The adequate treatment of non-resectable liver metastases from colorectal cancer which are resistant to systemic chemotherapy currently provides a great challenge. The aim is to identify and review key strategies in the treatment of colorectal liver metastases. A search for current literature on the topic of interventional strategies for colorectal metastases was performed in Medline in order to achieve this goal. Studies before 2005 and with ,20 patients treated for colorectal metastases were excluded. Transarterial chemoembolization (TACE), transarterial embolization and selective internal radiation therapy (SIRT) were identified as examples of regional strategies for colorectal liver metastases, utilizing the unique blood supply of the liver. Radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation were selected as examples for currently available ablative techniques. Median survival in the key studies reviewed ranged from 7.7 to 28.6 for TACE, 8.3-12.6 for SIRT, 8.2-53.2 for RFA and 29-43 months for MWA. After review of the literature, it can be concluded that interventional oncologic therapies are a safe and effective method for treating colorectal liver metastases. The use of new chemotherapeutic agents for local therapy and new ablation technologies and techniques may increase patient survival and allows a neoadjuvant therapy setting. In addition, a combination of local therapies may be used to increase effectiveness in the future, which is subject to further research.
INTRODUCTIONColorectal cancer is one of the most common cancers that shows fatal progression.1 Colorectal carcinoma most commonly metastasises to the liver due to haematogenous spread.2 At the time of diagnosis, 20-30% of patients have liver metastases, and during the course of disease, up to 60% of patients develop hepatic metastases.3 Although surgical excision is the first-line treatment for colorectal metastases, only 10-25% of patients are candidates for surgical resection. 4 Neoadjuvant systemic chemotherapy only allows 10-30% of patients with unresectable colorectal liver metastases sufficient downsizing for resection.
Glomus tumors are neoplasms arising from modified smooth muscle cells surrounding arteriovenous anastomosis in the dermis and subcutaneous tissues, which are contributing to blood flow regulation and temperature control on the skin surface. Glomus cells are sparse or absent in visceral organs, making extracutaneous presentation of glomus tumors an extremely rare finding. We briefly report histological considerations on glomus tumors of the trachea and sum the multidisciplinary aspects of their staged endoscopic and surgical management using the example of a rare case presentation.
AZA as a widely used immunosuppressive drug has side effects in about 5 - 10 % of the cases. The risk of hepatotoxicity in patients treated with AZA is often underestimated. Therefore, physicians treating patients with inflammatory bowel disease have to be precocious regarding the increase of hepatic enzymes and pathologic signs in liver imaging in relation of AZA treatment. The latter might refer to NRH which would lead to severe portal vein hypertension.
An undifferentiated carcinoma with osteoclast-like giant-cells is a very rare cystic tumor of the pancreas. An accurate preoperative diagnosis of cystic tumors is only achieved in about 30 percent. Therefore, surgical exploration should be considered for all cystic neoplasms and cystic tumors that are not clearly defined.
Einleitung ! Rosai beschrieb 1968 als erster ein undifferenziertes Pankreaskarzinom mit osteoklastenähnlichen Riesenzellen [9]. Die Häufigkeit dieser seltenen Entität wird mit 0,2 aller Pankreaskarzinome angegeben [10]. Nachdem zunächst eine geringfügig bessere Prognose angenommen wurde, haben neuere Untersuchungen gezeigt, dass die mediane Überlebenszeit -wie beim duktalen Pankreaskarzinom -11 Monate beträgt, wobei das Intervall bis zur Tumorprogression nach chirurgischer Resektion zwischen 4 und 120 Monaten liegt [3]. Wir berichten über ein undifferenziertes Pankreaskarzinom mit osteoklastären Riesenzellen, welches initial als eine Pankreaskopfpseudozyste gedeutet wurde. Abstract Breidert M et al. Rasch progrediente Pankreaskopfzyste… TumorDiagn u Ther 2007; 28: 296 -299 Thieme Onkologie aktuell 299 Heruntergeladen von: WEST VIRGINIA UNIVERSITY. Urheberrechtlich geschützt.
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