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PubMedDate not supplied

Diagnostic and clinical outcome of neurogenic tumours in the head and neck area.

A retrospective analysis of diagnostic procedures and clinical outcome of patients with neurogenic tumours of the head and neck region was performed. There were 25 patients - 16 with neurinoma, 5 with neurofibroma and 4 with neurogenic sarcoma - who presented with a mass in the head and neck area. In 13 patients, the neurinoma originated from the facial nerve, 2 of them were located in the middle ear and mastoid and showed facial palsy. Four patients presented with neurofibromatosis type 1. Twenty-three patients were operated on to remove the tumorous masses. Eighteen tumours were assigned intraoperatively to a cranial nerve main trunk, whereas 7 tumours originated from small branches or showed diffuse growth in neurofibromatosis. All benign neurogenic tumours were removed totally without relapse. One of 2 auricular nerve autografts in middle-ear facial nerve neurinoma resulted in a sufficient muscle tonus of the face. Three patients with malignancies died within 12-24 months showing local recurrencies (n = 1) and/or pulmonary metastasis (n = 2). As expected, neurogenic tumours are unusual neoplasms of the head and neck regions. On the other hand, neurogenic malignancies exhibit diagnostic problems as well as uncertain chances for long-term survival. Tumour staging, determined by extension and critical for treatment decisions, is well evaluated by CT scan and MRI. A multimodal therapy regimen with operation and radiation is recommended for neurogenic sarcoma also when developing in neurofibromatosis. However, in main trunk neurinomas, nerve autografting with interposition is the therapy of choice with a good chance of functional recuperation.

Combined Modality Therapy↗
PubMed1982

Computed tomography in the staging of gastrointestinal carcinoma.

In all areas of the gastrointestinal tract studied to date, CT can detect gastrointestinal neoplasia and accurately delineate both the local and distant extent of disease. Computed tomography can stage both primary and recurrent gastrointestinal neoplasms more accurately than any other method short of surgical exploration. In many cases, CT staging of a gastrointestinal neoplasm has lessened the need for exploratory surgery, reduced hospital stay, and permitted appropriate chemotherapy or radiation therapy to be instituted promptly and effectively. As more experience with CT in staging gastrointestinal neoplasms is accumulated, the value of CT will become more widely acknowledged.

Adenocarcinoma↗
PubMed1998

Timing of breast cancer surgery within the menstrual cycle: tumor proliferative activity, receptor status and short-term clinical outcome.

We verified the variations of primary tumour steroid receptor status and proliferative activity at different times and phases (follicular vs luteal) of the menstrual cycle and their relationship with short clinical outcome in a cohort of 248 N- breast cancer patients. Steroid receptor content (ER and PgR) was evaluated by DCC assay and proliferative activity by 3H-Thymidine autoradiographic assay (TLI). Median age was 44 years, 60% of tumors were T1, and cytohistological grade was G1-2 in 54% of cases. At surgery, 57% were in the luteal phase while 43% were in the follicular phase. No significant variations were found in mean TLI or ER and PgR characteristics of the primary tumors surgically treated in different periods of the menstrual cycle; however, the ER level resulted significantly higher in 4th with respect to the 3rd week of menstrual cycle, while PgR level was higher in PgR+ cases treated during the 3rd week. The number of relapses and disease-free survival curves after 36 months median follow-up did not differ significantly for patients treated in different periods of the menstrual cycle (12% and 9% of disease relapses in luteal and follicular phases; p=n.s.). We can conclude, therefore, that TLI, ER and PgR expressions could vary significantly during menstrual cycle only in certain specific tumor subgroups.

Adult↗
PubMed1980

Interstitial radiation therapy for carcinoma of the prostate.

Pelvic lymph node dissection and iodine 125 implantation has been systematically utilized at Memorial Sloan-Kettering Cancer Center (MSKCC) since 1970 as one form of management of selected patients with stage B or stage C prostatic cancer. Experience with the technique is reviewed on the basis of previously published data and on the basis of a five-year follow-up of the first 100 patients. The operative procedure has been generally well tolerated, with a low morbidity, with a mortality rate of 0.67% (2/300), and with minimal adverse effects on urinary, rectal, and sexual functions. Thirty-six percent of the patients had regional lymph node metastasis, and such was associated with a 71% incidence of distant metastasis at five years. However, at five years 14% of patients with positive nodes remain free of evidence of neoplasm, and 38% of patients with negative lymph nodes have evidence of bone metastasis. At five years, 11% of patients have evidence of local recurrence only; 19%, distant metastasis only; and 32%, both local recurrence and distant metastasis. Five-year survival without stratification relative to lymph node involvement is 100% (16/16) for stage B1, 88% (23/26) for stage B2, 66% (6/10) for stage B3, 33% (2/6) for stage C1, 53% (17/32) for stage C2, and 1/1 for stage C3, but endocrine therapy has presumably contributed to such survival in those patients developing intractable local recurrence and/or symptomatic distant metastasis within the five-year follow-up.

Brachytherapy↗
PubMed1986

Methods for detecting locally recurrent and contralateral second primary breast cancer.

The author has studied the roles of thermography, mammography and breast self-examination in detecting recurrent primary cancer or a second primary in the contralateral breast. Of 273 patients whose primary cancer was treated by lumpectomy, recurrence developed in 52 (19%); 51 were detected on clinical examination and 1 by mammography alone. None were detected by thermography alone. Of the 51 patients with a local recurrence detected clinically, 35 had undergone repeat mammography before biopsy. A change suggestive of a malignant condition was noted in only 15 (43%). Thirty-seven had adequately stable postoperative thermograms for review. Only 9 (25%) of these thermograms showed a change in pattern before or at the time the recurrence was detected. Similar results were found in the detection of a secondary primary in the contralateral breast in these patients and also in a further 193 women whose primary cancers were treated by total mastectomy during the same period. Close clinical supervision is the most efficient method of detecting local recurrence and contralateral second primary breast cancer.

Adult↗
PubMed1997

The role of magnetic resonance imaging. When to use it and what to look for.

There are no specific MRI features which are diagnostic in bone and soft tissue sarcomas, but a combination of certain findings allows an accurate diagnosis in some cases including giant cell tumour, chondrosarcoma, liposarcoma, neurofibrosarcoma, aggressive fibromatosis and pigmented villonodular synovitis. MRI is the method of choice for staging bone and soft tissue sarcomas. It is of particular use for identifying satellite nodules and skip lesions within the same bone or anatomical compartment. CT scan is important for screening for pulmonary metastases, and bone scan remains useful for screening for distant skeletal disease. The biopsy should be planned and performed after any MRI examination. MRI is the most sensitive post-therapy evaluation for local recurrence of bone and soft tissue sarcoma.

Bone Neoplasms↗
PubMed1981

Extraosseous osteosarcoma - two cases.

Two patients with extraosseous osteosarcoma of the gluteal region are presented. In one early case liquifaction of the tumour delayed the diagnosis due to confusion with a cold abscess. In the second patient the tumour developed in a region that had been subjected to post-operative radiotherapy for a uterine carcinoma seven years earlier. In both patients the tumour developed rapidly and with a fatal outcome only a few months after apparently satisfactory local excision.

Buttocks↗
PubMed1999

Tumours of the oropharynx and oral cavity: perineural spread and bone invasion.

Clinical examination of the oral cavity and oropharynx provides essential information in the assessment of neoplastic lesions. A precise evaluation of their deep spread along the most common growth pathways can be achieved by imaging, ranging from the basic, but nowadays incomplete, information of conventional X-ray, to the sophisticated details obtained by MR. Three oncological questions must be faced: the three dimensional evaluation of primary tumour spread; the assessment of nodal involvement; the post-treatment survey with the early detection of local recurrences, during the follow up. Either CT or MR accurately assesses the deep extension of neoplasms, nevertheless, the most cost-effective protocol is provided by a combination of CT and ultrasound (staging respectively T and N). MR is the technique of first choice when an infiltration of the base of the tongue or perineural spread is suspected, because of its superior ability to detect muscular invasion and segmental abnormalities of cranial nerves. Bone involvement can be adequately showed by MR not only because focal erosions of the cortical rim are well demonstrated, but also by means of the early demonstration of bone marrow abnormalities. Moreover, MR plays an essential role during the follow up, as it is the only morphological imaging technique permitting to differentiate recurrent tumour and necrosis from scar tissue.

Cicatrix↗
PubMed1983

Carcinoma of the esophagus twelve years after curative resection for carcinoma of the esophagus.

A patient is presented who developed a second squamous cell carcinoma of the esophagus twelve years after a curative esophagogastrectomy for a similar lesion in the proximal stomach. Factors predisposing to local recurrence at an esophageal anastomosis are reviewed. The long disease-free interval in this patient, however, strongly suggests a metachronous primary tumor rather than local recurrence.

Aged↗
PubMed1984

[Principles and results of narrow rectum continence resection in cancer].

The special anatomy of the "Rectum-Grenzlamellen" is the reason for justification to carry out a curative sphincter-preserving resection in carefully selected cases. In a small segment just above the pelvic floor muscles there are not any lymphnodes, when the lateral ligaments are divided and the rectum is thoroughly mobilized from the sacral concavity and stretched. The length of rectum below the tumor measured on fixed pinned-out pathologic specimens was about 2 cm. The local recurrences were 6% of 196 cases. The 5-year survival rate of this low restorative resection at St. Marks Hospital was excellent. These results suggest that a margin about 2 cm below a rectal carcinoma does not affect survival or local recurrence adversely.

Fecal Incontinence↗
PubMed2002

New techniques for imaging colorectal cancer: the use of MRI, PET and radioimmunoscintigraphy for primary staging and follow-up.

Modern imaging techniques such as computed tomography (CT) and ultrasound (US) are in the majority of cases able to detect local and metastatic spread of malignancy. Increasingly, the requirement is for even more accurate pre-operative tumour staging to enable the use of new surgical techniques, neo-adjuvant therapies and, postoperatively, to enable detection of tumour recurrence on follow-up. Recent imaging research has focused on magnetic resonance imaging (MRI) for the detection of local tumour extension particularly for rectal tumours and on positron emission tomography (PET) and radioimmunoscintigraphy (RIS) for the detection of metastatic nodal and soft tissue disease. This article briefly describes these three imaging modalities and their role in primary staging, detection of hepatic metastases and local recurrence.

Colorectal Neoplasms↗
PubMed1983

The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum.

With increasing use of low anterior resection, the length of rectum removed below the tumor is often less than the recommended 2 to 5 cm. It is important to know if this decreases the chance of cure. Between 1963 and 1975, 334 patients survived radical restorative operations for single rectal adenocarcinoma. The length of rectum below the tumor measured on fixed pinned-out pathologic specimens was 2 cm or less in 55 patients (group 1), 2 to 5 cm in 177 (group 2), and 5 cm or more in 102 (group 3). The Dukes' classification, histologic grade, and extent of local spread of the tumors were similar in the three groups. Overall crude 5-year survival rates for groups 1, 2, and 3 were 69.1%, 68.4%, and 69.6%, respectively. Corresponding cancer-specific death rates were 25.5%, 23.2%, and 21.6%. These rates were also similar in matching pathologic subgroups of the three main groups. Of 23 observed or suspected local recurrences, there were four recurrences in group 1 (7.3%), 11 in group 2 (6.2%), and eight in group 3 (7.8%). These results suggest that a margin less than 2 cm below a rectal carcinoma does not affect survival or local recurrence adversely.

Adenocarcinoma↗