Malignant mesothelioma of the pleura. Morphometric study

Between April 1994 and October 1996 on account of complicated obstruction of the lacrimal pathways temporarily into the lacrimal efferent system 144 silicone cannulas were inserted in 127 children aged 4 months to 9 years. A standard procedure was used, with the children under general inhalation anaesthesia, in collaboration of an ophthalmologist and otorhinolaryngologist using endonasal optics. By October 1996 100 cannulas were extubated, on average after 4.1 months. The effectiveness of the procedure evaluated on the basis of clinical manifestations and the Dye Disappearance test is 81%.     

Malignant tumors of the thyroid

Carcinoma of the thyroid gland is not common. The majority of lesions in this series were differentiated in type. The treatment of choice is almost total thyroidectomy supplemented by I131 in some cases. L-thyroxine was prescribed routinely for all patients postoperatively for replacement and depression treatment. The immediate postoperative mortality was about 1% and prognosis is relatively good. Undifferentiated thyroid carcinomas are fast growing and very lethal and unfortunately no method of treatment is effective. Only four patients in this group survived more than a year.     

Malignant brain tumors in the elderly

The increase in the incidence of primary brain tumors in the elderly over the last decade represents a serious problem because of the severe disability and risk of death associated with this disease. Surgery remains the mainstay of the management of malignant gliomas, and the magnitude of the resection correlates with the length of survival. The additional standard treatment modalities are reviewed. This article also discusses novel approaches being evaluated to treat both newly diagnosed and recurrent brain tumors.     

Malignant tumors of the small intestine

Primary malignant tumors of the small intestine are uncommon. The average annual incidence rate over a period of 30 years in Saskatchewan was 0.7 and 0.6 per 100,000 for male and females, respectively. The 209 patients who comprise the series represent 1.6% of the total number who had gastrointestinal cancers over the same period. The distribution of the tumors by site and histologic type is described. Both carcinoid and adenocarcinomatous tumors of the small intestine are associated with a high incidence of primary malignant neoplasms in other sites (17.0 and 20.3%, respectively). One patient with Peutz-Jeghers syndrome is of interest because of the malignant change which occurred in more than one of the small bowel polyps and because of consequent liver metastases. The reason for the poor prognosis in noncarcinoid small bowel malignant neoplasms is probably due to late diagnosis. The five-year disease-free survival in these tumors was 22.5%. Malignant carcinoids had a better overall five-year survival rate of 64%. For those confined to the bowel wall, the five-year survival rate was 73%, compared to 59% for those extending to nodes or metastasizing to distant organs.     

Malignant stromal tumors of the stomach

BACKGROUND/AIMS: The purpose of this paper is to expose our experience in malignant stromal tumors of the stomach. METHODOLOGY: We present 16 cases of malignant stromal tumors of the stomach, operated on in our hospital from 1977 to 1995. Age, sex, symptoms and signs, standard laboratory tests, diagnostic methods, location, size, infiltration of other organs, proliferating activity, treatment and survival rate are analyzed. Immune staining was performed using the avidin-biotin-peroxidase method, with the S-100 1/8000 and muscular actin 1/50 antiserum. All patients underwent surgical treatment, and neither chemotherapy nor radiotherapy were used. RESULTS: Thirteen patients died 5 to 78 months after surgery, and the other 3 are alive and free of disease 74, 48 and 38 months after resection, respectively. Five year survival rate was 37.5%. The most important prognostic factors were tumor size, infiltration of neighboring organs and high mitotic index. CONCLUSION: All the clinical data, survival rates and prognostic factors are similar to other published cases. Surgery is the first step in the treatment of these tumors, as the role of other therapeutic options is not well known yet.     

Malignant tumors in hemodialysis patients

We reviewed the incidence of malignant tumors among 923 patients with chronic renal failure, treated with hemodialysis (HD) in seven dialysis centers in Serbia between January 1983 and July 1993. Neoplasms were diagnosed in 45 cases (4.9%). The mean age of the cancer patients was 58.7 years. Eighteen cases (40.0%) were diagnosed in the first year after starting HD treatment and 21 (46.7%) cases were detected less than 5 years after induction of HD treatment. Most of the cancer patients (60.0%), especially the patients with Balkan endemic nephropathy (31.1%), developed cancer of the urinary tract. We concluded that HD patients have a several times greater risk of developing malignant tumors than the general population.     

Malignant salivary gland tumors

Records of 60 patients with primary salivary gland tumors were retrospectively analyzed. Most were European Jews, 60% were males, and the average age was 57 years. The parotid gland was the most frequent site of origin (76%). The main presenting symptom was painless swelling. Pain or facial palsy were rare and associated with poor prognoses. The most common types were mucoepidermoid, adenocystic, adenocarcinoma and malignant, mixed carcinomas (in descending order of frequency). Squamous cell carcinoma was the most prevalent histologic type. Most patients presented at an advanced stage. Treatment was mainly surgical and postoperative radiotherapy was given to those with advanced disease. Most recurrences occurred within 3 years of initial treatment. Actuarial 10-year survival for all patients was 40%. Superior survival rates were achieved in women, probably due to less aggressive malignancies. Low grade mucoepidermoid carcinoma had a favorable prognosis, whereas anaplastic carcinoma had the worst. Other significant prognostic factors included stage and grade of disease.     

Malignant vascular tumors in young patients

BACKGROUND: To the authors' knowledge there are few published series of malignant vascular tumors in patients age < or = 21 years. METHODS: The authors retrospectively documented the clinical presentation, pathology, treatment, and outcome of patients age < or = 21 years with malignant vascular tumors treated between 1970-1995 at Memorial Sloan-Kettering Cancer Center. The histologic sections were rereviewed to confirm the diagnosis. RESULTS: Four patients were identified with angiosarcoma and two with malignant hemangioendothelioma. Five patients were female and one was male; the median age at diagnosis was 11.8 years (range, 8 months-21 years). The tumor involved the skin in one patient, soft tissue in one patient, bone in two patients, and internal organs in two patients. One patient had associated diffuse angiomatosis and another had the Klippel-Trenaunay-Weber syndrome. This patient received prior radiation therapy to the primary site with the subsequent development of a vascular sarcoma. None of the patients had distant metastases at diagnosis. Resection was attempted in five patients and completed in four. Chemotherapy alone was given to three patients whereas radiation therapy alone and radiation plus chemotherapy were administered to one patient each. The median follow-up was 4.9 years (range, 1 month-12 years). There were three deaths from progressive disease and two deaths from locoregional recurrences. Reexcision and radiotherapy controlled one local recurrence. Another patient developed recurrence to regional lymph nodes and further dissemination. The primary tumor in all three survivors was excised completely whereas two of the three patients who died of progressive disease underwent an incomplete excision or biopsy alone. CONCLUSIONS: Malignant vascular tumors are rare in the first two decades of life and when they do occur are very aggressive. Complete resection is curative for patients with localized lesions.     

Malignant giant cell tumors of soft tissue

Clinco-morphological characteristics of malignant giant cell tumours of soft tissues in 31 patients are presented. Microscopically, the tumours consisted of histiocyte-like mononuclear cells possessing a phagocytic capacity, stretched out fibroblast-like cells forming collagen fibres, multinuclear giant cells of the type of osteoclasts. Three morphological variants were singled out: 1/ predominantly round-polygonal-cellular (histiocyte-like), 2/ predominantly spindle cell (fibroblast-like) and 3/ mixed. Clinically the tumours were divided into 2 groups: superficial (in 8 patients) and deep ones (in 23 patients) developed in skeletal musculature, deep fasciae and tendons, retroperitoneally, as well as in the mammary gland, mesentery of the small intestine, the stomach. The superficial tumours were characterized by relatively low malignancy. Prognosis in the majority of patients with deep tumours of soft tissues was unfavourable. The authors share the opinion of the investigators who consider these tumours to be a malignant variant of giant cell tumours of vagina tendinis and, bearing in mind the unestablished histogenesis of these tumours, think it expedient to retain the term "malignant giant cell tumours of soft tissues".     

Malignant skin tumors of neural crest origin

In a series of 90,000 consecutive surgical biopsies, ten malignant skin tumors were found that revealed at least two of three tissue components known to be derivatives of the neural crest, namely melanotic cells, neuroid structures, and chondrified tissue. The material studied supports a hypothesis presented earlier, that in spite of their morphologic variegation, such tumors from an entity defined by their common origin, the neural crest.     

Malignant tumors of internal organs and dermatoses

According to the author there are five possible kinds of relationship between visceral neoplasmas and diseases of the skin. 1. Instances in which neoplasma induces dermatosis (the so-called paraneoplastic diseases). 2. Instances in which defective immune mechanism or long-lasting immune suppression promote the development of neoplasma as well as of skin diseases due to microorganism and viruses. 3. Instances in which the tumor and dermatosis are associated without causal relationship. 4. Cases of malignant lymphoma arising from neoplastic proliferation of the cells of the reticulohistiocytic system involving visceral organs and the skin. 5. Skin metastases of internal neoplastic processes.     

Anatomy of the pleura

Earlier studies involving water-mediated transformations in lysozyme and ribonuclease A have shown that the overall movements in the protein molecule consequent to the reduction in the amount of surrounding water are similar to those that occur during enzyme action, thus highlighting the relationship among hydration, plasticity, and action of these enzymes. Monoclinic lysozyme retains its crystallinity even when the level of hydration is reduced further below that necessary for activity (about 0.2 gram of water per gram of protein). In order to gain insights into the role of water in the stability and the plasticity of the protein molecule and the geometrical basis for the loss of activity that accompanies dehydration, the crystal structures of monoclinic lysozyme with solvent contents of 17.6%, 16.9%, and 9.4% were determined and refined. A detailed comparison of these forms with the normally hydrated forms show that the C-terminal segment (residues 88-129) of domain I and the main loop (residues 65-73) in domain II exhibit large deviations in atomic positions when the solvent content is reduced, although the three-dimensional structure is essentially preserved. Many crucial water bridges between different regions of the molecule are conserved in spite of differences in detail, even when the level of hydration is reduced well below that required for activity. The loss of activity that accompany dehydration appears to be caused by the removal of functionally important water molecules from the active-site region and the reduction in the size of the substrate binding cleft.     

Tuberculosis of the pleura

BACKGROUND: Tuberculosis is a leading cause of mortality worldwide, with a growing death rate. Pleuritis remains the most common extrapulmonary site of involvement. Epidemiologic trends have altered the presentation of disease. The advent of molecular biology has allowed new insights into disease mechanisms. In this paper, I review the salient features of pleural tuberculosis, highlighting recent epidemiologic trends and advances in diagnosis. METHODS: Literature concerning pleural tuberculosis was identified by a MEDLINE search; additional sources were identified by review of the bibliographies from these papers. RESULTS: Tuberculous pleuritis is uncommon in the United States and now more commonly reflects reactivation of old infections. Patients with coexistent tuberculosis and HIV infection have a higher rate of pleural reaction than non-HIV-infected persons. CONCLUSIONS: Closed pleural biopsy remains the diagnostic procedure of choice; newer diagnostic methods do not have favorable operating characteristics in areas of low tuberculosis incidence. Recommended anti-tuberculous therapy is identical to active pulmonary disease; corticosteroids should not be routinely given.     

Malignant thyroid tumors in Hungary: morbidity and mortality

In 1993, 181 new cases (36 men and 145 women) of thyroid cancer were diagnosed pathologically in Hungary, i.e. a morbidity of 1.8/100,000 for the total population, and of 0.7/100,000 and 2.7/100,000 for men and women, respectively. The distribution of the histological diagnoses: 61% papillary, 25% follicular, 5% medullary and 3% anaplastic carcinomas, and 6% others. In the same year, 125 patients (31 men and 94 women) died from thyroid cancer, i.e. a mortality rate of 1.2/100,000 for the total population, and of 0.6/100,000 and 1.8/100,000 for men and women, respectively. The relatively low morbidity reflects the fact that no new strong aetiological factor is operative in Hungary. The substantial mortality rate, however, is influenced by the geographically determined aggressivity of the disease, the inadequacy of the diagnostic procedures and therapeutic measures, and lack of the active follow-up. The latter facts are especially prominent in centres with a low patient turnover. In the field of health care, various measures must be introduced to prevent an increase in the morbidity and to diminish the mortality. Reduction of the iodine deficiency, rationalization of the medical use of ionizing irradiation, and implementation of the necessary hormonal medication for all patients operated by resection for thyroid diseases are needed for tumour prophylaxis. Before any medical decision-making, the achievement of complete diagnostic information, including the pathological revision of clinically questionable cases, is of paramount importance. The fundamental goals as concerns the treatment modalities are as follows: increased surgical skill and level of performance of external irradiation, the availability of radionuclide therapy, and guidance of all types of thyroxine medication by endocrine experts.     

Malignant tumors of the pancreas and periampullary area. Our experience

The authors analyse and evaluate the clinical records of 45 patients treated in the last 4 years for pancreatic cancer and neoplasm of the bilioduodenapancreatic area, comparing the results with data available in the literature. In the group of patients treated with resection (12 cases), postoperative morbidity and mortality were respectively 28% and 6%, and three-years survival was 22%. The authors discuss particularly about reconstruction ways after duodenopancreatectomy, showing good results after reconstruction by Y loop sec. Roux and pancreato-jejunal anastomosis.     

Matrix metalloproteases and their inhibitors in the pleura

Vulvovaginal candidiasis is a frequent inflammatory process in women but it has not been widely studied in female sex workers (FSWs). To estimate the frequency of Candida species infection in FSWs and to identify related risk factors and clinical findings, we carried out a retrospective study of 1923 FSWs over 11 years. We also performed a prospective study of 163 consecutive FSWs with a history of candidiasis during a 4-year period. Candida species were isolated in 1967 samples (18.5% of the total). Candida albicans (89.3%) was the most frequent species, followed by Candida glabrata (2.7%), Candida parapsilosis (1.2%) and Saccharomyces cerevisiae (0.4%). In the prospective study of 163 patients, we found vaginal discharge in 76.1% of cases, soreness in 52.1% and vulval pruritus in 32.5%. We identified 12 patients (7.4%) with recurrent vulvovaginal candidiasis. No statistical difference was found between recurrent vulvovaginitis and the use of oral contraceptives, oral sex, tight-fitting clothing and synthetic underwear. FSWs have the same prevalence of candidiasis as other groups of women described in published literature. The proportion of albicans and non-albicans species does not differ between women with recurrent and non-recurrent vulvovaginal candidiasis (VVC).