1/13. Epithelioid variant of myxofibrosarcoma: expanding the clinicomorphologic spectrum of myxofibrosarcoma in a series of 17 cases.Myxofibrosarcoma (MFS) is one of the most common soft tissue sarcomas of elderly patients and has a predilection for the limbs. Herein, we report a previously undescribed variant of MFS showing epithelioid morphology. Seventeen cases diagnosed as epithelioid MFS were retrieved from the authors' files from among 570 cases of MFS. hematoxylin and eosin-stained sections were reexamined and immunostains for pan-keratin (15 cases), S-100 protein (15), desmin (15), and alpha-smooth muscle actin (13) were performed. Nine patients were men and 8 were women (age range 43 to 89 y; median 63.5). Fifteen patients presented with a mass, and in 2 of these there was also pain. Duration of symptoms varied from 1 to 24 months (median 3). Tumor size ranged from 2 to 15 cm (median 6.75). In 10 cases, the tumor was located in subcutaneous tissue and in 6 cases it was subfascial. The majority of the tumors were located on the limbs (8 lower extremities and 6 upper extremities) followed by neck (1), scalp (1), and trunk (1). Follow-up was available for 14 patients (range 2 to 240 mo; median 16). Twelve patients were treated by surgery followed by chemotherapy and/or radiation (8 cases). One patient received chemotherapy after an incisional biopsy and 1 patient was treated by surgery alone. Ten patients (71.4%) developed local recurrences. Seven patients (50%) developed metastases to lungs or retroperitoneum. Five patients (35.7%) have died of disease so far. Two patients were lost to follow-up. Morphologically, 14 cases were high grade, 2 were intermediate, and 1 was low grade. Tumors were characterized by a multinodular, infiltrating growth pattern with alternation of hypercellular and hypocellular myxoid areas; the latter showed prominent curvilinear vessels. Neoplastic cells were arranged singly and in small clusters in the myxoid areas or formed sheets in the hypercellular areas, where they showed epithelioid morphology with round nuclei, vesicular chromatin, prominent nucleoli, and moderate amounts of eosinophilic cytoplasm. The epithelioid areas were generally multifocal with admixed areas of conventional MFS. Immunostains were negative for all markers studied. Differential diagnosis included carcinoma, melanoma, myoepithelial carcinoma, pleomorphic liposarcoma, and pleomorphic rhabdomyosarcoma. In conclusion, epithelioid MFS is a rare variant of MFS, accounting for <3% of MFS in consultation material. Its natural history seems more aggressive than usual high-grade MFS, with approximately 70% local recurrence and 50% metastases, even within a relatively short follow-up period.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/13. Island scalp flap for superior forehead reconstruction.An island scalp fasciocutaneous flap, based on the posterior superficial temporal vessels, is described for single-stage reconstruction of full-thickness forehead and scalp defects. The hairline can be precisely determined and tailored to restore symmetry. By removing the hair-bearing dermis of the forehead portion of the flap and placing a full-thickness skin graft, aesthetic reconstitution of the forehead skin is achieved. This flap is especially useful when exposed calvarium limits other techniques.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/13. Use of contralateral rectus femoris flap: an alternative for covering exposed femoral vessels of the thigh.Myocutaneous coverage of large defects in the thigh following resection of tumors is necessary to ensure adequate protection of the underlying femoral vessels. The usual muscles employed as flaps to achieve this protection are ipsilateral sartorius, rectus femoris, tensor fasciae latae, gracilis, rectus abdominis, or vastus lateralis. However, for situations in which these muscles are not available, the surgeon needs an alternative flap. This report details the successful use of the contralateral rectus femoris muscle to cover exposed femoral vessels in the upper and middle thirds of the thigh. Findings of anatomical dissections confirm that, by freeing the muscle at its origin, its reach can be extended about 6 cm. Postoperatively, no functional deficits resulted from the flap and no damage to the skin graft occurred with radiation therapy. Use of the contralateral rectus femoris flap should therefore be considered when a reliable alternative to conventional flaps must be employed.- - - - - - - - - - ranking = 6keywords = vessel (Clic here for more details about this article) |
4/13. Desmoid tumours of the extremities.The authors report seven cases of desmoid tumors of the extremities. A tumour less than a few centimetres in size is best removed by wide local excision. Large growths should also be excised, but efforts should be made to preserve the vessels and nerves, since malignant transformation and metastases do not occur. Irradiation therapy should be considered for tumours which are surgically inaccessible. The problems of differential diagnosis between a desmoid tumour and a fibrosarcoma are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/13. Retroperitoneal sarcomas obstructing delivery: two case reports.Two patients with abnormal fetal lies underwent elective Caesarean section. Both abnormal lies were found to be due to retroperitoneal sarcomas overlying the bifurcation of the iliac vessels. One proved to be an inoperable and radioresistant fibrosarcoma. At seven and a half years after Caesarean section and following chemotherapy this patient is alive and well and has had two more children. The other tumour was a large myxoid liposarcoma which was completely removed at the time of Caesarean section. This patient is alive and well 18 months after operation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/13. Management of vascular soft tissue neoplasms using transcatheter embolization and surgical excision.Preoperative embolization of highly vascular soft tissue tumors was performed in four patients. Selective catheterization of branch vessels supplying the tumors successfully avoided inadvertent embolization of adjacent normal tissue. Operative blood loss was significantly less than anticipated, permitting an easier, more precise, and quicker operation. Two of the lesions were benign intramuscular hemangiomas; one was a fibrosarcoma, and one, a malignant schwannoma. Three tumors were resected completely. A small portion of one hemangioma could not be removed. All patients were free of recurrence during follow-up periods of 6 to 14 months.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/13. A unique surgical approach for massive retroperitoneal tumors.A unique approach to retroperitoneal tumors is described, utilizing an inverted U-shaped incision that allows exposure of the retroperitoneum, great vessels, and intraperitoneal organs.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/13. Modified technique for radical transmediastinal forequarter amputation and chest wall resection.Forequarter or interscapulothoracic amputation is a major surgical procedure indicated primarily in the treatment of malignant lesions involving the bony and soft tissue parieties of the upper part of the arm, shoulder, and scapula. It is also indicated in extensive trauma with irreparable damage to the shoulder area and as a palliative measure in intractable pain caused by incurable tumors of the shoulder girdle. Several operative techniques have been described: the classical Berger approach, an anterior pectoral approach, and posterior retroscapular approaches. A radical transthoracic approach has been described in cases in which the tumor had spread through the chest wall. The two main goals of these approaches have been early ligation of the subclavian vessels and immediate exploration for operability. This report details our experience with a modified technique for radical forequarter amputation and chest wall resection in which a transmediastinal approach is employed. This approach was used in two patients: One had a radiation-induced fibrosarcoma of the left axilla and adjacent chest wall following a radical mastectomy 19 years earlier, and the other patient had a recurrent rhabdomyosarcoma of the right axilla with invasion of the chest wall. This technique avoids time-consuming and individual excision of ribs and minimizes the amount of blood loss by early ligation of the internal mammary vessels. Safe and excellent exposure and division of the subclavian vessels and early exploration for mediastinal and intrathoracic involvement are made possible. Details of the procedure with illustrations are described.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
9/13. Pedunculated fibrosarcoma. Unusual presentation of an intraabdominal fibrosarcoma arising from the greater omentum.A 50 year old man presented with lower abdominal pain and hypotension of sudden onset. Emergency laparotomy for a suspected ruptured abdominal aortic aneurysm revealed the source of hemorrhage to be a ruptured vessel in the vascular pedicle of a large, oval tumor. This tumor had a unique appearance, lying virtually free within the abdominal cavity except for a 17 cm long umbilical cord-like vascular attachment to the greater omentum and a single fibrous adhesion to the anterior abdominal wall. Histologic examination disclosed the features of fibrosarcoma with a prominent population of myofibroblasts. review of the literature yielded no previous examples of a similar pedunculated fibrosarcoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/13. A case of low-grade fibromyxoid sarcoma of the thigh.A case of low-grade fibromyxoid sarcoma in the thigh of a 21 year old female is described. The patient had a fist-sized well-defined mass in her left thigh that enlarged over a 6 month period. Histologically, the neoplasm showed contrasting fibrous and myxoid areas with a swirling growth pattern. Cellularity was low to moderate, and the stromal cells were benign looking without mitoses or nuclear pleomorphism. The tissue was not noticeably vascular. Some stromal cells were aggregated around the blood vessels. The stromal cells were immunoreactive to vimentin, but were negative to keratin, desmin, alpha-smooth muscle actin, actin HHF35, S-100 protein, neuron-specific enolase, and epithelial membrane antigen. Ultrastructural examinations of the stromal cells revealed well-developed rough endoplasmic reticulum, mitochondria, pinocytotic vesicles, and numerous intermediate-sized filaments in the cytoplasm. These findings seem to indicate that the stromal cells were fibroblastic in origin. The occurrence of the tumor in a young adult, its location and its large, well defined borders together with the characteristics revealed through histological investigation, indicated that it was in fact what has been termed by Evans as a low-grade fibromyxoid sarcoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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