Solitary Fibrous Tumors of Chest: Another Look with the Oncologic Perspective

Solitary fibrous tumors are mesenchymal lesions that arise at a variety of sites, most commonly the pleura. Most patients are asymptomatic at diagnosis, with lesions being detected incidentally. Nevertheless, some patients present due to symptoms from local tumor compression (eg. of the airways and pulmonary parenchyma). Furthermore, radiological methods are not always conclusive in making a diagnosis, and thus, pathological analysis is often required. In the past three decades, immunohistochemical techniques have provided a gold standard in solitary fibrous tumor diagnosis. The signature marker of solitary fibrous tumor is the presence of the NAB2-STAT6 fusion that can be reliably detected with a STAT6 antibody. While solitary fibrous tumors are most often benign, they can be malignant in 10-20% of the cases. Unfortunately, histological parameters are not always predictive of benign vs malignant solitary fibrous tumors. As solitary fibrous tumors are generally regarded as relatively chemoresistant tumors; treatment is often limited to localized treatment modalities. The optimal treatment of solitary fibrous tumors appears to be complete surgical resection for both primary and local recurrent disease. However, in cases of suboptimal resection, large disease burden, or advanced recurrence, a multidisciplinary approach may be preferable. Specifically, radiotherapy for inoperable local disease can provide palliation/shrinkage. Given their sometimes -unpredictable and often- protracted clinical course, long-term follow-up post-resection is recommended

Postmastectomy irradiation in breast in breast cancer patients with T1-2 and 1-3 positive axillary lymph nodes: Is there a role for radiation therapy?

<p>Abstract</p> <p>Background</p> <p>We aimed to evaluate retrospectively the correlation of loco-regional relapse (LRR) rate, distant metastasis (DM) rate, disease free survival (DFS) and overall survival (OS) in a group of breast cancer (BC) patients who are at intermediate risk for LRR (T1-2 tumor and 1-3 positive axillary nodes) treated with or without postmastectomy radiotherapy (PMRT) following modified radical mastectomy (MRM).</p> <p>Methods</p> <p>Ninety patients, with T1-T2 tumor, and 1-3 positive nodes who had undergone MRM received adjuvant systemic therapy with (n = 66) or without (n = 24) PMRT. Patient-related characteristics (age, menopausal status, pathological stage/tumor size, tumor location, histology, estrogen/progesterone receptor status, histological grade, nuclear grade, extracapsular extension, lymphatic, vascular and perineural invasion and ratio of involved nodes/dissected nodes) and treatment-related factors (PMRT, chemotherapy and hormonal therapy) were evaluated in terms of LRR and DM rate. The 5-year Kaplan-Meier DFS and OS rates were analysed.</p> <p>Results</p> <p>Differences between RT and no-RT groups were statistically significant for all comparisons in favor of RT group except OS: LRR rate (3%vs 17%, p = 0.038), DM rate (12% vs 42%, p = 0.004), 5 year DFS (82.4% vs 52.4%, p = 0.034), 5 year OS (90,2% vs 61,9%, p = 0.087). In multivariate analysis DM and lymphatic invasion were independent poor prognostic factors for OS.</p> <p>Conclusion</p> <p>PMRT for T1-2, N1-3 positive BC patients has to be reconsidered according to the prognostic factors and the decision has to be made individually with the consideration of long-term morbidity and with the patient approval.</p

Non–Small Cell Lung Cancer: Prognostic Importance of Positive FDG PET Findings in the Mediastinum for Patients with N0–N1 Disease at Pathologic Analysis

In non-small cell lung cancer, preoperative evaluation of the mediastinum with PET may complement the surgical and histologic findings

Dosımetric comparıson of sıngle and multıple arc treatment plans ın sterotactic ablative treatment of early stage non-small cell lung cancer

Tıbbi sebeplerle inoperabl, erken evre (T1-2 N0) KHDAK’inin güncel tedavisi stereotaktik ablatif radyoterapidir (SABR). SABR, toraks, batın, pelvis, spinal ve paraspinal bölge yerleşimli primer ve oligometastik lezyonların tedavisinde yüksek tümör kontrol oranları sağlayan etkili bir radyoterapi (RT) tekniğidir. SABR’yi konvansiyonel RT tekniklerinden ayıran en önemli özellik yüksek fraksiyon dozlarının (>5Gy), az sayıda fraksiyon ile (1-12) küçük bir tümör hacmine odaklanarak (genellikle <5 cm) verilmesidir. SABR’de normal doku toksisitesini en aza indirebilmek için, hedefin hemen dışında keskin doz düşüşünün gerçekleşmesi gerekmektedir. Bu çalışmanın amacı, erken evre küçük hücreli dışı akciğer kanseri (KHDAK) tanılı hastalarda dört farklı SABR tekniğinin (coplanar tek ışın tek-ark, tek ışın iki-ark, iki ışın ikiark ve non-coplanar iki ışın iki-ark) doz/hacim parametrelerini karşılaştırmaktır. Bu amaçla erken evre KHDAK’i tanısı ile tedavi edilmiş 20 hastanın BT-sim görüntüleri retrospektif olarak kullanıldı. Her hasta için yeniden hedef hacim ve risk altındaki organ (RAO) konturlamaları yapıldı ve dört ayrı teknik için Monoco Planlama Sistemi (TPS) kullanılarak tedavi planları (60Gy/8fr) oluşturuldu. Hedef hacmin %98-99’unun 60Gy tam dozu alması için her dört uygulamada da benzer şekilde normalizasyon yapıldı. Seri yapıdaki RAO’ların doz hacim kriterlerine uymak için tüm planlar optimize edildi. Doz-hacim histogramlarından (DVH) faydalanılarak, her planda Dmaks, D95, Dmin değerleri bulunarak gruplar arasında istatistiksel olarak karşılaştırıldı. Ayrıca kalp için Dmaks ve Dort, proksimal bronşiyal ağaç, ösofagus, medulla spinalis, göğüs duvarı ve büyük damarlar için Dmaks, toplam akciğer için V5, V10, V20, Dort, aynı taraf akciğer için Dort, karşı taraf akciğer için ise Dort ve V5 değerleri 60 karşılaştırıldı. Aynı zamanda, monitor unit değerleri ve tedavi süreleri kaydedildi; heterojenite indeksi, konformite indeksi ve gradient indeks değerleri hesaplanarak, bu değerlerin gruplar arasındaki karşılaştırmaları yapıldı. Hedef hacim için değerlendirilen, Dmaks, D95 ve Dmin dozları planlar arasında karşılaştırılabilir bulunmuştur. Yalnızca, PTV’nin Dmaks dozu, tek ışın tek ark grubunda tek ışın iki ark grubuna göre istatiksel olarak anlamlı düzeyde büyüktür (p=0,033). Santral yerleşimli risk altındaki organlar için bakılmış olan, proksimal bronşiyal ağaç, ösofagus ve medulla spinalis maksimum doz değerleri non-coplanar iki ışın iki ark uygulamasında coplanar uygulamalara göre anlamlı düzeyde düşüktür. Toplam akciğerin V5 ve V10 değerleri ve karşı taraf akciğerin V5 değerleri, non-coplanar iki ışın iki ark uygulamasında diğer uygulamalara göre istatiksel anlamlılık düzeyinde düşük bulunmuştur. Toplam akciğer V20, Dort; aynı taraf akciğer Dort ve karşı akciğer Dort değerleri açısından, planlar arasında anlamlı fark bulunmamıştır. Sonuç olarak, Monaco TPS kullanılarak oluşturulan tek ışın tek ark SABR planları iki ark uygulamalara kıyasla daha düşük monitör unit değerleri ve tedavi sürelerine sahiptir. Aslında, tüm planlamalarda genel olarak uygun hedef ve RAO doz-hacim değerleri elde edilmiştir. Non-coplanar SABR planları, daha düşük gradient indeks, RAO maksimum doz ve doz-hacim değerleri elde etmek gerektiğinde kullanılabilir. Özellikle seri dizilimli RAO’lara yakın yerleşimli lezyonların SABR uygulamalarında, non-coplanar teknik bu yapıların maksimum dozlarını düşürmede fayda sağlayabilir. Ancak tek ark SABR planları, erken evre KHDAK'li hastaların tedavisinde genellikle uygun konformite ve gradient indeks değerleri ve hedef hacim ve RAO dozları sağlayabilmekte ve nispeten kısa tedavi süresi ve düşük set-up hatası riski ile uygulanabilmektedir.The current treatment of medically inoperable early stage NSCLC is stereotactic ablative radiotherapy (SABR). SABR is an effective radiotherapy (RT) technique that provides high tumor control rates in the treatment of primary or oligo-metastatic lesions located in the thorax, abdomen, pelvis, spinal and paraspinal regions. The most important feature that distinguishes SABR from conventional RT techniques is that high fraction doses (> 5Gy) are given with a small number of fractions (1-12 fx), focusing on a small tumor volume (usually <5 cm). In SABR applications, in order to minimize the risk of normal tissue toxicity, a sharp dose reduction is required just beyond the target. The aim of this study is to compare the dose /volume parameters of four different SABR techniques (coplanar single-beam single-arc, single-beam two-arc, two-beam two-arc ve non-coplanar two-beam two-arc) in patients with early stage non-small cell lung cancer (NSCLC). For this purpose, CT-simulation images of 20 patients with early stage NSCLC were used retrospectively. Target volumes and organs at risk (OAR) were delineated for each patient and then treatment plans (60Gy/8fr) generated by Monoca Treatment Planning System (TPS) were created separately for each different planning techniques. Similar 62 normalization process was performed for all four applications to ensure that 98-99% of the target volume received the full 60Gy dose. At the same time, monitor unit values and treatment times were recorded; heterogeneity index, conformity index and gradient index values were calculated and statistical comparisons of these values were made between the groups. All plans were optimized to comply with the dose volume criteria of the serial OARs. Using dose-volume histograms (DVH), Dmax, D95 and Dmin values were found in each plan and these were compared statistically between the groups. Besides, Dmax and Dort doses for the heart; Dmax values for proximal bronchial tree, esophagus, medulla spinalis, chest wall and great vessels; V5, V10, V20, Dort for the total lung; Dort for the ipsilateral lung, Dort and V5 values for the contra-lateral lung were calculated in all groups and compared each other statistically. The Dmax, D95 and Dmin doses evaluated for target volume were comparable between the plans. Only, the Dmax dose was statistically significantly higher in the single-beam singlearc group than in the single-beam two-arc group (p = 0.033). The proximal bronchial tree, esophagus and medulla spinalis maximum dose values (as centrally located serial organs at risk) were significantly lower in non-coplanar two-beam two-arc application compared to other (coplanar) plans. There was no significant difference between the groups in terms of Dmax values of the chest wall and great vessels. V5 and V10 values of the total lung and V5 values of the contralateral lung were found to be significantly lower in non-coplanar twobeam two-arc applications compared to other applications. V20 and Dort of the total lung, Dort of the ipsilateral lung and Dort of the contralateral lung did not show a significant difference between the plans. In conclusion, single-beam single-arc SABR plans created by Monaco TPS had lower monitor unit values and treatment times compared to all two-arc techniques. In fact, with all SABR planning techniques evaluated in our study, generally appropriate target and OAR dose-volume values were obtained. Non-coplanar SABR plans can be used when it is necessary to obtain a lower gradient index, maximum dose and dose-volume values of the OAR’s. Especially in SABR applications of lesions located close to serial OARs, noncoplanar technique can be beneficial in reducing the maximum doses of these structures. However, single-arc SABR plans can generally provide appropriate conformity and gradient index values and target volume and OAR doses in the treatment of patients with early stage 63 NSCLC and can be applied with a relatively short treatment time and low risk of set-up errors

Metástases nas leptomeninges da espinal medula num doente com carcinoma de céculas escamosas do pulmão

Resumo: As metástases nas leptomeninges da espinal medula ocorrem raramente nos tumores sólidos e o prognóstico é bastante reservado. Os adenocarcinomas e os carcinomas de pequenas células são os grupos histológicos mais envolvidos no que se refere aos tumores pulmonares. Um homem de 58 anos com história de carcinoma de células escamosas do pulmão com inversão mediastínica e metástases cerebrais apresenta lombalgias e fraqueza em ambos os membros inferiores. A RMN da coluna vertebral revelou espessamento na espinal medula e múltiplos nódulos do grupo das fibras da cauda equina. Tanto quanto sabemos, trata-se do segundo caso relatado de carcinoma pulmonar de células escamosas que apresenta metástases nas leptomeninges da espinal medula.Rev Port Pneumol 2008; XIV (6): 875-879 Abstract: Spinal leptomeningeal metastasis occurs rarely in solid tumors, and the prognosis is extremely poor. Adenocarcinomas and small-cell carcinomas are the most common histological type detected among lung tumors. A 58-year-old man with a history of squamous-cell lung carcinoma with mediastinal invasion and brain metastasis was examined because of his low back pain and weakness in both lower limbs. Spinal MRI revealed subpial enhancement in the spinal cord; and innumerable nodules with thickening of the cauda equina fibres. To our knowledge, this is the second reported case of squamous cell lung cancer with spinal leptomeningeal metastasis.Rev Port Pneumol 2008; XIV (6): 875-879 Palavras-chave: Espinal medula, leptomeninges, metástases, ressonância magnética nuclear, Key-words: Spinal, leptomeningeal, metastasis, lung cancer, magnetic resonance imagin

Metástases nas leptomeninges da espinal medula num doente com carcinoma de céculas escamosas do pulmão Spinal leptomeningeal metastasis in a patient with squamous cell lung cancer

As metástases nas leptomeninges da espinal medula ocorrem raramente nos tumores sólidos e o prognóstico é bastante reservado. Os adenocarcinomas e os carcinomas de pequenas células são os grupos histológicos mais envolvidos no que se refere aos tumores pulmonares. Um homem de 58 anos com história de carcinoma de células escamosas do pulmão com inversão mediastínica e metástases cerebrais apresenta lombalgias e fraqueza em ambos os membros inferiores. A RMN da coluna vertebral revelou espessamento na espinal medula e múltiplos nódulos do grupo das fibras da cauda equina. Tanto quanto sabemos, trata-se do segundo caso relatado de carcinoma pulmonar de células escamosas que apresenta metástases nas leptomeninges da espinal medula.Spinal leptomeningeal metastasis occurs rarely in solid tumors, and the prognosis is extremely poor. Adenocarcinomas and small-cell carcinomas are the most common histological type detected among lung tumors. A 58-year-old man with a history of squamous-cell lung carcinoma with mediastinal invasion and brain metastasis was examined because of his low back pain and weakness in both lower limbs. Spinal MRI revealed subpial enhancement in the spinal cord; and innumerable nodules with thickening of the cauda equina fibres. To our knowledge, this is the second reported case of squamous cell lung cancer with spinal leptomeningeal metastasis

11 Pneumologia 14-5 - Caso Clín.PDF

R e v i s t a P o r t u g u e s a d e P n e u m o l o g i a Caso Clínico Clinical Case Resumo Os tumores que metastizam para os gânglios inguinais têm frequentemente origem nos órgãos genitais e reprodutores, na pele, no recto ou ânus, ou na bexiga 1,2 . Há, no entanto, algumas descrições de casos raros de metástases inguinais de tumores localizados acima do diafragma 2-5 , e apenas três destes apresentavam uma metástase inguinal reconhecida antes da morte. Estes casos estão detalhadamente descritos na literatura médica de língua inglesa Abstact Tumours that metastasise to groin nodes most frequently originate in genital and reproductive organs, skin, rectum or anus, or urinary bladder 1,2 . However, rare cases of inguinal metastases from tumours above the diaphragm have been reported 2-5 and only three of them had an inguinal metastasis which was recognised antemortem and reported in detail in the English medical literature 3-5 . The primary tumours of these cases were malignant mesothelioma, salivary duct and breast carcinoma. In this paper, we report a case Gânglio inguinal como única evidência de cancro progressivo do pulmão Inguinal lymph node as the only evidence of progressive lung cancer Recebido para publicaçã

Merkel hücreli karsinomun nadir bir presentasyonu

Yetmişbir yaşındaki erkek hastanın sırt ağrısı şikayetiyle hastaneye başvurusu sonrasında yapılan tetkiklerinde sol paravertebral alan ikinci vertebra düzeyinde kitle tespit edilmiş ve kitlenin en blok rezeksiyonu sonrasında histopatolojik olarak Merkel hücreli karsinom tanısı konmuştur. Postoperatif birinci ayında manyetik rezonans incelemede aynı alanda tespit edilen ve inoperabl olarak değerlendirilen kitle hastalığın hızlı ilerlediğini düşündürdü. Hasta radyokemoterapinin 6. gününde pnömoni sonucunda ortaya çıkan solunum yetersizliği nedeniyle hayatını kaybetti. Bu çok nadir görülebilecek bir olgu olmakla birlikte, intratorasik kitlelerin ayırıcı tanısında Merkel hücreli karsinom da düşünülmelidir.We describe a 71-year-old male patient admitted to the hospital with posterior chest pain. Following the detection of a paravetebral mass at the level of the 2nd thoracic vertebra, the patient underwent a surgical en bloc resection of the mass. The histopathologic examination revealed a Merkel cell carcinoma. One month after the operation, magnetic resonance imaging showed an inoperable mass in the same location, which indicated a rapid progression of the tumor. The patient died of progressive respiratory failure due to pneumonia on the 6th day after the onset of radiochemotherapy. Although this appears to be an isolated case, Merkel cell carcinoma must be included in the differential diagnosis of intrathoracic masses

An Unusual Presentation of Merkel Cell Carcinoma

We describe a 71-year-old male patient admitted to the hospital with posterior chest pain. Following the detection of a paravetebral mass at the level of the 2nd thoracic vertebra, the patient underwent a surgical en bloc resection of the mass. The histopathologic examination revealed a Merkel cell carcinoma. One month after the operation, magnetic resonance imaging showed an inoperable mass in the same location, which indicated a rapid progression of the tumor. The patient died of progressive respiratory failure due to pneumonia on the 6th day after the onset of radiochemotherapy. Although this appears to be an isolated case, Merkel cell carcinoma must be included in the differential diagnosis of intrathoracic masses