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PubMed1987

Comprehensive phase II evaluation of aziridinylbenzoquinone (AZQ, diaziquone) in recurrent human primary brain tumors.

Ninety-three patients with primary intracranial brain tumors recurrent after cerebral irradiation were treated with aziridinylbenzoquinone (AZQ; Diaziquone). Twenty-four (26%) had tumor regression lasting a median of 9.2 months. Prior chemotherapy was not significantly associated with tumor regression but was associated with survival (median 7.3 months no prior chemotherapy versus 4.7 months with prior chemotherapy; logrank p = 0.03). AZQ demonstrated anti-tumor activity in a wide variety of primary intracranial neoplasms recurrent after radiation therapy and deserves study in patients at the time of diagnosis. We believe alternating or combining AZQ and BCNU should be rewarding. The principal toxicity of AZQ is myelosuppression.

Adolescent↗
PubMed1995

Recurrent mammary carcinoma after local excision. A segmental problem.

BACKGROUND: The acceptance of local operative therapy for mammary carcinoma has stimulated scrutiny of specific techniques with the goals of minimizing the incidence of local recurrence while optimizing the cosmetic result. Intraductal spread of carcinoma has been established as a major factor in determining the rate of local recurrence after breast-conserving therapy for mammary carcinoma. The relationship of the anatomic location of a recurrent neoplasm to that of the primary tumor is likely to be instructive in evaluating the effectiveness of various proposed approaches to primary excision. METHODS: Using the tumor registry of a tertiary care medical center, the authors reviewed all patients with mammary carcinoma treated with primary local excision during a 9-year period (1984-1992; n = 86), and identified all patients who subsequently experienced local recurrence (n = 5). The pathologic anatomic findings in each case were reviewed carefully and correlated with clinical and mammographic data. RESULTS: The rate of local recurrence in this series was 5.8%, similar to that of Veronesi's "lumpectomy" group (7%). In all five patients, the recurrent lesion was located in the same breast quadrant, along a radius from the nipple to the edge of the breast disc that crossed the site of the initial lesion. CONCLUSION: Local recurrence of mammary carcinoma after breast-conserving operative therapy most often occurs within the same segment; it is therefore proposed that its incidence may be substantially reduced with the use of a primary excision technique (based on normal breast anatomy) that removes en bloc the dominant tumor mass and the associated (possibly diseased) duct system.

Adult↗
PubMed1995

CT for the evaluation of carcinomas in the colon and rectum.

The role of conventional CT in assessing patients with colorectal tumors is well established. The low accuracy of CT for identifying early stages of primary colorectal cancers prevents the routine use of CT for preoperative staging. Nevertheless, CT is useful in examining patients suspected of having extensive disease, in deciding whether a patient will benefit from preoperative radiation, in designing radiation ports, and in detecting complications related to the neoplasm. For recurrent colorectal neoplasm, CT has the premier role. CT surpasses colonoscopy in detecting early masslike tumor recurrence at the anastomotic site because of its extrinsic component, and CT and MRI are the only methods that can fully evaluate cases of total abdominoperineal resection. After total abdominoperineal resection, however, CT cannot determine with certainty that a soft tissue density in the surgical bed represents recurrent tumor. In patients with colorectal neoplasms, preliminary results with multiplanar and three-dimensional reconstructions of helical CT images are promising, but their role needs further investigation.

Colonic Neoplasms↗
PubMed1987

DNA in meningioma tissues and explant cell cultures. A flow cytometric study with clinicopathological correlates.

Flow cytometry was performed on stored frozen tissues and explant cell cultures from 39 meningiomas using ethidium bromide and mithramycin in a selective staining technique for deoxyribonucleic acid (DNA). The ploidy index and percentage of cells in the G0/G1, S, and G2/M phases were calculated for each specimen. The results were compared with the age and sex of the patients; the site, the histological subtype, and mitotic rate of the neoplasms; and the estrogen- and progesterone-receptor levels assayed in cytosol-enriched supernatants from cryostat-cut sections. Sixteen neoplasms (41%) were aneuploid. These included two recurrent neoplasms, seven of the eight neoplasms from patients with multiple meningiomas, and three clinically aggressive neoplasms (one hemangiopericytic and two anaplastic meningiomas). Significant correlations were found between values for the ploidy index (r = 0.75, p less than 0.01), the percentage of S-phase cells (r = 0.82, p less than 0.01), and the percentage of G2/M-phase cells (r = 0.69, p less than 0.05) in vivo and in vitro. The results support the suggestion that flow cytometry for DNA in meningiomas may be of value in predicting the behavior of these neoplasms, and indicate that under controlled conditions explant cell cultures may provide a useful model for the proliferative characteristics of meningiomas in vivo.

Brain↗
PubMed2000

Posttherapeutic intraaxial brain tumor: the value of perfusion-sensitive contrast-enhanced MR imaging for differentiating tumor recurrence from nonneoplastic contrast-enhancing tissue.

BACKGROUND AND PURPOSE: Differentiation of tumor recurrence from treatment-related changes may be difficult with conventional MR imaging when newly enhancing lesions appear. Our aim was to determine the value of perfusion-sensitive contrast-enhanced MR imaging for differentiating recurrent neoplasm from nonneoplastic contrast-enhancing tissue. METHODS: Twenty patients in whom new enhancing lesions developed within irradiated regions were examined prospectively with perfusion-sensitive contrast-enhanced MR imaging. Twelve of them also underwent thallous chloride Tl 201 single-photon emission tomography (201Tl-SPECT). Normalized relative cerebral blood volume (rCBV) ratios and thallium indexes were evaluated to determine whether the new enhancing lesions were recurrent or not. Five instances of tumor recurrence and one of radiation necrosis were verified histologically; in the others, tumor recurrence was distinguished by lesions that progressively increased in size on serial MR examinations over at least 5 months, and nonneoplastic contrast-enhancing tissue was distinguished by lesions that disappeared or decreased in size on serial MR studies over at least 9 months. RESULTS: When normalized rCBV ratios were higher than 2.6 or lower than 0.6, enhancing lesions were either recurrent (n = 5) or nonneoplastic contrast-enhancing tissue (n = 3), respectively. All nonneoplastic contrast-enhancing tissue had a low thallium index, whereas three of four recurrent lesions had a high index. CONCLUSION: An enhancing lesion with a normalized rCBV ratio higher than 2.6 or lower than 0.6 may suggest tumor recurrence or nonneoplastic contrast-enhancing tissue, respectively. In these cases, further examination with 201Tl-SPECT may not be necessary. However, when the normalized rCBV ratio is between 0.6 and 2.6, 201Tl-SPECT may be useful in making the differentiation.

Adolescent↗
PubMedDate not supplied

Detection of locoregional and distant recurrences in breast cancer patients by using FDG PET.

Cases of recurrence of breast cancer can pose considerable diagnostic and therapeutic challenges for the oncologic team. The prognosis and management decisions are based on knowledge of the true extent of disease. Conventional staging methods, including physical examination, assessment of levels of tumor markers, cross-sectional imaging, and bone scintigraphy, may not reliably demonstrate the extent of disease in all cases. Physical examination and cross-sectional imaging (computed tomography [CT] or magnetic resonance imaging) can be problematic because (a) the sequelae of previous surgery and radiation therapy can be difficult to distinguish from recurrent neoplasms and (b) early metastatic disease (small lesions) can be difficult to distinguish from benign lesions that are too small to characterize. Positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) can help clarify inconclusive findings from physical examination and cross-sectional imaging. FDG PET is more sensitive than CT in detection of lymphatic spread of disease to locoregional and mediastinal nodes. Metastases at distant sites including the lung, bone, and the liver are also readily detected at FDG PET. FDG PET has been proved accurate in restaging cases of recurrent breast cancer and will likely aid in directing therapy in these cases.

Bone Neoplasms↗
PubMed1978

[Recurrent thyroid gland neoplasms].

The data on 106 patients with thyroid cancer recurrence are reported. The recurrences occurred in the zone of surgery in 76.4%, beyond this zone--in 23.6%. During a 3-year period the recurrence occurred in 41.5%, from 3 to 10 years - in 44.4%, after 10 years and longer - in 14.1%. One of the main causes of the recurrence is an inadequate extent of primarily performed surgery. The recurrent tumor was detected by palpation, regional metastases were detected in 47.1%, distant--in 22.6%. A lower differentiation of the recurrent tumor was noted. The combination treatment was employed in 64% of patients. The principal surgical procedures were as follows: total thyroidectomy and subtotal thyroidectomy.

Adult↗
PubMed2005

[Recurrence of endometrial cancer after surgical treatment].

OBJECTIVES: The purpose of the research was to analyze the frequency and location of endometrial cancer recurrence in a group of women who underwent surgery due to neoplasm and frequency of relaparotomy because of the neoplasm recurrence. MATERIALS AND METHODS: 292 women underwent operation in Dept. of Gynecology at Medical University of Gdansk due to endometrial cancer in clinical stage IA-IV by FIGO 1988 in the years of 1981-1996. All materials were analyzed using Microsoft Excel 97. The information was gathered from the following sources: case histories Dept.of Gynecology and Dept. of Oncology and Radiotherapy Medical University of Gdansk, case histories from Dept.of Radiotherapy Marine Hospital in Gdynia-Redlowo and questionnaires sent to patients. RESULTS: The mentioned above group of 292 women underwent surgery. As far as 233 instances (79.8%) are concerned, only hysterectomy with bilateral oophorectomy was used, in 23 situations (7.9%)--also the lymph nodes biopsy was performed whereas in 10 cases (3.4%)--appendectomy and/or omentectomy. 24 women (8.2%) underwent Wertheim-Meigs operation and only 2 patients (0.7%)--with vaginal hysterectomy. 138 women were chosen to take part in the next stage of treatment. The regression of neoplasm illness was discovered among 13 patients (4.5%) with the apex of vagina being the most common place. The result comprised of 6 women--46.1% of all recurrences. All regressions happened 1-2 years after surgery. 5-year-survival for patients with regression was 23.1% which is 3 women. Relaparotomy due to neoplasm illness took part in 9 situations (3.1%). The danger of fatality grew up to 16 month after first surgical treatment; after this period of time the risk of dying went down. CONCLUSIONS: The recurrence of endometrial cancer can be observed among small group of patients (4.5%). When we concentrate the patients with regression of neoplasm disease, we can observe a high rate of fatality.

Adult↗
PubMed1996

The risk of upper tract recurrence following cystectomy in patients with transitional cell carcinoma involving the distal ureter.

PURPOSE: Risk factors for the development of an upper urinary tract transitional cell carcinoma following radical cystectomy are identified. MATERIALS AND METHODS: The records of 430 patients who underwent cystectomy for transitional cell carcinoma of the bladder between 1981 and 1988 were retrospectively reviewed. RESULTS: Upper tract tumors developed in 11 patients (2.6%) at a median of 40 months after radical cystectomy. Of the potential risk factors evaluated only the presence of transitional cell carcinoma within the distal ureter showed a statistically significant correlation with upper tract recurrence (p = 0.001). Six of the 11 recurrent neoplasms were asymptomatic. Among the patients with upper urinary tract recurrence 5 died of disease, 4 had no evidence of disease and 2 were alive with cancer. CONCLUSIONS: Patients with distal ureteral involvement at cystectomy are at a high risk for upper tract recurrence. These patients should be monitored with routine upper tract cytology and imaging studies.

Aged↗
PubMed1976

[Prognosis in radiotherapy of patients with local recurrence of cervix neoplasms].

An analysis of the results of treatment in 231 patients with recurrences of cervical cancer is presented in relation to 5-year survival criterion ("dynamic analysis"). An actual 5-year survival rate was 16.0%. The most important factors determining the prognosis include the stage of the primary process, localization of the secondary tumor, terms of the recurrence and the absorbed dose of radiation given to the recurrence. Standardized rates showed a 3-5 fold improvement of the results of treatment in the presence of favourable prognostic factors. In combinations of favourable prognostic factors the 5-year survival rate of patients with recurrent cervical cancer reached 67.0%. The amount of the absorbed local dosage of radiation is of practical value for improvement of the results of treatment. Radiotherapy is the method of choice in treatment of patients with local recurrences of uterine cervix cancer.

Female↗
PubMed1995

Non-neoplastic causes of high signal intensity at T2-weighted MR imaging after treatment for musculoskeletal neoplasm.

OBJECTIVE: The objective of this study was to describe a variety of non-neoplastic causes of high-signal-intensity areas seen on T2-weighted magnetic resonance (MR) images obtained after treatment for malignant musculoskeletal neoplasm. DESIGN: MR examinations obtained after treatment for malignant musculoskeletal neoplasm in 11 patients were reviewed. The examinations of these patients were selected because at least one MR study of each patient showed high-signal-intensity areas on T2-weighted images at or near the site of the original tumor. The MR imaging findings were correlated with results of biopsy in four patients, and with information from follow-up radiologic examinations and the patients' medical records in all cases, to determine the cause of the high-signal-intensity areas. RESULTS: Non-neoplastic entities responsible for high-signal-intensity areas included postsurgical seroma, hematoma, postradiation therapy changes, fat necrosis and seroma, surgical hemostatic packing material, intercalary bone allograft, strut bone graft, atrophic muscle, and herniated colon and bladder. Knowledge of details of the surgical procedure and the time interval since surgery or irradiation aided in accurate interpretation of the findings, but did not allow immediate biopsy to be deferred in every case. CONCLUSION: High-signal-intensity areas on T2-weighted images in patients previously treated for malignant musculoskeletal neoplasm may represent a variety of entities other than residual or recurrent neoplasm, even in the presence of a mass. The MR imaging findings should be interpreted in conjunction with details of the specific clinical circumstances to prevent misdiagnosis and unnecessary biopsy.

Adolescent↗
PubMed1984

Polymorphous low-grade adenocarcinoma of minor salivary glands. A study of 14 cases of a distinctive neoplasm.

M. D. Anderson Hospital cases diagnosed as adenocarcinoma of minor salivary glands before 1977 were reviewed. Within this heterogeneous group of neoplasms there was identified one clinicopathologic tumor entity, which we have designated "polymorphous low-grade adenocarcinoma." The 14 tumors in that category were characterized by cytologic uniformity and histologic diversity; growth patterns varied (both within and among cases) from solid to tubular to papillary to cribriform (pseudoadenoid cystic) to fascicular, while the cells were always small to medium-sized, regular, and lacking in nuclear atypia. Mitotic figures were infrequent, and tumor necrosis was seen in only one instance (a recurrent neoplasm). Clear cytoplasm, oxyphilic and mucinous metaplasia, and intratubular calcification were sometimes present, and stromal mucinization and hyalinization were common. The tumors were always unencapsulated, and exhibited extension into surrounding tissues including bone. The 14 patients ranged in age from 27 to 76 years (median, 64 years). Eight were male and six were female; eight were white and six were black. The neoplasm was intraoral in all cases, involving the palate in 11, the buccal mucosa in two, and the posterior mandibular area in one. Local recurrence developed in one case, cervical lymph node metastasis in one, and both recurrence and cervical lymph node metastasis in two. The number of successive recurrences ranged up to three, and the interval to recurrence varied up to nine years (the interval to metastasis up to five years). Although radical surgical procedures were necessary for tumor control in some cases, no distant metastases occurred and all patients were clinically tumor-free at latest follow-up.

Adenocarcinoma↗
PubMed2000

Soft tissue aspiration cytopathology.

BACKGROUND: Fine-needle aspiration (FNA) biopsy as a diagnostic modality for the pathologic evaluation of soft tissue neoplasms and non-neoplastic soft tissue mass lesions is uncommon and controversial. This procedure contrasts with more traditional diagnostic methods such as marginal excision, incisional (open) biopsy, or even core biopsy to procure tissue from somatic sites. METHODS: The authors reviewed the results of cytopathologic diagnoses obtained by fine-needle aspiration biopsy over a consecutive 11-month period in patients that presented primarily with a palpable soft tissue mass. A few patients with deep non-palpable soft tissue masses also were evaluated by radiologically guided FNA. Cytopathologic diagnoses were verified by different means including tissue examination either by concurrent cell block or subsequent surgical biopsy, flow cytometry, clinical outcome, or repetition of the FNA procedure. Patients were followed for a minimum of one year to evaluate the mass clinically, to determine whether any further therapy was administered, and to assess disease status. RESULTS: Eighty-two aspirates were performed without complications from 77 patients ranging from 12-88 years of age (mean = 50 yrs.) with men outnumbering women 1.5:1. Soft tissue masses were most common in the extremities (41 cases), followed by the trunk (34 cases), retroperitoneum (5 cases), and head and neck (2 cases). Fine-needle aspirates were diagnosed as malignant in 42 (51%), benign in 32 (39%), nondiagnostic in 6 (7%), and atypical in 2 (2%) cases. Malignant aspirates were comprised of 24 sarcomas (57%), 9 carcinomas (21%), 6 malignant lymphomas (14%), and 3 melanomas (7%). Twenty-two aspirates (52%) had an initial diagnosis of malignancy, whereas 18 (43%) represented metastatic and 2 (5%) recurrent neoplasms. Confirmation of the cytopathologic diagnosis was by concurrent or subsequent tissue examination in 57%, flow cytometry in 5%, clinical outcome in 34%, and repeat aspiration in 4%. One false negative and no false positive diagnoses were issued for a sensitivity and specificity of 100% and 97% respectively in distinguishing benign and malignant lesions by FNA. Of the malignant aspirates, 83% could be subtyped whereas 72% of benign aspirates were correctly subtyped. For primary soft tissue sarcomas, 12 of 19 (63%) were accurately subtyped. In 48% of cases a concurrent cell block was obtained and found diagnostically useful in 54% of them. CONCLUSIONS: Aspiration cytopathology of soft tissue mass lesions using FNA biopsy can be an accurate and minimally invasive method for the initial pathologic diagnosis of primary benign and malignant soft tissue masses, for the pathologic confirmation of metastatic tumors to soft tissue, and for the documentation of locally recurrent soft tissue neoplasms. FNA cytopathology is capable of specifically subtyping a large percentage of primary and metastatic soft tissue tumors if cellular material either in the form of a cell block or flow cytometry is obtained in addition to cell smears.

Adolescent↗
PubMed2004

Karyometry detects subvisual differences in chromatin organisation state between non-recurrent and recurrent papillary urothelial neoplasms of low malignant potential.

AIM: To analyse nuclear chromatin texture in non-recurrent and recurrent papillary urothelial neoplasms of low malignant potential (PUNLMPs). MATERIALS: Ninety three karyometric features were analysed on haematoxylin and eosin stained sections from 20 PUNLMP cases: 10 from patients with a solitary PUNLMP lesion, who were disease free during at least eight years' follow up, and 10 from patients with unifocal PUNLMP, one or more recurrences being seen during follow up. RESULTS: Kruskal-Wallis analysis was used to search for features showing significant differences between recurrent and non-recurrent cases. Significance was better than p<0.005 for more than 20 features. Based on significance, six texture features were selected for discriminant analysis. Stepwise linear discriminant analysis reduced Wilk's lambda to 0.87, indicating a highly significant difference between the two multivariate data sets, but only modest ability to discriminate (70% correct case classification). A box sequential classifier was used based on data derived from discriminant analysis. The classifier took three classification steps and classified 19 of the 20 cases correctly (95% correct case classification). To determine whether significant case grouping could also be obtained based on an objective criterion, the merged data sets of non-recurrent and recurrent cases were submitted to the unsupervised learning algorithm P-index. Two clusters were formed with significant differences. The subsequent application of a Cooley/Lohnes classifier resulted in an overall correct case classification rate of 85%. CONCLUSIONS: Karyometry and multivariate analyses detect subvisual differences in chromatin organisation state between non-recurrent and recurrent PUNLMPs, thus allowing identification of lesions that do or do not recur.

Algorithms↗
PubMed1991

Primary neoplasms of the central nervous system in children.

Modern diagnostic imaging techniques are able to detect primary neoplasms of the central nervous system (CNS) in children safely and accurately but with less specificity as to cell type or degree of malignancy. These neoplasms, often peculiar in cell type and size, mediated by hydrocephalus in their clinical presentation, demand careful and often extensive imaging techniques best to evaluate their geography and character. Added to these basic observations, determination of the neoplasm from surrounding edema, detection of possible spread, and evaluation of residual or recurrent neoplasm are prime responsibilities of the pediatric neuroradiologist toward the child, neurosurgeon, and oncologist.

Angiography↗