The Use of Radiation Therapy in the Management of Selected Patients with Atypical Lipomas

Background and Objectives. Atypical lipomas are uncommon, slow-growing benign tumors. While surgery has been the primary treatment modality, we have managed some patients with radiation (RT) as a component of the treatment and have reported their outcomes in this study.Methods. A retrospective review of all cases of extremity and trunk atypical lipomas in The Sarcoma Database at the study institution was conducted.Results. Thirteen patients were identified. All patients underwent surgical resection at initial presentation and received pre- or postoperative radiation for subtotal resection (n=2), local recurrence (n=8), or progressive disease (n=3). The median total radiation dose was 50 Gy. Median followup was 65.1 months. All patients treated with RT remained free of disease at the last followup. No grade 3 or higher late toxicity from radiation was observed. No cases of tumor dedifferentiation occurred.Conclusion. For recurrent or residual atypical lipomas, a combination of reexcision and RT can provide long-term local control with acceptable morbidity. For recurrent tumors, pre-op RT of 50 Gy appears to be an effective and well-tolerated management approach.

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RADIOSURGERY FOR BENIGN INTRADURAL SPINAL TUMORS

Neurosurgery ◽

10.1227/01.neu.0000318174.28461.fc ◽

2008 ◽

Vol 62 (4) ◽

pp. 887-896 ◽

Cited By ~ 93

Author(s):

Peter C. Gerszten ◽

Steven A. Burton ◽

Cihat Ozhasoglu ◽

Kevin J. McCue ◽

Annette E. Quinn

Keyword(s):

Neurofibromatosis Type ◽

Primary Treatment ◽

Spinal Tumors ◽

Benign Tumors ◽

Tumor Control ◽

External Beam Irradiation ◽

Primary Treatment Modality ◽

Sacral Tumor

Abstract OBJECTIVE The role of stereotactic radiosurgery for the treatment of intracranial benign tumors is well established. There is less experience and more controversy regarding its use for benign tumors of the spine. This study evaluated the clinical efficacy of radiosurgery as part of the treatment paradigm of selected benign tumors of the spine. METHODS Seventy-three benign intradural extramedullary spinal tumors were treated with a radiosurgery technique and prospectively evaluated. Patient ages ranged from 18 to 85 years (mean age, 44 yr); the follow-up period was 8 to 71 months (median, 37 mo). Lesion location included 43 cervical, five thoracic, 19 lumbar, and six sacral. Tumor histology included neurofibroma (25 cases), schwannoma (35 cases), and meningioma (13 cases). Twenty-one cases were associated with neurofibromatosis Type 1, and nine patients had neurofibromatosis Type 2. Nineteen tumors (26%) had previously undergone open surgical resection, and six tumors (8%) had previously been treated with conventional external beam irradiation techniques. RESULTS Similar radiation doses were prescribed for all three histopathologies. The maximum intratumoral dose was 1500 to 2500 cGy (mean, 2164 Gy). Tumor volume ranged from 0.3 to 93.4 cm3 (mean, 10.5 cm3; median, 4.11 cm3). Radiosurgery was used for the treatment of postsurgical radiographic progression in 18 cases; it was used as the primary treatment modality in 14 cases; it was used for treatment of radiographic tumor progression in nine cases; and it was used for the treatment of postsurgical residual tumor in two cases. Long-term pain improvement occurred in 22 out of 30 cases (73%). Long-term radiographic tumor control was demonstrated in all cases. Three patients experienced new symptoms attributed to radiation-induced spinal cord toxicity 5 to 13 months after treatment. CONCLUSION Single fraction radiosurgery was found to be clinically effective for the treatment of benign extramedullary spinal neoplasms. Although surgical extirpation remains the primary treatment option for most benign spinal tumors, radiosurgery was demonstrated to have short-term clinical benefits for the treatment of such lesions. The long-term efficacy of spinal radiosurgery for such tumors will be determined with longer follow-up periods. Its role in patients with neurofibromatosis will also be further defined with greater clinical experience.

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Giant Parotid Pleomorphic Adenoma with Atypical Histological Presentation and Long-Term Recurrence-Free Follow-Up after Surgery: A Case Report and Review of the Literature

Case Reports in Dentistry ◽

10.1155/2020/8828775 ◽

2020 ◽

Vol 2020 ◽

pp. 1-18

Author(s):

Mohammed AlKindi ◽

Sundar Ramalingam ◽

Lujain Abdulmajeed Hakeem ◽

Manal A. AlSheddi

Keyword(s):

Pleomorphic Adenoma ◽

Surgical Management ◽

Early Stage ◽

English Literature ◽

Benign Tumors ◽

Adjuvant Radiation ◽

Extracapsular Dissection ◽

Slow Growing

Salivary gland tumors (SGT) comprise 3% of all head and neck tumors, are mostly benign, and arise frequently in the parotid gland. Pleomorphic adenoma (PA) is the commonest SGT, representing 60-70% of all benign parotid tumors. Clinically, parotid PA presents as irregular, lobulated, asymptomatic, slow-growing preauricular mass, involving both superficial and deep lobes, and could grow to gigantic proportions. Histologically, PA has epithelial and mesenchymal elements in chondromyxoid matrix and is managed surgically. Based on a review of 43 cases reported in English literature since 1995, giant parotid PA is reported as large as 35 cm (diameter) and 7.3 kg (resected weight). Although rare, 10 cases of malignant transformation were reported in the review. Surgical management included extracapsular dissection (ECD), superficial parotidectomy, and total parotidectomy for benign tumors, and adjuvant radiation or chemotherapy for malignant tumors. We further present the case of a 36-year-old healthy male with slow-growing and asymptomatic giant parotid PA, of 4-year duration. The patient presented with firm, lobulated preauricular swelling, provisionally diagnosed as PA based on radiographic and cytological findings. The tumor was resected through ECD, and the patient had uneventful postoperative recovery and a 7-year recurrence-free follow-up period. Histological examination revealed epimyoepithelial proliferation punctuated by chondromyxoid areas, with extensive squamous metaplasia and keratin cysts. To the best of knowledge from indexed literature, giant parotid PA is rarely reported in Saudi Arabia. In addition to its rarity, this case is reported for its benign nature despite atypical histological presentation, successful surgical management without complications, and long-term recurrence-free follow-up. Based on this report, clinicians must be aware of atypical histological presentations associated with PA and plan suitable surgical management and follow-up to avoid morbidity. Nevertheless, attempts must be made to diagnose and manage these lesions at an early stage and before they reach gigantic proportions.

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Laparoscopic resection of bilateral perinephric pseudocyst in a pediatric feline patient

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116919850646 ◽

2019 ◽

Vol 5 (1) ◽

pp. 205511691985064

Author(s):

Margaret Amparo Placer ◽

Cindy McManis

Keyword(s):

Laparoscopic Resection ◽

Kidney Injury ◽

Abdominal Distension ◽

Surgical Approaches ◽

Subtotal Resection ◽

Invasive Approach ◽

Less Invasive Approach ◽

History Of ◽

Grade 3

Case summary A 6-month-old male domestic shorthair cat presenting with abdominal distension and an acute history of renal azotemia was diagnosed with bilateral perinephric pseudocysts and International Renal Interest Society (IRIS) grade 3 acute kidney injury. Ultrasound-guided drainage of the cysts was performed initially; bilateral subtotal resection of the perinephric pseudocysts was later performed using laparoscopy as a more long-term solution. There was no regrowth or reformation of the perinephric pseudocysts 1 year after the procedure, and the cat remained in IRIS stage 2 chronic kidney disease 1 year postoperatively. Relevance and novel information Compared with traditional surgical approaches, laparoscopic resection of perinephric pseudocysts provides a less invasive approach. Bilateral perinephric pseudocyst in a pediatric feline patient (and associated treatment) has not previously been documented in the literature.

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Role of Adjuvant Radiosurgery after Thoracoscopic Microsurgical Resection of a Spinal Schwannoma

Case Reports in Neurological Medicine ◽

10.1155/2012/345830 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Toba N. Niazi ◽

Christian A. Bowers ◽

Meic H. Schmidt

Keyword(s):

Stereotactic Radiosurgery ◽

Treatment Modality ◽

Surgical Excision ◽

Primary Treatment ◽

Benign Tumors ◽

Noninvasive Treatment ◽

Thoracic Spinal ◽

Primary Treatment Modality ◽

Microsurgical Resection ◽

Spinal Schwannoma

Stereotactic radiosurgery to benign tumors of the spine has not been advocated as a primary treatment modality because of the favorable prognosis for these lesions after gross-total resection. There is even less evidence regarding its use as an adjuvant to neurosurgical resection of benign recurrent spinal disease. We describe the case of a 30-year-old man with a thoracic spinal schwannoma who had an interval increase of his lesion five months after thoracoscopic microsurgical resection. The patient opted for noninvasive stereotactic radiosurgery in lieu of additional surgical excision and has had stable disease 15 months after radiosurgical treatment with the linear accelerator (LINAC) system. In this setting, stereotactic radiosurgery provided a useful adjunct to thoracoscopic microsurgical resection. Future Class I and II evidence should be sought to evaluate the utility of stereotactic radiosurgery as a primary treatment modality or as an adjuvant for microneurosurgical resection of benign spinal lesions in patients who want noninvasive treatment after disease recurrence or who harbor medical comorbidities that would preclude them from being safe surgical candidates.

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Doxycycline Sclerotherapy of a Cervical Cystic Hygroma: A Caribbean Institution Experience

Case Reports in Otolaryngology ◽

10.1155/2020/9187205 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Nicholas Figaro ◽

Robbie Rampersad ◽

Solaiman Juman

Keyword(s):

Pediatric Patients ◽

Cystic Hygroma ◽

Primary Treatment ◽

Benign Tumors ◽

Cystic Lesions ◽

Formidable Challenge ◽

Select Group ◽

Primary Treatment Modality ◽

Cystic Lymphangiomas ◽

Number Of Patients

Cervical cystic lymphangiomas are rare benign tumors that pose a formidable challenge to surgeons confronted with managing this uncommon entity. Due to the intimacy with which these cystic lesions blend with critical cervical structures, a considerable number of patients who undergo surgical management are often plagued with recurrence and morbidity. As a result, doxycycline sclerotherapy has become an attractive, safe, and effective alternative as a primary treatment modality in a select group of pediatric patients. This case report presents an 18-month-old patient with a large cervical cystic hygroma that was effectively treated with exclusive doxycycline sclerotherapy.

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Comparison of the long-term toxicities conferred by two different doses of definitive chemoradiotherapy for stage II/III esophageal squamous cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.96 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 96-96

Author(s):

Emi Kubo ◽

Ken Kato ◽

Natsuko T. Okita ◽

Atsuo Takashima ◽

Yoshitaka Honma ◽

...

Keyword(s):

Cell Carcinoma ◽

Standard Dose ◽

Clinical Stage ◽

Performance Status ◽

Late Toxicity ◽

Stage Ii ◽

Definitive Chemoradiotherapy ◽

Concurrent Radiotherapy ◽

Grade 3

96 Background: Deﬁnitive chemoradiotherapy is one of the options for stage II/III esophagealsquamous cell carcinoma (ESCC). RTOG9405 recently reported that a higher dose of radiation did not confer any additional survival benefit over the standard dose (50.4 Gy). We comparedthe long-term toxicities conferred by chemoradiation at a dose of 60 Gy and 50.4 Gy for stage II/III ESCC. Methods: Eligibility criteria included clinical stage II/III (non-T4) (UICC-TNM, 6th edition) ESCC, performance status 0-2, and age 20-75 years. The study group comprised 254 patients who received definitive chemoradiotherapy as first-line therapy between January 2000 and August 2010 in our hospital. Group J (n=207) received 2 cycles of cisplatin (40 mg/m2 on days 1 and 8) with fluorouracil infusion (400 mg/m2/day on days 1-5 and 8-12), or 2 cycles of cisplatin(70 mg/m2 on day 1) with fluorouracil infusion (700 mg/m2/day on days 1-4) and concurrent radiotherapy at 60 Gy. Group R (n = 47) received 2 cycles of cisplatin (75 mg/m2 on day 1) with fluorouracil infusion (1000 mg/m2/day on days 1–4) and concurrent radiotherapy at 50.4 Gy. Long-term toxicity was evaluated according to the Common Terminology Criteria for Adverse Event Ver. 3.0. Results: The characteristics of both groups are as follows (J:R group): median age, 64:63; male/female, 178/29:42/5; PS 0/1/2, 90/104/1:33/14/0; stage IIA/IIB/III: 48/58/101:6/20/21. The median follow-up period was more than 60 months for both groups, with 5-year survival rates of 43.6% and 58.6% for the J and R group, respectively. The proportion of patients with grade 3/4 long-term toxicity in each group was as follows (J/R group): pleural effusion, (8.7%/0%; p = 0.036); pericardial effusion, (6.7%/2.1%; p = 0.196); radiation pneumonitis, (2.4%/4.2%); esophagitis, (0.9%/0%); and pericarditis, (2.4%/0%). Grade 3/4 late toxicity was observed more frequently in the J group (15.0%) than in the R group (6.4%) (p = 0.087). Treatment-related death due to pneumonitis was observed in only 1 patient in group J. Conclusions: The RTOG regimen at a dose of 50.4 Gy showed promising results while inducing lower late toxicity rates than when administered at 60 Gy.

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The Giant Paraganglioma of The Sigmoid Mesentery：A Case Report

10.21203/rs.3.rs-395424/v1 ◽

2021 ◽

Author(s):

Xinxin Wang ◽

Yuan Li ◽

Xiaojun Yang

Keyword(s):

Perioperative Period ◽

Primary Treatment ◽

Pathological Examination ◽

Pelvic Cavity ◽

Preoperative Preparation ◽

Case Presentation ◽

Anesthesia Monitoring ◽

Painless Mass ◽

Slow Growing

Abstract Background: PGL is originated from pheochromaffin cells in the adrenal paravertebral ganglion and often presented as a slow-growing, painless mass in the clinical, so many PGL are detected by imaging during physical examination. At present, surgery is still the primary treatment for radical treatment of PGL. However, If the disease and medical history cannot be asked in detail before surgery or imaging examination and related tests cannot be finished for diagnosis, the preoperative preparation will be insufficient and increasing the risk of surgery. Here, we reports the treatment of a case with undiagnosed giant sigmoid mesangial PGL before operation.Case presentation: The 56-year-old male patient was admitted to the hospital with "intermittent headache and dizziness for 3 years and aggravation for 1 week". Abdominal and pelvic CT showed that round soft tissue density shadow could be seen beside the left iliac artery in the pelvic cavity. The laparoscopic surgery was performed. The patient's blood pressure increased rapidly when the mass was removed intraoperatively, and decreased sharply when it was removed. Postoperative pathological examination showed that is a PGL.Conclusion: For patients diagnosed as space-occupying lesions accompanied by long-term persistent or intermittent hypertension, careful differentiation and diagnosis should be made in combination with the history and relevant examinations to reduce the misdiagnosis rate of the PGL. Meanwhile, the adequate preoperative preparation, intraoperative anesthesia monitoring and postoperative symptomatic supportive treatment should be done to reduce the risk of surgical treatment of this disease in the perioperative period.

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Long-term complications of definitive chemoradiotherapy for esophageal cancer using the classical method

Journal of Radiation Research ◽

10.1093/jrr/rrw078 ◽

2017 ◽

Vol 58 (1) ◽

pp. 106-113 ◽

Cited By ~ 11

Author(s):

Hitoshi Ito ◽

Satoshi Itasaka ◽

Katsuyuki Sakanaka ◽

Norio Araki ◽

Takashi Mizowaki ◽

...

Keyword(s):

Esophageal Cancer ◽

Classical Method ◽

Late Toxicity ◽

Chemoradiation Therapy ◽

Definitive Chemoradiation ◽

Grade 3 ◽

Posterior Field ◽

Long Term Survivors

Abstract Chemoradiation therapy is widely used to treat both inoperable and operable patients, and is less invasive than surgery. Although the number of long-term survivors who have received chemoradiation therapy is increasing, the long-term toxicity pattern and cumulative incidence of toxicity regarding this modality are poorly understood. Classically, chemoradiation therapy for esophageal cancer consists of an anterior–posterior field and a subsequent oblique boost field. We retrospectively analyzed patients who were treated with definitive chemoradiation therapy for esophageal cancer using this classical method from 1999 to 2008. For the assessment of toxicity, the National Cancer Institute Common Toxicity Criteria Version 3.0 was adopted. A total of 101 patients were analyzed. The median follow-up time was 16 months for all patients and 62 months for the surviving patients. Eleven patients experienced late toxicities of ≥Grade 3. Two patients died of late toxicities. The 3- and 5-year cumulative incidences for the first late cardiopulmonary toxicities of ≥Grade 3 were 17.4% and 20.8%, respectively. Cardiopulmonary effusions were observed within the first 3 years of completion of the initial treatment in seven out of eight patients. Sudden death and cardiac ischemia were observed over a 10-year period. Older age was found to be a risk factor for late toxicity after definitive chemoradiation therapy for esophageal cancer. Substantial toxicities were observed in patients who had received chemoradiation therapy for esophageal cancer using the classical method. To minimize the incidence of late toxicity, more sophisticated radiation techniques may be useful.

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Long-term health-related quality of life in patients treated for localized prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.93 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 93-93

Author(s):

Sanoj Punnen ◽

Janet E. Cowan ◽

Peter Carroll ◽

Matthew R. Cooperberg

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Primary Treatment ◽

Localized Prostate Cancer ◽

Study Cohort ◽

Urinary Function ◽

Primary Treatment Modality ◽

The Mean

93 Background: Few studies have reported long term quality of life after primary treatment for localized prostate cancer. The objective of this study was report 10 year sexual and urinary quality of life data for men undergoing various treatments in the Cancer of the Prostate Strategy and Research Endeavor database. Methods: Men who have been treated for localized prostate cancer and have baseline and follow up quality of life date made up the study cohort. Primary treatment modalities included radical prostatectomy (RP), external beam radiotherapy (EBRT), brachytherapy (BT), cryotherapy (CT), primary androgen deprivation therapy (ADT), and active surveillance/ watchful waiting (AS/WW). Sexual and urinary quality of life were assessed by the validated UCLA Prostate Cancer Index and measured on a scale from 0-100. Mixed model repeated measures analysis was used to assess the association between primary treatment modality and long term urinary and sexual quality of life. Results: 3, 772 men made up the study cohort. Among all men being treated for prostate cancer the mean urinary function score was 92 at baseline, 76 at 1 year, 81 at 5 years and 77 at 10 years. Urinary bother scores were 84 at baseline, 71 at 1 year, 82 at 5 years, and 78 at 10 years. With respect to sexual function the mean score was 49 at baseline, 23 at 1 year, 29 at 5 years, and 24 at 10 years. Finally, the mean sexual bother score was 59 at baseline, 37 at 1 year, 46 at 5 years, and 47 at 10 years. With respect to quality of life by primary treatment modality most treatments showed a similar pattern of decreased scores in the first year followed by an increased in the following two years and a plateau up to the 10 year mark. EBRT and BT showed a longer decline in sexual and urinary function post treatment while RP scores plateau after 3 years. Conclusions: Men undergoing primary treatment for localized prostate cancer experience declines in sexual and urinary function and bother in the first year which improves after 3 years and plateaus up to 10 years.

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Review of Atypical Lipoma and its Natural Treatment

International Journal of Pharmaceutical Sciences and Nanotechnology ◽

10.37285/ijpsn.2019.12.5.1 ◽

2019 ◽

Vol 12 (5) ◽

pp. 4623-4627

Author(s):

Brijesh Dasvani, ◽

Avani Khristi ◽

Vanniyer Thiyagarajan

Keyword(s):

Soft Tissues ◽

Benign Tumor ◽

Primary Treatment ◽

The Body ◽

Age Group ◽

Primary Treatment Modality ◽

Natural Treatment ◽

Atypical Lipoma ◽

Age Of Diagnosis ◽

Slow Growing

Atypical lipomatous are rare tumors that typically arise out of soft tissues in the body and common in adults. Most lipomas comprise of mature fat cells that exhibit characteristic of benign tumor by nature. They are round, motile, non-painful slow growing masses, with a characteristic soft and soggy feel, usually appear in the hypodermic area of skin. Atypical lipomas, though uncommon and slow growing can be associated with syndromes such as multiple hereditary lipomatosis, colorless adipose, Gardner's syndrome and Madelung's disease. While surgery has been the primary treatment modality, doctors have managed few patients with radiation therapy (RT). Median age of diagnosis was found in the range: 36–76 years but intramuscular lipomas may occur irrespective of age group, right from childhood to old age. However, the occurrence dominancy was found between the ages of 42 and 72 years, with the average age at presentation reported as 47 to 57 years.

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