Bo Rööser

Is local recurrence of minor importance for metastases in soft tissue sarcoma

The authors analyzed the relationship between treatment, local recurrence, and metastases in a population‐based series of 375 patients with soft tissue sarcoma of the extremities and the trunk wall. Treatment was inadequate (marginal excision alone) in 107 patients, local recurrence occurred in 112, and 128 patients developed metastases. Local recurrence was 3.5 times more common after inadequate treatment than after adequate and 2.5 times more common in patients with metastases than in those without. However, metastases were only 1.2 times more common after inadequate treatment than after adequate. Of the 128 patients who developed metastases, 63 had local recurrence and 65 had not. In these two subgroups the timing of metastases and the distribution of clinicopathologic factors—age, sex, tumor size, localization, depth, histotype, and malignancy grade—were similar. These findings indicate that local recurrence is of minor importance for development of metastases in soft tissue sarcoma. The increased local recurrence rate in metastatic tumors may be an expression of the aggressiveness of the primary tumor; highly malignant tumors combine a potential both for local and distant spread.

Reciprocal translocation t(3;12)(q27;q13) in lipoma

A reciprocal translocation, t(3;12)(q27;q13), was found as the sole karyotypic abnormality in an intramuscular lipoma. The morphology of the derivative 3q+ was strongly reminiscent of the large ring marker we have previously described in three other lipomas, indicating a pathway through which the rings may have arisen. These data, combined with the previous preliminary report by Turc-Carel et al. of a similar t(3;12) in another lipoma strongly suggest that this rearrangement may be a characteristic cytogenetic marker in benign lipogenic tumors.

Malignant fibrous histiocytoma of soft tissue. A population-based epidemiologic and prognostic study of 137 patients.

Epidemiology and prognosis were analyzed in a consecutive, population‐based series of 137 patients with malignant fibrous histiocytoma of soft tissue in the extremities and trunk wall, with a complete follow‐up of minimum 3 years. All but one patient were treated by surgery in 28 cases combined with adjuvant radiotherapy or chemotherapy. The annual incidence was 0.42/105. The ratio men to women was 1.1. The median age was 64 years (range, 22 to 87 years). The thigh was the most common location. The median size was 6 cm. Superficial tumors constituted 43% and were smaller than deep‐seated tumors. Eighty‐three tumors were storiform‐pleomorphic, 53 were myxoid, and one was of inflammatory type. The myxoid tumors were smaller and more often superficial. The cumulative 5‐year survival rate for all patients was 0.7, but differed markedly between the histologic types; it was 1.0 in patients with myxoid tumors and 0.5 in patients with storiform‐pleomorphic tumors. In the 77 patients with storiform‐pleomorphic tumors without metastases at presentation, only tumor size larger than 10 cm and tumor necrosis independently impaired survival. The 23 patients who had none of these risk factors had a 5‐year survival rate of 0.8.

Prognostication in soft tissue sarcoma. A model with four risk factors

A multivariate analysis of risk factors for death due to tumor was performed in 82 patients with highly malignant, histologic Grades III and IV primary soft tissue sarcoma of the locomotor system. All the patients had been operated on with a wide or radical surgical margin. Male sex, histologic malignancy Grade IV, extensive tumor necrosis, and tumor size > 10 cm were identified as risk factors. Patients with no or one risk factor had a 6(10)‐year survival rate of 100% (100%), equal to 96% (96%) in a group with Grade I and Grade II tumors operated on with the same margin. These two groups comprised 50% of all the patients operated on with a wide or radical margin. The 6(10)‐year survival rate decreased to 75% (75%) for patients with two risk factors and to 33% (22%) for patients with three or four risk factors. The risk factor model also applied to 62 patients operated on with marginal surgery; and for patients with three or four risk factors, more extensive surgery only had a small effect on long‐term survival. The model could be of value when eligibility criteria for trials with adjunctive chemotherapy are determined.

Marker ring chromosome—A new cytogenetic abnormality characterizing lipogenic tumors?☆

We have analyzed three intramuscular lipomas, two atypical and one with ordinary benign histology, as part of a systematic study of the karyotypic characteristics of mesenchymal tumors. A large ring chromosome of uncertain origin, but possibly representing a rearranged chromosome #3, was found in all three tumors. Previous reports on the chromosome banding pattern in lipogenic neoplasms are restricted to only three cases, all liposarcomas. In one of these, a well differentiated liposarcoma, a ring chromosome was described that was remarkably similar in morphology to the aberration reported here. We conclude that this ring chromosome may constitute a characteristic cytogenetic marker for lipogenic tumors.

Prognostic factors in synovial sarcoma

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.

Telomeric association in a malignant fibrous histiocytoma

SummaryIn a malignant soft-tissue fibrous histiocytoma 50–56 chromosomes were found in the majority of the metaphases. The most frequent numerical aberrations were one or two extra copies of chromosomes 4, 5, 18, 20, 22, and a missing chromosome 15. Structural rearrangements encountered were 11p+ and 1–5 unidentifiable markers. The most conspicuous feature was pairs of chromosomes intimately associated or fused at their telomeres, observed in 20 out of 22 metaphases. Although the telomeres of 6p, 11p, 16q, 20q, and 21p were involved most frequently, no preferential pattern of associations was detectable. This peculiar chromosomal behavior is compared to similar observations recently reported in a case of a B-cell lymphoid leukemia.

Acute compartment syndrome from anterior thigh muscle contusion: a report of eight cases

Eight patients with an anterior thigh muscle contusion or rupture developed an acute anterior compartment syndrome. All patients had an increased pressure in the quadriceps muscle, ranging between 41 and 80 mm Hg. At fasciotomy, three cases had a hematoma in the rectus femoris and four in the vastus intermedius, and in one case only, edema of the anterior compartment was found. Postoperatively, there was immediate pain relief in all cases, and after about 4 weeks, all patients had normal function. We recommend broad indications for fasciotomy and evacuation of hematoma after thigh muscle contusion or rupture.

Survival in soft tissue sarcoma Prognostic variables identified by multivariate analysis

The prognostic influence of 15 separate factors on local recurrence and survival was analyzed in 144 patients with highly malignant (histologic Grades III and IV) soft tissue sarcoma of the locomotor system. The minimum follow-up time was 6 years, or until death. Three factors, marginal excision, tumor necrosis, and extracompartmental tumor location were identified as risk factors for local recurrence. Five factors, local recurrence, Grade IV, male sex, tumor necrosis, and increasing tumor size were associated with decreased life expectancy.

Surgical margin in soft tissue sarcoma. The Scandinavian Sarcoma Group experience.

Two-hundred and forty adult patients with a high-grade soft tissue sarcoma were treated surgically in 18 hospitals participating in the Scandinavian Sarcoma Group Protocol I. The patients were randomized to either postoperative doxorubicin or control; patients whose surgical margin was judged marginal also received radiotherapy. The outcome after different surgical margins was analyzed in 185 tumors of Grades III or IV in the extremities. The total cumulative local tumor control was 91 percent (168 of 185) after a median of 47 months. The cumulative local control rates in the surgical groups were: compartmental or wide amputation--37/37 (100 percent), compartmental local excision--23/24 (96 percent), wide local excision--77/84 (92 percent), marginal excision and radiotherapy--19/21 (90 percent), and marginal excision alone (reevaluated margin)--12/19 (63 percent, significantly lower than others). The risk of local recurrence was 13 times higher after marginal than after compartmental surgery (P = 0.02) and 3 times higher if the tumor was larger than 10 cm (P = 0.05). The treatment with doxorubicin did not influence the risk of local recurrence. The survival rates did not differ significantly in the groups.