The published studies of the frequency of the splenic metastasis are autopsy studies, which are not usable for epidemiological statements because of selection bias. We show that splenic metastases arise in less than 1% of all metastases. A splenectomy in case of splenic metastases makes sense, if the metastases are isolated. It is also meaningful as a debulking procedure that would be followed by a chemotherapy, e.g. in case of an ovarial carcinoma. As a result the survival is increased for patients undergoing splenectomy (median survival 19.5 vs. 3 months).
BackgroundOver the past two decades, there has been a rising trend in malignant melanoma incidence worldwide. In 2008, Germany introduced a nationwide skin cancer screening program starting at age 35. The aims of this study were to analyse the distribution of malignant melanoma tumour stages over time, as well as demographic and regional differences in stage distribution and survival of melanoma patients.MethodsPooled data from 61 895 malignant melanoma patients diagnosed between 2002 and 2011 and documented in 28 German population-based and hospital-based clinical cancer registries were analysed using descriptive methods, joinpoint regression, logistic regression and relative survival.ResultsThe number of annually documented cases increased by 53.2% between 2002 (N = 4 779) and 2011 (N = 7 320). There was a statistically significant continuous positive trend in the proportion of stage UICC I cases diagnosed between 2002 and 2011, compared to a negative trend for stage UICC II. No trends were found for stages UICC III and IV respectively. Age (OR 0.97, 95% CI 0.97–0.97), sex (OR 1.18, 95% CI 1.11–1.25), date of diagnosis (OR 1.05, 95% CI 1.04–1.06), ‘diagnosis during screening’ (OR 3.24, 95% CI 2.50–4.19) and place of residence (OR 1.23, 95% CI 1.16–1.30) had a statistically significant influence on the tumour stage at diagnosis. The overall 5-year relative survival for invasive cases was 83.4% (95% CI 82.8–83.9%).ConclusionsNo distinct changes in the distribution of malignant melanoma tumour stages among those aged 35 and older were seen that could be directly attributed to the introduction of skin cancer screening in 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2963-0) contains supplementary material, which is available to authorized users.
Tailgut cysts are unusual benign cystic retrorectal malformations arising from persistent remnants of the postanal gut. Malignant transformation within this dysontogenetic lesion is very uncommon. We report the rare occurrence of a neuroendocrine tumor arising in a tailgut cyst with primary liver and lymph node metastases in a 55-year-old woman. The neuroendocrine differentiation of the tumor determines the therapeutic approach and prognosis.
EinleitungKlinische Ablaufpfade (clinical pathways, workflows) gewinnen zunehmend an Bedeutung, stellen sie doch einen wichtigen Faktor in der Qualitä tssicherung bzw. -verbesserung in der klinischen Versorgung dar [50]. Spezielle Bedeutung besitzen klinische Ablaufpfade bei Erkrankungen, bei denen in den letzten Jahren wesentliche Neuerungen und Fortschritte in Diagnostik und Therapie zu verzeichnen sind. Dies gilt in besonderem Maß fü r das Rektumkarzinom, bei dem durch die optimierte Chirurgie mit totaler mesorektaler Exzision (TME), neue bildgebende Verfahren und Ä nderungen in der multimodalen Therapie bedeutende Verbesserungen eingetreten sind. Daher hat sich eine interdisziplinä re Expertengruppe mit der Erstellung eines aktuellen klinischen Ablaufpfades fü r Diagnostik, Therapie und Nachsorge des Rektumkarzinoms beschä ftigt. Nach entsprechenden Vorbereitungen fand am 25. und 26.11.2005 in Burghausen ein ö ffentlicher Workshop statt, bei dem Experten unter Mitbeteiligung von etwa 50 interessierten Kollegen die aktuellen Probleme diskutierten. Danach wurde von einem Redaktionskomitee ein klinischer Ablaufpfad erstellt, der allen Mitgliedern der Expertenrunde vorgelegt und schließlich gemeinsam verabschiedet wurde. Er wird nachfolgend in Form von Textkä sten (mit tabellarischen Auflistungen) und 6 Algorithmen dargestellt. Vorbemerkungen Definition des Rektumkarzinoms -Maligner epithelialer Tumor mit Infiltration zumindest in die Submukosa (nicht eingeschlossen intraepitheliale Neoplasie, Dysplasie, Carcinoma in situ, fü r die dieser klinische Ablaufpfad nicht gilt). -Abgrenzung gegen Kolonkarzinom: Makroskopisch erkennbarer aboraler Tumorrand bei starrer Rektosigmoidoskopie 16 cm oder weniger von der Linea anocutanea entfernt (UICC 2003 [86]). -Abgrenzung gegen Analkanalkarzinome: Die Grenze zwischen Rektum und Analkanal liegt in Hö he des so Institutsangaben
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