Recent Experience in the Management of Meningeal Hemangiopericytomas

1997 ◽  
Vol 83 (5) ◽  
pp. 856-861 ◽  
Author(s):  
Andrea Brunori ◽  
Alberto Delitala ◽  
Giuseppina Oddi ◽  
Francesco Chiappetta
Keyword(s):  
Personal Experience ◽  
Clinical Evidence ◽  
Postoperative Radiotherapy ◽  
Radical Resection ◽  
Recent Experience ◽  
Dismal Prognosis ◽  
Visceral Metastases ◽  
Neurological Conditions

Although the histogenesis of meningeal hemangiopericytomas (HMP) remains controversial, both biological and clinical evidence seems to identify these neoplasms as a separate entity with respect to meningiomas. In order to assess the current prognosis of HMP we reviewed our personal experience limited to the last decade (1986-1995): during this period 7 patients (4M, 3F) were treated by surgery alone or surgery combined with postoperative radiotherapy. In spite of meticulous attempts at radical resection, the tumors recurred in all but two cases with a mean interval of 85 months, and a total of 18 operations were performed (2.57/patient; range 1-4). Massive intratumoral hemorrhage determined acute deterioration and required emergency surgery in two cases while in one patient diffuse visceral metastases were discovered at autopsy. Five patients are still alive at follow-up but only 2 of them are in good neurological conditions and without evidence of disease. These results are similar to those reported in other series. In view of our results we conclude that intracranial hemangiopericytomas still have a dismal prognosis. Advances in neuroimaging, neuroanesthesia, microneurosurgery and adjuvant therapy do not seem to have significantly affected the recurrence rate, quality of life and mortality.

Adjuvant Postoperative Radiotherapy in Locally Advanced Rectal and Rectosigmoidal Cancer

1980 ◽  
Vol 66 (5) ◽  
pp. 595-600 ◽  
Author(s):  
Roberto Zucali ◽  
Gianstefano Cardani ◽  
Fabio Volterrani
Keyword(s):  
Clinical Evidence ◽  
Postoperative Radiotherapy ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Pelvic Recurrence ◽  
Advanced Stage ◽  
Median Dose ◽  
Disease Free

A pelvic recurrence is the cause of death in about 1/3 of radically operated patients for rectal and rectosigmoidal cancer without clinical evidence of distant metastases. Preoperative and postoperative radiotherapy are largely used to reduce the incidence of locoregional relapses and to improve disease-free and overall survival and quality of life. Benefits from radiotherapy have been widely demonstrated, and adjuvant postoperative radiotherapy is at present strongly recommended. Twenty-one patients with locally advanced (stage B2, B3, C) rectal (11 cases) and rectosigmoidal cancer (10 cases) were treated with postoperative radiotherapy at the National Cancer Institute of Milan from 1975 to 1978. The pelvis received a median dose of 4500 rad (range, 4000–5200 rad) in 5 to 7 weeks through AP, PA opposed fields; 6 patients received a boost of 1000 rad on the perineum. Median follow-up after surgery is 83 months (range, 24–63 months). Only 1 case (« 5%) had a pelvic recurrence, at the perineum. The expected recurrence rate after surgery alone is 40 %, and our favorable results after postoperative radiotherapy are comparable with recent data from other institutions. Radiotherapy side effects were moderate and transient; no late damages to small bowel were observed.

Radical Resection in Signet Ring Carcinoma of the Ampulla of Vater: Report of an 11-Year Survivor

2006 ◽  
Vol 72 (2) ◽  
pp. 193-195 ◽  
Author(s):  
Mark Bloomston ◽  
Michael Walker ◽  
Wendy L. Frankel
Keyword(s):  
Radical Resection ◽  
Ampulla Of Vater ◽  
Signet Ring Cell ◽  
Gastrointestinal Malignancies ◽  
Dismal Prognosis ◽  
Signet Ring ◽  
Painless Jaundice ◽  
Poor Differentiation ◽  
Poorly Differentiated

Carcinomas of the ampulla of Vater are uncommon tumors but have a better prognosis than typical pancreatic cancers. They tend to be well or moderately differentiated while the poorly differentiated variants are still quite aggressive. Signet ring features associated with poor differentiation traditionally confer a dismal prognosis in other gastrointestinal malignancies, particularly gastric cancer. Signet cell ring morphology has only been described in a few ampullary carcinomas with all cases reporting short follow-up. We describe a 58-year-old woman who presented with painless jaundice and a prominent ampulla of Vater by endoscopy. She underwent pancreaticoduodenectomy and was found to have a 1.0 x 0.8 cm poorly differentiated carcinoma with prominent signet ring cell features arising from the ampulla of Vater and invading into the periampullary duodenum but sparing the pancreatic parenchyma. No distant or nodal metastases were seen (pT2N0M0). No adjuvant therapy was given, and the patient remains free of disease with 134 months of follow-up.

scholarly journals Ex situ liver resection and autotransplantation for advanced cholangiocarcinoma

2019 ◽  
Vol 12 (8) ◽  
pp. e230808 ◽  
Author(s):  
Ashish George ◽  
Ashwin Rammohan ◽  
Srinivas Mettu Reddy ◽  
Mohamed Rela
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
Liver Resection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Ex Situ ◽  
Extrahepatic Disease ◽  
Extended Hepatectomy ◽  
Dismal Prognosis

Advanced cholangiocarcinoma especially those involving the vasculature have extremely limited options of cure. Ex situ liver resection entails performing a total hepatectomy, resecting the tumour on the back-table followed by reimplantation (autotransplantation) of the liver. Application of this technique for these tumours has rarely been done due to complexity of the procedure and the dismal prognosis of the lesions. We present our experience of two cases of advanced intrahepatic cholangiocarcinoma with limited extrahepatic disease who underwent ex situ resection with autotransplantation. They underwent preoperative therapy with a waiting period to assess the tumour biology. Both patients underwent ex situ resection with extended hepatectomy on the back table. Both patients remain well on follow-up 24 months and 20 months, respectively, with excellent quality of life. Despite its technical complexity, ex situ liver resection may offer prolonged overall survival in selected patients with advanced cholangiocarcinoma and limited extrahepatic disease.

scholarly journals 2019 European Thyroid Association Guidelines for the Treatment and Follow-Up of Advanced Radioiodine-Refractory Thyroid Cancer

2019 ◽  
Vol 8 (5) ◽  
pp. 227-245 ◽  
Author(s):  
Laura Fugazzola ◽  
Rossella Elisei ◽  
Dagmar Fuhrer ◽  
Barbara Jarzab ◽  
Sophie Leboulleux ◽  
...  
Keyword(s):  
Personal Experience ◽  
Clinical Evidence ◽  
Ethical Issues ◽  
Negative Impact ◽  
Task Force ◽  
Favourable Outcome ◽  
Diagnostic Tools ◽  
Duration Of Treatment ◽  
Significant Negative Impact

The vast majority of thyroid cancers of follicular origin (TC) have a very favourable outcome, but 5–10% of cases will develop metastatic disease. Around 60–70% of this subset, hence less than 5% of all patients with TC, will become radioiodine refractory (RAI-R), with a significant negative impact on prognosis and a mean life expectancy of 3–5 years. Since no European expert consensus or guidance for this challenging condition is currently available, a task force of TC experts was nominated by the European Thyroid Association (ETA) to prepare this document based on the principles of clinical evidence. The task force started to work in September 2018 and after several revision rounds, prepared a list of recommendations to support the treatment and follow-up of patients with advanced TC. Criteria for advanced RAI-R TC were proposed, and the most appropriate diagnostic tools and the local, systemic and palliative treatments are described. Systemic therapy with multikinase inhibitors is fully discussed, including recommendations on how to start it and at which dosage, on the duration of treatment, and on the management of side effects. The appropriate relationship between the specialist and the patient/family as well as ethical issues are covered. Based on the available studies and on personal experience, the experts provided 39 recommendations aimed to improve the management of advanced RAI-R TCs. Above all of them is the indication to treat and follow these patients in a specialized setting which allows the interaction between several specialists in a multidisciplinary team.

scholarly journals Palbociclib in the first line combination hormone therapy of HER2- negative metastatic hormone-dependent breast cancer. Clinical follow-up

2018 ◽  
pp. 158-160
Author(s):  
M. A. Frolova ◽  
E. B. Glazkova ◽  
M. B. Stenina
Keyword(s):  
Breast Cancer ◽  
Hormone Therapy ◽  
Clinical Case ◽  
Time To Progression ◽  
First Line ◽  
Visceral Metastases ◽  
Successful Control

According with the present-day ideas, sequential lines of hormone therapy including those in patients with visceral metastases and multiple lesions form the basis of the treatment of HER2-negative metastatic hormone-dependent breast cancer. These measures make it possible to exercise the long-term control of the disease and maintain a good quality of life. In recent years, the clinical practice comprises the next-generation drugs that potentiate the effect of hormone therapy. These include cyclindependent kinases 4/6 inhibitors. Palbociclib (Ibransa, Pfizer) is the first representative of this class approved in Russia for the treatment of disseminated hormone-dependent breast cancer. The PALOMA-2 study demonstrated the high efficacy of the palbociclib combined with letrozole as a first-line hormone therapy. In the palbociclib and letrozole combination arm, the median time to progression was 27,6 months compared to 14,5 months in the letrozole monotherapy arm (p <0,001). The presented clinical case demonstrates the possibility of long-term successful control of the disease using palbociclib combined with letrozole hormone therapy.

Pedagoģiskās kompetences refleksija profesionālajā izaugsmē

2020 ◽  
pp. 115-126
Author(s):  
Alīda Samuseviča ◽  
Santa Striguna
Keyword(s):  
Professional Identity ◽  
Personal Experience ◽  
Cognitive Activity ◽  
Assessment Process ◽  
Professional Activity ◽  
Modern Education ◽  
Self Development ◽  
Pedagogical Competence

Formation of professional identity is an important point of reference for awareness of professional and personal experience. Moments of doubt and worry are both typical in the process of the acquisition of teacher’s profession, when going through these stages step by step, the belief in one’s own strength is achieved. The basis of teachers’ professional activity is their own self-development motivation and development together with their students, actualizing the didactic competence in the context of educational reforms. The self-educational competence can be characterised as an integrative quality of a personality and his/her professional activity, which is inseparable from the personality’s ability to engage in a systematic, independently organized cognitive activity directed towards the follow-up of education in general – cultural and professional aspects, and it is formed, organized and mentioned by the very subject of the cognitive activity. The data of the empirical research confirm that reflection on teachers’ involvement in the research and pedagogical work is a constant assessment process of their own activity and a requirement of modern education, as well as a deliberate professional necessity helping the practising teachers to develop their own theoretical and practical awareness of the issues of pedagogical competence enhancement.

scholarly journals Surgical approaches and strategies for skull base chordomas

2001 ◽  
Vol 10 (3) ◽  
pp. 1-7 ◽  
Author(s):  
Norihiko Tamaki ◽  
Tatsuya Nagashima ◽  
Kazumasa Ehara ◽  
Yasuhiko Motooka ◽  
Kanak Kanti Barua
Keyword(s):  
Quality Of Life ◽  
Skull Base ◽  
Radical Resection ◽  
Surgical Approaches ◽  
Recurrence Free Survival ◽  
Total Removal ◽  
Free Survival ◽  
Skull Base Chordomas

Object The management of chordomas involving the skull base continues to present a number of treatment-related problems. Recently, both radical resection and charged-particle irradiation or stereotactic radiosurgery have reportedly been found effective for tumor control and for promoting a better quality of life in patients. In this article the authors analyzed the outcomes in 17 patients with skull base chordomas who were surgically treated at Kobe University Hospital between 1972 and 2000. Methods Preoperative radiological examinations included magnetic resonance imaging, computerized tomography, angiography, and balloon occlusion test of the internal carotid artery. Among the various surgical approaches used to remove the tumor were the frontoorbitozygomatic, transmaxillary, transcondylar, transsphenoidal, and the transbasal. Total removal was achieved in two (12%), near-total removal in three (18%), subtotal removal in nine (52%), and partial removal in three patients (18%). Since 1990, chordomas have been radically resected via various skull base approaches; the combined total or near-total removal rate has been 80% in this period. Radical removal of the tumors has not led to an increased risk. At the final follow-up review (mean 59.5 month), 75% of the patients were still alive, and 25% had died of chordoma recurrence. The overall recurrence-free survival rate was 82% at 3 years and 51% at 5 years. The 5-year recurrence-free survival rate in the five patients who underwent the operation during the past decade was 77% (mean follow up of 5.2 years). In two patients with recurrent tumors who underwent radiosurgery, no evidence of tumor regrowth was demonstrated at 3 years posttreatment. Conclusions The authors suggest that for the treatment of skull base chordomas radical resection is a key factor for longer survival and improved quality of life. Patients with sufficiently small tumors, which show a favorable configuration and location, can be suitable candidates for stereotactic radiosurgery.

scholarly journals Clinical Analysis of Thyroid Carcinoma Showing Thymus-Like Differentiation: Report of 8 Cases

2013 ◽  
Vol 98 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Zhen Liu ◽  
Xu-Yong Teng ◽  
Da-Xin Sun ◽  
Wei-Xue Xu ◽  
Shao-Long Sun
Keyword(s):  
Thyroid Carcinoma ◽  
Postoperative Radiotherapy ◽  
Radical Resection ◽  
Clinical Analysis ◽  
Treatment Recommendation ◽  
Thyroid Transcription Factor 1 ◽  
Thyroid Transcription Factor ◽  
Medical University ◽  
Transcription Factor 1

Abstract Thyroid carcinoma showing thymus-like differentiation (CASTLE) is a kind of rare neoplasm of the thyroid gland. Because thyroid CASTLE is rare and difficult to diagnose, its clinicopathologic features have not been well defined, and no universally accepted treatment recommendation is available. We analyzed retrospectively the clinicopathologic data of 8 patients with thyroid CASTLE who underwent surgery and radiotherapy at the Shengjing Hospital of China Medical University between December 2008 and June 2012. All patients accepted radical surgery. All patients accepted postoperative radiotherapy, except one 79-year-old patient. There was no evidence of recurrence or metastasis during the follow-up period. The pattern of immunohistochemical staining was similar to that of thymic carcinoma. Six of 8 CASTLE cases expressed CD5. All 8 CASTLE patients were negatively expressed in thyroglobulin, thyroid transcription factor 1, and calcitonin. Patients with thyroid CASTLE have good outcomes after radical resection and postoperative radiotherapy. Positive CD5 immunoreactivity can contribute to diagnosis of this disease.

scholarly journals Unusual occurrence of supratentorial medulloepithelioma in a young female

2014 ◽  
Vol 05 (03) ◽  
pp. 261-264
Author(s):  
Andi Sadayandi Ramesh ◽  
Mahadevan Anita ◽  
Saini Jitender ◽  
Sampath Somanna
Keyword(s):  
Rare Case ◽  
Postoperative Radiotherapy ◽  
Young Female ◽  
Total Resection ◽  
Who Grade ◽  
Dismal Prognosis ◽  
Immuno Histochemistry ◽  
Unusual Occurrence ◽  
Very High

ABSTRACTMedulloepithelioma is an extremely rare PNET in late adolescence and adults with only two cases noted in literature. These are WHO grade IV tumors with dismal prognosis. Only few cases survived beyond 5 months. We report a rare case of supratentorial medulloepithelioma in a 17 year old girl. She had presented with right sided weakness, headache and vomiting. Imaging showed an enhancing mass lesion in left parietal region which undergone gross total resection. After surgery, her headache, vomiting and right sided weakness improved. On histopathology, the tumor had characteristic trabecular, ribbon and palisaded arrangement with brisk mitotic activity, necrosis and calcification. Immuno-histochemistry revealed positivity for Synaptophysin, Vimentin and EMA while GFAP was negative. MIB-1 labeling was very high. Patient received postoperative radiotherapy. On follow up after 14 months, she was clinically asymptomatic with no recurrence on imaging.

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