Sarcomatoid carcinoma of the kidney

Among 315 cases of parenchymal renal carcinoma resected between 1975 and 1985, 19 cases (6 per cent) of sarcomatoid carcinoma were identified. All patients were symptomatic or had a palpable mass in the flank at hospitalization. Tumor stage generally was advanced at operation and metastases were detected in 8 patients (Robson stage IV), all of whom died after an average postoperative survival of 8 months. In 3 patients there was tumor invasion of the renal vein (Robson stage IIIA), and they died after an average postoperative period of 11 months. Of 4 patients with perinephric fat invasion (Robson stage II) 2 died of cancer after an average survival of 15 months and 2 are alive with no evidence of disease for an average of 73 months postoperatively. In these later 2 cases the sarcomatoid areas constituted less than 5 per cent of the entire tumor and the remaining tumor was low grade carcinoma. In 3 patients adequate followup is not available and 1 was lost to followup. This histological variant of parenchymal cell carcinoma is a high grade malignancy with a poor prognosis. Operative treatment appears to be ineffective in modifying the behavior of the tumor.

Benign fibrous histiocytoma of bone

The cases of seven patients who had a lytic lesion that was histologically similar to a metaphyseal fibrous defect (non-ossifying fibroma) of bone were studied. The patients all were adults and had pain without a fracture. These features were considered distinctive for the lesion, which has the same histological appearance as benign fibrous histiocytoma of soft tissue. The lesion is a benign tumor with fibroblastic and histiocytic differentiation. This picture may be seen in foci in other lesions of bone (aneurysmal bone cyst, fibrous dysplasia, and giant-cell tumor). Ten cases of giant-cell tumor of bone that had a large component of the same foci were also reviewed. It should be emphasized that these areas are secondary reactive tissue rather than the true neoplastic tissue of benign fibrous histiocytoma.

Ewing's sarcoma of the mandible and maxilla. A report of three cases from the Istituto Beretta

Ewing's sarcoma of the jaw is a rare primary malignant bone tumor. Three cases, two in the mandible and one in the maxilla, are presented, together with complete histologic, radiographic, and clinical evaluations. While the prognosis for patients with this lesion remains poor, an increased rate of survival is now associated with multiple-drug chemotherapeutic regimens.

Malignant fibrous histiocytoma of soft tissue. An analysis of 78 cases located and deeply seated in the extremities

Seventy-eight cases of malignant fibrous histiocytoma (MFH) of soft tissues are reported. All tumors were deeply located in the extremities. An analysis is presented with regard to sex, age, site, macro- and microscopic features. The staging was assessed according to Enneking's classification (IB, one case; IIA, 25 cases; IIB, 42 cases; III, 10 cases). The recurrence rate after surgical treatment was high (37.5%) with significant differences after inadequate surgery (70%), wide excision (38%), or amputation (0%). Adjunctive radiotherapy rarely was effective in preventing local recurrence. The overall 5-year survival rate was 36%. The prognosis was worse in (1) tumors larger than 5 cm in diameter, (2) tumors that recurred early (less than 1 year) after surgery, and (3) tumors that had inadequate surgical treatment (intralesional or marginal excision).

Intermittent ischemia caused by dissection of the abdominal aorta through myxoid degeneration. Case report

Acute intermittent ischemia is generally caused by altered vasomotion and rarely by aortic dissection. There is reported a case of dissection of the abdominal aorta which presented a mixoid degeneration of the inner wall. The surgical finding was similar to a medio intimal aortic cylinder obtained generally during endarterectomy. Five years after the operation (endarterectomy of the mixoid cylinder) the patient presents a good patency of the aortoiliac area.

Angiosarcoma in chronic osteomyelitis

The authors present 4 cases of angiosarcoma occurring in chronic osteomyelitis observed at the Tumour Centre of the Rizzoli Institute. The literature is reviewed.

Malignant fibrous histiocytoma of bone. The experience at the Rizzoli Institute: report of 90 cases

Ninety cases of malignant fibrous histiocytoma (MFH) of bone are reported. An analysis is presented with regard to sex, age, site, symptoms, radiography, macroscopic, and microscopic features. The staging was assessed according to the following classification: I B: 3 cases; II A: 11 cases; II B: 66 cases; III: 10 cases. Among nonmetastatic patients, 68 had surgical treatment (adequate, 46; inadequate, 22); 8 had radiotherapy, and 3 refused any treatment. Among surgically treated patients, 20 had adjuvant chemotherapy, also. Follow-up information was obtained in all cases. Overall survival rates were 34% at 5 years, and 28% at 10 years. Surgery alone did not appear to be successful (5-year survival, 28%). Adjuvant chemotherapy improved the survival rate only in patients who underwent adequate surgery (5-year survival, 57%). The recurrence rate after surgical treatment was high (31%) with significant differences after inadequate (64%), wide (19%), or radical (6.5%) surgical treatment. Adjuvant chemotherapy was ineffective in preventing local recurrence. Radiation therapy effected a clinical cure in three cases; the authors believe that radiation therapy has to be used only in inoperable tumors.

Malignant fibrous histiocytoma of bone. The experience at the Rizzoli Institute: report of 90 cases

Ninety cases of malignant fibrous histiocytoma (MFH) of bone are reported. An analysis is presented with regard to sex, age, site, symptoms, radiography, macroscopic, and microscopic features. The staging was assessed according to the following classification: I B: 3 cases; II A: 11 cases; II B: 66 cases; III: 10 cases. Among nonmetastatic patients, 68 had surgical treatment (adequate, 46; inadequate, 22); 8 had radiotherapy, and 3 refused any treatment. Among surgically treated patients, 20 had adjuvant chemotherapy, also. Follow-up information was obtained in all cases. Overall survival rates were 34% at 5 years, and 28% at 10 years. Surgery alone did not appear to be successful (5-year survival, 28%). Adjuvant chemotherapy improved the survival rate only in patients who underwent adequate surgery (5-year survival, 57%). The recurrence rate after surgical treatment was high (31%) with significant differences after inadequate (64%), wide (19%), or radical (6.5%) surgical treatment. Adjuvant chemotherapy was ineffective in preventing local recurrence. Radiation therapy effected a clinical cure in three cases; the authors believe that radiation therapy has to be used only in inoperable tumors.

Desmoplastic fibroma of bone. A report of six cases

The clinical and pathological features of six cases of desmoplastic fibroma of bone are presented. Desmoplastic fibroma is rarely seen as a primary tumour of bone; when it does occur the sites of predilection are the long bones, but other sites such as the scapula and os calcis can be involved. Radiographically the lesion tends to expand the bone from within; it is well-demarcated and lytic, often with a trabeculated soap-bubble appearance. The cellular structure and the morphological arrangement are similar to those of aggressive fibromatosis of soft tissues. Differential diagnosis from malignant spindle-cell lesions of bone is important because the treatment of choice for desmoplastic fibroma of bone is simply excision with a thin layer of healthy tissue.

[Endoscopy findings in gastroduodenal pathology in a group of welders]

Fourteen welders were examined with the purpose to evaluate the incidence and the type of pathologic changes of the gastrointestinal tract due to the exposure to welding fumes. The medical examination was followed by endoscopic and bioptic study of gastric and duodenal mucosa. The results show the presence of pathologic changes, mainly of flogistic type, in all the microscopic investigations, although the appearance of the mucosa was generally normal. Moreover, the results of this investigation suggest that pathologic changes of gastrointestinal tract could precede those of the respiratory tract.

Mesenchymal chondrosarcoma of bone and soft tissues

Mesenchymal chondrosarcoma of bone and soft tissues treated at the Istituto Ortopedico Rizzoli are reviewed. The skeletal locations were prominent in five cases. Only two cases were in the soft tissues. Radiographic picture in the bone shows an aggressive osteolysis, with soft tissues invasion. Histologic picture is the same in bone and soft tissues, and is highly distinctive: islands of well-differentiated chondrosarcoma embedded in undifferentiated mesenchymal cells with high malignancy characteristics. The cases showed a poor prognosis, and no patient survived more than four years.

Periosteal chondroma. A review of twenty cases

We are reporting on the cases of twenty patients with periosteal chondroma to stress the importance of a proper clinical and radiographic diagnosis of this lesion. Awareness of the features of the lesion helps to prevent overtreatment of this benign condition, because the cytological findings may be ominous. Even the radiographic pattern may be suggestive of malignant disease. Periosteal chondromas apparently arise from under the periosteum of the diaphysis or metaphysis in adolescents and young adults. Close cooperation between the surgeon, the radiologist, and the pathologist is necessary to achieve proper diagnosis and treatment. Marginal excision is usually effective treatment.

[Incidence of lymph node metastases in epithelial neoplasms of the oral cavity: risk factors]

The incidence of pathological neck nodes metastases in a group of 60 patients with a diagnosis of oral squamous carcinoma is reviewed. Risk factors are a size of primary more than 4 cm and tumors of the anterior two-third of the tongue. Carcinomas of oral tongue, also of a size less than 4 cm (T1,T2), have a high incidence of subclinical metastases.