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Results for “Neoplasm Grading”

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PubMed2002

Stage Ta-T1 bladder cancer: the relationship between findings at first followup cystoscopy and subsequent recurrence and progression.

PURPOSE: We studied the relationship of first cystoscopy findings with recurrence and progression rates in a large, population based series of patients with bladder cancer. MATERIALS AND METHODS: All 463 patients with an initial diagnosis of stage Ta-T1 bladder cancer in western Sweden in 1987 to 1988 were followed at least 5 years. The 355 patients who were treated with transurethral resection only until repeat cystoscopy or longer were selected for this report. RESULTS: Negative first cystoscopy findings were associated with significantly decreased recurrence and progression rates for all grades, and for stage Ta and T1 tumors. However, some patients with initial high grade carcinoma (WHO 2 to 3) had stage progression despite negative first cystoscopy. On multivariate analyses first cystoscopy findings and papillary urothelial neoplasm of low malignant potential versus grades 1 to 3 but not stage and the number of tumors had prognostic significance for time to recurrence. Only first cystoscopy findings and grade had prognostic significance for time to stage progression. CONCLUSIONS: Our data support other groups who recommend a less intense cystoscopy followup schedule in patients with negative cystoscopy findings 3 months after initial transurethral bladder resection. We recommend that patients with initial papillary urothelial neoplasm of low malignant potential and low grade carcinoma (WHO 1) with negative first cystoscopy findings undergo repeat cystoscopy at month 12. In our opinion followup should not be less intense in patients with high grade carcinoma (WHO 2-3), even in those with stage pTa disease.

Cystoscopy↗

PubMed2005

MDCT urography of upper tract urothelial neoplasms.

OBJECTIVE: The purpose of our study was to review the MDCT urography appearance of pathologically proven transitional cell carcinomas of the renal collecting system and ureter and to correlate the MDCT urography findings with pathology findings. MATERIALS AND METHODS: Of 370 MDCT urography examinations performed over an 18-month period, 18 patients were diagnosed with 27 renal collecting system or ureteral urothelial neoplasms at endoscopic biopsy (n = 8) or surgery (n = 19). Initial MDCT reports were reviewed to determine the sensitivity of original reviewers in detecting these neoplasms. Two radiologists also retrospectively reviewed these scans and characterized the CT appearance of the neoplasms on both axial CT and 3D reformatted images. Findings at retrospective review were correlated with pathology results to determine whether any CT features could be used to predict tumor grade. RESULTS: Eighteen of 27 neoplasms were prospectively identified on MDCT urography, and an additional six neoplasms were detected on retrospective review. Three ureteral neoplasms could not be visualized. The 24 retrospectively detected neoplasms had three distinct MDCT appearances: circumferential urothelial wall thickening (n = 14), small masses (> 5 mm in maximal diameter) (n = 5), and large masses (> 5 mm in maximal diameter) (n = 5). All detected lesions could be seen on axial excretory phase images provided wide window settings were reviewed; however, only six were detected on 3D reconstructions. MDCT urography appearance did not correlate with tumor grade. CONCLUSION: MDCT urography is a promising technique for detecting upper urinary tract neoplasms. The static 3D reconstructions used in this study are insufficient for visualization. Axial image review remains essential for tumor identification.

Aged↗

PubMed2006

Typical bronchopulmonary carcinoid tumors: a ramifying bronchial presentation with metastatic behavior.

Bronchopulmonary typical carcinoid tumors (BTCT) are neuroendocrine neoplasms with histologic low grade characteristics considered benign. However, despite reassuring histologic classification, some of them demonstrate an aggressive nature and metastatic behavior. During a not yet concluded study aiming at establishing criteria to predict this metastatic behavior, three uncommon cases were observed. Metastasis occurred despite typical carcinoid microscopic features in 3 female patients of African origin presenting at macroscopic examination as ramifying bronchopulmonary typical carcinoid tumors following the bronchial tree. We suggest that clinical ramifying presentation may be related to metastatic behavior, even for bronchopulmonary typical carcinoid tumors not displaying histologic criteria for atypical carcinoid tumors.

Aged↗

PubMed1996

Amplification of the cyclin-dependent kinase 4 (CDK4) gene is associated with high cdk4 protein levels in glioblastoma multiforme.

Genetic alterations on the long arm of chromosome 12, including both gene amplification and allelic loss, are associated with malignant progression of human gliomas. The region of the chromosomal arm 12q that is amplified in malignant gliomas contains the CDK4 gene, a cell cycle regulatory gene which promotes cell division. To evaluate the frequency of CDK4 gene amplification, we analyzed a series of 355 brain tumors using a quantitative non-radioactive polymerase chain reaction assay. CDK4 gene amplification occurred in 9 of 81 glioblastomas (11%), but was rare in other neoplasms, including low-grade and anaplastic gliomas, meningiomas, medulloblastomas and metastatic carcinomas (only 6 of 274 cases). There was no correlation between CDK4 gene amplification and allelic loss of chromosome 12. To assess the significance of CDK4 gene amplification, we analyzed protein extracts from 37 glioblastomas by Western blotting with a commercially available polyclonal antibody to cdk4. All tumors with CDK4 gene amplification showed high cdk4 expression levels, whereas no increased cdk4 expression was seen in glioblastomas without CDK4 gene amplification. These data support the functional activity of CDK4 gene amplification in glioblastoma multiforme and point to an important role of CDK4 gene amplification in a subset of glioblastomas.

Brain Neoplasms↗

PubMed1993

Low-grade B-cell lymphoma of mucosa-associated lymphoid tissue arising in the kidney.

We describe a malignant lymphoma arising in the kidney that exhibited clinical and histologic features of low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). Clinically, the neoplasm involved the kidney and one perirenal lymph node (stage IIE) and did not recur or disseminate following nephrectomy, lymphadenectomy, and local radiation therapy. Histologically, the neoplasm recapitulated the features of low-grade B-cell lymphomas of MALT at other sites. The neoplastic cells resembled centrocyte-like cells, some of which formed lymphoepithelial lesions with renal tubules, and reactive lymphoid follicles were scattered within the neoplasm. The neoplastic cells expressed monotypic cytoplasmic Ig kappa. Low-grade B-cell MALT lymphomas arising in the kidney are rare. Their occurrence further demonstrates the diversity of anatomical sites that may be involved by MALT lymphomas. In addition, this neoplasm also had histologic and cytologic features resembling those of monocytoid B-cell lymphoma, supporting the hypothesis that low-grade B-cell lymphomas of MALT and monocytoid B-cell lymphomas are closely related and may be two morphological manifestations of the same neoplasm.

Aged↗

PubMedDate not supplied

From the Archives of the AFIP: neoplasms of the urinary bladder: radiologic-pathologic correlation.

In the United States, primary bladder neoplasms account for 2%-6% of all tumors, with bladder cancer ranked as the fourth most common malignancy. Ninety-five percent of bladder neoplasms arise from the epithelium; the most common subtype is urothelial carcinoma, which accounts for 90% of cases. Squamous cell carcinoma accounts for 2%-15%, with rates varying widely according to geographic location. Adenocarcinoma (primary bladder, urachal, or metastatic) represents less than 2%. Bladder cancer typically occurs in men aged 50-70 years and is related to smoking or occupational exposure to carcinogens. Most urothelial neoplasms are low-grade papillary tumors, which tend to be multifocal and recur but have a relatively good prognosis. High-grade invasive tumors are less common and have a much poorer prognosis. Squamous cell carcinoma and adenocarcinoma occur in the setting of chronic bladder infection and irritation. Mesenchymal tumors represent the remaining 5% of bladder tumors, with the most common types being rhabdomyosarcoma, typically seen in children, and leiomyosarcoma, a disease of adults. Rarer mesenchymal tumors include paraganglioma, lymphoma, leiomyoma, and solitary fibrous tumor. Although imaging findings are not specific for these tumors, patterns of growth and tumor characteristics may allow differentiation. For accurate staging, computed tomography and magnetic resonance imaging are the modalities of choice.

Carcinoma↗

PubMed2006

[Desmoid tumor of chest wall--an important differential diagnosis to malignancies].

Desmoid tumors are rare solid tumors that arise from musculoaponeurotic tissues. They are classified as benign as they do not metastasize. Desmoid tumors can, however, exhibit rapid local growth and clinically they can mimic sarcomas. Their histological appearance can also resemble some malignant neoplasms such as low grade sarcomas, rendering the differential diagnosis difficult. The present report describes a 60-year-old woman with a history of left mastectomy, performed for a lymph node negative adenocarcinoma. At follow-up 4 years later, a solid nodule was palpated below the right breast. The tumor increased in size over several weeks and caused local radiating chest pain. Clinically a breast cancer metastasis was suspected. Open biopsy revealed a desmoid tumor. The tumor was resected together with a part of the anterior hemithorax, and the defect in the chest wall covered with a Goretex-patch. Six months postoperatively, the patient is doing well with no signs of locally recurrent disease.

Diagnosis, Differential↗

PubMed2006

The solid-pseudopapillary tumor of pancreas: the clinical characteristics and surgical treatment.

BACKGROUND AND OBJECTIVE: Since being named and reclassified by WHO in 1996, solid-pseudopapillary tumor (SPT) of pancreas has been recognized as a special entitative disease that is different from pancreatic cancer and should be recognized and treated more accurately in the surgical process. The clinic characteristics and surgical strategy on 25 cases of SPT of pancreas from the authors' center are discussed. METHODS: The clinical pathology and the surgical methods of 25 SPTs were retrospectively studied. The analyses were performed by the statistical software package SAS6.12. RESULTS: No tumor recurrences were found in all patients. There was significant difference between operative types in radical resection and the tumor position of the pancreas (P = 0.0011). The judgment on the tumor's boundary could directly affect the adoptable operative types (P = 0.0099). CONCLUSIONS: As a uniquely entitative disease, SPT is a kind of uncommon neoplasm with low-grade malignancy with a strong rate of occurrence in women. Surgical resection is most favorable in the treatment of SPT, which has excellent prognosis. The course of SPT, the possible malignant cells by the frozen section biopsy, and the tumor's boundary are important for operators to decide an operative scheme. SPT that has infiltrated contiguous vessels, organs, even with local liver metastasis should not be regarded as operative contraindication. The choice of the local tumor resection, the part of pancreas resection or radical resection depends on the judgment of the tumor's boundary, whereas operative types in radical resection depend on the tumor position of the pancreas.

Adolescent↗

PubMed2003

Extended follow-up of long-term survivors of childhood acute lymphoblastic leukemia.

BACKGROUND: Children who survive acute lymphoblastic leukemia are at risk for leukemia-related or treatment-related complications, which can adversely affect survival and socioeconomic status. We determined the long-term survival and the rates of health insurance coverage, marriage, and employment among patients who had attained at least 10 years of event-free survival. METHODS: A total of 856 eligible patients were treated between 1962 and 1992 in 13 consecutive clinical trials. Survival rates, the cumulative risk of a second neoplasm, and selected indicators of socioeconomic status were analyzed for the entire group and for patients who did or did not receive cranial or craniospinal radiation therapy during initial treatment. RESULTS: Fifty-six patients had major adverse events, including 8 deaths during remission, 4 relapses, and 44 second neoplasms (41 of them radiation-related); most of the second neoplasms were benign or of a low grade of malignant potential. The risk of a second neoplasm was significantly higher in the 597 patients who received radiation therapy (irradiated group) than in the 259 patients who did not receive radiation therapy (nonirradiated group) (P=0.04; estimated cumulative risk [+/-SE] at 20 years, 20.9+/-3.9 percent vs. 0.95+/-0.9 percent). The death rate for the irradiated group slightly exceeded the expected rate in the general U.S. population (standardized mortality ratio, 1.90; 95 percent confidence interval, 1.12 to 3.00), whereas that for the nonirradiated group did not differ from the population norm (standardized mortality ratio, 1.75; 95 percent confidence interval, 0.34 to 5.00). The rates of health insurance coverage, marriage, and employment in the nonirradiated group were similar to the age- and sex-adjusted national averages. Despite having health insurance rates similar to those in the general population, men and women in the irradiated group had higher-than-average unemployment rates (15.1 percent vs. 5.4 percent and 35.4 percent vs. 5.2 percent, respectively), and women in the irradiated group were less likely to be married (35.2 percent vs. 48.8 percent). CONCLUSIONS: Children with acute lymphoblastic leukemia who did not receive radiation therapy and who have attained 10 or more years of event-free survival can expect a normal long-term survival. Irradiation is associated with the development of second neoplasms, a slight excess in mortality, and an increased unemployment rate.

Adolescent↗

PubMed2003

Utility of proton MR spectroscopy in the diagnosis of radiologically atypical intracranial meningiomas.

Our aim was to evaluate the usefulness of proton MR spectroscopy ((1)H MRS) in the diagnosis of radiologically atypical brain meningiomas. We studied 37 patients with intracranial meningiomas with MRI and (1)H MRS (TE 136 ms). Their spectra were quantitatively assessed and compared with those of 93 other intracranial brain neoplasms: 15 low-grade and 14 anaplastic astrocytomas, 30 glioblastomas and 34 metastases. The most characteristic features of meningiomas were the presence of alanine, high relative concentrations of choline and glutamine/glutamate and low concentrations of creatine-containing compounds, N-acetyl-containing compounds and lipids. These resonances were assembled in algorithms for two-way differentiation between meningioma and the other tumours. The performance of the algorithms was tested in the 130 patients using the leave-one-out method, with 94% success in differentiating between meningioma and other tumour. Of the 37 meningiomas, five (14%) were thought atypical on MRI, and in only one of these, found to be malignant on histology, was a diagnosis other than meningioma suggested by the algorithm. The other four were correctly classified. We suggest that (1)H MRS provides information on intracranial meningiomas which may be useful in diagnosis of radiologically atypical cases.

Adolescent↗

PubMed2006

[Cervical carcinoma in situ: a clinical and pathological analysis of 118 cases].

OBJECTIVE: To analyze the clinical characteristics and treatment of cervical carcinoma in situ. METHODS: The clinical data of 118 patients with cervical carcinoma in situ (CIS), aged 38.8 (24-77), were retrospectively analyzed. RESULTS: Cervical cytology showed that most of the lesions were cervical intraepithelial neoplasm (CINIII), high-grade squamous intraepithelial lesion (HSIL), or CIS. Most of the patients underwent colposcopic examination. All the patients underwent conization. 54% of the patients were given cold knife conization, and 46% of the patients received electric knife conization. 71 of the patients undergoing conization (60%) were followed-up. Another 40% received total hysterectomy and/or bilateral salpingo-oophorectomy. 17 cases were found pregnant after the conization. There were no differences in pathologically thorough resection and operational complication between the two surgery methods: cold knife conization and electric knife conization. Follow up study showed that conization had no effect on the subsequent pregnancy. CONCLUSION: Conization is necessary for the final diagnosis of cervical carcinoma in situ. Both cervical cytology and colposcopic examination are very important for screening of CINIII or CIS. For the young patients conization suffices, however, for the postmenopausal women or those unable to receive follow-up examination total hysterectomy and bilateral salpingo-oophorectomy should be considered.

Adult↗

PubMedDate not supplied

Pediatric neuro-oncology: controversies in current therapy.

Current Phase III clinical trials for the treatment of malignant central nervous system (CNS) tumors of childhood are reviewed. Combination neurosurgical, radiation treatment and chemotherapy have improved both the quality and duration of life for the affected children. Controversy exists regarding the appropriate adjunctive chemotherapy for newly diagnosed CNS neoplasms but this is being prospectively studied in controlled trials. Major dilemmas persist regarding the management of low-grade gliomas and recurrent CNS neoplasms. Preliminary data on possibly favourable protocols are cited. Future directions for clinical and basic laboratory investigation are also briefly reviewed.

Brain Neoplasms↗

PubMed1993

HLA class I expression and HPV-16 sequences in premalignant and malignant lesions of the cervix.

A series of 10 normal cervix epithelia, 38 condylomas, 17 CIN (cervical intraepithelial neoplasm) I/II (low-grade CIN), 10 CIN III (high-grade CIN), 27 squamous cell carcinomas and 7 adenocarcinomas of the cervix were studied in paraffin-embedded sections for the expression of MHC class I antigens, using antibodies against HLA antigens and the immunoperoxidase technique. A PCR technique was also used to evaluate the presence of HPV-16 DNA. All samples from normal tissue, benign, premalignant and CIN III lesions expressed HLA class I antigens. However, 15% of the invasive carcinomas completely lacked HLA-B and HLA-C antigen expression, 20% presented a heterogeneous pattern and 2 cases lacked HLA-B and HLA-C heavy chain but retained beta 2-microglobulin. MHC class I antigen expression on tumors was compared with clinical-pathological parameters. The absence of expression of HLA class I molecules was significantly associated with the Glanz histoprognostic index of malignancy. HPV-16 sequences were detected in 60% of the condylomas, 88% of the CIN I/II, 80% of the CIN III and 82% of the cervical carcinomas. Eight-six per cent of the tumors expressing HLA class I antigen presented HPV-16, whereas only 40% of the nonexpressing tumors did. Our results lead us to the following conclusions: a) HLA class I losses occurred when the tumor became invasive, and in tumors of a more aggressive histological type; b) The presence of HPV-16 was associated with tumors expressing HLA class I antigens.

Adenocarcinoma↗

PubMed1991

Polymorphous low-grade adenocarcinoma of minor salivary gland. A comparative histologic and immunohistochemical study.

Sixteen polymorphous low-grade adenocarcinomas were reviewed and compared with 17 adenoid cystic carcinomas and with 21 other histologically similar minor salivary gland neoplasms. The polymorphous low-grade adenocarcinomas were for the most part distinctive in their microscopic appearance. Typically they exhibited infiltrative growth by small uniform cells in single-layered ducts. A syncytium of tumor cells was also characteristic, although solid and cribriform patterns were seen, making definitive diagnosis difficult with some tumors. Immunohistochemical staining for S-100 protein, glial fibrillary acidic protein, actin, vimentin, and keratins resulted in relatively distinctive antigenic profiles for the tumors studied. Of significance was strong S-100 protein and weak actin staining of polymorphous low-grade adenocarcinomas, moderate actin staining of adenoid cystic carcinomas, moderate glial fibrillary acidic protein staining of monomorphic adenomas and pleomorphic adenomas, and nonreactivity of monomorphic adenomas for vimentin. It is believed that the immunoprofiles could be useful in the microscopic diagnosis of salivary gland tumors. The identification of antigens found normally in myoepithelial and epithelial cells supports the concept that these tumors are derived from pluripotential reserve cells.

Actins↗

PubMedDate not supplied

A critical appraisal of the role of brachytherapy for pediatric brain tumors.

While brachytherapy is increasingly being utilized in adult patients with brain tumors, there has been very little experience with this approach in pediatric patients. This report reviews the current published experience with brachytherapy for brain tumors in children. Intracavitary irradiation with radioactive colloid is quite effective in controlling cystic craniopharyngiomas and represents an alternative approach to this subgroup of patients with craniopharyngiomas. There has been a substantial experience with the use of permanent interstitial implants in cases of low-grade astrocytoma in Europe, but its value is difficult to judge because of the variable natural history of these slow-growing neoplasms. Very few high-grade astrocytomas have been treated with brachytherapy in children, but children with localized recurrences after conventional therapy should be considered for this approach.

Astrocytoma↗

PubMed2002

Synchronous serrated adenoma of the appendix and high-grade ovarian carcinoma: a case demonstrating different origin of the two neoplasms.

Association of mucinous adenomas of the appendix and mucinous ovarian tumors is well known. The origin of the ovarian tumor (metastasis from the appendix vs independent primary) is still debated. Serrated adenoma is a rare neoplasm of the distal gastrointestinal tract, and its precancerous role in the colorectum was recently postulated. A 74-year-old patient was subjected to hysterectomy with routine appendectomy due to a 17-cm tumor of her right ovary. Histological examination revealed a high-grade ovarian adenocarcinoma with peritoneal involvement. The appendix, grossly unremarkable, harbored a serrated adenoma with no evidence of invasion or malignant transformation. Immunohistochemical examination revealed CD7+, CK20-phenotype of the ovarian and reverse (CK7-, CK20+) phenotype of the appendiceal tumor. Microsatellite analysis demonstrated microsatellite instability (MSI-high) within the serrated adenoma (4/5 markers with positive amplification) and no MSI (0/6 amplified markers) in the samples from the ovarian carcinoma, its metastases and the uninvolved uterine cervix. There were also differences in LOH pattern between the ovarian adenocarcinoma and the serrated adenoma. The findings suggest two independent primaries with profound differences in tumorigenetic pathways of both lesions. To the best of our knowledge this is the first report of synchronous serrated adenoma of the appendix and ovarian carcinoma.

Adenocarcinoma↗

PubMed2002

Plexiform fibrohistiocytic tumor: a rare low-grade malignancy of children and young adults.

Plexiform fibrohistiocytic tumor (PFT) is a low-grade, superficial, soft tissue neoplasm with a limited but significant ability to metastasize. This type of tumor only rarely presents in the skin of the head and neck. Clinicians first encountering young patients with facial neoplasia, such as a PFT, might be unaware of its exact oncologic potential and instead be primarily concerned with the cosmetic outcome. We treated a 17-year-old boy with a PFT on his cheek who was initially treated only by shave biopsy. The tumor subsequently recurred and metastasized to the cervical lymph nodes 3 years after the initial biopsy. Therefore, appropriate initial therapy for PFT requires complete excision with negative resection margins.

Adolescent↗

PubMed1996

AgNORs and their relationship to cell size, histological grade, lymph node involvement, metastases, and survival pattern in carcinoma of the breast: a study from south India.

An AgNOR count using the Smith and Crocker [Histopathology 12:113-125, 1988] method of staining was performed on 200 cases of carcinoma of the breast. A count of coarse AgNORs per nucleus was made on 50 random cells and the mean of their number per nucleus calculated. The relationship of a single variable "AgNOR count" to other variables such as cell size, histological grade, number of positive ipsilateral axillary lymph nodes, and presence of metastasis in regions other than the ipsilateral axillary lymph nodes was found using a univariate method of analysis. Also, the effect of different independent variables, e.g., number of AgNORs, cell size, histological grade, number of positive axillary lymph nodes, and metastasis on a single variable, i.e., 4-year period of survival, was also assessed by a univariate method of statistical analysis. It was found that the AgNOR count was significantly related to the cell size, histological grade, and presence of metastasis. Large cells, grade III tumors, and neoplasms with evidence of metastasis showed larger numbers of AgNORs in their nuclei. It was observed that the number of AgNORs significantly affected the 4-year survival of patients. The higher the AgNOR counts, the poorer were the chances of surviving for 4 years. The other factors that influenced survival in the present study were the number of positive axillary lymph nodes and metastasis to sites other than axillary lymph nodes.

Axilla↗