scholarly journals Complete Resection of a Large Mediastinal Calcifying Fibrous Tumor

2020 ◽  
Vol 08 (01) ◽  
pp. e48-e51
Author(s):  
Géraldine L. P. Bono ◽  
Markus Lehner ◽  
Freimut H. Schilling ◽  
Nikolai Stahr ◽  
Miriam Nowack ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Residual Tumor ◽  
Anterior Mediastinum ◽  
Complete Resection ◽  
Venous Stasis ◽  
Surgical Removal ◽  
Large Tumor ◽  
Calcifying Fibrous Tumor ◽  
Magnetic Resonance Imaging Mri ◽  
Fibrous Tumor

AbstractCalcifying fibrous tumor (CFT) is a benign tumor entity which can present in a variety of different sites. Till date, eight cases with a mediastinal manifestation have been published in literature. Surgical removal is the treatment of choice for this often incidentally detected tumor. Surgery of thoracic CFT may be challenging due to its localization within the mediastinum. A 10-year old boy with a right-sided thoracic pectus carinatum-like deformity was referred for further evaluation, incidentally, revealing a mediastinal mass in computed tomography (CT). Laboratory results were all within normal range. Magnetic resonance imaging (MRI) showed a large tumor in the upper anterior mediastinum suggesting expansive but not infiltrative character. The tumor was displacing surrounding structures like the heart and the diaphragm. Lower venous stasis with dilation of the inferior cava vein could be demonstrated. The tumor was considered to be of benign dignity and surgical removal was indicated. Complete tumor resection could be achieved through a sternotomy approach, along with thymectomy. A partial resection of both the pericardium and diaphragm was required due to adhesion with soft tissue at those sites. The specimen's size was 320 mm × 145 mm × 100 mm, histologically confirmed as CFT. The patient showed no residual tumor at 3- and 9-month follow-up. This case is a report on a large mediastinal CFT which underwent successful complete surgical removal. Following tumor resection, prognosis is considered to be good; however, key issue is complete resection to avoid local tumor recurrence.

scholarly journals Indocyanin Green Videoangiography Study of Hemangioblastomas

2011 ◽  
Vol 38 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Yasuo Murai ◽  
Koji Adachi ◽  
Fumihiro Matano ◽  
Kojiro Tateyama ◽  
Akira Teramoto
Keyword(s):  
Residual Tumor ◽  
Preoperative Embolization ◽  
Surgical Removal ◽  
Vascular Differentiation ◽  
Brain Surface ◽  
Contrast Enhanced ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain ◽  
Angiographic Findings

Abstract:Objective:We present herein the intraoperative indocyanin green videoangiography (ICGVAG) findings for three cases of cerebellar hemangioblastoma (HB).Cases:Cerebellar HB was detected in three patients presenting with symptoms of vertigo and/or headaches and diagnosed on the basis of preoperative magnetic resonance imaging (MRI) and cerebral angiographic findings. Preoperative embolization of the tumor feeding artery was not performed in any of the patients. None of the patients underwent any procedure prior to ICGVAG that would affect the ICG findings, such as perilesional hemostatic coagulation or ablation. In each patient, it was possible to judge the approximate location of the tumor in relation to the brain surface and to distinguish the feeding and draining vessels. Following resection of the tumor, ICGVAG images confirmed that the mural nodule had been eliminated. None of the patients required blood transfusion, either during or after the surgery. For each patient, the lesion was pathologically confirmed as HB, postoperative contrast-enhanced MRI confirmed the absence of residual tumor, and diffusion-weighted MRI revealed no ischemic changes.Results:Differentiation of feeding and draining vessels in the region of the lesion is particularly important for successful surgical removal of HB. In the present three patients, ICGVAG findings enabled easy vascular differentiation and were also useful for confirming that there was no residual tumor. Indocyanin green videoangiography was concluded to be useful for safe resection of HB.

Microsurgical Resection of an Intramedullary Spinal Cord Hemangioblastoma Through an Anterior Cervical Approach: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Kyle Lindsey McCormick ◽  
Nikita Alexiades ◽  
Paul C McCormick
Keyword(s):  
Spinal Cord ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Complete Recovery ◽  
Surgical Removal ◽  
Intramedullary Spinal Cord ◽  
Dural Closure ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Microsurgical Resection

Abstract This video demonstrates the microsurgical removal of an intramedullary spinal cord hemangioblastoma through an anterior cervical approach. While most spinal hemangioblastomas arise from the dorsal or dorsolateral pial surface and can be safely resected through a posterior approach,1,2 ventral tumors can present a significant challenge to safe surgical removal.3-5 This patient presented with a progressively symptomatic ventral pial based hemangioblastoma at the C5-6 level with large polar cysts extending from C3 to T1. The tumor was approached through a standard anterior cervical exposure with a C5 and C6 corpectomy. Following midline durotomy, the tumor was identified and complete microsurgical resection was achieved. The principles and techniques of tumor resection are illustrated and described in the video. Following tumor resection and dural closure, a fibular allograft was inserted into the corpectomy defect and a C4-C7 fixation plate was placed. The patient was maintained in a supine position for 36 h. He was discharged home on postoperative day 3 in a cervical collar. The patient did well with near-complete recovery of neurological function. Postoperative magnetic resonance imaging at 6 wk showed a substantial resolution of the polar cysts and no evidence of residual tumor. The patient featured in this video consented to the procedure.

scholarly journals Intracranial teratomas in children: the role and timing of surgical removal

2008 ◽  
Vol 2 (5) ◽  
pp. 331-338 ◽  
Author(s):  
Rémy Noudel ◽  
Mathieu Vinchon ◽  
Patrick Dhellemmes ◽  
Claude Fabien Litré ◽  
Pascal Rousseaux
Keyword(s):  
Germ Cell ◽  
Mature Teratoma ◽  
Tumor Resection ◽  
Germ Cell Tumors ◽  
Timing Of Surgery ◽  
Surgical Removal ◽  
Primary Therapy ◽  
Large Tumor ◽  
Oncological Treatment ◽  
Malignant Germ Cell Tumors

Object In this study, the authors report their experience with the surgical treatment of intracranial teratomas with an emphasis on the indications for delayed resection after oncological treatment. Methods The authors retrospectively reviewed the cases of 14 children with intracranial teratomas. The mean age at diagnosis was 10.5 years (range 2 days–18 years), and 11 patients were male. The final histological analysis revealed pure mature teratoma in 5 cases, mixed teratoma with germinoma in 3 cases, and nongerminomatous malignant germ cell tumor in 6 cases. Thirteen patients underwent tumor resection, and these patients were divided into 2 subgroups according to the timing of surgery. In Group A, 10 patients underwent resection as the primary treatment because no tumor markers were detected in 4 patients, a teratomatous component was revealed on biopsy sampling in 3 patients, and a large tumor volume in 3 patients. In Group B, 3 patients underwent removal of residual pure mature teratoma after oncological treatment. Results Seven of the 8 patients (87.5%) with pure mature teratomas or with mixed teratoma and germinoma are currently alive (mean follow-up of 9 years); the eighth patient died of postoperative meningitis. Two of the 6 patients (33%) with mixed nongerminomatous malignant germ cell tumors died of tumor progression regardless of the timing of surgery. Conclusions The results of this study support the belief that microsurgical removal is the only effective treatment for intracranial teratomas. Surgery may be performed as the primary therapy when there is evidence of a noninvasive teratoma, and as a secondary therapy if there is only a partial response to neoadjuvant therapy or if progression is observed in mixed malignant germ cell tumors.

scholarly journals Aggressive, Multidisciplinary Staged Microsurgical Resection of a Giant Cervicomedullary Junction Chordoma

2019 ◽  
Vol 80 (S 04) ◽  
pp. S378-S379
Author(s):  
Sima Sayyahmelli ◽  
Ihsan Dogan ◽  
Aaron M. Wieland ◽  
Mark Pyle ◽  
Mustafa K. Başkaya
Keyword(s):  
Tumor Resection ◽  
Cranial Nerves ◽  
Surgical Removal ◽  
Retropharyngeal Space ◽  
Recurrence Rates ◽  
Recent Onset ◽  
Postoperative Mri ◽  
Swallowing Difficulties ◽  
Magnetic Resonance Imaging Mri ◽  
Two Stages

Chordomas of the cranial base are locally destructive tumors since they are surrounded by significant complex neurovascular structures. Thus, their surgical removal is challenging, recurrence rates are high, and their therapeutic strategies remain controversial.In this video, we present a 47-year-old man with a recent onset of swallowing difficulties, hoarseness, and weight loss for several weeks. In the neurological examination, he had complete paralysis of the 9th, 10th, 11th, and 12th cranial nerves. Magnetic resonance imaging (MRI) showed a heterogeneously enhancing expansile invasive mass lesion centered within the clivus and involving the C1, the occipitocervical junction, the retropharynx, and the hypoglossal canal. The decision was made to proceed with multiple staged surgeries. In the first surgical stage, we performed a mastoidectomy with the infralabyrinthine approach to perform a test clip ligation of the sigmoid sinus and to resect the tumor component that extended into the infralabyrinthine space. In the second stage, we performed a far-lateral transcondylar approach for tumor resection and occipitocervical fusion. In the third stage, we used a transoral approach with endoscopic assistance to complete the excision of the remaining tumor in the retropharyngeal space and anterior aspect of C1 and C2 bodies that were not accessible in the first two stages.The surgeries and postoperative course were uneventful. Postoperative MRI showed a gross total resection of the tumor. Histopathology indicated a chordoma. The patient subsequently received proton radiotherapy and has continued to do well without recurrence at 14 months' follow-up.The link to the video can be found at: https://youtu.be/uP9OSlKg_rE.

scholarly journals Case Report: Identification of Multiple TERT and FGFR2 Gene Fusions in a Pineal Region Glioblastoma Case

2021 ◽  
Vol 11 ◽  
Author(s):  
Xing Guo ◽  
Teng Chen ◽  
Shiming Chen ◽  
Chao Song ◽  
Dezhi Shan ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Residual Tumor ◽  
Pineal Region ◽  
Proliferation Index ◽  
Gene Fusions ◽  
Who Grade ◽  
First Case ◽  
Fgfr2 Gene ◽  
Magnetic Resonance Imaging Mri ◽  
Next Generation Sequencing Ngs

As an oncogenic somatic variant, telomerase reverse transcriptase promoter (TERTp) mutations are frequently observed in adult glioblastoma (GBM). Alternatively, we report the first case of glioblastoma with TERT amplification accompanied by multiple TERT and FGFR2 gene fusions instead of TERTp mutation. A 55-year-old woman presented with dizziness, headache, and diplopia for three weeks. Magnetic resonance imaging (MRI) demonstrated a heterogeneously enhancing lobulated mass centered in the pineal region. Partial tumor resection and ventriculoperitoneal shunt were achieved, and the residual tumor was then treated with standard radiation. The tumor was diagnosed as GBM, IDH-wild type, WHO grade IV, and the Ki67 proliferation index was high (30–40%). Intriguingly, TERT amplification without TERTp mutation was identified via next generation sequencing (NGS). Further analysis revealed multiple TERT (TERT–NUBPL, MARCH6–TERT, and CJD4–TERT) and FGFR2 (CXCL17–FGFR2, SIPA1L3–FGFR2, FGFR2–SIPA1L3, and FGFR2–CEACAM1) gene fusions. After the surgery, the patient’s condition deteriorated rapidly due to the malignant nature of the tumor and she died with an overall survival of 3 months. Our report provides the molecular clue for a novel telomerase activation and maintenance mechanism in GBM.

Rhabdomyosarcomas of the Nose and Paranasal Sinuses: Treatment Results in 15 Cases

2005 ◽  
Vol 133 (1) ◽  
pp. 42-50 ◽  
Author(s):  
Jochen Wurm ◽  
Jannis Constantinidis ◽  
Gerhard G. Grabenbauer ◽  
Heinrich Iro
Keyword(s):  
Paranasal Sinuses ◽  
Clinical Course ◽  
Average Duration ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Surgical Removal ◽  
Primary Therapy ◽  
Histologic Subtype

OBJECTIVE: Primary rhabdomyosarcomas (RMS) of the nose and the paranasal sinuses occur very rarely. Treatment of these tumors usually is conducted according to standardized therapy protocols like the German Cooperative Soft Tissue Sarcoma Study (CWS) or the Intergroup Rhabdomyosarcoma Study (IRS). The role of surgery still remains controversial. STUDY DESIGN AND SETTING: A retrospective analysis of 15 patients with an RMS of the nose or paranasal sinuses treated between 1979 and 2000 is presented. Patients' age ranged from 2 to 60 years, with an average of 22 years. Histologic subtypes encompassed 9 embryonal (e) and 6 alveolar (a) RMS. Resection of the tumor with subsequent radiochemotherapy (RCT) was performed in 6 cases, and primary RCT, in 9 cases. The average duration of follow-up was 4 years and 10 months. RESULTS: Overall 5-year survival was 40%. In the patient group subjected to tumor resection with subsequent RCT, 5-year survival was 66%, compared with 33% after exclusive primary RCT. With respect to histologic subtype, 5-year survival was 55% for eRMS, as compared with 33% for aRMS. Moreover, infiltration of the skull base and the presence of a residual tumor after primary therapy constituted factors associated with an unfavorable clinical course. CONCLUSIONS: Surgical removal of tumor with subsequent radiochemotherapy can be recommended if a complete resection and functionally and cosmetically satisfactory results appear possible. Patients with eRMS showed an overall more favorable clinical course than patients with aRMS.

scholarly journals Hepatocellular Carcinoma Showing Pathological Complete Response to Lenvatinib Monotherapy

2021 ◽  
pp. 772-777
Author(s):  
Hiroshi Shintani ◽  
Shoji Oura ◽  
Shinichiro Makimoto
Keyword(s):  
Hepatocellular Carcinoma ◽  
Anticancer Agents ◽  
Pathological Complete Response ◽  
Liver Tumors ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Complete Response ◽  
Complete Disappearance ◽  
Advanced Hepatocellular Carcinoma ◽  
Large Tumor

A 61-year-old man was referred to our hospital due to the liver dysfunction without hepatitis B or C infection. In addition to the elevated levels of α-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II, a large tumor, 10.8 cm in size, and multiple small tumors, up to 1.6 cm in size, in the liver on computed tomography (CT) led to the diagnosis of unresectable advanced hepatocellular carcinoma (HCC). Levatinib monotherapy resulted in complete disappearance of the small liver tumors and marked shrinkage of the largest tumor with complete disappearance of intratumoral enhancement on CT and normalization of serum AFP levels. After 2 months’ cessation of lenvatinib monotherapy due to side effects, the patient underwent residual tumor resection. The pathological findings showed no viable tumor cells, i.e. pathological complete response. The patient was discharged from the hospital on the twelfth day after the operation without any complication. Lenvatinib monotherapy appears to be more effective for HCC than other conventional treatments. In addition, oncologists should take into consideration the possibility of pathological complete response with newly developed anticancer agents including lenvatinib to develop therapeutic strategies to avoid unnecessary overtreatment.

Use of the histological pseudocapsule in surgery for Cushing disease: rapid postoperative cortisol decline predicting complete tumor resection

2012 ◽  
Vol 116 (4) ◽  
pp. 721-727 ◽  
Author(s):  
Stephen J. Monteith ◽  
Robert M. Starke ◽  
John A. Jane ◽  
Edward H. Oldfield
Keyword(s):  
Tumor Resection ◽  
Residual Tumor ◽  
Serum Cortisol ◽  
Complete Resection ◽  
Incomplete Resection ◽  
Cushing Disease ◽  
Postoperative Serum ◽  
Piecemeal Resection ◽  
Complete Tumor

Object Subnormal postoperative serum cortisol levels indicate successful surgery and predict long-term remission of Cushing disease. Given the short serum half-lives of adrenocorticotropic hormone (ACTH) and cortisol, it is unclear why the decline in cortisol postoperatively is delayed for 18–36 hours. Furthermore, the relevance of the rate of cortisol drop immediately after surgery has not been investigated. Methods Patient data were analyzed from a prospectively accrued database. After surgery, cortisol replacement was withheld and serum cortisol measurements were obtained every 6 hours until values of 1.0–2.0 μg/dl or less were reached. The authors selected patients in whom serum cortisol dropped to 2 μg/dl or less after surgery (101 patients). Tumor resection was categorized as follows: 1) complete resection using the histological pseudocapsule as a surgical capsule, 2) complete piecemeal resection), 3) known incomplete resection, and 4) total hypophysectomy. Results The median time to reach a cortisol level of less than or equal to 2.0 μg/dl was 9.9, 19.4, 25.3, and 29.5 hours with hypophysectomy, pseudocapsule, incomplete resection, and piecemeal techniques, respectively. Pseudocapsule resection produced a faster decline in cortisol than piecemeal techniques (p = 0.0001), but not as rapid a decline as hypophysectomy (p = 0.033). Conclusions Complete resection by other techniques is associated with delayed cortisol decline compared with pseudocapsule surgery, which may represent the product of residual tumor cells and therefore may explain the higher rate of recurrent disease associated with piecemeal techniques. The prompt drop in cortisol after hypophysectomy compared with patients with pseudocapsule surgery suggests that the corticotrophs of the normal gland can secrete ACTH for 10–36 hours after surgery despite prolonged and severe hypercortisolism.

Comparison of Motor Outcome in Patients Undergoing Awake vs General Anesthesia Surgery for Brain Tumors Located Within or Adjacent to the Motor Pathways

Neurosurgery ◽  
2019 ◽  
Vol 85 (3) ◽  
pp. E470-E476 ◽  
Author(s):  
Roni Zelitzki ◽  
Akiva Korn ◽  
Eti Arial ◽  
Carmit Ben-Harosh ◽  
Zvi Ram ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Brain Tumors ◽  
General Anesthesia ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Awake Craniotomy ◽  
Motor Deficits ◽  
Surgical Removal ◽  
Motor Outcome

Abstract BACKGROUND Surgical removal of intra-axial brain tumors aims at maximal tumor resection while preserving function. The potential benefit of awake craniotomy over craniotomy under general anesthesia (GA) for motor preservation is yet unknown. OBJECTIVE To compare the clinical outcomes of patients who underwent surgery for perirolandic tumors while either awake or under GA. METHODS Between 2004 and 2015, 1126 patients underwent surgical resection of newly diagnosed intra-axial tumors in a single institution. Data from 85 patients (44 awake, 41 GA) with full dataset who underwent resections for perirolandic tumors were retrospectively analyzed. RESULTS Identification of the motor cortex required significantly higher stimulation thresholds in anesthetized patients (9.1 ± 4 vs 6.2 ± 2.7 mA for awake patients, P = .0008). There was no group difference in the subcortical threshold for motor response used to assess the proximity of the lesion to the corticospinal (pyramidal) tract. High-grade gliomas were the most commonly treated pathology. The extent of resection and residual tumor volume were not different between groups. Postoperative motor deficits were more common in the anesthetized patients at 1 wk (P = .046), but no difference between the groups was detected at 3 mo. Patients in the GA group had a longer mean length of hospitalization (10.3 vs 6.7 d for the awake group, P = .003). CONCLUSION Awake craniotomy results in a better early postoperative motor outcome and shorter hospitalization compared with patients who underwent the same surgery under GA. The finding of higher cortical thresholds for the identification of the motor cortex in anesthetized patients may suggest an inhibitory effect of anesthetic agents on motor function.

Complete resection of a giant calcifying fibrous tumor of myocardial origin

2019 ◽  
Vol 68 (4) ◽  
pp. 389-391 ◽  
Author(s):  
Kenichi Okamura ◽  
Kan Nawata ◽  
Shogo Shimada ◽  
Minoru Ono
Keyword(s):  
Complete Resection ◽  
Calcifying Fibrous Tumor ◽  
Fibrous Tumor
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