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PubMed1999

Brain metastasis of Merkel cell carcinoma. Case report and review of the literature.

Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine tumor that is locally aggressive and has potential for metastatic spread. However, brain metastases are rare, and therapy for such tumors has never reported. The authors present a 48-year-old woman with MCC of the left elbow and a right cerebellar metastasis. After the right cerebellar mass was totally resected, radiation treatment and chemotherapy were performed. Eight cases of brain metastasis have been reported in the literature, but only 5 have been presented in sufficient detail for analysis. Therapy for brain metastases has always been palliative whole-brain irradiation and chemotherapy except for our patient, who underwent total removal of the tumor and survived for 11 months without neurological deficit. Except in the case of 1 with a particularly radiosensitive MCC, the patients with brain metastases died within 9 months after detection of the brain lesions. If possible, aggressive excision of brain metastases as well as of the primary lesion should be done.

Carcinoma, Merkel Cell↗
PubMed1979

The role of gallium-67 scanning in the clinical staging and preoperative evaluation of patients with carcinoma of the lung.

Gallium-67 scanning was evaluated in 100 patients with proved carcinoma of the lung. It was valuable in separating primary from secondary lung tumors, determining the extent of contralateral hilar or mediastinal lymph node involvement, and detecting distant organ metastases. In addition to multiplane whole-body Ga-67 tomographic scanning, colloid liver scans, bone scans, and computerized axial tomography scans of the brain were obtained to determine the presence of distant metastasis. The gallium scan detected 11 of 12 occult metastases and identified 7 of 7 liver, 9 of 14 brain, 4 of 4 soft tissues, 1 of 4 contralateral lung, and 9 of 11 bone metastases. The whole-body gallium scan accurately detected or excluded extrathoracic metastatic disease in 11 of 12 patients examined postmortem within three months of a gallium scan. An approach is recommended using gallium scanning along with chest roentgenograms for clinical staging and preoperative evaluation of patients with carcinoma of the lung. Specific organ scans should be reserved for the occasional symptomatic patient with a negative gallium scan or for clarification of an indeterminate gallium scan.

Bone Neoplasms↗
PubMed1994

Chondrosarcoma of the radius with distant metastasis in a dog.

A 9-year-old castrated male Doberman Pinscher was admitted for evaluation of lameness of the left forelimb. Radiography and examination of biopsy specimens revealed a moderately differentiated chondrosarcoma of the proximal portion of the radius. The dog was treated by local excision of the neoplasm, which involved resection of the radial head and proximal portion of the radius. Despite the large size of the dog and the weight-bearing forces exerted on the cubital joint, major problems with ambulation did not develop after surgery. Functional use of the limb returned slowly; however, substantial limb use was observed despite the development of mild degenerative changes of the joint and migration of the humeroulnar articulation. Six months after surgery, metastasis of a widely disseminated, poorly differentiated chondrosarcoma to the subcutaneous tissues and thoracic and abdominal cavities was diagnosed. Local redevelopment of the chondrosarcoma in the area of the cubital joint was not detected. Resection of the radial head and proximal portion of the radius may be considered a viable, alternative, limb-sparing technique. The biologically aggressive nature of this chondrosarcoma of the appendicular skeleton indicated that additional information was needed before a reliable prognosis could be established for this dog with this tumor type. Reports of low rates of metastasis have been based on insufficient numbers of dogs to adequately or accurately determine the long-term prognosis of dogs with chondrosarcoma of the appendicular skeleton.

Adrenal Gland Neoplasms↗
PubMed1990

[Malignant skin and soft tissue tumors--function preserving surgery--pathomorphologic aspects].

Special aspects of the localization and spontaneous regression of primaries of malignant melanoma, further more aspects of the pTNM-system as well as problems concerning perfusion therapy are pointed out and discussed. In the following the different biology of squamous cell and basal cell cancer dependent also on the localization of the primaries is described and discussed. Concerning the soft tissue tumor part immunohistochemical methods for the management of differential diagnosis are demonstrated and evaluated. These methods can be used for the delineation of extranodal Hodgkin and non-Hodgkin lymphoma infiltration from soft tissue tumors and in the differential diagnosis of polymorphous, spindle cell and epitheloid differentiated soft tissue tumors. Finally the problem of tumor grading and new grading systems (score) according to Coindre et al. are demonstrated and discussed.

Biomarkers, Tumor↗
PubMed1989

Levels of tissue polypeptide antigen in serum and the progression of gastric cancer.

Correlations between levels of tissue polypeptide antigen (TPA) in serum and histologic stage or progression of cancer were studied in 94 patients with gastric cancer. Levels of TPA in serum from patients with cancerous invasion into the vein of the stomach wall (v-invasion) were elevated in parallel to the progression of cancer by stage, and were significantly higher in each positive case than in each negative case of lymph node metastasis or of cancerous invasion into lymph vessels of the stomach wall (P less than 0.05 and P less than 0.01, respectively). There were no differences in levels of TPA in serum from patients without v-invasion when these cancers were classified by stage, progression, or histologic type. It appears that elevation of levels of TPA in serum is associated with v-invasion, and that a determination of the level of TPA in serum is useful for the prediction of hematogenic metastasis in cases of gastric cancer.

Antigens, Neoplasm↗
PubMed1984

[An autopsy case of extramedullary plasmacytoma with systemic dissemination 2 years after the onset of a localized tumor in the nasal cavity].

A 73-year-old male was admitted because of a localized tumor in the nasal cavity, which was suspected to be malignant lymphoma by biopsy specimens. Laboratory findings were within normal limits except for small amounts of M protein (IgG-lambda) in the serum. The patient was successfully treated by radiotherapy, with the disappearance of both the tumor and M protein. Two years after the onset, however, a solid tumor was observed in the soft tissue, followed by rapid systemic dissemination. An increase in M protein was obvious, and the biopsy specimens disclosed plasmacytoma. The patient died three months after admission, and post-mortem examinations revealed a diffuse infiltration of plasmacytes predominantly in the soft tissues.

Aged↗
PubMed1999

[Intrascrotal nontesticular tumors].

This is a review of literature data on rarely met with intrascrotal non-testicular tumors still not well enough clarified in clinical practice. Histologically these tumors derive from: 1. Epididymis. 2. Funiculus spermaticus and/or tunica vaginalis. 3. Tissues within the scrotum (fatty, fibrous, muscular, lymphatic, nervous). 4. Metastases. The individual types of neoplasms, some of them representing casuistic rarity, so far described as sporadic observations in the pertinent literature, are discussed. Adenomatoid tumor of epididymis and rhabdomyosarcoma are the most frequently encountered. Clinically paratesticular tumors do not lend themselves to differentiation from the ones involving the testis regardless of the fact that for some of them data on specific laboratory and serum or tissue tumor markers have been duely reported. Diagnosis is made histologically following operative management--orchiepididymectomy. According to histological pattern, if necessary the treatment proceeds with radio- or chemotherapy. Finally, two personal observations are described.

Adolescent↗
PubMed1986

Gene products of the HLA-D region in normal and malignant tissues of nonlymphoid origin.

Indirect immunofluorescence staining with monoclonal antibodies has shown a differential distribution of HLA-DR, DQ, and DP antigens in normal tissues of nonlymphoid origin. The distribution of HLA-DP antigens is similar to that of HLA-DR antigens, while that of HLA-DQ antigens is more restricted. Malignant transformation of cells of nonlymphoid origin may be associated with the appearance of the gene products of the HLA-D region. HLA-DR antigens appear more frequently than the other two types of HLA class II antigens and HLA-DP antigens more frequently than HLA-DQ antigens. Differential expression of the gene products of the HLA-D region was also found in autologous metastases removed from different anatomic sites from patients with melanoma. The HLA class II phenotype of surgically removed malignant lesions did not correlate with the degree of differentiation of tumor cells and/or with the expression and/or cellular distribution of HLA class I antigens. Furthermore, in melanoma lesions, no relationship was found between the HLA class II phenotype and the expression of 3 membrane bound and 1 cytoplasmic melanoma associated antigen recognized by monoclonal antibodies. The functional significance and the practical implications of the differential expression of the gene products of the HLA-D region by tumor cells are discussed.

Antibodies, Monoclonal↗
PubMed2006

Epithelioid sarcoma in children and adolescents: a report from the Italian Soft Tissue Sarcoma Committee.

BACKGROUND: Epithelioid sarcoma (ES) is an uncommon malignant soft tissue tumor. To the authors' knowledge, little information is available to date concerning its clinical features and management in children and adolescents, particularly with regard to the recently described proximal-type variant. The current study concerns 30 patients age<18 years who were enrolled in the Italian Soft Tissue Sarcoma Committee protocols. METHODS: Histopathologic specimens, clinical data, and treatment modalities were reviewed for the current analysis. Nineteen patients had classic ES and 11 had proximal-type ES. Surgery was the mainstay of treatment; radiotherapy was given to six patients considered to be at risk of local disease recurrence due to incomplete resection, and chemotherapy was administered to eight patients. RESULTS: With a median follow-up of 66 months, the 5-year event-free survival (EFS) and overall survival (OS) rates were 61.7% and 92.4%, respectively, but the OS rate dropped to 86.9% and 72.4%, respectively, at 10 years and 15 years. Local disease recurrence was the major cause of treatment failure. The most significant finding influencing both EFS and OS was tumor site, with a tumor location in the extremities predicting a favorable outcome. Initially unfavorable clinical findings and a worse outcome were associated with the proximal-type variant of ES. A response to chemotherapy was noted in three of the seven patients with measurable disease. CONCLUSIONS: The current study confirms some typical features of ES (i.e., the peculiar superficial distal location [i.e., the hand, fingers], indolent growth, and a tendency to recur locally). The current study data do not clearly confirm the strong tendency for the lymph node involvement described in adult ES patients. Further studies are needed to better define the clinical behavior and biology of the proximal-type variant of ES.

Adolescent↗
PubMedDate not supplied

Effective follow-up strategies in soft tissue sarcoma.

The value of surveillance for detection of recurrences in patients with soft tissue sarcoma (STS) after definitive surgical resection of the primary tumor is based on the premise that early recognition and treatment of local or distant recurrence can prolong survival. Surveillance strategies should meet the criteria of easy implementation, accuracy, and cost-effectiveness. Although guidelines have been proposed for follow-up of patients with STS, there are few data in the medical literature on the effectiveness of these recommendations. We reviewed the effectiveness of a surveillance program for primary extremity STS in an effort to provide an evidence-based rationale for follow-up of STS. We concluded that clinical assessment of patient symptoms, chest X-ray imaging, and physical examination are effective strategies for follow-up of extremity STS. Chest X-ray imaging also appears to be cost-effective, at least for high-grade extremity STS. Imaging of the primary extremity site by computed tomography (CT) scan or magnetic resonance imaging (MRI) on an annual basis and routine laboratory blood tests were ineffective strategies for recurrence detection. However, certain patient characteristics such as body habitus, previous radiation therapy, and location of the primary tumor site may require the use of CT scans and MRI for adequate clinical assessment. The role of specific surveillance strategies for recurrence detection for sarcomas of the trunk, head and neck, retroperitoneum, and viscera has yet to be defined.

Continuity of Patient Care↗
PubMed1984

[A case of carcinoma originating from accessory breast tissue of the axilla].

We report a case of carcinoma originating from accessory breast tissue of axilla and review 33 reported cases of carcinoma in heterotopic breast tissue. Although the incidence of accessory breast cancer is not high, early diagnosis and treatment are necessary, keeping in mind the possibility of this carcinoma when subcutaneous nodules of uncertain origin are found around the breast. Surgical treatment which must at least include wide local extirpation including the surrounding tissues and dissection of the axillary lymph nodes is necessary and adjunctive chemotherapy and irradiation appear to be useful.

Adenocarcinoma↗
PubMed1977

[Special indications for using the whole body scanner (author's transl)].

In addition to the role of the body scanner in the diagnosis of diseases of the body cavity and parenchymal organs, the authors review the scope and indications for using whole body computer tomography in special situations. Examples are given of its use in the diagnosis of tumours in the vicinity of the skull base, in the orbits, the facial skeleton, soft tissue tumours, bone diseases and CT-controlled biopsies.

Adult↗
PubMedDate not supplied

Fine needle aspiration biopsy of myxoid metastasis of malignant melanoma.

The cytopathologic features of the fine needle aspiration biopsy of a myxoid metastasis of a cutaneous malignant melanoma are documented. The cytologic findings included fusiform-to-round cells with elongated cytoplasmic processes, fibroblastlike cells and inflammatory cells in a characteristic amorphous background substance. Immunocytochemical staining for S-100 protein was positive. The cytologic findings correlated well the histologic, histochemical, immunohistochemical and ultrastructural studies of the neoplasm. The cytologic differential diagnosis between metastases of malignant melanoma and other myxoid tumors of soft tissues is discussed.

Biopsy, Needle↗
PubMed1999

High angiogenic activity in cells isolated from cystic hygroma: role of bFGF.

BACKGROUND: Cystic hygromas are characterized by a proliferation of small vessels and lymphatics with intervening fibrous tissue. Studies have shown malignant tumors and some benign neoplasms are dependent on angiogenesis, the induction of new capillaries from preexisting vessels. Growth and progression of these tumors are associated with a disturbance in the balance of angiogenic inducers and inhibitors. We have postulated that cells derived from cystic hygromas are angiogenic due to secretion of higher levels of angiogenic inducers that promote vascular proliferation. DESIGN: A large cystic mass was surgically removed and a portion of the sterile tumor was immediately placed in the medium. The tissue was minced, washed in phosphate-buffered saline, and grown to near confluence. Conditioned medium was collected under serum-free conditions after 48 hours. Secreted proteins were concentrated, quantitated, and analyzed in an in vitro endothelial cell migration assay and by Western blot. Antibody to factor VIII-related antigen was performed to confirm endothelial cell origin of the cultured cells. MAIN OUTCOME MEASURES: In vitro angiogenic activity of secreted proteins in a capillary endothelial migration assay was tested by using blocking antibodies to angiogenic inducer, basic fibroblast growth factor, and angiogenic inhibitor, thrombospondin-1. Total protein levels of thrombospondin-1 were determined by Western blot. RESULTS: Cells isolated from cystic hygroma are angiogenic in vitro and this angiogenic activity is due to secretion of high levels of angiogenic inducer, basic fibroblast growth factor, and lower levels of naturally occurring angiogenic inhibitor, thrombospondin-1. CONCLUSIONS: Cystic hygromas may represent another neoplasm dependent on angiogenesis. The angiogenic activity is due in part to elevated levels of potent angiogenic inducer, basic fibroblast growth factor. Antiangiogenic therapy directed at the endothelial cell may help suppress the growth of cystic hygromas.

Adolescent↗