[Role of chemotherapy in the treatment of soft tissue sarcoma in adults]

Soft tissue sarcomas of adults represent an heterogeneous group of rare malignant tumors, for which clinical and histopathological prognostic factors are now well defined. The GTNM classification recommended by the UICC is effectively predictive for the metastatic potential of these diseases. Although chemotherapy still have limits in advanced sarcomas, the efficacy level reached allows to consider its use with a curative intend, in multidisciplinary therapeutic program. A critical analysis of the studies already published shows that adjuvant chemotherapy can reduce the distant metastases rate in patients presenting an operable primary tumor. Furthermore, the preliminary results of a study indicate that neoadjuvant (induction) chemotherapy may be of value for primarily inoperable patients. All these encouraging results remain to be confirmed by further studies with a long-term follow up of the patients.

Bone loss in hypothyroidism with hormone replacement. A histomorphometric study

To determine the influences of hormone replacement on bone tissue in primary hypothyroidism, a histomorphometric study on undecalcified transiliac bone specimens was performed before treatment in ten patients, during the first month of treatment in 16 patients, and after more than six months of treatment in 15 patients. There were no obvious clinical or biologic signs of excessive replacement therapy. Before treatment, trabecular resorption surfaces were lower and bone cortical thickness was increased. From as early as the first month of treatment, trabecular resorption surfaces and cortical porosity were higher than normal but cortical thickness was still increased. After more than six months of treatment there was a significant loss of trabecular (decreased trabecular bone volume) and cortical (normal mean cortical width; increased porosity) bone with hyperremodeling (increased trabecular resorption surfaces and trabecular osteoid surfaces). This osteoporosis is similar to that observed in hyperthyroidism.

[Prostatic osteocondensing metastases and osteomalacia. Value of histomorphometric study. Preliminary results]

A clinical, biochemical and histomorphometric study of non-decalcified bone with measurement of calcification rate was carried out in 10 patients with sclerotic bone metastases from prostatic carcinoma. The patients were under oestrogen therapy, and a change of treatment was being considered. The histomorphometric study showed that 3 patients had osteomalacia. These patients differed from the others in that the pain they experienced in bones was stronger, more diffuse and more often permanent. All three had fracture of the femoral neck. They had hypocalcaemia, hypophosphataemia, hypocalciuria and increased serum alkaline phosphatase, but only phosphataemia was significantly lower than in non-osteomalacia patients. Osteomalacia was cured by vitamin D and calcium in one patient. Osteomalacia can only be reliably diagnosed in these patients by histomorphometry. This examination may be proposed to patients with sclerotic bone metastasis of prostatic origin, under hormonal therapy, presenting with diffuse skeletal pain or bone fragility without osteolysis, and with hypocalcaemia or hypophosphataemia.

[Conservative loco-regional treatment of soft tissue sarcoma in adults after induction chemotherapy]

Between June, 1979 and December, 1983, 23 adult patients with non-metastatic soft tissue sarcoma were treated with induction chemotherapy since local spread precluded primary conservative surgery. Eighteen patients received a combined cyclophosphamide, vincristine, adriamycin and dacarbazine treatment and 5, a combined adriamycin, cis-platinum and vindesine treatment. Both drug combinations exhibited toxic effects, notably on blood and digestive tract. However, tumoral volume was reduced by 50 p. cent or more in 14/23 patients, including 2 complete remissions; the course of the disease remained unchanged under treatment in only 3 cases. Chemotherapy facilitated surgical excision in 14 patients, and subsequent radiotherapy resulted in complete remission in 13 of these. None of the 13 patients relapsed during a mean follow-up period of 12 months (range: 3 to 48 months). Among the 9 patients who could not be operated upon, 5 benefited from radiotherapy with satisfactory local control, but only one still remains in complete remission. Thus, induction chemotherapy made it possible to achieve local control in two-thirds of patients with locally advanced sarcoma. However, a more prolonged follow-up is necessary to confirm that these results are long-lasting and to determine the effects of chemotherapy, if any, on the metastatic potential of these tumours.

Analysis of a series of sixty soft tissue sarcomas in adults treated with a cyclophosphamide-vincristine-adriamycin-dacarbazine (CYVADIC) combination

From 1976 to 1983, a group of 60 adult patients presenting with metastatic and/or locally advanced soft tissue sarcomas was treated with combination chemotherapy consisting in cyclophosphamide, vincristine, adriamycin, and DTIC (CYVADIC). A tumor response was obtained for 29 patients (48.3%), with 4 (6.7%) cases of complete regression. The median duration of the response was 10 months. Responses were noted in 14/22 patients receiving induction chemotherapy for advanced, and previously nonirradiated, primary tumors; among the patients with metastatic disease tumor regression was recorded in 17/32 patients with pulmonary metastases, but in none of the patients with metastases at other sites. Moreover, the attainment of a response was found to correlated with the patient's general condition, while response duration depended on the histoprognostic grade of the tumors.

Histomorphometric analysis of sclerotic bone from idiopathic myeloid metaplasia (nine cases)

The osteosclerosis of idiopathic myeloid metaplasia was investigated by a histodynamic study of undecalcified bone from nine patients. In all cases osteosclerosis resulted from woven bone formation. In moderate osteosclerosis only intrabecular woven bone was observed, with osteoclastic hyperresorption, hyperosteoidosis with many osteoblasts, and an increased calcification rate. This may represent an early stage of the disease, osteosclerosis resulting from increased bone remodelling, with woven bone formation by osteoblasts. However, in extensive osteosclerosis both intratrabecular and medullary woven bone was observed, with moderate osteoclastic hyperresorption, hyperosteoidosis without osteoblasts and a very low calcification rate. The latter pattern could correspond to an advanced stage, and could result from stromal bone formation without osteoblasts. The classical histodynamic profile of osteomalacia was sometimes observed. The link between bone pain and possible osteomalacia remains vague.

[Superior tibial epiphyseal osteochondroma with intra-articular development. Apropos of 2 cases in children]

Two cases of intra-articular development of an osteochondroma in the proximal epiphysis of the tibia are reported. The first case, a 3 year old boy, resulted in blocking of the knee. After resection of the mass the diagnosis was confirmed by pathology. The second patient, an 8 year old boy, had no symptoms and surgery was not performed, although ablation was required of an associated astragalian osteochondroma of tibiotarsal intra-articular development. Relations between these epiphyseal osteochondromata and hemimelic epiphyseal dysplasia and metachondromatosis are discussed.

[Breast hamartoma. Apropos of 11 cases. Review of the literature]

Eleven cases of breast hamartoma are reviewed. This benign lesion can be diagnosed on the basis of its mammographic appearance. It is characterized clinically by a well-circumscribed lump which can be readily shelled out at surgery; radiologically by its typical features of a clear or heterogeneous picture with a radiolucent zone; and histologically by its normal mammary tissue (a mixture of fibrous stroma, fatty tissue, ducts and lobules). Surgical enucleation is not mandatory, and is only performed when the hamartoma is uncomfortable and/or unsightly.

Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system

The pathological features of 155 adult patients with soft-tissue sarcomas were studied retrospectively, in an attempt to set up a grading system for these tumors. As the first step, seven histological criteria (tumor differentiation, cellularity, importance of nuclear atypia, presence of malignant giant cells, mitosis count, pattern of tumor necrosis and presence of vascular emboli) were evaluated in a monofactorial analysis. Five of these (tumor differentiation, cellularity, mitosis count, tumor necrosis, and vascular emboli) were correlated with the advent of metastases and with survival. A multivariate analysis, using a Cox model, selected a minimal set of three factors (tumor differentiation, mitosis count, and tumor necrosis) the combination of which was necessary and sufficient to retain all the prognostic information. A grading system was elaborated, which turned out to be correlated with the advent of metastasis and with patients' survival. A second multivariate analysis introducing clinical prognostic features showed that the histological grade was the most important prognostic factor for soft-tissue sarcomas. Thus, this grading system appears to be highly interesting because of its prognostic value and the facility of its elaboration. However, its reproducibility should be tested.

[Primary choriocarcinoma of the stomach. Immunohistochemistry study of a case and review of the literature]

A rare tumor, primary choriocarcinoma of the stomach occurred in a 68 year-old man. Histologic examination of the tumor revealed two components, choriocarcinoma and adenocarcinoma. The liver metastasis displayed only choriocarcinoma, the lymph nodes metastasis only adenocarcinoma. The diagnosis was confirmed by demonstration of beta HcG in serum and urines by radioimmunoassay and within syncytiotrophoblast cells by immunoperoxidase staining. A review of the literature is done. The pathogenesis is discussed with hypothesis that this tumor represents a form of retro-differentiation of a preexisting carcinoma. However, this diagnosis will only be certain when a metastasis of a non gestational, non gonadal choriocarcinoma will be eliminated.

Liposarcoma: patterns of tumor differentiation following induction chemotherapy

This report describes the clinical and pathological features and evolution of 2 cases of locally advanced undifferentiated liposarcoma. In each case, a tumor differentiation was noted after induction chemotherapy, which otherwise determined in both patient a dramatic tumor response. This may be explained by heterogenicity of the primary tumors, which may include several cell contingents with different responses to chemotherapy. This constitutes a potential impediment to the efficacy of induction or adjuvant chemotherapy.

Distinctive clinical features between lymphoblastic and immunoblastic non-Hodgkin's malignant lymphomas (Kiel's classification) in a series of 141 patients

Out of a series of 427 NHML based on the Kiel classification and without previous treatment, 186 were of high grade malignancy and among them were 83 lymphoblastic (LB) and 58 immunoblastic (IB) lymphomas which were included in this study. The LB and IB, which represent the majority of high grade NHML, were compared regarding their clinical features and courses. Eight main criteria were significantly different between these two groups: age of patient, immunological history, mediastinal and pleural involvement, primary or secondary involvement of the bone marrow, secondary leukaemia, secondary meningeal involvement, and involvement of the facial region. Some of these differences (mediastinum and meningeal involvement) are related to subtypes within LB. The differences between these two groups suggest that different treatment programs may be warranted.

[Histomorphometric study of nonpagetic bone in Paget patients. Results before and after diphosphonates]

An histomorphometric study with double tetracycline labelling was carried out on iliac biopsies taken from patients suffering from Paget's bone disease; 64 of the cases revealed non-pagetic bone in radiology, and 72 revealed a pagetic incidence. The purpose was to better compare non-pagetic bone with pagetic bone. 5 biopsies performed in a radiologically non-pagetic area were shown to be histologically pagetic. An histomorphometric profile of non-pagetic bone in a patient suffering from Paget's disease was established: increase in the reabsorption surfaces, of the periosteocytic uneven surfaces, of the volume and of the osteoid surfaces in the women; decrease in the osteoid thickness indicator and in the speed of normal calcification. These signs of hyperremodelling were, for the authors, connected with a hyperparathyroid condition which was secondary to calcium needs in the pagetic areas. The effects of diphosphonates on non-pagetic bone in the patients suffering from Paget's disease are clarified. This therapy has a beneficial action on the bone volume of non-pagetic bone, when the initial bony trabecular column is small.

The prognostic significance of specific histologic features of carcinoma of the colon and rectum

The prognostic significance of several histologic features of the primary tumors and regional lymph nodes was analyzed in 82 consecutive patients with carcinoma of the colon and rectum. Three criteria were shown to have a statistically significant favorable impact on prognosis: Dukes' A or B stage, the absence of mucinous components and the presence of lymphoplasmocytic infiltration in or around the tumor. Based upon the number of these criteria present, we were able to separate the patients into three distinct prognostic groups. We suggest that such a grouping is simple and should be considered in the design and analysis of future adjuvant trials done for carcinoma of the colon and rectum.

Bone histomorphometry in Paget's disease. Quantitative and dynamic analysis of pagetic and nonpagetic bone tissue

Transiliac bone biopsies from 136 untreated pagetic patients, taken from both pagetic (72 cases) and nonpagetic bone (64 cases), were quantitatively analyzed. Tetracycline double labeling analysis demonstrated that osteosclerosis of pagetic bone results from an overproduction of woven bone by the osteoblasts. Increased bone cell populations appeared as the consequence of an increased birthrate of the basic multicellular units. In 45% of patients biopsied in nonpagetic bone, there were prints of an increased bone remodeling attributed to a hyperparathyroidism secondary to the high calcium demand of pagetic bones.