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Malignant melanoma can be diagnosed clinically and histologically when it is small, flat, and confined to the epidermis. The criteria for the diagnosis are described. The application of these criteria can lead to simple excision of the lesion and the prevention of the malignant melanoma from evolving into a neoplasm with the potential for metastasis.
Two soft tissue neoplasms considered to represent malignant fibrous histiocytomas by light microscopy showed typical findings indicative of Schwann cell origin when examined by electron microscopy. These findings included the presence of cells exhibiting long interdigitating cytoplasmic processes, which frequently contained collections of microtubules and were surrounded by thin, frequently interrupted, basal lamina material. In addition, pinocytotic activity at the cell surfaces and immature junctions joining apposing cellular membranes were identified. No evidence of fibroblastic, fibrohistiocytic, or myofibroblastic differentiation was identified ultrastructurally in the neoplastic cells. Our findings stress the need for ultrastructural examination to adequately classify soft tissue sarcomas. The 2 cases presented illustrate that there are some schwannomas that may be inaccurately classified as malignant fibrous histiocytomas if only light microscopy is used. It seems that only by ultrastructural means is it possible to accurately classify these peculiar neoplasms.
A 54-year-old male died of cerebellar herniation induced by brain tumor. Radiological examination of this case showed two separate tumorous lesions in the brain and lung. Autopsy proved malignant astrocytoma in the brain and coincidental alveolar cell carcinoma in the lung. He had a history of asbestos exposure for 8 years doing piping work in a shipyard. Furthermore, we detected a large number of asbestos bodies in the lung and one asbestos body in the brain. Therefore, this rare case of double cancer (malignant astrocytoma and lung cancer) might have been induced by asbestos exposure.
Recent progress in cytogenetic and biochemical mutation assay technologies has enabled us to detect single gene alterations and gross chromosomal rearrangements, and it became clear that all cancer cells are genetically unstable. In order to detect the genome-wide instability of cancer cells, a new simple method, the DNA-instability test, was developed. The methods to detect genomic instability so far reported have only demonstrated the presence of qualitative and quantitative alterations in certain specific genomic loci. In contrast to these commonly used methods to reveal the genomic instability at certain specific DNA regions, the newly introduced DNA-instability test revealed the presence of physical DNA-instability in the entire DNA molecule of a cancer cell nucleus as revealed by increased liability to denature upon HCl hydrolysis or formamide exposure. When this test was applied to borderline malignancies, cancer clones were detected in all cases at an early-stage of cancer progression. We proposed a new concept of "procancer" clones to define those cancer clones with "functional atypia" showing positivities for various cancer markers, as well as DNA-instability testing, but showing no remarkable ordinary "morphological atypia" which is commonly used as the basis of histopathological diagnosis of malignancy.
In this report, we describe a highly unusual case of glandular malignant peripheral nerve sheath tumor presenting as a neck mass in a previously healthy 29-year-old man. Grossly, the tumor was found to arise from a swollen peripheral nerve trunk. The tumor was largely composed of spindle cells that demonstrated marked nuclear pleomorphism and numerous abnormal mitotic figures. In addition, histologically malignant glandular structures lined by simple nonciliated columnar cells with goblet cells were found clustered in the center of the tumor. Examination of the swollen peripheral nerve trunk revealed the presence of a plexiform neurofibroma. The spindle cells were positive for S100. The glands were negative for S100 but positive for keratin, epithelial membrane antigen, and neuroendocrine markers (somatostatin, chromogranin, Leu-7, and calcitonin). This patient was subsequently diagnosed as having von Recklinghausen disease and died of tumor metastasis to the lungs 34 months after the presentation. To our knowledge, only 3 similar cases have been previously described in the literature.
We report 3 cases of malignant fibrous histiocytoma occurring as primary neoplasms of the skin. The first case developed in a leg ulcer of traumatic origin. The second developed on the lower lip at the site of a squamous cell carcinoma which had been treated by radiotherapy. The third arose on a calf at a site of previous surgery. The literature on this malignancy is reviewed, with emphasis on cutaneous involvement.
The progress that has been achieved in the development of antitumour drugs and the management of the untoward side effects both contributed to the increasing importance of drug-therapy beside surgery and radiotherapy in cancer treatment. The treatment of the micrometastasis which appears very frequently already at the time of the diagnosis and also the control of the metastatic progression represent the main importance of drug therapy in cancer patients. In spite of the numerous clinical trials indicating the usefulness of drug therapy both as adjuvant in the management of the primary tumours and in the treatment of metastatic tumours there are certain reservation against chemotherapy in medical circle. It is noteworthy that at the present time the strategy of cancer-therapy is subject of considerate changes. Beside to achieve cure by eradication of the tumour cells it has been recommended in various oncological center that stabilization of the malignant disease and to offer a good quality of life for the patients should also be the aim of the therapy. The purpose of this communication is to present those factors which are necessary to consider in the planning of anticancer drug therapy. Certainly to achieve cure or to improve the quality of life of cancer patients it is important to select the most appropriate drug (cytostatics, hormones, biological response modifiers or agents improving the quality of life) and treatment schedule. Since antitumour drug therapy must be classified as active, palliative/active, palliative and supportive/terminal treatments the present survey gives emphases on the underlying role of malignant progression before deciding the type of treatment.
The authors Castaldo et al. (Clin. Chem., 1994, 30: 478-83) state, that the ascitic lactate dehydrogenase and ascitic cholesterol association correctly identified 100% of malignant ascites from ascites associated with cirrhosis and/or hepatocellular carcinoma, with help of stepwise multiple linear discriminant analysis. The free software Capsules--Ascites is via internet available (http:¿www.leeds.ac.uk/acb), which use the mathematical formula from this article. As we argue, Castaldo's state is not correct. Three independent multidimensional statistical methods--bivariate reference regions (program EVAL-KIT), cluster analysis (program BioAnalyst), geometrical distance classification (program GEODICLA) applicated on Castaldo's original data showed that lactate dehydrogenase and cholesterol have not satisfactory absolute discriminative power between malignant from nonmalignant ascites in general, but the probability to determinate the right diagnosis is about 91-93%. Research conducted in correctly selected probands should provide information which is valid not only for the selected sample but for the entire population, to achieve more generally valid conclusions, useful for practical decisions. In addition, in the compiled table show we sensitivity and specificity of different laboratory parameters publicated in 11 original articles in the nineties, all with diagnostic efficiency less 100%.
This retrospective laboratory-based study investigates the potential for malignant transformation of oral mucosal lesions in a population of 1.6 million. Over the 20-year period there were 745 patients diagnosed with primary intra-oral squamous cell carcinoma (OSCC), 165 patients with dysplasia and 1182 patients with 'non-dysplastic' lesions (epithelial hyperplasia, hyperkeratosis epithelial atrophy, lichen planus and lupus erythematosus). Malignant transformation occurred in 15% of dysplasias and in 1% of 'non-dysplastic' lesions at average intervals after diagnosis of 48 and 65 months respectively. Only 6% of patients with OSCC had a pre-invasive lesion biopsied. These data suggest that white lesions are only rarely the pre-invasive phase of OSCC. It is possible therefore that early changes are red, small or even microscopic with carcinoma developing without a clinically observable phase. More effective management strategies will require the development of tissue markers to enhance early detection.
Malignant peripheral nerve tumours (MPNT), e.g. malignant schwannoma, represent a relatively rare tumour entity which is usually regarded as a member of the group of soft-tissue sarcomas and treated accordingly. For chemotherapeutic approaches in metastasised disease, ifosfamide and doxorubicin have been identified as the most efficient agents, with overall response rates distinctly less than 50%. In case of non-response, recommendations for effective second-line regimens are lacking. We present the case histories of two patients with pulmonary metastasised MPNT that was primarily refractory to ifosfamide/doxorubicin. Both patients developed a partial remission with tumour reduction exceeding 50% after treatment with carboplatin in combination with etoposide (CE), 150 mg/m2 each, days 1-4 in 4-week intervals. Complete resectability of lung metastases could be achieved, with histologic evidence for advanced tumour regression at the time of resection. Patients remain in stable complete remission 20 and 28 months after surgery, respectively. Major CE-associated toxicity was cumulative myelosuppression, especially thrombocytopenia, reaching WHO grade 4. To our knowledge, this is the first report showing that CE is a possibly successful chemotherapeutic regimen in advanced MPNT, although further studies are necessary to evaluate its efficacy.
BACKGROUND AND OBJECTIVES: The CD4+ CD56+ lin- immunophenotype characterizes rare malignancies, so far considered as arising from the transformation of NK progenitors, and therefore classified as blastic NK-cell leukemia/lymphoma by the WHO committee. Recently it was formally demonstrated that such malignancies do, in fact, develop from plasmacytoid dendritic cells (pDC), according to immunophenotypic and functional criteria. The clinico-biological features of this neoplasm were moreover recently summarized from a large series of 23 patients. INFORMATION SOURCES: The main symptoms at presentation were cutaneous lesions and bone marrow failure, due to invasion by blastic cells, all of which were EBV negative and agranular. Most patients were initially sensitive to chemotherapy regimens, but they rapidly relapsed and died within 3 years. Only 2 allotransplanted patients were long survivors. Recurrent chromosomal aberrations involving chromosomes 5q, 6q, 12p, 13q, 15q and 9 were described and it was characteristic that these were associated in the same cell. In the present review we compared these findings to those in the literature. STATE OF THE ART AND PERSPECTIVES: The concordant characteristics led us to confirm that this neoplasm actually represents a new entity, that we propose to rename early pDC leukemia/lymphoma. The diagnosis is primarily based on a characteristic immunophenotypic profile i.e. CD4+ CD56+ CD3- CD13- CD33- CD19-. Complementary analyses assessing the expression of more specific pDC-related markers showed the cells to be HLA-DR+, CD123high, CD116low, CD45RA+, BDCA-2+ or BDCA-4+. Such complementary investigations are necessary only in the case of an atypical phenotype, in order to confirm a pDC origin and exclude another hematologic disease. This presently regards the expression of CD33 or cytoplasmic CD3e (cyCD3e) and the negativity of CD56.
TAG-72 is a tumor-associated antigen identified by the monoclonal antibody B72.3. Serum levels of TAG-72 were measured in patients with non-malignant and malignant disease. TAG-72 is not a specific marker of cancer and slightly elevated levels of this antigen can also be detected in the serum of healthy subjects. However, our results show that specificity (92%) and positive predictive value (86%) of this marker are very high. TAG-72 levels above the cut-off limit of 6 U/mL were found in patients with tumors of various organs, including gastrointestinal, ovarian, lung and breast cancer. TAG-72 assay sensitivity is related to tumor stage with values being highest with advanced disease, especially in patients with gastric cancer and lung adenocarcinoma.
Primary malignant lymphoma of the bladder is infrequent and usually has a low malignancy, with a possibility of long-lasting remission. Our case is that of a 73-year-old woman who presented with a tumor of the bladder revealed by hematuria. She was treated with incomplete endoscopic resection, which showed that the lesion was a B cell lymphoma. After a complementary 60-Gy radiation therapy, remission was complete at 6 months. The histological and immunological study showed the lymphomatous proliferation infiltrating the chorion and the expression of the usual B-lymphocytic markers by the tumoral cells. Lymphoma of the bladder was described for the first time in 1885, and only a few small series of vesical lymphomas have been published since then. The prognosis is usually favorable owing to long-lasting remission. Complete surgical resection does not improve the results, and radiation therapy is the treatment of choice.
PURPOSE: To investigate the roles of hTERT and p53 protein in malignant changes of oral mucosal precancerous lesions and the relations between hTERT and p53. METHODS: The expression of hTERTmRNA and p53 were measured using in situ hybridization and immunohistochemical assay in 9 cases of oral mucosal hyperplasia, 11 cases of light dysplasia, 10 cases of medium dysplasia, 9 cases of carcinomas in situ and 11 cases of squamous cell carcinomas. The results were processed by medical photographic system, and analyzed statistically by one-way ANOVA. The relation to hTERT and p53 was analyzed statistically by Pearson correlations. RESULTS: It was found that from hyperplasia to light dysplasia, medium dysplasia, carcinomas in situ and squamous cell carcinomas, the indexes of positive cell vessels and the value of OD increased, arriving at the apex in squamous cell carcinoma. With phenotypic progression and the degree of dysplasia, hTERT and p53 expression cells extend from basal layer to the keratinous layer. In highly-differentiated squamous cell carcinomas, expression cells were mainly located around the nests. Stained cells dispersed throughout the tumor tissue in low-differentiated squamous cell carcinomas. p53 was undetectable in hyperplasia and light dysplasia, but p53 was observed in 66.67% cases of high dysplasia and 72.72% cases of squamous cell carcinomas. There was not a significant linear correlation between hTERT and p53. CONCLUSIONS: The results suggest that activation of telomerase and p53 play a role in the process of malignant changes of oral mucosal precancerous lesions. Oral squamous cell carcinoma is a disease that has been found in association with many factors.
Multiparameter flowcytometry offers an insight into differentiation pathways, maturation stages and abnormal features of cell (sub)populations thus helping to establish and classify hematological malignancies. The Dutch Foundation for Immunophenotyping of Hematological Malignancies (SIHON) has formulated a guideline for a rapid screening followed by confirmation and classification in a standardized way. For this aim seven carefully composed monoclonal antibody combinations are elucidated for screening the test sample in a first phase. In this phase a relative frequency distribution of the cells will be established and a decision will be made about abnormal cells present, as well as their mature or immature state and the cell lineage they belong to. In a second phase, panels with cell lineage dependent monoclonal antibody combinations may be used to confirm and classify the abnormal cell population indicated in phase 1, as well as to establish the presence or absence of an abberant immunophenotype.
The infratemporal and paratonsillar regions can be the site of propagation of parotid tumors. Our personal experience with 3 cases of malignant parotid tumors extending into the infratemporal region and the study of the literature seem to show that: benign tumors, such as pleiomorphic adenomas, develop in depth towards the paratonsillar regin and not towards the infratemporal region; and conversely, malignant tumors rather invade the infratemporal regin and not the paratonsillar region. This extension occurs along the neurovascular axis through Juvara's retrocondylar buttonhole. If this notion was confirmed, it might have a semiological and therapeutic interest.
Twenty patients with malignant or potentially malignant tumors (osteogenic sarcoma, giant-cell tumor, synovial-cell sarcoma, chondrosarcoma, and chondroblastoma) located in the proximal end of the tibia or distal end of the femur were treated by local resection and arthrodesis employing an intramedullary rod and autogenous segmental cortical grafts obtained from the same extremity. Use of a customized bent, fluted rod in the most recent cases provided more stable fixation. There was only one local recurrence. In properly selected patients, the method provided a stable extremity that permitted resumption of a vigorous life-style within approximately one year.
A 2-month-old infant was diagnosed as having an invasive thymic tumor. Histologically and ultrastructurally, the tumor was composed of primitive mesenchymal cells, most likely malignant histiocytes. The child died at the age of 5 1/2 months with metastases to the bone and and liver. Review of the literature on thymic tumors and fibrous histiocytomas or malignant histiocytoma shows no similar case.