Radiologia Brasileira. Achados da tomografia computadorizada em met. MATERIALS AND METHODS: The four patients underwent radical nephrectomy for stage T1 (n=2) and stage T3a (n=2) renal cell carcinoma. Pancreatectomia Parcial Pdf WriterThe mean interval between nephrectomy and detection of pancreatic metastases was eight years. Two asymptomatic patients presented with solitary pancreatic metastases (confined to the pancreas). Two symptomatic patients presented with single and multiple pancreatic metastases, both with tumor recurrence in the contralateral kidney. RESULTS: Computed tomography studies demonstrated pancreatic metastases as solitary (n=2), single (n=1) or multiple (n=1) hypervascular lesions. Partial pancreatectomy was performed in two patients with solitary pancreatic metastases and both are free of disease at four and two years after surgery. CONCLUSION: Pancreatic metastases from renal cell carcinoma are rare and can occur many years after the primary tumor presentation. Pancreatectomia amb selecci. Duodeno-pancreatectomia 721,00 duodenorrafia 451,00 duodenotomia 601,00. Pancreatectomia segment. Phase transition of a two dimensional binary spreading model . El tratamiento consisti OBJETIVO: Descrever o progn. Finite Element Modelling of Steel Beams with Web Openings . El tratamiento consisti Algunos autores tambi Thanks for helping keep SourceForge clean. Screenshot instructions: Windows Mac Red Hat Linux Ubuntu. Click URL instructions: Right-click on ad, choose 'Copy Link. Pancreatectomia Parcial Pdf ViewerMultiple pancreatic metastases and pancreatic metastases associated with tumor recurrence in the contralateral kidney are uncommon. Usually, on computed tomography images pancreatic metastases are visualized as solitary hypervascular lesions, simulating islet- cell tumors. El manejo de las lesiones qu. Hospital Universitario Arnau de Vilanova Lleida jueves 11 de octubre de 12. Surgical management should be considered for patients with solitary pancreatic lesions. Resumo: OBJETIVO: Apresentar os achados da tomografia computadorizada observados em quatro pacientes submetidos a nefrectomia radical por carcinoma de c. Dois pacientes apresentaram met. Foi realizada pancreatectomia parcial em dois pacientes com met. RCC is characterized by a significant morbidity and mortality, with an estimate of about 3. United States of America(2). Complete surgical resection still remains as the sole curative management in these cases. However, recurrence occurs in about 2. Most frequent sites of tumor recurrence are lungs, bones, renal lodges, brain, liver and contralateral kidney (4). Less frequently, the following organs are involved: adrenal glands, gall bladder, thyroid, pancreas, muscles, skin or subcutaneous tissue. The present study was aimed at describing computed tomography (CT) findings observed in four patients who had developed pancreatic metastases after radical nephrectomy. Two patients presented only with solitary pancreatic metastasis (confined to the pancreas), the third one, with single pancreatic metastasis associated with tumor recurrence in the contralateral kidney, and the fourth one, with multiple pancreatic metastases in association with recurrent tumor in the contralateral kidney, pulmonary and subcutaneous metastases. MATERIALS AND METHODSMedical records and CT studies of four (three women and one man) patients with pancreatic metastases from RCC were reviewed. At the time of the diagnosis, all the primary tumors were T1- stage (two patients) and T3a- stage (two patients) conventional clear cell carcinomas. The mean time interval between nephrectomy and detection of pancreatic metastases was eight years. All of the patients were submitted to single slice helical CT. After localization of the pancreas, (non- contrast- enhanced, 1. Each of the series was obtained in a single apnea, with 3 mm col- limation, pitch 2: 1, 1. Vp and 2. 40–2. 80 m. A. A third phase was obtained at 1. So the images were reconstructed to 2. Solitary pancreatic metastasis, that is to say, with lesions confined exclusively to the pancreas, was observed in two patients, both asymptomatic. The third patient presented a single pancreatic metastasis associated with tumor recurrence in the contralateral kidney, and the fourth patient presented with multiple pancreatic metastasis associated with pulmonary and subcutaneous metastasis besides tumor recurrence in the contralateral kidney. RESULTSFour patients (three women and one man) with mean age 5. RCC classified into solitary (n = 2), single (n = 1) or multiple (n = 1). At the time of the radical nephrectomy, all of the patients presented T1- stage (n = 2) and T3a- stage (n = 2) RCC (conventional clear cell carcinomas). All of the single lesions presented hypervascularized at intravenous contrast- enhanced CT studies mimicking pancreatic islet- cell tumors. The mean size of the lesions was 1. In two patients with solitary metastasis, the lesion was localized in the tail of the pancreas (Figures 1 and 2). These two patients were submitted to partial pancreatectomy, and both are currently free of the disease, respectively four and two years after the surgery. One patient presented with single metastasis in the body of the pancreas (Figure 3) and tumor recurrence in the contralateral kidney. The follow- up of this patient was discontinued. The fourth patient presented with multiple, small, hypervascularized pancreatic metastases, recurrence of the tumor in the contralateral kidney and pulmonary and subcutaneous metastases (Figure 4). This patient has been treated with immunotherapy and, 2. DISCUSSIONTwenty- three percent of patients present with metastases at the time of detection of RCC, and 2. The greatest diameter, stage of the tumor, as well as its nuclear grade represent relevant factors for determining the prognosis for tumor recurrence(4). Pancreatic involvement by metastasis from RCC represents only 0. RCC propagation may occur via the vascular system (hematogenic metastasis) or via the lymphatic system (lymphogenic metastasis)(7). Although a consensus is still to be reached regarding a protocol for following- up patients submitted to radical nephrectomy for localized neoplastic disease(1. CT, particularly the arterial phase of the study, is considered by the authors as the modality of choice in the follow- up of patients submitted to surgery for renal cancer. Considering that, metastases from RCC may occur many years after the surgical resection, follow- up should include CT of chest, abdomen and pelvis at least one a year. This method is useful not only for detecting local recurrence but also distant metastases. Magnetic resonance imaging and PET- CT also constitute useful methods in the followup in selected cases(1. Usually, pancreatic metastases from RCC are solitary and hypervascularized and so may mimic primary islet cell tumors(1. These two patients with solitary pancreatic metastasis presented T1- stage tumors at the time of the nephrectomy and developed metastases, respectively, 1. The third patient presented a single pancreatic metastasis and tumor recurrence in the contralateral kidney. These findings were detected six years after the nephrectomy for a T3a- stage RCC. The fourth patient presented multiple pancreatic metastases in association with tumor recurrence in the contralateral kidney, pulmonary and subcutaneous metastases, 1. T3a- stage RCC. The differentiation between a primary islet cell tumor and metastatic involvement by RCC may be difficult, considering the hypervascularized appearance of both lesions at CT. In this circumstance, antecedents of a primary tumor should be researched, considering that metastases from RCC may occur many years after nephrectomy. Generally, functional islet cell tumors are small and symptomatic, whereas the non- functional ones are large. In dubious cases and if possible, CT- guided percutaneous fine- needle aspiration biopsy should be performed to allow an appropriate preoperative diagnosis(1. The finding of multiple pancreatic metastases observed in a patient in the present casuistic is compatible with previous descriptions(1. Pancreatic metastases in association with synchronic renal lesions like those observed in two patients in the present casuistic have not been reported in the literature. In cases of a solitary metastatic lesion (confined to the pancreas), where the tumor can be completely resected, the patients may present excellent rates of disease- free survival lasting as long as five years(1. CONCLUSIONS Pancreatic metastases from RCC are not frequent and may occur many years after the initial presentation. The solitary nature of pancreatic metastases from RCC, i. At CT, pancreatic metastases appear as hypervascularized lesions mimicking islet cell tumors. Patients with solitary pancreatic metastasis may benefit from surgical resection of the lesion. Adult malignant renal parenchymal neoplasms. In: Pollack HM, Mc. Clennan BL, editors. Philadelphia: Saunders; 2. Prasad SR, Humphrey PA, Catena JR, et al. Sandock DS, Seftel AD, Resnick MI. A new protocol for the follow- up of renal cell carcinoma based on pathological stage. Chae EJ, Kim JK, Kim SH, et al. Renal cell carcinoma: analysis of postoperative recurrence patterns. Ritchie AWS, de Kernion JB. The natural history and clinical features of renal cell carcinoma. Ninan S, Jain PK, Paul A, et al. Synchronous pancreatic metastases from asymptomatic renal cell carcinoma. Tongio J, Peruta O, Wenger JJ, et al. Metastases duodenales et pancreatiques du nephro- epitheliome: a prop. Diner EK, Williams CR, Behari A, et al. Metastatic renal cell carcinoma to contralateral ureter presenting as acute obstructive renal failure after radical nephrectomy. Hirota T, Tomida T, Iwasa M, et al. Solitary pancreatic metastasis occurring eight years after nephrectomy for renal cell carcinoma: a case report and surgical review. Kassabian A, Stein J, Jabbour N, et al. Renal cell carcinoma metastatic to the pancreas: a single- institution series and review of the literature. Minni F, Casadei R, Perenze B, et al. Pancreatic metastases: observations of three cases and review of the literature. Breda A, Konijeti R, Lam JS. Patterns of recurrence and surveillance strategies for renal cell carcinoma following surgical resection. Expert Rev Anticancer Ther. Tollefson MK, Takahashi N, Leibovich BC, et al. Contemporary imaging modalities for the surveillance of patients with renal cell carcinoma. Ichikawa T, Peterson MS, Federle MP, et al. Ascenti G, Visalli G, Genitori A, et al. Grimaldi G, Reuter V, Russo P. Bilateral non- familial renal cell carcinoma.
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January 2017
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