[Adenocarcinoma of the lung. Clinical and prognostic considerations].
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Biomedical subjects
Publications and source records attributed to A Santangelo.
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Among the series of class 111 cancers of the lung treated in 1980-85 the incidence of large cell carcinoma was 4%. Most of these cases presented lymph node invasion. Smoking does not appear to play a decisive role in pathogenesis. Survival at one year after surgery was nil. The diagnosis and treatment of this form do not permit a satisfactory prognosis.
111 patients were treated for lung cancer in 1980-1985. Small cell carcinomas accounted for 9% of the various histological types. The cases classified by TNM were treated by radical surgery where possible. There were no cases of disease free survival at two years.
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Clinical experience has shown that the otomastoid cholesteatoma is more aggressive and has a less favourable prognosis in the child than in the adult. In an attempt to verify whether, in children, the clinical behaviour of the cholesteatoma depends on the histomorphological characteristics of the perimatrix, we carried out a study of samples taken from 30 subjects under 16 years of age and from 30 adults (control group) during surgery for otomastoid cholesteatoma. The study took into account the number of plasmacytes, lymphocytes, macrophages, granulocytes and giant cells per high potency field (X 630). The results showed that in young subjects the perimatrix of the cholesteatoma is richer in mononuclear inflammatory elements with evidence of enzyme-collagenase activity. On the basis of this behaviour the authors conclude that the histomorphological characteristics of the surrounding matrix can play an important role in the pathogenesis of cholesteatoma and may explain the clinical differences that can be seen between cholesteatoma in children and in adults.
A new method of morphometric evaluation of nodal patterns in patients with laryngeal cancer was developed. In 8 selected cases with median tumor and unilateral metastasis, the morphometric data about the perimetastatic nodal tissue and contralateral node in the same patient were compared. The results showed the paracortical area to be consistently larger in lymph nodes without metastasis than in those containing metastases. The mean number of blasts, mitoses and postcapillary venules was also increased in the paracortical area in the non-metastasis-containing nodes. These data support the idea that delayed immunity may inhibit development of metastases. The need for objective morphometric methods in lymph node examination is emphasized.
A review of cases treated in 1978-82 revealed 1 case of lipid cell carcinoma of the breast out of 310 mammary carcinomas. Given the rarity of this histological type and the generally poorer than average prognosis, it seems likely that it should be considered separately from the other cases.
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In a series of 178 patients who underwent partial or total laryngectomy for laryngeal carcinoma, the morphologic changes at a distance from the neoplasm were investigated with whole organ serial sections. We found 60 cases with extensive squamous metaplasia of the epithelium outside of the vocal cords, 24 case with hyperplastic epithelium of the vocal cords, 29 cases with mild or moderate dysplasia, 5 cases with foci of in situ carcinoma, 3 cases with a second carcinoma with minimal stromal invasion, and 4 cases with a double synchronous primary carcinoma. In 55 cases we observed the contemporary presence of a carcinoma and a mono-or bilateral laryngocele. In the excretory ducts of the salivary glands present in the laryngeal mucosa we found a reserve cell hyperplasia in 100% of the cases, a mature squamous metaplasia in 25%, and an oncocytic metaplasia in 14%. These observations led us to consider the laryngeal cancer as an organ disease, in which the oncogenic stimulus operates on all the laryngeal structures and determines lesions of different severity up to neoplasm.
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In a retrospective review of 170 cases of malignancies of the tonsil the authors report on 81 malignant epithelial tumors. In 56 cases (69.1%), the tumor (squamous cell carcinoma) was composed of solid epithelial nests with different degrees of keratinization. In 24 cases (29.6%) the tumor (undifferentiated carcinoma of nasopharyngeal type) had histologic characteristics similar to the undifferentiated carcinomas observed in the nasopharynx. Only one case was unclassifiable. Squamous cell carcinomas occurred more frequently in males (6:1), in older age, with more frequent extratonsillar and nodal extension and a poorer prognosis. Undifferentiated carcinoma had a similar incidence in both sexes, occurred also at an early age, and more often seemed to be limited to the tonsil. The 10-year disease-free survival rate was 30% for undifferentiated carcinoma; all the patients affected by squamous cell carcinoma had a recurrence within 6 years of the diagnosis.
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