Difficulties in diagnosing and treating GIST: report and analysis of a case

Gastrointestinal stromal tumours account for fewer than 1% of malignant tumours of the digestive system. Analysing a case referred to us for observation, we review the literature with regard to diagnostic and therapeutic difficulties. A 68-year-old patient was referred to our institute with a diagnosis of "retroperitoneal haematoma". Computerised tomography showed a solid mass with a liquid component, occupying almost the whole of the abdominal cavity. An ultrasonography-guided biopsy examination suggested the presence of a sarcoma. Exploratory laparotomy and the histological examination, which was positive for CD117, CD34 and the smooth muscle marker caldesmon, allowed a diagnosis of gastrointestinal stromal tumour to be made. Thus, no thoroughly reliable and accurate diagnosis of gastrointestinal tumour can be made without surgical exploration and consequent histological and immunohistochemical examinations that still represent the only method capable of confirming or ruling out a diagnosis of gastrointestinal stromal tumour. Such tumours are rare and aggressive and their prognosis is closely related to tumour size and the mitotic index per high power field. Radical resection affords the only possibility of long-term survival.     

胃肠道间质瘤预后因素的临床分析

目的探讨影响胃肠道间质瘤(GIST)的预后因素。方法回顾性分析2000-2003年间41例GIST患者的免疫组织化学表达情况及肿瘤的大小、生长部位、核分裂数及手术的切除程度与该病预后的关系。结果GIST患者的病理切片中CD117、CD34和波形蛋白(vimentin)的表达比较高,分别为92.7%、82.9%和78.0%。生长在小肠的GIST比生长在胃和结直肠者预后差(P<0.05);肿瘤直径大于5cm患者的预后较小于或等于5cm的差(3年生存率为54%比72%,P<0.05);核分裂大于5/50HPF者预后较小于或等于5/50HPF者差(P<0.05);行不完全性切除手术者比行完全性切除者预后差(P<0.05)。结论完全性手术切除肿瘤能明显提高GIST患者的预后。生长在小肠的肿瘤、肿瘤直径大于5cm和核分裂大于5/50HPF是影响肿瘤预后的因素。     

胃肠道间质瘤32例的诊断和临床病理特征分析

目的探讨胃肠道间质瘤 (gastrointestinalstromaltumor,GIST)的诊断、病理组织形态、免疫组化特点和良恶性的参考指标。方法应用光镜观察 5 4例胃肠道间叶源性肿瘤的形态特征和通过免疫组化EnVision法检测CD1 1 7、CD34和S 1 0 0表达的情况 ,确诊并分析其中 32例GIST的临床病理特征。结果交界性恶性GIST在男性中多见。免疫组化染色显示CD1 1 7呈弥漫强阳性 ,CD34多呈弥漫强阳性 ,S 1 0 0偶尔呈局灶或散在阳性 ,阳性率分别为 1 0 0 %、5 9%和 1 6 %。结论CD1 1 7是诊断GIST的敏感而特异的标记物。肿瘤性坏死、肿瘤细胞密集和肠道肿瘤核分裂象≥ 1 /5 0HPF是判断恶性GIST的指标 ,男性是GIST潜在的恶性因素     

68例胃肠间质瘤临床病理及预后分析

目的:分析胃肠间质瘤(gastrointestinal stromal tumors,GISTs)临床病理特性及影响预后因素,探讨提高GISTs疗效的有效方法。方法:对随访的68例GISTs患者的临床资料行Kaplan-Meier生存分析。结果:生存分析显示肿瘤直径<5cm、病理核分裂像<5/50HPF、服用格列卫的患者生存率较高,手术治疗行肿瘤完整切除术与扩大切除术生存率差异无统计学意义(P=0.8705)。结论:肿瘤直径、核分裂像与预后有关,完整切除肿瘤可获得根治效果,术后服用格列卫能改善患者预后。     

Uncommitted gastrointestinal stromal tumour. Case report

Gastrointestinal Stromal Tumours (GIST) are mesenchymal tumours with uncertain prognosis. Malignant variety represents about 2.0% of malignant gastroenteric tumours. The Authors report a clinical case of malignant gastric and duodenojejunal GIST, in which the only surgical treatment seems to be definitive. R. S., a 69-year-old female, was admitted for asthenia and fever in January 1997. Endoscopic exploration, ultrasonography and CT-scan of the abdomen demonstrated an exophytic tumour in the greater gastric curvature and one tumour of 5.5 cm of diameter in the Treitz's angle. We performed a resection of the gastric tumour and the duodenojejunal angle. Postoperative course was uneventful and the patient was discharged after 14 postoperative hospital days. Histological analysis showed two spindle cells stromal tumours with mitotic rate > 20/10 HPF. The immunohistochemistry demonstrated the uncommitted origin of tumour cells. The patient refused the chemotherapy treatment. There was no local recurrence or metastasis at a follow up of 47 months, in spite the high malignancy degree. For this reason and because of the uncertain behaviour of benign GIST, the authors propose a lifelong follow up of the patients managed with potentially curative surgical resection.     

Gastrointestinal stromal tumours of the stomach: personal experience

Gastrointestinal stromal tumours are a relatively new nosological entity with an increasing incidence. CD117 positivity at immunohistochemical analysis is mandatory to distinguish them from other mesenchymal tumours. A gastric localisation is observed in more than 70% of cases. In the present paper 11 primary gastrointestinal stromal tumours of the stomach operated during the last decade at our institution were retrospectively reviewed. Hospital files and histological slides of 11 patients with gastrointestinal stromal tumours of the stomach undergoing surgical resection at our institution over the period from 1993 to 2003 were reviewed retrospectively. The variables analysed were: morphological and immuno-histochemical characteristics of the tumours, demographic data, type of surgical treatment and postoperative course. Long-term survival was evaluated on the basis of clinical and/or telephone follow-up in all patients. Immunohistochemical analysis for CD11 7 proved positive in all patients. The size of the tumours ranged from 3 to 23 cm: tumour size was > 5 cm and > 10 cm in 8 and 3 patients, respectively. Nodal involvement was detected in one patient and another had liver metastases. Surgical treatment consisted of wedge resection in 3 cases, distal subtotal gastrectomy in 4 and total gastrectomy in 4. In 2 patients surgical excision was extended to other organs. No postoperative mortality or major postoperative complications were observed. Nine patients were still alive at follow-up; 1 patient died as a result of a neoplastic relapse (38 months) and 1 died of other causes (48 months). The median survival was 42 months. Gastrointestinal stromal tumours are characterised by slow growth and therefore clinical signs are delayed. For that reason large tumours are often observed at the time of diagnosis. Surgical resection is the only potential curative treatment; but the risk of recurrence (local or at distance) remains high.     

Gastrointestinal stromal tumors: current issues

Gastrointestinal stromal tumours are rare neoplasms originating from the connective tissue of the digestive tract and constitute most of the non-epithelial primitive digestive tumours, with a percentage incidence of less than 1%. The term itself was first used in 1983 by Mazur and Clark to identify a heterogeneous group of tumours, all of them histologically characterised by hyperplastic fused cells, not necessarily leiomuscular ones, but even neural ones. The original stem cell has not been identified yet, but such tumours constantly present the expression of the surface antigens CD34 and CD117 which can be determined immunohisto-chemically. US endoscopy and fine needle aspiration with subsequent immunohistochemical analysis and study of c-kit gene mutation afford the best diagnostic accuracy. Current research is focused mainly on primary cells, probably the cells of Cajal, and on the study of the biological behaviour of gastrointestinal stromal tumours, which can be postulated by assessing several parameters, the most accurate of which seems to be the mitotic index. More recently, the possible therapeutic use of a tyrosine kinase inhibitor has been studied in tumours expressing the c-kit gene. Our experience is based on the histopathological and immunohistochemical study of 11 submucosal tumours (1 liposarcoma, 2 leiomiomas, and 8 gastrointestinal stromal tumours) out of a total of 75 submucosal tumours diagnosed. In the majority of cases a generic diagnosis of submucosal tumour was obtained with oesophagogastro-duodenoscopy and a surgical resection was then performed because of the symptoms. Only in 4 cases was the neoplasm found occasionally in the course of surgery for other reasons. The definitive diagnosis of gastrointestinal stromal tumour, as currently defined, was made only postoperatively by analysis of the histopathological and immunohistochemical findings. In all cases we evaluated the same parameters, i.e. actin, vimentine, S100, CD34, CD117, and Ki67, and confirmed constant high positivity for CD34 and above all for CD117. Even in the absence of unfavourable prognostic indicators, all patients are regularly followed-up.     

Solitary fibrous tumour of the pleura: surgical treatment.

OBJECTIVE: Solitary fibrous tumours (SFT) of the pleura are rare tumours originated from the mesenchimal tissue underlying the mesothelial layer of the pleura. This tumours present unpredictable clinical course probably related to their histological and morphological characteristics. METHODS: Twenty-one patients affected by SFT of the pleura were referred to us for surgical resection from September 1984 to April 2000. They were 15 males and six females with median age of 51 (range 15--73) years. Nine patients (43%) were symptomatic and predominant clinical symptoms or signs were dyspnoea (19%), coughing (14.3%), chest pain (28.5%), finger clubbing (14.3%) and hypoglycaemia (14.3%). Hypoglycaemia was related to a pathological incretion of insulin-like growth factor 2 by the tumour. Chest radiograph and computed tomography of the chest revealed intra-thoracic homogeneous sharply delineated round or lobulated mass sometimes associated with ipsilateral pleural effusion (19%) or causing pulmonary atelectasis with opacification of the complete hemithorax (19%). Surgical excision required 14 posterolateral thoracotomies, six anterior thoracotomies and one video-assisted thoracoscopy. Thirteen tumours arose from visceral pleura and wedge resection was performed, seven tumours arose from parietal pleura and extrapleural resection was carried out without any chest-wall resection, one tumour growth within the upper left lobe and required lobectomy. Tumours weighted from 22 to 1942 g and measured from 22x12x8 to 330x280x190 mm. At cut section seven cases (34%) revealed focal necrosis and hemorrhagic zones and on light microscopy six cases (28.5%) were characterized by high mitotic count: characteristics related with uncertain clinical behaviour. Immuno-histochemical reactions were in all cases positive for CD34. RESULTS: In all our patients resections were complete. Paraneoplastic syndromes like hypoglycaemia and clubbing receded after surgery. No intraoperative or perioperative medical or surgical complications occurred. Median chest-drain duration timed 3 (range 2--5) days and median hospital stay was 5 (range 4--7) days. Perioperative mortality rate was 0%. Median follow-up was 68 (range 2--189) months: during this period patients were submitted to chest X-ray with 6-months interval to evaluate possible local recurrence. Only one patient experienced tumour recurrence after 124 months follow-up: the tumour was suspected after observation of finger clubbing. The tumour was detected and excised by redo-thoracotomy. CONCLUSIONS: Surgical resection of benign solitary fibrous tumours is usually curative, but local recurrences can occur years after seemingly adequate surgical treatment. Malignant solitary fibrous tumours generally have a poor prognosis. Clinical follow-up and radiological follow-up are indicated for both benign and malignant solitary fibrous tumours.     

直肠间质瘤16例临床病理分析

目的 探讨直肠间质瘤的免疫组化特征和临床诊治经验。方法 对20例直肠间叶组织肿瘤进行CD117等免疫组化染色,对其中16例直肠间质瘤的免疫表型、临床资料及随访结果进行分析。结果 确诊直肠间质瘤16例,直肠平滑肌肉瘤3例,直肠神经鞘瘤1例。间质瘤组中良性2例、交界性1例、恶性13例,CD117和CD34的表达率分别为100％(16／16)和88％(14／16);直肠间质瘤患者,平均发病年龄为60岁,首发症状主要为排尿排便困难(38％)和腹痛(31％),14例(88％)肛诊阳性;术后1、3、5年生存率分别为89％、64％、48％,术后平均生存时间为47个月。结论 直肠间质瘤是最常见的直肠间叶源性肿瘤,生物学行为常表现为恶性,易局部浸润和术后复发,早期诊断、根治性切除和及时发现复发是改善预后的关键。     

Gastrointestinal stromal tumors of the jejunum and ileum: a clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up

Gastrointestinal (GI) stromal tumors (GISTs), the specific KIT- or PDFGRA-signaling driven mesenchymal tumors, are the most common mesenchymal tumors of the GI tract. This study analyzed 1091 tumors originally classified as smooth muscle tumors of the small intestine (including jejunum or ileum and excluding duodenum), and found that 906 (83%) of these were GISTs. The GIST patients had 55:45 male-to-female ratio with a median age of 59 years (range, 13-94 years). Only 0.6% of tumors occurred before the age of 21 years and 13.6% before the age of 40 years. The tumors varied from 0.3 to 40 cm (median, 7.0 cm) and most commonly presented with GI bleeding or acute abdomen; 18% were incidentally detected. Histologically, the tumors were relatively monotypic with spindle cell (86%), epithelioid (5%), or mixed patterns (9%). Skeinoid fibers were present in 44% of cases, and their presence was associated with a favorable course. Most epithelioid tumors were malignant, and this morphology sometimes emerged from less cellular and less mitotically active spindle cell tumors, suggesting that it represented a transformation. KIT was immunohistochemically detected in 98%, CD34 in 40%, smooth muscle actin in 34%, desmin in 0.2%, and S-100 protein in 14% of the tumors tested. Outcome was strongly dependent on tumor size and mitotic activity, with an overall 39% tumor-related mortality, twice that for gastric GISTs. Only <3% of tumors <5 cm and < or = 5 mitoses/50 HPF metastasized, whereas 86% of tumors >10 cm and >5 mitoses/50 HPF metastasized. In stark contrast to corresponding gastric tumors, tumors >10 cm with mitotic activity < or = 5/50 HPF and those < or = 5 cm with mitoses >5/50 HPF had a high metastatic rate (>50%); tumors >5 cm < or = 10 cm with low mitotic rate had a 24% metastatic rate. The median survival times of patients with low mitotic rate tumors who died of disease decreased by increasing tumor size. KIT exon 11 mutations were detected in 90 cases, exon 9 mutation in 17 cases, and exon 17 mutation in 1 case; the presence of mutation or mutation type was not prognostically significant. There were no PDGFRA exon 12 or 8 mutations. Systematic data on prognosis of small intestinal GISTs of various size and mitotic activity categories can be helpful in management and surveillance of patients with these tumors.     

Surgical strategy in primary retroperitoneal tumours

Sixty-nine patients with primary retroperitoneal tumours (17 benign, 52 malignant including 4 malignant tumours of uncertain origin) were reviewed to determine the best form of surgical strategy. Total resection was performed in 88 per cent of benign cases and in 65 per cent of malignant cases. In 62 per cent of the total resections for malignant tumours, en bloc excision included adjacent organs or anatomical structures. Operative mortality rate (in terms of the total number of operations performed) was 5 per cent. Postoperative complications occurred in 14 per cent and recurrences in 35 per cent. The overall 5-year survival rate was 67 per cent in patients with totally resected tumours and zero in patients whose tumours were treated by partial resection or biopsy. An aggressive surgical approach aimed at total excision of the tumour is the best form of therapy currently available. In the totally resected retroperitoneal tumour, the use of adjuvant radiotherapy and/or chemotherapy depends on the grade of the malignancy and clearance as assessed histologically. Careful follow-up based on the use of computerized axial tomography and ultrasound allows early identification of recurrence at a stage when the recurrence is amenable to total resection.     

胃肠道外间质瘤的临床特征、治疗与预后

目的探讨胃肠道外间质瘤（EGIST）的临床特征、治疗与预后。方法收集2000年1月-2005年12月诊治的EGIST共21例，并对其临床资料进行回顾性分析。结果本组21例的EGIST最主要的临床表现为发现腹部包块，腹痛。肿瘤原于肠系膜或网膜10例，腹膜后11例，浸润邻近器官7例，伴有远处转移5例。免疫组化染色结果：CD117、CD34、Desmin、Actin、S-100、NSE阳性率分别为90％、71％、5％、33％、19％、5％，与胃GIST免疫组化结果比较差异无统计学意义（P〉0．05）。本组11例行完整切除术，6例为不全切除术或肿瘤减灭术，4例肿瘤未能切除。19例患者获得随访，12例死亡，中位生存时间20个月。EGIST预后与核分裂数、肿瘤大小、肿瘤浸润邻近器官或远处转移、肿瘤是否完整切除有关（P〈0．05）。结论EGIST与GIST有相似的免疫组化染色特点，EGIST恶性程度高，预后比胃GIST差。完整切除肿瘤有助于延长患者生存时间，术后应长期随访。     

胃肠道间质细胞瘤临床病理与免疫组化研究

目的　探讨胃肠间质瘤 (GISTs)的临床病理和免疫组化特征 ,为其诊断提供参考指标。方法　对 3 5例GISTs进行病理形态学观察 ,并采用免疫组化染色检测其CD1 1 7、CD3 4、vimentin、SMA和S-1 0 0蛋白表达检测。结果　 3 5例GISTs中 ,良性 1 6例 ,恶性 1 7例 ,潜在恶性 2例 ,主要由梭形细胞和上皮样细胞构成。免疫组化vimentin、CD3 4、CD1 1 7肿瘤细胞显示明显阳性 ,阳性率分别为 1 0 0 %、88 6%、60 0 % ,SMA和S -1 0 0蛋白呈散在细胞阳性 ,阳性率分别为 3 4 3 %和 6 1 %。结论　GISTs是胃肠道最常见的间质肿瘤 ,HE染色下形态与平滑肌肿瘤和神经源性肿瘤较相似 ,免疫组化染色对其诊断和鉴别诊断具有重要作用 ,CD1 1 7特异性较高 ,CD3 4敏感性较高     

恶性胃肠道间质瘤60例临床分析

目的 总结恶性胃肠道间质瘤的（MGIST）的临床特点及治疗方法。方法 回顾性分析1994年3月至2005年3月收治的60例MGIST患者的临床资料。结果 60例患者中22例为潜在MGIST，38例为MGIST。病理检查，潜在MGIST患者肿瘤直径3．2～7．2（平均5．3）cm，瘤组织切面呈灰白、灰黄色，实性或有出血囊性变；MGIST患者肿瘤直径3，0～25．0（平均9．2）cm，瘤组织呈鱼肉样，肿瘤细胞丰富，可见不同程度出血坏死，明显异型性，核分裂多见。免疫组化测定：54例CD117阳性，53例CD34阳性，48例波形蛋白（vimentin）阳性，27例S100阳性，16例SMA阳性。全组患者均行手术完整切除肿瘤，2003年7月后有19例患者术后给予伊马替尼辅助治疗。41例单纯手术的患者术后2年内有80，5％的患者出现转移复发，而手术加伊马替尼辅助治疗者仅有21．1％的转移复发率（P〈0．05）。结论 CD117和CD34标记阳性是诊断MGIST最有价值的血清学指标；确诊靠肿瘤病理切片。手术加伊马替尼辅助治疗有效。     

CD34, CD117, and actin expression in phyllodes tumor of the breast

BACKGROUND: This study investigated the immunophenotypic patterns of CD34, CD117 (a product of the c-kit proto-oncogene), and actin (HHF35) in benign and malignant phyllodes tumors (PTs). We correlated the expression of CD34, CD117, and actin with histopathological grade. MATERIALS AND RESULTS: We analyzed 19 cases (7 benign and 12 malignant cases) of PTs using immunohistochemical analysis. Six of 7 benign PT stromal lesions stained positively for CD34, while only 3 of 12 cases of malignant PT were focally CD34 positive (P = 0.0106). Only 1 of the 7 benign PTs stromal lesions expressed CD117. Nine of the malignant PTs were composed CD117-positive fibroblasts. This result demonstrated that CD117 expression is associated with the malignant potential of PTs (P = 0. 0106). Actin (HHF-35) expression was found in 8 of 12 cases of malignant PTs (P = 0.027), but in only 1 of 7 cases of benign PTs. Actin expression was significantly (P = 0.04) correlated to frequent mitotic activity (>5 mitoses per 10 high-power fields). The immunophenotypic markers were not related to tumor size. Additionally, we sequenced part of the juxtamembrane region of the c-kit proto-oncogene and found point mutations in two malignant PTs. CONCLUSION: Our results demonstrated that expression of CD34 was associated with benign PTs, while CD117 and actin were preferentially expressed in malignant PTs. Our results implied that these immunohistological markers might be used for the histopathological grading of PTs.     

恶性直肠间质瘤11例临床诊治分析

为探讨恶性直肠间质瘤的临床诊治特点,回顾分析我院2005年1月至2010年6月经手术治疗的11例恶性直肠间质瘤患者的病历资料。结果显示,恶性直肠间质瘤病变部位多位于直肠下段,且病灶常常较大。本组1例经肛门行局部切除术,5例行Miles术,4例行Parks术,1例行姑息性乙状结肠腹壁造口术。免疫组化检查CD117阳性11例（100％）,CD34阳性9例（81．8％）。结果表明,恶性直肠间质瘤的最后诊断需依靠病理检查,CD117和CD34是其最有价值的确诊指标;其治疗仍应以外科手术为主,对位于低位直肠且病灶较大的恶性直肠间质瘤,宜行腹会阴部联合切口将肿瘤完整切除。     

Influence of tumour differentiation on survival after resection for rectal cancer in a series of 1296 patients

The influence of differentiation grade on tumour staging, local recurrence and long term survival prospects has been evaluated in a series of patients managed by resection for rectal cancer. Differentiation was known in 1095 of 1296 patients. Well-differentiated tumours were over-represented among Dukes' stage A cases and poorly differentiated among those with disseminated disease (P less than 0.001). Local recurrence was twice as common (31%) after curative resection of poorly differentiated tumours than of well (14%) or moderately (17%) differentiated. Five year cancer specific survival rates after resection (curative and palliative combined) of tumours of good, average or poor differentiation were 68%, 59% and 33%, respectively. After potentially curative resection, survival was also significantly worse in patients with poorly differentiated tumours (P less than 0.001); 5 year survival rates of patients with tumours of good, average or poor differentiation were 75%, 71% and 51%, respectively. Survival prospects beyond 5 years in patients with Dukes' stage A tumours were significantly reduced when the tumour was poorly differentiated; 5 and 10 year survival rates were 76% and 40%, respectively. However, patients with Dukes' stage C tumours of poor differentiation had an identical 5 and 10 year cancer specific survival, 26%. Patients with mucoid type tumours had worse survival prospects than those with non-mucoid type (P less than 0.02).     

Surgical management of retroperitoneal tumours: A 12-year review

Background: The aim of the present study was to determine the long-term outcome of patients who had undergone resection of retroperitoneal tumours. Methods: This was a retrospective review of 44 patients with preoperative diagnoses of retroperitoneal tumours, who had resections carried out between April 1996 and June 2008 at our institution. Results: Forty-four patients at our hospital underwent resection with curative intent for retroperitoneal tumours. Eight patients developed recurrences, and reoperations were carried out in these patients. Merely 23.1% of the patients underwent fine-needle aspiration, and of those patients, just 15.4% received the correct diagnosis for their retroperitoneal tumour. Liposarcoma was the most common tumour (31.1%). The overall mean largest diameter of the retroperitoneal tumours was 13.4 ± 8.8 cm, and the median largest diameter was 11.0 cm (range: 2–43 cm). No significant difference was found between the mean largest diameters of benign and malignant tumours (P = 0.08). Simultaneous surgical resection of adjacent organs was required in 46.1% of the patients. The overall survival at 5 years for patients with liposarcomas, other malignancies and benign tumours was 20%, 50% and 100%, respectively. The disease-free survival at 5 years for patients with liposarcomas was zero (P = 0.013), whereas, for other retroperitoneal malignancies and benign tumours, the disease free survival at 5 years was 38% and 100%, respectively. Conclusion: Surgical management of retroperitoneal tumours often requires a multidisciplinary approach. Long-term survival rates for patients with liposarcomas are relatively poor, and recurrences after surgical resection are common.     

Analysis and long-term survival in sternectomy with plastic reconstruction for primary and secondary neoplasms of the sternum

From January 1980 to December 1999, 88 patients underwent surgical resection for tumours involving the sternum. Thirty were males, aged 16 to 76 years, and 58 females, aged 23 to 78 years (mean ages: 48 and 53 years, respectively). There were 30 primary malignant tumours, 28 local recurrences or distant metastases from breast cancer, 16 other tumours, and 14 radionecroses. Total sternectomy was performed in 8 cases, subtotal (> 50%) in 32, and partial (< 50%) in 48. Concurrent en-bloc resection of the anterior ribs was performed in 61 patients, and of the clavicle in 13. Resection was extended to the lung in 22 patients, to the pericardium in 17, to both in 2, to the diaphragm and pericardium in 4. Bone and soft tissue defects were repaired with prosthetic material associated with a muscular or myocutaneous flap in 55 patients, with prosthetic material alone in 13 cases, with a muscular or myocutaneous flap in 5 cases, and with other techniques in the remaining patients. The resection was considered to be macroscopically radical in 78 patients and palliative in 10 cases. There was one perioperative mortality and significant morbidity was limited to 13 cases. Among the patients treated with a radical intent, 48 were alive and disease-free at the end of follow-up. The 10-year survival rate was 85% in primary tumours. For breast cancer relapses, 10-year survival was the same as 5-year survival (41.8%). In our experience, an en-bloc sternal resection for a primary or secondary tumour, followed by plastic repair using prosthetic material and/or a myocutaneous flap, is a safe, effective treatment. This intervention permits the execution of extensive radical resections for sternal neoplasms, as well as enabling the patient to obtain a better quality of life. Long-term survival after radical sternectomy also depends on the histological type of the tumour.     

Recurrence, progression and survival in bladder cancer. A retrospective analysis of 232 patients with greater than or equal to 5-year follow-up

A retrospective study of 232 bladder tumours with minimum follow-up 5 years is presented. The carcinoma was superficial in 66%, muscle-invasive in 31% and could not be staged in 3%. Primary treatment was mainly transurethral resection for superficial tumour, but was cystectomy or radiotherapy in 22 of 29 T1 G3. Of the superficial tumours, 71% recurred. Progression to higher T stage occurred in 15% of Ta and 29% of T1 tumours, and half of these patients died of bladder cancer. The corrected 5-year survival rates in grades 1, 2A, 2B and 3-4 were 96, 84, 64 and 43%, and in stages Ta, T1, T2 and T3 they were 94, 69, 40 and 31%. All patients with T4 tumour died within 4 years. Among the 45 patients with 40 Gy irradiation + cystectomy, the corrected 5-year survival rate was 83% in superficial and 64% in muscle-invasive tumours, and among the 38 with radical radiotherapy the rates in T1-3 were 46, 36 and 13%. Transurethral resection was successful in most Ta cases. Most T1 tumours were, like T2-4, of higher grade than Ta. Prognosis was worse in T1 than in Ta. After progression to muscle-invasive disease, even during close follow-up the outlook was poor, as poor as for patients with primary muscle-invasive disease.