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PubMed2004

The development of interval breast malignancies in patients with BRCA mutations.

BACKGROUND: At present, there is no consensus regarding how frequently BRCA mutation carriers should be screened for malignancies using breast imaging techniques. An interval malignancy is defined as a malignancy that becomes evident during the period between annual screening mammography scans; the finding of such a malignancy indicates that the malignancy either went undetected by the last breast imaging scan or developed during the interval since that last scan. METHODS: The authors retrospectively reviewed the medical charts of all BRCA mutation carriers who were followed by the genetic counselor at the Columbia-Presbyterian Comprehensive Breast Center (New York, NY) between September 1995 and September 2002. RESULTS: Thirteen BRCA mutation carriers elected to undergo close surveillance and thus were followed at our institution. Three of these 13 patients (23%) did not develop breast carcinoma, 4 (31%) developed breast carcinoma that was detected at the time of annual screening, and 6 (46%) developed palpable interval malignancies in less than 12 months. Among the six patients who developed interval malignancies, the mean time between the last screening mammogram and disease presentation was 5.1 months (range, 2-9 months); the average tumor size in this patient subgroup was 1.7 cm (range, 0.8-3 cm). Two of these six patients had ductal carcinoma in situ, whereas the remaining four had invasive breast carcinoma; three patients had positive lymph nodes at presentation. All six patients who developed interval disease exhibited dense breast tissue on the previous mammogram. Focused breast ultrasonography was able to identify the tumor mass in 3 of 4 patients (75%). CONCLUSIONS: Nearly half of all BRCA-positive women who chose to undergo close surveillance in the current study developed malignant disease less than a year after exhibiting normal findings on screening mammography. Half of these interval malignancies were positive for lymph node involvement. These results suggest that strong consideration should be given to screening BRCA-positive women at more frequent intervals and to using additional imaging techniques, such as breast ultrasonography and/or breast magnetic resonance imaging, as a part of this screening.

Adult↗

PubMed2006

The utility of fine-needle aspiration in the diagnosis of gastrointestinal stromal tumors: a cytomorphologic and immunohistochemical analysis with emphasis on malignant tumors.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the tubular gut and mesentery. Fine-needle aspiration biopsy (FNAB) currently is a useful tool in the diagnosis of GIST because of various mutations of the KIT protooncogene that are recognized as characteristic of these tumors. Despite such advances, the malignant potential of GIST remains variable, and few studies have reported their findings in patients with malignant GIST. Therefore, in the current study, the authors have reported their experience with FNAB as a diagnostic tool in one of the largest series of malignant GISTs and have analyzed the cytomorphologic features of the tumors relative to their clinical behavior to determine which, if any, cytologic features are indicators of malignancy. METHODS: All patients with histologically confirmed GIST who were diagnosed by image-guided FNAB and confirmed with positive CD117 staining from 1998 to 2003 were included in the study. All tumors were reviewed for various cytomorphologic features. For study purposes, the patients were divided into two groups: Group A included all patients with malignant tumors, defined as those with metastatic disease or recurrent disease after adequate surgery with or without chemotherapy; Group B included all other patients. RESULTS: In total, 26 tumors from 23 patients (8 males and 15 females) with a mean age of 60.9 years were available for review. There were 14 primary tumors, 7 metastases (to the liver), and 5 recurrences. Twenty-one tumors were unequivocally malignant and were placed into Group A; the remaining 5 tumors were placed into Group B. The tumors in both groups were characterized by spindled or epithelioid cells with minimal nuclear atypia or pleomorphism and a moderate amount of cytoplasm. None of the cytologic features that were evaluated could distinguish reliably between benign tumors and malignant tumors, as expected. However, on cytologic examination, all tumors that demonstrated mitoses (n = 7 tumors) and/or pretreatment necrosis (n = 3 tumors) were identified as malignant. CONCLUSIONS: FNAB remains a reliable method for the diagnosis of GIST. Immunohistochemical staining of cytologic material with CD117 has been reliable in establishing this diagnosis by FNAB, provided adequate tissue is procured. In the current study, the presence of necrosis or mitoses in cytologic specimens was correlated with a diagnosis of malignant GIST.

Biopsy, Fine-Needle↗

PubMed1991

Temporal change in diagnostic criteria as a cause of the increase of malignant melanoma over time is unlikely.

To assess whether the increase in malignant melanoma incidence could be due, at least in part, to changes in histological criteria of malignancy, pathologists in Australia, France, Italy, New Zealand, Norway, Sweden, the United Kingdom, the United States and the USSR reviewed diagnoses of 50 consecutive pigmented naevi (40 junctional and compound; 10 intradermal) and 20 consecutive malignant melanomas made in each participating centre around 1930, around 1955 and around 1980. Collaborating pathologists re-read the material, 2,665 cases in all, either from the original slide (82%) or from a recut block (17%), gave their diagnosis and indicated whether the lesion was benign (B), dubious benign (DB), dubious malignant (DM) or malignant (M). As the distribution of review diagnoses was much the same whether the original slide or one made from a recut block was read, the material was pooled. Overall, 2.8% of cases originally reported as B/DB were reviewed as DM/M, while 4.4% of the DM/M diagnoses were held to be B/DB. The shifts between categories were greatest around 1955 and least around 1980, suggesting increasing uniformity of interpretation. All available blocks were recut and sections sent to IARC for review: 1.7% (22) of 1293 B/DB diagnoses were considered to be DM/M and 3.3% (18) of 551 DM/M diagnoses were considered to have been B/DB. The consistently low frequency of shift in diagnostic category, whether the material was reviewed in the collaborating laboratories or by one pathologist at IARC, in a study designed to give maximum attention to those lesions--the junctional and compound naevi--in which a change in opinion as to malignancy would be most likely to arise, suggests that pathologists, irrespective of geographical location, are using common criteria. These findings argue against changes in histological interpretation as being responsible for more than a small portion of the continuous increase of some 3% to 8% per annum observed in malignant melanoma incidence. Other explanations, such as an increase in the frequency or potential for malignant transformation of precursor lesions, must be sought. The anatomical distribution of the malignant melanomas examined followed the usual site pattern by sex, and their thickness was observed to decrease over the period of the study in most centres.

Female↗

PubMed1994

Expression of integrins and CD44 isoforms in non-Hodgkin's lymphomas: CD44 variant isoforms are preferentially expressed in high-grade malignant lymphomas.

Low- and high-grade malignant non-Hodgkin's lymphomas have been investigated by immunohistochemistry for their expression of various integrins and CD44 isoforms. Comparison with the expression patterns obtained in non-malignant adult lymph nodes revealed the following differences: alpha 6 and beta 4 integrins were expressed in several high-grade malignant lymphomas to a lower degree than in both the low-grade malignant lymphomas and the normal lymph nodes; all other integrins (alpha 2, alpha 4, alpha 5, alpha v, beta 1, beta 2, beta 3, and beta 7) did not exhibit significant differences in the expression levels between malignant and non-malignant tissues. The standard isoform of CD44 (CD44s) was highly expressed in all lymphoid tissues. Using CD44 exons-specific monoclonal antibodies, CD44 variant isoforms were not detected in non-malignant lymph nodes and were detected only rarely in low-grade malignant lymphomas. In contrast, high-grade malignant lymphomas expressed several CD44 variant isoforms, which included the products from the variant exons 3v, 6v, and 9v, but not 4v. Specifically, detection of exon 3v and 6v products indicates a more aggressive phenotype.

Adult↗

PubMed1998

A multivariate logistic regression analysis in predicting malignancy for patients with ovarian tumors.

OBJECTIVE: Our objective was to improve the preoperative diagnosis of ovarian malignancy using a multivariate logistic regression analysis on the basis of demographic, serologic, gray-scale morphological, and Doppler variables. METHODS: One hundred seventy-one patients with ovarian tumors (120 benign, 51 malignant including 9 tumors of low malignant potential) were studied with transvaginal B-mode, color, and pulsed Doppler ultrasonography before surgery. Based on the gray-scale ultrasound imaging, each tumor was classified as a unilocular cyst, multilocular cyst, unilocular cyst with solid parts, multilocular cyst with solid parts, or solid tumor. Intratumoral blood flow velocity waveforms were recorded on all tumors except unilocular cyst and were evaluated for resistance index (RI) and peak systolic velocity (PSV). Serum CA 125 levels were also measured. RESULTS: Twenty tumors were unilocular cysts and were all benign. Seventy tumors including all unilocular cysts which showed no flows were all benign. The remaining 101 tumors (50 benign, 51 malignant including 9 tumors of low malignant potential) presented intratumoral blood flows. Univariate and multivariate logistic regression analyses were conducted to identify variables predictive of ovarian malignancy in these 101 tumors. The variables included age, menstrual state, serum CA 125 levels, B-mode classification, RI, and PSV. In univariate analysis, menopause, the positivity of CA 125 (> or = 35 U/ml), and PSV larger than or equal to 10.4 cm/s were found to be significantly associated with malignant tumors. The PSV value of 10.4 cm/s was the median in benign tumors. Multivariate analysis showed that serum CA 125 levels (> or = 35 U/ml) (P = 0.002) and PSV (> or = 10.4 cm/s) (P < 0.001) were to be independent predictors of malignancy. CONCLUSION: These results suggest that intratumoral PSV is the strongest means of differentiating benign from malignant ovarian tumors with suspicious gray-scale ultrasonographic findings.

Adolescent↗

PubMed1979

Malignant Schwannoma associated with von Recklinghausen's neurofibromatosis.

A series of 46 malignant schwannomas occurring in soft parts of patients having von Recklinghausen's neurofibromatosis was analyzed. The diagnosis of malignant schwannoma was based upon the occurrence of malignant spindled cells closely resembling Schwann cells in the neoplasm and the close association or origin of the malignant schwannoma in a neurofibroma (27 tumors), or a large peripheral nerve (31 tumors). Additional histologic features useful in making the diagnosis of malignant schwannoma included the arrangement of the spindled tumor cells in a whorled pattern about thin-walled, gaping blood vessels, perivascular cellular proliferation and the presence of prominent myxoid stroma containing abundant hyaluronidase-sensitive acid mucopolysaccharides. Nuclear palisading was present in only one case. Eight tumors containing both neoplastic Schwann cells and rhabdomyoblasts and five containing both neoplastic Schwann cells and rhabdomyoblasts (malignant "Triton" tumors) and five containing foci of malignant cartilage cells were included in the series. The neoplasms occurred principally in adults (median age, 34 years) and were most common in the lower extremity (18 cases) and retroperitoneum (11 cases). A mass with or without pain was the most common presenting symptom (28 cases). The median size of excised tumors was 11 cm. The malignant schwannomas were highly malignant neoplasms, causing the death of 39 patients within five years and two patients within 6--10 years after diagnosis. Only four patients were alive and free of tumor 5--15 years after diagnosis.

Adolescent↗

PubMed1980

Ectopic synthesis of pregnancy specific beta 1-glycoprotein (SP1) and placental specific tissue proteins (PP5, PP10, PP11, PP12) in nontrophoblastic malignant tumours. Possible markers in oncology.

By using an enzyme-bridge immunoperoxidase (PAP) technique, localization of so-called pregnancy-specific beta 1-glycoprotein (SP1) and placental-specific tissue proteins (PP5, PP10, PP11, PP12) was investigated in 19 cases of breast cancer, 24 cases of testicular malignant tumours, 12 cases of gastric cancer and some cases of other malignant tumours. These five glycoproteins isolated from human term placentae and characterized by Bohn are localised mainly in the cytoplasm, or nucleus of syncytiotrophoblast and appear to be specific for the trophoblast. But to a certain percentage these proteins could also be detected in the cytoplasma of malignant cells: In breast cancer, SP1 was present in 52.6% of cases, PP5 in 63.2%, PP10 in 68.4%, PP11 in 55.6% and PP12 in 31.6%. In testicular malignant tumours the detection rates of these proteins varied from 20.8 to 75.0% and in gastric cancer from 41.7 to 66.7%. In total 50% of the tumours tested were SP1-positive, 58.3% PP5-positive, 55.6% PP10-positive, 38.0% PP11-positive and 31.9% PP12-positive. In addition, it was found that mononuclear histiocytes showed a strong cytoplasmic staining for PP10 and PP12 and that a few other non-cancerous cells (i.e. striated cells in gastric metaplasia, gastric polyps etc.) stained for PP5, PP10, PP11 and/or PP12. All control sections were negative in malignant cells as well as in other tissue cells. This study confirms the reports that some kinds of malignant tumours produce SP1 and indicates that the ectopic production of proteins normally produced by the trophoblast is a common finding in malignant tumours. It furthermore suggests that such proteins may be useful as markers in monitoring patients with malignant diseases. The possible mechanisms of ectopic production of these inappropriate proteins in malignant tumours are discussed.

Breast Neoplasms↗

PubMed2000

Effect of rectal stump washout on the presence of free malignant cells in the rectum during anterior resection for rectal cancer.

PURPOSE: It is possible that implantation of viable malignant cells is one of the mechanisms of anastomotic recurrence in rectosigmoid cancer. The viability of shed intraluminal cells was previously established and malignant cells were retrieved on circular staplers in unwashed rectal stumps. The aim of this study is to evaluate the effectiveness of a defined and uniform washout protocol in eradication of intraluminal malignant cells during anterior resection. METHODS: In 14 consecutive patients the closed rectal stump was washed before insertion of the circular stapler. The washout was performed uniformly by instillation of ten increments of 50 ml of saline through a rectal tube. Samples from the first, fifth, and tenth washings were collected for cytologic examination. The presence or absence of malignant cells was then correlated with rectal stump length, length of the tumor-free distal margin, and differentiation and Dukes staging of the tumor. RESULTS: In 11 patients the first washing was positive for free malignant cells, and the fifth washing was still positive in 7 patients; however, the last (tenth) samples were clear in 10 patients, and malignant cells were recovered in only 4 patients. The rectal stump and the tumor-free distal margin were shorter in patients who still had positive cytology for free intraluminal malignant cells after stump irrigation with 500 ml of saline. No correlation was found with tumor differentiation or staging. CONCLUSIONS: Free malignant cells are shed into the rectal stump during anterior resection. Mechanical lavage with saline effectively eradicates these cells; however, the completeness of cleansing is volume related. Incomplete cleansing with 500 ml of saline correlates with lower tumors. Technically more difficult surgery involves traumatic handling of the tumor and possibly induces shedding of more malignant cells. We suggest that rectal stump washout during anterior resection for carcinoma should be routine, and the volume of the lavage fluid should be larger than 500 ml.

Aged↗

PubMed1995

Proliferative indices and oncoprotein expression in benign and malignant breast biopsies.

BACKGROUND: Prognostic factors are used routinely in the management of breast cancer. However, their potential for identifying precursor malignant lesions has not been assessed. METHODS: We have examined 285 breast biopsy specimens (140 benign, 145 malignant) for DNA ploidy, S-phase fraction, Ki-67 nuclear antigen proliferative indices, and HER-2/neu and epidermal growth factor receptor oncoproteins. RESULTS: When proliferative indices were compared between the benign and malignant groups, differences were noted for DNA ploidy, S-phase fraction, and cell cycling index (p < 0.0005). When the benign nonproliferative specimens were compared with the atypical/proliferative benign specimens, proliferative indices failed to show any differences. When the specific subset of proliferative/atypical benign breast tissue was compared with the malignant specimens, DNA index, S-phase fraction, and cell cycling index showed significant differences. The mean for epidermal growth factor receptor was greater in the non-proliferative group but not statistically significant (p < 0.1). HER-2/neu oncoprotein failed to show any differences between the benign and malignant groups. Within the atypical benign group, Ki-67 correlated strongly with S-phase fraction and HER-2/neu (p < 0.01). CONCLUSIONS: We have demonstrated that proliferative indices can differentiate between benign and malignant breast tissues but not among specific subgroups. In addition, epidermal growth factor may differentiate between nonproliferative and proliferative/atypical benign biopsy results. Oncoprotein determination, ploidy, and DNA proliferative indices may be useful in defining malignant and benign breast disease but are not useful in distinguishing between benign and malignant breast disease with an increased likelihood for malignant transformation.

Analysis of Variance↗

PubMed1986

Cell differentiation and malignancy.

An understanding of the mechanism that controls growth and differentiation in normal cells would seem to be an essential requirement to elucidate the origin and reversibility of malignancy. For this approach I have mainly used normal and leukemic blood cells, and in most studies have used myeloid blood cells as a model system. Our development of systems for the in vitro cloning and clonal differentiation of normal blood cells made it possible to study the controls that regulate growth (multiplication) and differentiation of these normal cells and the changes in these controls in leukemia. Experiments with normal blood cell precursors have shown that normal cells require different proteins to induce growth and differentiation. We have also shown that in normal myeloid precursors, growth-inducing protein induces both growth and production of differentiation-inducing protein so this ensures the coupling between growth and differentiation that occurs in normal development. The origin of malignancy involves uncoupling of growth and differentiation. This can be produced by changes from inducible to constitutive expression of specific genes that result in asynchrony to the coordination required for the normal developmental program. Normal myeloid precursors require an external source of growth-inducing protein for growth, and we have identified different types of leukemic cells. Some no longer require and other constitutively produce their own growth-inducing protein. But addition of the normal differentiation-inducing protein to these malignant cells still induces their normal differentiation, and the mature cells are then no longer malignant. Genetic changes that produce blocks in the ability to be induced to differentiate by the normal inducer occur in the evolution of leukemia. But even these cells can be induced to differentiate by other compounds, including low doses of compounds now being used in cancer therapy, that induce the differentiation program by other pathways. This differentiation of leukemic cells has been obtained in vitro and in vivo, and our in vivo results indicate that this may be a useful approach to therapy. In some tumours, such as sarcomas, reversion from a malignant to a non-malignant phenotype can be a result of chromosome changes that suppress malignancy. But in myeloid leukemia, the stopping of growth in mature cells by induction of differentiation bypasses the genetic changes that produce the malignant phenotype. These conclusions can also be applied to other types of normal and malignant cells.

Animals↗

PubMedDate not supplied

Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsy.

BACKGROUND: We assessed the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant portal vein thrombosis in patients who had cirrhosis with hepatocellular carcinoma (HCC). METHODS: Fifty-four consecutive patients who had cirrhosis, biopsy-proved HCC, and thrombosis of the main portal vein and/or left/right portal vein on US were prospectively studied with color Doppler US (CDUS) and CEUS. CEUS was performed at low mechanical index after intravenous administration of a second-generation contrast agent (SonoVue, Bracco, Milan, Italy). Presence or absence of CDUS signals or thrombus enhancement on CEUS were considered diagnostic for malignant or benign portal vein thrombosis. Twenty-eight patients also underwent percutaneous portal vein fine-needle biopsy (FNB) under US guidance. All patients were followed-up bimonthly by CDUS. Shrinkage of the thrombus and/or recanalization of the vessels on CDUS during follow-up were considered definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered consistent with malignancy. CDUS, CEUS, and FNB results were compared with those at follow-up. RESULTS: Follow-up (4 to 21 months) showed signs of malignant thrombosis in 34 of 54 patients. FNB produced a true-positive result for malignancy in 19 of 25 patients, a false-negative result in six of 25 patients, and a true-negative result in three of three patients. CDUS was positive in seven of 54 patients. CEUS showed enhancement of the thrombus in 30 of 54 patients. No false-positive result was observed at CDUS, CEUS, and FNB. Sensitivities of CDUS, CEUS, and FNB in detecting malignant thrombi were 20%, 88%, and 76% respectively. Three patients showed negative CDUS and CEUS and positive FNB results; follow-up confirmed malignant thrombosis in these patients. One patient showed negative CDUS, CEUS, and FNB findings. However, follow-up of the thrombus showed US signs of malignancy. Another FNB confirmed HCC infiltration of the portal vein. CONCLUSION: CEUS seems to be the most sensitive and specific test for diagnosing malignant portal vein thrombosis in patients with cirrhosis.

Aged↗

PubMed2001

CT features of malignant mucinous cystic tumors of the pancreas.

This study is aimed at evaluating which pre-operative findings at CT are prevailingly associated with histologically malignant appearance of mucinous cystic tumor (MCT) of the pancreas. The CT examinations of 52 female patients affected with pathologically proved MCT were retrospectively evaluated by two radiologists, blinded to the histopathological assessment of the biologic behavior (either benign or malignant). A multivariate logistic regression analysis was performed in order to identify the most important features associated with the malignant nature of MCT. Calcifications in the wall and/or in the septa, thick wall, and septations resulted in the most important features associated with malignancy. The simultaneous presence of all these radiological signs constitutes an almost "certain" marker of malignancy, being the risk equal to 0.95, whereas the simultaneous presence of at least two of them entails a risk of malignancy ranging from 0.56 to 0.74, according to the type of morphological features. On the other hand, the absence of the mentioned radiological features entails a negligible risk of malignancy (0.02). Mucinous cystic tumors characterized by multilocular macrocystic architecture, with thick wall and calcifications in the wall and/or the septa, present the highest risk of malignancy, and advocate prompt surgical intervention. When those signs are absent, the probability of malignancy is lower. In this case a non-operative management is possible.

Adult↗

PubMed2006

The risk of multiple primary malignancies with colorectal carcinoma.

PURPOSE: With advances in diagnostic techniques and treatment modalities, the number of patients identified with colorectal carcinoma who develop multiple primary malignancy during long-term follow-up has been increasing. We investigated multiple primary malignancies occurring in a large number of colorectal carcinoma patients who had undergone surgery in the 1980s at our institution. METHODS: A total of 1,304 Japanese patients with colorectal carcinoma treated between January 1980 and December 1989 were prospectively followed to investigate the situations in which multiple primary malignancies occurred. To determine whether the incidence of multiple primary malignancies in this series was higher than expected, we calculated the expected numbers of carcinoma occurrences and evaluated these findings by exact binomial test. RESULTS: The median follow-up period was 95 months. The incidence of multiple primary malignancy was 18.7 percent (143/765) among males and 14.7 percent (79/539) among females. The most common site of multiple primary malignancy among males was the stomach, followed by the lung, prostate, larynx, liver, esophagus, and urinary bladder. The most common site among females was the uterus, followed by the stomach, breast, and liver. The sites that showed a higher incidence of multiple primary malignancy than the expected value were: the prostate, larynx, urinary bladder, oral cavity/pharynx and thyroid among males, and the uterus and oral cavity/pharynx among females. CONCLUSIONS: Fifteen to 20 percent of Japanese colorectal carcinoma patients experienced multiple primary malignancies. Postoperative long-term screening methods should be established considering the actual occurrence numbers and risk rate of multiple primary malignancies in addition to metachronous colorectal carcinoma.

Aged↗

PubMed2005

The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for malignant glioma.

PURPOSE: To systematically review the evidence for the use of stereotactic radiosurgery or stereotactic fractionated radiation therapy in adult patients with malignant glioma. METHODS: Key clinical questions to be addressed in this evidence-based review were identified. Outcomes considered were overall survival, quality of life or symptom control, brain tumor control or response and toxicity. MEDLINE (1990-2004 June Week 2), CANCERLIT (1990-2003), CINAHL (1990-2004 June Week 2), EMBASE (1990-2004 Week 25), and the Cochrane library (2004 issue 2) databases were searched using OVID. In addition, the Physician Data Query clinical trials database, the proceedings of the American Society of Clinical Oncology (1997-2004), ASTRO (1997-2004), and the European Society of Therapeutic Radiology and Oncology (ESTRO) (1997-2003) were searched. Data from the literature search were reviewed and tabulated. This process included an assessment of the level of evidence. RESULTS: For patients with newly diagnosed malignant glioma, radiosurgery as boost therapy with conventional external beam radiation was examined in one randomized trial, five prospective cohort studies, and seven retrospective series. There is Level I evidence that the use of radiosurgery boost followed by external beam radiotherapy and carmustine (BCNU) does not confer benefit with respect to overall survival, quality of life, or patterns of failure as compared with external beam radiotherapy and BCNU. There is Level I-III evidence of toxicity associated with radiosurgery boost as compared with external beam radiotherapy alone. The results of the prospective and retrospective studies may be influenced by selection bias. Radiosurgery used as salvage for recurrent or progressive malignant glioma after conventional external beam radiotherapy failure was reported in zero randomized trials, three prospective cohort studies, and five retrospective series. The available data are sparse and insufficient to make absolute recommendations. Stereotactic fractionated radiation therapy has been reported as boost therapy with external beam radiotherapy for patients with newly diagnosed malignant glioma in only three prospective studies. As primary therapy alone without conventional external beam radiotherapy for newly diagnosed malignant glioma patients, stereotactic fractionated radiation therapy has been reported in only one prospective study. There were only three prospective series and two retrospective studies reported for patients with recurrent or progressive malignant glioma. CONCLUSIONS: For patients with malignant glioma, there is Level I-III evidence that the use of radiosurgery boost followed by external beam radiotherapy and BCNU does not confer benefit in terms of overall survival, local brain control, or quality of life as compared with external beam radiotherapy and BCNU. The use of radiosurgery boost is associated with increased toxicity. For patients with malignant glioma, there is insufficient evidence regarding the benefits/harms of using radiosurgery at the time progression or recurrence. There is also insufficient evidence regarding the benefits/harms in the use of stereotactic fractionated radiation therapy for patients with newly diagnosed or progressive/recurrent malignant glioma.

Adult↗

PubMed2003

Outcomes of active operation during intensive followup for second primary malignancy after esophagectomy for thoracic squamous cell esophageal carcinoma.

BACKGROUND: Recent advances in the treatment of thoracic esophageal cancer have afforded it a better prognosis. As a consequence, increasing attention is being paid to the outcomes with postoperative monitoring for second primary malignancies after esophagectomy, but no recent study has focused on the longterm followup and outcomes in these patients. STUDY DESIGN: In 1989, we began intensive prospective screening and surveillance designed to detect cancers of the head and neck, lung, stomach, residual esophagus, and colon/rectum after esophagectomy. Between 1989 and 2001, 365 patients underwent esophagectomy for thoracic squamous cell esophageal carcinoma in our department. Of those, 200 were followed up as part of this program. Excluded were patients in whom esophageal cancer recurred, patients with other prior or simultaneous malignancies, and patients who died within a year of operation. Clinicopathologic profiles and treatment outcomes were determined for 33 patients who developed a second primary malignancy after esophagectomy. RESULTS: The interval between the primary esophageal cancer and the secondary carcinoma was 49 +/- 40 months (median, 48 months). The second primary malignancies were located in the stomach (30%), head and neck (24%), lung (24%), colon/rectum (9%), liver (6%), pancreas (3%), and blood (6%). Twenty-one patients (64%) were classified as stage 0, I, or II; 10 (30%) were stage III or IV. Overall, the 2-year, 3-year, and 5-year survival rates following diagnosis of a second primary malignancy were 58.0%, 58.0%, and 48.6%, respectively. Of the 19 patients (58%) in whom second primary malignancies were detected before symptoms developed, the 5-year survival rate was 70.7%, which was significantly greater than that among patients whose secondary malignancies were discovered after symptoms developed (17.1%). CONCLUSIONS: Good outcomes in the treatment of second primary malignancies after esophagectomy for thoracic squamous cell esophageal carcinoma can be obtained with longterm, intensive followup and active surgical intervention for detected malignancies.

Aged↗

PubMed2004

Liver transplantation for primary sclerosing cholangitis; predictors and consequences of hepatobiliary malignancy.

BACKGROUND/AIMS: Hepatobiliary malignancies are frequently seen in primary sclerosing cholangitis (PSC) and they complicate the evaluation of patients and timing of liver transplantation. METHODS: Data from all Nordic PSC patients listed for liver transplantation during 1990-2001 were recorded prospectively. Predictors of hepatobiliary malignancy and patient survival rates have been analysed. RESULTS: Hepatobiliary malignancy was found in 52/255 (20%) patients accepted to the waiting list. Recent diagnosis of PSC, no ursodeoxycholic acid (UDCA) treatment, clinical suspicion and previous colorectal-cancer were predictors of malignancy. Among 89 patients with a strong suspicion of malignancy prior to acceptance, 35 (39%) had confirmed malignancy. A clinical suspicion had been raised in 35/52 (67%) patients with malignancy. Malignancy was found in 31/223 patients who received a liver allograft. The 1-, 3- and 5-year patient survival rates following transplantation for patients with PSC and cholangiocarcinoma were 65, 35 and 35%, respectively. CONCLUSIONS: Hepatobiliary malignancy is suspected in 1/3 of the PSC patients and found in 1/5. Although cholangiocarcinoma is regarded as a contraindication to liver transplantation (LTX), PSC patients with cholangiocarcinoma had a 35% 5-year survival following transplantation.

Adult↗

PubMed2005

Extrathymic malignancies in patients with myasthenia gravis.

INTRODUCTION: Myasthenia gravis (MG) is considered a paraneoplastic phenomenon of thymomas in 15% of patients. Co-existence of MG with extrathymic malignancies, and an increased risk of second malignancy in patients with thymoma have been reported. Data on clinical characteristics of MG patients with extrathymic malignancies and the role of concomitant diseases and their treatment are lacking. METHODS: The clinical records of 188 consecutive MG patients were studied retrospectively. We examined whether gender, age, generalized disease, seropositivity for acetyl-choline receptor antibodies, occurrence of thymoma, immunosuppressive therapy and occurrence of other autoimmune diseases determined an increased risk for development of extrathymic malignancy. RESULTS: This group followed the typical epidemiological characteristics of MG. Thirty-three patients (17.6%) had a thymoma. Twenty-nine patients (15.4%) had 30 extrathymic malignant tumors of various origins. Only four patients with extrathymic tumors had an associated thymoma. Tumors were diagnosed between 20 years prior to and 35 years after the appearance of MG. Older age of MG onset was the only risk factor identified for development of malignancy in MG. DISCUSSION: Extrathymic malignancies are common in MG patients, especially in the older age group. There are no specific clinical features of the subgroup of MG patients with cancer. Although MG is not a paraneoplastic phenomenon of extrathymic malignancy, the association between MG and malignancy may be due to a common background of immune dysregulation.

Adult↗

PubMed2004

Application of dynamic contrast-enhanced MRI to differentiate malignant lymphoma from squamous cell carcinoma in the head and neck.

Because malignant lymphoma, the second most common malignant tumor of the head and neck, and squamous cell carcinoma (SCC), the most common malignant tumor of the head and neck, require different treatments, it is important to be able to differentiate them. In the present study, we attempted to differentiate malignant lymphomas from SCCs using dynamic contrast-enhanced MRI (DCE-MRI). Seventeen lesions (in 8 cases) of malignant lymphoma and 30 cases of SCC were compared by DCE-MRI. Thirteen of 17 malignant lymphomas (76.5%) showed the maximum contrast index (CI) at 90-180 s, while 26 of 30 SCCs (86.7%) showed the maximum CI at a much faster 60-105 s. There was a statistically significant difference between SCC and malignant lymphoma in the time needed reach the maximum CI (p = 0.0177). There was also significant difference between SCC and malignant lymphoma in their maximum CIs (p < 0.001), with the maximum CIs of 29/30 SCCs (96.7%) above 2.0, while 12/17 malignant lymphomas (70.6%) showed CIs of less than 2.0. We consider these findings to be useful for distinguishing lymphomas from SCCs.

Aged↗