RESUMEN
Multiple myeloma is a deadly hematopoietic malignancy. Despite therapeutic advances such as autologous stem cell transplantation and novel chemotherapeutics, multiple myeloma remains incurable. Multiple myeloma cell localization in the bone marrow and the cross-talk with the bone niche trigger dramatic alterations in the bone marrow microenvironment critical for tumor progression, resistance to therapies and osteolytic bone destruction. It does not surprise that the molecular bases of such fatal interaction are under examination as source of novel potential pharmacological targets. Among these, the Notch family of receptors and ligands has gained growing interest in the recent years because of their early deregulation in multiple myeloma and their ability to affect multiple features of the disease, including tumor cell growth, drug resistance, angiogenesis and bone lesions. This review will explore the evidences of Notch deregulation in multiple myeloma, the state of the art of the currently known roles of its signaling in the fatal interaction between multiple myeloma cells, extracellular matrix and cells in the bone marrow stroma. Finally, we will present recent findings concerning the arguments for or against a therapy addressed to Notch signaling inhibition in the cure of multiple myeloma.
Asunto(s)
Mieloma Múltiple/etiología , Receptores Notch/fisiología , Células de la Médula Ósea/fisiología , Huesos/metabolismo , Adhesión Celular , Movimiento Celular , Progresión de la Enfermedad , Humanos , Péptidos y Proteínas de Señalización Intercelular/fisiología , Proteína Jagged-2 , Proteínas de la Membrana/fisiología , Mieloma Múltiple/inmunología , Mieloma Múltiple/patología , Neovascularización Fisiológica , Osteólisis , Receptores CXCR4/fisiología , Transducción de SeñalRESUMEN
PURPOSE: We provide a contemporary review of bladder tumor markers and summarize their role as prognostic indicators. MATERIALS AND METHODS: A comprehensive review of the literature on prognostic markers for transitional cell carcinoma of the bladder was performed. RESULTS: Intense research efforts are being made to identify and characterize better various bladder cancers and their true biological potential. The need to predict which superficial tumors will recur or progress and which invasive tumors will metastasize has led to the identification of a variety of potential prognostic markers. Blood group antigens, tumor associated antigens, proliferating antigens, oncogenes, peptide growth factors and their receptors, cell adhesion molecules, tumor angiogenesis and angiogenesis inhibitors, and cell cycle regulatory proteins have recently been identified. The potential clinical applications of these tumor markers are under active investigation. Recent attention has focused on which tumor markers may predict the responsiveness of a particular bladder cancer to systemic chemotherapy. CONCLUSIONS: At present conventional histopathological evaluation of bladder cancer (tumor grade and stage) cannot predict accurately the behavior of most bladder tumors. With a better understanding of the cell cycle, and cell to cell and cell to extracellular matrix interactions as well as improved diagnostic techniques (immunohistochemistry), progress is being made to identify and characterize other potential prognostic markers for transitional cell carcinoma of the bladder. The ultimate goal is to develop reliable prognostic markers that will accurately predict not only the course but also the response of a tumor to therapy. This information may then be used to dictate more aggressive treatment for tumors that are likely to progress and less aggressive treatment for those that are unlikely to progress. In the future these biological markers may also be used in gene therapy for the treatment of bladder cancer.
Asunto(s)
Carcinoma de Células Transicionales , Neoplasias de la Vejiga Urinaria , Antígenos de Neoplasias , Biomarcadores de Tumor , Carcinoma de Células Transicionales/genética , Carcinoma de Células Transicionales/inmunología , Carcinoma de Células Transicionales/patología , Moléculas de Adhesión Celular , Proteínas de Ciclo Celular , Factor de Crecimiento Epidérmico , Predicción , Humanos , Neovascularización Patológica , Oncogenes/genética , Pronóstico , Neoplasias de la Vejiga Urinaria/genética , Neoplasias de la Vejiga Urinaria/inmunología , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
BACKGROUND: The authors evaluated the experiences at their institution with radical cystectomy and urinary diversion performed on elderly bladder carcinoma patients to determine whether age had an impact on the clinical or functional results for this group of patients. METHODS: Between August 1971 and December 1996, 404 patients age 70 years or older (median age, 74 years) underwent radical cystectomy and urinary diversion for invasive bladder carcinoma: 352 (87%) were ages 70-79 years and 52 (13%) were age 80 years or older. Data analyzed included the following: perioperative mortality; early (within 90 days after surgery) and late (more than 90 days after surgery) postoperative complications, related and unrelated to the urinary diversion; length of hospital stay; pathologic staging; and clinical outcome. These data were then compared with those for 762 patients younger than 70 years (median age, 61 years) who underwent the same procedure during the same time period. RESULTS: The overall mortality rate for patients age 70 years or older was 2.8% (3.2% for those ages 70-79 years, 0% for those age 80 years or older), compared with 2% for patients younger than 70 years. The early complication rate for patients age 70 years or older was 32%, compared with 25% for patients younger than 70 years. Patients age 80 years or older had a similar early complication rate of 29%. Late postoperative complications occurred in 12.4% of patients age 70 years or older, compared with 22.8% of patients younger than 70 years. There was no significant difference between the two groups with regard to pathologic stage or length of hospital stay. The 3-year and 5-year overall survival rates for patients age 70 years or older were 60% and 53%, respectively, compared with 68% and 63%, respectively, for patients younger than 70 years (P=0.001). There was no statistical difference between the groups when rates of disease recurrence were compared (P=0.3627). The 5-year recurrence rate for patients age 70 years or older was 35%, compared with a 5-year recurrence rate of 31% for patients younger than 70 years. CONCLUSIONS: These data suggest that an aggressive, curative, radical surgical approach and urinary diversion may be a viable treatment strategy for properly selected elderly patients who are in generally good health and require definitive therapy for invasive bladder carcinoma.
Asunto(s)
Cistectomía , Neoplasias de la Vejiga Urinaria/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Neoplasias de la Vejiga Urinaria/mortalidad , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
A unique case is reported of a left adrenal cortical carcinoma with a splenic vein tumor thrombus. En bloc radical nephroadrenalectomy, distal pancreatectomy, splenectomy and splenic vein tumor thrombectomy were performed. Reconstruction of the proximal portal vein was required, incorporating a segment of the left renal vein (harvested from the surgical specimen) as a free interposition graft, bridging the defect between the superior mesenteric vein and portal vein. To our knowledge, this is the first reported case of an adrenal cortical carcinoma associated with a splenic vein tumor thrombus. In addition, the described technique used to reconstruct the proximal portion of the portal vein has not been previously reported.
Asunto(s)
Neoplasias de la Corteza Suprarrenal/complicaciones , Carcinoma/secundario , Vena Esplénica , Trombosis/complicaciones , Neoplasias Vasculares/secundario , Neoplasias de la Corteza Suprarrenal/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Carcinoma/diagnóstico por imagen , Femenino , Humanos , Trombosis/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: Salvage surgery followed by lower urinary tract reconstruction is a viable therapeutic option for patients in whom definitive radiation therapy for localized bladder or prostate cancer has failed. Improvements in surgical technique and postoperative care have significantly improved overall outcome. An enhanced understanding of the rhabdoid sphincteric mechanism responsible for maintaining urinary continence following cystoprostatectomy has helped make the orthotopic neobladder the procedure of choice for patients requiring lower urinary tract reconstruction. We describe our experience with salvage surgery and orthotopic bladder substitution following failed radical radiation therapy. MATERIALS AND METHODS: We evaluated the complications of 18 patients in whom definitive radiation therapy (total minimum dose 60 Gy. or greater) for bladder or prostate cancer had failed. All patients underwent a salvage procedure with creation of an orthotopic neobladder. RESULTS: Operative characteristics, postoperative outcomes and postoperative complications related or unrelated to urinary reconstruction were similar between irradiated and nonirradiated patients. Good day and night continence following surgery was reported by 67 and 56% of irradiated patients, respectively. Patients with poor postoperative continence were successfully treated with the placement of an artificial urinary sphincter. CONCLUSIONS: Salvage surgery with orthotopic urinary reconstruction is a safe, effective procedure that provides a functional lower urinary tract in patients in whom definitive pelvic radiation therapy has failed.
Asunto(s)
Cistectomía , Prostatectomía , Neoplasias de la Próstata/cirugía , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria , Anciano , Anciano de 80 o más Años , Cistectomía/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Prostatectomía/efectos adversos , Neoplasias de la Próstata/radioterapia , Terapia Recuperativa , Insuficiencia del Tratamiento , Neoplasias de la Vejiga Urinaria/radioterapia , Derivación Urinaria/efectos adversos , Incontinencia Urinaria/epidemiologíaRESUMEN
We report a case of a 13-year-old boy who developed an acute left hemiscrotum following a laparoscopic appendectomy for a perforated appendicitis. Laparoscopic techniques have provided surgeons and their patients with effective and less invasive methods to treat illness that previously required open surgery. However, complications can occur with these new surgical modalities. It is incumbent upon the surgeon to carefully document and evaluate these complications, facilitating preventive measures, and allow for a proper and timely diagnosis and treatment plan in the future. Herein, we present a previously unreported urologic complication of an acute scrotum following a laparoscopic appendectomy for a perforated appendicitis.
Asunto(s)
Enfermedades de los Genitales Masculinos/etiología , Laparoscopía/efectos adversos , Escroto , Hidrocele Testicular/complicaciones , Adolescente , Apendicitis/cirugía , Humanos , Perforación Intestinal , Masculino , Rotura EspontáneaRESUMEN
OBJECTIVE: To report the diagnosis and treatment of six patients with adrenocortical adenocarcinoma and venous tumour thrombus extension. PATIENTS AND METHODS: All six patients (four female and two male, age range 14-83 years) were approached surgically through a thoracoabdominal incision and all underwent radical ablative surgery with removal of the primary tumour, regional retroperitoneal lymphadenectomy and en bloc extraction of the venous tumour thrombus. RESULTS: Five patients with right-sided tumours had vena caval tumour thrombus involvement and one patient with a left-sided tumour had extension of tumour thrombus into the splenic vein. All patients had appropriate radiographic evaluation pre-operatively and all underwent successful radical surgery with en bloc resection of the venous tumour thrombus. CONCLUSION: For optimal management of this rare neoplasm, it is paramount that accurate diagnostic imaging be performed pre-operatively to help dictate the ideal surgical approach and to optimize successful treatment of this disease.
Asunto(s)
Neoplasias de la Corteza Suprarrenal/cirugía , Carcinoma Corticosuprarrenal/cirugía , Trombosis/cirugía , Vena Cava Inferior/cirugía , Adolescente , Neoplasias de la Corteza Suprarrenal/diagnóstico , Carcinoma Corticosuprarrenal/diagnóstico , Carcinoma Corticosuprarrenal/secundario , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Trombosis/diagnósticoRESUMEN
We report a rare case of a 24-year-old woman who presented during her second trimester of pregnancy with a presumptive diagnosis of right-sided xanthogranulomatous pyelonephritis (XGP). Despite attempted conservative management, the patient ultimately required a right nephrectomy without complications to either the patient or fetus. Pathology confirmed the diagnosis of XGP of the right kidney. Herein, we present a case report and a review of the literature concerning XGP and pregnancy.