Adult Tumor Patients Research Articles

Prognostic implications of tumor cell infiltration of the hematopoietic system in pediatric and adult tumor patients

Prognostic implications of tumor cell infiltration of the hematopoietic system in pediatric and adult tumor patients

Spinal cord ependymomas

Ependymomas are the most frequent spinal cord tumors in adult patients. Although magnetic resonance imaging can be a highly accurate diagnostic tool, it does not always provide accurate differentiation between ependymomas and astrocytomas. This is why the authors recommend surgical resection and histological evaluation in all intraspinal cord tumors. It cannot be said that a tumor is unresectable without first attempting to remove it. Complete removal should be accomplished whenever possible, and patients should undergo operation before they become neurologically impaired. Quality of life depends on preoperative neurological status. Postoperative radiotherapy should be avoided in all low-grade ependymomas even after partial removal. Radiotherapy may be used to treat anaplastic ependymomas, which are quite rare in the spinal cord. Patients with low-grade ependymomas must be followed for years and undergo reoperation if necessary. In our experience treating 93 spinal cord ependymomas, complete removal was achieved in 86 patients and only one patient underwent reoperation 18 years later for tumor recurrence. The gold standard in treatment protocol is gross-total resection without adjunctive radiation therapy. Good long-term outcomes have been achieved by using this strategy.

Reverse transcriptase-polymerase chain reaction amplification of MDR1 gene expression in adult soft tissue sarcomas.

Expression of the multidrug resistance gene MDR1 is reported to be an important determinant of the response to chemotherapy and survival in some cancers. We compared three methods for determining the intrinsic MDR1 expression in soft tissue sarcomas. We studied MDR1 gene expression in 39 samples from 33 cases of soft tissue sarcomas comprising 11 liposarcomas, nine malignant fibrous histiocytomas, six leiomyosarcomas, four malignant schwannomas, three fibrosarcomas, three synovial sarcomas, and three epithelioid sarcomas, and seven cases of benign soft tissue tumors in adult patients. To detect MDR1 mRNA, reverse transcriptase-polymerase chain reaction (RT-PCR) was performed in all samples. Furthermore, RNA dot-blot analysis with digoxigenin-labeled RNA probe and immunohistochemistry with JSB-1 and C-219 antibodies for P-glycoprotein were employed in 34 and 37 samples in soft tissue sarcomas, respectively. We compared these three detection techniques. Of the 39 specimens, 18 (46%) showed MDR1 PCR products. Liposarcomas (six of 11), malignant fibrous histiocytomas (six of nine), leiomyosarcomas (four of six), fibrosarcomas (two of three) revealed high or intermediate MDR1 expression at high frequency. No MDR1 expression was detectable in malignant schwannomas, synovial sarcomas, or epithelioid sarcomas. Of seven benign soft tissue tumors, one ganglioneuroma and one lipomatosis showed low levels of MDR1 expression. By RNA dot-blot analysis, MDR1 transcripts were detectable in 12 of 34 specimens (35%). Four samples were negative by dot blot despite positivity with RT-PCR. Concordance between MDR1 expression by RNA level with RT-PCR and dot blot and at the protein level with immunohistochemistry using C-219 was found in 16 (47%) of the 34 comparable specimens. Eight samples showed positive immunoreactivity for C-219 despite negative results in RT-PCR and dot-blot analysis. The intrinsic MDR1 expression in soft tissue sarcoma seemed to depend on certain tumor types, such as liposarcoma, malignant fibrous histiocytoma, leiomyosarcoma, and fibrosarcoma. For the evaluation of MDR1 expression, RT-PCR is useful because of its relative simplicity and sensitivity. However, the clinical significance of such low levels of MDR1 expression detected only by RT-PCR must be discussed within systematically treated patient groups.

Malignant Rhabdoid Tumor in Adults-Heterogenous Tumors with a Unique Morphological Phenotype

Five cases of malignant rhabdoid tumors in adult patients are described. The tumors were characterized by sheets of poorly cohesive cells with distinctive hyaline cytoplasmic inclusions and eccentrically placed large vesicular nuclei with prominent nucleoli. A variety of lineage differentiation was shown by immunohistochemistry and electron microscopy, the lesions representing leiomyosarcoma, gastric carcinoma, epithelioid sarcoma, Merkel cell carcinoma and desmoplastic small round cell tumor. Previously reported cases of rhabdoid tumors in adults support the contention that such tumors, although of distinctive morphologic phenotype, are of heterogenous lineage differentiation, and do not represent a distinct clinicopathologic entity.

Radiotherapy for brain tumors.

Improved techniques of radiotherapy have led to marked improvement in the results of radiotherapy for certain brain tumors, such as medulloblastoma and pineal germinoma, but results for malignant astrocytoma, the most common brain tumor, have been modest. This article reviews results of radiotherapy for brain tumors in adult patients over the last decade and comments on the new approaches being studied.

Prophylactic and therapeutic use of immunoglobulin for intravenous administration in patients with secondary immunodeficiencies associated with malignancies

Failure of host defense systems associated with malignancies may be attributable to the tumor, to cytoreductive therapy or to combined endogenous and iatrogenic influences. Management of the resulting increased susceptibility to infections may require supplementation of antibiotic therapy with additional forms of treatment, including passive immunization with antibodies. This review discusses the use of immunoglobulin preparations for intravenous administration (IVIG) in patients with secondary immunodeficiencies associated with neoplasia. A suitable model for evaluating the prophylactic effect of IVIG is chronic lymphocytic leukemia. Many observations suggest that IVIG reduces the frequency of acute respiratory infections. Another malignant condition with decreased serum levels of polyclonal immunoglobulins and high frequency of infections is multiple myeloma. A crossover study recently demonstrated that IVIG significantly (P less than 0.01) reduced the frequency of respiratory tract infections in these patients. Furthermore the prophylactic effect of IVIG was evaluated in patients with small cell carcinoma of the lung. In a randomized prospective trial it was noticed that IVIG applied during intensive chemotherapy and irradiation courses significantly (P = 0.04) reduced the frequency of infections. Evidence for a therapeutic effect of IVIG was obtained in adult tumor patients and in children with leukemia or non-Hodgkin's lymphoma who developed severe varicella-zoster virus infections. The treatment effectively controlled fever, skin lesions and neuralgia and prevented progression of the infection. Therapeutic usefulness of IVIG in bacterial infections is still based on anecdotal evidence. Experimental data suggest that in addition to effects mediated by specific antibodies, nonspecific interactions of IgG molecules with Fc-receptors on macrophages may be clinically important.

Wilms tumor in adult patient

The pathology of Wilms tumor in adults is similar to that in infants. Aggressive multidisciplinary therapy already established for children may give similar survival figures for adults. We report on a case of Wilms tumor in an adult who underwent radical nephrectomy and inferior vena cava resection.

Complement-fixation antibodies to adenovirus-associated viruses, cytomegaloviruses and herpes simplex viruses in patients with tumors and in control individuals.

Sprecher-Goldberger, S. (Institut Pasteur du Brabant, 1040 Brussels, Belgium), L. Thiry, N. Lefébvre, D. Dekegel and F. de Halleux. Complement-fixation antibodies to adenovirus-associated viruses, cytomegaloviruses and herpes simplex viruses in patients with tumors and in control individuals. Amer J Epidem 94: 351–358, 1971.—Complement-fixation (CF) antibodies to adenovirus-associated virus type 3 (AAV3) were found in 15% of 337 patients with tumors in contrast to 34% of 268 control individuals. The prevalence of AAV1 and AAV2 antibodies was nearly the same in both groups. In tumor patients, CF antibodies to adenoviruses were present in 54% of the sera with AAV2 antibodies and only in 29% of the sera without these antibodies, with no significant difference in the control group (37 and 34%). In addition, 46 cases of patients with cervical cancer significantly differed from their matched controls by a high prevalence of adenovirus antibodies in sera without AAV3 antibodies, a feature which was not found in 50 cases of breast cancer. In all adult tumor patients, CF antibodies to cytomegaloviruses were present in 55% of the sera with AAV3 antibodies and 33% of sera without these antibodies (p < 0.01) while the respective figures were 43 and 31% (0.2 > p > 0.1) in the controls. CF antibodies to herpes simplex virus did not show significant associations with AAV antibodies. Thus, in cancer patients, the epidemiology of AAV2 is different from that of AAV3, with a non-random association between antibodies to these viruses and those to adenoviruses and cytomegaloviruses.