between the two different imaging modalities, several biopsies of the liver lesions are performed, first echoguided (two different lesions) then surgically (removal of a third lesion). The pathological analysis of the specimens fails to highlight any malignant lesion and the diagnosis of multifocal steatohepatitis is made.
La stéatose hépatique est une pathologie fréquente. Dans de rares cas, elle peut se présenter sous forme de lésions multifocales. Le diagnostic différentiel avec une carcinomatose hépatique n'est alors pas toujours évident, surtout lorsque coexiste un contexte néoplasique. Radiologiquement, l'IRM permet presque systématiquement de faire la différence entre ces deux entités. Concernant l'imagerie métabolique au [18F]FDG PET/CT, il est important de garder à l'esprit que les plages de stéatose hépatique multifocales peuvent apparaître hypermétaboliques dans de rares cas. Mimant en tout point une présentation typique de carcinomatose métastatique, elles peuvent mener à un résultat faussement positif. Nous rapportons ici le cas d'une patiente de 73 ans chez qui un diagnostic de cancer colorectal vient d'être posé. Lors du bilan d'extension initial, une IRM hépatique met en évidence de multiples lésions décrites comme des plages de stéatose multifocale. Un [18F]FDG PET/CT réalisé parallèlement interprète ces mêmes lésions comme une carcinomatose métastatique du cancer colorectal. Face à cette discordance entre les deux modalités d'imagerie, des biopsies hépatiques, d'abord échoguidées à deux reprises, puis une biopsie-exérèse chirurgicale, sont réalisées. In fine, l'anatomopathologie ne retrouve aucune cellule néoplasique et le diagnostic de stéatohépatite multifocale hypermétabolique est retenu.
Assuntos
Fígado Gorduroso , Neoplasias Hepáticas , Neoplasias Peritoneais , Idoso , Fígado Gorduroso/diagnóstico por imagem , Feminino , Fluordesoxiglucose F18 , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tomografia por Emissão de Pósitrons , Compostos RadiofarmacêuticosRESUMO
The development of pulmonary nodules or lymph nodes in the course of a malignancy, in particular breast cancer, can sometimes correspond to the onset of sarcoidosis. Osteolytic lesions can simultaneously occur which further strengthens the impression of a metastatic disease. No particular test, biological markers or imaging technique, has a satisfactory discriminating power and a biopsy is needed to establish the correct diagnosis and decide on the adequate treatment. The concomitance of sarcoidosis and cancer raises the possibility of a granolumatous disease.
