Unclassified Sarcoma Research Articles

Primary retroperitoneal soft-tissue sarcomas.

Of the 98 soft-tissue sarcomas treated between 1973-1978, 12 were retroperitoneal in origin. Fifty percent underwent one to three previous surgical procedures. All patients were operated on. In 75% (nine out of 12), the tumor was completely resected. The operative mortality for total tumor excision was 11%. There were five liposarcomas, three leiomyosarcomas, two neurofibrosarcomas, and one synovial sarcoma and one unclassified sarcoma. Six of the 12 patients survived five years and three (25%) were alive without evidence of disease at 5 years. Three of the completely resected group received no further treatment; 2/3 survived 5 years; three had postoperative chemotherapy; 3/3 survived; and three others had radiation and chemotherapy subsequent to surgery; all three have died. The two most important prognostic factors were tumor grade and surgical excision. Only one patient with high grade tumor survived. Total surgical excision of the tumor offers the only hope for cure. Aggressive surgery in treating retroperitoneal soft part sarcomas is strongly recommended.

Variability of histologic pattern in recurrent soft tissue sarcomas originally diagnosed as liposarcoma

The histopathologic classification of liposarcoma and its clinicopathologic significance are well delineated in previous studies, but the literature is inexplicably mute on recurrent liposarcomas. Supposition and experience may have led to the assumption that the microscopic features remained static over a period of years and multiple recurrences. Thirteen sarcomas originally classified as liposarcoma were reviewed to assess patterns of histologic change with recurrence. A total of 52 recurrences was studied. In 7 of the 13 cases, multiple morphologic sarcomatous patterns were identified, either as a change with recurrence or as multiple discrete patterns within a tumor. All changes except in one case occurred before irradiation or chemotherapy. The variations included patterns such as malignant fibrous histiocytoma, hemangiopericytoma, malignant schwannoma, and unclassified spindle-cell sarcoma as well as the various liposarcoma subtypes. This variability of patterns can cause significant diagnostic difficulties and can cause one to question the validity of using monomorphic diagnoses in all cases. In addition, the polymorphic differentiation of these tumors supports the concept that soft tissue sarcomas are derived from a pluripotential mesenchymal stem cell.

Eikenella corrodens as Pathogen

Letters and Corrections1 June 1979Eikenella corrodens as PathogenJ.G. SlNKOVICS, M.D., C. PLAGER, M.D., KAREN MILLS, M.S.M. D.J.G. SlNKOVICS, M.D.Search for more papers by this author, C. PLAGER, M.D.Search for more papers by this author, KAREN MILLS, M.S.M. D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-90-6-991_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The facultative anaerobe Eikenella corrodens is a recognized human pathogen (1-5), but its pathogenicity still requires further documentation. We recently saw two patients who were infected with this microorganism.A 64-year-old man had poorly differentiated neoplasm in peritoneum, mesentery, diaphragm, and lungs. He also had ascites with malignant cells. The primary site was unknown. Unclassifiable sarcoma was suspected, and treatment was begun with vincristine, cyclophosphamide, doxorubicin, and 5-fluorouracil. The patient was anergic, became febrile, and developed pulmonary infiltrates. His sputum grew Klebsiella pneumoniae, Candida albicans, and Candida tropicalis. He became hypoxic (PO248 mm Hg) with CO2...

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Mill Hill No. 2 (MH2), an avian tumor virus, was studied for its transforming and oncogenic effects. In tissue culture it induced transformation of chicken fibroblasts and yolk sac macrophages. When injected into the chicken, the main feature of this virus was its ability to cause liver and kidney carcinoma, in addition to sarcoma. MH2-associated viruses did not transform cell cultures but were able to cause only lymphoma in the birds. Light and electron microscopy were used in a detailed histologic study of the tumors induced by MH2 virus. An unclassified round cell sarcoma was produced in soft tissues at sites of injection; there was no evidence of origin from endothelium. In the kidney, carcinomas mixed with a malignant stroma were found. Hepatocarcinomas were the dominant tumors found in the liver. The lymphomas produced by the associated virus were poorly differentiated and highly malignant. The study illustrated the highly oncogenic potential of this virus and offered a model for the analysis of the carcinogenic events in a more specific way.

Sarcomas of the limbs. Results of adjuvant chemotherapy using isolation perfusion.

Seventy-nine patients with soft-tissue sarcomas and eight with sarcomas of bone and cartilage were perfused using melphalan and dactinomycin. Almost half of the patients had liposarcoma or unclassified sarcoma and one fifth had fibrosarcoma or a synovial sarcoma. Thirty-eight percent of the patients received prior therapies and had local recurrences. Six percent of patients had distant metastasis. The five-year survival rate was 57% and the ten-year rate 45%. Fifty-nine percent were free of disease at two years and 9% had developed local recurrences by then. There was one surgical death in this series. Perfusion treats the region of involvement by soft-tissue sarcomas and thus reduces the surgical resection necessary to obtain disease control. It is not recommended for sarcomas arising from bone or cartilage.

Sarcoma of the uterus

Abstract Sarcoma of the uterus comprised 0.15 per cent of all admissions to the Woman's Clinic of the New York Hospital from 1933 to 1949. It represented 3.3 per cent of all genital-tract neoplasms, and 0.3 per cent of myomas were leiomyosarcomas. There were 13 endometrial, 18 myogenic, and 2 unclassified sarcomas. Thirty-one (93 per cent) of the patients were over 40 years of age. The chief symptoms were postmenopausal bleeding, abdominal pain, and the appearance of an abdominal mass. The uterus was enlarged in all but one patient. Radium had been previously inserted for benign causes in 3 (8.3 per cent). Cytological smears were obtained from 9 patients. Seven were correct (5 endometrial and 2 myogenic sarcomas) while the 2 false negative reports occurred in leiomyosarcoma. Surgery is the treatment of choice. The immediate postoperative mortality was 10 per cent. X-ray irradiation was not effective in 5 patients with advanced sarcoma. Regardless of the histological grade of sarcoma and the number of mitotic figures, the anatomical extent of the sarcoma is the most important factor in prognosis. Only one patient is alive in whom the sarcoma had extended outside of the uterus, while 13 patients in whom the sarcoma was confined to the uterus are alive. Nineteen patients have died; 6 had endometrial, 11 had myometrial, and 2 had unclassified sarcoma. Autopsies which were performed on 7 patients showed that metastases were the leading cause of death. Fourteen patients are alive. Seven, 2 with endometrial sarcoma and 5 with myometrial sarcoma, have lived for less than 5 years. Seven patients (21 per cent) have survived from 5 to 17 years. Five of these patients had endometrial sarcoma, while 2 had leiomyosarcoma.

Sources of Error in Radiological Interpretation in Tumors of Bone

THE diagnosis of tumors of bone remains one of the most difficult problems confronting surgeons, radiologists, and pathologists, and this in spite of intensive study of the subject by large numbers of clinicians and research workers. The literature on every aspect of this problem is extensive, and great advances have been made in the diagnosis of these lesions. From the Bone Registry of the American College of Surgeons has come a workable classification of tumors of bone which has done much to bring order out of the chaos of confusing and clinically impractical terminology previously existing (Table I). Kolodny (1), in his masterly review of the material of the Bone Registry up to 1927, evolved a classification of primary malignant newgrowths of bone which is clear, concise, and very practical. His classification is as follows: (A) Osteogenic sarcoma (B) Ewing's sarcoma (C) Myeloma (D) Unclassified sarcoma The groups are arranged in the order of frequency of the various types of primary bone neoplasms. Osteogenic sarcoma is by far the most common of malignant bone tumors, accounting for about 80 per cent of all cases. Ewing's sarcoma has been variously quoted as comprising from 7 to 15 per cent of cases, while myeloma is responsible for about 3 per cent of hemangioendotheliomas and angiosarcomas of bone, which Kolodny carries in the unclassified group, and rare tumors, as is also the periosteal fibrosarcoma. There is no better illustration in the field of medicine of the need of close correlation of clinical and laboratory data than in the diagnosis of bone tumors. It is very hazardous to express an opinion on roentgenographs of bone lesions without having at least an accurate abstract of the clinical history, and any discrepancy between the two calls for a careful review of all the findings. With regard to the roentgenographs themselves, no effort should be spared to obtain as good visualization of the tumor as possible. Films should be made in at least two directions if the lesion is in a long bone, and stereoscopic views if the lesion involves the trunk or skull. In these cases patients should be closely questioned as to the presence of symptoms in other parts of the body, and roentgenographs made of any area of which they complain. In certain cases it will be necessary to make films of the entire skeleton to show multiple primary lesions or the presence of metastases. In all cases of suspected primary malignant newgrowth of bone, chest films should be made to discover possible metastases, because of the fact that the chest is the commonest site of secondary involvement in malignant bone tumors. The essential point in the radiological investigation of cases of suspected bone tumor is to determine whether the patient has or has not primary malignant disease of bone. This may well be approached by the following stages: First: Has the patient a tumor of bone? Second: Is the tumor benign or malignant? If malignant, is it primary or secondary?

A Study of Bone Tumors Among Ex-service Men

THE clinical incidence of tone sarcoma has been estimated at 1 case per 100,000 of the living population (1); accordingly, there are approximately 1,200 persons with tone sarcoma alive at any one time in the United States. With a living World War veterans' population estimated at 4,330,598, the number of cases of bone sarcoma among ex-service men is small. However, on account of the prevalence of other types of bone tumors, and the various inflammatory as well as degenerative diseases of bones, it is desirable that the differential diagnosis of the different forms of bone disease, as well as their proper treatment, be thoroughly understood. Thanks to the untiring efforts and labor of such men as Codman, Bloodgood, and Ewing, and as the result of the establishment of the Registry of Bone Sarcoma, data regarding this subject have been compiled and have been made available to the profession. The clinical, X-ray, and pathological research work done has resulted in a more scientific, a more rational as well as a more practical viewpoint regarding the classification, criteria for diagnosis, treatment, and the prognosis of bone tumors. The present study is the result of an analysis of the histories of 45 cases of bone tumor among ex-service men. Some of the patients incurred the disability during the World War, others soon after their discharge from the military service. These patients were treated in Government and civilian hospitals. There was a lack of uniformity of certain of the data in the clinical histories of these cases, so that much of the information was difficult of statistical treatment. Nevertheless, in spite of this fact, the study reveals a considerable amount of important information concerning the subject under consideration. Classification of Bone Tumors The classification and the criteria for diagnosis used in this study are those recommended by the Committee of Registry of Bone Sarcoma. A review of Table I shows that 38, or 84.5 per cent, of the total number were cases of osteogenic sarcoma; 5, or 11.1 per cent, were benign giant-cell tumors; there was one case of unclassified sarcoma (extra-periosteal), and one case of benign osteogenic tumor. The cases were also classified according to whether they were central or periosteal in origin. It was found that 2 of the bone tumors were central in origin, while 17 were periosteal in origin. In 26 cases the origin of the tumor was not recorded. Histopathology It was previously indicated that these 45 cases were under treatment in a number of Government and civilian hospitals, so that the classification of the bone tumor, the criteria for diagnosis, and the microscopic interpretation of the stained tissue specimens were varied, making it difficult to arrive at an agreement of the divergent opinion's for purposes of statistical analysis. However, in spite of these difficulties, the cases were properly classified, both according to clinical criteria and upon the basis of cell structure.