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S178 ABSTRACTS
Poster Session: Soft Tissue Sarcoma
468. A recurrence of abdominal liposarcoma e Clinical case
M. Martins1, A.C. Carvalho1, D. Brito1, T. Santos1, V. Castro1,
J. Oliveira1, H. Mesquita1, J. Monteiro1, J. Pinto Correia1
1 Centro Hospitalar do Alto Ave, General Surgery, Guimaraes, Portugal
Background: Liposarcoma (LS) is the most common histological type
of sarcoma. There are five subtypes (well differentiated, myxoid, dediffer-
entiated, pleomorphic, mixed type).
Material and methods: Description of the case of a patient with ane-
mia, pain and swelling in the left flank by LS abdominal conditioning.
Results: A 59 year-old Portuguese female with history of gastric
sleeve, 1 year ago, was admitted with throbbing pain in the right flank
associated with distention and swelling bulky for 1 month of evolution. Re-
ported nausea, asthenia and anorexia. Previous analysis revealed haemo-
globin of 7.2 mg/dl. After admission and red blood cell transfusion,
abdominal tomography does reveal a large mass (25 � 12cm) adjacent
to the anastomosis. The deterioration of the patient’s condition lead to
excision of abdominal mass adherent to the spleen (splenectomy block),
whose history revealed pleomorfic liposarcoma. Postoperative pancreatic
fistula has treated conservatively. Asymptomatic at the time discharge.
In oncology where it is decided not to radiotherapy or chemotherapy.
Conclusions: The LS grows slowly and it’s diagnosed only when it be-
comes larger. The recommended treatment is complete resection even if
necessary adjacent organs. Radiotherapy or chemotherapy is not effective
in increasing survival.
No conflict of interest.
http://dx.doi.org/10.1016/j.ejso.2014.08.456
469. Oncovascular surgery: A new perspective facing advanced
retroperitoneal and pelvic malignancies
R. Pau1, M. Merlo2, R. Piana3, S. Sandrucci4
1 University of Turin Surgical Oncology, Vascular Surgery, Turin, Italy2 Citt�a Della Salute E Della Scienza, Vascular Surgery, Turin, Italy3 Citt�a Della Salute E Della Scienza, Orthopedic Surgery, Turin, Italy4University of Turin Surgical Oncology, Turin, Italy
Background: Surgical resection remains the cornerstone for the cura-
tive treatment of oncological disease. When a tumour mass encases a crit-
ical arterial or venous structure, successful symptom relief and long-term
oncological control may be achieved through careful preoperative planning
within a multi-disciplinary team incorporating oncological and vascular
specialists. To highlight the strategic issues pertaining to the vascular man-
agement of these patients, this review addresses the principles in planning
oncovascular surgery, namely where cancer resection necessitates concur-
rent ligation or reconstruction of a major vascular structure.
Material and methods: We considered 8 patients, 4 with a sarcoma of
the vena cava, two with a recurrent cervical carcinoma and two with a
retroperitoneal pelvic sarcoma. In three cases a vascular prosthesis was
employed, in the other cases a direct ligation or a tangential resection
was performed.
Results: After a 24 months mean follow-up one patient locally
recurred. In two cases distant metastases were observed after 4 and 9
months after the intervention. In one case we had a venous kidney infarc-
tion after one month from surgery. In all cases a slightly improvement of
referred compressive symptoms was observed; QoL improvement was not
assessed.
Conclusions: Major vessel involvement of a tumour mass should not
necessarily be considered a barrier to en bloc resection and hence curative
surgery. Radical surgical resection may offer the only chance for cure or
palliation for these patients. Detailed preoperative planning within an
extended multi-disciplinary team that includes vascular specialists is
essential for these complex patients. The observed outcomes for different
malignancies suggest that survival is dependent upon complete clearance
of the primary pathology and tumour biology rather than vascular-related
complications.
No conflict of interest.
http://dx.doi.org/10.1016/j.ejso.2014.08.457
470. Surgical treatment of retroperitoneal sarcomas. Ten years’
experience
A. Petrou1, K. Neofytou2, S. Corsava3, A. Papalambros4, M. Loizou1, E.
Felekouras4
1 Nicosia Teaching Hospital, Department of Surgical Oncology, Nicosia,
Cyprus2 The Royal Marsden NHS Trust, Department of Academic Surgery,
London, United Kingdom3 St George’s Medical School, London, United Kingdom4University of Athens Medical School, LAIKON Teaching Hospital, First
Department of Surgery, Athens, Greece
Background: Complete sarcoma resection, experienced aggressive
surgical technique and individualization of patient management is the
gold standard of treatment for patients suffering retroperitoneal
sarcomas.
Materials and methods: Clinical outcomes of primary retroperitoneal
sarcoma resections from January 2002 until January 2012, were reviewed
to determine the efficacy of complete surgical resection as the principle in-
strument for treatment without any radiotherapy or chemotherapy. The
duration of illness, histological type, tumor size and grade as well as organ
resection were recorded and subsequently reviewed. The surgeries took
place at the First Department of Surgery, University of Athens Medical
School, Athens, Greece, and at the Hepatobiliary and Surgical Oncology
Department, Nicosia Teaching Hospital, Nicosia, Cyprus.
Results: Our study included seventy-nine cases of sarcoma resections
(fifty-eight first-time laparotomies, sixteen second-time and five third-time
representing fifty-eight patients (33 male and 25 female). These resections
took place between 2002 and 2012. Most patients (95%) had complete
resection and 46 of them did not receive neither radiotherapy nor chemo-
therapy. 30 day mortality was zero. Patients who had had duration of
symptoms less than 3 months overall and their tumor size was less than
5cm and was histologically classed as liposarcoma low grade, had a five
year survival close to 100%. Patients with more than 3 months symptoms
duration, with high grade tumor, where tumor size was between 10e20 cm
or more and histological types were leiomyosarcoma, liposarcoma, malig-
nant fibrous histiocytoma or malignant peripheral nerve sheath tumor, had
an average 5-year survival of 35%.
Conclusions: R0/R1 surgical resection of retroperitoneal sarcomas
combined with individualized patient management when undertaken by
experienced surgical teams can succeed in treating patients without the
need of radiotherapy or chemotherapy adjuncts.
No conflict of interest.
http://dx.doi.org/10.1016/j.ejso.2014.08.458
471. A clear cell sarcoma e A clinical case
M. Martins1, C. Longras1, D. Andr�e1, A.C. Carvalho1, T. Santos1, J.
Monteiro1, J. Magalh~aes1, A. Castro1, J. Pinto Correia1
1 Centro Hospitalar do Alto Ave, General Surgery, Guimaraes, Portugal
Background: The clear cell sarcoma is a rare type of primary cancer
that affects young adults between 20 and 40 years. Are more common in
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ABSTRACTS S179
women and tend to grow along the tendons in the limbs, especially the
feet and hands. They are generally asymptomatic. A genetic cause is
cell sarcoma translocation gene. Clear cell sarcoma without translocation
may have other genetic mutations, currently unknown, causing the same
effect. Can be classified in two ways: by location or by type of translo-
cation. Types of clear cell sarcomas based on place of origin are: Clear
cell sarcoma typical of tendons and aponeurosis (Layers of tendons);
Clear cell sarcoma, gastrointestinal; Clear cell sarcoma of the skin
(Skin). By genetic classification, the most common types of transloca-
tions are EWSR1/ATF1 or EWSR1/CREB1. Some tumors have no
EWSR1 translocation.
Materials and methods: Describe the case of a 52 year old man pre-
sents about 3 nodular lesions on the dorsum with 3 months of evolution. It
is subjected to excisional biopsy that reveals clear cell sarcoma.
Results: A men, 52 years with hypertension is referred for outpatient
general surgery for 3 nodular lesions with about 5cm � 5 cm in the dorsal
region with 3 months of evolution. Held ultrasound lesion that was not spe-
cific. Chest computed tomography scan performed which showed two mi-
cronodules in the lung. Excisional biopsy of the lesion with confection of
skin flap and expanded margins was submitted. Histology revealed clear
cell sarcoma. In oncology consultation it was decided to start chemo-
therapy. The patient was asymptomatic at 3 months.
Conclusions: Treatment consists of surgery (wide local excision). As
clear cell sarcomas are usually invasive, surgery is the main treatment for
these lesions, aimed at removing the tumor with safety margins. Radia-
tion therapy is commonly used in the surgical area to kill microscopic re-
sidual tumor cells and thus reduce the chances of local recurrence. When
applied before surgery, radiotherapy can reduce the size of the tumor and
make minor surgical procedure. The most promising experimental strat-
egy for the treatment of clear cell sarcoma is a targeted therapy that is
designed to achieve specific characteristics of cancer cells. One type of
targeted therapy is the tyrosine kinase inhibitor that blocks hyperactive
signaling molecules in cancer cells that promote the growth of cancer
receiver.
No conflict of interest.
http://dx.doi.org/10.1016/j.ejso.2014.08.459
472. Deep-seated huge hibernoma of soft tissue: A rare differential
diagnosis of atypical lipomatous tumour/well differentiated
liposarcoma
N. Vassos1, M. Lell2, W. Hohenberger1, R. Croner1, A. Agaimy3
1 University Hospital Erlangen, Department of Surgery, Erlangen,
Germany2University Hospital Erlangen, Institute of Radiology, Erlangen, Germany3University Hospital Erlangen, Institute of Pathology, Erlangen, Germany
Background: Hibernoma is a rare benign fat-forming soft tissue tumor
that differentiates similar to brown fat, hence an origin from remnants of
fetal brown adipose tissue has been proposed. Mainly young adults are
affected, usually without significant clinical symptoms.
Material and methods: We report on four patients with hibernomas,
who were treated at our hospital during the last 10 years. The clinicopath-
ologic and immunohistochemical features are presented and treatment and
follow-up data discussed.
Results: Patients were 2 women and 2 men aged 21e67 years (mean:
45 yrs) who presented with a slowly growing, painless mass. The anatomic
location was the thigh, upper arm, lateral thoracic wall and paravertebral
soft tissue. Two of them were diagnosed preoperatively through a percuta-
neous core needle biopsy and the other two underwent surgery because of
high clinical and radiological suspicion of liposarcoma. The tumor’s size
ranged from 7 cm to 15.5 cm (mean: 11 cm). All were deep-seated subfas-
cial intramuscular masses. Histologically, all four tumors were of the
typical variant. All patients underwent a R0-surgical resection of the tumor
and they were recurrence-free at last follow-up (mean:47 months; range:
25e87).
Conclusions: Hibernoma may present as huge deep intramuscular soft
tissue mass in adults, closely mimicking well differentiated liposarcoma
and should be considered in the differential diagnosis of fatty soft tissue
tumors in any location. Surgical excision is the treatment of choice. The
tumor has no malignant or recurrence potential.
No conflict of interest.
http://dx.doi.org/10.1016/j.ejso.2014.08.460
Poster Session: Thyroid Cancer
473. Prognostic factors for disease-specific survival in 109 patients
with H€urthle cell thyroid carcinoma: A single-institution experience
I. Edhemovic1, R. Petric1, B. Gazic2, N. Besic1
1 Insititute of Oncology, Surgical Oncology, Ljubljana, Slovenia2 Insititute of Oncology, Pathology, Ljubljana, Slovenia
Introduction: H€urthle cell thyroid carcinoma (HCTC) is a rare disease.
It is believed that it is more aggressive than follicular thyroid carcinoma.
The aim of our study was to identify factors associated with disease-spe-
cific survival.
Patients and methods: Altogether 109 patients (27 male, 82 female,
median age 62 years, range 19e87 years) with HCTC treated at our insti-
tute from 1972 e 2011 were included in the present retrospective study.
Data on age, clinical and histopathology factors, tumor stage, recurrence,
disease-free and disease-specific survival were collected. Univariate anal-
ysis was used to identify factors associated with disease-specific survival.
Cox’s multivariate regression model was used to identify independent
prognostic factors for disease-specific survival.
Results: Of 109 patients, 12 (11%) had distant and 8 (7%) locoregional
metastases before the first treatment. A total or near-total thyroidectomy,
radioiodine ablation of thyroid remnant and external beam radiotherapy
was performed in 71%, 81% and 26% of patients, respectively. Recurrence
was diagnosed in 27 cases: locoregional, distant and both locoregional and
distant in 12, 12 and 3 cases, respectively. The follow-up period was 1 to
337 (median 107) months. By the end of the study, 68 patients were still
alive (52 had no evidence of disease, 16 were alive with disease), five pa-
tients were lost to follow-up, 16 patients died of causes unrelated to pri-
mary disease, while 20 patients died of thyroid carcinoma (18 of distant
metastases, 2 of distant and locoregional disease). The 5-year, 10-year
and 20-year disease specific survival were 95%, 88% and 62%, respec-
tively. Independent prognostic factors for disease-specific survival were:
age of patients, distant metastases and residual tumor after surgery. In pa-
tients older than 45 years of age the risk of shorter disease specific survival
was 6.5 times higher than in younger patients. In the patients with distant
metastases the risk of shorter survival was 3.3 times higher than in the pa-
tients without dissemination. The risk of shorter disease specific survival
was 21.9 and 5.1 times higher in patients with macroscopic and micro-
scopic residual tumor than in patients without residual disease,
respectively.
Conclusions: Long disease-specific survival was found in patients with
HCTC younger than 45 years of age, without distant metastases and
without residual tumor after surgery.
No conflict of interest.
http://dx.doi.org/10.1016/j.ejso.2014.08.461