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Frequency of for distant metastases and intervall following curative treatment of cervical carcinoma are reported in cases with no local neoplasms recurrence. Main localizations in this clinical study are lungs, bones and liver. Causes and conclusions for metaphylexis are discussed.
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The late results of the larynx reconstruction by means of the mucoseptal nasal graft after an enlarged fronto-lateral laryngectomy were described. The analysis of 460 patients showed a satisfying larynx lumen in almost all cases. In 21 cases due to the neoplasm recurrence a total laryngectomy were performed. The voice after surgery was socially good, and the wide larynx lumen was obtained.
PURPOSE: The aim of this study was to evaluate, in a group of patients suffering of colo-rectal cancer, the influence on local recurrence of some clinical and anatomo-pathological variables. METHODS: The study was limited to 833 patients who underwent potentially curative resection and have been followed for at least two years. All patients were evaluated every six months for the first three years and yearly thereafter by means of clinical, laboratory, endoscopic and radiological investigations. Recurrence was observed in 78 patients (9.4%); 19 of these had evidence of distal failure simultaneously (2.2%). The incidence was 2.4% and 17.7% in the carcinoma of the colon and rectum respectively. Median time of recurrence was 16 +/- 11 months; 75% presents within 23 months from operation. Chi-square test was used to relate incidence of recurrence to clinical and anatomo-pathological factors and then a multivariate logistic regression analysis was used to evaluate the most significant variables. RESULTS: Univariate analysis reveals a significant relationship between recurrence and age under 50 years (p = 0.01), presence of preoperative complication (p = 0.01), stage (p = 0.01), site (p = 0.000) of primary tumor and lymph-nodal involvement (p = 0.0002). No statistically significant difference was found between recurrence and tumor wall infiltration, number of lymph nodes involved, grading and morphology of primary tumor. Multivariate logistic regression analysis confirmed these results except for preoperative complication (p = 0.9). CONCLUSIONS: Authors believe that selection of patients to undergo adjuvant therapies is improved by identification of high-risk patients.
Observations of the behaviour of BMG in the blood serum (S-BMG) of 48 patients with infiltrative neoplasm of the urinary bladder indicated the increase of its concentration in 94% of patients. A correlation has been found between S-BMG and the stage of clinical advancement and histologic grading of the tumor. No statistically significant difference of values of S-BMG has been present in carcinoma and papilloma of the urinary bladder and recurrent neoplasms.
Twenty-nine patients with large masses attached to the carotid artery underwent surgical resection with preservation of the artery, and intraoperative 125Iodine implantation via an absorbable suture. Eighteen were treated for recurrent neoplasms, having failed prior surgery and/or irradiation therapy. Eleven were treated primarily. With the minimum follow-up of one year, 76% were disease free in the implant volume and 62% were disease free in the entire neck. Distant metastasis occurred in 45%. Mean survival was 15 months in the primary group (range, 2-50 months) and 12 months in the recurrent group (range, 4-26 months). This technique shows promise in providing local control without necessity for sacrifice of the carotid artery.
Apocrine carcinoma (AC) is an uncommon, poorly characterized type of breast tumor. In this review, 55 patients with intraductal (ID) AC and 17 patients with infiltrating (IF) AC were analyzed retrospectively to define the histologic features and clinical course of this neoplasm. Recurrences in the breast occurred in 3 of 20 ID-AC patients treated by biopsy alone, but not in the 2 patients who received local radiation therapy after biopsy. One patient with ID-AC had axillary metastases at the time of treatment by mastectomy and died of disease five years later. The remaining patients with ID-AC treated by mastectomy have remained disease free. One of the three patients with IF-AC treated by biopsy alone died of disease, and one of two patients with IF-AC treated by biopsy and radiotherapy was alive with carcinoma. Twelve patients with IF-AC were treated by mastectomy. Ten of them were recurrence free at the time of last observation. More than one-third of the cases of ID-AC and IF-AC were detected by mammography alone. Survival analysis of IF-AC cases compared with nonapocrine duct carcinoma cases matched for stage revealed no statistical difference in estimated recurrence-free survival or estimated survival probability. AC is a distinct morphologic entity with a natural history similar to that of nonapocrine ductal carcinoma.
INTRODUCTION: Soft tissue sarcomas (MTM) localized within the nonorbital and non-parameningeal head and neck region in children are associated with favourable prognosis. However in our material we have observed many therapeutic failures in this group of patients. The aim of the study was to analyze the reasons for disappointing results of oncological therapy in children with MTM treated between 1992 and 2004. MATERIAL AND METHODS: Nine children (M/F: 6/3; mean age 5,5 years). Five patients were diagnosed with rhabdomyosarcoma, four--with non-rhlabdomyosarcoma, including: angiosarcoma, malignant triton tumour, fibrosarcoma and leiomyosarcoma. RESULTS: mean duration of initial symptoms was 7 months. The first sign of the neoplastic disease in all children was tumour. In as many as five of nine patients initially a false histopathological diagnosis was made based on material obtained from aspiration biopsy of the tumour performed in non-oncological centres. This resulted in a significant delay of the proper diagnosis of malignant disease ranging from 2 to 15 months (mean 7 months). That is why all our patients presented with highly advanced stages of MTM or even in the phase of disease recurrence. Therapy was conducted according to the schemes: MMT-89, CWS-91, CWS-96 and CWS-2002. Durable complete remission after the first line therapy was obtained in one child only. Six patients developed MTM relapse and two--progression during chemotherapy. Finally five children remain disease-free after treatment termination with follow-up of 1 to 1,5 years. Four of then had microscopically complete delayed resection of the tumour or the relapse. Four patients died of neoplasm recurrence and progression. In three of them the proper diagnosis was delayed significantly and they were diagnosed in the first or even second relapse of the tumour. CONCLUSION: Unfavourable course and treatment results in MTM located in nonorbital and nonparameningeal head and neck region in our patients result from initial wrong histopathological diagnosis and delayed therapy institution.
There is a known association between lymphoid malignancy and Hodgkin's disease (HD), but the development of HD in children who have been treated for leukemia or lymphoma is very uncommon. Hodgkin's disease is, after retinoblastoma, the most common primary tumor that is associated with development of second malignant neoplasm. For reasons that remain to be determined, HD is very rare as a second malignancy [1, 2, 3]. We report the case of a eight-year-old girl who developed HD 6 years after treatment for common acute lymphoblastic leukemia (ALL). This case prompted us to review the published literature for cases of secondary HD in childhood. Our experience suggests that we should follow strictly our patients with ALL and be ready to intervene with invasive diagnostic procedures at the least suspicion of a second or recurrent neoplasm. The most frequent causes of second tumors are radiotherapy, genetic susceptibility and prior treatment with certain chemotherapeutic agents, such as nitrogen mustards. It is likely that any type of immunodeficiency, even without symptoms, might play a role in the development of second tumors in childhood.
The past decade has witnessed substantial growth in our knowledge of the genes and loci that are altered in Wilms tumor. Although Wilms tumor was one of the original paradigms of Knudson's two-hit model of cancer formation, it has become apparent that several genetic events contribute to Wilms tumorigenesis. Recent research has identified targets and regulators of the first Wilms tumor gene, WT1, has uncovered several candidate genes at the second Wilms tumor locus, WT2, and has identified two familial Wilms tumor loci, FWT1 and FWT2. The recent discovery of activating beta-catenin mutations in some Wilms tumors has also implicated the Wnt signaling pathway in this neoplasm. Recurrent abnormalities of other loci, including 16q, 1p, and 7p, have indicated that these sites may harbor Wilms tumor genes. An enhanced understanding of these and other genetic lesions will provide the foundation for novel targeted Wilms tumor therapies.
Between 1983 and 1988, 402 women, with ages ranging from 18 to 73 years were treated for cervical intraepithelial neoplasia using the CO2-laser. 89 patients underwent vaporization and 313 conization. Preoperative biopsy examination showed CIN III in 214 patients. Five cases of invasive cancer were diagnosed, either preoperatively (two cases), after conization (two cases) or on both occasions (one case). At the first postoperative examination residual disease was found in 21 patients of the vaporization group (23.6%) and in 13 patients of the conization group (4.3%). Later examinations (after 5-70 months) revealed recurrence in 10 patients in the vaporization group (11%) and in 13 patients in the conization group (4.3%). Median time for recurrence was 11 months. 30 patients were treated twice or more. No case of invasive cancer was diagnosed after treatment.
Based on experience with 17 patients and review of the literature, complete excision is possible for all benign thymic cysts and neoplasms. Recurrence is rare (2%). Most malignant thymomas in children are epithelial (73%). As with adults, prognosis depends on accurate surgical staging and aggressive surgical intervention. Even the largest tumors can be completely excised removing portions of lung, pleura, diaphragm, and pericardium in continuity as required. Cardiopulmonary bypass may be necessary when the innominate veins or the superior vena cava is involved. Irradiation is required for stage II and stage III lesions. Stage IV patients require irradiation and chemotherapy.
Nineteen mural-based stromal tumors of the rectum and anal canal were reviewed, with the objective of delineating pathologic features discriminative of malignancy in these uncommon neoplasms. Ten locally excised tumors failed to recur during long-term follow-up and were considered benign. All occurred in the submucosa and ranged in size from 1.0 to 7.0 cm (mean, 2.1 cm). Three were sparsely cellular; seven had the appearance of gastric-type cellular leiomyomas. All lacked nuclear atypia and displayed mitotic activity not exceeding 1 mitosis/50 high-power microscopic fields. In contrast, of nine tumors exhibiting malignant behavior, eight (89%) were located in the muscularis propria. Their mean size was 4.5 cm (range, 1.6 to 11 cm). Necrosis was present in six tumors (67%). Seven sarcomas retained a cellular leiomyomatous appearance but exhibited moderate cytologic atypia. Mitotic counts ranged from 5 to 58 mitoses/50 high-power microscopic fields. Three locally excised sarcomas recurred in the rectum at 2, 2, and 7 years. In five patients tumor recurred in the pelvis. Five patients died of disease 0.67, 1.2, 3, 5, and 11 years post-diagnosis. One patient died with sarcoma at 31 years. Three patients are without evidence of recurrent neoplasm 5, 5, and 7 years postresection. Our data indicate that not all anorectal, mural-based stromal neoplasms are a priori malignant. While location within the muscularis propria, size, nuclear atypia, and tumoral necrosis correlate with malignancy, mitotic activity is the cardinal indicator of sarcomatous behavior in stromal neoplasms of the rectum and anal canal.
OBJECTIVE: A retrospective review of seventeen patients who were operated through the maxillary swing approach was carried out to assess the efficacy of this approach in the management of tumors of the central and lateral cranial base. METHODS: From May 2000 to January 2005, 17 patients with primary or recurrent neoplasms involving the central cranial or lateral base underwent surgical resection via maxillary swing approach. Ten patients were male, and other seven patients were female, and age range was 7 to 58 years, with a mean age of 42. 6 years. Eight patients had tumors originally involving lateral cranial base, and nine patients had tumors originated from central cranial base. The pathology spectrum was very wide. Among them, five suffered from chordoma, two had rhabdomyosarcoma, two had squamous cell carcinoma, one had malignant fibrous histiocytoma, one had malignant melanoma, one had esthesioneuroblastoma, one had invaded hypophysoma, two had schwannoma, one had pleomorphic adenoma, and one had angiofibroma. Three patients had received previous surgery, two patients had previous radiation therapy and nine patients received postoperative radiotherapy. RESULTS: Sixteen of all seventeen patients had oncologically complete resection, one had near-total resection. This group patients was followed up from 10 to 60 months, with a median follow-up time of 28 months. Two patients died 14 and 26 months after surgery respectively, as a result of local recurrence and metastasis. One patient defaulted follow-up at 12 months after operation, and the other 14 patients were alive at the time of analysis. Of the 12 malignant tumors, the 1-and 2-year survival rate were 91.67% and 72.92%, respectively. The facial wounds of all patients healed primarily, and there were no necrosis of the maxilla, damage of the temporal branch of the facial nerve, lower-lid ectropion, and facial deformity. Epiphora and facial hypoesthesia were detected in all patients. Four patients (23.5%) developed palatal fistula, ten patients developed serous otitis media (58.8%), and four patients developed a certain degree of trismus (23.5%). Cerebrospinal fluid leak occurred in two patients. They subsequently healed with conservative management. CONCLUSIONS: The maxillary swing approach is a proven method for access to the central and lateral skull base with good exposure and acceptable morbidity. Complications and sequelae associated with this approach include facial scarring, transaction of the infraorbital nerve, impaired lacrimal drainage, eustachian tube dysfunction and serous otitis, palatal fistula, trismus etc. Some procedures should be performed for reducing the incidence and severity of complications in the maxillary swing approach.
A wealth of cytogenetic data has demonstrated that numerous somatic genetic changes are involved in the pathogenesis of human lung cancer. Despite the complexity of the genomic changes observed in these neoplasms, recurrent chromosomal patterns have emerged. In this review, we summarize chromosomal alterations identified in small cell and non-small cell lung cancer, using classical and molecular cytogenetic techniques. These analyses have uncovered a set of chromosome regions implicated in lung cancer development and progression. However, many of the target genes remain unknown. Newer technology, such as array-CGH, when combined with cDNA microarrays and tissue microarrays, will facilitate the integration of genomic and gene expression data and pave the way toward a molecular classification of lung carcinomas. The molecular implications of consistent chromosome imbalances found in lung cancer to date are also discussed.
OBJECTIVE: Microvascular free-tissue transfer to the head and neck has become an accepted method of reconstruction owing to increased success rates and superior aesthetic and functional results. Although the large number of arteries and veins in the neck make free-flap revascularization easier than in other recipient sites of the body, there are also unique problems that pose significant risks to the success of the procedure. We report our experience with 200 microvascular free flaps performed between 1987 and 1992. SETTING: This study was conducted at a tertiary referral center. PATIENTS: The majority of patients in this series underwent surgery for squamous cell cancer. Approximately 75% of the reconstructions were performed for defects of the oral cavity. There were 120 vascularized bone-containing free flaps for mandibular and midface reconstruction. The remaining 80 soft-tissue flaps were used for a variety of defects ranging from the scalp to the pharyngoesophagus. RESULTS: An overall success rate of 93.5% for free-tissue transfers is reported. Greater experience with this technique has resulted in a reduction and a change in the nature of the complications encountered compared with those seen in the early part of our series. Donor and recipient site complications, including flap failures and anastomotic revisions, are analyzed in detail with respect to age, radiation status, donor site, and whether the ablative procedure was done for a primary or recurrent neoplasm.
This report analyzes six ovarian Sertoli-Leydig cell tumors that showed retiform differentiation. The patients were young (6-29 years; average age, 17). The tumors were all limited to one ovary, and the patients have remained disease-free, with one exception, a patient who died of recurrent neoplasm 3.5 years after operation. On microscopic examination, the retiform areas were predominant in three cases and focal in the other three. The retiform areas consisted of an irregular anastomosing network of spaces lined by cuboidal cells, often with papillary formations and sometimes with tubules compressed to form slit-like spaces. In three cases the retiform areas appeared mature, and in three they were less differentiated. All tumors also had areas of typical Sertoli-Leydig cell tumor of either poor or intermediate differentiation. In the patient with metastatic disease, the metastases had a pure sarcomatoid pattern without any retiform areas.
While less common than stricture, recurrent neoplasm, and neuromuscular dysfunction, neopharyngeal diverticulum must be considered in the differential diagnosis of postlaryngectomy dysphagia. Symptoms of difficulty clearing the neopharynx during and after a swallow, with regurgitation of undigested material, should alert the clinician to this possibility. Experience with 3 postlaryngectomy patients with anterior neopharyngeal divericulae serve as the springboard for discussion of the clinical spectrum, radiologic features, contributory pathophysiologic factors, and therapeutic options concerning this condition. Surgical indications, approaches, and potential hazards are reviewed.