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Tumor Margins (tumor + margin)

Distribution by Scientific Domains

Medical Sciences	95%

Distribution within Medical Sciences

Dermatology	28%
Oncology & Radiotherapy	18%

Selected Abstracts

Presurgical Curettage Appropriately Reduces the Number of Mohs Stages by Better Delineating the Subclinical Extensions of Tumor Margins

DERMATOLOGIC SURGERY, Issue 9 2005
Vinh Q. Chung MD
Background. Whether presurgical curettage (PC), light curettage performed before Mohs surgery to delineate tumor margin, is appropriate or causes unnecessary removal of normal tissue has not been well established. Objective. We aim to determine histologically whether PC appropriately increases the size of the stage I specimen or causes unnecessary removal of healthy tissue. Methods. Before a surgical margin guided by PC was taken, a hypothetical margin determined by visual and tactile assessment alone (no curettage [NC]) was marked outside the clinically defined tumor. Histologic analysis at the NC and the PC margins revealed whether the increase in the stage I specimen as a result of PC was appropriate. Results. PC appropriately increased the stage I specimen in 21 cases and unnecessarily removed normal tissue in only 1 case. The estimation of tumor margins with PC was 15 times more accurate than with NC (p value = .0012). Conclusion. For basal cell and squamous cell carcinomas at least 4 mm in diameter, light curettage performed prior to Mohs surgery could better delineate subclinical extensions of the tumor margin and appropriately increase the size of the stage I specimen. [source]

Crescent Versus Rectangle: Is It a True Negative Margin in Second and Subsequent Stages of Mohs Surgery?

DERMATOLOGIC SURGERY, Issue 2 2010
YUE YU MD
BACKGROUND The hallmark of Mohs micrographic surgery is using tangential tissue sections that theoretically allow 100% of the tissue margin to be examined, but when taking additional layers for second and subsequent Mohs stages, no detailed methods have been described to ensure that 100% of the tissue margins are analyzed. METHOD A rectangular or a crescent-shaped layer is often used to take second and subsequent stages. Here we compare the two techniques for their theoretic advantages and disadvantages. SUMMARY The advantage of the rectangular shape has been ease of processing, as well as built in vertical "nicks" that automatically mark the border of the tissue removed, but the rectangular layer may not provide 100% evaluation of the tumor margin because the vertical edges of the rectangular layer are not always completely analyzed, and thus tumor cells cannot be visualized in the vertical margins of these layers. This might result in a false-negative margin reading, which can be avoided by using the crescent layer. CONCLUSION We propose taking second and subsequent Mohs layers with only a crescent shape, which allows true 100% tissue margin assessment. The authors have indicated no significant interest with commercial supporters. [source]

Presurgical Curettage Appropriately Reduces the Number of Mohs Stages by Better Delineating the Subclinical Extensions of Tumor Margins

Surgical margin determination in head and neck oncology: Current clinical practice.

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2005
Neck Society Member Survey, The results of an International American Head
Abstract Background. Our aim was to investigate the ways in which surgeons who perform head and neck ablative procedures on a regular basis define margins, how they use frozen sections to evaluate margins, and the effect of chemoradiation on determining tumor margins. Methods. A custom-designed questionnaire was mailed to members of the American Head and Neck Society asking members how they evaluate and define tumor margins. Results. Of 1500 surveys mailed, 476 completed surveys were received. The most common response for distance of a clear pathologic margin was >5 mm on microscopic evaluation. A margin containing carcinoma in situ was considered a positive margin by most, but most did not consider a margin containing dysplasia a positive margin. When initial frozen section margins are positive for tumor and further resection results in negative frozen section margins, 90% consider the patient's margin negative. Most surgeons sample the frozen section from the surgical bed rather than from the main specimen. Nearly half use wider margins when resecting tumors treated with neoadjuvant therapy. When resecting recurrent or residual tumors treated with previous chemoradiation therapy, most resect to the pretreatment margin. Conclusions. No uniform criteria to define a clear surgical margin exist among practicing head and neck surgeons. Most head and neck surgeons consider margins clear if resection completed after an initial positive frozen section margin reveals negative margins, but this view is not shared by all. Most surgeons take frozen sections from the surgical bed; however, error may occur when identifying the positive margin within the surgical bed. The definition of a clear tumor margin after chemoradiation is unclear. These questions could be addressed in a multicenter prospective trial. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source]

Telomere DNA content and allelic imbalance demonstrate field cancerization in histologically normal tissue adjacent to breast tumors

INTERNATIONAL JOURNAL OF CANCER, Issue 1 2006
Christopher M. Heaphy
Abstract Cancer arises from an accumulation of mutations that promote the selection of cells with progressively malignant phenotypes. Previous studies have shown that genomic instability, a hallmark of cancer cells, is a driving force in this process. In the present study, two markers of genomic instability, telomere DNA content and allelic imbalance, were examined in two independent cohorts of mammary carcinomas. Altered telomeres and unbalanced allelic loci were present in both tumors and surrounding histologically normal tissues at distances at least 1 cm from the visible tumor margins. Although the extent of these genetic changes decreases as a function of the distance from the visible tumor margin, unbalanced loci are conserved between the surrounding tissues and the tumors, implying cellular clonal evolution. Our results are in agreement with the concepts of "field cancerization" and "cancer field effect," concepts that were previously introduced to describe areas within tissues consisting of histologically normal, yet genetically aberrant, cells that represent fertile grounds for tumorigenesis. The finding that genomic instability occurs in fields of histologically normal tissues surrounding the tumor is of clinical importance, as it has implications for the definition of appropriate tumor margins and the assessment of recurrence risk factors in the context of breast-sparing surgery. © 2006 Wiley-Liss, Inc. [source]

Delineation of brain tumor margins using intraoperative sononavigation: Implications for tumor resection

JOURNAL OF CLINICAL ULTRASOUND, Issue 4 2006
Nobusada Shinoura MD
Abstract Purpose. Sonography has been employed for real-time intraoperative delineation of tumor boundaries during resection of brain tumors. However, the variably hyperechoic appearance of brain edema or gliosis surrounding the brain may interfere with accurate depiction of tumor margins. The goal of the present study was to use sononavigation, which provides coregistration between real-time sonograms and MRI scans, to assess the accuracy of sonographic determination of tumor margins. Methods. Sononavigation was performed on 12 brain tumors (7 metastatic brain tumors, 2 meningiomas, 1 anaplastic oligodendroglioma, 1 anaplastic pilocytic astrocytoma, and 1 anaplastic astrocytoma). Sonograms of tumor margins were categorized into 1 of 3 types: in type 1, the tumor margin was clearly visualized and corresponded to the margin of the enhanced lesion on MR scan in all areas; in type 2, the tumor margin was clearly seen in some areas but was obscure in others due to hyperechoic edema; and in type 3, the tumor margin was indistinguishable from surrounding tissues in all areas. Results. Three metastatic brain tumors and 1 meningioma were categorized as type 1. Three metastatic brain tumors, 1 meningioma, and 1 anaplastic oligodendroglioma were categorized as type 2. The anaplastic pilocytic astrocytoma, 1 metastatic brain tumor (which consisted mainly of necrotic tissue), and the anaplastic astrocytoma were categorized as type 3. These data assist in determining whether the sonographic appearance of tumor margins is accurate and whether to rely on information from either sonography (type 1) or the sononavigation system when resecting tumor types 1, 2, and 3. Conclusions. Sononavigation can help categorize the sonographic tumor margins into 3 different patterns, and this categorization can assist in determining which imaging modalities are needed to better delineate the tumor margins for subsequent resection. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:177,183, 2006 [source]

The disintegrin-metalloproteinases ADAM 10, 12 and 17 are upregulated in invading peripheral tumor cells of basal cell carcinomas

JOURNAL OF CUTANEOUS PATHOLOGY, Issue 4 2009
Shin Taek Oh
Background:, Members of the a disintegrin and metalloproteinase (ADAM) family are expressed in malignant tumors and participate in the pathogenesis of cancer. However, the presence of ADAM 10, 12, 17 and their role in basal cell carcinoma (BCC) have not been described. The purpose of this study was to investigate expression of ADAM 10, 12 and 17 in BCC. Methods:, Expression of ADAM 10, 12 and 17 was analyzed by immunohistochemistry in skin tissues obtained from 25 patients with different types of BCC. Results:, Immunoreactivity of ADAM 10, 12 and 17 was increased at the peripheral tumor margin compared with central areas of BCC tumor cell nests. Immunoreactivity of ADAM 10 and 12 was increased in the deep margin of invading tumor cell nests in mixed BCC. Focally increased expression of ADAM 12 was detected in squamous differentiated tumor cells of nodular BCC. In addition, immunoreactivity of ADAM 17 was increased in superficial BCC. Conclusions:, ADAM 10, 12 and 17 showed different expression pattern in BCC histologic subtypes, indicating their different role in the BCC pathogenesis. Overexpression of ADAM 10, 12 and 17 immunoreactivity in deep invasion area of BCC indicates that these three proteases may play an important role in the locally invasive and highly destructive growth behavior of BCC. Additionally, we suggest that ADAM 17 may play an important role in early development of BCC. [source]

Mixed neuronal,glial tumor of the digestive tract: Distinctive entity from gastrointestinal stromal tumor?

PATHOLOGY INTERNATIONAL, Issue 2 2002
Marie-Laure Chambonniere
A 53-year-old-woman presenting with pelvic discomfort was found to have a 9.5 cm tumor located in the wall of the ileon. Light microscopy showed that the tumor was made of fascicles of plump spindle cells and bizarre epithelioid cells. A cuff of lymphoid cells was also present at the tumor margin. The tumor cells strongly expressed tau protein, neuron-specific enolase, protein green product 9.5 and glial fibrillary acid protein (GFAP), but did not show positive immunostaining for S-100 protein, CD34 or CD117. The tumor showed unequivocal ultrastructural evidence of neural differentiation. Skeinoid fibers were scattered throughout the tumor. This is the first mixed neuronal,glial tumor of the digestive tract to be described in the literature. Such histological and immunohistochemical features could be misinterpreted as features of digestive schwannoma. We suggest that this tumor is distinct from gastrointestinal stromal tumors in lacking CD34 and CD117 expression. [source]

The intratumoral distribution of nuclear ,-catenin is a prognostic marker in colon cancer

CANCER, Issue 10 2009
David Horst MD
Abstract BACKGROUND: Most colon cancers harbor mutations of APC or ,-catenin, both of which may lead to nuclear ,-catenin accumulation in the tumor cells and constitutively activated expression of its target genes. In many colon cancers, however, nuclear ,-catenin accumulation is heterogeneous throughout the tumor and often confined to the tumor margin. Herein, the authors investigated whether the intratumoral distribution of nuclear ,-catenin can serve as a prognostic marker for survival and tumor progression of stage IIA colon cancer patients. METHODS: In total, 142 patients with primarily resected, moderately differentiated stage IIA colon cancer were included in this study. The patterning of nuclear ,-catenin expression was evaluated on immunohistochemically stained whole tissue sections of the tumors and was correlated with cancer-specific survival and disease-free survival using univariate and multivariate statistical analyses. RESULTS: Four distinct patterns of nuclear ,-catenin expression were identified, and 2 main categories comprising tumors with or without intratumoral regulation of nuclear ,-catenin were distinguished. Moreover, the results demonstrated that the patterning, and especially the regulation or absence of regulation of nuclear ,-catenin expression, was a strong predictive marker of patient survival and tumor progression. CONCLUSIONS: The current results indicated that the distribution of nuclear ,-catenin expression can be used as a good prognostic marker in patients with stage IIA colon cancer. Thus, the evaluation of nuclear ,-catenin may help to identify patients who will have a shorter than average survival and patients with a greater risk of disease progression who may be considered for adjuvant therapeutic modalities and intensified clinical aftercare in the future. Cancer 2009. © 2009 American Cancer Society. [source]

Presurgical Curettage Appropriately Reduces the Number of Mohs Stages by Better Delineating the Subclinical Extensions of Tumor Margins

The Efficacy of Curettage in Delineating Margins of Basal Cell Carcinoma Before Mohs Micrographic Surgery

DERMATOLOGIC SURGERY, Issue 9 2003
Désirée Ratner MD
Background. Curettage may be helpful as a preliminary step to outline the gross subclinical extensions of high-risk basal cell carcinomas (BCCs) before the first stage of Mohs micrographic surgery. Although many Mohs surgeons use curettage in the Mohs surgical setting, no prospective studies have as yet been performed that demonstrate the efficacy of curettage in delineating tumor margins before Mohs surgery. Objective. To document the efficacy of curettage in delineating BCC margins before Mohs micrographic surgery. Methods. This was a prospective evaluation of 599 patients with biopsy-proven BCCs treated with Mohs surgery. The preoperative dimensions of each tumor, the curetted dimensions before the first surgical stage, the proposed excisional margins before each surgical stage, and the final defect dimensions after each surgical stage were measured. The maximum curetted margin around each tumor was calculated and compared with typical Mohs excisional margins of 1, 2, 3, and 4 mm. A hypothetical 1-, 2-, 3-, or 4-mm excisional margin was added to the preoperative X and Y dimensions of each tumor, and the actual final defect sizes were compared with the hypothetical final defect sizes to determine whether an additional surgical stage would have been needed had curettage not been performed. The amount of tissue stretch occurring after specimen removal was calculated to determine whether tissue stretch falsely elevated the number of instances in which an additional surgical stage would have been needed had curettage not been performed. Results. The curetted margin around the observed extent of each tumor exceeded 1 mm in 87.6% of cases, 2 mm in 47.1% of cases, 3 mm in 19.7% of cases, and 4 mm in 5.7% of cases. The mean curetted margin was 1.7 mm. Taking a 1-mm margin in the first stage of Mohs surgery without first performing curettage would have necessitated an extra surgical stage in 99.2% of cases, whereas taking a 2-, 3-, or 4-mm margin would have necessitated an extra surgical stage in 93.0%, 88.1%, and 49.4% of cases, respectively. After calculating and eliminating the effects of tissue stretch, it was found that a 1-mm excisional margin taken in the first stage of Mohs surgery without first performing curettage would have necessitated an extra surgical stage in 99.0% of the cases. Taking a 2-, 3-, or 4-mm margin would have necessitated an extra surgical stage in 87.5%, 57.9%, and 29.5% of cases, respectively. Conclusion. Careful debulking and palpation with the curette significantly reduce the number of Mohs surgical stages required for BCC clearance. Even after taking the effects of tissue stretch into consideration, a significant proportion of tumors would still require an additional stage for tumor clearance without aggressive presurgical curettage. [source]

Primary and salvage (hypo)pharyngectomy: Analysis and outcome

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2006
FRACS, Jonathan R. Clark BSc(Med)
Abstract Background. Surgery for squamous cell carcinoma (SCC) arising or extending to the hypopharynx is generally reserved for advanced disease or salvage. The prognosis of patients requiring pharyngectomy is poor, and the perioperative morbidity is significant. The aim of the present study is to describe the disease-related and treatment-related outcomes of patients undergoing primary and salvage pharyngectomy for cancer of the hypopharynx and larynx over a 10-year period from a single institution. Methods. We retrospectively reviewed 138 partial and circumferential pharyngectomies performed at a tertiary referral center between 1992 and 2002. There were 31 females and 107 males. The median age was 62 years (range, 27,81 years), and mean follow-up was 3.6 years. Salvage pharyngectomy for radiation failure was performed in 72 patients (52%), and in 66 patients (48%) pharyngectomy was performed as the primary treatment. Results. The 5-year overall survival rate after salvage pharyngectomy was 31% and after primary pharyngectomy was 38%. The 5-year disease-specific survival (DSS) for salvage was 40% and after primary surgery was 45%. The 5-year local and regional control rates for salvage pharyngectomy were 71% and 70%, respectively, and for primary pharyngectomy were 79% and 67%, respectively. The perioperative mortality rate was 3.6%, and the combined morbidity rate was 70%. Postoperative hypocalcemia developed in 44% of patients, a pharyngocutaneous fistula developed in 31% of patients, and the long-term stricture rate was 15%. Variables adversely affecting DSS on univariate analysis were nodal metastases (p = .044), extracapsular spread (ECS) (p = .006), poorly differentiated tumors (p = .015), lymphovascular invasion (p = .042), and positive tumor margins (p = .026). ECS (p = .023) was the only independent prognostic variable on multivariable analysis; however, there was a trend toward significance for nodal metastases (p = .064) and tumor differentiation (p = .079). Conclusion. This study demonstrates that both salvage pharyngectomy and primary surgery for advanced disease are viable options with high locoregional control. However, this represents a high-risk group in terms of both operative morbidity and survival. Patients with nodal metastases, ECS, and poorly differentiated tumors are likely to succumb to their disease and should be selected for adjuvant therapy when possible. © 2006 Wiley Periodicals, Inc. Head Neck 28: 671,677, 2006 [source]

Surgical margin determination in head and neck oncology: Current clinical practice.

Vision enhancement system for detection of oral cavity neoplasia based on autofluorescence

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2004
Ekaterina Svistun MS
Abstract Background. Early detection of squamous cell carcinoma (SCC) in the oral cavity can improve survival. It is often difficult to distinguish neoplastic and benign lesions with standard white light illumination. We evaluated whether a technique that capitalizes on an alternative source of contrast, tissue autofluorescence, improves visual examination. Methods. Autofluorescence of freshly resected oral tissue was observed visually and photographed at specific excitation/emission wavelength combinations optimized for response of the human visual system and tissue fluorescence properties. Perceived tumor margins were indicated for each wavelength combination. Punch biopsies were obtained from several sites from each specimen. Sensitivity and specificity were evaluated by correlating histopathologic diagnosis with visual impression. Results. Best results were achieved with illumination at 400 nm and observation at 530 nm. Here, sensitivity and specificity were 91% and 86% in discrimination of normal tissue from neoplasia. This compares favorably with white light examination, in which sensitivity and specificity were 75% and 43%. Conclusions. Oral cavity autofluorescence can be easily viewed by the human eye in real time. Visual examination of autofluorescence enhances perceived contrast between normal and neoplastic oral mucosa in fresh tissue resections. © 2004 Wiley Periodicals, Inc. Head Neck26: 205,215, 2004 [source]

Telomere DNA content and allelic imbalance demonstrate field cancerization in histologically normal tissue adjacent to breast tumors

Clinicopathological review of 46 primary retroperitoneal tumors

INTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2007
Mitsuhiro Tambo
Objectives: To clarify the clinical factors including diagnostic imaging findings that may correlate with the histopathological malignancy in primary retroperitoneal tumors. Methods: The clinical backgrounds and imaging findings of 22 benign and 24 malignant primary retroperitoneal tumors were retrospectively investigated, and the prognosis of patients with malignant retroperitoneal tumors was assessed. Results: There were significant correlations between the presence of symptoms and malignancy (P < 0.01), as well as between the irregularity of tumor margins and malignancy (P < 0.01). On dynamic magnetic resonance imaging (MRI), 90% of malignant tumors showed early enhancement either with quick or slow washout, while 75% of benign tumors showed delayed and no enhancement (P < 0.002). All malignant and benign paraganglioma showed the same early enhancement with quick washout. Malignant lymphoma showed various enhancement patterns. The 2-year and 5-year cause-specific survival rates of the patients with malignant retroperitoneal tumors were 68.0% and 43.2%, respectively. All malignant lymphoma patients were mainly treated with chemotherapy after being diagnosed histologically. Malignant paraganglioma patients who could not meet complete resection needed chemotherapy for promising survival. Conclusion: The symptoms, the irregularity of the margins, and the specific enhancement pattern on the dynamic MRI may be important predictive factors of the primary malignant retroperitoneal tumors. Histological diagnosis was needed for malignant definition of paraganglioma because both benign and malignant paraganglioma showed similar clinical and imaging findings. Preoperative biopsy should be considered for selection of the appropriate treatment particularly in patients that are likely to have malignant lymphoma that could not be diagnosed definitively by the clinical and imaging findings. [source]

Delineation of brain tumor margins using intraoperative sononavigation: Implications for tumor resection

MR-guided ablation of hepatocellular carcinoma aided by gadoxetic acid

JOURNAL OF SURGICAL ONCOLOGY, Issue 8 2007
FACS, FRCSC, Oliver F. Bathe MD
Abstract Local recurrences are problematic following radiofrequency ablation (RFA) of hepatocellular carcinoma. Intraoperative magnetic resonance imaging (iMRI) is a potentially useful tool for the assessment of the extent of the thermal injury produced by RFA. The use of gadoxetic acid disodium, a hepatocyte-specific contrast agent with prolonged retention, is described as a method of improved assessment of the ablative margins relative to the tumor margins. J. Surg. Oncol. 2007;95:670,673. © 2007 Wiley-Liss, Inc. [source]

Increased brain tumor resection using fluorescence image guidance in a preclinical model

LASERS IN SURGERY AND MEDICINE, Issue 3 2004
Arjen Bogaards BSc
Abstract Background and Objectives Fluorescence image-guided brain tumor resection is thought to assist neurosurgeons by visualizing those tumor margins that merge imperceptibly into normal brain tissue and, hence, are difficult to identify. We compared resection completeness and residual tumor, determined by histopathology, after white light resection (WLR) using an operating microscope versus additional fluorescence guided resection (FGR). Study Design/Materials and Methods We employed an intracranial VX2 tumor in a preclinical rabbit model and a fluorescence imaging/spectroscopy system, exciting and detecting the fluorescence of protoporphyrin IX (PpIX) induced endogenously by administering 5-aminolevulinic acid (ALA) at 4 hours before surgery. Results Using FGR in addition to WLR significantly increased resection completeness by a factor 1.4 from 68±38 to 98±3.5%, and decreased the amount of residual tumor post-resection by a factor 16 from 32±38 to 2.0±3.5% of the initial tumor volume. Conclusions Additional FGR increased completeness of resection and enabled more consistent resections between cases. Lasers Surg. Med. 35:181,190, 2004. © 2004 Wiley-Liss, Inc. [source]

Fluorescence Lifetime Spectroscopy of Glioblastoma Multiforme,

PHOTOCHEMISTRY & PHOTOBIOLOGY, Issue 1 2004
Laura Marcu
ABSTRACT Fluorescence spectroscopy of the endogenous emission of brain tumors has been researched as a potentially important method for the intraoperative localization of brain tumor margins. We investigated the use of time-resolved, laser-induced fluorescence spectroscopy for demarcation of primary brain tumors by studying the time-resolved spectra of gliomas. The fluorescence of human brain samples (glioblastoma multiforme, cortex and white matter: six patients, 23 sites) was induced ex vivo with a pulsed nitrogen laser (337 nm, 3 ns). The time-resolved spectra were detected in a 360,550 nm wavelength range using a fast digitizer and gated detection. Parameters derived from both the spectral- (intensities from narrow spectral bands) and the time domain (average lifetime) measured at 390 and 460 nm were used for tissue characterization. We determined that high-grade gliomas are characterized by fluorescence lifetimes that varied with the emission wavelength (>3 ns at 390 nm, <1 ns at 460 nm) and their emission is overall longer than that of normal brain tissue. Our study demonstrates that the use of fluorescence lifetime not only improves the specificity of fluorescence measurements but also allows a more robust evaluation of data collected from brain tissue. Combined information from both the spectraland the time domain can enhance the ability of fluorescencebased techniques to diagnose and detect brain tumor margins intraoperatively. [source]