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Angiosarcoma in post-mastectomy lymphoedema. A report of one case of Stewart-Treves syndrome.

A 67 year old woman developed lymphoedema in the ipsilateral arm about 1/2 year after radical mastectomy for carcinoma of the breast with no metastases. 11 years later she developed an angiosarcoma in the same upper arm and this spread rapidly to the forearm and chest wall. She had considerable bleeding from the lesions and had to be given repeated blood transfusions. Radiotherapy was without effect and she died of pulmonary emboli 3 months after the diagnosis of angiosarcoma was made. No sign of distant metastases, 0ut a small carcinoma was found in the right breast. On going through the literature, the author has found 206 cases of Stewart-Treves Syndrome (development of angiosarcoma in post-mastectomy lymphoedema), 7 of which were from Scandinavia.

Aged↗

[Primary malignant liver tumors in children].

The review is based on the analysis of 17 national and 58 foreign publications dealing with the epidemiology, classification, age features, morphology, ultrastructure, histogenesis, complications and outcomes of primary malignant tumors of the liver in children. This analysis showed primary tumors of the liver in children to occupy the third place among neoplasia of the abdominal cavity and retroperitoneal space. There are no universally accepted terms for their designation and this prevents the development of a unique classification. Under 3 years, tumors develop predominantly from the embryonal tissue: hepatoblastomas of epithelial and mixed types frequently combined with congenital disorders and malformations of other organs. At more advanced age, hepatic carcinoma, a tumor of the adult type, is found. The review deals with the problems of histogenesis and classification of primary hepatic tumors in children. An opinion is given on the entodermo-mesodermal nature of embryonal hepatic tumors from the pluripotential blastema capable of malignization both into entodermal and mesodermal components. The prognosis of the disease is poor, 90% of children with hepatoblastoma and 80% with hepatocarcinoma die within one year after the diagnosis is established.,

Carcinoma, Hepatocellular↗

[Stewart-Treves syndrome. 2 cases with an ultrastructural study].

The authors present an ultrastructural study of two cases of Stewart-Treves syndrome in elderly women. Under light microscopy, the dermal and hypodermal proliferations showed vascular features which were more clearly preceptible in the second case than in the first. Ultrastructural studies showed, in the first case, clefts containing erythrocytes and surrounded by neoplastic cells which were linked by zonulae adherentes. A rudimentary form of basal membrane was also noted, with an exterior lining of pericyte-like cells. In the second case, typical capillary vessels were bordered by endothelial cells containing a few pinocytotic vesicles and microfilaments, in contact by zonulae adherentes. The walls of these vessels consisted of a clearly defined membrane lined with pericytes, and constituting, in some areas, an anastomotic network due to the swelling of the endothelial cells. Ultrastructural study suggests an angiosarcomatous origin of these lesions. Finally, the article includes a review of the literature.

Aged↗

[Roentgen diagnosis of the posterior part of the base of the skull].

Since the cranial nerves and the base of the skull are spatially close to each other, certain complexes of symptoms and signs give a very accurate indication of the possible location of the lesion. Basing on such neurologic-topical structuralisation, lesions of the cerebrellopontine angle, the foramen jugulare, the clivus and of the foramen magnum are discussed systematically. The various techniques of radiological imaging or examination are assessed in accordance with their diagnostic ranking, and characteristic constellations of findings are described.

Achondroplasia↗

[Treatment of Stewart-Treves syndrome].

The Stewart-Treves syndrome is the most dangerous complication of chronic lymphedema following mastectomy. Prognosis is poor. In the world literature 278 cases are described. At the Surgical Clinic of the University of Heidelberg 3 cases of Stewart-Treves syndrome have been treated so far. Decisive for the prognosis of this fast growing tumor of high malignancy is early detection and initiation of therapy. The only curative therapy seems to be radical surgery in the form of interthoracic scapular exarticulation of the arm at an early stage of this disease. Radio- and chemotherapy offer palliation in advanced tumor stage.

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