Cases reported "Pelvic Neoplasms"

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1/16. Treatment of giant ancient pelvic schwannoma.

    A 32-year-old patient presented with urinary retention and chronic constipation. Computerized tomography and magnetic resonance imaging showed a 10 x 11cm encapsulated tumor with cystic areas lying ventral to the sacrum. There was no evidence of invasion of bladder or rectum. At laparotomy, a 10 x 11 cm mass was found in the left pelvis. Final pathology revealed an ancient schwannoma. In most large series, 80% to 90% of the primary retroperitoneal tumors are malignant. Retroperitoneal schwannomas can be benign or malignant, roughly half of the reported cases showed malignancy. Benign schwannomas may arise along the course of any myelinated nerve, with the acoustic neuroma being the most frequent site. Immunostaining showed a strong expression of S-100 protein. The staining for this protein is helpful for differentiation of a benign schwannoma from a malignant peripheral nerve sheath tumor and from other benign spindle cell tumors. The treatment of choice for benign schwannomas is complete excision. recurrence or persistence seems to be associated with incomplete resection, which occurred in 10% of the reported cases. After surgery, the patient had normal erection, normal micturition, and normal defecation but no symptoms of motor and sensory disturbances.
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keywords = sacrum
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2/16. Neurofibromatosis involving the urinary bladder.

    We present two interesting cases of a 24-year-old man and a 14-year-old boy, uncle and nephew, with lower urinary tract symptoms, cafe au lait patches and subcutaneous nodules. ultrasonography and computed tomography scans showed a large, irregular lobulated soft tissue mass between the bladder and sacrum. cystoscopy, laparotomy and biopsies revealed neurofibromatosis involving the urinary bladder. No enlargement of the tumor or upper urinary tract obstruction has occurred during the long-term follow up. We recommend meticulous follow up of patients with giant intrapelvic neurofibromatosis.
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keywords = sacrum
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3/16. Clinical study of malignant tumors originating in the pelvic region.

    We evaluated the surgical problems encountered during treatment of 14 patients with malignant tumors originating in the pelvic region at our department. The tumor involved the iliac bone in 6 patients, the ischial bone in 2, the pubic bone in 2, and the gluteal region in 4. Invasion to the sacrum was observed in 7 patients. Twelve patients underwent surgical procedures consisting of intralesional resection in 6, marginal resection in 3, and wide margin resection in 3. Six of the 7 patients with sacral invasion developed local recurrence. Two patients with chondrosarcoma and one with parosteal osteosarcoma survived for 4 or more years, but the mean survival period in those with high grade malignant tumors was 11 months. These findings indicate the difficulties encountered in the treatment of malignant pelvic tumors.
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keywords = sacrum
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4/16. Radiofrequency ablation in the treatment of pelvic recurrence of rectal cancer.

    The aim was to assess the response to the treatment using thermal radiofrequency ablation in patients with pelvic recurrent rectal cancer. The location of the lesions as well as the placement of the percutaneous probe were guided by computed tomography. All ablations were performed with a RITA Medical Systems Starburst XL (nine-array, 5-cm) thermal ablation catheter and the Model 1500 generator (RITA Medical Systems, Inc.). The radiofrequency ablation treatment was performed in two patients with pelvic recurrent rectal cancer with poor response to chemoradiotherapy with no indication of new surgical treatment and suffering strong pain in the sacrum area. The serum carcinoembryonic antigen had a sharp reduction in a sixty-day period. The post-procedure tomography analysis showed the center of the tumor with necrosis and a ring of edema around it. Both patients had no complaints about the procedure, and they needed to take mild analgesics only on the first day right after the procedure for pain. In the follow-up one patient developed an abscess and needed to be readmitted but without recurrent pelvic pain. An effective response was shown by tumor necrosis and total relief of pain of the sacrum area.
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keywords = sacrum
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5/16. New indications for computer-assisted surgery: tumor resection in the pelvis.

    The resection of recurrent malignant pelvic tumors was supported by a commercially available navigation system in three patients. Preoperatively three-dimensional images from the pelvis were obtained by computed tomography or magnetic resonance imaging to identify the tumor extension. During surgery navigated tools oriented the surgeon to excise the tumor with adequate virtual margins. Navigation was helpful for tumor identification in one patient with a recurrent presacral mesenchymal chondrosarcoma. In the other two patients the tumor resection in the bone was done with three-dimensional observation of the osteotomies in the sacrum. In all three patients the histopathologic analysis confirmed that the neoplasms were excised accurately within their margins. We think that computer-assisted surgery is a potential method to increase the accuracy of tumor resections.
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keywords = sacrum
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6/16. Currarino syndrome: proposal of a diagnostic and therapeutic protocol.

    BACKGROUND/PURPOSE: The Currarino syndrome (CS) is a peculiar form of caudal regression syndrome (CRS) characterized by the association of hemisacrum, anorectal malformation (arm), and presacral mass. The authors analyzed retrospectively their series, and they propose a multidisciplinary diagnostic and therapuetic protocol that until now has not been introduced. methods: A series of 6 patients with CS is presented. Five of them were treated initially in other centers. None of them had an early diagnosis. All presented associated anomalies; in 50%, Hirschsprung's disease (HD) and other dysganglionoses were present. One patient died of a presacral ectopic nephroblastoma. RESULTS: Depending on the expressivity, 3 types of CS can be identified, complete, mild, and minimal. Dysganglionoses and HD can be considered part of CS. A multidisciplinary diagnostic and therapeutic protocol is presented. Main points are sacrum x-Ray, molecular genetic diagnosis, radiologic evaluation of every member of CS families, magnetic resonance (MR) evaluation of patient spine and pelvis, suction rectal biopsies, and search for associated anomalies. CONCLUSIONS: This protocol could give a valid contribution to the treatment of CS, allowing an early diagnosis and proposing a rational timing of multidisciplinary surgical procedures. early diagnosis and treatment are essential to avoid morbidity and mortality from an undiagnosed presacral mass.
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keywords = sacrum
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7/16. Pelvic ring reconstruction with a vascularized pedicle iliac bone graft for a large sacral schwannoma.

    A case of pelvic ring reconstruction with a vascularized pedicle iliac bone graft for removal of a huge sacral schwannoma is reported. It is necessary to reconstruct a pelvic ring when its integrity is impaired. Spinal instrumentation is essential for a temporary stability of the pelvic ring in the course of complete healing, which at times results in instrumentation failure. Several cases of pelvic ring reconstruction using vascularized fibular bone grafts have also indicated positive results attributable to their good blood circulation, but techniques with them are relatively complicated. We applied a vascularized pedicle iliac bone graft to the pelvic ring reconstruction after resection of a huge sacral schwannoma. When a stable pelvic ring was regained by using a lumbosacral instrumentation technique, a tricortical iliac bone graft with its vascular pedicle was harvested, transported into the dead space, and tied to the right residual sacrum and the left ilium. The vascularized graft healed rapidly, and continuity of the pelvic ring was regained. This method is effective for pelvic ring reconstruction in that it does not require microvascular techniques and rapid bone healing can be obtained.
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keywords = sacrum
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8/16. Large presacral schwannoma after radical prostatectomy.

    A 56-year-old man presented with long-standing, mild urinary frequency 6 years after radical prostatectomy. Pathologic assessment showed presence of organ confined prostate cancer (pT2a), Gleason 6 (3 3). Since the time of surgery, PSA level was undetectable and the patient remained without evidence of recurrent disease. However, digital rectal examination revealed the presence of a very large mass palpable on the anterior rectal wall. Therefore, the patient underwent abdominal/pelvic MRI which demonstrated presence of a solid, well-circumscribed pelvic mass extending from the level of the sacrum posteriorly to the anterior abdominal wall. Histologic examination of percutaneous biopsy of the mass was suggestive of schwannoma. The patient underwent laparotomic excision of the mass, which was confirmed to be a schwannoma, with its characteristic slender spill cells and elongate nuclei. No intra-operative complication was reported. The patient has no evidence of recurrence with complete resolution of urinary symptom one year after surgery.
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keywords = sacrum
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9/16. Metastasizing chordoma in early childhood: report of a case at 1.5 T.

    We present here the first report of an extraskeletal metastasizing presacral chordoma found in a child. MRI of this large lesion showed heterogeneous signal intensity on both the SE 550/30 and on SE 2440/100 images. MRI demonstrated this mass to be separate from the sacrum and provided nonionizing cross-sectional imaging prior to attempted surgical resection.
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keywords = sacrum
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10/16. Myomectomy during pregnancy: uncommon case report.

    A case of myomectomy during pregnancy is presented. Generally myomectomy is contraindicated during this period. On the 14th week of pregnancy our patient presented with progressive lower abdominal pain and a tender mass of nearly 12 centimeter diameter in the pouch of Douglas. Therefore an exploratory laparotomy was performed to exclude torsion of an adnexal mass or pedunculated subserous myoma. A dorsal degenerating myoma with short thick pedicle (4 cm diameter) was found. It was compressed between the promontory of the sacrum and the uterus. Myomectomy was performed and pregnancy progressed without complications.
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keywords = sacrum
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