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Wide Excision (wide + excision)
Selected AbstractsGS26P ABDOMINAL WALL ENDOMETRIOMA FOLLOWING CAESAREAN SECTIONANZ JOURNAL OF SURGERY, Issue 2007R. J. Whitfield Purpose Endometriosis is defined as the presence of aberrant endometrial tissue outside of the uterus that responds to stimulation by ovarian hormones. A large, circumscribed mass of such tissue is commonly termed an endometrioma. Abdominal wall endometriomas in association with caesarean section scars have been reported repeatedly in the obstetrics and gynaecology literature, but rarely in general surgical journals. Methodology In this paper, six patients are reviewed who presented between 2001 and 2006 with painful, tender nodules in and around caesarean section scars. Of these, four reported exacerbation of symptoms during, or just prior to menstruation. One patient had experienced 12 years of symptoms, previously attributed to intra-abdominal adhesions. Results All patients had their scar nodules excised. Five procedures were performed electively. One patient underwent emergency exploration of her caesarean scar for possible incarcerated incisional hernia. Ectopic endometrial tissue was seen in the histological specimens of all patients. Four patients reported resolution of their symptoms following surgery. One patient had ongoing symptoms post-operatively, with an additional mass lesion seen on ultrasound consistent with a second endometrioma. One patient did not attend follow-up. Conclusion General surgeons are commonly required to assess and manage abdominal wall masses, and should have an awareness of endometrioma in the differential diagnosis when such a lesion is seen in association with a caesarean section scar. Wide excision is usually very effective at alleviating symptoms of abdominal wall endometrioma. [source] Aggressive digital papillary adenocarcinoma: a reviewCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 2 2010H.-C. Hsu Summary Vigorous treatment of aggressive digital papillary adenocarcinoma (ADPA), including amputation, has been recommended by most authors, but the appropriateness and effectiveness of excision as an alternative to amputation has not been systematically evaluated. To evaluate the appropriateness and effectiveness of excision as an alternative to amputation in the treatment of ADPA, we reviewed the clinical presentations, treatments and patient outcomes presented in case reports on ADPA available on Ovid MEDLINE. We also assessed the results of immunohistochemical staining for proliferation markers in one patient in order to explain the nonaggressive nature of ADPA noted in that patient. Except for the duration of lesions, there was no significant difference in clinical outcome between the excision and amputation groups. We also found that p63 may be a useful marker for distinguishing primary ADPA from metastatic adenocarcinomas. In addition, the intensity of Ki67 expression in tumour cells may be a marker of aggressive behaviour and thus be helpful in therapeutic decision-making. Wide excision with or without sentinel lymph-node biopsy is a feasible alternative to amputation. It should be considered in patients who present with a long-standing history of ADPA without evidence of underlying bone invasion or distant metastasis and with low-intensity expression of proliferation markers. [source] Squamous Cell Carcinoma in Chronic Lymphedema: Case Report and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 10 2002Hiroshi Furukawa MD background. Squamous cell carcinoma (SCC) arising in chronic lymphedema is rare; only nine cases have been reported. objective. To present the evolution of SCC in chronic lymphedema. methods. Case report and literature review. results. The tumor was treated by wide excision and covered by a skin graft. conclusion. In most of the other reported SCC cases in lymphedema, there are additional factors for carcinogenesis. There is no additional carcinogenic factor except for chronic lymphedema in our case. This strongly supports that lymphedema itself is one of the carcinogenic factors for not only angiosarcoma but also SCC. [source] Leiomyosarcoma of the breast: A difficult diagnosis on fine-needle aspiration biopsyDIAGNOSTIC CYTOPATHOLOGY, Issue 3 2003Xiao Jun Wei M.D. Abstract Leiomyosarcoma of the breast is rarely encountered in fine-needle aspiration (FNA) cytologic material. We report a case of primary leiomyosarcoma of the breast in a 52-yr-old female. Aspiration cytology showed large, dissociated round to spindle cells with abundant vacuolated cytoplasm, pleomorphic nuclei, prominent nucleoli, and occasional intranuclear cytoplasmic invaginations. Mitotic figures, osteoclast-like giant cells, and stromal fragments were identified. A diagnosis of malignant neoplasm representing either a sarcoma, a poorly differentiated carcinoma, or a metaplastic carcinoma was made. The patient underwent a wide excision of the lesion after negative work-up. Histologic examination and immunohistochemical studies established the diagnosis of leiomyosarcoma. This case is presented here because we feel that, although FNA cytology with eventual ancillary studies is a valuable diagnostic tool to evaluate any breast mass, malignant spindle cell neoplasms of the breast still represent a diagnostic challenge for the cytopathologist. Recognition of all cytologic features of leiomyosarcoma may help to formulate a correct diagnosis. Diagn. Cytopathol. 2003;29:172,178. © 2003 Wiley-Liss, Inc. [source] Functional reconstruction of the lateral face after ablative tumor resection: Use of free muscle and musculocutaneous flapsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2001Tugrul Maral MD Abstract Background Wide resection of tumors of the middle third of the face often results in complex three-dimensional defects and facial paralysis either due to removal of the facial nerve within the tumoral tissue or to extensive resection of the facial muscles. Methods We report the cases of three patients who underwent wide excision of tumors of the cheek region, operations that resulted in tissue defects and facial palsy. Defect reconstruction and facial reanimation was accomplished in one stage through functional muscle transplantation. Results Follow-up of more than 1 year showed good symmetry at rest and reanimation of the corner of the mouth in all cases, but one patient, in which the ipsilateral facial main trunk was used as motor nerve supply to the transplanted muscle, developed significant muscle contracture and binding of the cheek skin. Conclusions Every effort should be made to optimize the functional and cosmetic outcomes of neurovascular muscle transfers through precise planning and careful execution of the intricate details of the surgical technique for muscle transplantation. © 2001 John Wiley & Sons, Inc. Head Neck 23: 836,843, 2001. [source] Wound conditioning of a deep tissue defect including exposed bone after tumour excision using PROMOGRAN* Matrix, a protease-modulating matrixINTERNATIONAL WOUND JOURNAL, Issue 3 2005Anne-Kathrin Tausche MD Abstract A case study reporting on the successful treatment of a patient affected by a basal cell carcinoma is submitted. Because the carcinoma had infiltrated deeply, a wide excision was necessary, including the removal of bone tissue. The deep tissue defect was treated with PROMOGRAN* Matrix, a protease-modulating matrix, to promote granulation and ensure that the skin graft do survive and heal successfully. In this case study, a rapid development of granulation tissue on the exposed surface of the bone was observed. The benefits of the dressing enabled a successful split-thickness skin grafting to be carried out which gave very good aesthetic and functional results. [source] Myxoid liposarcoma of the oral cavity with involvement of the periodontal tissuesJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2001Gianfranco Favia Abstract Background, aims: Liposarcoma is the 2nd most frequent soft tissue sarcoma in adults, but it is extremely rare in the head and neck and, particularly, in the oral cavity. We report on a 25-year-old female who presented with a periodontal mass, extended from the right upper 3rd molar to the right upper 2nd premolar, covered by intact oral mucosa. The clinical differential diagnosis included peripheral giant cell granuloma, salivary gland neoplasms, squamous cell carcinoma of the gingiva, sarcoma and malignant lymphoma. Methods: To accurately plan subsequent treatment, an excisional biopsy was performed and a myxoid liposarcoma was diagnosed. Consequently, the patient underwent wide excision of the neoplasm with maxillary en-block resection. Results: The post-operative course was uneventful and the patient is alive and well 8 years after the original diagnosis. The authors stress the importance of considering soft tissue sarcomas in the diagnostic approach to patients with unusual periodontal neoplasms and to plan adequate surgical sampling of the lesion (i.e. excisional biospy). Conclusions: This appears of pivotal importance as more limited specimens may result in inaccurate pre-operative diagnosis. [source] Primary Cutaneous Carcinosarcoma (PCCS0 Aka Metaplastic Carcinoma)JOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005Ramin Ram We describe a case of PCCS in a 73 year-old male who presented with a rapidly growing tumor of 6 months duration on the right ear. Clinical examination revealed a 5 × 4 × 4-cm ulcerated, crusted, exophytic tumor on the superior aspect of the helix. Histologically, the mass revealed a biphasic tumor with malignant epithelial and mesenchymal components. The epithelial component consisted of a few foci of basal cell carcinoma (BCC). The majority of the tumor was composed of osteogenic sarcoma and malignant fibrous histiocytoma (MFH). An intricate transition of BCC into sarcoma was noted in a few foci. Atypical mitosis and necrosis were common. The BCC and tumor giant cells in the MFH area showed positive immunoreaction for cytokeratin and CD68 respectively. The tumor was negative for S-100 protein, HMB-45, muscle actins, chromogranin, and synaptophysin. In conclusion, a PCCS growing predominantly as osteosarcoma and MFH is reported. Although the exact histogenesis of PCCS is unknown, primitive mesenchymal cells of the dermis, surrounding the follicular units, are capable of pluripotent differentiation and are likely the source of origin of the sarcoma. The known aggressive biological behavior warrants wide excision and given the rare reports of metastasis and death, regular follow-up is required [source] Outcomes of re-excision after unplanned excisions of soft-tissue sarcomasJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2005Mark W. Manoso MD Abstract Background and Objectives Unplanned excisions of soft-tissue sarcomas of the extremities occur commonly. Our goal was to evaluate the presence of residual disease, the treatment outcomes as they relate to local and distant recurrence and 5-year survival, and the limb functional outcomes in patients with unplanned sarcoma excision who were treated with re-excision and adjuvant therapy. Methods Between 1993 and 1999, 42 patients presented to our institution after unplanned excision of soft-tissue sarcomas. Of those 42 patients, 38 without gross residual disease or metastatic lesions formed the basis of this review. All 38 patients underwent revision wide excision; most (31) also received adjuvant therapy (radiation and/or chemotherapy). Clinical data were obtained from analysis of patient records and radiographic studies. Univariate analysis was performed with logistical regression, and multivariate analysis was performed with Cox modeling. Results The overall 5-year survival rate was 91.3% and the disease-free 5-year survival rate was 82.2%. Univariate analysis showed that stage-III disease (American Joint Committee on Cancer classification of soft-tissue sarcomas), lesions below the fascia, a histologic high-grade, and the development of organ metastasis were statistically significant factors for mortality. Stage-III disease also was significant for mortality on multivariate analysis. Only stage-III disease was significant for the development of local recurrence. Eighty-four percent of the patients had good to excellent functional outcomes. Conclusions Re-excision with adjuvant therapy proved to be a safe and effective method for treating the disease and preserving limb function. J. Surg. Oncol. 2005;91:153,158. © 2005 Wiley-Liss, Inc. [source] Malignant glomus tumor in the branchial muscle of a 16-year-old girlPATHOLOGY INTERNATIONAL, Issue 9 2001Kazuhito Matsumoto Malignant glomus tumor is an extremely rare neoplasm and its histological features are not well characterized. We report a 16-year-old female patient with a malignant glomus tumor. The patient was admitted to our hospital presenting with a mass in the right upper arm that she had noticed for the previous 6 months. Computed tomography and magnetic resonance imaging revealed an expanded mass involving the surrounding tissues. At surgery, an ill-defined and expanded mass was found, 5 × 4 × 3 cm in size, in the right branchial muscle. The tumor was extirpated, along with neighboring muscle tissues. Histologically, tumor cells were round to short-spindle shaped, forming solid sheets admixed with vessels of varying size. Their nuclei were uniformly oval to round, and their cytoplasms were slightly eosinophilic. The growth pattern of the tumor cells resembled that of glomus tumor, but mitotic figures were frequent (as high as 10 per 10 high-power fields). Immunohistochemically, the tumor cells were positive for vimentin and muscle actin, but negative for desmin. There were no areas typical of benign glomus tumor or sarcomatous change. These findings led us to a diagnosis of primary malignant glomus tumor arising de novo. There has been no recurrence or metastasis for 21 months after wide excision. [source] Communication with Older Breast Cancer PatientsTHE BREAST JOURNAL, Issue 4 2007Ian S. Fentiman MD Abstract:, An increasing proportion of patients with breast cancer are aged above 70 at the time of diagnosis and yet this particular age group has been underserved in terms of clinical research. Good communication between a doctor and a patient implies giving the advice and treatment most appropriate to that particular individual's needs, based upon their health and the tumor characteristics in the framework of their experience and belief system. Doctors need to be able to pick up both verbal and nonverbal cues and whenever possible to place the needs of the patient rather than her relatives as paramount. Consultations may be blighted at the onset by delays, unsympathetic staff, and patronizing doctors. Many older patients will wish to avoid mastectomy and for those with hormonally sensitive tumors wide excision and tamoxifen without axillary clearance or breast irradiation may provide a safe option. Undertreatment of those with hormonally insensitive cancer may lead to an increased risk of recurrence and premature death from breast cancer. Although there is an increasing realization of the need for clinical studies in older patients this group are grossly under-represented in trial portfolios [source] TREATMENT FOR DUCTAL CARCINOMA IN SITU IN AN ASIAN POPULATION: OUTCOME AND PROGNOSTIC FACTORSANZ JOURNAL OF SURGERY, Issue 1-2 2008Esther W. L. Chuwa Background: Breast cancer is the most common cancer among Singapore women and ductal carcinoma in situ (DCIS) is believed to be the precursor of most invasive breast cancers. The incidence of DCIS has increased dramatically with mammographic screening, but its treatment remains controversial. Further, results of treatment for DCIS in Asians, and in particular Singapore women, are lacking. We review our institution's results treating a predominantly Chinese population with DCIS of the breast before the introduction of mammographic screening and aim to determine treatment outcomes and identify prognostic factors for disease recurrence. Methods: Between January 1994 and December 2000, 170 consecutive patients with DCIS were treated at our institution. One hundred and three (60.5%) were managed with breast conservation (17 with local wide excision alone and 86 with adjuvant irradiation following wide excision) whereas 67 (39.4%) underwent mastectomy. Of those who underwent wide local excision, 56 (54.3%) underwent re-excision for margin clearance. Overall, the axilla was surgically staged in 47 (27.6%) and no nodal involvement was found in all cases. Pathological specimens were reviewed by one of the authors. Median follow up was 86 months (range 4,151 months). Results: Sixty-two patients (36%) were asymptomatic at presentation whereas most (64%) presented with clinical symptoms; out of these more than half (54%) presented with a palpable lump. The median size of tumours was 13 mm (range 1.5,90 mm). Patients who underwent breast conservation surgery had oncologically more favourable lesions , with a significantly higher incidence of smaller and non-palpable lesions and lesions of lower nuclear grade. However, there was also a significantly higher incidence of local recurrence in this group. At the end of follow up, there were 12 patients (7.1%) who developed local recurrence and 8 patients (4.7%) developed contralateral disease. The crude incidence of all breast events (including both local failure and contralateral events) at 5 years was 5.6%. Median time to the development of any breast event (local recurrence or contralateral disease) was 60 months (range 12,120 months). The cumulative 5-year recurrence-free survival for patients who underwent breast conservation surgery was 94%. Factors influencing local recurrence rate were close or involved margins (,1 mm) and lack of adjuvant radiotherapy. There were no cancer-specific deaths during the period of follow up. Conclusion: Our results indicate that rates of cancer-specific survival were similar after mastectomy and breast conserving surgery. However, a close or involved margin (,1mm) and lack of adjuvant radiotherapy were associated with local recurrence, with margin status being the independent predictor for local recurrence. Our results reinforce that optimizing local therapy is crucial to improve local control rates in women treated with DCIS in our population. [source] BREAST SPECIMEN ULTRASOUND AND MAMMOGRAPHY IN THE PREDICTION OF TUMOUR-FREE MARGINSANZ JOURNAL OF SURGERY, Issue 12 2006Kok-Yang Tan Background: Adequacy of margins is important for local recurrence control in breast-conserving surgery for breast cancer. This study aims to compare the accuracy of intraoperative specimen ultrasonography (IOUS) and specimen mammography in the prediction of achieving adequate histologically tumour-free margins during breast-conserving surgery. Methods: Between March 2003 and September 2004, a prospective study was carried out on 25 patients who underwent breast-conserving surgery. After wide excision, IOUS and specimen mammography were used to assess adequacy of margins. Further surgery was undertaken when either method showed an inadequate margin. The margins were assessed histologically and correlated with IOUS and mammographic findings. Results: Using IOUS alone, higher rates of histologically tumour-free margins were achieved compared with mammography alone. Combined IOUS and mammography achieved similar or slightly higher rates of histologically tumour-free margins compared with IOUS alone. If the margin measured on IOUS is twice the desired histological margin, this will result in achieving a histologically tumour-free rate of >90%. Associated ductal carcinoma in situ was the only significant factor found to decrease the rate of achieving adequate margins. Conclusion: Intraoperative specimen ultrasonography is useful in predicting histologically tumour-free margins during breast conserving surgery for cancer. [source] Merkel cell carcinoma (primary cutaneous neuroendocrine carcinoma): An overview on managementAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 3 2006Michael J Veness SUMMARY Merkel cell carcinoma is an uncommon but aggressive primary cutaneous neuroendocrine (small cell) carcinoma. There is ongoing debate regarding the optimal treatment of this disease. The early literature comprised small institutional studies with inherent weaknesses. Recent data have emerged from larger studies, including those from Australian institutions, that adds support to a multimodality approach as best practice. Despite this, the outcome for patients with unfavourable disease remains poor and in most series 25,30% of patients die as a direct result of Merkel cell carcinoma. The head and neck is the commonest site for presentation (50,60%) and wide excision (2,3 cm) of the primary lesion is usually recommended, although achieving this is often difficult within functional and cosmetic constraints. All clinically node-negative patients should be considered candidates for elective nodal treatment and those with clinical nodal disease should undergo nodal dissection and adjuvant radiotherapy. Recent evidence suggests that patients treated with surgery and adjuvant locoregional radiotherapy experience a better disease-free survival compared with those undergoing surgery alone. The role of platinum-based chemotherapy is evolving. The aim of this article is to discuss relevant issues in the management of a patient with Merkel cell carcinoma. [source] Characteristics of sentinel lymph nodes' metastatic involvement in early stage of vulvar cancerAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009Jaroslav KLÁT Background:, Nodal involvement is one of the most significant prognostic factors in early-stage vulvar cancer. Aims:, To determine the diagnostic accuracy of sentinel lymph node (SLN) detection in early-stage vulvar cancer and to describe the characteristics of metastatic lymph node involvement. Methods:, Of 23 women with early-stage squamous cell vulvar cancer included in the study, five had lateral lesions and 18 had midline lesions. SLN detection was performed by using a radioactive tracer and blue dye, followed by radical vulvectomy or radical wide excision with uni/bilateral inguinofemoral lymphadenectomy, depending on tumour size and localization. SLNs were subsequently examined with haematoxylin,eosin and immunohistochemistry. Results:, The SLN detection was successful in all 23 women (100%) and in 38 of 41 groins (92.3%) tested. The total number of SLNs was 67, with an average of 1.76 per groin. In total, 20 positive SLNs were detected in 14 of 23 patients. From a total of 20 positive SLNs, micrometastases were found in five SLNs and isolated tumour cells in one SLN. We experienced one case with a false negativity of SLN. Sensitivity, negative predictive value, accuracy and false negativity of SLN detection were 93.3%, 88.8%, 95.6% and 7.1% respectively. Conclusion:, The SLN biopsy performed by an experienced team is a feasible method, with high accuracy in patients with early-stage vulvar cancer. Prognostic value of micrometastases should be confirmed in further studies. [source] Low recurrence rate after surgery for dermatofibrosarcoma protuberansCANCER, Issue 5 2004A multidisciplinary approach from a single institution Abstract BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare sarcoma with a propensity for local recurrence. Treatments with wide excision, Mohs surgery, and other approaches have been reported with widely variable local control rates. The objective of this study was to review the experience with a multidisciplinary approach employing wide excision and Mohs surgery selectively in the treatment of patients with DFSP at a single academic institution over the past 10 years. METHODS The records of 62 patients with 63 DFSP tumors who underwent wide excision, Mohs surgery, or a multidisciplinary combination approach from January 1991 to December 2000 were reviewed retrospectively. Primary endpoints included the ability to extirpate the DFSP lesion completely, the tumor recurrence rate, and the need for skin grafts or local tissue flaps. Additional objectives included defining surgical practice patterns at the authors' institution. RESULTS Sixty-three DFSP lesions were removed from 62 patients. At a median follow-up of 4.4 years, no local or distant recurrences were detected in any patient. Forty-three lesions were treated with wide local excision, 11 lesions were treated with Mohs surgery, and 9 lesions were treated with a combination approach. Ninety-five percent of lesions that were approached initially with wide local excision were cleared histologically. Two patients (5%) received postoperative radiation for positive margins after undergoing maximal excision. Eighty-five percent of lesions that were approached initially with Mohs surgery were cleared histologically. The remaining 15% of lesions subsequently were cleared surgically with a wide excision. DFSP lesions that were approached initially with Mohs surgery tended to be smaller. Patients with head and neck lesions most often underwent Mohs surgery or were treated with a multidisciplinary combination approach (87%). CONCLUSIONS Wide local excision with careful pathologic analysis of margins was found to have a very low recurrence rate and was used for the majority of patients with DFSP lesions at the authors' institution. Wide local excision, Mohs surgery, and a multidisciplinary combination approach, selected based on both tumor and patient factors, were capable of achieving very high local control rates in the treatment of DFSP. The evolution of a multidisciplinary approach has provided a level of expertise that no single individual could achieve for the treatment of the full spectrum of DFSP lesions at the authors' institution. Cancer 2004;100:1008,16. © 2004 American Cancer Society. [source] Primary sarcoma of the breastJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2004Manoj Pandey Abstract Background and Objectives Primary sarcoma occurring in breast is rare and comprises 0.5,1% of all breast neoplasm. Majority of the series include both stromal and cystosarcoma phyllodes, only a few hundred cases of sarcomas other then cystosarcoma are reported. Patients and Methods We carried out a retrospective analysis of 19 patients with primary sarcoma of the breast treated between 1982 and 2002. Results Mean age of the patients was 38.6 years (12,70 years). Gradually progressive swelling was the commonest presenting feature. There were eight cases of angiosarcoma, four cases of spindle cell sarcoma, two each of pleomorphic sarcoma and stromal sarcoma, and one each of malignant fibrous histiocytoma, embryonal rhabdomyosarcoma, and sarcoma (NOS). Eight of these were high-grade (42%). Eight patients underwent either radical or modified mastectomy, three underwent wide excisions, and one underwent quadrantectomy. Ten (52.6%) patients received postoperative adjuvant radiation. Two patients received chemotherapy. After a mean follow-up time of 34.5 months (median 25 months), eight patients failed. Failure was local in five, opposite breast in one, and both local and distant in two. The disease free survival at 3-year was 39%. In univariate analysis only the margin of first surgery was found to be a significant predictor of survival (P,=,0.05). Conclusions Primary sarcomas of the breast are aggressive tumors. Surgical treatment should consist of at least simple mastectomy. All attempts should be made to achieve a negative margin as this appears to be the only factor influencing survival in these patients. J. Surg. Oncol. 2004;87:121,125. © 2004 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||