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Статті в журналах з теми "Seconds malignant neoplasm"
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Karthikeyan, Vilvapathy Senguttuvan, Sarath Chandra Sistla, Ramachandran Srinivasan, Debdatta Basu, Lakshmi C. Panicker, Sheik Manwar Ali, and Nagarajan Rajkumar. "Metachronous Multiple Primary Malignant Neoplasms of the Stomach and the Breast: Report of Two Cases With Review of Literature." International Surgery 99, no. 1 (January 1, 2014): 52–55. http://dx.doi.org/10.9738/intsurg-d-13-00056.1.
Повний текст джерелаАнотація:
Abstract Multiple primary malignant neoplasm is the occurrence of a second primary malignancy in the same patient within 6 months of the detection of first primary (synchronous), or 6 months or more after primary detection (metachronous). Multiple primary malignant neoplasms are not very frequently encountered in clinical practice. The relative risk for a second primary malignancy increases by 1.111-fold every month from the detection of the first primary malignancy in any individual. We present 2 patients treated for carcinoma of the breast who developed a metachronous primary malignancy in the stomach to highlight the rare occurrence of multiple primary malignant neoplasms. These tumors were histologically dissimilar, with distinct immunohistochemical parameters. The importance lies in carefully identifying the second primary malignancies, not dismissing them as metastases, and treating them accordingly.
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Dewi, Noni Trisna, Ramses Indriawan, Ewaldo Amirullah Hadi, and Tomi Irmayanto. "CASE REPORT : BREAST CARCINOMA STADIUM IIIB." Lombok Health And Science Journal 2, no. 1 (April 29, 2023): 6–8. http://dx.doi.org/10.29303/lhsj.v2i1.2502.
Повний текст джерелаАнотація:
Introduction: Breast Carcinoma is a malignant tumor originating from the parenchymal epithelial cells of the breast. This includes the ducts of the mammary glands and their supporting tissues, which grow infiltratively, destructively, and can metastasize. In 2018, an estimated 2.1 million women were newly diagnosed with breast cancer, about one new case diagnosed every 18 seconds. The global incidence of breast cancer has increased with an annual year increase of 3.1%
Case presentation: A female 51-years-old patient with right breast cancer on chemotherapy. She already has 6 times chemotherapy session the patient had a biopsy done one year ago and the results of the biopsy were obtained from a patient with grade 2 breast cancer, the patient had been offered to do breast removal but the patient refused, at this time the lump in the patient burst and bled continuously
Conclusion: Breast cancer (Carcinoma mammae) is cancer of the breast tissue. Ca Mammae occurs because the condition of the cell has lost its normal control and mechanism, so that it experiences abnormal, fast and uncontrolled growth. Ca Mammae is often defined as a malignant neoplasm disease originating from the mammary gland parenchyma. There are various hormonal and non-hormonal factors that are thought to increase the risk of breast cancer, including age, genetic and familial, hormonal, lifestyle, environment, and a history of benign tumors.
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Giongo, Sofia Marasca, Henrique Sarubbi Fillmann, Lucio Sarubbi Fillmann, and Alexandre Vontobel Padoin. "Quality Assessment of Colonoscopies Performed by Resident Physicians in Colorectal Surgery." Journal of Coloproctology 44, no. 02 (June 2024): e120-e125. http://dx.doi.org/10.1055/s-0044-1787140.
Повний текст джерелаАнотація:
Abstract Introduction Colorectal cancer is the third most common malignant neoplasm worldwide, with ∼ 150 thousand new cases each year. Screening policies have brought significant progress due to the possibility of early diagnosis and polyp resection. Therefore, there is a need for continuous evaluation of the quality of colonoscopies based on well-established criteria in the literature. Materials and Methods The present retrospective study assesses the quality of colonoscopies performed at a tertiary hospital, comparing resident physicians with their preceptors. A total of 422 preceptor exams and 115 resident exams were evaluated, with a comparison of the adenoma detection rate, cecal intubation rate, examination time, and bowel preparation quality. Results The adenoma detection rate in the exams performed by preceptors was of 46.9%, while in those performed by residents, it was of 35.2% (p = 0.038). The cecal intubation rate was of 98.6% in the preceptor group and of 94.8% in the resident group (p = 0.025). The median total examination time was of 13 minutes and 42 seconds in the preceptor group and of 19 minutes and 22 seconds in the resident group (p < 0.005). Conclusion During their training, resident physicians perform an adequate number of colonoscopies, which enables them to achieve adenoma detection rates, cecal intubation and examination times within the limits proposed by the literature.
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Burns, Ethan A., Cesar Gentille, Saro Kasparian, and Sai Ravi Pingali. "A Case of Histiocytic Sarcoma Arising from Mycosis Fungoides." Case Reports in Hematology 2019 (October 3, 2019): 1–7. http://dx.doi.org/10.1155/2019/7834728.
Повний текст джерелаАнотація:
Histiocytic sarcoma (HS) is an uncommon malignant neoplasm arising from mature histiocytes and most commonly characterized by the immunophenotypic expression of CD68, CD163, or lysozyme. Although rare, HS arising as a second primary malignancy following hematolymphoid neoplasms has been reported. To our knowledge, this is the first reported case of HS occurring as a second primary malignancy in a patient with mycosis fungoides (MF), with the retained immunophenotype markers CD30 and CD4.
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Ronchi, Andrea, Martina Di Martino, Alessandro Caputo, Pio Zeppa, Giuseppe Colella, Renato Franco, and Immacolata Cozzolino. "Fine-Needle Aspiration Cytology Is an Effective Diagnostic Tool in Paediatric Patients with Mucoepidermoid Carcinoma as Secondary Neoplasm." Acta Cytologica 64, no. 6 (2020): 520–31. http://dx.doi.org/10.1159/000508395.
Повний текст джерелаАнотація:
<b><i>Background:</i></b> Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumour in paediatric population, accounting for 16% of all cases. Patients affected by a previous solid or leukaemic neoplasm during their childhood may develop a second different tumour during the follow-up. In this setting, salivary gland MEC is relatively frequent, accounting for 6% of the second neoplasms in paediatric patients. Consequently, the occurrence of salivary gland nodules in paediatric patients with a previous neoplasm should be considered an event with a high risk of malignancy that poses peculiar diagnostic challenges. <b><i>Summary:</i></b> This study was designed to define clinical and instrumental findings and morphological features of MEC on fine-needle aspiration cytology (FNAC) samples in paediatric patients with and without a previous neoplasm. Five patients under 19 years are included in this series. FNAC was performed in all patients on a parotid nodule. We have identified 2 groups of patients: (a) 2 cases with previous history of malignancy (acute lymphoblastic leukaemia and Hodgkin lymphoma) and (b) 3 cases without previous malignant neoplasms. In all cases, a final diagnosis of MEC was rendered. <b><i>Key Messages:</i></b> MEC may occur as a second malignancy in paediatric patients. FNAC is certainly a valid and accurate diagnostic tool for this type of neoplasm, even in the paediatric age, allowing the correct management of the patients.
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Pytel, Nicholas, Erik Dedekam, Shahriar M. Salamat, and Diane Puccetti. "NCMP-22. SECOND MALIGNANCIES FOLLOWING TREATMENT FOR PRIMARY CENTRAL NERVOUS SYSTEM TUMORS IN PEDIATRIC PATIENTS: A SINGLE-INSTITUTIONAL RETROSPECTIVE REVIEW." Neuro-Oncology 22, Supplement_2 (November 2020): ii127. http://dx.doi.org/10.1093/neuonc/noaa215.533.
Повний текст джерелаАнотація:
Abstract Second malignant neoplasms following treatment for primary central nervous system (CNS) tumors in children are rare occurrences but may often have dire consequences, particularly, if thought to be induced by prior therapies. The authors retrospectively reviewed pediatric patients with primary CNS malignancies from the University of Wisconsin over the last 25 years (1994 – 2019) with any secondary malignant neoplasm and determined seven patients met criteria. Treatment modalities were reviewed with all patients receiving surgery, chemotherapy, and radiotherapy for treatment of their first malignancy. The second neoplasms found included 4 high-grade gliomas, 1 meningioma, 1 thyroid carcinoma, and 1 myelodysplastic syndrome. The median latency time between diagnoses was 9 years (range 4 -17 years). The outcomes varied according to histopathology of the second neoplasm with the high-grade glioma patients all deceased from progressive disease. The high-grade gliomas were thought to have been induced by prior radiation in most cases. The remaining patients are still alive, at the time of this writing, and in follow up after treatment for their second neoplasm. Thus, long-term follow up is essential for children treated for a primary CNS tumor given the variety of second neoplasms that could arise with differential consequences. In addition to our single institutional outcomes, we will also present an updated review of the literature of pediatric patients with primary CNS tumors and second malignancies.
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Pytel, Nicholas, Erik Dedekam, M. Shahriar Salamat, and Diane Puccetti. "RARE-41. SECOND MALIGNANCIES FOLLOWING TREATMENT FOR PRIMARY CENTRAL NERVOUS SYSTEM TUMORS IN PEDIATRIC PATIENTS: A SINGLE-INSTITUTIONAL RETROSPECTIVE REVIEW." Neuro-Oncology 22, Supplement_3 (December 1, 2020): iii451. http://dx.doi.org/10.1093/neuonc/noaa222.751.
Повний текст джерелаАнотація:
Abstract Second malignant neoplasms following treatment for primary central nervous system (CNS) tumors in children are rare occurrences but may often have dire consequences, particularly, if thought to be induced by prior therapies. The authors retrospectively reviewed pediatric patients with primary CNS malignancies from the University of Wisconsin over the last 25 years (1994 – 2019) with any secondary malignant neoplasm and determined seven patients met criteria. Treatment modalities were reviewed with all patients receiving surgery, chemotherapy, and radiotherapy for treatment of their first malignancy. The second neoplasms found included 4 high-grade gliomas, 1 meningioma, 1 thyroid carcinoma, and 1 myelodysplastic syndrome. The median latency time between diagnoses was 9 years (range 4 -17 years). The outcomes varied according to histopathology of the second neoplasm with the high-grade glioma patients all deceased from progressive disease. The high-grade gliomas were thought to have been induced by prior radiation in most cases. The remaining patients are still alive, at the time of this writing, and in follow up after treatment for their second neoplasm. Thus, long-term follow up is essential for children treated for a primary CNS tumor given the variety of second neoplasms that could arise with differential consequences. In addition to our single institutional outcomes, we will also present an updated review of the literature of pediatric patients with primary CNS tumors and second malignancies.
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Tavernier, Emmanuelle, Stephane de Botton, Nathalie Dhedin, Claude-Eric Bulabois, Oumedaly Reman, Norbert Vey, Frederic Garban, et al. "Secondary or Concomitant Neoplasms among Adults Diagnosed with Acute Lymphoblastic Leukemia (ALL) and Treated According to the LALA-87 and LALA-94 Trials." Blood 106, no. 11 (November 16, 2005): 1826. http://dx.doi.org/10.1182/blood.v106.11.1826.1826.
Повний текст джерелаАнотація:
Abstract Second malignant neoplasms are a serious complication after successful treatment of childhood ALL. Although treatment intensity and outcome were not comparable, with improvements in survival, it is important to evaluate the rate and the type of second neoplasms in adults with ALL. We analyzed the data from the GET-LALA group. A cohort of 1493 patients, aged 15 to 60 years and enrolled on two successive multicenter protocols between 1987 and 2002, was observed to determine the incidence of second neoplasms and associated risk factors. The median follow-up time from diagnosis was 6 years. By February 2005, secondary or concomitant neoplasms were documented in 23 patients (median age: 36 years, range:18–57) including 9 acute myeloid leukemias, 4 non Hodgkin lymphomas, 5 skin tumors, and 5 other solid tumors (1 lung cancer, 1 tongue carcinoma, 1 thymoma, 1 condrosarcoma, 1 histiocytosis). Neoplasms developed 0.5 to 13.8 years (median, 4.5 years) after the diagnosis of ALL. 22 patients were in first remission, one was in second remission. The overall cumulative risk of secondary neoplasms was 2.1% at 5 years, 4.9% at 10 years, 9.4% at 15 years. The cumulative risk of developing a second hematologic malignancy was 1.8% at 5 years, 2.2% at 10 years, 3.3% at 18 years; that of developing a solid tumor was 0.2% at 5 years, 2.8% at 10 years, 6.2% at 15 years. The development of secondary neoplasm was not associated with the use of any specific cytotoxic agent. However, risk of skin tumor increased with radiation dose and transplantation (p = 0.01). Overall survival after the diagnosis of a second malignant neoplasm was 55% at 10 years. However, the median overall survival in patients developing acute myeloid leukemia was of 5.7 months. Considering the low-survival rate of this large unselected adult ALL cohort (32% at 10 years), considering the poorer results comparing to childhood ALL treatment, the risk of secondary or concomitant neoplasm remains probably under estimated. Larger series with long-term follow-up are, however, mandatory. Figure Figure
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Fernández-Cuadros, Marcos E., Javier Nieto-Blasco, Antonia Geanini-Yagüez, Daniel Ciprián-Nieto, Bárbara Padilla-Fernández, and Mª Fernanda Lorenzo-Gómez. "Male Urinary Incontinence." American Journal of Men's Health 10, no. 6 (July 7, 2016): NP127—NP135. http://dx.doi.org/10.1177/1557988315590653.
Повний текст джерелаАнотація:
The aim of the current study was to determine the demographic characteristics and risk factors associated with male urinary incontinence (UI) and to assess the effectiveness and the effect on the quality-of-life of a pelvic floor muscle training (PFMT) protocol with electromyography-biofeedback (EMG-BFB) with surface electrodes. A prospective, quasi-experimental before-and-after study with a sample of 61 men out of 372 patients referred to the Pelvic Floor Unit from October 2005 to June 2012 was performed. The protocol consisted of 20 sessions of EMG-BFB supervised by a physiotherapist twice a week. The session durations were 30 minutes (118 work/rest cycles of pelvic muscles). Work lasted 3 seconds and rest 7 seconds. Patients were given standards of conduct and questionnaires (International Consultation on Incontinence–Short Form and Incontinence Quality-of-Life Measure) at the beginning and at the end of the treatment. The average age was 64.85 ± 14.34 years; 44.3% ( n = 27) had benign prostatic hypertrophy, 41.9% ( n = 25) had prostate malignant neoplasm, 86.9% ( n = 53) had undergone prostatectomy, 16.4% ( n = 10) had undergone abdominal surgery. Abdominal surgery and radical prostatectomy were significantly associated with UI ( p < .05). Stress urinary incontinence was the most common type of UI (86.67%), followed by mixed urinary incontinence (8.33%) and urge urinary incontinence (5%). A significant improvement ( p < .05) in both International Consultation on Incontinence–Short Form and Incontinence Quality-of-Life Measure questionnaires was observed when making comparisons regarding the results before and after the EMG-BFB treatment protocol. These results support that male UI is significantly associated with urological and abdominal surgery (including radical prostatectomy) and that EMG-BFB for PFMT improves incontinence and quality of life (social embarrassment, limiting behavior, and psychosocial impact) in the three types of UI on an overall basis.
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Manasi, Saha, Banerjee Alpana, and Datta Abhijit. "Histological Patterns of Ovarian Neoplasms – A Five Year Experience in North-East India." International Journal of Medical and Dental Sciences 7, no. 1 (January 9, 2018): 1576. http://dx.doi.org/10.18311/ijmds/2018/18904.
Повний текст джерелаАнотація:
<p><strong>Background:</strong> Ovary is one of the common sites of neoplasm in females. They manifest in wide spectrum of clinical, morphological and histological features. Ovary is the second most common site of primary malignancy in female genital tract.</p><p><strong>Objectives:</strong> To study the frequency of different histological types of ovarian tumors and to analyze age distribution of these tumors.</p><p><strong>Materials and Methods:</strong> This was a retrospective study of all cases of ovarian tumors received at Pathology Department of Agartala Government Medical College during the period of 5 years from January 2012 to December 2016.</p><p><strong>Results:</strong> A total number of 242 cases were studied. Among these 189 cases (78.1%) were benign, 12 cases (4.96%) were borderline and 41 cases (16.94%) were malignant. Benign neoplasms were most commonly seen between 3<sup>rd</sup> and 5<sup>th</sup> decade of age whereas malignant neoplasms after 4<sup>th</sup> decade. Serous cystadenoma was the commonest benign tumor followed by mucinous cystadenoma and mature cystic teratoma. Among the malignant surface epithelial tumors, mucinous cystadenocarcinoma was most common, followed by serous cystadenocarcinoma.</p><p><strong>Conclusion:</strong> Benign ovarian neoplasms outnumber the malignant ones in all age groups. Surface epithelial tumors are the most common class of tumors and mucinous cystadenocarcinoma is the commonest malignant neoplasm.</p>
Дисертації з теми "Seconds malignant neoplasm"
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Ducos, Claire. "Cancers secondaires chez les patients ayant survécu à un cancer durant l’enfance et Identification de variants rares associés." Electronic Thesis or Diss., université Paris-Saclay, 2024. http://www.theses.fr/2024UPASR013.
Повний текст джерелаАнотація:
Il est estimé qu’un enfant sur 440 développera un cancer avant sa majorité en France. Depuis quelques décennies, grâce à une amélioration des traitements et de la prise en charge, la survie à 5 ans des patients guéris d’un cancer pédiatrique atteint plus de 80 %. Cependant, la fréquence et la diversité des pathologies iatrogènes tardives ont également augmenté. Les seconds cancers font partie des effets ayant le plus d’impact sur la mortalité et la morbidité de cette population croissante. Bien que le traitement reçu lors du cancer pédiatrique soit un facteur de risque reconnu, ce dernier ne suffit pas à expliquer complètement le risque de cancers secondaires suggérant l’existence d’une composante génétique modulant ce risque. Dans un premier temps, nous avons cherché à mieux comprendre les facteurs de risque de l'un des seconds cancers les plus fréquents, celui de la thyroïde, en étudiant l’impact des radiations reçues par les organes lymphoïdes. Nous avons ainsi mis en évidence une association entre ce risque et l’irradiation de la rate et du thymus, deux organes clés du système immunitaire. Ensuite, afin de mieux comprendre l’impact génétique sur le risque de second cancer, nous avons réalisé une revue systématique de la littérature qui a permis de recenser l’ensemble des variants, gènes et voies biologiques déjà associés au risque des différents types de seconds cancers. Finalement, une étude cas-témoins nichée dans la cohorte French Childhood Cancer Survivors Study (FCCSS) a permis de montrer que différents gènes, porteurs de variants rares, tels que APOBEC3F et RNASEL, étaient associés au risque de seconds cancers. Nous avons également mis en évidence une association entre le risque de second cancer du sein avec le gène FANCM, et de second cancer de la thyroïde avec en particulier, les gènes IFI16 et HINFP. Ainsi, les résultats obtenus au cours de cette thèse fournissent des orientations prometteuses pour contribuer à identifier les patients les plus à risque de développer un second cancer. Nos résultats après validation pourraient être considérés pour adapter le suivi à long terme des survivants mais également le traitement des patients atteints d’un cancer pédiatrique afin de minimiser le risque de survenu d’un second cancer à l’âge adulteOne in 440 children in France is expected to develop cancer before reaching the age of majority. In recent decades, thanks to improvements in treatment and patient care, the 5- year survival rate for children diagnosed with cancer has reached over 80 %. However, the frequency and diversity of late iatrogenic events have also increased. Second cancers are one of the most significant adverse effects on mortality and morbidity in this growing population. Although the treatment received for pediatric cancer is a well-known risk factor, it is not sufficient to fully explain the risk of secondary cancers, suggesting the existence of a genetic component modulating this risk. Initially, we aimed to better understand the risk factors for one of the most frequent second cancers, thyroid cancer, by investigating the impact of radiation received by lymphoid organs. We have identified an association between this risk and irradiation of the spleen and thymus, two key immune system organs. Then, to better understand the genetic impact on the risk of second cancers, we conducted a systematic review of the literature, compiling all the variants, genes and biological pathways already associated with the risk of various types of second cancers. Finally, a case-control study nested in the French Childhood Cancer Survivors Study (FCCSS) cohort showed that various genes carrying rare variants, such as APOBEC3F and RNASEL, were associated with the risk of second cancers. We also demonstrated an association between the risk of second breast cancer with the FANCM gene, and second thyroid cancer with, notably, the IFI16 and HINFP genes. The results obtained in this thesis provide promising directions that could contribute to the identification of patients at the highest risk of second cancers. Once validated, our results could be applied to adapt the long-term follow-up of survivors and the treatment of pediatric cancer patients to minimize the risk of second cancers in adulthood
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Cottrell, Catherine E. "Genetic variation and complex disease: the examination of an X-linked disorder and a multifactorial disease." The Ohio State University, 2007. http://rave.ohiolink.edu/etdc/view?acc_num=osu1196182829.
Повний текст джерела
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Tanizawa, Roberta Sandra da Silva. "Estudo morfológico e por citogenética da medula óssea de portadores de síndrome mielodisplásica secundária no Serviço de Hematologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5167/tde-27092010-145739/.
Повний текст джерелаАнотація:
As Síndromes mielodisplásicas (SMD) são doenças clonais da célula progenitora hematopoética, cursando com citopenias, medula óssea displástica e tendência à evolução para leucemia. As SMD secundárias estão associadas a fatores de risco como doenças congênitas (Anemia de Fanconi), doenças hematológicas adquiridas (aplasia medular, HPN), exposição à quimioterápicos (alquilantes, inibidores de topoisomerase II) e radioterapia e substâncias químicas (benzeno, petróleo). Agentes imunossupressores associados ou não a fatores hemopoéticos particularmente utilizados para tratamento da Aplasia medular também se associam à SMD secundária. A OMS recentemente adotou o termo síndrome mielodisplásica/neoplasia mielóde (SMD/NM) relacionada à terapêutica para englobar casos de neoplasias mielóides que preencham critérios morfológicos não somente de SMD, mas também de leucemia mielóide aguda (LMA) ou neoplasias mieloproliferativas. O objetivo do trabalho foi analisar dados clínicos, morfológicos e citogenéticos de 42 portadores de SMD/NM secundária em uma coorte de pacientes diagnosticados no SH-HCFMUSP no período de 1987 a 2008. Vinte e três pacientes (54,8%) eram homens, com mediana de idade de 53,5 (4-88) anos. 45,2% eram portadores de doenças onco-hematológicas, 26,2% de anemia aplástica, 14,3% de tumores sólidos e 14,3% de outras doenças (auto-imunes e transplante de órgãos sólidos). 33% dos pacientes utilizaram exclusivamente QT, 26% combinação QT e RT, 2% RT isolada e 28% agentes imunossupressores. Cinco (11,9%) pacientes haviam sido submetidos a TCTH autólogo para tratamento de doença oncohematológica prévia. A mediana da latência entre a doença primária e a SMD secundária foi de 85 meses (23- 221 meses). Oito pacientes foram submetidos ao TCTH alogênico aparentado para tratamento da SMD secundária. Anemia, neutropenia, plaquetopenia e blastos circulantes foram observados em 64,3%, 54,8%, 78,6% e 26,2% dos casos respectivamente. Cerca de 1/3 dos aspirados medulares apresentavam hemodiluição, 29,7% apresentavam hipocelularidade global, 62,2% apresentavam contagem de blastos superior a 5% e 14,3% sideroblastos em anel acima de 15%. Displasia da série eritróide, granulocítica e megacariocítica foi observada em 79,4%, 77,1% e 68,2% dos casos respectivamente. A histologia medular realizada em 22 casos revelou hipocelularidade global, ALIPs e nódulos linfóides em 9,1%, 23,8% e 40,9% dos casos. A detecção por imunoistoquímica de células CD34>1%, CD117>1%, agrupamento de células CD34+ e de CD117+ e da proteína p53+ foi observada respectivamente em 77,2%, 82,3%, 59%, 29,4% e 33,3% dos casos. Anormalidades clonais foram observadas em 84,3% dos casos, com grande predomínio das não balanceadas (96%), sendo 37% com monossomia 7, 44,4% cariótipos complexos e 18% com outras anormalidades . A mediana de sobrevida de sobrevida global foi de 5,7 meses, pacientes submetidos ao TCTH alogênico para tratamento da SMD/NM secundária tiveram mediana de 40 meses (p=0,007). Fatores associados à pior sobrevida incluíram: doença oncohematológica prévia, baixa contagem plaquetária, elevação de DHL e ferritina, presença de células CD117+ agrupadas, imunoexpressão positiva da p53, citogenética anormal, IPSS intermediário II ou alto risco. Nenhum parâmetro estudado do aspirado medular se associou à sobrevida. Houve tendência à associação da imunoexpressão positiva de p53 a cariótipo anormal e IPSS de maior risco. Não se observou associação entre a presença de ALIP, porcentagem de blastos na morfologia medular e células CD34+ e CD117+. Estes dados reforçam a importância da análise citogenética e da imunoistoquímica da biópsia de medula óssea para diagnóstico e prognóstico das SMD secundárias e do TCTH alogênico no seu tratamento. Mais estudos com maior número de casos devem ser realizados para confirmar a importância do escore IPSS na SMD secundárias, provavelmente substituindo a porcentagem de blastos ao aspirado medular, pela presença de células precursoras detectadas por imunoistoquímicaMyelodysplastic syndromes (MDS) are clonal hematopoietic stem cell disorders, characterized by cytopenias, dysplastic bone marrow (BM) and propensity to progress to acute myeloid leukemia. Secondary MDS are associated with risk factors such as congenital disorders (Fanconis anemia), acquired bone marrow failures, exposure to chemotherapy (alkylating agents, topoisomerase II inhibitors) agents and radiation and chemicals (benzene, petroleum). Immunosuppressive agents associated with hematopoietic growth factors are also associated with secondary MDS. The WHO classification has recently adopted the term therapy-related myeloid neoplasms for cases of myeloid malignancies that fulfill morphological criteria not only for MDS but also for AML or myeloproliferative neoplasms.The aim of the study was to analyze clinical, morphological and cytogenetic features of 42 patients with secondary MDS/MN in a cohort of patients diagnosed at our institution from 1987 to 2008. 23 patients (54.8%) were male, median age 53.5 (4-88) years. 45.2% had primary hematologic malignancies, 26.2% aplastic anemia, 14.3% solid tumors and 14.3% other diseases (autoimmune diseases and solid organ transplantation). 33% had undergone chemotherapy alone, 2% RT alone, 26% both modalities and 28% immunosuppressive agents. Five (11.9%) patients had undergone autologous HSCT for treatment of previous malignancies. The median latency between the primary disease and secondary MDS/MN was 85 (23-221) months. Eight patients underwent allogeneic HSCT (allo- HSCT) for treatment of related secondary MDS. Anemia, neutropenia, thrombocytopenia and peripheral blasts were observed in 64.3%, 54.8%, 78.6% and 26.2%, respectively. BM aspirates was poorly representative in 1/3 of cases, 29.7% global hypocellularity, 62.2% more than 5% of blast counts and 14.3% more than 15% of ring sideroblasts. Dysplasia in erythroid, granulocytic and megakaryocytic series was observed in 79.4%, 77.1% and 68.2%, respectively. Twenty two BM biopsies were performed. Global hypocellularity, ALIP and lymphoid nodules were shown in 9.1%, 23.8% and 40.9%. The immunohistochemistry showed more than 1% of CD34+ and CD117+ cells, clusters of CD34+ and CD117+ and immunoexpression of p53 protein in 77.2%, 82.3%, 59%, 29.4% and 33.3%, respectively. Clonal abnormalities were observed in 84.3% of cases with high prevalence of unbalanced (96%) rearrangements. 37% showed monosomy 7 and 44.4% complex karyotypes. The median overall survival was 5.7 for all patients and 40 months for patients treated with allo-HSCT (P=0.007). Hematologic malignancies, low platelet count, serum high LDH and ferritin, detection of CD117+ clusters, positive immunoexpression of p53, abnormal cytogenetics, intermediate-II or high-risk IPSS groups were associated with poor survival. No parameter studied from bone marrow aspirate had impact in survival. p53 expression was associated to abnormal karyotype (P=0.092) and IPSS risk (P=0.054). There was no association between the presence of ALIP, BM blast counts and immunoexpression of CD34+ and CD117+. Our study shows that cytogenetic analysis and BM immunohistochemistry are very important in diagnosis and prognosis, and that allo-HSCT could improve the survival of secondary MDS/MN. More studies with larger numbers of cases should be conducted to confirm the importance of the IPSS for secondary MDS, probably replacing the bone marrow aspirate blast counts by the immunohistochemistry detection of precursor cells
Книги з теми "Seconds malignant neoplasm"
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Internal malignancy and the skin: Paraneoplastic and cancer treatment-related cutaneous disorders. Philadelphia, Pa: Saunders, 2008.
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Bhatia, Smita. "Second Malignant Neoplasms." In Handbook of Long Term Care of The Childhood Cancer Survivor, 209–20. Boston, MA: Springer US, 2015. http://dx.doi.org/10.1007/978-1-4899-7584-3_14.
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Tichelli, André, and Alicia Rovó. "Secondary Neoplasia (Other Than PTLPS)." In The EBMT Handbook, 425–32. Cham: Springer International Publishing, 2024. http://dx.doi.org/10.1007/978-3-031-44080-9_47.
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AbstractSecondary Neoplasia (SN) after HCT belong to the most feared long-term complications. They include any malignant disorder occurring after HCT. There are three types of SN: therapy-related myeloid neoplasms, occurring mainly after auto-HCT; donor-derived malignancies after allo-HCT; and second solid neoplasms after either auto- or allo-HCT. Many of these SN have a higher incidence compared to the general population. In this chapter, pathophysiology issues, risk factors, screening and management recommendations are discussed. Since SN can occur even decades after HCT, life-long surveillance is needed.
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Russell, Robert T., and Anna T. Meadows. "Organ Dysfunction, Second Malignant Neoplasms, and Survival." In The Surgery of Childhood Tumors, 615–27. Berlin, Heidelberg: Springer Berlin Heidelberg, 2016. http://dx.doi.org/10.1007/978-3-662-48590-3_32.
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"Second Malignant Neoplasm." In Encyclopedia of Cancer, 3342. Berlin, Heidelberg: Springer Berlin Heidelberg, 2011. http://dx.doi.org/10.1007/978-3-642-16483-5_5191.
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Plastaras, John P., Daniel M. Green, and Giulio J. D'Angio. "Second Malignant Neoplasms." In Abeloff's Clinical Oncology, 1023–37. Elsevier, 2008. http://dx.doi.org/10.1016/b978-0-443-06694-8.50070-1.
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Friedman, Debra L. "Second Malignant Neoplasms." In Abeloff's Clinical Oncology, 741–50. Elsevier, 2020. http://dx.doi.org/10.1016/b978-0-323-47674-4.00050-5.
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Friedman, Debra L. "Second Malignant Neoplasms." In Abeloff's Clinical Oncology, 894–903. Elsevier, 2014. http://dx.doi.org/10.1016/b978-1-4557-2865-7.00062-x.
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"Second Malignant Neoplasm SMN." In Encyclopedia of Cancer, 4141. Berlin, Heidelberg: Springer Berlin Heidelberg, 2016. http://dx.doi.org/10.1007/978-3-662-46875-3_102063.
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Castel Júnior, Sirilo Antonio Dal, Isabely Gelinski, and Walter de Biase da Silva Neto. "Evolution of the mortality rate for malignant neoplasm of the breast between 2011 and 2019 by health macro-regions in Goiás." In UNITING KNOWLEDGE INTEGRATED SCIENTIFIC RESEARCH FOR GLOBAL DEVELOPMENT. Seven Editora, 2023. http://dx.doi.org/10.56238/uniknowindevolp-040.
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INTRODUCTION: Malignant neoplasm of the breast in women is the second most frequent neoplasm, being, however, the leading cause of cancer deaths in women in Brazil, with a mortality rate of around 11.84 deaths/100,000 women in 2020. Thus, it is perceived that malignant neoplasm of the breast causes numerous deaths every year, indicating an aggressive disease with major sequelae for public health in Brazil.
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Accioly, Mariana Abreu, Heline de Mendonça Bezerra, Livia Solidade Barreto, Melina Fernandes Castro, and Hélio Bezerra da Silva. "Multiple myeloma: A literature review." In Navigating through the knowledge of education V.2. Seven Editora, 2024. http://dx.doi.org/10.56238/sevened2024.015-016.
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Multiple myeloma (MM) is a malignant neoplasm characterized by clonal proliferation of plasma cells in the bone marrow and production of monoclonal immunoglobulin, the changes caused by the disease are related to progressive bone destruction, kidney failure, suppression of hematopoietic and higher risk of infections. It is the second most common hematological neoplasm, being slightly more frequent in men.
Тези доповідей конференцій з теми "Seconds malignant neoplasm"
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Rocha, Ariane Silva da, Maria Paula Curado, and Gisele Aparecida Fernandes. "THIRD AND FOURTH IPSILATERAL AND CONTRALATERAL PRIMARY BREAST CANCER IN A COHORT OF WOMEN TREATED FROM 2000 TO 2015 AT AC CAMARGO CANCER CENTER." In Abstracts from the Brazilian Breast Cancer Symposium - BBCS 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s2040.
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This study aims to describe the clinical and pathological characteristics in women with breast cancer with three or four ipsilateral and contralateral malignant tumors. The second primary malignant neoplasm of the breast is a condition in which the frequency of occurrence is around 50%, mainly in young women. The occurrence of the third and fourth neoplasms is rare, between 0.73% and 11.7%. This is a retrospective cohort study of women with breast cancer from 2000 to 2015. We identified 375 women with second primary breast tumor, of which 6 (1.6%) had three and four new primary breast cancer. Of the six cases with three and four neoplasms, three cases occurred in the QIE (lower left quadrant), overlapping lesion in two cases, and two cases in the QSE (upper left quadrant). Zero clinical and pathological staging was observed in two cases, I in two cases, IIA in two cases, and IA in one case, invasive lobular carcinoma in four cases, and invasive ductal carcinoma in three cases. The molecular subtype luminal occurred in four cases, HER2 overexpressed in three cases, estrogen receptor and HER2 were negative in three cases, and progesterone positive in three cases. The time of diagnosis between the first, third, and fourth tumor ranges from 2 to 72 months. Therefore, more studies are needed on the third and fourth malignant breast tumors as it is a rare entity in patients whose genetic and molecular characteristics are poorly known.
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Desteffani, Karine Gomes Bandeira, Jade Menezes Maia, Letícia Karen Rodrigues de Souza, and Andressa Schmidt do Nascimento. "Epidemiological profile of hospitalizations in Brazil for malignant brain neoplasm among 2017 and 2020." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.065.
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Introduction: The malignant brain neoplasm is the cerebral tumor constituted by primitives cells with neuronal and glial diferentiation. Objective: To evaluate the profile of hospitalizations due to malignant brain neoplasm registered in Brazil among 2017 and 2020. Methods: We performed a cross secctional study from public health system database of hospitalar morbity related to hospitalizations by year and federative unit among 2017 and 2020. Results: In the period from 2017 to 2020, Brazil registered a total of 58.177 admissions for Malignant Neoplasm of the Brain. The Southeast region had highest rate of hospitalizations in that time interval, with a total of 25,266 cases (highest rate was 2019, with 6.636 cases). South region was the second place, with 13.738 hospitalizations (highest rate was 2020, with 3.613 cases). Third, Northeast region with 11,197 hospitalizations (the highest rate was 2018, with 2,837 hospitalizations). Fourth, the Central-West region, where 5.586 were hospitalizaed (with highest number of hospitalizations in 2018, 1.469 cases). The North region has the lowest incidence, with 2,390 hospitalizations (highest rate was 2019, with 665 hospitalizations). In relation to the total result of hospitalizations, the year 2019 has the highest rate of hospitalizations (n = 14.966) and the year 2020 the lowest rate (n = 14.235). Conclusion: The Southeast region had the highest rates of hospitalizations due to malignant brain câncer and the year of 2019 had the higher prevalence of hospitalized.
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Sherborne, Amy, Philip Davidson, Katharine Yu, Alice Nakamura, Mamunur Rashid, and Jean Nakamura. "Abstract A50: Mutational analysis of a mouse model of second malignant neoplasms." In Abstracts: AACR Special Conference: Advances in Pediatric Cancer Research: From Mechanisms and Models to Treatment and Survivorship; November 9-12, 2015; Fort Lauderdale, Florida. American Association for Cancer Research, 2016. http://dx.doi.org/10.1158/1538-7445.pedca15-a50.
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Zong, Xuchen, Jason D. Pole, Paul Grundy, Salaheddin M. Mahmud, Louise Parker, and Rayjean J. Hung. "Abstract 3713: Second malignant neoplasms after non-CNS embryonal tumors in North America." In Proceedings: AACR 106th Annual Meeting 2015; April 18-22, 2015; Philadelphia, PA. American Association for Cancer Research, 2015. http://dx.doi.org/10.1158/1538-7445.am2015-3713.
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Soares, Leonardo Ribeiro, Joana Ermida Spagnol, Flaviane Marques de Assis, Sebastião Alves Pinto, and Alexandre Roriz Blumenschein. "MALIGNANT PHYLLODES TUMOR IN A 14 YEAR‑OLD PATIENT: A CASE REPORT." In Scientifc papers of XXIII Brazilian Breast Congress - 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s1081.
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Introduction: Phyllodes tumor of the breast (PT) is a rare neoplasm, characterized by stromal and epithelial elements, and accounts for approximately 1% of breast cancer in women. There are three subtypes, according to the World Health Organization, based on histological features: benign, borderline and malignant. Pathogenesis, prognostic and biologic characteristics are unknown, thus the difficulty in assessing the recurrence risk of the tumor. In general, the treatment approach is breast conserving surgery, with a margin >1 mm, in order to prevent recurrence. There is currently a great concern with the increase of breast cancer cases in young women, which represents a significant burden in developing countries such as Brazil. The mean age of presentation of malignant PT is 40 years old, and there are rare cases reported in very young adults, 18 and 23 years old. There is one case series in the literature of benign PT in 14 to 16 years old adolescents. However, we did not find any report of malignant PT in this age group. Given the rarity of the case and the current importance of breast cancer in young women, we report a rare case of malignant PT in a patient with only 14 years of age. Case report: A 14-year-old female came to a visit due to an abnormal growth of the breast over the last nine months. She had no other complaints or comorbidities. In her family history, she has one aunt that had breast cancer. On physical examination, the patient presented gigantomastia and stretch marks stretch with a reddish appearance. It was identified a nodule of 5.0 cm located in the upper inner quadrant of the right breast, and the axillary region showed no abnormalities. On the ultrasound, the nodule measured 5.7 cm. The patient underwent a segmentary resection of the lesion. The anatomopathological study revealed a malignant PT with a low differentiation grade, measuring 7.0 cm in its largest dimension and free margins, however exiguous. Immunohistochemistry of the lesion revealed the expression of Ki-67, p-63 protein, cytokeratin-14, Bcl-2 and vimentin. On the magnetic resonance imaging, only surgical alterations were observed with no macroscopic residual tumor and the armpit was negative. In order to extend the surgical margins, a second approach was performed, associated with a reduction mammoplasty. The anatomopathological study then showed no residual neoplasm and free margins. The patient had good postoperative recovery and was satisfied with the esthetic results. After consultation with the oncologist, no adjuvant treatment was indicated.
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Salvador, Anna Dias, Gabriela Ramos Alves, Enaldo Melo Lima, Bernardo Ferreira Paula Ricardo, and Henrique Moraes Salvador Silva. "METASTATIC THYMOMA OF THE BREAST – CASE REPORT." In Scientifc papers of XXIII Brazilian Breast Congress - 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s1018.
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Introduction: Thymomas are rare malignant epithelial neoplasms arising in the thymus. These tumors are commonly located in the prevascular mediastinum but can also be found in other regions of the mediastinum, neck, pulmonary hilum, thyroid gland, lungs, pleura, or pericardium. This disease could be suspected as an incidental finding identified on imaging, local thoracic symptoms or due to a paraneoplastic syndrome. Pleural or pericardial effusions are the most common manifestations of more disseminated disease and may also cause thoracic symptoms. Extrathoracic metastases are seen in fewer than seven percent of patients at presentation, most commonly in the kidneys, extrathoracic lymph nodes, liver, brain, adrenals, thyroid, and bone. Case report: A 66-year-old, white female patient, with previous left mastectomy due to a phyllodes sarcoma in 1997. Diagnosed with malignant thymoma in 2013 and pleural involvement, undergoing systemic chemotherapy and surgery with complete remission of the disease at that time. Two years after, in 2015, presented with disease recurrence in the diaphragm, pleura and lymph nodes, undergoing new surgery, radiotherapy and a second line chemotherapy regimen. Over the years, the disease progressed despite the cancer treatment instituted. In December 2020, the patient presented nodulation in the right breast, with core biopsy suspicion of ductal carcinoma. Undergoing quadrantectomy with lymph node biopsy, with the surgical pathological report finding of thymoma metastasis, resected with free margins. The patient is currently at the 31st pembrolizumab cycle, in good clinical condition.
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Chagas, Carlos Ricardo, Ricardo Pinto, José Antônio Franco, Gabriela Del Prete Magalhães, and Natascha Carneiro Chagas. "PRIMARY ANGIOSARCOMA OF THE BREAST: A CASE REPORT." In Brazilian Breast Cancer Symposium 2022. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s2096.
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A 39-year-old woman presented to our mastology session with complaints of a right breast lump in 2014, which had grown very slowly and changed in color over the past year (purple). On physical examination, the breast was found in a 12-1 o’clock position, bruise-like, and soft-to-firm in consistency. On mammography, the lump presented diffuse-dense and ultrasonography showed an ill-defined mass and poor-delimited hyperechogenic infiltration in the upper inner portion of the right breast that measured about 7 cm in size. A core biopsy was performed on the suspicious lesion. The pathological result was necrotic breast tissue. A second core biopsy was performed with the diagnosis of malignant neoplasia, poorly differentiated. The immunohistochemistry was diagnosed with moderate-differentiated angiosarcoma. A modified mastectomy was performed and the initial diagnosis was confirmed. After that, she received adjuvant chemotherapy, but the treatment was interrupted due to epístaxis, hematemesis, and body paresthesia. After this, the progression of the disease was observed with metastasis in the lungs, stomach, mouth, gum, and brain. She was subjected to palliative treatment and died in November 2015. Discussion: Primary angiosarcoma of the breast is a very rare disease and corresponds to less than 1% of breast malignancies. Mammary angiosarcoma should be differentially diagnosed from benign hemangiomas, phyllodes sarcomas, stromal sarcomas, metaplastic carcinomas, fibrosarcomas, liposarcomas, squamous cell carcinomas with sarcomatoid features, myoepitheliomas, fibromatoses, and reactive spindle cell proliferative lesions. CD31 is a sensitive marker for this class of cancers, and CD34 positively ranges from 40% to 100%. These markers could help with the accurate diagnosis of angiosarcoma. Pathologically, these tumors are divided into three groups according to the classification proposed. Well-differentiated (grade I) tumors consist of anastomosing vascular channels that invade the surrounding breast tissue. Moderately differentiated (grade II) tumors have more solid neoplastic vascular growth and an increased mitotic rate. Poorly differentiated (grade III) lesions have obvious sarcomatous areas and areas of necrosis, hemorrhage, and infarction. In conclusion, primary mammary angiosarcoma is a rare neoplasm of the breast that affects a younger female population, compared to breast carcinomas, and has aggressive clinical behavior. Difficult differential diagnoses, due to atypical characteristics, can delay management.
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Camargo, Natasha Lure Bueno de, Claudia Cristina Klumpp, Hirofumi Iyeyasu, Renato Cagnacci Neto, and Fabiana Baroni Alves Makdissi. "RETROSPECTIVE CROSS-SECTIONAL ANALYTICAL STUDY ON PREGNANCY-ASSOCIATED BREAST CANCER IN PATIENTS TREATED AT A CANCER CENTER." In XXIV Congresso Brasileiro de Mastologia. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s1031.
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Introduction: Breast cancer is the second most common malignant neoplasm among women in Brazil and worldwide. It is considered pregnancy-associated when the malignant tumor occurs during pregnancy and up to the first year after delivery. However, current studies show an increased prevalence of these cases, and their causality is not yet well explained. Objective: The aim of this study was to perform a descriptive analysis of the profile of patients with breast cancer during pregnancy treated at our facility from 2010 to 2020. Methods: This retrospective cross-sectional study analyzed electronic health records from a database. The sample consisted of pregnant or postpartum patients diagnosed with breast cancer and treated at AC Camargo Cancer Center from 2010 to 2020. Variables were described based on absolute and relative frequency distributions. Statistical analysis was performed using the Mann-Whitney U test and the independent samples Kruskal-Wallis test. Results: The final sample comprised 44 patients. The mean age was 35 years. Most patients had no comorbidities, were married, white, and had access to the service through health insurance (95.5%). Ductal carcinoma was the most prevalent (84.1%). The main molecular subtypes were luminal B without HER2 expression (34.1%) and triple negative (25%). About 30% of the cases were associated with some genetic mutation. Most patients were diagnosed in the postpartum period (70.5%). Recurrence occurred in five cases. We found four cases of death, three of which had oncological causes. The comparative analysis of variables that could lead to worse prognosis, such as genetic mutation and molecular subtypes, did not indicate a higher recurrence of cases, since they were not statistically significant. Conclusion: The profile of patients with pregnancy-associated breast cancer treated at this cancer center partly follows the trend of other centers.
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Assunção, Silvaleide Ataides, Amanda Carlos de Lima Batista, Eduarda Duarte Mota Amorim, Giovanna Giulia de Carvalho Amoroso, Rebeka Gyovana Rodrigues Reis, Lara Letícia Gaspar Sousa, and Rosemar Macedo Sousa Rahal. "ANALYSIS OF EARLY MORTALITY BY BREAST CANCER IN BRAZIL AND GOIÁS FROM 2010 TO 2019." In Abstracts from the Brazilian Breast Cancer Symposium - BBCS 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s2068.
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Introduction: Breast cancer is the second leading cause of death among women, affecting mainly the age group of 50–59 years, the age at which screening tests are recommended. However, it has shown a progressive incidence below 50 years. For this reason, the objective is to analyze the statistical data on early mortality from breast cancer up to 50 years, in view of possible losses in diagnosis and early management. Methodology: A descriptive epidemiological study, a retrospective of time series, using the data from the Mortality Information System (SIM) of the Health Surveillance Secretariat of the Ministry of Health (SVS/MS) in the period of 2010 and 2019, in Brazil and in the State of Goiás, was analyzed. Malignant neoplasms of death and women up to 50 years of age were included as causes of death. The data were compared and tabulated in Excel. Results: Deaths due to malignant breast cancer in Goiás, between 2010 and 2019, were 35 (20–29 years old), 306 (30–39 years old), and 766 (40–49 years old), equivalent to 26.2% of the total number of deaths in all age groups (1,107 cases). In Brazil, deaths were 1,149 (20–29 years old), 9,876 (30–39 years old), and 24,586 (40–49 years old), totaling 23.3%. Conclusion: According to the analysis, it is possible to point to an increase in deaths, especially for those aged 40–49 years. The lack of inclusion of women in this group interferes with the prognosis, since it makes the late diagnosis feasible and, in more advanced stages, causes less chances of cure. Possible adaptations and strategies for screening this public and coverage by public health systems must be considered.
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Andrade, Thainá Sobral de, Yasmin Alves da Cruz Figueiredo, Victor Araújo Felzemburgh, and Pedro Paulo Oliveira Carneiro. "TRAM BREAST RETAIL RECONSTRUCTION: AN ANALYSIS IN THE LATE POSTOPERATIVE." In Abstracts from the Brazilian Breast Cancer Symposium - BBCS 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s2048.
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In Brazil, breast cancer represents the second most incident cancer among women and is the major cause of death from malignant neoplasms in females. Therefore, the treatment of this pathology needs to be studied in its various aspects, one of which is aesthetic care in breast reconstruction. Objectives: To evaluate the late result of breast reconstruction by TRAM (transverse rectus abdominis muscle flap), in addition to comparing the assessment instruments in the postoperative period. Postoperative photographs of 13 patients who underwent breast reconstruction by TRAM at Hospital Santo Antônio in Salvador, BA, in the period 2012 and 2018 were analyzed. This is a cross-sectional observational study, with aesthetic evaluation performed using two instruments. Results: In general, patients have satisfactory results in the two assessment tools. Of the patients studied, 61.5% had results within the parameters established by Mallucci, whereas evaluating the domains of Garbay’s criteria, the best mean result was related to the volume domain and the worst to the scar. Conclusion: The instruments proved to be appropriate for evaluating the patients in the study. The subjective analysis among the evaluators proved to be similar. The instrument used in morphometric analysis showed that the studied group of patients approached the parameter established as ideal.