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Recurrent Tumors (recurrent + tumor)
Selected AbstractsMR colonography for the assessment of colonic anastomosesJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 1 2006Waleed Ajaj MD Abstract Purpose To assess colonic anastomoses in patients after surgical treatment by means of MR colonography (MRC) in comparison with conventional colonoscopy (CC). Materials and Methods A total of 39 patients who had previously undergone colonic resection and end-to-end-anastomosis were included in the study. MRI was based on a dark-lumen approach. Contrast-enhanced T1-weighted (T1w) three-dimensional (3D) images were collected following the rectal administration of water for colonic distension. The MRC data were evaluated by two radiologists. The criteria employed to evaluate the anastomoses included bowel wall thickening and increased contrast uptake in this region. Furthermore, all other colonic segments were assessed for the presence of pathologies. Results In 23 and 20 patients the anastomosis was rated to be normal by MRC and CC, respectively. In three patients CC revealed a slight inflammation of the anastomosis that was missed by MRI. A moderate stenosis of the anastomosis without inflammation was detected by MRC in five patients, which was confirmed by CC. In the remaining 11 patients a relevant pathology of the anastomosis was diagnosed by both MRC and CC. Recurrent tumor was diagnosed in two patients with a history of colorectal carcinoma. In the other nine patients inflammation of the anastomosis was seen in seven with Crohn's disease (CD) and two with ulcerative colitis. MRC did not yield any false-positive findings, resulting in an overall sensitivity/specificity for the assessment of the anastomosis of 84%/100%. Conclusion MRC represents a promising alternative to CC for the assessment of colonic anastomoses in patients with previous colonic resection. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc. [source] Retrograde endoscopic laser therapy and ureteroscopic surveillance for transitional cell carcinoma of the upper urinary tractINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2006SOICHI MUGIYA Objective:, To investigate the efficacy of endoscopic laser therapy and ureteroscopic surveillance for transitional cell carcinoma (TCC) of the upper urinary tract. Methods:, Tumors of the upper urinary tract were detected at ureteroscopy. After TCC was diagnosed by biopsy, retrograde endoscopic laser therapy was performed. Recurrent tumors were treated endoscopically and the patients were followed by ureteroscopic surveillance at 3- to 6-month intervals. Results:, Seven patients underwent ureteroscopic treatment. The tumor was grade 1 in five patients and grade 2 in two patients. The average tumor size was 1.3 cm. One patient with large, multifocal tumors died of metastatic disease, and one died of an unrelated cause. One patient requested nephroureterectomy after endoscopic treatment. The remaining four patients were followed up for a mean of 32 months after initial treatment. Each patient received an average of 5.3 ureteroscopic surveillance procedures while 3.3 recurrences on average were detected. Recurrence occurred in all the patients who showed normal radiographic findings. Urine cytology was also of little value in predicting tumor recurrence, except in one patient with carcinoma in situ. The recurrent tumors detected by ureteroscopy were successfully treated by repeated endoscopic procedures. After the follow up, three patients remained alive with no signs indicative of disease, but one patient with an initial grade 2 tumor died of recurrence after 30 months. Conclusions:, Given that ureteroscopic evaluation is essential for surveillance after endoscopic treatment of upper urinary tract TCC because of residual concern about recurrence, patients treated endoscopically should be recommended to undergo long-term endoscopic follow up. [source] Primary Pulmonary Artery Sarcoma: Surgical Management and Differential Diagnosis with Pulmonary Embolism and Pulmonary Valve StenosisJOURNAL OF CARDIAC SURGERY, Issue 6 2009Xiao-Peng Hu M.D. We present six cases of primary pulmonary artery sarcomas and discuss clinical features, differential diagnosis, surgical treatment, and outcome of the tumors. Methods: Between January 1994 and July 2008, six patients were identified with the disease during operation. Three patients were initially diagnosed with pulmonary valve stenosis, and two patients had a presumptive diagnosis of chronic pulmonary embolism. Two patients had simple or partial tumor resection. Four patients had radical tumor resection and homograft reconstruction of the pulmonary arteries. Results: Histological examinations showed five malignant mesenchymomas and one fibrosarcoma. One patient died of refractory pulmonary hypertension during operation. Two patients died 4 months postoperatively because of brain metastases. Two patients were alive for 3 and 9 months, respectively after the operation with recurrent tumor. One patient is alive even 2 years after resection with no signs of recurrence or metastasis. Conclusions: Because of similar clinical features, pulmonary artery sarcomas are often confused with other pulmonary vascular obstructive diseases. Computed tomography scanning and gadolinium-enhanced magnetic resonance imaging could be useful methods for differential diagnosis. The prognosis is very poor. The survival time after resection varies from several months to several years depending on the presence of recurrence or metastasis. Early diagnosis and radical surgical resection presents the only opportunity for a potential cure. [source] Intractable recurrent cervical cancer with pelvic bone involvement successfully treated with external hemipelvectomyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2008Junzo Hamanishi Abstract The indication of external hemipelvectomy for lateral recurrent cervical cancer involving the pelvic bone is controversial. We report the second longest surviving patient of recurrent cervical cancer successfully treated by external hemipelvectomy. A 38-year-old woman who had undergone conization for stage Ia1 cervical cancer six years earlier had severe right inguinal pain. A large multicystic recurrent tumor was identified in the right obturator region. After chemotherapy and chemoradiation, the tumor regressed, but soon relapsed. The patient's symptoms flared and the tumor was enlarged involving the right iliac bone. We performed right external hemipelvectomy with amputation of the right lower extremity, right iliac wing and ischiopubic bone. There was no major complication after the operation and the patient was discharged on postoperative day 48. After 27 months of follow-up, she has no complaints and is without evidence of recurrence. In selected cases of intractable lateral recurrent cervical cancer with pelvic bone involvement, relief from tumor-related pain and a possibility of prolonged survival can be expected by external hemipelvectomy. [source] Retroperitoneal schwannoma bearing at the right vaginal wallJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2004Takafumi Inoue Abstract Benign schwannoma commonly arises from schwann cells of the neural sheath. We report a rare case of retroperitoneal schwannoma bearing at the vaginal wall. The tumor was a 7 × 5 × 4-cm solid mass revealed using several image techniques and diagnosed to be a retroperitoneal tumor preoperatively. The tumor was tightly attached to the vaginal submucosal tissue, so complete surgical resection was difficult. However, an almost complete resection was carried out macroscopically using laparotomy. Histologic and immunohistochemical studies confirmed the diagnosis. The patient has been followed for 18 months after the operation, but there is no evidence of recurrent tumor. [source] Angiogenic and lymphangiogenic microvessel density in recurrent pleomorphic adenomaJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 8 2009Andresa B. Soares Background:, Recurrent pleomorphic adenoma (RPA) is an uncommon and challenging disease. The aim of this study was to determine if there is a difference between RPA and the pleomorphic adenoma (PA) without recurrence related to tumor blood and lymphatic vascularization. Moreover, we compared the microvessel density (MVD) between cell-rich areas (predominance of epithelial cells) and cell-poor areas (predominance of myxoid and chondroid areas) of the stroma of PA and RPA. In addition, immunohistochemical staining for the Ki-67 antigen was conducted simultaneously to evaluate cell proliferation in PA and RPA. Methods:, A total of 19 cases of PA and 24 cases of RPA, blood, and lymphatic vessels were analyzed by immunohistochemical technique using the antibodies CD34, CD105, D2-40, and Ki-67. Results:, Comparing no recurrent with recurrent tumor, no significant difference was found in terms of lymphatic vessel density, MVD, and proliferation index. When MVD and proliferation index were compared with different areas in cellular composition (cell-rich and cell-poor areas), there was a significant difference in PA, as well as in RPA. Conclusion:, This study shows that although RPA presents more aggressive clinical behavior than PA, there is no difference between tumor blood and lymphatic vascularization, suggesting that there is no correlation between vascularity and risk of recurrence. Furthermore, vascularized stroma in PA, as well as RPA, depends on the proportion of the cellular composition. [source] Astroblastoma: Immunohistochemical and ultrastructural study of distinctive epithelial and probable tanycytic differentiationNEUROPATHOLOGY, Issue 1 2006Toshihiko Kubota We report the clinicopathological findings of astroblastoma found in an 8-year-old girl who was subsequently treated for 11 years. The primary superficially circumscribed tumor was located in the frontoparietal lobe, while the recurrent and the second recurrent tumor were restricted to the same region 11 years later. The tumors obtained on these three occasions showed fundamentally the same histological, immunohistochemical and fine structural features. They exhibited astrocytic as well as ependymal tanycytic features with apparent epithelial cell lineage. The tumor cells showed typical features of astroblastoma comprising prominent perivascular pseudorosettes with remarkable vascular sclerosis. The immunohistochemical study revealed intensive positivity of GFAP, vimentin, epithelial membrane antigen (EMA), cytokeratin, connexin 26 and 32, desmocollin 1 and neuronal cadherin. The fine structure revealed divergent types of junctional complexes, some of which were connected with tonofilament bundles. Numerous microvilli protruded and basal lamina abutted on the tumor cell surface. We report these unique histological features, and stress that astroblastoma should be categorized as a specific type of neuroepithelial tumor. [source] Ovarian leiomyosarcoma: An autopsy case reportPATHOLOGY INTERNATIONAL, Issue 2 2000Michiyo Nasu Primary non-specific sarcoma of the ovary is extremely rare, and only 22 reported cases of pure leiomyosarcoma (LMS) are known to the authors. We present an autopsy case of a primary ovarian leiomyosarcoma in a 73-year-old woman. She had noticed an abdominal mass after difficulty in defecating for several months. The excision of tumor with bilateral salpingo-oophorectomy and hysterectomy was carried out. A diagnosis of pure leiomyosarcoma of the left ovary was made on pathological examination with immunohistochemistry. Adjuvant radio,chemotherapy was not given. At 18 months' follow up, abdomino-pelvic sonography revealed an abdominal tumor and hepatic metastasis. The patient died 3.5 years after the initial surgery. The post-mortem examination revealed a peritoneal recurrent tumor and extensive distant metastases of the liver, lungs, pancreas, gastric mucosa, muscle and skin. The prognosis of the ovarian LMS is poor from the pertinent literature. Several prognostic indicators on histology including mitotic activity, proliferative activity and p53 status of the tumor are discussed. [source] Weight loss predicts mortality after recurrent oral cavity and oropharyngeal carcinomas,CANCER, Issue 3 2002Thao V. Nguyen B.S.E. Abstract BACKGROUND The prognosis of patients with recurrent tumors of the head and neck generally is considered poor. Better prediction of outcomes can help physicians counsel patients about the merits of additional treatment. The TNM system, which was created for patients with primary tumors, may not provide optimal information. Anatomic staging systems traditionally have ignored symptom-based variables, such as weight loss, despite their known prognostic value. The objectives of this study were 1) to measure the prognostic impact of weight loss, 2) to evaluate the prognostic value of the TNM staging system, and 3) to create a practical staging system capable of predicting survival after patients develop recurrent tumors of the oral cavity and oropharynx. METHODS A retrospective chart review was used to identify an inception cohort of patients seeking treatment for recurrent, persistent, and second primary tumors of the oral cavity and oropharynx at the University of Washington. The primary outcome variable was 1-year survival. RESULTS The 1-year survival rate for the cohort (n = 97 patients) was 38%, with a median survival of 0.7 years. Multivariate analysis (Cox regression) identified weight loss, previous radiation to the head and neck, and TNM stage of the recurrent tumor as factors that had a substantial impact on mortality. A second multivariate technique called conjunctive consolidation was used to determine the relative quantitative impact of each variable on survival and to develop a clinical staging system. Weight loss and previous radiation had the greatest influence, and the use of just these two variables resulted in a three-tiered staging system with 1-year survival rates of 62% (16 of 26 patients), 44% (18 of 41 patients), and 10% (3 of 30 patients). In contrast, the TNM staging system produced survival rates of 60% (patients with Stage I disease), 67% (patients with Stage II disease), 32% (patients with Stage III disease), and 32% (patients with Stage IV disease). CONCLUSIONS The authors found substantial variation in survival after patients developed recurrent tumors of the oral cavity and oropharynx. Two readily available clinical variables,weight loss and previous radiation,were combined to create a clinically practical staging scheme with more prognostic power than the TNM staging system. Until molecular markers can reliably used be to predict outcomes, greater attention needs to be given to the utility of simple, inexpensive, and surprisingly powerful clinical variables. Cancer 2002;95:553,62. © 2002 American Cancer Society. DOI 10.1002/cncr.10711 [source] 4362: Iodine-125 orbital irradiation : improvement of cosmetic results for patients needing postenucleation irradiationACTA OPHTHALMOLOGICA, Issue 2010C LEVY-GABRIEL Purpose Patients enucleated for malignant intraocular tumors (as retinoblastoma or uveal melanoma) that have extrascleral extension and/or optic nerve resection margin involvement, are at risk of orbital recurrence. These enucleated orbits were previously treated with external beam radiotherapy which induced late sequelae, in particular facial atrophy. Iodine 125 Orbital brachytherapy (BRT) was first realised in 1983 in South Africa as a technique to irradiate the content of the orbit while minimizing the dose to the surrounding bone and eyelids. We report our experience since 2000 with this technique Methods Six nylon tubes containing 125 I seeds were implanted though the eyelids around the periphery of the orbit. Each contained a metal gutter that screened the outer part of the seeds from the bony orbit. A seventh unscreened tube was placed in the center and a golden plaque with 125 I seeds on its inner surface was secured beneath the eyelid. The reference dose around the target was 45 Gy for retinoblastoma and 60 Gy for uveal melanoma Results Since 2000 13 patients underwent BRT : 9 retinoblastomas (median follow up 36 months, 1 child died of craniospinal metastasis), 3 uveal melanomas (median follow up 55 months, 1 patient developed a metastatic disease), and 1 medulloepithelioma (median follow up 45 months). No patient developed orbital recurrence after BRT. Regarding cosmesis, results were much more acceptable than with other forms of irradiation with a normal size prothesis adaptation Conclusion 125 I orbital brachytherapy is an effective method of irradiating the orbit to prevent recurrent tumor after enucleation with better cosmesis results than with other forms of irradiation, especially in case of children Commercial interest [source] Recurrent Clear Cell Hidradenoma of the FootDERMATOLOGIC SURGERY, Issue 7 2000Ryan Will BA Background. Clear cell hidradenoma is an uncommon neoplasm without established optimal treatment. Objective. Using Mohs micrographic surgery, a recurrent clear cell hidradenoma of the right foot was treated. Methods. Case report and literature review. Results. Two stages of Mohs micrographic surgery and subsequent repair successfully treated the recurrent clear cell hidradenoma. No recurrence of the neoplasm has been observed at 11 months follow-up. Conclusion Optimal treatment of clear cell hidradenoma is unestablished. Adequate primary local excision is essential. Mohs micrographic surgery should be considered for treatment, especially on recurrent tumors in critical locations. [source] Nuclear factor-,B expression as a novel marker of radioresistance in early-stage laryngeal cancer,,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2010Kenji Yoshida MD Abstract Background. The aim of this study was to evaluate the significance of nuclear factor-kappa B (NF-,B) expression as a marker of radioresistance in early-stage laryngeal cancer. Methods. Thirty-five patients with local recurrence and 70 case-matched patients without local recurrence were entered in this study. NF-,B expression was compared with Bcl-2 and epidermal growth factor (EGF) receptor expression by immunohistochemistry, using pretreatment biopsy specimens. The prognostic value of NF-,B was also evaluated. Twenty-nine recurrent tumors were compared with pretreatment tumors. Results. NF-,B expression in pretreatment tumors significantly correlated with local tumor control (p = .01), but bcl-2 and EGF receptor expression did not. Only NF-,B expression showed prognostic significance for local tumor control in both univariate and multivariate analyses (p = .008 and .04, respectively). NF-,B expression was markedly enhanced in 23 of 29 (80%) recurrent tumors. Conclusion. NF-,B expression may be a novel marker of radioresistance in early-stage laryngeal cancer. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [source] Is central neck dissection necessary for the treatment of lateral cervical nodal recurrence of papillary thyroid carcinoma?HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2007Jong-Lyel Roh MD Abstract Background: Although the pattern of cervical lymph node metastases from papillary thyroid carcinoma (PTC) has been described, little is known about the pattern of lateral cervical nodal recurrence. The aim of this study was to establish the optimal strategy for neck dissection in patients who underwent reoperation for lateral cervical recurrence of PTC. Methods: We reviewed the records of 22 patients who underwent neck dissection for lateral nodal recurrence of thyroid cancer between 2002 and 2004. Eight patients had thyroid remnants or recurrent tumors in the bed and 6 had undergone lateral neck dissection prior to referral. Patients underwent comprehensive dissection of the posterolateral and ipsilateral (n = 10) or bilateral (n = 12) central neck. The pattern of nodal recurrence and postoperative morbidity were analyzed. Results: All patients had lateral compartment involvement, 91% at mid-lower, 45% at upper, and 18% at posterior sites. Central nodes were involved in 86% of patients: 82% at ipsilateral paratracheal, 32% at pretracheal, 27% at superior mediastinal, and 2 patients at contralateral sites. Skip lateral recurrence with no positive central nodes was rarely observed (14%). Postoperative vocal cord palsy (n = 1) and hypoparathyroidism (n = 5) developed only in patients undergoing bilateral central compartment dissection. Conclusions: The inclusion of comprehensive ipsilateral central and lateral neck dissection in the reoperation for patients with lateral neck recurrence of PTC is an optimal surgical strategy. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source] Enhancing the outcome of free latissimus dorsi muscle flap reconstruction of scalp defectsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2004FRCS(C), Joan E. Lipa MD Abstract Background. Reconstruction of scalp and calvarial defects after tumor ablation frequently requires prosthetic cranioplasty and cutaneous coverage. Furthermore, patients often have advanced disease and receive perioperative radiotherapy. We evaluated the complications of scalp reconstruction with a free latissimus dorsi muscle flap in this setting. Methods. The complications and the oncologic and aesthetic outcomes of six consecutive scalp reconstructions with a free latissimus dorsi muscle flap and skin graft in five patients with advanced cancer were retrospectively evaluated. Patient, tumor, defect, reconstructive, and other treatment characteristics were reviewed. Reconstructive and perioperative techniques intended to improve flap survival and aesthetic outcome and reduce complications in these patients. Results. All patients (52,76 years old) had recurrent tumors (sarcoma, melanoma, or squamous cell carcinoma) and received postoperative radiotherapy. The mean scalp defect size was 367 cm2, and partial-thickness or full-thickness calvarial resection was required in all six cases. No vein grafts were needed. The mean follow-up period and disease-free survival time were 18 and 13 months, respectively. Three patients died of their disease, and two survived disease free. There were no flap failures or dehiscences. Complications consisted of donor site seroma in two patients; partial skin graft loss in one patient; and radiation burns to the flap, face, and ears in one patient. Scalp contour and aesthetic outcome were very good in all cases except for the one case with radiation burns. Conclusions. Good outcomes were achieved using a free latissimus dorsi muscle flap with a skin graft for flap reconstruction in elderly patients with advanced recurrent cancers who received perioperative radiotherapy. Several technical aspects of the reconstruction technique intended to enhance the functional and aesthetic outcome and/or reduce complications were believed to have contributed to the good results. © 2004 Wiley Periodicals, Inc. Head Neck26: 46,53, 2004 [source] Malignant transformation of supratentorial clear cell ependymomaNEUROPATHOLOGY, Issue 3 2009Masanori Kurimoto Recurrence of clear cell ependymoma is not a rare condition, but malignant transformation of clear cell ependymoma has not yet been well presented. The authors report a 44-year-old man who presented with progressive right hemiparesis. A brain tumor in the left frontal premotor area was removed and an initial pathological diagnosis of oligodendroglioma was made. The tumor recurred 4 months later, and reoperation of the tumor and adjuvant local radiotherapy were performed. The patient subsequently underwent surgical removal of recurrent tumors on another four occasions (6 times in total) during a period of 11 years and finally died of the original disease. Histopathological studies of all surgical and autopsy specimens were carried out. The first and second surgical specimens did not contain any ependymal rosettes or pseudorosettes, and thus a diagnosis of oligodendroglioma was made. However, the third surgical specimen showed pseudorosettes. At this time, the tumor had an ultrastructural appearance compatible with ependymoma. Thereafter, the recurrent tumors showed anaplastic features such as nuclear pleomorphisms and necrosis with pseudopallisading. The autopsy specimens resembled a feature of glioblastoma but the tumor was sharply demarcated from the surrounding parenchyma. [source] Malignant transformation of atypical endometrial hyperplasia after progesterone therapy showing germ-cell tumor-like differentiationPATHOLOGY INTERNATIONAL, Issue 6 2004Masanori Yasuda A 31-year-old woman was treated for atypical endometrial hyperplasia (AEH) with high-dose medroxyprogesterone acetate (MPA) therapy to preserve fertility. The AEH was found by repeated cytologic and histologic examinations to have completely disappeared with the therapy, but 3 years after her last follow up she required emergency surgery to treat severe genital bleeding. The hysterectomied uterus consisted mostly of poorly differentiated adenocarcinoma, G3 endometrioid type. Minor AEH was present in the exophytic area, in which some glands were cystically dilated. Part of the AEH had transformed into other histologic features with germ-cell-like differentiation, demonstrated by immunohistochemical positive reaction of placental alkaline phosphatase, alpha-fetoprotein, and human chorionic gonadotrophin. Recurrent AEH had undergone malignant transformation, resulting in the development of well- and poorly differentiated adenocarcinoma and tumor exhibiting germ-cell-like differentiation. The patient died of a massive tumor extension 7 months after surgery. The AEH before MPA therapy and the recurrent tumors had genetically different characteristics based on evidence of a loss of heterozygosity, detected at D8S1132 (chromosomal locus, 8q22.1) in the latter but not in the former, by analysis of genetic alterations using microsatellite markers. [source] Intracavitary cisplatin therapy for pediatric malignancies,PEDIATRIC BLOOD & CANCER, Issue 3 2010Howard M. Katzenstein MD Abstract Background Local control is essential for the successful treatment of pediatric solid tumors. Complete excision is often not possible and local control therapies are limited. Intracavitary cisplatin (IC-CDDP) may be utilized to supplement local control. The aim of the study was to determine the toxicity and efficacy of locally instilled intracavitary cisplatin in patients with recurrent tumors in closed body cavities. Procedure From 2001 to 2009, 12 patients (1,20 years) with recurrent or unresectable malignant tumors were treated with IC-CDDP. Nine had pulmonary lesions. Three patients had abdominal tumors. CDDP (200,mg/m2) was instilled by chest tube or Tenckhoff catheter. Patients were shifted every 15,30,min to allow distribution. After 4,hr, residual was drained by gravity. In 10/13 courses, sodium thiosulfate (STS) was administered to prevent nephrotoxicity. Three other patients received amifostine. Results Malignant pleural effusions resolved in 5/7 patients. This response was temporary in three patients. No patients had ascites prior to treatment. Three patients are alive and disease-free, 18 months, 4 years, and 6 years from treatment. They also had surgery and chemotherapy. Transient renal toxicity was noted in most patients. One patient, treated with amifostine, had persistent renal dysfunction. Conclusions IC-CDDP was effective in treating malignant pleural effusions and may be a palliative option for refractory disease. Long-term survival was achieved in two patients, treated at first diagnosis. The benefit of IC-CDDP in these patients is difficult to assess. Renal dysfunction is usually mild, and typically resolves, but warrants preventive measures with IC-CDDP therapy. Pediatr Blood Cancer. 2010;55:452,456. © 2010 Wiley-Liss, Inc. [source] Autologous stem cell transplantation as treatment modality in a patient with relapsed pancreatoblastoma,PEDIATRIC BLOOD & CANCER, Issue 3 2010Amir Ali Hamidieh MD Abstract Pancreatoblastoma (PB) is a rare malignant neoplasm of the pancreas, which occurs mostly during childhood. Presently, the optimal treatment strategy is neither clear nor uniform for patients in advanced stages, in particular those with metastasis, inoperable, or recurrent tumors. To our knowledge, until now, only one patient with PB has been treated with hematopoietic stem cell transplantation (HSCT) following aggressive chemotherapy and surgical resection. Here we report the second case of PB who was treated with aggressive chemotherapy combined with autologous peripheral blood stem cell transplantation. Pediatr Blood Cancer. 2010;55:573,576. © 2010 Wiley-Liss, Inc. [source] Chondrosarcomas of the Jugular ForamenTHE LARYNGOSCOPE, Issue 10 2008Mario Sanna MD Abstract Objectives/Hypothesis: Chondrosarcomas of the jugular foramen are extremely rare tumors. Our review of the literature revealed eleven previously reported cases. The aim of this study is to describe the presenting symptoms, radiographic findings, operative procedures, and postoperative outcome of five histologically confirmed cases of chondrosarcomas arising from the jugular foramen. A review of the literature is also presented. Study Design: Retrospective study of an quaternary referral otology and skull base private center. Methods: Five cases of surgically treated and pathologically confirmed jugular foramen chondrosarcomas were identified. The follow-up of the series ranged from 23 to 42 months (mean, 32.8 ± 7.7 months). Results: A single stage procedure was adopted in all the cases. Two patients underwent type A infratemporal approaches, one patient underwent a transotic approach extending to the neck with ligature of the internal jugular vein, one patient underwent a petro-occipital transigmoid approach, and one patient underwent a combined petro-occipital transigmoid,transotic approach. Gross total tumor removal was achieved in all patients. The most common complications were lower cranial nerve deficits. To date, no recurrence or residual tumors have been observed at radiological controls. Conclusions: We believe that the primary treatment for chondrosarcomas of the jugular foramen is gross total surgical resection of the tumor. It is our philosophy to reserve postoperative radiotherapy for patients with histologically aggressive tumors, as well as in cases with subtotal resection and recurrent tumors. [source] Insulin-like growth factor binding protein-3 (IGFBP-3) in the prostate and in prostate cancer: Local production, distribution and secretion pattern indicate a role in stromal-epithelial interactionTHE PROSTATE, Issue 11 2008Petra Massoner Abstract Background Insulin-like growth factor binding protein 3 (IGFBP-3) exerts inhibitory and proapoptotic effects on prostate cancer cells. Serum levels of IGFBP-3 were found to be associated with the risk of prostate cancer, but the data are still inconclusive. We present a detailed analysis of the expression and localization of IGFBP-3 in the prostate and a comparison with its expression pattern in tumors. Methods Expression and localization of IGFBP-3 were analyzed in cellular models and tissue by real-time RT-PCR, ELISA, immunohistochemistry, and immunofluorescence. Results All cell types of a panel of benign epithelial, stromal and tumor prostate cells expressed IGFBP-3. Significantly higher expression levels were registered in stromal cells. TGF-, stimulation boosted IGFBP-3 levels 60-fold in stromal cells. The pattern of expression was confirmed in microdissected tissue samples. Protein levels measured by ELISA paralleled the mRNA levels and more than 80% of IGFBP-3 was secreted. On tissue immunostaining, IGFBP-3 was found to be mainly located in the epithelium. The pattern suggested secretion of IGFBP-3, which was confirmed in prostate tissue cultured ex vivo and the ejaculate of vasectomized men. IGFBP-3 levels were increased in primary tumors but did not differ from benign epithelium in metastases and local recurrent tumors. Conclusions We registered a significant local production of IGFBP-3 in the prostate, which may well override the effect of protein entering from blood. The stroma,particularly reactivated stroma,is the main source of IGFBP-3 in the prostate, suggesting that this peptide acts as a mediator of stromal-epithelial interactions. Prostate 68: 1165,1178, 2008. © 2008 Wiley-Liss, Inc. [source] Unique Molecular Characteristics of Pediatric Myxopapillary EpendymomaBRAIN PATHOLOGY, Issue 3 2010Valerie N. Barton Abstract Myxopapillary ependymoma (MEPN) generally can be cured by gross total surgical resection and usually manifest a favorable prognosis. However, surgery is less curative in tumors that are large, multifocal or extend outside the thecal sac. Late recurrences may occur, particularly in pediatric patients. The role of adjuvant therapy is unclear in the clinical management of recurrent tumors. Clinical trial design requires a better understanding of tumor biology. Unique molecular features of MEPN were investigated by using microarray technology to compare the gene expression of five pediatric MEPN to 24 pediatric intracranial ependymoma (EPN). The upregulation of three genes of interest, homeobox B13 (HOXB13), neurofilament, light polypeptide (NEFL) and PDGFR,, was further studied by immunohistochemistry in a larger cohort that included adult MEPN and EPN specimens. Protein expression in MEPN was compared to subependymoma, spinal EPN, intracranial EPN and normal fetal and adult ependyma. Immunoreactivity for HOXB13, NEFL and PDGFR, was strongest in MEPN and virtually absent in subependymoma. Spinal and intracranial EPN generally expressed weak or focal staining. MEPN manifests unique gene and protein expression patterns compared to other EPNs. Aberrant expression of HOXB13 suggests possible recapitulation of developmental pathways in MEPN tumorigenesis. PDGFR, may be a potential therapeutic target in recurrent MEPN. [source] Aberrant Hypermethylation of p14ARF and O6 -methylguanine-DNA Methyltransferase Genes in Astrocytoma ProgressionBRAIN PATHOLOGY, Issue 1 2007Takao Watanabe MD The aim of the present study was to elucidate genetic alterations that are critically involved in astrocytoma progression. We characterized 27 World Health Organization grade II fibrillary astrocytomas which later underwent recurrence or progression, paying specific attention to the CpG island methylation status of critical growth regulatory genes. p14ARF and O6 -methylguanine-DNA methyltransferase (MGMT) hypermethylation represented frequent events (26% and 63%, respectively), which were mutually exclusive except in one case, with alternate or simultaneous methylation of these two genes occurring in 85% of our tumor series. Seventeen tumors (63%) contained TP53 mutations, which were closely related to the presence of MGMT methylation. Methylation of the p21Waf1/Cip1, p27Kip1 and p73 genes and homozygous deletion of the p16INK4a, p15INK4b and p14ARF genes were not detected in any of the primary low-grade tumors. The presence of p14ARF methylation at first biopsy was associated with shorter patient survival, whereas the presence of MGMT methylation carried a better clinical outcome after salvage therapy. Examination of 20 cases whose histological data for recurrent tumors were available revealed that malignant progression occurred in all of the tumors with p14ARF methylation but less frequently (50%) in the lesions with MGMT methylation. On analysis of their respective recurrent tumors, five of six patients whose primary low-grade tumors carried p14ARF methylation exhibited homozygous co-deletions of the p14ARF, p15INK4b and p16INK4a genes, which were restricted to glioblastoma as the most malignant end point. Our findings suggest that p14ARF hypermethylation and MGMT hypermethylation constitute distinct molecular pathways of astrocytoma progression, which could differ in biological behavior and clinical outcome. [source] Expression and structure of interleukin 4 receptors in primary meningeal tumorsCANCER, Issue 10 2005Sachin Puri M.Sc. Abstract BACKGROUND It was reported previously that malignant human tumors, like glioma and medulloblastoma, express high-density interleukin (IL-4) receptor mRNA and protein. Because IL-4 receptors (R) are sensitive targets for targeted therapeutics, knowledge of the expression of these receptors in other central nervous system tumors is of great interest. In this study, the authors examined the expression and subunit composition of IL-4R complex in primary human meningiomas. METHODS Reverse transcription-polymerase chain reaction (RT-PCR) analysis for IL-13R,1, IL-4R, and IL-2R,c was performed on total RNA extracted from 35 meningiomas and a normal human brain tissue sample. Results were confirmed in nine randomly selected tumors by quantitative real-time PCR and in situ immunofluorescence assay. RESULTS Transcripts for the IL-4R, and IL-13R,1 chains were overexpressed in meningiomas compared with normal brain tissue. The levels of IL-4R, mRNA appeared to be higher compared with the levels of IL-13R,1 mRNA. The results also showed that tumors with higher disease grade tended to have increased mRNA expression for the IL-4R, chain. This IL-4R, mRNA overexpression appeared to be more frequent in younger patients (age < 37 years). The transcripts for IL-2R,c chain were not detected in any of the tumor samples or in normal brain tissue. Quantitative real-time PCR confirmed the results of the RT-PCR analysis. Meningiomas also demonstrated a bright immunofluorescent staining for the IL-4R, and IL-13R,1 chains but no staining for IL-2R,c. CONCLUSIONS Expression of the IL-4R, and IL-13R,1 chains and absence of IL-2,c expression established that meningiomas expressed type II IL-4Rs. These receptors may serve as a target for cytotoxin/immunotoxin therapy in patients with meningioma who are not amenable to surgical resection or for recurrent tumors. Cancer 2005. © 2005 American Cancer Society. [source] Weight loss predicts mortality after recurrent oral cavity and oropharyngeal carcinomas,CANCER, Issue 3 2002Thao V. Nguyen B.S.E. Abstract BACKGROUND The prognosis of patients with recurrent tumors of the head and neck generally is considered poor. Better prediction of outcomes can help physicians counsel patients about the merits of additional treatment. The TNM system, which was created for patients with primary tumors, may not provide optimal information. Anatomic staging systems traditionally have ignored symptom-based variables, such as weight loss, despite their known prognostic value. The objectives of this study were 1) to measure the prognostic impact of weight loss, 2) to evaluate the prognostic value of the TNM staging system, and 3) to create a practical staging system capable of predicting survival after patients develop recurrent tumors of the oral cavity and oropharynx. METHODS A retrospective chart review was used to identify an inception cohort of patients seeking treatment for recurrent, persistent, and second primary tumors of the oral cavity and oropharynx at the University of Washington. The primary outcome variable was 1-year survival. RESULTS The 1-year survival rate for the cohort (n = 97 patients) was 38%, with a median survival of 0.7 years. Multivariate analysis (Cox regression) identified weight loss, previous radiation to the head and neck, and TNM stage of the recurrent tumor as factors that had a substantial impact on mortality. A second multivariate technique called conjunctive consolidation was used to determine the relative quantitative impact of each variable on survival and to develop a clinical staging system. Weight loss and previous radiation had the greatest influence, and the use of just these two variables resulted in a three-tiered staging system with 1-year survival rates of 62% (16 of 26 patients), 44% (18 of 41 patients), and 10% (3 of 30 patients). In contrast, the TNM staging system produced survival rates of 60% (patients with Stage I disease), 67% (patients with Stage II disease), 32% (patients with Stage III disease), and 32% (patients with Stage IV disease). CONCLUSIONS The authors found substantial variation in survival after patients developed recurrent tumors of the oral cavity and oropharynx. Two readily available clinical variables,weight loss and previous radiation,were combined to create a clinically practical staging scheme with more prognostic power than the TNM staging system. Until molecular markers can reliably used be to predict outcomes, greater attention needs to be given to the utility of simple, inexpensive, and surprisingly powerful clinical variables. Cancer 2002;95:553,62. © 2002 American Cancer Society. DOI 10.1002/cncr.10711 [source] Expression of estrogen receptor, progesterone receptor, and insulin-like growth factor receptor-1 and of MIB-1 in patients with recurrent pleomorphic adenoma of the parotid glandCANCER, Issue 8 2002Afina S. Glas M.D. Abstract BACKGROUND Patients with recurrent pleomorphic adenomas of the parotid gland are difficult to manage without considerable risk of facial nerve injury. The prognostic significance of progesterone receptor (PR) and estrogen receptor (ER) reported in these adenomas was evaluated in patients with recurrent pleomorphic adenomas, comparing the results in a group of patients with primary adenomas without recurrences during 10 years of follow-up. METHODS Paraffin embedded tumor samples from 52 patients with recurrent pleomorphic adenoma of the parotid gland were collected and stained immunohistochemically. Expression of PR, ER, Ki-67 antigen, and insulin-like growth factor receptor-1 (IGFR-1) was analyzed in resected samples of recurrent tumors and was compared with samples from a control group of patients with primary pleomorphic adenoma. RESULTS A difference (P < 0.05) in the type of tumor was observed between the recurrent group (more cell-poor variants) and the control group. ER expression was low in both groups (19% and 17%, respectively), but immunoreactivity for ER was higher (48%) in normal parotid gland tissue. PR expression in the recurrent group (96%) was higher compared with PR expression in the control group (61%; P < 0.001). PR expression and IGFR-1 expression were correlated weakly (correlation coefficient = 0.660; P = 0.053) in the recurrent group. The expression of growth fraction (Ki-67 score) and IGFR-1 was similar in both groups but was more extensive compared with normal parotid gland tissue. CONCLUSIONS PR seems to be a prognostic factor in recurrent pleomorphic adenoma of the parotid gland. The PR pathway can be considered a potential target for hormone treatment in patients with these recurrent adenomas. Cancer 2002;94:2211,16. © 2002 American Cancer Society. DOI 10.1002/cncr.10445 [source] Loss of E-cadherin expression resulting from promoter hypermethylation in oral tongue carcinoma and its prognostic significanceCANCER, Issue 2 2002Hsiao Wen Chang Ph.D. Abstract BACKGROUND E-cadherin is expressed on the surface of normal epithelial cells. Loss of E-cadherin expression has been found in cancers and is postulated to facilitate tumor cell dissociation and metastasis. This study evaluated the role of promoter dense methylation in the downregulation of E-cadherin expression in oral tongue carcinoma. METHODS E-cadherin expression of 109 oral tongue carcinomas (93 primary tumors, 7 locally recurrent tumors, and 9 metastatic lymph nodes) was evaluated by immunohistochemical staining of tumor tissues. The methylation status of the CpG islands at the promoter region of E-cadherin which flanked five HpaII (methylation sensitive restriction enzyme) digestion sites were evaluated by methylation sensitive polymerase chain reaction in 86 tumors (70 primary tumors, 7 locally recurrent tumors, and 9 metastatic lymph nodes). RESULTS Underexpression of E-cadherin was found in 83% of primary tumors, 86% of recurrent tumors, and 89% of nodal metastases. Hypermethylated E-cadherin promoter was found in 64% of primary tumors, 71% of recurrent tumors, and 67% of nodal metastases. Downregulation of E-cadherin expression was found to be related to promoter hypermethylation. Consistently weak expression of E-cadherin by promoter hypermethylation was observed in primary tumors, their corresponding metastatic lymph nodes, and recurrent tumors. Downregulation of E-cadherin expression was a significant poor prognostic factor for survival. CONCLUSIONS Methylation of CpG sites at the promoter region played a key role in the inhibition of E-cadherin expression in both primary oral tongue carcinomas and their corresponding recurrences and nodal metastases. The resulting downregulation of E-cadherin expression had adverse effects on the prognosis of patients who were treated by primary surgery. Cancer 2002;94:386,92. © 2002 American Cancer Society. [source] | |||||||||||||||||||||||||