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PubMed1990

Is there no influence of local control on the rate of metastases in high-grade soft tissue sarcoma?

Primary host and tumor-related prognostic factors, the occurrence of local recurrence, and the time interval between diagnosis of the primary tumor and metastatic disease were analysed in 39 patients with metastatic Grade 4 soft tissue sarcoma. The pattern of prognostic factors and the timing of metastases were the same in patients with and without local recurrence. Thus, primary prognostic factors alone may determine the risk of metastases in high-grade soft tissue sarcoma; local recurrence per se may not influence the prognosis in these cases.

Female↗
PubMed1980

Epithelioid sarcoma and synovial sarcoma in the same knee.

A patient who had had a synovial sarcoma removed from the soft tissues adjacent to his knee subsequently developed an epithelioid sarcoma on the opposite side of the same joint. The epithelioid sarcoma metastasized to lymph nodes, invaded blood vessels and produced death 16 years after it was first discovered. The unique association of these two tumors may be an interesting coincidence or may have some relevance to the histogenesis of epithelioid sarcoma.

Adult↗
PubMed2006

[Quantitative study of thyroid transcription factor-1 protein expression in lung carcinoma cell nucleus by tissue microarray].

OBJECTIVE: To investigate thyroid transcription factor-1 (TTF-1) expression in normal human adult type II alveolar epithelial cells, embryonic pneumocytes, lung carcinoma cells and lymph node metastases of lung cancer. METHODS: Lung carcinoma tissue microarray was constructed containing 765 cores of 20 normal adult lung tissues, 15 embryonic lung tissues, 100 lung carcinomas and 55 corresponding lymph node metastases. TTF-1 protein expression on the microarray was detected by immunohistochemical SP method using TTF-1 monoclonal antibody and assessed quantitatively with Leica Q500MC image analysis system. RESULTS: The number TTF-1 positive units (PU) was smaller in the nuclei of embryonic pneumocytes than in those of normal adult type II alveolar epithelial cells (P<0.001). The nuclei of lung carcinoma cells had smaller TTF-1 PU than normal adult type II alveolar epithelial cells and embryonic pneumocyte nuclei (P<0.001). The lung adenocarcinoma and small cell lung carcinoma cell nuclei had greater TTF-1 PU than squamous cell carcinoma and large cell lung carcinoma cell nuclei (P<0.001). TTF-1 PU was greater in squamous cell carcinoma cell nuclei than in large cell lung carcinoma cell nuclei (P<0.001). In lung adenocarcinoma, squamous cell lung carcinoma and large cell lung carcinoma, TTF-1 PU was greater in the cancerous cell nuclei of lymph node metastases than in the corresponding primary carcinoma cell nuclei (P<0.001, P<0.001, and P<0.05, respectively). In small cell lung carcinoma, TTF-1 PU of the cancerous cell nuclei of lymph node metastases was similar to that of primary carcinomas (P>0.05). TTF-1 PU was greater in lung carcinoma with lymph node metastases than in those without metastalsis (P<0.001). TTF-1 PU of the cell nuclei was not associated with the tumor growth pattern, differentiation and patients' gender (P>0.05), but was greater in TNM stage II-IV than in stage I (P<0.001). CONCLUSIONS: The amount of TTF-1 in the cell nuclei decreases in the order of normal adult type II alveolar epithelial cells, embryonic pneumocytes and lung carcinoma cells. TTF-1 expression is higher in adenocarcinoma and small cell carcinoma and lower in squamous carcinoma and large cell carcinoma. Stronger TTF-1 expression is associated with greater likeliness of lung carcinoma metastatie, and can be an important hallmark for metastasis potential of lung adenocarcinoma, squamous cell carcinoma and large cell carcinoma.

Adenocarcinoma↗
PubMed1982

Malignant mesothelioma of tunica vaginalis testis.

A case of biphasic malignant mesothelioma of the tunica vaginalis occurring in a sixty-four-year-old man is described. The tumor metastasized widely and led to the patient's death two and one-half years after diagnosis. Review of the literature revealed 7 cases of malignant mesothelioma of tunica vaginalis. These tumors appeared highly aggressive with early onset of metastasis. Histologically, the tumors may be epithelial, fibrous, or biphasic. In contrast to the benign variants of mesotheliomas, these tumors often show significant nuclear atypia, mitotic activity, and invasion of the epididymis, spermatic cord, lymphatic spaces, or the fibrous tissue of the tunica.

Humans↗
PubMed1989

Presence of PAF-acether in human breast carcinoma: relation to axillary lymph node metastasis.

PAF-acether (PAF; formerly platelet-activating factor), a potent lipid mediator of inflammation, is involved in multiple cellular functions. To evaluate the role of PAF in human cancer, we obtained specimens from patients with localized breast carcinoma and assayed them for PAF. PAF was found in almost all carcinoma, although it was not detected in most of the matched, nontumor breast tissue samples. Intratumor PAF level was elevated when axillary lymph node involvement was low. Greater axillary extension (two or more positive lymph nodes) was associated with a decreased intratumor PAF level. These findings, along with the independence of other prognostic factors, indicate that PAF is a tumor marker of axillary lymph node involvement.

Axilla↗
PubMed1976

Lymphatic dissemination of bone and soft tissue sarcomas: a lymphographic investigation.

The series consisted of 132 patients, 61 with primary bone sarcomas and 71 with primary soft tissue sarcomas. The patients were all evaluated by lymphography. The investigation included both patients who had not yet been treated and patients with suspected or confirmed metastases. All tumour diagnoses were confirmed microscopically. The findings as regards dissemination were based on clinical examinations, laboratory tests, roentgen examinations and lymphographies. In some cases, lymph node biopsies and surgical observations were also used. A total of 151 lymphographies were performed and 281 follow-up films taken. Preoperative lymphography was performed using the technique introduced by Kinmonth. For postoperative lymphography on the stumps of amputated extremities, two simple but useful methods were developed, which are presented here. Changes in the lymphographic appearance of lymph node metastases, the occurrence of new metastases, and the results of treatment were assessed by survey films and repeat lymphography. The generally accepted criteria for metastasis were used as a basis for the analysis of the lymphographic findings. The results may be summarized as follows: 1. Incidence of lymphatic dissemination. Different sarcomas varied greatly in their clinical course, including the frequency of dissemination. The lymphatic involvement in the metastatic cases was as follows: Bone sarcomas: 16 out of 28 (Table 10); of these, 13 were to regional lymph nodes, 8 to distant nodes and 5 to both (Table 14). Soft tissue sarcomas: 24 out of 40 (Table 11). All 24 had metastases in regional nodes, and 8 in distant nodes as well (Table 15). The highest frequencies of lymphatic spread in the different metastasized tumours were found to be: Bone sarcomas: reticulosarcoma 100%, Ewing's sarcoma 50%, osteosarcoma 47%. Soft tissue sarcomas: rhabdomyosarcoma 100%, synovial sarcoma 80%, neurogenic sarcoma 78%, leiomyosarcoma 67%. 2. Time-relation between lymphatic and haematogenic dissemination; The tendency to metastasize first via the lymphatics or via the blood vessels varied. Half of the cases of Ewing's sarcoma and reticulosarcoma had evidence of lymphatic spread before blood-borne metastases were detected. In the osteosarcoma cases, however, lymphatic dissemination was always preceded by haematogenic spread (Table 12). In synovial sarcoma, rhabdomyosarcoma and neurogenic sarcoma, the first dissemination was more frequently lymphatic than haematogenic (Table 13). 3. Possible existence of special lymphographic features of sarcoma metastases. Only reticulosarcoma displayed special characteristics. The lymph node metastases of reticulosarcoma of bone had lymphographic appearances similar to those found in reticulosarcoma of soft tissue or lymph node origin (Fig. 12). The lymph node metastases of other primary bone and soft tissue sarcomas had no specific lymphographic features and were indistinguishable from carcinomatous metastases (Figs 7, 9, 13, 15, 18, 19, 20, 22, 23). 4...

Adolescent↗
PubMed1984

Carcinoma of the prostate with soft tissue or non-regional lymphatic metastases at the time of diagnosis: a review of 47 cases.

The clinical course of 47 patients with carcinoma of the prostate who at the time of initial presentation had metastases to soft tissue or non-regional lymph nodes was retrospectively reviewed. The response rate to primary hormonal treatment (orchiectomy or oestrogens) and the duration of response were similar to those of 47 other patients presenting with skeletal metastases only. The survival of the patients in the study group was not statistically different from that of patients with skeletal metastases only. The results suggest that patients presenting initially with metastases to non-regional lymph nodes or soft tissue should be treated by the same therapeutic methods as for disseminated prostatic cancer in general (oestrogens or orchiectomy). Slight or no urinary symptoms at the time of initial presentation in spite of a locally advanced tumour was a common finding; 20% of the patients had normal serum prostatic acid phosphatase despite the presence of disseminated disease. Lymph node enlargement in the left supraclavicular fossa was the most common site of non-regional lymphatic spread. Elderly males with metastatic carcinoma in this region should be investigated for the possibility of prostatic cancer.

Adult↗
PubMed1975

Microinvasive carcinoma of the cervix. The significance of lymphatic invasion and confluent patterns of stromal growth.

Thirty examples of microinvasive carcinoma of the cervix were studied to determine the presence or absence of lymphatic invasion. Invasion of spaces resembling lymphatic spaces was demonstrated by step sections in more than half of the cases (57%). The pattern of invasion within the stroma, whether confluent or finger-like, did not correlate with the presence or absence of invasion of these spaces. All of the patients had been treated with a pelvic lymphadenectomy, and all of the lymph nodes were negative for metastasis. Thus, neither invasion of what have been considered to be lymphatics nor a confluent pattern of stromal invasion should be a criterion for excluding either the diagnosis of microinvasion or treatment by simple hysterectomy.

Carcinoma↗
PubMed1978

An evaluation of fast neutron beam teletherapy of metastatic cervical adenopathy from squamous cell carcinomas of the head and neck region.

One hundred thirteen patients with metastatic cervical adenopathy (MCA) from advanced squamous cell carcinoma of the head and neck completed fast neutron beam irradiation between September 1976 and March 1977. With a maximum follow-up time of 49.9 months (mean 14.5 months), 54% of the total group remain disease-free at the sites of their cervical adenopathy. Control of adenopathy measuring 3 cm or less in maximum dimension was 75% with neutrons only and 87.5% with mixed beams. Nodes measuring 3-6 cm were controlled 38.1% of the time with neutrons only and 59% of the time with mixed beams. Clinical control of adenopathy measuring greater than 6 cm was obtained in 12.5% with neutrons only and 29.4% with mixed beams. For patients with controlled primary tumors, the overall control rate in the neck was 72%; 100% of nodes 3 cm or less were controlled, 82% of nodes measuring from 3-6 cm were controlled, and 42% of nodes greater than 6 cm were controlled. Patients with controlled primary tumors treated with mixed beams had 100% control of nodes measuring 3 cm or less, 96% control of nodes measuring 3-6 cm, and 50% control of nodes measuring greater than 6 cm. Overall, the control rate for mixed beams was significantly better than for treatment with neutrons only. Morbidity was less (both acute and late) in the mixed beam-irradiated group.

Carcinoma, Squamous Cell↗
PubMed1989

Detection of lymph node metastases in colorectal carcinoma before and after fat clearance.

One hundred and three colorectal carcinoma specimens were examined to determine the value of the xylene and alcohol fat clearance technique in detecting lymph node metastases. The mesocolon or mesorectum was dissected initially by the traditional method and all the lymph nodes identified were examined histologically. After fat clearance the specimen was dissected again and further lymph nodes were examined. Forty-one specimens were obtained from the rectum and 62 from the colon. Traditional dissection produced a mean of 6.2 lymph nodes per specimen, but following fat clearance a further mean of 12.4 nodes per specimen were found. The total number of lymph nodes recovered varied from two to 69 with a mean of 18.5 per specimen. Traditional dissection showed 45 specimens (43.7 per cent) to have lymph node metastases but after fat clearance a further five specimens (4.8 per cent) were found to be lymph node positive. Therefore, of the 58 specimens graded initially as Dukes' B, five (8.6 per cent) were shown after fat clearance to be Dukes' C tumours. In the Dukes' C cases the mean (s.d.) number of involved lymph nodes per specimen was 2.7 (2.1) by traditional dissection and 4.2 (3.9) after fat clearance. Forty-seven (94.0 per cent) of the Dukes' C tumours were correctly identified after examination of specimens containing up to 13 lymph nodes. Fat clearance of the mesocolon or mesorectum should be used when traditional dissection has failed to identify at least 13 nodes and the tumour has been classified as Dukes' B.

Adipose Tissue↗
PubMed2006

The role of surgery in treatment of stage IV melanoma.

The prognosis for patients with melanoma has not improved over the last 30 years. So far, almost without exception, clinical trials conducted with single or multiple agent chemotherapy, biological therapy (interferon-alpha, interleukin-2), and biochemotherapy have failed to demonstrate consistent survival benefit. Without effective alternate treatments, surgery must be considered the primary treatment of melanoma, independent of disease stage. Although surgery is clearly favored as the treatment of localized melanoma, consensus opinion and clinician preference become divided once melanoma progresses beyond its primary site. Many physicians will adopt an attitude of resignation and hesitancy when treating metastatic melanoma. As a result, patients with advanced disease are often treated with medications that produce little survival or palliative benefit at the expense of significant toxicity. Numerous studies have demonstrated clear and durable survival advantages for patients undergoing complete resection of metastatic melanoma. Further, surgical resection can produce an immediate decrease in tumor burden with minimal morbidity and mortality at a reasonable cost.

Bone Neoplasms↗
PubMed1985

Characterization of tumour cells in malignant fibrous histiocytomas and other soft tissue tumours in comparison with malignant histiocytes. I. Immunohistochemical study on paraffin sections.

We have studied the possible origin of histiocytic cells, present in fibrous histiocytomas (MFH) by using immunohistochemistry to demonstrate lysozyme, alpha 1-antitrypsin, alpha 1-antichymotrypsin and receptors for peanut and soy bean agglutinin in tumour cells of MFH compared with their presence in tumour cells of malignant histiocytosis (MH) ('true' histiocytic lymphoma, 'true' histiocytic sarcoma). We included in this study a number of other soft tissue tumours (STT). Lysozyme was detected in half of the cases of malignant histiocytosis (n = 16) but in only two out of 77 MFH. alpha 1-Antitrypsin and alpha 1-antichymotrypsin usually occurred together although the latter was seen in more cases. Both markers were present in majority of cases of MH whereas they were detected in a minority of cases of MFH. MFH cases of the storiform subtype were less frequently stained than the pleomorphic or giant cell subtypes. Receptors for peanut or soy bean agglutinin were detected in nearly all MH cases, whereas their presence was only detected in a small number of MFH. Lysozyme was not detectable in other STT. alpha 1-Antitrypsin and alpha 1-antichymotrypsin were uncommonly present in other STT, except in osteosarcoma and rhabdomyosarcoma. These markers therefore have a limited value as indicators of a possible histiocytic origin of MFH. Lectins showed weak affinity for other STT. In accordance with others, we therefore conclude that the progenitor cell of MFH has to be sought within the undifferentiated mesenchymal cells and that histiocytes themselves probably do not give rise to MFH.

Chymotrypsin↗
PubMed2005

Pulmonary T2N0 adenocarcinoma with metastasis to a lymph node in the thoracic wall.

We experienced a rare case of lung cancer without hilar/mediastinal nodal involvement or direct invasion to the thoracic wall, but with metastasis to a lymph node in the thoracic wall. A 72-year-old woman with lung cancer was admitted to our hospital for the surgical therapy. She had suffered from right pleuritis in her childhood. During the dissection of the pleural adhesion around the whole lung, one small black lymph node was found in the thoracic wall and resected. Then, right middle and lower lobectomy and systematic nodal dissection were performed. The postoperative pathological examination revealed that nodal involvement was not observed in all samples except in the lymph node in the thoracic wall. In lung cancer patients with broad pleural adhesion, we should pay attention to lymph nodes in the thoracic wall. If we find them, the nodes should be resected for accurate staging.

Adenocarcinoma↗
PubMed2005

Angiography-proven liver metastases explain low efficacy of lymph node dissections in medullary thyroid cancer patients.

AIM: To report the role of liver angiography in the staging of medullary thyroid cancer (MTC) patients. MATERIAL AND METHODS: Sixty MTC patients with persistent or recurrent hypercalcitonemia (n=49), a characteristic general symptom (diarrhea, n=4) or a normal basal calcitonin level without general symptoms (n=7) were investigated by dynamic liver CT, MRI and angiography between 06/1998 and 06/2002. RESULTS: Dual-phase CT and MRI investigations identified hepatic metastases with relatively low frequency (8/58 on MRI, and 7/60 on CT). Angiography indicated liver involvement in 54/60 cases. The hepatic metastases were typically multiple, hypervascular, small foci (only 13 foci measured >/=10 mm). With one exception significant disease progression was not observed over 5 years of follow-up. CONCLUSIONS: Liver angiography is a powerful tool to reveal hepatic metastases in MTC patients. Frequent, inoperable liver metastases in hypercalcitoninemic MTC patients demonstrate that secondary lymph node dissection is an inefficient technique for restoration of a normal calcitonin level.

Angiography↗
PubMed2005

Versican in nonsmall cell lung cancer: relation to hyaluronan, clinicopathologic factors, and prognosis.

The aim of the study was to investigate the expression and prognostic role of versican in 212 patients with resected nonsmall cell lung cancer. Tumor samples were stained immunohistochemically, and the versican staining was evaluated both in tumor stroma and cancer cells. The staining results were compared to the clinical data of the patients, the tumor cell proliferation, and the expression of hyaluronan. In the whole material, low and high area percentages of stromal versican staining were observed in 135 and 77 carcinomas, respectively. Tumor cell-associated staining signal for versican was observed in 33 cases. In the whole material, the significant relationship between high stromal staining of versican and that of hyaluronan was noticed (P = .001). The expression of stromal versican was related to tumor type (P = .008) and high stromal staining was inversely correlated with poor tumor differentiation (P = .045), but not with tumor cell proliferation. Among adenocarcinomas, the high stromal staining of versican was associated with tumor recurrence (P = .024), higher tumor stage (P = .022), and lymph node metastases (P = .042). Versican expression was not related to patient outcome in the whole material, but among adenocarcinomas, the high stromal staining was related to poor disease-free survival (P = .0056). However, in Cox multivariate analysis with tumor stage, versican expression did not retain its prognostic significance. The results indicate that increased stromal versican is related to higher tumor recurrence rate and more advanced disease. Despite the important role of versican in nonsmall cell lung cancer, traditional clinicopathologic factors remained most significant in the current study.

Adult↗