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PubMed1995

The incidence of internal malignancies in pemphigus and bullous pemphigoid in Japan.

To evaluate the significance of the association of malignancy with autoimmune blistering diseases, we studied the incidence of internal malignancies in pemphigus and bullous pemphigoid based upon 496 cases of pemphigus and 1113 cases of bullous pemphigoid in Japan. Results showed that (1) an association between internal malignancies and pemphigus was observed in 25 out of 496 cases (5.0%), while that with bullous pemphigoid was seen in 64 out of 1113 cases (5.8%). Such association ratios were significantly higher than that of the controls aged over 70 years old (0.61%); (2) The average ages of pemphigus/bullous pemphigoid with malignancy were 64.7 and 69.2 years, respectively. The association ratio of malignancy with pemphigus increased by age, while that with pemphigoid was not correlated with aging; (3) Lung cancer was most common in pemphigus and gastric cancer in bullous pemphigoid; (4) There were no significant differences in the titers of circulating antibody, the presence or extent of mucous involvement or annular erythema between bullous pemphigoid patients with malignancy and without malignancy. Our results indicated that detailed examination for internal malignancy is essential for those patients with pemphigus or bullous pemphigoid.

Aged↗

PubMed1992

Histopathology of malignant salivary gland tumours.

This report is based upon the Salivary Gland Register in Hamburg and on the second revised edition of the WHO Histological Typing of Salivary Gland Tumours. The group of malignant salivary gland tumours contains carcinomas, malignant non-epithelial tumours, malignant lymphomas and secondary tumours. The various carcinomas are classified in a continuous separate listing because the different types are distinguished not only by histopathology, but also by differences in prognosis and treatment. The term "tumour" is replaced by "carcinoma" in two entities: acinic cell carcinoma and mucoepidermoid carcinoma. New entities are: polymorphous low-grade adenocarcinoma, basal cell adenocarcinoma, salivary duct carcinoma and malignant myoepithelioma. Carcinoma in pleomorphic adenoma can be distinguished as non-invasive and invasive carcinoma, and carcinosarcoma. Malignant non-epithelial tumours are mostly malignant fibrous histiocytoma, malignant schwannoma and rhabdomyosarcoma. The large majority of malignant lymphomas are non-Hodgkin-lymphomas with high differentiation. Many lymphomas are associated with chronic immunosialadenitis (Sjögren's syndrome). Secondary tumours are mostly metastases from primary squamous cell carcinomas or from melanomas of the skin (head and neck area). Haematogeneous metastases are very rare (mainly from lung, kidney or breast).

Adenocarcinoma↗

PubMed1994

Thymectomy and malignancy.

Three hundred ninety patients who underwent thymectomy for myasthenia gravis (MG) were followed up to investigate the development of associated malignancies. There were 102 patients with thymoma and 288 without thymoma. Malignant neoplasms were detected in ten patients, four of whom already had the tumor at the time MG was diagnosed. Thus, malignancy developed after thymectomy in six patients. Malignant fibrous histiocytoma (MFH) developed in three patients, as well as gastric cancer, gastric leiomyosarcoma, rectal cancer, liver cancer, lung cancer, breast cancer, and thymic carcinoid in one patient each. Nine of the ten malignancies developed in the thymoma group, and only one in the non-thymoma group. The predicted number of patients with malignancy was 2.63 in the thymoma group and 2.65 in the non-thymoma group. Our findings suggest that the presence of thymoma facilitates the occurrence of extrathymic malignancy, and that thymectomy never enhances the occurrence of malignancy but possibly inhibits it.

Adolescent↗

PubMed2006

The catastrophic antiphospholipid (Asherson's) syndrome and malignancies.

The catastrophic antiphospholipid syndrome is characterised by the rapid chronological development of fulminant thrombotic complications that predominantly affect small vessels. It has been reported as frequently occurring in patients with underlying malignancies. We analysed the web site-based international registry of patients with catastrophic APS. The clinical characteristics of patients with CAPS and an underlying malignancy were evaluated. Of the 262 patients included in the CAPS registry, information on associated malignancies was available in 23 (9%) cases. Haematological malignancies were present in 6 (26%) patients. Four of the patients suffered from lung carcinoma (17%), and two patients (9%) from colon carcinoma. In most of the patients (61%), malignancy was the precipitating factor for CAPS. In 4 patients (17%), however, surgical procedures related to the carcinoma were noted as precipitating factors. In one patient CAPS occurred during allogenic stem cell transplantation after diagnosis of acute lymphoblastic leukemia (ALL). Cerebral manifestations were most common and consisted mainly of cerebral infarcts and encephalopathy. Recovery occurred in 9/23 (39%) patients. Malignancy may be an important risk factor for CAPS. 9% of patients with CAPS presented with an underlying malignancy. In most of these patients, the malignancy and/or surgical procedures were the precipitating factors for CAPS.

Adolescent↗

PubMed2005

[Malignant tumor's of nasal fossae: anatomoclinic's study and a new classification: study about 21 cases].

PURPOSE: This work proposes to study the anatomoclinical, therapeutic and evolutionary characteristics of the malignant tumours of the nasal cavities. This study focuses exclusively on the malignant tumours strictly of the endonasal variety (excluding tumours from the olfactive placode and those extending to the paranasal cavitie). These tumours are not common not often studied in the literature and their is not codified (classification, treatment). A new classification of the malignant tumours (strictly endonasals varieties) is presented in this study. PATIENTS AND METHODS: This is a retrospective study of 21 malignant tumours of the nasal cavities selected between January 1989 and December 2001. The handling of these tumours rests on a tripod diagnosis: nasal endoscopy-imagery-biopsy. The following parameters are studied: epidemiological, histopathological, clinical, therapeutic and evolutionary. RESULTS: The average age of our population is 52,4 years with a male sex ratio of 1,3. The nasal obstruction is the principal revealing sign (82%) followed by the epistaxis (14,2%). The septal tumours are the most frequent (10 cases). The histopathological results of our study show the prevalence of the epithelial tumours: epidermoid carcinoma (8/21), adenocarcinoma (2/21) malignant melanoma (2/21). The non-epithelial varieties are dominated by lymphomas (NLH) (8/21). The surgery plays a dominant role in the treatment of these tumours. Most of the tumours were operated on, usually transfacially and often with postoperative radiotherapy. The endoscopic surgery was not valided. Our results show on the one hand the gravity of certain tumoral varieties: malignant melanoma, lymphomas(NHL) and on the other hand the overall unfavourable forecast of these tumours with a mortality rate of 42,8%. CONCLUSION: The malignant tumours of the nasal fossae, in particular in the specific context of this study (strict endonasal tumours) are rare and their handling is not codified. They are dominated by the epithelial malignant varieties, in particular in their septal localizations. The evolutionary profile is dominated by the loco regional recurrence. The forecast of these tumours is overall bad according to the tumoral stage, especially the histopathological varieties.

Adenocarcinoma↗

PubMed2006

Influence of the number of malignant regional lymph nodes detected by endoscopic ultrasonography on survival stratification in esophageal adenocarcinoma.

BACKGROUND & AIMS: The nodal staging of esophageal cancer accounts for the absence or presence of metastatic lymph nodes (N0 or N1, respectively). Surgical data suggest that patients have worse survival when esophagectomy specimens contain higher numbers of regional malignant lymph nodes. It has been proposed that the staging system for esophageal cancer be modified to include the number of malignant lymph nodes. The aim of this study was to determine the influence of the number of malignant-appearing regional lymph nodes detected on endoscopic ultrasonography (EUS) on survival in patients with esophageal adenocarcinoma. METHODS: Historical case series involved patients with esophageal adenocarcinoma who underwent EUS staging at a single center between 1994 and 2004. Endoscopy reports were reviewed to determine the number of malignant-appearing periesophageal lymph nodes seen on EUS examination. Subjects were categorized as having 0, 1-2, or >2 periesophageal lymph nodes. A regional cancer registry prospectively obtained survival data. RESULTS: Among 85 patients with esophageal adenocarcinoma, the Kaplan-Meier curves showed distinct survival advantages in those with fewer malignant-appearing regional lymph nodes (P=.0008). The median survivals were 66 months, 14.5 months, and 6.5 months for 0, 1-2, and >2 malignant-appearing lymph nodes, respectively. Survival was also influenced by celiac lymph nodes and tumor length, both of which were associated with increased number of malignant nodes. CONCLUSIONS: The number of malignant-appearing periesophageal lymph nodes detected by EUS is associated with improved survival stratification in patients with esophageal adenocarcinoma and should be considered in the presurgical staging of esophageal cancer.

Adenocarcinoma↗

PubMed2006

Comparison of some trace elements concentration in blood, tumor free breast and tumor tissues of women with benign and malignant breast lesions: an Indian study.

Fifty women residing in and around New Delhi, India and identified to have benign (25 nos.) and malignant (25 nos.) breast lesions were studied for the first time to access the association between environmental exposure to lead and risk of breast cancer and to determine the potential of changes in trace elements concentration as a diagnostic marker and/or its etiological involvement in the disease. Blood, tumor tissue and breast adipose tissue from tumor free area from each patient of the two groups, collected at the time of lumpectomy or mastectomy (only blood sample was collected from disease free control group), were analyzed to determine the concentration of Pb, Zn, Cu, Fe and Ca using Atomic Absorption Spectrometry. Blood lead was significantly higher in malignant cases than in those of benign and control (p<0.05 each). Lead level was also higher in tumor tissue when compared with their respective normal tumor free breast tissue, though non-significant, in both benign and malignant cases. Interestingly, Zn, Fe, and Ca levels were higher in blood of malignant cases than in those of their benign counterparts. Furthermore, these metals were also higher in tumor of malignant and benign cases as compared to normal tumor free breast tissue, many of them statistically significant (p<0.05/0.01/0.001). However, Cu level was insignificantly lower in the blood and tumor tissue of malignant cases when compared with their benign counterparts while it was significantly higher (p<0.05) in tumor of benign cases when compared with those of their respective normal tumor free breast tissue. There were statistically significant correlations between lead and trace element levels only in normal tumor free breast tissue of benign and malignant cases (r=0.41-0.73; p<0.05-0.001) but neither in blood nor tumor tissue of the two groups. These results suggest that in the backdrop of existing experimental and epidemiological evidences exposure to lead may be one of the risk factors for breast lesions; though it warrants further investigation. Further, modulation of trace elements level in both benign and malignant breast diseases patients may be of potential to be used as diagnostic marker of the disease process and its possible relationship etiologically.

Adult↗

PubMed2005

Haematological malignancies--a predictor of a poor outcome in patients with bacteraemia.

OBJECTIVES: To compare microbial agents causing first episodes of bacteraemia in patients with and without haematological malignancies, and to examine mortality within 90 days of follow-up. METHODS: We conducted a population-based study in North Jutland County, Denmark including patients (> or = 15 years) registered in the County Bacteraemia Registry with their first episode of bacteraemia during the period 1992-2002. Diseases prior to the bacteraemia were identified in the Hospital Discharge Registry. Mortality was determined through the Civil Registration System. We estimated adjusted mortality rate ratios (MRRs) using Cox's regression analysis. RESULTS: We included 7456 patients with a first episode of bacteraemia; of these, 444 (6%) had a haematological malignancy. Haematological patients had almost the same proportions of gram-negative (49% vs. 50%) and gram-positive (37% vs. 39%) bacteraemia as other patients. Cumulative 30-day mortality in patients with haematological malignancies was 32% vs. 20% in patients without any malignancy, yielding an adjusted MRR of 1.6 (95% CI 1.3-2.0). For patients with non-haematological malignancies the adjusted MRR was 1.5 (95% CI 1.4-1.7). CONCLUSION: Despite a similar distribution of the microbial agents causing bacteraemia, patients with haematological malignancies and also patients with non-haematological malignancies had increased 30-day mortality of bacteraemia when compared with patients without any malignancy.

Adolescent↗

PubMed2004

Risk of subsequent primary neoplasms developing in lung cancer patients with prior malignancies.

BACKGROUND: This study was performed to test the hypothesis that a history of other primary neoplasms before a lung cancer diagnosis increases the risk of subsequent malignancy. METHODS: Of 8363 lung cancer patients seen from 1978 to 2002, 881 (11%) had at least 1 previous nonlung primary malignancy. Charts were analyzed for the occurrence of subsequent malignancies. RESULTS: Lung cancer diagnosis in 881 patients consisted of 75% non-small cell, 12% small cell, and 13% other histologies. The median age was 66 years, with 56% male, 76% white, and 86% smokers. Of the 881 patients, 92% had no subsequent cancer (group 1), and 8% went on to experience the development of a new primary neoplasm (including lung) after their lung cancer (group 2). After adequate follow-up, the cumulative probability of developing a subsequent cancer did not differ markedly between those with and without a prior non-lung cancer diagnosis at 2 years (12% vs 10%) or 5 years (16% vs 15%). Group 1 patients had a significantly lower 1- and 5-year survival than group 2 patients (59% vs 48% and 29% vs 17%, respectively; P =.008). Although multivariate analysis suggested that stage, history of tobacco-associated neoplasm, and history of definitive surgical resection were important determinants in predicting long-term survival, a prior malignancy was not an independent risk factor in the development of subsequent malignancy. CONCLUSIONS: The risk of developing a subsequent malignancy is very high in lung cancer patients with prior primary malignancies, but it is not markedly different from the risks experienced by patients with no prior malignancies.

Aged↗

PubMed2005

The selective epidermal growth factor receptor tyrosine kinase inhibitor PD153035 suppresses expression of prometastasis phenotypes in malignant pleural mesothelioma cells in vitro.

OBJECTIVE: Malignant pleural mesothelioma is notoriously refractory to aggressive multimodality therapy. Epidermal growth factor receptor expression has been observed on malignant pleural mesothelioma cells. Epidermal growth factor receptor-mediated signaling promotes tumorigenesis and metastasis of cancer cells. The purpose of this study is to evaluate the ability of the epidermal growth factor receptor tyrosine kinase inhibitor PD153035 to abrogate the expression of prometastasis phenotypes in malignant pleural mesothelioma cells in vitro. METHODS: Epidermal growth factor receptor expression of malignant pleural mesothelioma cells and primary normal cells was quantitated by means of flow cytometry. PD153035-mediated growth inhibition was determined by means of 1-(4,5-Dimethylthiazol-2-yl)-3,5-diphenylformazan and clonogenic assays. Cell motility and invasion of extracellular matrix was evaluated with in vitro wound-healing and Matrigel invasion assays, respectively. Vascular epidermal growth factor levels in conditioned media were measured by using enzyme-linked immunosorbent assay. RESULTS: Epidermal growth factor receptor expression was detected on all 6 cultured malignant pleural mesothelioma cells, with 4 of 6 having normal receptor expression and 2 of 6 overexpressing the receptor. PD153035 suppressed cell motility and cell invasion through a Matrigel membrane, regardless of the baseline epidermal growth factor receptor expression. Decreased vascular epidermal growth factor production and significant inhibition of growth only occurred in malignant pleural mesothelioma cells that overexpress epidermal growth factor receptor. CONCLUSIONS: Epidermal growth factor receptor tyrosine kinase inhibitor PD153035 significantly inhibited motility and invasion in malignant pleural mesothelioma cells in vitro, regardless of their epidermal growth factor receptor expression levels. Inhibition of epidermal growth factor receptor-dependent signaling might be a useful strategy to diminish malignant pleural mesothelioma recurrence after aggressive cytoreductive surgery.

Antineoplastic Agents↗

PubMed2006

Antiphospholipid antibodies associated with malignancies: clinical and pathological characteristics of 120 patients.

OBJECTIVE: To describe the different types of malignancies associated with antiphospholipid antibodies (aPL). METHODS: We performed a computer-assisted (MEDLINE, National Library of Medicine, Bethesda, MD) search of the literature from 1966 to 2003 to identify all cases of malignancies having aPL. RESULTS: One hundred twenty patients were found. The mean age was 56+/-17 years (range 5 to 88). Sixty-two (52%) patients were men and 58 (48%) were women. A heterogeneous group of malignancies were found. Regarding hematological malignancies, 10 (8%) patients suffered from B-cell lymphoma, 8 (7%) from spleen lymphoma, 7 (6%) from chronic myeloid leukemia, and 6 (5%) from non-Hodgkin's lymphoma (NHL). Regarding solid tumors, renal cell carcinoma was diagnosed in 7 (6%) patients, primary tumor with unknown origin in 7 (6%), lung adenocarcinoma in 6 (5%), breast carcinoma in 6 (5%), and melanoma in 6 (5%). The main aPL-related manifestations were thrombocytopenia (25%), cerebrovascular accidents (24%), deep vein thrombosis (19%), pulmonary embolism (15%), and heart valve lesions (9%). In 17 cases, catastrophic antiphospholipid syndrome was considered to be triggered by the malignancy. Seventy-one (63%) of 113 patients recovered or are still alive after cancer treatment. Twenty-three (35%) of 65 patients achieved aPL remission after proper treatment of the malignancy. CONCLUSIONS: It is important to bear in mind, especially in elderly patients, that thrombotic events associated with aPL can be the first manifestation of malignancy. At the same time, the presence of aPL in patients with malignancies has important implications in their treatment and prognosis.

Antibodies, Antiphospholipid↗

PubMed2006

Primary malignant B-cell-type dural lymphoma: Case report.

BACKGROUND: The primary malignant dural lymphoma of B-cell type is rare. Our review of the literature (24 cases) indicated that patients with this tumor had female predominance, immunocompetency, and longer survival compared with those with primary malignant intracerebral lymphomas. Based on its clinicopathological features, this dural lymphoma may be classified differently from other types of malignant lymphomas in the central nervous system. CASE DESCRIPTION: The authors report an example of a patient who had a favorable course of malignant dural lymphoma. A 59-year-old woman presented with primary malignant dural lymphoma in the frontal area. Histological diagnosis was a diffuse large B-cell-type lymphoma of intermediate malignancy, but MIB-1 index was extremely high. Subtotal tumor removal was followed by 4 courses of chemotherapy. Thirty months after surgery, the patient is asymptomatic with no MRI evidence of recurrence. A combination of subtotal resection and chemotherapy for a primary malignant dural lymphoma is an effective means to attempt cure of this tumor. CONCLUSION: These rare tumors may be managed successfully by subtotal resection and postoperative treatment. We believe that chemotherapy is the treatment of choice after subtotal resection of malignant dural lymphomas, as experienced in our case.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2006

Value of frozen section analysis with suspected testicular malignancy.

OBJECTIVES: To determine whether frozen section analysis (FSA) assists safe conservative surgery for men presenting with suspected testicular tumors. METHODS: We performed a retrospective review of intraoperative testicular FSA used at a single university institution during an 11-year period. The exclusion criteria included lesions of paratesticular origin, size greater than 5 cm, and the known presence of elevated tumor markers or metastatic disease. RESULTS: Eighty men underwent FSA, facilitating the diagnosis of germ cell malignancy in 51 (54.3%) of the 94 new cases encountered during this period. Malignancy was reported by FSA in 52 patients (65.0%), but was later revised in 3 to benign Leydig cell tumor after orchiectomy. Also, 2 of 27 specimens reported as benign by FSA were revised to malignant after analysis of paraffin-embedded tissue from the biopsies. Both were seminoma and required delayed orchiectomy. FSA was reported as "suspicious" (intratubular germ cell neoplasia with necrosis) in 1 patient, in whom orchiectomy was performed and malignancy confirmed. In total, orchiectomy was avoided in 25 cases (31.3%). The positive and negative predictive value for FSA in the diagnosis of testicular malignancy was 94.2% and 92.6%, respectively. Of 13 lesions 1 cm or less, 10 (76.9%) were benign. All 26 lesions greater than 3 cm were malignant. A clear correlation between lesion size and the diagnosis of malignancy was demonstrated. CONCLUSIONS: FSA is a valuable tool assisting testicular preservation. Lesion size correlated with incidence of malignancy; therefore, FSA may be best used for small testicular lesions suitable for excision biopsy.

Adolescent↗

PubMed2001

The significance of malignancies incidental to microcalcifications in breast spot localization biopsy specimens.

BACKGROUND: Incidental breast cancer is occasionally found in spot localization biopsy specimens adjacent to mirocalcifications in benign breast disease. Because this phenomenon could prove problematic for percutaneous sampling of microcalcifications without excisional biopsy, we studied surgical specimens from patients with cancers incidental to microcalcifications and compared them with specimens with microcalcifications within the malignancy. METHODS: The pathology database at the Mount Sinai Medical Center from January 1993 to July 1998 was reviewed to identify breast cancer patients who underwent spot localization biopsy for microcalcifications. Patients presenting with microcalcifications within malignancy (determinate) were compared with patients with mirocalcifications in benign breast tissue adjacent to malignancy (incidental). RESULTS: Thirty-two (13%) of the 241 specimens had microcalcifications in benign tissue adjacent to malignancy and 209 (87%) had microcalcifications within the malignancy. Fifty-six percent of the incidental cases and 65% of the controls had ductal carcinoma in situ. Infiltrating lobular carcinoma accounted for 25% of the incidental cancers and 2% of the determinate cancers (P <0.001). Fifty-seven percent of the infiltrating carcinomas incidental to mammographic findings were infiltrating lobular carcinoma compared with 7% of the nonincidental infiltrating carcinomas. None of the incidental invasive carcinomas were poorly differentiated (P = 0.002). There were no significant differences with regard to age, tumor size, stage, differentiation, estrogen and progesterone receptors, type of surgery and final margin status. In none of the patients with incidental malignancies did local or distant recurrences develop. CONCLUSIONS: Incidental carcinomas were found in 13% of spot localization biopsy specimens obtained for suspicious mammographic microcalcifications and have a favorable prognosis. Infiltrating lobular carcinomas are more commonly found with incidental microcalcifications than with determinate microcalcifications, and incidental invasive carcinomas are less likely to be poorly differentiated. The majority of malignancies, both determinate and incidental to microcalcifications, are due to ductal carcinoma in situ. Incidental malignancies commonly occur adjacent to fibrocystic changes and their other pathologic characteristics are not significantly different from nonincidental carcinomas. Despite the absence of radiographic findings, these patients can be successfully treated with breast conservation.

Biopsy↗

PubMed2004

Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study.

BACKGROUND: Complete excision of nonsmall cell lung cancer is necessary during a limited resection procedure, as a malignant positive margin can lead to margin relapse. Because there is scant information available regarding the optimal size of a malignant negative margin, we conducted a multicenter, prospective study to more fully elucidate this area of concern. METHODS: Two hundred five pulmonary tumors (22 nonsmall cell lung cancers and 183 undiagnosed lesions) were excised, of which 118 nonsmall cell lung cancer lesions were analyzed. Malignant status was considered positive when either a cytologic or histologic technique revealed the margin to be malignant. Maximum tumor diameter (from 4 to 45 mm with an average of 15.3 mm), margin distance (from 0 to 25 mm with an average of 9.3 mm), tumor location, extent of stapling carried out, and performance of a thoracotomy were the variables. RESULTS: Seventy-two of the sample tissues (61%) were malignant negative. The negative group had smaller maximum tumor diameter, greater margin distance, lesions in more easily resectable regions, and more often required stapling only. Using a multivariate analysis, maximum tumor diameter and margin distance were found to be independent factors. The number of malignant negative margins was 7/7 (100%) when the margin distance was greater than 20 mm, and the number of malignant negative margins was 21 of 21 (100%) when the resected tumors had a margin distance greater than the maximum tumor diameter. CONCLUSIONS: Malignant positive margins were not found when the margin distance was greater than the maximum tumor diameter, which was considered to be the optimal margin distance for prevention against margin relapse.

Aged↗

PubMed1997

Endosonographic differentiation of benign and malignant stromal cell tumors.

BACKGROUND: Endosonography (EUS) is a valuable technique for diagnosing gastrointestinal stromal cell tumors. However, EUS features that are predictive of malignancy in these tumors have not been defined. METHODS: Videotapes and photographs of EUS examinations performed prior to surgical resection of 35 stromal cell tumors (9 malignant) were blindly reviewed by a single examiner. EUS features associated with malignancy were determined. Interobserver agreement in interpreting these features was then measured among a panel of five expert endosonographers who judged EUS videotapes of 35 resected stromal cell tumors (10 malignant). RESULTS: Stepwise logistic regression analysis demonstrated that tumor size (diameter > 4 cm), irregular extraluminal border, echogenic foci, and cystic spaces were independently associated with malignancy in stromal cell tumors (p < 0.05). Interobserver agreement for irregular extraluminal border, echogenic foci, and cystic spaces, as measured by mean kappa statistic, was 0.43, 0.39, and 0.28, respectively. For the five experts, the sensitivity for detecting malignancy ranged between 80% to 100% when at least two of the three features were judged to be present. The likelihood of finding malignancy ranged between 0% to 11% for the experts when all three features were judged absent. CONCLUSIONS: Tumor size and certain EUS features are useful for predicting malignancy in stromal cell tumors. Absence of these features indicates benign disease. Agreement among experts in interpreting these EUS features is fair to moderate.

Diagnosis, Differential↗

PubMed1999

Predictors of malignancy in childhood peripheral lymphadenopathy.

PURPOSE: The aim of this study was to identify factors associated with malignant etiologies of childhood peripheral lymphadenopathy and to construct a model that may be used to assess the risk of malignancy. METHODS: The medical records of 60 consecutive patients 18 years old or less who underwent peripheral lymph node biopsies were reviewed. RESULTS: Increasing node size, number of sites of adenopathy, and age were associated with an increasing risk of malignancy (P < .05 for all variables). Graphs useful for risk determination were constructed based on these variables. Additional factors associated with malignancy included the presence of supraclavicular adenopathy (P < .01), an abnormal chest x-ray (P < .01), and fixed nodes (P < .01). Variables that were not statistically different between patients with benign and malignant adenopathy included the duration of adenopathy (P = .43), the presence of fever (P = .36), cough (P = .14), splenomegaly (P = .93), skin involvement (P = .39), tenderness (P = .49), and bilateral adenopathy (P = .39). Fluctuance was associated with benign adenopathy (P < .04). CONCLUSIONS: The risk of malignancy increased with increasing size and number of sites of adenopathy and age. Other significant predictors of malignancy included supraclavicular location, an abnormal chest x-ray, and fixed nodes. These data may be used to supplement clinical judgment to predict the risk of malignancy.

Child↗

PubMed1990

HLA-DR expression in B-cell non-Hodgkin's malignant lymphomas: a multiparameter flow cytometry study.

Ten cases of reactive follicular hyperplasia and 31 cases of B-cell non-Hodgkin's malignant lymphoma were studied using multiparameter flow cytometry. A bimodal distribution for HLA-DR expression, but not for surface immunoglobulin or B cell-specific antigens CD19 and CD20, was observed commonly in mixed cell type and infrequently in non-mixed cell type B-cell malignant lymphomas. On the basis of HLA-DR distribution alone, 31 cases of B-cell malignant lymphomas of low, intermediate, and high grades could be separated into mixed and non-mixed cell types, with only two misclassifications (P = 0.0001). Exceptionally, one case of malignant lymphoma, follicular and diffuse, mixed-cell type had a unimodal HLA-DR distribution, and one case of malignant lymphoma, diffuse, large noncleaved cell type had a bimodal HLA-DR distribution. In all cases of malignant lymphoma, follicular, mixed-cell type studied, low HLA-DR was correlated with small cells, and high HLA-DR was correlated with large cells. In contrast, HLA-DR expression and cell size were not as directly correlated in cases of malignant lymphoma, diffuse, mixed-cell type. These observations suggest that most, but not all, cases of B-cell malignant lymphomas of the mixed cell type can be separated from other B-cell lymphomas on the basis of HLA-DR distribution.

Adolescent↗