[Morphology and histological classification of heart neoplasms].
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Biomedical subjects
Publications and source records attributed to S F Serov.
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Two groups of patients were involved in the study. In the first group (22 observations) radiation treatment was applied 4 times every other day with a single focal dose of 6 Gy (the total tumor dose 24-30 Gy, 1400-1600 NSD units, 70-85 TDF units). The period between the beginning of irradiation and surgery was usually 15-20 days. In the second group (12 observations) radiation was applied 4 times with a daily single dose of 5 Gy (total tumor dose 20 Gy, 1140 NSD units, 20 TDF units). Operation was performed 24-48 hours after the completion of radiation treatment. The so-called tumor damage index M +/- m was 36% +/- 4.8% in the first group, and 21% +/- 4.4% in the second group. The mitotic index decreased twice in the first group, and in the second group it dropped to zero. The obtained data demonstrate that in different schemes of radiation dose fractionation morphological changes observed in irradiated rectal adenocarcinomas are far from being similar. For objective evaluation of the changes different quantitative morphological criteria are needed.
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Post-radiation changes were studied in 21 patients suffering from esophageal cancer who had undergone preoperative irradiation. The results of quantitative morphological analysis were compared with the data obtained from examination of 15 patients operated for tumors but unexposed to radiation. Tumor damage index proved to be 35.0% +/- 4. Mitotic index remained unchanged, while pathological mitoses in tumors increased four times after irradiation (62.0% +/- 5.8 as compared with 15.4% +/- +/- 4.4). They are mostly observed in the dispersion of chromosomes in metaphase. It is concluded that in order to adequately visualise radiation-induced damage to tumor, different morphological criteria should be used in its evaluation, depending on the length of post-irradiation period.
Electron-microscopy was used to study the intraoperative material in 37 patients with serous (24), mucinous (8) and endometroid (5) ovarian neoplasms of benign, boundary and malignant forms. It was shown that the polysome-lamellae complexes are characteristic only of the carcinoma epithelium and practically are observed neither in benign nor in boundary analogs. This may serve an additional criterion of a malignant nature of neoplasms at the ultrastructural level. Taking into account the architectonics 3 variants of the polysome-lamellae complexes should be distinguished: polysome-lamellae, lamellae and lattice structures. All these variants may be encountered in one and the same tumor.
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Histological assays of the endometrium in females aged over 48 (curettement performed for metrorrhagia, preparations of the corpus uteri cancer and of the uterus, taken from cadavers of persons having no genital lesions) have demonstrated atrophy and transitional mucosa on which background there occurred microadenomatosis foci in some cases. Enhancement of epithelial atypism, its proliferation and larger microadenomatosis foci, microcarcinoma foci allow microadenomatosis to be referred to as precancer proper.
One study group consisting of 22 patients received 4-5 focal doses of 6 Gy every other day (total dose--24-30 Gy, 1,400-1,600 NSD). There was a 15-20 day interval between radiation therapy commencement and surgery. Another 12 patients received 4 daily doses of 5 Gy (total dose--20 Gy, 1,140 NSD) and were operated on 24-48 hrs after irradiation. The oncolytic index was 36% plus or minus 4.8 in study group 1 and 21% plus or minus 4.4--in group 2 (P less than 0.05). Mitotic index in group 1 fell from 6.7 to 3.1%, while in group 2--to zero.
The intraoperative material was examined morphologically in 254 patients, aged from 31 to 71, with serous ovarian cystadenocarcinoma. One hundred patients were not given a preoperative course of chemotherapy, and 154 patients were administered thio-TEPA in various dosage. As a dose of the drug was increased less mitotic activity was noted, which may serve as a quantitative indicator of the chemotherapy efficacy.
The authors studied morphologically serous cystic adenocarcinomas of the ovary from 27 patients aged from 30 to 70 years. 100 patients were not given a preoperative course of chemotherapy, and 107 patients received different chemical drugs preoperatively. Changes in the mitotic activity indicate the sensitivity or resistance of the tumor to different chemical drugs.
Electron-microscopy examination of 13 soft tissue tumors in human subjects has revealed in four of them, diagnosed histologically as polymorphous-cellular sarcoma, fibrosarcoma, monophase and biphase synovioma, the ultrastructural features allowing them to be classified as rhabdomyosarcomas.
The study is based on the authors' personal material (81 patients). It was found that malignant endometrioid ovarian tumors invade metastatically the greater omentum more rarely than serous carcinomas--in 42% according to our findings, versus 60--80% as reported in the literature with regard to serous neoplasms. Metastases of endometrioid carcinoma into the omentum are more frequently observed in patients over 40. Ascitic fluid is found in 38% of the patients, that is twice as rare as in serous cystic adenocarcinomas.
Using electron microscopy the authors have studied the operation material of 15 patients with serous (9 cases) and endometrioid (6 cases) ovarian neoplasms. It was demonstrated that the epithelium of endometrioid neoplasms differs from that of serous ones by less polymorphism, the absence of cilia, the signs of secretory activity and more intense development of tonofibrils in the cytoplasm.
Use of the complex of morphological methods (histological, morphometric, electron microscopy and tissue culture technic) in examining the operation material enabled a more precise and full idea to be formulated of the principal stages of the morphogenesis of serous ovarian cystomas and also allowed the validation of their differentiation between benign, boundary (intermediate) and malignant types.
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Based on histomorphological study of over 200 observations, the author suggests the morphological characteristics of basic varieties of secondary ovarian tumors. Some aspects of the nomenclature are discussed, and the classification of neoplasms under consideration is presented. Among epithelial secondary tumors of the ovaries special attention is given to Krukenberg tumor and metastases of cancer with "functioning stroma". The classification also takes into account mesenchymal, neurogenic, hemopoietic and other tumors.
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