RESUMEN
OBJECTIVE: To evaluate survival in patients with metastatic iliac nodal involvement from carcinoma of the penis. PATIENTS AND METHODS: Thirteen patients with metastases to the iliac nodes were selected from 68 with squamous cell carcinoma of the penis who had undergone amputation and bilateral ilio-inguinal lymphadenectomy. The 1978 Tumour-Nodes-Metastasis system was used for staging. Deep and superficial lymph nodes were removed during the inguinal procedure. Lymph nodes below the common iliac artery (external and obturator) were removed and histologically evaluated for the presence of metastases. RESULTS: The mean (median, range) follow-up was 55.5 (8. 8, 0.3-235) months, at the end of which five patients were free of cancer, seven had died from cancer or treatment-related complications and one was lost to follow-up. Four of the five survivors had metastases to only one iliac lymph node. CONCLUSION: Ilio-inguinal lymphadenectomy may have a significant role in increasing the survival of patients with metastases to only one iliac lymph node.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Escisión del Ganglio Linfático/métodos , Neoplasias del Pene/cirugía , Adulto , Anciano , Carcinoma de Células Escamosas/secundario , Humanos , Ilion , Metástasis Linfática , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
PURPOSE: The major issue in penile cancer is deciding who should or should not undergo lymph node dissection. Clinical and invasive methods are not reliable for staging. Clinical and pathological factors involved in lymph node metastases and prognosis were evaluated in 145 patients with penile carcinoma staged according to the 1978 TNM system, and treated with amputation and lymphadenectomy. MATERIALS AND METHODS: Clinical factors studied were patient age, race, disease evolution time, symptoms, and clinical T and N stages. Pathological factors of the primary tumor considered were tumor thickness, histological grade, lymphatic and venous embolization, infiltration of the corpora cavernosa, corpus spongiosum and urethra, mononuclear and eosinophilic infiltrates, and cell alterations suggestive of human papillomavirus. All slides were reviewed by 1 pathologist. The Cox regression hazards method for multifactorial analysis was used. RESULTS: Followup ranged from 0.7 to 453.2 months (mean 85.8, median 32.7). The 5-year disease-free and overall survival rates were 45.3 and 54.3%, respectively. Venous and lymphatic embolizations were the main factors affecting significantly the incidence of lymph node metastasis, which were the main risks factors for recurrence and death. Pathologically proved infiltration of the corpora cavernosa, urethra and adjacent structures, which corresponded to stages T2, T3 and T4 disease, respectively, of the current TNM classification, were not significant predictors for incidence of lymph node metastasis, disease-free and overall survival or risk factors for recurrence and death. CONCLUSIONS: Because venous and lymphatic embolizations were related to greatest risk of lymph node metastasis, we propose their evaluation in staging and therapeutic planning of patients with infiltrative tumors of the penis.
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Amputación Quirúrgica , Carcinoma de Células Escamosas/cirugía , Escisión del Ganglio Linfático , Neoplasias del Pene/cirugía , Adulto , Anciano , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/secundario , Supervivencia sin Enfermedad , Estudios de Seguimiento , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Análisis Multivariante , Neoplasias del Pene/mortalidad , Neoplasias del Pene/patología , Pronóstico , Tasa de SupervivenciaRESUMEN
The accuracy of an alternative method of preparing cytologic smears from material collected under laparoscopic examination was studied. "Washed-biopsy" cytology was performed by saline solution lavage of the fragments using a cytocentrifuge. Rich and well-preserved cellularity was obtained. Among 51 cases, cytology revealed 12 benign, 3 suspicious and 36 malignant cases, including 9 true negatives, 3 false negatives and 36 true positives. Suspicious cases were excluded from the analysis. The sensitivity, specificity, positive and negative predictive values, and efficiency, when comparing the cytologic to the definitive diagnoses, were, respectively, 92.3%, 100.0%, 100.0%, 75.0% and 93.7%. We recommend the routine use of the washed-biopsy method in laparoscopic examinations to improve the accuracy of cytologic investigations.
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Neoplasias Abdominales/patología , Técnicas de Preparación Histocitológica , Neoplasias Abdominales/ultraestructura , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
A case of calculous cholecystitis and rudimentary appendix in a 45 year old female patient with complete situs inversus is reported. After radiologic and sonographic examination, surgical treatment resulted in symptoms relief. A high index of suspection is imperative for the precise diagnostic and therapeutic approach.