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Postirradiation laryngeal osteosarcoma: case report and literature review.

BACKGROUND: Laryngeal sarcoma is a rare disease entity. In review of the literature, chondrosarcoma is the most common sarcoma, followed by fibrosarcoma. Osteosarcoma is very rare; there are only seven cases reported in the literature. Postirradiation sarcoma is a late complication of radiotherapy. Osteosarcoma is the most common type in this group. The larynx is often involved in the radiation field of treatment for head and neck malignancies. However, postirradiation laryngeal osteosarcoma has not yet been reported. METHODS: We present a 56-year-old man who under went radiotherapy for nasopharyngeal carcinoma 32 years ago and later developed a laryngeal osteosarcoma. RESULTS: The patient underwent total laryngectomy but died 1 year and 9 months later with locally extensive disease. CONCLUSIONS: We report the first case of postirradiation laryngeal osteosarcoma. In addition to surgical treatment, adjunctive therapies should be considered for this group of patients.

Fatal Outcome↗

Second primary tumors in patients with retinoblastoma. A review of the literature.

PURPOSE: The aim of this survey was to review the different studies regarding the occurrence of second primary tumours (SPT) among survivors of retinoblastoma. METHODS: Ovid (Medline, Current contents life, Psychlit, Embase) was searched for the years 1966-1995 using the mesh headings: 'retinoblastoma', 'second primary neoplasms', and 'multiple primary neoplasms'. The inclusion criteria were: the study should involve 50 patients or more and should not be limited to one specific SPT. A checklist with criteria regarding the study design and the results was applied to each study. RESULTS: Eleven studies were identified which met the inclusion criteria. Thirty-five different types of SPT (Ntotal = 243) were reported. Most of them were osteosarcomas (37.0%), followed by melanomas (7.4%), soft-tissue sarcomas (6.9%), brain tumors (4.5%), fibrosarcomas (3.3%), chondrosarcomas (3.3%), and sarcomas (3.3%). Less frequently reported were leukemias (2:4%), sebaceous cell carcinomas (1.6%), and non-Hodgkin lymphomas (1.6%). Pineoblastoma, which in fact is a trilateral retinoblastoma and not an SPT, was found in 2.4%. Despite the differences, all 11 studies showed a higher incidence of SPT compared to the general population. Only 4 studies were judged to be free from selection bias, reporting a cumulative incidence of SPT of 8.4% 18 years after diagnosis, 15.7% at the age of 20 years, 19% at the age of 35 years, and a relative risk of 15.4 for SPT, respectively. CONCLUSION: SPT is a serious problem for the survivors of hereditary retinoblastoma and its importance should be recognized in (genetic) counseling of patients.

Adolescent↗

[Clinical patterns of soft-tissue sarcoma in children].

INTRODUCTION AND OBJECTIVES: Soft tissue sarcomas are rare mesenchymal neoplasms that constitute less than 10% of all pediatric malignancies. Half of these are rhabdomyosarcomas, the remaining 50% have a varied and heterogenous histologic and clinical patterns (fibrosarcoma, synovial cell sarcoma, extraskeletal Ewing's sarcoma, angiosarcoma, liposarcoma, leiomyosarcoma, ...). The purpose of this work is to evaluate our clinical experience with soft tissue sarcomas in uncommon sites over the past 10 years in order to delimitate the prognostic factors in survival and modalities of treatment. MATERIAL AND METHODS: Between 1989 and 1998, 10 patients were diagnosed with soft tissue sarcomas in uncommon sites and treated by us over a total number of 139 pediatric neoplasms (7.19%). Data on these patients were obtained from careful review of medical records. Variables investigated included histologic findings, tumor size, age at presentation, primary site, clinical group, radiologic test performed, surgical treatment, radiotherapy and adjuvant chemotherapy, complications and survival rates. Charts were registered in database Access. Statistical analysis was performed by the SPSS 8.0 statistical program. RESULTS: The following histologic types of these 10 tumors were identified: 1 hemangiopericytoma in oral cavity, 2 extraosseous Ewing's sarcoma, 1 botryoid rhabdomyosarcoma of the bladder, 1 mediastinal fibrosarcoma, 1 retroperitoneal rhabdomyosarcoma, 1 paratesticular rhabdomyosarcoma, 1 cervical condrosarcoma, 1 alveolar rhabdomyosarcoma and 1 deltoid rhabdomyosarcoma. 50% were rhabdomyosarcomas and the remaining 50% have a variated sarcomatous histologic pattern with a difficult classification. The mean age at diagnosis was 7 years (4.6 years accounted for rhabdomyosarcoma alone). Surgery with complete excision were performed only in six cases. Adjuvant chemotherapy with IVA was followed by radiotherapy only in four patients. All the children classified in clinical groups II, III or IV needed 2nd. line regimens of chemotherapy. Three patients died in the follow-up instead of the multimodal treatment. Survival ranged from 6 months to 9 years (mean 4 years). CONCLUSIONS: The impact of surgical resectability on outcome in these tumors has been clearly demonstrated over other factors like histologic appearance. Distant metastasis are infrequent but local recurrence are a constant in all cases with incomplete surgical resection. Based on those facts we could advanced an adequate approach to this kind of neoplasms: 1) wide complete surgical resection is mandatory; 2) radiotherapy will only be necessary if margins of resection cannot control the local disease, and 3) chemotherapy have not clearly demonstrated his benefits as adjuvant therapy in clinical group I lesions but his employ is recommended in all cases because of the poor prognosis due to local recurrence.

Adolescent↗

Mutation analysis of p53 gene in childhood malignant solid tumors.

Alterations of the p53 gene have been extensively investigated in a wide variety of human malignancies. However, data on childhood malignant solid tumors are still limited. Mutations of the p53 gene on exons 5 through 8 were examined in 82 childhood malignant solid tumors by the polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) method, and the nature of these mutations was confirmed by direct sequencing. The 82 tumors examined included neuroblastomas (n = 44), Wilms' tumors in = 13), hepatoblastomas (n = 11), rhabdomyosarcomas (n = 10), extraosseus Ewing sarcomas (n = 2), undifferentiated sarcoma of the liver (n = 1), and fibrosarcoma (n = 1). Two sarcoma samples were identified as having point mutations. One was a rhabdomyosarcoma with a missense mutation at codon 273, substituting histidine (His) for arginine (Arg). Another was an undifferentiated sarcoma of the liver with a missense mutation at codon 245, substituting serine (Ser) for glycine (Gly). No mutations were detected among neuroblastomas, Wilms' tumors, or hepatoblastomas. The two sarcomas with mutations were localized tumors. Both patients who had these tumors are disease free for 8 and 5 years after treatment, respectively. The overall incidence of p53 mutations was low (2.4%, 2 of 82). However, the incidence, when calculated for sarcomas, was higher at 14.3% (2 of 14). These data indicate that p53 mutations are generally uncommon in childhood malignant solid tumors examined. However, in some childhood sarcomas, p53 mutations appear to have a causative role in the development of these tumors.

Child↗

Sarcoma in lupo.

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Fibrosarcoma↗

[Antitumor activity of new derivatives of camptothecin].

With the purpose of obtaining more potent and less toxic camptothecin (CPT) analogs, we prepared many derivatives of CPT. Among them, 7-ethyl-CPT (SN 22) and 7-ethyl-10-hydroxy-CPT (SN 38) showed strong antitumor activity with less toxicity. They were, however, insoluble and when they were made soluble, their activity was markedly diminished, as a result of cleavage of the delta-lactone ring. We therefore attempted to make soluble derivatives without breaking the delta-lactone ring and obtained 7-ethyl-10-[4-(1-piperidino)-1-piperidino]-carbonyloxy-CPT (CPT-11), which showed very strong antitumor activity by i.p., i.v. or p.o. administration against the ascites type of L1210 leukemia, P388 leukemia, sarcoma 180, Meth A fibrosarcoma, B16 melanoma, Ehrlich carcinoma and MH134 hepatoma and the solid type of sarcoma 180, Meth A fibrosarcoma, Lewis lung carcinoma, C3H/HeN mammary carcinoma, Ehrlich carcinoma and MH134 hepatoma. The antileukemic activity of CPT-11 against L1210 was much higher than that of adriamycin. The acute toxicity of CPT-11 was extremely low, particularly in the case of oral administration, the LD50 being 765.3 mg/kg, 22 times greater than that of CPT-Na.

Animals↗

Chromosomal translocation t(X;18) in human synovial sarcomas analyzed by fluorescence in situ hybridization using paraffin-embedded tissue.

Synovial sarcoma is characterized cytogenetically by translocation t(X;18)(p11.2;q11.2). In this study, 28 cases that had been diagnosed initially as synovial sarcoma, including 2 fibrosarcomas, and 1 leiomyosarcoma were collected and examined for translocation t(X;18) on paraffin-embedded tissues by fluorescence in situ hybridization (FISH). Of the synovial sarcomas, 25 showed findings consistent with translocation t(X;18) with an additional copy signal for the total probe of X and 18 chromosomes. The other three cases, as well as the two fibrosarcomas and the leiomyosarcoma, did not show this translocation. One (case 26) of three negative cases was diagnosed finally as leiomyosarcoma and another (case 27) as malignant peripheral nerve sheath tumor from histological and immunohistochemical analysis. Thus, in all, 25 (96%) of 26 synovial sarcomas showed findings consistent with translocation t(X;18). In summary, translocation t(X;18) is a chromosomal aberration specific for synovial sarcoma. The fluorescence in situ hybridization technique can be used even on cells from paraffin-embedded tissues, and is a useful diagnostic aid for synovial sarcoma.

Adolescent↗

Antigenic differences among osteogenic sarcoma tumor cells taken from different locations in human tumors.

Sections were taken from the center, midzone, and margin of four human osteogenic sarcomas and one fibrosarcoma. Single-cell suspensions of tumors were examined in an indirect immunofluorescence assay with autologous or homologous anti-osteogenic sarcoma antisera as the intermediate reactant and fluorescein-labeled anti-human IgG as the final reactant. Cells were stained under conditions in which the fluorescence intensity was directly proportional to the density of the tumor-associated antigen on these cells. The density of tumor-associated antigen on cells from the center of the five tumor masses was low; cells from the midzone had intermediate levels of tumor antigen density, and cells at the margin had the highest levels. Similar preparations stained with polyspecific anti-HLA antisera did not demonstrate such a gradient. Since osteogenic sarcomas grow outward from the center, with the outer margin populated by the youngest cells, these results suggest that the oldest cells in the tumor bear the least tumor antigen, and the youngest tumor cells have the most. This is not compatible with theories which postulate that the immune system modulates the growth of a tumor so that only the least antigenic cells are allowed to grow. Alternative mechanisms are discussed.

Antibodies, Anti-Idiotypic↗

[Occurrence of viral particles of avian sarcoma viruses in sarcoma tissue].

An electron-microscopic examination was performed of chicken fibrosarcoma caused by avian sarcoma virus (ASV), strain B 77, to investigate virus budding and release through the cytoplasmic membrane. The virus particles of type C- were 90-100 nm in size, the electron-optically denser nucleoids being clearly differentiated from the outer membrane.

Animals↗

Malignant fibrous histiocytoma and pleomorphic sarcoma in association with medullary bone infarcts.

A malignant fibrous histiocytoma arose in the proimal tibia of a 40-year-old man who had multiple, symmetrically distributed, medullary bone infarcts of unknown etiology, involving the distal femora and the tibiae. Despite amputation and chemotherapy, widespread metastases developed and death occurred 19 months after surgery. A polemorphic sarcoma, probably representing an anaplastic malignant fibrous histiocytoma, arose in association with a single medullary infarct in the proximal humerus of a 33-year-old woman. She remains well without evidence of disease five years after treatment by radical radiotherapy followed by shoulder disarticulation. Sarcoma arising in association with bone infarction is a rare entity. Sixteen cases reported in the medical literature, including our own, are reviewed. The sarcomas arose in the tibia in nine cases, the femur in six cases and the humerus in one case. The patients were usually older individuals and 13 of the 16 were male. All but two had multiple bone infarctions. Four of the patients had caisson disease, three had what is probably an hereditary bone dysplasia, one had sickle cell disease and eight had infarcts of unknown etiology. Most patients have had a rapidly fatal outcome. Thirteen of the sarcomas have been fibrosarcomas or malignant fibrous histiocytomas, both of which are rare primary bone tumors. Analysis of the published cases of bone infarction-related sarcomas suggests that the risk of developing a sarcoma is greatest in infarcts with large medullary components.

Adult↗

Methods for the differentiation of giant cells in canine and feline neoplasias in paraffin sections.

In the following study cells with at least two cell nuclei are addressed as giant cells. In 47 biopsies of feline neoplasias (fibrosarcoma, haemangioendothelsarcoma, mammary adenocarcinoma, osteoidsarcoma, complex sarcoma), and 25 biopsies of canine neoplasias (malignant seminoma, mammary adenocarcinoma, haemangioendothelsarcoma, fibrosarcoma, osteoblastic sarcoma, complex sarcoma) giant cells are distinguished either as neoplastic giant cells or as reactive (non-neoplastic) giant cells. Cell nuclei of neoplastic giant cells which are labelled with the monoclonal antibody MIB 1 are mitotic active; cell nuclei are polymorph and can show atypical mitosis; the cytoplasmic reaction with tartrate resistant acid phosphatase (TRAP) is negative. Negative reactions with MIB 1, positive TRAP staining and homogeneous cell nuclei are distinctive for osteoclast-like glant cells. Other non-neoplastic giant cells (e.g. foreign body cells, Langhans-giant cells) are negative with both MIB 1 and TRAP. Double staining of paraffin sections is possible. Routine formalin-fixation, embedding in paraffin and decalcifying tissue samples do not interfere with MIB 1 immunoreactions or TRAP reactions. Methodological modifications that were necessary for the preparation of paraffin sections from canine and feline tissue samples are discussed. As the presence of neoplastic giant tumour cells is an index for a poor prognosis in human medicine, not only the entity of the tumour must be named, but also the exact significance of the giant cell type:, e.g. fibrosarcoma with osteoclast-like giant cells, hepatic carcinoma with reactive giant cells, malignant seminoma with neoplastic giant cells, angiosarcoma with both neoplastic giant cells and osteoclast-like giant cells. This would enable the classification of further neoplasias dealing with clinical courses of the diseases. Over the past years our stains have remained stable. It is possible to carry out retrospective investigations with archived tissue samples and make permanent preparations. A reclassification and a refined form of diagnosis (tumour and giant cell type) would be recommended.

Animals↗

Metastasizing fibrosarcomas in hamsters (BMH) after injection of B77 sarcoma virus transformed mouse cells.

Injection of virogenic mouse cells B77-1026 into newborn Syrian hamsters resulted in arising of progressively growing autochthonous fibrosarcomas. From hamster tumors five stable tumor cell lines (BMH/1--BMH/5) were established in vitro. All cells of the newly established tumor cell lines had hamster karyotype, they were able to grow in soft agar and did not contain rescuable B77 viral genome. BMH tumor cells injected into syngeneic newborn as well as young adult hamsters produced tumors at the site of application and metastasized frequently into viscera. From metastases in different organs further tumor cell lines and single cell clones were established in vitro. All these tumor cell lines and clones exhibited higher metastatic capacity than the parent cell lines.

Animals↗

[Recent entities in soft tissue tumor pathology. Part 2].

The second part of this review on the pathology of soft tissue tumors focuses on malignant entities of recent description, including the following: soft tissue giant cell tumor, inflammatory myxohyaline tumor, inflammatory fibroblastic sarcoma, low grade fibromyxoid Evans sarcoma and its variant, the hyalinizing spindle cell tumor with giant rosettes, spindle cell liposarcoma, proximal type epithelioid sarcoma, sclerosing epithelioid fibrosarcoma. For each entity, the diagnostic criteria, the clinical presentation and the differential diagnosis are described. The role of immunohistochemistry and molecular pathology in the identification and delineation of these new entities is emphasized.

Diagnosis, Differential↗