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PubMed1977

Malignant mixed tumors arising in salivary glands. I. Carcinomas arising in benign mixed tumors: a clinicopathologic study.

Forty-seven cases of malignant mixed tumor (MMT) arising in major and minor salivary glands are presented. By definition, all these lesions contained both a benign mixed tumor (BMT) as well as a malignant neoplasm, usually a poorly differentiated carcinoma. In some cases, the carcinoma developed in a previously untreated salivary gland mass which was known to have been present for many years, others evolved in a recurrent previously resected BMT and still others originated in a previously undetected BMT. Adverse prognostic factors included: carcinomatous involvement of the resection lines, perineural invasion, metastases in lymph nodes, and origin in a major salivary gland. Lesions arising in the palate had a better prognosis as compared to major salivary gland tumors. Some patients died of locally uncontrollable tumor and others because of metastatic disease. Local recurrences of MMT were seen frequently; 18 patients (38%) had a total of 32 local recurrences. Of patients followed five years or more, seven (35%) had died of tumor, 11 (55%) had no evidence of disease, and two (10%) had died of other causes. Prolonged follow-up is required because recurrences and death from tumor may be seen many years following the diagnosis of MMT. Recommendations for therapy are made. Criteria for differentiating MMT from recurrent BMT and from cylindromatous carcinoma are discussed.

Adenocarcinoma↗
PubMed2002

Pathologic features of superficial esophageal squamous cell carcinoma with lymph node and distal metastasis.

BACKGROUND: Endoscopic mucosal resection (EMR) is a less invasive localized treatment for patients with esophageal carcinoma. However, indications for EMR use in cases of superficial esophageal carcinoma are controversial. The authors evaluated histopathologic risk factors for lymph node metastasis and recurrence. METHODS: In the specimens resected, the authors examined depth, the superficial area and the area attached to or infiltrating the lamina muscularis mucosa. RESULTS: The authors found that the superficial area and the attached or infiltrated area reflected the depth of the tumor. However, there was a recurrence of esophageal carcinoma even in m3 cases attached only to the lamina muscularis mucosa. CONCLUSIONS: The authors concluded that ml and m2 esophageal carcinoma had almost no risk of lymph node metastasis and recurrence no matter how extensive the superficial area. In addition, sm2 and sm3 carcinoma have a high frequency of lymph node metastasis and recurrence. M3 and sm1 carcinoma run the risk of lymph node metastasis and recurrence however small the superficial area and the area attached to or infiltrating the lamina muscularis mucosa. Treatment strategies for patients with superficial esophageal carcinoma, including EMR, should take the above findings into account.

Aged↗
PubMed2003

Current management of mucosal melanoma of the head and neck.

While mucosal-based melanomas of the head and neck region are uncommon lesions, when they do arise they usually follow an inexorably aggressive course. Experience with these tumors is, necessarily, limited; as such, well-worked out treatment protocols for the treatment of such lesions are in short supply. It appears as though mucosal melanomas (MuMs) develop more frequently in the nasal cavity and paranasal sinus region, and less often in the oral cavity. It seems that the incidence of nodal metastasis is significantly lower for sinonasal MuMs than it is for MuMs of the oral cavity; this observation may influence decisions about performing neck dissection as a function of location of the primary MuM. At present, surgical excision remains the mainstay of treatment; however, anatomical complexities within the region can hamper attempts at complete excision. Radiotherapy has not traditionally been relied on for routine treatment of MuM, although some recent reports have challenged this view. Chemotherapy is, at present, employed principally in the treatment of disseminated disease and for palliation. As a diagnostic matter, MuM belongs to the class of tumors that, on light microscopy, may with some regularity be confused with other malignancies (including sarcomas, plasmacytomas, and carcinomas); as a consequence, this is a diagnosis which is often best confirmed by way of ancillary testing via immunohistochemical studies. A better grasp of the best means of treating MuM will likely come only when large referral centers are able to pool their experiences with these uncommon yet virulent malignancies.

Head and Neck Neoplasms↗
PubMed1975

[Surgery of the tongue and floor of the mouth (author's transl)].

Most carcinomas of the oral tongue and floor of the mouth are presently treated surgically, often combined with pre- or postopervative irradiation. The treatment plan is mainly determined by the primary site and the local and regional extension, desirable are general rules on the basis of the TNM classification. The indications and principles of the most important operative procedures are discussed: Local excision, partial glossectomy, excision of the floor of the mouth with marginal mandibulectomy, composite resection. Operations for removal of the primary and radical neck dissection with preservation of the mandible (e.g. the pull-through procedure) are rarely advised. A radical neck dissection is indicated in each carcinoma of the oral tongue or floor of the mouth with palpable lymph nodes. If no nodes are palpable, an elective neck dissection is advised in view of the high frequency of clinically occult lymph node metastases (between 23 and 43%). Reconstructive measures following radical tongue and floor of the mouth operations are required for regaining a motility of the remaining tongue, for reconstruction of the floor of the mouth and for replacement of the mandible.

Carcinoma, Squamous Cell↗
PubMed1994

Three-dimensional studies on the structure of the tissue surrounding the superior mesenteric artery.

The anatomy and topography of tissue surrounding the superior mesenteric artery were examined histopathologically, and the structure surrounding the superior mesenteric artery (SMA) was reconstructed with data from histologic examination and three-dimensional analyses. Specimens were obtained from three autopsy cases without abnormalities, two surgically resected cases of cancer of the pancreatic head, and one autopsy case of cancer of the pancreatic head. The endothelium or basal membrane of blood and lymph vessels were identified immunohistochemically, and the distribution of lymph nodes, blood vessels, lymph vessels, and collagen fibers was determined. The superior mesenteric plexus was found to be a relatively dense structure with a thickness of about 2 mm, composed of collagen fibers and connective tissue, which concentrically enveloped the small arteries, the superior mesenteric artery, nerve bundles, and capillaries. Lymph vessels larger than a few micrometers in diameter were often found outside of the plexus, and this plexus contained no lymph nodes in any sections. The three-dimensional study of the modes of spread along the superior mesenteric artery of pancreatic cancer revealed two types of spread: the tumor extends mainly by neural invasion, and the tumor extends mainly by lymph node metastases. These morphologic features suggest that lymphatic flow in the vicinity of the superior mesenteric artery passes primarily outside of the plexus, and complete excision of lymph nodes close to the superior mesenteric artery with preservation of the superior mesenteric plexus is feasible if there is no neural invasion into retropancreatic tissues.

Biomarkers↗
PubMed1997

[A phase-I/II study on the local hyperthermia of cervical N2/N3 lymph node metastases].

BACKGROUND: Patients with advanced lymph node metastases from head and neck tumors at stage N2/N3 (i.e. UICC IV) present a difficult therapeutic problem. Despite combined radio-chemotherapy and hyperfractionated and/or accelerated fractionation regimens, local control of these tumors remains unsatisfactory. For this reason, the value of local radio wave/microwave hyperthermia was examined for this patient group in a phase I/II study.

Adult↗
PubMed1977

Multidisciplinary treatment for childhood sarcoma.

Surgical extirpation of the primary tumor has traditionally been utilized as initial treatment for sarcomas in children. The present report, however, demonstrates that sarcomas are optimally treated by means of a coordianted multidisciplinary approach. The latter offers the potential for achieving improved survival and preservation of organs and limbs, particularly for structures of the head and neck, for extremities, and in the genitourinary system.

Adolescent↗
PubMed1987

The superior mesenteric artery fat plane: is obliteration pathognomonic of pancreatic carcinoma?

Obliteration of the fat plane surrounding the superior mesenteric artery has been described as characteristic of pancreatic carcinoma. To determine the specificity of this and other computed tomography findings in the pancreas and peripancreatic region, scans of 86 patients were reviewed without clinical history. Diagnoses included pancreatitis (26 patients); pancreatic adenocarcinoma (14 patients); lymphoma (17 patients); metastatic nonpancreatic carcinoma (14 patients); and normal findings (15 patients). Confluent adenopathy could not be reliably differentiated from a pancreatic mass except when adenopathy separated the common bile duct from the duodenum. Retrocrural adenopathy was unusual with pancreatic carcinoma. The fat plane surrounding the superior mesenteric artery was obliterated with pancreatic carcinoma (36%), nonpancreatic carcinoma (29%), and lymphoma (24%), but not with pancreatitis, although perivascular edema was seen in 19%. Evaluation of the celiac axis was less rewarding. Obliteration of the superior mesenteric artery fat plane is a sign of malignancy, but it is not specific for pancreatic carcinoma. We propose that the superior mesenteric artery origin be considered within a paraaortic space, separate from the anterior pararenal space. This explains its characteristic lack of involvement by pancreatitis.

Adipose Tissue↗
PubMed2005

Results of multimodal treatment for desmoplastic small round cell tumors.

PURPOSE: Desmoplastic small round cell tumors (DSRCTs) are rare aggressive neoplasms that frequently present with large symptomatic intraabdominal masses. We examined the effects of multimodal therapy including induction chemotherapy, aggressive surgical debulking, and external beam radiotherapy on patients with DSRCT. METHODS: Institutional Review Board permission was obtained. Sixty-six patients were diagnosed by histology, immunohistochemistry, and or cytogenetics as having DSRCT at our institution from July 1, 1972, to July 1, 2003. Data were collected on patient demographics, presenting symptoms, tumor location and extent, treatment regimen, and overall survival. RESULTS: A majority of patients were male (91%), Caucasian (85%), and with a median age of 19 (7-58) years old at diagnosis. The most common presenting complaint was an intraabdominal mass (64%). In 63 patients (96%), the primary tumor was located in the abdomen or pelvis. Thirty-three (50%) had positive lymph nodes and 27 (41%) had distant parenchymal metastases at diagnosis. Overall, 3- and 5-year survivals were 44% and 15%, respectively. Twenty-nine of these patients (44%) underwent induction chemotherapy (P6), surgical debulking, and radiotherapy. Three-year survival was 55% in those receiving chemotherapy, surgery, and radiotherapy vs 27% when all 3 modalities were not used (P < .02). Gross tumor resection was highly significant in prolonging overall survival; 3-year survival was 58% in patients treated with gross tumor resection compared to no survivors past 3 years in the nonresection cohort (P < .00001). Ten patients (15%) have no evidence of disease with a median follow-up of 2.4 years (range, 0.4-11.2 years). CONCLUSIONS: Multimodal therapy results in improved survival in patients with DSRCT. Aggressive surgical resection of these extensive intraabdominal neoplasms correlates with improved patient outcome.

Abdominal Neoplasms↗
PubMed2004

Perinodal involvement of cancer cells in gastric cancer patients.

BACKGROUND: En-bloc resection for cancer has been a standard procedure based on the concept that there may be a small number of "invisible" cancer cells around the primary tumor and metastatic lymph nodes. However, there are few histopathologic studies of this issue. METHODS: Perinodal involvement of cancer cells, defined as existence of cancer cells in the attached fatty tissue around the dissected lymph nodes, was assessed in 123 node-positive and 15 node-negative gastric cancers by both hematoxylin-eosin staining and immunohistochemistry. RESULTS: Perinodal involvement was found in 79 (57%) of the 138 patients. The incidence was higher in patients with tumors invading the deeper layer, the macroscopic diffuse type, the presence of lymphatic or vascular invasion (P<.05), and advanced disease (stage I, 17%; II, 62%; III, 67%; IV, 80%). Survival of patients with perinodal involvement was less than that of patients without perinodal involvement (46% vs 87%; P<.005). Perinodal involvement was found, by multivariate analyses, to be a significant prognostic factor. CONCLUSIONS: Perinodal cancer cells are observed frequently in gastric cancers with lymph node metastases, and the involvement appears to be a reliable prognostic factor for gastric cancers.

Adenocarcinoma↗
PubMed1997

Micro-anatomy of primary lymphatics in oral mucosa: a scanning electron microscopic study.

Primary or initial lymphatics cannot readily be recognised by conventional histological methods because they have usually collapsed in excised tissues. We have investigated the distribution of 81 initial lymphatics in 24 specimens of normal tissue and specimens from 11 squamous cell carcinomas and their relationship with the invasion of carcinoma. We used indirect injection methods and the distended initial lymphatics were observed by scanning electron microscopy. The lymphatics were arranged in a network consisting of integrated lymph capillaries and precollectors in the subepithelial area. There was a zone of high density 100 microm below the epithelium. The arrangement of initial lymphatics in oral mucosa was similar to that in the skin of head, in contrast to initial lymphatics in the skin at other sites. We saw no carcinoma cells penetrating into initial lymphatics and the route of tumourous infiltration into lymphatics deserves further investigation.

Carcinoma, Squamous Cell↗
PubMed2005

D2-40 immunohistochemical analysis of pediatric vascular tumors reveals positivity in kaposiform hemangioendothelioma.

Kaposiform hemangioendothelioma is a distinctive vascular neoplasm affecting predominantly children and neonates. In neonates it needs to be differentiated from common infantile hemangioma and other vascular lesions of infancy. Kaposiform hemangioendothelioma immunoreacts with vascular endothelial growth factor receptor 3, and partial lymphothelial differentiation of this lesion has been suggested. D2-40 has been recently proposed as a selective marker of lymphatic endothelium. We performed immunohistochemical analysis with the D2-40 antibody on 24 kaposiform hemangioendotheliomas and 48 other pediatric vascular lesions including common infantile hemangioma (n=10), rapidly involuting congenital hemangioma (n=10), non-involuting congenital hemangioma (n=9), verrucous hemangioma (n=9), and pyogenic granuloma (n=10) to define whether this marker can be applied in the diagnosis of vascular lesions of infancy. In all, 23 of 24 (96%) kaposiform hemangioendotheliomas exhibited a distinct staining, while none of the other lesions immunoreacted with D2-40. D2-40 stained the neoplastic spindled cells and lymphatic channels adjacent to vascular lobules of kaposiform hemangioendothelioma. These findings support D2-40 as a new determinate marker for kaposiform hemangioendothelioma, useful in differentiating it from other vascular lesions of infancy and suggest lymphothelial differentiation of the neoplastic component of kaposiform hemangioendothelioma. Further studies are necessary to define the identity of the D2-40 antigen and to elucidate the biologic significance of its selective lymphothelial reactivity..

Actins↗
PubMed2000

Angiomyomatous hamartoma and associated stromal lesions in the right inguinal lymph node: a case report.

Angiomyomatous hamartoma is a rare disease with a predisposition for the inguinal lymph nodes. A 51-year-old male patient visited a local hospital because of a right inguinal mass, measuring 3 x 4 cm in size, which was resected. The resected specimen showed irregularly distributed thick-walled vessels in the hilum, extending into the medulla and focally into the cortex of the node, eventually becoming more dispersed and associated with smooth muscle cells splaying into sclerotic stroma. These findings are compatible with an angiomyomatous hamartoma. Another tumor-like mass appeared shortly after the resection at the same location, but was not an angiomyomatous hamartoma, rather it was composed of edematous stromal tissue with proliferating smooth muscle cells. The stromal component included thick-walled blood vessels and lymphatics. Although it could not be determined whether these associated changes in the surrounding stroma are a cause or an effect of angiomyomatous hamartoma, they indicate the clinical difficulty in determining an appropriate area of resection and may provide clues to the pathogenesis of angiomyomatous hamartoma.

Actins↗
PubMed2000

Calcium signals in prostate cancer cells: specific activation by bone-matrix proteins.

Cancer of the prostate commonly metastasizes to bony sites where cells acquire an aggressive, rapidly proliferating, androgen-independent phenotype. The interaction between bone and prostate, thus, becomes a key factor in disease progression. Fluctuations in intracellular ionized Ca2+ [Ca2+]i are rapid, regulated signal transduction events often associated with cell proliferation. Hence, Ca2+ signals provide a convenient measure of early events in cancer cell growth. This study developed single cell fluorescent imaging techniques to visualize Ca2+ signals in Fura-2 loaded prostatic cancer cell lines of various metastatic phenotypes. Solubilized bone fractions containing extracellular matrix and associated proteins were tested for the ability to trigger Ca2+ signals in prostate cancer cell lines. Fractions representing the complete repertoire of non-collagenous proteins present in mineralized bone were tested. Results demonstrated that two bone fractions termed D3b- and D4a-triggered Ca2+ signals in prostate cancer cells derived from bone (PC-3), but not brain (DU-145) metastases of prostate cancer. Lymph-node derived LNCaP cells also did not produce a Ca2+ signal in response to addition of soluble bone matrix. No other bone fractions produced a Ca2+ signal in PC-3 cells. It is of interest that bone fractions D3b and D4a contain a number of non-collagenous matrix proteins including osteonectin (SPARC) and osteopontin (OPN), as well as prothrombin. Moreover, antibody LM609 that recognizes the alpha v beta 3 integrin, blocks the ability of OPN to trigger a Ca2+ transient in PC-3 cells. These studies support a conclusion that bone-matrix proteins play a role in the growth and progression of metastatic prostate cancer, and that prior growth in bone may be associated with development of a bone-matrix-responsive phenotype.

Adenosine Triphosphate↗
PubMed1991

[Problems in recognizing recurrences of craniocervical malignancies in CT].

A retrospective study was carried out involving 39 patients with malignant tumours of the head and neck in order to differentiate by CT changes due to local tumour or lymph node recurrences and various post-operative or post-irradiation changes. In these patients, two or more CT examinations of the neck were available, derived from a fourth generation scanner. The suspected lesions were classified according to their type and the appearances correlated with the treatment and clinical findings. There was frequent overlap between the appearances of benign and malignant changes, so that in individual cases a definite decision often proved impossible.

Adult↗
PubMed2003

Percutaneous endoscopic gastrostomy associated gastric metastasis.

An interesting case of gastric metastasis of head and neck cancer after percutaneous endoscopic gastrostomy (PEG) placement is presented. Gastric metastases may appear in 3 morphologic varieties endoscopically. They may be multiple nodules of varying size, submucosal tumor masses with tip ulceration, or nonulcerated masses. Histologically, they may be seen as microscopic infiltration, a gross nodule, gross ulceration, or a gross hypertrophied wall. A case of PEG associated gastric metastasis has been reported almost every year since 1989. Even then, PEG placement by pull method continues to be a common procedure for patients diagnosed with head and neck cancer. The mechanism of gastric metastasis in patients with PEG is unclear. Seeding as well as hematogenous and lymphatic spread to traumatized tissue may be the cause.

Brain Neoplasms↗