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PubMed1979

Retroperitoneal sarcomas obstructing delivery: two case reports.

Two patients with abnormal fetal lies underwent elective Caesarean section. Both abnormal lies were found to be due to retroperitoneal sarcomas overlying the bifurcation of the iliac vessels. One proved to be an inoperable and radioresistant fibrosarcoma. At seven and a half years after Caesarean section and following chemotherapy this patient is alive and well and has had two more children. The other tumour was a large myxoid liposarcoma which was completely removed at the time of Caesarean section. This patient is alive and well 18 months after operation.

Adult↗

PubMed1983

Cyclophosphamide, doxorubicin, and cisplatin combined in the treatment of advanced sarcomas.

Twenty-five patients with evaluable histologically confirmed inoperable metastatic sarcomas were treated once every four weeks with cyclophosphamide, doxorubicin, and cisplatin in doses of 400, 40, and 60 mg/m2, respectively. Cyclophosphamide and doxorubicin were given by rapid intravenous injection followed immediately by cisplatin by slow intravenous infusion (2-6 hr) in 1 liter of 0.45% saline with mannitol added. Leukopenia, alopecia, and vomiting were common side effects and three patients refused further treatment because of vomiting following their initial courses. No drug-related deaths occurred and we removed no one from the study because of toxicity problems. Among the 9 patients who experienced objective tumor regression were 2 of 2 with hemangiosarcoma, 3 of 5 with malignant fibrous histiocytoma, 3 of 5 with osteosarcoma, and 1 of 1 with pleomorphic liposarcoma of bone. Although not therapeutically gratifying, these results appear to be better than any previously observed at our institution.

Adolescent↗

PubMed1999

Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and postmetastasis survival.

OBJECTIVE: To report the patterns of disease and postmetastasis survival for patients with pulmonary metastases from soft tissue sarcoma in a large group of patients treated at a single institution. Clinical factors that influence postmetastasis survival are analyzed. SUMMARY BACKGROUND DATA: For patients with soft tissue sarcoma, the lungs are the most common site of metastatic disease. Although pulmonary metastases most commonly arise from primary tumors in the extremities, they may arise from almost any primary site or histology. To date, resection of disease has been the only effective therapy for metastatic sarcoma. METHODS: From July 1982 to February 1997, 3149 adult patients with soft tissue sarcoma were admitted and treated at Memorial Sloan-Kettering Cancer Center. During this interval, 719 patients either developed or presented with lung metastases. Patients were treated with resection of metastatic disease whenever possible. Disease-specific survival was the endpoint of the study. Time to death was modeled using the method of Kaplan and Meier. The association of factors to time-to-event endpoints was analyzed using the log-rank test for univariate analysis and the Cox proportional hazards model for multivariate analysis. RESULTS: The overall median survival from diagnosis of pulmonary metastasis for all patients was 15 months. The 3-year actuarial survival rate was 25%. The ability to resect all metastatic disease completely was the most important prognostic factor for survival. Patients treated with complete resection had a median survival of 33 months and a 3-year actuarial survival rate of 46%. For patients treated with nonoperative therapy, the median survival was 11 months. A disease-free interval of more than 12 months before the development of metastases was also a favorable prognostic factor. Unfavorable factors included the histologic variants of liposarcoma and malignant peripheral nerve tumors and patient age older than 50 years at the time of treatment of metastasis. CONCLUSIONS: Resection of metastatic disease is the single most important factor that determines outcome in these patients. Long-term survival is possible in selected patients, particularly when recurrent pulmonary disease is resected. Surgical excision should remain the treatment of choice for metastases of soft tissue sarcoma to the lung.

Adolescent↗

PubMed1993

Mapping of amplification units in the q13-14 region of chromosome 12 in human sarcomas: some amplica do not include MDM2.

Amplification of cellular oncogenes may be important for the development and progression of malignant tumors. In human sarcomas, amplification of several genes located to the q13-14 region of chromosome 12 has been reported. Because the mdm2 protein seems to inactivate the tumor suppressor protein p53, a selective growth advantage of 12q13-14 amplification has previously been assigned to increased copy number and expression of the MDM2 gene. We have analyzed a panel of 98 human sarcomas of different subtypes to characterize the 12q13-14 amplica and determine which of the genes GLI, A2MR, SAS, MDM2, and GADD153 (CHOP) in this region was most consistently amplified. MDM2 was amplified in 9 of the tumors, SAS in 10, GADD153 in 4, GLI in 2, and A2MR in 2. Amplification was, in most cases, associated with increased expression of the corresponding gene. SAS and MDM2 were coamplified in 8 of the tumors, whereas GADD153, GLI, and A2MR were only amplified together with SAS. One liposarcoma showed amplification of MDM2 alone, whereas two osteosarcomas and a rhabdomyosarcoma cell line showed amplification of SAS and GADD153 (CHOP) but not MDM2. It is suggested that the selective target for these amplica may be an as yet unidentified gene localized between SAS and MDM2.

Animals↗

PubMed1984

High-dose adriamycin (ADM) and cis-platinum (DDP) in advanced soft-tissue sarcomas and invasive thymomas. A pilot study.

Eighteen previously untreated patients with advanced unresectable or metastatic soft-tissue sarcomas (STS) and two patients with locally invasive thymoma were treated with a combination of adriamycin (ADM) 80 mg/m2 on day 1 and cis-platinum (DDP) 120 mg/m2 on day 1. The regimen was repeated at 4-weeks intervals. In STS the overall remission rate was 44%, with 21% complete remissions. The overall survival was 15 months (3-35+), responders surviving a median of 20 months (3-35+) and nonresponders, a median of 9 months (3-20+). Tumor responses lasted a median of 8 months (3-35+). Two patients with liposarcoma have now survived disease-free for at least 2 years and are potentially cured. The two patients with thymoma experienced complete remission lasting 4+ and 20+ months. Substantial hematologic toxicity was prominent, due to the high-doses used in this combination regimen.

Adult↗

PubMed1996

Pleomorphic soft tissue myogenic sarcomas of adulthood. A reappraisal in the mid-1990s.

325 diverse sarcomas, 39 rhabdomyosarcomas (RMS), including all histologic variants, and 135 leiomyosarcomas (LMS) were identified. Within these two groups, 18 (46%) of the RMS and 14 (10%) of the LMS represented pleomorphic variants. These neoplasms were studied by morphology (histology and ultrastructure) and by immunohistochemical methods employing antibodies to intermediate filaments (vimentin and desmin) and actin isoforms [alpha-smooth (sm) and alpha-sarcomeric (sr) actins]. Twenty-four pleomorphic malignant fibrous histiocytomas (MFH) and eight pleomorphic liposarcomas (LS) were examined in a similar fashion. By light microscopy, the pleomorphic RMS, LMS, and MFH were indistinguishable, as each was dominated by pleomorphic cells disposed in a haphazard growth pattern; moreover, many featured fascicular, storiform, and sclerotic zones. The distinction between these neoplasms became apparent only following immunohistochemistry and/or ultrastructural study. All pleomorphic RMS disclosed rudimentary sarcomeres and exhibited the following cytoskeletal profile: vimentin (+) (18 of 18), desmin (+) (14 of 18), alpha-sr actin (+) (18 of 18) and alpha-sm actin (+) (five of 18). All the pleomorphic LMS featured smooth-muscle differentiation of variable degrees in the form of cytoplasmic bundles of microfilaments and associated dense bodies; their cytoskeletal profile was vimentin (+) (14 of 14), desmin (+) (seven of 14), alpha-sr actin (+) (none of 14), and alpha-sm actin (+) (eight of 14). The latter was demonstrated in all moderately differentiated, but absent or only focally expressed in poorly differentiated variants. All pleomorphic MFH and LS were devoid of myogenic (skeletal or smooth) ultrastructural features and expressed vimentin solely. This combined morphological and immunohistochemical study illustrates the following: First, these pleomorphic sarcomas are often indistinguishable by histologic growth pattern alone; thus, an accurate diagnosis requires study with all of these techniques. Second, pleomorphic myogenic sarcomas are restricted to adults and are not uncommon neoplasms among pleomorphic sarcomas: RMS (28%), LMS (21%), MFH (38%), and LS (13%). Third, the study defines desmin-negative and alpha-sm actin-positive pleomorphic RMS, and desmin-negative and alpha-sm-actin-negative pleomorphic LMS.

Actins↗

PubMed1977

The conservative hemipelvectomy.

Conservative hemipelvectomy is the resection of the ischium, ilium and subjacent extremity. It differs from the orthodox hemipelvectomy method by retaining the ilium, which permits the patient to have normal balance, Sarcomas of the soft tissue extend toward the attachment of the pelvis. The operation has been performed upon ten patients, and the entire operative procedure can be done using the anterior approach, thus minimizing the need to turn the patient. This technique is less traumatic than either disarticulation of the hip joint or hemipelvectomy and can be performed in approximately one and one-half hours, blood loss being limited to an amount varying from 500 milliliters to 1 liter. No postoperative deaths have been recorded. Of the ten patients operated upon, none have had a local recurrence. One obese elderly woman with a liposarcoma died two years after operation from diffuse metastases. The other nine patients are alive and well from two to six years after amputation. The balance of these patients is manifested by the fact that two of them are excellent amputee-skiers.

Amputation, Surgical↗

PubMed1992

Sarcomas in north west England: III. Survival.

Survival data on a population-based series of bone, soft tissue and visceral sarcomas diagnosed in the North West of England between 1982-84 and subjected to histopathological peer review are presented. Five-year crude survival for all cases was 34%. Survival in males and females did not differ significantly (P = 0.6, 5-year survival 32% vs 36%) but was markedly worse for patients diagnosed over the median age of 60 years, even when allowance was made for underlying mortality (P = 0.03, 34% vs 44%). Five-year survival rates for the major site groups were: bone 44%; soft tissues of head, neck and trunk 36%; soft tissues of extremities 35%; female genital tract 35%; retroperitoneum 15%; gastro-intestinal tract 13%. Analysis by the major histological types revealed the following survival rates: leiomyosarcoma--female genital tract 25%, gastro-intestinal tract 14%, non-visceral soft tissue 21%; malignant fibrous histiocytoma of soft tissue 29%; liposarcoma 52%; osteosarcoma of bone 46%; and chondrosarcoma of bone 50%.

Adult↗

PubMed2005

Molecular profiling of giant cell tumor of bone and the osteoclastic localization of ligand for receptor activator of nuclear factor kappaB.

Giant cell tumor of bone (GCT) is a generally benign, osteolytic neoplasm comprising stromal cells and osteoclast-like giant cells. The osteoclastic cells, which cause bony destruction, are thought to be recruited from normal monocytic pre-osteoclasts by stromal cell expression of the ligand for receptor activator of nuclear factor kappaB (RANKL). This model forms the foundation for clinical trials in GCTs of novel cancer therapeutics targeting RANKL. Using expression profiling, we identified both osteoblast and osteoclast signatures within GCTs, including key regulators of osteoclast differentiation and function such as RANKL, a C-type lectin, osteoprotegerin, and the wnt inhibitor SFRP4. After ex vivo generation of stromal- and osteoclast-enriched cultures, we unexpectedly found that RANKL mRNA and protein were more highly expressed in osteoclasts than in stromal cells, as determined by expression profiling, flow cytometry, immunohistochemistry, and reverse transcriptase-polymerase chain reaction. The expression patterns of molecules implicated in signaling between stromal cells and monocytic osteoclast precursors were analyzed in both primary and fractionated GCTs. Finally, using array-based comparative genomic hybridization, neither GCTs nor the derived stromal cells demonstrated significant genomic gains or losses. These data raise questions regarding the role of RANKL in GCTs that may be relevant to the development of molecularly targeted therapeutics for this disease.

Bone Neoplasms↗

PubMed2003

Surgical management of retroperitoneal sarcomas associated with external and intraoperative electron beam radiotherapy.

AIMS: To report outcomes of adults with retroperitoneal sarcoma (RS) treated by surgery, external beam radiotherapy (EBRT) and intraoperative electron beam radiotherapy (IORT). METHODS: From July 1988 to February 2001; 24 patients with primary and recurrent RS were diagnosed and treated. The median dose and energy of IORT delivered was 15 Gy/9meV. EBRT dose varies between 45-50 Gy. RESULTS: There were five primary and 19 recurrent tumours. One primary and five recurrent tumours underwent R0 resection. There were 12 liposarcomas and 19 grade I tumours; 13 patients developed local recurrence and three developed distant metastases.Twenty-two patients received IORT associated with EBRT: 11 developed recurrences. Six patients developed Neurotoxicity (4 grade II and 2 grade III). Disease free survival and overall survival at 5 years was 28 and 56% respectively. CONCLUSIONS: EBRT with IORT treatment is a promising technique for local control. Lower recurrence rates are associated with radical (R0) surgical procedures.

Adult↗

PubMed2003

Histopathological and histochemical patterns of soft tissue sarcomas in Ilorin, Nigeria.

This research was carried out on soft tissue sarcomas processed in the Department of Pathology of University of Ilorin Teaching Hospital over a period of 18 years (1979-1996). Tumours in which pathognomonic features necessary for diagnosis were present on haematoxylin and eosin sections were diagnosed accordingly while special stains were employed to highlight characteristic features of some other tumours. Also a panel of special stains was performed on the poorly differentiated tumours. The three commonest tumours were fibrosarcoma, rhabdomyosarcoma and liposarcoma in decreasing order of frequency. Fibrosarcoma and leiomyosarcoma were commonest in middle age while rhabdomyosarcoma was commonest in childhood and early adult life. There was a male preponderance of the tumours with a male to female ratio of 1.3:1. With the use of special stains, typical diagnostic histological characteristics were found in 3 out of the 13 tumours initially diagnosed as poorly differentiated thereby reducing their number to 10. Plans are underway to do immunohistochemical studies and chromosomal analysis on the tumours through collaborative studies.

Adolescent↗

PubMed2001

Oncogenic TLS/ERG and EWS/Fli-1 fusion proteins inhibit RNA splicing mediated by YB-1 protein.

The translocation liposarcoma protein TLS has recently been shown to function as an adapter molecule coupling gene transcription to RNA splicing. Here we demonstrate that YB-1, a protein known to play important roles in transcription and translation, interacts with the COOH-terminal domains of TLS and the structurally related Ewing's sarcoma protein EWS. Through this interaction, YB-1 is recruited to RNA polymerase II and promotes splicing of E1A pre-mRNA to the 13S isoform. This splicing function of YB-1 is inhibited by exogenous TLS/ERG or EWS/Fli-1 fusion proteins, which bind to RNA polymerase II but fail to recruit the YB-1 protein. In Ewing's sarcoma cells that express endogenous EWS/Fli-1, this linkage between YB-1 and RNA Pol II via EWS (or TLS) was found to be defective. Together, these results suggest that TLS and EWS fusion proteins may contribute to malignant transformation through disruption of RNA splicing mediated by TLS- and EWS-binding proteins such as YB-1.

3T3 Cells↗

PubMed1994

Malignant mesenchymomas of soft tissue associated with numerous osteoclast-like giant cells mimicking the so-called giant cell variant of "malignant fibrous histiocytoma".

Three cases of malignant mesenchymoma with numerous osteoclast-like giant cells, arising in deep soft tissue, and which mimicked the so-called giant cell variant of "malignant fibrous histiocytoma" have been studied. All three neoplasms arose in adults; two patients were male and one was female. Two tumours arose in the thigh, and one in the right shoulder. Two patients died within 2 years of the primary excision while the third is alive and well at 2.5 years. Histologically, one case showed leiomyosarcoma plus liposarcoma, one leiomyosarcoma plus osteosarcoma, and one tumour consisted of liposarcoma plus osteosarcoma; all components were assessed morphologically as high-grade malignant. All three cases showed prominent osteoclast-like giant cells in the leiomyosarcomatous or osteosarcomatous areas, thereby closely mimicking the phenotype of so-called giant cell variant of "malignant fibrous histiocytoma". We discuss briefly differences in soft tissue sarcomas demonstrating this distinctive osteoclast-rich phenotype.

Adult↗

PubMed1997

TLS (FUS) binds RNA in vivo and engages in nucleo-cytoplasmic shuttling.

TLS, the product of a gene commonly translocated in liposarcomas (TLS), is prototypical of a newly identified class of nuclear proteins that contain a C-terminal domain with a distinct RNA recognition motif (RRM) surrounded by Arg-Gly-Gly (RGG) repeats. Its unique N terminus serves as an essential transforming domain for a number of fusion oncoproteins in human sarcomas and leukemias. In this study we use an in vivo UV crosslinking procedure to probe the interactions of TLS with RNA. TLS is found to bind RNA in vivo and the association of TLS with RNA is rapidly diminished by treating cells with transcriptional inhibitors. This suggests that the species bound by TLS turns over rapidly. Surprisingly, the RRM was found to be dispensable for RNA binding by TLS in vivo, suggesting that at any one time most of the interactions between TLS and RNA in the cell are not sequence specific. Analysis of inter specific heterokaryons formed between human and mouse or Xenopus cells revealed that TLS engages in rapid nucleocytoplasmic shuttling, a finding confirmed by the ability of anti-TLS antibodies to trap TLS when injected into the cytoplasm of HeLa cells. Cellular fractionation experiments suggest that TLS binds to RNA in both the nucleus and cytoplasm and support the hypothesis that TLS functions as a heterogeneous ribonuclear protein (hnRNP)-like chaperone of RNA. These findings are discussed in the context of the role altered forms of TLS play in cellular transformation.

Animals↗

PubMed1987

Localized extremity soft tissue sarcoma: an analysis of factors affecting survival.

The management of extremity soft tissue sarcoma is undergoing rapid change as new techniques of adjuvant treatment are developed. Critical assessment of these advances requires a fundamental understanding of the natural course of this disease. In an effort to define important prognostic factors, this review of 423 adults with localized extremity soft tissue sarcomas, treated at one institution (1968 to 1978), was undertaken. The effect of the following variables on survival was examined: patient factors, ie, age, sex, symptoms, and status at presentation; tumor factors, ie, site, size, depth, bone or neurovascular invasion, histogenesis, grade, and nodal status; and treatment factors, ie, biopsy technique, type of operation, surgical margins, adjuvant treatment, and subsequent local treatment failure. Patient factors with an adverse impact on survival included age greater than 53 and the presence of local symptoms. High tumor grade, positive regional nodes, histology other than liposarcoma, fibrosarcoma or malignant fibrohistiocytoma, invasion of vital structures, proximal site, deep location, and size greater than 10 cm were also poor prognosticators. Treatment factors correlating with optimal survival included limb sparing surgery, adequate margins, biopsy with delayed definitive resection, and absence of subsequent local failure. Patients treated by amputation had a greater proportion of risk factors than patients treated with limb-sparing surgery (LSS). When the data were subjected to multivariate analysis, the following variables emerged as independent predictors of poor outcome: local symptoms, age greater than 53, high grade, proximal site, size greater than 10 cm, positive regional nodes, surgery by amputation, and inadequate margins. These factors are now to be evaluated in our prospective study based on 600 patients with soft tissue sarcoma of all sites admitted to our institution in the last 3 years. These factors should be considered as important stratifications in prospective trials.

Adolescent↗

PubMedDate not supplied

Computed tomography of primary retroperitoneal malignancies.

The CT examinations and medical records of 33 patients with primary retroperitoneal malignancies were reviewed. Computed tomography findings were then compared with those from scans performed on 122 patients with non-Hodgkin lymphoma who presented during the same time interval. Primary retroperitoneal neoplasms had three distinct CT appearances. Twenty-one patients (64%) had large soft tissue masses. Seven patients (21%) had masses with fatty density components, and five patients (15%) had tumors that were primarily of water attenuation. With the exception of those liposarcomas that contained recognizable fat, CT could not distinguish among the different cell types. Seventeen patients with non-Hodgkin lymphoma had large dominant retroperitoneal soft tissue masses that resembled primary retroperitoneal malignancies. In most cases, however, CT was able to differentiate these tumor masses from primary retroperitoneal tumors. Although 19 of 20 sarcomas of soft tissue attenuation were heterogeneous, only six of the 17 lymphomas presenting as dominant masses had such an appearance. Computed tomography is extremely helpful in initially evaluating patients with primary retroperitoneal tumors and in assisting the surgeon in planning his or her approach by accurately defining tumor extent.

Adolescent↗

PubMed2003

Expression of estrogen receptors alpha and beta in soft tissue sarcomas: Immunohistochemical and molecular analysis.

Sex hormones can regulate differentiation and growth of mesenchymal cells and their neoplastic counterparts. This study aims to investigate the expression status of estrogen receptors (ER), ER alpha and ER beta, in a variety of soft tissue sarcomas. One hundred and twenty soft tissue sarcomas were immunohistochemically examined for the expression of ER alpha and ER beta proteins. Fifty-six tumors were further analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and 30 tumors were further analyzed by in situ hybridization (ISH) assay for their gene expression. The expression level of ER proteins was assessed in correlation with clinicopathological parameters such as patients' age, gender, and tumor Ki-67 labeling index. Forty-five (37.5%) tumors expressed ER alpha protein and 52 (43.3%) tumors expressed ER beta protein at variable levels. Both receptors were expressed with relatively high frequencies in several types of tumors (e.g. dermatofibrosarcoma protuberance, well-differentiated liposarcoma, myxoid liposarcoma, and myxoid malignant fibrous histiocytoma). A positive correlation was seen between the expression levels of ER alpha and ER beta in the current series. Thirty-one of the 42 informative cases examined by RT-PCR and 15 of the 16 informative tumors examined by ISH showed compatible results with those by immunohistochemistry. Neither gender nor age had a significant influence on the ER expression status. No significant correlation between the expression level of either type of ER and the tumor proliferation activity was identified. The results indicate that both ER isoforms are frequently expressed in certain subsets of soft tissue sarcomas, but their expression levels seem unrelated to the tumor proliferation activity.

Adult↗

PubMed1994

Myxoid liposarcoma. Experience with chemotherapy.

BACKGROUND: Myxoid liposarcoma (ML) is the most common type of liposarcoma. It has been classified as an intermediate grade tumor with a definite metastatic potential but a relatively indolent natural history. Little is known about its sensitivity to chemotherapy. METHOD: The authors reviewed their experience with chemotherapy in ML from 1986 to 1992. The patient population was identified through a search of the database maintained by the Department of Melanoma-Sarcoma Medical Oncology of the M.D. Anderson Cancer Center. RESULTS: Forty-four patients each with a histologically confirmed diagnosis of ML were identified. Twenty-one were treated with chemotherapy. The median age was 45 years (31-69 years); there were 14 men and 7 women. The ML in 19 patients was in the lower extremity, one in the head and neck, and one pelvic. The median size of the primary tumor was 15 cm (range, 7-48 cm) in maximum dimension. Of the 18 patients who received doxorubicin- and dacarbazine-based chemotherapy as a frontline regimen [median of 3 (2-9) cycles] and were evaluable for response, 8 (1 completed response, 7 partial responses) achieved an objective response (44%, 95% confidence interval 21-67%). Two of the remaining three patients who were also treated with a similar regimen were not evaluable for response (one received chemotherapy postoperatively, and the other received concomitant radiation and doxorubicin), and the third patient received ifosfamide as frontline chemotherapy because of a significant cardiac history. Seven patients received chemotherapy in the neoadjuvant setting, 13 for recurrent or metastatic disease, and 1 postoperatively after complete tumor resection. At the last follow-up, 10 patients were alive with no evidence of disease, 3 were alive with disease, and 8 had died. The median follow-up was 51 months (range, 6-199 months) from diagnosis. CONCLUSION: The authors conclude that doxorubicin- and dacarbazine-based chemotherapy is effective in the treatment of ML.

Adult↗