Osteosarcoma as a second malignant neoplasm.

PURPOSE: The aim of this study is to compare primary and secondary osteosarcomas using data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program. METHODS: Osteosarcoma cases were identified in the SEER Cancer Incidence Public-Use Database, 1973-96 (1,511 primary and 133 secondary osteosarcomas). Secondary osteosarcomas were further classified as occurring within or outside the previously irradiated field. Comparisons among groups were performed by nominal logistic regression. Survival analyses were performed using Kaplan-Meir and proportional hazards regression. RESULTS: Secondary osteosarcomas were more likely to have a non-extremity primary site and an older age at diagnosis (>40 years) (<0.0001 for both). Secondary osteosarcoma cases continued to be more likely to have a non-extremity site when excluding those occurring within the radiation field. Five-year overall survival was 50% lower for secondary osteosarcomas for both extremity and non-extremity sites. Primary malignancies associated with secondary osteosarcomas included 14 lymphomas/leukemias, six sarcomas, 54 carcinomas, and seven other cancers. Secondary osteosarcomas occurring within a field of radiation were more likely to occur at a younger age, have a malignancy with a primary morphology other than carcinoma, a non-limb site, and a longer duration between their primary malignant neoplasms and the development of osteosarcoma. No difference in the overall survival was noted between secondary osteosarcomas occurring within an irradiated field and those that did not. CONCLUSIONS: Secondary osteosarcomas are associated with carcinomas especially in the elderly. Although a 50% decreased 5-year survival was observed for secondary osteosarcomas in this study, this might not reflect the current outcomes with more aggressive therapy.     

Actinomycosis of the parotid masquerading as malignant neoplasm.

Background  

Primary actinomycosis of the parotid gland is of rare occurrence and can mimic a malignant neoplasm both clinically as well as radiologically.     

Soft tissue sarcoma as a second malignant neoplasm in the pediatric age group

BACKGROUND: Survivors of childhood malignancies have an increased risk of developing second malignant neoplasms (SMN) due to their prior treatment and/or genetic susceptibility. A small proportion of SMNs are soft tissue sarcomas (STS), whose prognosis is generally thought to be poor, though publications on such patients' treatment and outcome is limited. METHODS: The authors analyzed 25 patients who were registered for the Italian Cooperative Group protocols for pediatric STS from 1979 to 2000. The primary tumor was STS in five patients; Hodgkin disease in five patients; leukemia in four patients; retinoblastoma, neuroblastoma, and Wilms tumor in two patients each; and other tumor types in five patients. SMNs occurred after a median of 8 years (range, 1.9-15.0 years) and included rhabdomyosarcoma (RMS) in 4 patients, malignant peripheral nerve sheath tumor in 4 patients, extraosseous Ewing family tumor (EFT) in 4 patients, leiomyosarcoma in 3 patients, fibrosarcoma in 2 patients, synovial sarcoma in 2 patients, and other tumor types in 6 patients. Treatment generally was administered according to the guidelines for primary STS. RESULTS: Seven non-RMS patients with STS underwent surgery alone, whereas 18 patients received chemotherapy and 8 patients received radiotherapy. Retreatment was feasible with acceptable toxicity. Fifteen patients were alive in complete remission of their SMN at the time of last follow-up. Responses to chemotherapy and survival were satisfactory for patients with tumors such as RMS and EFT. Complete tumor resection was correlated with a favorable prognosis in patients with other types of STS and in patients with postirradiation sarcoma. Two patients developed a third malignancy. CONCLUSIONS: Although prior treatment may hinder the management of these patients, pediatric STS second malignancies can be cured using the same strategies used for de novo pediatric sarcomas. Long-term follow-up is mandatory given the risks of further malignancies and more severe, treatment-related side effects.     

Long-term risk of second malignant neoplasm after a cancer in childhood

The risk of subsequent second malignant neoplasm was studied in a cohort of 634 patients, treated for a childhood cancer at the Gustave Roussy Institute between 1942 and 1969, and in complete remission five years after diagnosis. The most frequent types of first primary cancers (FPC) were Wilms' tumours (28% of the children), neuroblastomas (16%), lymphomas (12%) and soft tissue sarcomas (11%). Median follow-up duration after FPC was 19 years. Thirty-two patients (obs = 32) developed a total of 35 second cancers. Bone, thyroid, connective tissues and skin were the most frequent types of second cancer, with six patients for each type. The average annual incidence of second cancer was 0.36%. The average annual incidence for the periods 5-9, 10-14, 15-19, 20-24 and 25+ years after FPC was respectively 0.16%, 0.34%, 0.36%, 0.71% and 1.18%. The cumulative incidence of second cancer for the periods 5-20, 5-25 and 5-30 years after FPC was, respectively, 4.3% (95% CI: 2.8-6.6%), 7.8% (95% CI: 5.1-11.8%) and 13.0% (95% CI: 8.2-20.0%). The expected number of cancers in the cohort, computed from Danish cancer incidence data, was exp = 2.2. When compared to this expected number, the average annual excess incidence of second cancer, defined as obs-exp divided by the number of person years of observation, was 0.33%. This rose from 0.15% for the period 5-9 years after FPC to 1.09% for the period beginning 25 years after FPC. The standardised incidence ratio of second cancer (i.e. obs/exp) was 15 (95% CI: 10-21), and was fairly constant in the period extending from 15 to 20 years after FPC diagnosis. Obs/exp was equal to 25 for the patients who had had chemotherapy and equal to 9 for those who had not. Cyclophosphamide seemed less carcinogenic than the other alkylating agents. Obs/exp was similar for the patients who had received radiotherapy and for those who had not. The risk of cancer increased with age in the reference population and increased faster in the cohort, because the standardised incidence ratio is constant over a long period.     

Classic Kaposi's sarcoma as a second primary neoplasm

Although the incidence of classic Kaposi's sarcoma (CKS) has been investigated, its occurrence following a primary neoplasm and its association with this first neoplasm need to be determined. We analyzed a series of 124 patients with a secondary CKS (8.4% of a total of 1485 incident cases) which occurred between 1961 and 1992 in the Jewish Israeli population. Data on first neoplasms and subsequent Kaposi's sarcoma were retrieved from the Israel Cancer Registry. Acquired‐immune‐deficiency‐syndrome‐related Kaposi's sarcomas were excluded from the case series. Four controls were randomly selected for each CKS case among all Cancer Registry cases free from a second neoplasm at the time of diagnosis of the CKS in the case, and matched on gender, year of birth and year of diagnosis of the first neoplasm. The average time lapse between first neoplasm and secondary CKS was 4.5 years, being shorter for prostate cancer and for hematopoietic malignancies. As compared with Israel‐born Jews, the risk of a subsequent CKS was significantly increased in immigrants [odds ratio (OR) 3.0]; this risk was particularly high in immigrants from the former Soviet Union (OR 9.4) and Poland (OR 7.0). There was no clear trend with age at immigration; however, low age at immigration and a short length of stay in Israel endowed a higher risk of developing a secondary CKS, markedly among patients suffering from solid tumors as the first primary. There was an excess of secondary CKS following a non‐Hodgkin's lymphoma (OR 5.3), a Hodgkin's lymphoma (OR 7.5), a leukemia (OR 5.3) or a breast cancer (OR 2.2). Cancer patients with a first primary in the lung, colon, stomach, larynx, liver, pancreas or kidney showed secondary CKS less frequently. Despite the lack of control of therapy for the first neoplasm, development of secondary CKS seems to be mediated by mechanisms similar to those for hematopoietic neoplasms and selected non‐hematopoietic neoplasms, such as breast cancer. The trend toward increased risk after a short time lapse and the difference in risk among immigrants indicate that genetic susceptibility is part of the complex interplay between cellular proliferation and control systems. Int. J. Cancer 80:178–182, 1999. © 1999 Wiley‐Liss, Inc.     

小儿腹部恶性肿瘤的介入治疗

目的：探讨对一期手术切除困难的腹部恶性肿瘤术前行介入治疗的意义。材料和方法：对１３例腹部恶性肿瘤进行介入治疗,肝母细胞瘤６例,神经母细胞瘤４例,肾母细胞瘤２例,肾上腺皮质癌１例。所有病例先行动脉插管造影,确定肿瘤主要供血动脉,对肿瘤供血动脉行超选 择性插管,局部注入化疗药物有栓塞剂。结果：１３例中７例手术切除了肿瘤,１例剖腹探查余５例通过介入治疗后,肿瘤缩小。１３例病人随访６～１３个月,生存１１例     

Leiomyosarcoma as a second metachronous malignant neoplasm following colon adenocarcinoma. A case report and review of the literature

Long-term cancer survivors are at increased risk for the development of second primary malignancies. This is usually associated with common genetic and etiologic factors and the treatment modality used for the primary cancer. In this paper we describe the case of a patient who developed a leiomyosarcoma in his left arm 5 years after he had a colon adenocarcinoma resected. Both primary tumours were treated successfully with surgical resection alone. The literature regarding second primary neoplasms, specifically focused on sarcomas, is briefly reviewed.     

Acinic cell carcinoma of the parotid in children

The imaging findings of two children with acinic cell carcinoma of the parotid gland are presented. Ultrasonic features are emphasized. One of these children, a 6-year-old boy, suffers from the oculocerebrorenal syndrome of Lowe, a rare congenital, inherited condition manifested by defects of the nervous system (mental retardation, hypotonia), eyes (cataracts, glaucoma) and kidneys. To date, no known association exists between these two rare entities. The other child, a 10-year-old girl, was otherwise well. The ultrasound findings of both cases demonstrate features more classic for a benign intraparotid mass than for a potentially malignant lesion. The possibility of acinic cell carcinoma should be considered if a well-defined, relatively homogenously hypo-echoic intraparotid mass is encountered in a child, especially if cystic spaces are present.     

Mandibular sarcoma as a second neoplasm following radiotherapy for a nasopharyngeal carcinoma in childhood (case report)

We report an unusual case of mandibular sarcoma which developed in the field of irradiation of a patient treated successfully 10 years previously for nasopharyngeal carcinoma (NC). Although second malignant neoplasms are not rare among survivors of childhood cancer, this event is not included among the type of failures and complications of treatment of NC occurring either in children.     

Multiple primary malignant neoplasm in patients with laryngeal carcinoma

BACKGROUND AND OBJECTIVES: The aim of this study was to study the incidence, localization, and nature of second primary tumors arising in patients with primary laryngeal carcinoma and their correlation with the site, staging, and grade of differentiation. METHODS: Between 1979 and 1996, 877 patients underwent laryngeal surgery (850 male and 27 female; age range = 30.5-76 years). The second primary tumor was multicentric in 7 cases (14%), systemic in 16 cases (33. 3%), and "coincidental" in 25 cases (52%). In 3 cases the tumors were simultaneous, in 7 cases they were synchronous, and in 38 cases they were metachronous. In the 48 patients with multiple primary malignant neoplasm, the index tumor was glottic in 38 cases and supraglottic in the remaining 10, but the incidence of second tumors in these two groups was virtually matching, respectively: 38/709 (5. 3%) and 10/168 (5.9%). RESULTS: This study did not identify any correlation between the second primary tumor and the extension of the first neoplasm (T) and the presence of laterocervical lymph node metastases (N). Our data showed a higher incidence of second tumor in patients having G1 carcinomas compared with the other series with G2 and G3 carcinomas. As far as survival rates are concerned, a significant reduction was observed in patients developing a second primary tumor, regardless of whether the index tumor was glottic or supraglottic. CONCLUSIONS: The incidence of new tumors in patients with laryngeal carcinoma is not linked to the site, size, staging, or grade of differentiation of the index tumor.     

Acute lymphoblastic leukemia occurring as a second malignant neoplasm in childhood: report of three cases and review of the literature.

PURPOSE: The long-term effects of childhood cancer and its therapy are a problem of increasing concern. One of the most important of these late effects is the development of second malignant neoplasms (SMNs), which occur in approximately 8% of children within 20 years of diagnosis of a malignancy. These secondary cancers may result (individually or in combination) from increased genetic susceptibility, the mutagenic effects of chemotherapy and/or radiation therapy, or chance. Whereas the development of acute nonlymphocytic leukemia (ANLL) as an SMN is a well-recognized phenomenon, acute lymphoblastic leukemia (ALL) has been infrequently described as an SMN in either adults or children. PATIENTS AND METHODS: We report three patients treated at our institution in whom ALL developed as an SMN after treatment for neuroblastoma, Wilms' tumor, and Hodgkin's disease. These cases prompted us to review the published literature for cases of secondary ALL in childhood. Patients whose initial malignancy was diagnosed at age less than 16 years were classified as pediatric patients. SMNs were defined as cancers of clearly distinct histologic type occurring 6 or more months after diagnosis of the first malignant neoplasm. RESULTS: Including the three index cases, a total of 18 children with secondary ALL are reviewed, and the clinical features are discussed and compared with those of secondary ANLL. CONCLUSIONS: This review summarizes the published case histories of secondary ALL. The data suggest that ALL represents approximately 5% to 10% of the cases of acute leukemia that arise as SMNs in both adults and children.     

Mucoepidermoid carcinoma of the stomach

A rare case of mucoepidermoid carcinoma of the stomach in a 70-year-old man is reported. The protruded mass with central depression resembled a submucosal tumor, located on the posterior wall of a part of the cardia, fornix, and upper corpus. Histologically, submucosal ectopic glands composed of columnar cells, mucus-producing cells that closely resemble gastric epithelium, and ciliated epithelium were observed. The tumor consisted of an admixture of cuboidal, columnar cells, mucus-producing cells, singled or pseudostratified ciliated epithelium, and squamous metaplastic cells. The tumor cells were intimately continuous with the submucosal ectopic glands. Gradual transition between tumor cells and epithelium of submucosal ectopic glands was recognized. It is supposed that mucoepidermoid carcinoma of the stomach in this case derived from preexisting submucosal ectopic mucous glands of the stomach.     

Malignant melanoma with gall bladder metastasis as a second neoplasm in the course of prostate cancer

Malignant melanoma is a neoplasm with an often unpredictable course and metastases potentially affecting all organs of the human body. Metastases into the gall bladder are rare. The role of hormonal background in the development and progression of malignant melanoma has not been established. The authors present a case of a 63-year-old man who had initially undergone long-term hormone therapy for the treatment of prostate cancer, and later presented with melanoma metastatic to the gall bladder.     

Mucoepidermoid carcinoma arising from a preexisting cyst of the liver

A case of mucoepidermoid carcinoma of the liver of a 46-year-old female is described. The resected mass from the left lobe of the liver measured 3 X 3 X 2 cm. The cut surface showed a well demarcated white, round shape, and a cystic formation measuring 1.8 X 1.4 cm was present in the center of the mass. Microscopically, the mass showed high-grade-type mucoepidermoid carcinoma, which consisted of squamous cells, mucus-producing cells, and glandular cells. The cystic wall was lined with apparently benign glandular, mucus-producing cells, squamous metaplastic cells, and tumor cells. The tumor was intimately contiguous with the cyst and gradual transition between tumor cells and cystic lining cells was recognized. It is suggested that the mucoepidermoid carcinoma of the liver in the present case was derived from malignant transformation of a preexisting cyst of the liver.     

Electron beam therapy in treatment of parotid neoplasm

In a retrospective analysis, 42 patients with malignant primary tumor of the parotid gland were evaluated considering survival, local recurrence and tolerance of treatment. All patients referred to radiotherapy were treated by electron beam (10-15 MeV) and followed for more than 5 years. Postoperative radiotherapy after radical operation, with no macroscopic disease, was performed in 18 patients, 7 of whom were treated by radical re-operation and radiation of a recurrent parotid neoplasm. In these groups, the local recurrence rate was 4/18 (22%) and 2/7 (29%), the 5-year survival rate was 9/18 (50%) and 5/7 (71%). In 17 patients, radiotherapy started with gross tumor left behind. This group showed a local recurrence rate of 10/17 (59%) and a 5-year survival of 7/17 (41%). Treatment was well tolerated with no major sequelae. Local tumor control and its impact on survival is discussed.     

Mucoepidermoid carcinoma of the thyroid gland.

An extremely rare case of mucoepidermoid carcinoma of the thyroid in a 56-year-old woman is presented. The patient clinically having Hashimoto's thyroiditis was noted a nodule in her neck. The tumor was sited in the midportion of the left lobe of the thyroid, and histologically it showed both squamous features and mucin production. The squamous cells were arranged in solid sheets with horny pearls and the mucous cells tended to line dilated duct-like elements. Ultrastructurally, the epidermoid cells had aggregates of tonofilaments and well-developed desmosomal attachments, and the mucous cells contained numerous mucin granules in their cytoplasm. Immunohistochemical studies revealed that cytokeratin antibodies showed positivity for both the lining cells and squamous cells, whereas carcinoembryonic antigen positivity was found in the lining cells and intraluminal material. The tumor cells were negative for thyroglobulin, calcitonin, vimentin, chromogranin, and neuron-specific enolase. These unusual histologic and immunohistochemical features are suggestive of a tumor related to the so-called "solid cell nest" of the thyroid.