1/4. Disseminated carcinomatosis after laparoscopic surgery for presumably benign ruptured ovarian teratoma.The authors reported the intraperitoneal carcinomatosis after laparoscopic surgery for presumably benign ruptured ovarian teratoma in a 28-year-old woman. A 28-year-old female patient exhibited intraperitoneal carcinomatosis after a laparoscopic surgery for ruptured mature teratoma of the ovary with occult malignant transformation. The complication was found two months after initial laparoscopic surgery. Laparoscopic surgery was smooth including oophorectomy, and removing all spilled specimens within the abdominal cavity. At the end of the laparoscopic surgery, cleaning the abdominal cavity and irritating the port site were also performed. Cytology of the abdominal cavity and all removed specimens did not show evidence of malignancy. She followed up regularly and uneventfully except for persistently abdominal fullness and erythematous change of umbilical portal site. Evidence demonstrated intestinal obstruction associated with ascites after a detailed evaluation. Although the patient received supportive treatment the symptom exacerbated. Therefore, the patient was treated with exploratory laparotomy. pathology proved with intraperitoneal carcinomatosis caused by squamous cell carcinoma. All tumor evaluations including tumor markers, a thorough physical examination, imaging studies and evaluations of the nuclear medicine were negative except of intraperitoneal carcinoma, origin to be determined. The patient is dead 14 months' post-treatment by exploratory laparotomy. Although it was not clear that the laparoscopic approach or the disease itself worsened indeed the prognosis because the disease was already disseminated before the laparoscopy, we still emphasized the possible limitation of laparoscopic surgery if diagnosis at original surgery is impaired, of if excision is incomplete and the delay between the laparoscopic procedure and the carcinomatosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Port-site metastasis: the influence of biology.OBJECTIVE: Several surgical and technical mechanisms have been proposed for the development of port-site metastasis, but the influence of tumor and host biologic factors has not been emphasized. We present a case of a pelvic chordoma that metastasized to a prior laparoscopic radical nephrectomy port-site. methods: A 62-year-old woman underwent laparoscopic radical nephrectomy (LRN) for a pT1b grade 3 renal cell carcinoma, followed 6 weeks later by resection of a sacral chordoma. The incisions and areas of dissection for the two procedures were discontinuous. RESULTS: Eight months following the LRN she developed a nodule in one of the laparoscopic port-sites. The port-site metastasis was treated with wide surgical resection, which was confirmed as metastatic chordoma on histologic examination. CONCLUSION: Based on the chronological sequence and physical distance between surgical sites, only biological factors could have contributed to this port-site metastasis. This unusual case highlights the important role that tumor and host biologic mechanisms play in the development of port-site metastasis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/4. Passive seeding in metanephric adenoma: a review of pseudometastatic lesions in perinephric lymph nodes.Lymph node involvement derived from a discrete neoplastic process fundamentally implies tumor malignancy. However, rarely, inconsequential passive transport of benign neoplastic cells to the lymph node can occur and may cause confusion as to the nature of the neoplasm (ie, malignant vs benign). We describe a 10-cm right renal metanephric adenoma incidentally discovered in a 30-year-old woman during cesarean section for a triplet pregnancy. Subsequent nephrectomy following an equivocal needle biopsy diagnosis showed histologic features classic for metanephric adenoma, including the lack of cytologic atypia and mitoses. necrosis present in this lesion appeared to be secondary to tumor physical disruption. The tumor cells were positive for wilms tumor 1 (WT1) antigen, pankeratin, and CD57, focally positive for epithelial membrane antigen, and negative for cytokeratin 7, cytokeratin 34betaE12, and CD56. Electron microscopy confirmed the tumor's epithelial nature, and cytogenetics revealed a diploid 46XX karyotype. The tumor proliferation index with Ki-67 was only 3% to 5% and the proliferating cell nuclear antigen index was 0%. A single, concurrently resected hilar lymph node contained scattered subcapsular, sinusoidal, and focally intralymphovascular psammoma bodies along with occasional adherent epithelial cells. These cells were highlighted by pankeratin but were nonreactive to WT1 antigen, similar to the nonviable cells in the primary tumor. Clinical surveillance and follow-up showed no disease recurrence 4 years after nephrectomy. We postulate that the lymph node inclusions found in this case represent passive transport of neoplastic cells to the lymph node following manipulation of the renal mass. We conclude that this phenomenon is understudied and underrecognized and can easily be mistaken for metastasis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/4. Caveat arthroscopos: extra-articular lesions of bone simulating intra-articular pathology of the knee.In the period from 1977 to 1981, eleven patients with a primary bone neoplasm and one with a bone abscess, located in the shaft or distal end of the femur or the proximal part of the tibia, were referred to the massachusetts General Hospital Orthopaedic Oncology Unit. All had had diagnostic or therapeutic arthroscopy. For one of the patients no roentgenograms had been made prior to arthroscopy. For another, roentgenograms had been made but were not repeated prior to the arthroscopy three months later. In six patients the lesions were clearly evident on the roentgenograms; they were not reported in four patients, while in two patients the lesions were not considered to be a contraindication to arthroscopy. Two lesions were located in the femoral shaft and one was in the popliteal space, but they had not been noted by the surgeon or radiologist. In four patients the lesion arising from the bone was biopsied through the arthroscope, introducing tumor cells into the joint and theoretically causing synovial seeding of the lesion. The problems raised by this study are obvious to all orthopaedic surgeons who perform arthroscopy. Any patient who is thought to have an intra-articular lesion must first be fully evaluated by history, physical examination, and, most importantly, appropriate biplane roentgenograms prior to the performance of any procedure. If a lesion arising from the bone is encountered during an arthroscopic procedure, the lesion must be biopsied not transsynovially, but through a separate extracapsular approach.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |