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Paul H. Sugarbaker - One of the best experts on this subject based on the ideXlab platform.
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psoas iliacus muscle invasion from Mucinous appendiceal neoplasm radiologic appearance and outcome of treatment in 3 patients
Surgical Oncology-oxford, 2018Co-Authors: Paul H. SugarbakerAbstract:Abstract Background Mucinous appendiceal neoplasms have a pattern of metastases that is different from the other gastrointestinal cancers. The first site for cancer dissemination is the peritoneal space surrounding the primary Tumor and this is followed by increasingly extensive peritoneal spread. Invasion of the psoas and iliacus muscle is an unusual phenomenon. Method From a prospective database of appendiceal Mucinous neoplasms treated by cytoreductive surgery (CRS) and perioperative hyperthermic chemotherapy (HIPEC), patients with psoas muscle invasion were reviewed. Their clinical features and treatments were tabulated. Results Three patients with ages 33, 60, and 63 were identified. Two patients had disease progression into the psoas muscle 33 and 95 months after CRS plus HIPEC. One had dissecting Mucinous Tumor into psoas, iliacus and quadratus lumborum muscle at the time of diagnosis of the appendiceal Mucinous neoplasm. All three survived at least five years from their initial treatment. Conclusion Despite the fact that Mucinous Tumor invasion was outside the peritoneal cavity, long term benefit from psoas muscle resection with a Mucinous appendiceal neoplasm is possible and resection possibly with HIPEC should be considered.
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Psoas/iliacus muscle invasion from Mucinous appendiceal neoplasm. Radiologic appearance and outcome of treatment in 3 patients.
Surgical oncology, 2018Co-Authors: Paul H. SugarbakerAbstract:Abstract Background Mucinous appendiceal neoplasms have a pattern of metastases that is different from the other gastrointestinal cancers. The first site for cancer dissemination is the peritoneal space surrounding the primary Tumor and this is followed by increasingly extensive peritoneal spread. Invasion of the psoas and iliacus muscle is an unusual phenomenon. Method From a prospective database of appendiceal Mucinous neoplasms treated by cytoreductive surgery (CRS) and perioperative hyperthermic chemotherapy (HIPEC), patients with psoas muscle invasion were reviewed. Their clinical features and treatments were tabulated. Results Three patients with ages 33, 60, and 63 were identified. Two patients had disease progression into the psoas muscle 33 and 95 months after CRS plus HIPEC. One had dissecting Mucinous Tumor into psoas, iliacus and quadratus lumborum muscle at the time of diagnosis of the appendiceal Mucinous neoplasm. All three survived at least five years from their initial treatment. Conclusion Despite the fact that Mucinous Tumor invasion was outside the peritoneal cavity, long term benefit from psoas muscle resection with a Mucinous appendiceal neoplasm is possible and resection possibly with HIPEC should be considered.
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Histopathologic analysis in 46 patients with pseudomyxoma peritonei syndrome: failure versus success with a second-look operation.
Modern pathology : an official journal of the United States and Canadian Academy of Pathology Inc, 2001Co-Authors: Hui Yan, Sophie R. Pestieau, Barry M. Shmookler, Paul H. SugarbakerAbstract:Pseudomyxoma peritonei syndrome is a disease characterized by Mucinous ascites and Mucinous Tumor disseminated on peritoneal surfaces; the disease almost always originates from a perforated appendiceal epithelial Tumor. Histopathologic assessment of aggressive versus noninvasive character of the Mucinous Tumor has been shown to have an impact on survival in patients treated with cytoreductive surgery and intraperitoneal chemotherapy. Out of a database of 312 patients having a complete cytoreduction for pseudomyxoma peritonei syndrome, 46 patients (24 male and 22 female) had at least one second-look surgery. Before this review, all 46 of these patients were clinically uniformly categorized with a diagnosis of pseudomyxoma peritonei. Using the criteria described by Ronnett and colleagues, all specimens from the multiple surgical procedures performed on these patients were reviewed and reclassified as disseminated peritoneal adenomucinosis (adenomucinosis), adenomucinosis/Mucinous adenocarcinoma (hybrid), or Mucinous adenocarcinoma. The review was performed in a blinded fashion by a single pathologist (HY). To facilitate a critical evaluation of these histopathologic assessments, the patients were separated into two groups: (1) 19 patients who had a second-look surgery that was unsuccessful in that they went on to die of their disease or in that they currently have disease progression and a limited survival and (2) 27 patients who had a successful second look and currently continue disease free with a minimum 3-year follow-up period. As a result of this review, 11 of 19 patients with an unsuccessful second look and originally designated pseudomyxoma peritonei were reclassified as hybrid-type malignancy (four patients) or Mucinous adenocarcinoma (seven patients). Only two patients were reclassified in the successful second-look group (P =.0005). Transitions from a less aggressive to a more invasive histology from one cytoreduction to the next occurred on 13 occasions in patients whose second-look surgery failed and in one patient with a successful second-look surgery (P
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pleural extension of Mucinous Tumor in patients with pseudomyxoma peritonei syndrome
Annals of Surgical Oncology, 2000Co-Authors: Sophie R. Pestieau, Jesus Esquivel, Paul H. SugarbakerAbstract:Background Pseudomyxoma peritonei syndrome is a rare disease arising from perforation of an adenoma of the appendix. The syndrome is characterized by progressive accumulation of Mucinous fluid and Tumor within the abdomen and pelvis. Although this Tumor is only superficially invasive and does not metastasize, it is a fatal disease. Extra-abdominal spread of pseudomyxoma peritonei is a rare occurrence, with few reports in the medical literature. This review focuses on pleural extension of Mucinous Tumor in patients with pseudomyxoma peritonei syndrome.
Masao Tanaka - One of the best experts on this subject based on the ideXlab platform.
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Total pancreatectomy for intraductal papillary-Mucinous Tumor of the pancreas : Reappraisal of total pancreatectomy
Hepato-gastroenterology, 2005Co-Authors: Koji Yamaguchi, Hiroyuki Konomi, Kiichiro Kobayashi, Yasuhiro Ogura, Yukio Sonoda, Masahiko Kawamoto, Kenji Nakano, Masao TanakaAbstract:Background/Aims: Total pancreatectomy is rarely performed as the treatment of pancreatic carcinoma because of markedly impaired quality of life and poor prognosis. Intraductal papillary-Mucinous Tumor (IPMT) of the pancreas is characterized by extensive intraductal spread and favorable outcome even in its invasive stage. The role of total pancreatectomy was reappraised in the treatment of IPMT. Methodology: A total of five Japanese patients with IPMT underwent total pancreatectomy and their clinical follow-up data were reviewed. Results: Total pancreatectomy was performed due to massive involvement of the entire pancreas in two patients, positive surgical margins on frozen section in one, benign IPMT with concomitant pancreatic cancers in one and recurrent IPMT in the remnant pancreas after distal pancreatectomy for IPMT in the other. Three of them underwent total pancreatectomy of the Whipple type, another underwent total gastrectomy and the other underwent the pylorus-preserving method. Surgical margins were negative by histology and no lymph node metastases were evident. Two patients had severe infection including liver abscess in one and pneumonia in the other. The former died on postoperative day 82 and the latter was controlled by medical treatment and discharged on postoperative day 73. The other three patients had an uneventful postoperative course and were discharged from 29 to 62 days after the operation. Long-term follow-up of the four patients revealed that three patients had hypoglycemic attacks, two diabetic retinopathy and two fatty liver. The four patients were doing well from 683 to 4,140 days after the operation without signs of recurrence. Conclusions: Total pancreatectomy would be indicated as a treatment of benign or malignant IPMT with extensive involvement when patients' condition permits and gives a chance of cure, although careful long-term medical care and follow-up are essential.
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intraductal papillary Mucinous Tumor of the pancreas concomitant with ductal carcinoma of the pancreas
Pancreatology, 2002Co-Authors: Koji Yamaguchi, Kenji Nakano, Jiro Ohuchida, Takao Ohtsuka, Masao TanakaAbstract:Background: Despite the recent progress of diagnostic and therapeutic modalities, the clinical course of patients with ductal carcinoma (DC) of the pancreas remains dismal. Intraduc
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intraductal papillary Mucinous Tumor of the pancreas a historical review of the nomenclature and recent controversy
Pancreas, 2001Co-Authors: Koji Yamaguchi, Masao TanakaAbstract:Summary: A number of studies on mucin-producing cystic neoplasm of the pancreas have been reported since the first report of the Tumor in 1982. There has been some controversy about nomenclatures and clinicopathologic entities of mucin-producing cystic Tumor, Mucinous cystic Tumor, and intraductal papillary Tumor of the pancreas. In 1996 and 1997, new classifications of pancreatic neoplasms were published by the World Health Organization (WHO) and Armed Forces Institute of Pathology (AFIP). According to the new WHO and AFIP classifications, mucin-producing cystic neoplasm of the pancreas corresponds mainly to intraductal papillary-Mucinous Tumor and Mucinous cystic Tumor of the pancreas, and these two diseases are independent conditions. Intraductal papillary-Mucinous Tumor is regarded as a unique clinical entity, but controversy remains about the term and clinicopathologic entity. Some confusion and problems remain betweeen the two lesions. In this review, we review their historical background, terminology, WHO and AFIP classification, and problems with classification.
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intraductal papillary Mucinous Tumor of the pancreas assessing the grade of malignancy from natural history
American Surgeon, 2001Co-Authors: Koji Yamaguchi, Atsushi Sugitani, Kazuo Chijiiwa, Masao TanakaAbstract:Intraductal papillary-Mucinous Tumor of the pancreas is a spectrum of conditions ranging from benign to malignant, and very few papers have referred to the natural history of this disease. In this communication the indicators of malignancy were examined from a viewpoint of natural history. Follow-up computed tomographies (CTs) more than 6 months after the diagnosis were reviewed in 17 Japanese patients with intraductal papillary-Mucinous Tumor of the pancreas. They were divided into two groups by the presence or absence of morphological progressive changes by the follow-up CTs, and the clinicopathological features were compared between the two groups to examine possible malignant indicators. The 17 patients consisted of seven patients in the no-change group and ten in the progressive group. The distribution of the patients was not different with regard to age; gender; or presence or absence of pancreatitis, diabetes mellitus, or unique findings of the ampulla of Vater between the two groups. The dilatation of the main pancreatic duct (> or = 3 mm) was more frequent in the progressive group: (eight of ten patients; 80%) than in the no-change group (two of seven patients; 29%) (P = 0.03). Six (86%) of the seven Tumors in the no-change group were located in the branch duct, whereas five (50%) of the ten in the progressive group were situated in the main pancreatic duct. Histopathologic diagnoses of the resected specimens of the four in the no-change group examined were intraductal papillary-Mucinous adenoma in three and adenoma with moderate dysplasia in one, whereas the diagnoses in the six in the progressive group examined were adenoma in two, adenoma with moderate dysplasia in two, and carcinoma (invasive) in two. The patients with intraductal papillary-Mucinous Tumor of the pancreas with a dilatation of the main pancreatic duct at the time of diagnosis should be followed up more carefully than those without dilatation. Once progressive morphological changes are detected by the follow-up CTs surgical resection should be considered because of possible malignancy.
Robert H Young - One of the best experts on this subject based on the ideXlab platform.
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primary ovarian Mucinous Tumors with signet ring cells report of 3 cases with discussion of so called primary krukenberg Tumor
The American Journal of Surgical Pathology, 2008Co-Authors: Glenn W Mccluggage, Robert H YoungAbstract:The distinction between a primary ovarian Mucinous carcinoma or even a borderline Mucinous Tumor and a metastatic Mucinous carcinoma may be difficult. A constellation of clinical, gross pathologic and morphologic features is used in this distinction. One of the most important morphologic features suggesting a metastatic Mucinous carcinoma in the ovary is the presence of signet ring cells; these are considered rare in primary ovarian Mucinous Tumors. In this study, we report 3 primary ovarian Mucinous Tumors with a component of signet ring cells. The Tumors arose in patients aged 27, 55, and 60, were unilateral, confined to the ovary and stage IA. They ranged from 9 to 27 cm; 1 was grossly a multiloculated cystic lesion and 2 were cystic and solid. In one case, the neoplasm had the architecture of a Mucinous adenofibroma but had frankly malignant cells lining glands and forming solid aggregates of cells. A second Tumor also had the background of an adenofibroma. The third was mostly a Mucinous cystadenoma. In one case, endometriosis was present in the same ovary; teratomatous elements were not identified in any case. Immunohistochemistry, performed in 2 cases, showed both to be diffusely positive with CK7 and CA19.9, including the signet ring cells. CK20 was positive in both cases (1 focal; 1 diffuse). Estrogen receptor and CA125 were diffusely positive and carcinoembryonic antigen and CDX2 focally positive in 1 case. Chromogranin and synaptophysin were negative. Investigations to exclude a gastrointestinal neoplasm in 2 cases were negative. Features favoring a primary rather than a metastatic neoplasm are unilateral Tumor, low stage, background of adenofibroma or cystadenoma, associated endometriosis in 1 case and an absence of features which are characteristic of secondary Mucinous carcinomas in the ovary, such as surface Tumor deposits, a nodular growth pattern, and lymphovascular permeation. Immunohistochemistry is of limited value because of overlapping immunophenotype between a primary ovarian Mucinous Tumor and a metastasis from the stomach, pancreas, biliary tree, appendix, or colorectum, the most likely primary sites for a secondary exhibiting similar features. Our study illustrates that signet ring cells occur rarely in a primary ovarian Mucinous Tumor; even when conspicuous the features differ from those of the usual Krukenberg Tumor. At least some cases of so-called primary Krukenberg Tumor may be similar to our cases. However, the designation primary Krukenberg Tumor should not be used as, apart from the signet ring cells, a resemblance to a "true" Krukenberg Tumor of the secondary type is limited. The Tumors should be classified according to the underlying background neoplasm with a notation concerning the signet ring cell component.
Sophie R. Pestieau - One of the best experts on this subject based on the ideXlab platform.
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Histopathologic analysis in 46 patients with pseudomyxoma peritonei syndrome: failure versus success with a second-look operation.
Modern pathology : an official journal of the United States and Canadian Academy of Pathology Inc, 2001Co-Authors: Hui Yan, Sophie R. Pestieau, Barry M. Shmookler, Paul H. SugarbakerAbstract:Pseudomyxoma peritonei syndrome is a disease characterized by Mucinous ascites and Mucinous Tumor disseminated on peritoneal surfaces; the disease almost always originates from a perforated appendiceal epithelial Tumor. Histopathologic assessment of aggressive versus noninvasive character of the Mucinous Tumor has been shown to have an impact on survival in patients treated with cytoreductive surgery and intraperitoneal chemotherapy. Out of a database of 312 patients having a complete cytoreduction for pseudomyxoma peritonei syndrome, 46 patients (24 male and 22 female) had at least one second-look surgery. Before this review, all 46 of these patients were clinically uniformly categorized with a diagnosis of pseudomyxoma peritonei. Using the criteria described by Ronnett and colleagues, all specimens from the multiple surgical procedures performed on these patients were reviewed and reclassified as disseminated peritoneal adenomucinosis (adenomucinosis), adenomucinosis/Mucinous adenocarcinoma (hybrid), or Mucinous adenocarcinoma. The review was performed in a blinded fashion by a single pathologist (HY). To facilitate a critical evaluation of these histopathologic assessments, the patients were separated into two groups: (1) 19 patients who had a second-look surgery that was unsuccessful in that they went on to die of their disease or in that they currently have disease progression and a limited survival and (2) 27 patients who had a successful second look and currently continue disease free with a minimum 3-year follow-up period. As a result of this review, 11 of 19 patients with an unsuccessful second look and originally designated pseudomyxoma peritonei were reclassified as hybrid-type malignancy (four patients) or Mucinous adenocarcinoma (seven patients). Only two patients were reclassified in the successful second-look group (P =.0005). Transitions from a less aggressive to a more invasive histology from one cytoreduction to the next occurred on 13 occasions in patients whose second-look surgery failed and in one patient with a successful second-look surgery (P
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pleural extension of Mucinous Tumor in patients with pseudomyxoma peritonei syndrome
Annals of Surgical Oncology, 2000Co-Authors: Sophie R. Pestieau, Jesus Esquivel, Paul H. SugarbakerAbstract:Background Pseudomyxoma peritonei syndrome is a rare disease arising from perforation of an adenoma of the appendix. The syndrome is characterized by progressive accumulation of Mucinous fluid and Tumor within the abdomen and pelvis. Although this Tumor is only superficially invasive and does not metastasize, it is a fatal disease. Extra-abdominal spread of pseudomyxoma peritonei is a rare occurrence, with few reports in the medical literature. This review focuses on pleural extension of Mucinous Tumor in patients with pseudomyxoma peritonei syndrome.
Bengt Ehliar - One of the best experts on this subject based on the ideXlab platform.
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primary retroperitoneal Mucinous Tumor of low malignant potential histogenetic aspects and review of the literature
Apmis, 1997Co-Authors: Nikos Papadogiannakis, Adel Gad, Bengt EhliarAbstract:We report an unusual Mucinous Tumor of low malignant potential, of ovarian-like type, arising in the retroperitoneum of an otherwise healthy 33-year-old woman. This is the fifth described case of such a Tumor in the world literature, and the first reported in Scandinavia or Europe. We also discuss aspects of the histogenesis of this type of Tumor and review the available literature. The histological heterogeneity and metastatic potential of the Tumor warrant careful histopathologic analysis and follow-up of patients presenting with such lesions.