“Hurricane-like” Presentation of a Recurrent Marjolin's Ulcer in a Young Female

2021 ◽  
pp. 153473462110286
Author(s):  
Aakansha G. Goswami ◽  
Somprakas Basu ◽  
Vijay K. Shukla
Keyword(s):  
Distant Metastases ◽  
Young Female ◽  
Conventional Wisdom ◽  
R0 Resection ◽  
Rapid Progression ◽  
Visceral Metastasis ◽  
Marjolin’S Ulcer ◽  
Progressive Course

Marjolin’s ulcer (MU) with rapid progression and multiple distant metastases is rare. We report a case of an MU of the thigh developing in a postburn scar, which after successful R0 resection developed multiple bony and visceral metastasis to femur, vertebra, skull, lung, and liver within 3 months of excision. We highlight the “hurricane-like” recurrence in an MU, which is unusual for the metachronous disease. We stress that MUs, unlike conventional wisdom, need a thorough metastatic workup at presentation, and prognostication of a possible rapidly progressive course after surgery which may lead to grave prognosis and mortality.

scholarly journals Well differentiated endocrine carcinomas of the pancreas

2011 ◽  
Vol 139 (9-10) ◽  
pp. 625-630
Author(s):  
Radoje Colovic ◽  
Nikica Grubor ◽  
Marjan Micev ◽  
Vladimir Dugalic ◽  
Dejan Stojakov ◽  
...  
Keyword(s):  
Distal Pancreatectomy ◽  
Pancreatic Head ◽  
Distant Metastases ◽  
Massive Bleeding ◽  
R0 Resection ◽  
Gastric Bleeding ◽  
Poorly Differentiated ◽  
The Difference ◽  
Well Differentiated ◽  
Endocrine Carcinomas

Introduction. For the difference from poorly differentiated, well differentiated endocrine carcinomas of the pancreas are the tumours in whom with aggressive surgery and chemotherapy fair results can be achieved. Objective. The aim of the study was to point out the importance of such treatment. Methods. Over a 6-year period eight patients (seven female and one male) of average age 51 years (ranging from 23 to 71 years) were operated on for well differentiated endocrine carcinoma: six of the head and two of the tail of the pancreas. There were two functional and six nonfunctional tumours. Pain in the upper part of the abdomen in seven, mild loss in weight in two, strong heartburn in two, obstructive jaundice in three, diarrhoea in one, sudden massive bleeding from gastric varicosities due to prehepatic portal hypertension caused by pancreatic head tumour in one, and bruise in one patient were registered preoperatively. US and CT in all, angiography in one, octreoscan in two and PET scan in one patient were performed. Whipple?s procedure was performed in six and distal pancreatectomy in two patients, as well as systemic lymphadenectomy in all and excision of liver secondary tumours in two patients. In the patient with massive gastric bleeding a total gastrectomy was performed first, followed by Whipple?s procedure a month later. Results. R0 resection was achieved in all patients. Lymph nodes metastases were found in six patients. Six patients were given chemotherapy. One patient died 3 years after surgery, seven are still alive, on average 2.5 years. A local recurrence after distal pancreatectomy that occurred 5 years after surgery was successfully reresected and the patient is on peptide-receptor radiotherapy. In other six patients there were no local recurence or distant metastases. Conclusion. With aggressive surgery and chemotherapy fair results can be achieved in well differentiated endocrine carcinomas of the pancreas.

Prognostic significance of surgery after chemotherapy in patients with type 4 gastric cancer

2020 ◽  
Author(s):  
Takaaki Arigami ◽  
Daisuke Matsushita ◽  
Keishi Okubo ◽  
Takako Tanaka ◽  
Ken Sasaki ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Multivariate Analysis ◽  
Tumor Response ◽  
Prognostic Significance ◽  
Distant Metastases ◽  
Clinical Indication ◽  
R0 Resection ◽  
Prognostic Impact ◽  
Chemotherapeutic Regimen ◽  
Response To Chemotherapy

Abstract Background The majority of patients with type 4 gastric cancer have distant metastases with extremely poor prognosis. Consequently, considering a therapeutic strategy that improves the prognosis of these patients is clinically important. The present study aimed to assess the clinical indication and prognostic impact of surgery in patients with type 4 gastric cancer who underwent chemotherapy. Methods A total of 67 patients with type 4 gastric cancer who underwent chemotherapy were retrospectively enrolled. All patients were grouped into progressive disease (PD) and non-PD groups by tumor response to chemotherapy. Results Distant metastases occurred in 58 patients. With regard to tumor response, 16 and 51 patients had PD and non-PD, respectively. The prognosis was significantly poorer in patients with PD than in those with non-PD (p < 0.0001). Among 23 patients who underwent surgery after chemotherapy, 21 had a R0 resection. The presence or absence of surgery was significantly correlated with age, first-line chemotherapeutic regimen, lymph node metastasis, clinical stage, number of distant metastatic sites, peritoneal dissemination, and tumor response (p = 0.0412, p = 0.0096, p = 0.0024, p = 0.0059, p = 0.0128, and p = 0.0020, and p = 0.0066, respectively). Multivariate analysis selected tumor response and surgery as an independent prognostic factor (p = 0.0001 and p = 0.0009, respectively). Moreover, multivariate analysis for the surgery group demonstrated that metastatic nodal status (N0-1 vs N2-3) and residual tumor status (R0 vs R1-2) were significant independent prognostic factors (p = 0.0258 and p = 0.0458, respectively). Conclusion Our retrospective study suggests that surgery after chemotherapy for type 4 gastric cancer may improve the prognosis of responders with N0-1 status and a curative R0 resection.

scholarly journals Solitary extrapleural fibrous tumor with hepatic bilobar metastases: multimodal approach treatment

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Maitane I. Orue-Echebarria ◽  
Laura Garciafília ◽  
Luis Rodriguez-Bachiller ◽  
Benjamín Díaz-Zorita ◽  
Enrique Velasco ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Solitary Fibrous Tumor ◽  
Future Liver Remnant ◽  
Distant Metastases ◽  
R0 Resection ◽  
Two Stage ◽  
Liver Remnant ◽  
Therapeutic Decisions ◽  
Mesenchymal Neoplasm ◽  
Fibrous Tumor

Abstract Background Solitary fibrous tumor is an unusual fibroblastic mesenchymal neoplasm typically described in the pleura. It may appear anywhere with a varied anatomic distribution and essentially it can develop from any soft tissue or visceral location. Its course is usually indolent and it rarely causes distant metastases, so it has a prolonged survival rate. It sometimes presents itself as a disseminate disease being the liver the most frequently involved location. In these occasions, the management should be discussed in a multidisciplinary tumor committee formed by surgeons, oncologists and radiologists. Surgery remains the gold standard for treatment. Case representation We present the case of a woman with a tumor in the left abdominal wall and bilobar massive liver metastases, both locations histologically diagnosed as solitary fibrous tumor. She receives biological treatment for a severe case of Crohn´s disease. Evaluated in a multidisciplinary committee, surgery was recommended for both the primary lesion and the liver metastases. The hepatobiliary surgeons considered a two-stage hepatectomy with portal vein embolization (PVE) as the best strategy. After the first procedure consisting in cleaning the left hepatic lobe followed by PVE the future liver remnant volume (FLRV) was considered inadequate, so the patient was also treated with right transarterial radioembolizacion with yttrium 90 (TARE-Y90) intending a double goal: to treat the tumor and to increased the FLRV. Furthermore, a severe flare of Crohn´s disease forced us to intensify the patient’s treatment with the addition of biological agents (infliximab and adalimumab) until complete remission of the symptoms. The second stage of the liver surgery had to be postponed for more than 6 months and could finally be carried out without complications, achieving an R0 resection. The postoperative course was uneventful and the follow up has showed no recurrence to date. Conclusion Solitary fibrous tumours with extensive liver metastases are infrequent but when they appear modern surgical strategies like two stage hepatectomy are the treatment of choice and must be carried out by specialised units. The therapeutic decisions should be guided by a multidisciplinary committee.

scholarly journals LAPAROSCOPIC ADRENALECTOMY IN SURGICAL TREATMENT OF ADRENANOCORTICAL CARCINOMA

2019 ◽  
Vol 21 (1) ◽  
pp. 75-78
Author(s):  
A V Krivosheev ◽  
T A Britvin ◽  
M E Beloshitsky
Keyword(s):  
Surgical Treatment ◽  
Laparoscopic Adrenalectomy ◽  
Distant Metastases ◽  
Long Term Results ◽  
R0 Resection ◽  
Morphological Examination ◽  
Number Of Patients ◽  
Immunohistochemical Studies

Relevance of research: аdrenalectomy remains the only method of potentially radical treatment of adrenocortical carcinoma (AСС), and the complete resection is considered one of the leading factors in the prognosis of disease. The question of the possibility and feasibility of using video- endoscopic technologies in the treatment of patients with ACC is still being discussed. Objective: the purpose of our study was to evaluate the effectiveness of laparoscopic adrenalectomy in the treatment of ACC patients. Material and methods: the study is based on the analysis of the results of diagnostics and surgical treatment of 12 patients who underwent laparoscopic adrenalectomy and verified ACC during histological and immunohistochemical studies. Results: stage I were verified (according to the ENSAT) in 4 cases, in 4 - II stage, and in 4 - III stage. The median of tumor size was 4.9 cm. Intraoperative and postoperative complications did not occur. In all cases, the R0-resection was confirmed by morphological examination. The median patient follow-up was 71 months (1; 141), during this period 11 patients were alive, 1 patient, who had surgery in stage III died of disease progression (distant metastases) 49 months after surgery. During the follow-up period tumor recurrence did not occur. Overall 5-year survival was 75% (95% CI; 30-95%). Conclusion: despite the small number of patients included in this study, satisfactory immediate results (absence of complications, R0-resection) and long-term results allow us to consider video- endoscopic surgery as an effective treatment for patients with ACC.

scholarly journals Multiple Cutaneous Metastases as Initial Presentation in Advanced Colon Cancer

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Sudheer Nambiar ◽  
Asha Karippot
Keyword(s):  
Advanced Colorectal Cancer ◽  
Clinical Manifestations ◽  
Colon Adenocarcinoma ◽  
Distant Metastases ◽  
Cutaneous Metastasis ◽  
Ascending Colon ◽  
Visceral Metastasis ◽  
Cutaneous Metastases ◽  
Advanced Colon Cancer ◽  
Metastatic Lesions

Skin metastases from advanced colorectal cancer are relatively rare and occur most often when the cancer is advanced, following the spread to other organs. Cutaneous metastases occur in about 3% of advanced colorectal cancers. We present an extremely rare case of a 68-year-old woman with advanced ascending colon adenocarcinoma that presented with multiple rapidly progressing painless cutaneous metastatic lesions with no other distant metastases. Of all the tumors, breast cancer most commonly spreads as cutaneous metastasis is followed by lung, colorectal, renal, ovarian, and bladder cancers. Cutaneous metastases can present in a variety of clinical manifestations, such as a rapidly growing painless dermal or subcutaneous nodule with intact overlying epidermis or as ulcers. In cases where the cutaneous deposit is isolated, as in visceral metastasis, there is a role for radical management such as wide local excision and reconstruction. In our patient, since she had multiple cutaneous metastases she began treatment with palliative systemic combination chemotherapy.

scholarly journals Early Marjolin’s ulcer developing in a penile human bite scar of an adult patient presenting at Bugando Medical Centre, Tanzania: A Case Report

2012 ◽  
Vol 14 (4) ◽  
Author(s):  
Phillipo L. Chalya ◽  
Joseph B. Mabula ◽  
Japhet M. Gilyoma ◽  
Peter Rambau ◽  
Nestory Masalu ◽  
...  
Keyword(s):  
Early Recognition ◽  
Distant Metastases ◽  
Chronic Ulcer ◽  
Human Bite ◽  
Early Appearance ◽  
Marjolin’S Ulcer ◽  
Appropriate Treatment ◽  
Poorly Differentiated ◽  
Node Metastases ◽  
Chronic Ulcers

Marjolin’s ulcer is a rare but well documented cutaneous malignancy that arises in a scar or chronic ulcer, and is characterized by an aggressive course. The latent period from the injury to the appearance of cancer has been reported to be 25-40 years. Early occurring Marjolin’s ulcer has rarely been described in the literature and its development in a penile human bite scar is still rare. We report a rare case of a 33 year-old patient who presented with an early appearance of Marjolin’s ulcer developing in a penile human bite scar. On histological examination it was found to be poorly differentiated squamous cell carcinoma. He was managed by total penile amputation. Five months after surgery, the patient presented to our surgical outpatient clinic with inguinal lymph node metastases and distant metastases to the lung, liver and bones. However, the patient died shortly after admission. This report highlights the possibility of early appearance of Marjolin’s ulcer arising from a chronic ulcer or healed scar in an unusual sites such as the penis. It is therefore recommended that all chronic ulcers should be thoroughly investigated at presentation, to avoid labelling malignancies ‘chronic ulcers’, leading to delay in appropriate treatment. Early recognition and aggressive treatment of Marjolin's ulcers and close follow-up are urgently needed to improve outcomes in our environment.

PS02.105: LONG-TERM RESULTS OF PREOPERATIVE CHEMOTHERAPY WITH DOCETAXEL, CISPLATIN AND FLUOROURACIL IN PATIENTS WITH ADVANCED ESOPHAGEAL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 150-151
Author(s):  
Takashi Ui ◽  
Hirofumi Fujii ◽  
Yoshinori Hosoya ◽  
Alan Lefor ◽  
Hiroyuki Yamaguchi ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Preoperative Chemotherapy ◽  
Conflicts Of Interest ◽  
Cell Cancer ◽  
Progression Free Survival ◽  
Distant Metastases ◽  
Long Term Results ◽  
R0 Resection ◽  
Curative Surgery

Abstract Background Although preoperative docetaxel, cisplatin, and fluorouracil (DCF) therapy is reportedly effective in patients with advanced esophageal squamous cell cancer (ESCC), long-term results after preoperative DCF therapy are not well known. We retrospectively reviewed the long-term results after preoperative DCF therapy. Methods This study includes 63 patients with advanced thoracic esophageal carcinoma (excluding T4 tumors) receiving preoperative chemotherapy between February 2010 and February 2014. All patients were intended to receive two courses of treatment every four weeks, or three courses every three weeks. Patients underwent curative surgery four to five weeks after completing chemotherapy. Results Radical resection was performed in 58 patients (92%). R0 resection was completed in 48 patients (83%). The 5-year overall survival and progression free survival were 55% [95% confidential interval, 0.41–0.66] and 0.46% [0.34–0.58], respectively. Recurrences occurred in 34 patients (54%). Distant metastases developed in 13/48 (27%) after R0 resection. Chemotherapy-related adverse events included G4 hematotoxicity (n = 50, 79%, neutrophil < 500), febrile neutropenia (n = 16, 25%), and G3 non-hematotoxicity (n = 15, 24%). Conclusion These results suggest that preoperative DCF therapy may be effective and improve the long-term outcomes in patients with advanced esophageal carcinoma. Disclosure All authors have declared no conflicts of interest.

scholarly journals Recurrent metastatic primary inflammatory myofibroblast tumour of the gallbladder following pancreaticoduodenectomy

2020 ◽  
Vol 13 (2) ◽  
pp. e232861
Author(s):  
Roi Anteby ◽  
Brianne J Sullivan ◽  
Malary Mani ◽  
Benjamin Golas
Keyword(s):  
Distant Metastases ◽  
R0 Resection ◽  
Soft Tissue Tumour ◽  
En Bloc ◽  
Tissue Tumour ◽  
Common Causes ◽  
Long Term Follow Up ◽  
Surgical Treatments

Inflammatory myofibroblast tumour (IMT) is an uncommon soft tissue tumour with an unpredictable clinical course: mostly benign, occasionally locally aggressive and rarely capable of metastasis. Diagnosed mainly in the mesentery, omentum, retroperitoneum, pelvis and lungs, IMT is extremely rare as a primary gallbladder tumour. Despite improved radiographical capabilities, differentiating the tumour from other more common causes of gallbladder neoplasms necessitates histopathological and immunohistochemistry tests. Once diagnosed, malignant potential should be taken into consideration, striving for an en bloc R0 resection and postoperative long-term follow-up with routine ancillary imaging. The authors present the case of a recurrent primary IMT of the gallbladder, after two surgical treatments, including a pancreaticoduodenectomy. Now 3 years after initial diagnoses the patient is asymptomatic, but has developed local and distant metastases and is being treated with systemic corticosteroid.

scholarly journals Rare giant dermatofibrosarcoma protuberans with uncommon fibrosarcomatous transformation - case report and review of literature

2021 ◽  
Vol 8 (10) ◽  
pp. 3171
Author(s):  
Manisha Aggarwal ◽  
Dinesh Manchikanti ◽  
Sunayana Misra ◽  
Shaji Thomas ◽  
Ashish Arsia ◽  
...  
Keyword(s):  
Clinical Course ◽  
Dermatofibrosarcoma Protuberans ◽  
Distant Metastases ◽  
Metastatic Potential ◽  
Recurrence Risk ◽  
Skin Tumor ◽  
Rapid Progression ◽  
Split Skin Grafting ◽  
Aggressive Clinical Course ◽  
Slow Growing

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma with aggressive local behavior but with a low metastatic potential. Although slow growing and indolent, they rarely reach huge sizes. Very uncommonly, these locally invasive tumors undergo fibrosarcomatous transformation with a more aggressive clinical course, with higher rate of recurrence risk and distant metastases. A 32-years-old lady, presented with a gradually progressive lump in the upper central back for the past 6 years, with rapid progression in size during the last 6 months. On examination, she had a single lump of size 18×18 cm in the midline of the upper back, with prominent veins over its surface. Magnetic resonance imaging (MRI) showed no connection with the spinal canal and appeared flush with the paraspinal muscles. Core needle biopsy showed DFSP. The patient underwent a wide local excision with split skin grafting. The histopathology now showed a fibrosarcomatous transformation of DFSP. The patient again underwent a wide re-excision with a 3 cm margin. Histology reported no evidence of tumor cells in the specimen. The patient’s postoperative period was uneventful and she was referred for adjuvant radiotherapy. DFSP is a rare, slow-growing malignant fibroblastic mesenchymal skin tumor with low metastatic potential. However, in any patient with long standing DFSP with a recent increase in size, this fibrosarcomatous transformation must be kept in mind as it represents an uncommon form of DFSP that tends to follow a more aggressive clinical course, with higher rate of recurrence risk and distant metastases.

Safety and efficacy of repeated anti-CEA radioimmunotherapy (RAIT) with 131I-labetuzumab post salvage resection of colorectal liver metastases

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14507-14507
Author(s):  
T. Liersch ◽  
J. Meller ◽  
T. Lorf ◽  
C. Sahlmann ◽  
M. Niessner ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Survival Data ◽  
Primary Tumor ◽  
Survival Rates ◽  
Distant Metastases ◽  
R0 Resection ◽  
Safety And Efficacy ◽  
Salvage Resection ◽  
Tumor Stages

14507 Background: As shown recently (JCO 2005; 23:6763–70), a single application of RAIT improved both, median overall survival (OS), and 5-year survival rates of colorectal cancer (CRC) patients (pts) post salvage resection of liver metastases (LM) compared to controls without RAIT (P=0.004). In an ongoing phase II trial we are evaluating the safety and efficacy of repeated RAIT at doses of 2x 40–50 mCi/m2 (3 mos apart) post salvage resection of LM. Methods: To date, 26 pts (8x f, 18x m; age: 63 ± 9 ys) who underwent surgery for CRC-LM have received the first dose of 131I-labetuzumab (Immunomedics, In., NJ, USA), a humanized monoclonal antibody against CEA, within 2 months of LM surgery. Three months after the first RAIT, a second infusion of 40–50 mCi/m2 has been applied to all pts after completion of standardized re-staging procedures. Results: The primary tumor sites were 17 colonic and 9 rectal cancers; primary tumor stages were 5x UICC-II, 7x UICC-III, 14x UICC-IV. 13 pts received adjuvant therapy. In 11 pts preoperative chemotherapy (FOLFOX or FOLFIRI) was given to achieve resectability of bilobular LM. After resection of LM (y)mTNM tumor stages were 1x mTNM-I, 6x mTNM-II, 6x mTNM-III and 4x mTNM-IV, respectively. After first RAIT, hematologic Grade 3 and 4, toxicity (WBC/platelet count) occurred in 8/14 and 5/3 pts, respectively. No cumulative toxicity was seen after repeated RAIT, with complete bone marrow recovery observed in all cases so far. To date, all pts are alive. Of the total, 17 pts received RAIT with adjuvant intention (as classified by FDG-PET and CT scans at pre-RAIT re-staging). In these, DFS was 70% post salvage resection of LM during ongoing follow-up of 15 months (median; range: 4–23 mos). As of Dec. 20, 2006, cancer recurrence was detected in 5/17 pts (3x pulmonary, 1x intrahepatic, 1x both) and in 4 pts R0-resection of distant metastases was done. 1 patient with pulmonary and intrahepatic relapses receives polychemotherapy with palliative intention. The pts‘ compliance to repeated RAIT has been 100%. Conclusion: RAIT re-treatment to date appears to be safe, feasible, and well accepted. Extended follow-up of the encouraging survival data will be presented. No significant financial relationships to disclose.

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