Primary Lesions In Patients Research Articles

Correlação entre a evolução clínica e a freqüência de micronúcleos em células de pacientes portadores de carcinomas orais e da orofaringe

To verify the correlation between the micronucleus frequency and the presence of local recurrences or second primary lesion in patients with carcinoma of the oral cavity. We studied the frequency of micronucleus of the oral mucosa in 27 untreated patients with carcinoma of the oral cavity and oropharynx. The patients were monthly followed after initial treatment, in an attempt to identify local recurrences or second primary lesions. Of the 24 patients evaluated during the whole time, 5 cases (20,8%) were alive and free of disease, and 19 cases died, 18 (75%) owing to cancer and 1 to perfurative peptic ulcer. In relation to micronucleus frequency, no difference was observed among the patients with local recurrence of the disease (N=14) and the patients who died of other causes or were alive and free of disease (N=10) (p = 0.83). There was higher micronucleus frequency in the stages T3 and T4 (p = 0.01). In the present study was not possible to find a clinical correlation between the frequency of micronucleus of the oral mucosal and the risk of development of local recurrence or second primary tumor in patients with upper aerodigestive tract carcinoma.

Is abdominoperineal resection a good option for stage IV adenocarcinoma of the distal rectum?

The management of the primary lesion in patients with stage IV adenocarcinoma of the distal rectum is controversial. An abdominoperineal resection (APR) may be a good option. A retrospective analysis of the medical records of 21 patients with stage IV distal rectal adenocarcinoma treated with an APR between January 1991 to December 2000 was performed. All patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 1 and normal preoperative alkaline phosphatase and total bilirubin levels. Twelve patients (92%) with liver metastases had less than 25% of total liver volume involvement. Twenty patients (95%) had complete resolution of their symptoms related to the primary rectal cancer. The median follow-up was 19 months (range 3-92 months), with a median survival of 21.6 months and a 2-year overall survival of 34%. Patients with stage IV distal rectal adenocarcinoma who have a good performance status, normal preoperative liver function tests, and minimal metastatic disease to the liver can be offered resective surgery.

Telomerase activity in gynecological tumors.

The aim of this study was to define the clinical implications of semi-quantitative telomerase activity in gynecological tumors by comparing the telomerase activity of cancerous lesion and the adjacent non-cancerous lesion. In 118 cases of gynecologic tumors, including 41 uterine cervical tumors, 43 uterine body tumors and 34 ovarian tumors, telomerase activities were determined using TRAPeze telomerase detection kit for the extension reaction of the telomere sequence and the PCR reaction for amplification of the sequence, and using fluorecence-based telomere repeat amplification protocol (F-TRAP) method for the detection. In all gynecologic cancers examined, telomerase activity of the cancerous lesion was significantly higher than that of the non-cancerous lesion. Telomerase activity in the uterine cervix increased in the following order of the normal uterine cervix, cervical dysplasia and cervical cancer. Regarding the endometrial cancer, telomerase activity at the primary lesion in patients with lymph node metastases was significantly higher than that in patients without lymph node metastases. When telomerase activity was compared by histologic subtypes of the ovarian cancer, clear cell adenocarcinoma showed significantly lower telomerase activity than the other subtypes, especially endometrioid adenocarcinoma. In all gynecologic cancers examined, there was no clear correlation between the telomerase activity and age at diagnosis or age of menopause. Although all tumors with 100 units or more telomerase activity were cancerous, the sensitivity was 39% in cervical cancer, 41% in endometrial cancer and 21% in ovarian cancer, respectively. Cervical intraepithelial neoplasia (CIN) had already increased telomerase activity and endometrial cancer with lymph node metastases had also greater activity than that without lymph node metastases. Although telomerase activity in ovarian cancer tended to increase as stage advances, it is noteworthy that clear cell adenocarcinoma showed significantly lower telomerase activity than endometrioid adenocarcinoma.

Clinical assessment of positron emission tomography for the diagnosis of local recurrence in colorectal cancer.

The clinical value of positron emission tomography (PET) for the diagnosis of local pelvic recurrence of colorectal cancer was evaluated. Computed tomography (CT) and magnetic resonance imaging (MRI) of the pelvis were performed at regular intervals in 23 patients who had undergone resection for colorectal cancer. The 23 patients had a total of 25 lesions. PET images of the 25 lesions and of six primary lesions in patients with rectal cancer were obtained. A differential absorption ratio (DAR) was calculated in order to examine the accumulation of [18F]2-fluoro-2-deoxy-D-glucose (18FDG) on PET images. Histological diagnoses of the pelvic masses were obtained by CT-guided needle biopsy. On CT or MRI, a pelvic mass with a spicular shape (n = 1) was non-recurrent, whereas a nodular or lumpy shape indicated a locally recurrent lesion (n = 10). Masses with a nodulospicular shape (n = 12) did not correlate with the histological features. On PET, 15 of 16 histologically proven local recurrences were imaged positively. By setting a DAR of 2.8 as a cut-off value, local recurrences could be diagnosed with 100 per cent accuracy. PET is a clinically useful tool for the detection of local recurrence of colorectal cancer, particularly for distinguishing between recurrence and granulation tissues in the pelvic cavity.

Metastatic head and neck cancer: role and usefulness of FDG PET in locating occult primary tumors.

To assess the usefulness of 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) of the head and neck in locating occult primary lesions in patients with metastatic cervical adenopathy. Seventeen patients with metastatic cervical adenopathy of unknown primary origin were referred for FDG PET of the head and neck. All patients had undergone correlative anatomic imaging within 1 month of FDG PET. Surgical, clinical, and histopathologic findings were used to assess the performance of FDG PET. Increased apical lung uptake at FDG PET led to a biopsy-proved diagnosis of primary lung cancer in two patients. Of the remaining 15 patients, 10 had a focus of increased activity; directed biopsy of these sites led to confirmation of a primary carcinoma in seven patients. Correlative anatomic imaging failed to demonstrate the primary sites of disease in two of these seven patients. None of the five patients with negative FDG PET studies have manifested evidence of a primary site of disease during follow-up of 8-42 months (mean, 29 months). FDG PET allows effective localization of the unknown primary site of origin in metastatic head and neck cancer and can contribute substantially to patient care.

Secretory profile of immunoreactive growth hormone-releasing hormone (IR-GHRH) during sleep in man and its clinical value.

To clarify the role of growth hormone-releasing hormone (GHRH) in the regulation of the episodic growth hormone (GH) secretion which is known to occur constantly in the initial slow wave stage of nocturnal sleep in man, we studied the relation between the secretions of plasma immunoreactive(IR)-GHRH and GH while recording electroencephalograms. In subjects who showed a normal sleep pattern, the plasma IR-GHRH level increased 3- to 4-fold just before the surge of plasma GH, suggesting that GH release in the initial slow wave stage of sleep is mainly mediated by GHRH. However, when there was an apparent GH surge just before the onset of sleep, the magnitude of the GH response associated with the initial slow wave stage tended to be blunted, even when sufficient IR-GHRH was released. We also observed no appreciable fluctuations of plasma IR-GHRH during nocturnal sleep in a patient diagnosed as having GH-deficient dwarfism, suggesting the primary lesion was on the hypothalamus level, not the pituitary, in such a patient. In a case of multiple endocrine neoplasia (MEN) type I with an ectopic (GHRH-producing pancreatic tumor, no remarkable elevation of plasma IR-GHRH was detected in the initial slow wave stage of nocturnal sleep. We conclude that the present study is significant not only in demonstrating the physiology of GHRH release, but also in establishing a safe, reliable and practical test for routine clinical use to investigate intrinsic ability to release GHRH and the primary lesions in patients with disorders of GH secretion.

Effects of endocrine therapy on the primary lesion in patients with prostate carcinoma as evaluated by endorectal magnetic resonance imaging

Effects of endocrine therapy on the primary lesion in patients with prostate carcinoma as evaluated by endorectal magnetic resonance imaging

Effects of endocrine therapy on the primary lesion in patients with prostate carcinoma as evaluated by endorectal magnetic resonance imaging

Little effort has been made at the quantitative and qualitative evaluation of patients with prostate carcinoma, including downsizing and downstaging of the primary lesion, after conservative therapy. The current study was undertaken to investigate the qualitative and quantitative effects of endocrine therapy on the primary prostate carcinoma using magnetic resonance imaging (MRI). The primary prostate carcinoma was evaluated by endorectal MRI approximately 4 months after the initiation of endocrine therapy in 48 patients with histologically confirmed prostate carcinoma detected by endorectal MRI before therapy. The volumes of the prostate gland, the carcinoma, and the noncarcinomatous components were reduced to 60.2 +/- 2.7%, 25.5 +/- 2.9%, and 83.2 +/- 6.3% of their pretreatment volumes respectively after endocrine therapy, indicating that the tumors are more susceptible to endocrine therapy than the nontumorous components. The number of prostate carcinomas that demonstrated low signal intensity compared with the normal peripheral zone on T2-weighted images decreased after endocrine therapy and the number of carcinomas with enhancement of T1-weighted contrast-enhanced images increased after therapy. Seven of the 48 patients underwent downstaging after endocrine therapy, based on the endorectal MRI evaluation. The results of the current study suggest that downsizing and occasionally downstaging of the carcinoma may occur after endocrine therapy in patients with prostate carcinoma. In addition, the androgen sensitivity of the prostate carcinoma tissue is relatively high compared with the residual noncancerous prostate gland.

Cancer cell morphology at the invasive front and expression of cell adhesion-related carbohydrate in the primary lesion of patients with colorectal carcinoma with liver metastasis.

Liver metastasis from colorectal carcinoma is an important problem in surgical treatment and profoundly affects the prognosis of patients. If it were possible to identify characteristic features in the primary lesion strongly related to liver metastasis, these could be used as prognostic markers for liver metastasis. To search for such features, the primary lesions of patients with colorectal carcinoma with liver metastasis were investigated. Three groups of colorectal carcinoma were examined: Group A with synchronous liver metastases; Group B with only lymph node metastases without recurrence for 5 years; and Group C with recurrence of liver metastases. Groups A and B included 24 cases and Group C, 20. We focused on cancer cell morphology at the invasive front and expression of sialyl Lewis X (sialyl Lex) in the primary cancer. At the invasive front in Group A it was frequently found that polygonal, not columnar, cancer cells with a single or solitary trabecular form with indistinct polarity, showed an infiltrative growth pattern. This type of morphology was termed "focal dedifferentiation" and graded four levels. Eleven of 24 cases (46%) had severe focal dedifferentiation in Group A, 1 of 24 (4%) in Group B, and 6 of 20 (30%) in Group C. Sialyl Lex staining was positive in 12 of 24 cases (50%) in Group A, in 3 of 24 cases (13%) in Group B, and in 7 of 20 cases (35%) in Group C in the primary carcinoma. In respect to the staining of (sialyl Lex) at focal dedifferentiation, it was positive in 17 of 24 cases (71%) in Group A, in 4 of 24 cases (17%) in Group B and in 11 of 20 cases (55%) in Group C. Focal dedifferentiation and sialyl Lex staining in the primary cancer showed a significant difference between Groups A and B. Sialyl Lex staining at focal dedifferentiation showed a significant difference between Groups A and B and Groups B and C. Other adhesion related molecules, sialyl LeA and CEA, showed no difference among Groups A, B, and C. Both focal dedifferentiation and expression of sialyl Lex antigen in the primary lesion are considered good markers for assessing the metastatic proclivity of colorectal cancer.

Familial cutaneous melanoma

Family history is an important risk factor for cutaneous malignant melanoma. We evaluated the clinical characteristics of patients with cutaneous familial melanoma. A chart review was conducted, including all patients who presented to Massachusetts General Hospital Pigmented Lesion Clinic over an 8-year period. A total of 102 patients from 49 families were confirmed with shaving cutaneous melanoma. Eighty-two per cent had a personal and/or family history of dysplastic naevi. Within families, subsequent affected patients had thinner primary lesions with substantially lower median thickness than those diagnosed first. Seventeen per cent had multiple primary melanomas, with the median thickness of subsequent primaries being much lower than that of the first primary lesions. The mean thickness of primary lesions in patients with one primary lesion was marginally significantly greater than that in patients with multiple primaries. Verification of family history is essential given the implications of a positive family history. Screening family members of all patients with cutaneous melanoma and surveillance examinations for all patients with cutaneous melanoma is recommended.

Radiation as a Therapeutic Modality in Sarcomas of the Soft Tissue

Management of the primary lesion in patients with soft tissue sarcomas is combined modality in the majority of instances. The modalities are surgery and irradiation. Radical surgery as currently practiced in major oncology centers does not achieve local control in an important proportion of patients.

Carbohydrate Antigens and Liver Metastasis in Colorectal Cancer

A comparative immunohistochemical study was performed to analyse the expression of cancer-associated carbohydrate antigens by primary and metastatic lesions of colon cancer. We used monoclonal antibodies which reacted with Lea, Lex and Tn as well as their sialylated derivatives. Twenty-one primary lesions in patients without metastasis and 26 primary and metastatic lesions in patients with liver metastasis were studied. Sialyl Lea was expressed by 57% of the primary lesions of patients without metastasis, 65% of the primary lesions of patients with metastasis and 73% of their liver metastases. Sialyl Lex was expressed by 60% of the primary lesions of patients with and without metastasis as well as by approximately 80% of the liver metastases. Sialyl Lea and sialyl Lex showed strong expressions in the liver metastases, significantly greater than in the primary lesions. The findings indicate the increased expressions of sialyl Lea and sialyl Lex to be correlated with liver metastasis of colorectal cancer.

Oxygenation of mammary tumors: from isotransplanted rodent tumors to primary malignancies in patients.

As a result of a compromised and anisotropic microcirculation, isotransplanted mammary tumors in mice exhibit hypoxic and anoxic tissue areas which are heterogeneously distributed within the tumor mass. Similarly, in poorly perfused human breast cancer xenografts, hypoxia develops at early growth stages and expands with tumor growth. In contrast, breast cancer xenografts with high perfusion rates exhibit an oxygenation status comparable to that of most normal organs. There is clear experimental evidence that the efficiency of tumor blood flow in isotransplanted tumors and in xenografted human breast cancers is the principal modulator of tissue oxygenation. The pO2 distribution found in primary lesions in patients ranged from the pO2 histograms obtained in "low-flow" isotransplants and xenografts to those measured in "high-flow" breast cancer xenografts or normal tissues. From our extended and systematic clinical studies there is clear indication that the oxygenation status of human breast cancers in situ does not correlate with the clinical stage and/or histological grade of an individual tumor.

Does neck stage influence local control in squamous cell carcinomas of the head and neck?

Recently, reports have suggested that the probability of local control of head and neck cancers treated with radiotherapy alone is inversely related to the extent of neck node disease at presentation. This has led some to conclude that primary lesions in patients with neck node metastases should be treated more aggressively than lesions of the same T stage in patients presenting with a clinically negative neck. We reviewed the records of 607 patients with squamous cell carcinoma of the head and neck to determine the relationship between the extent of neck node disease at diagnosis and the probability of tumor control at the primary site. All patients were treated with continuouscourse irradiation alone to the primary site and have a minimum follow-up of 2 years. Mucosal sites analyzed included the oropharynx (soft palate, tonsillar region, base of tongue), hypopharynx (pharyngeal wall, pyriform sinus), and supraglottic larynx. Patients with simultaneous primary lesions were excluded from the analysis. Parameters tested included T stage, N stage, and fractionation (once daily or twice daily). For statistical analyses, N stage was grouped as N0, N1, N2A–N3A, and N2B–N3B. Local control was analyzed using a multivariate analysis, the forward stepwise long-rank test of association of covariates. Multivariate analyses revealed that the following parameters significantly influenced local control: oropharynx, T stage only (p = .0010); hypopharynx, T stage ( p = .001) and twice-daily fractionation ( p = .0031); and supraglottic larynx, T stage only ( p = .0002). No significant correlation was found between neck stage and primary tumor control on univariate or multivariate analyses. Our data do not support the conclusion that primary lesions are controlled less often in patients with clinically positive neck nodes.

Assessement of restenosis vs primary lesions in patients with peripheral vascular disease using in situ hybridization and gene expression of two nonmuscle myosin isoforms

Assessement of restenosis vs primary lesions in patients with peripheral vascular disease using in situ hybridization and gene expression of two nonmuscle myosin isoforms

大脳深部血管障害における遠隔部脳血流低下

Recent positron or single photon emission computed tomographic studies have demonstrated that the impairment of regional hemodynamics or metabolism in cerebrovascular disease is not limited to the focal lesion, but also involves more remote areas. The present study evaluated cerebral blood flow in areas remote from the primary lesion in patients with subcortical cerebrovascular disease, and assessed correlations with the clinical features. Twenty patients aged 61-89 (mean, 74.7 +/- 6.7 years) were divided into the L group (lacunar infarction in deep penetrating arterial territory, n = 7), the NL group (non-lacunar subcortical infarction caused by main trunk occlusion or severe stenosis, n = 6), and the H group (putaminal or thalamic hemorrhage, n = 7). Ipsilateral cortical and contralateral cerebellar blood flow were assessed using single photon emission computed tomography with 123I-IMP. Although only some patients of the L group showed a mild reduction of ipsilateral cortical blood flow, most of the patients in the NL and H groups showed a moderate or severe flow reduction. The cortical blood flow reduction was suggested to be caused by several mechanisms, including brain edema, a decreased perfusion pressure associated with disease of large arteries, partial cortical neuronal damage, and deactivation. The degree of the flow reduction was considered to depend on the relative contribution of each of these factors. Contralateral cerebellar blood flow reduction, i.e., crossed cerebellar diaschisis, was observed more frequently and prominently in the NL and H groups than in the L group.(ABSTRACT TRUNCATED AT 250 WORDS)

Nonseminomatous Germ Cell Tumor of the Testicle: Does Extensive Staging of the Primary Tumor Predict the Likelihood of Metastatic Disease?

To assess the hypothesis that local extent of the primary lesion in patients with nonseminomatous germ cell tumors of the testicle can predict disseminated disease, clinicopathological correlations of the primary tumor and metastases were determined in a retrospective review of 120 patients treated at our institution from 1970 to 1982. Pathological staging was available for all 93 patients with subdiaphragmatic disease and the primary tumor was examined by routine histological techniques in all cases. Increased primary tumor stage, as evidenced by invasion into the tunica vasculosa or extension into the rete testis, epididymis and/or lower or upper spermatic cord, was associated with metastatic disease in 91, 96, 97 and 97 per cent of the patients, respectively. Only 9 per cent of the patients with pathological stage A disease had vascular invasion compared to 45 and 67 per cent of those with stages B and C disease, respectively (p less than 0.01). Furthermore, metastases and/or eventual dissemination occurred in 84 per cent of the patients with clinical stage A disease and vascular invasion, and in only 23 per cent of those without vascular invasion (p less than 0.01). Size of the primary tumor was not of predictive value. Local extension of the primary lesion was common with embryonal carcinoma but it was not demonstrated when the predominant histological type was teratoma or teratocarcinoma, although metastases were present in 37 and 46 per cent of the latter cases, respectively. The implications of these findings, especially with regard to expectant management for clinical stage A nonseminomatous germ cell testis tumors, are discussed.

Posterior urethral valves

During the past decade some urologists and radiologists have doubted the existence of posterior urethral valves. It has been suggested that the primary lesion in patients thought to have urethral valves is bladder neck obstruction. During the past seven years we have seen an average of three new cases of posterior urethral valves per annum. In all cases the valves themselves, not the bladder neck, obstructed the urethra. The urologist may miss valves at urethroscopy, but use of the new fibreoptic endoscope has improved his chances of seeing them. Posterior urethral valves may not be demonstrated radiologically if the radiologist does not use a rapid recording device or if the patient does not micturate forcefully during micturating cystourethrography. Failure to detect the valves may lead to an erroneous diagnosis of bladder neck obstruction.