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Malignant Neoplasms
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Mark Biro, Vesna Petronic-Rosic
Management: Definitive management of localized DFSP includes surgical excision or Mohs micrographic surgery (MMS). DFSP tumors excised with positive histopathologic margins have >50% likelihood of recurrence. For this reason, MMS is recommended for cosmetically sensitive area’s including the head and neck, whereas conventional excision is utilized for involvement of the trunk and extremities. If there is concern for local involvement of deeper or vital structures, a CAT scan or an MRI may be used to determine the extent of tumor invasion prior to definitive treatment. If there are concerns for distant spread, CAT imaging with contrast dye can evaluate for sites of distant metastasis. For metastatic DFSP or tumors nonamenable to surgery, tyrosine kinase inhibitors, such as imatinib, as well as radiation therapy can be used as adjuvant therapy.
Soft Tissue Sarcomas
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Thomas F. DeLaney, David C. Harmon, Karol Sikora, Francis J. Hornicek
PET-CT scanning has been shown to be useful in discriminating between benign and high-grade lesions although it is unsuitable for distinguishing between benign and low- to intermediate-grade lesions. PET-CT may be of substantial value in defining response to pre-operative therapy. MRI studies should always include T2-weighted sequences as these provide the optimum contrast between lesion and muscle. Contrast-enhanced T1-weighted images (especially with fat-suppression techniques) are also helpful. Depending upon the pattern of presentation and the nature of any planned surgery, an arteriogram may be of value. For rhabdomyosarcoma, epithelioid sarcoma, high-grade synovial, clear cell sarcoma, angiosarcoma, and unclassified sarcomas, PET-CT evaluation of the regional nodes should be considered. Bone scans need not be performed unless specifically indicated by distant sites of bone pain. We do not consider a positive bone scan near or adjacent to an STS to be proof of invasion of periosteum or bone. For a diagnosis of invasion of bone there must be clear radiographic evidence of destruction of cortical bone. The single most important examination for distant metastasis is whole-lung CT; this should be obtained in all patients with intermediate- or high-grade tumors.
Sinonasal tumours
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Yujay Ramakrishnan, Shahzada Ahmed
Red flag symptoms such as a unilateral nasal mass, facial swelling, diplopia or blurred vision, proptosis, and cranial neuropathy should raise a high index of suspicion and merit urgent assessment. Regional and distant metastasis are relatively rare, with the incidence of neck metastasis less than 10%. Distant metastasis is less frequent.
Survival benefit of surgical treatment for patients with stage IVB endometrial cancer: a propensity score-matched SEER database analysis
Published in Journal of Obstetrics and Gynaecology, 2023
Yixin Zhang, Zhimin Hao, Sufen Yang
Adenocarcinoma of the endometrium (known as endometrial cancer, EC) is a common malignancy among gynecological tumours, which is the most common genital tumour in women in the United States, according to the National Comprehensive Cancer Network (NCCN) Guidelines (NCCN 2022). Most cases are accompanied by vaginal bleeding, which can help in early detection leading to favourable prognosis. However, the mortality rates of EC have increased more than the incidence rates in recent years, possibly related to an increased proportion of patients with an advanced stage, a high-risk pathological type, and an older age of onset (NCCN 2022). Patients with stage IVB disease account for a relatively small proportion, but they contribute to the majority of mortality. Stage IV disease constitutes 3–13% of all cases, with a 5-year survival rate of 10–20% (Ayhan et al.2002). The liver and lungs are the primary sites of distant metastasis, with the brain and bones being the less common sites (Fujimoto et al.2009, Wang et al.2022).
Incidentally detected steroid cell tumour presenting with abnormal uterine bleeding: a rare case report with review of literature
Published in Journal of Obstetrics and Gynaecology, 2022
Priyanka Yadav, Navpreet Kaur, Shramana Mandal, Nita Khurana, Ashok Kumar
These are benign tumours, however 30–45% cases are reported to be malignant. Distant metastasis is the most direct evidence of malignancy. Criteria for malignancy has been described as equal to or greater mitosis 2 mitoses per 10 high-power fields, vascular invasion, grade II or III nuclear atypia, and necrosis or haemorrhage with a diameter greater than 7 cm on gross pathologic specimen (Hayes and Shully 1987). In the present case no necrosis, haemorrhage, nuclear atypia was noted. Surgery is the mainstay of treatment, in steroid cell tumours NOS, as is with other ovarian stromal tumours. For early stage tumours, conservative surgery with unilateral oophorectomy may be done if there is a desire to maintain the fertility. Those who have completed their family, total hysterectomy, bilateral salpingo-oophorectomy, and complete staging are indicated. In our patient total abdominal hysterectomy with unilateral salpingooophorectomy was performed. Radiation or adjuvant chemotherapy should be carried out if the neoplasms proved to be malignant or distant metastasis is reported (Zang et al. 2017). There is no consensus on the adjuvant therapy for metastatic or malignant steroid cell tumours NOS. The Gynaecologic Oncology Group has shown that BEP is effective as the first line treatment for malignant ovarian stromal tumours. The use of GnRH-agonists as primary adjuvant therapy for sex cord stromal tumours including steroid cell tumours has also been advocated. Testosterone levels needs to be monitored for disease progression or recurrence (Lee et al. 2016).
How breast cancer recurrences are found – a real-world, prospective cohort study
Published in Acta Oncologica, 2022
Sylvia Myller, Arja Jukkola, Anniina Jääskeläinen, Nelli Roininen, Peeter Karihtala
The first indicators of distant metastases were pain (n = 23, 38%), abnormalities in imaging (ultrasound, computed tomography (CT) scans, native X-ray, magnetic resonance imaging), laboratory tests or clinical examination (n = 18, 30%), palpable or visible lesion detected by the patient (n = 7, 12%), respiratory symptoms (n = 5, 8%) and decrease in general condition (n = 3, 5%), with five cases with missing information (8%). Overall, 48 (79%) patients with distant metastasis had symptoms at the time of diagnosis of distant metastasis, pain being the most common (n = 27, 44%). Distant metastases were confirmed with imaging (n = 20), biopsy or cytology (n = 16) or both (n = 15). Imaging modalities used were CT scans, magnetic resonance imaging and ultrasound combined with biopsy.