Hodgkin's disease: the significance of vascular invasion

The prognostic significance of vascular invasion by endometrial carcinoma

BACKGROUND

Recently, invasion of vascular spaces by endometrial carcinoma has received particular attention as a prognostic factor. The goal of the current investigation was to re-examine the effect of vascular invasion on tumor recurrence and survival in patients with endometrial carcinoma.

METHODS

Surgical specimens from 238 patients with endometrial carcinoma were examined for the presence of vascular invasion by tumor cells. Vascular invasion was compared with clinicopathologic features and postoperative survival. Survival curves by vascular invasion were evaluated by the Kaplan-Meier method.

RESULTS

In a histopathologic review of 238 cases of endometrial carcinoma, 82 neoplasms demonstrated vascular invasion. Vascular invasion significantly correlated with the extension of primary tumor, depth of myometrial invasion, and histologic grade. Patients with lymph node metastasis had a significantly higher incidence of vascular invasion. Survival at 5 years for patients with vascular invasion was 73.4%. This was significantly lower than the survival rate of 91.5% for women without this finding (P < 0.001). Among patients with lymph node metastasis, 80.2% of the patients with vascular invasion survived for 5 years compared with 95.3% of the patients without vascular invasion (P < 0.05). Ten of 47 patients with no lymph node metastasis but with vascular invasion developed recurrent carcinoma. Nine of these ten patients apparently had extrapelvic recurrences.

CONCLUSIONS

The presence of vascular invasion is a reliable prognostic indicator. Recording of tumor recurrence pattern may lead to a better selection of patients for adjuvant systemic therapy after surgery.

Intrathoracic Hodgkin's disease. A case presentation with multiple pulmonary nodules in the absence of mediastinal or hilar node disease

Patients with Hodgkin's disease (HD) most commonly present with peripheral lymph node enlargement. The finding of pulmonary parenchymal involvement is usually associated with hilar and/or mediastinal adenopathy; such instances are felt to represent spread to the lung by contiguity. Noncontiguous spread to peripheral lung parenchyma in the absence of hilar or mediastinal node involvement has rarely been reported. This is the first documented case report in a 32-year-old woman with nodular sclerosing HD. The unusual clinical presentation in this patient was associated with the histologic detection of vascular invasion in the lymph node and open-lung biopsy specimens.

The prognostic significance of lymph-vascular space invasion in stage I endometrial cancer

Surgical specimens from 111 patients with Stage I endometrial cancer were reviewed for the presence of lymph-vascular space invasion by tumor cells. Lymph-vascular space invasion was noted in 16 cases, and occurred most frequently in poorly differentiated tumors with deep myometrial penetration. Tumor recurrence developed in 44% of patients whose tumors demonstrated lymph-vascular space invasion as opposed to only 2% of patients without this finding (p less than 0.001). Of seven patients with lymph-vascular space invasion who experienced tumor recurrence, five developed extra-pelvic metastases. Discriminant function analysis of these data revealed a statistically significant correlation between lymph-vascular space invasion and tumor recurrence, independent of histologic differentiation of myometrial penetration. These findings suggest that lymph-vascular space invasion by tumor cells is an important prognostic variable in Stage I endometrial cancer which should be considered in treatment planning.

Hodgkin's disease: unfolding concepts concerning its nature, management and prognosis

The evolution of our concepts concerning the fundamental nature and natural history of Hodgkin's disease is reviewed. Recent evidence establishes that it is indeed a malignant neoplasm, albeit a curious one, the giant cells of which display aneuploid karyotypes, often with marker chromosomes indicating their clonal derivation, and the functional and surface marker properties of cells of the mononuclear phagocyte series. The disease tends initially to spread by contiguity from one lymph node chain to others with which direct lymphatic channel communications exist. Essentially all patients, even those with limited disease, have some degree of impairment of cell-mediated immunity, apparently due to inhibition of T-lymphocyte function. Lymphangiography, computed tomography, and laparotomy with splenectomy have greatly improved the accuracy of clinical staging. Total lymphoid megavoltage radiotherapy and/or multidrug combination chemotherapy now permit the eradiction of disease of all stages, resulting in a dramatic improvement in prognosis and an increasing frequency of permanent cure of this once inevitably fatal condition.

Histology, age and sex distribution, and pathologic correlations of Hodgkin's disease: a study of 184 cases observed in Rome, Italy

The Rye classification has been applied to 184 cases of Hodgkin's disease diagnosed in one of the largest hospitals of Rome, Italy, over a period of three years. Mixed cellularity was the most common histologic type. Nodular sclerosis had an intermediate frequency, while lymphocyte predominance and lymphocyte depletion showed the lowest incidence. There was a male predominance in almost all age groups, reflecting a total male to female ratio of 1.5:1. The most frequent sites of primary involvement were cervical, supraclavicular, and axillary nodes, while mediastinal nodes were found primarily involved in a limited number of cases. Incidence, results, and anatomic distribution of lesions were evaluated in 120 untreated patients who underwent staging procedures. A correlation was found between increasing histologic malignancy and abdominal spread of the disease. The most common form of abdominal disease was the simultaneous involvement of two or more tissues, and the association most frequently observed was that of lymph nodes and the spleen. Separate infiltration of the liver was rare, while involvement of bone marrow only was never observed.

On the pathogenesis of sclerosis and nodularity in nodular sclerosing Hodgkin's disease

Ten cases of nodular sclerosing Hodgkin's disease involving lymph nodes were studied by electron microscopy to determine the ultrastructural composition of the nodule-stromal interphase and the collagenized regions. In addition to a few lymphocytes, rare eosinophils and neutrophils, abundant filamentous and granular electron dense material, collagen fibers and myofibroblasts were observed in all instances. Since myofibroblasts possess contractile and synthetic properties, it is likely they contribute to the retraction and sclerosis which together represent one of the morphologic hallmarks of the disease. The dense fibrosis and contractile state of such tissue may constitute a beneficial host response to contain and limit local and vascular invasion by the neoplastic cellular population, thus contributing to the relative benignity of this form of Hodgkin's disease.

Therapeutic implications of patterns of recurrence in cancer of the uterine cervix

Five hundred twenty-six patients with invasive cervical cancer, treated at the University of Kentucky from 1964 to 1976, were followed 2--12 years after therapy. One hundred and sixty patients (31%) developed tumor recurrence. Recurrent cancer was noted with 1 year after therapy in 58% of patients and within 2 years of treatment in 76% of patients. Only 6% of patients with recurrent cervical cancer survived 3 or more years. Stage of disease, cell type, lesion size, and the presence of lymph vascular space invasion by tumor cells were all shown to be prognostically significant. The addition of extrafascial hysterectomy to radiation therapy significantly decreased the incidence of recurrence in stage IB cervical tumors 5 cm or more in diameter. Analysis of this data suggests that radical hysterectomy and pelvic lymphadenectomy is as effective as irradiation only in the treatment of large cell squamous carcinomas 2 cm or less in diameter.

The significance of vascular invasion and lymphocytic infiltration in invasive cervical cancer

Surgical specimens from 100 patients with stage I B cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy were reviewed with respect to vascular invasion and lymphoplasmacytic infiltration. Lymph nodes from these patients were classified morphologically according to the criteria proposed by Cottier. Vascular invasion was associated with a significant increase in nodal metastases and tumor recurrence particularly to extrapelvic sites. A marked lymphoplasmacytic infiltrate around tumor cells was associated with decreased nodal metastases and tumor recurrence. There was no significant relationship between the degree of lymphoplasmacytic infiltration of the primary tumor and regional lymph node morphology.