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 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Errors in clinical staging of bladder carcinoma occur in about 50 per cent of patients. Sources of error include (1) a variable assortment of diagnostic studies performed, (2) inexactitudes inherent in the diagnostic measures employed, (3) insufficient corroboration by surgical and pathologic staging, (4) the lack of a satisfactory means for detecting micrometastases, and (5) a generalized confusion regarding the multiple classifications available for clinical staging. More precise clinical staging will be influential in treatment decision-making and in prognosis. Minimum requirements for clinical staging of the primary tumor currently include complete examination, excretory urography, cystoscopy, bimanual examination under anesthesia, and transurethral resection or biopsy. Polycystography, triple contrast cystograpy and arteriography may be helpful occasionally to document muscle invasion. Pedal lymphangiography and lymphography can in selected cases be helpful in detecting otherwise silent nodal involvement in spite of its inability to demonstrate many primary or regional lymph nodes. Familiarity with the above diagnostic options and the advantages and limitations of each is essential for each physician caring for a patient with bladder carcinoma. Conversion to TNM classification for bladder carcinoma that is similar to that of the UICC seems appropriate (1) because of its more rational approach to extent of involement by primary tumor, lymph node and distant sites, and (2) in order for our western hemisphere urologists to communicate better with our colleagues from around the globe. Such a system is now under consideration by a subcommittee of the American Joint Committee on Staging and End Result Reporting.
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PMID:Pitfalls in clinical staging of bladder tumors. 82 29

An infrequent initial presentation for malignant melanoma is the diagnosis of metastatic disease without a history of an obvious primary lesion. Confusion exists in the literature concerning the workup, treatment, and prognosis of the unknown primary melanoma. A retrospective, computer-aided chart review of 580 consecutively registered patients with melanoma at the University Treatment Center (Tampa, FL), identified 18 patients with an unknown primary presentation. There were 10 males and 8 females with a mean age of 38.4 years. Ninety-four percent of the patients were diagnosed with metastatic disease in a nodal basin, whereas 1 patient had a resected isolated lung mass as the initial presentation. In the patients who presented after having a biopsy of a single positive node for diagnosis, more disease was recovered in the nodal basin with a formal node dissection in 59% of the patients. Actuarial survival curves were constructed for the group with unknown primary melanoma. As a control population, survival curves were constructed of the subpopulation of patients with melanoma who had a known primary and had stage III (regional nodal disease) at diagnosis. There was no difference in survival between those with known and unknown primary melanoma (p = 0.96).
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PMID:Metastatic melanoma with an unknown primary. 164 14

The presence of a large mediastinal mass (bulk disease) in patients with newly diagnosed Hodgkin disease is believed by many to predict a poorer prognosis and to warrant more aggressive treatment. These masses are formed by an aggregate of mediastinal lymph nodes. The determination of bulk disease is confusing, with at least 27 definitions having been proposed. This study seeks to determine the best definition, and determine the role of thoracic computed tomography (CT) versus chest radiographs in the evaluation of mediastinal bulk disease. One hundred seven consecutive newly diagnosed adult patients with Hodgkin disease were evaluated using 13 commonly used definitions of mediastinal bulk. Of the 76 patients with mediastinal disease, 73 had bulk disease as defined by at least one definition. Of the 16 patients who had recurrence of mediastinal disease, only the presence of bulk disease according to one definition (hilar adenopathy, greater than or equal to 2 cm) was statistically significant in its prediction (P = .05). No definition based on the size of the mediastinal nodal mass reliably predicted those patients with recurrence. No differences in our data were found for differing stages or disease cell types, the presence of extension, or with differing treatment regimens. This study highlights the confusion and controversy surrounding the use of bulk disease of the mediastinum as an adverse prognostic indicator. The numerous methods of measuring mediastinal bulk in patients with newly diagnosed Hodgkin disease are confusing, overlap, and are not statistically reliable in predicting recurrence. Efforts to create a standard or ideal definition were unsuccessful. Thoracic CT was useful in those patients whose bulk disease distorted only one side of the mediastinal silhouette on chest radiographs.
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PMID:Mediastinal bulk in Hodgkin disease. Method of measurement versus prognosis. 176 46

Squamous differentiation is identified in about 25% of endometrial adenocarcinomas (AC). Its significance has been the subject of debate for decades, and it has been reported that the prognosis of adenoacanthoma (AA) is better than, the same as, and worse than that of AC. Part of this confusion has resulted from semantic differences relating to the use of AA and adenosquamous carcinoma (AS). To investigate the prognostic importance of squamous differentiation in endometrial carcinomas and compare the prognostic utility of two classification systems, 456 women were studied who had typical AC and 175 women who had typical AC containing areas of squamous differentiation (AC + SQ) and who had been entered in a Gynecologic Oncology Group protocol of Stage I and II endometrial adenocarcinoma. Assessment of histologic grade and depth of invasion was done both by the pathologist at the member institution and at a second highly structured review. Differentiation of the squamous component of endometrial carcinomas was found to parallel that of the glandular component in most tumors. The biologic behavior of endometrial carcinomas with squamous elements was similar, but not identical, to that of typical AC. Although the frequency of nodal metastasis was similar for both AC and AC + SQ, the presence of squamous elements was associated with an increased probability of survival. Division of AC + SQ by depth of myometrial invasion and by architectural grade of the glandular component provided useful prognostic information that was superior to that resulting simply from division of AC + SQ into AA or AS. The authors recommend that these terms be replaced by "adenocarcinoma with squamous differentiation" and that the pathologist provide information on the architectural grade and depth of myometrial invasion to guide the gynecologist in determining appropriate therapy.
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PMID:The significance of squamous differentiation in endometrial carcinoma. Data from a Gynecologic Oncology Group study. 191 65

Regional lymph node status is a key factor in the staging of pediatric renal tumors on the National Wilms' Tumor Study (NWTS). A review of cases entered on the NWTS has uncovered a number of cases where benign lymph node findings were mistaken for metastases. Most frequently, this was due to the presence of complexes of epithelial cells and Tamm-Horsfall protein within nodal sinuses. The epithelial cells were derived from damaged nephrons, usually resulting from obstruction by tumor. Another epithelial pseudometastic lesion, intranodal squamous epithelial cells, was found to originate from metaplastic calyceal urothelium. Benign mesothelial or coelomic inclusions similar to those previously described in pelvic and periaortic lymph nodes of adult females were found in nodes of four patients, including two boys, who are, to our knowledge, the first to be described with this finding. Other sources of confusion included protrusion of lymphoid follicles or germinal centers into nodal sinuses, thick endothelial cells of postcapillary venules mimicking epithelial tubules, nodal megakaryocytes resembling anaplastic nuclear changes, and histiocytic granulomas. Immunocytochemical methods were useful in evaluating some of these phenomena. Recognition of these pseudometastatic lesions is essential in order to avoid unnecessary and potentially hazardous therapeutic intensification.
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PMID:Benign nodal lesions mimicking metastases from pediatric renal neoplasms: a report of the National Wilms' Tumor Study Pathology Center. 217 2

Although the classification proposed by Dukes has been repeatedly modified, causing unnecessary confusion, his original concept remains unrefuted; cancer penetration through the bowel wall and lymph node metastasis are two major prognostic factors, of which nodal metastasis represents a more advanced stage. However, the results of our exhaustive computer analyses did not support this concept, and better classifications may be developed using our computer algorithm, enabling us to refine the indication for extensive surgery or limited resection. There are two trends of surgical treatment in Japan. One is an attempt to extend the area of resection including the paraaortic and parailiac nodes, and also iliac vessels. Patients treated by this method show a higher survival rate if compared with historical controls in Japan. However, extensive surgery of the rectum is associated with poor quality of life with bladder and anal dysfunctions as well as sexual impotence. The other trend is to limit the extent of resection and minimize the functional defect. The organs thus saved include the sphincter and autonomic nerves. The results are almost comparable with those of more radical surgery. With aggressive re-resection of recurrent tumors in the liver, lungs, lymph nodes and local areas, the number of long-term survivors is now increasing who would otherwise have died.
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PMID:[Large bowel cancer: prognostic factors, surgical treatments and their results]. 219 95

The clinicopathologic features of nine patients with Kimura's disease and 15 patients with angiolymphoid hyperplasia with eosinophilia (ALHE) were studied and compared in order to clarify the confusion between these two entities. The common features shared by both conditions included male predominance, predilection for the head and neck regions, tendency to recur, and vascular nature of the lesion with lymphoid and eosinophilic infiltrates. However, Kimura's disease was usually seen in younger individuals for a longer duration and occurred as a deeply seated, large soft-tissue mass, without significant change of the overlying skin initially. In addition, it was often accompanied by peripheral blood eosinophilia and elevated serum IgE. In contrast, ALHE lesions were multiple small dermal papular or nodular eruptions observed in older patients and present for a shorter duration; they were less frequently accompanied by peripheral blood eosinophilia. The main histopathological difference was the presence of "histiocytoid" or "epithelioid" blood vessels in ALHE but not in Kimura's disease. Kimura's disease was further characterized by eosinophilic folliculolysis; IgE deposits in the germinal centers; and frequent involvement of regional lymph nodes, salivary glands, and skeletal muscles. The eosinophilic infiltration, especially the formation of eosinophilic microabscesses, along with increased number of small blood vessels, perinodal eosinophilic infiltration, and eosinophilic folliculolysis characterized the nodal involvement by Kimura's disease. Our study indicates that Kimura's disease and ALHE are two distinct clinicopathologic entities. We place particular emphasis on the involvement of regional lymph nodes in Kimura's disease. In addition, we observed Charcot-Leyden crystals and polykaryocytes in both conditions. One of the patients with Kimura's disease also had an associated nephrotic syndrome.
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PMID:Kimura's disease. Involvement of regional lymph nodes and distinction from angiolymphoid hyperplasia with eosinophilia. 278 48

From 1984 to 1987, seventy-two patients with squamous cell carcinomas involving oropharynx, hypopharynx, larynx and cervical lymph nodes, who underwent surgery, were examined to determine the value of computed tomography (CT), magnetic resonance (MR), high-resolution real-time sonography (US) and palpation in preoperative staging of cervical nodal metastases. The clinical staging was compared with the microscopic findings in the neck specimens and with operative reports. For the identification and description of cervical lymph node metastases, US and CT are more valuable than MR and palpation. In comparison to CT, however, US has advantages in most cervical areas as a dynamic method with variable representation of interesting regions. False positive errors are related to confusion with inflammatory nodes in all examinations. Metastatic infiltration of surrounding tissue especially of neck vessels, are best recognised by means of US and MR. However, the high rates of sensitivity and low rates of specificity of all methods point to the possibility of a great number of false positive errors in demonstrating tissue infiltration.
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PMID:[Detection and assessment of cervical lymph node metastases in head-neck tumors. A comparison of methods]. 266 91

To determine the architecture of the atrioventricular (AV) junctional region, structures in atrial preparations were correlated to those in serial sections made either parallel or perpendicular to the long axis of the AV node (AVN)/AV bundle complex. The results demonstrated the following for the first time: 1) A right medial atrial wall (MAW) extends anteriorly from the interatrial septum, superior to the interventricular septum (IVS). 2) An atrial interventricular septum (A-IVS) groove is located between the base of the MAW and the crest of the IVS. 3) Three atrionodal bundles converge to form a proximal AV bundle (PAVB), which in turn is contiguous with the AVN. The atrionodal bundles are associated with the MAW or the superomedial and inferolateral margins of the coronory sinus. Terminal portions of the atrionodal bundles and the PAVB reside within the A-IVS groove. The AV bundle was termed distal (DAVB) to avoid confusion. 4) The location of the AVN/DAVB complex topographically is deep to the apex of the septal cusp of the tricuspid valve subjacent to the MAW. Intracardially, the AVN/DAVB complex is within the central fibrous body. Significantly, this study resulted in the first unequivocal demonstration of discrete bundles of myocardial fibers associated with the atrial end of the AV node. Moreover, it appears likely that the atrionodal AV bundles are continuous with the sinoatrial nodal extensions, thereby forming internodal tracts.
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PMID:Atrioventricular node and input pathways: a correlated gross anatomical and histological study of the canine atrioventricular junctional region. 278 19

The treatment of choice for disseminated prostate cancer remains endocrine manipulation, either bilateral orchiectomy or exogenous estrogens. The recommended dose of diethylstilbestrol is 1 mg tid. Unanswered questions include: When should endocrine manipulation be instituted for the patient with advanced prostatic cancer? At the time of diagnosis, when clinical symptoms occur, or not at all? With few exceptions those patients relapsing after initial endocrine manipulation do not respond to successive attempts at further endocrine therapy. Much of the confusion in this regard relates to the variable response criteria used, more often subjective than objective. Since the polyclonal theory of prostatic cancer is attractive, its logical extension is the evaluation of combinations of treatments including both endocrine manipulation and cytotoxic agents. Because the currently available antiandrogens and luteinizing hormone-releasing hormone agonists have mechanisms of action different from conventional estrogens or bilateral orchiectomy, they too may have a role in the multimodal treatment of advanced prostatic cancer. Therapy for stage D1 prostatic cancer implies that information is available either from pelvic lymphadenectomy or from fine-needle aspiration cytology related to abnormal findings on CT scanning, lymphangiography, or excretory urography. Some evidence exists supporting the case of potential cure by radical prostatectomy when pelvic nodal involvement is minimal. Other options include standard external beam irradiation therapy, endocrine therapy with transurethral prostatic resection, and finally, observation until distant metastases occur. Because of the increased risk of distant metastases in patients with stage D1 prostatic cancer, adjuvant chemotherapy programs are rational with clinical trials now in progress.
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PMID:The patient, disease status, and treatment options for prostate cancer: stages D1 and D2. 635 Oct 40


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