Evidence Of Carcinoma Research Articles

Treatment of bladder cancer with interstitial iridium-192 implantation and external beam irradiation

Although interstitial implantation of invasive carcinoma of the bladder has been shown to be an effective treatment in Europe, there has been little experience with this method in the U.S. During the past 6 years, 14 patients at the Hospital of the University of Pennsylvania with single bladder tumors < 5 cm and no evidence of carcinoma in situ on random bladder biopsies have been treated by a combination of external beam radiation and iridium wire implant. The iridium wire is inserted by an afterloading technique following tumor exposure via suprapubic cystotomy. Following delivery of the prescribed dose, the sources are removed percutaneously. Three patients with current or high grade T1 lesions and 11 patients with T2–T3A lesions haven been treated with a median follow-up of 22 months (range 17 to 65 months), 9 patients are currently NED, 4 patients have died of disease, and 1 patient has died of intecurrent disease. there have been two isolated bladder recurrences, both non-invasive, one having been treated with cystectomy and one being treated locally. In addition, one patient developed regional failure, two developed distant metastases only, and one developed local recurrence following distant failure. The 2-year actuarial local control rate is 84%, with an overall 2-year actuarial survival of 66%. Complications have been minimal. Bladder implantation by this method is technically simple and produces excellent local control with acceptable morbidity.

Evaluation of Prostatic Cancer Histology and Grade Distribution: Experience With the Colorado Central Cancer Registry

Although well-defined grading schemes for prostatic adenocarcinoma have been developed, they are not yet universally accepted by practicing surgical pathologists. The complexity of these schemes often leads surgical pathologists to develop their own modified Broders scheme. This study compared the grade distribution as obtained by a community of surgical pathologists with that obtained using the National Prostatic Cancer Project (NPCP) and Gleason grading schemes. In 1978, 308 cases of prostate cancer were reported to the Colorado Central Cancer Registry (CCCR) from the Denver Standard Metropolitan Statistical Area. Two hundred eighteen of these cases were regraded. The grade distribution as reported by the CCCR revealed a predominance of low-grade tumors (grade I-41%, grade II-28%, grade III-17%, grade IV-3%). Regrading of these same cases revealed a shift to higher grades (NPCP: grade I-14%, grade II-11%, grade III-37%, grade IV-29%; Gleason: pattern scores less than 6-30%, score 6-24%, score 7-12%, score 8-11%, score 9-10%, score 10-4%). Twenty-one cases of histologic variants which were not originally diagnosed were also noted (six mucinous, 12 ductal, two endometroioid, one squamous). There were 18 cases in which no evidence of carcinoma was confirmed. These results suggest that there is a tendency to underestimate grade and potentially malignant behavior when well-defined prostatic cancer grading schemes are not applied.

Histologic control of biochemical steroid receptor analysis in endometrial carcinomas

Histologic review of 422 specimens from endometrial carcinoma submitted for biochemical cytosol estrogen and progesterone receptor analysis revealed that 16 (4.0%) contained no evidence of carcinoma on permanent histologic sections. An additional 11 (2.5%) contained focal carcinomas on permanent sections but had no evidence of malignancy in frozen sections of the tissue submitted for receptor analyses. Despite the paucity or even absence of malignancy, many of these specimens had significant cytoplasmic estrogen and progesterone receptors derived from endometrial and myometrial tissues. Rigorous histologic control of specimens from endometrial carcinomas submitted for biochemical steroid receptor analyses is necessary to establish valid clinical and histologic associations of steroid receptor content.

Histopathology of Methylbenzylnitrosamine-Induced Esophageal Carcinoma in the Rat: Comparison With Cytomorphology&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;

The incidence of human carcinoma of the esophagus is increased in association with environmental nitrosamines and dietary zinc deficiency. For examination of the role of zinc deficiency in esophageal carcinogenesis, methylbenzylnitrosamine [(MBN) CAS: 937-40-6] was used to induce esophageal carcinoma in rats fed either a zinc-deficient or control diet. Histologic examination of the MBN-treated Sprague-Dawley rat esophagi revealed a significantly higher incidence of esophageal carcinoma in the zinc-deficient rats vs. controls (62 vs. 33%). In addition, three distinct cytologic and histologic patterns were observed in the animals with esophageal carcinoma: pattern I--basal cell hyperplasia, atypical basal cells, few dyskeratotic cells; pattern II--basal cell hyperplasia, atypical basal cells, many dyskeratotic cells; and pattern III--many dyskeratotic cells without basal cell hyperplasia. These three patterns did not occur simultaneously in the same esophagi, and zinc deficiency did not alter the appearance of these patterns. A strong correlation between the appearance of moderate or severe dysplasia cytologically and microinvasive carcinoma histologically was demonstrated. In those animals with histologically evident microinvasive carcinoma, there was no cytologic evidence of carcinoma in situ or invasive carcinoma. Cytology of these esophageal carcinomas revealed only moderate or severe dysplasia. To the extent that the rat model represents the evolution of esophageal carcinoma in humans, the results presented here suggest that the cytologic appearance of moderate or severe dysplasia indicates the need for further evaluation of patients at risk for esophageal carcinoma.

Florid Papillomatosis of the Nipple

The present study was undertaken to review the pathology of florid papillomatosis (FP) of the nipple and to examine the relationship of FP to breast carcinoma. Clinical features of 49 women studied did not differ appreciably from those noted on prior reports, except that in one instance the lesion was probably congenital. Histologically, three distinct growth patterns were found: sclerosing papillomatosis (17 cases), papillomatosis (12 cases), and adenosis (3 cases). In 17 other cases, mixtures of these proliferative patterns were seen. FP with the sclerosing papillomatosis pattern more frequently had areas of focal necrosis in hyperplastic ducts and scattered mitoses, features that might be interpreted as evidence of carcinoma. No prognostic significance can be attributed to these patterns, since all types were cured by excision with follow-up that averaged 8.3 years. Seven of the 49 women had carcinoma in the same breast as FP: Two women had invasive carcinoma that appeared to arise from FP, and four women had concurrent invasive carcinomas that were separate from the FP; the seventh woman developed diffuse intraductal carcinoma 10 years after FP was excised from the same breast. Three of the seven women were also treated for contralateral breast carcinoma. Also reviewed were lesions from two men who had carcinoma arising in FP. One had intraductal carcinoma with Paget's disease and the other had invasive carcinoma. Appreciation of the diverse histological patterns of FP may be helpful in avoiding an erroneous diagnosis of carcinoma. Features indicative of carcinoma arising in FP are Paget's disease and areas of invasion. FP of the nipple is rarely the substrate for mammary carcinoma and is adequately treated by local excision. Coexistence with carcinoma elsewhere in the same or opposite breast occurs often enough to warrant thorough examination of the breasts when FP of the nipple is diagnosed. The risk of subsequent carcinoma following excision of FP appears to be low, but clinical follow-up is prudent.

Histologic control of biochemical steroid receptor analysis in endometrial carcinomas

Histologic review of 422 specimens from endometrial carcinoma submitted for biochemical cytosol estrogen and progesterone receptor analysis revealed that 16 (4.0%) contained no evidence of carcinoma on permanent histologic sections. An additional 11 (2.5%) contained focal carcinomas on permanent sections but had no evidence of malignancy in frozen sections of the tissue submitted for receptor analyses. Despite the paucity or even absence of malignancy, many of these specimens had significant cytoplasmic estrogen and progesterone receptors derived from endometrial and myometrial tissues. Rigorous histologic control of specimens from endometrial carcinomas submitted for biochemical steroid receptor analyses is necessary to establish valid clinical and histologic associations of steroid receptor content.

Noncaseating pulmonary granulomas associated with small cell carcinoma of the lung

Noncaseating pulmonary granulomas are rarely associated with primary carcinoma of the lung. The patient described herein presented with constitutional symptoms and nodular pulmonary infiltrates associated with noncaseating granulomas without evident neoplasm in both transbronchial and open lung biopsy specimens. Despite corticosteroid therapy for presumed sarcoidosis, chest roentgenographic findings worsened and repeated transbronchial biopsy 12 months after the onset of initial symptoms revealed small cell carcinoma of the lung. Twenty-two months after initiation of chemotherapy, the patient is well with no evidence for carcinoma.

Hepatitis D (delta agent) in primary hepatocellular carcinoma and liver disease in Senegal.

A total of 308 individuals belonging to ten different ethnic groups in Senegal were investigated. They suffered from primary hepatocellular carcinoma (PHC), liver cirrhosis, chronic hepatitis and other liver diseases, or were healthy controls. Their sera were investigated for the presence of markers of infection with hepatitis B and D (delta agent) virus. Out of 130 clinically diagnosed patients with PHC, 88 had alpha-fetoprotein levels above 100 micrograms/l, supporting the diagnosis. After clinical examination, 133 subjects were considered to be healthy or to have a liver disease other than PHC. Among these, 83 (31 clinically healthy and 52 with liver disease) had alpha-foetoprotein less than 15 micrograms/l and were therefore considered not to have PHC. Out of the 88 patients with definite PHC, 74% were positive for HBsAg, whereas out of the 83 subjects without PHC, 50% of those with other liver disease and 26% of the healthy controls were positive. Anti-delta was present in 21% of the patients with or without PHC. It was found in nine different ethnic groups in the country. The present data confirm that HBV is related to the etiology of PHC. The present investigation showed a high prevalence of delta antibodies in patients with PHC, but against the role of hepatitis D infection in the evolution of malignancy is the fact that it was equally common in chronic liver disease without evidence of carcinoma.

Automated sonomammographic-xeromammographic-pathologic correlations in the assessment of carcinoma of the breast.

Automated sonomammography and xeromammography were compared in a group of 293 patients referred for a variety of symptomatic and asymptomatic conditions. Twenty of the 293 patients had mammographic evidence of carcinoma that was confirmed pathologically. Seventeen of these patients had sonomammographic evidence of a solid mass; 11 of these demonstrated signs of malignancy, such as irregular border, and desmoplastic reaction manifested by thickening of Cooper's ligaments, skin retraction, periductal fibrosis or disruption of architecture. Statistical analysis of the results reveals that a high degree of sensitivity and specificity in the diagnosis of malignant breast disease can be accomplished with automated sonomammography.

Laparoscopy in gall bladder carcinoma

Twenty three patients with gall bladder carcinoma were critically evaluated by laparoscopy. The diagnosis was confirmed in each case by either preoperative histology and/or cytology or surgery. On the basis of laparoscopic appearance the criteria for diagnosis of gall bladder carcinoma were classified in terms of direct and indirect evidence. Direct included a mass lesion involving gall bladder or nodules over gall bladder and/or along the adjoining area of the liver. A hard irregular mass in the region of gall bladder covered by omentum along with tortuous blood vessels should be considered as presence of indirect evidence. Direct evidence of carcinoma was present in 15 (65%) and indirect in 8 (35%) patients. In presence of direct evidence of carcinoma cytology only was positive i n80% biopsy alone in 60% and the two techniques in combination yielded tissue diagnosis in 86% of patients. The yield of positive biopsy or cytology was not remarkable in presence of indirect evidence. Laparoscopy also helped in avoiding surgery in 39 % of patients with gall bladder carcinoma due to the presence of multiple metastatic lesion over the liver surface.

Regan variant alkaline phosphatase in gastrointestinal carcinoma

A fast-moving alkaline phosphatase band on polyacrylamide gel electrophoresis has been found in 6 patients with carcinoma of the liver and gastrointestinal tract. This isoenzyme resembled the placental isoenzyme in its inhibition by L-phenylalanine, its resistance to L-homoarginine inhibition and its molecular weight. However, it differed from the placental and Regan isoenzymes in its sensitivity to L-leucine and ethylenediaminetetra-acetic acid, its lower retardation by neuraminidase, its electrophoretic mobility and its decreased heat stability. The latter two properties also distinguished it from the Nagao isoenzyme. It was identified as the Regan Variant. The Regan Variant has hitherto been reported largely in hepatocellular carcinoma. In the present paper we report its appearance in the sera of patients who have neoplasms in a variety of primary sites in the gastrointestinal tract. It is emphasized that, while the presence of the Regan Variant in serum may be taken as evidence of carcinoma, no conclusions can be drawn as to the site of the disease.

Ovarian carcinoma terminating in acute nonlymphocytic leukemia following alkylating agent therapy

Rapidly fatal acute myelogenous leukemia (AML) occurred in a woman with advanced (Stage III) ovarian carcinoma who was treated with thiotepa for 30 months. This patient was 1 of 10 long term survivors and represented less than 2% of patients with advanced ovarian carcinoma with regional metastases who received long term chemotherapy during the period 1947-1975. Acute leukemia developed 44 months after initial diagnosis and was preceded by a 10 month period of pancytopenia following cessation of thiotepa. The leukemia did not respond to treatment and the patient expired 3 weeks after its onset. At autopsy, leukemic infiltration of organs was seen, but there was no evidence of carcinoma. A review of the literature suggests that the development of AML reported in ovarian cancer patients is related to alkylating agent therapy.

False-Positive Cytological Diagnosis of Lung Carcinoma in Patients with Pulmonary Infarcts

Cytological examination of specimens obtained from the tracheobronchial tree has become an integral part of the evaluation of pulmonary lesions. Cytological criteria for the diagnosis of carcinoma exist and are well defined. Certain benign processes, however, may possess features strongly suggestive of carcinoma of the lung. We report 3 patients in whom a positive cytological diagnosis of carcinoma of the lung was made by an experienced cytopathologist. At operation each patient was found to have a pulmonary infarct and no evidence of carcinoma. Review of this experience has disclosed cytological and clinical features that should alert the clinician to the possibility that the cytological diagnosis of lung cancer may be misleading in certain nonmalignant diseases.

Okkultes Nasopharynxkarzinom

Clinical and histological examination of a cervical lymph node, removed from a 15-year-old boy, revealed nasopharyngeal carcinoma as the probable diagnosis. But the decisive diagnostic pointer was a markedly raised Epstein-Barr virus antibody titre, which gives the diagnosis at a time when there may not as yet be clinical evidence of carcinoma. Serial serum titre determinations are of prognostic value: with increasing spread of the tumour there is a rise in antibody titre. Autopsy confirmed that the nasopharynx had been the site of the primary tumour.

Cancer in old burn scars

30 cases of carcinoma in old burn scars, treated over a ten-year-period, are described. 24 of these were males, 6 were females. The time interval between the burn and evidence of carcinoma was from ten years to over forty. In all of our patients carcinoma was preceded by deep second and third degree burns, which healed without skin grafting and over a long period of time. The clinical presentation was in most cases a flat, indurated, ulcerating lesion with fairly regular edges; we found exophytic and papillary forms only in some. Histopathological investigation showed all lesions to be squamous-cell carcinoma. Lymphatic radiographic studies have been performed in patients with enlarged lymph nodes. In all patients a radical surgical procedure was performed: wide excision of the ulcerofibrous tissue with covering of the resulting defects, primarily or primarily delayed, with split-skin grafts. Where bone was involved, or on the foot, skin flaps were used. Dissection of inguinal lymph nodes was performed in three patients in which metastases were found histopathologically and by lymphangiography. Looking at the results, we find that 23 patients are free of recurrences in a follow-up of over ten years while 7 showed recurrences after 1–5 years.

PROSPECTIVE STUDY OF OUTPATIENTS WITH EXTENSIVE COLITIS

171 patients with extensive colitis have been followed up as outpatients for periods up to seven years between 1966 and 1973. The mean length of follow-up was 3.3 years. 7 patients have died compared with the expected mortality of 4.83, giving an excess mortality of 0.003 per patient-year. 3 patients have developed carcinoma of the large bowel; they remain well seven, six, and two years after operation. In all 3, epithelial dysplasia was observed on rectal mucosal biopsy, and no patient in this series has developed carcinoma without this abnormality being present. 11 other patients had epithelial dysplasia on rectal biopsy; 4 of these underwent colectomy without evidence of carcinoma in the operative specimen. 29 patients underwent colectomy without mortality, 7 during a severe attack of colitis, the remainder electively. These results suggest that patients with quiescent extensive colitis can be managed conservatively with relative safety provided that close supervision is maintained.

End results in the irradiation of primary carcinoma of the vagina.

Primary carcinoma of the vagina is a radiotherapeutic problem which deserves a good prognosis. Because it is an infrequent disease (1 to 1.5 per cent of gynecologic cancer), there are few radiation therapists or surgeons who have had extensive experience in its management. Between 1919 and 1955, 174 patients with primary carcinoma of the vagina were examined at the Roswell Park Memorial Institute. Thirteen of these are not included in this report because 7 received surgery only (average survival of nineteen months, extremes one and a half and forty-three months), 5 were treated elsewhere, and 1 was given irradiation to the inguinal metastases only (survived fourteen months). This report includes, however, the 132 patients with carcinoma reported by one of us (W.T.M.) in 1957. All the cases in this report are squamous-cell carcinomas except for 1 adenocarcinoma. This was identified as a primary vaginal lesion only after a careful clinical search revealed no other primary site. The average age of the 161 irradiated patients was 57.4 years. Four were under forty years of age and 27 over seventy. The youngest patient was thirty-four. Although carcinoma may originate in any segment of the vagina, the most common site of origin was the posterior wall (approximately 45 per cent of this series). Symptoms were usually those of ulceration; namely, watery discharge and/or bleeding of an average duration of seven months. Ten out of the 161 irradiated patients were asymptomatic at the time the neoplasm was diagnosed. Clinically, the cases have been classified as follows: Stage I (90 cases): The lesion is limited to the vagina or immediate paravaginal tissue. Peripherally, it may involve the face of the cervix but not the mucosquamous junction. Area of lesion is not a factor. Stage II (57 cases): The lesion has extended beyond the immediate paravaginal tissue, e.g., vulva, parametrium, regional lymph nodes, mucous membrane of the urethra, bladder, or rectum, and distant metastases. Stage III (14 cases): The lesion has received definitive treatment (surgery or irradiation) before admission to and irradiation at the Roswell Park Memorial Institute, Buffalo, N. Y. Treatment Many different radiotherapeutic technics have been used in the treatment of the patients reported in this series and have been described by one of us (W.T.M.) in previous publications (1, 2). It is important to state that most patients are best treated by a combination of teleradiation and surface or interstitial radioactive sources. Only the small accessible lesion can be managed confidently by an interstitial implant or surface applicator alone. The technic must be individualized to meet the particular clinical situation. End Results Table I shows the number of five-year survivals without evidence of carcinoma. Tables II and III illustrate how the successful cases in the 1940–1955 series were managed. Table IV lists the complications observed after a post-treatment period of at least six months. Conclusion Primary carcinoma of the vagina is a radiotherapeutic problem that has resulted in a 59 per cent five-year “cure” rate in those 27 patients with clinical Stage I involvement irradiated since 1940, at which time x-ray qualities of 2.5 mm. to 9.0 mm. Cu h.v.l. became available.

Segmental tuberculosis of the colon.

Five cases of segmental hyperplastic tuberculosis of the colon are reported, the lesions representing every segment. Primary resection is recommended as the treatment of choice. All five patients (only one of whom exhibited evidence of pulmonary tuberculosis) underwent segmental excision of the lesion and end-to-end anastomosis. The postoperative course was uneventful in all instances, and there have been no complications or recurrences. Evidence of carcinoma was not found in any case. In four cases, intestinal tuberculosis was suspected radio-logically prior to operation.

Occult papillary carcinoma of the thyroid gland: a study of 140 cases observed in a 30-year period.

Of 140 occult papillary carcinomas treated surgically at the Mayo Clinic over a 30-year period, 58 were associated with nodal metastasis and 82 were found incidental to thyroid operations for other conditions. Of the 58 patients with nodal metastasis, 4 have died from causes unrelated to thyroid carcinoma and 1 patient is untraced. The remainder are alive, without evidence of carcinoma, three to thirty-two years after operation. Of the 82 patients without metastasis, 11 are dead of known causes other than thyroid carcinoma. The remainder are living after periods ranging up to thirty years, and in none is either local or distant metastasis known to have developed, although a few differences were noted. Histologically, no clear-cut line could be drawn between those lesions associated with nodal metastasis and those discovered incidental to operation for a variety of thyroid disorders.

Observations on the Critical Margin for the Complete Excision of Carcinoma of the Skin

Carcinomata of the skin can be treated dermatologically by means of x-ray, radium, surgical excision, or curettage and desiccation. With any of these methods, it is important to remove not only all of the tumor tissue but, if recurrences are to be prevented, a certain amount of carcinomafree tissue as well. The present study was undertaken to determine how much healthy tissue must be removed in such cases to insure an adequate margin of safety. The subjects consisted of 169 patients with basalor squamous-cell carcinoma of the skin treated by curettage and chemosurgery in the Dermatology Clinic or in private practice during the past six years. None had evidence of metastases. In each case layers of tissue were removed from the malignant area until microscopic examination of the excised material showed no further evidence of carcinoma. Since the extent of the lesions can usually be determined