bluuebunny/crossref_metadata_2025 huggingface dataset:
Relation of proliferative activity to survival in patients with gastric carcinoma
Authors: Tonemura Yutaka , Kamata Toru , Ooyama Shigekazu , Sugiyama Kazuo , Kimura Hironobu , Kosaka Takeo , Yamaguchi Akio , Miyazaki Itsuo
Published: February 2007

The prognostic significance of proliferative activity in 167 gastric carcinomas was studied by means of an in vitro labeling method with bromodeoxyuridine (BrdU), using specimens obtained by endoscopic biopsy, and the results were correlated with conventional prognostic factors. The BrdU labeling indices (BrdU LI) varied from 2.1 to 45%. When the in vitro BrdU LI were plotted against in vivo BrdU LI, a significant correlation was found between in vitro and in vivo BrdU LI (P< .01). These results show that the in vitro BrdU LI of specimens obtained by endoscopic biopsy indicate accurate proliferative activities of gastric cancers. The BrdU LI were closely correlated with nodal status, vessel invasion, and tumor size. With regard to the correlation of BrdU LI and prognosis, patients whose tumors had a high BrdU LI (BrdU greater than 10%) died significantly earlier than did those with low BrdU LI (BrdU LI less than 10%). When the BrdU LI and all the pathologic findings were entered simultaneously into the regression model, nodal status, tumor size, serosal involvement, and BrdU LI emerged as independent prognostic parameters. The present studies demonstrated the usefulness of the in vitro BrdU‐labeling method to estimate the malignancy of gastric cancer preopera‐tively, and this method may be useful in designing the operative procedure and multimodal therapy for individual patients.
Safety of EEA staplers for anastomosis between upper esophagus and the gastric tube
Authors: Sugimachi Keizo , Ohno Shinji , Maekawa Soichiro , Mori Masaki , Kuwano Hiroyuki , Ueo Hiroaki
Published: February 2007

The EEA stapling devices used for intrathoracic anastomosis between the upper esophagus and the gastric tube in patients with carcinoma of the thoracic esophagus were evaluated, and the results were compared with those of an antesternally reconstructed esophagus. These approaches were both used by the same surgical team. An intrathoracic anastomosis using the EEA stapler was made in 53 patients with carcinoma of the thoracic esophagus. Minor anastomotic leakage occurred in five patients (9.4%). Good results were obtained with total parenteral nutrition for 2 weeks. Intrathoracic anastomotic complications were never fatal. Among another 106 patients with antesternally reconstructed esophagus, with the EEA stapler there were 28 patients with anastomotic leakage (26.4%) and two operative mortalities (1.9%). Intrathoracic anastomosis with the EEA stapler is recommended because it is secure and the operative procedure is simple and time‐saving. For successful use of the instrument. proper technical procedures must be followed.
Site, size, and tumour involvement of resected extrapulmonary lymph nodes in lung cancer
Authors: Kayser K. , Bach S. , Bülzebruck H. , Vogt‐Moykopf I. , Probst C.
Published: February 2007

A prospective study was performed analyzing resected extrapulmonary lymph nodes of 544 operated lung carcinoma patients. Volume of lymph nodes was determined by weight. Lymph nodes were cut in serial sections 300 μm thick, and the volume of tumour metastasis in each resected lymph node was computed measuring the tumourous area in the lymph node sections. The following results were obtained: Percentage of resected lymph nodes varied with lymph node site and site of the primary lung cancer. Hilar lymph nodes were resected in 50% of the patients, lymph nodes of the main and stem bronchi in 57% and 63%, respectively. Tumour metastases were found in 10%‐15% of the resected lymph nodes. The size of the lymph nodes varied to a large amount and was found to be independent of the lymph node site if no metastases could be detected. Lymph nodes measuring <0.1 ccm were tumour infiltrated in 9% (77/706 lymph nodes), large lymph nodes (>10 ccm) in 62% of the cases (20/32). Tumourous involved lymph nodes of the main bronchus were found more frequently in cases of central localized lung cancer compared to carcinoma arising from the peripheral lung, where the opposite was seen in subaortal located lymph nodes. The percentage of lymph node involvement and size of tumour infiltrated lymph nodes was found to be independent of tumour cell type. Size of resected lymph nodes is not a reliable parameter for estimating existence of tumour infiltrations.
Gastroesophageal anastomotic leakage following resection of carcinoma of the esophagus and gastric cardia: Analysis of ten cases
Authors: Tang Guo‐Xue , Wang Zhe‐Sheng , Liu De‐Gui , Liu Shun‐Shou
Published: February 2007

Postoperative anastomotic leakage is one of the most dangerous and, unfortunately, most frequent complications. Many methods have been tried to prevent such leakage. The incidence of leakage has decreased to 3.84% in our hospital in recent years. Ten cases of gastroesophageal anastomotic leakage following resection of carcinoma of the esophagus and gastric cardia are analyzed and a new tool, the three‐leaf clamp, which reduced the anastomotic leakage, is introduced.
Inhibition of the growth of human melanoma xenografts in nude mice by human tumor‐specific cytotoxic T‐cells
Authors: Crowley Nancy J. , Slingluff Craig L. , Vervaert Carol E. , Darrow Timothy L. , Seigler Hilliard F.
Published: February 2007

Melanoma‐specific T‐cells (CTLs) are specifically cytotoxic for autologous tumor, when assayed in vitro. To examine their effectiveness in vivo, we tested the ability of these human T‐cells to inhibit growth of human melanoma xenografts by using a Winn assay. Nude mice receiving specific CTLs (n = 10) demonstrated a dramatic inhibition of tumor growth. All treated mice were tumor‐free at day 50 and nine remained tumor‐free at day 65, vs. control mice (n= 10) with average tumor volumes of 321 mm3 and 808 mm3, respectively. To control for the possibility that a non‐specific response to the human T‐cells could inhibit tumor growth, an additional group received allospecific CTLs. There was no inhibition of tumor growth in this group (n =8), with the average tumor volume of 2,768 mm3 at day 40 vs. 1,882 mm3 in the control group (n = 10). We conclude that these tumor‐specific CTLs can inhibit tumor growth in vivo and may prove useful in the adoptive immunotherapy of melanoma.
Distribution of fibronectin in adenocarcinoma of the lung: Classification and prognostic significance
Authors: Nishino Toyohiko , Ishida Teruyoshi , Oka Takeshi , Yasumoto Kosei , Sugimachi Keizo
Published: February 2007

Fibronectin (FN) was investigated in 75 stroma from lung adenocarcinoma patients. Distribution of FN was classified into three patterns based on immunohistochemical evidence: dense, moderate, and sparse distribution. The incidence of the sparse pattern in both stage I and stage III disease was significantly greater in the infiltrating than in the noninfiltrating areas. The patients were divided into two groups, long‐term survivors and short‐term survivors. In the group with stage I disease, the incidence of the sparse pattern was significantly greater in the infiltrating than in the non‐infiltrating areas. In both areas, the incidence of sparse pattern was greater in the short‐term than in the long‐term survivors. These data suggest that the disappearance of FN reflects the aggressiveness of the tumor and presumably plays an important role in the prognosis of adenocarcinoma of the lung.
Malignant eccrine spiradenoma of the hand
Authors: Zamboni Anthony C. , Zamboni William A. , Ross Donald S.
Published: February 2007

A malignant eccrine spiradenoma (MES) of the hand is described in a patient who developed bilateral pulmonary metastasis more than 10 years later. A review of the literature including observations on clinical behavior and recommendations for treatment of this rare adnexal tumor is presented.
Role of adrenal imaging in surgical management
Authors: Lamki Lamk M. , Haynie Thomas P.
Published: February 2007

Adrenal imaging using radiopharmaceuticals is a functional test that can contribute significantly to surgical management and follow‐up of patients with either benign or malignant conditions of the adrenal cortex and medulla. Imaging of the cortex is achieved by iodine‐131‐labeled iodomethyl nor‐cholesterol (NP‐59), while adrenal medulla imaging can be successfully accomplished by 131I‐metaiodobenzylguanidine (MIBG), which localizes in the adrenergic nerve terminal with norepinephrine. Both tests carry high sensitivity and specificity for functional tumors and hyperplasia, and often better than CT scanning. This article reviews the current status and clinical utility of nuclear imaging of the adrenal cortex in congenital hyperplasia, low renin hypertension and aldosteronism, and Cushing's syndrome. Adrenal medulla imaging is reviewed in light of our experience at the University of Texas M.D. Anderson Cancer Center in pheochromocytoma, neuroblastoma, and other neuroectodermal tumors. Investigation of 131I‐MIBG therapy of metastatic tumors of neuroectodermal origin potentially offers a means of at least controlling symptoms of hormonal secretion in these patients.
Long‐term survival in patients treated for testicular seminoma
Authors: Hannun Yusef , Vugrin Davor
Published: February 2007

Forty‐eight patients with newly‐diagnosed testicular seminomas were followed for a mean of 7 years after treatment. At the time of diagnosis, seminoma was confined to testis in 74% (36) and was metastatic to retroperitoneal lymph nodes in 15% (7) and to distant nodal sites or parenchymal organs in 10% (5). Ninety‐six percent remained free of disease, 94% in first complete remission (CR) and 2% after treatment of first recurrence. Long‐term disease‐free survival in CR per stage was 97% (35/36) for Stage I, 100% for Stage II, and 80% (4/5) for Stage III. However, three patients, who received prior chest radiation therapy (RT), died from acute myocardial infarction 2, 9, and 10 years after treatment and while free of disease.
Impact of the time interval between surgery and postoperative radiation therapy on locoregional control in advanced head and neck cancer
Authors: Schiff Peter B. , Harrison Louis B. , Strong Elliot W. , Fass Daniel E. , Shah Jatin P. , Spiro Ronald , Sessions Roy , Gerold Frank , Vikram Bhadrasain , Fuks Zvi Y.
Published: February 2007

Between January 1975 and December 1980, 111 patients with AJCC stages III and IV squamous cell carcinoma of the head and neck were treated with surgery followed by planned postoperative radiation therapy. A previous analysis of a subgroup of these patients showed that, when radiation was delayed more than 6 weeks from surgery, a higher incidence of regional failure occurred compared with the incidence observed when therapy began within a 6 week period. We have looked back at this group of patients plus others in an attempt to determine whether other factors played a role in the results obtained. In the current study, 50 patients had a delay of 6 weeks or more and, of these, 11 (22%) suffered a locoregional recurrence. However, 8 of these 11 patients received suboptimal radiation doses (less than 56 Gy) for permanent control of the disease. In fact, of 17 patients who received at least 60 Gy and had more than a 6 week delay, only 2 (12%) had locoregional failure. This was similar to the incidence of failure in the patients who received at least 60 Gy and who started radiation within the first 6 weeks from surgery (3/20 [15%]). The effect of delay was apparent only in those who received less than 60 Gy (27% vs. 7%, P < 0.05). Therefore, we cannot validate the previous conclusion that a greater than 6 week delay in the delivery of postoperative radiation therapy in advanced head and neck cancers produces poorer results. The current analysis suggests that a prolonged delay in postoperative radiation therapy in itself does not have a negative impact on locoregional control as long as appropriate tumorcidal doses of more than 60 Gy are employed.
Prognostic significance of laminin in adenocarcinoma of the lung
Authors: Nishino Toyohiko , Ishida Teruyoshi , Oka Takeshi , Yasumoto Kosei , Sugimachi Keizo
Published: February 2007

The distribution of laminin in tumor‐associated basement membrane was immunohistochemically investigated in 115 cases of adenocarcinoma of the lung. The distribution of laminin was classified into continuous and discontinuous staining patterns. The incidence of the discontinuous pattern was less in early‐stage disease than that in advanced stages (P < 0.01). In patients with stage I, the incidence of discontinuous patterns was greater in short‐term survivors than in long‐term survivors (P < 0.05). By contrast, in patients with stage III, the discontinuous pattern of laminin was frequently seen in both long‐term survivors and short‐term survivors, with no difference between the two groups. These data suggest that the discontinuous pattern of laminin in tumor‐associated basement membrane reflects the spread and dissemination of tumor, hence a close relationship to the prognosis.
Bloody nipple discharge during pregnancy: A rationale for conservative treatment
Authors: Lafreniere Rene
Published: February 2007

Five cases of bloody nipple discharge during pregnancy without associated breast masses were seen over the past 3 years by the author. Because of the reported association of breast cancer with bloody nipple discharge, close follow‐up of these women at monthly intervals during pregnancy and trimonthly during the postpartum period was carried out. In all instances, the discharge appeared late during the second trimester or during the third trimester of pregnancy. It was unilateral and spontaneous and arose from multiple ducts, and it was associated with an increase in breast size and always with the larger breast of the two. The discharge cytologic study done on all cases was negative for neoplastic cells and the discharges resolved spontaneously within 2 months of onset. Postpartum follow‐up ranging from 6 months to 3 years has revealed no evidence of neoplastic changes thus far. Mammograms ordered before these patients were referred were not helpful due to the increase in density of the breast tissue secondary to the pregnancy. Because a few cases of breast cancer during pregnancy have presented solely with a bloody nipple discharge, I recommend extremely close follow‐up of these women and no surgical intervention unless a mass is discovered or the nipple discharge cytology is either suspicious or positive at the initial visit or during follow‐up.
Combined hormonal therapy with high‐dose diethylstilbestrol diphosphate (DES‐DP) intravenous infusion plus vindesine (VND) for the treatment of advanced prostatic carcinoma: A controlled study
Authors: Cervellino Juan C. , Araujo Carlos E. , Pirisi Claudia , Podskubka Oscar , Morera Eduardo
Published: February 2007

Fifty‐one patients with stage D prostate cancer, who had failed primary hormone treatment, were treated with diethylstilbestrol diphosphate (DES‐DP) 1.5 g 24 hr intravenous infusion from day 1 to day 7 (group A). In group B, patients were treated with DES‐DP as in A, plus vindesine (VND) 3 mg/m2 intravenously on days 8, 15, and 22. Cycles were repeated every 28 days for six consecutive cycles. All 51 patients were evaluable for response, toxicity, time to progression, and survival. Pre‐treatment clinical and laboratory characteristics were comparable. The National Prostatic Cancer Project Criteria were used for evaluation. A minimum of two cycles were required for evaluation of response. No complete response was seen. In group A, 9 “partial response” and 7 “no change” (80%), and in group B. 11 “partial response” and 12 “no change” (74%) were registered. Median survival time was 40 weeks. Toxicity ranged from mild to moderate. DES‐DP + VND seemed to improve duration of objective response compared to DES‐DP alone, but the difference was not significant.
Evaluation of voice by patients and close relatives following different laryngeal cancer treatments
Authors: Schuller David E. , Trudeau Michael , Bistline Jane , Laface Karen
Published: February 2007

The purpose of this study was to assess perception of life style change among laryngeal cancer patients. Seventy‐five patients (total laryngec‐tomy 35, supraglottic laryngectomy 15, hemilaryngectomy 12, radiotherapy eight, laser cordectomy five) and close relatives responded to a questionnaire and interview eliciting perception of: 1) posttreatment voice quality; 2) side effects of treatment vocationally and socially; and 3) degree of vocal or communicative change associated with vocational or social change. Whereas 43% of the patients reported vocational change and 37% reported social change, 88% expressed satisfaction with their posttreatment voices. This may have been due to the perceptions of the relatives, who generally had a more positive view of the patients' voices. Although laryngeal cancer had an impact on patient life style, patients seldom related this to vocal dysfunction.
Laryngotracheal invasion by well‐differentiated thyroid cancer: Diagnosis and management
Authors: Britto Errol , Mbbs Sushila Shah , Parikh Deepak M. , Rao Raja S.
Published: February 2007

Ten cases of laryngotracheal invasion by well‐differentiated thyroid cancer are described. All the patients were over 40 years of age, with a male preponderance of 4:1. A mass in the neck, stridor, and hemoptysis was the common symptom. Bronchoscopy done in six of ten patients revealed an intraluminal tumour in all. Radiographs of the neck showed invasion of the trachea in six patients. Surgery consisted of tracheostomy alone (three of ten), total thyroidectomy with laryngectomy (one of ten), circumferential resection of trachea (one of ten), and total thyroidectomy with tracheotomy and “shaving” of the intraluminal disease in five of ten patients. Adjuvant external radiation, radioiodine, or laser therapy was given when indicated. Of the ten patients, three died and seven survived. Five of seven were alive without disease for 2.5 years or more, and one had skull metastasis 2 years later but no local disease.
Correlation between mammography and the pathology of nonpalpable breast lesions
Authors: Albert Michael P. , Sachsse Eckart , Coe Nicholas P. W. , Pace David W. , Reed William P.
Published: February 2007

One hundred consecutive needle localization biopsies were performed for nonpalpable breast lesions discovered on low‐dose mammography of asymptomatic women between June, 1984, and August, 1986. Malignant disease was found on 21 biopsies. Four were carcinoma in situ, and 17 were infiltrating carcinomas. Only three of the infiltrating carcinomas had metastasized to regional nodes, as confirmed by subsequent axillary dissection. Two of these metastatic tumors involved two nodes and the third only one. The findings on the remaining 79 biopsies were benign. Forty‐eight mammograms were read as “benign”; all (100%) were benign pathologically. Thirty‐one mammograms were considered “malignant”; 19 (61%) were malignant pathologically. Only two of the 21 mammograms given “suspicious” interpretations were malignant. Microcalcifications correlated with malignancy only 30% of the time (12/42).
Married couples and cancer
Authors: Walach Natalio
Published: February 2007

The occurrence of cancer in 46 couples related only by marriage and treated in a regional hospital is reported. Twenty‐four pairs had tumors of the same histopathologic type. Three couples had the same tumors with similar histology: brain (astrocytoma), urinary bladder (transitional cell carcinoma), and lung (adenocarcinoma). The possible significance of environmental, nutritional, and contamination factors are emphasized, although this is a probably coincidental phenomenon.
Expression of ras oncogene p21 protein in esophageal squamous cell carcinoma
Authors: Ruol Alberto , Stephens Janet K. , Michelassi Fabrizio , Segalin Andrea , Chiarelli Silvia , Peracchia Alberto , Skinner David B. , Little Alex G.
Published: February 2007

In order to investigate the value of ras oncogene expression as a prognostic indicator in esophageal squamous cell carcinoma, we evaluated the level of ras oncogene protein product (p21) in 52 specimens resected between 1977 and 1986. All patients were followed until death or for at least 2 years. Pathology slides and archival paraffin blocks were retrieved for confirmation of the original diagnosis, study of histopathologic features, and measurement of p21 content. P21 titers were obtained using the RAP‐5 monoclonal antibody in a semiquantitative immunohistochemical assay. Titer was expressed as the highest dilution of antibody giving definitive staining using the avidin‐biotin peroxidase method. Ras oncpgene was expressed in 88.5% of the specimens. We did not find a significant correlation between ras expression and any of a variety of clinical and histopathologic prognostic parameters. Although patients' median survival after resection of specimens with ras oncogene expression was less than half the median survival after removal of tumors without such expression, this difference was not statistically significant. Further prospective investigations are needed to assess the role of ras oncogene evaluation in clinical practice.
Surgical treatment of the cancer patient: Preoperative assessment and perioperative medical management
Authors: Ewer Michael S. , Ali M. K.
Published: February 2007

Cancer patients undergoing surgery often present with unusual and challenging problems. Their age and the fact that they are often chronically ill place them at increased surgical risk. In many instances the need for surgical intervention is crucial to the extent that risk‐assessment becomes an academic issue, especially for those patients whose only reasonable chance for either cure or palliation of unbearable disease is surgery. However, the internist's role in these situations often has preoperative, intraoperative, and postoperative ramifications. Preoperatively, the internist assesses operative risk and intervenes, when possible, to reduce the likelihood of surgical complications. Patients who clearly cannot survive surgery may be identified and channeled to other treatment modalities. Intraoperatively, the internist may be called upon to help with the management of acute organ failure, cardiac arrest, or vascular collapse. Following surgery, the internist may help by managing cardiopulmonary problems and treating infectious complications. The critical care internist is therefore an important member of the perioperative team and often provides valuable expertise, which can help to identify and treat problems expediently.
Tumor recurrence and options for further treatment after resection of liver metastases in patients with colorectal cancer
Authors: Hohenberger Peter , Schlag Peter , Schwarz Volker , Herfarth Christian
Published: February 2007

The aim of this study was to evaluate the pattern of recurrence and its impact on therapy in patients undergoing liver resection for colorectal metastases. Within 7 years 105 patients were operated on; 75 patients were followed up for at least 2 years postoperatively with a median follow‐up of 30 months (range 24–93 months). The median time interval when patients were free of tumor recurrence was only 9 months. The initial recurrence site was the liver in 47% and the other sites were ex‐trahepatic in 39%. Seventy‐one percent of the patients developed disseminated metastases as the disease progressed. The median survival time after diagnosis of tumor recurrence was 14 months and was significantly affected by the type of treatment used for the recurrence. Surgical resection was followed by a 23‐month median survival, while systemic and intra‐arterial chemotherapy led to a 14‐ and 15‐month median survival time, respectively. Untreated patients had a median survival of only 4 months. It is concluded that liver resection for colorectal secondaries leads to a very limited number of disease‐free survivors after 5 years. As a few patients may profit from a surgical treatment even in cases of recurrence, surgery should not be regarded as useless.
Phyllodes tumor of the breast: A clinicopathologic study of 34 cases
Authors: Kario Kazuomi , Maeda Sakan , Mizuno Yoshifuml , Makino Yoshihiko , Tankawa Hidemitsu , Kitazawa Souhei
Published: February 2007

Thirty‐four cases of phyllodes tumor of the breast were studied to evaluate the clinical and pathological features, which correlate with local recurrence. Histologically, local recurrence correlated with the finding of more than ten mitotic figures per ten high‐power fields, marked cellularity, prominent nuclear pleomorphism, and stromal overgrowth. Older patients and patients with larger tumors had a higher probability of local recurrence. Stromal overgrowth correlated with the other histological parameters, with rapid tumor growth, a tumor diameter of over 10 cm, and with local recurrence. It was thus considered to be a histological indicator of the malignant potential of phyllodes tumor of the breast.
Selective management of patients with neutropenic enterocolitis using peritoneal lavage
Authors: Sauter Edward R. , Vauthey Jean Nicolas , Bolton John S. , Sardi Armando
Published: February 2007

Neutropenic enterocolitis is a symptom complex of fever, abdominal pain, distention, nausea, vomiting, diarrhea, and bloody stools occurring in a patient with a low neutrophil count and is most often seen in patients with acute leukemia after a course of chemotherapy. In most cases, neutropenic enterocolitis is a self‐limited condition, but complications of transmural intestinal necrosis and bowel perforation may occur in a small number of patients. Surgical management should be reserved for those patients with bowel wall necrosis or perforation; however, early identification of these patients is difficult. We report our experience with the use of diagnostic peritoneal lavage in three patients with the symptoms and signs of neutropenic enterocolitis. In each case, Gram's stain of lavage fluid revealed no evidence of polymicrobial contamination of the peritoneal cavity. All three patients were managed medically, with resolution of their abdominal symptoms. Peritoneal lavage is helpful in excluding bowel perforation and avoiding unnecessary surgical intervention in patients with neutropenic enterocolitis.
Distinguishing malignant mesothelioma from pulmonary adenocarcinoma: An immunohistochemical approach using a panel of monoclonal antibodies
Authors: Tuttle Steven E. , Lucas Joel C. , Bucci Donna M. , Schlom Jeffery , Primus James
Published: February 2007

A panel of six monoclonal antibodies (MAbs) was employed to evaluate antigen expression in pulmonary adenocarcinomas and mesotheliomas. Monoclonal anti‐human milk fat globulin (HMFG‐2), anti‐carcinoembryonic antigen (NP‐2), antiepithelial membrane antigen (EMA), anticytokeratin (PKK‐ l), anti‐tumor‐associated antigen 72 (B72.3), and anti‐human myelomonocytic antigen (Leu M‐1) antibodies were used to localize their respective antigens in formalin‐fixed, paraffin‐embedded tumors by using the avidin‐biotin‐complex immunoperoxidase technique. In all, 28 mesotheliomas obtained from Ohio State University Anatomic Pathology files and from a Southwest Oncology Group (SWOG) protocol were compared to 22 pulmonary adenocarcinomas by using this MAb panel. None of the mesotheliomas demonstrated positive staining with MAbs NP‐2 (anti‐CEA) or Leu M‐1. However, 95% (21/22) of adeno‐ carcinomas stained with one of these two antibodies. Although neither of these two MAbs stained all adenocarcinomas, each antibody demonstrated positive immunostaining in more than 90% of the adenocarcinomas studied. Therefore, MABs NP‐2 and Leu M‐1 are, individually, quite useful for distinguishing mesothelioma from adenocarcinoma. However, in our study, no single MAb could be used to distinguish these two tumor types in every case. MAb B72.3 stained 91% (20/21) adenocarcinomas but also stained 7% (2/28) of mesotheliomas. MAb HMFG‐2 reacted positively with 95% of adenocarcinomas, but also stained 39% of the mesotheliomas, usually in a membranous pattern. MAbs EMA and PKK‐1 were not found useful in distinguishing mesothelioma from adenocarci‐noma. We conclude that MAbs Leu M‐1 and NP‐2 were both useful in distinguishing mesothelioma from pulmonary adenocarcinoma in that positive staining was demonstrated in adenocarcinomas and not mesothe‐liomas.
Utility of surgical margins in the radiotherapeutic management of soft tissue sarcomas
Authors: Avizonis Vilija N. , Sause William T. , Menlove Ronald L.
Published: February 2007

Seventy‐four adult patients with localized soft tissue sarcomas were treated with radiation therapy following surgery between 1965 and 1988. Fiftythree were treated after the first excision of their tumor with 6 (11.3%) local recurrences. Twenty‐one received radiation after excision of recurrent disease with 11 (52.4%) local failures (P <.0005). Metastatic disease occurred in 14 (26.4%) of the primary tumors and 8 (38.1%) with multiple previous excisions (P <.48). Of those patients treated for primary sarcoma, there were no local failures with pathologically wide margins or if a single margin was microscopically positive. Local failure occurred in 4 of 26 (15.4%) if the tumor was merely enucleated and in 2 of 11 (18.2%) who had grossly positive surgical margins (P not significant). Local failure was also more common in truncal locations (33.3%) as compared with extremity locations (8.7%, P=.1359). Additional factors analyzed which adversely affected prognosis included tumor grade, stage, and inadequate radiation dose.
Acral with melanoma: A review of 185 patients identification of prognostic variables
Authors: Slingluff Craig L. , Vollmer Robin , Seigler Hilliard F.
Published: February 2007

One hundred eight‐five patients with acral melanoma treated since 1972 were reviewed. These included 53 subungual lesions, 123 plantar lesions, and 9 palmar lesions. Eighty percent presented with stage I disease. Mean age was 57 years. Males outnumbered females 1.1:1. Seventeen percent (17%) were blacks. Actuarial 10‐year survival was 58% for stage I patients and 35% for stage II patients. Univariate Cox regression analyses identified 5 prognostic variables affecting survival: stage at diagnosis (P< 0.00l), race (P< 0.00l), ulceration (P=0.012), Clark's level (P=0.014), and thickness of the primary lesion (P=0.013). Factors unrelated to survival included sex of the patient, site (volar vs. subungual), histology, and treatment with amputation. Multivariate analysis for patients with stage I lesions identified race (P=0.00l) and ulceration (P=0.018) as significant variables, with thickness approaching significance (P=0.094). In an additional series of 71 patients with melanomas arising from extremity sites near the junction of glabrous and non‐glabrous skin, survival was significantly poorer for those arising from glabrous skin (P=0.024), and reflects a higher incidence of metastatic disease at diagnosis. Specific active immunotherapy was the principal adjuvant used for these patients, and survival was comparable to that reported with regional perfusion therapy. Acral melanoma a) has a strong racial predilection, b) carries a grave prognosis, and c) arises from glabrous skin. It is a clinical entity distinct from other extremity melanomas. Surgical management with either wide excision or amputation is appropriate for the primary lesion.
Long‐term experience with a totally implanted catheter system in cancer patients
Authors: Freytes Cesar O. , Reid Patricia , Smith Kirby L.
Published: February 2007

Long‐term experience with totally implanted catheter systems (TICS) is limited. We retrospectively evaluated the performance and long‐term complications of TICS for intravenous infusion in cancer patients; 134 systems were implanted in 128 patients. The median duration of implantation was 144 weeks with 49 systems implanted for more than one year. Complications related to surgical factors included malposition of reservoir (2%), skin perforation or wound dehiscence (1.5%) and pneumothorax (< 1%). Complications not related to surgical factors included: drug extravasation (1.5%), mechanical malfunction (1.5%), vein thrombosis (< 1%), clotting of the reservoir or catheter (2%), skin infection (1.5%), and sepsis (< 1%). The total complication rate was 13%. Most complications resolved spontaneously or with medical treatment and only 6 patients (4.6%) required re‐implantation of a second system. We conclude that with long‐term usage of TICS, the complication rate remains low, making it a safe and viable alternative for patients requiring long‐term intravenous therapy.
Effect of prostaglandin E in multiple experimental models: V. Effect on tumor/host interaction
Authors: Waymack J. Paul , Chance William T.
Published: February 2007

Prostaglandin E (PGE) has long been incriminated as a cause of the immunosuppression seen in cancer patients and for the increased rates of tumor growth due to the impairment of the immunologic response to the tumor. We have investigated the effect of PGE on tumor‐host interaction by utilizing a parenterally administered long‐acting PGE derivative, 16,16‐dimethyl‐prostaglandin E (dPGE). Administration of dPGE was found to decrease the rate of tumor growth but at a cost of decreasing tumor‐free body mass. The dPGE did not alter resting metabolic rates but did alter some parts of brain dopamine metabolism and significantly decreased the serum level of multiple amino acids. In conclusion, elevated PGE levels may significantly alter metabolism in tumor patients.
Toxicity comparison of neoadjuvant versus adjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (M‐VAC) in radical cystectomy patients
Authors: Bahnson Robert R. , Ernstoff Marc S. , Miller Ralph J. , O'Donnell Walter F.
Published: February 2007

A reduction in the toxicity of M‐VAC chemotherapy has been postulated for patients who receive these drugs prior to radical cystectomy for muscle invasive bladder carcinoma: A review of the toxicity and patient dropout rates from a group of 9 patients who received neoadjuvant M‐VAC was little different from 9 patients who were treated with M‐VAC after radical cystectomy. This similarity suggests that preoperative M‐VAC should not be favored on the basis of reduced patient morbidity.
Small cell carcinoma of the pancreas and biliary tract
Authors: Motojima Koichi , Furui Junichiro , Terada Masazumi , Shiogama Toshiaki , Kohara Norihiro , Tsunoda Tsukasa , Tsuchiya Ryoichi
Published: February 2007

Four cases of anaplastic carcinoma of the pancreas or biliary tract were studied clinicopathologically and immunohistochemically. All four cases were intermediate cell type and contained a minimum amount of microscopic foci of differentiated glandular adenocarcinoma. Argyrophilic tumor cells were not seen in any of the four tumors. Immunohistochemically, no tumor was positive for hormonal products, but all tumors were positive for epithelial markers.

These findings suggest that the anaplastic carcinoma are not derived from argyrophilic cells, but rather from adenocarcinomas which have the potential for anaplastic metaplasia. The long‐term survival of one patient emphasized the importance of chemotherapy in the treatment of small cell carcinoma of the pancreas and biliary tract.
Neoadjuvant cis‐DDP in esophageal cancers: An experience at a regional cancer centre, India
Authors: Murthy S. Krishna , Prabhakaran P. S. , Chandrashekar M. , Deshpande Raman , Doval D. C. , Copinath K. S.
Published: February 2007

We are analysing the results of 80 patients who underwent surgery during 1983‐84 for esophageal cancer. Forty patients who received pre‐operative single agent Cis‐DDP were grouped under “A” and 40 patients who went for surgery directly were grouped under “B.” Twenty‐two patients (55%) of Group A showed tumor necrosis. Both groups underwent resection and hand‐sewn anastamosis of the esophagus. There were 10 post‐operative deaths among 80 resected cases, 9 of them being from anastomatic leak. Cis‐DDP has induced negligible side effects. A comparatively high survival rate during early years in patients who responded to Cis‐DDP suggests that neoadjuvant chemotherapy might be of value.
Carcinoma of the pancreas: A retrospective review
Authors: Harris Gary J. , Gaskill Harold V. , Cruz Anatolio B.
Published: February 2007

Eighty‐five patients with adenocarcinoma of the pancreas were reviewed in order to evaluate the efficacy of our methods of diagnosis and treatment. The most useful diagnostic test was percutaneous transhepatic cholangiography (PTC) with a diagnostic rate of 96%. Pancreaticoduodenectomy (Whipple procedure) and total pancreatic resection were performed in 13 and 2 patients, respectively. The remaining 50 patients underwent various palliative drainage procedures. Twenty patients did not undergo operation for various reasons. The primary tumor was found in the head of the pancreas in 50 patients (59%), the body in 6 patients (7%), and in the tail in 8 patients (9%). Postoperative complications, including sepsis, bleeding, intra‐abdominal abscesses, and anastomotic leaks, occurred in 37% of the patients. There were one operative and 9 postoperative deaths. The average survival for those patients undergoing surgical intervention was 6 months. There were no 5‐year survivors.
Symptomatic pericardial effusion in breast cancer patients: The role of fluid cytology
Authors: Edoute Yehouda , Kuten Abraham , Ben‐Haim Shlomo A. , Moscovitz Marian , Malberger Ehud
Published: February 2007

Clinical and cytologic findings in 21 breast cancer patients with symptomatic pericardial effusion are presented. The etiology of the pericardial effusion was definitely malignant, by cytology/histology in 13 patients (62%), and suspected malignant by cytology in 2 patients (9%). One patient (5%) with definitely nonmalignant pericardial effusion by cytology was found to be histologically positive at autopsy. In 5 patients (24%) there was no histological/cytological evidence of malignancy; radiation pericarditis could be the etiology in 4 of these 5 patients. The median time from the diagnosis of breast cancer to the development of symptomatic pericardial effusion was 60 months (range: 1–219 months). Ten patients developed cardiac tamponade; they were treated by either pericardiocentesis or pericardiectomy. The mean survival of patients with negative cytology/histology was 12 months; patients with suspicious cytology had a mean survival of 9 months; patients with malignant effusion, treated by pericardiectomy, had a mean survival of 22.3 months, while patients with malignant pericardial effusion, who were not subjected to surgery, had a mean survival of 4.7 months, only. It is concluded that the etiology of symptomatic pericardial effusion in breast cancer patients is not always malignant, which emphasizes the role of fluid cytology in establishing definite diagnosis.

The survival probability is a function of the extent of extracardiac disease; among patients with malignant pericardial effusion those selected for pericardiectomy have a longer than average survival.
Multiple endocrine neoplasia type IIb: A clinicopathological report
Authors: Van Zyl Jacobus Alwyn , Muller Anna Gertruida Smuts , Rossouw Daniel Johannes , Van Velden Dirk Johannes Jacobus
Published: February 2007

The clinicopathological findings in a 12‐year‐old boy with multiple endocrine neoplasia type IIb (MEN‐IIb) are presented. He demonstrated the characteristics of a Marfanoid habitus and had mucosal neuromas of the lips, tongue, eyelids, and cornea. The enlarged right thyroid lobe showed an increased thallium‐201 chloride uptake, and the serum calcitonin level was markedly raised. A total thyroidectomy was performed. Histopathological examination showed an infiltrating medullary carcinoma of the thyroid (MCT) and metastatic spread to supraclavicular lymph nodes. Special stains, immunocytochemistry, and electron microscopy revealed mucin‐containing follicular structures lined by calcitonin‐positive and thyroglobulin‐negative tumour cells. Ultrastructurally the mucosal neuromas consisted of proliferating perineurial and Schwann cells. The serum calcitonin level fell below 300 pmol/L, and his stools returned to normal postoperatively. Because the incidence of MCT in MEN‐IIb is virtually 100%, a total thyroidectomy in high risk patients—even before clinical evidence of malignant tumours—may be the only hope of cure.
Renal oncocytoma: Long‐term follow‐up and flow cytometric DNA analysis
Authors: Jow William W. , Zeid Mohamed Y. , Cowan Daniel , Malin Barry , Deberry John L.
Published: February 2007

We report a retrospective study on the clinicopathologic features and flow cytometric DNA analysis of ten renal oncocytomas compared with a control group of ten randomly selected renal cell carcinomas. Among the oncocytoma patients, no recurrences or metastases were noted over an average follow‐up of 6.7 years (range = 6 months to 16 years). Reproducible, high‐quality DNA histograms were obtained on the paraffin‐embedded specimens by using our modified flow cytometric procedure. One aneuploid (10%) and two hyperdiploid tumors (20%) were found in the oncocytoma group. There was no correlation between these abnormal DNA histographic patterns and survival or tumor stages. On the contrary, a good correlation was found between tumor grades and DNA ploidy in the controls.

We conclude that renal oncocytoma is a clinically benign tumor, yet it may exhibit varying degrees of flow cytometric DNA abnormalities, which have no predictive value on survival and probably reflect the characteristics of oncocytes rather than its malignant potential.
Primary undifferentiated small cell carcinoma of the esophagus: Clinicopathological and flow cytometric evaluation of eight cases
Authors: Isolauri Jouko , Mattila Jorma , Kallioniemi Olli‐Pekka
Published: February 2007

We present a clinicopathological and flow cytometric evaluation of eight primary small cell carcinomas of the esophagus representing 1.5% of all esophageal malignancies diagnosed during a 22‐year period (1965–1987) in the Tampere University Central Hospital. The mean age of the patients (four male and four female) was 67 years (range 55–75 years). Five cases had distant metastases at the time of diagnosis. Three patients were treated by esophageal resection, one by laser vaporisation, and four by chemotherapy. The median survival time was 4 months (range 9 days to 8 months). A complete local response to chemotherapy in serial esophagogramms was detected in one patient. All four patients given chemotherapy survived longer than those treated with esophageal resection only. Four (67%) of the six carcinomas analyzed by DNA flow cytometry contained DNA‐aneuploid stemlines. The median S‐phase fraction of these small cell carcinomas was high (16.3%), reflecting rapid cell proliferation rate, which may be related to their responsiveness to chemotherapy.
Lugol stain for intraoperative determination of the proximal surgical margin of the esophagus
Authors: Sugimachi Keizo , Tsutsui Shinichi , Kitamura Kaoru , Morita Masaru , Mori Masaki , Kuwano Hiroyuki
Published: February 2007

An adequate proximal surgical margin is difficult to determine particularly in cases of esophageal carcinoma with surrounding intraepithelial invasion. We report here readily facilitated intraoperative approaches for detection of the exact margin of carcinomatous invasion of the esophagus.

The resected specimen of the esophagus is incised longitudinally and placed in a 1% Lugol bath for 2–3 minutes. The normal squamous epithelium includes glycogen that interacts with the iodine of Lugol's solution and the normal epithelium of the esophagus becomes a uniform greenish‐brown. A squamous cell carcinoma does not include glycogen, hence is not stained with this solution and a clear identification is feasible. Thus, a carcinomatous infiltration not recognizable in routine examinations becomes macroscopically visible when Lugol's solution is used.
Primary soft tissue tumours of the pelvis causing referred pain in the leg
Authors: Ball Adrian B. S. , Serpell Jonathan W. , Fisher Cyril , Thomas J. Meirion
Published: February 2007

Referred pain in the leg is occasionally due to a pelvic soft tissue tumour. Among 11 patients who presented this way, one had a lymphoma, one had a benign schwannoma, and nine had soft tissue sarcomas. Most patients had undergone a variety of procedures, including laminectomy, before the correct diagnosis was established. In five cases, an accurate diagnosis was obtained by needle biopsy. The lymphoma responded to chemotherapy, and the benign schwannoma was excised. Of the nine patients with soft tissue sarcoma, six underwent marginal/intracapsular excision, three receiving supplementary radiotherapy, and two were treated by nonsurgical means. Hindquarter amputation was technically impossible or inappropriate in these cases. All those with high‐grade tumours have died or have metastases. Of four patients with low‐grade tumours, three have exhibited only slow disease progression. Careful judgment and a precise histopathological diagnosis are required in planning treatment for patients with pelvic soft tissue tumours causing referred pain in the leg.
Diagnosis and treatment of primary and recurrent retroperitoneal liposarcoma
Authors: Witz Misha , Shapira Yirmiahu , Dinbar Alex
Published: February 2007

We retrospectively reviewed 16 patients in whom primary retroperitoneal liposarcoma was diagnosed and treated. These patients were classified according to the first definitive surgical procedure employed: complete excision with or without radiotherapy; partial excision followed by radiotherapy; only biopsy of tumor followed by radiotherapy. Distribution of tumors according to histologic type was: well differentiated myxoid type, 10; poorly differentiated myxoid type, 4; and mixed type, 2. The main factor in determining resectability was extent and fixation of tumor to vital structures. Recurrent retroperitoneal disease developed in four patients all of whom underwent secondary intervention. We concluded from our experience that complete surgical excision is the most effective primary therapeutic approach for patients with primary and recurrent retroperitoneal liposarcoma.
Squamous cell carcinoma of the umbilicus associated with acquired immune deficiency syndrome
Authors: Lee Brian T. , Lefor Alan T. , Didolkar Mukund S.
Published: February 2007

A variety of malignancies, including hematologic malignancies, Kaposi's sarcoma, as well as adenocarcinomas and squamous cell carcinoma have been reported in association with acquired immune deficiency syndrome. Tumors of the umbilical area are unusual and can represent lesions of urachal origin. These may require extensive resection and are associated with a poor prognosis. We describe here a case of a young woman with AIDS who developed a squamous cell carcinoma of the umbilicus which suggests more than a casual relationship between these two conditions.
Refinements in technique. Open biopsy without wound closure for skeletal neoplasms
Authors: Cramer Kathryn E. , Schwartz Herbert S.
Published: February 2007

During the past several years, the indications for limb salvage in musculoskeletal neoplasms have been expanded. As a result, interest in the topic of diagnostic biopsy has been renewed. Post biopsy hematoma formation and the iatrogenic spread of cancer cells has led to universally accepted guidelines for biopsy technique. These include meticulous hemostasis and wound closure. A technique of open biopsy without wound closure in which the biopsy site in a long bone with contained neoplasm remains open and hematoma allowed to drain into the dressings is outlined. A discussion of the theoretical advantages and disadvantages of this technique is presented.