scholarly journals An Unusual Location for a Nonurachal Bladder Adenocarcinoma

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
George Khludenev ◽  
Akshay Reddy ◽  
Sinan Akosman ◽  
Michael J. Whalen
Keyword(s):  
Bladder Neoplasms ◽  
Operative Management ◽  
Large Mass ◽  
Disease Recurrence ◽  
Oncologic Outcomes ◽  
Medical Community ◽  
Standardized Treatment ◽  
Treatment Paradigm ◽  
Negative Tumor ◽  
Bladder Adenocarcinoma

Malignant bladder neoplasms represent a significant disease burden not only for urologists but also the broader medical community. While the majority of bladder tumors are urothelial in origin, up to two percent are found to be adenocarcinomas. Among bladder adenocarcinomas, roughly one-tenth are urachal and are frequently located at the dome of the bladder where urachal remnants can often be found. We describe a case of bladder adenocarcinoma that presented at the dome of the bladder but ultimately exhibited a nonurachal histology. A 65-year-old male with a history of myocardial infarction and cerebrovascular accident with residual right-sided hemiparesis and aphasia was referred to our clinic for evaluation of a bladder mass discovered in the setting of painless gross hematuria. Diagnostic cystoscopy demonstrated a large mass at the dome of the bladder, and subsequent transurethral resection revealed stage T1 mucinous adenocarcinoma arising in a villous adenomatous lesion without the presence of muscle in the specimen. The patient underwent a robotic-assisted laparoscopic partial cystectomy with extended bilateral pelvic lymph node dissection. Postoperatively, the patient experienced short-lived paralytic ileus and was discharged on postoperative day 5. Follow-up surveillance imaging at 6 months with CT chest, abdomen, and pelvis, repeat office cystoscopy, and negative tumor markers postoperatively indicated no evidence of disease recurrence. Characterization of bladder adenocarcinomas into urachal and nonurachal subtypes is critical in differentiating the operative management and oncologic outcomes of the respective neoplasms. However, given the paucity of literature describing treatment approaches to bladder adenocarcinoma in general, existing methods have largely mirrored genetically similar neoplasms, including ovarian and colon adenocarcinomas. Although there is still much to be understood regarding the potential mechanisms of carcinogenesis of nonurachal adenocarcinomas, further investigation may pave the way for a more standardized treatment paradigm and provide insight into the potential utility of modern immunotherapies.

scholarly journals Adaptive Magnetic Resonance-Guided Stereotactic Body Radiotherapy: The Next Step in the Treatment of Renal Cell Carcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Brian Keller ◽  
Anna M. E. Bruynzeel ◽  
Chad Tang ◽  
Anand Swaminath ◽  
Linda Kerkmeijer ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Oncologic Outcomes ◽  
Invasive Treatment ◽  
Non Invasive ◽  
Treatment Paradigm ◽  
Plan Adaptation ◽  
New Treatment ◽  
Tissue Sparing

Adaptive MR-guided radiotherapy (MRgRT) is a new treatment paradigm and its role as a non-invasive treatment option for renal cell carcinoma is evolving. The early clinical experience to date shows that real-time plan adaptation based on the daily MRI anatomy can lead to improved target coverage and normal tissue sparing. Continued technological innovations will further mitigate the challenges of organ motion and enable more advanced treatment adaptation, and potentially lead to enhanced oncologic outcomes and preservation of renal function. Future applications look promising to make a positive clinical impact and further the personalization of radiotherapy in the management of renal cell carcinoma.

Colon Cancer

2018 ◽  
Author(s):  
Richard S Hoehn ◽  
Felipe Quezada-Diaz ◽  
Jesse J Smith
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Surgical Resection ◽  
Distant Metastases ◽  
Disease Recurrence ◽  
The United States ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Increased Risk ◽  
Localized Disease

Colon cancer is a leading cause of cancer-related death in the United States and worldwide. Routine screening has led to early diagnosis and improved survival for many patients but is still greatly underused. Complete surgical resection provides the best opportunity for cure of localized disease and requires removal of a defined segment of colon along with its lymphovascular pedicle, including a minimum of 12 lymph nodes. Minimally invasive approaches have been shown to provide better perioperative outcomes and patient recovery, with oncologic outcomes equivalent to those of traditional open surgery. Patients with lymph node metastases are at an increased risk of distant metastases and disease recurrence. Survival for these patients has improved in the recent years with the advent of oxaliplatin-based adjuvant chemotherapy. In addition, surgical resection is increasingly being used to control and sometimes cure distant metastases. In this chapter, we review the current strategies for diagnosing and managing colon cancer.   This review contains 1 video, 5 figures, 4 tables and 48 references Key Words: adjuvant chemotherapy, anastomosis, colectomy, colon cancer, neoadjuvant chemotherapy, surgery, survival, laparoscopic, robotic

scholarly journals Case of primary hepatic leiomyosarcoma successfully treated with laparoscopic right hepatectomy

2020 ◽  
Vol 13 (2) ◽  
pp. e233567 ◽  
Author(s):  
Stephanie Vella ◽  
Kelvin Cortis ◽  
David Pisani ◽  
James Pocock ◽  
Luca Aldrighetti
Keyword(s):  
Physical Examination ◽  
Surgical Resection ◽  
Epigastric Pain ◽  
Large Mass ◽  
Disease Recurrence ◽  
Right Hepatectomy ◽  
Liver Lobe ◽  
Laparoscopic Right Hepatectomy ◽  
The Right

We describe the case of a 77-year-old woman, presenting with non-specific epigastric pain. Physical examination and subsequent imaging revealed the presence of a large mass in the right liver lobe. This was shown to be a leiomyosarcoma on biopsy histology. Further investigation confirmed this to be a primary hepatic leiomyosarcoma with no evidence of metastases. The patient underwent successful surgical resection. She is currently under imaging follow-up, with no evidence of disease recurrence.

Nonoperative management (NOM) in rectal cancer: Physician perspectives on offering NOM as standard of care.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 79-79
Author(s):  
Andrea Marie Covelli ◽  
Fayez A. Quereshy ◽  
Erin Diane Kennedy ◽  
Sami A. Chadi ◽  
Frances Catriona Wright
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Oncologic Outcome ◽  
Standard Of Care ◽  
High Volume ◽  
Operative Management ◽  
Oncologic Outcomes ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
And Gender

79 Background: 20% of rectal cancer patients will have a complete clinical response (cCR) following neoadjuvant chemoradiotherapy. Non-operative management (NOM) with close surveillance can spare patients proctectomy and avoid the sequelae of surgery. Patients are interested in and advocate for NOM, whereas oncologists appear to be reluctant to offer this option. We wished to identify the perceptions and barriers that oncologists face when considering NOM. Methods: This qualitative study explored oncologists’ experiences treating rectal cancer and identified their perceptions and values around NOM. Purposive and snowball sampling identified medical, radiation and surgical oncologists’ who treat a high volume of rectal cancer across Canada. Oncologists varied in length/location of practice and gender. Data were collected via semi-structured interviews. Constant comparative analysis identified key concepts. Results: Data saturation was achieved after 40 interviews: 20 surgeons, 12 radiation and 8 medical oncologists. The dominant theme was “NOM is not ready for prime time’. Most oncologists felt that there is insufficient long-term data around NOM and single center studies appear ‘too good to be true’. Physicians voiced concerns about worsening oncologic outcomes in the setting of regrowth, the challenges in determining a cCR and apprehension around patient compliance to surveillance. Some oncologists felt that NOM is limited to a very select population and voiced reluctance in offering it to younger patients or patients with more advanced disease. There was little consideration to improved functional outcomes with NOM. Overall the majority of participants felt that NOM is ‘ trading the benefit of saving the rectum for the uncertainty of an inferior oncologic outcome’. Conclusions: Oncologists felt that NOM should not be offered as a standard of care option following a cCR. Most felt that there is insufficient data supporting NOM and are concerned around worse oncologic outcomes. Patient views of NOM are critically needed to assess if patients value the same outcomes. Additional research is needed to address barriers should patients wish to consider NOM as a treatment option in the setting of a cCR.

scholarly journals Vaginal oligometastatic disease of colorectal primary: Report of a novel therapeutic approach

Rare Tumors ◽  
2021 ◽  
Vol 13 ◽  
pp. 203636132110445
Author(s):  
Sobiya Ansari ◽  
Yixiang Liao ◽  
Summer Dewdney ◽  
Dian Wang ◽  
Parul Barry
Keyword(s):  
African American Woman ◽  
American Woman ◽  
Hepatic Flexure ◽  
Final Pathology ◽  
Oligometastatic Disease ◽  
Brachytherapy Boost ◽  
Standardized Treatment ◽  
Treatment Paradigm ◽  
Rare Malignancy

Vaginal oligometastatic disease of colorectal primary is a rare malignancy with few reported cases in the literature and no standardized treatment paradigm. We report on the definitive management of an unusual case of an elderly woman with the aforementioned disease. A 78-year-old African-American woman presented with vaginal spotting and was found to have a vaginal lesion. Final pathology was consistent with moderately differentiated adenocarcinoma of colorectal primary. Extensive work up, which included endoscopies, pathologic analyzes, and imaging workup, did not reveal a primary gastrointestinal malignancy. The patient underwent partial vaginectomy and final pathology once again confirmed moderately differentiated adenocarcinoma of colorectal primary (CDX 2 and CEA positive, ER/PR, and CK 7 negative) with negative margins. She went on to receive adjuvant concurrent chemoradiation with 5-FU based chemotherapy. She received 45 Gy in 25 fractions to the whole pelvis followed by an HDR brachytherapy boost to 12 Gy in two fractions. Unfortunately, 10 months after completing radiation, she was found to have adenocarcinoma arising from a hepatic flexure colon polyp on colonoscopy. She required definitive surgical resection and was staged as mpT3N0M1. She received 12 cycles of 5-FU and at 2-year follow-up was found to be disease free with no evidence of locoregional recurrence or distant metastatic disease. Continued long-term follow up is warranted.

Prognostic role of cell cycle–related biomarkers in clear cell renal cell carcinoma.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 404-404
Author(s):  
Bishoy A. Gayed ◽  
Ramy F. Youssef ◽  
Aditya Bagrodia ◽  
Payal Kapur ◽  
Arthur I. Sagalowsky ◽  
...  
Keyword(s):  
Cell Cycle ◽  
Clear Cell ◽  
Disease Recurrence ◽  
Oncologic Outcomes ◽  
Cumulative Number ◽  
Pathological Features ◽  
Aberrant Expression ◽  
Cox Regression Analysis ◽  
Oncological Outcomes ◽  
The Impact

404 Background: Cell cycle regulatory molecules are implicated in various stages of carcinogenesis. In this study we systematically evaluate the impact of aberrant expression of cell cycle regulators on oncological outcomes in clear cell renal carcinoma (ccRCC). Methods: After obtaining IRB approval, immunohistochemistry for Cyclin D, Cyclin E, p16, p21, p27, p53, p57, and Ki-67 was performed on tissue microarray constructs of patients treated with radical or partial nephrectomy for ccRCC between 1997-2010. Comprehensive clinical and pathologic data elements were collected. A prognostic marker score (MS) was defined as favorable if ≤4 biomarkers were altered; unfavorable if >4 biomarkers were altered. The relationship between MS and aggressive pathological features and oncological outcomes was evaluated. Results: The study included 452 patients, 277 males (61%). Median age was of 57 years (range, 17-85) and median follow up of 20 months (range, 0-150). The tumors demonstrated extrarenal extension (pT3-T4) in 120 (27%) patients and advanced grade (G 3/4) in 169 (37%). Regional nodal involvement and systemic metastases at the time of nephrectomy was present in 22 (5%) and 51(11%) patients, respectively. Unfavorable MS was found in 80 (18%) patients and was associated with distant and nodal metastasis, advanced T stage, advanced grade, tumor necrosis, sarcomatoid differentiation, lymphovascular invasion, fat invasion, adrenal involvement, and presence of venous thrombus (p < .05). A statistically significant correlation between unfavorable MS and disease recurrence (HR 6.5 and p = 0.01) and a correlation approaching significance with cancer specific mortality (HR 3.4 and p = 0.06) was demonstrated in Kaplan Meier survival analysis. In a multivariate Cox regression analysis, unfavorable MS was an independent predictor of disease recurrence (HR 2.268, CI 1.00-5.12 p = 0.049). Conclusions: The cumulative number of aberrantly expressed cell cycle biomarkers correlates with aggressive pathological features and inferior oncologic outcomes. Our findings support prospective pathway-based exploration of biomarkers to augment current clinico-pathologic predictors of oncologic outcomes in ccRCC.

Local Treatment in the Management of Oligometastatic Prostate Cancer

2018 ◽  
Author(s):  
Derya Tilki ◽  
Christopher P Evans
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Metastatic Prostate Cancer ◽  
Randomized Clinical Trials ◽  
Retrospective Studies ◽  
Local Treatment ◽  
Oncologic Outcomes ◽  
Newly Diagnosed ◽  
Oligometastatic Prostate Cancer ◽  
Treatment Paradigm

Oncologic outcomes of patients with newly diagnosed metastatic prostate cancer (mPCa) are poor, with overall survival in the range of 44 to 60 months. The treatment paradigm for newly diagnosed mPCa is changing. Previous retrospective studies reported a survival benefit for local treatment (radical prostatectomy or radiotherapy) in addition to androgen deprivation treatment in the setting of oligometastatic prostate cancer. Several randomized clinical trials are now evaluating integration of local treatment in the approach to mPCa. The aim of this review is to summarize the studies reporting local treatment in men with mPCa at diagnosis. This review contains 1 table and 27 references.  Key Words: cytoreductive prostatectomy, hormone-naive, local treatment, metastatic prostate cancer, oligometastatic, radical prostatectomy, radiotherapy, randomized

scholarly journals CARCINOMA UROTELIAL DA BEXIGA: RELATO DE CASO

2020 ◽  
Vol 12 (3) ◽  
pp. 82-85
Author(s):  
Gabriel Bandeira Santos ◽  
Felipe Iankelevich Baracat ◽  
Oscar Rubini Ávila
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Bladder Neoplasms ◽  
Kidney Injury ◽  
Disease Recurrence ◽  
Good Prognosis ◽  
Pelvic Lymphadenectomy ◽  
Common Symptom ◽  
Macroscopic Hematuria ◽  
Muscle Invasive

Among male patients, bladder cancer is the fourth most common and is rarely identified in young individuals. The most common symptom is macroscopic hematuria and the initial treatment is transurethral resection of the bladder, in which the stage and classification are identified. Smoking is known to be the main risk factor for bladder cancers. Radical cystectomy and bilateral pelvic lymphadenectomy are the “gold standard” treatment for muscle-invasive bladder cancer. Around 25% of bladder neoplasms are muscle-invasive at diagnosis, but the patients have a good prognosis with this kind of treatment. The Bricker technique is the most used for the reconstruction of the neobladder. In this paper we report the case of a male patient, 55 years old, with invasive high-grade bladder cancer, treated with a radical cystectomy, lymphadenectomy and neobladder using the Bricker technique. After the surgical procedure, the patient remained in the Intensive Care Unit for two days, presenting acute kidney injury and the need for three hemodialysis sessions. The recovery was adequate, with a good postoperative evolution. We emphasize the importance of reporting to the patient about the indispensable clinical follow-up, which must be done until medical discharge, to avoid disease recurrence and the need for more aggressive treatments, as we will see in this case.

scholarly journals Indeterminate Cell Histiocytosis – Case Report and Review of Literature

2018 ◽  
Vol 10 (1) ◽  
pp. 18-24
Author(s):  
Aleksandra R. Vojvodić ◽  
Željko Mijušković ◽  
Lidija Kandolf Sekulović
Keyword(s):  
Dendritic Cells ◽  
Case Report ◽  
Case Reports ◽  
Treatment Options ◽  
Disease Recurrence ◽  
Braf V600e ◽  
Histopathological Analysis ◽  
Entire Body ◽  
S 100 ◽  
Standardized Treatment

Abstract Introduction. Indeterminate cell histiocytosis is a rare proliferative disorder of indeterminate dendritic cells, reported in only 50 case reports so far. It is clinically presented as yellow, red or brown papules and nodules that appear in otherwise healthy adult individuals. Indeterminate cells are distinct dendritic cells of the skin that have ultrastructural similarities to the epidermal Langerhans cells but do not contain the characteristic Birbeck’s granules and they are also langerin-negative, unlike LCH. Indeterminate cell histiocytosis is an exceptional entity with variable clinical, histopathologic or immunohistochemical findings, sharing morphologic and immunophenotypic features with both Langerhans- and non-Langerhans cell histiocytoses. Case Report. We present a case of indeterminate histiocytosis in a 77-year-old man with 3-year history of asymptomatic, multiple reddish and brown papules and nodules over the entire body, including the oral mucosa. Skin biopsy was done, and histopathological analysis with immunohistochemistry was performed. The positive ICH staining of cells for CD68, CD1a, and S-100 enabled us to diagnose ICH in our patient. Also, BRAF V600E mutation was detected in tumor tissue. The treatment was started with methotrexate that was effective for 6 months, but due to the disease recurrence, further therapy with thalidomide was advised, without effect. Conclusion. Indeterminate histiocytosis is a rare disease, therefore no standardized treatment has been established and the treatment options are limited.

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