Circumferential Tumor Research Articles

Endoscopic Nd:YAG laser treatment of rectosigmoid cancer.

Forty nine patients with rectosigmoid carcinoma considered unsuitable for surgery underwent endoscopic Nd:YAG laser treatment for palliation of symptoms and tumour eradication, if feasible. Altogether 25 (51%) of the lesions had distal margins less than 7 cm from the anus and 36 (73%) extended above the peritoneal reflection. In seven patients with tumours less than 3 cm in diameter, symptomatic improvement was achieved in all (mean follow up 16 months) and complete tumour eradication in three. In the remaining 42 patients with larger tumours (34 greater than 2/3 circumferential, mean length 5.5 cm), symptomatic improvement was achieved with repeated treatments (average 3.4) in 31 (74%) over a mean follow up of 19 weeks. Of the parameters assessed, only circumferential tumour extent proved significant in predicting functional outcome after treatment. All treatment failures (eight initial, three late) occurred in patients with extensive tumours, and only seven of these patients were considered fit for colostomy. Bowel perforation occurred in two patients (5%) but there was no treatment-related mortality. Mean stay in hospital for all laser treatments was nine days (30% were outpatient attendances). These results suggest that laser therapy may be the palliative treatment of choice in patients with rectal carcinoma unsuitable for surgery.

Gastrointestinal Laser Endoscopy—Future Horizons

The laser, especially the neodymium:yttrium-aluminum-garnet device, has been a dominant influence on the development of gastrointestinal therapeutic endoscopy. More than 2,000 such procedures were performed in the first 5 years of experience with laser endoscopy at the Mayo Clinic. The major areas for future development are (1) the control of acute and chronic gastrointestinal bleeding, (2) the palliation of malignant gastrointestinal neoplasms, and (3) the management of benign and malignant obstructive lesions of the biliary tract. Refinements in laser devices, delivery systems, and techniques such as photodynamic therapy will be needed to achieve more selective tissue destruction. Improvements in the new adjunctive endoscopic methods of electronic (video) endoscopy and ultrasonography may enhance evolving laser applications by more accurately identifying diseased tissues and guiding their destruction.

Primary optic nerve sheath meningiomas. Report of nine cases.

Between 1979 and 1987 the authors treated nine cases of primary optic nerve sheath meningioma. The definitive treatment for these lesions is surgical resection, although no single best plan for optimal management has been determined. The data indicate that only small anterior tumors may be removed with preservation of useful vision. With posterior circumferential tumors, there have been no cases of tumor removal with preservation of vision. A management strategy directed toward preservation of vision is discussed.

Quantitation of ellipsoid tumor areas using a circumferential measuring device.

A controlled trial of a new circumferential area measuring device, the Tumorimeter, was performed on a set of 30 radiographs of chest nodules ranging in size from 1.5 to 5.0 cm diameter. The Tumorimeter is a hand-held device with a sliding radiolucent loop used to circumferentially measure ellipsoid tumors. It is calibrated in cm2 of surface area. In a crossover comparison with standard Vernier-type calipers, the Tumorimeter was significantly more accurate than bidimensional caliper determinations (less than or equal to 5% surface area error vs a 21-28% overestimate error for calipers). It was also more rapid (an average of 10.5 sec for the Tumorimeter vs 22.3 sec for calipers for each measurement). Both results were statistically significant, P less than 0.0001 by analysis of variance. This trial demonstrates that enhanced speed and accuracy in tumor measurement are possible by using ellipsoid assessments of radiographs. A prospective clinical trial is planned to compare rectangular areas obtained using bidimensional tumor widths, with ellipsoid areas obtained by circumferential tumor measurements using the Tumorimeter.

Total reconstruction of the hypopharynx and cervical esophagus.

Patients with extensive circumferential tumors of the hypopharynx and those with carcinomas of the cervical esophagus usually require resection of a cylindrical segment of the upper digestive tube. These patients present similar difficulties of reconstruction and also share a very poor prognosis. At times, the same complicated technical effort is required for palliation and definitive cure alike. From 1970 through 1982 at the University of Texas-M.D. Anderson Hospital at Houston, 78 patients underwent complete resection of the hypopharynx (54 patients) or the cervical esophagus (24 patients) for advanced malignant tumors. Seventy-three tumors were squamous cell carcinomas, and the remaining 5 were cancers that originated in the salivary gland. These large tumors were not staged according to the TNM system, since they frequently involved two different anatomic structures and a precise clinical assessment was not always possible. The only criterion for inclusion of patients in this series was the need to replace the entire pharynx or cervical esophagus after removal of the cancer. Of the 78 patients, 64 received their entire treatment at our institution, and of this group, 44 patients had only one surgical procedure. All patients in the series had circumferential resection as the final surgical step at our institution. The types of repair used in this group of patients were a cutaneous flap or graft in 44 patients, a colon bypass in 16 patients, a lateral trapezius musculocutaneous flap in 9 patients, and a pectoralis major musculocutaneous flap in 6 patients. In three additional patients, the reconstruction was initially delayed for various reasons and was ultimately abandoned. Technical considerations and a detailed analysis of the complications and palliative value of each procedure are presented. The merit of these procedures is judged according to the quality and the length of the patient's survival. Although the degree of palliation varies considerably according to the technique used, the survival rates were similar in all cases, the average being 43 percent at 5 years after the first treatment attempt and 27 percent at 5 years after the surgical resection that required a complete circumferential reconstruction.

RECTAL VILLOUS ADENOMA: A CASE REPORT AND REVIEW OF THE LITERATURE

Recently, we experienced one case of rectal villous adenoma in a 76-year-old male who consulted the Saitama Cancer Center Hospital with diarrhea as his chief complaint. A soft, circumferential tumor was found in the rectum and was diagnosed to be villous adenoma. Anterior resection was performed and pathological examination revealed a large, wide-based villous adenoma, 10×9cm in size, localized to the mucosa propria, which was of moderate severity. Part of the tumor showed severe atypia, but no malignancy was observed. Seven months of postoperative follow-up has not revealed any signs of recurrence. Among the 53 cases, including this one, reported so far in Japan, there have been no cases of carcinomatous infiltration over the submucosal layer in tumors less than 5cm in diameter, whereas in tumors 8cm or more in diameter, the incidence of malignancy was 83%, and the incidence of advanced cancer was also increased. However, it is not possible to generalize from tumor size alone, and findings as tumor characteristics are important. It is necessary to evalute each finding comprehensively, and selection of operative technique should be performed on a case-by-case basis. As a rule, local resection is adequate, but radical operations, such as anorectal resection or anterior resection with lymph node dissection, are necessary when carcinomatous infiltration is strongly suspected from tumor findings such as hardness and morbidity.

Villous Adenoma of the Small Bowel : An Unusual Lesion

This paper describes a large circumferential benign tumor of the jejunum indistinguishable from villous adenoma of the colon. The lesion was recognized and resected 21/2 years after the onset of symptoms. The clinical course of the patient was characterized by intermittent bowel obstruction and preoperatively by hemorrhage and intussusception, all common clinical features of jejunal tumors. The lesion is considered to represent a previously undescribed villous adenoma of the small bowel.

ROENTGEN FEATURES OF RENAL ADENOMAS.

Adenomas are common benign tumors of the kidney, occurring as single or multiple yellowish-grey nodules within the renal cortex immediately below the renal capsule. Reports of their incidence at necropsy vary from 0.08 per cent to 3.0 per cent (1, 2). In most instances they are small and incidental findings. The tumors of larger size cause a localized bulge of the renal surface and may also project into the parenchyma to distort the collecting system. Adenomas grow slowly, causing atrophy of the adjacent renal parenchyma which is replaced by connective tissue. This forms a well defined, fairly thick capsule completely surrounding the tumor. Numerous thin-walled venous channels and occasional remnants of renal tissue are encountered within the capsule (Fig. 1). Only a portion of the tumor circumference remains in contiguity with kidney parenchyma; the greater part of the tumor projects into the surrounding perirenal tissues (Fig. 2). Histologically, adenomas are divided into papillary, tubular, and alveola...