(1/270) Thymic carcinoma of the thymic hormone secretory type in a cow.
An 8-year-old Holstein cow had tumor nodules and enlarged lymph nodes in the mediastinum, and metastatic tumor masses in the pelvic cavity. The neoplastic cells were characterized by squamous features and intracytoplasmic vacuoles carrying microvilli, some of which contained periodic acid Schiff-positive globular cores, but tubular structures or goblet cells were absent. Many neoplastic cells stained positively for keratin, and occasional cells were positive for thymosin. The presence of secretory granules in the cytoplasm was confirmed by electron microscopy. This neoplasm was considered to be of thymic hormone-secreting epithelial cell origin. (+info)
(2/270) Osteosarcoma of the pelvis.
Over a 25-year period we have treated 36 patients with osteosarcoma of the pelvis. Of the tumours, 24 (67%) were primary osteosarcomas and 12 (33%) arose either after irradiation or in association with Paget's disease. Six patients had a hindquarter amputation and 12 were treated by a limb-salvage procedure with intrapelvic excision. The five-year survival rate of all the patients with pelvic osteosarcoma was 18%, while for 17 treated by chemotherapy and surgery it was 41%. The prognosis for patients presenting with metastases or with secondary osteosarcoma was appalling and none survived after 29 months. No patient over the age of 50 years when seen initially survived for a year. Youth and a good response to chemotherapy along with complete surgical excision offer the best chance of cure. (+info)
(3/270) Osteoid osteoma. Direct visual identification and intralesional excision of the nidus with minimal removal of bone.
We describe 100 consecutive patients with osteoid osteoma. Of the 97 who had operations, 89 were treated by intralesional excision and eight by wide resection. The three remaining patients were not operated on because the osteoid osteoma was almost painless, or was found in the pedicle of the 12th thoracic vertebra at the site of entrance of the artery of Adamkjewicz. The diagnosis was confirmed histologically in all specimens. No local recurrences were observed at a minimum follow-up of one year. All except one patient were mobilised two to four days after surgery. A precise preoperative diagnosis of the lesion is mandatory, based on clinical findings, standard radiographs, thin-section CT and a bone scan. We compared our operative technique with 247 cases in which the percutaneous technique of removal or coagulation of the nidus had been performed. The latter procedure has a less constant rate of primary cure (83% v 100%). Its principal indication appears to be for osteoid osteomas in the proximal femur and the pelvis. (+info)
(4/270) Factors associated with tumor volume and primary metastases in Ewing tumors: results from the (EI)CESS studies.
BACKGROUND: Tumor volumes of more than 100 ml and the presence of primary metastases have been identified as determinants of poor prognosis in patients with Ewing tumors. We sought to assess the prevalence of critical tumor size and primary metastases in a large national sample of patients at the time of first diagnosis and to identify factors that are associated with their occurrence. PATIENTS: The present report is based on data of 945 German patients who were enrolled into the (EI)CESS therapy studies between 1980 and 1997. It is assumed that registration of German patients with Ewing tumors under the age of 15 years was almost complete since around 1985. Diagnoses of primary tumors were ascertained exclusively by biopsies. Analyses were restricted to patients with Ewing tumors of bone due to the few occurrences in soft tissues. METHODS: Tumor volume data as assessed by radiography, computed tomography or nuclear magnetic imaging were available for 821 patients. The diagnosis of primary metastases was based on thoracic computed tomography or on whole body bone scans in 936 patients. Suspicious lesions had to be confirmed by bone marrow biopsies. We explored how year of first diagnosis, age at first diagnosis, sex, histological subtype and site of the primary tumor related to tumor size and presence of metastases by univariate and multivariate statistical techniques. RESULTS: Sixty-eight percent of the patients (n = 559) had a volume above 100 ml with smaller tumors being more common in childhood than in late adolescence and early adulthood. Extensive volumes were observed in almost 90% of the tumors located in femur and pelvis while they were less common in other sites (P < 0.001). On average, 26% of all patients presented with clinically apparent primary metastases. The detection rate of metastases was markedly higher in patients diagnosed after 1991 (P < 0.001). Primary metastases were also significantly more common for tumors originating in the pelvis and for peripheral neuroectodermal tumors (PNET; P < 0.01). Tumors greater than 100 ml were positively associated with metastatic disease (P < 0.001). Multivariate analyses, which included simultaneously all univariate predictors in a logistic regression model, indicated that most of the observed associations were essentially unconfounded. The adjusted odds ratios (OR) for the presence of tumor volumes > or = 100 ml were OR = 1.5 per age rise of 10 years, and OR = 5.8 for pelvis and OR = 7.1 for femur as primary tumor site (all P < 0.001). The presence of metastases was significantly associated with the year of diagnosis (OR = 1.9, after 1991 vs. before 1986), pelvis as site of the primary tumor (OR = 1.8), a PNET (OR = 1.5), and tumor size > or = 100 ml (OR = 1.6). CONCLUSIONS: In conclusion, we find that the prevalence of established factors for an unfavorable prognosis is disturbingly high among patients diagnosed with Ewing tumors. Recent progress in imaging techniques seems to account for much of the rise in the detection rate of metastases after 1991. We identify age and, in particular pelvic and femoral site as the major determinants of local tumor extension. Occurrence of primary metastases is independently related to tumor size, pelvic site, and PNET. (+info)
(5/270) Prospective cross-validation of Doppler ultrasound examination and gray-scale ultrasound imaging for discrimination of benign and malignant pelvic masses.
OBJECTIVE: To cross-validate, prospectively, the diagnostic performance of established ultrasound methods for discrimination of benign and malignant pelvic masses. METHODS: A total of 173 consecutive women with a pelvic mass judged clinically to be of adnexal origin underwent preoperative ultrasound examination including color and spectral Doppler techniques. A total of 149 tumors were benign, and 24 were malignant. The sensitivity and false-positive rate with regard to malignancy were calculated for the following methods, using cut-off values recommended in previous publications: Lerner score; ultrasound morphology, i.e. tumors without solid components being classified as benign and tumors with solid components as malignant; tumor color score; pulsatility index; resistance index; time-averaged maximum velocity; peak systolic velocity; the combined use of ultrasound morphology and tumor color score and the combined use of ultrasound morphology and peak systolic velocity. Sensitivity and false-positive rate were also calculated for subjective evaluation of the gray-scale ultrasound image and for subjective evaluation of the gray-scale ultrasound image supplemented with subjective evaluation of color Doppler ultrasound examination. The confidence with which the diagnosis was made, based on subjective evaluation, was rated on a visual analog scale. RESULTS: Subjective evaluation of the gray-scale ultrasound image was by far the best method for distinguishing benign from malignant tumors (sensitivity 88%, false-positive rate 4%), followed in descending order by subjective evaluation of the gray-scale ultrasound image supplemented with color Doppler examination, the Lerner score and the time-averaged maximum velocity. Adding Doppler examination to subjective evaluation of the gray-scale image did not increase the number of correct diagnoses, but it increased the confidence with which a correct diagnosis was made in 14% of tumors. In 11 tumors (6% of the series as a whole), the addition of Doppler examination changed the diagnosis based on subjective evaluation of the gray-scale ultrasound image from an incorrect (n = 1) or uncertain (n = 10) diagnosis to a correct and confident diagnosis. CONCLUSION: In experienced hands, subjective evaluation of the gray-scale ultrasound image is the best ultrasound method for discriminating between benign and malignant adnexal masses. The main advantage of adding Doppler examination to subjective evaluation of the gray-scale image is an increase in the confidence with which a correct diagnosis is made. (+info)
(6/270) Pattern recognition of pelvic masses by gray-scale ultrasound imaging: the contribution of Doppler ultrasound.
OBJECTIVE: To determine the extent to which Doppler ultrasound examination contributes to a correct specific diagnosis of a pelvic mass when the preliminary diagnosis is based on subjective evaluation of the gray-scale ultrasound image (pattern recognition). METHODS: In 173 consecutive cases, women scheduled for surgery because of a pelvic mass judged clinically to be of adnexal origin underwent preoperative gray-scale and color Doppler ultrasound examination. On the basis of subjective evaluation of the gray-scale ultrasound image, the ultrasound examiner classified each tumor as probably benign or malignant. If possible, a specific diagnosis was made, e.g. 'endometriosis' or 'dermoid cyst'. The confidence with which the diagnosis was made was rated subjectively on a visual analog scale. The diagnosis based on gray-scale imaging was re-evaluated after color Doppler examination, the diagnostic confidence after Doppler examination also being rated on a visual analog scale. 'Malignancy' was not considered a specific diagnosis. RESULTS: Pattern recognition of the gray-scale ultrasound image resulted in no unequivocal specific diagnosis in 51% (88/173) of cases, a correct specific diagnosis in 42% (72/173) and an incorrect specific diagnosis in 7% (13/173). Doppler examination added to a correct specific diagnosis in only 5% (8/173) of cases, either by changing an incorrect specific diagnosis to a (more) correct one (five tumors), or by increasing the confidence with which a correct specific diagnosis was made (three tumors). Doppler examination was misleading in one tumor. CONCLUSION: By using pattern recognition of the gray-scale ultrasound image, a correct specific diagnosis can be made in almost half of adnexal tumors scheduled for surgery. Subjective assessment of the color content of the tumor scan contributed little to the specific diagnosis of pelvic tumors. (+info)
(7/270) LMCE3 treatment strategy: results in 99 consecutively diagnosed stage 4 neuroblastomas in children older than 1 year at diagnosis.
PURPOSE: To tailor postinduction therapy for stage 4 neuroblastoma in children who are older than 1 year at diagnosis according to status after induction. PATIENTS AND METHODS: From March 1987 to December 1992, 99 patients who were consecutively admitted were included in the Lyon-Marseille-Curie East of France (LMCE)3 strategy. After induction with the French Society of Pediatric Oncology NB87 regimen and surgery, patients who were in complete remission immediately proceeded to consolidation therapy with vincristine, melphalan, and fractionated total-body irradiation (VMT). All other patients underwent a postinduction strategy before VMT, either an additional megatherapy regimen or further chemotherapy with etoposide/carboplatin. RESULTS: The progression-free survival (PFS) is 29% at 7 years from diagnosis, which compares favorably with that of a similar cohort of 72 patients previously reported by our group (LMCE1; PFS of 20% at 5 years and 8% at 14 years, P =.004). In the multivariate analysis, only age younger than 3 years at diagnosis (P =.0085) and achievement of complete or very good partial remission after NB87 and surgery (P =.00024) remained significant. The PFS of the 87 patients who were included in the postinduction strategy was significantly better than that of the comparable 62 patients on the LMCE1 study (32% v 11% at 7 years; P =.005). CONCLUSION: The progressive improvements in the LMCE results over the last 10 years suggest that improvements in supportive care measures and increases in each component of this strategy (induction, postinduction, consolidation) may all contribute to increased survival rates. (+info)
(8/270) Successful treatment of recurrent pelvic desmoid tumour with tamoxifen: case report.
The case report of a young woman with recurrent pelvic desmoid tumour successfully treated with tamoxifen is described. The desmoid tumour recurred within 6 months after the initial exploratory laparotomy. Tamoxifen therapy led to complete relief of ascites within 2 months and complete tumour regression by the end of the fourth month, and the patient has remained stable for 6 years. Without sacrificing pelvic organs or major vessels and preserving reproductive ability, tamoxifen should be considered as the first drug of choice in such a recurrent condition. (+info)