Two children With cancer that persisted after multiple exploratory laparotomies, external beam radiation therapy, and muitidrug chemotherapy had gold 198 (ImAu) seeds implanted into their localized but unresectable tumor. Both children are alive, are receiving no therapy, and are disease-free more than 2 years later. These two cases indicate the value of interstitial implant therapy in the treatment of some children with cancer.Cancer 57:951-954,1986.ERsISTENT, localized, and unresectable cancer after P surgery, external beam radiation therapy, and multidrug chemotherapy is a difficult therapeutic problem with a grim prognosis. Additional radiation in the form of an interstitial implant inserted at operative exposure of the tumor has been used successfully under these circumstances in This article reports two children who became tumor-free after the insertion of a gold 198 (I9*Au) implant into their residual cancer and advocates the use of interstitial radiation in the occasional child who has localized but unresectable cancer. Report of Cases Case 1A 10-year-old girl experienced acute right lower quadrant pain on July 10, 1981. She underwent a laparotomy for acute a p pendicitis at another hospital. A large tumor was found arising from the left side of the pelvis. The mass displaced the bladder anteriorly and to the right, and pushed the rectum posteriorly and to the right. The tumor was not resectable, and biopsy could only be performed through the posterior wall of the opened bladder. Light microscopy showed neoplastic cells that resembled rhabdomyoblasts. The cytoplasm often contained rounded hyaline inclusions (Fig. IA). Electron microscopy showed that these inclusions were composed of tightly packed filaments, rather characteristic for "whorled filamentous bodies" (Fig. IB). A diagnosis of malignant rhabdoid tumor was made; this was subsequently confirmed by J. B. Beckwith, MD. The patient was treated at monthly intervals with vincristine, Adriamycin (doxorubicin), and Cytoxan (cyclophosphamide). A computerized tomographic (CT) scan performed after four cycles of chemotherapy demonstrated a 50% reduction in the volume of the tumor and no evidence of any metastases. A second-look laparotomy performed on December 7, 198 1 revealed an 8 X 10-cm tumor mass that extended along the left pelvic side wall between the vagina and the obturator foramen from the brim of the pelvis to the ischial tuberosity. The rectum and uterus were free; however, dense adherence of the tumor to the bony pelvic side wall precluded en bloc resection. The tumor capsule was opened, and much of the tumor was scooped and scraped out.The patient's pelvis was then given 4577 cGy of 4 MeV photons via parallel-opposed portals in 26 fractions. Multiple-drug chemotherapy was continued at monthly intervals. A CT scan obtained in March 1982 demonstrated a persistent 5 X 3 X 3-cm tumor, but no evidence of metastases was found. A thirdlook laparotomy was d e d out on March 27,1982. 19"Au seeds were ordered in advance because it had not been possibl...
Background Plasmacytomas of the skull base are not commonly encountered in clinical practice, with few reported cases in the literature. They form part of the spectrum of plasma cell neoplasms and are classified as a solitary bone plasmacytoma if arising from the sphenoid bone. Its radiographic appearance can lead to misdiagnosis as one of the tumours that are more frequently seen in the skull base, especially meningiomas. Due to the risk of evolution into multiple myeloma, accurate diagnosis is essential. Case presentation A 56-year-old male presented to the emergency department with rapid proptosis and worsening vision in his right eye for one week’s duration. Imaging studies revealed an extra-axial right sphenoid bone tumour with invasion into the temporalis muscle and orbit, leading to significant proptosis. Tumour debulking was done, but there was no improvement in vision postoperatively. Final histology was consistent with a plasmacytoma. The patient was referred to the oncologist for radiation therapy, but subsequently developed further lesions consistent with multiple myeloma. Conclusions Plasmacytomas need to be considered in the differential diagnosis of skull base tumours. Due to their excellent response to radiation, these patients should have early oncology intervention to prevent irreversible neurological deficits.
e15154 Background: Unlike in breast cancer or melanoma, resection during sentinel lymph node mapping (SLNM) in colon cancer (CCa) includes regional lymphadenectomy including SLNs and non-SLNs. However, SLNM often identifies micrometastases that can be missed by conventional (Conv) surgery and pathologic examination. It is unknown whether this impacts survival or recurrence. Hence, a retrospective analysis was undertaken to study overall (OS) and disease -specific (DSS) survival between patients (pts) undergoing SLNM vs Conv surgery based on the number of +ve LNs. Methods: SLNM was done by subserosal injection with blue dye followed by segmental resection including regional lymphadenectomy. All SLNs were ultrastaged and other nodes were examined by conv. methods with H&E. Results: There were 309 pts in SLNM (GpA) vs 499 pts in Conv surgery (GpB); with average no. of lymph nodes (LNs) and +ve LNs 17.3/1.6 vs 14.4/2.49 respectively. For GpA, success rate was 99.6% and the average no of SLN was 3. Of the pts in GpA vs GpB, 1+ve LN were found in 38% vs 27%, 2+ve LNs in 10% vs 16%, and > 2 LNs in 53% vs 57%, respectively. Comparing 5 years OS between GpA vs GpB, for 1+ve LN was 62.8% vs 52.38%, for 2 +ve LNs 72.7% vs 48.65% and for > 2 +ve LNs 35% vs 33.33%, respectively. Similarly, DSS for 1 +veLN was 54.4% vs 47.6%, 2+ve LNs 40% vs 40.54% and > 2+ve LNs, 30.4% vs 25.76%, respectively (Table). Conclusions: Compared to Conv surgery, SLNM identified higher no. of LNs per pt with high success rate. Five-year OS and DSS also are better in SLNM vs Conv surgery for all +ve LN gps. Hence, SLNM in CCa may have prognostic value. A larger multicenter trial needs to be done to validate such data. [Table: see text]
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