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PubMed1985

Thymic epithelial neoplasms.

We studied 57 tumors of the thymus seen at Vanderbilt University Medical Center between 1957 and 1982. By applying current diagnostic criteria, the classification of 13 tumors was changed. There were 45 epithelial tumors of thymus, including 32 thymomas, two thymic carcinomas, eight carcinoids, and three germinomas. The gross and microscopic features of these neoplasms overlap each other and several other tumors, but with knowledge of the variations it was usually possible to establish a diagnosis with light microscopy. In more difficult cases, electron microscopy was the most useful diagnostic method. New developments in immunologic staining were also of value. The diagnosis of thymoma was used for circumscribed and invasive neoplasms of thymic epithelium without anaplasia. Cytologically malignant thymic epithelial tumors were classified as thymic carcinoma. Thymic carcinomas were more aggressive than thymomas and were not associated with syndromes such as myasthenia gravis or anemia. Thymic carcinoids were frequently aggressive, and several of them produced corticotrophin or calcitonin. Thymic germinomas were histologically identical to testicular seminoma, but may be confused with thymoma because of their lymphocytic infiltrate. Invasive germinomas were radiosensitive.

Adolescent↗
PubMed1995

Pathology of human papillomavirus in the female genital tract.

Human papillomavirus (HPV) has emerged as a major factor in the genesis of intraepithelial and invasive neoplasms of the female genital tract. The strength of the relationship of HPV to genital neoplasia has been supported by studies involving epidemiologic, clinical, pathologic and molecular data. The many subtypes of HPV have been characterized into risk groups that reflect their propensity to be associated with cancer precursors and invasive disease. The strong correlation between HPV and squamous dysplasia suggests that classification of cervical intraepithelial lesions into similar risk categories should be possible. However, the clinical predictive value of HPV testing and typing remains controversial.

Female↗
PubMed2000

Epidemiology and etiology of premalignant and malignant urothelial changes.

Bladder neoplasms are common around the world. Incidences are particularly high in the Nile River Valley secondary to schistosomiasis, which is frequently associated with the development of squamous cell carcinoma similar to that of other chronic inflammatory processes of the lower urinary tract. However, elsewhere, most bladder tumors are of the urothelial (transitional) cell type. There is a marked male predominance and there are extensive racial differences. It is predominantly a neoplasm that occurs in patients aged >50 years. Urothelial carcinomas comprise two distinct diseases both biologically and molecularly: a low-grade papillary tumor which frequently recurs; and a high-grade malignancy which can present as dysplasia or carcinoma in situ, but frequently presents as invasive disease. However, epidemiological investigations of urothelial malignancies have generally not distinguished between preneoplastic and invasive neoplasms or between these two types of urothelial neoplasms. It is recommended that future studies should distinguish between these entities. The most common etiologic factor of urothelial malignancies besides schistosomiasis is cigarette smoking. In addition, numerous specific chemicals have been identified as bladder carcinogens in humans, some relating to specific occupational exposures. Bladder carcinogens include aromatic amines and amides, such as 4-aminobiphenyl, benzidine, 2-naphthylamine and phenacetin-containing analgesics, and certain cancer chemotherapeutic agents, such as phosphoramide mustards. More recently, occupational exposure to various combustion gases, such as diesel exhaust, has been related to an increased risk of developing bladder neoplasms. Also, exposure to chlorination by-products in drinking water and to arsenic has been suggested as increasing the risk of bladder neoplasia. As numerous specific chemicals appear to be related to the development of bladder tumors, various polymorphisms of enzymes involved in their metabolism have been suggested as affecting the susceptibility to their carcinogenicity. This has been particularly true with respect to the role of acetyltransferases in relation to aromatic amine carcinogenesis. Dietary influences have also been suggested as affecting bladder neoplasia susceptibility. Various heterocyclic amines generated by pyrolysis of food have been suggested as potential dietary factors increasing the risk of bladder cancer, particularly in relation to the ingestion of red meat. Despite the existence of several identifiable factors that increase or decrease the risk of bladder cancer, many patients have no known carcinogens or risk factors.

Adenocarcinoma↗
PubMed2002

Juvenile parameningeal rhabdomyosarcoma in a dog causing unilateral denervation atrophy of masticatory muscles.

A 23-month-old, male, Labrador retriever dog with a history of slowly progressive right-sided atrophy of the masticatory muscles was submitted for necropsy. A highly invasive neoplasm which destroyed adjacent soft tissues including the right trigeminal nerve was found in the right side of the cranial cavity. Metastases to the liver were also present. Microscopical features of the neoplasm were compatible with those of rhabdomyosarcoma, embryonal type. This diagnosis was confirmed by immunohistochemical demonstration of desmin and muscle actin within tumour cells. In human patients, rhabdomyosarcoma is the most common soft tissue sarcoma of childhood and adolescence. Parameningeal rhabdomyosarcomas are well-known topographic variants that are often non-amenable to complete surgical resection and therefore carry a more guarded prognosis. Juvenile parameningeal rhabdomyosarcoma resulting in denervation atrophy of the muscles of mastication has not been reported previously in dogs. Rhabdomyosarcoma should be included in the differential diagnosis of neoplastic conditions in the head and neck region of juvenile dogs presented with cranial nerve palsies or other neurological deficits suggestive of meningeal or central nervous system invasion.

Actins↗
PubMed1992

Distant metastasis from a carcinoid tumor of the appendix less than one centimeter in size.

The presentation and management of a patient with liver metastasis from a 0.6 cm carcinoid tumor of the appendix is presented. This is the first documented case of distant metastasis from a carcinoid of the appendix less than 1 cm in size. Histopathologic, immunohistochemical, and electron microscopic studies support the appendiceal carcinoid as being the primary neoplasm. Invasion of the mesoappendix was the only finding to suggest potentially aggressive behavior. We reviewed the literature and found 414 previously reported cases that provided complete information regarding tumor size, mesoappendiceal invasion, and presence of metastasis. For the entire group the frequency of metastasis was related to tumor size greater than 2 cm (p less than 0.0001) and invasion of the mesoappendix (p less than 0.0001). After dividing the group based on size, mesoappendiceal invasion was related to metastasis in those tumors less than 2 cm in size (p less than 0.0001) but not in tumors larger than 2 cm (p = 0.1538).

Appendiceal Neoplasms↗
PubMed1987

Epidemiological data on cervical carcinoma relevant to cytopathology.

Epidemiological studies based on cervical cytopathology have aroused widespread interest since it was realized that they could be a useful tool for measuring the effectiveness of screening programs and defining practical measures for the prevention of invasive neoplasms and deaths. In the present article, published evidence from screening programs, cohort investigations and case-control studies is reviewed, and possibilities for further analyses and applications are discussed. In particular, when estimates of the relative protections conveyed by Pap smear from various case-control studies conducted on different populations and using different criteria of selection were pooled, a surprisingly close concordance emerged, with overall risk estimates of invasive cervical cancer of 0.42 for women reporting one smear, and of 0.20 for two or more smears in the past. This protection appeared to be long-lasting in a considerable proportion of cases, since the major determinant of invasive cancer risk was the number of previous smears rather than the interval since last smear, and a noticeable residual effect was evident even more than 10 years after the last smear. Besides providing a measure of the effectiveness of cytological screening and helping define the optimal frequency of screening using the limited resources available, case-control studies should permit accurate estimates of the sensitivity of the test and quantify the probability of transition and the duration of various stages of the neoplastic process, i.e., permit a better understanding of the natural history of the disease.

Carcinoma↗
PubMed1984

The use of greater omentum vascularized free flaps for neurosurgical disorders requiring reconstruction.

The heterotopic transfer of composite tissue, with microvascular anastomosis of an arterial supply and venous drainage to locally existing vessels, has received considerable attention in the plastic surgical literature. The use of latissimus dorsi musculocutaneous free flaps has been reported in the repair of large defects of the scalp, cranium, and dura following resection of invasive neoplasms or trauma. When the defect involves primarily subcutaneous tissue loss resulting in abnormal contour, omental free flaps provide effective coverage and restoration of contour. In addition, the inherent capability of the omentum to combat infection and form an ideal bed for the establishment of skin or bone grafts provides further indications for its use. The authors have used omental free flaps in nine cases to reconstruct gunshot wounds of the head, orbit, and face, heal chronic cavitating frontal sinus infections, form a base over exposed dura for reconstruction of the skull with rib grafts, and cover large defects after resection of invasive tumors or infected scalp. These wounds of neurosurgical interest were reconstructed with acceptable structural and aesthetic results. The indications, surgical techniques, results, alternative procedures, and potential complications of this procedure are discussed. The authors believe that omental free flaps should be considered an option in the armamentarium of reconstructive approaches for skull, dural, scalp, orbital, and facial wounds.

Adult↗
PubMed1992

Malignancy of eye melanomas originating in the retinal pigment epithelium of transgenic mice after genetic ablation of choroidal melanocytes.

Eye tumors of the retinal pigment epithelium (RPE) have been thought generally to be benign, whereas choroidal ones are malignant. To test this assumption in mice, the W/Wv (Kit) mutant genotype was introduced into melanoma-prone transgenic mice whose recombinant simian virus 40 transforming sequences are specifically expressed in pigment cells. W/Wv causes programmed death of neural crest-derived pigment cells, including choroidal ones, but leaves intact the brain-derived pigment cells, such as those in the RPE. Dysplastic cells arose in the RPE, contiguous with frank melanotic neoplasms. Invasion of the optic nerve, and tumor growth outside the orbit, attested to the malignancy of these RPE-derived melanomas. The widespread melanosis previously seen in mice with this transgene was absent when W/Wv was added, thus validating its chief origin from neural crest cells.

Age Factors↗
PubMed1987

Interstitial radiobrachytherapy of malignant cerebral neoplasms: rationale, methodology, prospects.

The local use of radionuclides in the management of neoplastic processes was initially considered over 80 yr ago and has enjoyed increasing enthusiasm in the treatment of somatic and central nervous system tumours during the past 30 yr. The marriage of complex neuroimaging techniques and modern stereotactic devices has markedly enhanced the technical precision of interstitial radiobrachytherapy of malignant cerebral neoplasms. In applying these techniques, it is imperative to achieve an optimal placement of radionuclide sources in order to develop a geometrically homogenous, controlled distribution of radiation. Critical considerations include determination of tumour volume and contour, and development of a homogenous dose rate (dependent upon multiple sources at varying intensity) that will not only effect tumour cell kill but do this without excessive production of radionecrosis which necessitates craniotomy because of mass. Using the Brown-Roberts-Wells (BRW) stereotactic guidance system and an image-defined, volumetrically determined target, implants of multiple iridium 192(192Ir) sources were used to establish appropriate isodose envelopes. A methodology for achieving the described objectives is detailed as it applies to a variety of malignant intracerebral neoplasms (glioblastoma multiforme, malignant astrocytoma, malignant mixed glioma, primary cerebral lymphoma, metastatic carcinoma and malignant pineal region tumours). Technical realization of precision implantation relying upon imaging data may be acheived with this method with satisfactory responses that are dependent upon histological tumour type and the morphology of the tumour distribution as related to the image. Early and late complications related to the surgical technique and radionuclide applications were less than 5%. Although encouraging, these techniques require further definition and greater data accrual before uniform application outside major medical centres can be justified. It is anticipated that improvement in results with intrinsic gliomas and other invasive neoplasms will be realized with further definition of tumour boundaries by tract biopsy techniques and concurrent utilization of hyperthermia and brain protective methods.

Brachytherapy↗
PubMed1983

A semi-automated procedure for aiding the diagnosis of cervical neoplasms based on the measurement of acid-labile DNA in exfoliated cells.

Measurements of acid-labile fractions of DNA in cells exfoliated from cervical neoplasms (invasive squamous-cell carcinomas) using Feulgen techniques have shown elevated values in both abnormal and cytologically normal cell nuclei. These increased values occur early in the hydrolysis profiles before the Feulgen hydrolysis optimum for the cell nuclei of normal patients has been attained. They are of sufficient magnitude to enable a microcomputer programmed in BASIC to distinguish between normal and abnormal cells, even when the latter are of cytologically normal appearance. By semi-automating the measurement procedure using a microcomputer interfaced with a Vickers M86 microdensitometer, the assessment of acid-labile DNA in cell nuclei is proposed as a useful aid to the existing cytological diagnosis of cervical neoplasms.

Carcinoma, Squamous Cell↗
PubMed2004

Cathepsins in basal cell carcinomas: activity, immunoreactivity and mRNA staining of cathepsins B, D, H and L.

In the majority of neoplasms invasion is inevitably linked to metastasis and even small tumors have the dormant potential for metastasis. In basal cell carcinoma (BCC) invasion can be evaluated separately because local invasion but no metastasis occurs. Important proteases in invasion and metastasis are the cathepsins. Their activity and regulation has not yet been evaluated in BCC. We determined the activities, immunoreactivities and mRNA of cathepsins B, L and H in sections of different subtypes of BCC. BCC cells and peritumoral cells contained activities for cathepsins B and L. In all parts of the tumor, the reaction with cathepsin B and L substrate was stronger than in normal skin. The immunoreactive protein and mRNA for these proteases, in contrast, was elevated only occasionally in small tumor nodules. Immunoreactive protein and mRNA of cathepsin D was detected predominantly in the center of tumor nodules. Cathepsin H activities, immunoreactivities and mRNA in most BCCs were higher than in normal skin, and the reactive cells were located between and around tumor nodules, but not in the tumor nests. The results indicate that cathepsins B and L are involved in invasion of BCC cells. Cathepsin H of the peritumoral cells may either promote invasion of the tumor cells by degradation of the extracellular matrix or may reflect an elevated activity of the surrounding immunological cells. The pattern of cathepsin staining markedly differs from that observed in melanomas and may characterize locally invading non-metastatic tumors.

Basal Cell Carcinoma↗
PubMed1982

Ameloblastoma and keratinizing ameloblastoma in dogs.

Ameloblastomas reviewed in this report were locally invasive neoplasms arising from the epithelial structures of the dental lamina, and were characterized histologically by features which are unique to dental lamina epithelium. These include the formation of epithelial sheets in which the cells nearest the stroma form a palisading row aligned perpendicularly to the basement membrane and the cells toward the center separate from each other except at desmosomal attachments. This is similar to the appearance of th stellate reticulum of the early enamel organ. Other features include epithelial cords which branch and interconnect, and the intimate association of epithelial structures and collagenous matrix. In our dogs, other important features were the deposition of inclusions similar in appearance to enamel matrix between the cells of the epithelium and various degrees of keratinization. All ameloblastomas studied were locally invasive tumors which occurred at various sites on the gingiva. The average age of the dogs was 8.7 years and the age range was three to 13 years. Radiographically, all of the tumors studied resulted in periodontal osteolysis. Six dogs were treated with radiation therapy, but details of the radiotherapy of two dogs could not be located. Of the other four dogs, one is alive 48 months after radiotherapy with no evidence of tumor regrowth. Regrowth of the oral tumor was apparent in the other three dogs six, 21, and 34 months after completion of the radiotherapy. Three dogs were treated by radical mandibulectomy; all are alive with no evidence of tumor recurrence at two, 20, and 28 months postoperatively. Two dogs had local dissection (curettage) of tumors and the tumors recurred at 12 and 15 months after surgery. One dog was euthanatized after diagnosis of the oral tumor because of a progressive neuropathy.

Ameloblastoma↗
PubMed1976

[Aspects of the pathology of the arm after irradiation of breast cancer].

The complications of modern surgical and radiotherapeutic methods of treating mammary neoplasms are studied on the basis of 36 cases. Although swollen arms are rare nowdays following the development of greater pectoral conservative mammectomy, lesions of the shoulder and post-radiotherapy plexal paralysis represent a heavy price to pay for these methods. Shoulder lesions are of two types with different prognosis : scapulo-humeral periarthritis, which is very frequent (22 cases) and related to post-radiotherapy axillary fibrosis, and glenohumeral radio lesions (2 cases), which result in blockage of the humeral head because of necrosis. The brachial plexus may be injured by high-energy irradiation. These pathological conditions of the plexus (11 cases), often associated with a painful syndrome that is intolerable, objective sensory disorders, and a motor deficiency that is poorly systematized, are difficult to differentiate clinically from cases of paralysis resulting from invasive neoplasms. Often it is possible to distinguish between them only by means of biopsy, which is difficult. Therapy of these plexopathies is difficult and is usually palliative, necessitating, in particular, the use of neurosurgery of the pain (radicotomies and cordotomies) rather than of neurolyses, the results of which are disappointing.

Adult↗
PubMed1982

A clinicopathologic correlation of mammographic parenchymal patterns and associated risk factors for human mammary carcinoma.

The five-year screening experience for 10,131 asymptomatic women evaluated at the Louisville Breast Cancer Detection Demonstration Project (LBCDDP) disclosed 144 breast carcinomas in 1,209 patients (12%) aged 35 to 74 years in whom 904 biopsies and 305 aspirations were performed. This study included 44,711 high-quality xeromammograms (XM) prospectively classified by the modified Wolfe mammographic parenchymal patterns into low-risk (N(1), P(1)) versus high-risk (P(2), DY) groups, with expansion of the P(2) cohort into three additional categories. Using BMDP computer-program analysis, each XM pattern was collated with 21 nonneoplastic and 18 malignant pathologic variables and commonly associated risk factors. A separate analysis of epithelial proliferative and nonproliferative fibrocystic disease of the breast (FCDB) was performed. The histopathology for each biopsy, with distinction of FCDB and neoplasms, was analyzed with regard to the statistical probability of influencing the XM pattern. An average of 1.05 biopsies per patient were performed in women with findings suggestive of carcinoma at clinical and/or XM examinations. An equal distribution of the N(1), P(1), and P(2) DYXM patterns was observed in the 10,131 screenees. Of 8.5% of the screened population having biopsies, 623 were observed to have nonproliferative FCDB and 137, proliferative FCDB. For women 50 years of age or younger, these pathologic variables were seen more frequently in the P(2) DY patterns (p < 0.001), whereas no difference in XM pattern distribution was observed for the screenee 50 years of age or older for proliferative FCDB (p = 0.65). Sixteen percent of the biopsied/aspirated lesions were carcinomas, yielding a biopsy/cancer ratio of 6.25:1. These in situ and invasive neoplasms were more commonly (p < 0.04) observed in 55% of the P(2) (P(2f), P(2n), P(2c)) categories, while 64% of all cancers appeared more frequently in the P(2) DY subgroup (p <0.001), compared with this pattern in the screened population. An equal distribution frequency of the XM classification existed for screenees 50 years of age or older with cancer (p = 0.50), while screenees 35-49 years of age were more often observed to have the high-risk P(2), DY patterns (p <0.001). Analysis of 1,759 histologic characteristics in biopsies of 863 patients with FCDB revealed ductal and lobular hyperplastic lesions, sclerosing adenosis, or epithelial cyst(s) to be the major constituents of 64-69% of the high-risk P(2) (P(2f), P(2n), P(2c)) image (p < 0.001). These data suggest that XM parenchymal patterns observed in asymptomatic screenees incompletely correlate with known pathologic variables and risk factors. Additionally, benefit for recognition of these preinvasive proliferative pathologic factors and carcinomas appears restricted to the younger screenee. The clinical integration of these risk factors with XM patterns may allow preselection of patients deserving of frequent follow-up for breast cancer; however, these data do not support the contention that Wolfe XM patterns are predictors for screening strategies or that they decisively enhance patient management.

Adult↗
PubMed2003

Epidemiology of AIDS-related malignancies an international perspective.

Patients with HIV infection are at increased risk for developing Kaposi's sarcoma, non-Hodgkin's lymphoma, and several other cancers. The relative risks for the most common epithelial cancers in the general population--lung, breast, colon/rectum, stomach, liver, and prostate--are not increased substantially in people with AIDS, however. Accumulating data suggest that HIV-infected patients also are at increased risk for developing Hodgkin's lymphoma, cervical carcinoma in situ (CIS), other anogenital neoplasms (invasive cancer and CIS), leiomyosarcoma, and conjunctival squamous cell carcinoma. There is inconclusive evidence, however, with regard to HIV infection being associated with invasive cervical cancer, testicular seminoma, or hepatocellular carcinoma. Notably, other viral infections have been implicated in the etiology of many of these conditions. The introduction of highly active antiretroviral therapy (HAART) has decreased the incidence of AIDS-associated cancers in Western countries, but less than 1% of AIDS patients are receiving HAART in the HIV epicenter of sub-Saharan Africa. Further therapeutic advances that extend survival with HIV infection with varying reconstitution of immune competence may lead to additional alterations in cancer risk.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Spontaneous intestinal adenocarcinoma in geriatric macaques (Macaca sp.).

BACKGROUND AND PURPOSE: Intestinal adenocarcinoma appears to be the most common malignant neoplasm in macaques, and is a substantial cause of morbidity and mortality in the elderly. METHODS: A retrospective review of 32 cases was done. RESULTS: Thirty-two cases were reviewed. Clinical examination had revealed severe weight loss, anorexia, and palpable abdominal mass. Microcytic hypochromic anemia, intermittent fecal occult blood positive test results, hypoproteinemia, and hypoalbuminemia were the predominant clinical laboratory findings. Carcinoembryogenic antigen serologic testing and single-strand conformational polymorphism analysis were performed in selected cases. The most common sites of the intestinal adenocarcinoma were ileocecal junction, colon, ileum, jejunum, and cecum. Metastases were evident in 34% of the cases and involved peripheral nodes, liver, lungs, pancreas, and adrenal gland. Overall survival of 12 macaques that underwent surgical excision was 83% at 6 months, 58% at 1 year, 50% at 1.5 years, 33% at 2 years, and 8% at 4 years. The overall mean survival rate (MSR) was > 483 postoperative days. CONCLUSION: Intestinal adenocarcinomas should be amenable to surgical resection. Early detection of localized, non-invasive neoplasms will increase surgical cure rate. Survivability could be potentially improved by use of adjuvant therapies.

Adenocarcinoma↗