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Angiosarcoma of gastrointestinal tract is extremely rare. Since 1948, we can find only six reported cases of primary colonic angiosarcoma. The review of the six reported cases and a report on the first colonic angiosarcoma to be seen in an adolescent male are presented. The treatment of the colon angiosarcoma is wide surgical excision. The prognosis is poor. Our case is the second one to be alive, more than 18 months after surgery, with no evidence of recurrent disease.
The DNA ploidy status of 186 fresh primary breast tumors was analyzed in a comparative study of flow cytometric (FCM) and image (IA) analyses. Tumor size, histology and nodal status were also taken into account. The same piece of fresh tissue was used for touch imprints (IA) and for DNA analysis by FCM. Both methods provided concordant DI values in 158 (85%) tumors (r = 0.7490). The tumor grade and lymph node status significantly correlate with ploidy estimated by FCM and IA. We conclude that FCM and IA provide comparable results of DNA content although occasional discrepancies occur. IA seems to be a more sensitive method especially for diploid cases detected by FCM.
Nearly sixty years have passed since Taylor first published the concept of ovarian epithelial semimalignant tumors. After confirmation of this suggestion by FIGO and WHO these tumors became the subject of analyses which helped to separate unfavourable prognostic cases in this group. We would like to present a description of basic and latest papers on borderline ovarian tumors.
BACKGROUND AND OBJECTIVES: Depth of invasion and stage of the disease are established prognostic indicators in cutaneous malignant melanoma. The role of other parameters is still an open problem. METHODS: In 93 consecutive patients with cutaneous malignant melanoma, the level of invasion, tumor thickness, ulceration, vascular invasion, lymphoplasmocytic infiltrates, and mitotic index were evaluated by histology. Expression of Ki-67 and PCNA proliferative antigens together with vimentin, S100, and HMB 45 proteins were assessed by immunohistochemistry. RESULTS AND CONCLUSIONS: Disease-free and overall survival were correlated with tumor stage, tumor thickness, level of invasion, macroscopic pattern, ulceration, vascular invasion, expression of HMB 45, PCNA, and Ki-67/MIB1. Stage, HMB 45, and PCNA were independent prognostic factors for disease-free survival, whereas tumor stage, tumor thickness, and expression of both proliferative antigens influenced overall survival independently. The variables studied demonstrated reciprocal correlation; therefore, analysis of many prognostic parameters in malignant melanoma could be recommended.
BACKGROUND AND OBJECTIVES: Radical surgery is the best mode of treatment of retroperitoneal sarcomas (RS); however, common recurrences are unpredictable. METHODS: For the better understanding of outcomes and possibilities of treatment retrospective analysis of different factors, including DNA content, was performed based on 70 patients. RESULTS: Leiomyosarcoma and liposarcoma were most common histologic types of classified sarcomas. Different kinds of resection were successfully performed in 51 patients (73%) and 35 of their available DNA specimens were analyzed. The actuarial 5- and 10-year survival rates in the resection group were 53% and 40%, respectively, with the median survival of 57 months. Patients with diploid resected tumors had a better 10-year survival rate (58%), than those patients with aneuploid tumors (25%,)--P<0.005. Those patients with low-grade sarcomas had a significantly longer survival than those with high-grade sarcomas (10-year survival rate: 44% compared to 29%). In the univariate analysis, adjuvant therapy, type of histology, type of surgery, location of tumor, and S-phase fraction had no influence on survival. In the multivariate analysis (Cox), only ploidy was an independent prognostic variable. Relative risk of death was over three times higher for aneuploid than for diploid tumors. CONCLUSION: Tumor ploidy should be analyzed in every case of retroperitoneal sarcoma for better assessment of prognosis and possible indication for adjuvant therapy.
In non-Hodgkin's lymphoma (NHL) patients, prognostic significance of S-phase fraction (SPF) is well known, however the significance of DNA ploidy status and antigen expressions is still unclear. The purpose of the present study is to evaluate the prognostic and predictive impact of SPF, immunophenotype and DNA ploidy in prospectively analysed NHL patients. The study was performed on lymph node biopsies of 117 nodal NHL patients. The median follow-up of patients was 25 months (range 1-64 months). All histologically verified lesions were considered according to the Working Formulation and Kiel classification. SPF, immunophenotype and ploidy were determined by flow cytometry. The rate of 2-year overall survival was 56%. SPF and DNA ploidy status were found to be independent prognostic factors in low and high grade lymphomas, respectively. Patients with near-tetraploid lymphomas were characterised by unfavourable clinical outcome, whereas hypertetraploidy was a favourable prognostic indicator. Among B-cell lymphomas CD5 expression seems to be of prognostic significance.
DNA content according to six various ploidy classes was analysed by flow cytometry on fresh tumor tissue in 701 unselected, consecutive breast cancers. Age, menopausal status, tumor size, histology and in particular nodal status were also taken into consideration. Diploid and nondiploid mammary carcinomas differed significantly in values of proliferative indicators. In node positive patients nondiploid tumors were more frequent. In node negative and node positive breast cancer patients tumor grade strongly influenced disease free survival and in the last group hypertriploidy (1.6 < DI < or = 1.8) was also an independent prognostic factor. The combination of tumor grade and hypertriploidy permitted differentiation of three groups of node positive patients, differing in the risk of relapses.
A group of 350 unselected breast cancer patients, treated at the Center of Oncology in Cracow, Poland, between January 1992 and December 1994, was analyzed. The following reciprocally interrelated histologic characteristics were evaluated: 1) histologic tumor type (considered in 3 categories of aggressivity), 2) tumor grade (according to Scarf-Bloom-Richardson), 3) constituent of in-situ carcinoma in invasive cancers and characterization of breast lobuli, 4) tumor growth pattern (microfocal, macrofocal or mixed), 5) invasion of nerves, 6) vascular invasion by cancer cells in tumor surroundings, 7) extensiveness of tumor necrosis, 8) involvement of the breast distant from the tumor mass by cancer cells, 9) status of axillary lymph nodes, 10) invasion of metastatic lymph node surroundings. Metastases in axillary lymph nodes were independently influenced by vascular invasion in tumor surroundings and tumor diameter. The disease-free survival was independently influenced by tumor diameter, necrosis and stage of the disease (pTNM), whereas total survival related to tumor diameter, nodal status, microfocal pattern of tumor growth, vascular invasion and involvement of breast by cancer distant from the tumor mass was independently influenced only by tumor stage (pTNM).
In this study 80 cases of predominantly adult rhabdomyosarcoma are presented as follows: 20 cases of the embryonal type, 32 cases of the alveolar and 8 cases of the pleomorphic type. Additional histologic classification was performed in each type. In myotube stage the histologic picture of fetal muscles cannot be compared to the alveolar type of rhabdomyosarcoma. Desmin and sarcomeric actin are observed in 47.7% of all cases, and myoglobin and myosin in only 23.1%. The reactions were diffuse, disperse, or focal. Electron microscopic study subdivides desmin positive tumors into three groups of differentiation. DNA analysis shows that most desmin positive cells are diploid in comparison to all the tumor cells that are hyperdiploid and tetraploid.
Clinicopathologic parameters of 70 consecutive mesenchymal tumors from 63 patients were evaluated. In all these cases, the DNA content was analyzed by flow cytometry, and the expression of proliferative antigen MIB1 and p53 protein was assessed by immunohistochemistry. Our study verified the prognostic usefulness of proliferative indicators, above all MIB1-index, which strongly correlated with tumor grade and independently influenced overall survival.
Stomach is the most common site of extranodal lymphoma, but lymphoma's biology differs from other types of gastric cancer. From 1982 to 1994, 80 cases of primary gastric lymphoma were treated in Cancer Center in Kraków. In order to assess the best mode of treatment the retrospective analysis of disease related parameters was performed. Sixty four patients were primary treated with surgery, and 11 with radiotherapy. After surgery 21 patients received adjuvant chemo or radiotherapy. Radical resection of tumor was done in 37 cases, in next 25 only palliative surgery was possible. There was 28 cases of lymph node metastases in resected specimens. At 5 years, the overall survival was 64.4% with the median survival of 43 months. Patients primarily treated with surgery had better 5--years survival rates compared with others (72.1% and 36.8%, respectively-p < 0.05). The chance of survival was related with the tumor grading and 5 years survived 86.5% patients with well differentiated lymphomas, and 52.6% patients with nondifferentiated tumors. There was no influence on survivals other variables as duration of symptoms, type of surgery, histological margins or adjuvant therapy. The Cox multivariate analysis showed the grading, type of first treatment and lymph node status as the only three significant factors related to survivals. The relative risk of death for nondifferentiated lymphomas was 7 times higher, than for well differentiated tumors. The primary surgery (even nonradical) of gastric lymphoma is the best mode of treatment and the grading is the most important prognostic factor influencing the survivals.
Expression of the multidrug resistance gene MDR1 is reported to be an important determinant of the response to chemotherapy and survival in some cancers. We compared three methods for determining the intrinsic MDR1 expression in soft tissue sarcomas. We studied MDR1 gene expression in 39 samples from 33 cases of soft tissue sarcomas comprising 11 liposarcomas, nine malignant fibrous histiocytomas, six leiomyosarcomas, four malignant schwannomas, three fibrosarcomas, three synovial sarcomas, and three epithelioid sarcomas, and seven cases of benign soft tissue tumors in adult patients. To detect MDR1 mRNA, reverse transcriptase-polymerase chain reaction (RT-PCR) was performed in all samples. Furthermore, RNA dot-blot analysis with digoxigenin-labeled RNA probe and immunohistochemistry with JSB-1 and C-219 antibodies for P-glycoprotein were employed in 34 and 37 samples in soft tissue sarcomas, respectively. We compared these three detection techniques. Of the 39 specimens, 18 (46%) showed MDR1 PCR products. Liposarcomas (six of 11), malignant fibrous histiocytomas (six of nine), leiomyosarcomas (four of six), fibrosarcomas (two of three) revealed high or intermediate MDR1 expression at high frequency. No MDR1 expression was detectable in malignant schwannomas, synovial sarcomas, or epithelioid sarcomas. Of seven benign soft tissue tumors, one ganglioneuroma and one lipomatosis showed low levels of MDR1 expression. By RNA dot-blot analysis, MDR1 transcripts were detectable in 12 of 34 specimens (35%). Four samples were negative by dot blot despite positivity with RT-PCR. Concordance between MDR1 expression by RNA level with RT-PCR and dot blot and at the protein level with immunohistochemistry using C-219 was found in 16 (47%) of the 34 comparable specimens. Eight samples showed positive immunoreactivity for C-219 despite negative results in RT-PCR and dot-blot analysis. The intrinsic MDR1 expression in soft tissue sarcoma seemed to depend on certain tumor types, such as liposarcoma, malignant fibrous histiocytoma, leiomyosarcoma, and fibrosarcoma. For the evaluation of MDR1 expression, RT-PCR is useful because of its relative simplicity and sensitivity. However, the clinical significance of such low levels of MDR1 expression detected only by RT-PCR must be discussed within systematically treated patient groups.
In the group of forty five primary mammary carcinomas Ki67 reactivity was evaluated with flow cytometry and immunohistochemistry. The expression of proliferative antigen, evaluated with both methods did not correlate with other indicators of proliferative activity. This result is probably associated with the physicochemical properties of breast cancer cells.
Based upon a group of 108 consecutive mammary carcinomas a comparative analysis of morphological parameters, DNA-ploidy and indicators of proliferation activity was made. A correlation between Bloom-Richardson scale, mitotic index, PCNA-labeling index and DNA-index was shown. The ploidy of mammary carcinomas was significantly related to the values of proliferative fraction, as well as to PCNA-labeling index. Among patients with axillary metastases the tumor size and the value of PCNA-labeling index were significantly higher than those in patients with negative lymph nodes.
In the present study the immunophenotyping and the DNA parameters in the group of 38 patients with B-cell non-Hodgkin's lymphoma of low grade malignancy were evaluated in relation to the Kiel Classification. The study was performed with flow cytometry. The evaluation of the FSC/SSC light scatters enables selective immunophenotyping and also corresponds to tumor histology. The lymphoma cells reactivity with selected anti-lymphocyte antibodies depended on their histological type, however no characteristic phenotype, except for lymphocytic lymphoma, for each lymphoma type could be distinguished. Low grade lymphomas were characterized, in general, by low proliferative activity. The differences in percentage of cells in S-phase fraction within selected groups of lymphoma could be a valuable indicator of the clinical outcome.
The immunophenotype and the DNA parameters of 21 high grade B-cell non-Hodgkin's lymphomas considered in terms of the Kiel Classification were studied by flow cytometry. The centroblastic and immunoblastic lymphomas differed in the expression of lymphocyte markers, however no characteristic immunophenotype for each lymphoma type could be distinguished. Assessment of the FSC/SSC dot plots with histology enables to distinguish subpopulations of the lymphoma cells. The immunoblastic and centroblastic lymphomas were characterized by high proliferative activity although no significant differences in S-phase values between both groups could be found.
B-cell non-Hodgkin's lymphomas classified previously according to the Kiel Classification were reclassified according to the Working Formulation. The comparative analysis of flow cytometric data was done for these two classification systems. It was established that flow cytometric data describe defined groups of malignancy more precisely in the Working Formulation, especially in case of the low grade lymphomas.