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Leiomyosarcoma versus myofibrosarcoma: observations and terminology.

Two spindle cell sarcomas, which showed similarities in light microscopic histology and immunostaining and were diagnosed as leiomyosarcomas by these criteria, were compared ultrastructurally to show the value of electron microscopy in subtyping these neoplasms. Both were subcutaneous, case 1 occurring in the nasolabial fold and case 2 in the upper calf. Both consisted of fascicles of spindle cells, and both stained positively for vimentin and alpha-smooth muscle actin; only case 2 stained additionally for desmin. Case 1 showed strong and case 2 weak or negative staining for fibronectin. By electron microscopy, case 1 contained prominent rough endoplasmic reticulum, peripheral fine filaments with focal densities, and fibronexus junctions. By contrast, case 2 was characterized by an external lamina and well-developed bundles of fine filaments with focal densities. Case 2 was considered a typical leiomyosarcoma, and case 1 was interpreted as showing myofibroblastic differentiation. The nomenclature for these myofibroblastic tumors is discussed, and myofibrosarcoma and leiomyosarcoma, myofibroblastic variant are suggested as suitable terms.

Adult↗

[Malignant glial tumor with skeletal muscle differentiation. Description of a case].

A case of CNS gliomyosarcoma, in a 71-year-old female with skeletal muscle differentiation is presented. The tumor was composed by two cell types: one showed features typical of glial cells, the other was constituted by elements having immunohistochemical positivity with desmin, sarcomeric actin, myoglobin and myogenin antisera. It is postulated an origin from a cell capable of dual differentiation.

Actins↗

[An electron-autoradiographic study of capillaries in malignant tumors].

Using electron microscopy the ultra structure of endothelial cells in malignant tumors (myogenic sarcomas), removed in 6 patients, was investigated. It was found that endothelial cells of blood capillaries in malignant neoplasms show some peculiar features in the basal layer structure and in formation of a multitude of orifices of various diameter in the capillary wall. Electron radiographic investigations of endothelial cells of a transplantable sarcoma strain in the experiment have evidenced a greater number of ribosomes in the cytoplasm and enhancement of the DNA synthesis in nuclei. These findings are indicative of increased proliferative properties of these cells.

Animals↗

[Acute renal failure as complication of neoplastic disease in children].

Three cases of acute renal failure (ARF) requiring renal replacement therapy (RRT) in the course of neoplastic disease were presented. 7.5-yr-old girl admitted with postrenal failure during palliative radiotherapy had metastases in retroperitoneal space. Improvement followed percutaneous placement of nephrostomy catheters. 16-yr-old boy with acute myeloid leukemia was effectively treated with hemodialysis for prerenal and renal ARF mediated by vasomotor, infectious and toxic factors. In 11-yr-old boy ARF was the first clinical presentation of non-Hodgkin's lymphoma. Chemotherapy brought restoration of renal function. As a conclusion we emphasize complex etiology of ARF in such patients as well as the necessity of early introduction of RRT and thorough diagnosis and proper management of the causes of impaired renal function.

Acute Kidney Injury↗

Myofibrosarcoma of subcutaneous soft tissue of the cheek.

A low grade soft tissue sarcoma from the naso-labial fold and designated as myofibrosarcoma (sarcoma of myofibroblasts) is described using standard light microscopy techniques, immunohistochemistry and electron microscopy. Pink fibrillated cytoplasm, regarded as one of the typical histological features of leiomyosarcoma, was not obvious but immunostaining for alpha-smooth muscle actin was positive suggesting smooth muscle differentiation. By electron microscopy, tumour cells contained abundant rough endoplasmic reticulum cisternae and a large Golgi body; there were modest but numerous bundles of fine filaments with focal densities. A conventional lamina was lacking but the cell surface was characterised by fibronexus junctions in which there was a conspicuous extracellular, fibronectin-containing fibril, apparently mediating contact between cell and matrix. The tumour cells therefore showed myofibroblastic differentiation. The cell surfaces showed strong immunoreactivity with an anti-fibronectin antibody. Myofibrosarcoma is not a widely recognised entity and this case is only the 7th example to be documented in detail by means of both immunohistochemistry and ultrastructure. The combination of electron microscopy for detecting the fibronexus junction and immunostaining for fibronectin at the cell periphery is suggested as potentially useful for distinguishing myofibrosarcoma from leiomyosarcoma.

Actins↗

Characteristics and outcome of children with primary soft tissue sarcomas of extremities.

OBJECTIVES: To determine the characteristics and outcome or patients with primary soft tissue sarcomas of extremities in children. MATERIAL AND METHODS: Thirty-six patients treated for soft tissues sarcomas were enrolled into the study. Features analysed: the incidence of soft tissues sarcoma of extremities, the time from first clinical symptoms to making the diagnosis, the primary site of tumour; histopathologic type of tumour, stage of disease, methods and results of the treatment. RESULTS: The time From first symptoms to making the diagnosis was 5.4 months (mean). The site of the tumour was the femur in 6 patients, arm in 3, knee in 1. Histopathologic types: synovial sarcoma in 4 patients, malignant haemangiopericytoma in 2, rhabdomyosarcoma in 2, sarcoma myogenes in 1, primitive neuroectodermal tumour in l. Stage of disease: III deg. -- 8 patients, IV deg. -- 2. Patients underwent treatment according to the soft tissue sarcoma protocols. Results of treatment: first complete remission was observed in 7 patients; second complete remission in 1, one patient is on postoperative treatment. One patient died. CONCLUSIONS: 1. Combined treatment achieves full remission in the majority of patients with soft tissues sarcomas localized within the limbs. 2. In patients with large tumours (>5 cm) the treatment should to be started with inductive chemotherapy, and the surgery should be postponed. 3. Early excision of the tumour should be considered in cases of small tumours (< 5 cm), when resection with wide margin of healthy tissues is possible, without deteriorating the function of the limb or cosmetic damage.

Adolescent↗

Myofibrosarcoma of the adrenal gland.

Adrenal masses have varying presentations. Most commonly, adrenal masses are discovered incidentally on CT or MRI during an evaluation for an unrelated complaint. Although the majority of these are nonfunctional cortical adenomas, hormonally active tumors and adrenocortical carcinoma must also be considered in the differential diagnosis. Rarely, retroperitoneal tumors may mimic an adrenal mass. We report a case of a 49-year-old man with anemia and weight loss who was found to have a large retroperitoneal mass arising from the adrenal gland. Surgical treatment involved en bloc resection of the right kidney, adrenal gland, segments 7 and 8 of the liver, and a portion of the right hemidiaphragm. Final pathology revealed a low-grade myofibrosarcoma. We believe that this is the first case report of a myofibrosarcoma of the adrenal gland. Myofibrosarcomas are rare malignant tumors composed of myofibroblasts that arise from the deep soft tissues. These tumors have a predilection for the head and neck, trunk, or extremities. Myofibrosarcomas can be differentiated from other sarcomas by immunohistochemical staining and pathologic features. We will briefly discuss the workup of an adrenal mass and focus on the diagnosis of myofibrosarcoma.

Adrenal Gland Neoplasms↗

[Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion for peritoneal carcinomatosis caused by recurrent inflammatory myofibroblastic sarcoma: a case report and review of the literature].

Peritoneal carcinomatosis is a fatal diagnosis, associated with poor prognosis and quality of life. Survival is usually estimated in month. Traditionally surgery for peritoneal carcinomatosis was indicated only for palliative effort. Advances in tumour biology, cytoreductive surgery and pharmacology have improved the approach for this condition. An aggressive combined approach to peritoneal surface malignancy involves peritonectomy and intraperitoneal perioperative hyperthermic chemotherapy. Cytoreductive surgery reduces carcinomatosis to microscopic residual disease so that intraperitoneal hyperthermic chemotherapy is able to eradicate cancer. Hyperthermic chemotherapy enhances the cytotoxicity of the drugs and increases their penetration into the cancerous tissue. Careful patient selection is crucial for this multimodality approach. Quantitative prognostic indicators are useful in the assessment of outcome, like peritoneal cancer index and completeness of cytoreduction score. Cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy improves survival but is associated with significant morbidity and mortality. This review is based on a case report of a 22-year-old female patient who had peritoneal carcinomatosis of inflammatory myofibroblastic sarcoma and was treated by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy at our department.

Adult↗

Low grade myofibroblastic sarcoma of tongue: a case report.

A case of a 24-year-old woman with a 6 weeks lasting nodule of the right margin of the tongue is described. The nodule was 20 mm in diameter and showed surface ulceration. The diagnosis of low grade myofibroblastic sarcoma was supported by histological, immunohistochemical and electronmicroscopic examination. Although the tumor resection was not complete, the patient is free of disease 1 year after operation. The differential diagnostics of low grade myofibroblastic sarcoma is discussed.

Adult↗

In vitro interferon and virus production at in vivo physiologic oxygen tensions.

Rhabdomyosarcoma (TE) and cervical carcinoma (MS) cells 24 h previously brought from medium with a PO2 of 18 kilo Pascal (kPa) (ambient air) to PO2 of 6 or 3 Kpa (in vivo physiologic values) were infected with Sendai virus, and the interferon (IFN) and virus production was followed in the ensuing 24 h period. With TE cells the IFN production decreased when moving from 18 to 6 Kpa and ceased completely at 3 Kpa, while the virus production responded inversely. MS cells produced most IFN at the lowest oxygen tension, and virus production was only moderately affected. Growth for three months at the three different oxygen tensions prior to infection reduced the difference in IFN production at the different oxygen tensions. On the same target cells different human virus responded in different ways to the tested oxygen tensions. It is concluded that mimicking the in vivo situations might require primary cultures of virus and cells to be started and passaged at in vivo physiological oxygen tensions.

Carcinoma↗

Lymphatic dissemination of bone and soft tissue sarcomas: a lymphographic investigation.

The series consisted of 132 patients, 61 with primary bone sarcomas and 71 with primary soft tissue sarcomas. The patients were all evaluated by lymphography. The investigation included both patients who had not yet been treated and patients with suspected or confirmed metastases. All tumour diagnoses were confirmed microscopically. The findings as regards dissemination were based on clinical examinations, laboratory tests, roentgen examinations and lymphographies. In some cases, lymph node biopsies and surgical observations were also used. A total of 151 lymphographies were performed and 281 follow-up films taken. Preoperative lymphography was performed using the technique introduced by Kinmonth. For postoperative lymphography on the stumps of amputated extremities, two simple but useful methods were developed, which are presented here. Changes in the lymphographic appearance of lymph node metastases, the occurrence of new metastases, and the results of treatment were assessed by survey films and repeat lymphography. The generally accepted criteria for metastasis were used as a basis for the analysis of the lymphographic findings. The results may be summarized as follows: 1. Incidence of lymphatic dissemination. Different sarcomas varied greatly in their clinical course, including the frequency of dissemination. The lymphatic involvement in the metastatic cases was as follows: Bone sarcomas: 16 out of 28 (Table 10); of these, 13 were to regional lymph nodes, 8 to distant nodes and 5 to both (Table 14). Soft tissue sarcomas: 24 out of 40 (Table 11). All 24 had metastases in regional nodes, and 8 in distant nodes as well (Table 15). The highest frequencies of lymphatic spread in the different metastasized tumours were found to be: Bone sarcomas: reticulosarcoma 100%, Ewing's sarcoma 50%, osteosarcoma 47%. Soft tissue sarcomas: rhabdomyosarcoma 100%, synovial sarcoma 80%, neurogenic sarcoma 78%, leiomyosarcoma 67%. 2. Time-relation between lymphatic and haematogenic dissemination; The tendency to metastasize first via the lymphatics or via the blood vessels varied. Half of the cases of Ewing's sarcoma and reticulosarcoma had evidence of lymphatic spread before blood-borne metastases were detected. In the osteosarcoma cases, however, lymphatic dissemination was always preceded by haematogenic spread (Table 12). In synovial sarcoma, rhabdomyosarcoma and neurogenic sarcoma, the first dissemination was more frequently lymphatic than haematogenic (Table 13). 3. Possible existence of special lymphographic features of sarcoma metastases. Only reticulosarcoma displayed special characteristics. The lymph node metastases of reticulosarcoma of bone had lymphographic appearances similar to those found in reticulosarcoma of soft tissue or lymph node origin (Fig. 12). The lymph node metastases of other primary bone and soft tissue sarcomas had no specific lymphographic features and were indistinguishable from carcinomatous metastases (Figs 7, 9, 13, 15, 18, 19, 20, 22, 23). 4...

Adolescent↗

[Analysis of the TNF receptor in KYM cells by affinity cross-linking].

We investigated the identity of the TNF receptor on the KYM cell membrane by cross-linking 125I-TNF and the presumed receptor site with DSS, and subjecting the TNF-receptor complex to electrophoresis. Four specific bands were observed at 145 K, 50 K, 35 K, and 17 K, and those at 50 K, 35 K and 17 K being consistent with trimers, dimers and monomers of TNF, respectively. The 145 K band disappeared after addition of excess unlabelled TNF or anti-human recombinant TNF monoclonal antibody (IV3-E), which quenched the cytotoxic activity of TNF and inhibited the TNF binding to the receptor. The molecular weight of native TNF as estimated by gel filtration was 45 K and this observation showed that native TNF existed only as the TNF trimer. These results confirmed that 95K, i.e., the difference between 145 K and 50 K, is the molecular size of the TNF receptor.

Antibodies, Monoclonal↗