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Biomedical subjects

J Lamovec

Publications and source records attributed to J Lamovec.

At least 37 records · Page 2Linked to original sources

Epithelioid hemangioma of small tubular bones: a report of three cases, two of them associated with pregnancy.

We report three cases of epithelioid hemangioma of small tubular bones in women aged 20, 24, and 50 years. In two patients, the tumor appeared during or shortly after pregnancy. We studied clinical data, radiographs, and hematoxylin- and eosin-stained slides, and we performed immunohistochemical and flow cytometric DNA analysis. The tumor was in distal phalanges of the fingers in two patients and in metatarsal bone in one. Cortical bone destruction with infiltration of the surrounding soft tissue was seen in all of the patients. Light microscopic examination showed characteristic morphology, highlighted by epithelioid endothelial cells with different degrees of vasoformativity. Immunohistochemically, the epithelioid cells showed strong positive reaction for Factor VIII in all three patients, for CD31 in two, and for CD34 in one. Ulex europaeus antigen and keratins were negative. Laminin and collagen IV delineated innumerable predominantly abortive vascular structures, which were encircled by cells that presumably were pericytic and that were positive for smooth muscle actin. A relatively high degree of immunostaining for proliferating cell nuclear antigen and Ki67 contrasted with the low mitotic rate and low percentage of cells in S phase. Progesterone and estrogen receptors were negative. Epithelioid hemangiomas of small tubular bones are rare lesions that are characterized by early bone destruction and infiltration of soft tissues. Their association with pregnancy may be fortuitous; if any gestation-related proliferative stimulation exists, it does not seem to be mediated through steroid receptors.

Adult↗

Familial occurrence of small-cell carcinoma of the ovary.

To our knowledge, familial occurrence of small-cell carcinoma of the ovary in first-degree relatives has not been described before. We studied two separate cases of small-cell carcinoma in a 21-year-old patient and in her 40-year-old mother, both of whom died of disseminated disease. Both tumors were studied with immunohistochemistry, using a variety of antibodies, and with flow cytometry. Microscopically, the tumor in the daughter was of the usual small-cell type, while that of her mother belonged to a large-cell variety. Immunohistochemically, both tumors showed some degree of epithelial differentiation but also expressed reactivity to some other antigens, most notably to smooth-muscle actin and muscle-specific actin. Both tumors showed a diploid DNA pattern and low S-phase fraction with flow cytometry. Neither of the cases expressed hypercalcemia. Small-cell carcinoma of the ovary may appear as a small-cell or large-cell variety in a familial setting. A diploid DNA pattern appears to be characteristic. Because this tumor was first reported relatively recently, the frequency of its familial occurrence is not known.

Adult↗

Primary bone sarcoma with rhabdomyosarcomatous component.

We present three cases of primary bone sarcoma with rhabdomyosarcomatous component which in one case appeared in a pure form, i.e., as rhabdomyosarcoma; in the other two cases it presented as one of multiple components of the tumor. The first patient was a 70-year-old man with a tumor of the left femur involving surrounding soft tissue of the thigh. Histologically, this was a case of so-called dedifferentiated chondrosarcoma with pleomorphic rhabdomyosarcoma representing high grade malignant component. The second patient, a 31-year-old man, developed a tumor in the left tibia which was a rare, fibrosarcoma-like type of rhabdomyosarcoma. The third patient was a 43-year-old woman with a tumor in the left tenth rib which was shown to be osteo- and chondrosarcoma with a minor rhabdomyosarcomatous component and was classified as malignant mesenchymoma. All patients were treated by surgery and chemotherapy. The first two of them died of metastatic disease 3 months, and 3 years and 4 months following surgery, respectively. Light microscopical diagnosis of rhabdomyosarcoma of hematoxylin-eosin sections was confirmed immunohistochemically in each case using reactions to desmin, muscle specific actin and myoglobin, and ultrastructurally in two cases. Rhabdomyosarcomatous component in primary bone tumors appears to be rarely present but more cases may be diagnosed in the future, if immunohistochemical and ultrastructural examinations are to be employed.

Adult↗

Addition of IFN-alpha to treatment of malignant brain tumors.

Despite many attempts to improve the survival after surgery of patients with malignant astrocytoma the prognosis is poor. We have used natural IFN-alpha in 16 patients with malignant astrocytoma treated between 1987 and 1990; 6 for recurrent tumors. Radiation therapy was given in 2 Gy fractions daily to a total dose of 50 Gy in the tumor area, 5 fractions per week and IFN twice per week, cisplatinum 60 mg/m2 i.v. every second week and vincristine 2 mg every week in 12-h i.v. infusions. Eight patients were reoperated when clinical deterioration suggested recurrent tumor; histological examination showed no residual tumor in 7 of them. Of these 8 patients 3 are alive and well, 2 of them after more than 5 years. The study suggests that malignant astrocytoma can be successfully eradicated with surgery, irradiation, IFN-alpha and chemotherapy. The treatment had, however, unacceptably high neurotoxicity. Earlier removal of the tumor necrosis, before clinical deterioration, could possibly diminish the high complication rate and consequently improve survival.

Adult↗

Secretory carcinoma of the breast: light microscopical, immunohistochemical and flow cytometric study.

We studied five cases of secretory carcinoma of the breast (SC) by light microscopy, by immunohistochemistry, and by flow cytometry. Four cases were retrieved from the series of 7038 cases of breast carcinoma seen in our department during the 20-yr period of 1973 to 1992; one case was seen recently. Histologically, different growth patterns in SC were observed; the most characteristic feature was prominent intra- and extracellular secretion. Immunohistochemically, all tumors showed strong positive reaction for alpha-lactalbumin and S-100 protein, whereas the reactions to carcinoembryonic antigen and gross cystic disease fluid protein were variable. By flow cytometry, four tumors were examined (three of them were diploid and one near diploid), and they all showed low S-phase fraction. Immunohistochemical findings in SC were compared to a group of 13 cases of nonsecretory carcinoma that all showed an appreciable degree of secretion or morphological similarities to SC. In a single case of cystic hypersecretory carcinoma an unequivocal positive reaction for alpha-lactalbumin was demonstrated; S-100 positive reaction was seen in two cases. It was concluded that in an appropriate morphological setting, positive reaction for alpha-lactalbumin is an essential feature in diagnosing SC. S-100 protein positivity and diploid flow cytometric pattern are also characteristics of SC.

Adult↗

Epithelioid angiosarcoma of the thyroid gland. Report of two cases.

We present two cases of epithelioid angiosarcoma of the thyroid gland from two patients in Slovenia. In both cases, the tumor appeared as a dominant nodule in a multinodular goiter. Histological appearance of the tumor was similar in both cases and characterized by large epithelioid tumor cells with numerous intracytoplasmic lumina, large nuclei, and very prominent nucleoli. Such cells formed vascular structures as well. Neoplastic cells were positive for factor VIII-associated antigen in both cases. Reaction to Ulex europaeus lectin was positive in one case, and characteristic ultrastructural features were seen in another case. In both cases, some neoplastic cells also showed keratin positivity. Angiosarcoma is a rare but definite possibility in a differential diagnosis of anaplastic thyroid tumors in Slovenia.

Female↗

Adenocarcinoma in a sigmoid neovagina 22 years after Wertheim-Meigs operation. Case report.

The development of carcinoma in the neovagina has rarely been reported. Depending on the type of tissue that has been used for the transplant, the tumor appears either as a squamous cell carcinoma or adenocarcinoma. It is important to draw a distinction not only between the patients with squamous cell carcinoma and adenocarcinoma, but also between those with neovagina performed due to congenital absence of the vagina and others in whom the procedure was performed because of an advanced cancer in the true pelvis. In the latter group of patients, it is generally difficult to distinguish a residual disease from a second primary of the same histology. There is no dilemma, however, when the histology differs as in the case presented. The patient reported here underwent surgery for squamous cell carcinoma of the cervix, stage Ib, in 1967. The intervention comprised a Wertheim-Meigs resection and sigmoid vaginoplasty. Considering the favourable histological findings, postoperative irradiation was not indicated. Following the procedure, the patient had been well and free of any major complaint for 22 years after surgery when she presented with a moderately differentiated adenocarcinoma of the neovagina. She was successfully operated upon and had no evidence of disease at the last follow-up examination, two and a half year after surgery.

Adenocarcinoma↗

Primary carcinoid of the kidney.

A case of primary carcinoid tumour of the kidney in a 40-year-old man is reported. It was initially diagnosed as a Wilms' tumour monomorphic type. After total unresponsiveness to specific therapy, specimens were reexamined and immunohistochemical and electron microscopic examinations were also employed disclosing the real nature of the tumour which showed cytoplasmic positivity for neuron-specific enolase in tumour cells and presence of numerous electron dense core neuroscretory granules in their cytoplasm.

Adult↗

Teleangiectatic sarcomatoid carcinoma of the breast.

We report a case of breast carcinoma in a lactating woman with an osteosarcomatous and chondrosarcomatous metaplasia and multicystic hemorrhagic appearance. Grossly and on low microscopic power it simulated a teleangiectatic osteosarcoma. Clinical and mammographic presentation and fine needle aspiration biopsy initially suggested a hemangioma which resulted in delayed treatment.

Adult↗

Sclerosing inflammatory pseudotumor of the urinary bladder in a child.

A case of inflammatory pseudotumor of the urinary bladder in a 2-year-old child is presented. It was characterized by nodular intravesical growth and massive infiltration of the bladder wall. Microscopically, the lesion showed in its largest part a relatively paucicellular spindle cell growth and a sclerotic appearance with a thin superficial cellular zone resembling granulation tissue. Another morphological characteristic was a marked capillary proliferation revealed by immunohistochemical reactions to factor VIII-associated protein, laminin, and collagen IV. The last feature appears to be an integral part of the process, which most closely resembled fibromatosis of the adult type, a rare pattern of growth in inflammatory pseudotumor.

Child, Preschool↗

Malignant fibrous histiocytoma of the heart.

We describe a 54-year-old man with a recurrent malignant fibrous histiocytoma in the left atrium. During the patient's first hospitalization, the tumor clinically presented as a typical atrial myxoma and was removed by routine procedure. Histologically, it was diagnosed as sarcoma, probably rhabdomyosarcoma. Nine months later the patient was readmitted because of recurrence. This time, the tumor, along with interatrial septum and a part of the anterior atrial wall, was excised by means of cardiac explantation and reimplantation. On light microscopic, immunohistochemical, and electron microscopic examination, the tumor was classified as a storiform-pleomorphic type of malignant fibrous histiocytoma. No other therapeutic procedures were performed, and 11 months after the second surgery the patient died of massive hemorrhage from a duodenal ulcer. A recurrent tumor in the left atrium and several distant metastases were found at autopsy.

Autopsy↗

Metastatic pattern of infiltrating lobular carcinoma of the breast: an autopsy study.

We analyzed the autopsy records and autopsy histological slides of 261 patients with breast carcinoma who died at the Institute of Oncology, Ljubljana, from January 1972 to October 1989, with particular attention to the metastatic pattern of infiltrating lobular carcinoma (ILC) which we compared with infiltrating ductal carcinoma (IDC). In 226 of 261 patients who died with metastatic disease there were 25 cases of ILC, 195 cases of IDC, 4 cases of mixed IDC-ILC, and 2 cases of mucinous carcinoma. There was no statistically significant difference in frequency of metastases to common metastatic sites, such as the liver, bone, and pleura, with the exception of the lungs, in which IDC metastases prevailed (P less than 0.006). By contrast, a statistically highly significant prevalence of ILC metastases to the peritoneum/retroperitoneum, hollow viscera, internal genital organs, leptomeninges, and myocardium was found (P values of less than 0.006- less than 10(-6). The metastases to these sites were characterized by diffuse growth of neoplastic cells that infiltrated in a lymphoma or leukemia-like fashion. Such metastases may remain clinically silent for a long time, in spite of their extensiveness. The difference of metastatic pattern between ILC and IDC is insufficiently appreciated in most of the published studies on ILC.

Autopsy↗

Pleomorphic fibroma of tendon sheath.

We report an example of fibroma of tendon sheath with pleomorphic bizarre cells without mitoses. The tumor appears to be morphologically identical to a similar tumor in the skin and represents yet another example of a benign soft-tissue neoplasm with disturbing morphological features.

Fibroma↗

Association of leptomeningeal carcinomatosis in carcinoma of the breast with infiltrating lobular carcinoma. An autopsy study.

We analyzed the autopsy records of 261 patients with breast carcinoma, who died at The Institute of Oncology, Ljubljana, Yugoslavia, for the presence of metastases to the central nervous system, particularly for the presence of leptomeningeal carcinomatosis. Metastases to the central nervous system were found in 41 (18.1%) of 226 patients who had metastatic cancer. In 24 cases (10.6%), metastases were seen in brain parenchyma; in 11 cases (4.9%), only dura mater was involved, and in six cases (2.6%), leptomeningeal carcinomatosis was found. All patients with leptomeningeal carcinomatosis showed some symptoms of central nervous system involvement while alive. The patients died between 2 weeks and 2 months after the onset of central nervous system symptoms. Four of six patients with such a complication presented with locally advanced or disseminated carcinoma on the first admission. With regard to histologic findings, three patients had infiltrating lobular carcinoma, two had infiltrating ductal carcinoma, and one had mixed infiltrating lobular and ductal carcinoma, with a metastasizing lobular component. Metastases to the brain parenchyma were found exclusively in infiltrating ductal carcinoma. We stress that infiltrating lobular carcinoma represents a distinctive type of breast cancer with an unusual propensity to disseminate into leptomeninges, as this occurred in almost 14% of all cases of infiltrating lobular carcinoma in our series in contrast to a 1% incidence in cases of infiltrating ductal carcinoma.

Breast Neoplasms↗

Intratumor application of human leukocyte interferon-alpha in patients with malignant brain tumors.

Seventeen patients with malignant brain tumors have been treated by local application of human leukocyte interferon-alpha (HLI-alpha) in addition to radiation; eight of these patients also received chemotherapy. Twelve patients were treated for primary tumor and five for recurrence. After partial removal (or biopsy), an Ommaya reservoir was placed with its catheter in the tumor cavity, and 3 Gy was given to the whole brain in 2 weeks with a local boost of 1.5 Gy in 1 week. During radiation therapy HLI-alpha (2 x 10(6) U) was given through the Ommaya reservoir two or three times per week. Vincristine (2 mg) was given during radiation therapy weekly and in combination with cisplatin (60-80 mg) every other week. Four patients are alive and well 11, 14, 15, and 30 months after treatment and 5 have died without tumor. The fact that the patients did not survive despite the effective local tumor control suggests that, at least in some of them, degenerative changes in the brain tissue as a result of the combined treatment might have been the cause of death.

Adult↗