RESUMEN

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare low grade tumor with a locally aggressive behavior and low metastatic potential. OBJECTIVES: To evaluate the factors that are associated with relapse in DFSP. Methods Retrospective analysis of medical records from 61 patients with dermatofibrosarcoma. Fluorescence in situ hybridization was used to detect translocations. RESULTS: Of 61 patients, 6 experienced a relapse. No patient with resection margins greater than 3 cm had a recurrence. One relapse was observed in a patient treated with at least 2 cm margins and 4 relapses occurred in 16 patients whose margins were below 2 cm (P = 0.018). The frequency of translocations was 77.8%. The recurrence rate was lower in patients with translocation, but this difference was not significant. Immunohistochemical markers did not correlate with recurrence rates, but greater FasL expression was associated with recurrence in patients with margins smaller than 3 cm. CONCLUSIONS: Surgical margins smaller than than 2 cm are related to higher recurrences in dermatofibrosarcomas. In this analysis a 2 cm margin was acceptable for treatment. Between all the immunohistochemical markers analyzed, only FasL was associated with a higher recurrence rate in patients with margins smaller than 3 cm.

Asunto(s)

Biomarcadores de Tumor/metabolismo , Dermatofibrosarcoma/patología , Recurrencia Local de Neoplasia/patología , Neoplasias Cutáneas/patología , Translocación Genética , Adolescente , Adulto , Anciano , Apoptosis , Proliferación Celular , Niño , Preescolar , Dermatofibrosarcoma/genética , Dermatofibrosarcoma/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/metabolismo , Pronóstico , Estudios Retrospectivos , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/metabolismo , Adulto Joven

RESUMEN

Dermatofibrosarcoma protuberans (DFSP) is a locally invasive neoplasia with a pattern of infiltrative growth that leads to extended resections. To avoid unnecessary resections and spare tissues, its treatment requires an adequate assessment of the margins. We present a case where artificial dermis (Matriderm®) was used followed by skin graft for reconstruction. We present a 50-year-old woman with a DFSP in the occipital region. She was referred to us after a first surgery with positive margins. A wide local excision with a 2-cm margin was performed and periosteal tissue was also removed, which led to exposure of the skull. Matriderm was placed on the bone surface and dressings were changed every other day. Meanwhile, margins were evaluated by the complete circumferential and peripheral deep margin assessment (CCPDMA) and were positive for DFSP in the superior margin. After 4 weeks the area was completely covered by granulation tissue and a new resection followed by reconstruction with a skin graft was performed. With regard to the difficulties in the margin assessment in DFSP, we present artificial dermis (Matriderm) as an option for reconstructive surgery in these patients, especially when a skin graft cannot be performed as a first option.

Asunto(s)

Colágeno , Dermatofibrosarcoma/cirugía , Elastina , Neoplasias de Cabeza y Cuello/cirugía , Cuero Cabelludo , Neoplasias Cutáneas/cirugía , Trasplante de Piel , Dermatofibrosarcoma/patología , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Persona de Mediana Edad , Neoplasias Cutáneas/patología , Piel Artificial

RESUMEN

BACKGROUND: The isolated limb infusion (ILI) technique is a simpler and less invasive alternative to isolated limb perfusion, which allows regional administration of high-dose chemotherapy to patients with advanced melanoma and other malignancies restricted to a limb. METHODS: Patients from two institutions, treated by ILI between 1998 and 2009 for extensive disease restricted to a limb, were included. The cohort included 31 patients with melanoma who presented with in-transit metastases or an extensive primary lesion, one patient with squamous cell carcinoma and another with epithelioid sarcoma not suitable for local surgical treatment. RESULTS: A complete response was achieved in 26.3% of patients and a partial response in 52.6%. Toxicity was assessed according to the Wieberdink limb toxicity scale. Grade II toxicity was noted in 39.5% of patients, grade III in 50% and grade IV in 10.5%. Toxicity was correlated with the results of a number of clinical and laboratory tests. The toxicity of melphalan and actinomycin D was dose-dependent. For melphalan, the relationship between toxicity and mean dose was as follows: grade II--34.7 mg; grades III and IV--47.5 mg (P = 0.012). The relationship between toxicity and maximum serum creatine phosphokinase (CPK) was as follows: grade II--431.5 U/L; grades III and IV--3228 U/L (P = 0.010). CONCLUSION: Toxicity after ILI is dose-dependent and serum CPK correlates with toxicity.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Quimioterapia del Cáncer por Perfusión Regional/efectos adversos , Hipertermia Inducida , Melanoma/terapia , Neoplasias Cutáneas/terapia , Adulto , Anciano , Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia del Cáncer por Perfusión Regional/métodos , Terapia Combinada , Dactinomicina/administración & dosificación , Relación Dosis-Respuesta a Droga , Extremidades , Femenino , Humanos , Masculino , Melfalán/administración & dosificación , Persona de Mediana Edad , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To assess the prevalence of the main metabolic alterations found in patients with recent diagnosis of urolithiasis in the West region of Paraná state, Brazil. MATERIALS AND METHODS: We made a retrospective study on 425 patients with evidence of recent formation of renal stones. Laboratory assessment consisted in 3 samples of 24-hour urine with dosing of calcium, uric acid, citrate, oxalate, sodium and creatinine. A urine culture was also made and qualitative cystinuria and urinary pH following 12-hour fasting and water restriction were evaluated. RESULTS: In 96.5 percent of patients a cause was detected for the urolithiasis. Metabolic alterations most frequently found were: hypercalciuria (38.3 percent), hypocitraturia (29.6 percent) and hyperexcretion of uric acid (21.6 percent). Low urinary volume (17.9 percent), urinary tract infection (12.9 percent), hyperparathyroidism (3.3 percent), renal tubular acidosis (1.2 percent), cystinuria (0.9 percent) and anatomical alterations (12.7 percent) were also observed. CONCLUSIONS: Hypercalciuria, hypocitraturia and hyperuricuria are the most frequent metabolic disorders in the population under study and these data are in accordance to the literature.

RESUMEN

OBJECTIVE: To assess the prevalence of the main metabolic alterations found in patients with recent diagnosis of urolithiasis in the West region of Parana state, Brazil. MATERIALS AND METHODS: We made a retrospective study on 425 patients with evidence of recent formation of renal stones. Laboratory assessment consisted in 3 samples of 24-hour urine with dosing of calcium, uric acid, citrate, oxalate, sodium and creatinine. A urine culture was also made and qualitative cystinuria and urinary pH following 12-hour fasting and water restriction were evaluated. RESULTS: In 96.5% of patients a cause was detected for the urolithiasis. Metabolic alterations most frequently found were: hypercalciuria (38.3%), hypocitraturia (29.6%) and hyperexcretion of uric acid (21.6%). Low urinary volume (17.9%), urinary tract infection (12.9%), hyperparathyroidism (3.3%), renal tubular acidosis (1.2%), cystinuria (0.9%) and anatomical alterations (12.7%) were also observed. CONCLUSIONS: Hypercalciuria, hypocitraturia and hyperuricuria are the most frequent metabolic disorders in the population under study and these data are in accordance to the literature.