[Malignant soft tissue fibrohistiocytoma. Pathological anatomy].
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Diagnosis, Differential↗
Biomedical subjects
G Contesso
Publications and source records attributed to G Contesso.
[Adjuvant immunotherapy with polyadenylic-polyuridylic acid (Poly A.Poly U) in operable cancer of the breast. Recent results of a controlled therapeutic trial].
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Adenocarcinoma↗
[Soft tissue clear cell sarcomas. Reevaluation of clear cell sarcomas of the tendons and the aponeuroses in 14 cases].
A retrospective study is realized including 14 cases of clear cell sarcomas of tendons and aponeuroses, found in the files of Institut Gustave-Roussy (1969-1983). The main microscopic features are emphasized. In comparison with other soft tissue sarcomas, clear cell sarcomas are clinically characterized by a great frequency of local lymph node metastases (4 of 14 cases). The prognosis is usually particularly poor. The exact histogenesis remains obscure, but the results of special stains, support origin from migrated neural crest cells: melanin is visualized in 2 out of 12 tumors in which Fontana-Masson is performed. S 100 protein, a neuroectodermal marker, is positive by immunoperoxidase technique (PAP) in 6 of 10 tested cases. A better diagnostic approach is allowed with the help of ultrastructural study performed in 3 cases. These tumors must be separated from synovialosarcomas. Because the histogenesis is not actually sure, it is preferable to call them "soft tissue clear cell sarcomas".
Adolescent↗
[Primary chemotherapy in soft tissue sarcomas considered inoperable].
Fourteen adult patients with inoperable soft tissue sarcoma (with metastases in 4 cases) received chemotherapy as primary treatment. Nine cases were treated by CYVADIC (cyclophosphamide, vincristin, doxorubicin, DTIC) and five cases by DECAV (DTIC, cyclophosphamide, cis-platinum, doxorubicin, vindesine). An objective response was obtained in 7 cases (1 complete remission and 6 regressions greater than 50%) and stabilization in 4 cases. Seven patients became operable after 2 to 6 courses of chemotherapy and a complete resection could be performed in 6 cases. The duration of the response was 2 to 39 months. Toxicity with both combinations was acceptable. We conclude that chemotherapy can provide initial tumor reduction and permit subsequently less radical surgery.
Adolescent↗
Benign giant-cell tumours of bone with pulmonary metastases and favourable prognosis. Report on two cases and review of the literature.
This paper reports two giant-cell tumours of bone of low-grade malignancy, both complicated by the development of pulmonary metastases in which the histological appearances were identical to those of the primary neoplasm. Ten similar cases in the literature are reviewed.
Adult↗
[Anatomopathology of breast cancer and hormone receptors].
The authors present the results obtained from a series of 511 operable adenocarcinomas (were excluded sarcoma, non infiltrating carcinoma and tumours too small for dosage). Estrogen (ER) and progesterone (PR) receptors were determined on the cytosol with a single saturating-dose method (5nM). The cut-off between positive and negative tumours was 100 fm/g tissue with a border area (100-200 fm/g). Correlation between ER, PR and the followed histological characters were studied: 1) Anatomic size of the tumour: no correlation was found. 2) Histological type: there was a significant correlation (p less than 0.001) between ER, PR and current histological types: among the infiltrating ductal carcinoma, the highly differentiated ones were more often ER+, PR+ (69%) than the atypical one (33%). This correlation remained according to the hormonal status of the patients. The particular types but infiltrating lobular carcinoma were mainly without receptors. 3) Histological grading: there was a significant correlation (p less than 0.001) between this character and the (ER, PR) rate of the tumour: 25% of the tumours of grade III were (ER+, PR+) against 57% of the grade I. As for the histological type, this correlation remained according to the hormonal status of the patients. 4) Stromal reaction: there was a significant correlation between (ER, PR) and inflammatory reaction (p = 0.002) or elastosis (p = 0.002) respectively. Inflammatory reaction was more often reported in tumours without receptors (73% in ER-, PR- tumours against 56% in ER+, PR+ ones). On the opposite, elastosis was correlated with the presence of receptors (52% in ER+, PR+ tumours against 34% in ER-, PR- ones). 5) Lymph-nodes involvement: no correlation was found with hormonal receptors (47% ER+, PR+ in the N- cases against 48% in the N+ cases).
Adenocarcinoma↗
[Malignant lymphomas and other hematosarcomas with initial breast localization. Retrospective study of 20 cases].
A review of 20 cases of malignant lymphomas and other hematopoietic sarcomas initially localized in the mammary gland permitted us to determine some main clinical and morphologic features. Ages range from 14 to 74 years. Clinical features consist of two principal aspects: a radiologically homogeneous, well circumscribed mass or an inflammatory tumor. After staging, one half of the cases remain localized only in the mammary gland (extranodal stage I). Granulocytic sarcoma, monoblastic sarcoma and Hodgkin's disease are very rare. Non Hodgkin's lymphomas are the most frequent. In 40 per cent of the cases, it is a diffuse, large non cleaved cell type, according to the working formulation for clinical usage (centroblastic in the Kiel classification). These are probably B cell derived malignant lymphomas. Eleven per cent of the cases fall into the large cell with multilobated nuclei type according to Pinkus, which probably is a T cell derived malignant lymphoma. Treatment consists of radiotherapy and/or chemotherapy, mastectomy is not advisable. Like any malignant lymphoma localized in other sites, prognosis depends on two main data: clinical stage of the disease and histologic type. Ten patients are in complete remission, the median survival being 3.5 years.
Adolescent↗
[Osteogenic sarcomas of the limbs. Radical treatment of the primary tumor: choosing between irradiation and amputation ].
In osteogenic sarcomas of the extremities, radical therapy of the primary tumor now seems more precisely delineated. In most cases, especially in large tumors with lytic lesions or fractures, and in children. Irradiation is indicated only in small tumors with condensation, and in tumors of the proximal metaphysis of the humerus. Conservative surgical treatment with carcinologically satisfactory resection of involved bone followed by reconstruction, is currently under evaluation. Such treatment is indicated in specific cases: children in the final stage of growth, and small tumors without major involvement of soft tissues that respond to preoperative chemotherapy.
Adolescent↗
[Male breast tumours. Anatomico-clinical study based on 73 cases (author's transl)].
Breast cancer is 100 times less frequent in males than in femalees. In this series the predominant histological form clearly was adenocarcinoma, present in 69 out of 73 patients. The patients' age varied from 7 to 82 years. In 91% of the cases, the malignancy presented as a painless, isolated tumour, often associated with retraction of the nipple. After 5 years 68% of patients operated upon immediately after diagnosis and 35% of those initially treated by radiations were still alive, as were 72% of patients with less than 7 cm tumours and 44.8% of those with larger tumours. It appears that breast cancer in males is less aggressive than is usually believed. Its histological features and its treatment are comparable to those of femal breast cancer.
Adenocarcinoma↗
Computed tomography in the evaluation of 41 cases of Ewing's sarcoma.
Computed tomography (CT) has already proved extremely effective both in cerebral and abdominal pathology. Several recent publications describing first heterogeneous series [1, 2, 7, 11-17], then studies of a single type of lesion [3-6, 8] have illustrated its usefulness in the study of bone lesions. This report deals with 41 cases of Ewing's sarcoma studied by CT at the Institut Gustave Roussy from October 1977 to July 1981, and tries to show both the limitations and indications of this technique for the diagnosis, treatment, and follow-up of Ewing's sarcoma as well as in the diagnosis of any eventual recurrence.
Adolescent↗
Nipple discharge from the breast.
Abnormal nipple discharge is rare, constituting only 3-5% of mammary consultation. In the present paper 267 patients with primary nipple discharge operated on at Institut Gustave-Roussay (IGR) in Villejuif, France, between January 1, 1960 and December, 1974 were evaluated. In all cases, the nipple discharge was symptomatic, spontaneous, and represented the primary reason for the patient's consultation. During the same period 1,145 cases of nipple discharge were treated at IGR. Of the 1,145 cases with symptomatic nipple discharge, 267 patients (23%) required surgical intervention. Among these, fibrocystic disease and duct ectasia were the leading causes of nipple discharge occurring in 42% of surgical specimens. Twenty one per cent of the patients had carcinoma and 35% were found to have intraductal papilloma. The overall incidence of malignancy, however, was 4.8% among the 1,145 women with nipple discharge. On the average, patients with nipple discharge due to malignancy were ten years older than those with benign lesions (Table 2). Approximately 25% of patients with malignant discharge and 5% with benign discharge have associated tumor. Over 60% of the patients with both discharge and a mass had malignancy.
Adolescent↗
[Liposarcoma in adults. Prognostic factors in a series of 84 cases (author's transl)].
A retrospective study of 84 patients with liposarcoma treated at the Gustave Roussy Institute between 1956 and 1978 has elicited a number of factors which influence the prognosis, namely: (1) the site of the initial tumour: patients with liposarcoma of the head, trunk and extremities have a better survival rate than those with retroperitoneal tumours or tumours of the pelvic and pectoral girdles; (2) the histological type: differentiated forms have a brighter prognosis than undifferentiated forms; (3) the size of the tumour: tumours of less than 10 cm in diameter have a more favourable prognosis than larger tumours; and (4) the patient's age, which in fact correlates with the histological type. Local recurrences are common but do not seem to worsen the prognosis. The only curative treatment is surgery, but radiotherapy reduces the risk of local recurrences and chemotherapy may be considered in cases with poor prognosis.
Adult↗
Papillary tumors of large lactiferous ducts.
The breast pathology files at the Institut Gustave-Russy in Villejuif, France, were searched for papillary cystadenomas and papillary carcinomas diagnosed between January 1, 1960, and December 31, 1974. A total of 158 cases were selected for this study; they were subclassified into 74 papillary cystadenomas, 63 papillary carcinomas, and 21 multiple papillomas. Spontaneous nipple discharge was the primary reason for consultation in 88% of solitary cystadenoma patients, 48% of multiple papilloma patients, and 23% of the carcinoma patients. The data support the benign nature of papillary cystadenoma inasmuch as none of the 73 patients treated with local excision developed cancer of the same breast, with only one patient having recurrence of the lesion. In contrast, multiple papilloma was associated with a high recurrence rate and malignant transformation. According to Scarff and Bloom's grading system, papillary carcinoma was found to be of low grade malignancy with a five-year survival rate of over 90%.
Adult↗
Kinetic parameters and the course of the disease in breast cancer.
The correlation between the labeling index (LI) of the primary mammary tumor and the course of the disease after initial treatment was studied prospectively on 128 patients. The surgical specimens of breast tumors were incubated in vitro with tritiated thymidine and autoradiographies were performed. Patients were treated by a simple mastectomy and axillary lymph nodes dissection; patients in whom one or more lymph nodes were found to be involved received postoperative radiotherapy. None of the patients received adjuvant chemotherapy. As the LIs were not known at the time of treatment, their values did not influence the choice of therapy. The follow-up period is greater than six years for all patients. The higher the LI, the shorter were the time intervals from initial treatment to first relapse or from first relapse to death. Moreover, significant correlations were found between the LI and the relapse-free survival and the survival rates. The proportion of relapses was particularly small in the group with the low LI. The shape of the curve suggests that the outcome in this group will be better than that in the group with a high or a median LI. The LI kept its prognostic value after multiple adjustments for other prognostic factors such as the staging, the size of the tumor, the number of metastasis bearing axillary lymph nodes, the presence of an inflammatory reaction, and hormonal status. The LI is significantly correlated with the histologic grading and in particular with its mitotic components. Thus, proliferative activity assessed by LI or the mitotic index appears to provide significant independent prognostic information.
Breast Neoplasms↗
Oestrogen and progesterone cytosolic receptors in clinically inflammatory tumours of the human breast.
Oestrogen (RE) and progesterone (RP) cytosolic receptors have been studied in 59 clinically inflammatory tumours of the human breast. The results were compared to those obtained in a series of 496 operable tumours. A single saturating dose of oestradiol for RE and R 5020 for RP was used and the cut-off between negative and positive tumours was 100 fmol/g tissue. A significant difference was seen (P less than 0.02) between the 2 classes of patients: (RE-, RP-) tumours were commoner among clinically inflammatory tumours (48%) than among operable ones (28%), independently of menopause. Concerning the histological type (based on an assessment of differentiation) and the histological grading (Scarff and Bloom) there was a significant difference (P less than 0.001) between the 2 populations of tumours. No significant difference was found in the distribution of RE and RP among the 3 histological types, whereas a significant correlation existed between histological grading and RE (P less than 0.02). Finally, patients with RE+ clinically inflammatory tumours constitute a lower risk group, especially when they are free of metastases at the time of diagnosis. The presence of RE therefore seems to indicate, as in the operable tumour group, a favourable prognosis.
Breast Neoplasms↗
[Primary mammary cytosteatonecrosis : radiological, clinical, and pathological features in 29 cases (author's transl)].
The authors report 29 cases of primary mammary cytosteatonecrosis. Diagnosis can be difficult when clinical and radiological signs suggest a cancer, and this was the case in about half of these cases. Radiological signs suggest the diagnosis in only 10 p. cent of cases, even though the evocative signs (clear images surrounded by a border of condensation) are usually associated with suspicious shin lesions, and require histological verification. Even though lesions that are limited in extent when examined clinically and radiologically may be a cancer, the inverse position, though very much less frequent, can also apply, and a very suggestive lesion with spicules and skin retraction may be benign. Histological examination before any minor surgery is always essential.
Adolescent↗
[Micro-analysis of hormone receptors in needle biopsies of human mammary lesions and tumors. Determination of estrogen receptors].
Estrogen receptors measurement was assayed in human mammary tumors as well as corresponding fine needle aspiration biopsies (95 cases). Correlations between these two determinations were highly significant just as correlations between aspiration biopsies of the same tumor. Some factors may disturb the quality of aspiration biopsy results particularly: 1) a low number of tumoral cells expressed by the cell density, 2) ratio: sample weight-cytosol volume lower than 1/17 corresponding to a too grent dilution, 3) a sample weight lower than 20 mg.
Biopsy, Needle↗
Adjuvant treatment with polyadenylic-polyuridylic acid (Polya.Polyu) in operable breast cancer.
Adjuvant immunotherapy with polyadenylic-polyuridylic acid (PolyA.PolyU) was tested in a randomised trial on 300 patients with operable breast cancer, all of whom were treated by surgery with or without radiotherapy. They were randomly divided into an experimental group of 155 patients who were treated with 30 mg PolyA.PolyU intravenously per week for 6 weeks and a control group of 145 patients who received normal saline intravenously on the same schedule. The mean follow-up time was more than 50 months in both groups. The overall survival was significantly higher in the treated group (p less than or equal to 0.05), in whom the 5-year "relapse-free" surival was also increased. In node-positive patients, treatment increased the relapse-free survival (p less than or equal to 0.03) and overall survival (p less than or equal to 0.07). No side-effects were noted. Thus, immunotherapy with PolyA.PolyU appears to be a simple, non-toxic, and efficient adjuvant treatment in operable breast cancer.
Breast Neoplasms↗