Retropharyngeal spread of carcinoma of the thyroid.
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To study the derivation of tumor cells of malignant fibrous histiocytomas (MFH), their phenotypical marker profile was investigated and compared with those of malignant histiocytosis (MH) and of different types of soft tissue tumors (STT). The presence of the following markers was investigated: on paraffin sections, alpha-1-antichymotrypsin (ACT); on frozen sections antigens associated with lymphocytes, macrophages and fibroblasts, the enzymes acid phosphatase, nonspecific esterase, and beta-glucuronidase; and, on isolated and cultured cells, the receptors for EA-gamma and complement. Furthermore, the capacity to phagocytose sensitized erythrocytes and carbon particles was studied in vitro. MFH tumor cells and a part of other types of STT shared the expression of ACT and lysosomal enzymes with MH. They differed, however, from MH by the absence of monocyte/macrophage-associated antigens and by the expression of fibroblast-associated antigens, which property they had in common with other STT. MFH tumor cells were not able to form rosettes or to phagocytose Ig-sensitized erythrocytes, but they showed phagocytosis of carbon particles. The results strongly indicate that MFH tumor cells originate from (primitive) fixed mesenchymal cells and are not related to monocyte-derived histiocytes.
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Intranodal myofibroblastoma (IM) is a recently delineated clinicopathologic entity represented by a myofibroblastic proliferation of the lymph node. It usually occurs at the groin and presents clinically as a single enlarged lymph node. Its clinical behavior is entirely benign and local excision is curative. The authors herein report a case of IM diagnosed by aspiration biopsy cytology (ABC). The main diagnostic clues to the cytologic diagnosis of this entity as well as the differential diagnosis are presented.
Lymph node metastases occur in an appreciable number of soft-tissue sarcomas. The histologic subtype plays a most important role. Synovial sarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma, and angiosarcoma manifest relatively frequently such metastases, whereas fibrosarcoma, liposarcoma, and malignant schwannoma do so very infrequently. With the use of the newer radiologic techniques, it is expected that this feature will be more clearly defined and taken into account in planning the treatment. For histologic subtypes known frequently to manifest metastases to the regional lymph nodes, the latter should be considered for inclusion in the surgical and/or radiation treatment plan, particularly for primary tumors situated close to a nodal basin; and careful follow-up of these nodes should be practiced.
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Epithelioid sarcoma is an uncommon soft tissue tumor, most prevalent in the extremities of young adults. Youth has been described as a favorable prognostic factor. We describe four patients (two children aged 10 years and two adolescents aged 18 years) with extremity epithelioid sarcoma. Both 10-year-old children had rapid disease evolution and died 3 and 6 months after the diagnosis was made. Both tumors were strict diploid at DNA flow cytometry, but one had an abnormal karyotype (trisomy 2). Both adolescents are disease-free 18 months and 18 years after combined treatment consisting of local resection, regional lymph node dissection, and isolated regional perfusion with cytostatic agents.
Records of patients with renal cell carcinoma extending into the inferior vena cava were reviewed. Patients with nodal metastases or distal spread were excluded, leaving 19 cases available for analysis. The over-all 3 and 5-year survival rates were 56 and 38 per cent, respectively, but a striking difference in survival was observed when those patients with perinephric fat involvement (T3ac) were separated from those whose tumours had not penetrated through the renal capsule (T3c). The 3 and 5-year survival rates for patients with T3ac tumors were 14 and 0 per cent, compared to 82 and 67 per cent for patients with T3c tumors. Patients with T3ac tumors had metastases earlier (mean 13 months) than patients with T3c tumors (mean 22 months). The over-all mean survival duration was 50 months. However, the mean survival duration of patients with T3ac tumors was 17 months, compared to 75 months for patients with T3c tumors.
The authors report a case of chest skeletal muscle involvement by recurrent adenocarcinoma of the breast, in which individual myofibers were invaded by breast carcinoma cells. This unusual type of skeletal muscle involvement is especially interesting because it is known that the sarcolemma of skeletal myofibers is very resistant to enzymatic, mechanical, and chemical breakage.
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BACKGROUND: The determination of a simple and reliable prognostic factor that allows identification of patients at high risk of early cancer recurrence and subsequent death after resection of esophageal carcinoma should contribute to more accurate management of patients suffering from this disease. STUDY DESIGN: The aim of this study was to assess the prognostic value of thoracic recurrent nerve nodal involvement after curative resection of esophageal squamous cell carcinoma. The prognostic importance of gender, age, tumor penetration, and extent of lymph node involvement was evaluated in 55 patients after curative resection of esophageal squamous cell carcinoma. RESULTS: Thirty-four of 55 patients (62%) had nodal metastases and 10 of 55 (18%) had thoracic recurrent nerve nodes involved. The median overall survival was 28 months. By univariate analysis, survival was higher in association with the absence of adventitial invasion (p = 0.04), of nodal involvement (p = 0.03), and of thoracic recurrent nerve nodal involvement (p = 0.0001). In a Cox proportional hazards regression model, thoracic recurrent nerve nodal involvement appeared the strongest predictive factor (adjusted hazard ratio 8.4 (3.0-23.7)). CONCLUSIONS: Assessment of thoracic recurrent nerve nodes is appropriate to identify patients who are at high risk of disease-related death after surgical resection.
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A typical case of intranodal myofibroblastoma arising in a submandibular lymph node is reported. It provides proof that this tumor can occur in extrainguinal regions and suggests that the submandibular region is a prevalent site. The combination of benign spindle cells and foci of pale fibrillary matrix and hemosiderin granules were characteristic features in the fine-needle aspiration cytologic findings.
Dermatofibrosarcoma protuberans is a slow-growing, locally aggressive, fibrous tumor that, on rare occasions, metastasizes to distant sites or regional lymph nodes. We have found 28 patients with metastasis in the literature; 9 of these patients had lymph node metastasis. In this report we present a case of dermatofibrosarcoma protuberans of the lower extremity with metastasis to inguinal lymph nodes appearing 10 months after wide excision and skin grafting of the primary lesion. The clinical and pathological features of this case are presented. Although, along with our patient, 10 cases of regional lymph node metastasis are not justification for regional lymph node dissections, they do emphasize the need for regional lymph node examinations in the long-term follow-up of dermatofibrosarcoma protuberans cases.
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It was recently demonstrated that interleukin-8 (IL-8) is produced by cultured melanoma cells and acts as an essential autocrine growth factor. Earlier studies from our laboratory demonstrated a direct correlation between IL-8 expression in human variant cell lines and their metastatic potential in nude mice. In the present study we examined the expression of IL-8 in human malignant melanomas using immunohistochemistry to correlate IL-8 levels with disease stage. None of the radial growth phase (RGP) tumours (melanoma in situ) expressed IL-8. In contrast, 50% of the vertical growth phase (VGP) tumours (invasive melanoma), which have a high risk of metastasis, showed IL-8 immunoreactivity. Further, all the metastatic lesions analysed showed intense staining for IL-8; the levels were higher than those observed in the primary skin tumours. In summary, the data suggest an association between the expression of IL-8 and the metastatic phenotype.
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