颈动脉体瘤诊断和治疗探讨(附8例报告)

 目的　探讨颈动脉体瘤的诊治方法。方法　回顾性分析 1983至 1997年间我院收治的 8例颈动脉体瘤患者的临床资料。 2例单纯切除肿瘤 ,2例合并颈外动脉切除 ,4例合并颈动脉分歧部切除术。结果　 8例患者 (10 0 % )手术后长期生存 ,且不伴有严重的并发症。结论　数字减影血管造影、超声检查足以明确诊断。充分的颈动脉压迫训练是手术成功的重要前提。可根据肿瘤与血管的关系选择适当的术式     

卵巢恶性肿瘤胃肠道转移的手术治疗

目的 总结分析卵巢恶性肿瘤胃肠道转移手术及并发症特点,探讨其治疗价值及可行性。方法 回顾性分析１３１例卵巢恶性肿瘤胃肠转移行手术治疗患者的临床资料。统计数据采用计算机软件处理。结果 卵果恶性肿瘤胃肠转移占同期收治原发性卵巢恶性肿瘤的２８．９％,Ⅲ、Ⅳ期占９３．９％,治疗方式为手术加化疗、５８．９％行单纯肠壁病灶切除及修补,４１．１％行部分肠切除要术后并发症发生率为２６．９％,术后２年及５年生存率分     

原发性十二指肠恶性肿瘤的诊治及预后分析

目的:探讨原发性十二指肠恶性肿瘤的诊治及预后。方法:采用回顾性分析的方法,选取2008年1月至2013年2月我院收治的原发性十二指肠恶性肿瘤患者90例,收集患者的临床资料并进行比较分析。对比患者的诊断方法、外科治疗情况、预后以及影响预后的因素。结果:90例患者中,腺癌57例（63.33%）、恶性间质瘤20例（22.22%）、类癌7例（7.78%）、其他肿瘤6例（6.67%）;术前B超检出率为24.39%（10/41）,腹部增强CT检出率为53.33%（48/90）,十二指肠低张造影检出率为84.00%（21/25）,十二指肠镜检出率为90.36%（75/83）;90例患者均接受了手术治疗,其中60例行胰十二指肠切除术,9例行十二指肠节段性切除,3例行胃大部分切除术并十二指肠球部肿瘤切除术,18例行姑息短路手术。90例原发性十二指肠恶性肿瘤患者的1、3、5年生存率分别为81.11%（73/90）、55.56%（50/90）、31.11%（28/90）。单因素回归分析显示,患者术后的生存率与手术方式、肿瘤分化程度、肿瘤浸润深度以及淋巴转移情况有关（P<0.05）;多因素Cox回归分析显示,手术方式、肿瘤浸润深度以及淋巴转移均为影响患者预后的独立危险因素（P<0.05）。结论:原发性十二指肠恶性肿瘤具有多样的临床表现,十二指肠镜检查以及低张造影均为其有效的诊断方法。手术切除是原发性十二指肠恶性肿瘤的主要治疗方法,手术方式、肿瘤浸润深度以及淋巴转移均为影响患者预后的独立危险因素。     

Long-term results of surgical therapy for phyllodes tumor of the breast

We report that the long-term results of surgical therapy for phyllodes tumor of the breast. During ten years, we experienced twenty-eight patients of phyllodes tumors of the breast. They were treated by surgical operation. Twenty-one cases were performed local excision with at least 1 cm surgical margin, and seven cases were performed muscle preserving mastectomy without axillary lymph nodes dissection. Pathological surgical margins of all patients were negative. Five patients were recognized the local recurrence, and only one patient was recognized a distant metastasis. The total recurrence rate was 21.4%. The patients with local recurrence were diagnosed the benign phyllodes tumor of the breast at the first operation. The mean time to recurrence was 5.4 years. If the pathological diagnosis was benign phyllodes tumor and surgical margin was negative at the first operation, it is necessary to follow up the patients, because there is a risk of local and distant metastasis.     

Phyllodes tumor of the breast: stromal overgrowth and histological classification are useful prognosis-predictive factors for local recurrence in patients with a positive surgical margin

BACKGROUND: The local recurrence rate of phyllodes tumors is high and ensuring a sufficient surgical margin is considered important for local control. However, the preoperative diagnosis rate of phyllodes tumors is low and we often encounter cases in which a sufficient surgical margin is not achieved, since in routine medical practice the lesion may not be diagnosed as phyllodes tumor until postoperative biopsy of a mammary mass. Furthermore, there are no established therapeutic guidelines for surgical stump-positive phyllodes tumors. We reviewed the outcomes of excision of phyllodes tumors to investigate factors involved in local recurrence and to determine the indication for re-excision in stump-positive cases. METHODS: The subjects were 45 patients treated for phyllodes tumors at our institution from January 1980 to July 2005. Age, tumor size, surgical method, stromal cellular atypia, mitotic activity, stromal overgrowth, histological classification and surgical stump status were analyzed. RESULTS: Median age was 45 years old (range 28-75) and tumor size was 1-17 cm (median 3.5 cm). Pathologic diagnoses were benign, borderline and malignant in 31, five and nine cases, respectively, and the surgical stump was negative in 27 lesions and positive in 15. Median follow-up was 101 months (range 1-273), with local recurrence in six cases and distant metastasis in one. The local recurrence-free rate was 88, 88 and 84% and the disease-free rate was 85, 85 and 81% after 5, 10 and 15 years, respectively. Overall 10-year survival was 97%. In univariate analysis, a positive surgical margin, stromal overgrowth and histological classification were predictive factors for local recurrence after breast-conservation surgery (P = 0.0034, 0.0003, 0.026). A positive surgical stump was the only independent predictor of local recurrence in multivariate analysis (RR 0.086; 95% CI 0.01-0.743, P = 0.012). Stromal overgrowth was a predictive factor for local recurrence in cases with a positive surgical margin (P = 0.0139). CONCLUSION: Wide excision is the preferred therapy for phyllodes tumor and preoperative diagnosis is important for good local control. Re-excision is recommended in cases with a positive surgical margin and stromal overgrowth and malignancy.     

Inhibitory effect of UFT on postoperative lung metastasis of mammary adenocarcinoma in SHR rats

It is well known that UFT has significant therapeutic effects against experimental and clinical cancers at the primary sites. In this experiment, we studied the inhibitory effect of UFT on the lung metastasis of spontaneously developed rat mammary carcinoma (SST-2) after surgical excision of the primary site. In comparison of UFT-treated (15 or 30 mg/kg/day) with 5-FU-treated (9.7 or 19.5 mg/kg/day) groups, UFT was more effective than 5-FU in the antitumor activity and the inhibitory effect of lung metastasis with/without surgical excision of the primary sites. Rats (5-10 rats per group) were inoculated s.c. with 1 x 10(6) SST-2 cells and administered with UFT orally (15, 30 or 60 mg/kg/day) starting the day after tumor inoculation for 30 days. The therapeutic effect of UFT was studied by the growth rate of primary tumor and the numbers of metastatic colonies in the lung 35 days after tumor inoculation, comparing the UFT-treated with control groups. UFT administration at the doses of 30 or 60 mg/kg/day markedly inhibited the growth of the primary tumors and the number of metastatic lung colonies decreased, compared with that of the control group. However, in the group of rats treated at the dose of 60 mg/kg/day, 60% of rats died from the side effects of UFT such as weight loss, hemorrhage etc. In all groups in which the primary tumors were surgically excised 20 days after tumor inoculation and then treated with UFT (15, 20 or 30 mg/kg/day), we observed marked prolongation of survival period and inhibition of lung metastasis as well. Furthermore, we studied the effect of combination therapy of UFT and lentinan (1 mg/kg/day i.p.) on the metastasis of SST-2 cells after surgical excision of the primary sites. It was more effective than UFT alone. Thus, it is clear that UFT is an effective anticancer drug to inhibit metastasis of tumors in the lung after surgical excision of primary tumor.     

Paragangliomas-- a decade of clinical experience

BACKGROUND AND OBJECTIVES: This study is a review of 14 patients with paragangliomas between 1986 and 1996. The purpose was to determine the sites of origin, clinical manifestations and analyze the benefits of different treatment modalities. METHODS: There were 20 tumors in 14 patients. Three (21.0%) of the patients had familial history. There were 7 (50%) females and 7 (50%) males. Anatomically 14 (70%) tumors were in head and neck, 5 (25%) were in the retroperitoneum, one (5%) was in the heart. Of the head and neck tumors 9 (64.25%) were in the carotid body, 3 (21.42%) were found in the vagus, and 2(14.33%) were found in the middle ear. The tumor found in the heart was in the atrial septum. The clinical behavior of paragangliomas is determined by cellular characteristics, secreting capabilities and tumor location. The symptoms and signs depend on the site of origin and the stage at which it presents. The clinically functioning tumors were 3 (17%) in our experience and they typically present with uncontrolled hypertension. The carotid body and mediastinal tumors usually manifested as asymptomatic masses. The intravagal tumors presented with paresis of the nerve. Malignancy rarely occurs and is defined by the existence of metastasis rather than by histology. In our series 2 (10%) of the patients presented with metastasis to lymph nodes, and the vertebrae. The diagnoses in our patients were established by CT and MRI scanning. Angiography was performed in 5 patients with carotid body tumor, two of whom underwent therapeutic embolization to reduce the tumor size. The mainstay of treatment was surgical removal, though radiation has been advocated for patients who cannot undergo surgery. RESULTS: All patients underwent successful surgical resection of the tumor after appropriate preoperative preparation. Late mortality occurred in two (12.5%) patients at 3 and 5 years from unrelated etiology. Four (25%) patients were lost to follow-up. Three (18.7%) patients developed new primaries, two of them at two years and one after 8 years. One (6%) patient developed recurrent paraganglioma after remaining disease free for 20 years. CONCLUSION: In conclusion, paragangliomas are rare with multicentricity being more common in patients with familial history. The malignant potential of the tumor is determined by metastasis as there are no characteristic cellular change. Aggressive surgery is mandatory to obtain disease free survival with low morbidity and mortality. Recurrences can also be successfully operated with low morbidity.     

Endoscopic radiofrequency ablation for liver metastasis of colorectal cancer

The application of radiofrequency ablation (RFA) for liver metastasis of colorectal cancer has not yet acquired an established status in clinical cancer therapy research. Removing as much tumor tissue as possible is desirable, but some cases do not allow optimal surgical ablation due to general condition of the patient and tumor status. We introduced endoscopic RFA for liver cancer in 2003, and have applied the procedure to 6 cases with H1 or H2 liver metastases of colorectal cancer to which surgical ablation could not be applied due to the poor general health of patients. Mean tumor diameter was 22.9 mm, and mean number of tumors per patient was 1.2. Tumor location was: S4, n = 2; S5, n = 1; S4, n = 1; S7, n = 2; and S8, n = 1. Mean frequency of session was 3.0. No complications occurred in any cases, and no reoperations were required. Although no recurrence of tumors in the vicinity of ablation was observed, 2 cases of each lung metastasis and intrahepatic recurrence were identified. Intrahepatic recurrence underwent hepatic arterial infusion (HAI) chemotherapy for simultaneous metastatic hepatic tumors (H2) prior to RFA, and relapses occurred in the metastatic focus where the efficacy of HAI was observed. At this point, 2 deaths were reported, 1 each from cancer and other diseases, and mean duration of survival after the procedure was 451.2 days. These results indicate that endoscopic RFA with good local control should be an available treatment for cases involving colorectal cancer with metastasis to the liver in which surgical ablation is difficult to apply.     

The role of radiotherapy in the management of malignant hemangiopericytoma: report of eleven new cases and review of the literature.

The response of hemangiopericytoma to radiation therapy was studied in 11 patients treated at Memorial Hospital. Response of greater or lesser degree was noted in 26 of 29 radiation therapy courses administered. These included 14 instances of complete tumor regression. Dose and tumor size were the main factors influencing response. The tumors tend to regress slowly and incompletely; yet effective relief of symptoms and long term local control (average duration 27 months) usually was achieved. These results and those reported by others believe the alleged inefficacy of radiation therapy in the management of these tumors. Palliative radiation therapy seems to be worthwhile even in advanced cases. Because of the high rate of local recurrence after surgical excision, treatment strategies combining local excision of large primary tumors with wide-field, high-dose radiation therapy are worthy of trial.     

胰腺实性-假乳头状瘤的CT表现及手术可行性评价

探讨胰腺实性-假乳头状瘤的CT特征,以提高术前诊断准确性并为手术和预后评估提供依据。方法: 回顾性分析经手术病理证实的胰腺实性-假乳头状瘤20例,男2例,女18例,年龄12～73岁,平均年龄（30.3±16.2）岁,所有病例均行CT平扫及多期动态增强检查,分析肿瘤的CT表现,并与术中实际情况进行对照。结果:CT平扫:20例肿物均表现为较大的胰腺肿块,其中13例明显突出于胰腺轮廓外;肿块呈类圆形、椭圆形或分叶状,边缘较清楚;13例为囊实性,3例为囊性,4例为实性;其中9例肿物内可见钙化。14例肿块位于胰头,其中4例胰管轻度扩张,1例明显扩张,均未见胆管扩张。1例伴肝转移。CT增强:3例囊性肿物的囊壁及分隔可见强化;17例实性及囊实性肿物的实性部分平扫为等密度或较低密度,增强后均有强化,动脉期强化程度均较低,平均CT值（51.45±10.63）HU,静脉期和实质期强化程度较动脉期提高,平均CT值分别约（82.05±22.04）HU和（81.83±19.86）HU,并与动脉期差别均有统计学意义（t1=-7.34,P=0.000和t2=-7.36,P=0.000）,但静脉期和实质期强化CT值无差别（t3=-0.15,P=0.880）。所有20例肿瘤均已行手术切除,其中包括肝转移灶。结论:结合患者年龄、性别和临床表现特点,CT检查多能对胰腺实性-假乳头状瘤做出正确诊断,鉴于肿瘤多为低度恶性或良性,一般均可行手术切除。      

Ganglioneuroblastoma in adults.

Ganglioneuroblastoma is a rare neoplasm of adults. Some information about the natural history and response to therapy can be obtained from two cases seen recently at our hospital and 17 cases in the literature. These tumors occur in adults of any age and are usually located in the retroperitoneum, mediastinum, or neck. Evidence of the tumor may be present years before diagnosis. Elevations of urinary catecholamines were documented in three cases and the levels correlated with progression or resection of the neoplasm. The tumor spreads either by local invasion or distant metastasis. Attempts at radiotherapy and chemotherapy in the treatment of unresectable or disseminated tumor has not resulted in objective improvement. This contrasts with the widely reported objective successes and cures of ganglioneuroblastomas occurring in childhood. Surgical excision of localized disease was the only curative therapeutic modality in the cases we reviewed.     

Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases

BACKGROUND AND OBJECTIVES: Phyllodes tumors (PTs) are uncommon biphasic breast tumors that usually occur in adult females. They are composed of a benign epithelial component and a cellular, spindle cell stroma forming a leaf-like structure. No one morphologic finding is reliable in predicting the clinical behavior of the tumor. The purpose of this study was to explore the clinicopathologic factors associated with outcome and metastasis. METHODS: We retrospectively reviewed the records of 172 patients seen at Mackay Memorial Hospital from January 1985 to December 2003. Clinical data analyzed included age, presenting symptoms and signs, tumor size, location, type of surgery, time to recurrence, and metastasis. The clinicopathologic factors associated with outcome and metastasis were analyzed statistically using the chi-square test with Yate correction. RESULTS: The mean follow-up was 71 months (range 7-237). The mean age was 37 years (range 11-73). The majority of tumors were found in the upper outer quadrant (46.0%), with an equal propensity to occur in either breast (48.8% vs. 50.0%). The pathologic diagnoses included 131 benign, 12 borderline, and 29 malignant lesions. Nineteen patients (11%) had a recurrence and three (1.7%) had metastases. The initial diagnosis of all 19 recurrent tumors were benign. Age, surgical approach, mitotic activity, and surgical margin were significantly correlated with recurrence (P = 0.029, 0.020, 0.048, and 0.00018, respectively). Stromal cellularity, stromal overgrowth, stromal atypia, mitotic activity, tumor margin, and heterologous stromal elements were significantly correlated with metastases (P = 0.032, 0.00008, 0.000002, 0.004, 0.005, and 0.046, respectively). Mammography and breast echo were not reliable for differentiating PTs from fibroadenomas (6.9% vs. 37.9% and 3.3% vs. 45%, respectively). Frozen section was of limited value (41.6%). The role of adjuvant radiotherapy and chemotherapy remains to be defined. Local excision, wide excision, or mastectomy with negative surgical margins yielded high local control rates (88.7%, 88.2%, and 100%, respectively), but local excision was associated with a relatively high percentage of positive surgical margins (18.3%). A total of 42 modified radical mastectomies were performed. The reasons for these procedures included a diagnosis of malignancy on frozen section or because the tumors were so large, they were assumed to be carcinomas. No axillary lymph node metastases were found. Fifteen patients in our series had tumors with infiltrating tumor margin, severe stromal overgrowth, atypia, and cellularity. All three patients with metastases (3/15) were in this group. Presence of metastases was significantly correlated with this group (P = 0.0000038). CONCLUSIONS: Wide excision with a clear margin may be the preferable initial therapy, even for malignant PTs. Routine axillary lymph node dissection is not recommended. Patients have tumors with infiltrating tumor margin, severe stromal overgrowth, atypia, and cellularity are at high risk for metastases.     

Flaxseed and its components reduce metastasis after surgical excision of solid human breast tumor in nude mice

This study determined the effect of 10% flaxseed (FS) and its components, secoisolariciresinol diglycoside (SDG) and flaxseed oil (FO) alone or in combination (SDG+FO), on the metastasis and recurrence of human breast tumor after excision in nude mice. Mice were injected orthotopically with human breast cancer cells (MDA-MB-435) and fed basal diet (BD). When the tumors reached an average size of 110 mm(2) (0.9 g), surgical excisions were performed, and the mice were assigned to one of five diet groups for 7 weeks. The total incidence of metastasis was significantly lower in the FS, SDG, and SDG+FO groups. Reduced lung and lymph node metastases were observed in the FS and SDG+FO groups. In the FS and FO groups, a greater reduction in lung and total metastases was found when excised tumors were 0.9 g. There was no significant difference in tumor recurrence among groups. In conclusion, FS and its components inhibited tumor metastasis but not tumor recurrence after surgical excision of the primary tumor.     

Brain metastases and testicular tumors: long-term survival.

In this updated and expanded retrospective analysis, the treatment records of 24 patients with brain metastases from nonseminomatous germ cell testicular tumors (NSGCT's) treated at the Indiana University Department of Radiation Oncology from 1975 through 1988 were reviewed. All patients received standard cisplatin-based induction chemotherapy. These patients were divided into three groups. Group 1 (n = 10) consisted of patients who presented initially with brain metastases and had no prior systemic treatment. Group 2 (n = 4) consisted of those patients who, after achieving a complete response (CR) with cisplatin, vinblastine, and bleomycin (PVB) +/- doxorubicin, developed a relapse confined to the brain. Group 3 (n = 10) consisted of those patients who were initially treated with PVB +/- doxorubicin or bleomycin, etoposide, and cisplatin (BEP) and eventually developed progressive disease and brain metastases. Group 1 was treated with whole brain irradiation (WBRT) and PVB +/- doxorubicin or BEP. Group 2 was treated with WBRT, cisplatin-based chemotherapy +/- surgical excision. Group 3 was usually treated with WBRT palliatively. Six patients, three in Group 1 and three in Group 2, are alive and disease-free with follow-up of 5+ years from beginning WBRT. Two additional patients in Group 1 survived 5+ years from beginning WBRT before dying with disease. No patient in Group 3 survived. Patients with brain metastases who have potentially controllable systemic disease should be treated curatively with WBRT (5000 cGy/25 fractions) +/- surgical excision and concomitant chemotherapy.     

Carotid Body Tumors and Our Surgical Approaches

Glomus tumors known as paragangliomas are neoplasms arising from the neural crest. They are named according to the place they originate from. Tumors originating from the carotid body at the carotid bifurcation are called Carotid Body Tumors (CBT). Surgical intervention is planned according to the Shamblin classification. 17 patients were operated after being diagnosed with CBT in our clinic between February 2007 and June 2010. 12 (70.5%) of the patients were male, and 5 (29.4%) of the patients were female. The average age was 42 (ages ranging between 32 and 47). Nine of the patients were diagnosed and treated with Shamblin type I tumor, seven of the patients with type II and one patient with type III. Only one patient had bilateral carotid tumor. In all patients with Shamblin type I and II, blunt dissection of the tumor was conducted smoothly by means of thermal cautery in the subadventitial plane. The patient with Shamblin type III had tumor invasion in the carotid artery and adjacent tissues were in an adherent state. Therefore mass resection was carried out by resecting 2 cm of the distal portion of the common carotid artery and 3 cm of the proximal portion of the internal carotid artery. 6 mm of synthetic polytetrafluoroethylene graft was interpositioned between the common carotid artery and the internal carotid artery. External carotid artery was anastomosed to this graft in an end-to-end fashion. The patient developed vocal cord paralysis postoperatively on the lesion side. The patient who underwent bilateral tumor excision developed Baroreflex Failure Syndrome. In the two patients thrombus developed in the internal carotid artery in the early postoperative period. These patients underwent thrombectomy and developed hemiplegia on the lesion side. One of them died on the seventh post-operative day while in follow-up in the intensive care unit. Surgical resection is the recommended treatment for carotid body tumors. Shamblin I and II type tumors’ dimensions and pathological characteristics allow dissection. However Shamblin III tumors may require carotid artery resection and reconstruction due to tissue invasion. The possibility of post-operative cranial nerve paralysis and arterial thrombosis should be taken into account.     

直肠间质瘤的手术方式及预后分析（附15例报告）

 目的 总结直肠间质瘤的手术方式和预后。 方法 对武汉大学中南医院2000年1月～2007 年1月收治的15例直肠间质瘤的外科手术方式、手术入路和治疗效果进行回顾性分析。 结果 15例直肠间质瘤患者中,3例行腹会阴联合切除,4例行直肠前切除术,8例行经肛门肿瘤局部切除术。3例在两年之内局部复发,再次行扩大切除。100%的病人接受了随访。到随访期结束,除1例死于腹腔种植转移,2例死于肝转移外,其余均无病生存。 结论 外科手术是直肠间质瘤的主要治疗手段,治疗效果满意。手术方式因肿瘤大小和临床病理特征不同而多样选择。     

Paragangliomas of the Head & Neck: the KMC experience

To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unilateral, painless, pulsatile swelling in the upper neck. Intra-operatively, three of the tumors were classified into Shamlin’s Grade II and one each into Grade III and Grade I. A carotid blow-out occurred in one of the patients with Grade II disease, which was managed. ECA resection had to be done in one case. Seven patients were diagnosed to have glomus jugulare and two with glomus tympanicum. Six glomus jugulare tumors presented with hearing loss, ear discharge and obvious swelling. Glomus tympanicums presented with hearing loss but no bleeding from the ear. On examination, tumors presented with an aural polyp with no VII nerve deficits. Both tympanicums were classified as Fisch Type A, three of the jugulares classified as Type B, two as Type D2 and one as Type D1. Tumors were found to be supplied predominantly by the ascending pharyngeal artery. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare. The transcanal approach was used for both patients with glomus tympanicum. Paragangliomas are uncommon tumors that need accurate diagnosis and skilled operative techniques. Though the surgical approaches may appear complicated, the removal provides good cure rates with minimal morbidity and recurrence. Lateral skull base approaches should be the armamentarium of every head and neck surgeon.     

Extraskeletal myxoid chondrosarcoma: a Multi-Institutional Study of 42 Cases in Japan

BACKGROUND: Extraskeletal myxoid chondrosarcoma (EMC) is a rare malignant neoplasm. Despite a consensus for the distinct clinicopathologic entity of EMC, its clinical features remain controversial. In addition, most studies have contained a small number of patients who underwent definitive surgical treatment. METHODS: Forty-two cases of EMC, which had been identified from files of eight affiliated hospitals and confirmed for histologic diagnosis at the Pathology Center, were analyzed for histologic grade, demographics, treatments, outcomes, and prognostic factors. The average follow-up period was 7.4 years. RESULTS: Included in the study were 20 men and 22 women with a mean age at diagnosis of 52.1 years. The tumors were located mainly in the lower extremities (69%). Thirty-three tumors (79%) were classified as Grade 1 and nine as Grade 2 according to the modified French System. Overall survival was 100% at 5 years and 88% at 10 years. Disease-free survival was 45% at 5 years and 36% at 10 years. Inadequate initial surgery was defined as a significant risk factor for local recurrence by univariate analysis of all 42 patients but not by the analysis of those 30 patients who had undergone wide tumor excision or amputation. Wide excision led to the recurrence rate of 14%. CONCLUSIONS: These findings supported the role of wide excision in the local control of EMC, irrespective of the previous excision procedure or recurrence. The protracted clinical course of the tumors and the presence of patients who had distant metastasis develop after definitive surgery of the primary tumor represented EMC as intermediate malignancy.     

A staging system for soft-tissue sarcoma and its evaluation in relation to treatment

In order to define the significant factors for a staging system of soft-tissue sarcomas(STS), histologic and clinical findings in 190 adult patients with localized STS in the extremities and trunk were reviewed. The male-to-female ratio was 1.21. The histologic grading of tumors was defined according to the criteria recently proposed by us: tumors were low-grade in 65 cases, intermediate-grade in 57 cases and high-grade in 68 cases. The initial surgical procedure was as follows: intracapsular excision in 9 cases, marginal excision in 104 and wide local excision in 77, including 15 amputations. The mode of treatment was surgery alone (101 patients), surgery and chemotherapy (58), surgery and radiotherapy (22) and surgery and combined chemo- and radiotherapy (9). Univariate analysis revealed histologic grade, sex, tumor size and tumor depth to be significant prognostic factors. Multivariate analysis revealed histologic grade to be the only independent factor for prognosis. Significant clinical factors in each histologic grade were then evaluated. In the low-grade group, local recurrence significantly affected prognosis. Most of the patients with local recurrence had had marginal resection as the initial surgical procedure. No clinical factors affecting prognosis in the intermediate-grade group could be determined. In the high-grade group, patients with wide local excision and adjuvant chemotherapy had a better prognosis than those with marginal excision with or without adjuvant chemotherapy and wide local excision without chemotherapy (p=0.09). In conclusion, histologic grade was the only significant factor for the staging of STS. On the basis of our staging system, different modalities of treatment for each grade of STS might be indicated; adequate surgery is essential for the prevention of local recurrence, which resulted in reduced mortality in patients with low-grade STS. For high-grade STS, the prevention of distant metastasis by combined extensive surgery and adjuvant chemotherapy may make long-term survival possible.