Pathological Resection Research Articles

A Prospective, Blinded Trial Comparing the Accuracy of PET, EUS and CT with Resection Pathology in the Staging of Esophageal Cancer Following Neo-Adjuvant Chemotherapy

A Prospective, Blinded Trial Comparing the Accuracy of PET, EUS and CT with Resection Pathology in the Staging of Esophageal Cancer Following Neo-Adjuvant Chemotherapy

Effect of donor age on cultivation of human oral mucosal keratinocytes

Cultured mucosal grafts (CMG) are among recently developed biological grafting materials to cover large oral mucosal defects following resection of mucosal pathology. This study evaluates the effect of donor’s age on the cultivation process of oral mucosal keratinocytes for grafting. Human mucosal epithelial cells were utilized and classified into three donor age groups: 3–30 years (14 patients); 31–60 years (9 patients); and >60 years (6 patients) (11 males and 18 females). Isolation and cultivation of oral mucosal keratinocytes were according to Rheinwald and Green [Cell 6 (1975) 331], originally developed for epidermal keratinocytes. Isolated primary cell lines were seeded and cultivated. Propagation of cell lines (“passages”), time period required to reach confluence, yield of cells and plating efficiency were recorded. All cells propagated well up to the fourth passage. Thereafter, a decline was observed and was more distinct with age. Period to confluence was longer among the old age group. Yield of cells in fourth passage was high among the young age group and decreased with age. Plating efficiency in passages 4–6 decreased with age. These results suggest that age-related changes in cultivation of oral keratinocytes are not general phenomena, but rather limited to the donor age of 60 years and above. In this age group all the parameters studied were adversely affected. Oral mucosal keratinocytes may be a useful model for oral aging.

Multimodality treatment in the control of deep musculoaponeurotic fibromatosis.

Deep musculoaponeurotic fibromatoses are rare soft tissue neoplasms with a propensity for local recurrence. A retrospective analysis was carried out of the factors contributing to local disease control in 75 patients treated between 1963 and 1993. Multivariate analysis identified the type of surgical excision (P < 0.001) and involvement of pathological resection margins (P < 0.02) as significant factors contributing to local recurrence. After a median follow up of 47 months (range 24 months to 29 years) 31 (49 per cent) of the 63 patients who had an 'adequate' surgical resection developed local recurrence. The median time before development of local recurrence was 83.4 (range 8-129) months in patients with clear pathological resection margins. This was significantly shortened to 13.1 (range 2-35) months in those with positive margins (P < 0.001). Adequate surgical extirpation is the most important determinant in local disease control. Treatment of local recurrence ranged from observation during periods of disease stabilization to multimodality treatment for aggressive disease.

971 Poster Efficacy of post-operative adjuvant radiotherapy (RT) for pathological T3 (pT3) and/or positive resection margin (RM) prostate adenocarcinoma with undetectable post-operative PSA following radical prostatectomy (RP)

971 Poster Efficacy of post-operative adjuvant radiotherapy (RT) for pathological T3 (pT3) and/or positive resection margin (RM) prostate adenocarcinoma with undetectable post-operative PSA following radical prostatectomy (RP)

Histological, genomic and clinical heterogeneity of clear cell hepatocellular carcinoma.

The aim of the study was to determine whether clear cell type hepatocellular carcinoma should still be regarded as a separate uniform diagnostic entity. We retrospectively studied 118 cirrhotic patients with hepatocellular carcinoma treated by orthotopic liver transplantation, and 31 noncirrhotic patients with hepatocellular carcinoma treated by either liver surgical resection or transplantation. The pathology of all liver resections was reviewed. Microsatellite instability was performed on paraffin-embedded samples at loci located on chromosomes 2p, 3p, 5q, 8q, 9p, 13q, 16q and 17p. Among the 118 cirrhotic patients, 10 (8.5%) had a clear cell hepatocellular carcinoma; these had clinical characteristics and prognosis similar to the other cirrhotic patients. No genetic alterations were detected in these tumours. Among the 31 noncirrhotic patients, one (3.2%) had a clear cell hepatocellular tumour. This 170-mm tumour had a lipid density on computed tomography, and its histology resembled chromophobe cell renal carcinoma. Furthermore, this tumour had unusual genomic alterations, with microsatellite instability in 6/8 chromosome loci. Clear cell hepatocellular carcinoma is a heterogeneous entity in which a chromophobe cell subtype should be identified.

Influence of age and predicted forced expiratory volume in 1 s on prognosis following complete resection for non-small cell lung carcinoma.

To evaluate age of the patient at the time of surgery and estimated postoperative forced expiratory volume in 1 s (FEV1%) as predictors of long-term survival following complete resection of non-small cell lung carcinoma (NSCLC). Retrospective, observational study. Records of patients operated on for NSCLC between January 1994 and December 1997 were reviewed. One hundred and ninety three patients who underwent complete pathological resection and survived surgery were included for study. Patients were divided in groups depending on age at the time of surgery and predicted postoperative FEV1% calculated according to the number of resected segments. Values of the 75th percentile of age (70.29 years) and 50th percentile of predicted FEV1% (52.9) were the cut-points selected for group division. To increase the power of the analysis pathological staging was also converted in a binary variable and resumed to localized (stage I) or extended (stage II-IIIB). Univariate analysis of the effect of each variable on survival was assessed by Kaplan-Meier method and log-rank test. Relationship between variables was investigated using 2x2 tables and Fisher's exact test. Unrelated variables (extension, age and low estimated postoperative FEV1%) entered in a Cox-regression model to predict long-term survival following resection. Pathological stage (P<0.0001), age (P=0.01) and low estimated postoperative FEV1% (P=0.0007) showed independent value to predict the outcome. Advanced age and low predicted postoperative FEV1% play an adverse effect on survival of completely resected NSCLC.

Thoracoscopic lung resection in children

Purpose: The aim of this study was to evaluate the technique of video-assisted thoracic surgery (VATS) in lung resections in infants and children.Methods: From December 1992 to December 1998 113 consecutive patients, ages 3 weeks to 19 years, underwent VATS for biopsy or resection of various lung pathology. This included 88 wedge biopsies, 12 resections of bullous or cystic disease, 9 lobectomies or segmental resections, and 4 bronchogenic cysts.Results: All procedures were completed successfully. Two patients with metastatic disease had surgery converted to a standard thoracotomy for extensive resections. The average operating time for a wedge biopsy of 2 sites was 26 minutes and 210 minutes for a lobectomy. The average hospital stay after wedge resection was 1.1 days. There were no complications related to the VATS approach.Conclusion: VATS is a safe and effective technique in the diagnosis and treatment of pediatric pulmonary disease.

The torn acetabular labrum - a hip arthroscopist's view.

The torn acetabular labrum is a classical indication for hip arthroscopy. Clinical and imaging diagnosis are not so reliable compared to hip arthroscopy, which also allows therapeutic intervention. Advances in the technique of arthroscopic examination of the hip joint enable an accurate diagnosis of a torn acetabular labrum as well as arthroscopic resection of such pathology. During 267 consecutive hip arthroscopies, 37 labral lesions (13,9 %) could be identified and were resected successfully. The morphological classification of labral tears, and their frequency was allocated to radial flap tears (57 %), fibrillated radial tears (22 %), longitudinal peripheral tears (16 %) and unstable labra (5 %). One year after surgery, 78 % of the patients were improved, whereas 5 were not improved and 3 had worsened. Larger series with longer follow-up should be reported enabling scientific assessment of the procedure. At this early stage, however, we would recommend that all patients with a suspected labral tear should undergo hip arthroscopy.

Operative ultrasonography for upper genital tract pathology.

A procedure using transvaginal sonohysterography (SHG) to perform operative intrauterine biopsies and resections is described. Seven women, six with intrauterine pathology noted on diagnostic SHG and one with a thickened endometrium noted on transvaginal ultrasonography, underwent attempted operative SHG. The indications were peri- and postmenopausal bleeding (n = 4) and infertility requiring assisted reproduction (n = 3). Access to the uterine cavity was accomplished with a 9-F cervical access catheter (CAC) with a 3-ml balloon (BEI Medical Systems, ZSI Gynecology Products Division, Chatsworth, CA), which was placed in the cervical canal or lower uterine segment. Depending on the position of the noted uterine pathology, a 6-F uterine ostial access catheter (UOAC) (BEI Medical Systems, ZSI Gynecology Products Division) was placed through the CAC. The uterine cavity was distended with 5-10 ml of 1% Lidocaine and a 3-F loop grasper or finger-like biopsy grasper was then passed through the UOAC or a 5-F operative instrument directly within the CAC with attempted resection under ultrasound guidance. Biopsied samples were sent to pathology for definitive diagnosis. Office hysteroscopy was then performed to confirm adequate resection. Three of six patients had adequate resection or biopsy of intrauterine pathology, while the seventh patient successfully had a directed biopsy of the fundal cavity under ultrasound guidance. In one case, the visualized lesion could not be grasped. In the other two cases, each patient had severe cervical stenosis and declined in-office cervical dilation precluding the procedure. Each procedure was well tolerated, with an average time from start to finish of about 25 min (range, 18-43 min) without complications. Operative SHG makes it possible to resect and biopsy intrauterine pathology often missed on Pipelle sampling. If found to be as effective as hysteroscopy, operative SHG would provide a cost-effective alternative. Further study is ongoing to perfect the existing instruments to allow removal of larger lesions both safe and possible.

Labrum lesions from the viewpoint of arthroscopic hip surgery

The torn acetabular labrum is a classical indication for hip arthroscopy. Clinical and imaging diagnosis are not so reliable compared to hip arthroscopy, which also allows therapeutic intervention. Advances in the technique of arthroscopic examination of the hip joint enable an accurate diagnosis of a torn acetabular labrum as well as arthroscopic resection of such pathology. During 267 consecutive hip arthroscopies, 37 labral lesions (13.9%) could be identified and were resected successfully. The morphological classification of labral tears, and their frequency was allocated to radial flap tears (57%), fibrillated radial tears (22%), longitudinal peripheral tears (16%) and unstable labra (5%). One year after surgery, 78% of the patients were improved, whereas 5 were not improved and 3 had worsened. Larger series with longer follow-up should be reported enabling scientific assessment of the procedure. At this early stage, however, we would recommend that all patients with a suspected labral tear should undergo hip arthroscopy.

Prediction of Residual Neoplasia Based on Pathologic Severity and Resection Margin Status of Conization Specimens

Prediction of Residual Neoplasia Based on Pathologic Severity and Resection Margin Status of Conization Specimens

Human defunctionalized colon: a histopathological and pharmacological study of muscularis propria in resection specimens.

Despite the regression of "diversion colitis," temporary functional disorders after bowel continuity restoration could be caused by changes in the smooth muscle of excluded segments; however, studies on the muscularis propria have yielded contradictory results. This study was aimed at evaluating possible histopathological changes in muscular layers and motility of the defunctionalized human colon. Ten patients with defunctionalized colorectum (group A) and 10 controls (group B) underwent restorative or primary resection surgery. Strips were taken proximal to the colostomy (specimens A1) and the defunctionalized segment (specimens A2), and from the proximal (specimens B1) and distal extremity (specimens B2) of resected colons. Measurements of the thickness of the muscularis propria and of the volume density of the myenteric plexus, as well as of spontaneous motility and responses to electrical and pharmacological stimulation were taken. The muscularis propria was thicker in A2 than in A1 specimens (P = 0.004) and in B2 than in B1 specimens (P = 0.007). No differences were recorded either in the myenteric plexus volume density or in colonic motility. No differences were recorded in intergroup comparisons. As no structural or functional changes related to defunctionalization were found, clinical disorders after colorectal restoration could rather result from underlying colonic pathology and/or incomplete distal colon resection.

Risk factors of tracheostomal recurrence after laryngectomy for laryngeal carcinoma

Tracheostomal recurrence after total laryngectomy for laryngeal carcinoma has a poor prognosis. The independent risk factors of tracheostomal recurrence are, however, not well documented. This is a multivariate analysis of the risk factors of tracheostomal recurrence after total laryngectomy for 322 laryngeal squamous cell carcinomas. The factors included in the analysis were sex, age, tumor stage, sites of tumor involvement, preoperative airway obstruction, preoperative tracheostomy, extent of surgical resection, radiotherapy, and pathological resection margin. Seventeen (5%) patients developed tracheostomal recurrence. Univariate analysis showed that preoperative airway obstruction, subglottic involvement, and postcricoid extension were significant factors associated with tracheostomal recurrence. Multivariate analysis using logistic regression method showed that both subglottic and postcricoid involvement were independent predisposing factors for tracheostomal recurrence. The tracheostomal recurrence rates were 2% in patients without the risk factor and 10% in patients with the presence of one or both risk factors. Subglottic and postcricoid involvement were independent risk factors for tracheostomal recurrence.

Chest wall invasive non-small cell lung cancer: Patterns of failure and implications for a revised staging system

To assess outcomes and patterns of failure for chest wall invasive non-small cell lung cancer (T3 or IIIA NSCLC), data were acquired prospectively on 47 consecutive patients at a single institution over 6 years. Preresectional stagings included bone scan, head and chest/abdominal computed tomography, and mediastinoscopy. There were 25 superior sulcus tumors (radiation and/or chemotherapy followed by resection) and 22 other chest wall invasive NSCLCs (resection alone). There were no perioperative deaths. Seventeen patients (36%) had an operative complication (median length of stay increased from 7 to 12 days; p < 0.05). A complete pathologic resection was achieved for 44 of 47 patients (94%). The median survival was 38 months (actuarial 2- and 5-year survival rates of 62% and 50%, respectively). Median lengths of survival for superior sulcus and other chest wall tumors were 36 and > 60 months, respectively. Significant univariate predictors of decreased overall and cancer-free survival were poor performance status, positive margins, and positive lymph nodes. Recurrence was observed in 22 of 47 patients (46%) at a median of 8 months (range 2-24); patterns of failure were in the ipsilateral chest (n = 2; 4%) and at a distant site (n = 15; 32%) or both (n = 5; 11%). The operative risk for chest wall invasive NSCLC is acceptable, even after neoadjuvant therapy, allowing for a 94% complete resection rate. The survival of this subset of stage IIIA patients may warrant a reappraisal of the international staging system.

Surgical pathology of epilepsy resections in childhood

In this review, we discuss the important pathological lesions observed in temporal lobectomies and neocortical resections performed for medically refractory seizures in children. A higher percentage of pediatric cases appear to be "lesional" with computed tomography (CT) and magnetic resonance imaging (MRI) and abnormalities and "dual pathology" lesions appear to be more common than pure mesial temporal sclerosis. Almost a third of cases appear to be neuronal migration disorders and low-grade gliomas with some lesions harboring both neoplastic and malformative components. Our experience suggests a role for cytomegalovirus in some cases of Rasmussen's encephalitis.

Intraoperative electron beam radiation therapy for recurrent locally advanced rectal or rectosigmoid carcinoma

A multimodality approach of moderate-dose to high-dose preoperative radiation therapy, surgical resection, and intraoperative electron beam radiation therapy (IORT) has been used for patients with locally recurrent rectal or rectosigmoid carcinoma. The 5-year actuarial local control and disease-free survival for 30 patients undergoing this treatment program were 26% and 19%, respectively. The most important factor predicting a favorable outcome was complete resection with negative pathologic resection margins. The determinant local control and disease-free survival for 13 patients undergoing complete resection were 62% and 54%, respectively, whereas for 17 patients undergoing partial resection these figures were 18% and 6%, respectively. There did not appear to be a difference in local control or survival based on the original surgical resection (abdominoperineal resection versus low anterior resection). However, the likelihood of obtaining a complete resection after preoperative radiation therapy was higher in patients who had previously undergone a low anterior resection than patients undergoing prior abdominoperineal resection. For the 30 patients undergoing external beam irradiation, resection, and IORT, the most significant toxicities were soft tissue or sacral injury and pelvic neuropathy. Efforts to further improve local control are directed toward the concurrent use of chemotherapy (5-fluorouracil with and without leucovorin) as radiation dose modifiers during external beam irradiation and the use of additional postoperative radiation therapy.

Inverted papilloma: An uncommon benign cause of a ureteral filling defect

A case of inverted papilloma of the ureter in a 62-year-old man is presented along with a literature review of 14 cases. This rare benign tumor should enter the differential diagnosis of a ureteral filling defect especially when it has a smooth configuration. Preoperative consideration of this diagnosis may lead to intraoperative confirmation of pathology and conservative resection.

Surgery for Mitral Regurgitation

Mitral regurgitation is a valvular heart lesion that is difficult to diagnose accurately; thus, it is difficult to determine the appropriate timing for surgical correction. With increasing use of reparative techniques, including local resection of valve pathology and placement of an annuloplasty ring, and the realization that chronic atrial fibrillation leads to decreased long-term survival, the timing of surgery has changed. In addition, serial noninvasive studies have indicated that despite the absence of symptoms, patients may progress to a myopathic condition if the regurgitation progresses over a long period and surgery is not performed when signs of left ventricular dysfunction are evident. Preservation of the papillary muscle is also extremely important for late postoperative function in patients with mitral regurgitation, and reparative surgery that preserves both anterior and posterior papillary muscle complexes and continuity with the anulus appears to satisfy this assumption. Worldwide experience is reviewed and I present conclusions related to the appropriate indications for mitral valve repair or replacement in patients with mitral regurgitation.

Treatment of tumors involving the anterior cranial fossa.

The potential for a tumor of the upper face, either malignant or nonmalignant, to involve the anterior cranial base is often not appreciated. This leads to inadequate preoperative investigation and to surgery performed by the head and neck surgeon without the help of the neurosurgeon. In this way, complete tumor resection may be compromised or delayed. Neither of these situations is desirable. If the potential for anterior cranial fossa invasion is recognized, there should be prior consultation with the neurosurgeon and a combined operative procedure. Exposure of these lesions has considerably improved with experience in congenital craniofacial deformities: this will allow en bloc resection of most pathologies. Immediate reconstruction after resection of nonmalignant tumors is advocated, but in aggressive--particularly in recurrent--malignancies, delayed reconstruction is advised. Careful combined follow-up with frequent blind biopsies should be carried out as indicated.

Maxillofacial injuries: Reconstructive surgery of the dehiscent parotid duct and dehiscent peripheral facial nerve

Maxillofacial injuries: Reconstructive surgery of the dehiscent parotid duct and dehiscent peripheral facial nerve