bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ductal Carcinoma in Situ (DCIS)
Authors: Cronin Patricia A , Van Zee Kimberly J 
Published: January 2021

Ductal carcinoma in situ (DCIS) is noninvasive intraductal carcinoma of the breast and is defined as a malignant proliferation of ductal epithelial cells that are confined to the milk ducts. It is a nonobligate precursor of invasive breast cancer, but at present, there is no reliable method of predicting which lesions will invade in a given time frame. Historically, DCIS was an uncommon lesion; however, widespread use of screening mammography has resulted in a significant increase in the rate of detection, and DCIS now accounts for about 20% of all breast cancers in the United States. Current treatment options for DCIS include breast-conserving surgery (BCS) alone, BCS with radiotherapy (RT), BCS with endocrine therapy, BCS with both RT and endocrine therapy, mastectomy, and even bilateral mastectomy. There is currently concern about overtreatment of this lesion, but there are no reliable data regarding outcomes without treatment. Although survival is excellent with all standard treatments, local recurrence rates vary widely with various treatment options. Given the variety of options available, the goal of treatment is to tailor the management plan to the individual and optimize the balance of risks and benefits according to the values and priorities of the woman herself.

This review contains 10 figures, 6 tables and 54 references.
Key words: active surveillance, breast conservation, ductal carcinoma in situ, endocrine therapy, intraductal carcinoma, margins, mastectomy, radiation, recurrence, risk factors
Axillary Metastasis with Occult Primary Breast Cancer
Authors: Kuritzky Anne , Khazai Laila , Diaz Roberto , Laronga Christine 
Published: January 2021

The identification of an axillary metastasis in the absence of a primary breast cancer can pose a diagnostic and therapeutic dilemma. The clinician should first use more sensitive imaging modalities, such as breast magnetic resonance imaging, to attempt to find the primary index lesion. If the primary cancer remains occult and the molecular markers are consistent with a breast origin, then the recommended treatment includes multimodality therapy including surgery, chemotherapy/endocrine treatment, and radiation. Historically, the modified radical mastectomy was the standard of practice. Recently, in the era of improved adjuvant therapies, breast-conserving surgery with irradiation is also being considered. Multiple retrospective reviews have shown no difference in survival or recurrence with these two surgical pathways. However, due to the rare nature of this clinical presentation, no multiinstitutional or prospective clinical trial data are available.
Key words: axillary lymph node dissection, axillary metastasis, breast cancer, breast conservation, local recurrence, occult primary tumor, radiotherapy
Primary Cutaneous Melanoma
Authors: Farley Clara R , Delman Keith A , Lowe Michael C 
Published: January 2021

Melanoma presents a significant health burden as its incidence continues to rise in both sexes and remains the most common cause of skin cancer–related death. Risk factors for the development of melanoma include sun exposure, fair complexion, increasing age, previous melanoma, multiple dysplastic nevi, and familial syndromes. Wide local excision is the standard of care for those with early forms of melanoma, with sentinel lymph node biopsy in appropriate populations. Sentinel lymph node status contributes to the discussion as to whether to pursue completion lymphadenectomy. This review outlines surgical treatment of primary cutaneous melanoma, including wide local excision, sentinel lymph node biopsy, and completion lymphadenectomy.

This review contains 10 figures, 4 tables and 33 references
Key words: biopsy, cutaneous, lymphadenectomy, margin, melanoma, pathology, primary, sentinel node, surgery, treatment
Merkel Cell Carcinoma
Authors: Karakousis Giorgos , Vining Charles C , Sinnamon Andrew J 
Published: January 2021

Merkel cell carcinoma (MCC) is a rare and highly aggressive carcinoma of the skin with a high recurrence rate and propensity for metastasis. It was first described in 1972 and subsequently reclassified as a neuroendocrine tumor. Merkel cells are now thought to arise from the epidermal stem cells, not neural crest progenitor cells, as originally thought, and are the only cutaneous cells that form electron-dense neurosecretory granules. Although rare, the incidence of MCC is rapidly increasing. MCC is more often than not associated with Merkel cell polyomavirus, which may be involved in the malignant transformation and pathogenesis of MCC. Mortality exceeds that of the more commonly occurring skin cancer melanoma, with an overall 5-year survival rate ranging from 30 to 64%. Large reviews have documented recurrence rates ranging from 25 to 50% for local recurrence, 52 to 59% for regional recurrence, and 34 to 36% for distant metastases. Early-stage disease can sometimes be cured with surgery and radiation. Due to the rarity of MCC, statistically significant prospective data are lacking to validate prognostic features and treatment. Therefore, recommendations are largely based on small studies, meta-analyses, and expert consensus. Moreover, no consistent molecular activator in MCC has been identified, resulting in large variability in targeted therapies used in its treatment. New therapies to treat advanced MCC, including immunotherapy, hold promise for improved outcomes in the future. This review summarizes current knowledge regarding the etiology, prognosis, and management of MCC.
This review contains 6 figures, 4 tables and 52 references
Key words: Merkel cell carcinoma, Merkel cell polyomavirus, Merkel cell tactile receptor
Malignant Tumors of the Spleen
Authors: Paniccia Alessandro , Chapman Brandon , Gleisner Ana 
Published: January 2021

Malignant tumors of the spleen are rare lesions that can be divided into three broad categories: lymphoproliferative diseases, metastatic lesions, and primary splenic (nonlymphoid) malignant neoplasms. Additionally, although myeloproliferative diseases are not tumors of the spleen, they do have the potential to either directly or indirectly affect splenic function, often manifesting as splenomegaly, hypersplenism, or both. Lymphoproliferative and myeloproliferative diseases are almost always systemic diseases. Consequently, medical therapy is the primary treatment, and splenectomy is currently reserved for patients with hematologic disorders refractory to medical management—for palliation of symptoms caused by splenomegaly or hypersplenism—and in the rare case of the pure splenic form of the disease. Patients affected by malignant splenic lesions often present with vague symptomatology, including generalized malaise, fatigue, weight loss, and fever. These symptoms may be accompanied by abdominal pain, a palpable left upper quadrant mass, or overt splenomegaly. Radiologic imaging, including ultrasonography, computed tomography, and magnetic resonance imaging, is mandatory in the evaluation of splenic tumors and may narrow the differential diagnosis. Management of splenic metastases should be individualized and, whenever possible, determined in a multidisciplinary setting. Splenectomy is the treatment of choice for patients with primary malignant tumors of the spleen in the absence of metastatic disease.

This review contains 10 figures, 8 tables and 51 references
Key words: angiosarcoma, leukemia, malignant splenic tumor, metastatic splenic tumor, spleen, splenectomy, splenic lymphoma
Evaluation of a Soft Tissue Mass in the Extremity or Trunk
Authors: Thomas Daniel C , Han Dale 
Published: January 2021

Soft tissue sarcoma (STS) represents a diverse group of malignant tumors derived from mesenchymal elements. Evaluation of a soft tissue mass of the trunk or extremity starts with a detailed history and physical examination, which will help guide further diagnostic evaluation. Imaging should then be obtained for an STS, with MRI being the preferred modality for the trunk or extremities. Imaging can assist with diagnosis and delineate the extent of the primary lesion, including the relationship to contiguous structures, for treatment planning and assessing resectability. Pathology diagnosis is most commonly performed via examination of a specimen obtained through image-guided percutaneous core-needle biopsy. This requires multidisciplinary planning between Surgery and Radiology to place the needle within the anticipated definitive surgical incision to allow for en bloc resection of the needle tract. Once the diagnosis of an STS is made, appropriate staging studies should be performed based on the history and physical examination and tumor histology, grade, and size. Clinical and pathology data are used to stage STS patients using the American Joint Committee on Cancer staging system, which incorporates the STS site, size and grade of the primary tumor, and absence or presence of nodal and distant metastatic disease.
This review contains 6 figures, 6 tables and 50 references
Key words: core-needle biopsy, extremity, histology, imaging, risk factors, soft tissue mass, soft tissue sarcoma, staging evaluation, trunk, tumor grade
Basics of Imaging Techniques in Evaluation of Soft Tissue Tumors
Authors: Aherne Emily Alanna , Hwang Sinchun 
Published: January 2021

Medical imaging plays a pivotal role in the detection, diagnosis, and clinical management of primary soft tissue tumors. Various imaging modalities have been used, and each modality offers unique advantages in the workup of soft tissue tumors by localizing the lesions in different compartments of the body and characterizing macroscopic tissue composition of the lesions in a noninvasive and safe manner. We review the clinical role and technical aspects of the frequently used imaging modalities, including magnetic resonance imaging (MRI), computed tomography, ultrasonography, positron emission tomography, and plain radiography with an emphasis on MRI as a mainstay imaging modality and a brief discussion of advanced techniques. We also review imaging features of common soft tissue tumors that can be detected and characterized using current imaging techniques.

This review contains 54 figures, 1 table and 37 references.
Key words: computed tomography, diffusion-weighted imaging, imaging, magnetic resonance imaging, positron emission tomography, soft tissue, technique, tumor, ultrasonography
Management of Recurrent Retroperitoneal Sarcoma
Authors: Parsyan Armen , Gupta Abha , Catton Charles , Gladdy Rebecca 
Published: January 2021

Retroperitoneal sarcomas (RPSs) are a heterogeneous group of mesenchymal tumors. The mainstay of treatment of RPS is curative surgical resection, which often involves a multivisceral resection. The predominant pattern of failure in RPS is local recurrence, which poses significant management challenges and limits survival. There is a paucity of high-level evidence to guide the management of primary and recurrent RPS, mainly due to the rarity of the disease. This review highlights the challenges and decision making in the diagnosis and management of recurrent RPS.

This review contains 6 figures, 5 tables and 50 references
Key words: chemotherapy, distant recurrence, leiomyosarcoma, liposarcoma, local recurrence, radiation therapy, retroperitoneal sarcoma, surgical resection
Leiomyosarcoma
Authors: Fiore Marco , Pasquali Sandro , Colombo Chiara 
Published: January 2021

Leiomyosarcoma of soft tissue is a rare tumor affecting one new patient in every 100,000 people yearly. The most frequent sites of origin are the retroperitoneum and abdomen, followed by the limbs and trunk, skin, major vessels, and, rarely, organs. Increasing evidence suggests that all of these tumors originate from the smooth cell muscles of blood vessels. Surgery is the main treatment for localized disease. The risk of disease progression at distant sites outweighs that of local recurrence, suggesting that extensive resections are not recommended, particularly for retroperitoneal tumors. Moreover, leiomyosarcomas are sensitive to various chemotherapy regimens. The eighth edition of the AJCC TNM staging system introduced new accurate nomograms for predicting patient survival that are improving prognostic stratification for identifying those patients at higher risk for disease progression who are likely to benefit from perioperative treatments. More research for this rare tumor is needed to identify innovative predicting and prognostic biomarkers and new effective treatment strategies.

This review contains 14 figures, 3 tables and 56 references
Key words: inferior vena cava leiomyosarcoma, leiomyosarcoma, retroperitoneal sarcoma
Postoperative and Ventilator-Associated Pneumonia
Authors: Coopersmith Craig M. , Fitzgerald Caitlin A. 
Published: January 2021

Postoperative pneumonia is currently the third most common complication seen in surgical patients and is associated with an increase in both patient morbidity and hospital costs. The incidence of postoperative pneumonia varies among the different surgical subspecialties. A number of evidence-based strategies exist regarding the prevention and management of pneumonia. However, the majority of studies on ventilator-associated pneumonia (VAP) do not specifically focus on surgical patients but rather are based on mixed medical-surgical ICU patients. The aim of this review is to define the incidence, pathogenesis, and risk factors of both postoperative and VAP; determine what pathogens are commonly encountered; discuss treatment methods; and introduce measures that can be implemented in both the surgical wards and the ICU aimed at preventing this complication.
This review contains 5 figures, 7 tables, and 64 references.
Key Words: antimicrobial therapy, disease prevention, postoperative pneumonia, surgical critical care; ventilator associated pneumonia, culture, prevention, management, bundles, diagnosis
Thoracic Injuries and Management Options
Authors: Radomski Michal , Sarani Babak 
Published: January 2021

Thoracic trauma accounts for nearly 25% of deaths secondary to blunt trauma. The most common chest injury is a rib fracture, which can be associated with a mortality risk as high as 35%. Other injuries include pneumothorax, hemothorax, esophageal injury, aortic transection, blunt cardiac injury, tracheobronchial disruption, and pulmonary contusion. The majority of thoracic injuries can be treated successfully with either observation or tube thoracostomy and general supportive care alone. Independent contributors to mortality include inadequate pain control, poor pulmonary hygiene, failure to intubate appropriately, and excessive crystalloid-based resuscitation.

This review contains 3 figures, 5 tables and 64 references
Key words: aorta, bronchus, esophagus, hemothorax, pneumothorax, pulmonary contusion, rib fracture, thoracic, trachea, tracheobronchial
Basic Management of Pelvic Fractures
Authors: Simpson Amelia , Coimbra Raul , Costantini Todd W 
Published: January 2021

The management and treatment of complex pelvic fractures require knowledge of the initial evaluation of a trauma patient, pertinent anatomy, and techniques available for hemorrhage control. Trauma patients with complex pelvic fractures are at high risk for hemorrhage and require thoughtful and expeditious management. A multidisciplinary team including a trauma surgeon, an orthopedic surgeon, and an interventional radiologist is required for optimal treatment of these complex injuries. The team must be managed by the trauma surgeon to guide ongoing resuscitation as the patient may travel throughout the hospital to undergo several interventions to control hemorrhage. A number of techniques can be emergently implemented for fracture stabilization and hemorrhage control, including temporary application of a pelvic binder, preperitoneal pelvic packing, external fixation, and angioembolization. The patient’s clinical status, fracture pattern, and bleeding source must be considered when deciding which hemorrhage control techniques should be performed. New temporary hemorrhage control interventions, such as resuscitative endovascular balloon occlusion of the aorta, have shown early success in control of pelvic fracture–related hemorrhage and require further investigation. Pelvic fractures are associated with a number of neurovascular and genitourinary injuries, which can carry long-term morbidity. This review discusses the diagnosis, management, and treatment of complex pelvic fracture and associated hemorrhage.
This review contains 5 figures, and 55 references.
Key words: angioembolization, pelvic fixation, pelvic fracture, preperitoneal packing, resuscitative endovascular balloon occlusion of the aorta
Surgical Treatment of Stage I Rectal Cancer
Authors: Garcia-Aguilar Julio 
Published: January 2021

For treatment of early-stage rectal cancer, local (transanal) excision offers the advantages of lower rates of morbidity, mortality, and functional impairment in comparison with radical surgery such as total mesorectal excision (TME). Minimally invasive platforms facilitate removal of rectal tumors that are beyond the reach of conventional transanal excision techniques. The main drawback of local excision is the higher risk of local recurrence compared with TME. The risk of local recurrence is higher in patients with close resection margins, tumors penetrating beyond the submucosa, or tumors with unfavorable histologic features. In these patients, outcomes for immediate proactive TME are generally better than observation followed by reactive salvage TME in case of local recurrence. The use of neoadjuvant chemoradiotherapy may make local excision a viable option for T2 rectal tumors. As chemoradiation and local excision are being increasingly used for later-stage tumors, advances in imaging technologies will play a crucial role in facilitating careful patient selection.

This review contains 5 figures, 5 tables and 37 references
Key words: endocavitary contact radiotherapy, local excision, local recurrence, rectal cancer, salvage surgery, total mesorectal excision, transanal endoscopic operation, transanal excision, transanal minimally invasive surgery
A Standardized Clinical Pathway Approach to Esophageal Cancer
Authors: Wirsching Andrea , Low Donald E 
Published: January 2021

Clinical pathways associated with the surgical treatment of esophageal cancer patients represent an important development to maximize the opportunity for clinical and cost efficiency in patient care. The main goals implemented in standardized clinical pathways are a comprehensive preoperative workup and tumor board presentation; anesthesia management dedicated to enable enhanced recovery and standardized steps of postoperative recovery, including early mobilization; efficient removal of tubes, catheters, and lines; and early enteral feedings. Recent studies report a decreased length of hospital and intensive care unit stay and decreased costs associated with the routine application of these pathways. Some reports have also shown a decrease in postoperative morbidity and mortality related to the implementation and refinement of standardized clinical pathways. The present review is dedicated to all aspects of standardized clinical pathways for esophagectomy and aims to give an insight into key components of the clinical pathway, which have evolved over the last 20 years at our institution.
This review contains 3 figures, 8 tables, and 33 tables.
Key words: clinical pathway, costs, enhanced recovery, esophageal cancer, esophagectomy, hospital stay, implementation, length of stay, outcome, standardized pathway
Small Intestine: Neuroendocrine and Miscellaneous Tumors
Authors: Baumgartner Joel M , Banerjee Sudeep , Sicklick Jason K 
Published: January 2021

Carcinoid tumors are the most common nonduodenal small bowel tumors. Although the diagnosis of any small bowel tumor is challenging, serum tumor markers and specialized imaging can aid in the diagnosis of carcinoid. Localized carcinoids are treated with surgical resection, whereas metastatic tumors are treated with somatostatin analogues, although liver-directed therapies can improve disease-related symptoms. In contrast, small bowel lymphomas are primarily treated with chemotherapy and sometimes radiation, although surgical intervention may be necessary for diagnosis and resection for palliation of symptoms. Furthermore, there are many benign etiologies of small bowel tumors, including adenoma, leiomyoma, and lipoma. The small bowel can also be a site of distant metastases for which surgical management is reserved for the treatment of complications such as bleeding, obstruction, perforation, or pain.

This review contains 3 figures, 3 tables and 17 references.
Key words: carcinoid tumor, desmoid tumor, locoregional therapy, mesentery, neuroendocrine tumor, small bowel, small bowel lymphoma, somatostatin
Management of Locally Recurrent Sarcoma in the Extremity
Authors: Krumeich Lauren , Neuwirth Madalyn G , Karakousis Giorgos 
Published: January 2021

Extremity sarcomas are a heterogeneous group of malignant tumors with a varied propensity for local recurrence. This review focuses on factors associated with local recurrence and survival, diagnostic workup, management, outcomes, and surveillance. Local recurrence is more common in patients with previous local recurrence, positive margins, high-grade histology, and deep tumors. In the absence of metastases, the mainstay of treatment is limb-sparing surgery, with radiation to improve local control. Modalities such as brachytherapy or proton therapy may be valuable in the setting of previous irradiation. Systemic chemotherapy is typically limited to the treatment of distant disease, although chemotherapy can be delivered locally via limb perfusion or infusion for locally advanced or recurrent disease. Amputation is used if local control cannot be achieved while preserving adequate limb function or as a palliative option for pain, bleeding, or fungating tumors. Prognostic factors associated with poor survival include tumors that recur with high-grade histology, with a large size (> 5 cm), or within a short interval (< 16 months). Reports of 5-year overall survival in patients with locally recurrent sarcomas vary from 36 to 65%. Surveillance includes physical examination, cross-sectional imaging, and chest x-ray. Genetic profiling and intratumoral injections provide novel therapeutic targets.

This review contains 1 figure, 4 tables and 40 references.
Key words: chemotherapy, hyperthermic isolated limb perfusion, intratumoral injection, isolated limb perfusion, local recurrence, margin status, radiation, soft tissue sarcoma, wide local excision
Pediatric Tumors: Rhabdomyosarcoma
Authors: Groundland John , Shaw Sara , Randall R L 
Published: January 2021

Rhabdomyosarcoma (RMS) is a group of soft tissue sarcomas that share a common feature of primitive skeletal muscle differentiation. Three main subtypes have been characterized: embryonal, alveolar, and pleomorphic. Presentation and prognosis of RMS are highly variable, depending on anatomic location, subtype, and risk stratification. Currently, treatment centers on systemic control with cytotoxic chemotherapy and local control with surgery and/or therapeutic radiation.

This review contains 3 figures, 10 tables and 50 references
Key words: alveolar rhabdomyosarcoma, embryonal rhabdomyosarcoma, pediatric soft tissue sarcoma, pleomorphic rhabdomyosarcoma, rhabdomyosarcona, t(2;13), t(1;13)