Biomedical subjects

C A Moran

Publications and source records attributed to C A Moran.

At least 91 records · Page 5Linked to original sources

PubMed1995

Liposarcoma of the anterior mediastinum and thymus. A clinicopathologic study of 28 cases.

We studied 28 cases of anterior mediastinal liposarcoma occurring in 16 males and 12 females with a mean age of 43 years (range, 14-72). Presenting symptoms included dyspnea (four cases) and chest pain (four cases), although 11 tumors were detected incidentally by routine chest radiography. Seven cases were believed to be located within the thymus. Most (i.e., 25) of the cases were of low grade, with the well-differentiated lipoma-like or sclerosing subtypes constituting 60% and the myxoid subtype constituting 28%; the remaining 12% exhibited mixed features. Three cases were pleomorphic type. Several low-grade tumors exhibited widespread, dense aggregates of mature-appearing lymphocytes and plasma cells, which occasionally obscured the mesenchymal nature of the neoplasm, suggesting instead a lymphoid neoplasm or a reactive fibroinflammatory condition. The three high-grade tumors showed combinations of pleomorphic and round cell patterns, with focal myxoid areas. Of the cases grossly arising within the thymus, only one showed extensive thymic tissue within the lesion ("thymoliposarcoma"); six others exhibited residual thymus peripheral to the tumor. Clinical follow-up in 23 cases revealed recurrence in seven patients (31.8%), with a mean interval to recurrence of 3 years. Eight patients died (mean survival, 2.6 years), one postoperatively and three following a recurrence. Fifteen patients were alive (mean survival, 2 years), four with recurrent tumor. The myxoid tumors had a somewhat more aggressive course than the well-differentiated tumors. Metastases were not observed in any of the patients.

Adolescent↗

PubMed1995

Mucoepidermoid carcinomas of the thymus. A clinicopathologic study of six cases.

Six cases of mucoepidermoid carcinoma of the thymus are presented. The patients were two men and four women aged 17 to 66 years (median age, 34.5). Clinically, three patients had symptoms of chest discomfort and three were asymptomatic. Grossly, the tumors in three patients were described as cystic structures varying in size from 7 to 8 cm in greatest dimension, with focal areas of induration within the walls of the cyst that averaged from 1.5 to 3 cm. The other three cases had grossly and radiographically well-circumscribed, homogeneous tumor masses. Histologically, the lesions showed a spectrum of features that ranged from those of well-differentiated, to moderately well-differentiated, to poorly differentiated mucoepidermoid carcinoma, with sheets and solid islands of squamoid cells admixed with mucin-secreting epithelium lining gland-like spaces. In four cases, the tumor was histologically seen in continuity with the epithelial lining of multilocular cystic structures; the nonneoplastic components of the cysts contained abundant inflammation and showed the features of otherwise conventional acquired multilocular thymic cysts. Clinical follow-up showed that the two patients with intermediate and high-grade tumors died within 2 and 7 months after initial diagnosis. One of these patients showed at autopsy residual tumor limited to the mediastinum, whereas the other patient died with metastases to pericardium and myocardium despite postoperative radiation therapy. Two patients with low-grade tumors were alive and well with no residual disease 2 and 3 years after surgery, and the other two were lost to follow-up. Mucoepidermoid carcinoma of the thymus should be included in the differential diagnosis of cystic neoplasms of the thymus. As with their counterparts at other sites, the biologic behavior of these tumors closely correlates with their degree of differentiation and amount of cytologic atypia.

Adolescent↗

PubMed1995

Mediastinal seminomas with prominent cystic changes. A clinicopathologic study of 10 cases.

We present 10 cases of thymic seminomas associated with prominent cystic changes. All patients were males, aged 16 to 79 years (median, 23.5). Clinically, two patients presented with chest pain/four were asymptomatic and the tumors were discovered on routine chest radiographs; one tumor was discovered incidentally at autopsy; and in three patients no clinical information was obtained. Grossly, the tumors were described as multilocular cystic lesions that ranged in size from 7 to 19 cm in greatest dimension, showing small focal areas of induration within the cyst walls. Histologically, the lesions were characterized by cystic spaces lined by squamous or cuboidal epithelium showing severe chronic inflammatory changes with areas of cholesterol cleft granulomas, lymphoid follicular hyperplasia, and scattered foci of residual thymic parenchyma within the walls of the cysts, resulting in a picture indistinguishable from acquired multilocular thymic cysts. Careful examination, however, revealed microscopic foci composed of a neoplastic proliferation of large polygonal cells with slightly eosinophilic to clear cytoplasm and large nuclei with prominent nucleoli. The atypical cells were admixed with an inflammatory background and were often accompanied by a florid granulomatous reaction. Periodic acid-Schiff histochemical reaction with diastase revealed moderate amounts of glycogen within the cytoplasm of the tumor cells. Immunohistochemical studies in five cases showed positive labeling of the tumor cells with placental alkaline phosphatase. Nine patients were treated by complete surgical excision of the mass, and additional postoperative radiation therapy was given to two patients. Follow-up information available for five patients showed all to be alive and well from 2 to 19 years after diagnosis (mean follow-up, 9 years). Four of the patients were lost to follow-up. The pathogenesis of the cystic process in these cases remained unsettled but may represent a reactive change secondary to epithelial hyperplasia of thymic epithelium. Thymic seminoma should be considered in the differential diagnosis of cystic lesions of the anterior mediastinum; extensive sampling of such lesions is therefore recommended for proper evaluation.

Adolescent↗

PubMed1995

Solitary fibrous tumors of soft tissue. A clinicopathologic and immunohistochemical study of 12 cases.

We describe 12 cases of primary soft tissue neoplasms that showed the histologic and immunohistochemical features of solitary fibrous tumors of serosal surfaces (solitary fibrous mesothelioma, submesothelial fibroma). Nine patients were women and three were men whose ages ranged from 28 to 83 years. Seven lesions were located in the head and neck region, and the remainder were located in the back, buttock, perineum, and groin. The lesions measured from 1 to 6 cm in greatest diameter and presented grossly as well-circumscribed, unencapsulated, soft to rubbery tissue masses. Histologically they were characterized by a proliferation of spindle cells exhibiting a variety of growth patterns, including storiform, herringbone, neural with wavy nuclei, and hemangiopericytic admixed with areas of sclerosis. In two cases the lesions showed areas of increased cellularity with occasionally scattered mitotic figures. Three cases were located adjacent to a major salivary gland; in one, entrapment of normal salivary gland acini and ducts could be observed at the edges of the lesion. Immunohistochemical studies showed positive staining of the spindle cells with CD34 (anti-HPCA-1) and vimentin antibodies and negative staining with keratin, actin, desmin, S-100 protein, collagen type IV, and factor VIII related antigen. Follow-up from 6 months to 12 years has shown no evidence of recurrence or metastasis in any of our patients. Solitary fibrous tumors appear to represent ubiquitous mesenchymal neoplasms that may not be necessarily restricted to serosal surfaces. Identification of these lesions is of importance to avoid misdiagnosis with other more aggressive conditions in soft tissue locations.

Adult↗

PubMed1995

Thymic carcinoid with prominent mucinous stroma. Report of a distinctive morphologic variant of thymic neuroendocrine neoplasm.

Four cases are described of a distinctive morphologic variant of thymic carcinoid that was characterized by abundant stromal mucin admixed with the neuroendocrine elements resulting in a histologic picture reminiscent of metastatic mucin-secreting carcinoma. The patients were three men and a woman, aged 22 to 43 years. The tumors presented with symptoms of chest discomfort, cough, and dyspnea and were described as large anterior mediastinal masses on chest radiographs and computerized scans. Histologically, all cases showed nests and strands of tumor cells embedded in an abundant lightly eosinophilic, mucinous stroma with small cellular clusters as well as scattered single tumor cells seen floating in the mucin. The mucinous matrix was negative for periodic acid Schiff's and mucicarmine stains; alcian blue stains at pH 2.5 showed strong positivity of the mucinous material; this reaction was abolished by treatment with hyaluronidase, indicating the presence of nonepithelial stromal mucosubstances. Immunohistochemical stains showed strong positivity of the tumor cells with CAM 5.2, chromogranin, synaptophysin, and neuron-specific enolase, and negative staining with carcinoembyronic antigen and epithelial membrane antigen. Electron microscopy done in one case showed abundant dense-core cytoplasmic neurosecretory granules; there was no evidence of glandular secretory activity by the tumor cells. The tumors in two patients behaved in a highly aggressive fashion, with invasion of the chest wall, recurrence, and metastases to the lungs, pleura, and axillary, retroperitoneal, and mesenteric lymph nodes. Thymic carcinoid should be considered in the differential diagnosis of mediastinal neoplasms displaying prominent mucinous features. Application of immunostains and electron microscopy will be of value for establishing the correct diagnosis in this setting.

Adult↗

PubMed1995

Smooth muscle tumours presenting as pleural neoplasms.

Five smooth muscle tumours presenting as pleural neoplasma are presented. The patients were three women and two men aged between 21 and 69 years (mean = 45 years). Clinically, one patient presented with chest pain, one with empyema and the other three were asymptomatic. Two of the tumours were located in the left side of the chest cavity and three in the right side. In four cases, the lesions presented as solitary pleural-based masses that varied in size from 10-18 cm in greatest dimension: in two of these cases, involvement of the diaphragm was present in addition to the pleural involvement. In one case, the tumour was seen to totally encase the right lung simulating the growth pattern of malignant mesothelioma. Histologically, three cases displayed an atypical spindle cell proliferation with marked cellular pleomorphism, mitoses and areas of hemorrhage and necrosis. The other two cases were characterized by a bland-appearing smooth muscle proliferation of uncertain malignant potential composed of elongated cells with a moderate amount of eosinophilic cytoplasm and cigar-shaped nuclei, lacking significant nuclear pleomorphism or mitotic activity. Immunohistochemical studies showed strong positivity for alpha-smooth muscle actin in all cases, and for desmin in four of five cases, and a focal positive reaction for keratin in one case. Ultrastructural examination in one of the high-grade tumours showed features of smooth muscle differentiation. Three of the patients were treated by complete surgical excision while, in the other two patients, the lesions were incompletely resected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Thoracic mycoses from endemic fungi: radiologic-pathologic correlation.

The endemic fungi Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides immitis are primary human pathogens whose major portal of entry is the respiratory tract. Their clinical manifestations are categorized as acute, chronic or chronic progressive, or disseminated fungal disease. Most acute pulmonary infections are self-limited, and many are asymptomatic. Chronic, progressive, or disseminated disease is much less common and most often occurs in immunocompromised patients. The radiologic manifestations of these disorders are protean. They include interstitial or air-space opacities, solitary or multiple pulmonary nodules, parenchymal masses, cavities, and hilar or mediastinal adenopathy. The diagnosis of a thoracic mycosis requires familiarity with the epidemiology of the fungus in question, the various modes of clinical presentation, and the full spectrum of radiologic manifestations. Although skin and serologic tests can be useful, definitive diagnosis requires culture of the fungus from infected tissue or demonstration of the organism at microscopic examination.

AIDS-Related Opportunistic Infections↗

PubMed1995

Thoracic mycoses from opportunistic fungi: radiologic-pathologic correlation.

Fungi of the genera Aspergillus, Candida, and Cryptococcus and the class Zygomycetes are the most common causes of thoracic opportunistic mycoses in immunocompromised patients. Candidiasis and zygomycosis usually manifest as severe, often life-threatening, pneumonias. Aspergillus species are commonly implicated as the causative organisms in a broad spectrum of pulmonary disorders, ranging from hypersensitivity lung disease in atopic patients to invasive pneumonia in immunocompromised patients. Cryptococcus neoformans infects both immunologically normal and abnormal patients, with variable clinical and radiologic findings. The diagnosis of an opportunistic mycosis requires familiarity with the epidemiology of the disease, the various modes of clinical presentation, and the full spectrum of radiologic manifestations. Because many of these fungi may normally colonize in the upper respiratory tract, sputum cultures are considered diagnostically unreliable. Instead, definitive diagnosis hinges on either culture of the fungus from infected tissue or demonstration of the organism at microscopic examination.

Adult↗

PubMed1995

Extramedullary hematopoiesis presenting as posterior mediastinal mass: a study of four cases.

We present four cases of extramedullary hematopoiesis occurring in the posterior mediastinum. The patients are two women and two men between the ages of 20 and 87 years. Two patients presented with a history of thalassemia, and one had a history of anemia of undetermined etiology. One patient was asymptomatic, and the posterior mediastinal mass was detected during a routine chest radiographs. Surgical resection of the mass was performed in one patient, whereas a biopsy was performed in the other three. Histologically, all the cases showed the typical features of extramedullary hematopoiesis, namely the presence of numerous lymphocytes admixed with megakaryocytes and red cell precursors. Follow-up information ranging from 2 mo to 3 years showed that all patients are alive and well.

Adult↗

PubMed1995

Extramedullary plasmacytomas presenting as mediastinal masses: clinicopathologic study of two cases preceding the onset of multiple myeloma.

We present two cases of extramedullary plasmacytoma presenting as a mediastinal mass and preceding the onset of full-blown multiple myeloma. The patients are a 62-year-old woman who presented with progressive dyspnea and left-sided chest pain and a 59-year-old asymptomatic man. In both patients, radiographic studies revealed a posterior and anterior mediastinal mass, respectively. Surgical resection of the tumor was performed in the two cases. The tumors were characterized by a well-circumscribed proliferation of plasma cells surrounded by residual lymph nodal tissue. Immunohistochemical studies on paraffin sections demonstrated lambda light chain restriction. Follow-up in our patients revealed that both of them developed multiple myeloma after 6 months and 2 years, respectively. One patient received treatment with melphalan and prednisone and is currently alive and well without evidence of disease, 2 years after diagnosis. The second patient died 4 years after resection of his tumor with evidence of disease in lumbar spine, skull, and lungs. Extramedullary plasmacytoma presenting as a mediastinal mass may precede the onset of full-blown multiple myeloma; therefore, institution of early systemic therapy in these patients may be of value in preventing further progression of the disease.

Chest Pain↗

PubMed1995

Primary salivary gland-type tumors of the lung.

Primary pulmonary neoplasms that bear similar histopathologic features to those seen in salivary glands are rare. Although their presence has been well documented in the literature, it has been primarily in the form of single case reports. Consequently, it has been difficult until recently to determine their prevalence, clinical behavior, treatment, and spectrum of histopathologic features. Moreover, because of the rarity with which these tumors occur, one needs to be familiar with their diverse histopathologic features to comfortably arrive at the correct diagnosis. Because of their close histological similarities to their salivary gland counterparts, careful clinical evaluation is necessary to establish the primary nature of these tumors in the lung and to rule out the possibility of a metastasis. Another feature that may generate difficulties in interpretation is that some of these tumors may share certain histopathologic and some immunohistochemical features with each other. This may pose a serious problem, particularly when dealing with small biopsy samples. Therefore, the use of special studies such as electron microscopy and routine histochemistry may be beneficial and must be used in addition to conventional microscopy and immunohistochemistry to corroborate the diagnosis. In essence, the diagnosis of these tumors requires a combined approach that must include a detailed clinical history, a reasonably sized sample for histopathologic evaluation, histochemical and immunohistochemical studies, and an ultrastructural examination.

Adenoma, Pleomorphic↗

PubMed1995

Malignant mixed epithelial/mesenchymal neoplasms of the lung.

The existence of biphasic neoplasms occurring primarily in the lung is a well-known albeit rare event. The spectrum of malignant tumors displaying a mixed epithelial/mesenchymal growth pattern is rather narrow when these tumors occur primarily in the lung. The two most often encountered neoplasms showing features of epithelial and mesenchymal differentiation are carcinosarcomas and pulmonary blastomas. Tumors with analogous features are of ubiquitous distribution in the human body and have been described in numerous other organs, including the gastrointestinal tract, the genitourinary tract, and the endocrine system. Although the histopathologic features of these tumors may seem simple in most cases, there appear to be numerous pitfalls in their diagnosis; gray areas still remain in the characterization of these tumors, because a certain degree of overlap may be encountered with these two conditions. Such problems are understandable because the incidence of these tumors in the general population is very rare. Therefore, one is expected to find divergent points of view regarding these neoplasms. It is of importance, however, to unify criteria not only for diagnostic purposes, but also to determine the prevalence and behavior of these neoplasms, because such information may provide a rationale for adjustment and improvement in the treatment and diagnosis of these unusual neoplasms. We will review past and current concepts regarding these unusual tumors, as well as their more salient histopathologic features.

Age Distribution↗

PubMed1995

Unusual manifestations of metastatic tumors to the lungs.

Because of the lung's rich capillary bed and central location in the circulatory system, this organ is one of the most frequent recipient sites for metastatic spread of disease. The histopathologic diagnosis in the vast majority of cases is straightforward and usually supported by clinical findings and a prior history of a known primary tumor elsewhere. However, unusual circumstances may arise: a primary tumor may remain occult at the time of pulmonary metastases, the metastasis may develop after a long period of latency, or the histopathologic appearance of the metastasis may assume a form that is uncharacteristic or inconsistent with the suspected primary lesion, which raises the possibility of the emergence of a second primary tumor in the lung. Herein we review a variety of unusual manifestations of metastatic disease to the lungs that may pose difficulties for diagnosis and interpretation. Emphasis is made on the histological differential diagnosis and the clues that may alert the pathologist to recognizing the process as metastatic in origin.

Breast Neoplasms↗

PubMed1995

Outcomes of cochlear implants for New Zealand children and their families.

Six children with multichannel cochlear implants and their families were evaluated by means of multiple measures to determine the impact of the cochlear implant on the child's speech perception, language, communication mode, and behavior and on the parents' stress levels. The children showed quite variable improvements in speech perception with the implant. One child showed marked improvements in language 6 months after implantation. Two of the children had behavior problems preimplantation that showed some improvement after implantation. Parenting stress was very high in some families, but on average, stress was lower and social support networks were more extensive than those previously reported in studies of parents of deaf children in the United States.

Child↗

PubMed1995

Malignant thymic neoplasms that may mimic benign conditions.

The thymus is a complex, highly specialized organ that is derived from the third and fourth pharyngeal pouches and contains elements that originate from all three germinal layers. As such, it shows certain specific and distinctive reaction patterns to injury that are frequently encountered in a variety of reactive and inflammatory conditions. These reaction patterns, however, can also often be associated with neoplastic diseases arising from this organ, and in some instances, their presence may contribute to obscure the malignant nature of the underlying process. We present a review of the main tumor entities that may be mistaken for benign conditions of the thymus, with emphasis on the three major reaction patterns to injury that may be associated with malignant neoplasms of this organ: prominent cystic changes, stromal fibrosis, and reactive and hyperplastic changes of thymic epithelium. Histologic clues helpful for diagnosis and the differential diagnosis of these lesions are discussed.

Diagnosis, Differential↗

PubMed1995

Gastrointestinal stromal tumors with prominent myxoid matrix. Clinicopathologic, immunohistochemical, and ultrastructural study of nine cases of a distinctive morphologic variant of myogenic stromal tumor.

Nine cases are presented of a distinctive morphologic variant of myogenic gastrointestinal stromal tumor characterized by an unusually prominent myxoid stromal background reminiscent of a neural neoplasm but lacking the immunohistochemical or ultrastructural features of peripheral nerve sheath or ganglionic differentiation. The patients included six women and three men aged 42 to 86 years (mean, 70). The lesions occurred in the stomach (seven cases) and small intestine (two cases) and ranged in size from 2.5 to 9.5 cm. They were described grossly as well circumscribed, unencapsulated, with a prominently myxoid and often cystic cut surface. Histologically, the lesions were composed of a proliferation of round, spindle, or stellate cells embedded in an abundant myxoid stroma. Histochemical stains showed strong positive reaction of the myxoid stromal background with alcian blue at pH 2.5; this staining reaction was abolished by treatment with hyaluronidase, indicating an abundance of connective tissue mucosubstances rich in hyaluronic acid. Immunohistochemical stains showed strong positivity of the tumor cells with vimentin antibodies in all cases and focal weak to moderate positive staining with muscle actin (HHF35) in eight cases and with desmin in two. Stains for keratin, S-100; epithelial membrane antigen, and collagen type IV were uniformly negative. Ultrastructural examination carried out in all cases showed features consistent with those previously described for myogenic gastrointestinal stromal tumors, namely, scattered mitochondria and prominent Golgi apparati, strands of rough endoplasmic reticulum, focal accumulation of intracytoplasmic microfilaments with occasional focal condensations, subplasmalemmal attachment plaques and immature cell junctions, focal extracellular basal lamina material, and surface-oriented micropinocytotic activity. The myxoid changes observed in these tumors may represent a secondary, nonspecific reaction pattern of the tumor cells to some noxious stimulus, or they may be a form of degenerative phenomenon such as that commonly observed in smooth-muscle tumors of the uterus and other sites. Myogenic gastrointestinal stromal tumors with prominent myxoid stroma should be distinguished from benign schwannoma of the stomach and gastrointestinal autonomic nerve tumors. Because of the differences in prognosis for these entities, immunohistochemical and ultrastructural examinations are recommended for the evaluation of gastrointestinal stromal neoplasms with prominent myxoid features.

Actins↗

PubMed1995

Primary intrapulmonary thymoma. A clinicopathologic and immunohistochemical study of eight cases.

We describe eight cases of primary intrapulmonary thymoma occurring in seven women and one man between the ages of 25 and 77 years. Clinically, all patients had initial radiographic findings of a parenchymatous intrapulmonary mass without evidence of mediastinal involvement either radiologically or at surgery. The lesions varied from 0.5 to 10 cm in greatest diameter. Five tumors were located close to the hilum, while the other three were discovered deep within the lung and in subpleural locations. In one case, the lesion appeared to arise endobronchially and infiltrate the surrounding parenchyma. In another case, in addition to the main hilar mass, there were two smaller tumor nodules found deep within the same lung. Histologically, the lesions were characterized by the classic biphasic cellular composition of thymomas, i.e., an admixture in varying proportions of epithelial cells and lymphocytes. Four cases were characterized by sheets of lymphocytes admixed with scattered epithelial cells that were separated by fibrous bands into lobules. Three cases were composed predominantly of sheets of epithelial cells admixed with scattered small lymphocytes and containing prominent perivascular spaces. In two of these cases, focal areas of spindling of the cells were noted. One case was composed predominantly of a spindle cell proliferation with perivascular spaces and numerous small lymphocytes. Immunohistochemical stains for keratin and epithelial membrane antigen in six cases highlighted the epithelial cells scattered against the lymphoid cell background. Seven patients were treated by surgery. In one patient the tumor was deemed inoperable at the time of exploration owing to extensive pleural infiltration and was treated by postoperative radiation; the lesion recurred locally in the pleura 8 years later. Clinical follow-up in three patients after surgical incision showed them to ba alive and well without evidence of disease at 10 months, 2 years, and 8 years, respectively. Two of the patients had been followed clinically for 2 and 4 years following discovery of their lung masses on routine chest radiograph before resection of their tumors. Two patients died of unrelated conditions; in one of them, the lesions had been followed clinically for 6 years before surgery; this patient died 6 months later from coronary artery disease, without evidence of recurrence or metastasis. Our findings suggest that intrapulmonary thymomas are slow-growing tumors that may respond well to surgical resection when confined to the lung. As with their mediastinal counterparts, invasive tumors will require additional treatment for the possibility of recurrence of metastasis.

Adult↗

PubMed1995

Primary pulmonary rhabdomyosarcomas: a clinicopathologic and immunohistochemical study of three cases.

Three cases of primary pulmonary rhabdomyosarcoma in adults are presented. The patients were all men between the ages of 57 and 78 yr (mean 67.5). All patients presented with symptoms referable to their tumors, including cough, shortness of breath, pleuritic chest pain, and weight loss. In one patient, a history of tobacco and alcohol abuse was obtained. Anatomically, two tumors were located in the left upper lobe and one in the left lower lobe. Grossly, the tumors ranged in size from 6 to 11.5 cm and were tan-gray, firm masses with areas of necrosis and hemorrhage. Histologically, the tumors were characterized by a spindle cell proliferation admixed with areas showing a pleomorphic cell population with numerous rhabdomyoblasts and areas of hemorrhage and necrosis. Immunohistochemically, all three tumors showed strong positivity with desmin and myoglobin antibodies and negative staining with antibodies against keratin, epithelial membrane antigen, and S-100 protein. All patients had a fatal outcome. Two patients died a few days after admission with respiratory distress; the third one died 2 years after diagnosis with widely metastatic disease. Autopsy findings in all cases disclosed disseminated metastases to multiple abdominal and thoracic organs. Primary pulmonary rhabdomyosarcoma should be considered in the differential diagnosis of poorly differentiated pulmonary neoplasms in adults and should be distinguished from other primary and metastatic sarcomas.

Aged↗