• Title/Summary/Keyword: Primary tumor resection

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Surgical Strategy for Skull Base Chordomas : Transnasal Midline Approach or Transcranial Lateral Approach

  • Wang, Benlin;Li, Qi;Sun, Yang;Tong, Xiaoguang
    • Journal of Korean Neurosurgical Society
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    • v.65 no.3
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    • pp.457-468
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    • 2022
  • Objective : The clinical management paradigm of skull base chordomas is still challenging. Surgical resection plays an important role of affecting the prognosis. Endonasal endoscopic approach (EEA) has gradually become the preferred surgical approach in most cases, but traditional transcranial surgery cannot be completely replaced. This study presents a comparison of the results of the two surgical strategies and a summary of the treatment algorithms for skull base chordomas. Methods : We retrospectively analyzed the surgical outcomes and follow-up data of 48 patients with skull base chordomas diagnosed pathologically who received transnasal midline approaches (TMA) and transcranial lateral approaches (TLA) from 2010 to 2020. Results : Among the 48 patients, 36 cases were adopted TMA and 12 cases were performed with TLA. In terms of gross total resection (GTR) rate, 27.8% in TMA and 16.7% in TLA and with EEA alone it was increased to 38.9%, while 29.7% in primary surgery. In TMA, the cerebrospinal fluid (CSF) leak remains the most common complication (13 cases, 36.1%), other main complications included death, cranial nerve palsy, hypopituitarism, all the comparisons were no statistical significance. The Karnofsky Performance Scale scores in TMA were all better than those in TLA at different time, and the overall survival (OS) and recurrence free survival/progression free survival was just the reverse. Conclusion : The EEA for skull base chordomas resection has improved the GTR rate, but transcranial approach is still an alternative approach. It is necessary to select an appropriate surgical approach based on the location and the pattern of tumor growth in order to obtain the best surgical outcomes.

Congenital Infantile Fibrosarcoma (선천성 영아 섬유육종)

  • Kim, Tae-Hyoung;Chung, Jae-Hee;Song, Young-Tack
    • Advances in pediatric surgery
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    • v.10 no.1
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    • pp.52-55
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    • 2004
  • A newborn male baby was transferred to our hospital with a left inguinal mass. The mass was huge measuring $10{\times}10cm$, engorged, and dark-blue colored as a result of internal hemorrhage. Unstable vital signs were combined with DIC and acute renal failure. Emergency operation was performed because of the suspicion of bowel perforation. The peritoneal cavity was full of ascitis and the distal jejunum had a 0.5 cm perforation. Segmental resection of the jejunum and incisional biopsy of the inguinal mass were performed. On pelvic and thigh MRI, the mass protruded into pelvic cavity and encircled large vessels and nerves of the thigh. Pathologic diagnosis was congenital infantile fibrosarcoma. Fifteen days after operation, primary tumor excision was undertaken. The second look operation, performed after 6 times VAC chemotherapy, revealed no remained malignant cell on microscopic section. The baby has been followed closely for the last eight months.

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Dural Marginal Zone Lymphoma Confused with Meningioma en Plaque

  • Kim, Min-Young;Kim, Seong-Min;Chung, Seung-Young;Park, Moon-Sun
    • Journal of Korean Neurosurgical Society
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    • v.42 no.3
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    • pp.220-223
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    • 2007
  • We report a case of dural marginal zone lymphoma which showed the usual radiological findings resembling meningioma. A 59-year-old woman presented with headache. Initial computed tomography and magnetic resonance images showed a frontal convexity meningioma. The patient underwent a craniotomy and subtotal (simpson grade II) resection of tumor was done. Pathological examination confirmed an extranodal marginal zone B-cell lymphoma of Mucosa-Associated Lymphoid Tissue (MALT). The lesion was composed of a lymphoid mass with irregularly shaped follicles surrounded by many monomorphic small lymphocytes and a stained marginal zone for B-cell markers CD20 and CD29a. The natural history of primary CNS lymphoma and MALT type lymphoma are different. B-cell MALT lymphoma can mimic meningioma in its radiological features. Accordingly, MALT lymphoma of the CNS must be considered in the differential diagnosis of meningioma.

Therapeutic Effect of OK-432 for Lymphangioma in Children (OK-432를 사용한 소아 림프관종 치료효과)

  • Jung, Sung-Eun;Kim, Dae-Yeon;Shim, In-Bo;Lee, Seong-Cheol;Park, Kwi-Won;Kim, Woo-Ki
    • Advances in pediatric surgery
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    • v.4 no.2
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    • pp.131-136
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    • 1998
  • Lymphangioma is a congenital malformation of the lymphatic system that expands into the surrounding tissues in a manner similar to a malignant tumor. Surgical excision has been the treatment of choice, but the results are often unsatisfactory due to incomplete resection, fluid collection and recurrences. Intralesional injection of OK-432(lyophilized incubation mixture of Group A Streptococcus pyogenes of human origin) was employed in treating 24 patients with lymphangiomas between 1992 and 1997. The method was used in 21 patients as a primary therapy, and in 3 patients for unresectable or recurrent cases as a secondary treatment. The results were excellent in 8 patients (33.3%), good in 7 patients (21.8 %) and poor in 7 patients (21.8 %). The side effects were fever under $39^{\circ}C$ and local inflammation. However these symptoms subsided in a few days without serious sequelae. These results suggest that intralesional injection of OK-432 is safe and effective treatment for primary lymphangioma as well as a secondary therapy for unresectable or recurrent cases.

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Banked Vena Caval Homograft Replacement of the Inferior Vena Cava for Primary Leiomyocsarcoma

  • Lim, Jae Hong;Sohn, Suk Ho;Sung, Yong Won;Moon, Hyeon Jong;Choi, Jae-Sung;Oh, Se Jin
    • Journal of Chest Surgery
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    • v.47 no.5
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    • pp.473-477
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    • 2014
  • Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumor. Herein, we report the case of a 52-year-old male patient who had postprandial abdominal distension and right upper quadrant abdominal pain. The abdominal computed tomography (CT) angiogram showed an IVC mass extending from the infrahepatic to the suprarenal inferior vena cava. The radiologic findings were suggestive of an IVC leiomyosarcoma. Surgical resection and reconstruction with a cryopreserved homograft were performed. The follow-up abdominal CT angiogram revealed the patient to be disease-free 6 months after surgery with patency of the IVC and renal vein.

Cytologic Features of Metastatic Retroperitoneal Seminoma - A Case Report - (후복막강에 전이한 정상피종의 세포학적 소견 - 1예 보고 -)

  • Kwon, Mi-Seon;Seo, Eun-Joo;Kim, Young-Shin;Kang, Chang-Suk;Shim, Sang-In
    • The Korean Journal of Cytopathology
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    • v.6 no.1
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    • pp.71-75
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    • 1995
  • A fine needle aspiration biopsy specimen of a retroperitoneal mass in a 26-year-old man who had had an orchiectomy for seminoma was submitted for cytologic evaluation. Cytologic features of the specimen included uniform neoplastic cells found singly or in groups of several cells intermingled with lymphocytes in a characteristic foamy, lacelike background. These cells varied from 10 to 20 m in diameter. The nuclei were round to ovoid with fine or reticular chromatin and one or more prominent nucleoli. The poorly defined cytoplasm stained pale-blue or blue with cytoplasmic vacuoles. The cytologic appearance was consistent with seminoma. Documented reports of the cytological appearance of seminoma are rare. The diagnosis of primary gonadal seminoma by fine needle aspiration biopsy is probably not indicated since the treatment of a primary gonadal tumor, regardless of its histogenesis, requires surgical resection. However, fine needle aspiration biopsy is extremely valuable in the diagnosis of extragonadal as well as metastic and recurrent seminoma.

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Prognostic role of preoperative carcinoembryonic antigen levels in colorectal cancer: propensity score matching

  • Kim, Cho Shin;Kim, Sohyun
    • Journal of Yeungnam Medical Science
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    • v.34 no.2
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    • pp.216-221
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    • 2017
  • Background: This study was conducted to investigate preoperative carcinoembryonic antigen (CEA) as a prognostic factor in colorectal cancer. Methods: Between January 2000 and July 2011, 1298 patients with primary adenocarcinoma colorectal cancer without metastasis, who underwent curative resection were retrospectively identified. The patients were divided into two groups according to serum CEA level at primary diagnosis: a high CEA (HCEA) group (serum CEA ${\geq}6ng/mL$) and a normal CEA (NCEA) group (serum CEA <6 ng/mL). A 1:1 propensity score matching analysis was applied to reduce bias. Finally, 364 patients were enrolled in this study. Matched variables were age, gender, preoperative chemoradiotherapy, tumor site, cell differentiation and pathologic stage. Results: The clinicopathological characteristics of the two groups did not differ significantly difference. The systemic metastasis rate was 16.5% (30/182) and 25.3% (46/182) in the NCEA and HCEA groups, respectively (p=0.039). There were no significant differences in local recurrence or metastatic sites between groups. The 5-year disease-free survival (DFS) rate of the HCEA group was worse than that of the NCEA group; however, there was no significant difference in overall survival between the two groups. Conclusion: Elevated preoperative CEA was related to frequent systemic recurrence and low DFS. Therefore, elevated preoperative CEA could be considered a prognostic factor for worse clinical outcomes in patients with colorectal cancer.

Neuroendocrine Carcinoma of the Lung - A Report of two Cases - (Neuroendocrine carcinoma of the lung 치험 2례)

  • 문준호
    • Journal of Chest Surgery
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    • v.25 no.8
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    • pp.806-811
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    • 1992
  • The primary neuroendocrine carcinomas[NEC] of the lung are relatively rare. There are classified histologically into the following groups. 1] bronchial carcinoid, 2] well differentiated neuroendocrine carcinoma[WDNC], 3] intermediate cell neuroendocrine carci-noma[ICNC], 4] small cell neuroendocrie carcinoma[SCNC]. The NE cells can be found throughout the mucosa of the bronchial tree by the electron microscopy. By the immunocytochemistry, Neuron-specific enolase[NSE], serotonin, born-csin, and calcitonin are found in normal solitary NE cells and neuroepithelial bodies. The immunohistochemistry has the advantage that it can be applied on routine pathology specimens. The NSE was localized in all of the NE granule bearing tumors but also present in 57 per cent of the non NE carcinomas. Together the combination of chromogranin A, bombesin and NSE should provide an exellent signature for tumor cells expressing NE features, such as carcinoids and other NE carcinomas. We have experienced two cases of primary pulmonary NEC in 59 and 29 years old men. The former was admitted due to exertional dyspnea and left chest pain, the latter, newly developed mass on chest X-ray. They were treated by Lt pneumonectomy with LN dissection and RLL resection with LN dissection The postoperative diagnoses were could be confirmed by NSE study as NEC which were SCNEC and INEC in subgroups. The postoperative courses were uneventful.

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A Clinical Study on Primary Lung Cancer (폐암의 임상적 고찰)

  • Lee, Jeong-Cheol;Lee, Jong-Tae;Kim, Gyu-Tae
    • Journal of Chest Surgery
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    • v.19 no.1
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    • pp.140-147
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    • 1986
  • A clinical study was made on 72 cases of primary lung cancer operated in the department of thoracic & cardiovascular surgery, Kyungpook national university hospital from January 1975 to May 1985. The ratio of male to female was 13.4: I and mean age was 53. Histologically, squamous cell carcinoma comprised 72.2% of 72 operated cases. Before admission to our hospital, the erroneous diagnoses were made at local clinics on the 43 cases[59.7%] and a large percentage of them was diagnosed as pulmonary tuberculosis. And then, total of 56 cases received inadequate treatment or delayed the operation. For the location of the tumor, right to left ratio is 1.2:1 and the right upper lobe was most often involved [23.6%]. Operation was performed on the 72 cases and resection on the 59 cases[8.2%]. Postsurgical staging showed that stage III was found most frequently [59.4%] and T,N,M, was 28% of total cases. Two common surgical complications were bleeding in 7 and acute respiratory failure in 6 cases, and these 6 cases of acute respiratory failure were all died. On the basis of these experiences, we conclude that aggressive effort is needed for the early accurate diagnosis and adequate treatment of lung cancer.

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Use of Expandable Prostheses in Malignant Bone Tumors in Children (소아 악성 골종양의 치료에서 확장형 종양대치물의 이용)

  • Han, Il-Kyu;Lee, Sang-Hoon;Cho, Hwan-Seong;Oh, Joo-Han;Kim, Han-Soo
    • The Journal of the Korean bone and joint tumor society
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    • v.14 no.1
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    • pp.10-16
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    • 2008
  • With the advent of effective chemotherapy and the realization of high economic cost associated with amputation, limb salvage surgery has become the standard of treatment in children with primary malignant bone tumors. Reconstruction after resection of malignant bone tumors of children has to address the leg length inequality and also has to be durable to cope with high functional demands of young patients. Expandable endoprostheses have been used in children for achieving limb length equality with substantial risk of complications. Recently, significant advances in prosthetic designs have reduced the morbidities associated with these prostheses. The purpose of this study was to review the indications, characteristics, complications and recent developments of expandable endoprostheses used for malignant bone tumors in children.

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