Radiation therapy in craniopharyngiomas

Eighteen patients with cranipharyngiomas, who were studied and treated between 1970–1980, are presented. Each patient was treated with surgery and radiotherapy (50–60 Gy). Six patients were treated with radiotherapy because the tumor recurred after surgery. An extensive representation of the clinical symptomatology typical of this tumor was seen. In 3 patients an improvement in visual symptoms was demonstrated; in 11 the headaches and vomiting were controlled after treatment. The 18 treated patients are still alive without evidence of progression of the tumor, after a period of 2 to 12 years. Our experience supports the contention that conservative surgery coupled with radical radiotherapy remains the treatment of choice for the craniopharyngioma.     

Phosphorus-32 therapy for cystic craniopharyngiomas

Background and purpose

To examine control rates for predominantly cystic craniopharyngiomas treated with intracavitary phosphorus-32 (P-32).

Material and methods

22 patients with predominantly cystic craniopharyngiomas were treated at Indiana University between October 1997 and December 2006. Nineteen patients with follow-up of at least 6 months were evaluated. The median patient age was 11 years, median cyst volume was 9 ml, a median dose of 300 Gy was prescribed to the cyst wall, and median follow-up was 62 months.

Results

Overall cyst control rate after the initial P-32 treatment was 67%. Complete tumor control after P-32 was 42%. Kaplan-Meier 1-, 3-, and 5-year initial freedom-from-progression rates were 68%, 49%, and 31%, respectively. Following salvage therapy, the Kaplan-Meier 1-, 3-, and 5-year ultimate freedom-from-progression rates were 95%, 95%, and 86%, respectively. All patients were alive at the last follow-up. Visual function was stable or improved in 81% when compared prior to P-32 therapy. Pituitary function remained stable in 74% of patients following P-32 therapy.

Conclusions

Intracystic P-32 can be an effective and tolerable treatment for controlling cystic components of craniopharyngiomas as a primary treatment or after prior therapies, but frequently allows for progression of solid tumor components. Disease progression in the form of solid tumor progression, re-accumulation of cystic fluid, or development of new cysts may require further radiotherapy or surgical intervention for optimal long-term disease control.     

Surgery and radiation therapy in the management of craniopharyngiomas

Twenty-nine patients with histologically confirmed craniopharyngioma were treated from 1960 to 1978, inclusive. Twelve patients were below the age of 15 years, the remaining were adults. Seventy-five percent (9/12) of the patients below the age of 15 showed increased intracranial pressure at presentation and 58% (7/12) showed visual disturbances. In the adult group, 47% (8/17) presented with increased intracranial pressure and 88% (15/17) with visual disturbances. Hormonal, mental and behavior changes were almost equally distributed in both age groups. All patients underwent craniotomy, with subtotal resection of the tumor. Three adults died of postoperative complications (10%), of whom two died of pulmonary emboli and one of cerebral hemorrhage. Of the remaining 26 patients, 13 received immediate postoperative radiotherapy to a total dose of 50.0 to 56.0 Gy, in a target volume including the sellar and parasellar region during an overall treatment period of five to six weeks. All patients were evaluable with a minimum follow-up of four years since they finished their treatment or until death. The five-year recurrence-rate in the group that did not receive postoperative radiation therapy was 45% (5/11 patients) and the five-year rate of death of disease in this group was 27% (3/11 patients). For the group that received immediate postoperative radiation therapy the five-year recurrence-rate was 11% (1/9 patients) and no death of disease was observed in this group. This difference between the two groups was not significant. The corresponding 10-year rates were 71% (5/7 patients) for recurrence and 57% (4/7 patients) for death of disease in the group without, and in the group with immediate postoperative radiation therapy the rate was 25% (2/8 patients) for recurrence and 0 for death of disease. This difference turns out to be significant. Critical analysis of the morbidity in patients surviving after treatment showed no adverse effect on the visual or endocrine status of the group that received postoperative irradiation. It is concluded that in the management of patients with craniopharyngiomas, postoperative irradiation after subtotal resection improves the prognosis of the patient and does not add to visual or endocrine morbidity.     

Histological study of routine tonsillectomy specimen

Introduction

Palatine and nasopharyngeal tonsils are lymphatic flesh clusters of tissue of the respiratory and digestive tract’s epithelium. There is not much literature pertaining to the histological assessment of resected tonsils though anecdotal case reports of choristoma, squamous cell cysts of the tonsil have been reported which mimicked chronic tonsillitis. Tonsils also are an important site for head and neck cancer in adults.

Aim & objective

To study the histological features of routine tonsillectomy specimens and to study for the presence of choristomatic tissue or any other benign pathology as a cause of chronic tonsillitis.

Patients & methods

Fifty consecutive tonsillectomy specimens, which were received in the department of Pathology, Gandhi Medical College, were evaluated with regards to clinical information. Among 50 patients, a slight predominance of men (56 %) over women (44 %) was observed.

Conclusion

The mesenchymal tissue consisted mainly of epithelium and lymphoid tissue with cartilage in a single case and fat in three cases. The role of imaging techniques, in assessing the need for early surgical intervention in cases with chronic tonsillitis, can be determined by assessing the micropathology of tonsillectomy specimens and is an arena for further research. We discussed the role of FDG-PET scan in the assessment of the same.     

胶质纤维酸性蛋白和波形蛋白与星形细胞瘤组织分级关系的探讨

应用ＧＦＡＰ及Ｖｉｍｅｎｔｉｎ（ＡＢＣ法）对２６例星形细胞瘤进行免疫组化分析。结果显示所有星形细胞瘤均呈ＧＦＡＰ，ＶＩＭ阳性表达。ＧＦＡＰ阳性细胞数与病理学分级呈负相关，组织学分级高分化差的星形细胞瘤，阳性级别低。而ＶＩＭ表达与组织学分级无相关。ＧＦＡＰ阳性表达对星形胶质细胞瘤的恶性程度及指导临床治疗有重要价值。     

胃溃疡癌的组织学观察

本文复习了1964年至1986年523例普通胃癌资料,为回顾组;并对1987年至1988年77例胃癌标本做系列取材切片,为前瞻组。同时以100例胃良性溃疡病进行对照。根据Hauser氏胃溃疡癌诊断标准,对慢性胃溃疡、胃溃疡伴胃癌、溃疡癌、癌溃疡和溃疡癌伴胃癌进行组织学观察,探讨了这些病变之间的关系。提出溃疡底疤痕组织呈“山峰状”改变,粘膜层与肌层靠拢和粘膜下层受挤压是良性胃溃疡与溃疡癌的共同特点。     

上、下肢相关脊神经后根的应用组织学观察

目的：了解国人脊神经上、下肢相关后根组织学特征，为临床应用提供组织学依据。方法：取一健康男性新鲜脊神经C5—T1、T12—S2后根标本，行HE及Gomori嗜银染色，光、电镜观察后根的组织学结构，图像分析纤维数量及直径、面积。结果：后根外膜及束膜菲薄，束间大小束混合分布，束内神经纤维混合相杂。上肢后根以C7为最粗大，下肢后根以Sl最粗大。结论：各后根具有相同的组织学结构，相似的神经纤维配比。临床手术人工分束较易。     

小儿肝母细胞瘤术前化疗的组织学改变

目的观察肝母细胞瘤术前化疗后的组织学变化。方法采用软X线拍片、瘤组织浸泡银染方法，比较5例肝母细胞瘤化疗前后的组织学变化。结果化疗后瘤组织发生明显的坏死、纤维化，面积达80％以上。栓塞剂在瘤组织中的分布与瘤组织坏死纤维化的分布及程度无关。结论进展期肝母细胞瘤术前化疗有效。较短时间的肝动脉栓塞化疗可以达到与静脉化疗相近的组织学上的抗肿瘤效果。     

Histological Changes in Recurrent Soft Tissue Sarcomas: Analysis of 56 Patients

Histological changes in 56 patients with recurrent soft tissuesarcomas (STS) were analysed. The original tumors included 23malignant fibrous histiocytomas, five liposarcomas, four leiomyosarcomas,four synovial sarcomas, four neurogenic sarcomas, four dermatofibrosarcomasand 12 other assorted tumor types. The histo-logical featuresof the recurrent tumors which underwent changes included increasedcellularity, an increased number of mitotic figures, extensionof sclerotic areas and the appearance of a storiform pattern;these were found in 30%, 43%, 41% and 29% of cases, respectively.No case showed a histological change from one subtype to another.A follow-up study revealed increased cellularity and mitoticcounts in the recurrent tumors to be signs of an unfavorableprognosis.     

5406 例不同类型食管肿瘤临床病理特征对比分析

 目的 探讨小细胞癌、癌肉瘤等少见食管肿瘤以及小年龄组食管肿瘤的临床病理特征。方法 回顾性分析5406例食管肿瘤术后的病理诊断结果，观察各种肿瘤的早诊率、淋巴结转移率及年龄分布情况，对比分析所见各种食管肿瘤的特点。结果 5406例中29例双原癌（同时合并贲门腺癌）；5377例均为单发食管肿瘤，其中鳞癌95．5％，腺鳞癌1．8％，腺癌0．5％，其他类型4％。全部病例中早诊率为9．1％，淋巴结转移率为39．6％。各型早诊率和淋巴结转移率之间差异无显著性（χ²=7．384，12．677；P=0．597，0．178）。小细胞癌与鳞癌的淋巴结转移率之间差异有显著性（χ²=4．704，P=0．030）。小年龄组（≤40岁）与其他年龄组比较，两组间早诊率及淋巴结转移率差异均无显著性（x^2=0．186，0．558；P=0．666，0．455）。结论 食管胸中段是各型肿瘤的好发部位。食管肿瘤以鳞癌最多，腺鳞癌次之，其次为小细胞癌、腺癌及癌肉瘤等。各型肿瘤的早诊率及淋巴结转移率均相似，仅小细胞癌淋巴结转移率明显高于鳞癌。各年龄段食管肿瘤早诊率及淋巴结转移率无统计学差异。提高食管肿瘤的早诊率是亟待解决的问题。     

"新生食管"再生过程的组织学观察

背景与目的:在器官及组织重建过程中,由于植入材料的组织相容性及材料界面不同可诱发不同的愈合结果。本研究通过观察新型生物材料人工食管植入后诱导机体修复、再生“新生食管”的生理过程,从而探讨“新生食管”的愈合机制。方法:以病理大切片技术及特殊染色法对术后1、3、6、12、24个月的实验犬“新生食管”标本进行组织学研究,观察其组织结构的动态变化、食管重塑及其组织结构再生的过程。结果:人工食管植入后早期可替代食管缺损,术后1个月左右人工食管完全脱落;诱导的“新生食管”于术后3～6个月完成粘膜爬覆,12个月左右出现粘膜下肌层、神经纤维、粘液腺、毛细血管等结构的再生,并完成纤维结缔组织层的重塑;“新生食管”术后3～6个月新生管腔狭窄较明显,12个月后狭窄缓解。结论:新型生物材料人工食管通过早期替代并诱导纤维结缔组织沉积、裹覆而形成“新生食管”;“新生食管”经过1年左右粘膜上皮爬覆、肉芽组织增生、血管、组织结构形成等过程而再生出可完成食物正常通过的再生食管;“新生食管”的狭窄与疤痕过度增生及收缩有关。     

Histological grading in ductal carcinomain situ of the breast

With the early discovery and diagnoses of breast carcinoma, the diagnosis of ductal carcinomas in situ (DCIS) is much more frequent. It recently has been emphasized that DCIS doesn’t represent a single entity. The purpose of the present study was to investigate the relationship among histologic grading, subtype and the expression of c-erbB-2, p53, MIB-1 and Estrogen Receptor (ER) so as to provide reliable parameters of prognosis and potential malignancy for the treatment of these patien…     

骨肉瘤患者同种异体骨移植后的组织学与扫描电镜观察

目的分析骨肉瘤患者同种异体骨植骨愈合与吸收的形态学特征及影响因素。方法收集2例骨肉瘤患者临床移植的大段异体骨标本,通过大体、组织学和扫描电镜观察,探讨移植骨愈合和吸收的形态学特点。结果例1观察到新骨的形成,植入骨与宿主骨发生骨性结合,在结合部位观察到骨爬行替代的演变过程。扫描电镜下看到愈合处多为松质骨,有形成面和吸收面及不同阶段的成骨细胞和各种形态的破骨细胞。例2植入骨和宿主骨发生自然离断,两端均吸收破溃,无愈合。宿主骨端有较多的破骨细胞和吸收窝,看不到形成面和成骨细胞。结论植骨方法、对接情况、固定方式、年龄及不同部位的供体骨均影响植骨愈合。     

术前病理学诊断在胸腺肿瘤诊疗中的应用

背景与目的探讨术前病理学诊断在胸腺肿瘤诊断和治疗中的价值及其对胸腺肿瘤治疗的影响。方法对中国胸腺肿瘤协作组（Chinese Alliance for Research in hTymomas, ChART）收集的1994年-2012年的多中心且具有明确活检状态的胸腺肿瘤患者的临床病理资料进行回顾性分析,探讨术前病理学诊断的应用趋势及其对胸腺肿瘤患者预后的影响。结果1,902例胸腺肿瘤患者中,术前病理学诊断患者336例（17.1%）。近年来术前病理学诊断的比例较前明显增加（P=0.008）,胸腔镜/纵隔镜/超声内镜下经支气管活检（endobronchial ultrasound, E-BUS）比例较前升高（P=0.029）。术前行病理学诊断患者的生存明显差于无病理学诊断患者（P<0.001）,术前病理学诊断后的目的与肿瘤的Masaoka分期（P<0.001）、切除程度（P=0.025）、病理类型（P<0.001）具有相关性。术前病理学诊断后直接手术患者的生存要明显优于诱导治疗后再手术患者（P<0.001）。结论胸腺瘤诊断主要依靠临床及组织学判断,近年来术前病理学诊断在胸腺肿瘤的诊断和治疗中起重要作用;根治性手术切除是胸腺肿瘤的首先治疗手段;术前病理学诊断后直接手术患者的预后要明显优于诱导治疗后患者。     

Histological features of breast cancer, highly sensitive to chemotherapy

Background  To establish tailor-made therapy for breast cancer, we investigated the possibility of predicting chemotherapy sensitive cases based on pre-therapeutic histological features. as]Methods: A total of 87 breast cancer patients underwent neoadjuvant chemotherapy with a paclitaxel (80 mg/m²/qlw, 12 courses) or an epirubicin regimen (90 mg/m²/q3wks, 4 courses). We investigated the chemo-sensitivity of invasive ductal carcinoma, solid-tubular carcinoma consisting of highly malignant cancer cells with many mitoses. We refer to this type of carcinoma as“chemo-sensitive carcinoma”and compared the histological therapeutic effects of chemo-sensitive and chemo-insensitive carcinomas. Results  1) Out of 87 patients, 20 cases (23%) showed the histological features of chemo-sensitive carcinomas on pre-therapeutic needle biopsy specimens. The remaining 67 cases (77%) were classified as chemo-insensitive carcinoma. 2) Histologically marked or complete response were observed in 50% (10/20) of chemo-sensitive carcinomas and 10% (7/67) of chemo-insensitive carcinomas (x² = 15.33, P=0.0001). Multivariate analysis of chemo-sensitive carcinoma, including HER2, hormone receptor and p⁵³ status, revealed that chemo-sensitive carcinoma had a significant correlation with the histological therapeutic effects (P=0.01119). 3) Pathological complete response (pCR) was achieved in 35% (7/20) of chemo-sensitive carcinomas and 1.5% (1/67) of chemo-insensitive carcinomas (x²=20.71,P<0.0001). Multivariate analysis revealed that chemo-sensitive carcinoma had a significant correlation with pCR (p=0.0091) Conclusion  The histological features of chemo-sensitive carcinoma were significant predictive factors for chemotherapeutic efficacy.     

Histological Factors Associated with Initial Bone Metastasis of Invasive Ductal Carcinoma of the Breast

Bone is one of the most common sites of recurrence of breast cancer. Therefore, it would be clinically very useful if breast cancers with a high probability of bone metastasis (BM) could be identified by histopathological examination of the primary lesions. To elucidate histological characteristics associated with predisposition to initial BM, we examined nine histopathological parameters in the primary lesions of 110 invasive ductal carcinomas (IDCs) of the breast with 0 to 3 regional node metastases. These cases had recurrence between 4 months and 10.1 years after the initial radical surgery. The first metastatic site was bone in 24 cases, whereas other sites were involved in 86 cases. IDCs growing in a strand growth pattern or with fibrotic focus (FF) had a significantly higher frequency of initial BM than those growing in a non-strand growth pattern or without FF, respectively. Strand growth pattern was a significant predictor of the initial BM in multivariate analysis. In all 54 IDCs that developed BM during the follow-up period, osteolytic metastasis was significantly more frequent in the group with FF than in that without FF. This study demonstrated that strand growth pattern and the presence of FF are significant histopathological factors associated with initial BM. The combination of those predictive factors along with prognostic factors may provide a useful approach to identify patients at high risk for initial BM, enabling early treatment for the recurrent cancer.