Surgical Technique,Morbidity, and Outcome of Primary Retroperitoneal Sarcoma Involving Inferior Vena Cava

Background  

Retroperitoneal sarcomas (RSTS) involving inferior vena cava (IVC) are rare entities. Vascular resection and reconstruction represent a technical challenge. The aim of the study was to review a monoinstitutional series of IVC resections for RSTS (mainly IVC leiomyosarcoma), focusing on the type of vascular replacement, morbidity, and oncologic outcome.     

The Outcome of Cholangitis After Percutaneous Biliary Drainage in Neoplastic Jaundice

The purpose of this paper is to evaluate factors affecting the outcome of cholangitis after PTBD in jaundiced cancer patients. Twenty nine patients with neoplastic jaundice (male/female ratio 13/16, median age 55 years) with full clinical data, were treated by PTBD and developed cholangitis at a median of 9 days later. Four patients (14%) died of biliary sepsis a median of one month after PTBD while the other 25 survived a median of 6 months, with one week median duration of cholangitis. The probability of the cholangitis resolving was analyzed by time to resolution and it was found that 50% and 100% of the recoveries occurred 5 and 9 months respectively from the onset of the complication.The series was analyzed to determine the role of several variables (disease/patient/treatment related) in the resolution of cholangitis. Only a low stricture site, a large initial drainage catheter (10F) and a temperature increase exceeding 39^° C were correlated with a positive outcome. We conclude that PTBD-related cholangitis has, in our experience, a good chance of cure, low mortality rate and satisfactory 6 months median survival.     

Extraskeletal myxoid chondrosarcoma: tumor response to sunitinib

Background

Extraskeletal myxoid chondrosarcoma (EMCS) is a rare soft tissue sarcoma of uncertain differentiation, characterized in most cases by a translocation that results in the fusion protein EWSR1-CHN (the latter even called NR4A3 or TEC). EMCS is marked by >40% incidence of metastases in spite of its indolent behaviour. It is generally resistant to conventional chemotherapy, and, to the best of our knowledge, no data have been reported to date about the activity of tirosin-kinase inhibitor (TKI) in this tumor. We report on two consecutive patients carrying an advanced EMCS treated with sunitinib.

Methods

Since July 2011, 2 patients with progressive pretreated metastatic EMCS (Patient1: woman, 58 years, PS1; Patient2: man, 63 years, PS1) have been treated with continuous SM 37.5 mg/day, on an individual use basis. Both patients are evaluable for response. In both cases diagnosis was confirmed by the presence of the typical EWSR1-CHN translocation.

Results

Both patients are still on treatment (11 and 8 months). Patient 1 got a RECIST response after 4 months from starting sunitinib, together with a complete response by PET. An interval progression was observed after stopping sunitinib for toxicity (abscess around previous femoral fixation), but response was restored after restarting sunitinib. Patient 2 had an initial tumor disease stabilization detected by CT scan at 3 months. Sunitinib was increased to 50 mg/day, with evidence of a dimensional response 3 months later.

Conclusions

Sunitinib showed antitumor activity in 2 patients with advanced EMCS. Further studies are needed to confirm these preliminary results.

     

Use of Severini's coaxial catheters in gastrointestinal interventional radiology

The growing importance of gastrointestinal interventional radiology has led to the development of new instruments and materials for the different proposed purposes. The authors present a set consisting of two coaxial catheters which was created for percutaneous transhepatic biliary drainage (Severini set). Its easy handling, adaptability and tolerability make it a versatile instrument in the hands of interventional radiologists for positioning large-calibre catheter (9-14 F) in deep sites. Hereafter are reported the results in 29 patients treated with different therapeutic aims and the use of the set for different pathologies. The catheters allowed a complete resolution of the collections communicating with the gastrointestinal tract in 4 of 5 patients. The catheter was inserted as a feeding tube in 22 patients. Finally, it was used as a gastrostomy catheter in 2 patients. Neither early nor late complications due to insertion or use of this set were observed.     

Diagnostic accuracy of the double-contrast enema for colonic polyps in patients with or without diverticular disease

The accuracy of the double-contrast enema for the diagnosis of polypoid lesions in the presence or absence of diverticula was evaluated by retrospectively reviewing the medical records of 202 patients subjected to examination and endoscopy. Analysis of the data on 215 polypoid lesions showed that (a) the diagnostic accuracy of the examination is not affected significantly by the presence of diverticula; (b) the sensitivity of the examination is highly dependent on the size of the polyps (smaller or larger than 0.5 cm) but not on the form (sessile or pedunculated); and (c) the positive predictive value is higher in patients without diverticula. The double-contrast enema was confirmed to be a valid method for the diagnosis of polypoid lesions.     

Reduced-dose craniospinal irradiation is feasible for standard-risk adult medulloblastoma patients

Journal of Neuro-Oncology - The optimal treatment strategy for pediatric atypical teratoid rhabdoid tumor (ATRT) is inconclusive. This study evaluated the prognostic value of early radiotherapy...     

A case of rhombencephalitis caused by Listeria monocytogenes successfully treated with linezolid

Infection of the central nervous system due to Listeria monocytogenes is uncommon. The treatment of choice is ampicillin. We describe in this report a case of rhombencephalitis caused by Listeria monocytogenes successfully treated with linezolid. To the best of our knowledge, this is the first case in which linezolid was used to treat infection of the central nervous system caused by this organism.     

Synovial sarcoma in children and adolescents: a critical reappraisal of staging investigations in relation to the rate of metastatic involvement at diagnosis

BackgroundEuropean protocols for paediatric synovial sarcoma (SS) require that all children routinely undergo chest computed tomography (CT) scanning and bone scanning as initial staging procedures. This study aims to determine the rate of initial metastases in paediatric SS based on specific clinical characteristics, thereby investigating whether these diagnostic procedures are really necessary in all patients.MethodsData on 258 previously-untreated SS patients <21 years old were pooled from the databases of different European paediatric groups (study period 1988–2005) for this analysis, and the associations between patients’ characteristics and any presence of metastasis were estimated.ResultsFifteen cases (5.8%) had distant metastases at diagnosis (86% pulmonary). The presence of metastases was unassociated with patients’ gender or age, tumour grade or site, but it was influenced by T-status, and especially primary tumour size: the risk of metastases was 32 times higher in cases of tumour >5 cm than for tumours ⩽5 cm.ConclusionsOur findings suggest that tumour diameter can be used as a variable for identifying patients at greater risk of metastases and warranting more accurate radiological investigations. Chest CT scanning may improve the accuracy of pulmonary staging over X-ray, but requires different ionising radiation exposures that might have carcinogenic potential: it can be omitted for patients with tumours ⩽5 cm. Given the very low risk of bone metastases, bone scans may be recommended only in cases with evidence of lung metastases.