Cancer

Shafir, R.; Hiss, J.; Tsur, H.; Bubis, J. J.

doi: 10.1002/1097-0142(19820815)50:4<817::AID-CNCR2820500434>3.0.CO;2-Vpmid: 7093918

In the past few years a change has been noticed in the behavior of cutaneous malignant melanoma, with higher cure and survival rates. A retrospective review of all cases of primary cutaneous malignant melanoma during the years 1970–1979 in Chaim Sheba Medical Center reveals a possible explanation for this. The microscopic findings were reevaluated, diagnosis confirmed, and thickness of the tumor measured in millimeters. The number of cases diagnosed rose from eight in 1970 to 45 in 1979. A constant rise in number of thin melanomas (less than 0.75 mm in depth) was noticed. The percentage of thin melanoma rose from 11.1% of all melanomas in 1970 to 57.7% in 1979. Greater public and medical awareness of the danger of pigmented cutaneous lesions has probably triggered an earlier diagnosis of melanoma. Each suspected lesion is completely excised with a 1‐cm free margin. No further excision is undertaken if a thin melanoma is diagnosed (excluding the more malignant regressing melanoma) on frozen section. Of the patients seen in 1979, 57% were spared wide excision and general anesthesia.

Davis, Stephen; Mietlowski, William; Rohwedder, Jay J.; Griffin, John P.; Neshat, Amir A.

doi: 10.1002/1097-0142(19820815)50:4<646::AID-CNCR2820500405>3.0.CO;2-0pmid: 7046908

A randomized trial of 381 patients with extensive lung cancer compared immunochemotherapy with levamisole (150 mg/m2 orally three times a week), cyclophosphamide (700 mg/m2 IV every three weeks) and CCNU (70 mg/m2 orally every six weeks) with the same chemotherapy without levamisole. When disease progressed, doxorubicin hydrochloride or doxorubicin hydrochloride plus levamisole was used. Hematologic toxicity required reduction of the levamisole dosage to 2.5 mg/kg (100 mg/m2) three times a week, every other week. When corrections are made for all variables, levamisole itself had a negative influence on survival. Patients given 150 mg/m2 had a shorter median time to treatment failure (P = 0.02), lower response rate (P = 0.02), more toxicity (P = 0.08), and shorter median survival (P = 0.08). Patients with 10% or greater weight loss had significantly shorter survival (P = 0.006). The regimen with the reduced dosage of levamisole also was more toxic (P = 0.05) but otherwise did not differ from the control regimen. The cause of the adverse effect of levamisole is unknown. It did not occur because of an excess of toxic deaths or because smaller doses of cytotoxic drugs were given to patients treated with levamisole. Neither the initial lymphocyte count nor the Candida skin test reactions had a significant effect on the study endpoints when correction was made for dominant prognostic factors such as the initial performance status and weight loss.

Meyer, John S.; Connor, Robert E.

doi: 10.1002/1097-0142(19820815)50:4<746::AID-CNCR2820500420>3.0.CO;2-Apmid: 7093909

The thymidine labeling indice (TLI) of normal and abnormal epithelium in the human breast was measured in 108 surgical specimens. The mean values for various histologic entities were: normal lobule 0.91%; normal postlobular duct 0.71%; lobular hyperplasia 0.82%; ductal hyperplasia, lobular cell type 0.74%; intraductal hyperplasia 0.79%; papillary intraductal hyperplasia 1.02%; blunt duct adenosis 0.68%; cyst 0.56%; infiltrating carcinoma 6.82%; carcinoma in situ 5.53%. The TLI of the normal lobule declined significantly with increasing age, but that of the normal postlobular duct did not. Before the menopause, the mean TLI of the normal lobule was 1.01%, and that of the normal postlobular duct was 0.75%. After the menopause the values had declined to 0.26% and 0.41%, respectively. These findings indicated that the lobules are more sensitive to stimulation by sex steroids than the postlobular ducts. The TLIs of the various benign proliferative entities were not significantly correlated with age, and like the normal lobule and postlobular duct were near the low end of the range of TLI of breast carcinoma. Benign proliferative entities with TLIs in the high part of the breast carcinoma range were not encountered.

Dakhil, Shaker; Ensminger, William; Cho, Kyung; Niederhuber, John; Doan, Kate; Wheeler, Richard

doi: 10.1002/1097-0142(19820815)50:4<631::AID-CNCR2820500403>3.0.CO;2-Mpmid: 7046907

Starch microspheres 40 μm in diameter, which are rapidly degraded by serum amylase, have been administered through hepatic arterial catheters to five patients with primary and metastatic liver cancer to determine whether (1) arterial blood flow through the liver could be temporarily blocked, and (2) such occlusion at the level of the arteriolar capillary bed would enhance regional uptake and catabolism and decrease systemic exposure to simultaneously administered hepatic arterial bischlorethylnitrosourea (BCNU). It was possible with 10 ml of microspheres (9 × 106 microspheres/ml) injected into the hepatic artery to transiently (for 15‐30 minutes) reduce hepatic flow by 80‐100% in the five patients. When BCNU (50 mg/m2 in one minute) was given with microspheres there was a 30‐90% reduction in systemic nitrosourea exposure and in peak levels. No myelosuppression was noted and hepatic toxicity consisted of acute pain due to BCNU and 1.5‐2.0 fold transient enzyme elevations. One patient with cholangiocarcinoma showed a partial response lasting three months; three patients had stable disease and one patient with colon carcinoma had progressive disease. Thus, this pilot study suggests that concurrent intra‐arterial microspheres and BCNU may have the potential to improve selective regional drug effect with marked diminution in systemic toxicity.

Paschal, Barton R.; Muss, Hyman B.; Ii, Frederick Richards,; Robert Cooper, M.; White, Douglas R.; Jackson, Don V.; Stuart, John J.; Spurr, Charles L.

doi: 10.1002/1097-0142(19820815)50:4<668::AID-CNCR2820500408>3.0.CO;2-Kpmid: 7093904

Fourteen previously untreated patients with metastatic nonseminomatous germ‐cell cancer of the testis (NSGC) were treated with a modified VAB‐4 regimen that was designed to reduce treatment‐related morbidity. Nine of ten patients with minimal disease and the only patient with advanced pulmonary disease achieved a complete response (CR) with chemotherapy alone. Two of three partial responders with advanced abdominal disease were converted to CR status with radiotherapy and/or surgery. None of the 12 CRs has had a relapse (median duration of follow‐up, 28+ months). We observed no granulocytopenic fever or permanent renal insufficiency. These results indicate that NSGC patients with a low tumor burden can be spared substantial toxicity without the complete response rates being adversely affected.

Kuzur, Michel E.; Cobleigh, Melody A.; Greco, F. Anthony; Einhorn, Lawrence H.; Oldham, Robert K.

doi: 10.1002/1097-0142(19820815)50:4<766::AID-CNCR2820500424>3.0.CO;2-Xpmid: 7093910

Endodermal sinus tumor (EST) of the mediastinum is a rare germ‐cell neoplasm affecting mainly young adult males. Ten patients with EST were treated with a multimodality approach that included surgery, chemotherapy, and radiotherapy. All patients had relapses after achieving a transient response except one who is still in complete remission more than five years following the diagnosis of the disease. Optimal therapy for this neoplasm has yet to be discovered. The disease is a subset of extragonadal germ cell tumors which appears to be lethal in most cases, particularly when the primary tumor is unresectable. The first case of five‐year disease‐free survival is described.

Horino, Nobuko

doi: 10.1002/1097-0142(19820815)50:4<659::AID-CNCR2820500407>3.0.CO;2-Lpmid: 6980045

The effect of various intermittent combination chemotherapies on the immune status of 30 patients with malignancies was examined 1‐3 weeks after they received their last injection. PWM‐induced polyclonal B‐cell activation of lymphocytes from patients treated with combination chemotherapies that included doxorubicin was impaired despite a normal 3H‐thymidine uptake by lymphocytes stimulated with PHA, PWM, and insoluble SPA. This suppressive effect was always found in patients with ALL. However, in patients with solid tumors, PWM‐induced immunoglobulin production returned to normal 7‐8 weeks after the last doxorubicin injection. Serum immunoglobulin levels in patients treated with doxorubicin were slightly lower than in those treated without doxorubicin. It is hypothesized that doxorubicin may change the lymphocyte surface membrane and interrupt the T‐ and B‐cell interaction that is needed for immunoglobulin production.

Chalvardjian, Ara; Derzko, Christine

doi: 10.1002/1097-0142(19820815)50:4<710::AID-CNCR2820500415>3.0.CO;2-Hpmid: 6284338

Gynandroblastoma is a rare, sex‐cord stromal tumor of the ovary that shows morphologic evidence of female and male differentiation. Such a tumor produced masculinization in a 24‐year‐old woman, whose symptoms disappeared following removal of the tumor. By electron microscopy, the granulosa cell nests displayed Call‐Exner (CE) bodies of the hyaline type composed of multiple layers of basal lamina resembling CE bodies of the normal graafian follicle. In contrast, CE bodies of a classic granulosa theca cell tumor were of the spongiform type, consisting of a space limited by a single basal lamina containing altered granulosa cells and cell processes. Both types of CE bodies to arise following secretion by and/or degeneration of granulosa cells, the variation in morphology between the two resulting from differences in amounts of basal lamina deposited. The tubular components of the tumor resembled more closely the rete ovarii than they did Sertoli cells, and it is proposed that such structures be called by the alternate and less specific term “androblastoma.” The identity of Leydig cells was established by demonstration of intracytoplasmic Reinke crystals. Despite a difference in architectural pattern, there was a close ultrastructural resemblance between the different sex‐cord components of the gynandroblastoma.

Nagao, Koichi; Matsuzaki, Osamu; Saiga, Hajime; Sugano, Isamu; Shigematsu, Hidekazu; Kaneko, Toshio; Katoh, Takayuki; Kitamura, Takeshi

doi: 10.1002/1097-0142(19820815)50:4<736::AID-CNCR2820500419>3.0.CO;2-Mpmid: 6284339

Five‐hundred‐thirty‐one cases of primary epithelial tumors of the parotid gland were examined. The incidence of basal cell adenomas was 7.5% (40 cases). The tumors could be classified histologically into these subtypes: basal cell (21/40; 52.5%); tubular, (13/40; 32.5%); trabecular (4/40; 10.0%); and papillary (2/40; 5.0%). The pattern of classic basal cell adenoma predominated in the basal‐cell type but was also seen in varying degrees in the latter three types with a reciprocal transition. Accordingly, it could be suggested that tubular, trabecular, and papillary types are variants of basal cell adenoma. The higher incidence of basal cell adenomas in our survey could be accounted for by this categorization. Histologically, basal cell adenomas presented various features: (1) cystic formation (26/40; 65.0%), being most frequently seen in tubular and trabecular types; (2) adenoid cystic pattern (4/40; 10.0%); (3) elastosis in the stromal tissues (2/40; 5.0%). Basal cell adenomas were clinicopathologically compared with 291 cases of pleomorphic adenomas. Basal cell adenomas were seen more often in female patients, (60.0%), as were pleomorphic adenomas (68.4%). They were observed more frequently in patients over 50 years of age and the average was ten years higher than for pleomorphic adenoma. The tumor size tended to be smaller (below 2 cm at the greatest diameter) than pleomorphic adenomas.

Farhi, Diane C.; Shikes, Robert H.; Silverberg, Steven G.

doi: 10.1002/1097-0142(19820815)50:4<702::AID-CNCR2820500414>3.0.CO;2-Fpmid: 6284337

The fibrolamellar variant of hepatocellular carcinoma is described and the ultrastructural findings in three cases are reported. The findings confirm the oncoytic nature of the tumor and the presence of distinctive bands of collagen. This tumor may represent a neoplasm of hepatic oncocytes. It appears to have distinct epidemiologic differences from other hepatocellular carcinomas, which typically arise in cirrhotic livers, and it may have a better prognosis. As such, it should be recognized as a distinct clinicopathologic subset in the broad group of hepatocellular carcinomas.