Multifocal Growth Research Articles

耳下腺ワルチン腫ようの手術法

Warthin's tumor is benign and exclusively involves the parotid gland but may, however, often show multifocal and/or bilateral growth. The aim of this study was to evaluate the surgical procedure for removal of this tumor. Sixty patients with Warthin's tumor in the parotid gland who presented at the Kansai Medical University Hospital from 1990 to 1999 were the subjects of the present study. The surgical procedures were as follows. We performed enucleation for tumors in the deep lobe. Tumors in the superficial lobe were resected with partial parotidectomy, and an enucleative procedure was also performed at the bottom of the tumor where the tumor capsule directly touched the facial nerve. No recurrence was observed in all sixty cases including cases of rupture of the capsule before or during surgery. Therefore, we recommend that enucleation is a useful choice as a surgical procedure for the removal of Warthin's tumor after accurate detection of the tumors using MRI. The overall incidences of temporary and permanent facial nerve palsy were 19.7% and 0%, respectively. The incidence of palsy increased after surgery for multiple tumors or deep lobe tumors. These findings indicate that more careful consideration for preservation of the facial nerve should be given in such cases and that simultaneous surgery for such tumors in the bilateral parotid glands should be avoided to prevent bilateral facial nerve palsy.

High Incidence of Asian Variant Intravascular Large B-Cell Lymphoma (IVL) among IVL in Japan: Clinicopathologic Study of 95 Patients.

IVL is a rare form of aggressive B-cell lymphoma characterized by multifocal and predominant growth within vessels. Although its neurologic and dermatologic manifestations at diagnosis have been well documented, clinical courses of IVL are protean by patients. Systematic strategies for diagnosis and treatment of IVL are still to be established. To address these issues, we retrospectively analyzed a series of patients with IVL. This study was conducted by a refractory lymphoma study group, supported by the Ministry of Labor, Health and Welfare of Japan, and approved by the institutional review board of each participating institution. Both histopathological findings of IVL and positive reactions for at least one B-cell antigens (CD20, CD19 or CD79a) were required for inclusion. There were 95 patients (49 males and 46 females), with a median age of 67 years old (range 41–85). Most patients of IVL were associated with poor prognostic factors; i.e., 95% had more than 1 site of extranodal involvement, 91% had stage III/IV disease, 82% showed performance status greater than 1, and 94% had serum lactate dehydrogenase higher than normal level. Eighty-five percent was classified to the high-risk group of the International Prognostic Index (IPI). Therefore, IPI is not useful for the prognostification of IVL. Thirty-five patients (37%) were positive for CD5. Hemophagocytosis in the bone marrow, a key pathologic criterion for Asian variant of IVL (AIVL; Murase et al: Brit J Haematol 2000), was noted in 53 of 79 patients (67%) with available information. All these 53 patients met the clinical and laboratory criteria for AIVL, including anemia, thrombocytopenia, hepatosplenomegaly, and absence of tumor formation. In contrast, no hemophagocytosis was observed in 13 patients who did not meet the criteria. Patients with IVL were further characterized by the presence of B symptoms (76%), neurologic abnormality (27%), skin lesion (13%), and leukocytopenia (<4x109/L; 27%). Bone marrow involvement was identified in 76% of the patients. Leukemic lymphoma cells were noted in 28% of the patients. Since 16 patients were diagnosed at autopsy, and 4 died shortly after the diagnosis or failed to follow, 75 were enrolled for analyses of prognostic factors. Univariate analyses for overall survival showed no use of anthracycline containing regimen (p=0.001), older age (p=0.005), lower platelet count (<100x109/L; p=0.006), and higher serum soluble IL-2 receptor (5x103U/mL or more; p=0.017) as unfavorable prognostic factors. Multivariate analysis using Cox regression model revealed that all these three factors were independent and significant prognostic factors (no anthracycline regimen: p=0.002, Hazard ratio [HR] 3.25, 95% confidence interval [CI] 1.53–6.90; age by 10 years: p=0.014, HR 1.36, 95%CI 1.07–1.66; and platelet <100x109/L: p=0.037, HR 2.12, 95%CI 1.05–4.31). These findings suggest patients with IVL should be treated chemotherapy containing anthracyclines.

HEPATOCELLULAR CARCINOMA AND LIVER TRANSPLANTATION: AN ANALYSIS OF PROGNOSTIC FACTORS

O368 Aims: Orthotopic liver transplantation (OLT) is the only curative treatment of inoperable hepatocellular carcinoma (HCC). The prognosis after OLT depends on the characteristics of the primary tumor such as size, grading and vascular invasion and it is still controversial which patient to transplant. We performed an uni- and multivariate analysis of prognostic factors in 64 HCC patients undergoing OLT. Methods: Between 1998 and 12/2003 64 patients suffering from HCC were transplanted. 34 received a neoadjuvant treatment by transarterial chemoembolisation (TACE) with Mitomycin C and Lipiodol at intervalls of 6 weeks (mean 4.9 sessions) while waiting for OLT (male 27, female 7; age 58,5±7.3 years; liver function Child A 76%, Child B 18%, Child C 6%; Milan Criteria (MC) fulfilled 32%, beyond MC 68%). The control group consisted of 30 patients without (19/30) or other (11/30) pretreatment (male 20, female 10; age 56.1±6.4 years; liver function Child A 33%, Child B 20%, Child C 47%; Milan Criteria (MC) fulfilled 60%, beyond MC 40%). The median follow up was 672 days. Univariate and multivariate analyses of several prognostic factors for recurrence-free survival after OLT were performed using Kaplan Meier method and Cox regression, respectively. Results: Recurrence-free survival (5 years) of all patients was 45%, 84% (TACE group) and 23% (non TACE group), respectively. 16/64 patients died after OLT, 6/16 (37%) due to HCC recurrence, 10/16 (63%) due to HCC unrelated causes. 1/34 (3%) patient with TACE pretreatment, but 9/30 (30%) without TACE died due to HCC unrelated causes. HCC recurrence after OLT occurred in 3/34 (9%) patients in the TACE group (2 patients are still alive), and 5/30 (17%) patients in the non-TACE group. In the TACE group MC were fulfilled in 11/34 patients, 23/34 patients were beyond the MC, survival was comparable: 86% vs. 83%. 25/34 TACE patients had stable disease during pretreatment, all of them are recurrence-free after 3 years. 9/34 had progressive tumor under TACE, only 51% are recurrence-free (p=0.001). In the multivariate analysis only TACE vs. non TACE showed an influence on survival (p=0.008). The influence of tumor stage, MC, grading, solitary vs. multifocal growth or waiting time was not significant. The univariate analysis of prognostic factors proved statistical influence on recurrence-free survival for TACE vs. non-TACE (p=0.004) and waiting time >150 days (p=0.028). Vascular invasion (p=0.093), grading (p=0.138), tumor size (p=0.621), MC (p=0.433), and solitary vs. multifocal growth (p=0.967) had no significant influence on survival. Conclusions: Neoadjuvant treatment of HCC patients awaiting OLT influences recurrence-free survival, whereas tumor characteristics as stage, grading and MC do not. Sequential TACE without tumor progress is a strong predictor for recurrence-free survival. Even in patients with large tumors OLT may be justified if the tumor is stable during TACE pretreatment and if TACE is performed in close intervalls.

Multifocal pathomorphological study of bladder cancer with the use of luminescence analysis.

Operation material from patients with various forms of urinary bladder cancer was examined. Systemic involvement resulting from multistage and multifocal tumor growth due to previous multicentric changes was demonstrated. Fluorescent study showed that in urinary bladder cancer tumor transformation involves not only adjacent, but also distant mucosa.

Osteosarcomas in the Lungs of an ICR Mouse

Osteosarcomas were found in the lung of a 62-week-old ICR female mouse having malignant systemic lymphoma. Macroscopically, the firm white nodules were located in all lobes of the lungs. Microscopically, the multiple nodules were mainly composed of irregularly shaped bone/osteoid tissues and pleomorphic or spindle-shaped osteoblast-like cells. Most of the tumors were well-differentiated and bone/osteoid tissues were abundant in the middle of the tumors, while at the tumor periphery and in a few nodules tumor cells were dominant with thin trabeculae of osteoid. These cells had hypochromatic, irregularly oval nuclei with a few small nucleoli, and, furthermore, anisokaryosis and mitosis were observed. The tumor cells were also present in the blood vessels and bronchial tubes. Immunohistochemically, the cells were positive for proliferating cell nuclear antigen (PCNA) and vimentin, but negative for cytokeratin and S-100 protein. Ultrastructurally, the cells had prominent nucleoli and dilated rough endoplasmic reticula, and collagen fibers with high electron density particles (hydroxy apatite) were observed around the cells. These findings suggest that the present tumors were malignant osteogenic neoplasms, and we diagnosed these tumors as osteosarcomas. Based on the multifocal growth pattern and presence in the blood vessels, in spite of the primary site being unknown, the tumors were considered to be metastatic.

Patterns of chromosomal aberrations in urinary bladder tumours and adjacent urothelium.

Bladder cancer is often characterized by recurrent and multifocal growth, and tumours are frequently accompanied by precancerous alterations of the surrounding urothelium. These findings have led to the hypothesis that cells from areas of genetically aberrant but morphologically non-cancerous or even unremarkable mucosa may be the source of bladder carcinomas. Fluorescence in situ hybridization (FISH) was performed using ten probes targeting five different chromosomes that are known to be frequently altered in bladder cancer (centromere 1, 8, 9, 11, 17 and 1p36, 8p23, 9p21, 11q13, 17p13) on paraffin-embedded tissue sections of 11 superficial bladder cancers. Copy number changes of the tumours were compared to those in the urothelium adjacent to the tumour. Eleven of 11 (100%) tumours and eight of 11 (73%) samples of adjacent urothelium showed copy number changes of at least one chromosome. The occurrence of similar patterns of chromosomal aberrations in the tumours and their associated urothelium supports the hypothesis of a clonal relationship. It is concluded that FISH analysis targeting five different chromosomes is more sensitive than conventional histology for distinguishing between neoplastic and normal cells of the urothelium.

The need for routine adrenalectomy during surgical treatment for renal cell cancer: the Hannover experience.

To further clarify the need for routine adrenalectomy during the surgical treatment of renal cell cancer, as in the absence of clinically overt metastatic disease, tumorous lesions within the adrenal gland are found in only 2-10% of patients, with most being over-treated by adrenalectomy. The medical records of 819 patients undergoing adrenalectomy combined with nephrectomy, irrespective of the local extension of the primary tumour or the clinical stage at first diagnosis, were reviewed to determine the reliability of currently available imaging methods in predicting adrenal gland metastases. Several patient and tumour characteristics were correlated with the presence of intra-adrenal metastases, and their possible independent prognostic value was determined by a multivariate logistic regression model. There was metastatic spread into the adrenal gland in 27 of 819 (3.3%) patients. In only three of eight patients in whom the adrenal was identified as the only metastatic site were preoperative abdominal computed tomography scans interpreted as false-negative. On multivariate statistical analysis only the presence of distant metastases, vascular invasion within the primary tumour and multifocal growth of renal cell cancer within the tumour-bearing kidney were identified as independent predictors of the presence of intra-adrenal metastases. None of the patient or tumour characteristics evaluated reliably predicted the likelihood of adrenal metastases in patients with no evidence of disseminated metastatic spread. However, previously published data indicate that the frequency of metachronous metastases within the contralateral kidney (1.8-3.8%) is significantly higher than the risk of a preoperatively undetected isolated intra-adrenal metastatic lesion when currently available imaging modalities are applied. Therefore, routine adrenalectomy should not be recommended if the preoperative radiological examinations are normal.

Nodular goiter and goiter nodules: Where iodine deficiency falls short of explaining the facts.

While the concept of iodine deficiency (ID) still dominates most discussions about the pathogenesis of multinodular goiter (MNG), the present review focuses on those mechanisms that may cause MNG in the absence of ID. Among the many facets of MNG that cannot simply be explained by ID, are the frequent occurrence of the disease in patients not exposed to ID, the autonomous growth of goiters - often accompanied by subclinical or even overt thyrotoxicosis -, the inverse relationship between goiter size and serum TSH, the multifocal, heterogeneous and nodular growth pattern, the heterogeneity of function with the familiar patchy iodine metabolism on scintiscans, the growth of clonal and polyclonal nodules, the prominent genetic predisposition. Even the notoriously low intrathyroidal iodine concentration - common to endemic as well as to sporadic goiter - is a secondary, rather than a primary event. Thus, the fundamental process of goitrogenesis, is independent from ID but operates through mechanisms innate to the hereditary and acquired heterogeneity among the thyrocytes themselves. In this view, goiter nodules and nodular goiters are true benign neoplasias arising by mechanisms common to all benign endocrine and nonendocrine neoplasms. However, superimposed iodine shortage greatly enhances the incidence of MNG and shifts its clinical appearance toward younger ages by adding one more growth factor - presumably enhanced TSH secretion - to an intrinsically activated growth regulating network.

Locoregional recurrence of retroperitoneal soft tissue sarcoma: second chance of cure for selected patients

Background: Locoregional recurrence of a retroperitoneal soft tissue sarcoma (RSTS) may offer a second chance of curative surgical treatment. In a population-based study the proportion of patients developing isolated locoregional recurrences (LR) was determined and the outcome of these patients was analysed. Method: In a retrospective nationwide study, data were collected on 142 patients treated between 1 January 1989 and 1 January 1994 for primary RSTS. In patients who had been treated radically for their primary sarcoma (77/142, 54%), the pattern of recurrence was evaluated. Factors predictive of survival for patients with LR were studied. Results: After a median follow-up of 86 (range 60–101) months, 32 patients (42%) had developed LR, and distant metastasis (DM) had been diagnosed in 17 patients (22%). Median disease-free interval between the initial operation and the establishment of LR or DM was 22 and 19 months, respectively. Five-year cumulative survival of patients with established LR was 37% in comparison with 11% for patients with DM (P=0.062). Factors predictive of favourable outcome in patients with LR were the absence of multifocal recurrence (n=13 P=0.01), lipomatous histomorphology (n=20 P=0.02), and a complete resection of recurrent sarcoma (n=17 P=0.04). Conclusion: After a median follow-up of 7 years following radical treatment of a primary RSTS, 42% of the patients had developed isolated locoregional recurrences. A complete resection of recurrent disease, lipomatous histomorphology and the absence of multifocal growth influenced prognosis favourably.

Prognostic factors in patients with differentiated thyroid carcinoma.

To study the prognostic factors in patients with differentiated thyroid carcinoma. Retrospective analysis. University hospital, Germany. 139 consecutive patients who underwent surgery for follicular (n = 42) and papillary thyroid carcinoma (n = 97). Survival rate, type of operation (systematic lymphadenectomy or no lymphadenectomy). Median observation time was 72 months (range 1-203). The 5 and 10 year survival rates in patients with papillary carcinoma were 92% and 89% respectively, and in those with follicular carcinoma 88% and 80%, respectively. Prognostic factors for papillary carcinoma were distant metastases, age, and extrathyroidal growth, and for follicular carcinoma they were distant metastases, extrathyroidal extension, and multifocal growth. The Union International contre le Cancer and European Organisation for Research and Treatment of Cancer scores and the age, grade, extent and size score were all highly significant. The extent of lymphadenectomy, primary or secondary thyroidectomy, and partial or total thyroidectomy did not influence survival. Staging and score systems may be helpful in calculating prognosis in differentiated thyroid carcinoma, but the benefit of systematic lymphadenectomy remains controversial.

Immediate breast reconstruction after mastectomy for cancer

Aims: The oncological, surgical and cosmetic results, patient satisfaction and psychological morbidity of immediate breast reconstruction following mastectomy for breast cancer were evaluated. Methods From 1980 to 1994, 79 immediate breast reconstructions were performed in Malmö. From 1985 immediate breast reconstruction was performed in 21% of mastectomies among patients ≤65 years. The most common indication for immediate reconstruction was extensive DCIS±multifocal invasive growth. In 61 cases permanent implants were used and in 18 expanders. The median volume in the permanent implants was 225 ml, compared with 380 ml in cases where expanders were used. Results: Post-operative complications requiring re-operation occurred in 13%. After introduction of the expander technique, no necrosis requiring explanation has occurred. Of the patients receiving radiotherapy, 71% developed capsular contracture (10/14). Four patients developed locoregional recurrence. Three-quarters of the patients had an acceptable to very satisfactory cosmetic result. Eight per cent were judged to have a Baker III–IV contracture. Of the patients, 85% were satisfied with the softness of the reconstructed breast and 76% stated the result to be in accordance with their expectations. Conclusions: We find immediate breast reconstruction after mastectomy a safe operation with results comparable to those after late reconstruction and without an increased risk of recurrence. Immediate reconstruction with an implant is not recommended in cases where radiotherapy may be necessary.

Genetic characterization of multifocal tumor growth in renal cell carcinoma

The primary cancer found in the kidney is renal cell carcinoma (RCC), which does not as yet have a delineation of the types of lesions that progress to tumor malignancy. We studied tissues from primary tumors and secondary lesions, and compared it with the surrounding normal kidney tissue using comparative genomic hybridization to determine their potential for malignancy. Although our sample size was small, we found that small multifocal tumors have the same potential as primary carcinoma to lead to RCC malignancy. Further genetic studies in a larger sample of patients is necessary before the risk of different lesions to remain benign or progress to RCC can be defined absolutely.

Surgical therapy of basalioma of the facial skin

The present investigation reviews the history of 673 patients having undergone surgical treatment for 1301 BCC of the face between 1977 and 1992 at our department. Based on this series the features with bearing on the surgical strategy, such as type, size and location of the lesions, will be outlined. Emphasis is put on the variants of local flap reconstruction and skin grafting techniques, particularly in the problem zones of the nose and eyelids, where no excess skin for closure of the defect is available. Throughout the whole series histologic control of the adequacy of marginal and deep tumor resection was performed. It became obvious that the required ranges for clearance to tumor edges and removal in depth cannot be predefined arbitrarily or on pure clinical judgement. Frequently a two-stage procedure of resection and repair will be necessitated. Recurrences during the mandatory follow-up were thoroughly reassessed to identify the reason for failure (e.g. accuracy of histologic category, multifocal growth, predisposition) and related to the time span from primary excision. Our series confirms that morphologically controlled surgical excision of the BCC of the face and subsequent application of reconstructive techniques produces both safe oncologic and esthetic results.

Early stomach carcinoma--pathologic-anatomic findings and prognosis

The therapy for early gastric cancer (endoscopy, gastric resection, D1/2 dissection) is controversial. In a retrospective study (4/86-12/95) we analyzed the prognosis of 57 early gastric cancer patients with respect to pathological findings and surgical therapy. The R0 resection rate was 100%. In 7% multifocal tumor growth was seen. The 5-year survival rate was 70%. LN-metastases were found in 12% of all cases, more often in pT1b than in pT1 a tumors (17 vs 9%) and more often in large carcinomas than in small carcinomas (> 1000 mm2: 27%; < 300 mm2: 0%). Long-term survival was significantly better in pN0 patients than in patients with LN metastasis (P = 0.020). Prognosis of early gastric cancer after curative resection is good.

Tumor-specific deposition of immunoglobulin G and complement in papillary thyroid carcinoma

Despite its predilection for multifocal growth and regional metastasis, papillary thyroid carcinoma (PTC) is a clinically indolent malignancy with an exceptionally favorable long-term prognosis. Together with the often striking inflammatory reaction present in PTC, its quiescent behavior has been suggested to reflect the activation of a tumor-induced immune response. To examine this possibility, we have studied the deposition of immunoglobulins and complement in PTC tissue. Samples from 70 cases of neoplastic and autoimmune thyroid diseases, including PTC ( n = 41), follicular, anaplastic, and medullary carcinomas ( n = 12), follicular adenoma ( n = 6), Graves' disease ( n = 8), and Hashimoto's thyroiditis ( n = 3) were analyzed immunohistochemically. Cellular deposits of immunoglobulin G (IgG), particularly subclasses IgG 1 and IgG 4, and complement factors C3d, C4d, and C5 were shown in up to 80% of the PTC cases, whereas the other thyroid diseases studied showed little or no cellular deposition. Nonneoplastic tissue of PTC-containing thyroid glands ( n = 22) lacked staining for IgG in 50% of the cases, and 82% were devoid of complement. The results suggest a tumor-specific immune response in PTC with activation of the classical complement cascade.

Detection of multi-focal breast carcinoma using 2[18F] fluoro-deoxy-D-glucose positron emission tomography (FDG-PET)

The elevated rate of glycolysis in malignomas compared to normal tissues can be visualised by positron-emission-tomography (PET) using 2[18F]fluoro-deoxy-D-Glucose (FDG). Based on the case of a 38-year old woman with multifocal carcinoma of the right breast (pT1 c pN0 M0, G2) as a vehicle, we describe a FDG-PET procedure which is comparable to established methods of nuclear medicine (e.g. bone scan) with regard to patient's burden and time consumption and could be used on a routine basis. This technique allowed correct assessment of suspicious breast findings and visualised multifocal growth of a tumour which was judged to be a unifocal breast cancer by conventional methods of clinical examination, mammography and ultrasound.

Mutations of codon 918 in the RET proto-oncogene correlate to poor prognosis in sporadic medullary thyroid carcinomas.

The hereditary multiple endocrine neoplasia syndromes types 2A and B (MEN 2A and B) were recently linked to germline mutations in the RET proto-oncogene, altering one of five cysteine residues in exon 10 or 11 (MEN 2A), or substituting a methionine for a threonine at codon 918 in exon 16 (MEN 2B). The latter mutation also occurs somatically in some sporadic medullary thyroid carcinomas (MTC), and has in a previous study been correlated with a less favorable clinical outcome. In the present study, 46 MTCs were selected for investigation of the codon 918 mutation. The mutation was found in 29 tumors (63%), and was significantly correlated with a poor outcome, with regard to distant metastasis or tumor recurrence (p < 10(-4)). Two tumors showed multifocal growth and C-cell hyperplasia, and these patients were therefore also investigated for germline mutations in exons 10, 11 and 16. The codon 918 mutation was found only in the tumors, thus of somatic origin. The RET codon 918 mutation may have prognostic impact, and therefore preoperative assessment may influence decision-making in the treatment of patients suffering from MTC.

Variability and discontinuity of the pathognomonic systemic effects caused by Walker 256 tumor progression in rats.

Cancer pathognomonic systemic effects (PSE) have high individual variability. For this reason present data were collected daily and synchronized considering four main points: inoculation day, onset of PSE, aggravation and death. The subclinical period free of PSE ranged between 15.7 +/- 2.2 days, the clinical period was less variable, 8.9 +/- 0.5 days, divided in a moderate and a grave phase of nearly the same length. PSE involved disturbances of fundamental homeostatic regulations: appetite, sodium, water, immune, etc. PSE triggering correlated highly with survival (r2 = 0.95, P < 0.01), but poorly with primary tumor growth, and it was anticipated by metastases from 20.5 +/- 2.6 to 10.6 +/- 1.1 days (P < 0.01). After multifocal simultaneous inoculations, PSE triggering was anticipated to 4.2 +/- 0.2 days (marked reduction of individual variability), in the presence of small total-tumor masses, absence of macroscopic metastases, and without changes in the following clinical period features. PSE triggering seems to be a major prognostic indicator probably related to multifocal tumor growth.

The Importance of the Groin Node Status for the Survival of T1 and T2 Vulval Carcinoma Patients

The purpose of this study was to analyze (1) the prognostic factors for survival of T1 and T2 carcinoma patients and (2) the impact of the initial groin node status for the time to recurrence and site of recurrence. We performed a follow-up study on 190 women with a T1 or T2 squamous cell carcinoma of the vulva. Data were obtained on age and general medical condition, the clinical and histological characteristics of the primary tumor and the inguinofemoral lymph nodes, treatment, recurrences, and survival. The standard treatment was radical vulvectomy with bilateral inguinofemoral lymphadenectomy supplemented with postoperative radiotherapy to the primary site, groin, and pelvic side walls if groin metastases were present. Compared to patients without lymph node metastases in the groin, the relative risk of dying within a given time period was estimated to be 2.47 (limits of the 95% confidence interval: 1.24, 4.93) and 9.69 (3.90, 24.03) for patients with unilateral and bilateral node metastases, respectively. The number of metastatic lymph nodes or their intra- or extranodal growth was not associated with survival. The relative risk of dying within a given time period was 2.71 (1.36, 5.40) for patients with a T2 tumor compared to those with a T1 tumor and 2.37 (1.31, 4.31) for patients with vasoinvasive growth compared to those without capillary-lymphatic tumor infiltration. Tumor thickness, differentiation grade, and multifocal growth did not determine survival. In the multivariate Cox regression analysis, the presence of inguinofemoral lymph node metastases proved to be the most important prognostic factor for patients' survival. Of the 119 patients who underwent lymphadenectomy but in whom no groin node metastases were found, 6 (5%) patients manifested an early recurrence (i.e., residual cancer or a recurrence within 2 years after the diagnosis). In contrast, of the 51 patients with histologically documented groin node metastases, 15 (29.4%) manifested an early recurrence and these recurrences appeared equally distributed over the primary site and other sites. Only 1 of the 51 women with documented inguinofemoral lymph node metastases presented with the first manifestation of recurrent cancer in the groin. Groin node metastases did not increase the risk for late recurrences. The presence of inguinofemoral lymph node metastases (none/unilateral/bilateral) is the most important predictor of failure to survive. Groin node metastases are associated with early recurrences which seldomly manifest primarily in the groin if it is hospital policy to supplement the surgical excision with adjunctive radiotherapy.

Prim�re Sarkome der Leber beim Erwachsenen

Eleven adult patients with primary sarcoma of the liver underwent surgery at the University Hospital of Hamburg-Eppendorf between 1985 and January 1994. In 8 cases it was possible to resect the tumor with wide margins (R0), in 1 of these in the course of orthotopic liver transplantation. Three patients had primarily marginal resection (R1). By the end of the study period 7 of the patients who underwent initial R0 resection are tumor-free, with a mean survival time of 57 (5-104) months. The patient with orthotopic liver transplantation developed metastases 31 months after primary surgery. At 7 months after initial R1 resection, 1 patient is alive with no evidence of disease while 2 others died after 30 and 35 months, respectively. Patients with non-metastasized, primary sarcomas of the liver can expect long-term survival if the tumor is resected with wide margins in an anatomical hepatectomy. In the case of multifocal growth in the liver transplantation can be considered.