The Role of Visceral Transplantation for Neoplastic Disease

2020 ◽  
Vol 04 (03) ◽  
pp. 273-281
Author(s):  
Masato Fujiki ◽  
Amit Nair ◽  
Giuseppe D'amico ◽  
Mohammed Osman
Keyword(s):  
Patient Survival ◽  
Ex Vivo ◽  
Tumor Resection ◽  
Case Series ◽  
National Database ◽  
Neuroendocrine Neoplasms ◽  
Neoplastic Disease ◽  
Desmoid Tumors ◽  
Post Transplant ◽  
Recipient Tissue

AbstractVisceral transplantation has been utilized as the most radical surgical treatment for neoplasms not amenable to conventional resection. The main indications for this procedure include mesenteric desmoid tumors threatening the root of mesentery and metastatic neuroendocrine neoplasms. Published case-series of visceral transplantation for such indications are reviewed in this article. Patients with desmoid tumors associated with familial adenomatous polyposis are transplanted with intestinal or multivisceral allografts. With surgical modification of technique, the native spleen is preserved while duodenopancreatic complex is removed to obviate the risk of malignant transformation of duodenal polyposis after transplantation. Preservation of spleen decreased incidence of post-transplant lymphoproliferative disorder, conferring therapeutic advantage. Patient survival is comparable to that of other indications, and desmoid tumor recurrence has been observed in the recipient tissue but not in the donor allograft. For visceral transplantation of metastatic neuroendocrine neoplasms, the majority of these patients have diffuse liver involvement, thus requiring full multivisceral transplantation. Post-transplant patient survival is acceptable with limited data available on recurrence. Autotransplantation following ex vivo tumor resection using visceral allografts has been also performed in a limited, select cohort of patients with various pathologies. Adenocarcinomas are associated with a prohibitive recurrence rate following the procedure, and its use for this indication is therefore not recommended. A national database of visceral transplantation undertaken for neoplastic disease should be developed to better understand predictors of outcomes and to help produce and standardize selection criteria.

Prognostic Evaluations Tailored to Specific Gastric Neuroendocrine Neoplasms: Analysis Of 200 Cases with Extended Follow-Up

2018 ◽  
Vol 107 (2) ◽  
pp. 114-126 ◽  
Author(s):  
Alessandro Vanoli ◽  
Stefano La Rosa ◽  
Emanuela Miceli ◽  
Catherine Klersy ◽  
Roberta Maragliano ◽  
...  
Keyword(s):  
Patient Survival ◽  
Gastric Wall ◽  
Distant Metastases ◽  
Neuroendocrine Neoplasms ◽  
Neoplastic Disease ◽  
Type I ◽  
Tumor Type ◽  
Specific Patient ◽  
Type Iii

Background: Gastric neuroendocrine neoplasms (NENs) are very heterogeneous, ranging from mostly indolent, atrophic gastritis-associated, type I neuroendocrine tumors (NETs), through highly malignant, poorly differentiated neuroendocrine carcinomas (pdNECs), to sporadic type III NETs with intermediate prognosis, and various rare tumor types. Histologic differentiation, proliferative grade, size, level of gastric wall invasion, and local or distant metastases are used as prognostic markers. However, their value remains to be tailored to specific gastric NENs. Methods: Series of type I NETs (n = 123 cases), type III NETs (n = 34 cases), and pdNECs (n = 43 cases) were retrospectively collected from four pathology centers specializing in endocrine pathology. All cases were characterized clinically and histopathologically. During follow-up (median 93 months) data were recorded to assess disease-specific patient survival. Results: Type I NETs, type III NETs, and pdNECs differed markedly in terms of tumor size, grade, invasive and metastatic power, as well as patient outcome. Size was used to stratify type I NETs into subgroups with significantly different invasive and metastatic behavior. All 70 type I NETs < 0.5 cm (micro-NETs) were uneventful. Ki67-based grading proved efficient for the prognostic stratification of type III NETs; however, grade 2 (G2) was not associated with tumor behavior in type I NETs. Although G3 NETs (2 type I and 9 type III) had a very poor prognosis, it was found that patient survival was longer with type III G3 NETs compared to pdNECs. Conclusions: Given the marked, tumor type-related behavior differences, evaluation of gastric NEN prognostic parameters should be tailored to the type of neoplastic disease.

Primary Calvarial Ewing Sarcoma: A Case Series

2021 ◽  
Author(s):  
Sandeep Mohindra ◽  
Manjul Tripathi ◽  
Aman Batish ◽  
Ankur Kapoor ◽  
Ninad Ramesh Patil ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Tumor Resection ◽  
Case Series ◽  
Radical Excision ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Intradural Tumor ◽  
Age Range

Abstract Background Calvarial Ewing tumor is a relatively rare differential among bony neoplasms. We present our experience of managing primary calvarial Ewing sarcoma (EWS), highlighting their clinical and radiological findings. Method In a retrospective analysis, we evaluated our 12-year database for pathologically proven EWS. A literature search was conducted for the comparative presentation and update on the management and outcome. Result From January 2008 to December 2020, we managed eight patients (male:female = 5:3; age range 6 months to 19 years, mean 11.5 years) harboring primary calvarial EWS. All cases underwent wide local excision; two patients required intradural tumor resection, while one required rotation flap for scalp reconstruction. Mean hospital stay was 8 days. All patients received adjuvant chemo- and radiotherapy. Three patients remained asymptomatic at 5 years of follow-up, while two patients died. Conclusion Primary calvarial EWS is a rare entity. It usually affects patients in the first two decades of life. These tumors can be purely intracranial, causing raised intracranial pressure symptoms, which may exhibit rapidly enlarging subgaleal tumors with only cosmetic deformities or symptoms of both. Radical excision followed by adjuvant therapy may offer a favorable long-term outcome.

Congenital Diaphragmatic Hernia: Demographics and 30-day Outcomes in Adults

2020 ◽  
pp. 000313482096006
Author(s):  
Joseph G. Brungardt ◽  
Quinn A. Nix ◽  
Kurt P. Schropp
Keyword(s):  
Postoperative Complications ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Pediatric Population ◽  
Case Series ◽  
National Database ◽  
Improvement Program ◽  
American College Of Surgeons ◽  
Postoperative Diagnosis ◽  
Acs Nsqip Database

Background Congenital diaphragmatic hernia (CDH) is a pathology most often affecting the pediatric population, although adults can also be affected. Few studies exist of adults undergoing repair of this defect. Using a national database, we sought to determine demographics and outcomes of this population. Methods An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2015-2018) was performed, capturing patients with postoperative diagnosis of CDH, distinct from ventral hernia. Two groups were created based upon surgical approach of open or minimally invasive (MIS) repair. Baseline demographics and outcomes were compared. Results 110 patients undergoing surgical correction of CDH were captured in the database. We found rates of return to the operating room (4.55%), postoperative respiratory failure (5.45%), and reintubation (3.64%) with no difference between groups. There was no mortality and no difference between groups in length of operation, discharge to home, or postoperative complications. Patients undergoing open repair had a longer length of stay than patients in the MIS group (6.47 ± 10.76 days vs. 3.68 ± 3.74 days, P = .0471). Mesh was used in MIS more often than the open group (47.30% vs. 5.56%, P < .0001). Discussion This study describes rates of postoperative complications in patients undergoing repair of CDH, and suggests outcomes those are equivalent between patients receiving open or MIS approaches. Further case series or retrospective studies are needed to further describe this population of patients.

scholarly journals Decrease post-transplant relapse using donor-derived expanded NK-cells

Leukemia ◽  
2021 ◽  
Author(s):  
Stefan O. Ciurea ◽  
Piyanuch Kongtim ◽  
Doris Soebbing ◽  
Prashant Trikha ◽  
Gregory Behbehani ◽  
...  
Keyword(s):  
Nk Cells ◽  
Nk Cell ◽  
Ex Vivo ◽  
Disease Free Survival ◽  
Dependent Manner ◽  
Post Transplant ◽  
Haploidentical Transplantation ◽  
High Doses ◽  
High Level

AbstractIn this phase I/II clinical trial, we investigated the safety and efficacy of high doses of mb-IL21 ex vivo expanded donor-derived NK cells to decrease relapse in 25 patients with myeloid malignancies receiving haploidentical stem-cell transplantation (HSCT). Three doses of donor NK cells (1 × 105–1 × 108 cells/kg/dose) were administered on days −2, +7, and +28. Results were compared with an independent contemporaneously treated case-matched cohort of 160 patients from the CIBMTR database.After a median follow-up of 24 months, the 2-year relapse rate was 4% vs. 38% (p = 0.014), and disease-free survival (DFS) was 66% vs. 44% (p = 0.1) in the cases and controls, respectively. Only one relapse occurred in the study group, in a patient with the high level of donor-specific anti-HLA antibodies (DSA) presented before transplantation. The 2-year relapse and DFS in patients without DSA was 0% vs. 40% and 72% vs. 44%, respectively with HR for DFS in controls of 2.64 (p = 0.029). NK cells in recipient blood were increased at day +30 in a dose-dependent manner compared with historical controls, and had a proliferating, mature, highly cytotoxic, NKG2C+/KIR+ phenotype.Administration of donor-derived expanded NK cells after haploidentical transplantation was safe, associated with NK cell-dominant immune reconstitution early post-transplant, preserved T-cell reconstitution, and improved relapse and DFS. TRIAL REGISTRATION: NCT01904136 (https://clinicaltrials.gov/ct2/show/NCT01904136).

scholarly journals Toxoplasma encephalitis presenting as neoplastic disease: A single institution case series

2021 ◽  
Vol 25 ◽  
pp. 101174
Author(s):  
Jennifer L. Perez ◽  
Zachary C. Gersey ◽  
Daniel F. Marker ◽  
Georgios A. Zenonos ◽  
Pascal O. Zinn
Keyword(s):  
Case Series ◽  
Neoplastic Disease ◽  
Single Institution ◽  
Toxoplasma Encephalitis

scholarly journals Complex Bone Tumors of the Trunk—The Role of 3D Printing and Navigation in Tumor Orthopedics: A Case Series and Review of the Literature

2021 ◽  
Vol 11 (6) ◽  
pp. 517
Author(s):  
Martin Schulze ◽  
Georg Gosheger ◽  
Sebastian Bockholt ◽  
Marieke De Vaal ◽  
Tymo Budny ◽  
...  
Keyword(s):  
3D Printing ◽  
Tumor Resection ◽  
Case Series ◽  
Main Process ◽  
Patient Centered ◽  
Individual Care ◽  
Real Time Visualization ◽  
Bone Tumor Resection ◽  
Virtual Modeling

The combination of 3D printing and navigation promises improvements in surgical procedures and outcomes for complex bone tumor resection of the trunk, but its features have rarely been described in the literature. Five patients with trunk tumors were surgically treated in our institution using a combination of 3D printing and navigation. The main process includes segmentation, virtual modeling and build preparation, as well as quality assessment. Tumor resection was performed with navigated instruments. Preoperative planning supported clear margin multiplanar resections with intraoperatively adaptable real-time visualization of navigated instruments. The follow-up ranged from 2–15 months with a good functional result. The present results and the review of the current literature reflect the trend and the diverse applications of 3D printing in the medical field. 3D printing at hospital sites is often not standardized, but regulatory aspects may serve as disincentives. However, 3D printing has an increasing impact on precision medicine, and we are convinced that our process represents a valuable contribution in the context of patient-centered individual care.

scholarly journals Gastric Mixed Neuroendocrine Non-Neuroendocrine Neoplasms: A Western Center Case Series

2021 ◽  
Vol 9 (3) ◽  
pp. 47
Author(s):  
Marcus Fernando Kodama Pertille Ramos ◽  
Marina Alessandra Pereira ◽  
Arthur Youssif Mota Arabi ◽  
Melissa Mello Mazepa ◽  
Andre Roncon Dias ◽  
...  
Keyword(s):  
Gastric Adenocarcinoma ◽  
Tumor Size ◽  
Lymphovascular Invasion ◽  
Comparison Group ◽  
Case Series ◽  
Clinicopathological Characteristics ◽  
Neuroendocrine Neoplasms ◽  
Rare Tumor ◽  
Term Survival

Background: Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) represent a rare tumor composed of adenocarcinoma and neuroendocrine carcinoma components. This study reports a case series of gastric MiNEN and discusses issues related to its diagnosis, management, and outcomes. Methods: We retrospectively analyzed data from patients with gastric MiNEN who underwent surgical resection at our service from 2009 to 2020. Patients with gastric adenocarcinoma served as a comparison group. Clinical, pathologic, and surgical characteristics were compared. Results: During the selected period, 5 gastric MiNEN patients and 597 patients with gastric adenocarcinoma were included. Among the clinical variables, age, sex, BMI, and laboratory exams were similar between the two groups. Only ASA classification was different (p = 0.015). Pathological variables such as tumor size, lymphovascular invasion, number of retrieved lymph nodes, and pTNM staging were also similar between both groups. Lastly, early surgical outcomes and long-term survival did not differ between gastric MiNEN and adenocarcinoma patients. Conclusion: A MiNEN is a rare tumor that represents less than 1% of GC patients undergoing curative treatment, and demonstrated clinicopathological characteristics and outcomes similar to gastric adenocarcinoma.

scholarly journals Epidemiologic Study of the Discoid Meniscus: Investigating Demographic-Based Predictors in Large-Scale Claims Database

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0008
Author(s):  
Sahej S Randhawa ◽  
Emily P Tran ◽  
Nicole A Segovia ◽  
Theodore J Ganley ◽  
Marc Tompkins ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Total Population ◽  
Clinical Care ◽  
Epidemiologic Study ◽  
Case Series ◽  
Incidence Rates ◽  
National Database ◽  
Discoid Meniscus ◽  
Racial Categories ◽  
Claims Database

Background: Discoid meniscus epidemiology remains poorly defined for race and sex, in part, due to limitations of retrospective studies and small case series. A better understanding of epidemiology may improve clinical care and diagnostic precision. Purpose: Our purpose is to better define the epidemiology of discoid meniscus by analyzing a large, national database for incidence rates by sex and race. Methods: Analysis was conducted on the national-scale Clinformatics Data Mart Database by Optum. Proportions of the database’s racial categories (Asian, Black, Hispanic, White, and Unknown) in the total population of diagnosed discoid meniscus cases (n = 1,006) were calculated and compared via chi-squared tests to the total database population (n = 65,759,970). This analysis was repeated for the population of patients who received knee arthroscopies (81,205). Incidence rates were calculated from these populations as well. Finally, a multivariable logistic regression analysis based on the population of arthroscopy-receiving patients was performed to control for age, reported gender, and income. Results: Proportions of Asian, Black, Hispanic, and White racial categories in the discoid meniscus group were 5.7%, 7.3%, 20.6%, 66.4%, respectively; the proportions of each racial category in the total population were 5.2%, 10.3%, 13.5%, 71.0%, respectively. Incidence rates (per 10,000) for these groups in the arthroscopy population were 72.9, 25.6, 49.2, 25.6, respectively. Our logistic regression model indicated that race was not a statistically significant predictor for our dataset after income adjusting. Adjusting for other covariates, the odds of a discoid meniscus diagnosis decreased by 6% for each increase in age (p < 0.001) and were 41% lower for males compared to females (p < 0.001). Conclusion: Prior studies have suggested that race (Asian and Hispanic, is a predictor of higher incidence of discoid meniscus – this study did not show a difference in incidence based upon race. Patient sex and age was identified as significant predictors for discoid meniscus, and increasing age showed a decreasing incidence of this condition. This study’s analysis of a large, national claims database allows for a comprehensive epidemiological study on this topic, offering proportions and incidence rates by race appropriate for application to the US population. Its conclusions promote patient sex and age as significant predictors and question the beliefs on race-associated incidence often based on comparing results from the corpus of single-site cohort studies. Tables/Figures: [Table: see text]

scholarly journals Gender and Sex Are Key Determinants in Osteoarthritis Not Only Confounding Variables. A Systematic Review of Clinical Data

2021 ◽  
Vol 10 (14) ◽  
pp. 3178
Author(s):  
Matilde Tschon ◽  
Deyanira Contartese ◽  
Stefania Pagani ◽  
Veronica Borsari ◽  
Milena Fini
Keyword(s):  
Health Care ◽  
Sex Differences ◽  
Ex Vivo ◽  
Case Series ◽  
Cartilage Volume ◽  
Review Literature ◽  
Care Needs ◽  
Clinical Pain

Many risk factors for osteoarthritis (OA) have been noted, while gender/sex differences have been understated. The work aimed to systematically review literature investigating as primary aim the relationship between gender/sex related discriminants and OA. The search was performed in PubMed, Science Direct and Web of Knowledge in the last 10 years. Inclusion criteria were limited to clinical studies of patients affected by OA in any joints, analyzing as primary aim gender/sex differences. Exclusion criteria were review articles, in vitro, in vivo and ex vivo studies, case series studies and papers in which gender/sex differences were adjusted as confounding variable. Of the 120 records screened, 42 studies were included. Different clinical outcomes were analyzed: morphometric differences, followed by kinematics, pain, functional outcomes after arthroplasty and health care needs of patients. Women appear to use more health care, have higher OA prevalence, clinical pain and inflammation, decreased cartilage volume, physical difficulty, and smaller joint parameters and dimensions, as compared to men. No in-depth studies or mechanistic studies analyzing biomarker differential expressions, molecular pathways and omic profiles were found that might drive preclinical and clinical research towards sex-/gender-oriented protocols.

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