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Differentiation of radiation-induced fibrosis from recurrent pulmonary neoplasm by CT.

We describe and compare the computed tomographic (CT) manifestations of radiation fibrosis and recurrent neoplasm and consider the potential application of CT in the follow-up of patients after radiotherapy for bronchogenic carcinoma. Thirty-one patients were evaluated in this retrospective study. The CT findings in 20 patients with radiation fibrosis were compared with those in 11 patients with recurrent tumor. In 19 of the 20 patients with radiation fibrosis, CT allowed demonstration of consolidation, with a straight lateral margin and containing ectatic air-containing bronchi. In 9 of the 11 patients with recurrent tumor, CT showed a soft tissue mass with a convex lateral border and without air-containing bronchi. Twenty of the 31 patients had a suspected recurrence on plain chest radiographs. CT permitted accurate differentiation between radiation fibrosis and recurrent tumor in all patients, with the exception of two who had large pleural effusions. Because of its great specificity, CT appears useful in complementing chest radiographs in the follow-up of patients after radiotherapy.

Carcinoma, Bronchogenic↗

CT cystography and virtual cystoscopy in the assessment of new and recurrent bladder neoplasms.

OBJECTIVE: To determine if CT cystography and virtual cystoscopy have a role in the assessment of neoplasms of the urinary bladder. MATERIAL AND METHODS: Twenty five adults suspected of having bladder tumours underwent CT cystography. Twenty three had subsequent virtual cystoscopic reconstructions from the axial data. The examinations were reviewed by two radiologists and the findings were correlated with those at conventional cystoscopy. RESULTS: Seventeen masses larger than 0.5 cm were identified by CT cystography in 16 patients. Two patients had normal CT cystography, but one had small recurrent neoplasms on conventional examination. Seven patients had nodular mucosal irregularities which were subsequently shown to be neoplastic in three. Accuracy for diagnosis of neoplasm in all patients was 88%. CONCLUSION: CT cystography is very accurate at identifying masses larger than 0.5 cm and can show mucosal abnormalities as small as 2 mm. It is minimally invasive and can be diagnostic when conventional cystoscopy is inconclusive. It can indicate appropriate areas for assessment and biopsy at conventional examination. Virtual cystoscopy gave comparable views to conventional cystoscopy, but did not add diagnostic information. It is not likely to replace conventional cystoscopy, but may be helpful in occasional circumstances where the latter is inconclusive, or can not be performed.

Adult↗

Urethral wash cytopathology for monitoring patients after cystoprostatectomy with urinary diversion.

BACKGROUND: Urethral wash cytopathology (UWC) has been recommended for monitoring patients after cystoprostatectomy with preservation of the penile urethra and urinary diversion. The rationale has been that early detection of urethral neoplasms (recurrences) would allow for urethrectomy to be performed before an invasive tumor developed and thus prevent or delay disease progression. Negative results of UWC would spare the patient a major surgical procedure. The authors analyzed the clinical and pathologic records of patients undergoing cystoprostatectomy with urinary diversion and preservation of the penile urethra to determine the cytohistologic correlations and to document the effect of UWC monitoring on the rate of disease progression. METHODS: All cases of men undergoing a cystoprostatectomy with urinary diversion and preservation of the penile urethra over a 12-year period at the study institution were included. Records were reviewed to determine the degree of risk associated with the pathologic findings at surgery and to document the presence or absence of disease progression for each individual. The pathologic specimens of all cases monitored with UWC were reviewed separately by both authors to establish cytohistologic correlations. Standard statistical methods were applied. RESULTS: Of 176 patients, urethral recurrence and disease progression occurred in both high-risk and low-risk groups. Among the 48 individuals monitored with UWC, 13 had a positive diagnosis, and 10 of these 13 had been subsequently treated with urethrectomy. Among 128 patients not monitored with UWC, 16 underwent urethrectomy. Patients in both groups had recurrent urethral neoplasms. Most lesions were focal carcinomas in situ occupying the paraurethral glands. One individual in each group had no further disease progression, even though the urethral tumor was invasive. Urethrectomy was found to have no statistically significant association with the rate of disease progression, regardless of whether the procedure resulted from a positive UWC or was provoked by patient/clinician concern. When groups were compared on the basis of monitoring with UWC, there was no statistical difference in the rate of disease progression between those monitored with UWC and those who were not. Within the monitored group, however, the cytopathologic interpretations of UWC were statistically significant; patients with positive findings were found to have the highest rate of disease progression, and those with negative findings experienced the lowest (P < 0.04). CONCLUSIONS: Both monitoring with UWC and urethrectomy might benefit selected individuals, but neither method appeared to have a statistically significant effect on disease progression in a nonrandomized group of patients. A positive UWC was associated with a high likelihood of disease progression and could justify more intensive follow-up for progressive disease at other sites.

Adult↗

Sonography of the scrotum after orchiectomy: normal and abnormal findings.

Sonography is the primary imaging technique for evaluating the scrotal contents. In this pictorial essay, we illustrate a range of normal and abnormal sonographic findings in patients after orchiectomy, including the appearances of the normal postorchiectomy space, acute and subacute hematomas, recurrent neoplasm, second primary tumor in the remaining testis, and testicular prostheses.

Adult↗

Esophageal cytology in the follow-up of patients with treated upper aerodigestive tract malignancies.

BACKGROUND: Patients with an history of carcinoma of the upper aerodigestive tract are at high risk for recurrence or the development of new tumors in this region. In the majority of follow-up protocols, these patients undergo radiologic and endoscopic evaluation as a means of surveillance for the early detection of recurrence. The brush biopsy-capsule technique represents a noninvasive and inexpensive screening device for this patient population. In the current study, the authors retrospectively assessed the sensitivity, specificity, and predictive value of esophageal brush-capsule cytology for the detection of malignant lesions of the upper aerodigestive tract in this high risk patient population. METHODS: Cytologic specimens from 334 patients with previously treated upper aerodigestive malignancies were available for review. The cytologic, endoscopic, and clinical follow-up of each case were studied over a follow-up period of 3 years. Gold standard was the clinical follow-up for the negative cases (who were not submitted to biopsy) and biopsy for the positive cases. Sensitivity, specificity, and predictive value were calculated. RESULTS: Using cytology 33 malignancies were detected in 25 patients during a 3-year follow-up period. The test was found to have a sensitivity of 88.7% and a specificity of 90.7%. In 66% of cases the malignancies were located in the oropharynx; the others were located in the esophagus. In 70% of cases the malignancies were detected at an early stage. CONCLUSIONS: Esophageal brush-capsule cytology is a simple noninvasive technique that has been proven to be useful in the early detection of metachronous and recurrent neoplasms in the follow-up of patients with previously treated carcinomas of the ear, nose, and throat.

Adult↗

Carcinoma in situ of the vagina. A study and review.

A retrospective study has been carried out on 25 patients treated at the University of Michigan Medical Center for carcinoma in situ of the vagina. Intraepithelial carcinoma of the vagina occurred as a primary entity, following treatment for preinvasive and invasive carcinoma of the cervix, and following hysterectomy for benign disease of the uterus. These patients were treated with either radium implantation or some form of surgery. Five patients had recurrences. These 5 were all subsequently retreated and are alive and without evidence of further recurrent neoplasm. This series of carcinoma in situ of the vagina is compared to other reported series. Emphasis is directed toward the need for continued use of Papanicolaou smear cytology tests in posthysterectomy patients, regardless of the reason for hysterectomy.

Adult↗

Diffusion-weighted imaging of radiation-induced brain injury for differentiation from tumor recurrence.

BACKGROUND AND PURPOSE: Differentiation between tumor recurrence and treatment-related brain injury is often difficult with conventional MRI. We hypothesized that the diffusion-weighted imaging (DWI) could help differentiate these 2 conditions, because water diffusion may be greater for necrotic tissues in the treatment-related brain injury than for tumor tissues in recurrence. Our aim was to analyze whether DWI findings of recurrent tumor are distinct from those of radiation necrosis. METHODS: Seventeen patients were examined prospectively. Two readers assessed the images by consensus for homogeneity and signal intensity of the lesions. Five regions of interest were drawn within the lesions on trace DWI images and apparent diffusion coefficient (ADC) maps. The minimal, maximal, and mean values of each lesion were compared between the 2 groups. Findings in 12 of 17 patients were verified histologically by surgery or biopsy; the diagnoses in the remaining 5 patients were made on the basis of follow-up MRI findings and clinical follow-up. RESULTS: There were a total of 20 lesions; 12 lesions were due to radiation necrosis and 8 lesions to tumor recurrence. In the radiation necrosis group, 8 lesions had marked hypointensity. In the recurrence group, however, no marked hypointensity was seen. The maximal ADC values within each lesion were significantly smaller for the recurrence group than for the necrosis group (P = .039). CONCLUSION: Radiation necrosis usually showed heterogeneity on DWI images and often included spotty, marked hypointensity. Significant difference was found in the maximal ADC values between radiation necrosis and tumor recurrence. DWI was useful in differentiating recurrent neoplasm from radiation necrosis.

Adult↗

The enigma of post-radiation oedema and residual or recurrent carcinoma of the larynx and pyriform fossa.

Persistence of significant laryngeal oedema following radiotherapy presents the surgeon with a diagnostic dilemma. Though the oedema may represent a prolonged response to irradiation, the possibility of residual carcinoma must be considered. Several authors have commented upon it and have suggested frequent biopsies to prove the presence of residual or recurrent neoplasm (Ward et al., 1975; Lederman, 1970; Calcaterra et al., 1972). Some reluctance to laryngeal biopsy has been exercised to avoid inciting a fulminant perichondritis. However, the difficulty of obtaining a positive biopsy in a post-irradiated case is well known, and repeated negative biopsies do not exclude the presence of a residual tumour. The present paper studies 52 histopathologically proven cases of carcinoma of the larynx and laryngopharynx which had received radiotherapy earlier. These cases underwent salvage radical surgery on clinical suspicion of residual/recurrent tumour, manifested by persistence of significant laryngeal oedema and/or fixation of the larynx. No positive biopsies had been obtained following radiotherapy.

Adolescent↗

Mixed-type liposarcoma of the oral cavity: a case with unusual features and a long survival.

A case of mixed-type liposarcoma, which showed unusual dedifferentiation in the recurrence, is reported. The rapidly growing mass in the palate of a 60-year-old Japanese woman first revealed a combination of myxoid liposarcoma with features resembling storiform malignant fibrous histiocytoma. The recurrent neoplasm, showing an abrupt transition between myxoid and non-lipogenic parts, partially reverted to sclerosing well-differentiated liposarcoma. The patient died 10.1 years after the first operation.

Fatal Outcome↗

[Clinico-diagnostic and therapeutic considerations on retroperitoneal liposarcoma].

Two patients with retroperitoneal liposarcoma are presented to determine the accuracy of diagnostic methods and the role of surgical treatment. In both the patients the large retroperitoneal liposarcoma recurred locally after surgery. Histological features, clinical presentation, diagnostic procedures, extent of surgical resection and adjuvant treatment are reviewed. These data suggest that an aggressive surgical approach followed by adjuvant postoperative irradiation is the treatment of choice in primary and recurrent neoplasms.

Aged↗

Ki-67 (clone MIB-1) proliferation index in recurrent glial neoplasms: no prognostic significance.

BACKGROUND: To determine if the Ki-67 (MIB-1 clone) proliferative index (PI) has prognostic potential in patients with recurrent astroglial neoplasms. METHODS: We conducted a retrospective review of 27 patients whose initial and recurrent specimens were available. Histopathology was determined according to the World Health Organization classification. Proliferation index was calculated on formalin-fixed tissue using the Ki-67 (MIB-1 clone) antibody. Morphometric data were analyzed in conjunction with clinical data and Cox Proportionate Hazards Analysis, Spearman's correlation coefficient and Mann-Whitney Test. RESULTS: Initial histopathology included 14 glioblastoma multiforme, 7 anaplastic astrocytoma, 3 oligoastrocytoma, and 3 astrocytoma. Recurrent specimens showed changes consistent with treatment. While univariate analysis shows initial histology correlated with survival (p<0.036), PI did not correlate with survival after either initial (p = 0.86) or recurrent (p = 0.46) surgery for any tumor type. PI difference between specimens also did not correlate with survival (p = 0.91). Initial PI did not correlate with recurrent PI either (p = 0.43). CONCLUSIONS: Ki-67 PI does not confer additional prognostic information for patients with recurrent astroglial neoplasms. One possible explanation for this observation is that treatment may alter the PI independent of its effect on tumor growth.

Adult↗