Primary splenic angiosarcoma is a very rare and aggressive neoplasm with a high metastatic rate a... more Primary splenic angiosarcoma is a very rare and aggressive neoplasm with a high metastatic rate and dismal prognosis. Since only a few cases have been adequately reported in the medical literature, we report here a further six cases. The records of all cases of primary splenic angiosarcoma treated at Chang Gung Memorial Hospital from April 1991 to July 2004 were retrospectively reviewed. Of the six cases identified (three men and three women; range, 7-69 years; median, 44 years), four presented with palpable abdominal masses or left upper quadrant abdominal pain. Other systemic symptoms, such as bleeding gums, fatigue, fever, body weight loss, and gastrointestinal bleeding were noted. An abnormal hematogram was found in five patients, with all of these five showing anemia, and three thrombocytopenia. Splenomegaly was present in all patients. Hemoperitoneum due to splenic rupture was noted in one patient. Three patients had distant metastasis to the liver (n = 2), bone (n = 1), bone marrow (n = 1), and small bowel (n = 1) at diagnosis. Liver (n = 3), bone (n = 1), and bone marrow (n = 1) metastases were found in four patients after initial therapy. Five of the six cases underwent a splenectomy, one underwent partial hepatectomy, and one received chemotherapy. The respective 1-, 3- and 5-year survival rates were 60%, 40%, and 40%, and the median survival time was 36 months. One patient was disease-free 162 months after splenectomy. The clinical presentations of splenic angiosarcoma were similar to those of previous reports apart from the higher rate of splenomegaly observed in this study. In contrast to reported pediatric cases, our patient achieved long-term disease-free survival after splenectomy alone.
Small bowel metastasis from primary bone leiomyosarcoma is very rare. Here we report on a 50-year... more Small bowel metastasis from primary bone leiomyosarcoma is very rare. Here we report on a 50-year-old man who presented with general weakness, weight loss (six kg in two months) and intermittent tarry stools for two months. He had undergone an above-knee amputation for left tibia leiomyosarcoma seven years previously. No local recurrence and/or distant metastasis developed during a seven-year period of follow-up. Subsequent imaging study revealed a multilobulated mass in the ileum. He received segmental resection of the small bowel and a multilobulated mass was noted in the submucosal layer of the ileum with mucosa ulceration. His postoperative course was uneventful. Histopathological examination of the resected mass revealed small bowel metastatic leiomyosarcoma. No local recurrence or distant metastases were detected during a six-month follow-up period. To the best of our knowledge, this is the first report of small bowel metastasis from primary bone leiomyosarcoma presenting with lower gastrointestinal bleeding.
Background: To assess the safety and the clinical outcome of distal pancreatectomy, with preserva... more Background: To assess the safety and the clinical outcome of distal pancreatectomy, with preservation of the spleen as well as splenic artery and vein, for benign distal pancreatic lesions. Methods: Five consecutive patients with benign distal pancreatic lesions (3 with insulinoma, 1 with non-functioning islet cell tumor and 1 with serous cystadenoma) underwent spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Prograde distal pancreatectomy was performed for 4 patients and retrograde pancreatectomy for the other. The operative time, blood loss due to surgery, length of post-operative hospitalization and post-operative complications were analyzed and evaluated. Results: Surgery was successful for all 5 patients. Whilst 2 of the patients revealed major medical disease, no post-surgical complications were experienced by any of the 5 patients. The mean operative time, extent of blood loss, and postoperative hospital stay were, respectively, 238 minutes (range 175-270), 170 ml (range 50-300), and 8.4 days (range 6 - 15). Conclusion: From our experience, spleen-preserving distal pancreatectomy can be safely performed with the conservation of the splenic artery and vein. Our result revealed that this well-known procedure can be improved in terms of blood loss, surgical duration and length of hospital stay. We believe that this procedure should be performed for benign lesions of the distal pancreas whenever indicated and possible.
Background/aim: Laparoscopic surgery (LS) is being adopted for gastrointestinal stromal tumors (G... more Background/aim: Laparoscopic surgery (LS) is being adopted for gastrointestinal stromal tumors (GISTs) of the stomach. Few studies have examined the outcome of LS for intestinal GISTs. In the present study, we evaluated the outcomes of LS for intestinal GISTs. Patients and methods: This study was a prospective-collecting retrospective review of 85 patients with intestinal GISTs who underwent LS or laparotomy in 102 months. The demographic data and oncological outcomes were compared. Results: The cohort included 85 patients (26 LS and 59 laparotomy patients). The LS group presented earlier oral resumption and a shorter hospital stay. The recurrence rate, recurrence-free and overall survival were comparable. Tumor size greater than 7 cm [risk ratio (RR)=4.148; p=0.022] and mitotic index of greater than 5/50 high-power fields (RR=5.500; p=0.002) were two predictors for tumor recurrence. Conclusion: The study demonstrated that LS for intestinal GISTs leads to oncological outcomes comparable to those of laparotomy. Moreover, LS was associated with favorable perioperative recovery and a shorter hospital stay. With strict precautions, LS is a safe and effective procedure for intestinal GISTs.
We read the recent study "Clinical efficacy of lenvatinib for the treatment of radioiodine-r... more We read the recent study "Clinical efficacy of lenvatinib for the treatment of radioiodine-refractory thyroid carcinoma: A systematic review and meta-analysis of clinical trials" by Zhipeng Yan, et al. for the evaluation of lenvatinib in the treatment of radioiodine-refractory thyroid carcinoma. This article is protected by copyright. All rights reserved.
Primary splenic angiosarcoma is a very rare and aggressive neoplasm with a high metastatic rate a... more Primary splenic angiosarcoma is a very rare and aggressive neoplasm with a high metastatic rate and dismal prognosis. Since only a few cases have been adequately reported in the medical literature, we report here a further six cases. The records of all cases of primary splenic angiosarcoma treated at Chang Gung Memorial Hospital from April 1991 to July 2004 were retrospectively reviewed. Of the six cases identified (three men and three women; range, 7-69 years; median, 44 years), four presented with palpable abdominal masses or left upper quadrant abdominal pain. Other systemic symptoms, such as bleeding gums, fatigue, fever, body weight loss, and gastrointestinal bleeding were noted. An abnormal hematogram was found in five patients, with all of these five showing anemia, and three thrombocytopenia. Splenomegaly was present in all patients. Hemoperitoneum due to splenic rupture was noted in one patient. Three patients had distant metastasis to the liver (n = 2), bone (n = 1), bone marrow (n = 1), and small bowel (n = 1) at diagnosis. Liver (n = 3), bone (n = 1), and bone marrow (n = 1) metastases were found in four patients after initial therapy. Five of the six cases underwent a splenectomy, one underwent partial hepatectomy, and one received chemotherapy. The respective 1-, 3- and 5-year survival rates were 60%, 40%, and 40%, and the median survival time was 36 months. One patient was disease-free 162 months after splenectomy. The clinical presentations of splenic angiosarcoma were similar to those of previous reports apart from the higher rate of splenomegaly observed in this study. In contrast to reported pediatric cases, our patient achieved long-term disease-free survival after splenectomy alone.
Small bowel metastasis from primary bone leiomyosarcoma is very rare. Here we report on a 50-year... more Small bowel metastasis from primary bone leiomyosarcoma is very rare. Here we report on a 50-year-old man who presented with general weakness, weight loss (six kg in two months) and intermittent tarry stools for two months. He had undergone an above-knee amputation for left tibia leiomyosarcoma seven years previously. No local recurrence and/or distant metastasis developed during a seven-year period of follow-up. Subsequent imaging study revealed a multilobulated mass in the ileum. He received segmental resection of the small bowel and a multilobulated mass was noted in the submucosal layer of the ileum with mucosa ulceration. His postoperative course was uneventful. Histopathological examination of the resected mass revealed small bowel metastatic leiomyosarcoma. No local recurrence or distant metastases were detected during a six-month follow-up period. To the best of our knowledge, this is the first report of small bowel metastasis from primary bone leiomyosarcoma presenting with lower gastrointestinal bleeding.
Background: To assess the safety and the clinical outcome of distal pancreatectomy, with preserva... more Background: To assess the safety and the clinical outcome of distal pancreatectomy, with preservation of the spleen as well as splenic artery and vein, for benign distal pancreatic lesions. Methods: Five consecutive patients with benign distal pancreatic lesions (3 with insulinoma, 1 with non-functioning islet cell tumor and 1 with serous cystadenoma) underwent spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Prograde distal pancreatectomy was performed for 4 patients and retrograde pancreatectomy for the other. The operative time, blood loss due to surgery, length of post-operative hospitalization and post-operative complications were analyzed and evaluated. Results: Surgery was successful for all 5 patients. Whilst 2 of the patients revealed major medical disease, no post-surgical complications were experienced by any of the 5 patients. The mean operative time, extent of blood loss, and postoperative hospital stay were, respectively, 238 minutes (range 175-270), 170 ml (range 50-300), and 8.4 days (range 6 - 15). Conclusion: From our experience, spleen-preserving distal pancreatectomy can be safely performed with the conservation of the splenic artery and vein. Our result revealed that this well-known procedure can be improved in terms of blood loss, surgical duration and length of hospital stay. We believe that this procedure should be performed for benign lesions of the distal pancreas whenever indicated and possible.
Background/aim: Laparoscopic surgery (LS) is being adopted for gastrointestinal stromal tumors (G... more Background/aim: Laparoscopic surgery (LS) is being adopted for gastrointestinal stromal tumors (GISTs) of the stomach. Few studies have examined the outcome of LS for intestinal GISTs. In the present study, we evaluated the outcomes of LS for intestinal GISTs. Patients and methods: This study was a prospective-collecting retrospective review of 85 patients with intestinal GISTs who underwent LS or laparotomy in 102 months. The demographic data and oncological outcomes were compared. Results: The cohort included 85 patients (26 LS and 59 laparotomy patients). The LS group presented earlier oral resumption and a shorter hospital stay. The recurrence rate, recurrence-free and overall survival were comparable. Tumor size greater than 7 cm [risk ratio (RR)=4.148; p=0.022] and mitotic index of greater than 5/50 high-power fields (RR=5.500; p=0.002) were two predictors for tumor recurrence. Conclusion: The study demonstrated that LS for intestinal GISTs leads to oncological outcomes comparable to those of laparotomy. Moreover, LS was associated with favorable perioperative recovery and a shorter hospital stay. With strict precautions, LS is a safe and effective procedure for intestinal GISTs.
We read the recent study "Clinical efficacy of lenvatinib for the treatment of radioiodine-r... more We read the recent study "Clinical efficacy of lenvatinib for the treatment of radioiodine-refractory thyroid carcinoma: A systematic review and meta-analysis of clinical trials" by Zhipeng Yan, et al. for the evaluation of lenvatinib in the treatment of radioiodine-refractory thyroid carcinoma. This article is protected by copyright. All rights reserved.
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