Showing papers in "Cancer in 1973"
TL;DR: It is suggested that the total dose of adriamycin should be limited to less than 550 mg/m2 to permit safer use of this efficacious cancer chemotherapeutic agent.
Abstract: The cardiotoxic effects of adriamycin were studied in 399 patients treated for far-advanced carcimma. Forty-five patients (11%) exhibited transient electrocardiographs changes. Eleven others developed severe congestive heart failure. Eight of these latter patients died within 3 weeks of the onset of the cardiac decompensation. The diffuse nature of this myocardiopathy was suggested by: 1. a conspicuous decrease in the QRS voltage on the electrocardiograms; 2. rapidly occurring cardiac dilatation and ventricular failure, and 3. refractoriness to inoiropic drugs and mechanical ventricular assistance. Postmortem examination of the hearts in two cases showed a striking decrease in the number of cardiac: muscle cells present, degeneration of the remaining myocardial cells, loss o contractile substance, mitochondrial swelling, and intramitochondrial dense inclusion bodies. Congestive heart failure occurred only once in the 366 patients who were treated with less than 550 mg/m2 of adriamycin (0.27%), but there were 10 cases of cardiac failure in the 33 patients who received more than 550 mg/m2 of this drug (30%). Therefore, until more direct means are established to prevent adriamycin-induced congestive heart failure, it is suggested that the total dose of adriamycin should be limited to less than 550 mg/m2 to permit safer use of this efficacious cancer chemotherapeutic agent.
1,450 citations
TL;DR: In conclusion, bleomycin appeared to be useful in the treatment of patients with specific tumors refractory to standard treatment and/or whose bone marrow status precluded the use of conventional chemotherapy.
Abstract: Bleomycin, a new antibiotic antineoplastic agent, has undergone extensive clinical trial. Data from 1,174 patients were reviewed and summarized by cell type. The most commonly used dose schedule was 15 mg/m2 twice a week intravenously. Significant response rates were achieved in patients with squamous cell carcinoma of various anatomical sites, lymphomas, and testicular carcinoma. Most responses were of 1 to 2 months' duration. Drug toxicities included significant skin and pulmonary complications and some degree of drug-induced pyrexia and nausea with vomiting. Rare insignificant bone marrow depression was encountered. The limitations of a retrospective clinical review of this type using uncontrolled pooled data from various patient populations were discussed. In conclusion, however, bleomycin appeared to be useful in the treatment of patients with specific tumors refractory to standard treatment and/or whose bone marrow status precluded the use of conventional chemotherapy. The final role of bleomycin in cancer chemotherapy awaits the results of controlled prospective clinical trials.
775 citations
TL;DR: The overall recommendation at present is that patients with prostatic cancer should not be treated until their symptoms require relief, and at that time it is recommended starting treatment with 1.0 mg DES daily.
Abstract: The results of these clinical trials over the past 12 years have revealed an unsuspected toxicity of DES used in treating patients with cancer of the prostate when given in a dose of 5.0 mg daily. The first VA study did not show that orchiectomy was superior to estrogen in treating cancer of the prostate or that the combination orchiectomy plus estrogen had much to offer beyond the benefits of estrogen alone when indicated. The preponderance of evidence from the second study shows that 1.0 mg of DES appears to be about as effective as the 5.0 mg dose in treating cancer of the prostate but does not carry the excess hazard of cardiovascular deaths. Our overall recommendation at present is that patients with prostatic cancer should not be treated until their symptoms require relief, and at that time we recommend starting treatment with 1.0 mg DES daily. These recommendations may change as we continue to analyze our data.
584 citations
TL;DR: Plasma cell granuloma of the lung represents localized proliferations predominantly of mature plasma cells, with Russell bodies, reticuloendothelial cells, and intermediate forms, supported by a stroma of granulation tissue, which may contain interlacing or whorled masses of fibroblasts.
Abstract: Plasma cell granuloma of the lung, a designation that we consider preferable to “inflammatory pseudotumor,” represents localized proliferations predominantly of mature plasma cells, with Russell bodies, reticuloendothelial cells, and intermediate forms, supported by a stroma of granulation tissue. Other cellular elements, including lymphocytes and large mononuclear cells, may coexist with the plasma cells. The latter may have a large content of cytoplasmic fat, hence the term “xanthoma” or “fibroxanthoma” applied by some. The stroma may contain interlacing or whorled masses of fibroblasts, and may be focally ossified or calcified. It is often hyalinized with an appearance similar to that of paramyloid. These lesions are usually asymptomatic, and are most commonly detected in routine chest films as circumscribed “coin” lesions, or large masses. They may be static or increase slowly in size. In a minority, they are sessile or polypoid intrabronchial masses. More than two thirds of the patients are less than 30 years of age; indeed plasma cell granulomas are prominent among the large solitary intrapulmonary lesions in children. Bacterial cultures and skin tests for mycobacteria and fungi have been negative. The prognosis is good even after lobectomy, and probably even after segmental resection. Plasma cell granulomas have structural features and a natural history quite distinct from those of sclerosing hemangioma and myeloma.
584 citations
TL;DR: Most of the chondrosarcoma‐like tumors of the base of the skull have a paradoxically indolent course and assessment of long‐term survival patients indicated that extensive surgical resection combined with irradiation offers the best palliation and prolongation of life.
Abstract: Special attention was given to chordomas and all cartilaginous tumors at the base of the skull during a study of the clinical and pathologic data on 155 chordomas (76 sacrococcygeal, 55 spheno-occipital, and 24 vertebral) seen at the Mayo Clinic. Attention also was drawn to a histologically separate group of spheno-occipital chordolmas which comprised one third of the tumors in this location and was associated with a surprisingly better prognosis. These tumors, which may bear a striking histologic resemblance to chondrosarcomas or chondromas, had clinical and roentgenologic features that convinced us of their kinship to ordinary chordomas and led us to designate them as “chondroid” chordomas. When these were excluded from the cartilaginous tumors of the base of the skull, there remained only four such tumors, all chondrosarcomas, in the files of the Mayo Clinic. Thus most of the chondrosarcoma-like tumors of the base of the skull have a paradoxically indolent course. Assessment of long-term survival patients indicated that extensive surgical resection combined with irradiation offers the best palliation and prolongation of life.
566 citations
TL;DR: It is concluded that histopathologic classification proposed by Rappaport et al. and the Ann Arbor Staging Classification are both useful guides to the management and prognosis of the non‐Hodgkin's lymphomas.
Abstract: An analysis is presented of the histopathologic, clinical, and prognostic features in a series of 405 previously untreated patients with non-Hodgkin’s lymphomas referred to Stanford University Medical Center between 1960 and 1971. .411 biopsies were histologically classified according to the criteria of Rappaport et al. and clinical extent of disease was thoroughly evaluated prior to treatment and staged according to the Ann Arbor Classification. Nodular lymphomas constituted 44% of the group and diffuse lymphomas 56%. Patients under the age of 35 years and those over 60 tended to have diffuse lymphomas. Although 39% of the patients had Stage IV disease at presentation, localized forms (Stage I, I,., 11, 11,) were observed in 37%. Localized extralymphatic involvement occurred more often in patients with diffuse than nodular lymphomas (11 < 0.001). Systemic symptoms occurred in 24% of patients with diffuse and 17% of those with nodular lymphomas; however, their presence did not adversely affect survival. Mediastinal adenopathy was noted in 24% of diffuse and 18% of nodular lymphomas (P = NS), and mediastinal “skipping” was observed in 20% of diffuse and 40% of nodular lymphomas (p < 0.05). By the criteria used, 81% of evaluable patients (Stages I1 through 111,) with nodular lymphoma and 90% of those with diffuse lymphoma had contiguous sites of involvement (p = 0.07). Two frequently observed sites of initial extralymphatic involvement were bone marrow and gastrointestinal; the former was observed more often in advanced lymphocytic lymphomas, whether nodular or diffuse, and the latter in advanced, diffuse lymphomas. Actuarial survival correlated strongly with the histopathologic type of lymphoma; in each cellular category, patients with nodular lymphomas survived significantly longer than those with diffuse lymphomas (1’ < 0.05). Age at presentation also influenced survival in relation to certain histologic patterns. Patients with diffuse lymphocytic or mixed lymphomas who were less than 40 years of age had a worse prognosis than those over 40 (p = 0.02). In contrast, older patients with nodular lymphocytic and mixed lymphomas fared worse than those under 40 (p < 0.01). Patients with either initial bone marrow or gastrointestinal involvement survived longer if their lymphoma had a nodular pattern. It is concluded that histopathologic classification proposed by Rappaport et al. and the Ann Arbor Staging Classification are both useful guides to the management and prognosis of the non-Hodgkin’s lymphomas.
558 citations
TL;DR: The most common presenting signs and symptoms were bone disease, a palpable neck mass, and renal stones, and the most important histologic features were mitoses and fibrous bands.
Abstract: Seventy cases of carcinoma of the parathyroid collected over a 40-year period are analyzed. The average age of the patients was 44.3 years, and there was no sex predominance. The most common presenting signs and symptoms were bone disease, a palpable neck mass, and renal stones. The initial serum calcium value averaged 15.2 mg/100 ml. The most important histologic features were mitoses and fibrous bands. Local recurrence occurred in 30% of the cases. Metastatic spread, which occurred in 30% of the cases, was usually late and to regional lymph nodes, lungs, liver, and bone. Less than half the patients died of the disease within 5 years.
538 citations
TL;DR: The biologic behavior of these tumors was malignant, with an average duration of 18 months from onset of symptoms to death, and it is suggested that the mesenchyme is also an aspect of tumor differentiation.
Abstract: Predominantly undifferentiated tumors occurring in the cerebrum of young individuals are referred to as “primitive neuroectodermal tumors.” Twenty-three of these cases were collected which had certain common features. Grossly they tended to be cystic and compressed adjacent brain. Microscopically they were malignant-appearing and demonstrated a prominent mesenchymal component. Sixteen cases showed focal evidence of glial and/or neuronal-appearing differentiation. It is suggested that the mesenchyme is also an aspect of tumor differentiation. The biologic behavior of these tumors was malignant, with an average duration of 18 months from onset of symptoms to death.
519 citations
TL;DR: Most instances of so‐called “mucocele” should be regarded as mucinous neoplasms, analogous in many aspects to the epithelial tumors of the colon, with peculiarities probably due to the anatomical characteristics of the organ in which they arise.
Abstract: The evaluation of 73 appendiceal lesions fulfilling the criteria of so-called “mucocele” showed that they comprise 3. distinctive clinicopathologic entities: 1) Focal or diffuse mucosal hyperplasia, with no epithelial atypia and mild distention of the lumen (18 cases). The microscopic pattern is highly reminiscent of the colonic hyperplastic polyp. This is a benign lesion, almost always a pathologic finding in appendices removed incidentally. Of the 18 cases classified as such, 5 were associated with adenocarcinoma of the large bowel, and 1 with ovarian mucinous cystoma; 2) Mutinous cystadenoma, exhibiting some degree of epithelial atypia and marked distention of the lumen (46 cases). Four of these were associated with ovarian mucinous cystoma and 9 with adenocarcinoma of the large bowel. In 10 cases, variable amounts of acellular mucus were present in the periappendiceal region and occasionally free in the peritoneal cavity. In 3 of these cases the mucus most probably originated from a coexistent ovarian tumor. Of the followed patients, none died as a consequence of the appendiceal cystadenoma. Simple excision of the lesion was curative in every case; and 3) Mucinous cystadenocarcinoma (9 cases). This group was distinguished from the previous one by the presence of stromal invasion by glands and/or epithelial cells in the peritoneal implants. Six were associated with peritoneal involvement (so-called pseudomyxoma peritonei); in 2 others, the lesion was limited to the appendix, and in the remainder there was direct extension into the urinary bladder. Of the 6 patients with peritoneal extension, 4 died as a result of the disease 2-11 years after the original surgery, 1 was lost to followup, and the sixth case is a recent observation. The 2 patients with localized tumor were alive and well 2 and 19 years after treatment, respectively. The patient with direct extension into the urinary bladder was alive and well 7 years after an anterior pelvic exenteration. On the basis of these findings we suggest that most instances of so-called “mucocele” should be regarded as mucinous neoplasms, analogous in many aspects to the epithelial tumors of the colon, with peculiarities probably due to the anatomical characteristics of the organ in which they arise.
484 citations
TL;DR: In addition to recording the histogenetic mode of development of a malignant melanoma, a histologic system of reporting is recommended which includes mitotic activity, levels of invasion, and vascular involvement.
Abstract: Apart from the rare malignant melanomas occurring in blue nevi, primary cutaneous malignant melanoma arises in 1 of 3 ways, regardless of the presence or absence of a pre-existing nevus. These three types have been designated: 1. Malignant melanoma, invasive, with adjacent intra-epidermal component of Hutchinson's melanotic freckle type; 2. Malignant melanoma, invasive, with adjacent intra-epidermal component of superficial spreading type; and 3. Malignant melanoma, invasive, without adjacent intra-epidermal component. Occasionally, both clinically and histologically, there may be difficulty in deciding whether a malignant melanoma belongs to category 1 or 2, but, in the majority of cases, these 2 types can be quite readily distinguished. In addition to recording the histogenetic mode of development of a malignant melanoma, a histologic system of reporting is recommended which includes mitotic activity, levels of invasion, and vascular involvement. There are other parameters such as the cell type, pigmentation, lymphocytic infiltrates, evidence of spontaneous regression, associated nevi, and solar changes in the dermis, all of which are of unknown significance. The recording of these features, which are clearly of interest for research purposes, is left to individual discretion. It is emphasized that all the usual macroscopic descriptions and measurements should continue to be recorded.
414 citations
TL;DR: It is concluded that adriamycin is an active agent, most remissions occur promptly, and significant cardiotoxic reactions appear to be cumulative.
Abstract: Four hundred and seventy-two patients with disseminated neoplasia were treated with two or more doses of adriamycin. The initial dose for “good risk” patients was 75 mg/m2 every 3 weeks, and for “poor risk” patients was 60 mg/m2 every 3 weeks. Objective remissions were seen in 118/472 patients, with best results noted in lymphomas (21/48), sarcomas (21/64), and carcinoma of the breast (16/50). Eighty-nine per cent of remissions occurred within three courses. Hematopoietic toxic effects were seen in 73% of patients; nausea, vomiting, and/or stomatitis were observed in 43%. Changes in electrocardiograms were seen in 42/472 patients after cumulative doses of adriamycin ranging from 45 mg/m2 to 600+mg/m2. Irreversible congestive heart failure occurred in two patients after cumulative doses of 555 mg/m2 and 825 mg/m2, respectively. It is concluded that adriamycin is an active agent, most remissions occur promptly, and significant cardiotoxic reactions appear to be cumulative.
TL;DR: All cases of minor salivary neoplasm seen at Memorial Hospital during a 25‐year period are reviewed, and adenoidcystic carcinoma was the lesion most frequently encountered.
Abstract: All cases of minor salivary neoplasm seen at Memorial Hospital during a 25-year period are reviewed. More than 88% had malignant tumors, and adenoidcystic carcinoma was the lesion most frequently encountered. Although the palate was the site most often involved, great diversity in clinical presentation was noted. Neither the symptomatology nor the gross appearance was of assistance in predicting the histology of these lesions. All but 10% of the patients were treated surgically. Elective radical neck dissection was avoided in those with malignant tumors inasmuch as metastases were as likely to appear in distant sites as in regional lymph nodes. The determinate “cure” rate 5, 10, and 15 years after treatment was 44.5, 32.6, and 21.4%, respectively. Histology, anatomic site, and the extent of the disease were the factors which most influenced survival.
TL;DR: Testicular tumors constitute the fourth most common cause of deaths from neoplasia in the age group of 15–34 years of age and the most important metastatic tumor of the testes is malignant lymphoma, initially manifested as testicular tumor.
Abstract: Observations on 6,000 testicular tumors revealed the following: Testicular tumors constitute the fourth most common cause of deaths from neoplasia in the age group of 15–34 years of age. There is a definite geographic, racial, and age distribution. The cause of testicular tumors is unknown, but cryptorchidism, trauma, infections, and genetic and endocrine factors appear to play a role in their development. Germ cell tumors comprise the large majority of testicular tumors and present one or more of 4 bask histologic patterns: seminoma, embryonal carcinoma, choriocarcinoma, and teratoma. In 40% the tumors show admixtures of 2 or more of these basic cell types. Tumors of specialized gonadal stroma constitute about 6% of testicular tumors and consist of Leydig cell, Sertoli cell, and granulosa-theca cell tumors, or admixtures of these. The most important metastatic tumor of the testes is malignant lymphoma, initially manifested as testicular tumor.
TL;DR: Three peripheral nerve sheath tumors are reported which showed an intermingling of schwannian elements and rhabdomyosarcoma, a type of compound tumor first described by Masson in 1932, which indicates the tumor to be highly malignant.
Abstract: Three peripheral nerve sheath tumors are reported which showed an intermingling of schwannian elements and rhabdomyosarcoma, a type of compound tumor first described by Masson in 1932. One of the patients had von Recklinghausen's disease. The tumor in two patients showed pleomorphic rhabdomyosarcoma, while in a third patient it grew partially as an embryonal rhabdomyosarcoma. All three tumors contained areas of malignant schwannoma, but, in this latter case, the rhabdomyosarcoma appeared to arise from an area of benign Schwann cell growth. Two of the patients died following spread of the malignant muscle component. All previously reported examples of this tumor developed in individuals showing stigmata of von Recklinghausen's disease. Data from our three cases and from seven cases from the literature indicates the tumor to be highly malignant. Of the nine patients with follow-up, seven were dead within 3 to 20 months of their diagnosis. Those recurrent tumors or metastases that were examined histologically (four cases) showed rhabdomyosarcoma.
TL;DR: 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.
Abstract: 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.
TL;DR: Granulocytic sarcoma (chloroma) was present in 23 of 338 myelogenous leukemia patients autopsied in Hiroshima and Nagasaki during 1949‐1969, and gross tumors occurred most frequently in bone, ovary, lymph nodes, kidney, dura, lung, arm, and breast.
Abstract: Granulocytic sarcoma (chloroma) was present in 23 of 338 myelogenous leukemia patients autopsied in Hiroshima and Nagasaki during 1949-1969. There was no evidence that granulocytic sarcoma was more frequent among those who received heavy atomic-bomb irradiation, although the incidence of myelogenous leukemia was greatly increased in the heavily irradiated group compared with controls. Granulocytic sarcoma was found in 19 of 237 persons with acute myelogenous leukemia, in 3 of 77 with chronic myelogenous leukemia, and 1 of 24 with chronic myelogenous leukemia with blast crisis. It was distinguished from myelogenous leukemia by: significantly higher frequency in children and young adults; clinical manifestations of pain and tumor formation (often with exophthalmos) followed by paralysis and/or urinary incontinence; slightly shorter survival time; and greater intensity of leukemic infiltration in the pituitary. At autopsy, gross tumors occurred most frequently in bone, ovary, lymph nodes, kidney, dura, lung, arm, and breast. The pathogenesis of tumor formation in leukemia is discussed.
TL;DR: The findings substantiate the rationale for preserving the contralateral uninvolved ovary in a young woman with a borderline mucinous ovarian tumor and suggest the two should be separated if meaningful data on frequency, behavior, and therapeutic results are to be obtained.
Abstract: The tremendous variation in length of survival of patients with mucinous cystadenocarcinoma of the ovary largely reflects the lack of uniform histologic criteria for the diagnosis. Evaluation of the efficacy of therapy for patients with Stage I carcinoma is especially difficult, since borderline tumors have been included that are histologically and clinically intermediate between a cystadenoma and a cystadenocarcinoma. A review of 688 primary mucinous tumors confined to one or both ovaries at the time of initial surgery indicated 80% were benign cystadenomas. The remaining 20% (136 neoplasms) were characterized by a proliferation of atypical epithelium that had features suggestive of malignancy. By analyzing the depth of stratification of the atypical cells and the presence or absence of stromal invasion, 97 Stage I borderline tumors (71%) were delineated from 39 Stage I cystadenocarcinomas (29%). Typically, the borderline tumor was a large, multilocular neoplasm that had papillary infoldings and two to three layers of atypical epithelial cells, but no invasion of the stroma. The “true” carcinoma had a greater degree of cellular stratification and/or unequivocal stromal invasion. An infiltrative growth pattern was identified in 56% of the carcinomas. Only 3 (4%) of 87 patients followed with a borderline tumor died with neoplasm compared to 9 (33%) of 27 patients followed with a cystadenocarcinoma. Rupture of tumor with spillage did not adversely affect the prognosis. Since the prognosis of the borderline mucinous tumor is vastly superior to that of a cystadenocarcinoma, the two should be separated if meaningful data on frequency, behavior, and therapeutic results are to be obtained. Our findings substantiate the rationale for preserving the contralateral uninvolved ovary in a young woman with a borderline mucinous ovarian tumor.
TL;DR: The pathologic features and the behavior of 35 cases of lipoblastomatosis, a benign tumor frequently confused with a liposarcoma, were presented and it is suggested that the term “benignlipoblastoma” be employed for the circumscribed type and the term’s used for the diffuse type.
Abstract: The pathologic features and the behavior of 35 cases of lipoblastomatosis, a benign tumor frequently confused with a liposarcoma, were presented. In the reviewed material, the tumor affected exclusively infants and young children, with 88% of the cases occurring before the age of 3 years. It involved most commonly the soft tissues of the lower and upper extremities. A circumscribed and a diffuse form of lipoblastomatosis could be distinguished. The circumscribed form was the mose common one (23 of 35 cases); usually it was superficially located and clinically comparable to a lipoma. The diffuse form was more deeply situated and was analogous to a diffuse lipomatosis. Nine cases belonged in this category. In three cases, the data were insufficient to classify them as to the circumscribed or diffuse type. Microscopically, both forms showed an identical histologic picture consisting of tabulated immature adipose tissue composed of lipoblasts, a plexiform capillary pattern, and a richly myxoid stroma. Although the term “lipoblastomatosis” has been used in the past for both circumscribed and diffuse forms, it is suggested that the term “benign lipoblastoma” be employed for the circumscribed type and the term “benign lipoblastomatosis” for the diffuse type of this tumor. Follow-up information revealed a benign clinical course with a low rate of recurrence (14%), probably attributable to incomplete removal of the tumor; three of the five recurrent tumors were of the diffuse type. Complete local excision appears to be the treatment of choice.
TL;DR: During the period from 1920‐1970, 902 patients with a tumor of the peripheral nervous system were treated at the Memorial Sloan‐Kettering Cancer Center, and Histologic review of this material revealed 115 cases which fulfilled strict criteria for clinicopathologic diagnosis of malignant schwannoma.
Abstract: During the period from 1920-1970, 902 patients with a tumor of the peripheral nervous system were treated at the Memorial Sloan-Kettering Cancer Center. Histologic review of this material revealed 115 cases which fulfilled strict criteria for clinicopathologic diagnosis of malignant schwannoma, i.e., tumorinvolved nerve trunks with fusiform or oval swelling and arising from the nerve sheath. There was no significant age or sex predilection. Association with plexiform neuroma or with stigmata of von Recklinghausen's disease was found to be indicative of a poor prognosis. Radical local excision controlled small tumors. Muscle group dissection or major amputation was reserved where large tumors or recurrence precluded local excision. Lymphatic invasion and lymph node involvement by malignant schwannoma was not observed. Regional lymph node dissection is unnecessary.
TL;DR: It is shown that CNS leukemia is primarily an arachnoid disease, and abnormalities in brain parenchyma apparently result from leukemic extension through pia‐glial membrane or interference with local perfusion due to constriction of blood vessels by perivascular arachNoid leukemia.
Abstract: A histopathologic study was performed to evaluate the distribution and extension of intracranial leukemic infiltrates and their relationship to other morphological disturbances of the central nervous system (CNS) in childhood acute lymphocytic leukemia Of 126 brains examined, 70 had arachnoid leukemia at the time of autopsy The earliest evidence of leukemia was seen in the walls of superficial arachnoid veins With more advanced arachnoid leukemia, the disease was seen to extend into the deep arachnoid surrounding blood vessels as they course through the brain The arachnoid leukemia followed a predictable expanding pattern to eventual invasion of brain parenchyma with destruction of the pia-glial membrane Leukemic infiltrate at the capillary-neural tissue interface was present only following destruction of pia-glial membrane secondary to deep arachnoid leukemia Arachnoid fibrosis and certain brain parenchymatous lesions were found in association with arachnoid leukemia The brain lesions included gliosis, necrosis, cerebral hemorrhage, and nonhemorrhagic degenerative encephalopathy This study demonstrates that CNS leukemia is primarily an arachnoid disease Disturbances of brain parenchyma apparently result from leukemic extension through pia-glial membrane or interference with local perfusion due to constriction of blood vessels by perivascular arachnoid leukemia
TL;DR: The relevance of the marked variability and unpredictability in the natural history of prostatic cancer thus revealed to treatment decisions and interpretations of the results of treatment in the aging host are indicated.
Abstract: Various possibilities in the stage progression of prostatic carcinoma in the untreated host are supported by an analysis of pertinent literature. The relevance of the marked variability and unpredictability in the natural history of prostatic cancer thus revealed to treatment decisions and interpretations of the results of treatment in the aging host are indicated.
TL;DR: A series of 51 patients treated with 92 separate lung fields for metastatic pulmonary disease between 1958 and 1971 is reviewed and a newly derived formula for estimated single doses (ED) is developed.
Abstract: A series of 51 patients treated with 92 separate lung fields for metastatic pulmonary disease between 1958 and 1971 is reviewed. The treatment data are converted into nominal single doses (NSD) and a newly derived formula for estimated single doses (ED). The 5% incidence level of pneumonitis without dactinomycin is 770 rets (NSD) and 510 rets (ED) and with dactinomycin, 520 rets (NSD) and 450 rets (ED). A safe treatment regimen for avoiding radiation pneumonitis is 1500 rads in 10 fractions with dactinomycin and 2500 rads in 20 fractions without dactinomycin.
TL;DR: Adriamycin was given to 234 patients with leukemia and other types of neoplastic diseases and produced complete remissions and good partial remissions in children with acute leukemia previously treated, and in adults, the therapeutic responses have been less consistent and were confined to lymphomas and soft tissue sarcomas.
Abstract: Adriamycin was given to 234 patients with leukemia and other types of neoplastic diseases. In children with acute leukemia previously treated, adriamycin produced complete remissions (12%) and good partial remissions (26%). Tumor regressions were seen in 60% of the patients with solid tumors. These included lymphoma, embryonal rhabdomyosarcoma, neuroblastoma, Ewing's sarcoma, Wilms' tumor, ovarian tumor, hepatoma, embryonal carcinoma, malignant teratoma, and retinoblastoma. The therapeutic responses in adults have been less consistent and were confined to lymphomas and soft tissue sarcomas. The dose in children was 0.5 mg/kg daily to a total of 2-4 mg/kg per course. In adults, the single dose was 0.4 mg/kg to a total of about 2.5 mg/kg in 10 days. Adriamycin at half the dose of daunomycin produced comparable toxicities, except for earlier and more frequent oral ulcers and alopecia. Varying degrees of transient electrocardiographic changes have been seen in children. Adriamycin may have contributed to cardiac failure and death in one child, who had recurrent pulmonary metastases.
TL;DR: Results of a clinicopathologic study of seven cases of a previously unreported disease of minor salivary gland are presented, and necrotizing sialometaplasia shows marked similarity to mucoepidermoid carcinoma.
Abstract: Results of a clinicopathologic study of seven cases of a previously unreported disease of minor salivary gland are presented. Necrotizing sialometaplasia is a disease of adults with four of seven patients being in the sixth decade of life. In every case, this benign inflammatory process involved only the tissues covering the hard palate, and, in six instances, it was characterized by ulceration. Lobular necrosis and marked squamous metaplasia of salivary gland are consistent features. Microscopically, necrotizing sialometaplasia shows marked similarity to mucoepidermoid carcinoma, and criteria are presented to aid in distinguishing these two conditions. There have been no recurrences following local surgical excision. Etiologic factors remain obscure.
TL;DR: A heterogeneous pattern, often characterized by pseudolobulation of cellular areas, a prominent tendency to sclerosis, a frequently marked vascularity, and a pronounced variation in cellular size and shape distinguished this tumor, designated “sclerosing stromal tumor” from the fibroma, thecoma, and other forms of ovarian stroma.
Abstract: Ten cases of a distinctive, hitherto undescribed type of benign ovarian stromal tumor are reported. These tumors occurred predominantly in the second and third decades and appeared to be without function. A heterogeneous pattern, often characterized by pseudolobulation of cellular areas, a prominent tendency to sclerosis, a frequently marked vascularity, and a pronounced variation in cellular size and shape distinguished this tumor, designated “sclerosing stromal tumor” from the fibroma, thecoma, and other forms of ovarian stromal tumor.
TL;DR: The data indicate that this test system assays certain early and tumor histology‐related aspects of the hosttumor relationship and is potentially useful for the study of factors associated with development of cancer and monitoring effect of tumor treatment.
Abstract: The in vitro reactivity of peripheral blood lymphocytes and the effect of serum on normal lymphocyte reactivity was determined in 89 patients with non-lymphoid tumors by quantitation of phytohemagglutinin (PHA)-induced tritiated thymidine incorporation. The reactivity of lymphocytes from patients with sarcomas and squamous carcinomas was impaired, and their sera suppressed normal lymphocyte reactivity. The cellular and serum abnormalities coexisted in patients with sarcomas but occurred independently in patients with squamous carcinomas. Patients with melanomas and adenocarcinomas did not differ from controls by these parameters. With the exception of patients with melanomas, a similar incidence of abnormalities occurred in patients with localized tumors and those with metastases. These data indicate that this test system assays certain early and tumor histology-related aspects of the hosttumor relationship and is potentially useful for the study of factors associated with development of cancer and monitoring effect of tumor treatment.
TL;DR: The results indicate that craniospinal irradiation alone, 2400 rads, or cranial irradiation with simultaneous intrathecal methotrexate is effective in preventing CNS relapse, resulting in marked improvement in complete remission duration and a 50% frequency of long‐term leukemia‐free survival and possible cure.
Abstract: During the past 10 years, 1962 to 1972, we have administered irradiation to the central nervous system (CNS) during the first few weeks of remission of acute lymphocytic leukemia (ALL) as an integral part of a treatment plan aimed at cure of ALL. Its purpose has been to eradicate residual leukemia in the CNS and thus prevent CNS relapse. The results indicate that craniospinal irradiation alone, 2400 rads, or cranial irradiation, 2400 rads, with simultaneous intrathecal methotrexate is effective in -preventing CNS relapse. This results in marked improvement in complete remission duration and a 50% frequency of long-term leukemia-free survival and possible cure. Although intermittent intrathecal methotrexate during remission is said to reduce the incidence of CNS relapse by one half, a 15-fold reduction results from adequate preventive CNS irradiation. Until a better method is found, all children with ALL should receive adequate CNS irradiation early during remission in order to prevent CNS relapse and to prolong complete remission.
TL;DR: Combined systematic therapy offers the best chance of cure for children with rhabdomyosarcoma originating in the head and neck, and late recurrences or complications require further follow‐up.
Abstract: Combined systematic therapy offers the best chance of cure for children with rhabdomyosarcoma originating in the head and neck. Recommended therapy includes: 1. local excision or biopsy; 2. radiation therapy with doses of 6,000 rads/6 weeks, and 3. multi-drug chemotherapy, i.e., vincristine sulfate, actinomycin D, and cyclophosphamide. Severe ocular, dental, soft tissue, and possibly bone complications may be encountered. Provision for prompt medical and nursing support must be available for possible associated morbidity. Of 19 patients treated, minimum 2-year survival is 74%, and local control 89%. Late recurrences or complications require further follow-up.
TL;DR: DNR cardiotoxicity may be related to the inability of non‐dividing cardiac muscle cells to repair DNR‐induced alterations in DNA.
Abstract: To elucidate the mechanisms of the cardiotoxicity induced by daunorubicin (DNR), histologic and ultrastructural studies were made of the hearts of six patients with acute leukemias. Three of these patients had received relatively high total doses (455, 460, and 500 mg/m2) of DNR; one patient had received a relatively low total dose (120 mg/m2) of DNR; two patients who had not been treated with this drug served as controls. Histologic changes observed only in the hearts of the three patients who had received relatively high doses of DNR consisted of scattered foci of damaged, degenerating, and atrophic muscle cells. These changes were more widespread in the patient who had received the highest dose of DNR and developed clinical signs of cardiotoxicity. Alterations of chromatin were observed in 10% of nuclei of cardiac muscle cells in the three patients treated with relatively high doses of DNR. These changes consisted of transformation of variable amounts of chromatin into thick fibers, 160-200 A in diameter, intermediate-sized fibers, 70-100 A in diameter, and thin filaments, 30-40 A in diameter. These alterations were interpreted as representing various stages of uncoiling and unraveling of chromatin and were considered to be related to the phenomenon of intercalation of DNR into DNA. DNR cardiotoxicity may be related to the inability of non-dividing cardiac muscle cells to repair DNR-induced alterations in DNA.
TL;DR: Autopsy study of the colon of Hawaii Japanese indicates that, unlike native Japanese, diverticulosis and both adenomatous and hyperplastic polyps are very common in this population, consistent with observations that other populations show parallel trends for these conditions and large intestinal carcinoma.
Abstract: Autopsy study of the colon of Hawaii Japanese indicates that, unlike native Japanese, diverticulosis and both adenomatous and hyperplastic polyps are very common in this population. This is consistent with observations that other populations show parallel trends for these conditions and large intestinal carcinoma. The adenomatous and hyperplastic polyps are more likely to occur together than either are likely to occur alone or in association with diverticulosis. Hyperplastic polyps are more likely to occur at anatomic sites which exhibit the highest frequency of cancer than do adenomatous polyps in this population.