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Zhu Y, Fan G, Cao L, Zhu H, Wu S, Zhao J, Zhou G. Survival outcomes of patients with brain metastasis of osteosarcoma can be improved by aggressive multi-disciplinary interventions including chemotherapy. Br J Neurosurg 2024; 38:654-659. [PMID: 34261400 DOI: 10.1080/02688697.2021.1950624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVE Brain metastasis in osteosarcoma (BMO) is rare and its clinical characteristics are often buried among studies on brain metastasis of bone and soft tissue sarcomas. The aim of the present study was to summarize the incidence, clinical characteristics, treatment and outcomes of patients with BMO. METHODS This retrospective study included 7 patients with BMO who received treatment in our center between 2005 and 2019. The clinical medical records of the 7 patients, together with data of 70 BMO patients published in 33 articles and retrieved by means of PubMed and Medline, were analyzed, retrospectively. RESULTS Data analysis of the 97 BMO patients showed a high correlation between the interval from the primary diagnosis to BMO occurrence and the interval from the primary diagnosis to prior metastases. Multivariate analysis showed that chemotherapy, radiotherapy and surgery were three main factors affecting the overall survival of BMO patients (HR = 0.427; HR = 0.372; HR = 0.296). Surgery combined with chemotherapy or radiotherapy offered a better overall survival than surgery alone. CONCLUSION Patients with BMO may obtain survival benefits from regular neuroimaging and early aggressive multi-disciplinary interventions including surgical resection, postoperative radiotherapy and chemotherapy. SYNOPSIS This is a retrospective study describing the characteristics of metastasic intervals, locations, clinical features and prognosis in 97 patients with brain metastasis of osteosarcoma (BMO). Multivariate analysis showed that chemotherapy was effective as surgery and radiotherapy for the treatment of BMO. Our findings emphasize the importance of regular neuroimaging and early aggressive multi-disciplinary interventions including surgical resection, postoperative radiotherapy and chemotherapy.
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Affiliation(s)
- Yan Zhu
- Jinling Hospital Department of Orthopaedics, Nanjing Medical University, Nanjing, China
| | - Gentao Fan
- Jinling Hospital Department of Orthopaedics, Nanjing Medical University, Nanjing, China
| | - Lili Cao
- Jinling Hospital Department of Orthopaedics, Southeast University, Nanjing, China
| | - Hao Zhu
- Jinling Hospital Department of Orthopaedics, Nanjing University, Nanjing, China
| | - Sujia Wu
- Jinling Hospital Department of Orthopaedics, Nanjing Medical University, Nanjing, China
| | - Jianning Zhao
- Jinling Hospital Department of Orthopaedics, Nanjing Medical University, Nanjing, China
| | - Guangxin Zhou
- Jinling Hospital Department of Orthopaedics, Nanjing Medical University, Nanjing, China
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Hsu FC, Yu DS, Pu TW, Wu MJ, Meng E. Unusual presentation of penile giant condyloma acuminatum with spontaneous prepuce perforation: A case report. World J Clin Cases 2023; 11:7107-7112. [PMID: 37946780 PMCID: PMC10631422 DOI: 10.12998/wjcc.v11.i29.7107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Giant condyloma acuminatum (GCA) is an uncommon condition affecting the anogenital area. CASE SUMMARY Here, we report an 88-year-old male patient who presented with a 5-year history of a progressive appearance of multiple cauliflower-like warts over his penile shaft, pubis region, and groin as well as urine leakage along the distal penile shaft. Physical examination revealed an ulcerative skin perforation with pus discharge under the distal prepuce base, which was initially suspected to be a urethral fistula. However, during surgery, it was discovered that the perforation was caused by a giant condyloma lesion that had obliterated the prepuce opening, with infection and high pressure causing subsequent skin perforation. He underwent circumcision and wide excision with electrocauterization of the warts. He was discharged after the surgery, and the residual lesion was treated with imiquimod and low-dose oral tegafur-uracil. CONCLUSION Penile GCA can cause prepuce perforation and can be postoperatively treated with imiquimod and low-dose oral tegafur-uracil.
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Affiliation(s)
- Fu-Chieh Hsu
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - Dah-Shyong Yu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - Ta-Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - Min-Jui Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
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Mihailov R, Tatu AL, Niculet E, Olaru I, Manole C, Olaru F, Mihailov OM, Guliciuc M, Beznea A, Bușilă C, Candussi IL, Moroianu LA, Stănculea FC. Surgical Management of Perianal Giant Condyloma Acuminatum of Buschke and Löwenstein: Case Presentation. Life (Basel) 2023; 13:1916. [PMID: 37763319 PMCID: PMC10532963 DOI: 10.3390/life13091916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION The Buschke-Löwenstein tumor (BLT) is an uncommon sexually transmitted ailment attributed to the human papillomavirus (HPV)-usually the 6 or 11 type (90%)-with male predominance and an overall infection rate of 0.1%. BLT or giant condyloma acuminatum is recognized as a tumor with localized aggressiveness, displaying distinctive features: the potential for destructive growth, benign histology, a rate of 56% malignant transformation, and a high rate of recurrence after surgical excision. There are several treatment choices which have been tried, including laser, cryotherapy, radiotherapy, electrocoagulation, immunotherapy, imiquimode, sincatechins, intralesional injection of 5-fluoruracil (5-FU), isolated perfusion, and local or systemic chemotherapy. In the case of an extensive tumor, preoperative chemotherapy or radiotherapy is used for tumor shrinkage, making the debulking procedure safer. HPV vaccines significantly decrease the incidence of genital warts, also decreasing the risk of BLT; HPV-6 and HPV-11 are included in these vaccines. MATERIALS AND METHODS We present a 53-year-old heterosexual man, hospitalized in our department in June 2021 with a typical cauliflower-like tumor mass involving the perianal region, which progressively increased in size for almost 7 years. The perianal mass was completely removed, ensuring negative surgical margins. The large perianal skin defect which occurred was reconstructed with fascio-cutaneous V-Y advancement flap. There was no need for protective stoma. The literature review extended from January 1980 and December 2022, utilizing Pubmed and Google Scholar as search platforms. RESULTS Due to the disease's proximity to the anal verge and the limited number of reported cases, arriving at a definitive and satisfactory treatment strategy becomes challenging. The optimal approach entails thorough surgical removal of the lesion, ensuring well-defined surgical margins and performing a wide excision to minimize the likelihood of recurrence. In order to repair the large wound defects, various rotation or advancement flaps can be used, resulting in reduced recovery time and a diminished likelihood of anal stricture or other complications. Our objective is to emphasize the significance of surgical excision in addressing BLT through the presentation of a case involving a substantial perianal condyloma acuminatum, managed successfully with complete surgical removal and the utilization of a V-Y advancement flap technique. In the present case, after 5 months post operation, the patient came back with a buttock abscess, which was incised and drained. After another 5 months, the patient returned for difficult defecation, with an anal stenosis being diagnosed. An anal dilatation and sphincterotomy were carried out, with good postoperative results. CONCLUSIONS The surgical management of Buschke-Löwenstein tumors needs a multidisciplinary team with specialized expertise. The reconstruction techniques involved can be challenging and may introduce additional complications. We consider aggressive surgery, which incorporates reconstructive procedures, as the standard treatment for Buschke-Löwenstein tumors. This approach aims to achieve optimal surgical outcomes and prevent any recurrence.
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Affiliation(s)
- Raul Mihailov
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Alin Laurențiu Tatu
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Dermatology Department, Saint Parascheva Infectious Diseases Clinical Hospital, 800179 Galați, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research Center (MICDIR), “Dunărea de Jos” University of Galați, 800201 Galați, Romania
| | - Elena Niculet
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Iulia Olaru
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Corina Manole
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Florin Olaru
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Oana Mariana Mihailov
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
| | - Mădălin Guliciuc
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Adrian Beznea
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Camelia Bușilă
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania
| | - Iuliana Laura Candussi
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania
| | - Lavinia Alexandra Moroianu
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
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Mumoli N, Evangelista I, Colombo A, Conte G, Mazzone A. Giant condyloma acuminatum of the perineum. IDCases 2021; 26:e01326. [PMID: 34804801 PMCID: PMC8585615 DOI: 10.1016/j.idcr.2021.e01326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, ASST Ovest Milanese, Magenta, MI, Italy
| | | | - Alessandra Colombo
- Department of Internal Medicine, ASST Ovest Milanese, Magenta, MI, Italy
| | - Giulia Conte
- Department of Internal Medicine, ASST Ovest Milanese, Magenta, MI, Italy
| | - Antonino Mazzone
- Department of Internal Medicine, ASST Ovest Milanese, Magenta, MI, Italy
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Giant Condyloma Acuminata (Buschke-Lowenstein Tumor): Review of an Unusual Disease and Difficult to Manage. Infect Dis Obstet Gynecol 2021; 2021:9919446. [PMID: 34305393 PMCID: PMC8266468 DOI: 10.1155/2021/9919446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
Giant condyloma acuminatum (GCA) or Buschke-Loewenstein tumor is a rare disease, with an estimated prevalence of 0.1%. It was initially described in 1896 by Buschke and later in 1925 by Buschke and Loewenstein. Classic condyloma acuminata (CCA) and squamous cell carcinoma (SCC) were initially described as different entities. These three entities are currently considered to correspond to the same spectrum of different but not exclusive malignant transformations, associated with multiple risk factors such infection by human papilloma virus (HPV), immunodeficiencies, poor hygiene, multiple sexual partners, and chronic genital infections. HPV subtypes 6 and 11 are associated with 90% of GCA. It presents as a cauliflower-like tumor in the genital region with bad odor, bleeding, and local infection, differential diagnosis with multiple conditions should be considered, and sexually transmitted diseases should always be investigated. GCA has a higher rate of malignant transformation than CCA and tends to infiltrate adjacent soft tissues. The therapeutic approach is controversial but is considered that the resection with free edges is the gold standard and can be combined with adjuncts. The recurrence rate is high. Overall mortality is 21% and is associated with morbidity caused by recurrences. Imiquimod cream 5% has recently shown good results as monotherapy and in combination with ablative and surgical treatments. The quality of life is diminished in patients with this condition. In this review, we address the different aspects of this rare entity including the therapeutic approach.
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Ying Z, Li X, Dang H, Yin N, Gao C. Molecular immune mechanisms of HPV-infected HaCaT cells in vitro based on toll-like receptors signaling pathway. J Clin Lab Anal 2019; 34:e23101. [PMID: 31785031 PMCID: PMC7083446 DOI: 10.1002/jcla.23101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To explore the molecular immune mechanism of HPV-infected HaCaT cells in vitro based on TLRs signaling pathway by analyzing the effects of interfering TLRs on inflammatory and immune factors in the signaling pathway. METHODS FCM was used to analyze the proportion of Th1, Th2, Th17, and Treg cells in blood samples. HPV-infected HaCaT cells were divided into five groups: A, B, C, D, and E. Group A added TLR3 antagonist, group B added TLR9 antagonist, group C added equivalent saline, group D added IRF3 agonist, and group E added IRF3 inhibitor. Immunohistochemistry was used to analyze the expression of TLR3 and TLR9 in HaCaT cell model; ELISA was used to analyze the expression of inflammatory factors IL-2, TNF-a, and IFN-beta; WB was used to analyze the expression of TRAF3, IKK epsilon, and TBK1; RT-PCR was used to analyze the expression of IRF3 and IRF7 in each cell model. RESULTS The proportion of blood immune cells in patients with HPV infection was Th1, Th17, Th2, and Treg, with statistical significance (P < .05); the expression of TLR3 and TLR9 in HPV-infected cells was higher than that in negative control group, with statistical significance (P < .05); TLR3 was higher than TLR9, with no significant difference (P > .05); the expression of IL-2, TNF-alpha, IFN-beta in each group, TLR3, and TLR9 was higher than that in negative control group (P < .05). The expression of TRAF3, IKK epsilon, and TBK1 in the control group was higher than that in the TLR3 and TLR9 inhibitor groups, and the expression of IRF3 and IRF7 in the TLR9 inhibitor group was higher than that in the TLR3 inhibitor group (P < .05); the expression of IRF3 and IRF7 in the TLR3i and TLR9i inhibitor groups was lower than that in the TLR3 inhibitor group (P < .05). Compared with the control group, IRF3a group was higher than the control group, IRF3i group was lower than the control group, the difference was statistically significant (P < .05). CONCLUSION TLR3 and TLR9, the key factors of TLRs, are highly expressed in HaCaT cells infected with HPV. Through TLRs-IKK-e-IRFs-IFN signaling pathway, they can induce high expression of inflammatory factors, IKK-e, IRFs, and IFN, and improve immunity.
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Affiliation(s)
- Zuolin Ying
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojie Li
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Dang
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na Yin
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuang Gao
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Braga EA, Lopes GDJ, Saad SS. Argon plasma versus electrofulguration in the treatment of anal and perianal condylomata acuminata in patients with acquired immunodeficiency virus. Acta Cir Bras 2017; 32:482-490. [PMID: 28700010 DOI: 10.1590/s0102-865020170060000009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/18/2017] [Indexed: 02/02/2023] Open
Abstract
Purpose: To compare the effectiveness of anal and perianal condylomata treatment using argon plasma and electrofulguration. Methods: From January 2013 to April 2014, 37 patients with anal and perianal condylomata, who had been diagnosed through proctological examination, oncotic cytology, polymerase chain reaction (PCR) and histology, underwent treatment with argon plasma and electrofulguration. The perianal and anal regions were divided into two semicircles. Each semicircle was treated using one of the methods by means of simple randomization. Therapeutic sessions were repeated until all clinical signs of infection by HPV were eliminated. The patients were evaluated according to several variables like the genotype of HPV, HIV infection, oncological potential per genotype, oncotic cytology and histology. Results: Among all the variables studied, only immunosuppression due to HIV influenced the results, specifically when the fulguration method was used. There was no significant difference in effectiveness between argon and fulguration based on lesion relapse (p > 0.05). However, among HIV-positive patients, fulguration presented worse results, with a significant difference (p = 0.01). Conclusion: Regarding treatment of anal and perianal condylomata acuminata, comparison between applying fulguration and argon demonstrated that these methods were equivalent, but use of fulguration presented more relapses among HIV-positive patients.
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Affiliation(s)
- Eduardo Angelo Braga
- MSc, Fellow PhD Degree, Postgraduate Program in Interdisciplinary Surgical Science, Division of Surgical Gastroenterology, Department of Surgery, Medical School, Universidade Federal de São Paulo (UNIFESP), Sao Paulo-SP, Brazil. Conception and design of the study, acquisition of data, manuscript writing
| | - Gaspar de Jesus Lopes
- PhD, Chairman Professor, Division of Surgical Gastroenterology, Department of Surgery, Medical School, UNIFESP, Sao Paulo-SP, Brazil. Critical revision, final approval
| | - Sarhan Sydney Saad
- PhD, Assistant Professor, Division of Surgical Gastroenterology, Department of Surgery, Medical School, UNIFESP, Sao Paulo-SP, Brazil. Critical revision, final approval
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