Primary retroperitoneal neoplasms: CT findings in 90 cases with clinical and pathologic correlation.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
H M Reiman
Publications and source records attributed to H M Reiman.
Management of retroperitoneal sarcomas.
The records of 116 adult patients who underwent operative treatment for retroperitoneal sarcomas at the Mayo Clinic during the years 1963 to 1982 were reviewed. Clinical, pathologic, and treatment variables were analyzed for their influence on recurrence and death from disease. Leiomyosarcomas, liposarcomas, and malignant fibrous histiocytomas represented 93% of the tumors. The primary tumor was completely excised in 54% of patients. Recurrent tumor developed in 68% of patients (median time to recurrence, 1.3 years). Tumor fixation to adjacent structures (T3 tumor) or a high-grade tumor (G2-4) identified patients at increased risk for recurrent disease. Five-year and 10-year survival rates were 40% and 22%, respectively. Survival was significantly better for patients who had (1) complete surgical excision of their tumors, (2) low-grade tumors (G1), (3) tumors not fixed to adjacent retroperitoneal structures (T1 and T2 sarcomas), and (4) tumors without metastases when initially seen. Complete surgical excision offers patients with retroperitoneal sarcomas the best chance for long-term survival, but recurrent disease remains a vexing problem. The therapeutic challenges in the treatment of retroperitoneal sarcomas continue to be the development of therapy that will increase the rate of complete resection, decrease the rate of local recurrence, and enhance patient survival.
Adult↗
Soft-tissue sarcoma: Mayo Clinic experience.
Soft-tissue tumors encompass a wide variety of lesions and continue to pose a difficult treatment problem. The outlook, however, is improving, and there have been recent advances in pretreatment assessment, clinicopathologic correlation, and adjuvant treatment programs. We retrospectively reviewed our experience in a large series of soft-tissue tumors treated at the Mayo Clinic as well as recent experience using chemotherapy and radiation treatment.
Adult↗
Lipofibromatous hamartoma of nerve.
Seventeen cases of lipofibromatous hamartoma of nerve (14 with histologic confirmation) were treated between 1935 and 1985. One patient had bilateral involvement. Fourteen lesions were located in the upper extremity and four in the lower extremity. Twelve of the 18 lesions were associated with combined soft tissue and skeletal enlargement, or true macrodactyly. Three other lesions had soft tissue enlargement other than that noted intraneurally. Three patients were treated with carpal tunnel release alone and 14 with combined procedures to decrease the size of the affected part. Sensibility in the affected part often appeared unrelated to removal or preservation of hamartomatous nerve tissue. Complications related to nerve surgery included recurrence of carpal tunnel syndrome in one patient, recurrent soft tissue mass in one patient, and painful calcification of the involved tissues 20 years postoperatively in one patient.
Adolescent↗
Embryonal rhabdomyosarcoma of bladder and prostate: nuclear DNA patterns studied by flow cytometry.
Nuclear deoxyribonucleic acid ploidy studies with paraffin-embedded archival tumor specimens were performed by flow cytometry on extracted nuclei from 13 embryonal rhabdomyosarcomas of the bladder and prostate. Preparation of embedded tissue specimens into single dissociated nuclei was by the Hedley technique and they were stained with propidium iodide according to the Vindeløv method. Before the era of chemotherapy, 6 of 7 patients died of disease at a median of 5.5 months post-treatment. All 6 deaths occurred in patients with deoxyribonucleic acid aneuploid patterns that were stage II or greater. The 1 survivor had a deoxyribonucleic acid aneuploid pattern and stage I disease and is alive at 12 years of followup. Since 1971, 6 patients were treated with primary polychemotherapy and surgery. All 6 patients are alive without evidence of disease at a mean followup of 75 months (range 12 to 180 months). All 6 patients had deoxyribonucleic acid aneuploid tumors. One patient was stage I and 5 patients were stage III. Thus, all patients with pediatric embryonal rhabdomyosarcoma of the bladder and prostate had deoxyribonucleic acid aneuploid tumors. These patients responded well to treatment with the combination of chemotherapy and surgery.
Aneuploidy↗
Incidence of malignant bone and joint tumors in Olmsted County, Minnesota, 1935 through 1981.
During the 47-year period 1935 through 1981, 30 cases of malignant bone and joint tumors (in 20 male and 10 female patients) were identified among Olmsted County, Minnesota, residents. The incidence rates per 100,000 population, age-adjusted to the 1970 US total white population, were 1.0 overall, 1.4 for male subjects, and 0.7 for female subjects. Mortality rates, likewise age-adjusted, were 0.7 overall and 1.1 and 0.3 for male and female subjects, respectively. These rates are similar to those from tumor registries, a finding that suggests that reporting of these tumors is relatively complete. The similarity of the incidence and the mortality rates is consistent with the high case-fatality rate. A comparison of the Olmsted County cases with Mayo Clinic referral cases provides some evidence for referral bias, as the referral patients were significantly younger and had significantly more high-grade tumors.
Adolescent↗
Histopathology of childhood sarcomas, Intergroup Rhabdomyosarcoma Studies I and II: clinicopathologic correlation.
Histopathologic material from 1,782 patients registered in the Intergroup Rhabdomyosarcoma Study Committee (IRS)-I and -II were reviewed by the IRS Pathology Committee in order to provide a uniform approach to classification and correlate patient survival with tumor type. Categories considered eligible were the four types of rhabdomyosarcoma (RMS) (criteria of Horn and Enterline), extraosseous Ewing's tumor (EOE), and a group of somewhat variable undifferentiated sarcomas designated small round cell sarcoma, type indeterminate (STI). Tumors that were clearly sarcomas but were unclassifiable also were included (NOS). The committee diagnoses were embryonal (Emb) RMS in 877 (54%), alveolar (Alv) RMS in 343 (21%), botryoid (Botr) RMS in 88 (5%), pleomorphic (Pleo) RMS in 11 (1%), STI in 135 (8%), and EOE in 84 (5%). One in nine were mixtures of types, eg, Emb and Alv. Five percent of the sarcomas could not be classified because of inadequate material. In general, there was close agreement (94%) between the review committee and institutional pathologists in the diagnosis of RMS, but not in the specific types, particularly Alv RMS (41%) and STI (36%). This observation is important, since patients with Alv RMS and STI tumors had decreased survival compared with the other histologies. The prognosis varied by histology, with Botr having the best, Alv RMS and STI the worst, and Emb RMS and EOE an intermediate prognosis.
Age Factors↗
Epithelioid sarcoma. An analysis of fifty-one cases.
Analysis of the cases of fifty-one consecutive patients who had an epithelioid sarcoma revealed the five-year rate of survival to be approximately 70 per cent and the ten-year rate, approximately 50 per cent. The five-year rate of survival was about 40 per cent for the male patients and about 80 per cent for the female patients. If the primary tumor was more than three centimeters in diameter or was deeply situated, the patients had a reduced life-span, as did the patients in whom the tumor was focally necrotic. More male than female patients had necrosis of the tumor, as seen on the pathological specimens. No significant difference in life-span was noted among the patients in whom the resection had a marginal, wide, or radical surgical margin. The data indicate that wide or radical resection should be done as soon as epithelioid sarcoma is diagnosed.
Adolescent↗
Desmoplastic melanoma of the head and neck.
The pathologic and clinical findings in cases of desmoplastic melanoma of the head and neck seen at the Mayo Clinic in Rochester, Minnesota, during the past 20 years were analyzed. The nine cases acceptable for study included six usual and three neurotropic variants as defined by light microscopic criteria. Immunopathologic studies of all cases using S-100 protein and desmin, and electron microscopy in four cases, were unsuccessful in distinguishing between the two subtypes. Clinical behavior was aggressive regardless of histologic subtype. Extensive surgical treatment when the diagnosis is made is advocated. The combination of the rarity and the subtle histologic features of desmoplastic melanoma continues to make the correct diagnosis of this entity a challenge for the clinician and pathologist.
Aged↗
Liposarcoma of the musculoskeletal system.
Two hundred eleven cases with the diagnosis of liposarcoma of the musculoskeletal system were reviewed. The mean age at diagnosis was 52.9 years. The primary site was the proximal lower extremity in 52%. Myxoid-type liposarcoma was most frequent (60%). Metastasis was observed in 45%. One hundred two patients without prior treatment or distant spread at diagnosis were studied separately. Recurrence was noted in 26%. The median survival time was 7.5 years, with a 5-year survival of 59% and a 10-year survival of 45%. Significant variation in survival time was related to histologic grade, Enneking's stage, tumor size, and histologic type.
Adolescent↗
Colon and anorectal cancer after pelvic irradiation.
Seventy-six cases of colon or anorectal cancer after pelvic irradiation for other malignant or benign lesions were reviewed. The patients were 13 men and 63 women with a mean age of 65 years; 67 percent had received irradiation for gynecologic malignancy. The cancer developed at a mean of 15.2 years after irradiation (peak frequency between five and ten years); 85 percent of the patients had a mild to prominent radiation reaction around the cancer. Of the 72 adenocarcinomas, 26 percent were mucinous. Only 17 percent of patients presented with symptoms of radiation proctitis, and the mean radiation dosages were not high. High radiation dosage and severe radiation damage may not be essential for radiation-associated colorectal cancer. The overall five-year survival rate was 48 percent. Close surveillance of the colon and anorectal regions of these high-risk patients at five years after irradiation is indicated.
Adult↗
Primary extranodal soft tissue lymphoma of the extremities.
Since true primary lymphomas of soft tissues are extremely rare and there are few well-documented cases in the literature, we report eight cases to help define the clinical and pathologic features of this type of extranodal lymphoma. Among 7,000 malignant lymphomas seen at Mayo Clinic over a 10-year period, we found eight cases of Stage IAE extranodal malignant lymphoma that presented as a soft tissue mass in the upper or lower extremities. The tumors occurred in the following sites: thigh (n = 4), upper arm (n = 2), ankle (n = 1), and calf (n = 1). Two cases had low-grade histology: small lymphocytic lymphoma and follicular mixed small-cleaved and large-cell lymphoma. An intermediate-grade histology was present in two cases: diffuse mixed small- and large-cell lymphoma and diffuse large-cell (cleaved) lymphoma. Half of the patients had a high-grade lymphoma: diffuse large-cell (n = 3) and large-cell, immunoblastic (n = 1). The results of immunohistochemistry and electron microscopy in selected cases are discussed in the context of the differential diagnosis with other small, round-cell cancers. Four patients died of recurrent lymphoma, one at 7 months, two at 15 months, and one at 4 years. Three patients are alive without evidence of disease at 3, 8, and 13 years. One patient is alive and is receiving chemotherapy for locally recurrent lymphoma 6 months after diagnosis.
Adult↗
Aggressive fibromatosis of the plantar aspect of the foot. A case report.
Distinguishing superficial plantar fibromatosis from deep fibromatosis of the plantar aspect of the foot is difficult both clinically and histologically. An illustrative case is presented. Clinical factors suggestive of aggressive fibromatosis include presentation at an age younger than 20 years, tumor dimension exceeding 3 cm (without prior surgical excision), and multicentric occurrence in the affected limb. On histological review, the absence of nodule formation favors the diagnosis of deep aggressive fibromatosis.
Adult↗
Hibernoma. A case report.
Hibernoma is a rare soft-tissue tumor clinically presenting as a firm, freely movable, nontender mass, most commonly in the interscapular region. It is slow growing and usually asymptomatic. Examination of the overlying skin may demonstrate evidence of hypervascularity. On gross examination, the tumor is encapsulated and highly vascular, with its color varying from tan to reddish brown. Microscopic examination is usually diagnostic, demonstrating the characteristic multivacuolated oval or polygonal cells. Because of its benign character, treatment consists of simple excision. This article describes a case of a patient with hibernoma.
Aged↗
Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases.
A review was done of 120 cases of malignant peripheral nerve sheath tumor (MPNST) seen during a 71-year period. Of the 120 patients, 52 were males and 68 were females with a mean age at diagnosis of 35.3 years; 12 patients were younger than 20 years. The series included 62 (52%) patients with neurofibromatosis, 13 (11%) with postradiation sarcomas, and 19 (16%) with metaplastic foci. The incidence of MPNST arising in neurofibromatosis was 4.6% in the current series and 0.001% in the general clinic population. Tumors greater than 5 cm and the presence of neurofibromatosis adversely affected the prognosis (P less than 0.05). When both features were present, survival was greatly decreased. Patients with tumor in the extremities did better than those with head or neck lesions. Metaplastic foci or previous radiation at the tumor site did not alter the prognosis. Each tumor was graded 1 to 4 on the basis of cellularity, pleomorphism, mitotic index, and necrosis. No significant correlation was noted between survival and either grade or mitotic rate. Survival was improved when total rather than subtotal resection was done. This was most marked in patients with a small lesion, which may reflect the difficulty in adequately excising large tumors. Adjuvant radiation or chemotherapy did not appear to affect survival. The MPNST is an aggressive uncommon neoplasm, and large tumor size, the presence of neurofibromatosis, and total resection are the most important prognostic indicators.
Adolescent↗
Intrathoracic lymphangioma.
Of 14 cases of intrathoracic lymphangioma, 4 occurred in the anterior, 5 in the superior, and 4 in the posterior mediastinum. One lesion was diffuse and associated with disappearing bone disease (Gorham's disease). The anterior mediastinal lymphangiomas occurred in adults and seemed to arise from the mediastinum. They could not be distinguished from other anterior mediastinal lesions on plain film roentgenograms. The lesions of the superior mediastinum were extensions from cystic hygromas of the neck and occurred primarily in children. Recurrence was common because complete resection was not possible. Computed tomography was helpful in detecting the cervical extension and cystic nature of these lesions. Although two of the four posterior compartment lesions were isolated lymphangiomas, the other two were part of a much more extensive and generalized lymphangiomatosis that included bone lesions and subdiaphragmatic extension. Both of these latter cases were complicated by chylothorax after attempted removal of the mediastinal lymphangioma. Computed tomography and lymphangiography were helpful in determining the extent of the disease and the cystic and lymphatic nature of the mass. The patient with Gorham's disease had extensive lymphangiomatosis of the thorax and recurrent chylothorax; surgical treatment was unsuccessful. Although lymphangioma is a benign tumor, its infiltrative tendency complicates its removal and contributes to its postoperative recurrence.
Adolescent↗
Neurilemoma of the lower extremity.
A series of 76 patients with 85 neurilemomas of the lower extremity was reviewed. The tumors were located throughout the lower extremity and had varied clinical presentations, which often posed problems in diagnosis. Pain, however, was a consistent symptom, and 63 (83%) of the patients presented with local or radiating (or both) pain. Electromyography was done in seven cases, but the results were abnormal in only two. When evaluating a painful mass or an atypical pain in the lower extremity, the clinician should have a high index of suspicion for neurilemoma.
Adult↗
Cartilage- and bone-forming tumors of the soft tissues.
Benign and malignant cartilage- and bone-forming tumors arising in soft tissues are unusual. Hyaline cartilage tumors may easily be mistaken as malignant if the histologic criteria of intraosseous lesions are applied directly. Other chondroid- and bone-forming tumors also may be difficult to recognize. The correct pathologic diagnosis within this group of neoplasms requires close clinical correlation, as well as familiarity and careful interpretation of a broad histologic spectrum.
Bone Neoplasms↗