Giant occipital meningocele in an 8-year-old child with Dandy–Walker malformation

Introduction  

The possibility of an association between Dandy–Walker malformation and occipital meningocele is well-known. However, just an overall number of about 40 cases have been previously reported. Giant occipital meningocele has been described only in three newborns. Incidence, pathology, clinical presentation, and proper management of this association are still poorly defined.     

Acinar Cell Carcinoma of the Pancreas in the United States: Prognostic Factors and Comparison to Ductal Adenocarcinoma

Introduction  Pancreatic acinar cell carcinoma (ACC) is a rare tumor with poorly defined prognosis. Objective  Our objective was to compare a large population of patients with ACC to pancreatic ductal cell adenocarcinoma (DCC) in order to determine distinguishing characteristics and to assess survival. Methods  Patients were identified from the National Cancer Database. Regression methods were used to identify differences between ACC and DCC and to identify predictors of survival for resected ACC. Eight hundred sixty-five patients with ACC were identified. Results  Median tumor size was 6.9 cm (vs. 4.6 cm DCC); 32.1% had nodal metastases (vs. 48.0% DCC); and 47% had high-grade tumors (vs. 37.3% DCC). Resection margins were R0 77.3%, R1 13.7%, and R2 9.0%. Patients with ACC were more likely to be male, white, and have larger tumor size, no nodal involvement, or pancreatic tail tumors. Stage-specific 5-year survival was significantly better for resected ACC vs. DCC Stage I: 52.4% vs. 28.4%, II: 40.2% vs. 9.8%, III: 22.8% vs. 6.8%, and IV: 17.2% vs. 2.8%. On multivariable analysis, age < 65, well-differentiated tumors, and negative resection margins were independent prognostic factors for ACC. Discussion  ACC carries a better prognosis than DCC. Aggressive surgical resection with negative margins is associated with long-term survival in these more favorable pancreatic cancers. This paper was presented at the Society for Surgery of the Alimentary Tract (SSAT) in San Diego, CA, USA, in May 2008. Grant Support: KYB is supported by the American College of Surgeons, Clinical Scholars in Residence program.     

Clinicopathologic Features and Treatment Trends of Pancreatic Neuroendocrine Tumors: Analysis of 9,821 Patients

The natural history of pancreatic neuroendocrine tumors (PNET) remains poorly defined. Our objectives were to examine the clinicopathologic features of PNETs, to assess treatment trends over time, and to identify factors associated with undergoing resection. From the National Cancer Data Base (1985–2004), 9,821 patients were identified with PNETs. Clinicopathologic features and treatment trends were examined. Multivariable logistic regression was used to assess factors associated with undergoing resection. Of 9,821 patients with PNETs, 85% were nonfunctional, 7.1% were functional, and 7.9% were carcinoid tumors. Of the 3,851 (39.0%) patients who underwent pancreatectomy, 449 (11.7%) received adjuvant chemotherapy, and 254 (6.6%) received adjuvant radiation. From 1985 to 2004, utilization of pancreatectomy increased from 39.4 to 44.3% (P < 0.0001). Patients were less likely to undergo resection if they were >55 years old, had tumors in the head of the pancreas, tumors ≥4 cm, or had distant metastases (P < 0.0001). Patients treated at NCCN/NCI, academic, or high-volume hospitals were more likely to undergo resection. There are disparities in the utilization of pancreatectomy for PNETs. As PNETs have a better prognosis than adenocarcinoma, concerns regarding the morbidity and mortality of pancreatic surgery and neoplasms should not preclude resection.     

Cancer Recurrence: An Important but Missing Variable in National Cancer Registries

Background

Cancer recurrence is a critically important outcome to patients and providers. However, no publicly available cancer registry data contain recurrence information. The National Cancer Data Base (NCDB) collects recurrence data; however, this information is not provided to researchers because of completeness and accuracy concerns. Our objective was to examine completeness of cancer recurrence information in the NCDB.

Methods

Stage I–III thyroid/colon/melanoma/pancreas/breast cancers diagnosed in 2002–2005 were identified. Recurrence status, recurrence type, and recurrence date were evaluated for data completeness. Patient, tumor, and hospital factors were examined using generalized linear mixed models. Pseudo-R ² statistics estimated the relative contribution of patient and hospital factors.

Results

Of 702,144 patients with thyroid/colon/melanoma/pancreas/breast cancers treated in 1405 hospitals, recurrence information was incomplete in 21.5/24.0/20.2/34.8/18.2 % of patients, respectively. On average, hospitals had incomplete recurrence information on 56.7–66.7 % of their patients. Patients with incomplete information had more comorbidities, a higher cancer stage, non-private insurance, and lived farther from the hospital. Hospitals with the poorest collection were larger tertiary hospitals serving higher-income patients. However, these patients and hospital factors explained less than 3 %, while unexplained hospital variation accounted for the largest part of the observed variation (%ΔR ² = 84 %).

Conclusions

The majority of hospitals report incomplete recurrence information for more than half of their patients. The presence of incomplete recurrence information was largely dependent on undefined hospital factors, rather than patient or tumor characteristics. Attempts to improve cancer recurrence information should focus on hospital operational and process factors surrounding how the hospital tumor registries collect recurrence data.     

Acute traumatic fractures to the craniovertebral junction: preliminary experience with the “MILD” score scale

Purpose

Traumatic fractures to the craniovertebral junction (CVJ) are rare events requiring complex clinical management. Several classification systems are currently in use; however, recent improvements of junctional knowledge has focused attention on the role of ligaments and membranes in vertebral biomechanical stability. The aim of this study was to present our preliminary experience with the “MILD” score scale, which should allow fast and effective classification of all CVJ traumatic fractures based on vertebral instability in the acute setting.

Methods

A prospective study was conducted on 38 consecutive patients with 43 traumatic junctional fractures identified by computed tomography (CT) scan in the acute trauma phase. The MILD scale was applied to all fractures, and a score was obtained for each patient. All cases underwent magnetic resonance imaging (MRI) to assess the anatomical integrity of ligaments and membranes.

Results

Twenty-seven patients (71 %) were classified as MILD type 1 (0–1 points), showed a negative MRI, and healed with conservative treatment. Eight patients (21 %) were classified as MILD type 2 (2 points) and showed modest indirect signs of ligamentous injuries. Four of these patients healed with conservative treatment, while three patients underwent surgery due to wide bone fracture fragment displacement. Three patients (8 %) were classified as MILD type 3 (3 points), all of whom showed extensive ligamentous damage and underwent surgery.

Conclusions

The close association between the MILD scale and spinal instability is promising, although further studies are warranted in order to confirm our preliminary data.     

The extent of vascular resection is associated with perioperative outcome in patients undergoing pancreaticoduodenectomy

Background

Few studies have examined the relation between extent of vascular resection and morbidity following pancreaticoduodenectomy (PD) with vein resection (PDVR).