Late ovarian metastases in carcinoma of the colon and rectum

We reviewed 63 patients with metachronous ovarian metastases from colorectal carcinoma to determine the natural history of this problem, and whether aggressive surgical treatment is beneficial. Ovarian metastases usually occurred in younger patients (mean age, 51 years) and in 55.5% of the patients, the metastases were part of diffuse intra-abdominal disease. The mean survival rate for all patients following surgery was 16.6 months. The survival rate did not correlate with menstrual status, interval to recurrence, or Dukes' stage of the original cancer. Ability to remove all gross disease at the time of oophorectomy was the major determinant of survival. Surviving patients who were rendered disease free surgically (n = 15) lived a mean of 48 months compared with 9.6 months for patients with localized, but unresectable disease (n = 9), and eight months for patients with diffuse disease (n = 35). Surgical attempts to remove all gross disease seem to result in significantly improved survival rates even though a cure is rare. Bilateral oophorectomy is warranted as part of the palliative treatment of women who are seen with stage D cancers to prevent the development of large symptomatic metastases that require further therapy.

Does clearing of axillary lymph nodes contribute to accurate staging of breast carcinoma?

The major prognostic indicator in carcinoma of the breast is the presence of metastases in axillary lymph nodes. However, 25% of patients with negative axilliary nodes by standard pathologic techniques are dead of metastatic breast carcinoma within 10 years. "Clearing" of the axillary fat has been shown to increase the yield of lymph nodes. Forty-two pathologic Stage I and II breast carcinoma specimens were cleared following routine pathologic examination to determine whether stage was changed by the clearing procedure. A total of 857 lymph nodes were recovered from 42 patients by routine techniques. Clearing increased the number of nodes found by 30%, to 1114. In the 31 node-negative patients an additional 178 nodes were identified, increasing the mean number of nodes per patient from 20 to 26. The number of additional nodes found per specimen ranged from 0 to 19. None of the additional nodes identified contained metastases. In the node-positive patients, 79 additional nodes were found by clearing, including 33 with metastases. No change in stage resulted, although the mean number of nodes per patient was increased from 22 to 30. Although an occasional positive lymph node may be overlooked by manual dissection, the rarity of this event makes routine clearing of the axillary contents impractical for carcinoma of the breast except in a research setting. Whether this conclusion applies equally to other tumors and other lymph node groups requires further study.

Comparison of conventional surgical resection, radioactive implantation, and bypass procedures for exocrine carcinoma of the pancreas 1975-1980

To examine the efficacy of a variety of procedures for treatment of biopsy proven exocrine adenocarcinoma of the pancreas, a retrospective review of 231 patients surgically treated at a single institution from January 1975 through December 1980 was performed. Thirty-nine patients underwent resection for cure, of which 19 were conventional resection, 33 I125 implantation, 76 biliary or GI bypass, and 83 biopsy alone, a resectability rate of 16.9%. There was one pancreatic fistula in the implant group. Median survival following implant was 8 months (0%, 30-day mortality) and, for conventional resection (n = 19), 17 months with an inhospital mortality of 16%. Median survival excluding inhospital mortality was 17 months for the conventional resection group. For bypass, median survival was 4 months (p = 0.0001 vs. conventional resection) with an inhospital mortality of 14%. Of patients discharged from hospital, 5 of 16 (31%) survived 2 years in the conventional resection group, while 4 of 132 (3%) survived 2 years in the nonresected groups. Only one patient (5% of resected) has survived 4 years in the conventional resection group, although eight others are alive and at risk in this group. Resectability rate for patients referred with adenocarcinoma of the pancreas remains low. The only long-term survivors are in those patients undergoing resection. Local implantation with I125 requires prospective evaluation because of an apparent influence on palliation without significant morbidity.

Staging of breast cancer: a new rationale for internal mammary node biopsy

Metastases to the axillary nodes, the internal mammary nodes, or both, define a group of patients at very high risk of having systemic micrometastases leading to recurrent disease and death if surgical therapy alone is used. In our review of 7,070 patients with breast cancer in whom both axillary nodes and internal mammary nodes were examined histologically, 5% to 10% had internal mammary node metastases in the absence of axillary node metastases. With the availability of effective systemic therapy that can improve the survival of patients with operable breast cancer who have lymph node metastases, information obtained from internal mammary node biopsies assumes practical significance. Our current policy is to perform internal mammary node biopsies on patients with operable breast cancer who have medial and central primary tumors of any size and lateral primary tumors 2 cm or greater in diameter if a frozen section of the most suspicious node in the axillary dissection shows no histologic evidence of metastasis.

Genetic studies of the Macushi and Wapishana Indians. I. Rare genetic variants and a "private polymorphism' of esterase A

Blood samples from 509 Macushi and 623 Wapishana Amerindians of of Northern Brazil and Southern Guyana have been analyzed with reference to the occurrence of rare variants and genetic polymorphisms of the following 25 systems: (i) Erythrocyte enzymes: acid phosphatase-1, adenosine deaminase, adenylate kinase-k, carbonic anhydrase-1, carbonic anhydrase-2, esterase A1,2,3, esterase D, galactose-1-phosphate uridyltransferase, isocitrate dehydrogenase, lactate dehydrogenase, malate dehydrogenase, nucleoside phosphorylase, peptidase A, peptidase B, phosphoglucomutase 1, phosphoglucomutase 2, phosphogluconate dehydrogenase, phosphohexoseisomerase, triosephosphate isomerase and (ii) Serum proteins: albumin, ceruloplasmin, haptoglobin, hemoglobin A2 and transferrin. Fifteen different rare variants were detected, involving 11 of these systems. In addition, a previously undescribed variant of ESA 1,2,3 which achieves polymorphic proportions in both these tribes is described. Excluding this variant, the frequency of rare variants is 1.1/1000 in 12510 determinations in the Macushi and 4.7/1000 in 15396 determinations in the Wapishana. The ESA 1,2,3 polymorphism was not observed in 382 Makiritare, 232 Yanomama, 146 Piaroa, 404 Cayapo, 190 Kraho and 112 Moro. Irregularities in the intratribal distribution of this polymorphism in the Macushi and Wapishana render a decision as to the tribe of origin impossible at present. Gene frequencies are also given for previously described polymorphisms of 5 systems: haptoglobin, phosphoglucomutase 1, erythrocyte acid phosphatase, esterase D, and galactose-1-phosphate-uridyl-transferase.

The genetic structure of a tribal population, the Yanomama Indians. IX. Gene frequencies for 18 serum protein and erythrocyte enzyme systems in the Yanomama and five neighboring tribes: nine new variants

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