:: Music ::

In one of those moods so I thought I would share some music that I have been listening to while thinking about myself and others with this sobering disease. -M.

Temple Of The Dog - Say Hello To Heaven

Please, mother mercy
Take me from this place
And the long winded curses
I keep hearing in my head
Words never listen
And teachers never learn
Now I'm warm from the candle
But I feel too cold to burn
He came from an island
And he died from the street
He hurt so bad like a soul breaking
But he never said nothing to me
So say hello to heaven

New like a baby
Lost like a prayer
The sky was your playground
But the cold ground was your bed
Poor stargazer
Shes got no tears in her eyes
Smooth like whisper
She knows that love heals all wounds with time
Now it seems like too much love
Is never enough, you better seek out
Another road cause this one has
Ended abrupt, say hello to heaven

I never wanted
To write these words down for you
With the pages of phrases
Of things well never do
So I blow out the candle, and
I put you to bed
Since you cant say to me
Now how the dogs broke your bone
Theres just one thing left to be said
Say hello to heaven

:: LISTEN ::

:: General Update ::

WASHINGTON — Sen. Edward Kennedy's battle with a malignant brain tumor is likely to put a dramatic personal stamp on a health care cause he first championed nearly 40 years ago: The nation's war on cancer.

Kennedy had already begun work on an overhaul of the 1971 National Cancer Act when his tumor was diagnosed, and advocates hope the fact that Kennedy has fallen victim to this disease will generate public support and lend new urgency to the need to update the bill.

"People think of Ted Kennedy as a fighter and as someone who has always been there for everyone," said Daniel E. Smith, president of the American Cancer Society Cancer Action Network, the American Cancer Society's advocacy arm. "The fact that he now is fighting this disease is a jolt. It's a wake-up call to everyone."

"With that diagnosis, the irony for us is Senator Kennedy has been one of our great champions," Smith said.

The 76-year-old Kennedy has been a prominent and passionate advocate of cancer research and other health care issues throughout his long tenure in the Senate.

Prospective Randomized Trial

A prospective randomized trial comparing patient-
controlled epidural analgesia to patient-controlled
intravenous analgesia on postoperative pain control
and recovery after major open gynecologic cancer
surgery

http://snipurl.com/jf4ae  [www_sciencedirect_com]

Methods
A randomized controlled clinical trial included
women undergoing laparotomy for a gynecologic
disorder. Patients were randomized to postoperative
IV morphine PCA (control arm) or to postoperative
morphine–bupivacaine PCEA (treatment arm).
Postoperative outcomes such as pain, and length of
hospital stay were compared with an intention-to-
treat analysis. The primary endpoint was
postoperative pain at rest and when coughing —
assessed by a 10-point visual analog scale (VAS).

Results
Between 9/04 and 6/07, 153 patients were randomized
and 135 were evaluable (PCEA = 67; PCA = 68). Over
75% of the women in this study had gynecologic
cancer. Patients in the PCEA arm had significantly
less postoperative pain at rest on Day 1 and during
the first 3 postoperative days when coughing
compared to the PCA arm (P < 0.05). The mean pain
score at rest on Day 1 was 3.3 for the PCEA group
compared to 4.3 for the PCA group (P = 0.01).
Overall, postoperative pain at rest and while
coughing in the first 6 days was less in women
treated with PCEA compared to PCA (P < 0.003).

Conclusions
PCEA offers superior postoperative pain control
after laparotomy for gynecologic surgery compared to
traditional IV PCA. Women requiring major open
surgery for gynecologic cancer should be offered
PCEA for postoperative pain management if there are
no contraindications.

Leiomyosarcoma of the Adrenal vein: a novel approach to surgical resection

Another great study is also listed here.

Here is an excerpt:
This is a 64-year old woman who presented with a 13 × 6.5 × 6.6 cm heterogeneous mass arising in the region of the right adrenal gland and extending into the inferior vena cava (IVC) and the right atrium. Biochemical evaluation excluded a functional tumor of the adrenal gland, and multiple tumor markers were negative. We present the novel use of deep hypothermic circulatory arrest (DHCA) in the resection of an adrenal vein leiomyosarcoma extending into the right atrium. The patient remains free of disease ten months after surgery. DHCA afforded a bloodless operative field for optimal resection of disease from within the IVC.

Leiomyosarcoma is a soft-tissue tumor that differentiates from smooth muscle. Primary leiomyosarcomas of vascular origin are relatively rare and frequently arise within the IVC [1-3]. Rarely, leiomyosarcomas may arise from the renal or adrenal vein. We report the case of a leiomyosarcoma of the adrenal vein and a novel approach to surgical resection involving the use of deep hypothermic circulatory arrest (DHCA).

(Figure 1).

Figure 1. Sagittal view of abdominal MRI. Tumor (arrow) extends from the superior pole of the right kidney to the right atrium.

A leiomyosarcoma of the adrenal vein was first reported in 1981, in a 50-year old patient with a 12 cm leiomyosarcoma arising from the left adrenal vein [4]. Since that time, there have been only eight other reported cases. We report a ninth case, using the novel approach of surgical resection under DHCA

More About LMS

Surgical Treatment of Leiomyosarcoma of the Distal Duodenum
R. Orda, J. Sayfan, I. Wasserman

Department of Surgery 'A', Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel



Malignant tumors of the small intestine are rare. An uncommon finding of leiomyosarcoma located in the fourth part of the duodenum was diagnosed by gastrointestinal contrast studies, CT and angiography. Although malignant lesions of the small bowel are usually diagnosed late and thus are far advanced, curative resection was possible in our case. The location and histology of the tumor permitted a 'pancreas-preserving segmental duodenectomy'. The operative approach and exposure using the Cattell maneuver is described. It is emphasized that the more extensive pancreatoduodenectomy should be reserved for adenocarcinomas or lesions situated in the proximal part of the duodenum. Thirteen years following the operation, the patient is asymptomatic while CT and gastrointestinal contrast studies reveal no evidence of disease.

Alternative Names Mass; Neoplasm

Definition Return to top

A tumor is an abnormal growth of body tissue. Tumors can be cancerous (malignant) or non-cancerous (benign).

Causes Return to top

In general, tumors appear to occur when there is a problem with the dividing of cells in the body. Typically, the division of cells in the body is strictly controlled. New cells are created to replace older ones or to perform new functions. Cells that are damaged or no longer needed die to make room for healthy replacements.

If the balance of cell division and death is disturbed, a tumor may form.

Problems with the body's immune system can lead to tumors. Tobacco causes more deaths from cancer than any other environmental substance. Other causes include:

• Benzene and other chemicals and toxins
• Drinking excess alcohol
• Excessive sunlight exposure
• Genetic problems
• Inactivity (sedentary lifestyle)
• Obesity
• Radiation

Certain viruses can play a role in the development of tumors, such as cervical cancer (human papillomavirus) and hepatocellular carcinoma (hepatitis B virus).

Some tumors are more common in one gender than the other. Some are more common among children or the elderly. Others vary with diet, environment, and your family history.

Symptoms Return to top

Symptoms depend on the type and location of the tumor. For example, lung tumors may cause coughing, shortness of breath, or chest pain, while tumors of the colon can cause weight loss, diarrhea, constipation, iron deficiency anemia, and blood in the stool.

Some tumors produce no symptoms, but symptoms that may occur with tumors include:

• Chills
• Fatigue
• Fever
• Loss of appetite
• Malaise
• Night sweats
• Weight loss

Exams and Tests Return to top

Like the symptoms, the signs of tumors vary based on their site and type.

When a tumor is found, a biopsy is performed to determine if the tumor is non-cancerous (benign) or cancerous (malignant). Depending on the location of the tumor, the biopsy may be a simple procedure or a serious operation.

Most patients with tumors undergo CT scans or MRI to determine the exact location of the tumor and how far it has spread. More recently, positron emission tomography (PET) scans have been used to find certain tumor types.

Other tests include:

• Biopsy of the tumor
• Blood chemistries
• Bone marrow biopsy (most often for lymphoma or leukemia)
• Chest x-ray
• Complete blood count (CBC)

Treatment Return to top

Treatment also varies based on the type of tumor, whether it is benign or malignant, and its location. If the tumor is benign (meaning it has no potential to spread) and is located in a "safe" area where it will not cause symptoms or affect the function of the organ, sometimes no treatment is needed.

Sometimes benign tumors may be removed for cosmetic reasons, however. Benign tumors of the brain may be removed because of their location or harmful effect on the surrounding normal brain tissue.

If a tumor is malignant, treatments include:

• Surgery
• Radiation
• Chemotherapy
• A combination of these methods

If the cancer is in one location, the goal of treatment is usually to remove the tumor with surgery. If the tumor has spread to local lymph nodes only, sometimes these can also be removed. If all of the cancer cannot be removed with surgery, the options for treatment include radiation and chemotherapy, or both. Some patients require a combination of surgery, radiation and chemotherapy.

However, lymphoma is rarely treated with surgery. Chemotherapy and radiation therapy are most often used for treating lymphoma.

Support Groups Return to top

The diagnosis of cancer often causes a lot of anxiety and can affect a patient's entire life. There are many resources for cancer patients (see cancer resources).

Outlook (Prognosis) Return to top

The outlook varies widely among different types of tumors. If the tumor is benign, the outlook is generally very good. However, there are some instances where a benign tumor can cause significant problems, for instance, in the brain.

If the tumor is malignant, the outcome depends on the stage of the tumor at diagnosis. Some cancers can be cured. Some that are not curable can still be treated and patients can live for many years with the cancer. Still other tumors are quickly life-threatening.

Possible Complications Return to top

Complications can occur if a tumor is located in a region of the body where it affects the function of the normal organ. If the tumor is malignant, it can also cause complications if it spreads (metastasizes).

When to Contact a Medical Professional Return to top

Call your health care provider if you notice any suspicious lumps or bumps on your body, or if you notice a new or changing mole on your skin.

Prevention Return to top

You can reduce the risk of cancerous (malignant) tumors by:

• Eating a healthy diet
• Exercising regularly
• Limiting alcohol
• Maintaining a healthy weight
• Minimizing exposure to radiation and toxic chemicals
• Not smoking or chewing tobacco
• Reducing sun exposure if you burn easily

Update Date: 8/3/2008

Leiomyosarcoma of the maxillary sinuses: report of two cases.

Leiomyosarcoma is a malignant smooth-muscle tumor that has a predilection for the gastrointestinal tract and the female genital tract. It is locally fast-spreading and highly aggressive, and the prognosis is poor. We report two cases of leiomyosarcoma of the maxilla maxilla /max·il·la/ (mak-sil´ah) pl. maxil´las, maxil´lae [L.] the irregularly shaped bone that with its fellow forms the upper jaw. max´illary

---

max·il·la
n. pl. in patients who sought treatment for maxillary swelling, nasal obstruction, and epistaxis; one patient also had orbital involvement and cervical lymph node metastasis. Both patients underwent radical surgery followed by chemo- and/or radiotherapy. The patient with orbital involvement died shortly thereafter, but the other was disease-free at 18 months.

Case reports
Patient 1. A 27-year-old woman sought treatment for a 6-month history of painful swelling over the right maxillary area that was accompanied by nasal obstruction, epistaxis, proptosis proptosis /prop·to·sis/ (prop-to´sis) forward displacement or bulging, especially of the eye.

---

prop·to·sis
n. pl. , and loose teeth.
Clinical examination revealed that the diffuse swelling measured 5 x 4 cm and involved the orbit (figure 1). The tumor extended inferiorly to the angle of the mouth, laterally to the front of the tragus., and medially to the dorsum. of the nose. It obliterated the nasolabial fold and involved the skin at the root of the nose. The skin over the swelling appeared to be stretched. Movement of the right eyeball was restricted. Intraorally, the swelling destroyed the hard palate and alveolus. On anterior rhinoscopy, the mass could be seen filling the entire nasal cavity. Findings on postnasal postnasal /post·na·sal/ (-na´z'l) posterior to the nose.

---

post·na·sal
adj.
1. Located or occurring posterior to the nose or the nasal cavity.
2. examination were normal. Examination of the neck revealed that multiple cervical lymph nodes Cervical lymph nodes are lymph nodes found in the neck. Anterior cervical nodes
The anterior cervical nodes are a group of nodes found on the anterior part of the neck. at levels I and II were hard, nontender, and mobile.

[FIGURE 1 OMITTED]
We arrived at a clinical diagnosis of a malignancy of the right maxilla with orbital infiltration and metastasis to the cervical lymph nodes. Computed tomography (CT) revealed a large soft-tissue density in the right maxillary sinus that had destroyed all of the maxillary walls except the posterior wall and that had involved the orbit (figure 2). There was no intracranial extension.

[FIGURE 2 OMITTED]
Analysis of the biopsy specimen revealed that the tumor tissue was made up of fascicles of spindle-shaped cells with eosinophilic eosinophilic /eo·sin·o·phil·ic/ (-fil´ik)
1. readily stainable with eosin.

2. pertaining to eosinophils.

3. pertaining to or characterized by eosinophilia. cytoplasm and oval to elongated and blunt-ended vesicular nuclei (figure 3). Mitosis was conspicuous. Areas of necrosis, fibrosis, hyalinization, and inflammatory infiltrates were seen. The reticulin reticulin /re·tic·u·lin/ (re-tik´u-lin) a scleroprotein from the connective fibers of reticular tissue.

---

re·tic·u·lin
n. stain showed abundant reticulin fibers around individual tumor cells. The van Gieson's and Masson's trichrome stains showed smooth-muscle differentiation in the spindle cells. These features were those of a leiomyosarcoma.

[FIGURE 3 OMITTED]
The patient underwent radical maxillectomy with orbital exenteration exenteration /ex·en·ter·a·tion/ (ek-sen?ter-a´shun)
1. surgical removal of the inner organs; evisceration.

2. in ophthalmology, removal of the entire contents of the orbit. and radical neck dissection Radical Neck Dissection Definition

Radical neck dissection is an operation used to remove cancerous tissue in the head and neck.
Purpose . A temporary obturator obturator /ob·tu·ra·tor/ (ob´tu-rat?er) a disk or plate, natural or artificial, that closes an opening.

---

ob·tu·ra·tor
n.
1. was inserted. The patient underwent chemo- and radiotherapy for 3 days, but died of aspiration pneumonia.

Patient 2. A 42-year-old woman reported a 2-month history of swelling over the left maxillary region, nasal obstruction, epistaxis, and loose teeth and a 1-month history of swelling in the left upper jaw. The jaw swelling arose after she had had three teeth extracted by a dentist.

Clinical examination revealed that the diffuse swelling over the left maxillary area measured 3 x 2 cm. The swelling extended superiorly to the infraorbital region, inferiorly to the angle of the mouth, laterally to the malar bone malar bone
n.
See zygomatic bone. , and medially to the ala of the left nostril, where it obliterated the left nasolabial fold. The skin over the swelling was normal. The same swelling was seen intraorally, and it had destroyed the hard palate and extended to the alveolus, where it had obliterated the gingivobuccal sulcus sulcus /sul·cus/ (sul´kus) pl. sul´ci [L.] a groove, trench, or furrow; in anatomy, a general term for such a depression, especially one on the brain surface, separating the gyri. . The surface of the mass in the oral cavity was smooth, and the mucous membrane was intact. Anterior rhinoscopy revealed that a smooth mass in the nasal cavity had filled the left nostril. Findings on postnasal examination were normal. The orbit and the movement of the left eyeball were also normal. There were no palpable lymph nodes.

We arrived at a clinical diagnosis of a malignancy of the left maxilla without orbital infiltration. CT showed a large soft-tissue density in the maxillary sinus that had destroyed the anterior floor and the medial wall of the left maxillary sinus (figure 4). Biopsy analysis identified the lesion as a leiomyosarcoma. The patient underwent a total maxillectomy followed by radiotherapy, and she received a permanent prosthesis. At the 18-month follow-up, she was symptom-free (figure 5).

[FIGURES 4-5 OMITTED]
Discussion

The first case of maxillary leiomyosarcoma was reported in 1958. (1) Since then, only about 65 cases have been reported throughout the world. (2)

Incidence. Leiomyosarcomas account for 6.5% of all soft-tissue sarcomas, and only 3% of them arise in the head and neck. (3) When they occur in the sinonasal tract, the most common sites are the nasal cavity, the maxillary sinus, and the ethmoid sinus, in that order.

Clinical features. Leiomyosarcomas of the sinonasal tract are more common in men than in women. (4) The average age at diagnosis is 50 years. (5) Initial symptoms in order of decreasing frequency include nasal obstruction, epistaxis, facial pain, and facial swelling. Sinonasal tract leiomyosarcoma is characterized as locally aggressive rather than as having high metastatic potential. (1) Any degree of orbital invasion, which occurred in our patient 1, is disastrous. Leiomyosarcoma with regional lymph node involvement is rare, but cervical node metastasis has been reported in 15% of leiomyosarcomas that arise in the oral cavity. (6)

Histopathology. On histologic examination, the tumor is made up of interlacing fascicles of spindle-shaped cells that have elongated, blunt-ended nuclei and eosinophilic cytoplasm. Numerous mitotic figures are present. The cytoplasm of the tumor cells stains red in Masson's trichrome medium. (7)

Radiology. On CT, leiomyosarcomas appear as bulky masses, and they are frequently associated with extensive necrotic or cystic changes. These tumors do not contain calcifications, but they do cause frank bony destruction, as occurred in both of our patients. On magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. , leiomyosarcomas show intermediate enhancement with contrast and intermediate to high signal intensity on T2-weighted imaging. (3)

Differential diagnosis. Depending on the patient's age and the location of the tumor, the differential diagnosis includes malignant schwannoma, malignant fibrous histiocytoma malignant fibrous histiocytoma
n.
A deeply situated tumor, especially on the extremities of adults, frequently recurring after surgery and metastasizing to the lungs. , fibrosarcoms, amelanotic melanoma, malignant lymphoma, squamous cell carcinoma squamous cell carcinoma
n.
A carcinoma that arises from squamous epithelium and is the most common form of skin cancer. Also called cancroid, epidermoid carcinoma. , extramedullary plasmacytoma, metastatic tumor, glandular tumor, chondroma chondroma /chon·dro·ma/ (kon-dro´mah) pl. chondromas, chondro´mata a benign tumor or tumor-like growth of mature hyaline cartilage. , chondrosarcoma, osteogenic sarcoma, and inverted papilloma. (3,6)

Treatment. Although regional lymph node involvement is rare, when it does occur, resection of the primary tumor with wide margins and neck dissection is the treatment of choice. Recent studies show that combination therapy with mesna, doxorubicin, ifosfamide, and dacarbazine or combination therapy with cyclophosphamide cyclophosphamide /cy·clo·phos·pha·mide/ (-fos´fah-mid) a cytotoxic alkylating agent of the nitrogen mustard group; used as an antineoplastic, as an immunosuppressant to prevent transplant rejection, and to treat some diseases , doxorubicin, vincristine vincristine /vin·cris·tine/ (vin-kris´ten) an antineoplastic vinca alkaloid; used as the sulfate salt in the treatment of various neoplasms, including Hodgkin's disease, acute lymphocytic leukemia, non-Hodgkin's lymphoma, Kaposi's , and dacarbazine is effective against soft-tissue sarcomas.

The clinical features of leiomyosarcoma in our 2 patients differed in that patient 1 exhibited orbital involvement and cervical lymph node metastasis. Her prognosis was very poor and despite radical surgery and postoperative chemo- and radiotherapy, she died of complications. Patient 2, who had less extensive disease, responded well to treatment.

References
(1.) Konrad HR. Nasal neoplasms. In: English GM, ed. Otolaryngology. Philadelphia: J.B. Lippincott, 1993:1-11.
(2.) Ortega JM, Gomez-Angulo JC, Aragones P, et al. [Leiomyosarcoma of the paranasal sinuses with intracranial involvement: Report of a clinical case and review of the literature]. Neurocirugia (Astur) 2001;12:331-7.
(3.) Tanaka H, Westesson PL, Wilbur DC. Leiomyosarcoma of the maxillary sinus: CT and MRI CT and MRI
Two high technology methods of creating images of internal organs. Computerized axial tomography (CT or CAT) uses x rays, while magnetic resonance imaging (MRI) uses magnet fields and radio-frequency signals. Both construct images using a computer. findings. Br J Radiol 1998;71: 221-4.
(4.) Carran RL, Myers EN. Neoplasms of the nose and paranasal sinuses. In: Bailey BJ, ed. Head and Neck Surgery: Otolaryngology. 2nd ed. Vol. 2. Philadelphia: Lippincott-Raven, 1998:1450.
(5.) Rice DH, Stanley RB. Surgical therapy of tumors of the nasal cavity, ethmoid sinus and maxillary sinus. In: Thawley SE, Panje WR, eds. Comprehensive Management of Head and Neck Tumors. 2nd ed. Vol. 1. Philadelphia: W.B. Saunders, 1999:571.
(6.) Sumida T, Hamakawa H, Otsuka K, Tanioka H. Leiomyosarcoma of the maxillary sinus with cervical lymph node metastasis. J Oral Maxillofac Surg 2001;59:568-71.
(7.) Izumi K, Maeda T, Cheng J, Saku T. Primary leiomyosarcoma of the maxilla with regional lymph node metastasis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:310-19.

From the Department of Otolaryngology (Dr. Prasad, Dr. Alva, and Dr. Madhu) and the Department of Pathology (Dr. Khadilkar), Kasturba Medical College, Mangalore Kasturba Medical College (KMC), Mangalore, is a medical college based in Mangalore, Karnataka, India.

It is a constituent college of Manipal University(Formerly known as MAHE), which is a deemed University recognized by an Act of UGC. , India.

Reprint requests: Kishore Chandra Prasad, MS, DLO, Nethravathi Bldg., 1st Floor, Balmatta, Mangalore 575 001, Dakshina Kannada, Karnataka State, South India.

Phone: 91-824-244-5858, ext. 5498; fax:91-824-242-8379; e-mail:kishorecprasad@yahoo.com

New findings from Mayo Clinic describe advances in leiomyosarcoma

2009 APR 20 -- According to recent research from the United States, "Inferior vena cava (IVC) leiomyosarcoma is a rare tumor of smooth muscle origin. It is often large by the time of diagnosis and may involve adjacent organs."

"A margin-free resection may be curative, but the resection must involve the tumor en bloc with the affected segment of vena cava and locally involved organs. IVC resection often requires vascular reconstruction, which can be done with prosthetic graft. Case presentation: We describe a 39-year-old man with an IVC leiomyosarcoma that involved the adrenal gland, distal pancreas, and blood supply to the spleen and left kidney.

Data on gastrointestinal stromal tumors described by D. Pasku et al

Leiomyosarcoma of Spermatic Cord

This was a 4.0 cm leiomyosarcoma arising in the spermatic cord of a 61 year old man. Paratesticular leiomyosarcoma is an extremely rare neoplasm. For a recent review of this tumor, refer to: Fisher C et al. Am J Surg Pathol 2001 Sep; 25(9):1143-9.

According to a study from Greece, "The location of gastrointestinal stromal tumors (GIST) outside of the gastrointestinal system is a rare event. Case presentation: A 56-year old woman presented with a GIST of the pelvis was misdiagnosed and treated as a uterine leiomyosarcoma."

"The diagnosis was made after the CD117 (KIT) positivity in the biopsy of the excised bowel mass four years from the first presentation. During this period she presented a bilateral muscle and subcutaneous metastasis in the gluteal area. The correct diagnosis of the extra-gastrointestinal stromal tumor is a challenge even for experienced pathologists. CD117 (KIT)...