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Unusual primary tumors of the heart.

Primary tumors of the heart, with the exception of atrial myxomas, occur rarely; tumors metastatic to or directly invasive of the heart are far more common. About 75% of primary tumors are benign, and 75% of these are atrial myxomas. The benign tumors include rhabdomyomas, fibromas, papillary fibroelastomas, hemangiomas, pericardial cysts, lipomas, hamartomas, teratomas, mesotheliomas, and paragangliomas or pheochromocytomas. The last 3 may also be malignant. The malignant tumors consist of various sarcomas: myxosarcoma, liposarcoma, angiosarcoma, fibrosarcoma, leiomyosarcoma, osteosarcoma, synovial sarcoma, rhabdomyosarcoma, undifferentiated sarcoma, reticulum cell sarcoma, neurofibrosarcoma, and malignant fibrous histiocytoma. Cardiac tumors produce a large variety of symptoms through any of 4 mechanisms. Their mass can obstruct intracardiac blood flow or interfere with valve function. Local invasion can lead to arrhythmias or pericardial effusions with tamponade. Bits of tumor can embolize, causing systemic deficits when the tumors are on the left side of the heart. Finally, the tumors may cause systemic or constitutional symptoms. Some tumors, of course, produce no symptoms and become evident as incidental findings. The most useful diagnostic tool is the echocardiogram, which in almost all cases precisely locates the tumor and defines its extent. The echocardiographic appearance may also allow quite accurate prediction of the tumor type and whether it is malignant or benign. Magnetic resonance imaging serves as the next most important test where the density of T1 and T2 images may allow tumor cell type identification. With few exceptions, these tumors require operative excision. Most benign tumors can be resected completely; a few, because of their large size, cannot be, and only tumor debulking may be possible. Heart transplantation should be considered for these patients. Many of the malignant tumors cannot be resected completely, either because of the extent of local spread and invasion or because of the frequent distant metastases. Transplantation may also be an option for those with extensive local disease. The long-term results for resected benign tumors are excellent; the long-term results for sarcomas are very poor, and there are few survivors. For patients with unresectable sarcomas, radiation and chemotherapy may be used, but without great expectation of successful results.

Fibroma↗

[A rare cardiac tumor: the malignant fibrous histiocytoma. Description of a case].

The present report describes the case of a 61-year-old woman with malignant fibrous histiocytoma of the left atrium originating from the left atrial free wall, operated on in emergency for a suspected large left atrial myxoma that, at the echo scan, was consistently protruding through the left atrioventricular orifice at each diastole and was almost completely occluding the left ventricular inflow, causing signs of congestive heart failure and severe dyspnea. Surgery was performed as radically as possible, but the histological examination of the specimen revealed the exact diagnosis of the neoplasm. About 75% of primary tumors are benign and 75% of these are atrial myxomas. The malignant tumors consist of various sarcomas: myxosarcoma, liposarcoma, angiosarcoma, fibrosarcoma, leiomyosarcoma, osteosarcoma, synovial sarcoma, rhabdomyosarcoma, undifferentiated sarcoma, reticulum cell sarcoma, neurofibrosarcoma, and malignant fibrous histiocytoma. The long-term results for sarcomas are very poor and there are few survivors after several months from surgery due to the extent of local spread and invasion or because of the frequent distant metastases. Malignant fibrous histiocytoma constitutes about 2% of all cardiac malignancies, which might grow within several localized areas, occasionally in the heart. Echocardiography represents the best examination procedure for both diagnosis and follow-up of patients with cardiac tumors.

Female↗

Ultrastructure of mesodermal mixed tumor of the uterus.

A case of mesodermal mixed tumor arising in the uterus of a 57-year-old woman is presented. The tumor was a mixture of adenocarcinoma with occasional squamous metaplasia, stromal sarcoma, myxosarcoma and chondrosarcoma. Light and electron microscopic examinations of the tumor revealed close transition between stromal sarcomatous component and each of other sarcomatous and carcinomatous component. The histogenesis of mixed mesodermal tumor was discussed and it was concluded that the tumor might be derived from endometrial stromal cell which possessed the pluripotency to differentiate toward various epithelial and mesenchymal tissues including the heterologous mesenchymal tissue.

Adenocarcinoma↗

NTP Toxicology and Carcinogenesis Studies of Rotenone (CAS No. 83-79-4) in F344/N Rats and B6C3F1 Mice (Feed Studies).

Toxicology and carcinogenesis studies of rotenone (more than 98% pure), a pesticide, were conducted in B6C3F1 mice and F344/N rats for 14 days, 13 weeks, and 2 years. Results of the Fourteen-Day Studies: In the 14-day studies (dietary rotenone concentrations of 0-600 ppm in the first 14-day studies and 0-4,800 ppm in the second 14-day studies), rough hair coats and dose-related decreases in mean body weight gain were observed in rats. Rats fed diets containing rotenone at concentrations of 1,200 ppm or higher lost weight. No compound-related toxic effects were observed in mice. Results of the Thirteen-Week Studies: In the 13-week studies (concentrations of 0-1,200 ppm rotenone in feed for rats and 0-50,000 ppm for mice), compound-related effects included lower body weight gain in rats at 150 ppm or more; and bone marrow atrophy and inflammation and hyperplasia of the forestomach in male rats at 300 ppm or more and in female rats at 150 ppm or more. These findings were used to establish the dietary concentrations of rotenone for the 2-year studies. Experimental Design for the Two-Year Studies: Two-year studies of rotenone were conducted by administering diets containing 0, 38, or 75 ppm rotenone to groups of 50 F344/N rats of each sex for 103 weeks. Groups of 50 B6C3F1 mice of each sex were administered diets containing 0, 600, or 1,200 ppm rotenone on the same schedule. The estimated average amount of rotenone consumed per day was 1.7 mg/kg or 3.5 mg/kg for low dose or high dose rats and 115 mg/kg or 250 mg/kg for low dose and high dose mice. Survival and Mean Body Weight in the Two-Year Studies: Survival of control and dosed rats was similar (male: control, 22/50; low dose. 31/50; high dose, 30/50; female: control, 27/50; low dose, 32/50; high dose, 31/50). Mean body weights of dosed and control male rats were comparable. Mean body weights of high dose female rats were 5%-9% lower than those of the controls between weeks 58 and 88. Survival of high dose male mice was significantly greater than that of the controls (male: 29/50; 36/50; 47/50; female: 37/50; 42/50; 45/50). Final mean body weights of dosed mice were lower than those of the controls by 8%-13% for males and 17%-24% for females. Neoplastic Effects in the Two-Year Studies: Parathyroid gland adenomas were observed in 1/41 control, 0/44 low dose, and 4/44 high dose male rats. The historicalincidence of this uncommon tumor in untreated control male rats in NTP studies is 4/1,314 (0.3%). Because these tumors are rare and because the highest incidence ever seen in a control group is 1/50, the increase in these tumors may have been related to rotenone administration. The incidence of subcutaneous tissue fibromas, fibrosarcomas, sarcomas, myxosarcomas, or neurofibrosarcomas (combined) in low dose female rats was greater (P<0.05) than that in the controls (0/50; 5/50; 3/50). These tumors were combined because of their possible common histiogenic origin from fibroblasts or undifferentiated mesenchymal cells. The incidence of those tumors in the low dose females was greater than the historical rats at this laboratory (9/337, 3% +/- 1%) and throughout the Program (50/2,021, 2% +/- 2%). Because of the lack of a significant dose-related trend and because statistical significance was attained only by combining tumors of differing morphology, the subcutaneous tissue tumors in female rats were not considered to be chemically related. The incidences of these tumors in dosed male rats were not significantly different from that in the controls. Hepatocellular adenomas or carcinomas (combined) occurred in male mice with a negative (P<0.02) trend, and the incidence in the high dose group was lower than that in the controls (12/47; 12/49; 1/50). Because this low rate of combined liver tumors is unusual, this decrease may have been related to rotenone administration. Subcutaneous tissue fibromas, sarcomas, fibrosarcomas, or neurofibrosarcomas (combined) in male mice occurred with a significant (P<0.05) negative trend (8/49; 4/50; 2/50). The incidence in the high dose group was signignificant (P<0.05) negative trend (8/49; 4/50; 2/50). The incidence in the high dose group was significantly lower than that in the controls by the life table test (P=0.01). Genotoxicity: Rotenone was not mutagenic when tested according to a preincubational protocol with Salmonella typhimurium strains TA100, TA1535, TA1537, and TA98 with or without metabolic activation by rat or hamster liver S9. Rotenone induced forward mutations in the mouse L5178Y/TK&plusmn; lymphoma assay without activation; it was not tested in the presence of S9. Results of tests with rotenone in Chinese hamster ovary cells were negative for induction of sister chromatid exchanges (SCEs) in the absence of exogenous metabolic activation (at concentrations at which the chemical was very toxic), equivocal for SCEs in the presence of rat liver S9 (due to a nonrepeatable positive response when tests were conducted up to toxic concentrations), and negative for chromosomal aberrationsin both the presence and absence of metabolic activation. Data Audit: An audit of the experimental data was conducted for the 2-year studies of rotenone. No data discrepancies were found that influenced the final interpretations. Conclusions: Under the conditions of these 2-year feed studies, there was equivocal evidence of carcinogenic activity of rotenone for male F344/N rats, as indicated by an increased incidence of parathyroid gland adenomas (uncommon tumors). There was no evidence of carcinogenic activity in female F344/N rats fed diets containing 38 or 75 ppm rotenone. There was no evidence of carcinogenic activity for male or female B6C3F1 mice fed diets containing 600 or 1,200 ppm rotenone for 2 years. The decreased incidence of liver neoplasms in male mice may have been related to the administration of rotenone. Synonym: 1,2,12,12a-tetrahydro-8,9-dimethoxy-2-1-methylethenyl)-[1]benzopyrano[3,4-b]furo2,3-h][1]benzopyran-6(6H)-one Trade Names of Formulations: Derrin; Derris; Tubatoxin; Nicouline; Prentox; Noxfish; Rotocide; Barbasco; Cube Root; Haiari; Dactinol

Journal Article↗

Vascularized free fibular transfer combined with autografting for the management of fracture nonunions associated with radiation therapy.

BACKGROUND: The purpose of this study was to evaluate the functional results, rates of union, and complications associated with vascularized free fibular transfer combined with autografting for the treatment of nonunions in previously irradiated bone. METHODS: Seventeen patients who had had eighteen vascularized free fibular transfers combined with autografting for the treatment of nonunion of a fracture in previously irradiated bone were included in this study. There were eleven female patients and six male patients. Eight patients had a bone neoplasm and nine, a soft-tissue neoplasm. The diagnosis was Ewing sarcoma in four patients; lymphoma, malignant fibrous histiocytoma, and rhabdomyosarcoma in two patients each; and cavernous hemangioma, metastatic breast carcinoma, reticulum-cell sarcoma, myxosarcoma, hemangiopericytoma, and fibrosarcoma in one patient each. The remaining patient had a soft-tissue tumor for which the diagnosis was not known. All patients received radiation therapy. The average dose was 5564 centigray. There were no recurrent tumors. The average interval between the radiation therapy and the original fracture was 111 months. The fracture was in the femur in thirteen patients, in the humerus in three, and in the tibia in one. All patients had operative or nonoperative treatment, or both, of the initial fracture, and two had iliac-crest bone-grafting after the initial open reduction and internal fixation procedure. The ages of the patients ranged from thirteen to eighty-two years at the time of the vascularized free fibular transfer. All fibular transfers were applied as onlay grafts because no nonunion was associated with a large segmental defect. Cancellous autogenous bone graft from the iliac crest was used as an additional graft at the proximal and distal junctions of the graft with the bone and at the fracture site in all patients. The average duration of follow-up after the vascularized free fibular transfer was fifty-seven months (range, twenty-eight to 112 months). RESULTS: Sixteen of the eighteen fracture sites united, after an average of 9.4 months (range, three to twenty-four months). Thirteen patients had an excellent result, one had a good result, two had a fair result, and one had a failure of treatment. Four patients had an infection, including one who continued to have a nonunion. The other three patients had union after treatment with antibiotics, debridement, and removal of the hardware. Another patient who had a recalcitrant nonunion eventually required an above-the-knee amputation. CONCLUSIONS: On the basis of this review, we suggest that microvascular fibular transfer combined with autografting is an appropriate treatment option for difficult nonunions associated with previously irradiated bone.

Adolescent↗

Primary mesenchymal (nonangiomatous/nonlymphomatous) neoplasms occurring in the canine spleen: anatomic classification, immunohistochemistry, and mitotic activity correlated with patient survival.

Surgical submissions from canine splenectomy cases spanning a 3-year period (1988-1990) were evaluated. Eighty seven neoplasms of the spleen considered to be of nonangiomatous and nonlymphomatous origin were selected for morphologic classification, mitotic index determination, immunohistochemical analysis, and patient survival determination. In 76/87 cases, patient survival information was available, and the mitotic index was determined in 83/87 cases. Immunohistochemistry for selected antigens (vimentin, desmin, smooth muscle actin, myosin, and factor VIII-related antigen) was performed in 58/87 of the cases. Morphologic classification of these lesions in standard HE preparations yielded the following neoplastic groups: fibrosarcoma (19/87), undifferentiated sarcoma (19/87), leiomyosarcoma (14/87), osteosarcoma (8/87), mesenchymoma (7/87), myxosarcoma (6/87), histiocytic sarcoma (6/87), leiomyoma (3/87), lipoma-myelolipoma (2/87), liposarcoma (2/87), and malignant fibrous histiocytoma (1/87). A lack of distinct morphologic characteristics among many of the neoplasms that were classified as either fibrosarcoma, leiomyosarcoma, or undifferentiated sarcoma contrasted these groups with the relatively unambiguous features that distinguished the other sarcoma groups. Using immunohistochemical staining for muscle-specific antigens (desmin, smooth muscle actin, and myosin), specific staining often overlapped extensively within the neoplastic groups of fibrosarcomas, leiomyosarcomas, and undifferentiated sarcomas, suggesting either ambiguous morphologic findings or the possibility of a common histogenesis from smooth muscle trabeculae or a distinct population of splenic myofibroblasts. The biological behavior of all tumors examined could be placed into three categories of patient survival: (1) benign, noninvasive tumors (leiomyoma, lipoma) with prolonged survival intervals; (2) malignant tumors (fibrosarcoma, undifferentiated sarcoma, leiomyosarcoma, osteosarcoma, myxosarcoma, histiocytic sarcoma, and liposarcoma), showing severely truncated survival (median 4 months with 80-100% mortality after 12 months; and (3) intermediate survival periods (median 12 months with 50% 1 year survival) attributed to a single group of neoplasm, the mesenchymomas. The biological behavior of primary splenic nonangiomatous, nonlymphomatous sarcomas was most closely correlated with observed mitotic index. Splenic neoplasms of this type with a mitotic index < 9 showed significantly (P < 0.0001) longer survival intervals than those with an index > 9. With the exception of osteosarcoma, all anatomically defined tumor groups contained one or more specimens with a mitotic index < 9. The clinical prognosis given for splenic sarcomas should be modified according to the mitotic index as a predictive value for patient survival.

Animals↗

Purification of Norman Murine Sarcoma DNA polymerase alpha forms with different DNA template primer binding affinity and different specific activity.

1. DNA polymerase alpha was isolated from Norman Murine Myxosarcoma cells using ion exchange, immunoaffinity, and DNA affinity chromatography, showing two distinct enzyme forms designated A1 and A2. 2. Chromatographic analysis of polymerase alpha forms A1 and A2 indicate a charge difference and a difference in affinity of binding to DNA between polymerase alpha forms which were equally reactive to anti-DNA polymerase alpha monoclonal IgG. 3. Polymerase A1 specific activity was about 3600 U/mg while A2 specific activity was about 40,000 U/mg.

Animals↗

Primary tumors of the mandible. A study of 49 cases.

Forty-nine cases of primary tumors of the mandible have been reviewed. The anatomic location, pathologic features, sites of metastases, survival rates, and treatment methods were evaluated. Lesions studied included ameloblastoma, osteogenic sarcoma, reticulum cell sarcoma, fibrosarcoma, chondrosarcoma, myxosarcoma, epidermoid carcinoma, adenocarcinoma, and giant cell sarcoma. An in-depth discussion of primary osteogenic sarcoma of the mandible is presented. Because of upper cervical lymph node metastases in two cases of osteogenic sarcoma of the mandible, an upper neck dissection should be considered in the primary treatment. Also presented in this study are the first reported cases or primary myxosarcoma of the mandible and giant cell sarcoma of the mandible. Recent methods of treatment of ablative resection of the mandible followed by immediate or delayed repair are discussed. A revised technic for mandibular replacement which has met with success in six of seven cases is presented.

Adenocarcinoma↗

Fast neutron radiotherapy for soft tissue sarcomas. University of Washington experience and review of the world's literature.

Sixteen patients with inoperable soft tissue sarcomas were treated definitively with fast neutrons at the University of Washington between August, 1970 and May, 1982. Eleven of these 16 patients were treated with curative intent and form the basis of this report. Actuarial plots are shown for local tumor control and survival. This work is placed in the context of worldwide experience in using fast neutrons to treat unresectable soft tissue sarcomas.

Fast Neutrons↗

Sarcoma of the urinary bladder in the adult. Pathomorphological considerations.

The author discusses problems of morphological diagnosis and pathogenesis with reference to a case of sarcoma of the urinary bladder presenting the following particularities: exulcerated pedunculate macroscopic aspect, histological leiomyo- and myxosarcomatous differentiation, angiomatous hyperplasia and a late favourable course after partial cystectomy.

Humans↗

Myxoid monophasic synovial sarcoma: case report of an unusual histological variant.

We report the case of a 61-year-old woman who presented a recurrent myxoid synovial sarcoma involving the right ankle and foot. This tumor, defined as a synovial sarcoma showing more than 50% myxoid change in the stroma, has only recently been described as a rare histological variant. The histological diagnosis is particularly difficult in such cases, as the one we are describing, where the tumor is entirely myxoid and monophasic raising the possibility of other myxoid soft tissue neoplasms, such as extraskeletal myxoid chondrosarcoma, malignant peripheral nerve sheath tumor or leiomyosarcoma. On the basis of morphological and immunophenotypical findings, the diagnosis of myxoid synovial sarcoma should be properly established, especially in view of its unusual clinical course and treatment. Furthermore, we will discuss the clinicopathological and immunohistochemical features observed in our case.

Female↗

Myxoid synovial sarcoma: an underappreciated morphologic subset.

Focal myxoid change is a well-recognized feature of synovial sarcoma, but the presence of a predominantly myxoid stroma is rare. We describe seven cases of myxoid synovial sarcoma in which marked myxoid change initially obscured the diagnosis, leading to confusion (principally with malignant peripheral nerve sheath tumor). The median age (20 yr) and tumor location (four lower extremity, two upper extremity, and one head and neck region) were similar to those found in typical synovial sarcoma. Histologically, five cases were monophasic spindle cell lesions with a lacy appearance in areas with a prominent Alcian blue-positive myxoid stroma. Each case had foci with more typical features of synovial sarcoma, including a fascicular growth pattern with a variably collagenized stroma, stromal mast cells, a hemangiopericytoma-like vascular pattern, and calcification. Two cases showed small foci of glandular (biphasic) differentiation. Immunohistochemically, all of the seven cases were positive for epithelial membrane antigen, four of six were positive for pan-keratin, three of six were positive for S-100, two of four were positive for CD99, and six of six were negative for desmin. Clinical follow-up in six cases ranged from 8 to 48 months (median, 21 mo). Local recurrence developed in three patients at 9, 20, and 24 months, respectively. In one of these three patients, lung metastases developed at 13 months, and the patient died of disseminated disease at 23 months. In another of the three patients, lung metastases developed at 27 months. Three patients had no evidence of disease at 8, 15, and 15 months. Our data are too limited to indicate any clinical differences between myxoid synovial sarcoma and conventional synovial sarcoma Recognition of this rare histologic variant of synovial sarcoma is important because it can easily be mistaken for other myxoid spindle cell neoplasms, potentially resulting in suboptimal therapy.

Adolescent↗