1/19. Clinical delivery of intensity modulated conformal radiotherapy for relapsed or second-primary head and neck cancer using a multileaf collimator with dynamic control.BACKGROUND AND PURPOSE: Concave dose distributions generated by intensity modulated radiotherapy (IMRT) were applied to re-irradiate three patients with pharyngeal cancer. patients, MATERIALS AND methods: Conventional radiotherapy for oropharyngeal (patients 1 and 3) or nasopharyngeal (patient 2) cancers was followed by relapsing or new tumors in the nasopharynx (patients 1 and 2) and hypopharynx (patient 3). Six non-opposed coplanar intensity modulated beams were generated by combining non-modulated beamparts with intensities (weights) obtained by minimizing a biophysical objective function. Beamparts were delivered by a dynamic MLC (Elekta Oncology Systems, Crawley, UK) forced in step and shoot mode. RESULTS AND CONCLUSIONS: Median PTV-doses (and ranges) for the three patients were 73 (65-78), 67 (59-72) and 63 (48-68) Gy. Maximum point doses to brain stem and spinal cord were, respectively, 67 Gy (60% of volume below 30 Gy) and 32 Gy (97% below 10 Gy) for patient 1; 60 Gy (69% below 30 Gy) and 34 Gy (92% below 10 Gy) for patient 2 and 21 Gy (96% below 10 Gy) at spinal cord for patient 3. Maximum point doses to the mandible were 69 Gy for patient 1 and 64 Gy for patient 2 with, respectively, 66 and 92% of the volume below 20 Gy. A treatment session, using the dynamic MLC, was finished within a 15-min time slot.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/19. Metachronous neurohypophysical immature teratoma occurring 10 years after total resection of pineal mature teratoma.An 18-year-old boy presented with an immature neurohypophysial teratoma occurring 10 years after total resection of a mature pineal teratoma through an occipital transtentorial approach in 1989. Thorough histological examination had revealed a mature teratoma. He developed panhypopituitarism and diabetes insipidus in 1999. magnetic resonance imaging revealed a suprasellar tumor occupying the third ventricle. This tumor was totally resected through a frontobasal approach. Histological examination revealed an immature teratoma. This tumor occurred in a different site from the initial tumor and was considered to be de novo and thus a so-called metachronous germ cell tumor. patients with completely resected mature teratoma require extended follow-up, including periodic magnetic resonance imaging, because of the risk of such a metachronous germ cell tumor.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
3/19. Thyroid carcinoma after successful treatment of osteosarcoma: a report of three patients.We report three cases of papillary thyroid carcinoma occurring after successful treatment of osteosarcoma. Only one of the three patients received radiation therapy (to the chest) as part of the primary treatment of osteosarcoma. The onset of thyroid carcinoma occurred between 8 and 16 years from the cessation of osteosarcoma therapy. All patients are alive and disease-free from both malignancies. Whereas the association between osteosarcoma and thyroid carcinoma has not previously been recognized, there have been five case reports of these two entities occurring in the same patient. Three of these cases occurred in patients with werner syndrome. None of the patients reported here had physical stigmata of werner syndrome or a family history consistent with a hereditary cancer syndrome. Thyroid carcinoma occurs infrequently in patients with osteosarcoma, but in view of the rarity of these two disorders, this association may represent an inherited predisposition to these malignancies.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/19. Characterization of adjacent breast tumors using oligonucleotide microarrays.BACKGROUND: Current methodology often cannot distinguish second primary breast cancers from multifocal disease, a potentially important distinction for clinical management. In the present study we evaluated the use of oligonucleotide-based microarray analysis in determining the clonality of tumors by comparing gene expression profiles. METHOD: Total rna was extracted from two tumors with no apparent physical connection that were located in the right breast of an 87-year-old woman diagnosed with invasive ductal carcinoma (IDC). The rna was hybridized to the Affymetrix Human genome U95A Gene Chip (12,500 known human genes) and analyzed using the Gene Chip Analysis Suite 3.3 (Affymetrix, Inc, Santa Clara, CA, USA) and JMPIN 3.2.6 (SAS Institute, Inc, Cary, NC, USA). gene expression profiles of tumors from five additional patients were compared in order to evaluate the heterogeneity in gene expression between tumors with similar clinical characteristics. RESULTS: The adjacent breast tumors had a pairwise correlation coefficient of 0.987, and were essentially indistinguishable by microarray analysis. Analysis of gene expression profiles from different individuals, however, generated a pairwise correlation coefficient of 0.710. CONCLUSION: Transcriptional profiling may be a useful diagnostic tool for determining tumor clonality and heterogeneity, and may ultimately impact on therapeutic decision making.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/19. Endoscopic comparison of two cases: distal resection of reconstructed gastric tube.Recently, with the improvement of the prognosis of esophageal cancer, subsequent gastric cancer has increased. However, the standard surgical treatment for such patients has not been established as of yet. Since the patient's physical condition is relatively poor after Ivor-Lewis esophagectomy, it is important that surgical strategies must be decided according to both physical and cancerous conditions. Hence, various surgical procedures have been reported to date. The authors experienced two cases with cancer occurring in the reconstructed gastric tube after Ivor-Lewis esophagectomy. One was subsequent primary gastric cancer, and the other was metastatic gastric cancer. Distal resection of the gastric tube including the dissection of the right gastroepiploic vessels was carried out in both cases. Vascular reconstruction by utilizing microsurgery technique was attempted for each case, but failed in one case. After surgery, four sessions of endoscopic examinations were carried out. In the early period, we could identify mucosal ischemic change in the remnant gastric tube in the case without successful vascular reconstruction. On the contrary, no ischemic change was revealed in the other with successful vascular reconstruction. Hence, we came to the conclusion that vascular reconstruction must be added to the cases, which undergo distal resection of the reconstructed gastric tube with regional vascular dissection.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
6/19. Mucoepidermoid carcinoma arising in Warthin's tumor of the parotid gland.Malignant transformation of Warthin's tumor is extremely rare, although it is the second most common benign tumor of the parotid gland. We describe our experience of mucoepidermoid carcinoma arising in Warthin's tumor of the parotid gland in a 64-year-old man. He had a swelling in the left parotid-masseteric region. The removed tumor was well encapsulated and histopathologically comprised Warthin's tumor and low-grade mucoepidermoid carcinoma. The mucoepidermoid carcinoma infiltrated lymphoid stroma of the Warthin's tumor, but capsular invasion is not found. Considering the clinical course and physical examination, the lesion was diagnosed as mucoepidermoid carcinoma arising in Warthin's tumor because its features filled the criteria of malignant transformation of Warthin's tumor. There has been no recurrence or distant metastasis for 19 months. Histological change from Warthin's tumor to mucoepidermoid carcinoma may be implicated in squamous or goblet cell metaplasia of epithelial cells. It is considered that the neoplastic cells of Warthin's tumor acquire malignant genotypes simultaneously with this dual differentiation.- - - - - - - - - - ranking = 8.9097794458057keywords = physical examination, physical (Clic here for more details about this article) |
7/19. Management of breast carcinoma identified intraoperatively during reduction mammaplasty.Before reduction mammaplasty, patients should be assessed for breast cancer risk and evaluated with physical examination and mammography. patients determined to be at increased risk should be informed of the possibility of occult breast carcinoma and the potential treatment options. Intraoperative discovery of an occult carcinoma may allow for breast conservation therapy under certain circumstances if an appropriate biopsy sample is taken from the tumor and if clear margins are obtained.- - - - - - - - - - ranking = 8.9097794458057keywords = physical examination, physical (Clic here for more details about this article) |
8/19. Cushing's syndrome due to bilateral adrenocortical adenomas with unique histological features.Cushing's syndrome due to bilateral cortisol-secreting adenomas rarely occurs. We present a case of Cushing's syndrome due to bilateral adenomas. Both adenomas had distinct cell compositions, and were compared with emphasis on immunohistochemical and enzyme histochemical analysis for cytochrome P450(11beta) and 3beta-hydroxysteroid dehydrogenase (3betaHSD). A 37 year-old female was diagnosed with ACTH-independent Cushing's syndrome based on physical findings and hormonal evaluation. High-resolution CT scan showed bilateral adrenocortical adenomas and atrophied glands. 131I-methylnorcholesterol incorporation into both glands suggested both adenomas were functional. Clinical diagnosis prior to surgery was ACTH-independent Cushing's syndrome due to functioning bilateral adenomas. The left adrenal gland was totally resected, while the right one was partially resected by laparoscopic approach. Both adenomas were black on cut sections, and were comparatively evaluated by immunohistochemical and enzyme histochemical analysis for P450(11beta) and 3betaSD. The left adenoma was 1.6 cm in diameter and had a complex cellular composition and enzyme expression similar to that of primary pigmented nodular adrenocortical disease (PPNAD), while the right adenoma was 1.8 cm in diameter with compact cells typical of a solitary cortisol-producing adenoma. Adjacent bilateral adrenal cortex showed marked atrophy, but contained several micronodules. serum cortisol levels, both at basal and after a low dodexamethasone, normalized thirteen months after surgery. In conclusion, the present case of Cushing's syndrome with bilateral adrenal adenomas demonstrated for the first time the simultaneous occurrence of two distinct adenomas, an ordinary cortisol-producing adenoma and a PPNAD-like adenoma. Further case reports of multiple adrenal adenomas should be well-analyzed to clarify whether the results from this case represent a new subgroup of ACTH-independent Cushing's syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/19. Four ovarian cancers diagnosed during laparoscopic management of 1011 women with adnexal masses.OBJECTIVES: This study was conducted to assess the value of laparoscopic management of adnexal masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery. STUDY DESIGN: The setting is a predominantly referral-based, private subspecialty practice. All operations were preformed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA 125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically. RESULTS: Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four. CONCLUSIONS: Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA 125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.- - - - - - - - - - ranking = 8.9097794458057keywords = physical examination, physical (Clic here for more details about this article) |
10/19. A possible case of werner syndrome presenting with multiple cancers.The treatment of a man with six metachronous primary cancers is described. The primary lesions were in the soft palate, both edges of the tongue, the hard palate, the esophagus, and the right ureter. Pathologically, all of the first five tumors in the head and neck and esophagus were proven to be squamous cell carcinoma with various grades of differentiation, and the last one was transitional cell carcinoma. The cancers were found in the early clinical stage, and were completely controlled one by one except for the ureteral tumor under treatment. His characteristic medical history and physical findings, i.e. bilateral cataracts, short stature, baldness, diabetes mellitus, high-pitched voice, and multiple malignancies, met the clinical criteria for possible werner syndrome, a genetic premature aging disorder, though the possibility of phenocopy of this syndrome has not been ruled out. We have followed him carefully because he might be vulnerable to malignant tumor formation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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