RESUMO
BACKGROUND: Germ cell tumors are tumors composed of tissues derived from more than one of the three germinal layers. They are more common in the testes and ovaries, but can present in many different regions in the midline, including the sacral region, retroperitoneum, mediastinum, and brain. Testicular germ cell tumors generally metastasize to the retroperitoneum, lungs, and brain; metastases to soft tissue are very rare. CASE PRESENTATION: Here we describe a case of a single soft-tissue mass in the thigh of a 27-year-old man, with histology showing areas of mature teratoma tissues derived from the ectodermal and mesodermal lineages, and areas of immature teratoma tissue composed of small undifferentiated cells, with primitive neuroectodermal differentiation foci forming neuroepithelial elements - thus classified as immature teratoma. The patient had no other clinical or radiological evidence of involvement, besides the lymph nodes. CONCLUSION: The case presented suggests a rare and unexpected primary immature teratoma of the thigh.
Assuntos
Neoplasias de Tecidos Moles/patologia , Teratoma/patologia , Adulto , Biomarcadores Tumorais/análise , Biópsia , Diferenciação Celular , Linhagem da Célula , Evolução Fatal , Humanos , Imuno-Histoquímica , Masculino , Recidiva Local de Neoplasia , Neoplasias de Tecidos Moles/química , Neoplasias de Tecidos Moles/cirurgia , Teratoma/química , Teratoma/secundário , Teratoma/cirurgia , Coxa da Perna , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
INTRODUCTION: The management of a post-chemotherapy retroperitoneal mass secondary to testicular cancer can present a surgical challenge when involving adjacent organs or major vascular structures. We present the first video of a retroperitoneal lymph node dissection (RPLND) with IVC (inferior vena cava) thrombectomy, caval wall resection resulting from metastatic non-seminomatous germ cell testis (NSGCT) cancer. METHODS: In this surgical video, we highlight important surgical considerations in the management of a postchemotherapy retroperitoneal mass with direct IVC wall invasion and level 2 thrombus in such a patient. RESULTS: A 34 year old man underwent a right inguinal orchiectomy for a mixed NSGCT (embryonal, yolk sac, and teratoma components) and elevated serum tumor markers. He underwent systemic chemotherapy (BEP regimen x 4 cycles) with subsequent near normalization of tumor markers. His post-chemotherapy imaging revealed a 6 cm residual retroperitoneal mass with a level 2 IVC tumor thrombus and suspected direct infrarenal IVC wall invasion from the mass. The patient underwent an open post-chemotherapy RPLND, IVC thrombectomy, IVC resection and grafting. The final pathology report of the retroperitoneal mass revealed teratoma with no viable germ cell tumor elements and negative surgical margins. His intra-operative and post-operative stages were unremarkable with his IVC graft remaining patent and no evidence of disease recurrence at last follow-up. CONCLUSION: We present the first surgical video of a post-chemotherapy RPLND with IVC thrombectomy, caval wall resection and grafting for metastatic NSGCT. The final pathology report of teratoma with no viable tumor highlights the local vascular invasive potential of such pathology.
Assuntos
Excisão de Linfonodo/métodos , Neoplasias Retroperitoneais/secundário , Teratoma/secundário , Neoplasias Testiculares/patologia , Trombectomia/métodos , Veia Cava Inferior/cirurgia , Adulto , Humanos , Masculino , Neoplasias Retroperitoneais/cirurgia , Espaço Retroperitoneal , Teratoma/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Adulto , Humanos , Masculino , Excisão de Linfonodo/métodos , Neoplasias Retroperitoneais/secundário , Teratoma/secundário , Neoplasias Testiculares/patologia , Trombectomia/métodos , Veia Cava Inferior/cirurgia , Espaço Retroperitoneal , Neoplasias Retroperitoneais/cirurgia , Tomografia Computadorizada por Raios X , Teratoma/cirurgiaRESUMO
Introduction: The laparoscopic retroperitoneal lymph node dissection (L-RPLND) has shown results at least comparable to open surgery in terms of perioperative complications and oncological results, but its application in the post chemotherapy scenario is still matter of study. The development of robotic surgery and its advantages over laparoscopic surgery, make this an attractive option for complex procedures. We report our initial experience with robotic-assisted retroperitoneal lymph node dissection (R-RPLND). Methods: We describe the cases of two patients who underwent R-RPLND due to a Post Chemotherapy residual mass of a non-seminomatous testicular cancer. Results: Two patients, 27 and 30 years old, presented with retroperitoneal residual mass after 4 and 6 cycles of Bleomicin, Etoposide and Cis-Platinum. The first patient had a 4.3 cm left para-aortic mass and the other had a 6 cm mass behind the third portion of the duodenum. The mean surgical time was 255 minutes (210-300), with an estimated mean blood loss of 450 cc (100-800) and a mean hospital stay of 60 hours (72-48). The pathologic result was Teratoma in both cases. There was no periopera-tive morbidity. Conclusions: We believe that R-RPLND is a feasible and safe alternative in selected patients. However still needs more experience and longer follow up to asess its oncological outcome.
Introducción: La linfadenectomía retroperitoneal lumboaórtica laparoscópica (LRLA-L) ha demostrado resultados al menos comparables a la cirugía abierta en términos de complicaciones peri operatorias y resultados oncológicos. Sin embargo, su aplicación en el escenario postquimioterapia es todavía materia de estudio. El desarrollo de la cirugía robótica y sus ventajas sobre la cirugía laparoscópica hacen de este tipo de cirugía una opción atractiva para procedimientos más complejos como esta intervención postquimioterapia. Reportamos nuestra experiencia inicial en Linfadenectomía lumboaórtica laparoscópica robóticamente asistida postquimioterapia. Métodos: Describimos el caso de dos pacientes sometidos a una a una linfadenectomía retroperitoneal lumboaórtica asistida por robot (LRLA-R), portadores de una masa retroperitoneal postquimioterapia secundaria a un carcinoma testicular de células germinales no seminoma. Resultados: Dos pacientes, de 27 y 30 años de edad, con una masa retroperitoneal residual después de 4 y 6 ciclos de Bleomicina, Etoposido y Cis-Platinum respectivamente. El primer paciente presentó una masa para-aórtica izquierda de 4,3 cm y el segundo paciente una masa en relación a la tercera porción del duodeno de 6 cm. El tiempo operatorio promedio fue de 255 minutos (210-300) con un sangrado promedio estimado de 450 ml (100-800). El tiempo promedio de hospitalización fue de 60 hrs (48-72). En ambos casos el resultado histológico evidenció la presencia de Teratoma. No se presentaron complicaciones perioperatorias. Conclusiones: Creemos que la LRLA-R en pacientes con masa residual post-quimioterapia es una técnica reproducible y segura en pacientes seleccionados, sin embargo, todavía es necesario un mayor número de pacientes y tiempos de seguimiento para poder evaluar los resultados oncológicos.
Assuntos
Humanos , Masculino , Adulto , Excisão de Linfonodo , Laparoscopia/métodos , Neoplasias Testiculares/cirurgia , Robótica , Teratoma/secundário , Metástase Linfática , Neoplasias Testiculares/patologia , Neoplasias Testiculares/tratamento farmacológico , Espaço Retroperitoneal , Teratoma/cirurgiaRESUMO
BACKGROUND: Gliomatosis peritonei is the metastatic implantation of mature glial tissue within the peritoneal cavity of patients with ovarian teratomas. There is no clear guidance for how long these patients should be followed up. CLINICAL CASE: We report the follow-up imaging findings of a 33-year-old female with abdominal distension and abdominal pain and who was postoperatively diagnosed with immature ovarian teratoma with gliomatosis peritonei. CONCLUSIONS: Differentiation of peritoneal implants seems to be important for prognosis. Malignant transformations after several years cannot be excluded. Therefore, new studies will determine if it is necessary to create guidelines for the postsurgical monitoring of these patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Glioma/secundário , Neoplasias Ovarianas/patologia , Ovariectomia , Neoplasias Peritoneais/secundário , Teratoma/secundário , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Apendicectomia , Ascite/diagnóstico por imagem , Ascite/etiologia , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Terapia Combinada , Etoposídeo/administração & dosagem , Feminino , Glioma/diagnóstico por imagem , Glioma/tratamento farmacológico , Hepatectomia , Humanos , Histerectomia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Imagem Multimodal , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/tratamento farmacológico , Tomografia por Emissão de Pósitrons , Esplenectomia , Neoplasias Esplênicas/secundário , Neoplasias Esplênicas/cirurgia , Teratoma/diagnóstico por imagem , Teratoma/tratamento farmacológico , Teratoma/patologia , Teratoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Lumboaortic lymphadenectomy is a therapeutic alternative for patients with nonseminomatous testis tumors and its principal untoward effect is the loss of ejaculation. The anatomic knowledge of lymph node metastasis allows lower limit definition of aortic dissection, maintaining the diagnostic sensitivity and ejaculation. We report three patients with nonseminomatous testis tumors subjected to a reduced video-laparoscopic lumboaortic lymphadenectomy. An adequate amount of tissue was obtained in all and lymph node metastasis found in two. No complications occurred and patients were discharged 48 hours later. It is concluded that this technique is an alternative staging technique with low morbidity that allows a rapid patient discharge.