Postoperative high-dose-rate brachytherapy in the prevention of keloids

BACKGROUND: The aim of this study is to show the efficiency of keloidectomy and postoperative interstitial high-dose-rate (HDR) brachytherapy in the prevention of keloids. METHODS AND MATERIALS: Between 1998 and 2004, 35 patients with 54 keloids were treated postoperatively with HDR brachytherapy. The first HDR dose was applied within 6 hours after surgery, and two additional HDR doses were administered on the next day with a six-hour interval. The majority of patients received 6 Gy as the first dose postsurgery and two fractions of 4 Gy (38 keloids) on the next day. Seven keloids were treated postoperatively with three fractions of 6 Gy. The biologically effective dose (BED), derived from the linear quadratic concept, was applied to calculate the BED for the various radiation regimens. The keloid recurrence rates at specific BED values were compared with those derived for other fractionation schemes in the literature. RESULTS: Four recurrences/nonsatisfactory results out of nine treated keloids were observed after treatments with 1 x 4 Gy + 2 x 3 Gy. Only one recurrence out of 38 was found after 1 x 6 Gy + 2 x 4 Gy and none after 3 x 6 Gy. Better cosmetic results were found at the higher-dose schemes. CONCLUSION: The results of this study prove the effectiveness of HDR brachytherapy after keloidectomy provided that the total HDR dose is sufficient. Currently our scheme is 3 x 6 Gy.     

Solitary necrotic nodule of the liver misinterpreted as malignant lesion: considerations on two cases

In our experience, we document 2 cases of a rare and non-tumoral lesion of the liver misinterpreted as necrotic tumor: necrotic solitary nodule. In the first clinical case, ultrasound (US) showed a polylobated lesion (35 x 35 x 38 mm) at segment 8. Color-doppler identified a compression of celiac axis (Dunbar syndrome). Arteriography revealed a subtotal stenosis of celiac tripod soon after the emergence of the left gastric artery. FNAB-CT showed a highly cellulated tissue with a necrotic core surrounded by a fibersclerotic tissue. The patient underwent surgery: cholecystectomy and correction of Dunbar syndrome. US follow-up showed a progressive reduction in diameter of the lesion (24 x 25 x 25 mm at 24 months), suggesting in this case the role of ischemic injury in the pathogenesis of the lesion. In the second clinical case, a hypoechoic lesion (32 x 32 x 30 mm) of segment 6 as occasional US finding during the staging for prostate cancer was shown. FNAC-CT showed a positive result for necrotic cells. Surgical treatment consisted in a wide excision of the lesion. Histologically the lesion was solitary necrotic nodule. The diagnosis of this rare lesion is accidental. In accordance with the literature (50% of cases), we founded an associated tumor. Radiology doesn't differentiate solitary necrotic nodule and other solid lesions. Diagnosis is histological (in our second case, FNAC-CT misinterpreted the tumor as a malignant lesion, while histology showed the real nature of it).     

A case of hepatoid adenocarcinoma of the stomach

A patient, male, 57 years old, with hepatoid adenocarcinoma of the stomach is reported. Chief complaint was right upper abdominal mass and anorexia for 11 months. The patient's serum AFP level was found to be elevated (652.8 ng/ml) and a mass was observed in left hepatic lobe by isotope scan. It was diagnosed as primary hepatic carcinoma. A large ulcerative tumor (14 x 13 x 0.8 cm) in gastric pylorus-antrum and liver metastasis were found by autopsy. Histologically, the tumor, diagnosed as hepatoid adenocarcinoma of the stomach by pathology, was composed of two but closely related to well differentiated tubular papillary adenocarcinoma and differentiated hepatoid adenocarcinoma. Histogenesis, production of AFP and its significance, and clinicopathologic characteristics of this tumor are discussed with review of literature.     

Inflammatory pseudotumor of the spleen: a case report

We report on an inflammatory pseudotumor of the spleen. A 72-year-old woman visited our hospital complaining of nausea. Physical examination and laboratory investigations were unremarkable. Ultrasonography, computed tomography, magnetic resonance imaging and angiography showed a hypovascular splenic mass measuring about 5 cm in diameter with a calcification in the center of the lesion. Splenectomy was performed. The removed spleen, weighing 145 g, contained a tan-white, circumscribed mass, measuring 6.2 x 5.5 x 5.3 cm. Histologically, the splenic mass was composed of an admixture of inflammatory cellular elements, predominantly plasma cells and lymphocytes with hyalinization, fibrosis, lymph follicles and multinuclear giant cells, suggestive of a inflammatory pseudotumor. The patient is currently alive and asymptomatic, 24 months after surgery. Inflammatory pseudotumors of the spleen are extremely rare and only 39 cases have been reported in the medical literature.     

Angiosarcoma of the breast: Immunohistochemical demonstration of steroid receptors and literature review

A 44-year-old female with bilateral angiosarcoma of the breast with multiple skin metastases is reported. She presented with a 6x8 cm and 1x1 cm mass in her left and right breasts, respectively, and multiple skin lesions around the chest. Histologically, the excised tumor was diagnosed as angiosarcoma of the breast with skin metastasis. Tumor cells were immunohistochemically positive with factor VIII-related antigen, CD34, alpha-smooth muscle actin and vimentin, and positive with UEA-I lectin. The majority of tumor cell nuclei expressed progesterone receptor (PgR) protein but estrogen receptro (ER) protein and androgen receptor (AR) protein were nagative. According to the literature, angiosarcoma of the breast mostly affects females in their fourth (33%) and fifth (40%) decades (mean age, 39.5 +/- 10.7 years). The survival rate depends on tumor size and tumor differentiation. The 3-year survival rate is 86% in patients with a tumor size less than 5 cm, and 90% in well-differentiated group I lesions.     

Estimating the magnitude and field-size dependence of radiotherapy-induced mortality and tumor control after postoperative radiotherapy for non-small-cell lung cancer: calculations from clinical trials

PURPOSE: To create, on the basis of available data, a mathematical model to describe the tumor stage- and field size-dependent risks/benefits of postoperative radiotherapy (PORT) for non-small-cell lung cancer (NSCLC), and to assess whether this simple model can accurately describe the reported changes in overall survival. METHODS AND MATERIALS: The increase in overall survival afforded by PORT is assumed equal to the increase in cancer-specific survival minus the rate of RT-induced mortality. The increase in cancer-specific survival is the product of the probabilities of (residual local disease) x (sterilization of residual disease with PORT) x (absence of metastatic disease). Data were extracted from the literature to estimate these probabilities. Different models were considered to relate the RT-induced mortality to field size. RESULTS: The rate of RT-induced mortality seems to be proportional to the cube of the field size. When these mortality rates are included in the model, the predicted changes in overall survival approximate the literature values. CONCLUSION: Clinical data can be explained by a simple model that suggests that RT-induced mortality is strongly dependent on field size and at least partly offsets the benefit afforded by PORT. Smaller RT fields, tailored to treat the areas most at risk for recurrence, provide the highest therapeutic ratio. The data used do not reflect the impact of chemotherapy, which will reduce the rate of distant metastases and enhance the efficacy of RT.     

Radiotherapy for unresectable endocrine pancreatic carcinomas.

Surgery, when possible, is the treatment of choice for the uncommon endocrine tumours of pancreas. Unresectable cases are usually treated with cytostatic drugs or alpha-interferon. We describe a patient with unresectable, locally advanced endocrine pancreatic carcinoma (measuring 5 x 5 x 6 cm) that was totally cured by external radiation therapy only (40 Gy). This case together with four cases in the literature indicate that external radiation therapy should be considered in locally unresectable endocrine pancreatic carcinomas.     

An associated concomitant early multiple esophageal carcinoma and gastric carcinoma

Presented is the case of a 71-year-old female with an associated, concomitant early multiple esophageal carcinoma and a gastric carcinoma. An esophageal endoscopy revealed a reddish region in the upper and middle esophagus. This lesion, in part, remained unstained by lugol. Further, three lesions were observed at the upper and middle portions of the esophagus in a resected specimen, and the macroscopic diagnosis was 0-II c, These lesions were histologically diagnosed as being moderately differentiated squamous cell carcinomas, 5 x 15 mm, 2 x 5 mm, and, 3 x 5 mm in size. Furthermore, a lesion in the cardia was found superimposed on the esophageal cancer, and diagnosed as being an adenocarcinoma (II b), 10 x 15 mm in size. In the literature, reports of a concomitant association of an early esophageal carcinoma and a gastric carcinoma amount to 19 cases in Japan, our case being the twentieth case. In formatively, our case was found to display a multiple carcinoma in the esophagus.     

Localized fibrous tumor (localized fibrous mesothelioma) of the liver

A case of localized fibrous tumor (LFT) (localized fibrous mesothelioma) of the liver in an 83-year-old woman is presented. The tumor was 15 x 9 x 8 cm and was confined to the left lateral segment of the liver. Occasional mitotic figures (MF) (2 to 3 per 50 high-power fields [HPF]) were present. Strong, diffuse vimentin positivity was demonstrated by immunohistochemistry. Immunoreactivity for cytokeratins (AE1-3), epithelial membrane antigen (EMA), desmin, and desmosomal proteins (desmoplakin I + II) was absent. Electron microscopic examination showed a mesenchymal appearance of the majority of neoplastic cells, with a few ultrastructural features suggestive of mesothelial differentiation. These findings supported a submesothelial origin of the tumor. After a partial hepatectomy with total gross and microscopic removal of the tumor, the patient was alive without recurrence at 2 years, 5 months later. A review of the English literature showed six additional cases that are probably similar. Currently, all tumors have been clinically benign, although follow-up information has been limited.     

Mammary fibroadenoma showing osseous metaplasia: a case report

Discussed is a 33-year-old premenopausal woman who noted a mass in her right breast. On palpation, the tumor was determined as being 3.5 x 2.5 cm in size, well circumscribed, of a firm consistency, and freely movable. Mammography showed a well-defined oval lesion which contained a coarse calcification in the upper external quadrant. An ultrasound study revealed a well-defined oval low echoic lesion with a high echoic portion in the internal echo. The tumor was extirpated and a gross inspection found it to be an ordinary fibroadenoma, 3.2 x 2.5 x 1.5 cm in size. Histologically the lesion was a hyalinized fibroadenoma showing osseous metaplasia. A review of the literature has not revealed cases of a benign breast tumors showing an osseous and/or cartilagenous metaplasia. Notable however is that many reports show mammary osteosarcomas as originating from a fibroadenoma. Thus, this tumor also might have possibly developed into a osteosarcoma.     

Pharmacokinetic evaluation of two different formulations of megestrol acetate in patients with advanced malignancies

The bioequivalence of two megestrol acetate formulations, 160-mg tablets and 160-mg sachets, was investigated in a single-dose, open-label, balanced-for-sequence cross-over study involving 12 advanced-cancer patients. The observed plasma megestrol-acetate time course obtained with both formulations was consistent with the literature data. The main source of variability in the pharmacokinetic parameters was intersubject variability; drug formulation played only a minor (and nonsignificant) role. The width of the 90% confidence interval of the areaunder-the-curve (AUC) ratio (sachets: tablets) computed according to Schuirmann (0.9–1.4) was mainly due to the presence of a single outlier, showing an AUC ratio of 2.7. The trend to higher bioavailability of the new formulation was not significant, especially as compared with the doseresponse data reported in the literature.     

The gatekeeper effect of epithelial-mesenchymal transition regulates the frequency of breast cancer metastasis

When carcinoma cells metastasize, they change their phenotype to enhance motility. Cells making this switch selectively express S100A4, a p53-associated, calcium-binding protein known in the fibroblast literature as fibroblast-specific protein-1 (FSP1). FSP1 normally acts as a conversion signal for the local formation of tissue fibroblasts by epithelial-mesenchymal transition. We describe here a novel connection between the process of fibroblast development and the acquisition of a metastatic phenotype in genetically engineered mice with mammary carcinoma. More frequent lung metastases were observed in na?ve recipients given purified populations of green fluorescent protein (GFP)(+) tumor cells harvested from PyV-mT x FSP1(+/+.GFP) F1 mice compared with GFP(-) tumor cells (P < or = 0.01), where GFP expression is under the control of the FSP1 promoter. The expression of GFP in these metastases reversibly attenuates with the establishment of secondary tumor nodules. Reduced numbers of metastases were also observed in PyV-mT x FSP1(GFP/GFP) F1 mice carrying null alleles for FSP1 (P < or = 0.04) and in PyV-mT x FSP1.Delta TK(+) F1 mice rescued with nucleoside analogues while expressing thymidine kinase under the control of the FSP1 promoter (P < or = 0.01). We propose that epithelial-mesenchymal transition associated with the expression of FSP1 in tumor cells has a functional role in determining the latency of tumor dispersion and may be a convenient therapeutic target for controlling a key initiating event in metastatic progression.     

Atypical thymic carcinoid and malignant somatostatinoma in type I multiple endocrine neoplasia syndrome: case report

Thymic carcinoid and malignant somatostatinoma are both rare, and their concurrent presence in multiple endocrine neoplasia type 1 (MEN-1) has never been reported in the English literature to date. We present a patient with thymic carcinoid and malignant somatostatinoma in association with MEN-1. The patient eventually died of pulmonary aspergillosis and respiratory failure. Autopsy showed a 16 x 10 x 8-cm thymic carcinoid tumor, parathyroid and adrenal gland hyperplasia, and malignant somatostatinoma of the pancreas with a metastatic tumor over the splenic hilum.     

x-刀治疗肺癌14例分析

目的探讨X-刀治疗肺癌的方法、疗效、并发症。方法对14例肺癌患者行X-刀治疗，随访1～18个月，结合文献进行临床分析及疗效评价。结果1月后部分缓解7例，其中5例周围型肺癌；3月后完全缓解3例，均为周围型肺癌；3月后恶化1例，6月后恶化3例；1月左右死亡3例。其中2例中心型肺癌。结论X-刀治疗周围型肺癌效果优于中心型肺癌，且可以反复进行，为临床治疗中晚期肺癌提供了有效的方法。     

Rhabdomyomatous mesenchymal hamartoma presenting as a skin tag in the sternoclavicular area

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital lesion of the dermis and subdermis. It has been described predominantly in newborns, with 30 cases reported in the English literature. Typically, it appears as a skin tag, papule, nodule or a mass involving the face or sternal notch. A 28-day-old girl presented with a 1.4 x 0.8 cm soft skin tag in the right sternoclavicular area. Physical examination revealed no congenital anomalies. A shaved biopsy showed that the core of the lesion contained striated muscle fibers mixed with hair follicles and sebaceous and eccrine glands. Thin epidermis lined the outside of the tag. We report a patient with a RMH in a site not previously reported and discuss the differential diagnosis.     

Determination of subcutaneous tumor size in athymic (nude) mice

Summary The athymic (nude) mouse is a useful model for studying the biology and response to therapies of human tumors in vivo. A survey of recent literature revealed the use of 19 different formulas for determining the size of subcutaneous tumors grown as xenografts in nude mice (2 for determining tumor area, 3 for tumor diameter, and 14 for calculating tumor volume). We compared the volumes, areas, and diameters predicted by each of the 19 formulas with the actual weights of 50 tumors ranging from 0.46 to 22.0 g established in nude mice as xenografts from human cell lines. In addition to determining how well each formula predicted relative tumor size, we analyzed how well each formula estimated actual tumor mass. The ellipsoid volume formulas (/6 x L x W x H and 1/2 x L x W x H) were best for estimating tumor mass (r=0.93), whereas measurements of diameter correlated poorly with tumor mass (r<0.66). Although determination of tumor area correlated well with tumor mass in small tumors (r=0.89), correlations of area with tumor mass for large tumors were poor (r=0.41). We conclude that determination of the ellipsoid volume from measurements of three axes consistently yields the most accurate estimations of both relative and actual tumor mass.Supported in part by NCI grant CA44904     

Malignant systemic mastocytosis.

Malignant Systemic Mastocytosis is a very rare condition. Only about less than 40 well documented cases have been reported as per the available literature. The paper presents the case report of a 54 year old male patient who presented with huge hepatosplenomegaly and abdominal lymphadenopathy. Splenectomy specimen was 17 x 16 x 10 cm size with cut surface studded with numerous tiny 1-2 mm nodules. Histologic sections of spleen showed extensive mast cell (typical and atypical) infiltrates. Liver biopsy and abdominal lymphnode biopsy specimens and bone marrow smears also showed similar infiltration by mast cells. Special stains done for non-specific esterase and chloracetate esterase showed strong positivity for mast cells. The results of immunohistochemical and electron microscopic studies are also presented.     

Methylene blue in the treatment and prevention of ifosfamide-induced encephalopathy: report of 12 cases and a review of the literature

Ifosfamide is an alkylating agent used in the treatment of a variety of solid tumours. Ten to 15% of patients treated with ifosfamide develop an encephalopathy. Methylene blue (MB) may be used in the treatment of this encephalopathy. The purpose of this study was to evaluate the neuroprotective effect of MB in these patients and to review the literature. Between 1993 and 1997, 52 patients (age 16-77 years) with solid tumours were treated with ifosfamide in dosages ranging from 3 to 5 g m(-2) q3w when given in combination schedules and up to 12 g m(-2) q4w when given as a single agent. Twelve patients developed central nervous system (CNS) depression, defined as National Cancer Institute Common Toxicity Criteria (NCI-CTC) neurocortical toxicity grade 2 or higher. Eight were treated with MB at a dose of 6 x 50 mg day(-1) intravenously (i.v.). Four recovered fully within 24 h, two recovered partially after 24 h and completely after 48 h while two recovered only after 72 h. Four patients did not receive MB and all recovered only after 48 h. Three patients received prophylaxis with MB at a dose of 4 x 50 mg day(-1) i.v. for the subsequent chemotherapy cycles. Two developed milder encephalopathy; one had no CNS depression at all. We conclude that MB is an effective treatment for ifosfamide-induced encephalopathy. Our findings suggest that it may also be used as a prophylactic agent.     

A case of asbestos exposure complicated by a malignant pheochromocytoma

Reported is a case of non-functioning malignant pheochromocytoma. The patient had an occupational history of asbestos exposure and pleural plaque was seen in the chest X-rays. The tumor appeared from right adrenal gland and its size was 12 x 15 cm, which was measured by CT scanning. This determined to be non functioning because catecholamines in the serum and VMA in the urine were within normal limits. A metastasis of this tumor was seen in the lung, the liver, and the bone. So far as is known, this is the first case of asbestos exposure complicated with malignant pheochromocytoma that has been reported in the Japanese literature.     

An Unusual Case of Bronchial Carcinoid Predominantly Consisting of Large Cells

A 58-year-old woman presented an unusual variant of bronchialcarcinoid. A tumor measuring 20 x 25 mm was recognized upongross examination in the upper lobe of the right lung. Microscopically,the tumor consisted of large polyhedral cells with a pseudoglandulararrangement similar to pheochromocytoma cells. Immunohistochemically,the tumor cells contained serotonin, S-100 protein and neuron-specificenolase. Thus, we consider this neoplasm to be a large cellvariant of bronchial carcinoid which, to our knowledge, hasnot been described in the literature