Primary retroperitoneal tumors

Seventy-five cases of primary retroperitoneal tumors observed at the Istituto Nazionale Tumori of Milan during the period 1932 to 1973, 56 of which had a histopathologic classification (51 malignant and 5 benign), are reported. By examination of the diagnostic and therapeutic criteria employed and the survival data (9 of the 51 malignant cases were alive at 3 years, and 3 of these were alive at 5 years), the authors point out the difficulty of an early diagnosis and, therefore, of a radical surgery, the need for a programmed therapy, and the importance of the angiographic examination in the diagnostic strategy.     

Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases

The authors analyzed 153 cases of histologically verified intracranial germ cell tumors. The histological diagnosis was germinoma in 63 patients (41.2%), teratoma in 30 (19.6%), and other types of tumors in 60 patients (39.2%). The patients were treated by a consistent policy of surgical removal with histological verification followed by radiation therapy with or without chemotherapy. The 10- and 20-year survival rates of patients with pure germinoma were 92.7% and 80.6%, respectively. The 10-year survival rates of patients with mature teratoma and malignant teratoma were 92.9% and 70.7%, respectively. Patients with pure malignant germ cell tumors (embryonal carcinoma, yolk sac tumor, or choriocarcinoma) had a 3-year survival rate of 27.3%. The mixed tumors were divided into three subgroups: 1) mixed germinoma and teratoma; 2) mixed tumors whose predominant characteristics were germinoma or teratoma combined with some elements of pure malignant tumors; and 3) mixed tumors with predominantly pure malignant elements. The 3-year survival rates were 94.1% for the first group, 70% for the second group, and 9.3% for the third group, and the differences were statistically significant. Twenty-six patients with malignant tumors received chemotherapy that consisted of cisplatin and carboplatin combinations with or without radiation therapy. However, chemotherapy was not significantly more effective than radiation therapy alone. From these treatment results, the authors classified tumors into three groups with different prognoses and proposed a treatment guideline appropriate for the subgroups.     

Extragonadal germinal tumors of retroperitoneal localization

Extragonadal germ cells tumors can arise primarily in the retroperitoneum. It has been suggested that these neoplasms might be metastasis from an occult testicular lesion which would have regressed later. We report our experience with seven retroperitoneal germ cell tumors without testicular involvement. The most frequent symptoms were lumbar or abdominal pain and paraneoplastic syndrome. Abdominal palpable mass was noticeable in 85% of patients. We point out the computerized tomography and echography as the most sensitive exploration for diagnosis. The confirmation of retroperitoneal tumor was achieved preoperatively in all cases. Surgical and chemotherapy treatment was performed. Radiotherapy was employed in two cases. The mean survival was 9.5 months (6-24 m.). Retroperitoneal lymphadenectomy after chemotherapy has not improved the survival. Relapses of the diseases were noticed after and apparently partial or complete response to chemotherapy.     

The surgery of huge retroperitoneal tumors

A comparative study of the causes of death of tuberculosis patients living in the industrial centres of the Ural for the period of 1953-1990 has shown that beginning in 1980's the frequency of progressive forms of tuberculosis increases, while the proportion of cardiopulmonary and chronic renal insufficiency as the cause of death diminishes (5.8 and 0.6%, respectively). Among those who died subjects of the able-bodied age and those with antisocial mode of life account for 40%. The middle-aged and elderly subjects (average age is 67 years) die mainly of silicotuberculosis among whom 40% die of cardiopulmonary insufficiency.     

Primary amenorrhoea: analysis of 48 cases

BACKGROUND: Chorioamnionitis is a leading cause of morbidity and mortality in preterm infants. Only rarely is Staphylococcus aureus implicated. A case of methicillin resistant Staphylococcus aureus causing chorioamnionitis and endometritis is presented. CASE REPORT: A 39-year-old gravida 2 para 1 female, who previously worked as the unit clerk in the pediatric pulmonary unit of a children's hospital, was initially admitted at 22 weeks with a shortened cervix. The patient refused emergency cerclage. She was released from the hospital and returned at 25 4/7 weeks' estimated gestational age with possible spontaneous rupture of membranes. An amniocentesis was performed and revealed a gram stain positive for many gram positive cocci as well as a glucose of < 2 mg%. The patient was started on intravenous ampicillin and gentamicin and induction of labor with oxytocin was begun. Approximately 1 day after the patient's delivery, the culture from the amniocentesis was noted to have grown methicillin resistant Staphylococcus aureus, and the patient's (as well as the neonate's) regimen was switched to vancomycin. CONCLUSION: A Medline search revealed no cases of methicillin resistant Staphylococcus aureus causing chorioamnionitis. When chorioamnionitis or refractory endometritis is encountered in a patient who works in the health care industry, methicillin resistant staphylococcus aureus must be considered.     

Uterine tumors resembling ovarian sex-cord tumors. A clinicopathologic analysis of fourteen cases

Uterine tumors with histologic resemblances to ovarian sex-cord tumors were encountered in 14 women in the fourth to sixth decades of life, most of whom had abnormal vaginal bleeding and enlarged uteri suggesting leiomyomas. The tumors in six cases (Group I) were identical to one or another form of well-recognized endometrial stromal tumor except for focal epithelial-like differentiation resembling that seen in sex-cord tumors. These tumors were mostly poorly circumscribed large mural masses. The focal sex-cord-like differentiation was manifested by cords, trabeculae, nests and tubules of epithelial-like cells; eosinophilic bodies resembling Call-Exner bodies were seen in one case. Five of the six patients with tumors of this type have been followed for postoperative intervals of 22 months to 15 years, and pelvic recurrences have developed in three. The tumors in eight cases (Group II) differed from those in Group I by having a predominant or exclusive pattern reminiscent of an ovarian sex-cord tumor. These tumors, most of which were single, well-circumscribed, yellow to tan, mural masses 4 to 10 cm in diameter, appeared benign, with no recurrence during postoperative periods of four months to seven years. The relations of the two groups of tumors to one another and to previously described similar tumors. including so-called granulosa-cell tumors and "plexiform tumors" of the uterus, are discussed, and an origin from endometrial stromal cells is postulated.     

Primary tracheal tumors

A 33-year study (from 1963 through 1995) was conducted on 144 patients who underwent surgery for primary tumors of the trachea: 70 females and 65 males aged between 7 and 69 years. In 77 patients the tumor was in the thoracic trachea, in 26 in the cervical trachea, and in 41 at the tracheal bifurcation. The tumor was benign in 24 and malignant in 120. The most frequent malignant tumors were adenoidcystic carcinoma (more than 50%), squamous cell carcinoma, and carcinoid. The main diagnostic methods used were lateral and oblique roentgenography, tracheobronchoscopy and in the last 10 years, CT scans. One hundred forty-six operations were performed (2 patients underwent surgery twice). In 60, sleeve resection with anastomosis was made; in 37, different kinds of carinal resections were performed. Total hospital mortality was 15%. After resection for malignant tumors, 3-year, 5-year and 10-year survival rates were 47.5%, 35.9%, and 27.1%, respectively.     

Complex radiation diagnosis of retroperitoneal tumors and tumor-like states

The paper presents the results of complex radiation diagnosis of 118 cases of retroperitoneal tumors and tumor-like states, including 71 patients with tumors of mesenchymal origin, 7 with those of neurogenic origin, 6 with cysts, 9 with lymphogranulomatosis, 8 with retroperitoneal fibrosis, 12 with metastases, and 5 with hematomas. A wide complex of routine and up-to-date high-technology radiation diagnostic techniques was used to study the patients. The authors show the merits and dismerits of each technique. Greatest attention is given to the assessment of current techniques, primarily to ultrasonography (US) and computed tomography (CT). The studies have indicated that despite some specific features, many retroperitoneal tumors and tumor-like states bear similarities when various radiation methods are employed. The authors describe some syndromes which can be used to make a diagnosis. Despite the high capacities of US and CT in studying the normal and pathological structures of the human body, there are still great difficulties in differentiating different abnormalities when even the latest techniques are applied, these cases need paracentic aspiration or open biopsy.     

Primary tumors of the aorta

Primary tumors of the aorta are rare and are usually malignant. Thirty-three cases are reported in the world literature, of which 2 are myxomas. The diagnosis is difficult and is commonly made postoperatively or at autopsy. We present a case of intraluminal aortic myxoma that presented as recurrent arterial emboli and was managed successfully. This case showed the sensitivity of magnetic resonance imaging and transesophageal echocardiography in diagnosis.     

Primary mesenchymal tumors of the urinary bladder. A histological and immunohistochemical study of 30 cases

The light microscopic and immunohistochemical features of 30 primary mesenchymal neoplasms of the urinary bladder are reported. Half of the cases represented smooth and striated muscle tumors (five leiomyomas, seven leiomyosarcomas including epithelioid and myxoid subtypes, one rhabdomyoma, one embryonal rhabdomyosarcoma and one alveolar rhabdomyosarcoma). One third of the tumors were of fibrohistiocytic origin (one fibrous histiocytoma and eight malignant fibrous histiocytomas including fascicular and storiform, inflammatory and pleomorphic subtypes). In addition, a malignant epithelioid schwannoma, a round cell liposarcoma, two hemangiomas and two mixed mesodermal tumors were observed. The morphology of the vesical mesenchymal tumors was identical to that of their counterparts known to occur in other sites, particularly in the soft tissue. Muscle-specific actin, alpha-1-antichymotrypsin, S-100-protein and neuron-specific enolase proved to be useful and reliable immunomarkers for differential diagnosis of poorly differentiated leio- and rhabdomyosarcomas, malignant fibrous histiocytomas and malignant schwannomas. Since some tumors coexpressed several classes of intermediate filaments, diagnostic immunocytochemistry should only be used considering a larger panel of antibodies and in close correlation with the histological and cytological features of the neoplasms.     

Value of limited dissection of residual retroperitoneal masses after chemotherapy for malignant non-seminoma tumors of the testis. Apropos of 74 cases

Since asplatin salts have been used in chemotherapy, the efficiency of this treatment has changed the destiny of advanced forms of testicular cancer. The universally recommended treatment of post-chemotherapy residual retroperitoneal tumor masses is radical retroperitoneal lymph node dissection. Results of our 74 limited expresses of these tumor masses confirm that the chosen treatment was appropriate. It guarantees the future and limits genital sequellae in young patients. It is perfectly consistent with the therapeutic history of this model in cancerology: precisely defined indications for the therapeutic means of a pluridisciplinary pool of resources always increases efficiency, reduces the need for invasive treatment, and limits sequellae.     

Primary tumors of the thoracic skeleton

From 1975 to 1990, eighty-nine primary tumors of the thoracic skeleton; ribs, sternum, scapula, clavicle, and thoracic spine, were treated. Forty-four tumors (49%) were benign lesions. Forty-five tumors were malignant and were proportionately distributed amongst the five sites. The most common malignancies were Ewing's sarcomas, chondrosarcomas, plasmacytomas, osteogenic sarcomas, and lymphomas. All patients with Ewing's sarcomas were treated with combination chemotherapy, surgical resection, and radiation therapy for those with residual disease after surgery. Only one patient has died of disease. Patients with primary chondrosarcomas were treated by surgery alone and all are free of disease or have died without disease. Patients with solitary plasmacytomas or primary lymphomas of bone were treated with radiation therapy initially. Half the patients developed systemic disease. The patients with osteogenic sarcomas included several with radiation induced lesions and Paget's osteosarcoma and all but one died of disease.     

Primary nontrophoblastic tumors of the placenta

Looking from histogenetical point of view primary neoplastic alterations of placenta and umbilical cord can be divided in two main groups. First group consists of neoplasms of trophoblastic disease's origin: placental site trophoblastic tumor, choriocarcinoma and hydatidiform mole, according to most authors it not belonging to neoplasms. The second group consists of nontrophoblastic tumors, like: chorioangioma and teratoma. Hepatocellular adenoma and leiomyoma are also enclosed to the nontrophoblastic tumors. It hasn't been defined yet whether all nontrophoblastic changes in placenta or in umbilical cord should be considered as neoplasms or like pseudoneoplastic changes. Comparing to neoplasms of trophoblastic disease's origin nontrophoblastic tumors are not frequent changes to be observed, moreover they are always benign tumors. In some cases these neoplasms are asymptomatic, however clinical course of some of them may become severe. The influence of nontrophoblastic tumors on pregnancy and delivery is often underestimated. It could be observed that studies on these neoplasms are performed very seldom what may be result of their infrequent appearance and because of their asymptomatic natural history. In this study we presented an up-to date opinions about the histopathogenesis of the nontrophoblastic tumors and also their histopathological characteristics and the most common symptoms which can accompany the development of these neoplasms. An important notice is that these tumors can remain undetected during macroscopic examination of secundines.     

Primary solid tumors of the mesentery

The interest for the primary solid tumors of the mesentery (TSPM) is justified by the difficulties of preoperative diagnosis and surgical treatment of these unusual lesions. We analyzed 68 TSPM operated in the Department of General Surgery of Fundeni Hospital between 1960-1993. In the study were included only the lymphoma presented as mesenteric masses (n = 17); the enlarged mesenteric lymph nodes were excluded. The most common malignant tumor was the fibroma (n = 8) and lipoma (n = 10). In the resection of mesenteric tumors exposure of the superior mesenteric vessels is important. The relation between tumoral and superior mesenteric vessels is the necessary criterion of resectability: in 41 cases from 43 unresectable lesions the reason of unresectability was the invasion of the superior mesenteric vein and artery; in only two cases the reason was the presence of liver metastases. The resectability was not influenced by the multiplicity of the lesions: in all cases with multiple mesenteric tumors (6 patients) the resection was performed. The distant metastases of TSPM are rare; on the contrary, the local invasion is common.     

Primary lymphoreticular tumors of the orbit

Primary orbital lymphomas are rare. We report nine such cases (4 with DWDL, 3 with DPDL, 1 with DHL and 1 unclassifiable lymphoma). All patients achieved clinical complete remission (CR). Of those who completed treatment more than a year ago, three continue to be in CR at 17, 24 & 25 months and two are lost to follow up.     

Clinical considerations on retroperitoneal liposarcoma. Report of 2 cases

Liposarcoma is one of the more common tumours of the soft retroperitoneal tissues. It usually occurs in aged subjects and displays a marked contrast between its malignant histological picture and its protracted, poorly symptomatic clinical picture. Eventually, compression or invasion of nearby organs appears, whereas the patient's general condition is not affected. Two personal cases are described.