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The clinical radiological and anatomohistological features of fourteen cases of epiphyseal chondroblastoma are described. The seat, origin, and evolution of the tumor are discussed. The diagnosis of the epiphyseal localization is easy, but there are same problems in the differential diagnosis of the epiphyseal-metaphyseal of metaphyseal forms.
The authors report the case of a 71 year old woman affected by a solitary intracranial plasmacytoma. Computed tomography statement and monoclonal gammapathy found in the serum and in the cerebrospinal fluid permitted the diagnosis. Brain tumor and gammapathy improved after radiotherapy. A review of the 17 cases reported in the available literature showed some characteristics of these tumors : epidemiology, localization, evolution.
In 318 cases of human primary breast carcinoma, the presence and content of estrogen receptor (ER) have been correlated to histopathological features of these carcinomas. We have evidenced that: a) there is a relationship between the ER presence, the histoprognostic grade and the histological type; b) there is no correlation between the frequency of ER presence, the neoplasic cellularity and the stromal reaction. The presence of ER appears to be related to a differentiated state of the carcinoma and to a moderate neoplasic activity. These data show that ER, correlated with histopathological features, could be used as an estimation's factor of the cellular activity of a human mammary carcinoma, thus as a factor of better prognostic value for the evolution of this tumor.
Integrins are a family of transmembrane glycoproteins that serve as cell-cell and cell-substratum adhesion molecules and help regulate cellular differentiation and proliferation. In malignant cells, which exhibit abnormal differentiation and growth properties, the expression of an altered integrin repertoire could therefore be expected. From a tumorigenic human fibrosarcoma cell line we isolated a unique complementary DNA corresponding to the alpha 6 integrin subunit. Northern blot analysis using this complementary DNA as probe indicated that alpha 6 integrin mRNA was abundantly expressed in all neoplastically transformed fibroblast cell lines but not in normal diploid fibroblasts. In addition to its potential as a marker for the neoplastic transformation of human fibroblasts, the alpha 6 integrin mRNA was also found to be consistently expressed at higher levels in tumorigenic fibroblasts than in immortalized but nontumorigenic fibroblasts. This differential expression of alpha 6 integrin was reflected at the cell surface protein level using cytofluorometric analysis with specific monoclonal antibody. In contrast, the levels of cell surface expression of other integrins were unchanged (such as alpha 3 and beta 1) or down-regulated (such as alpha 5) when transformed cells were compared with normal fibroblasts. The incremental up-regulation of alpha 6 integrin was selective and paralleled the progression of normal cells to immortalized cells and finally to tumorigenic cells. This elevated alpha 6 subunit associated with the beta 1 subunit to form a heterodimer receptor for laminin. Since fibrosarcoma cell invasion of basement membrane has been shown to involve alpha 6 beta 1 integrin, then the induction or up-regulation of alpha 6 expression is an important step in tumor progression and evolution to the invasive phenotype in fibrosarcoma.
The authors describe the anatomopathological, clinical and evolutive characteristics of the metatypical carcinoma, based on four cases and on the existing literature. Evolution of these tumors, with a maxillo-facial preferential location, is usually longer than for other cutaneous carcinomas. Cases presented in this article illustrate the severity of such lesions, whose treatment requires extensive amputations and rather unusual reconstruction procedures.
The relationship between p53 gene mutation and carcinogenesis and evolution of malignant tumor is a hot spot of current research in molecular pathology of tumors. The detection of p53 gene mutation usually needs complicated DNA blotting and sequencing technology. We used newly-developed PCR-RFLP technique to detect the point mutation of the 7th exon of p53 gene in fresh and paraffin embedded tissues of hepatocellular carcinoma in studying 40 cases. It was shown that the p53 gene mutation rate in hepatocellular carcinoma was 30%, and this mutation was correlated with the metastasis of hepatocellular carcinoma.
Since the availability of the H2-receptor antagonists (1978), seven patients admitted to the Department of Emergency Surgery, University of Pisa, with Zollinger-Ellison syndrome (ZES) sustained by extrapancreatic gastrinomas underwent elective surgical treatment. There were four women and three men, with a mean age of 37.3 years (16 to 67 years of age). Preoperative localization studies included endoscopy of the upper part of the gastrointestinal tract, computed axial tomography, ultrasound, selective angiography and transhepatic portal vein sampling for gastrin and were effective in four patients. In the other three patients, the localization of the gastrinoma was made at laparotomy. Four patients had gastrinomas of the duodenal and jejunal wall. Three underwent excisional operations, whereas the remnant was treated with pancreatoduodenectomy. In three of the patients, the location of the gastrinoma was extrapancreatic and extraintestinal, and surgical treatment consisted of nodal excision (two patients) and hepatectomy. None of the patients had undergone a gastric operation in addition to tumorectomy procedures. Soon after excisional operation, ZES recurred in one patient and a second laparotomy with nodal excision resulted in a cure. On long term follow-up evaluation, ranging from 15 to 136 months (mean of 85.1 divided by 37.3 months), no patients showed a recurrence of ZES. The possibility of extrapancreatic gastrinoma should be suspected in patients with sporadic ZES. The need for emergency surgical treatment in these patients is minimized by the medical control of the gastric secretion that consents diagnostic studies for the preoperative localization of the gastrinoma. Even if only suspected, the site of the extrapancreatic gastrinoma has an increased chance to be identified at operation. This consents to remove gastrinomas mostly by a minimal excisional procedure resulting in the normalization of gastric secretion and the prevention of malignant evolution of these tumors.
Progressive microsatellite changes in replication error positive (RER+) endometrium were used to reconstruct evolutionary stages of nonfamilial adenocarcinoma. RER+ putative endometrial precancers (atypical endometrial hyperplasias) progress to RER+ carcinomas, which retain some of the altered microsatellites acquired in earlier precursor stages. The RER+ phenotype may provide a specific marker for early-stage endometrial neoplasms that cannot be resolved by routine histopathology and may be a useful tool to stratify stages in the evolution of RER+ tumors.
Somatostatin receptors have been identified on the cellular surface of a subset of patients with small cell lung cancer (SCLC) and may be associated with a less aggressive evolution of the tumor. Moreover, medical therapy with somatostatin analogues holds promise for neoplastic growth control. We performed planar imaging in 22 patients with histologically proven SCLC at 2-4 and 24 hours after the injection of 111-185 MBq of 111In-DTPA-octreotide (Octreoscan, Byk-Gulden). Tumor uptake was observed in 19 patients in both early and late scans, while 2 patients previously treated with chemotherapy showed negative early and late scans. One patient had a positive early scan and a negative late scan. All the scintigraphic studies showed more extensive disease than expected by CT. No significant modification in tumor uptake of radiooctreotide was observed in three patients studied before and after chemotherapy. In conclusion, 111In-octreotide is a suitable radiopharmaceutical for the in vivo evaluation of the somatostatin receptors of small lung cancer. The prognostic and therapeutical implications of this nuclear technique must be further investigated, however.
We analyzed the informations concerning the late postoperative evolution for 405 (60%) of 760 patients with colon cancer operated between 1968-1996 in the Surgical Clinic from Tg.-Mureş and we found a global 5-year survival rate of 35.57%. The conclusion after this study was that the most important worsening prognostic factors were the advanced stage evolution of the tumor and the occlusion. The females had a better prognosis than the males. The rural patients had a better prognosis than the urban. In our study the younger age isn't a worsening factor for survival. The patients with a longer history of the symptoms had an unexpected better survival rate than the others. Localization of the tumors at the site of the descending colon and flexures is an important negative prognostic factor. The penetrating feature of the tumor is more important than the lymphatic invasion for prognosis. Subtotal colectomy performed for stenotic tumors of the left colon, even in emergency for occlusions gave us one of the best 5-year survival rate (75%). The histopathologic type of undifferentiated carcinoma and the mucinous adenocarcinoma are associated with the poorest survival rate. The lymphoma has a better survival rate than the carcinoma. The perioperative blood transfusion, even though is associated with a low survival rate it is not an important prognostic factor.
Carcinoid tumors are rare, often insidious neoplasms arising from neuroendocrine cells. The majority arise in the gastrointestinal system, and are often incidentally found during investigation, although some may present as an emergency bleed or perforation. The prosaic symptoms of flushing, diarrhea, and sweating are often overlooked; thus, the diagnosis is usually much delayed and the tumor is advanced at presentation. This diagnostic delay renders effective management difficult and adversely affects outcome. This overview provides a current assessment of the evolution of the diagnostic techniques available to establish an accurate biochemical (5-hydroxyindole-3-acetic acid and chromogranin A) and topographic diagnosis (octreoscan, radio-labeled metaidobenzylguanidine, computerized tomography, magnetic resonance imaging, positron emission tomography, enteroclysis, endoscopic ultrasound, enteroscopy, capsule endoscopy, and angiography) of carcinoid tumors. The utility and shortcomings of the respective modalities available are evaluated. Although considerable advances have been made in establishing the diagnosis of carcinoid tumors and in defining the topography of metastatic disease, the major limitation is the inability to establish an early and timely diagnosis before the advent of metastatic disease.
OBJECTIVE: To analyze the influence of personal and histopathological factors as prognostic variables in the evolution of upper urothelial tumors submitted to radical surgery. METHODS: Multifactorial retrospective study of a series of 61 patients submitted to radical surgery for upper urinary tract transitional cell tumors. Patient habits and histopathological factors are analyzed. The statistical significance of the different factors was analyzed using the Pearson chi-square test for the qualitative variables, with analysis of the residuals and Kaplan-Meier survival curves and statistical validation with the Mantel Cox test. The level of significance was p < 0.05. RESULTS: A statistically significant correlation was found for tumor-related death and pathological stage, positive lymphadenectomy and positive lymphadenopathy on the CT (p < 0.05). The presence or absence of a history of smoking was not available for all patients and was therefore not evaluable. The most frequent reason for consultation was hematuria (39%). Tumor growth was mostly of the papillary type (79%), localization was mostly in the renal pelvis (30%) and the most frequent procedure was nephroureterectomy without endoscopic detachment (60%). CONCLUSIONS: The pathological stage and a positive lymphadenectomy or the presence of positive lymphadenopathies on the CT were found to be prognostic factors in urothelial tumors of the upper urinary tract.
It is tried to differentiate between various stages of malignant evolutive push and normal mammary tumors to establish an individual therapeutic procedure. Besides mammography and thermometry, investigations of urinary excretions of estrogenic and androgenic steriods are qualified for this purpose. Patients with malignant evolutive push showed an increased excretion of estrogens which reached its highest levels in patients suffering from inflammatory mammary carcinomas. The excretion of 17-ketosteroids shows a behaviour vice versa. Altogether mammary tumors with malignant evolutive push are characterized by a state of absolute and relative hyperestrogenity respectively. This phenomenon preferably depends on the clinical stage of the disease than on the age of the patients.
An analysis is presented of clinical, radiological and evolutive aspects of 106 neurogenic mediastinal tumors operated in the Clinic for Tjhoracic surgery from Bucharest. The predominance is stressed of tumours originating in the nervous sheaths (62%), and the high incidence of tumours of the nervous cells (sympatomas, ganglio-neuroblastomas) in children. An analysis is made of the various surgical aspects. and the post-operative results, mostly favourable in over 90% of the subjects that underwent surgery.
BCG-immunopotentiated antitumor immunity was studied in a model in which irradiated murine tumor cells, mastocytoma P815, were injected into subcutaneous sites prepared by a prior injection of BCG; challenge in a distant foot-pad was used as an indicator of specific resistance. The onset of antitumor immunity correlated with the proliferation of lymph node cells draining the immunization sites and the development of delayed type hypersensitivity (DTH) to the tumor. Tuberculin hypersensitivity, however, was depressed during the evolution of DTH to the tumor. Antitumor immunity was transferred locally with spleen or lymph node cells that were sensitive to anti-theta sera and complement but not to anti-lg and complement. They had velocity sedimentation rates in a bovine serum albumin gradient of 3.9-5.9 mm/hour and were relatively resistant to vinblastine at the peak of the immune response. Sera from immunized mice failed to confer antitumor immunity either in vitro or on transfer in vivo.
Loss of heterozygosity (LOH) of chromosomal regions bearing tumor suppressors is a key event in the evolution of epithelial and mesenchymal tumors. Identification of these regions usually relies on genotyping tumor and counterpart normal DNA and noting regions where heterozygous alleles in the normal DNA become homozygous in the tumor. However, paired normal samples for tumors and cell lines are often not available. With the advent of oligonucleotide arrays that simultaneously assay thousands of single-nucleotide polymorphism (SNP) markers, genotyping can now be done at high enough resolution to allow identification of LOH events by the absence of heterozygous loci, without comparison to normal controls. Here we describe a hidden Markov model-based method to identify LOH from unpaired tumor samples, taking into account SNP intermarker distances, SNP-specific heterozygosity rates, and the haplotype structure of the human genome. When we applied the method to data genotyped on 100 K arrays, we correctly identified 99% of SNP markers as either retention or loss. We also correctly identified 81% of the regions of LOH, including 98% of regions greater than 3 megabases. By integrating copy number analysis into the method, we were able to distinguish LOH from allelic imbalance. Application of this method to data from a set of prostate samples without paired normals identified known regions of prevalent LOH. We have developed a method for analyzing high-density oligonucleotide SNP array data to accurately identify of regions of LOH and retention in tumors without the need for paired normal samples.
Cystosarcoma phylloides (c.p.) is a rare fibroepithelial neoplasm of the mammary gland exhibiting considerable histological variations ranging from the aspect of hypercellular fibroadenoma to that of pleomorphic sarcoma. In this study, 58 cases of c.p. were graded according to their histology into 3 groups of increasing malignancy-benign tumors: 23 cases (42%), borderline tumors: 16 cases (27%) and malignant tumors: 18 cases (31%). Their clinical properties and evolution have been compared. These tumors were found exclusively in women, most often during the 5th and 6th decade of life (age range from 19 to 81 years). In two thirds of the cases, the history of the disease was shorter than 6 months. The symptoms were generally scant. Only in 2 cases were severe local lesions observed. The postoperative clinical course has been followed for at least 5 years in 32 instances. Recurrences were observed in 5 patients, the histology being as a rule the same as that of the primary tumor. The 12 patients with benign tumors are well 5 years or more after operation. One of the patients presenting a malignant tumor died of lung embolism soon after mastectomy. 2 out of 10 patients with borderline tumors died within 6 years with metastases of the mammary tumor. Our analysis confirms the experience that c.p. are relatively benign but often recurring neoplasms that rarely disseminate. As far as prognosis and treatment are concerned, tumors of questionable dignity should be considered malignant. To avoid such vague terms as "benign or malignant c.p." we support OBERMANN'S suggested separation of c.p. into "cellular fibroadenoma" and "periductal fribrosarcoma". Wide local excision for small and benign tumors is recommended. All other forms require simple mastectomy. Prophylactic dissection of the axillary lymph nodes is not necessary as these tumors usually disseminate hematogenously. Roentgen therapy or chemotherapeutic agents are not useful in treatment.
The pre-selected tumor cells injection in the cecal wall of rat, seems to be a intermediate model between spontaneous evolution of a colon tumor and intrasplenic or direct intraportal injections. From rhabdomyosarcoma cells (RMS S4-MH-) which present the advantage to prudce up lymphatic, pulmonary and hepatic metastases after subcutaneously injection, first subcutaneously (S.C.), intrasplenic (I.S.) and intracecal sites were compared: In the I.C. model, tumor was obtained in 80% of case and the survival was nearly similar to S.C. model's one. The lymphatic metastases were more and more distal as the evolution and the liver metastases were rarely observed. The I.S. model increased quickly and there were always liver metastases; In the two cases, pulmonary metastases were rarely observed (0 and 2/5). With adenocarcinoma colonic cells (Pro b) I.C. injection in the rat, tumor were obtained in 48% of cases without peritoneal dissemination; lymphatic nodes metastases were observed in 80% of cases; liver metastases was obtained in one animal from metastasis pulmonary selection cell lines. The I.C. model allows to estimate the liver and lymphatic nodes part; improved, it would be used to test adjuvant therapies and immunoscintigraphy.