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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Successful management of sarcomas of the extremities in children implies not only achievement of local control but also satisfactory function and maintenance of the growth potential. The popliteal and antecubital fossae, because of their complex neurovascular anatomy, all of which is essential, make resection with satisfactory margins difficult. We reviewed our experience with 14 patients (3 to 20 years old; median, 13 years) with soft tissue sarcomas arising in the popliteal (11 patients) or antecubital (3 patients) fossae. There were four rhabdomyosarcomas (3 alveolar, 1 embryonal) and 10 other sarcomas, the most frequent being synovial sarcoma (5 patients). Chemotherapy was given to all patients with rhabdomyosarcomas. The one patient presenting with metastatic disease was treated, after biopsy of the primary, by chemotherapy and radiation and survived 21 months. In three patients, the primary management was an above-the-knee amputation and two of three survived (3 and 43 months). In 10 patients a wide local excision of the primary tumor was performed. Radiation therapy was administered to five, either as external beam (3 patients) or as brachytherapy (2 patients). In this group, there were no local recurrences. Four patients remain free of disease (4 months to 18 years) and one developed pulmonary metastasis. Among the five non-irradiated patients, three developed local recurrences, requiring above-the-knee amputation for disease. The fourth patient relapsed in the lung and only one of the five is free of disease at 36 months. Of the 8 patients not treated with amputation, one acquired a leg length discrepancy, which required correction, and one has a minimal extension deficit of the knee.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sarcomas of the flexor fossae in children: is amputation necessary? 140 59

344 previously untreated patients, under 19 years of age, with soft tissue sarcoma (STS) entered the first German STS Study, CWS-81. 218 of them with chemosensitive STS (Group A: rhabdomyosarcoma [RMS], synovial sarcoma, extraosseous Ewing's sarcoma, undifferentiated sarcoma and malignant peripheral neuroectodermal tumor) were evaluable for this analysis after a minimum potential follow-up of 6 years. A staging system based on the extent of disease, defined post-surgically, was used. The chemotherapy for stages I-III (VACA cycle) consisted of vincristine, dactinomycin, cyclophosphamide and doxorubicin. Patients with metastatic disease as well as stage III patients who failed to respond to VACA, were given ifosfamide instead of cyclophosphamide. The definitive local tumor control procedure for patients in stages II-III depended upon the tumor status at second-look surgery after 16 weeks of chemotherapy (no irradiation, 40Gy or 50Gy). The DFS rate after 5 years for group A was 57 +/- 4% and for patients with non-metastatic tumors (Stages I-III), 69 +/- 4%. There was no difference in prognosis between stages I and II (DFS rate 88 +/- 5% and 88 +/- 6% respectively). The DFS rate for stage III was 54 +/- 5% and for stage IV, 11 +/- 5%. Lack of local tumor control was the main cause of therapy failure: 10% of patients with localized disease never achieved CR, 18% relapsed locally. The most important prognostic factors were tumor size (p = .0002) and the degree of tumor regression after primary chemotherapy (p = .02).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Treatment of soft tissue sarcomas in childhood and adolescence: results of the CWS-81 multicenter therapy study]. 194 28

Neoplastic cavitary lesions are an unusual type of pulmonary metastases. The authors report two cases of cystic metastatic sarcoma of the lungs that illustrate the clinical, radiologic, and pathologic difficulties encountered in the diagnosis of these lesions. In one patient, multiple small, thin-walled cystic metastases from a lower leg leiomyosarcoma were the only manifestation of metastatic disease. The cystic lesions did not change over an 8-month period and a diagnosis of malignancy was not established until spontaneous pneumothorax, presumably due to rupture of the malignant blebs, prompted a thoracotomy. In the second patient, three thin-walled bullae developed after treatment of noncystic pulmonary metastases from a lower-leg synovial sarcoma. In both patients, the cystic lesions were not evident on chest radiographs, but were well visualized with computed tomography (CT), where they mimicked benign bullous disease. However, additional small cavitary lesions not seen with CT were present in resected pulmonary wedge specimens from both patients. A great degree of variability in the cellular composition of the cyst wall lining in both cases, and a lack of any solid neoplastic tissue masses in one case, led to histopathologic difficulties that required immunohistochemical studies for definitive diagnosis of the metastatic disease. These cases show that pulmonary bullae, even though thin-walled and benign-appearing on CT, may be a manifestation of pulmonary metastases. These lesions must therefore be surgically removed from patients in whom a curative resection of pulmonary metastases is warranted.
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PMID:Cystic pulmonary metastatic sarcoma. 215 5

The authors submit a case-history on their first successful application of a Nd:YAG laser in pulmonary surgery. They operated a 17-year-old boy with metastases of a synovial sarcoma in both wings of the lungs. First the boy was operated on the left side by the classical technique, half a year later the authors used a Nd:YAG laser on the right side. By means of the laser four metastases were removed. The postoperative course was without complications. One month after operation the patient was discharged from the care of oncologists and was free of complaints. The authors compare the surgical techniques and the postoperative course of the patient. A Nd:YAG laser is a suitable supplement of the equipment of pulmonary surgeons. Since the described case the authors used the laser in same indication in another three patients.
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PMID:[Removal of pulmonary metastases using the Nd:YAG laser]. 217 55

Metastases of cutaneous malignant melanoma (MM) of ordinary type can resemble various types of soft tissue sarcoma light microscopically to a degree which has not been previously recognized. Twenty-one cases are described, in which the tumours were originally diagnosed as a soft tissue sarcoma. Seven tumours were predominantly of blue and spindle-cell, fascicular type, resembling malignant peripheral nerve sheath tumour and at times monophasic synovial sarcoma. Ten tumours which were of fascicular and predominantly storiform type, and included uni- and multi-nuleated pleomorphic cells resembled malignant fibrous histiocytoma. Due to the presence of multivacuolated lipoblast-like tumour cells, 2 of these 10 tumours resembled pleomorphic liposarcoma. One had a predominantly myxoid and hypocellular appearance and 5 additional tumours included such areas. The diagnoses were revised after ultrastructural examination with the demonstration of melanosomes in 13 of 16 studied cases and the immunohistochemical demonstration of positivity using anti-S-100 protein antibodies and the anti-melanoma antibody NKI/C3 in all cases. The anti-melanoma antibody HMB 45 gave a positivity in 9 of 21 cases. Light microscopically, sparse amounts of melanin were noted in 7 tumours using the Whartin-Starry technique. Eleven tumours occurred at sites close to major lymph node groups and in 9 of these cases, lymphoid tissue was associated with the tumours, suggesting that they represented lymph node metastases. Following a review of the patients' clinical histories and renewed clinical examination, primary cutaneous MM was demonstrated in 10 of 21 patients and in 1 case an MM in regression was detected. The origin of the 10 tumours without a detected primary is discussed, including the possibility of an overlooked primary, spontaneous regression of a primary and a de novo origin from lymph nodes and soft tissues.
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PMID:Metastases of malignant melanoma simulating soft tissue sarcoma. A clinico-pathological, light- and electron microscopic and immunohistochemical study of 21 cases. 217 52

Synovial sarcoma is a high-grade malignancy with a marked propensity for local recurrence and a moderate rate of regional lymph node involvement. It usually causes death from massive pulmonary metastases. Despite its aggressive biologic behavior, en bloc wide local resection of small extremity tumors rather than amputation may be indicated if removal of all gross disease is possible. Extremity morbidity from resection of vessels, nerves, and soft-tissue bulk can be minimized by the use of composite reconstruction techniques currently available. A case report is presented to illustrate aggressive limb-sparing surgical therapy of a small, favorably located synovial sarcoma with immediate neurovascular and soft-tissue reconstruction. The literature is reviewed to aid subsequent surgeons faced with management of this uncommon tumor.
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PMID:Management of synovial sarcoma of the median nerve at the elbow. 253 98

The authors analyzed the prognosis in a population-based series of 24 patients with primary synovial sarcoma in the extremities (22) and trunk wall (two), all of whom were principally treated by surgery. No patient had evidence of metastatic disease at the time of diagnosis of the primary tumor. After 3 to 19 years of follow-up, six patients had developed local recurrence and 12 had died of metastatic disease including those six with local recurrence. All patients with tumors smaller than 4 cm were alive without evidence of disease, as were also four of the five patients who had larger tumors, but with a mitotic rate lower than 15 per 10 high-power fields. The association between local recurrence and metastatic disease may be more statistical than causal, since patients with both these events had more often larger tumors with a high mitotic rate.
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PMID:Prognostic factors in synovial sarcoma. 254 85

Since 1981, 37 cases of soft tissue sarcomas have been treated in our clinic. There were 20 males and 17 females with an average age of 43.5 years old. Histopathological classifications were liposarcomas 9 cases, MFH 8 cases, synovial sarcoma 5 cases, rhabdomyosarcoma 3 cases etc. Twenty-four cases (65%) were located in lower extremity, 11 cases (30%) in upper extremity, and 2 cases (5%) in trunk. All cases were treated with surgical intervention. Postoperative radiation was undertaken in 4 cases and adjuvant chemotherapy in 12 cases, respectively. There were 28 cases (76%) of excisional surgery; i.e., so-called limb salvage operation, and 9 cases (24%) of amputation or disarticulation. In August 1987, 10 cases had died of disease (DOD) and 27 cases were alive, but 4 cases were alive with disease (AWD). Each of the DOD and AWD cases were in stage III (by Enneking's surgical staging system) at first arrival to our clinic, or multioperated cases or cases with rapid distant metastases soon after operation. In conclusion, it was emphasized that in order to improve the clinical results, the soft tissue sarcomas must be treated earlier and that more effective chemotherapeutical protocols should be developed in the future.
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PMID:[Clinical treatment of 37 cases of soft tissue sarcomas in the past 6 years]. 254 25

Clinicopathologically we studied the autopsy cases including 110 soft tissue sarcoma (28 malignant fibrous histiocytomas, 23 rhabdomyosarcomas, 18 leiomyosarcomas, 11 liposarcomas, 7 synovial sarcomas, 4 angiosarcomas, 3 malignant schwannomas, and 16 others) and 29 malignant bone tumors (19 osteosarcomas, 3 Ewing's sarcomas, 3 chondrosarcomas, and 4 others). We may summarize as follows: (1) In autopsy cases sarcomas occurring in the retroperitoneum outnumbered those in surgical cases in frequency, probably because most retroperitoneal tumors could not be removed and were difficult to diagnose without the help of autopsy findings. (2) Metastases were disclosed most often in the lungs, followed by the bones and liver. Lymph-node metastases were also encountered more frequently than expected, particularly in rhabdomyosarcoma (48%) and synovial sarcoma (57%). (3) Transition in histologic features, including cellular differentiation, nuclear grade and cellularity, from the surgically resected tumors to the tumors at autopsy in the same case, occurred not infrequently.
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PMID:[An analysis of autopsy cases of malignant soft tissue and bone tumors]. 254 28

The authors report a synovial sarcoma of the hand with an unusual case history and a favorable outcome after two years. A forty-four-year old woman suffering from uncharacteristic pain in the right hand with slightly abnormal EMG-findings for the median nerve was treated by operative release of the carpal tunnel. No unusual findings were discovered intraoperatively. The patient continued suffering from disabling pain for another year so that a second operation was performed by another surgeon. He discovered a tumor behind the median nerve which could not be removed radically because of profuse bleeding. In spite of diagnosing a sarcoma, the patient refused further surgery, however combined radio- and chemotherapy was administered for one year. The tumor was reduced in size but did not disappear. Following open biopsy and proved presence of sarcoma, the remaining tumor was removed by amputating the ulnar part of the hand. Two years following this last operation, the patient is free of local symptoms and there is no evidence of metastases.
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PMID:[Unusual course of malignant synovioma of the flexor tendon sheath of the hand]. 254 38


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