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Malignant mediastinal teratoma in a 15-year-old girl.

A well-differentiated anterior mediastinal teratoma was removed from the right hemithorax of a 15-year-old girl presenting initially with ascites. Death followed a precipitous clinical deterioration from widespread sarcomatous metastatic disease. The true malignant nature of this tumor was not apparent on initial resection and evaded detection until shortly before death. These unique features prompted a review of the pertinent literature on malignant mediastinal teratoma in children. A similar case had not been reported previously.

Adolescent

Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases.

A retrospective clinicopathologic evaluation of 42 patients with cystosarcoma phyllodes was undertaken to determine if tumor size, contour, degree of stromal atypia and mitotic activity were reliable indicators of clinical behavior. Excluding size, the latter three determinants showed a positive correlation with prognosis and served as the basis of a classification in which 18 benign, 5 borderline and 19 malignant cystosarcomas were diagnosed. The tumors occurred in women averaging 44.3 years of age who most often presented with a palpable occasionally painful mass with a median diameter of 5 cm. Excision or simple mastectomy were the more frequent forms of therapy. Local recurrences were experienced by 6 patients and occurred in all 3 categories of tumor. Only malignant neoplasms developed systemic metastases which was observed in 4 patients 3 of which have died. On borderline tumor recurred 14 times and eventually proved fatal as a result of contiguous pulmonary involvement. A plea is made to label the stroma of malignant cystosarcomas as to the cell(s) of origin so future investigators may evaluate the effect of various soft tissue patterns on prognosis.

Adolescent

Primary linitis plastica of the colon: report of two cases and review of the literature.

Two cases of primary linitis plastica of the large intestine will be presented and discussed. Characteristic clinical features of this type of adenocarcinoma of the large intestine include younger age of presentation, low incidence of hepatic metastasis and a high incidence of ovarian, lymph node and peritoneal metastasis. Pathological features reveal thickening of the intestinal wall by diffuse infiltrating tumor cells of the characteristic signet ring cells, abortive glands and undifferentiated or anaplastic cells. The prognosis is poor.

Adenocarcinoma, Mucinous

Benign and low grade variants of mixed mesodermal tumor (adenosarcoma) of the ovary and adnexal region.

Eleven examples of a rare group of neoplasms composed of both epithelial and mesenchymal components are reported. Ten arose from the ovary and one arose separately in the para-ovarian region. The neoplasms are distinctive in that the stoma is more cellular than that of adenofibromas, but epithelial component is not malignant, as in carcinosarcoma and mixed mesodermal tumors, and the stoma is not sarcomatous in the low grade varieties. The 11 cases were highly variable in the cellularity and atypism of the stromal cells. The term, adenosarcoma, for these tumors is not acceptable because some were too low a grade to be regarded as sarcomas, and reports of the uterine counterpart disclose that some contain heterologous elements. For that reason, a term that will embrace the full spectrum of changes in the stroma--benign through sarcomatous--is needed. We propose that they be regarded as variants of mixed mesodermal tumor so that both the benign neoplasms and low grade sarcomas can be accommodated under one designation. Of the 11 cases, five lowest grade examples were all confined to the ovary and did not recur after surgical excision, but some of these were borderline in malignancy and probably would have progressed if untreated. Two of the 3 intermediate grade neoplasms extended beyond the ovary but were arrested by surgical excision. The 3 highest grade neoplasms were overly sarcomatous. One of these extended beyond the ovary but was arrested by combination chemotherapy. The para-ovarian adenosarcoma (also high grade) metastasized and proved fatal.

Adenofibroma

Leiomyosarcoma of the small and large bowel.

From 1950 through 1974, a total of 108 cases of primary intestinal leiomyosarcoma were seen at the Mayo Clinic. Most of these uncommon tumors occurred in the fifth and sixth decades of life, and more of them in men than in women (2.6:1). There were 73% in the small bowel, 25% in the large bowel, and 2% in the anus. Gastrointestinal bleeding and pain were the two most common signs at presentation, and they led to surgical exploration in all cases where they appeared. By the time surgery was performed, only 48% of the tumors could be resected with hope of cure. Within that group of cases, 50% of the patients survived 5 years, but only 35% survived 10 years, late recurrence being common. The histologic grade of the tumor affected survival to erroneous early optimism in prognosis.

Adult

Anaplastic dysgerminoma.

A rare case of rapidly evolving dysgerminoma produced death by tumor in less than two months after onset of symptoms. It is important to recall that dysgerminoma possesses considerable malignant potential, which infrequently is manifested by rapidly progressive disease. Certain risk factors, present in the pathological specimen, serve to indicate the aggressive potential of such neoplasms.

Adolescent

Metastasizing pleomorphic adenoma of the salivary gland.

A case of metastasizing pleomorphic adenoma in which both the primary tumor and metastasis were composed of benign pleomorphic structures is reported and previously reported cases reviewed. The metastasis commonly developed many years after the excision of the primary tumor and was usually preceded by local recurrences. The most common sites of metastasis were the bone and lung. Mitotic activity and infiltrative growth pattern are the histologic features in the primary tumor important in predicting the metastasizing potential. The treatment of choice for the metastatic tumor appears to be surgical excision. Radiotherapy seems to have a limited role other than providing temporary palliation.

Adenoma

Electron microscopic findings in primitive neuroectodermal tumors of the cerebrum.

The fine structure of 3 primitive neuroectodermal neoplasms of the cerebral hemispheres was studied. The predominant tumor cells were undifferentiated cells with prominent nuclei and scanty cytoplasm containing few organelles. Ultrastructural evidence suggesting differentiation into ependymal, neuronal and possibly astrocytic elements was also present. This study suggests that the cell of origin of this tumor is a primitive multipotential cell of the cerebrum.

Adolescent

Anastomotic recurrence in the oesophagus complicating gastrectomy for adenocarcinoma of the stomach.

Gastric adenocarcinomas often spread to the distal oesophagus. Failure to control the disease in this area during total and proximal subtotal gastrectomy results in recurrence at the oesophageal anastomosis. The incidence of recurrence in a series of 351 such patients was 10 per cent and was influenced by the location of the main lesion, the stage of the disease, the presence of tumour at the margin of resection and the length of clearance of the oesophageal margin. Recurrence were prevented only with in vivo margins greater than 12 cm. Dysphagia combined with radiological signs of oesophageal obstruction was diagnostic of anastomotic recurrence regardless of the results obtained by oesophagoscopy and biopsy. Treatment was seldom effective in patients developing recurrence. Complete excision of the entire recurrent process offered the only hope for a long survival in these patients. Prevention by obtaining adequate oesophageal clearance at the time of gastrectomy is the only reasonable approach to this problem. The adequacy of resection cannot be judged accurately by intraoperative palpation of the oesophagus or by frozen section examination of the surgical margins.

Adenocarcinoma

Secondary liposarcoma of the ovary.

This report is the first description of a secondary ovarian liposarcoma. The primary growth was in the mediastinum. The growth rate of the ovarian tumor was very rapid, but the patient died of cardiopulmonary causes. The mode of spread is discussed, and it probably occurred by transcelomic migration and surface implantation.

Adult

Microinvasive carcinoma of the uterine cervix.

There has been remarkable improvement in the early diagnosis of cervical carcinoma in recent years. There is, however, disagreement regarding the definition and treatment of microinvasive carcinoma of the uterine cervix. This review analyzes a large number of reports representing current opinion about the definition, diagnosis and appropriate management of early cervical carcinoma.

Adult

Patterns of spontaneous metastasis manifested by three rat prostate adenocarcinomas.

Three transplantable rat prostate adenocarcinoma cell lines were assessed for patterns of metastasis, ie, routes of dissemination and larger organ(s) selected for implantation. Two lines (I and III) were disseminated only through ipsilateral lymphatic channels to the lungs. The third cell line (II) was disseminated through lymphatic and blood channels to lungs, liver, and kidneys. The pattern of spontaneous metastasis is a characteristic of the tumor cell; but there is evidence that the rate and extent of metastasis can be modified experimentally.

Adenocarcinoma

Nephroblastoma (Wilms tumor): tubule density and prognosis.

Relative differences in tubules density of the primary tumors have been suggested to be prognostically useful in nephroblastoma (Wilms tumor). Forty cases from our institution were retrospectively graded according to tubule density. There were significant differences in disease-free survivals between histologic grades. When compared to other clinical and pathologic staging criteria, tubule density was not more useful prognostically than the staging systems tested. However, when used in conjunction with clinical or pathologic stage, tumor grade improved prognostic sensitivity. Regardless of grade or stage, patients less than 24-months-old at diagnosis had better disease-free survival.

Age Factors

Malignant lymphomas of the nervous system.

In a series of some 7,000 patients with tumors of the central nervous system, 208 patients (about 3%) had some form of a malignant lymphoma. Slightly less than half of these tumors were primary in the brain; the remainder had cranial involvement as part of a generalized process. The tumors consisted of Hodgkin's disease, lymphosarcomas, reticulosarcomas and plasmacytomas. The brain was involved in one of two ways: either as localized tumor masses resembling certain gliomas, or as diffusely invasive neoplasms resembling exudative cellular inflammatory processes. They had a peculiar predilection for the septum pellucidum but occurred also in the cerebral lobes, basal ganglia, brain stem and cerebellum. They all produced a fibrillary stroma of reticulin fibers and they spread along the perivascular spaces, in the cerebrospinal subarachnoid space, or intraventricularly on and beneath the ependymal lining. One type of lymphoma often fused into another - thus a single tumor often consisted of Hodgkin's sarcoma, lymphosarcoma and reticulosarcoma. In an addition series of 57 cases of spinal cord involvement by malignant lymphomas, there were no instances of a primary tumor; all patients had either primary lymphomas of the brain with secondary spread to the spinal subarchnoid space, or had spinal cord compression as a result of tumor in the vertebrae, the spinal epidural space, or the spinal dura. Hence the spinal cord involvement was a secondary manifestation of a lymphoma elsewhere. Peripheral nerve involvement by lymphomas resulted in destruction of myelin sheaths and axons by tumor cell infiltration and the neuropathy was always part of a generalized lymphomatosis.

Brain Neoplasms