Partial Sacrectomy for Resection of a Sacral Chordoma: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E412-E412
Author(s):  
Martin Julian Gagliardi ◽  
Alfredo Guiroy ◽  
Alfredo Sícoli ◽  
Nicolás Gonzalez Masanés ◽  
Alejandro Morales Ciancio
Keyword(s):  
Osteolytic Lesion ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Wide Resection ◽  
Resection Margins ◽  
Low Grade ◽  
En Bloc ◽  
Ct Guided ◽  
Sacral Chordoma ◽  
Sacrococcygeal Region

Abstract Sacral chordomas are infrequent tumors that arise from remnants of the notochord. They are most often found in the sacrum and skull-base.1,2 These lesions rarely metastasize and usually have an indolent and oligosymptomatic clinical course. Chordomas show low sensitivity to standard radiation therapy and chemotherapy. Operative resection with wide resection margins offers the best long-term prognosis, including longer survival and local control.1,3 However, achieving a complete resection with oncological margins may be difficult because of the anatomic complexity of the sacrococcygeal region.4 The main complications of sacral resection include infections, wound closure defects, and anorectal and urogenital dysfunction. The rate of these complications is significantly increased when the tumor involves the S2 level or above. We report the case of a 64-yr-old male who presented with progressive sacrococcygeal pain and a feeling of incomplete evacuation. A heterogeneous, osteolytic lesion was found at the sacrococcygeal region. Full body imaging tests were negative for other lesions. A computed tomography (CT) guided biopsy was made. We usually use the midline approach in case we have to include the needle path in the resection. The pathology confirmed a sacrococcygeal, low-grade chordoma. We decided to perform an en bloc resection. A posterior, partial sacrectomy was planned distal to the S4 level.

scholarly journals Successful en Bloc Resection for Femoral Head Clear Cell Chondrosarcoma Without Biopsy: A Case Report

2021 ◽  
Author(s):  
Manabu Hoshi ◽  
Naoto Oebisu ◽  
Yoichi Ohta ◽  
Ayaka Tomimoto ◽  
Hiroaki Nakamura
Keyword(s):  
Femoral Head ◽  
Clear Cell ◽  
Surgical Margin ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Wide Resection ◽  
Low Grade ◽  
En Bloc ◽  
Postoperative Function ◽  
Clear Cell Chondrosarcoma

Abstract Background: Clear cell chondrosarcoma (CCCS) is a rare, low-grade, malignant chondrogenic bone tumour. This tumour commonly occurs at the epiphysis of long bones, particularly in the proximal femur. Case presentation: This report describes a 58-year-old man with right hip pain since 5 months. Plain radiography, magnetic resonance imaging (MRI), and computed tomography (CT) revealed the characteristic appearance of chondroid mineralisation in the right femoral head, suggesting typical CCCS. Although a biopsy is the gold standard for definite diagnosis before treatment, wide resection with removal of the biopsy tract is thought to affect negatively affect surgical margin and postoperative hip function. En bloc resection without a biopsy and a hip hemiarthroplasty were performed instead. The pathological diagnosis was CCCS, and an adequate surgical margin was obtained. No local recurrence or distant metastases were found, and postoperative function was excellent at the final follow-up. Conclusion: The femoral head is a typical location of CCCS. Wide resection with adequate margins is the main treatment strategy for CCCS. When radiological features are typical, performing an en bloc resection without performing a biopsy is an acceptable treatment that may improve patient outcomes.

scholarly journals Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

2021 ◽  
Vol 09 (02) ◽  
pp. E258-E262
Author(s):  
Christian Suchy ◽  
Moritz Berger ◽  
Ingo Steinbrück ◽  
Tsuneo Oyama ◽  
Naohisa Yahagi ◽  
...  
Keyword(s):  
Case Series ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Published Data ◽  
Low Grade ◽  
Recurrence Rates ◽  
En Bloc ◽  
Long Term Follow Up

Abstract Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.

scholarly journals Leptomeningeal dissemination of a low-grade lumbar paraganglioma: case report

2017 ◽  
Vol 26 (4) ◽  
pp. 501-506 ◽  
Author(s):  
Nick Thomson ◽  
Karel Pacak ◽  
Meic H. Schmidt ◽  
Cheryl A. Palmer ◽  
Karen L. Salzman ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Ct Scanning ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Chemotherapeutic Agents ◽  
Low Grade ◽  
Leptomeningeal Dissemination ◽  
Mri Findings ◽  
En Bloc ◽  
Pet Scanning

Leptomeningeal dissemination of paraganglioma is rare, with only 2 prior cases in the literature. The authors present the case of a metastatic low-grade lumbar paraganglioma via leptomeningeal dissemination. This report emphasizes the utility of 3,4-dihydroxy-6-18F-fluoro-l-phenylalanine (18F-FDOPA) PET scanning for diagnosis, as well as the combination of radiation therapy and alkylating chemotherapeutic agents for the treatment of this rare phenomenon. The patient was a 61-year-old woman who presented with low-back pain and was found to have an isolated L-3 intrathecal tumor on MRI. Sixteen months after gross-total en bloc resection of the paraganglioma, the patient again became symptomatic with new neurological symptoms. MRI findings revealed enhancing leptomeningeal nodules throughout the spine. 18F-FDOPA PET/CT scanning was used to confirm the diagnosis of disseminated paraganglioma. Intrathecal thiotepa, radiation therapy, and systemic therapy with capecitabine and temozolomide have been used sequentially over a 2-year period, with each able to stabilize tumor growth for several months. The authors also summarize the 2 other reports of leptomeningeal dissemination of paragangliomas in the literature and compare the course and management of the 3 cases.

scholarly journals A rare presentation of a retroperitoneal cystic teratoma in an adult.

2021 ◽  
Author(s):  
Elroy Weledji ◽  
Ngwane Ntongwetape
Keyword(s):  
Adult Female ◽  
Cystic Teratoma ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Rare Presentation ◽  
Lesser Sac ◽  
Infancy And Childhood ◽  
Sacrococcygeal Region ◽  
Tissue Origin

Being of embryonal tissue origin, the teratomas are rare in adults, typically occurring either in the gonads or in the sacrococcygeal region in infancy and childhood. We present a case of a teratoma in the lesser sac of an adult female managed by en-bloc resection with the infiltrating stomach segment.

scholarly journals A Giant retroperitoneal liposarcoma encasing entirely the right kidney: A case report and a review of nephrectomy indications

2021 ◽  
Author(s):  
Houssem Harbi ◽  
Amira Akrout ◽  
Mohamed Fourati ◽  
Amine Zouari ◽  
Nozha Toumi
Keyword(s):  
Elderly Patient ◽  
Case Report ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Margins ◽  
En Bloc ◽  
Retroperitoneal Liposarcoma ◽  
R1 Resection ◽  
The Right

A 68-year-old female was operated for a giant dedifferentiated retroperitoneal liposarcoma (RLS) encasing entirely the right kidney. She had an en-bloc resection of the tumor with right nephrectomy. The en-bloc resection should avoid R1 resection margins. Renal conservation is suggested if the kidney is widely displaced and for elderly patient.

Endoscopic resection of low grade, subglottic chondrosarcoma

2009 ◽  
Vol 123 (12) ◽  
pp. 1364-1366 ◽  
Author(s):  
Y Oestreicher-Kedem ◽  
T G Dray ◽  
E J Damrose
Keyword(s):  
Endoscopic Resection ◽  
Cricoid Cartilage ◽  
Voice Quality ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Low Grade ◽  
Retrospective Case ◽  
En Bloc ◽  
Extensive Resection ◽  
Airway Patency

AbstractIntroduction:This paper evaluates the feasibility of transoral, endoscopic resection of macroscopically localised, low grade, subglottic chondrosarcoma.Method:Retrospective case study including patients diagnosed with low grade, subglottic laryngeal chondrosarcoma. Tumours were resected endoscopically via direct laryngoscopy with microlaryngeal technique, under jet ventilation. The post-operative course, vocal fold function, airway patency and oncological results were evaluated.Results:Two male patients aged 49 and 60 years underwent endoscopic, translaryngeal, en bloc resection of low grade chondrosarcoma of the cricoid cartilage. Extubation was performed immediately after surgery. Neither patient required tracheostomy or developed subglottic stenosis. No tumour recurrence was noted after an average follow up of 10.5 months. Voice quality was stable and dyspnoea improved.Summary:Transoral, endoscopic resection of low grade, subglottic chondrosarcoma is a viable technique with good functional outcomes. Extensive resection of subglottic disease is possible, which may afford patients an alternative to total laryngectomy.

Clear Cell Chondrosarcoma With Chondroblastoma-Like Features: A Case for Team Diagnosis

2018 ◽  
Vol 26 (8) ◽  
pp. 766-771
Author(s):  
Ryan M. Kiefer ◽  
John Wojcik ◽  
Kumarasen Cooper ◽  
Kristy L. Weber ◽  
Ronnie Sebro
Keyword(s):  
Clear Cell ◽  
Osteolytic Lesion ◽  
Bone Lesion ◽  
Final Diagnosis ◽  
En Bloc Resection ◽  
Low Grade ◽  
Adjacent Area ◽  
En Bloc ◽  
Left Femur ◽  
Clear Cell Chondrosarcoma

Clear cell chondrosarcoma (CCCS) is a rare variant of conventional chondrosarcoma with low-grade malignant features that may be confused radiographically and histologically with chondroblastoma. We report a case of a 50-year-old female who presented with 6 months of left hip pain. Initial radiographs demonstrated an osteolytic lesion with adjacent area of sclerosis in the proximal left femur. Magnetic resonance imaging demonstrated a marrow-infiltrative lesion with periosteal reaction and thickened enhancing periosteum. Biopsy of the sclerotic area demonstrated chondroblastoma-like findings, whereas biopsy of the lytic area showed features suggestive of CCCS. The patient eventually underwent en bloc resection and reconstruction with a proximal femoral megaprosthesis. The final diagnosis was CCCS. We present this unusual case with review of the radiographic and histologic features of CCCS with attention to its ability to mimic chondroblastomas. This case highlights the importance of sampling radiographically heterogeneous areas within a bone lesion to facilitate accurate diagnosis and appropriate management.

scholarly journals Endoscopic Mucosal Resection Performed Underwater for Nonampullary Duodenal Epithelial Tumor: Evaluation of Feasibility and Safety

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Goro Shibukawa ◽  
Atsushi Irisawa ◽  
Ai Sato ◽  
Yoko Abe ◽  
Akane Yamabe ◽  
...  
Keyword(s):  
Treatment Method ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Low Grade ◽  
En Bloc ◽  
Serious Adverse Events ◽  
Epithelial Tumor ◽  
Gastrointestinal Lesions ◽  
Secondary Objective ◽  
Nodular Lesions

Objectives. Recently, opportunities to encounter superficial nonampullary duodenal epithelial tumor (SNADET) have increased. EMR and ESD are performed to treat SNADET. However, the rate of perforation is higher than that of other gastrointestinal lesions, regardless of which method is used. Underwater EMR (UW-EMR) is immersion treatment of SNADET, which has low risk of perforation and can remove lesions safely and completely. In the present study, we retrospectively investigated patients in whom UW-EMR was performed to evaluate the feasibility and safety of UW-EMR for the treatment of SNADET. Methods. The primary endpoint was to evaluate the feasibility of UW-EMR for the treatment of SNADET, and secondary objective was to determine the operation’s safety. Results. There were 14 participants, with a total of 16 lesions, who underwent UW-EMR between August 2015 and December 2017. Histological heteromorphism revealed that seven patients had low-grade adenoma, seven had high-grade adenoma, and two had adenocarcinoma. En bloc resection was performed in 14 lesions. In two patients, nodular lesions were observed in the scar and biopsy confirmed recurrences. There were no serious adverse events including bleeding or perforation. Conclusions. UW-EMR may be a safe and effective treatment method for SNADET, if its therapeutic indication is adequately considered.

scholarly journals Giant cell tumor cuboid: a rare case report.

2019 ◽  
Vol 26 (09) ◽  
pp. 1597-1599
Author(s):  
Mukesh Kumar ◽  
Masroor Ahmed ◽  
Muhammad Saleem ◽  
Khurram Sahar
Keyword(s):  
Giant Cell Tumor ◽  
Giant Cell ◽  
Skeletal Maturity ◽  
Osteolytic Lesion ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Cell Tumor ◽  
En Bloc ◽  
Cuboid Bone ◽  
The Right

Osteoclastoma (Giant Cell Tumor) of Cuboid bone is a rare bone tumor. GCT is primarily seen in metaphyseo-epiphyseal region of long bones after skeletal maturity. This patient is a 17 years old female, presented with painful swelling of the right foot. On conventional radiographs, there is osteolytic lesion in Cuboid bone of right foot. En bloc resection and autologous bone grafting (iliac crest) was done. Patient's pain and swelling disappeared following the procedure and there is no evidence of recurrence at 18 months follow up.

485 MINIMALLY INVASIVE EN-BLOC OESOPHAGECTOMY: ANALYSIS OF THE OUTCOMES ALONG A LEARNING CURVE

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
F Di Maggio ◽  
A Lee ◽  
Z Vrakopoulou ◽  
H Deere ◽  
A Botha
Keyword(s):  
Survival Rate ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Hospital Stay ◽  
Open Surgery ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Margins ◽  
En Bloc ◽  
Minimally Invasive Oesophagectomy

Abstract   Minimally invasive oesophagectomy is technically demanding but benefits perioperative morbidity and intra-hospital mortality. We previously described open total adventitial resection of the cardia (TARC) as an optimal anatomical resection technique for lower oesophageal and gastro-esophageal junction cancers. We wanted to investigate whether the peri-operative benefits of minimally invasive techniques, along with en-bloc resection of the primary tumour, translate into long term survival benefit in a specialized high volume center along a surgeon learning curve. Methods Data from 198 consecutive patients undergoing oesophagectomy by a single surgeon was collected prospectively. Patient stratification was made to chronologically reflect four main stages of our learning curve: open surgery, Laparoscopic Ivor Lewis, laparoscopy/thoracoscopy with mini-thoracotomy and laparoscopic TARC. Primary outcomes included five-year survival rate, operating time, hospital stay, specimen lymphnodes. Peri-operative complications and mortality are also described. 45 patients had open surgery; laparoscopy (n = 50) was initiated after two years, and thoracoscopy (n = 56) introduced after case 94. MIO was performed for the last 47 patients. Patients in all groups had similar demographics, histological diagnosis, preoperative and pathological staging. Results 158 patients were male (79.8%); age was 63 +/− 10 years. Overall five-year survival rate was 45%; perioperative mortality rate was 1.5% (n = 3); 13 patients were returned to theatre. Hospital stay was 22+/−23 days. Specimen lymph nodes were 21+/− 8. Resection margins were negative (ACP) in 193 cases (97.4%). Five-year survival rates during the 4 phases were 38.6%, 44.9%, 42.8% and 59% respectively, showing a benefit trend towards the end of the learning curve (p = 0.03). Specimen lymph nodes were: open = 20.5+/−9.5; Lap = 19.5+/− 7; mini-tho = 19.9+/− 7; MIO = 25+/− 10 (p = 0.027). Resection margins were &gt; 1 mm in 68.1%(open), 67.3%(lap), 64.2%(mini-tho) and 79.5(MIO). Conclusion Laparoscopic en-bloc resection of cancers of the OGJ requires a long learning curve. Proficiency gains along this learning curve affects oncological quality of oesophageal resectional surgery and benefits patients survival after minimally invasive oesophagectomy.

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