scholarly journals Digital Papillary Adenocarcinoma, a Rare Malignant Tumor

2019 ◽  
Vol 2 (1-3) ◽  
pp. 89-93
Author(s):  
Cláudia Vale ◽  
André Carvalho ◽  
Tiago Roseiro ◽  
João Antunes ◽  
Óscar Tellechea ◽  
...  
Keyword(s):  
Case Report ◽  
High Risk ◽  
Malignant Tumor ◽  
Slow Growth ◽  
Papillary Adenocarcinoma ◽  
Risk Of Recurrence ◽  
Left Thumb ◽  
Delayed Treatment

We present a case report of a digital papillary adenocarcinoma (DPA) on the left thumb with slow growth that was completely excised, without recurrence or metastasis during 24-month follow-up. DPA is a rare malignant tumor often located on the digits of the hand. Due to its slow growth and a non-specific appearance, the diagnosis is often missed or delayed. Treatment should be surgical with clear resection of the margins due to high risk of recurrence and/or metastasis.

scholarly journals Rare presentation of a testicular angiofibroma treated with testis sparing surgery

2016 ◽  
Vol 88 (4) ◽  
pp. 330 ◽  
Author(s):  
Luca Leone ◽  
Paola Fulvi ◽  
Giulia Sbrollini ◽  
Alessandra Filosa ◽  
Enrico Caraceni ◽  
...  
Keyword(s):  
Case Report ◽  
Malignant Tumor ◽  
Gold Standard ◽  
Conservative Surgery ◽  
Pathological Examination ◽  
Benign Tumors ◽  
Frozen Sections ◽  
Rare Presentation ◽  
Final Histology

Introduction: Testicular benign tumors are very rare (< 5%). Testicular Angiofibroma (AF) is one of those, however the gold standard of treatment and follow-up is still unclear. Case report: A 47 years-old man with only one functioning testis was referred to our clinic for a palpable right testicular mass and atrophic contralateral testis. Patient underwent testis-sparing surgery with inguinal approach and intraoperative frozen sections examination with diagnosis of AF. Final histology confirmed AF. Post-operative follow-up was uneventful. Clinical and ultrasonographic follow-up was negative after 8 months. Conclusion: We report a conservative surgery in a patient with AF of the solitary testis. AF is a benign para-testicular fibrous neoplasm that could be misinterpreted as malignant tumor and treated with orchiectomy. Testis-sparing surgery is recommended in this case with intraoperative pathological examination. The excision of the mass is enough but in front of a possible recurrence a long follow-up is advisable.

scholarly journals Aggressive angiomyxoma of the perineal region

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984339 ◽  
Author(s):  
Clémence Raptin ◽  
Jean-Philippe Lucot ◽  
Alfred Bassil ◽  
Edouard Poncelet ◽  
Jean-François Prolongeau ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
High Risk ◽  
Genital Prolapse ◽  
Aggressive Angiomyxoma ◽  
Rare Tumour ◽  
Long Term Follow Up ◽  
Perineal Region

Aggressive angiomyxoma is a rare tumour that frequently involves the perineal region with a high risk of local recurrence. This is a case report of a 24-year-old female patient with a genital prolapse. We performed a surgical treatment. Histological examination found an aggressive angiomyxoma. The tumour recurred 1 year after surgery. Long-term follow-up is necessary.

Extended treatment with adjuvant imatinib (IM) for patients (pts) with high-risk primary gastrointestinal stromal tumor (GIST): The PERSIST-5 study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 11009-11009 ◽  
Author(s):  
Chandrajit P. Raut ◽  
N. Joseph Espat ◽  
Robert G. Maki ◽  
Dejka M. Araujo ◽  
Toni Faith Williams ◽  
...  
Keyword(s):  
High Risk ◽  
Treatment Duration ◽  
Patient Choice ◽  
Free Survival ◽  
Risk Of Recurrence ◽  
Primary Gist ◽  
Included Patient ◽  
First Recurrence ◽  
Clinical Trial Information

11009 Background: Adjuvant IM reduces risk of recurrence and improves survival in pts with high-risk primary GIST. Joensuu et al 2016 demonstrated higher 5-yr overall survival (OS) rates of 91.9% vs 85.3% in pts treated with adjuvant IM for 3 vs 1 yr, respectively. It is unknown if further extension of treatment duration can improve outcome. Methods: PERSIST-5 is a single-arm, phase II trial that enrolled pts ≥18 yrs of age, who underwent macroscopically complete resection of primary KIT (+) GIST with high risk of recurrence within 12 wks prior to IM treatment. High risk was defined as primary GIST (any site) ≥2 cm with a mitotic count ≥ 5/50 HPF or non-gastric primary GIST ≥5 cm. Pts were treated with IM 400 mg/d for 5 yrs or until progression, relapse, or intolerance. Primary endpoint was recurrence-free survival (RFS, defined as time of treatment start to first recurrence or death). Results: IM was administered to 91 pts with a median age of 60 yrs (range 30-90). Median tumor size was 6.5 cm (range 2.3-30 cm; 55% gastric origin). Median treatment duration was 55.7 mos (range, 0.5-75). Forty-six (50.5%) pts completed study treatment. The 5- and 8-yr estimated RFS rates were 90% (95% CI, 80-95) and 81% (95% CI, 62-91), respectively. The 5- and 8 year OS rate was 95% (95% CI, 86-99). There were 7 recurrences; 1 pt recurred and died while on IM ( PDGFRA D842V mutation) and 6 pts recurred after IM discontinuation. Two pts died after IM discontinuation, unrelated to study treatment and without recurrence. Forty-five pts discontinued study treatment; common reasons included patient choice (20%), adverse events (AEs, 17%), protocol deviation (4%), and loss of follow-up (4%). The most common AEs of all grades (regardless of relationship to IM) were nausea (71%), diarrhea (63%), fatigue (50%), muscle spasm (41%), vomiting (39%), and periorbital edema (34%). Conclusions: Five yrs of IM treatment was effective in preventing recurrence in pts with sensitive mutations who underwent resection of primary GIST. Nearly half of the patients discontinued treatment early, and most recurrences occurred after IM discontinuation. Clinical trial information: NCT00867113.

Prospective randomized trial of genomic classifier impact on treatment decisions in patients at high risk of recurrence following radical prostatectomy (G-MINOR).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. TPS154-TPS154 ◽  
Author(s):  
Todd Matthew Morgan ◽  
David Christopher Miller ◽  
Rodney Dunn ◽  
Linsell Susan ◽  
Linda Okoth ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
Treatment Decisions ◽  
Risk Of Recurrence ◽  
Clinical Center ◽  
Patient Reported ◽  
Impact On Treatment ◽  
The Impact

TPS154 Background: Approximately 30% of patients will have ≥pT3 disease and/or positive surgical margins at radical prostatectomy (RP), indicating a high risk of local recurrence. While current guidelines recommend consideration of adjuvant radiotherapy (aRT) in this setting, < 10% undergo aRT. The Decipher assay is a novel, tissue-based genomic classifier (GC) developed and validated in the post-RP setting as a predictor of metastasis. Current retrospective evidence suggests that patients with a high GC score may benefit from aRT, while observation may be safe for those with a lower GC score. However, there are no randomized prospective data evaluating the clinical utility of biomarkers in men with adverse features after RP. Here we see to determine the impact of GC test results on adjuvant treatment decisions for high-risk post-RP patients vs. clinical factors alone. Methods: Genomics in Michigan ImpactiNg Observation or Radiation (G-MINOR) is a 4-year (12-month enrollment, 3-year follow-up) prospective, cluster-crossover, unblinded, study of 350 subjects from twelve Urology practices in the Michigan Urological Surgery Improvement Collaborative (MUSIC). MUSIC is a physician-led quality improvement consortium nearly all academic and community urology practices within the state of Michigan. Each clinical center participating in this trial will be randomly assigned to either a Genomic Classifier (GC)-based strategy or control arm for a period of 3 months. Patients in both arms will receive a predicted risk of recurrence based on a validated clinical nomogram, the CAPRA-S score, enabling a head-to-head comparison of the Decipher assay with a freely-available validated prognostic tool. Random assignments will be generated centrally by a study statistician and provided to centers immediately before commencing enrollment in each 3-month period. Each center will have two GC and two UC enrollment periods, maintaining study-wide balance and blinding of assignments in subsequent periods. Patients will be followed for receipt of adjuvant therapy as well as oncologic (recurrence, metastasis, and death) and patient-reported quality of life. Clinical trial information: NCT02783950.

scholarly journals Bilateral Simultaneous Quadriceps Tendon Rupture in a 24-Year-Old Obese Patient: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Fahad H. Abduljabbar ◽  
Abdulaziz Aljurayyan ◽  
Bayan Ghalimah ◽  
Lawrence Lincoln
Keyword(s):  
Case Report ◽  
Knee Injuries ◽  
Quadriceps Tendon ◽  
Knee Extension ◽  
Delayed Treatment ◽  
Basketball Game ◽  
Tendon Ruptures ◽  
Male Patients ◽  
Magnetic Resonance Imaging Mri

Introduction. Simultaneous bilateral quadriceps tendon ruptures (SBQTR) are uncommon knee injuries and most frequently occur in male patients, over 50 years of age. It can be associated with one or more predisposing risk factors like obesity, steroids use, and hyperparathyroidism. The main focus of this paper is to review SBQTR in obese patients. Case Report. We are reporting the youngest patient in the literature to date, a 24-year-old obese male patient, who presented to the emergency department complaining of bilateral knee pain and inability to walk after a fall during a basketball game. His clinical examination revealed the presence of a palpable suprapatellar gap and loss of knee extension bilaterally. Magnetic resonance imaging (MRI) confirmed that both of his quadriceps tendons were ruptured. A day after his diagnosis, the patient underwent successful operative repair followed by rehabilitation. At the two-year follow-up, the patient had full strength of both quadriceps muscles with no extension lag. Conclusion. The diagnosis of SBQTR can be challenging. Early diagnosis and treatment are associated with better functional outcome compared to delayed treatment. Physicians should have a high index of clinical suspicion in order not to miss such an injury and achieve favourable outcomes.

Identification of stage I/II colorectal cancer patients at risk of recurrence: The role of elastica stains to detect venous invasion.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14117-e14117
Author(s):  
Campbell SD Roxburgh ◽  
Alan K Foulis ◽  
Manal Atwan ◽  
Paul G Horgan ◽  
Donald C. Mcmillan
Keyword(s):  
Colorectal Cancer ◽  
At Risk ◽  
High Risk ◽  
Venous Invasion ◽  
Stage I ◽  
Low Grade ◽  
Cancer Specific Survival ◽  
Node Negative ◽  
Risk Of Recurrence

e14117 Background: Venous invasion (VI) is a high-risk characteristic in colorectal cancer (CRC) and in stage II disease guides provision of adjuvant therapy. However, reported rates vary in published studies from 10-90%. We recently reported use of elastica stains improve reproducibility of reporting, increasing rates to >50% (Roxburgh, Ann Surg, 2010). Furthermore, compared to H&E alone, elastica detected VI provided superior prediction of 3yr cancer survival in an unselected cohort of CRC patients. The present study aims to examine how the approach could be used in patients with node negative CRC. Methods: We retrieved pre-2003 tumour blocks, sectioned and stained them with elastica. Post-2003, elastica detected VI was routinely reported. A minimum of 3 blocks was required for analysis. Those who died within 30 days of surgery or had neoadjuvant therapy were excluded. Results: 244 stage I/II patients underwent surgery between 1997-2006. 65 cases pre-2003 were analyzed retrospectively. The rate of elastica detected VI was 54%. Elastica detected VI related to other high-risk pathology including T stage (p<0.001), serosal invasion (p<0.01), tumour grade (p<0.05) and low-grade lymphocytic infiltrate (P<0.05). Minimum follow-up was 5 yrs; mean follow-up 99 months (60-178), during which there were 99 deaths, 48 from cancer. Absence of VI related to improved 5-yr cancer specific survival (93% vs 66%). On multivariate analysis, VI independently related to cancer specific survival (HR=5.5,95%CI 2-13,p<0.001) with margin involvement (HR=2.4,95%CI 1-6,p=0.067) and serosal involvement (HR=2.2,95%CI1-4, p=0.015). For CRC mortality, the area under the receiver operator curve was highest for VI compared with other pathology (AUC 0.69, 95%CI 0.6-0.8, P<0.001). Absence of VI related to 5-yr survivals of 92% and 97% in colon and rectal cancer respectively. Conclusions: More objective assessment of VI with routine elastica staining provides accurate prediction of survival in stage I/II CRC. Presence of VI was associated with a 5.5 fold increased risk of cancer death at 5 yrs. Such results support routine use of elastica stains to identify patients with node negative disease at risk of recurrence.

Severe pacemaker pocket infection during the COVID-19 pandemic, transvenous lead removal

2021 ◽  
Vol 15 (09) ◽  
pp. 1277-1280
Author(s):  
Milos Dusan Babic ◽  
Lazar Angelkov ◽  
Milosav Tomovic ◽  
Mihailo Jovicic ◽  
Darko Boljevic ◽  
...  
Keyword(s):  
Case Report ◽  
Delayed Diagnosis ◽  
Lead Removal ◽  
Pacemaker Lead ◽  
Cardiac Device ◽  
Delayed Treatment ◽  
Pocket Infection ◽  
Endocardial Lead ◽  
Lead Endocarditis

Introduction: The estimated infection rate after permanent endocardial lead implantation is between 1% and 2%. Pacemaker lead endocarditis is treated with total removal of the infected device and proper antibiotics. In this case report, we present a patient with delayed diagnosis and treatment due to the COVID-19 outbreak. Case Report: An 88-year-old, pacemaker dependent woman with diagnosed pacemaker pocket infection was admitted to the University Cardiovascular institute. The patient had a prolonged follow-up time due to the COVID-19 outbreak. She missed her routine checkup and came to her local hospital when the generator had already protruded completely, to the point where she held it in her own hand. Transthoracic echocardiogram showed possible vegetations on the lead. Transesophageal echocardiography was not performed due to the COVID-19 pandemic. On the day after the admission the patient underwent transvenous removal of the pacemaker lead using a 9 French gauge rotational extraction sheathe (Cook Medical). The extracted lead was covered in a thin layer of vegetations. Further follow-ups showed good recovery with no complications. Conclusions: A case showing delayed treatment of pacemaker pocket infection, due to delayed follow-up time during the COVID-19 pandemic. This patient underwent successful transvenous removal of the infected pacemaker lead, along with adequate antibiotic therapy, which has proven to be the most effective method of treating cardiac device-related endocarditis.

Tonsillectomy in the Anticoagulated Patient

2007 ◽  
Vol 116 (8) ◽  
pp. 589-593 ◽  
Author(s):  
Stephanie M. Cole ◽  
Matthew B. Patterson ◽  
Craig L. Cupp
Keyword(s):  
Case Report ◽  
High Risk ◽  
Perioperative Management ◽  
Postoperative Hemorrhage ◽  
Secondary Hemorrhage ◽  
Anticoagulated Patient ◽  
Bridging Strategy ◽  
Risk For Thrombosis ◽  
Anticoagulated Patients

Objectives: The objectives of this study were to review perioperative bridging strategies for anticoagulated patients and to describe a novel bridging strategy for tonsillectomy in an anticoagulated patient that addresses both primary and secondary hemorrhage risks. Methods: A literature review and a case report are presented. PubMed was reviewed for evidence-based recommendations on perioperative management of anticoagulated patients. A case report is detailed of a 28-year-old woman with antiphospholipid syndrome on warfarin for high risk of venous thrombosis who underwent tonsillectomy. A perioperative bridging strategy incorporating outpatient low–molecular weight heparin and inpatient unfractionated heparin was implemented to minimize risks of thrombosis and primary and secondary posttonsillectomy hemorrhage. Results: Limited evidence supports a consensus on the best perioperative management of anticoagulated patients. Tonsillectomy in an anticoagulated patient has not been described previously. The patient in this case underwent successful tonsillectomy with no thrombosis or bleeding after 1 month of follow-up. Conclusions: Tonsillectomy can be done relatively safely in an anticoagulated patient at high risk for thrombosis. The perioperative bridging strategy should account for its unique risk of primary and secondary postoperative hemorrhage. A proposed algorithm for managing these competing risks is presented.

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