Primary Leiomyosarcoma of the Inferior Vena Cava: is vascular reconstruction always necessary?

Primary leimyosarcoma of the inferior vena cava is considered as rare vascular retroperitoneal sarcoma. Although radical resection with free margin is necessary, vascular strategies are very challenging.

Long-term results of triple valve repair in rheumatic heart disease

Background The aim of this study is to analyze the clinical outcomes of triple valve repair for rheumatic heart disease in terms of both early results and long-term benefits. Methods Between January 2008 and December 2016, all the patients who underwent triple valve repair for rheumatic heart disease were included in this study. Results Thirty-eight patients underwent triple valve repair procedure for rheumatic heart disease at our institute. Mean age was 33 years; 60.5% were females. Techniques used to achieve mitral valve repair were: commisurotomy (n = 26), prosthetic ring annuloplasty (n = 9), posterior teflon annuloplasty (n = 23), leaflet shaving (n = 14), implantation of neochordae (n = 5) and pericardial patch augmentation of mitral valve leaflets (n = 6). For aortic valve repair, the techniques used were: commisurotomy (n = 23), leaflet shaving (n = 16), pericardial patch augmentation (n = 3), subcommisural plication (n = 10), free margin plication (n = 2) and free margin resuspension (n = 1). Tricuspid valve repair was performed using modified Devega's technique (n = 32), commisurotomy (n = 9) and posterior annular plication (bicuspidization) (n = 5). The operative mortality was 0%. There was no primary repair failure. Estimated survival at the end of 1 year, 5 years and 10 years was 100%, 91.6% and 65.8%, respectively. Overall freedom from reintervention at 1, 5 and 10 years was 100%, 96.4% and 61.4, respectively. Conclusion Triple valve repair provided satisfactory early and long-term results in this challenging subset of patients and can be considered as an acceptable option for significant triple valve disease due to the absence of anticoagulation-related events.

Tumor Volume Predicts High-Risk Patients and Guides Initial Chemoradiotherapy for Early Cervical Cancer

We evaluated the relationship between the minimum tumor-free margin, tumor volume, and adverse pathological risk factors in early cervical cancer and explored the predictive value of these parameters for different types of risk patients to guide individualized therapeutic strategies. Patients who received the initial treatment of radical operation of cervical cancer and their postoperative pathological reports in our hospital from July 1, 2017, to June 30, 2019, were reviewed. Their minimum tumor-free margin and tumor volume were measured on preoperative magnetic resonance imaging. Student’s t-test and the receiver operating characteristic curve analysis were used for data analysis. A total of 240 patients were included. Adverse pathological risk factors were as follows: deep cervical infiltration, 95 (39.6%) cases; lymph vascular space invasion, 91 (37.9%); lymph node metastasis, 20 (8.3%); parametrial infiltration, 8 (3.3%); tumor diameter ≥4 cm, 7 (2.9%); and positive surgical margin, 1 (0.4%). According to the adverse pathological factors, there were 20 (8.3%) high-risk patients, 50 (20.8%) medium-risk patients, and 170 (70.8%) low-risk patients. The ranges of the minimum tumor-free margin and tumor volume were 0.01–13.5 mm and 105–27,990 mm3, respectively. The minimum tumor-free margin with lymph node metastasis was significantly smaller than that without (P <0.05). The tumor volume with parametrial infiltration, deep cervical infiltration, or lymph vascular space invasion was significantly greater than that without (P < 0.05). The tumor volume was significantly different among low-, medium-, and high-risk patients (P <0.05). Tumor volume was of predictive value for high-risk patients (P < 0.05). With 3,505 mm3 as the cutoff value, the sensitivity and specificity for the prediction of high-risk patients were 88.9% and 84.8%, respectively. Tumor volume can be used as a great predictor of high-risk patients (cutoff value, 3,505 mm3), which could be an indication of initial chemoradiotherapy for early cervical cancer.

Diagnostic difficulty of an aggressive and recurrent giant cell granuloma: a short case report

Introduction: The central giant cell granuloma (CGCG) is a rare benign lesion of the jaws, rarely aggressive,mostly affecting the mandible in children and young adults. The diagnosis may be difficult, complementaryhistological analyses being necessary to differentiate it from other giant cell tumours. Observation: A 28-year-old woman consulted for a painful gingival swelling surrounding the inferior right second molar. Cone Beam (CBCT) showed anunilocular radiolucent mandibular lesion. Histological examination performed after the curettage of the lesion could not differentiate between a peripheral GCG with bone extension, a giant cell tumour (GCT) or a CGCG. The patient was lost of view for 4 months until an aggressive recurrence. Asegmental mandibulectomy in disease-free margin was performed. Immunohistochemical and genetic testscomplementary to histology finally permitted to concludeto a CGCG. The patient presented no recurrence in 4 years of follow-up. Discussion: Surgical removal in disease-free margin is the gold standard treatment in aggressive CGCG. Nonetheless, literature reports alternative pharmacological treatments alone or in addition to surgery. In this case, the aggressiveness of the tumour and the absence of patient compliance for follow-up have led to the decision of a radical treatment of the recurrence. Conclusion: Aggressive CGCG requires a rapid diagnosis and a primary disease-free margin surgical resection to avoid mutilating treatment of the recurrence.

Results Following Surgical Resection of Recurrent Chordoma of the Spine: Experience in a single institution

Background: Chordoma of the spine is a low-grade malignant tumor with vague and indolent symptoms thus large tumor mass is encountered at the time of diagnosis in almost cases and makes a difficult for En-bloc free-margin resection. Salvage therapy for recurrent chordoma is very challenging due to its relentless nature and refractory to adjuvant therapies. The aim of this present study was to report the oncologic outcome following surgical resection of chordoma of the spine. Materials and Methods: Retrospective review of 10 consecutive cases of recurrent chordoma patients who underwent surgical treatment between 2003 and 2018 at one tertiary-care center was conducted. Results: There were 10 patients, 4 females and 6 males were included in this study. Eight patients had local recurrence. The recurrence was encountered at the muscle, surrounding soft tissue and remaining bony structure. Distant metastases were found in 2 patients. The median time to recurrent or metastasis was 30 months after first surgery. Conclusion: En-bloc free margin resection is mandatory to prevent recurrent. The clinical vigilance and investigation to identify tumor recurrent should be performed every 3 to 6 months, especially, in the first 30 months and annually thereafter. Detection of recurrent in early stage with a small mass may be the best chance to perform an En-Bloc margin free resection to prevent further recurrent.

Results Following Surgical Resection of Recurrent Chordoma Of the Spine: Experience in a Single Institution

Background: Chordoma of the spine is a low-grade malignant tumor with vague and indolentsymptoms thus large tumor mass is encountered at the time of diagnosis in almost cases and makes a difficult for En-bloc free-margin resection. Salvage therapyfor recurrent chordoma is very challenging due to its relentless nature and refractory to adjuvant therapies. The aim of this present study was to report the oncologic outcome following surgical resection of chordoma of the spine.Materials and Methods:Retrospective review of 10 consecutive cases of recurrent chordoma patients who underwent surgical treatment between 2003 and 2018atone tertiary-care center was conducted.Results: There were 10 patients, 4 females and 6 males were included in this study. Eight patients had local recurrence. The recurrence was encountered at the muscle, surrounding soft tissue and remaining bony structure. Distant metastaseswere found in 2 patients. The average time of recurrence was 28 months after first surgery. Conclusion:En-bloc free margin resection is mandatory toprevent recurrent. The clinical vigilance and investigation to identify tumor recurrent should be obtained periodically,in the first 28 months. Detection of recurrent in early stage with a small mass may be the best chance to perform an En-Bloc margin free resection to prevent further recurrent.