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At least 19 recordsLinked to original sources

Combined cranio-orbital surgery for extensive malignant neoplasms of the orbit.

Extensive, invasive neoplasms of the cranio-orbital region are generally considered to be inoperable and are treated with local radiation therapy and occasionally with chemotherapy. Upon local recurrence of these neoplasms, further treatment efforts are usually deemed futile. Over the past 4 years, 10 patients with extensive neoplasms of the cranio-orbital region that were previously thought to be inoperable were referred to us for further evaluation. Five of these patients had failed an intensive course of radiation therapy. Radical regional cranio-orbital resection was performed. The resection included the skin, globe, sphenoid wings, and orbitofrontal bone. The maxillary sinus and nasal septum were left exposed. The exposed dura mater and the frontal and temporal bones were resurfaced with split-thickness skin grafts. All patients in this series have survived free of local disease to date. Combined cranio-orbital resection offers both palliation and a possible cure for patients with extensive, invasive neoplasms of the cranio-orbital region. Reconstructive surgery can be performed using full-thickness flaps after 2 years of observation for local recurrence.

Adolescent

[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

Clinically stationary choroidal melanoma with extraocular extension.

A malignant melanoma of the choroid was observed for three years because of an erroneous diagnosis of disciform macular degeneration. No lateral or vertical growth was noted during the observation period, but significant extrascieral extension was discovered at the time of radioactive phosphorus uptake test and enucleation.

Aged

Peripapillary choroidal melanomas. Extension along the optic nerve and its sheaths.

We reviewed 26 cases of peripapillary melanoma, 21 (80.8%) of which extended into the optic nerve or its meningeal sheaths. Most melanomas that extended into the optic nerve were necrotic and of the mixed or epithelioid cell type; all invaded the overlying retina and occurred in blind eyes with secondary glaucoma. The extension of melanoma cells into the subarachnoidal space was only influenced by the presence of the melanoma around the optic nerve head (peripapillary). The prognosis of these patients was highly dependent on the presence of orbital extension. A long piece of optic nerve should be excised when eyes with peripapillary melanomas are enucleated.

Choroid Neoplasms

Leiomyomatosis of the colon.

Excluding the rectum, smooth muscle cell tumors of the large bowel are extremely rare lesions. A unique case is reported of an infiltrating multinodular myomatous growth of semi-constrictive type affecting the ascending and transverse colon along its entire circumference and over a length of 35 cm. In the mesocolon near the colonic wall two tumor foci were present. Contrary to expectations from the growth behavior, histological examination revealed well differentiated smooth muscle cells with distinct myofilaments and absence of nuclear abnormalities and mitotic figures. No clinical evidence of malignancy was found and no recurrence was detected during a 39-month follow-up period which included a second-look operation. The contrasting fidings are discussed and it is concluded that the tumor should be considered a benign multicentric lesion, for which the term "leiomyomatosis of the colon" is suggested.

Adult

Prospective study of non-infiltrating carcinoma of the breast.

A long-term prospective study of non-infiltrating breast carcinoma is being carried out in order to study the natural history and proper management of such lesions with particular interest in patients treated solely by local excision. During an 11-year period, 175 patients with lobular Ca in situ and intraductal Ca have been followed. None has developed recurrent disease including 18 undergoing wide local excision only. Histologic examination revealed that 36% of mastectomy specimens showed multifocal lesions, whereas only one of the patients treated by wide local excision had more than one microscopic focus. For these reasons total mastectomy is recommended as the treatment of non-infiltrating breast carcinoma. Subsequent development of contralateral cancer has occurred in ten patients.

Adult

A topographic approach to breast cancer: the relation of topographic and mammographic findings.

One hundred and twenty-eight patients with breast cancer who, on the basis of mammographic study, were treated by mastectomy were analyzed. The purpose of this endeavor was to correlate the roentgenologic features with the pathologic findings. The correlation between them was very good: the type of tumor opacity, the microcalcifications, and the various other radiologic patterns were compatible with both localized and extensive breast cancer. Mammography appears to be valuable in the selection of patients suitable for conservative treatment.

Breast Neoplasms

Clinicopathologic features of unsuspected regional lymph node metastases in prostatic adenocarcinoma.

Histologic features of the primary tumor and their effects on the incidence of unsuspected pelvic lymph node metastases have been studied in a prospective series of 62 patients with clinical stage B1, B2, or C prostatic adenocarcinoma who underwent pelvic lymph node removal. Twenty-one patients (34%) proved to have unsuspected nodal metastases. Differentiation of the primary tumor and extent of involvement of the prostate by carcinoma were the only two features that correlated significantly with the incidence of pelvic nodal metastases, 56% of those with undifferentiated tumors had metastases. Thirty-one of these patients underwent total prostatectomy; an average of only 46% of the sections of prostate contained tumor in the patients without metastases but an average of 65% of the sections were involved by carcinoma in those patients who did have nodal metastases.

Adenocarcinoma

Adenoid cystic carcinoma of the larynx: a report of four cases and a review of the literature.

Adenoid cystic carcinoma (cylindroma) is a well-recognized tumor that is frequently encountered in the major salivary glands, the lacrimal glands and in the minor salivary glands of the oral cavity and upper respiratory tract. Only 60 cases of adenoid cystic carcinoma have been described arising in the larynx. Four new cases are reported and the literature is reviewed. In the larynx, these tumors arise almost exclusively in the subglottic and supraglottic regions--areas having large numbers of seromucinous glands of the minor salivary gland type. These malignant tumors, whether occurring in the larynx or elsewhere, tend to grow quite slowly with prolonged non-specific symptomatology and protracted clinical course. Despite their slow growth, in a majority of cases, they eventually lead to the death of the patient.

Adult

Multiple infiltrating glomus tumors in children.

Two children with multiple infiltrating glomus tumors of the lower extremities presented in infancy with clinical and, in one, radiological, signs of varicose veins. Surgical therapy was followed by multiple recurrences, a phenomenon attributable to the infiltrative properties of the tumor. This variant of multiple glomus tumor may be congenital and is probably hamartomatous in nature.

Adolescent

Malignant myoepithelioma of the parotid gland.

Myoepithelial cells are a significant component of most types of salivary gland neoplasms. A small but increasing number of case reports have also shown that pure myoepitheliomas form a distinct class of neoplasms with unique histological features. Previously reported cases have been either benign or, at most, locally aggressive. We present here a case of a malignant myoepithelioma of the parotid gland, confirmed by electron microscopy, that was locally aggressive and eventually metastasized. Review of this case and of existing reports indicates that myoepitheliomas exhibit a wide range of biological behavior that seems to correlate with their histological appearance.

Aged

Malignant mediastinal teratoma in a 15-year-old girl.

A well-differentiated anterior mediastinal teratoma was removed from the right hemithorax of a 15-year-old girl presenting initially with ascites. Death followed a precipitous clinical deterioration from widespread sarcomatous metastatic disease. The true malignant nature of this tumor was not apparent on initial resection and evaded detection until shortly before death. These unique features prompted a review of the pertinent literature on malignant mediastinal teratoma in children. A similar case had not been reported previously.

Adolescent