RESUMO
BACKGROUND: Retroperitoneal ganglioneuromas are rare entities. Their treatment is complete surgical resection. Due to the proximity to major vessels, variable location and unknown malignant status, surgeons are often reluctant to use a laparoscopic approach for the resection of retroperitoneal masses. To our knowledge, only five cases of laparoscopic resection of retroperitoneal ganglioneuroma have been previously reported. CLINICAL CASE: We present the case of a 53-year-old woman who complained of intense, diffuse, stabbing, intermittent, nonradiating abdominal pain sharpest in both flanks during the preceding 6 months. A contrast-enhanced CT scan showed a well-defined, homogeneous 4-cm mass located in the retroperitoneum, extending from the exit of the inferior mesenteric vessels up to the renal veins. A laparoscopic anterior transperitoneal approach was performed with infraumbilical Hasson trocar and two 10-mm trocars in both iliac fossas. Operation time was 90 min. The patient was discharged on the second postoperative day. Histopathology reported a retroperitoneal ganglioneuroma. After 12 months follow-up, the patient is alive and disease-free. CONCLUSIONS: For digestive surgeons not used to the retroperitoneal access through the lateral position, the anterior transperitoneal approach can be a safe alternative for the resection of retroperitonal neoplasms.
Assuntos
Ganglioneuroma/cirurgia , Laparoscopia , Neoplasias Retroperitoneais/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , PeritônioRESUMO
BACKGROUND: Surgical resection is the only potentially curative treatment for pancreatic cancer, but it is associated with high complication rates. Outcome is poor, even in those resected cases. Identification of prognostic factors preoperatively may help to improve treatment of these patients, based on the expected response. METHODS: A retrospective study of clinical variables of 59 patients with histological diagnosis of pancreatic carcinoma at University Hospitals Ramon y Cajal and La Princesa (Madrid, Spain) between 1999 and 2003 was performed. RESULTS: We analyzed 59 patients (32 males and 27 females) with a mean age of 63.76 years. All patients were operated on, performing palliative surgery in 32% and tumor resection in 68%, including pancreaticoduodenectomy in 51% and distal pancreatectomy in 17%. Median overall survival was 14 months (range: 1-110 months). We observed that the presence of abdominal pain (p = 0.042) and back pain (p = 0.004) at diagnosis, palpation of abdominal mass at physical examination (p = 0.012), preoperative levels of hemoglobin <12 g/dl (p = 0.0006) and serum albumin <2.8 g/dl (p = 0.021), perineural infiltration (p = 0.025), lymph node affection (p = 0.004), stages II, III, and IV (p = 0.001), and presence of residual tumor (R+) (p = 0.008) are all associated with poor survival. CONCLUSIONS: Abdominal and back pain, palpation of abdominal mass at physical examination, preoperative levels of hemoglobin <12 g/dl and serum albumin <2.8 g/dl, perineural infiltration, lymph node affection, stages II, III, and IV, and the presence of residual tumor are associated with poor outcome.
Assuntos
Neoplasias Pancreáticas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
The cancer stem cells hypothesis arises from observation of normal tissue hierarchy and the demonstration of stem cells in normal tissues. Scientists continue to debate whether the putative cancer cells derive from the transformation of normal tissue stem cells or from more differentiated cells. The existence of a subpopulation of tumour cells with stem-cell-like characteristics, including very slow replication and resistance to standard chemotherapy, posses a novel therapeutic challenge. This review summarises the state of development of normal and cancer breast cells and the clinical and therapeutic relevance.