Tumor Debulking | ScienceGate

Background: Pilomyxoid astrocytoma (PMA) is a variant of pilocytic astrocytomas but exhibits more aggressive behavior. Further, it is more prevalent in the hypothalamic/chiasmatic regions and is only rarely encountered in the thoracic spine. Case Description: A 9-year-old male presented with severe spastic paraparesis (motor/sensory) attributed to a thoracic cord PMA and scoliosis. The magnetic resonance (MR) showed an intraaxial ill-defined expansile lesion with heterogeneous enhancement extending from the cervicothoracic junction to conus medullaris. A multilevel decompressive laminectomy was performed with restricted tumor debulking; an expansile duraplasty was also effected. Two years later, the patient has moderately improved and has not shown any symptom progression. Conclusion: We recommend the early performance of a thoracic MR in children with idiopathic scoliosis presenting with the onset of a significant spastic paraparesis.

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A curative treatment strategy using tumor debulking surgery combined with immune checkpoint inhibitors for advanced pediatric solid tumors: An in vivo study using a murine model of osteosarcoma

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2018.08.023 ◽

2018 ◽

Vol 53 (12) ◽

pp. 2460-2464 ◽

Cited By ~ 2

Author(s):

Takahiro Shimizu ◽

Yasushi Fuchimoto ◽

Hajime Okita ◽

Kazumasa Fukuda ◽

Yuko Kitagawa ◽

...

Keyword(s):

Solid Tumors ◽

Murine Model ◽

Immune Checkpoint ◽

Treatment Strategy ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Debulking Surgery ◽

Pediatric Solid Tumors ◽

Tumor Debulking

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Intraoperative Detection of Pediatric Brain Tumor Margins Using Raman Spectroscopy.

Neurosurgery ◽

10.1093/neuros/nyz310_132 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Rashad Jabarkheel ◽

Jonathon J Parker ◽

Chi-Sing Ho ◽

Travis Shaffer ◽

Sanjiv Gambhir ◽

...

Keyword(s):

Machine Learning ◽

Raman Spectroscopy ◽

Brain Tumor ◽

Brain Tumors ◽

Brain Tissue ◽

Pediatric Brain Tumor ◽

Tissue Samples ◽

Tumor Margins ◽

Pediatric Brain ◽

Tumor Debulking

Abstract INTRODUCTION Surgical resection is a mainstay of treatment in patients with brain tumors both for tissue diagnosis and for tumor debulking. While maximal resection of tumors is desired, neurosurgeons can be limited by the challenge of differentiating normal brain from tumor using only microscopic visualization and tactile feedback. Additionally, intraoperative decision-making regarding how aggressively to pursue a gross total resection frequently relies on pathologic preliminary diagnosis using frozen sections which are both time consuming and fallible. Here, we investigate the potential for Raman spectroscopy (RS) to rapidly detect pediatric brain tumor margins and classify brain tissue samples equivalent to histopathology. METHODS Using a first-of-its-kind rapid acquisition RS device we intraoperatively imaged fresh ex vivo pediatric brain tissue samples (2-3 mm × 2-3 mm × 2-3 mm) at the Lucille Packard Children's Hospital. All imaged samples received standard final histopathological analysis, as RS is a nondestructive imaging technique. We curated a labeled dataset of 575 + unique Raman spectra gathered from 160 + brain samples resulting from 23 pediatric patients who underwent brain tissue resection as part of tumor debulking or epilepsy surgery (normal controls). RESULTS To our knowledge we have created the largest labeled Raman spectra dataset of pediatric brain tumors. We are developing an end-to-end machine learning model that can predict final histopathology diagnosis within minutes from Raman spectral data. Our preliminary principle component analyses suggest that RS can be used to classify various brain tumors similar to “frozen” histopathology and can differentiate normal from malignant brain tissue in the context of low-grade glioma resections. CONCLUSION Our work suggests that machine learning approaches can be used to harness the material identification properties of RS for classifying brain tumors and detecting their margins.

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Appendix cancer mimicking ovarian cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200211000-00015 ◽

2002 ◽

Vol 12 (6) ◽

pp. 768-772 ◽

Cited By ~ 2

Author(s):

P. A. Gehrig ◽

J. F. Boggess ◽

D. W. Ollila ◽

P. A. Groben ◽

L. Van Le

Keyword(s):

Ovarian Cancer ◽

Abdominal Mass ◽

Correct Diagnosis ◽

Disease Process ◽

Advanced Ovarian Cancer ◽

Stage Iv ◽

Treatment Modalities ◽

Primary Adenocarcinoma ◽

Appendiceal Cancer ◽

Tumor Debulking

Appendiceal adenocarcinoma is a rare malignancy for which there is no characteristic clinical presentation. We describe five women who presented with signs and symptoms characteristic of advanced ovarian cancer but whose final diagnosis was stage IV appendiceal cancer. Between 1998 and 1999, five women treated for presumed ovarian cancer were identified as having primary appendiceal cancer. Medical records and pathology were retrospectively reviewed. The median age was 47 years (range 36–61 years). All had elevated preoperative CA125 levels with a median value of 171 μ/ml (range 46–383). Four women underwent right hemicolectomy with two requiring radical surgical tumor debulking to render them optimally debulked. Four had postoperative chemotherapy, the most common agent used was 5-flourouracil. Median survival was 6.75 months (range 19 days-11 months). Primary adenocarcinoma of the appendix is rare; therefore, the clinical utility of radical tumor debulking and chemotherapy is not well described. Given the poor survival in our series, all efforts should be considered palliative. Although this disease process is uncommon, it should be entertained by gynecologic oncologists in the differential diagnosis of an intra-abdominal mass and ascites. The ability to make the correct diagnosis and differentiate between an ovarian and appendiceal primary is critical as the treatment modalities vary.

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Mechanical Cavity Creation with Curettage and Vacuum Suction (Q-VAC) in Lytic Vertebral Body Lesions with Posterior Wall Dehiscence and Epidural Mass before Cement Augmentation

Medicina ◽

10.3390/medicina55100633 ◽

2019 ◽

Vol 55 (10) ◽

pp. 633

Author(s):

Piechowiak ◽

Isalberti ◽

Pileggi ◽

Distefano ◽

Hirsch ◽

...

Keyword(s):

Soft Tissue ◽

Vertebral Body ◽

Posterior Wall ◽

Balloon Kyphoplasty ◽

Cement Leakage ◽

Cement Augmentation ◽

Tissue Mass ◽

Vacuum Suction ◽

Tumor Debulking ◽

Vertebral Body Stenting

Background and Objectives: We describe a novel technique for percutaneous tumor debulking and cavity creation in patients with extensive lytic lesions of the vertebral body including posterior wall dehiscence prior to vertebral augmentation (VA) procedures. The mechanical cavity is created with a combination of curettage and vacuum suction (Q-VAC). Balloon kyphoplasty and vertebral body stenting are used to treat neoplastic vertebral lesions and might reduce the rate of cement leakage, especially in presence of posterior wall dehiscence. However, these techniques could theoretically lead to increased intravertebral pressure during balloon inflation with possible mobilization of soft tissue tumor through the posterior wall, aggravation of spinal stenosis, and resultant complications. Creation of a void or cavity prior to balloon expansion and/or cement injection would potentially reduce these risks. Materials and Methods: A curette is coaxially inserted in the vertebral body via transpedicular access trocars. The intravertebral neoplastic soft tissue is fragmented by multiple rotational and translational movements. Subsequently, vacuum aspiration is applied via one of two 10 G cannulas that had been introduced directly into the fragmented lesion, while saline is passively flushed via the contralateral cannula, with lavage of the fragmented solid and fluid-necrotic tumor parts. Results: We applied the Q-VAC technique to 35 cases of thoracic and lumbar extreme osteolysis with epidural mass before vertebral body stenting (VBS) cement augmentation. We observed extravertebral cement leakage on postoperative CT in 34% of cases, but with no clinical consequences. No patients experienced periprocedural respiratory problems or new or worsening neurological deficit. Conclusion: The Q-VAC technique, combining mechanical curettage and vacuum suction, is a safe, inexpensive, and reliable method for percutaneous intravertebral tumor debulking and cavitation prior to VA. We propose the Q-VAC technique for cases with extensive neoplastic osteolysis, especially if cortical boundaries of the posterior wall are dehiscent and an epidural soft tissue mass is present.

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