Low Incidence Of Metastasis Research Articles

TESTIS-SPARING SURGERY FOR BENIGN LESIONS OF THE PREPUBERTAL TESTIS

Testis tumors in children are more likely to be benign that those in adults, and those tumors that are malignant are associated with a much lower incidence of metastases. As a result, a less-aggressive surgical approach to pediatric lesions has evolved. A testis-sparing operation in appropriate cases has potential psychological and cosmetic advantages for the developing child, and there may be functional advantages for fertility when the child matures.

Immunohistological investigation of type IV collagen in the basement membrane surrounding the cancer nest (cancer nest membrane) of head and neck squamous cell carcinoma--its relation to frequency of cervical lymph node metastasis

Lymphoducts and blood vessels exist in the stroma, while none can be detected in the cancer nest itself within cancerous tissue. This explains why metastasis of carcinoma cannot occur without the escape of tumor cells through the basement membrane surrounding the cancer nest into the stroma. Accordingly, observation of the continuity of the basement membrane, what we call the cancer nest membrane, is essential for elucidating the first step of metastasis. Since type IV collagen is the most important structure composing the basement membrane, investigation of the immunohistological localization and continuity of type IV collagen is of value in predicting the metastatic aggressiveness of squamous cell carcinoma. We therefore studied biopsy tissues from the advancing lesion of head and neck squamous cell carcinoma in 95 untreated patients. The tissues were fixed in 85% ethanol and embedded in paraffin, and 5-um thin sections prepared were then immunohistochemically stained for type IV collagen by the ABC method for observation of the continuity status of the cancer nest membrane in relation to metastasis. The basement membranes of normal mucosal epithelium and normal interstitial capillaries were utilized as positive controls, and negative controls were obtained by using PBS in place of the primary antibodies for the immunohistochemical reaction. Membrane discontinuity (breaks or absence) correlated significantly with cervical lymph node metastasis, while intact membrane was associated with a low frequency of cervical lymph node metastasis. There was no obvious relation between the clinical T category and the continuity of the membrane; pN (+) carcinomas with membrane discontinuity included even T1 supraglottic and hypopharyngeal carcinomas, as well as T2 or higher oral mucosal carcinomas and T3 or higher glottic carcinomas, suggesting variation with tumor site. Hypopharyngeal and supraglottic carcinoma was associated with membrane discontinuity and a high incidence of cervical lymph node metastasis. On the other hand, glottic and oral carcinoma more often presented with intact membranes and had a lower incidence of metastasis, although carcinomas in these sites that did present with discontinuity of the membrane were associated with a high incidence of cervical metastasis. Therefore, observation of the continuity of the cancer nest membrane by the expression of type IV collagen may be useful in selecting better specific therapies and determining the necessity of prophylactic neck dissection. A correlation between the degree of tumor differentiation and the continuity of the membrane was also found; well-differentiated tumors with discontinuity of the membrane were frequently associated with cervical lymph node metastasis.(ABSTRACT TRUNCATED AT 400 WORDS)

Neuroendocrine carcinomas of the lung

N EUROENDOCRINE carcinomas of the lung are tumors related to the Kulchitsky cell, a neuroendocrine cell normally present in the bronchial mucosa.lV2 These tumors account for approximately 25% of all lung tumors and include three subtypes: classic carcinoid, atypical carcinoid, and small cell carcinoma. These three different subtypes share many common morphologic and biochemical features, but represent a spectrum of aggressiveness with some overlap of clinical, radiologic, and pathologic features.‘V3 A more extensive discussion of the pathology of these tumors is given in the article by Pietra in this issue. Classification into three subtypes is important because their treatment and prognosis are different.4 At one end of the spectrum is the carcinoid tumor, a low-grade carcinoma with low incidence of metastasis and good prognosis following surgical resection. At the other end of the spectrum is the small cell carcinoma, an extremely malignant tumor that metastasizes early in its course and is usually not amenable to surgical resection. The treatment consists of chemotherapy and radiotherapy. Atypical carcinoids are tumors of intermediate malignant potential and prognosis. They are usually treated by lobectomy or pneumonectomy with or without adjuvant chemotherapy and radiotherapy. Because of the differences in treatment among these tumors, accurate preoperative diagnosis is critical. However, because of the overlap between the three subtypes and their similar cytologic features, preoperative differential diagnosis is difficult and often misleading. Cytologic specimens obtained by sputum, bronchoscopy, or fine-needle aspiration biopsy are usually able to suggest the diagnosis of neuroendocrine carcinoma, but there is unavoidable error in distin-

Squamous Cell Carcinoma of the Eyelids

A clinicopathologic study of 31 squamous cell carcinomas of the eyelid was conducted. The tumor was encountered less frequently than in previous reports, due largely to the refinement of the pathologic diagnosis. Eighteen cases originally diagnosed as squamous cell carcinoma were eliminated because the diagnoses were changed to sebaceous gland carcinoma (10), basal cell carcinoma (4), seborrheic keratosis (2), inverted follicular keratosis (1), and papillama (1). One of our 31 patients experienced tumor metastasis and tumor-related mortality. Despite the low incidence of metastasis, management recommendations include complete surgical excision using intraoperative frozen-section monitoring of the surgical margins.

The prognosis and treatment of angiosarcoma of the face and scalp

Angiosarcoma of the face and scalp (AS) is a rare but well-recognized vascular tumour, generally accepted to have a very poor prognosis. However, most previous studies have been limited because of small patient numbers. We have collected clinical data on 71 patients with AS from the time of initial histological diagnosis. Information obtained included age at diagnosis, sex, race, clinical appearance and size of lesions, therapeutic procedures, clinical course, incidence of metastases, survival time and response to therapy. All the patients were Caucasian with a mean age of 74 years (range 56–72 years) and a male to female ratio of 1:5:1. Tumours occurred predominantly on the upper face and scalp but male patients frequently presented with central facial lesions. Three main clinical patterns were confirmed: nodules, bruise-like induration and areas of ulceration with bleeding. Most patients were treated by radiotherapy (64%) or by excision alone (10%). The remainder received no therapy or combined therapy. Radiotherapy-treated patients fell into two groups: group I (71%) had short survival times (x= 13.5 months), large lesions (63% < 10 cm), and a high incidence of metastatic disease (50% of patients); group 2 patients (29%) survived longer (x = 5.5 years) and had a low proportion of large tumours (8%) with a low incidence of metastatic disease (8%). Patients treated by excision alone had a high incidence (86%) of metastatic disease. Our data suggests that AS remains a disease of poor prognosis in elderly patients with large lesions. However, small (< 5 cm) lesions have a far better prognosis and the use of radiotherapy may be associated with prolonged survival and a lower incidence of metastases than simple excision.

Chemotherapeutic Treatment of the Nb Rat Adenocarcinoma Androgen-Insensitive Tumor III

Single and combination chemotherapy were evaluated in the treatment of these Nb rat prostate adenocarcinomas. Single-agent treatment consisted of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), cyclophosphamide, adriamycin, and cis-platinum; the combination therapy included BCNU and adriamycin; BCNU, adriamycin, and 5-fluorouracil; cyclophosphamide and cis-platinum; adriamycin and cis-platinum; and adriamycin, cis-platinum, and cyclophosphamide. Controls had a metastatic incidence of 46%. The best results as measured by tumor volume and low incidence of metastasis were achieved with triple drug therapy utilizing adriamycin, cis-platinum, and cyclophosphamide; and cis-platinum and cyclophosphamide. This tumor, Nb Pr A.I. III, has proven to be the most unresponsive tumor in the Noble prostatic adenocarcinoma prostate model. No animal treated with any of the above regimes had complete tumor regression.

Chemotherapeutic treatment of the Nb rat adenocarcinoma androgen-insensitive tumor III.

Single and combination chemotherapy were evaluated in the treatment of these Nb rat prostate adenocarcinomas. Single-agent treatment consisted of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), cyclophosphamide, adriamycin, and cis-platinum; the combination therapy included BCNU and adriamycin; BCNU, adriamycin, and 5-fluorouracil; cyclophosphamide and cis-platinum; adriamycin and cis-platinum; and adriamycin, cis-platinum, and cyclophosphamide. Controls had a metastatic incidence of 46%. The best results as measured by tumor volume and low incidence of metastasis were achieved with triple drug therapy utilizing adriamycin, cis-platinum, and cyclophosphamide; and cis-platinum and cyclophosphamide. This tumor, Nb Pr A.I. III, has proven to be the most unresponsive tumor in the Noble prostatic adenocarcinoma prostate model. No animal treated with any of the above regimes had complete tumor regression.

Intravascular bronchiolo-alveolar tumor (IVBAT): A low-grade sclerosing epithelioid angiosarcoma of lung.

Intravascular bronchiolo-alveolar tumor (IVBAT) is a rare and highly distinctive pulmonary tumor of disputed cellular nature. Both epithelial and endothelial differentiation of this neoplasm have been suggested. We have studied multiple nodules of IVBATs from three patients by light and electron microscopy and by immunohistochemical methods for Factor VIII-related antigen (FVIII RAG). Our light and ultrastructural studies are in essential agreement with the previous suggestion of the endothelial nature of the neoplasm and our demonstration of the presence of FVIII RAG in many of the tumor cells offers new evidence strongly supportive of their endothelial differentiation. We believe that IVBAT and a group of extrapulmonary tumors described as epithelioid hemangioendothelioma and endovascular papillary angioendothelioma are similar biologically indolent neoplasms of epithelioid and dendritic endothelial cells characterized by stromal sclerosis, intravascular spread, a low incidence of metastases and slow clinical evolution. Thus, we regard IVBAT as a low-grade sclerosing angiosarcoma of the lung.

A study of the influence of various diagnostic and therapeutic procedures applied to a murine squamous carcinoma on its metastatic behaviour.

An experimental tumour system for the study of metastasis has been developed using a syngeneically transplanted murine squamous carcinoma of spontaneous origin. Implants of the tumour, which does not elicit a significant immune response, grew and metastasized regularly to regional lymph nodes and lungs, in a manner comparable with that of the more malignant types of human epithelioma. The system has been used to test the influece of pre-operative irradiation, regional lymph node excision, tumour biopsy and manipulation, on metastasis. Of these, only pre-operative irradiation with 2000 rad 24 h before tumour excision produced a significant differential effect--a lower incidence of metastasis. By contrast, local radiation therapy sufficient to cause complete tumour regression but insufficient to achieve long-term local cure was shown to result in accelerated metastasis. A highly significant inhibition of metastasis was observed with the drug ICRF 159, but histological features suggested that its anti-metastatic effect in this system did not depend on morphological changes which might prevent dissemination of tumour cells.

Primary mucinous (adenocystic) carcinoma of the skin

A 65-year-old man had a primary mucinous tumor of the right side of the neck with distinctive histologic and histochemical features. Primary mucinous (adenocystic) carcinoma of the skin should be differentiated from the sweat gland carcinomas in general since their biologic reaction is characterized by a very low incidence of metastasis.

Primary Mucinous (Adenocystic) Carcinoma of the Skin

A 65-year-old man had a primary mucinous tumor of the right side of the neck with distinctive histologic and histochemical features. Primary mucinous (adenocystic) carcinoma of the skin should be differentiated from the sweat gland carcinomas in general since their biologic reaction is characterized by a very low incidence of metastasis.