Cases reported "Rectal Neoplasms"

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1/17. A case of chordoma in association with rectal carcinoma.

    A 74-year-old male patient presented with anal and sacral pain 18 months after abdomino-perineal resection for rectal cancer. Computerized tomography (CT) of the pelvis demonstrated a well defined mass anterior to the lower sacrum, posteriorly infiltrating and destroying the fourth and fifth sacral nerves and invading the right gluteal fossa. A 7.5 x 15 x 2 cm encapsulated mass was demonstrated during the operation using a posterior approach and the lower sacral segments together with the tumour were removed by amputation at S3 level. Histopathology revealed chordoma. This case is unique because of the rarity of chordoma in association with rectal tumour at the sacrococcygeal region.
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ranking = 1
keywords = sacrum
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2/17. The partial gluteus maximus musculocutaneous turnover flap. An alternative concept for simultaneous reconstruction of combined defects of the posterior perineum/sacrum and the posterior vaginal wall.

    Three cases with posterior perineo-sacral defects are presented. One is a 57-year-old white female following amputation of her rectum for carcinoma, radiation and chemotherapy with a significant residual sacral/perineal defect and loss of the posterior vaginal wall. The two other patients had radical pelvic exenteration after recurrent rectum carcinoma. A new myocutaneous turnover flap as a modification of the conventional gluteus maximus flap was designed to solve the particular reconstructive problems. The flap is based on branches of the inferior gluteal artery. The posterior cutaneous femoral nerve and the motor branches of the inferior gluteal nerve not leading into the muscle portion of the flap are left intact. The skin island can be used for vaginal reconstruction or can be de-epithelialised to fill perineal cavities. This new flap eventually enabled the successful reconstruction of the posterior vaginal wall and appropriate sacral/perineal soft tissue coverage in the first case. In the other patients the flap was used to achieve closure of the deep through-and-through defect acutely in one case, and after a 3-week interval in the other.
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ranking = 4
keywords = sacrum
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3/17. Fine-needle aspiration cytologic diagnosis of giant-cell tumor of the sacrum presenting as a rectal mass: A case report.

    A giant-cell tumor of the sacrum is rare, and poses significant therapeutic and surgical difficulties largely because of its location. patients usually present with pain in the lower back radiating to one or both lower limbs, with or without neurological deficit. The index case presented with difficulty in defecation, in addition to pain in both lower limbs for 6 mo. The patient was seen to have a rectal mass, and a per-rectal fine-needle-aspiration was performed. The smears showed a cellular aspirate composed of a large number of osteoclastic giant cells, admixed intimately with clusters and a scattered population of mononuclear cells. Mitotic figures were not observed. Although the differential diagnosis of osteoclastic giant cell-containing lesions is broad, the presence of strong cohesiveness between the mononucleated cells and giant cells in cohesive clusters is a very helpful diagnostic feature, and was a prominent finding in the present case.
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ranking = 5
keywords = sacrum
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4/17. Pelvic radioiodine uptake in a rectal wall teratoma after thyroidectomy for papillary carcinoma.

    A 30-yr-old woman with previously resected papillary thyroid carcinoma was found to have a pelvic lesion which concentrated radioiodine. By performing simultaneous 131I whole-body and 99mTc-methylene diphosphonate bone scans, we found the lesion to be in soft tissue between the sacrum and bladder. Radioiodine therapy was postponed so that the lesion, a benign teratoma of the rectal wall, could be surgically removed. Prior to laparotomy, the patient received a second tracer dose of 131I so that the lesion could be located at surgery with a hand-held gamma detector. A postoperative whole-body 131I scan confirmed that the lesion had been removed, thus reducing the absorbed radiation that would have been received by the ovaries during radioiodine therapy. Although the lesion contained both thyroid and gastric epithelium, accumulated 131I was limited to the area with thyroid follicles.
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ranking = 1
keywords = sacrum
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5/17. Successful resection of locally advanced rectal carcinoma combined with preoperative chemoradiation.

    Chemoradiation increases the local control and colostomy-free survival in patients with advanced anal canal carcinomas. We recently experienced a 50-year-old female patient with locally advanced carcinoma of the rectum invading to the sacrum, which could not be surgically resected. Therefore, we performed a colostomy and transarterial infusion of anti-tumor drugs including 50 mg cisplatin and 10 mg mitomycin C via the inferior mesentery artery in September 1999. She then underwent radiotherapy with a total dose of 64 Gy for the primary tumor. After the radiotherapy the patient received 125 mg/body of 1-leucovorin by 2-hour infusion and, one hour after starting the 1-leucovorin infusion, she received an intravenous bolus of 250 mg/body of 5-fluorouracil. This regimen was conducted biweekly for 13 courses followed by oral administration of 400 mg 5'-deoxyfluorouridine for one year. Since the chemoradiation resulted in a successful response, the patient underwent curative resection of the primary tumor in June 2001. The resected tumor (32 x 35 mm) had clean margins. Although the carcinoma cells had disappeared, fibrous lesions were observed over a broad area. Based on these pathologic findings, the treatment effect was judged as grade Ib.
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ranking = 1
keywords = sacrum
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6/17. 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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ranking = 2
keywords = sacrum
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7/17. Tamponade of presacral hemorrhage with hemostatic sponges fixed to the sacrum with endoscopic helical tackers: report of two cases.

    Presacral venous hemorrhage is a severe complication in low rectal surgery. This complication was encountered in 5 of 165 patients (3 percent) who underwent a presacral dissection for rectal mobilization. Conventional hemostatic measures often are ineffective to arrest this hemorrhage, and a number of alternative hemostatic techniques have been proposed. We report the successful tamponade of presacral hemorrhage with absorbable hemostatic sponges fixed to the sacrum with endoscopic helical tackers.
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ranking = 5
keywords = sacrum
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8/17. Combined multistep approach in a locally advanced rectal cancer with sacral invasion: case report.

    Composite pelvic resection with sacrectomy may provide good local control in case of locally advanced rectal cancer infiltrating the sacral bone. A combined multidisciplinary approach including chemotherapy and radiotherapy is here presented for a case of rectal tumor invading the sacrum.
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ranking = 1
keywords = sacrum
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9/17. Triad of anorectal stenosis, sacral anomaly and presacral mass: a remediable cause of severe constipation.

    Two neonates with intestinal obstruction and two children (aged 1 and 4 years) with severe constipation since birth are reported in whom stenosis of the distal rectum was found. In association with the rectal anomaly, three of them had a presacral tumour (teratoma in two, hamartoma in one) and all had a deformed sacrum. An embryological hypothesis to explain this association has been postulated by Currarino, after whom this triad has been named. Two patients were related (father and daughter). The role of hereditary factors in the occurrence of the syndrome has been reported before. Operative treatment of the rectal stenosis was necessary in all patients. Preoperative diverting colostomy was performed in three cases, followed by a posterior sagittal approach to excise the rectal stenosis and the presacral mass. In one case, persistent cerebrospinal fluid leakage required re-exploration for closure of a tear in a congenitally abnormal dural sac. The fourth patient had undergone a low anterior resection in the past via the abdominal route and needed rectal dilatation afterwards for some time. The final result in all patients appears satisfactory, although follow-up is short. Most cases of this triad have been reported in children but a number of patients have been diagnosed only as adults. Recognition of this triad should imply a careful search for neural crest malformations. Operative treatment to correct all soft tissue anomalies leads to good results.
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ranking = 1
keywords = sacrum
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10/17. A case of rectal carcinoid with extensive sacral breakage.

    A 48 year old woman with a massive retrorectal tumor extensively invading the sacrum is presented herein. A submucosal tumor, apparently of rectal origin, was found on the posterior rectal wall infiltrating posteriorly into the sacrum. Abdominosacral resection of the rectum with partial sacrectomy was thus performed and postoperative examination revealed the tumor to be carcinoid which has hitherto been associated with moderately benign behavior. Although remote metastasis was absent, extensive lymph node metastasis was observed, however, 2 years have passed since the operation without any evidence of recurrence.
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ranking = 2
keywords = sacrum
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