The clinicopathologic features of 53 cases of postradiation soft tissue sarcoma (PRS) were correlated with the physical characteristics of the administered radiation. All but three patients received radiation for malignant processes. Of the secondary sarcomas, malignant fibrous histiocytoma (MFH) accounted for 36 cases (68%), followed by seven extraskeletal osteosarcomas (13%), six fibrosarcomas (11%), two malignant Schwannomas (4%), one extraskeletal chondrosarcoma, and one angiosarcoma. The sex incidence, age of the patient at time of diagnosis, and location of the PRS correlated only with the clinical characteristics of the initial treated condition. The latency period (mean 10 years) showed an indefinite relationship to patient survival but no definite relationship to the patient's age at the time of the initial radiation. There was no difference between patients treated with megavoltage radiation (39 patients) and with orthovoltage radiation (seven patients) in the type of sarcoma, location, or survival, although the orthovoltage group received a lower mean radiation dose (3880 rads) than the megavoltage group (4446 rads). Megavoltage radiation, however, produced deeper tissue radiation changes and was associated with a shorter latency period. Most PRS were poorly differentiated, produced abundant collagen, and had a dismal prognosis.

Postradiation soft tissue sarcomas. An analysis of 53 cases.

In an attempt to further understand the nature of atypical fibroxanthoma of the skin, 140 lesions were subjected to clinical, histologic, and histochemical studies. Atypical fibroxanthoma most commonly presented as a solitary, nonspecific nodule or ulceronodule on exposed skin of the face in the elderly. A clinical variant occurred in much younger persons on the covered areas of the trunk and limbs. Histologically, atypical fibroxanthoma develops as a circumscribed, cellular proliferation within the dermis, with occasional infiltration into the subcutis. Morphological patterns vary from lesions showing plump spindle cells in interlacing fascicles to those with haphazardly arranged large polyhedral cells. Bizarre multinucleated giant cells with foamy cytoplasm and numerous mitotic figures enhance its distrubing sarcoma-like appearance. Among 101 patients followed for periods up to 15 years, no metastatic lesions were found and only nine lesions recurred. Correlation of the clinical and follow-up data support the concept that in spite of its alarming histologic appearance, atypical fibroxanthoma of skin appears to behave in a benign manner.

Atypical fibroxanthoma of the skin. A clinicopathologic study of 140 cases

Verrucous carcinoma of the oral cavity has been established as a distinctive clinical and pathologic entity (1, 2, 11, 15). Typically, the lesion appears as a slow-growing warty mass on the gingival or buccal mucosa of an elderly patient. Histologically, it is characterized by a well differentiated pattern of squamous epithelium in abundant papillomatous hyperkeratotic folds. The tumor slowly invades deeper structures, including bone, but rarely metastasizes (1, 2, 7, 15). A predilection for the mucosa of the oral cavity of tobacco chewers has been noted (1,2, 11), but the lesion also occurs in the larynx and on the squamous mucosa of the vulva, vagina, and glans penis (15). Reports on satisfactory results of treatment of verrucous carcinoma with surgery and diathermy have appeared in the literature (11, 15, 21). Although a large number of cases of squamous carcinoma of the oral cavity have been irradiated (4, 8, 15, 19), the poor response of verrucous carcinoma to this particular method of treatment has ...

Anaplastic transformation in verrucous carcinoma of the oral cavity after radiation therapy.

Atypical fibroxanthomas of the skin.

Thirty-eight cutaneous lesions previously diagnosed as spindle cell squamous carcinoma, “atypical fibroxanthoma,” or dermal sarcoma are presented. Two patients had two lesions each; thus, there were 36 patients. Cases of spindle cell melanoma (including desmoplastic melanoma), sarcoma of subcutaneous origin, and “neuroid sarcoma” were excluded. On review, the lesions fell into two categories: (1) those with a definite component of invasive squamous carcinoma in addition to sarcoma-like areas (8 cases), and (2) those in which such a squamous component was not identified (30 cases). Cases in the former group were considered proven spindle cell squamous carcinomas, while those in the latter group were designated noncommittally as sarcoma-like tumors. Almost all patients were white and over 40 years of age. Four sarcoma-like tumors (from three patients) arose in areas previously treated with x-ray and all but two (both spindle cell squamous carcinomas) of the remainder in both categories arose in sun-damaged skin. Prognosis did not differ significantly between the two categories but depended primarily on the depth of invasion. Two of two tumors that extended into bone and four of seven that invaded skeletal muscle caused death; all of those involving only dermis (24) or dermis and subcutis (five) were successfully extirpated. Origin in an area that had received x-ray was also an unfavorable prognostic indicator; all three patients whose lesions arose in such areas died of tumor. This may have been related to depth of invasion because the three fatal postradiation sarcoma-like tumors all invaded muscle. It was concluded that the distinction between spindle cell squamous carcinoma and “atypical fibroxanthoma” is of little prognostic import per se, but rather that prognosis is primarily dependent on the depth of invasion and, perhaps, the type of antecedent irradiation.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2819800515%2945%3A10%3C2687%3A%3AAID-CNCR2820451034%3E3.0.CO%3B2-R

Spindle cell squamous carcinomas and sarcoma-like tumors of the skin: a comparative study of 38 cases.

Sarcoma-like tumors of the skin following irradiation.

The SARS-CoV-2 virus was initially contained in China but rapidly spread across the globe. The grave threat was not apparent until it was already in our midst. Our organization implemented an Incident Command System (ICS), based on previous experience, to respond to the COVID-19 pandemic in a comprehensive and effective manner. This well-known management and response framework is used by many specialties and organizations in disasters of different complexity and size. Our ICS was able to assemble the appropriate people, assess the situation, and develop and implement plans to deal with the COVID-19 crisis. The effectiveness of the ICS structure and its execution was instrumental in getting in front of the virus and managing regional activities. The ICS is an effective tool to improve safety and mitigate risk when dealing with large-scale disasters and should be implemented and practiced before the need arises. Our organization implemented a formal Incident Command System (ICS) very early as a response to the COVID-19 pandemic. Although it recently disbanded, we are maintaining its core functionality and communication as we continue to deal with COVID-19 into the future. The author has observed the ICS being used at hospitals through hurricanes, blizzards, and riots but never saw it work as well as it did during the initial weeks of the pandemic. This group deftly navigated through uncharted waters by leveraging the spirit and structure of Incident Command.

/pdf/incident-command-in-the-time-of-covid-19-d3bmkhs6lq.pdf

Jim Cook

Papers

Sarcoma-like tumors of the skin following irradiation.

Incident Command in the Time of COVID-19.

Diagnosing Harvey: A Laboratory Medicine Department’s Response to a Disaster Situation