bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-Selection for Mammography and Breast Cancer Incidence by Stage
Authors: Bucchi Lauro , Serafini Monica , Nanni Oriana , Buzzi Gianfranco , Morini Nori , Naldoni Carlo , Schincaglia Patrizia
Published: April 2018

Aims and Background

In the field of breast cancer control, obtaining population-based data on spontaneous mammography (MG) screening should be a priority. This study focuses on the breast cancer incidence and stage distribution in relation to MG use in Ravenna (Italy), 1987-88.

Methods

We estimated the MG rates, expected (E) incidence based on mortality data, observed (O) incidence, predicted excess incidence based on MG rates, observed excess incidence, and stage distribution according to the MG history.

Results

The highest MG rate (37%) was found among residents aged 40-44 but none of these had a T1a-bN0 breast cancer diagnosed nor was the predicted excess incidence demonstrated. Between 45 and 64 years, 80% of self-selected screenees had repeat (“incidence”) MG and the O:E incidence ratio was 1.32 (95% Cl 1.09-1.58). The observed excess incidence was 3.8-fold (95% Cl 2.56-5.16) greater than that predicted. Advanced (T2+ and/or N1+) cases accounted for 42% of patients diagnosed within 3 years of their last MG, for 55% of those diagnosed more than 3 years after their last MG, and for 70% of those with no previous MG. Above age 70, a significant worsening of stage at diagnosis was associated with a clear-cut drop in the proportion of breast cancer patients with previous self-referral for MG.

Conclusions

The results indicate that self-selection and its implications are major features of spontaneous screening practice.
Phase II Study with Iododoxorubicin in Measurable Advanced Colorectal Adenocarcinoma. Effective Rescue Using Weekly High-Dose 5-Fluorouracil (WFU)
Authors: Villar-Grimalt Anselmo , Aranda Enrique , Massutí Bartolomeu , Belón Joaquin , Antón Antonio , Jimeno Jose María , Candel Ma Teresa , de Paredes Ma Luisa García , Colajori Elena ,   Spanish Cooperative Group for Gastrointestinal Tumor Therapy (TTD), Work Group of SEOM (Spanish Medical Oncology Society)
Published: April 2018

Aims and background

To evaluate a new anthracycline 4′-iodo-4′-deoxydoxorubicin (I-DOX) in patients with measurable advanced colorectal adenocarcinoma in a phase II study.

Methods

We investigated therapeutic activity and toxicities associated with repeated courses of I-DOX 80 mg/m2 administered every 3 weeks. Eighteen patients entered the trial, all of them evaluable for response and toxicity.

Results

A total of 47 courses were administered. The median cumulative I-DOX dose was 238 mg/m2 (80-320). Myelosuppression, particularly leukopenia, was the most frequent and serious side effect associated with I-DOX treatment; World Health Organization (WHO) grade 3-4 leukopenia occurred in 4 patients (22%). No thrombocytopenia was observed except in 1 patient who presented WHO grade 4. Only 1 patient developed febrile neutropenia but recovered uneventfully. Overall, the I-DOX treatment was well tolerated. Grade 3-4 nausea/vomiting was observed in 2% of the cycles and no other severe toxicities were recorded. Echocardiography or multiple gated scan was performed before treatment and during follow-up in 14 patients to measure left ventricular ejection fraction (LVEF), and a decrease > 15% was detected in 3, including 1 whose LVEF fell below normal values (48%) (normal range > 49%). There were no cases of congestive heart failure or treatment-related deaths. No complete or partial response (PR) was observed. Twelve patients received weekly high-dose 5-fluorouracil (WFU) as rescue. Four patenties had PR, 5 no change and 3 progressive disease (PD). The median time to PD of the whole group from study entry to failure after WFU was 30 weeks and the overall median survival was 11 months.

Conclusions

As reported for other anthracyclines, I-DOX showed no activity in colorectal adenocarcinoma; however, the use of an investigational agent as front-line chemotherapy for colorectal adenocarcinoma does not compromise further response to 5-FU.
Control of Emesis by a Low Dose of Ondansetron and Dexamethasone
Authors: Di Bartolomeo Maria , Bajetta Emilio , Biganzoli Laura , Di Leo Angelo , Buzzoni Roberto , Zampino M. Giulia
Published: April 2018

Aims and background

Ondansetron, a selective serotonin type 3 receptor antagonist, has been investigated at a wide range of doses. Recent studies have demonstrated that a single dose of this drug is active, either by intravenous bolus or continuous infusion. The main aim of this study was to evaluate the efficacy of a low dose of ondansetron in a simple and feasible schedule as follows: ondansetron 8 mg i.v. and dexamethasone 8 mg i.v. given before chemotherapy on day 1. Oral ondansetron 8 mg was subsequently given in the evening of day 1, and then even 12 hours on days 2, 3 and 4.

Methods

Forty-chemotherapy-naive patients receiving cisplatin, dacarbazine or other emetogenic drugs were enrolled in the study. All courses of chemotherapy were given in an outpatient setting.

Results

During the first cycle, complete control of acute emesis was achieved in 88% of cases, and no delayed emesis was recorded in 76%; acute and delayed nausea were absent in respectively 78% and 69% of cases. During the second, third and fourth cycles complete control of acute emesis was achieved in respectively 92%, 80% and 86% of cases, and no delayed emesis was recorded in 71%, 82% and 82%. No severe adverse effects were observed.

Conclusions

Our study shows that a single intravenous administration of low-dose ondansetron combined with intravenous dexamethasone and followed by oral ondansetron twice daily is effective in controlling emesis in patients receiving chemotherapy, and that it is feasible as an ambulatory regimen.
A Feasibility Study of Ovarian Cancer Screening: Does Fine-Needle Aspiration Improve Ultrasound Specificity?
Authors: Schincaglia Patrizia , Brandelli Lorena , Cicognani Alessandra , Buzzi Gianfranco , Orsini Luigi F. , Bovicelli Luciano , Jasonni Valerio M. , Bucchi Lauro
Published: April 2018

Aims and background

The prognosis for ovarian cancer patients depends on the stage at diagnosis. As a prerequisite for any proposed procedure for ovarian cancer screening, high levels of specificity should be obtained using combinations of tests. Based on preliminary data from an ongoing feasibility study, this report is focused on the possible gain in specificity provided by fine-needle aspiration of occult ovarian masses detected by ultrasound.

Methods

Ultrasonography was used as a basic test, and fine-needle aspiration was obtained from selected patients. Those with (a) positive aspiration cytology or histology, (b) complex or solid masses showing volume increase, (c) complex or irregular masses and inadequate samples, and (d) recurrent cystic lesions were operated on.

Results

A total of 3541 asymptomatic patients 50-69 years of age underwent ultrasonography, and 98 were selected for fine-needle aspiration. Of these, 19 (positivity rate 19/3541 or 0.5%) were operated on. Two ovarian cancer cases (FIGO Stage II and III) were detected (detection rate 2/3541 or 0.6 × 1,000; positive predictive value 2/19 or 10.5%). Specificity was 3443/3539 or 97.3% for ultrasound alone and 3522/3539 or 99.5% for the procedure as a whole. Surgical exploration for relapses of benign cysts reduced by some 50% the potential gain in positive predictive value provided by aspiration cytology compared with ultrasound alone.

Conclusions

Although fine-needle aspiration has improved the performance of ultrasound, this 2-levei procedure does not appear to achieve acceptable levels of specificity.
Changes in Diagnostic Approach and Factors Affecting Treatment and Survival of Pancreatic Carcinoma in a Retrospective Series over Twelve Years
Authors: Girelli Carlo Maria , Reguzzoni Giorgio , Barzaghi Franco , Berrino Franco
Published: April 2018

Aims

Identify the following aspects of pancreatic carcinoma: 1) the prevalence of some risk factors, 2) the accuracy of the diagnostic tecniques and the pattern of their utilization over the years, 3) the factors affecting the therapeutic choice and mortality.

Methods

Retrospective study on all patients with a final diagnosis of pancreatic carcinoma seen at the Ospedale di Busto Arsizio, from January 1978 to August 1989.

Results

There were 155 patients, 68 ±11.6 years old, with a 1.2 male to female ratio. Antemortem pathologic confirmation was obtained in 127 cases (82%); 45% were smokers and 45% drinkers. Diabetes mellitus, a history of peptic disease, a past neoplasm and gallstone disease were respectively present in 36.1%, 12.3%, 11% and 8.2% of the cases; 61.9% 23.8% and 9% of the tumors were located respectively in the head, body and tail; 1.3%, 40% and 51.5% were respectively in stage II, III and IV. Ultrasound abdominal scanning and computerized tomography sensitivity were respectively 67.5% and 72.5% (p = NS). In addition, carcinoembryonic antigen, fine needle aspiration biopsy and percutaneous transhepatic cholangiography showed respectively a 66.6%, 88.9% and 93% sensitivity. Together the non-invasive imaging procedures dramatically decreased the number of unnecessary exploratory laparotomies over the years (p = 0.005) without changing the stage at diagnosis or survival. Among the tested variables (age, sex, year of diagnosis, past diseases, co-morbidity, location and stage of the tumor), only the head location and a less advanced stage were significantly related to a surgical choiche (p< 0.001). Overall one-year survival rate was 13.4%, and among the tested variables, only a less advanced stage and the aggressive treatment were associated to a longer survival (p< 0.001).

Conclusions

The prevalence of diabetes mellitus in patients with pancreatic carcinoma may be higher than previously expected; the wide use of diagnostic imaging, dramatically reduced the number of unnecessary exploratory laparotomies over the years; aggressively treated patients with a less advanced stage have a slight, but significant improvement in survival.
Retroperitoneal Malignant Schwannoma. A Case Report
Authors: Trifero Mauro , Frattaroli Fabrizio Maria , Ciccone Anna Maria , Guadalaxara Antonio , Oddi Giuseppina , Pappalardo Giuseppe
Published: April 2018

The isolated retroperitoneal malignant schwannoma unassociated with Von Recklinghausen's disease is an unusual neoplasm, representing 0.01% of all retroperitoneal malignant neoplasms, with a poor prognosis, and an average survival at 5 years of 50% in patients treated by radical exeresis. At present, it is impossible, without histologic and immunohistochemical examinations, to differentiate it from other isolated retroperitoneal sarcomatous neoplasms. The authors report a case of retroperitoneal malignant schwannoma 20 cm in diameter in a 62-year-old woman surgically treated by radical exeresis. Postoperative complications were absent, and the patient, discharged from the hospital on the 12th postoperative day, died 8 months later of diffuse metastases, withouth local relapse. Despite the patient's short survival, the authors believe radical surgery to be the best therapeutic choice. Only surgery can establish a final diagnosis and can offer the best chance of survival and a significant and sometimes prolonged relief of symptomatology.
Intrapleural Administration of Interleukin-2 and Lak Cells in Locally Advanced Non-Small-Cell Lung Cancer. A Case Report
Authors: Matteucci Paola , Tresoldi Moreno , Chiesa Giuseppe , Tognella Silvia , Citterio Giovanni , Fortis Claudio , Besana Carlo , Rugarli Claudio
Published: April 2018

Aims and background

The systemic administration of recombinant interleukin-2 (rIL-2) and lymphokine-activated killer (LAK) cells is ineffective in non-small-cell lung cancer (NSCLC). However, there is some evidence that their intrapleural administration could be effective, since it increases the concentrations of the cytokine and the effector cells in the tumor area, thereby obtaining greater antitumor activity.

Study design

We report the case of a patient affected by a locally advanced lung adenocarcinoma with pleural effusion (T4 NO MO – stage 1Mb) treated with repetitive courses consisting of a priming continuous i.v. infusion (48 h) of rIL-2 (18 MIU/m2/day) intraplural administration of LAK cells (3 – 9 × 109/day), in a single daily bolus, for 3 consecutive days and concomitant administration of rlL-2 (1.8-7.2 × 106 IU/day), for 5 days.

Results

We observed early disappearance of neoplastic cells in the pleural effusion, progressive decrease until disappearance of the pleural effusion, cavitation of the primary lesion during the treatment, and its stabilization for 9 months until progression. Radiologic changes were accompanied by a marked eosinophilia (up to 50 × 109/L), and the intrapleural route of administration of rIL-2 induced a relevant increase in eosinophil count in peripheral blood. Immunologic changes in lymphocyte subpopulation phenotypes were also observed. The performance status of the patient improved, and she was still alive and eupnoic 25 months from the diagnosis and 23 months from the start of treatment.

Conclusions

This case suggests a therapeutic role for intrapleural rIL-2, and we believe that the relationship among intrapleural administration of rIL-2 and LAK cells, the development of peripheral eosinophilia, and clinical response should be further investigated.
Thyroid Cancer in Children and Adolescents
Authors: Fassina Ambrogio S. , Rupolo Maurizio , Pelizzo Maria Rosa , Casara Dario
Published: April 2018

Aims and background

It was the aim of this paper to report clinical and pathologic characteristics and outcome of treatment in terms of relapse-free and overall survival in 36 patients under 20 years of age and treated for thyroid cancer at Padua University Hospital from January 1968 to December 1988 and followed until December 1992.

Methods

The median follow-up was 112 months (range 3 to 228 months). Age at diagnosis ranged from 4 to 20 years with a mean age of 15 years and a male/female ratio of 1:2.9. A thyroid nodule or a laterocervical mass was the most frequent sign of presentation. The routine diagnosis schedule included thyroid scintigram, neck echotomography and in the last decade fine needle aspiration biopsy.

Results

Sixteen (28%) patients had a family history of thyroid disease. Histology revealed that papillary carcinoma was present in 43 patients (76.8%), follicular carcinoma in 9 (16%), medullary carcinoma in 2 (3.6%) and lymphoma in 2 (3.6%). Fifty-four patients were treated with total thyroidectomy, of these 34 had bilateral neck dissection and 20 unilateral nodal dissection; 2 patients underwent simple lobectomy with unilateral dissection. Nodal involvement was present in 41 (73%) cases, and synchronous visceral metastases were detected with scan and/or chest X-ray in 10 (18%) cases. In the case of differentiated thyroid carcinoma, patients with residual disease or thyroid remnants were treated with 131I metabolic therapy. All patients were put on suppressive hormone therapy. At this writing, 52 (93%) patients were in complete remission and 4 (7%) had persistent disease. Recurrences developed in 2 (3.5%) patients: one presented lung metachronus metastases and one local recurrence; no deaths have occurred.

Conclusions

From this experience, total thyroidectomy appears to be the appropriate approach for differentiated tumors in children and adolescents because the disease is often diffuse, secondary deposits may be easily detected, and the value of thyroglobulin measurement can be improved. Following this strategy, overall recurrence risk was low and 131I therapy was curative in patients with nodal and lung metastases.
pTNM Stage Distribution in Breast Cancer: A Population-Based Survey in Northern Italy
Authors: Rodella Stefania , Turazza Monica , Picoco Cosimo , Stanziai Franco , Bonetti Franco , Molino Anna Maria , Donati Luciano Fiore ,   Collaborative Group of Pathologists for Cancer Registration in Verona, Buongiorno E. , Calabrese G. , Castelli P. , Lestani M. , Marino F. , Mencarelli R. , Pelosi G.
Published: April 2018

Aims and background

The role of distribution by stage at diagnosis in breast cancer has been considered in many studies, with particular regard to evaluation of prognosis, impact of screening programs and quality of care. Nevertheless, international comparisons of descriptive data can be hampered by lack of homogeneity in staging methods. The TNM is presently the most common staging system used all over the world, although some criticism have been raised recently against its pragmatic value. The present study reports a population-based survey of pathologic TNM distribution in incident cases of female breast cancer in the Verona province, a geographical area of northern Italy covered by cancer registration.

Methods

All histologically proven incident cases of breast cancer were identified in the study period 1988-1990 and classified as for tumor size and nodal involvement according to the pathological TNM criteria. The type of surgical treatment was also registered for all cases diagnosed in 1990.

Results

one thousand two hundreds and fifty-four invasive and in situ breast cancers were observed and pT1 cases accounted for 44.4%. Nodal involvement was present in 41.5% of invasive cancers. A surgical treatment was performed in 1213 patients (96.7%). Axillary dissection was reported in 1080 cases, 820 of them (76.6%) having 10 or more lymph nodes examined. Radical mastectomy accounted for 74% of the 458 breast cancers diagnosed in 1990 and 31.6% of the eligible cases were conservatively treated.

Conclusions

Cancer registries should be encouraged to report data on stage distribution in breast cancer (and in other malignancies). This practice could improve international comparisons and give an essential contribution to studies on survival, screening programs and quality of care.
Dose Intensification of Chemotherapy in Advanced Breast Cancer: A Feasibility Phase II Study
Authors: Pedrazzoli Paolo , Zamagni Claudio , Martoni Angelo , Capotorto Anna Maria , Da Prada Gian Antonio , Pavesi Lorenzo , Preti Pietro , Lelli Giorgio , Pannuti Franco , Cuna Gioacchino Robustelli della
Published: April 2018

Aims and background

Dose intensification of chemotherapy is associated with increased response rates in advanced breast cancer. Achievement of dose incrementation is usually limited by drug-dependent bone marrow toxicity. The recent availability of recombinant human colony-stimulating factors (CSFs) have made it possibile to evaluate their potential in ameliorating chemoterapy-induced myelosuppression. The aim of this study was to evaluate tolerability and effectiveness of an intensified mitoxantrone, methotrexate and mitomycin-C (3M) regimen, given with G-CSF support in patients with advanced breast cancer (ABC).

Study design

Twenty-eight eligible patients with advanced breast cancer were treated with mitomycin -C (7 mg/sqm iv every 4 weeks), methotrexate (35 mg/sqm iv) and mitoxantrone (7 mg/sqm iv every 2 weeks) for 6 cycles. Recombinant human granulocyte colony-stimulating factor (r-HuG-CSF, Filgrastim) (5 μg/kg/day) was given subcutaneously from day 2 to day 12 after each chemotherapy administration to prevent leukopenia.

Results

Of the 27 evaluable patients, 4 had complete response and 14 achieved partial response; the overall response rate was 63% (95% Cl; 46.8%-82.2%). The median duration of response was 8 months (range, 4-13+). Chemotherapy-related toxicity was mild: only 3 out of 163 courses had to be postponed due to myelotoxicity.

Conclusions

The 3M regimen given at 2- week intervals is a feasible, active and well toleratel treatment in patients not previously treated for metastatic breast cancer.
Proliferating Cell Nuclear Antigen (PCNA) in Low-Grade Astrocytomas: Its Prognostic Significance
Authors: Vigliani M. Claudia , Chiò Adriano , Pezzulo Tiziana , Soffietti Riccardo , Giordana Maria T. , Schiffer Davide
Published: April 2018

Aims and background

A clear line cannot be drawn between well-differentiated and anaplastic astrocytomas, and a subset of low-grade tumors, histologically indistinguishable from the others, behaves similarly to anaplastic astrocytomas. The proliferative index could aid in the identification of this subgroup, for which a different therapeutic approach would be indicated.

Methods

We immunohistochemically evaluated the proliferating ceil nuclear antigen (PCNA) expression in 77 well-differentiated astrocytomas, since PCNA has been considered a good proliferation marker. The prognostic significance of PCNA labeling index (LI) was assessed in univariate and multivariate analysis, taking into consideration some clinical and histologic factors known to affect prognosis.

Results

PCNA immunostaining identified a subgroup of tumors, characterized by a LI > 5%, with a median survival close to that observed in anaplastic astrocytomas. The survival table of such a group was significantly different from that of the group with a lower LI (p = 0.0009). Multivariate analysis confirmed that PCNA-LI is an independent prognostic factor (p = 0.001).

Conclusion

These data suggest that PCNA immunostaining can be a useful tool to define the prognosis of low-grade astrocytomas on routine biopsy material.
Chemoprotective Action of Rasayanas against Cyclosphamide Toxicity
Authors: Praveenkumar Vayalil , Kuttan Ramadasan , Kuttan Girija
Published: April 2018

Aims and backgrond

Mylosuppression has been found to be one of the major drawbacks in cancer chemotherapy. Presently the effect of Rasayanas, an indigenous herbal drug preparation having immunomodulatory activity, in reducing myelosuppression and subseguent leukopenia was studied.

Methods

Animals were injected cyclophosphamide (50 mg/kg b.wt. daily for 14 days) with or without Rasayanas (50 mg/animal) and total white blood cells, bone marrow cellularity and survival of the animals were determined.

Results

Oral administration of Brahma Rasayana (BR) and Ashwagandha/Rasayana (AR) was found to protect mice from cyclophosphamide induced leukopenia. Total white blood cell counts in BR and AR treated animals on day 12 were 3800 and 3000 cells(mm3 respectively, which was significantly high compared to that of controls (700 cells/mm3). When the treatment was stopped on day 14 the value increased to 27,000 and 26,000 cells/mm3. The bone marrow cellularity were also significantly high in BR and AR treated animals (3.45 × 106 and 2.38 × 16 cells femur respectively) compared to that of controls. (0.72 × 106 cells/femur).

Conclusion

The results indicate the usefulness of Rasayanas in chemotherapy induced myelosuppression and leukopenia.
Solitary Plasmacytoma of Bone and Extramedullary Plasmacytoma: Two Different Nosological Entities?
Authors: Guida Michele , Casamassima Addolorata , Abbate Ines , Paradiso Angelo , Zito Alfredo , Marzullo Franco , Lorusso Vito , Timurian Artur , Cramarossa Angelantonio , De Lena Mario
Published: April 2018

Background

The relationship between solitary plasmacytoma and multiple myeloma is still unclear, but they can be distinguished by their different clinical course. Indicators of disease activity and extension, and of a possible evolution to multiple myeloma, have not been identified as yet.

Methods

Two cases of solitary plasmacytoma are described: one of the mandible and one extramedullary plasmacytoma (EMP) of the rhinopharynx. Pathologic data included immunohistochemical staining for heavy and light Ig chains, and for the proliferating cell nuclear antigen (PCNA). Analysis of the peripheral immunological status and serum parameters ( β2 microglobulin, thymidine kinase, IL-2, IL-6 and soluble IL-2 receptor) was performed and correlation was made with the clinical status. Flow cytometry analysis of nuclear DNA content and S-phase cell fraction were also studied in both neoplasms.

Results

Solitary plasmacytoma of bone (SPB) showed important basal immunologic alterations and a marked increase in all serum parameters considered with respect to EMP. Ploidy analysis demonstrated an almost complete aneuploidy cell population for the SPB patient (80%), whereas in the EMP patient only 2% of the cells were aneuploid. The S-phase ceils were 16% and 4%, respectively. PCNA index was 60% in SPB and 10% in EMP.

Conclusions

Solitary plasmacytoma of the bone appeared to be a more aggressive form of plasmacellular neoplasia, distinct from EMP and similar to multiple myeloma. The study of serum parameters, together with analysis of PCNA, ploidy and S-phase fraction, can aid in better understanding disease activity, and in the choice of more adequate treatment. Moreover, serial analysis of some serum factors might be useful markers for monitoring the disease.
Biologic Charachterization of Pleural Metastases from Lung Adenocarcinoma: Description of the New DV90 Cell Line
Authors: Monti Franco , Szymczuk Stefania , Chessa Luciana , Prudente Sabrina , Nicoletti Giordano , Fattori Pier Paolo , Pini Emanuela , Desiderio Franco , Pasquini Enzo , Tison Vittorio , Ravaioli Alberto
Published: April 2018

Aims and background

The characterization of pleural metastases from lung adenocarcinoma is often limited to single biologic features.

Methods

The present paper describes the cellular kinetic parameters, as well as immunocytochemical, ultrastructural and genetic characteristics of the new DV90 cell line, established from the pleural effusion of a stage IV lung adenocarcinoma.

Results

The cell line has a diploid DNA content, a doubling time of 24 h and 7% cloning efficiency, it is tumorigenic in nude mice. Ultrastructural investigation revealed the typical features of lung adenocarcinoma; the diagnosis was confirmed by its immunohistochemical reactivity with a panel of monoclonal antibodies specifically capable of identifying adenocarcinoma cells. Genetic analysis revealed a 46 X, –Y, +8, der (6)t(6?)(q27;?) karyotype and hyperexpression of the protein codified by genes Her2/Neu and p53.

Conclusion

The importance of multidisciplinary biologic characterization in identifying the origin and biological behavior of pleural metastases deriving from lung adenocarcinoma is discussed.
In Vitro Synergic Effect of Interferon Gamma Combined with Liposomes Containing Muramyl Tripeptide on Human Monocyte Cytotoxicity Against Fresh Allogeneic and Autologous Tumor Cells
Authors: Galligioni Enzo , Santarosa Manuela , Favaro Daniela , Spada Antonella , Talamini Renato , Quaia Michele
Published: April 2018

Aims

The purpose of the present study was to investigate whether human recombinant interferon- γ (hrIFN - γ) can act synergically with various activators in increasing the cytotoxicity of cancer patient monocytes against fresh autologous and allogeneic tumor cells.

Methods

Fresh target cells were obtained by means on the mechanical and enzymatic dissociation of human renal carcinomas. A 375 and SW 626 cell lines were used as positive controls. Monocytes from renal cancer patients and normal volunteers were activated in vitro with lipopolysaccharide, muramyl tripeptide (MTP-PE) or liposomes containing MTP-PE (MTP-PE liposomes), with or without a pre-incubation with hrIFN- γ and were tested for cytotoxicity by means of a 72-hr 111indium-release assay. All of the patients were tumor free at the time of the study.

Results

Cancer patient peripheral blood monocytes were activated in vitro by different immunomodulators and became cytotoxic to freshly dissociated autologous or allogeneic tumor cells. A synergic effect producing maximal cytotoxicity was obtained with an appropriately scheduled combination of hrIFN- γ (10 U/ml) and MTP-PE liposomes (50 nm/ml), free lipopolysaccharide (10 μg/ml) or MTP-PE (100 μg/ml). The synergic cytotoxicity was observed against fresh allogeneic and autologous tumor cells, as well as against cultured cells.

Conclusions

All of these data support the possibility of a combined treatment using hrIFN- γ and MTP-PE liposomes in human studies, particularly when it is borne in mind that liposomes can prevent the direct toxicity of many immunomodulators and that the low levels of hrIFN- γ required for the synergic activation are not toxic in vivo.
Diagnostic Accuracy of Primary Liver Cancer: Implications for Cancer Registration
Authors: Donato Francesco , Rodella Stefania , Chiesa Roberta , Picoco Cosimo , Donati Luciano Fiore , Nardi Giuseppe
Published: April 2018

Aims and background

We evaluated some standardized criteria for classifying incident cases of liver cancer into either primary liver cancer (PLC) or unspecified liver cancer (ULC) on the basis of the diagnostic examinations performed and their results.

Methods

A pilot hospital-based study (98 cases) was carried out in Verona, northern Italy, with the main aim of assessing the feasibility of the method. The same procedures were subsequently applied in a population-based study (349 cases) in Brescia, northern Italy.

Results

Diagnosis was made on histologic data in 38.7% and 41.8% of the hospital based and population-based studies, respectively, with a wide variation among different hospitals. The percentage of cases classified as PLC was 78.6% in the hospital-based study and 78.8% in the population-based study. No differences in the proportion of cases attributed to PLC were found according to patients’ age and sex or hospital of admission. The repeatibility of the procedure was assessed by a cross-panel review of 198 cases, and concordance was found in 91.9% of them.

Conclusions

An operational method for case definition of PLC based on the results of the diagnostic examinations currently performed and some suggestions for cancer registration are proposed.
Indium-111-DTPA-octreotide Scintigraphy Modulation by Treatment with Unlabelled Somatostatin Analogue in Smali-Cell Lung Cancer
Authors: Soresi Enzo , Bombardieri Emilio , Chiti Arturo , Boffi Roberto , Invernizzi Giovanni , Crippa Flavio , Maffioli Lorenzo
Published: April 2018

Aims and background

Small-cell lung cancer (SCLC) tissue expresses somatostatin receptors and can be visualized by means of the indium-111-labelled somatostatin analogue DTPA-D-Pheoctreotide. The aim of the study was to investigate whether treatment with a cold somatostatin analogue can affect the imaging of somatostatin receptor scintigraphy.

Methods

Three patients with SCLC were treated with 200 μg of cold octreotide three times a day subcutaneously for 7 days. Whole body and planar scintigraphy was performed before and after the treatment.

Results

111In-DTPA-octreotide uptake was increased in cancer lesions, whereas fixation in normal tissues (liver, spleen, kidneys) decreased.

Conclusions

This is the first demonstration of an enhancement of SCLC imaging following unlabelled somatostatin analogue administration. Similar results have been described by other authors in a limited number of carcinoid tumors.
Inflammatory pseudotumor of the Liver. A Report of Two Cases with Unusual Histologic Picture
Authors: Uccheddu Alessandro , Faa Gavino , Cois Alessandro , Ambu Rossano
Published: April 2018

Two cases of inflammatory pseudotumor (IPT) of the liver are reported. Clinical presentation was vague and aspecific. Laboratory tests and data from imaging techniques provided no specific information on the actual nature of the lesions and were misleading, suggesting a malignant lesion in one patient and a complicated hydatid cyst in the other. On gross examination, the tumors appeared yellowish ore grey-yellow in color, with a firm cut surface and well circumscribed from the surrounding parenchyma, although a true capsule was not evident. Variability in the histological pattern was also observed, even though the major finding was in both cases an admixture of lymphocytes, plasmacells, granulocytes and monocytes. Lymphocytes were immunohistochemically heterogeneous; monocytes showed in one case large hyperchromic atypical nuclei, confirming the previously, reported possibility that some cases of IPT may be mistaken for sarcomas. Further evidence is added in support of the hypothesis that some liver IPT may result from the evolution of cholangitic abscesses.
Clinical Utility of Radioimmunoscintigraphy of Non-Hodgkin's Lymphoma with Radiolabelled LL2 Monoclonal Antibody., Lymphoscan™: Preliminary Results
Authors: Gasparini Massimo , Bombardieri Emilio , Tondini Carlo , Mattioli Lorenzo , Hughes Lynne , Buraggi Gian Luigi , Goldenberg David M.
Published: April 2018

Aims and Background

Adequate clinical staging of non-Hodgkin's lymphoma patients is essential because only localized disease can be treated satisfactorily. Many imaging procedures are necessary to stage the disease accurately. The objective of this study was to evaluate the efficacy of an anti-lymphoma antibody in the Fab’ fragment form, labelled with 99mTc, to detect malignant lesions.

Methods

Radioimmunodetection (RAID) with 99mTc-labelled B-cell lymphoma monoclonal antibody IMMU-LL2-Fab’ (LymphoSCAN™; Immunomedics, Morris Plain, NJ, USA) was investigated in 10 patients (5 females and 5 males; age range, 20-72 years) with histologically proved non-Hodgkin's lymphoma. Of the 10 lymphomas, 7 were intermediate grade and 3 were low grade. Whole body images with multiple planar views were obtained at 30 min, 4-6 and 24 h after i.v. injection of 1 mg LL2-Fab’ labelled with 740-925 MBq of 99mTc. SPET of the chest or abdomen was performed in all patients 5-8 h after the immunoreagent injection.

Results

No adverse reactions were observed in any patient after Mab infusion, and no appreciable changes were seen in the blood counts, renal or liver function tests. A total of 18 of 21 (85.7%) lymphoma lesions were detected by RAID. All the tumor localizations were confirmed by clinical examination and with other imaging techniques, such as CT scan, MRI or gallium scan. In this series of patients no false-positive results were noted. As regards the biodistribution of the immunoreagent, no appreciable bone marrow activity was seen; splenic targeting was demonstrated in all patients; the tumor-to-non-tumor ratios ranged from 1.2 to 2.8 ad measured by the ROI technique; no difference in uptake was noted for different tumor grades. The images obtained 24 h after injection did not reveal new lesions, but areas of doubtful uptake were seen as positive focal areas in the delayed scan.

Conclusions

LymphoSCAN™ seems to be useful for detection, staging and follow-up of non-Hodgkin's lymphoma patients.
Bone Hemangioendothelioma: An Immunohistochemical Study Related to Histological Malignancy and Proliferative Activity (NORs)
Authors: Benassi Maria Serena , Gamberi Gabriella , Ragazzini Paola , Sollazzo Maria Rosa , Ferrari Cristina , Sangiorgi Luca , Treré Davide , Derenzini Massimo , Picei Piero
Published: April 2018

Aims and Background

Forty-four bone hemangioendotheliomas (HEs) of different histological grades were studied to evaluate the expression and distribution of laminin, type IV collagen, cathepsin G and cathepsin D in cell differentiation and malignancy.

Results

In poorly-differentiated HEs the discontinuous distribution of laminin and type IV collagen around angioblastic cords, tubes and cavities revealed an irregular and disorganized basement membrane (BM) architecture corresponding to an increased cell proliferation and secretion of cathepsin D and cathepsin G by tumor cells.

Conclusions

The mean nucleolar organizer region (NOR) area, as a measure of cell proliferation, was significantly higher in grade 4 malignancies than in lower grades, revealing novel prognostic parameters.
Pain at Tumor Site after Vinorelbine Injection: Description of an Unexpected Side Effect
Authors: Colleoni Marco , Gaion Fernando , Vicario Giovanni , Nelli Patrizia , Pancheri Francesca , Sgarbossa Gigliola , Manente Paolo
Published: April 2018

Aims and Background

Vinorelbine is a new semisynthetic vinka alkaloid that has demonstrated good tolerability and interesting activity in a large spectrum of solid tumors. It was the aim of this paper to report the presence of a rarely documented side effect.

Methods

In our experience, 135 patients were treated with vinorelbine during the period 10/92 to 11/94 for a total of 1080 cycles. In 26% of the cycles, vinorelbine was administered in monochemotherapy and in 74% in polychemotherapy regimens. The dose of vinorelbine, administered in a weekly schedule, was 25 mg/m2 in 109 patients and 30 mg/m2 in 26 patients. In general, no analgesic premedication was used. Sixty-five patients had lung cancer, 45 had breast cancer, and 25 miscellaneous cancer. Only 4 patients had a previous history of neurotoxicity.

Results

Ten patients (7%) had pain in the tumor site within a few minutes of the vinorelbine injection. According to WHO grade, 5 cases had moderate and 5 severe pain. Pain was always reversible. In 5 cases ketorolac was administered after pain detection with resolution of the symptoms; in 4 cases it was necessary to deliver buprenorphine. One patient was admitted to the coronary unit because a myocardial infarction was suspected after retrosternal pain and required i.v. morphine. Seven cases refused to continue the treatment, and 3 cases had no further problem after ketorolac premedication.

Conclusions

Although rare, the presence of severe pain after vinorelbine injection may adversely affect the treatment course. Such data are helpful in the recognition and management of this reversible side effect.
Long-Lasting Complete Remission of Pulmonary Metastases Consequent to Renal Cell Carcinoma Obtained with Interferon-β Therapy: Review of the Literature and a Case Report
Authors: Scoponi Claudio , Torresi Umberto , Di Giuseppe Michaela
Published: April 2018

This case report describes a complete remission of pulmonary metastases, consequent to renal cancer, achieved with interferon- β therapy. After nephrectomy (July 1990), this female patient was proposed for therapeutic assessment: vinblastine chemotherapy was carried out for 10 cycles, whereas concomitant immunotherapy of interferon-α was discontinued after 30 days owing to lack of tolerability. In replacement, interferon- β administration from the 5th cycle of chemotherapy at the dose of 3 MIU 3 times a week was well tolerated. Interferon- β was interrupted 27 months later, due to an increase in transaminase levels. Partial remission of pulmonary metastases was assessed after 9 months of interferon- β therapy, and a complete remission was assessed after 1 and 2 years of therapy. In November 1994, the patient was still in good clinical conditions and disease-free after 37 months from the achievement of complete remission.
Radiation-Induced Primary Brain Lymphoma: A Case Report
Authors: Stein Moshe E. , Haim Nissim , Ben-Shachar Menachem , Goldsher Dorith , Bernstein Zvi , Ben-Arieh Yehudith , Kuten Abraham
Published: April 2018

A patient who developed primary brain lymphoma 6 years following whole brain irradiation due to a low-grade glioma is described. The patient had no evidence of congenital or acquired immunodeficiency state and achieved a good and prompt response to aggressive chemotherapy, including high-dose methotrexate. The previous radiation therapy is implicated in the etiology of the lymphoma because of the geometric coincidence, the relatively long latency period and the different histology. A brief review of current literature is reported.
Malignant Melanotic Schwannoma or Schwannian Melanoma?
Authors: Bosman Cesare , Boldrini Renata , Corsi Alessandro
Published: April 2018

A 43-year-old man underwent surgical removal of L4-L5 nerve root tumor which bulged to the extra and intradural spaces and extended as a dumbbell through the intervertebral foramen. Histological examination showed pleomorphic tumor cells with heavy melanin pigmentation. Most of the tumor cells were immunohistochemically positive for vimentin, S-100 protein and HMB-45 antigen; basic myelin protein was detectable in single tumor cells. Electron-microscopy revealed melanosomes in different stages of differentiation and some characteristics of Schwann cells, such as redundant basal lamina production. Taken together the tumor showed features of histological malignancy and incomplete schwannian differentiation with considerable overlap between melanoma and malignant melanotic schwannoma.
Head and Neck Metastases of Renal Cancer after Nephrectomy: A Report of 2 Cases
Authors: Airoldi Mario , Succo Giovanni , Valente Guido , Cavalot Andrea , Gabriele Pietro , Bumma Cesare
Published: April 2018

Two cases of metachronous metastases of renal cell adenocarcinoma are reported. One case presented a solitary metastasis of the ethmoid-orbit which was resected. The patient has remained well for the following 12 months. The second case presented with a secondary to the tongue and multiple metastases elsewhere. Electrodissection achieved a good palliative result.
Gonadoblastoma with Coexistent Features of Mixed Germ Cell-Sex Cord Stroma Tumor: A Case Report
Authors: Colafranceschi Maurizio , Massi Daniela
Published: April 2018

Gonadoblastoma and mixed germ cell-sex cord stroma tumor have been widely recognized as two separate entities on the basis of both clinical and pathological features. The typical morphological pattern of both tumor types was found by us to coexist in the same gonadal tumor in a 14-year-old 46,XY phenotypically female subject who also had a contralateral dysgerminoma. A subserous implant showing the mixed germ cell-sex cord pattern of the primary tumor was detected in the uterine body. Following therapy the patient is alive and well after a 7-year follow-up. The distinction between gonadoblastoma and mixed germ cell-sex cord stroma tumor requires discussion.
Colorectal Cancer in Young Adults
Authors: Yılmazlar Tuncay , Zorluoğlu Abdullah , Özgüç Halil , Korun Nusret , Duman Hakan , Kaya Ekrem , Kızıl Ayhan
Published: April 2018

The study was carried out to promote a greater awareness of the potential for colorectal cancer in young adults under 40 years of age. During the 8 years between 1986 and 1993, 237 patients with adenocarcinoma of the colon and rectum were operated at the Uludağ University Hospital. Of these 237 cases, 46 patients under 40 years old were reviewed retrospectively. They accounted for 19.4% of the total number of patients with carcinoma of the colon and rectum operated during the same period. Rectal bleeding was the most common presenting symptom. The mean duration of time from the onset of symptoms to diagnosis was 5.8 months. The rectosigmoid area was the most frequently involved site (80%). Seventy-six percent of the patients had Dukes’ stage C or D tumors. Forty-eight percent of the tumors were either poorly differentiated or mucinous. The cumulative survival rate at 5 years was 43.4%. Patients under 40 years old with carcinoma of the colon and rectum are usually symptomatic and have advanced disease at the time of presentation. Although colorectal cancer is usually a disease of older patients it is becoming more common in younger populations.
Alpha Interferon as Initial Treatment of Essential Thrombocythemia. Analysis after Two Years of Follow-Up
Authors: Pogliani Enrico Maria , Rossini Fausto , Miccolis Isabella , Ferrarlo Alessandra , Perego Daniele , Casaroli Ivana , Bolis Silvia , Fagnani Daniele , Brambilla Milena , Corneo Gianmarco
Published: April 2018

Aims and background

Recombinant alpha-interferon has been shown to be effective in essential thrombocythemia and in thrombocytosis associated with other myeloproliferative disorders.

Patients and methods

Twenty-five untreated patients were enrolled in our study from May 1989 to April 1992. Recombinant alpha interferon-2b was administered at an initial dose of 2 megaunits (MU)/m2 three times a week at escalating doses to 5 MU/m2 or the maximum tolerated dose. The mean follow-up for patients still in treatment at the time of this report was 35.9 months (range, 24-63).

Results

Fourteen patients (56%) had achieved a complete remission by a mean time of 152 days; 6 patients (24%) had achieved a good partial remission by a mean of 180 days. In addition to the favorable effect on platelet count, a marked improvement in clinical symptoms was observed. Treatment had to be discontinued in 9 patients (36%), 5 for toxicity (3 neurologic, 1 anemia and 1 severe hypertriglyceridemia) at a median of 155 days from the beginning of therapy (range, 30-400). Four patients refused to continue therapy because of low tolerance (flu-like syndrome) at mean of 160 days from the beginning of therapy (range, 34-301).

Conclusions

In our study, lower doses were administered compared with previous short-time trials. The present data show that interferon is an effective alternative to cytostatic agents in long-term treatment of patients with essential thrombocythemia, even when used at lower dosages.
Proliferating Cell Nuclear Antigen Immunoreaction in Adrenal Tumors
Authors: Damiani Durval , Manna Tais Della , Aquino Luz G.W. , Dichtchekenian Vaê , Alves Venâncio Avancini Ferreira , Filho Adhemar Longatto , Kanamura Cristina Takami , Setian Nuvarte
Published: April 2018

Aims and background

We studied, retrospectively, 33 cases of adrenal tumors of children at the Pediatric Endocrinology Unit, Children's Institute, São Paulo State University Medical School, from 1975 to 1993. All patients had at least 2 years of follow-up with a few exceptions.

Methods

Clinical follow-up data were correlated with histopathologic review, laboratory data and cell kinetic evaluation (based on detection of proliferating cell nuclear antigens).

Results

With one exception, all the patients had presented signs of androgen production and had high levels of dehydro-epiandrosterone-sulfate. Tumor weight evaluation represented a good parameter of neoplasm evolution: of 19 cases weighing less than 250 g, 17 had no evidence of disease after surgery, and 2 had an unfavorable prognosis. Of 14 cases weighing more than 250 g, only 1 had no evidence of disease and 13 had an unfavorable evolution.

Conclusions

Proliferating cell nuclear antigen (PCNA) was not helpful to evaluate adrenal neoplasm evolution: our study did not show any correlation between PCNA score and prognosis.
Iatrogenic Pneumocephalus in a Man with Undifferentiated Nasopharyngeal Carcinoma. A Case Report
Authors: Guida Michele , Cramarossa Angelantonio , Mastria Antonella , Perotti Pia , Mattavelli Franco , Gramaglia Alberto , Cantù Giulio , Lorusso Vito , De Lena Mario
Published: April 2018

A case of pneumocephalus in a 45-year-old male with undifferentiated rhinopharyngeal carcinoma is described. The patient was initially subjected to radiotherapy and then to transmaxillary resection and a second course of stereotactic radiotherapy for recurrent disease. Lastly, the patient was treated with chemotherapy because of local-regional disease progression. After two cycles of cisplatin, adriablastine and bleomycin, the patient suddenly entered in coma. Cerebral CT scan evidenced the presence of air in the frontal and lateral cornua, in the subarachnoid space of the base cisternae extending to the 7th cervical vertebra. After 8 months of a clinical stationary condition, the patient died. The various treatments used are critically reviewed, and modern therapeutic approaches for the neoplasm and the toxicity involved are discussed. We conclude that in nasopharyngeal carcinoma, for patients who relapse after radiotherapy, successive local-regional therapies (surgery, re-irradation) should be carefully evaluated to avoid demolishing treatments, which are burdened with severe side effects that might influence the quality of life with only slight improvement of overall survival. Furthermore, the presence of persistant aqueous rhinorrhea in these patients should be carefully evaluated, because it could be an early symptom of a cerebrospinal fluid leak.