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Clinical Stage I (clinical + stage_i)
Selected AbstractsSingle-Institution Experience in the Management of Patients with Clinical Stage I and II Cutaneous Melanoma: Results of Sentinel Lymph Node Biopsy in 240 CasesDERMATOLOGIC SURGERY, Issue 11 2005Jordi Rex MD Background. Lymphatic mapping and sentinel lymph node biopsy (SLNB) has been developed as a minimally invasive technique to determine the pathologic status of regional lymph nodes in patients without clinically palpable disease and incorporated in the latest version of the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma. Objective. To analyze the results of SLNB and the prognostic value of the micrometastases and the pattern of early recurrences in patients according to sentinel lymph node (SLN) status. Method. Patients with cutaneous melanoma in stages I and II (AJCC 2002) who underwent lymphatic mapping and SLNB from 1997 to 2003 were included in a prospective database for analysis. Results. The rate of identification of the SLN was 100%. Micrometastases to SLN were found in 20.8% of patients. The rate of SLN micrometastases increased according to Breslow thickness and clinical stage. Breslow thickness of 0.99 mm was the optimal cutpoint for predicting the SLNB result. Twenty-four patients (12.3%) developed a locoregional or distant recurrence at a median follow-up of 31 months. Recurrences were more frequent in patients with a positive SLN. Among patients who had a recurrence, those with a positive SLN were more likely to have distant metastases than those with negative SLN. Nodal recurrences were more frequent in patients with a negative SLN compared with those with a positive SLN. Conclusions. The status of the SLN provides accurate staging for identifying patients who may benefit from further therapy and is the most important prognostic factor of relapse-free survival. THIS WORK WAS SUPPORTED BY GRANTS FROM FONDO DE INVESTIGACIONES SANITARIAS (98/0449), BECA DE FORMACIÓ DE PERSONAL INVESTIGADOR (2001/FI0757), AND THE RED ESPÑOLA DE CENTROS DE GENÓMICA DEL CÁNCER (C03/10). [source] Lymphoproliferative disorders in autoimmune diseases in Japan: Analysis of clinicopathological features and Epstein-Barr virus infectionINTERNATIONAL JOURNAL OF CANCER, Issue 3 2004Yoshihiko Hoshida Abstract Lymphoproliferative disorders (LPD) occasionally develop in individuals with immune deficiencies such as immunosuppressive conditions and autoimmune diseases (AID). In our study, the clinicopathologic features and virus status were analyzed in 53 cases with LPD developing in rheumatoid arthritis (RA) and other AID. AID in only 4 of 53 patients had been treated with some sort of immunosuppressive therapy, including methotrexate. Median age at the diagnosis of LPD in AID was 60 years old with marked female predominance (M/F = 0.4). The median interval between the onset of AID and LPD development was 45 months, and longer in RA patients than in other AID (p < 0.01). The primary site of lymphoma was nodal in 21 cases and extra-nodal in 24, with clinical Stage I in 17, II in 5, III in 13, and IV in 13. Immunohistochemistry showed that 39 cases were B cell type, 10 were T cell type and 4 were Hodgkin lymphoma (HL). Then majority of B cell cases were diffuse large B cell lymphomas, and 2 were diffuse polymorphic type. EBER-1 in situ hybridization for Epstein-Barr virus (EBV) showed positive signals in tumor cells in 16 of 53 (30.2%) cases. The EBV-positive rate in T cell LPD (70%) was much higher than that in B cell LPD (12.8%) (p < 0.01). All 4 cases of HL were EBV-positive. Immunohistochemistry showed a latency II pattern of EBV infection (LMP-1+ and EBNA-2,). Five-year overall survival rate was 33%. Multivariate analysis showed that only type of AID was an independent factor for survival of patients, i.e., LPD in RA showed the most favorable prognosis. In conclusion, LPD in AID generally shared common features with sporadic LPD except for a much higher EBV-positive rate in T cell LPD. © 2003 Wiley-Liss, Inc. [source] PREDICTIVE VALUE OF ENDOSCOPY AND ENDOSCOPIC ULTRASONOGRAPHY FOR REGRESSION OF GASTRIC DIFFUSE LARGE B-CELL LYMPHOMAS AFTER HELICOBACTER PYLORI ERADICATIONDIGESTIVE ENDOSCOPY, Issue 4 2009Akira Tari Background:, Some gastric diffuse large B-cell lymphomas have been reported to regress completely after the successful eradication of Helicobacter pylori. The aim of this study was to investigate the clinical characteristics of gastric diffuse large B-cell lymphomas without any detectable mucosa-associated lymphoid tissue (MALT) lymphoma that went into complete remission after successful H. pylori eradication. Patients and Methods:, We examined the effect of H. pylori eradication in 15 H. pylori -positive gastric diffuse large B-cell lymphoma patients without any evidence of an associated MALT lymphoma (clinical stage I by the Lugano classification) by endoscopic examination including biopsies, endoscopic ultrasonography, computed tomography, and bone marrow aspiration. Results:,H. pylori eradication was successful in all the patients and complete remission was achieved in four patients whose clinical stage was I. By endoscopic examination, these gastric lesions appeared to be superficial. The depth by endoscopic ultrasonography was restricted to the mucosa in two patients and to the shallow portion of the submucosa in the other two patients. All four patients remained in complete remission for 7,100 months. Conclusion:, In gastric diffuse large B-cell lymphomas without a concomitant MALT lymphoma but associated with H. pylori infection, only superficial cases and lesions limited to the shallow portion of the submucosa regressed completely after successful H. pylori eradication. The endoscopic appearance and the rating of the depth of invasion by endosonography are both valuable for predicting the efficacy of H. pylori eradication in treating gastric diffuse large B-cell lymphomas. [source] Unusual histological variants of cutaneous malignant melanoma with some clinical and possible prognostic correlationsJOURNAL OF CUTANEOUS PATHOLOGY, Issue 9 2005Franco Rongioletti We present a review of most of the unusual histological variants of cutaneous melanoma and describe their immunohistochemical features, associate clinical findings, and possible behavior related to the histological subtype. In addition, we propose their classification into four groups corresponding to the (1) architectural patterns; (2) cytologic features; (3) stromal changes; and (4) the possible association of these findings (i.e. architectural + cytologic features). Although most of these unusual variants have the same prognosis as conventional melanomas, with Breslow thickness and ulceration, being the most important predictor of survival in clinical stage I, some of them have a peculiar biologic behavior that the clinicians and the dermatopathologists should know in order to give melanoma patients all educational information available. [source] Vertical partial hemilaryngectomy with reconstruction by false cord imbricationANZ JOURNAL OF SURGERY, Issue 5 2010Kuauhyama Luna-Ortiz Abstract Background:, To evaluate global survival, disease-free period, complications, evolution and function in vertical partial hemilaryngectomy (VPHL) plus reconstruction with false cord. Methods:, Descriptive and retrospective study. In aertiary care medical center in Mexico City. Eight patients with early diagnosis of early glottic cancer (T1 and T2), treated with VPHL plus reconstruction with false cord imbrication. Results:, Fifty percent of the patients were clinical stage I, 37.5% stage II and 12.5% stage III. Nasogastric tube was not placed and oral feeding was reinitiated within 3 days on average. Tracheostomy was removed after an average of 2.1 days. Average hospital stay was 3.3 days. Average of the PSS-HNC (Performance Status for Head and Neck Cancer) and Karnofsky Performance Status evaluation was 91 to 97 and 100 at 1 year of evaluation. Voice evaluation demonstrated normal voice in 87.5% of patients. Intensity was below normal with improvement on annual evaluation. Global survival was 100% and disease-free period was 71% at 3 years. Conclusions:, VPHL with reconstruction by false cord imbrication is an excellent therapeutic option for early glottic cancers. Multiple functional advantages are demonstrated without sacrificing oncological control as well as providing an audible and intelligible voice. In cases of recurrence, various management options are available. [source] Is head and neck melanoma a distinct entity?BRITISH JOURNAL OF DERMATOLOGY, Issue 4 2006A clinical registry-based comparative study in 5702 patients with melanoma Summary Background, The head and neck region is more heavily exposed to ultraviolet (UV) radiation than any other body site. Therefore, cutaneous malignant melanoma (CMM) of the head and neck area is proposed to have notable differences from melanoma at other body sites regarding clinicopathological features and survival of patients. Objectives, The present retrospective study based on clinical registry data aims to compare clinical features and prognostic factors of head and neck melanoma (HNM) vs. melanoma at other anatomical regions (MOR) in order to detect differences which may be associated to the mode of sun exposure. Methods, The clinical records and histopathological findings of 844 patients with clinical stage I and II invasive HNM were compared with the data of 4858 patients with MOR. Survival analysis was performed using the Kaplan,Meier estimate, and the multivariate Cox proportional hazard model was used to evaluate independent prognostic factors. Results, Melanoma density was clearly higher for HNM than for MOR: this was particularly true for the face, where it was elevated by a factor of 2·6. There was a higher male/female ratio in patients with HNM and they were significantly older than patients with MOR (P < 0·0001). Breslow tumour thickness did not differ between HNM and MOR. However, CMMs at the scalp were significantly thicker and to a higher degree ulcerated. Concerning clinicopathological CMM subtypes, there was an increased proportion of lentigo maligna melanoma among HNM and of nodular melanoma in the scalp and neck regions. Excision margins were narrower and the rate of complete primary excision was lower in HNM than in MOR. Overall, there was no significant statistical difference in cumulative 10-year survival rates according to Kaplan,Meier estimates among patients with HNM (84·6%) and MOR (87·8%). Tumour thickness turned out to be the variable with the highest prognostic impact followed by ulceration in both HNM and MOR. Conclusions, In relation to the skin surface significantly more CMMs were found in the head and neck area than in other anatomical regions. This might indicate, but does not prove, that UV exposure promotes the development of CMM. Although HNM showed specific clinicopathological features, prognosis remained unaffected. Thus HNM seems not to be a distinct subtype of CMM. [source] Cytomorphological variations, proliferation and angiogenesis in the prognosis of cutaneous melanomaCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 3 2003N. Jonjic Summary Depth of invasion and stage of the disease are well known prognostic indicators in cutaneous melanoma (CM). However, the role of other parameters, such as the variations in cytomorphology of melanocyte tumours, mitotic activity and angiogenesis is still open to question. The aim of this study was to analyse proliferation by mitotic activity index (MAI) and immunostaining of proliferating cell nuclear antigen (PCNA), and the intensity of neovascularization (microvessel density; MVD) in CM clinical stage I in relation to epithelioid, spindle and nevoid cell type, histological type (superficial spreading melanoma and nodular melanoma), Clark's level and Breslow thickness. Finally, the role of all parameters in the prognosis of CM was evaluated. Statistical analysis demonstrated that cytological characteristics of CM correlate only with Clark's level, while histological types correlate with MAI, PCNA and MVD. MAI and PCNA also showed correlation between groups according to Clark's level and Breslow thickness. Finally, tumour cell PCNA was found to correlate with MVD. Survival of patients with CM correlated significantly with MAI. These results suggest that cytological variation, histological type, PCNA and MVD alone are not independent prognostic parameters, whereas MAI is a potentially important prognostic marker in CM. [source] | ||||||||||