RESUMEN
OBJECTIVE: Elastofibroma dorsi (ED) is a rare benign tumor located in the subscapular region. The aim of this study was to evaluate our clinical findings, surgical approach, and management of ED patients based on single-center data with the relevant literature. METHODOLOGY: A retrospective evaluation was conducted on 20 patients who were operated on for ED. RESULTS: Of the 16 (80%) female patients and 4 (20%) male patients, the main complaint was swelling (80%), and 10 cases (50%) had unilateral involvement. All patients were operated on using standard surgical procedures. Despite a long follow-up period (6-53 months, mean of 26.6 months), no recurrences were observed. Two patients (10%) required simple needle aspiration due to post-operative seroma, and one patient, due to infection, required evacuation (5%). CONCLUSION: Although rare, ED should not be overlooked in patients with swelling in the back region. Our data suggests that surgery can be safely performed in such patients after a clinical and radiological diagnosis of ED has been established.
OBJETIVO: Evaluar los hallazgos clínicos, el enfoque quirúrgico y el manejo de los pacientes con urgencias a partir de los datos de un solo centro y la literatura relevante. MÉTODO: Se realizó una evaluación retrospectiva de 20 pacientes que fueron operados de ED. RESULTADOS: En los 16 (80%), pacientes del sexo femenino y cuatro (20%) del sexo masculino, la queja principal fue la tumefacción (80%) y 10 casos (50%) tuvieron afectación unilateral. Todos los pacientes fueron operados utilizando procedimientos quirúrgicos estándar. Con un largo periodo de seguimiento (6-53 meses, media de 26.6 meses), no se observaron recurrencias. Dos pacientes (10%) requirieron aspiración con aguja simple por seroma posoperatorio y un paciente (5%) requirió evacuación por infección. CONCLUSIONES: Aunque es raro, el ED no debe pasarse por alto en pacientes con hinchazón en la región de la espalda. Nuestros datos sugieren que la cirugía se puede realizar de manera segura en estos pacientes después de haber establecido el diagnóstico clínico y radiológico de ED.
Asunto(s)
Fibroma , Neoplasias de los Tejidos Blandos , Humanos , Masculino , Femenino , Estudios Retrospectivos , Fibroma/cirugía , Fibroma/diagnóstico por imagen , Fibroma/patología , Persona de Mediana Edad , Adulto , Anciano , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Seroma/etiologíaRESUMEN
BACKGROUND: Radiation-associated soft tissue sarcomas (RA-STS) are rare complications of patients receiving radiation therapy (RT) and are generally associated with a poor prognosis. Most of the literature surrounding RA-STS of the chest is centered on angiosarcoma. Therefore, we aim to document the management and outcome of patients with non-angiosarcoma RA-STS of the chest. METHODS: We reviewed 17 patients (all female, median age 65 years) diagnosed with RA-STS. The most common primary malignancy was breast carcinoma (n = 15), with a median RT dose of 57.9 Gy. All patients underwent surgical resection; five patients (29%) received radiotherapy; and five patients (29%) received peri-operative chemotherapy. RESULTS: The 5-year local recurrence and metastatic-free survival were 61% and 60%, while the 5-year disease-specific survival was 53%. Local recurrence was associated with death due to disease (HR 9.06, p = 0.01). Complications occurred in nine of patients, most commonly due to a wound complication (n = 7). At the most recent follow-up, the median Musculoskeletal Tumor Society Score was 63%. CONCLUSION: RA-STS involving the chest wall are aggressive tumors with a high risk of local relapse and death due to disease. Local recurrence was associated with death due to disease; as such, we recommend aggressive surgical management with evaluation for adjuvant therapies.
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Recurrencia Local de Neoplasia , Sarcoma , Humanos , Femenino , Anciano , Persona de Mediana Edad , Sarcoma/radioterapia , Sarcoma/patología , Sarcoma/mortalidad , Sarcoma/terapia , Sarcoma/cirugía , Recurrencia Local de Neoplasia/patología , Neoplasias Inducidas por Radiación/patología , Neoplasias Inducidas por Radiación/mortalidad , Neoplasias Inducidas por Radiación/etiología , Neoplasias Inducidas por Radiación/cirugía , Anciano de 80 o más Años , Estudios Retrospectivos , Adulto , Neoplasias Torácicas/radioterapia , Neoplasias Torácicas/patología , Neoplasias Torácicas/mortalidad , Pared Torácica/patología , Pared Torácica/efectos de la radiación , Estudios de Seguimiento , Neoplasias de los Tejidos Blandos/radioterapia , Neoplasias de los Tejidos Blandos/mortalidad , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/terapia , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de la Mama/patología , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/terapiaRESUMEN
Spinocellular carcinoma is a tumor lesion that frequently occurs in photo-exposed areas, presenting characteristics such as keratinization, scaly areas and even ulcerations. Its potential for metastasis makes early identification and diagnosis essential in order to carry out correct treatment of said lesion. In the spectrum of spinocelullar carcinomas is Keratoacanthoma, which has been in debate about its origin and its benignity. We present the clinical evolution, treatment, results, and bibliographic review of a keratoacanthoma.
El carcinoma espinocelular es una lesión tumoral que se da frecuentemente en zonas foto-expuestas, presentando características tales como queratinización, zonas descamativas e incluso ulceraciones. Su potencial de metástasis hace imprescindible la identificación y diagnóstico precoz para poder realizar un correcto tratamiento de dicha lesión. Dentro de su espectro se encuentra el Queratoacantoma, el cual ha estado en debate sobre su origen y su benignidad. Nosotros presentamos la evolución clínica, tratamiento, resultados y revisión bibliográfica de un queratoacantoma.
Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Queratoacantoma , Tumor de Células Granulares/cirugía , Tumor de Células Granulares/diagnóstico por imagenRESUMEN
OBJECTIVES: The aim of this study was to evaluate the effect of STS resection in the thigh on MS and the HRQoL. METHODS: Fourteen adults patients with STS in the thigh who underwent wide resection and limb preservation were evaluated. The patients were submitted to the Mini-Mental State Examination (MMSE). A hand-held dynamometer was used to measure the MS the flexors, adductors, abductors, and extensors muscles of the operated and non-operated thighs and between the dominant and non-dominant operated sides. The Musculoskeletal Tumor Society (MSTS) and Short Form Health Survey-36 (SF-36) questionnaires were applied to quantify the psychometric properties of the HRQoL. The data were submitted to statistical analysis using the Wilcoxon test (MS), and Mann-Whitney and Spearman correlation (MSTS and SF-36) (α = 0.05). RESULTS: There was no significant difference in MS between the operated side and the non-operated side, and between the dominant and non-dominant operated side (ρ > 0.05). The MSTS presented a significant difference in the emotional acceptance for patients submitted to radiotherapy (ρ = 0.029). The SF-36 showed significant differences in the emotional aspect for patients submitted to chemotherapy (ρ = 0.027) and in the social aspect between the dominant and non-dominant operated side (ρ = 0.024). CONCLUSIONS: The HRQoL of adult patients is hampered after the treatment of STS even when MS is maintained.
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Sarcoma , Neoplasias de los Tejidos Blandos , Adulto , Humanos , Muslo/patología , Calidad de Vida , Psicometría , Sarcoma/cirugía , Sarcoma/patología , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/patología , Fuerza MuscularRESUMEN
OBJECTIVE: To report to what degree narrative operative reports for soft tissue sarcoma (STS) and mast cell tumor (MCT) resections met a predetermined template made up of essential elements. ANIMALS: 197 consecutive client-owned animals between May 1, 2017, and August 1, 2022. PROCEDURES: A consensus list of 9 elements made up the final synoptic operative report (SR) template. Consecutive narrative surgery reports (NRs) of dogs that underwent MCT or STS resection were then reviewed to determine how many of the SR elements were present in each NR. A score was then determined for each NR out of a maximum total of 9. RESULTS: Overall, 197 reports (99 MCT and 98 STS) were included. The median score was 5 (56% of elements reported). No report had all 9 elements, and 1 report had none of the elements reported. When MCT and STS were analyzed independently, the median score was 6 (67% of elements reported) for MCT and 5 (56% of elements reported) for STS. There was a trend of more cases with MCT that had a preoperative diagnosis, intraoperative measurements of the tumor, and surgeon margins marked compared to dogs with STS. More dogs with STS had an estimated Enneking dose compared to dogs with MCT. CLINICAL RELEVANCE: Our data show that essential elements of STS and MCT resection in dogs were inconsistently recorded and no case had all elements present. This mirrors data in people and presses the need for more standardization in reporting of cancer operations in veterinary medicine.
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Enfermedades de los Perros , Sarcoma , Neoplasias de los Tejidos Blandos , Perros , Animales , Mastocitos/patología , Enfermedades de los Perros/cirugía , Enfermedades de los Perros/patología , Sarcoma/cirugía , Sarcoma/veterinaria , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/veterinaria , Estudios RetrospectivosRESUMEN
Pelvic soft tissue sarcomas (PSTS) are a rare, heterogeneous group of tumors. They have been usually analyzed with retroperitoneal sarcomas (RPS), but actually have key differences. Due to their unique anatomic location, symptomatic presentation of PSTS may be more common than RPS. Adequate imaging approach is paramount for guiding differential diagnosis, while preoperative biopsy is mandatory, especially when preoperative treatment may be considered as initial approach. The most frequent histologic subtype is leiomyosarcoma, which is different as expected in the retroperitoneum where liposarcoma is the commonest histology. Also solitary fibrous tumor is commonly diagnosed in the pelvis. Surgical approach for PSTS differs from that for RPS mainly due to anatomic relations. Similarly, in the lack of definite evidence from specific trials about neoadjuvant and adjuvant treatments, the anatomic constraints to obtain wide margins in the pelvis as well as the expected functional outcome in case of organ resections should be factored into decision for individualized treatment offer. Vascular and genitourinary involvement are frequent, as well as herniation through pelvic foramina. For these reasons a multidisciplinary surgical team should always be considered. Early referral of these patients to high-volume centers is critical and may impact on survival, given that optimal initial resection is a major predictor of curative treatment. International consensus on PSTS treatment is advocated, similarly to the recent efforts realized for RPS.
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Leiomiosarcoma , Liposarcoma , Neoplasias Retroperitoneales , Sarcoma , Neoplasias de los Tejidos Blandos , Humanos , Sarcoma/diagnóstico , Sarcoma/terapia , Sarcoma/patología , Liposarcoma/patología , Leiomiosarcoma/diagnóstico , Leiomiosarcoma/cirugía , Pelvis/patología , Neoplasias Retroperitoneales/diagnóstico , Neoplasias Retroperitoneales/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/cirugía , Recurrencia Local de Neoplasia/patologíaRESUMEN
BACKGROUND: Intraoperative molecular imaging (IMI) has been shown to improve lesion detection during pulmonary sarcomatous metastasectomy. Our goal in this study was to evaluate whether data garnered from IMI-guided resection of pulmonary sarcoma metastasis translate to improved patient outcomes. STUDY DESIGN: Fifty-two of 65 consecutive patients with a previous history of sarcomas found to have pulmonary nodules during screening were enrolled in a nonrandomized clinical trial. Patients underwent TumorGlow the day before surgery. Data on patient demographics, tumor biologic characteristics, preoperative assessment, and survival were included in the study analysis and compared with institutional historical data of patients who underwent metastasectomy without IMI. p values < 0.05 were considered significant. RESULTS: IMI detected 42 additional lesions in 31 patients (59%) compared with the non-IMI cohort where 25% percent of patients had additional lesions detected using tactile and visual feedback only (p < 0.05). Median progression-free survival (PFS) for patients with IMI-guided pulmonary sarcoma metastasectomy was 36 months vs 28.6 months in the historical cohort (p < 0.05). IMI-guided pulmonary sarcoma metastasectomy had recurrence in the lung with a median time of 18 months compared with non-IMI group at 13 months (p < 0.05). Patients with synchronous lesions in the IMI group underwent systemic therapy at a statistically higher rate and tended to undergo routine screening at shorter interval. CONCLUSIONS: IMI identifies a subset of sarcoma patients during pulmonary metastasectomy who have aggressive disease and informs the medical oncologist to pursue more aggressive systemic therapy. In this setting, IMI can serve both as a diagnostic and prognostic tool without conferring additional risk to the patient.
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Neoplasias Pulmonares , Metastasectomía , Sarcoma , Neoplasias de los Tejidos Blandos , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Metastasectomía/efectos adversos , Metastasectomía/métodos , Imagen Molecular , Neumonectomía/métodos , Pronóstico , Estudios Retrospectivos , Sarcoma/diagnóstico por imagen , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Tasa de SupervivenciaRESUMEN
El tumor fibroblástico superficial de tejidos blandos positivo para antígeno CD34 (CD34) es un tumor raro, de baja frecuencia, que se caracteriza histológicamente por un marcado pleomorfismo, baja actividad mitótica, e inmunoreactividad difusa para CD34. Puede tener un comportamiento similar al de un tumor mesenquimal de malignidad intermedia. Existen sólo 52 casos publicados en la literatura. Se presenta el caso de una paciente de 31 años con una masa en tejidos blandos en región inguinal izquierda, de crecimiento progresivo, de varios meses de evolución dolorosa. La masa fue biopsiada y, con la sospecha de un tumor fibroblástico superficial positivo para CD34, fue posteriormente tratada con una resección ampliada de la lesión y con cobertura del defecto en la piel con un colgajo local de avance de V-Y, con una evolución satisfactoria en su seguimiento postquirúrgico. El reporte de patología confirmó la sospecha diagnóstica de un tumor con reactividad fuerte para CD34, con proteína P53 en 60% a 70%, antígeno Ki67 menor al 15%, sin pérdida de proteína nuclear INI-1, y negatividad para CD31, CD163, AE1AE3, CAM5.2, EMA, CD30, receptores de progestágenos, proteína S100, y desmina, con bordes negativos.
Superficial CD34 (CD34) antigen positive fibroblastic soft-tissue tumor is a rare, lowfrequency tumor, characterized histologically by marked pleomorphism, low mitotic activity, and diffuse immunoreactivity for CD34. It may behave like a mesenchymal tumor of intermediate malignancy. There are only 52 cases published in the literature. We present the case of a 31-year-old patient with a long progressive and painful growth of a soft-tissue lesion in the left inguinal region. The mass was biopsied and, with the suspicion of a superficial CD34-positive fibroblast tumor, it was subsequently treated with an enlarged resection of the lesion and covering the skin defect with a local V-Y advancement flap, with a satisfactory evolution in the postoperative follow-up. The pathology report confirmed the diagnostic suspicion of a tumor with strong reactivity for CD34, with P53 protein in 60% to 70%, Ki67 antigen in less than 15%, without loss of INI-1, and with negativity for CD31, CD163, AE1AE3, CAM5.2, EMA, CD30, progestin receptors, S100 protein and desmin, with negative borders.
Asunto(s)
Humanos , Femenino , Adulto , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/patología , Antígenos CD34 , Neoplasias Cutáneas/patologíaRESUMEN
Little is known about soft tissue sarcomas (STS) in Brazil, once the federal statistics regarding estimates on incidence and mortality of the most common cancers that affect the Brazilian population currently do not include STS. This study aims to perform a broad evaluation and description of the epidemiological profile, access to treatment and main clinical outcomes of the Brazilian STS patient. A population-based cohort study of 66,825 patients who underwent procedures related to STS treatment registered in the Brazilian public health system (Sistema Único de Saúde, SUS) databases. Median age was 57 years, 30% of them older than 65 years and 50.7% of the cohort was female. The majority, 50,383 patients (75.4%), was diagnosed between 2008 and 2015. Most prevalent anatomic sites were upper and lower limbs (12.6%) and the registry of sarcomas without a specific location comprehended 29.7% of the cohort. The majority of patients resided in the Northeast (40.2% of the patients). Surgery was the first treatment modality in 77.7% of the cases. For survival analysis, only patients with stage and histological grade information were included. The 1-, 5- and 10-year survival rate of the patients was, respectively, 75.4% (95% CI = 74.1-76.7%), 43.4% (95% CI = 41.5-45.5%) and 18.6% (95% CI = 14.8-23.3%).
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Sarcoma/epidemiología , Neoplasias de los Tejidos Blandos/epidemiología , Adolescente , Adulto , Anciano , Brasil/epidemiología , Bases de Datos Factuales , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Prevalencia , Probabilidad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Sarcoma/diagnóstico , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/cirugía , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
Inflammatory myofibroblastic tumor (IMT) is a lesion of intermediate biological potential with local recurrences and rare metastases found in multiple anatomical locations. We present a case of a pure intraarticular IMT of the knee, a location that has not been previously documented, with genetic confirmation of ALK-CARS fusion detected with next-generation sequencing. A 20-year-old healthy male was admitted to the orthopedic oncology department due to several months of pain and restriction in movement of his left knee. On magnetic resonance imaging, multiple intraarticular nodular lesions were seen. The patient underwent 2 synovectomies within the course of 1 year. The initial biopsy was interpreted as nodular fasciitis. The second biopsy revealed exuberant tissue displaying compact fascicles of spindle cells intermixed with myxoid areas in a background of inflammatory cells, highly suggestive for IMT. Due to the unusual intraarticular location, equivocal ALK immunostaining and the differential diagnosis with nodular fasciitis, we performed targeted next-generation sequencing using Archer FusionPlex Sarcoma panel, which can identify multiple fusions in a single assay. An ALK-CARS fusion was found, supporting the diagnosis of IMT. This report emphasizes the added value of broad molecular analysis in cases with unusual clinical presentation, equivocal immunohistochemistry, and a wide differential diagnosis.
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Articulación de la Rodilla/patología , Proteínas de Fusión Oncogénica/genética , Neoplasias de los Tejidos Blandos/diagnóstico , Membrana Sinovial/patología , Aminoacil-ARNt Sintetasas/genética , Quinasa de Linfoma Anaplásico/genética , Biopsia , Procedimientos Quirúrgicos de Citorreducción , Diagnóstico Diferencial , Fascitis/diagnóstico , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/inmunología , Articulación de la Rodilla/cirugía , Imagen por Resonancia Magnética , Masculino , Neoplasias de los Tejidos Blandos/genética , Neoplasias de los Tejidos Blandos/inmunología , Neoplasias de los Tejidos Blandos/cirugía , Sinovectomía , Membrana Sinovial/diagnóstico por imagen , Membrana Sinovial/inmunología , Adulto JovenRESUMEN
Low-grade fibromyxoid sarcoma (LGFMS) is a rare sarcoma subtype. The most common tumor locations are the deep soft tissue of extremities or trunks. We report a rare case of recurrent LGFMS in the inguinal region involving the scrotum and both testicles. A 38-year-old male patient reported a history of multiple nodular lesions in the left inguinal region accompanied by local inflammation. The patient was submitted for local resection of the lesion at our institution, with histopathological diagnosis of LGFMS. He missed his follow-up, returning with a large bulge in the left inguinal region involving the scrotum with signs of tissue necrosis and local purulent discharge. Surgical exploration was performed and the patient underwent tumor resection in the left inguinal region and the entire scrotum, with bilateral orchiectomy, with the margins enlarged to the right inguinal region and proximal surface of the penis. Local reconstruction was performed with a left fascia lata tensor muscle flap and ipsilateral thigh coverage using partial skin graft. On microscopic examination, the tumor showed spindle cells arranged in bundles, with abundant collagen and myxoid stroma with interspersed prominent vessels. The immunohistochemical study carried out showed immunoreactivity with Ki67 (<5%), immunonegativity with desmin and S100, confirming the diagnosis of LGFMS. Postoperative recovery was good and no recurrence was seen after two years. The patient is in good health, realizing multidisciplinary outpatient follow-up and performing continuous testosterone replacement. Surgical resection with negative margins for localized disease remains the standard treatment for LGFMS.
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Fibrosarcoma/cirugía , Escroto/patología , Neoplasias de los Tejidos Blandos/cirugía , Adulto , Fibrosarcoma/patología , Humanos , Masculino , Escroto/cirugía , Neoplasias de los Tejidos Blandos/patologíaRESUMEN
BACKGROUND: Low-grade fibromyxoid sarcoma is a very rare tumor that tends to develop in deep soft tissues of young adults and has the potential for local recurrence and distant metastasis. CLINICAL CASE: We present the case of a 36-year-old man with a low-grade fibromyxoid sarcoma in the right shoulder, which was initially reported as a 4-year-old tumor, undergoing extensive resection with a histopathological report of low-grade fibromyxoid sarcoma, whose deep surgical edge was in bony contact. A simple and contrasted axial tomography was performed where an 8 mm left lung lesion was observed in the upper lobe lower lingular segment of heterogeneous content, hyperdense with contrast medium reinforcement. Left lateral thoracotomy is performed for metastasectomy and pathology corroborates the diagnosis of metastasis from fibromyxoid sarcoma. CONCLUSION: Low histological fibromyxoid sarcoma is a very rare tumor that must be differentiated from other soft tissue tumors. Recurrences and metastases are reported, despite short or prolonged disease-free periods of up to 50 years, so patients with a history of this tumor should be followed up.
INTRODUCCIÓN: El sarcoma fibromixoide de bajo grado es un tumor muy raro que tiende a desarrollarse en tejidos blandos profundos de jóvenes adultos y tiene el potencial de recurrencia local y metástasis a distancia. CASO CLÍNICO: Presentamos el caso de un hombre de 36 años con un sarcoma fibromixoide de bajo grado en el hombro derecho, el cual fue inicialmente reportado como un tumor, de 4 años de evolución, sometido a resección amplia con reporte histopatológico de sarcoma fibromixoide de bajo grado, cuyo borde quirúrgico profundo estaba en contacto con el hueso. Se realizó tomografía simple y contrastada, en la que se observó una lesión pulmonar izquierda de 8 mm en el lóbulo superior, segmento inferior lingular, de contenido heterogéneo, hiperdensa con reforzamiento del medio de contraste. Se realizó toracotomía lateral izquierda para metastasectomía y el estudio patológico corroboró el diagnóstico de metástasis del sarcoma fibromixoide. CONCLUSIÓN: El sarcoma fibromixoide de bajo grado histológico es un tumor muy raro que se debe diferenciar de otros tumores de tejidos blandos. Se reportan recidivas y metástasis, a pesar de periodos libres de enfermedad cortos o prolongados de hasta 50 años, por lo que se debe dar seguimiento a los pacientes con el antecedente de este tumor.
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Fibrosarcoma , Sarcoma , Neoplasias de los Tejidos Blandos , Adulto , Preescolar , Fibrosarcoma/diagnóstico , Fibrosarcoma/cirugía , Humanos , Masculino , Recurrencia Local de Neoplasia , Sarcoma/diagnóstico , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/cirugía , Tomografía Computarizada por Rayos XAsunto(s)
Lipoma/patología , Neoplasias de los Tejidos Blandos/patología , Adipocitos/patología , Femenino , Humanos , Biopsia Guiada por Imagen , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Enfermedades Raras , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/cirugía , Tejido Subcutáneo/patología , Tomografía Computarizada por Rayos X , Ultrasonografía , Adulto JovenAsunto(s)
Humanos , Femenino , Adulto Joven , Neoplasias de los Tejidos Blandos/patología , Lipoma/patología , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Ultrasonografía , Adipocitos/patología , Tejido Subcutáneo/patología , Enfermedades Raras , Biopsia Guiada por Imagen , Lipoma/cirugía , Lipoma/diagnóstico por imagenRESUMEN
OBJECTIVES: Misnaming low-grade lipomatous tumors poses a clinical and medicolegal challenge, potentially subjecting patients to expensive and unnecessary surgeries. The terms atypical lipomatous tumor (ALT) and "well-differentiated" liposarcoma (WDL) have been used interchangeably in pathology reports, scholarly works and consensus recommendations, creating vagaries between low-virulence extremity tumors and retroperitoneal disease with metastatic potential. METHODS: A systematic review was performed on all studies that reported on the local recurrence rate and metastasis of ALTs and WDLs in living human subjects. Local recurrence and metastases were compared using Fisher's Exact Test. RESULTS: In total, 20 studies evaluated ALTs (n=936), whereas 13 studied WDLs (n=626). Mean follow-up was 6.6±2.0 years (median, 7.0 y). No metastatic disease was observed among ALTs, whereas 15 patients with WDLs (2.7%, P<0.0001) had metastases. The local recurrence rate of ALTs was significantly lower than WDLs after both marginal (15.1%, 141/936 vs. 46.0%, 288/626, P<0.0001) and wide excisions (3.3%, 2/59 in ALT vs. 17.4%, 19/109, P=0.007). CONCLUSIONS: ALT should be reserved for extremity lesions meeting appropriate histopathologic criteria that represent nonmetastatic disease, reducing over-diagnosis, over-treatment, and patient risk.
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Liposarcoma/patología , Liposarcoma/cirugía , Recurrencia Local de Neoplasia/mortalidad , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Biopsia con Aguja , Terapia Combinada , Diagnóstico Diferencial , Supervivencia sin Enfermedad , Extremidades/patología , Femenino , Humanos , Inmunohistoquímica , Hibridación Fluorescente in Situ , Liposarcoma/clasificación , Liposarcoma/epidemiología , Masculino , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/terapia , Neoplasias de los Tejidos Blandos/clasificación , Neoplasias de los Tejidos Blandos/epidemiología , Análisis de SupervivenciaRESUMEN
INTRODUCTION: Soft tissue sarcomas (SFT) are a group of rare and heterogeneous neoplasms (representing less than 1% of cancer in adults and 15% in pediatric patients), for which there is no updated records in the Latin American population. This study aims to describe the current situation of patients treated at a cancer institute in Latin America. METHODS: We obtained records from 250 patients with a diagnosis of SFT, treated at the National Institute of Neoplastic Diseases of Peru (INEN) during the period 2009-2013, with a mean follow-up of 62 months. The following data were recorded: epidemiological, clinical, treatment and follow-up. The analysis of global survival was done with the Cox proportional hazards model. RESULTS: SFT showed a greater frequency in males (60.8%), with a peak incidence after 50 years of age (69.6%). Tumor location was predominantly in the lower extremities (64.4%), and the most frequent histologic subtypes were: undifferentiated pleomorphic sarcoma (34%) and liposarcomas (25.6%); clinical stage iii was the most frequent (30.8%). The 5-year overall survival rate was 63.9%, while the statistical analysis found a significant association between global survival and the variables: age (>50 years), tumor size (>5cm), depth (subfascial), histologic grade (G3), local and distant recurrence, showing shorter survival times in these groups. CONCLUSIONS: This study has clarified the epidemiology, treatment and prognosis, as well as the variables that have an impact on the survival of the Latin American patients with SFT studied.
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Sarcoma/epidemiología , Sarcoma/mortalidad , Neoplasias de los Tejidos Blandos/epidemiología , Neoplasias de los Tejidos Blandos/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , América Latina/epidemiología , Liposarcoma/patología , Extremidad Inferior/patología , Masculino , Persona de Mediana Edad , Perú/epidemiología , Pronóstico , Sistema de Registros , Estudios Retrospectivos , Sarcoma/patología , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Adulto JovenRESUMEN
Leiomyomas within the foot are rare occurrences that are difficult to diagnose clinically and radiographically. They are benign and tend to be slow growing, often with minimal or no pain. We present an unusual case of a worker's compensation patient who presented with a new-onset mass within his foot that was thought to be a fibroma, but was later discovered to be a fast-growing leiomyoma after surgical excision. We also present a review of the literature regarding leiomyomas within the foot and ankle.
Asunto(s)
Pie/cirugía , Leiomioma/patología , Leiomioma/cirugía , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Adulto , Pie/diagnóstico por imagen , Humanos , Leiomioma/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Neoplasias de los Tejidos Blandos/diagnóstico por imagenRESUMEN
OBJECTIVE: To evaluate urinary tract and bowel function in children with sacrococcygeal teratoma, compare the findings with healthy children, and assess predictors of poor outcome. STUDY DESIGN: This was a controlled cohort study of all patients operated for sacrococcygeal teratoma at a tertiary pediatric surgery center, 2000-2013. Urinary and bowel function were compared with healthy control patients matched for age and sex. Perioperative and histopathologic risk factors were analyzed. RESULTS: In total, 17 patients with sacrococcygeal teratoma and 85 healthy control patients were included in the study. Patients with sacrococcygeal teratoma more often were reported to have uncontrolled voiding (12% vs 0%, P < .01), difficulty in bladder emptying (24% vs 0%, P < .001), and pyelonephritis (18% vs 1%, P < .05). Constipation was more common in patients with sacrococcygeal teratoma (47 % vs 14%, P < .05), but the overall bowel function score was equal in the 2 groups. Children with large tumors and immature histology were more likely to have a dysfunctional outcome (P < .05). CONCLUSIONS: Uncontrolled voiding, difficulty in bladder emptying, pyelonephritis, and constipation were more common in patients with sacrococcygeal teratoma than in healthy children. Dysfunctional outcome was more prevalent in children with large and immature teratomas.