Residual mass: an indication for further therapy in patients with advanced seminoma following systemic chemotherapy.

1987 ◽  
Vol 5 (7) ◽  
pp. 1064-1070 ◽  
Author(s):  
R Motzer ◽  
G Bosl ◽  
R Heelan ◽  
W Fair ◽  
W Whitmore ◽  
...  
Keyword(s):  
Biochemical Markers ◽  
Surgical Excision ◽  
Residual Tumor ◽  
Imaging Studies ◽  
Residual Mass ◽  
Viable Tumor ◽  
Close Observation ◽  
Residual Masses ◽  
Additional Therapy ◽  
Residual Viable Tumor

Forty-one advanced seminoma patients with normal biochemical markers and a complete or partial radiographic response after cisplatin-based chemotherapy had a complete reevaluation of all known sites of disease. Twenty-three patients had a residual mass, and in 14 the mass was greater than or equal to 3 cm. Nineteen patients with a residual mass, including 13 with a mass greater than or equal to 3 cm in diameter, had surgical excision or biopsy. Four patients had viable seminoma and one patient had teratoma; all five of these patients had residual masses greater than or equal to 3 cm. Four patients with a residual mass were observed without surgery. One patient with a residual mass greater than or equal to 3 cm progressed with biopsy-proven seminoma. Therefore, six of 14 patients (42%) with a residual mass greater than or equal to 3 cm had viable residual tumor. Eighteen patients had no residual mass after chemotherapy. Ten of these patients had surgery or biopsy; none had viable tumor, but two have relapsed. Eight patients were observed and none have relapsed. Advanced seminoma patients with a residual mass greater than or equal to 3 cm after chemotherapy are at high risk for residual viable tumor. Additional therapy is indicated for these patients. For patients with normal imaging studies or a residual mass less than 3 cm, close observation without surgery is generally possible.

Postchemotherapy Retroperitoneal Surgery Remains Necessary in Patients With Nonseminomatous Testicular Cancer and Minimal Residual Tumor Masses

2003 ◽  
Vol 21 (17) ◽  
pp. 3310-3317 ◽  
Author(s):  
Jan Oldenburg ◽  
G. Cecilie Alfsen ◽  
Hans H. Lien ◽  
Nina Aass ◽  
Håkon Wæhre ◽  
...  
Keyword(s):  
Germ Cell ◽  
Induction Chemotherapy ◽  
Cell Cancer ◽  
Residual Tumor ◽  
Retroperitoneal Lymph Node Dissection ◽  
Residual Mass ◽  
Malignant Germ Cell Tumor ◽  
Additional Therapy ◽  
Residual Lesions

Purpose: To determine preoperative parameters that predict the histology of specimens obtained by retroperitoneal lymph node dissection (RPLND) in patients with nonseminomatous germ cell cancer (NSGCT) whose residual mass was ≤ 20 mm in diameter after modern cisplatin-based induction chemotherapy. Patients and Methods: Eighty-seven patients with metastatic NSGCT underwent RPLND after having received cisplatin- or carboplatin-based induction chemotherapy. In all patients, the largest diameter of the residual mass on the transaxial plane was ≤ 20 mm, as assessed by abdominal computed tomography (CT) immediately before RPLND. Results: Complete fibrosis or necrosis was found in 58 patients (67%), teratoma was found in 23 patients (26%), and vital malignant germ cell tumor was found in six patients (7%), including one patient with rhabdomyosarcoma in the RPLND specimen. In five of the six latter patients, the residual lesion was ≤ 10 mm at pre-RPLND CT. No pre- or postchemotherapy clinical or radiologic parameter was identified that significantly predicted the histology of the residual mass. Conclusion: One third of retroperitoneal postchemotherapy lesions ≤ 20 mm contained residual vital tumor tissue, despite modern chemotherapy regimens. Therefore, postchemotherapy RPLND remains necessary in patients with minimal-size residual lesions to facilitate easy and safe follow-up and initiate additional therapy as early as possible, thus avoiding recurrences.

scholarly journals A Huge Cemento-Ossifying Fibroma of Paranasal Sinus: A Case Report

2012 ◽  
Vol 55 (3) ◽  
pp. 146-149
Author(s):  
Ibrahim Erdim ◽  
Zahide Mine Yazici ◽  
Rasim Yilmazer ◽  
Nurten Sever ◽  
Fatma Tulin Kayhan
Keyword(s):  
Case Report ◽  
Paranasal Sinus ◽  
Male Patient ◽  
Paranasal Sinuses ◽  
Surgical Excision ◽  
Ossifying Fibroma ◽  
Radiological Appearance ◽  
Close Observation ◽  
Slow Growing

Cemento-ossifying fibroma is a well-bordered, slow-growing, benign fibro-osseous disease. Although its localization is generally in the mandible, it can be seen in any area of the craniofacial region. Radiology and histopathology help to diagnose the condition. Treatment is based on close observation and/or surgical excision. In this case, we report the case of a 62-year-old male patient who had a large radiological appearance, cemento-ossifying fibroma in the paranasal sinuses.

scholarly journals A rare clinical case: schwannoma of tongue

2019 ◽  
Vol 5 (3) ◽  
pp. 789
Author(s):  
Chandra Veer Singh ◽  
Sheetal Radia ◽  
Saalim Sheikh ◽  
Vijay Haribhakti
Keyword(s):  
Head And Neck ◽  
Rare Case ◽  
Neck Region ◽  
Surgical Excision ◽  
Imaging Studies ◽  
Head And Neck Tumours ◽  
Head And Neck Region ◽  
Complete Surgical Excision ◽  
Slow Growing ◽  
Rule Out

<p class="abstract">Schwannoma are slow growing tumours, which can arise from any peripheral nerve. 10% of schwannomas that occur in the head and neck region mostly originate from the vagus or sympathetic nervous system. Extracranial schwannomas in the head and neck region are rare neoplasm. Intraoral schwannoma are only 1% of the all head and neck tumours. Diagnosis is established by imaging studies such as magnetic resonance imaging or computed tomography, while FNAC is used to rule out other conditions. We report a rare case of lingual schwannomas generally present as a painless lump schwannoma of the tongue in a 27-year-old male complaining of asymptomatic swelling over a posterolateral surface of the tongue, treated by complete surgical excision. The diagnosis was established on the basis of clinical, histopathological, and immunohistochemical examination. We report a rare case of schwannoma over the posterolateral surface of tongue. Prognosis is good for the patient when this condition is correctly diagnosed as the condition rarely recurs after complete resection.</p>

RESECTION OF METASTASES IN WILMS' TUMOR: A REPORT OF THREE CASES CURED OF PULMONARY AND HEPATIC METASTASES

PEDIATRICS ◽  
1968 ◽  
Vol 41 (2) ◽  
pp. 446-451
Author(s):  
Phillips P. Wedemeyer ◽  
James G. White ◽  
Mark E. Nesbit ◽  
Joseph B. Aust ◽  
Arnold S. Leonard ◽  
...  
Keyword(s):  
Pulmonary Metastases ◽  
Wilms Tumor ◽  
Hepatic Metastases ◽  
Surgical Excision ◽  
Residual Tumor ◽  
Pulmonary Involvement ◽  
Hepatic Lobectomy ◽  
Therapeutic Modalities ◽  
The Third ◽  
First Case

Three cases of Wilms' tumor metastatic to both the lungs and liver are described. The first case had pulmonary metastases on three occasions. The initial episode was treated with radiation, the second by excision, and the third by combined chemotherapy. The second case also had three recurrences of pulmonary metastases; the first two were treated by excision and the third was treated by radiation followed by excision of residual tumor. Pulmonary involvement occurred only once in the third case and was treated by combined radiation and actinomycin D. All three cases had hepatic metastases. Hepatic lobectomy was employed in two cases and radiation was used in a third. The apparent cure of these cases emphasizes the importance of vigorously applying the therapeutic modalities currently available. The frequent use of surgical excision in these cases was based upon three advantages of this modality: minimal damage to normal tissues, undiminished effectiveness on repeated use, and ability to discover metastases otherwise undetectable. The indications for resection for pulmonary metastases are discussed. Hepatic lobectomy, previously unreported in Wilms' tumor, would appear to merit more extensive use.

Is postchemotherapy retroperitoneal surgery necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses?

1992 ◽  
Vol 10 (4) ◽  
pp. 569-573 ◽  
Author(s):  
S D Fosså ◽  
H Qvist ◽  
A E Stenwig ◽  
H H Lien ◽  
S Ous ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Tumor Markers ◽  
Primary Tumor ◽  
Residual Disease ◽  
Mature Teratoma ◽  
Residual Tumor ◽  
Retroperitoneal Lymph Node Dissection ◽  
Retroperitoneal Mass ◽  
Residual Masses ◽  
Minimal Residual

PURPOSE At least one third of the patients with metastatic testicular cancer are rendered tumor-free by cisplatin-based chemotherapy. One may question, therefore, the routine use of postchemotherapy retroperitoneal lymph node dissection (RLND), especially if the residual masses are less than 20 mm in diameter. To define the role of such surgery, we analyzed the postchemotherapy histology in testicular cancer patients with minimal residual disease. PATIENTS AND METHODS Seventy-eight patients with advanced nonseminomatous testicular cancer underwent RLND after three to four cycles of cisplatin- or carboplatin-based chemotherapy. In all patients, the largest diameter of the residual retroperitoneal mass was less than 20 mm. RESULTS Complete fibrosis/necrosis was found in 51 patients, mature teratoma in 22, and vital malignant germ cell tumor in five. In two of the latter five patients, alphafetoprotein (AFP) had increased immediately before RLND. In the 76 patients with normal pre-RLND tumor markers, the presence of undifferentiated malignant teratoma (MTU) in the primary tumor and normal prechemotherapy tumor markers were independent parameters predicting complete fibrosis/necrosis, which was demonstrated in all 15 patients with these two pretreatment parameters. CONCLUSIONS Postchemotherapy RLND can be omitted in patients with MTU in the primary tumor who have normal AFP/human chorionic gonadotropin (AFP/HCG) before chemotherapy and whose residual retroperitoneal mass is less than 20 mm in diameter. If the pre-RLND tumor markers are normal, RLND should be performed in all other patients with small residual masses, even in the presence of a normal computed tomography (CT) and particularly if regular follow-up of the patients is not guaranteed.

Simultaneous retroperitoneal, thoracic, and cervical resection of postchemotherapy residual masses in patients with metastatic nonseminomatous germ cell tumors of the testis.

1996 ◽  
Vol 14 (6) ◽  
pp. 1765-1769 ◽  
Author(s):  
P C Brenner ◽  
H W Herr ◽  
M J Morse ◽  
J Sheinfeld ◽  
A Aprikian ◽  
...  
Keyword(s):  
Germ Cell ◽  
Operative Procedure ◽  
Radical Neck Dissection ◽  
Germ Cell Tumors ◽  
Chylous Ascites ◽  
Median Length ◽  
Simultaneous Resection ◽  
Viable Tumor ◽  
Prolonged Air Leak ◽  
Residual Masses

PURPOSE We report our experience with simultaneous resection of residual masses above and below the diaphragm in patients with metastatic nomseminomatous germ cell tumor (NSGCT) of the testis. MATERIALS AND METHODS Twenty-four patients underwent simultaneous resection of residual postchemotherapy masses in the retroperitoneum and chest, including three who also had radical neck dissection. All had been heavily pretreated with chemotherapy and five had undergone previous retroperitoneal lymph node dissections (RPLNDs). RESULTS The combined procedure was performed with no mortality and low morbidity. The median length of the procedure was 5 hours 45 minutes, median blood loss 500 mL, and median length of hospital stay 9 days. Complications included one patient with chylous ascites and one with a prolonged air leak, both of which resolved with conservative management. Eighteen patients had similar pathologic findings in all sites: 13 with necrosis only and five with teratoma only. Six patients had discordant pathology in the abdomen and chest, including one with viable tumor in the chest only and two with viable tumor in the abdomen only. The overall actuarial 5-year survival rate for all patients was 79%. CONCLUSION Simultaneous resection of neck, chest, and abdominal residual masses after chemotherapy for germ cell tumors is both a feasible and safe alternative to staged excision in selected patients who require surgical intervention at multiple sites and fulfills the objective of rendering patients disease-free in a single operative procedure.

Fibrosis in Nodular Sclerosis Hodgkin Lymphoma Is Predictive of a Residual Mass Following Therapy.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4630-4630
Author(s):  
Alanna J Church ◽  
Nasim Shabazi ◽  
David LeBrun ◽  
Tara Baetz
Keyword(s):  
Hodgkin Lymphoma ◽  
Functional Imaging ◽  
Conflicts Of Interest ◽  
Post Treatment ◽  
Line Treatment ◽  
Residual Mass ◽  
Nodular Sclerosis ◽  
Residual Masses ◽  
Initial Biopsy

Abstract Abstract 4630 Persistence of a mass after first-line treatment is a common problem in nodular sclerosis Hodgkin lymphoma (NSHL). Up to 64% of patients demonstrate residual abnormalities on computed tomography (CT) after therapy, but only 42% of those patients will relapse on follow-up. This is primarily caused by the inability of CT to distinguish viable tumor tissue from fibrosis. Clinicians are faced with the dilemma of whether to pursue second-line treatment for a mass that may be simply scar tissue. The ability to predict which patients are at higher risk for residual mass following curative treatment can aid in the planning of follow-up imaging modalities such as positron emission tomography (PET) scanning which can map out metabolically active tissue (i.e. tumor versus fibrosis) and the need for biopsy of a residual mass. This study was designed to test the hypothesis that the presence of abundant fibrosis in the initial biopsy predicts the presence of residual, post-therapy masses composed primarily of fibrotic tissue. Subjects were consecutive NSHL patients from the years 1996 to 2007 identified from our institution based on the availability of histology slides from the initial diagnostic biopsy, clinical follow-up data, and the results of post-treatment imaging investigations. The initial biopsies were reviewed by a lymphoma pathologist and resident without knowledge of the residual mass status. The proportion of the tissue consisting of fibrous material was graded as a percentage of the total biopsy tissue. The clinical charts were reviewed for baseline patient characteristics, cancer stage and the presence of a residual mass on CT scan 6 months after treatment. Of the 47 subjects included in the study, 25 had residual masses and 22 had none. Patients with increased fibrosis on initial biopsy were significantly more likely to have a residual mass after initial therapy (p=0.028). The degree of fibrosis was independent of gender, stage, and Hasenclever score. Degree of fibrosis was the only factor that was predictive of the presence of a residual mass. Of the 16 patients with residual masses with follow-up Gallium imaging, the result of the scan was more likely to be negative (indicating that the mass is not metabolically active) for patients with a high grade of initial fibrosis (p=0.148). Taken together, these results suggest that patients with increased fibrosis on their initial NSHL biopsy are more likely to have residual masses, but that these masses are less likely to be malignant. The results support the hypothesis that the degree of fibrosis at the initial NSHL biopsy is predictive of a post-treatment residual mass. These findings have potential implications for patient follow-up: clinicians whose patients have abundant fibrosis at initial biopsy may be reassured that a post-treatment residual mass is less likely to represent persistent malignancy and thus can be followed with functional imaging rather than pursuing unnecessary biopsies. Our results further reinforce the importance of functional imaging like PET, particularly in this patient population Disclosures: No relevant conflicts of interest to declare.

Clinical characteristics and outcomes of patients with primary mediastinal germ cell tumors.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 389-389
Author(s):  
Siwat Sakdejayont ◽  
Chirawadee Sathitruangsak ◽  
Patrapim Sunpaweravong ◽  
Arunee Dechaphunkul
Keyword(s):  
Thoracic Surgery ◽  
Germ Cell ◽  
Surgical Resection ◽  
Clinical Characteristics ◽  
Germ Cell Tumors ◽  
Residual Tumor ◽  
Pulmonary Complications ◽  
Serological Response ◽  
Viable Tumor ◽  
Mediastinal Germ Cell Tumors

389 Background: Mediastinal germ cell tumors (MGCTs) account for 20% of all mediastinal tumors. Cisplatin-based chemotherapy followed by surgical resection of residual tumor remains the standard of care. To prevent pulmonary complications secondary to extensive thoracic surgery, non-bleomycin containing regimen is generally preferred. This study aims to review clinical characteristics and outcomes of these patients. Methods: A retrospective chart review was undertaken in patients with MGCTs treated in our institution between 1993 and 2013. Results: A total of 40 patients were enrolled with a median age of 24. Only one patient is female. Stratified by histology; eight patients (20%) had pure seminoma, 25 patients (62.5%) had pure non-seminoma, four patients (10%) had mixed seminoma and non-seminoma, and three patients (7.5%) had malignant transformation (two adenocarcinoma, one sarcoma). Median tumor size was 13 centimeters. Ninety-two percent of patients received chemotherapy as a first treatment modality, whereas 8% underwent upfront surgery. All patients received cisplatin-based chemotherapy: Eighty seven percent bleomycin, etoposide and cisplatin; 13% etoposide and cisplatin. Seventy-two percent of patients completed four planned cycles of chemotherapy. Thirty-one patients were able to assess radiological response: 3.2% complete response, 58.1% partial response, 29.0% stable disease, and 9.7% progressive disease. Forty-four percent of patients achieved completely serological response with chemotherapy. Seventeen patients underwent surgical resection of residual tumor. Among these, viable tumor was seen in 35% (6 out of 17 patients). No patients complicated with clinically significant pulmonary complications after thoracic surgery. The five year overall survival (OS) of patients with seminoma was 72.9% as compared with 19.9% in those with non-seminoma (p=0.012). For those who received chemotherapy followed by surgical resection with no viable tumor or only mature teratoma detected (N=11), the five year OS was 64.9%. Conclusions: Our study confirmed the importance of multi-modality approaches with primary chemotherapy followed by surgical resection of residual tumor. Bleomycin-containing regimen can be safely used in this setting.

scholarly journals Preeclampsia: A Possible Complication of Primary Hyperparathyroidism

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Bader Abdullah Alharbi ◽  
Mohammed Ali Alqahtani ◽  
Mohammed Hmoud ◽  
Essam Awadh Alhejaili ◽  
Reema Badros
Keyword(s):  
Primary Hyperparathyroidism ◽  
Epigastric Pain ◽  
Early Recognition ◽  
Surgical Excision ◽  
Surgical Removal ◽  
Fetal Ultrasonography ◽  
Emergency Cesarean ◽  
Biophysical Profile ◽  
Close Observation ◽  
Intravenous Hydration

Background. Primary hyperparathyroidism is rare in pregnancy. An association between primary hyperparathyroidism and preeclampsia has been reported in few cases worldwide.Case. A 28-year-old woman (gravida 2, para 0, and abortus 1) in her 27th week of gestation was hospitalized due to a high reading of blood pressure (194/115 mmHg) that was not accompanied by any symptoms or signs of preeclampsia. Incidentally, she was found to have a high adjusted calcium and serum parathyroid hormone (PTH) level during admission. Ultrasonographic examination of the neck revealed the presence of parathyroid adenoma. She was scheduled for surgical excision after receiving an intravenous hydration. Fetal ultrasonography revealed a growth restricted fetus with normal biophysical profile. On the sixth day of hospitalization, the patient complained of headache and epigastric pain, with elevated BP and proteinuria. The fetal nonstress test was “nonreassuring.” Subsequently, she had an emergency cesarean delivery and surgical removal of the adenoma. The mother and her newborn were then transferred to intensive care, where their clinical course was unremarkable. The mother was discharged after 3 days, while the neonate stayed for close observation for 60 days.Conclusion. Early recognition of primary hyperparathyroidism among women with preeclampsia is important to prevent maternal and fetal morbidity and mortality.

Anterior approaches in juvenile nasopharyngeal angiofibromas with intracranial extension

2000 ◽  
Vol 122 (2) ◽  
pp. 277-283 ◽  
Author(s):  
Giovanni Danesi ◽  
Benedict Panizza ◽  
Antonio Mazzoni ◽  
Vincenzo Calabrese
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Surgical Excision ◽  
Residual Tumor ◽  
Lateral Approach ◽  
Treatment Modalities ◽  
Intracranial Extension ◽  
Midface Degloving

Although surgery is regarded as the mainstay of treatment for juvenile nasopharyngeal angiofibromas (JNAs), ancillary treatment modalities such as radiotherapy and on rare occasions chemotherapy are still recommended by many for intracranial extension with apparent radiologic involvement of the cavernous sinus and internal carotid artery. Further, most authors undertaking surgical excision of this subgroup of patients would recommend a lateral or combined frontal and lateral approach for its removal. In a series of 49 cases of JNA, 14 were found during surgery to have intracranial extradural extension; the anterior approach was used for their removal. Although in these cases, on radiography the cavernous sinus often looked to be invaded and the internal carotid artery was displaced superolaterally, there was no difficulty in establishing a plane of dissection. Total removal was achieved in 11 of the 14 cases with a single-stage procedure. Of the 3 cases with residual tumor, only 1 occurred intracranially. Removal was achieved by a subtemporal approach in this case. For the extracranial residual tumors 1 required a midface degloving and the other, with a 1-cm residual tumor in the nasopharynx, has been treated conservatively for 6 years with no evidence of growth. No deaths or significant complications have occurred, and radiotherapy has not been required. We conclude that JNAs are tumors with a predilection for spread but that rarely invade dura, acting instead to displace it. We believe that surgery is the method of choice for treating these lesions and that an anterior surgical approach with microsurgical techniques should be used in the first instance. In the last 2 cases we preferred a midface degloving technique to avoid facial scarring and because this approach allows a widening of the surgical field if needed by the performance of bilateral maxillary free bone flaps. On the rare occasion that a lateral approach, with its attendant permanent conductive hearing loss, is found to be necessary for total tumor removal, this can be done as a staged procedure. This may be necessary when the tumor has spread lateral to the horizontal internal carotid artery.

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