Fifteen year radiotherapy experience with chondrosarcoma of bone

A retrospective analysis of 20 patients with chondrosarcoma of bone treated for cure between 1961 and 1976 using supervoltage radiotherapy and/or neutrons is presented. Radiotherapy was used alone or in combination with other modalities. The 20 patients were divided into four groups: 1) 11 patients who received radiotherapy alone, 2) three patients who received postoperative radiotherapy following less than radical local excision, 3) three patients who received radiotherapy with chemotherapy but without surgery, and 4) three patients who received radiotherapy for tumor recurrent after surgery. Typical tumor doses ranged from 4000 to 7000 rad at 1000 rad/week using parallel-opposed fields. Failure of radiotherapy was indicated by progression of symptoms and increasing tumor size. At 53 months, the average follow-up, the survival rate is 65% (13/20), including one patient with distant metastases, and two patients who developed local recurrent disease after radiotherapy and were surgically salvaged. Seven patients died with uncontrolled local disease; six of them also had distant metastases. Five patients developed severe complications. All four patients treated with a combination of neutron and photon beam alone show no evidence of local failure, compared with only one of the seven patients treated with conventional radiotherapy alone.

Immunoperoxidase localization of prostatic acid phosphatase in prostatic carcinoma with sarcomatoid changes

Immunoperoxidase staining of tissue for prostatic acid phosphatase has been useful in confirming the prostatic origin of metastatic deposits. This technique was used on the prostate tumors of 2 patients to differentiate between a true carcinosarcoma and a pure epithelial carcinoma with sarcomatoid changes. Positive staining for prostatic acid phosphatase in both the sarcomatoid element, as well as the area of well-differentiated carcinoma, confirmed the common epithelial cell origin of these components. Electron microscopy further confirmed these findings by demonstrating desmosomes in the sarcomatoid areas. Although each type of tumor is rare, differentiation between true carcinosarcomas and true carcinomas with sarcomatoid changes is important to elucidate further their different clinical behaviors and responses to therapy.

Histologic grading study of prostate adenocarcinoma: the development of a new system and comparison with other methods--a preliminary study

A new grading system for adenocarcinoma of the prostate (MDAH System) and its simplified version, both based on the percentage of tumor that is differentiated (gland-forming) or undifferentiated (non-gland-forming), were compared with the grading systems of Mostofi and Gleason. In a study group of 182 patients with Stage C adenocarcinoma of the prostate, the MDAH system identified 84 patients (46%) as Grade 1, 75 (41%) as Grade 2--3, and 23 (13%) as Grade 4. Kaplan-Meier survival curves predicted a 91% five-year survival for Grade 1 patients, a 60% 5-year survival for Grade 2--3 patients, and a 15% five-year survival for Grade 4 patients. Wilcoxon (Gehan modification) tests showed that the survival was significantly different among Grades 1, 2--3, and 4. The MDAH System is an improvement over other grading systems in that it is a simple, low-power microscopic method that depends only on the percentage of gland formation in the tumor and further reflects the biologic behavior of the tumor as measured by the patient's survival.

Extracranial metastases of oligodendroglioma: report of a case and review of the literature

The case of a 33-year-old woman with oligodendroglioma with extraneural metastases involving the masseter muscle, the cervical lymph nodes, the lumbar vertebrae, and the right iliac bone is described. Oligodendroglioma with metastases outside the central nervous system is extremely rare, and only a very few cases have been reported.

Radiotherapy (2500 rad) for testicular leukemia: local control and subsequent clinical events: a Southwest Oncology Group study

The effectiveness of radiotherapy, 2500 rad over two weeks, in treating leukemic infiltrates of the testicles was studied in 38 boys who met the requirements for tissue conformation of testicular involvement and examination of the bone marrow. The study group was heterogeneous with respect to specific histology and prior therapy. Complete regression of testicular infiltrates was confirmed by repeated biopsy examinations of 32 of 33 patients undergoing the procedure. The single treatment failure occurred in a boy with acute myelogenous leukemia. In all other patients, local disease control following radiotherapy persisted throuthout the remainder of the clinical course. Three of 5 children, however, showed evidence of reseeding of the testicle as a part of the relapse process at post-mortem examination. Statistical analysis of data from the 35 patients with acute lymphocytic leukemia showed the subsequent course of the disease with respect to next relapse, involving either bone marrow (BM) or the central nervous system (CNS), to be dependent on the acute leukemia prognostic group, as determined by age and peripheral white blood cell count (WBC) at the time of diagnosis, and timing of extramedullary disease (EMD). Patients with poor prognosis at the time of diagnosis and EMD afterward had a 3.8 times greater risk of a subsequent BM or CNS relapse than did patients with good or average prognosis and no EMD at any time (P = 0.07). Of the candidate prognostic factors examined with repect to survival, only the number of prior BM relapses was of statistical significance (P = 0.044). Children with two or more prior BM relapses had the worst prognosis for survival from testicular relapse, with a death risk of 3.6 times greater per unit of time than that of children with no or one prior BM relapse. Protective BM and CNS rescue therapy was recommended for those otherwise in complete remission (CR) at the time of testicular relapse. The median times to next relapse for patients receiving both BM and CNS recue therapy and for patients given CNS recue only were 42+ and seven weeks, respectively ( P = 0.09). The type of rescue received did not appear to affect survival time following testicular CR.

Metastases from transitional cell carcinoma of urinary bladder

In 107 patients who died of metastatic transitional cell carcinoma, the most common sites for metastases at necropsy were the lymph nodes, liver, lung, bone, and adrenal gland. Metastases first were documented clinically in multiple-organ sites in one third of the patients; solitary metastases were present in only 9 patients at necropsy. The mean duration of survival for patients was thirteen months from the diagnosis of the primary tumor. The metastatic lesion(s) generally were evident clinically within eleven months of the primary diagnosis; death ensued usually within three months. Our finding that the majority of patients presented initially with high-grade tumors suggests that a high-grade lesion, regardless of its clinical stage, warrants early aggressive therapy.

Renal cell carcinoma presenting as breast carcinoma

A second case of renal cell carcinoma presenting as primary breast carcinoma is described. Although metastasis to breast is usually an indication of generalized disease, this patient survived for over four years.

Vesical adenocarcinoma occurring in patient with pelvic lipomatosis

This is the first case reported of adenocarcinoma of the urinary bladder in a patient with pelvic lipomatosis and cystitis glandularis. The abnormal pelvic fat hampered endoscopic evaluation and transurethral biopsy, confused clinical staging, and complicated preoperative irradiation and cystectomy. The development of adenocarcinoma in this patient indicates the potential for malignant transformation of cystitis glandularis and underscores the necessity for endoscopic follow-up of persons with pelvic lipomatosis.

Ewing sarcoma: its course and treatment in 50 adult patients

34 patients were treated for Ewing sarcoma with primary presentation. There were 10 females and 24 males with average age of 21 years (range 16-36 years). These patients received radiotherapy (greater than 5,000 R) to the primary site and combination chemotherapy with vincristine, cyclo-hosphamide, doxorubicin and actinomycin D. Of 19 patients with primary presentation in an extremity, 12 remain alive at 29 months without clinical evidence of tumor (63%); 2 patients are alive with relapse. All 10 patients with primary presentation in the pelvis died despite vigorous treatment. 3 patients are alive out of 5 patients with primary presentation in chest or abdominal wall or axilla but only 1 patient remained tumor-free. Of the entire group of 34 patients, 12 remained tumor-free at 27 months (35%). 2 relapsed patients were rendered surgically tumor-free and receive further treatment. 20 patients died or are receiving treatment for advancing disease. 16 patients were treated for locally recurrent (1 patient) or metastatic (15 patients) Ewing sarcoma. There were 6 females and 10 males (average age 24.7 years). These patients received palliative radiotherapy and combination chemotherapy with vincristine, cyclophosphamide, doxorubicin, actinomycin D and dacarbazine. At 36 months, 3 patients are alive tumor-free and 1 patient is alive with stable disease. 12 patients died, 2 after temporarily achieving complete remission.

Intracisternal tubules in human melanoma cells

Aggregates of parallel microtubules have been found within cisternae of the rough endoplasmic reticulum in cells of six human metastatic melanomas. The tubules have a uniform diameter and regular spacing and in longitudinal sections can be seen to possess a fine periodicity. They are compared with tubuloreticular inclusions reported in other cells.

Primary localized amyloidosis of male urethra (amyloidoma)

Amyloidosis of the urethra is extremely rare. The first reported case of amyloidosis of the fossa navicularis is presented.

Secondary tumors of ureter

Carcinoma metastatic to the ureter, representing hematogenous or lymphatic spread from a distant primary neoplasm, was diagnosed in 39 patients. Although the lesions are uncommon and usually represent late manifestations of malignant disease, earlier recognition and relief of urinary tract obstruction may allow for improvement in symptoms and survival.

Epithelioid sarcoma of penis

A rare case of an epithelioid sarcoma of the penis arising as a superficial plaque in the glans and causing pain on erection is reported. This tumor is characterized by a slow growth and infiltrative pattern with a high propensity for local recurrence. Proper treatment is wide local excision.

The value of percutaneous needle biopsy in the management of primary bone tumors

Thirty-four suspected primary bone neoplasms were evaluated by needle biopsy at M. D. Anderson Hospital and Tumor Institute between September 1976 and February 1978. Adequate material for evaluation was obtained in 31 cases. The accuracy rate of the procedure was 93%. Needle biopsy is a rapid, effective and safe method of evaluating unsuspected primary lesions of bone. The indications, contraindications, and technique are emphasized. The benefits over open biopsy are indicated.

Radiographic aspects of massive bone osteoarticular allograft transplantation

Experience with 56 cases of osteoarticular allograft transplantation of the extremities is presented. Cadaveric allograft including a joint surface and a variable amount of shaft is used in the treatment of aggressive benign and low-grade malignant tumors involving a long bone near a joint. The preoperative radiographic evaluation is outlined. Thirty-four patients had an uncomplicated course. Twenty-two patients had complications including aseptic fracture, infection, and tumor recurrence. The radiographic spectrum of both complicated and uncomplicated cases is illustrated.

Percutaneous needle biopsy of bone in the cancer patient

Needle biopsy of skeletal lesions is easily accomplished by the percutaneous technique. Although this approach has been utilized for many years, the frequency has definitely increased of the 91 cases performed at M. D. Anderson Hospital and Tumor Institute from September 1976 to September 1977, adequate material was obtained in 92.3% of the patients, and the diagnosis was established accurately in 83.5% of the cases. No complications were encountered. The technique, indications, and contraindications are discussed and illustrated with representative cases. The contribution of this technique to the management of patients with malignant disease is significant. The benefits include rapid and accurate establishment of a tissue diagnosis, avoidance of a surgical procedure with its associated risks and cost, and simplicity and safety of the procedure facilitating its repetition if needed.

The radiographic spectrum of periosteal osteosarcoma

Fifteen cases of a recently described variety of osteosarcoma, periosteal osteosarcoma, were studied to define their radiographic characteristics. All the lesions were limited to the cortex that was always thickened but without invasion of the medulla cavity. The tumors presented as non-homogeneous masses of spiculated osteoid matrix progressively denser from the periphery to their cortical base. The average age was 28 and the most common location was the proximal third of the femur; all the lesions were diaphyseal in location. The spectrum of radiographic features and differential diagnosis are described in detail.

Liposarcoma of spermatic cord

Four patients with myxoid liposarcoma of the spermatic cord are presented, three of whom have survived longer than five years. Wide local excision is usually the treatment of choice with radiotherapy reserved for control of either extensive local disease or following incomplete removal of the lesion.

Plasmacytoma of testis presenting as primary testicular tumor

Two cases of plasmacytoma of the testis presenting as primary testicular tumors are presented. This lesion may be confused both clinically and histologically with other more common pathologic conditions.

Mucinous adenocarcinoma of the prostate

The third case of mucous-forming adenocarcinoma of the prostate with metastases to the bone is reported. The primary tumor was unresponsive to definitive radiotherapy and subsequent metastases to the lung, liver and bone failed to respond to hormonal manipulation and chemotherapy.