Charles E. Platz

Predicting therapeutic outcome in patients with diffuse histiocytic lymphoma treated with cyclophosphamide, adriamycin, vincristine and prednisone (CHOP)

Seventy‐five patients with diffuse histiocytic lymphoma (DHL) ranging in age from 33 to 94 years were treated with cyclophosphamide, Adriamycin, vincristine and prednisone (CHOP). Thirty‐eight patients (51%) achieved complete remission, but nine of these patients relapsed after remission lasting one to 23 months (median time to relapse, four months). We used multivariate analysis to identify those characteristics that significantly affected treatment outcome. The chances for complete remission were adversely affected by DHL appearing after histologic conversion from another lymphoma (P = 0.006), the presence of systemic symptoms (P = 0.024), and not having the large noncleaved (LNC) histologic subtype (P = 0.040). The chance for relapse from complete remission was increased only by the presence of systemic symptoms (P = 0.042). Overall survival was adversely affected by the presence of bone marrow involvement (P = 0.002), having other than LNC histologic subtype (P = .010), and the presence of systemic symptoms (P = 0.043). It appears that patients whose DHL appears de novo and who also are symptom status A (70% long‐term disease‐free survival) or have the LNC histologic subtype (67% long‐term disease‐free survival) have an excellent outlook when treated with CHOP at the doses used in this study. However, patients with B symptoms (16% long‐term disease‐free survival), histologic conversion to DHL (8% long‐term disease‐free survival), previous chemotherapy (8% long‐term disease‐free survival), and bone marrow involvement (8% long‐term disease‐free survival) respond poorly and for these patients other treatments need to be identified. In addition, patients with B symptoms who achieve complete remission with CHOP are at high risk to relapse (59% relapse rate) and should be considered for “intensification” therapy after complete remission is documented. Cancer 50:1695‐1702, 1982.

A Comparison of Urologic Application of Bipolar Versus Monopolar Five French Electrosurgical Probes

Urologic endoscopic procedures often involve electrosurgery. Recently bipolar probes have become commercially available. This study compares monopolar and bipolar electrosurgical probes in relation to power losses in urologic endoscopic instruments with the infusion of sterile water and saline, and the power transmitted by probes to tissue correlated to tissue destruction in each fluid. The power losses through each instrument in both solutions were minimal. The bipolar electrode functioned at a much lower power output than did the monopolar electrode. The bipolar probe was also more effective in saline than sterile water. The depth, width and volume of tissue damage for both electrodes were found to vary with generator power output. The data shows the burns had similar diameters for both probes but the bipolar probe caused significantly less burn depth than the monopolar probe. These initial studies indicate that bipolar electrodes can function in normal saline with less depth damage compared to the monopolar probe.

Cryosurgery in prostatic cancer: Survival

From 1969 through 1976 we performed cryosurgery in 229 cases of prostatic cancer. This article presents survival in cryosurgery and other treatment groups. In every stage, despite a preponderance of large primary tumors and poor-risk patients, cryosurgery matched total prostatectomy and compared favorably to other modalities, including radiation therapy, at our center and elsewhere. According to previous authors, and in view of the present data, eradication of the local lesion is associated with better survival even in advanced cases. Cryosurgery provides a safe, effective method.

In vivo effect of 5 French bipolar and monopolar electrosurgical probes on the porcine bladder

SummaryPrevious in vitro studies have indicated bipolar electrosurgical probes would electrodesiccate tissue in a normal saline solution. This study applies similar sized monopolar and bipolar electrosurgical probes to porcine bladder in order to compare each probes effect in vivo. The power delivered by each probe was calculated; the width and depth of the porcine bladder damage was measured and the volume of the damage calculated. The animals were sacrificed at 24, 48 and 96 h post-procedure so that the amount of tissue destruction could be quantitated relative to the bladders natural tissue reaction. The data shows the power (watts) delivered by the monopolar probe to be approximately six times that of the bipolar probe. Like-wise, the area of bladder wall damage was larger with monopolar at all time periods sampled and showed significant differences at 24 and 48 h. These studies indicate that in viable bladder, tissue bipolar probes will electrodessicate at a lower power and with less shortterm tissue damage.

Small Intestinal Cancer: a Population-Based Study of Incidence and Survival Patterns in the United States, 1992 to 2006

Background: The etiology of cancers of the small intestine is largely unknown. To gain insight into these rare malignancies, we evaluated contemporaneous incidence and survival patterns. Methods: Using small intestine cancer data from 12 population-based registries of the Surveillance, Epidemiology and End Results Program, we calculated age-adjusted and age-specific incidence rates (IRs), IR ratios, and relative survival (RS) rates. Results: In total, 10,945 small intestine cancers (IR = 2.10/100,000 person-years) were diagnosed during 1992 to 2006, including carcinomas (n = 3,412; IR = 0.66), neuroendocrine cancers (n = 4,315; IR = 0.83), sarcomas (n = 1,084; IR = 0.20), and lymphomas (n = 2,023, IR = 0.38). For all histologic groups, males had significantly higher IRs than females, and distinct age-specific gender patterns were limited to intermediate-/high-grade lymphomas. Neuroendocrine cancer rates varied significantly by race, with rates highest among blacks and lowest among Asians/Pacific Islanders. Carcinoma IRs were highest among blacks; sarcoma IRs were highest among Asians/Pacific Islanders; and lymphoma IRs were highest among whites. Age-specific IR patterns were similar across racial/ethnic groups. During 1992 to 2006, duodenal cancer IRs increased more markedly than those for other subsites. RS varied little by gender or race. Neuroendocrine cancers had the most favorable RS, and carcinomas had the least favorable. The greatest improvement in 5-year RS from 1992 to 1998 to 1999 to 2005 was observed for sarcomas and lymphomas. Conclusions: Distinct small intestine cancer IR patterns according to histologic subtype suggest different underlying etiologies and/or disease biology, with susceptibility varying by gender, racial/ethnic groups, and subsite. Temporal patterns support a possible role for diagnostic bias of duodenal cancers. Impact: Future epidemiologic studies of small intestine cancer should consider histologic subtype by gender, race/ethnicity, and subsite. Cancer Epidemiol Biomarkers Prev; 19(8); 1908–18. ©2010 AACR.

Nephrogenic Adenoma: A Report of 9 Cases and Review of the Literature

AbstractNephrogenic adenoma is a rarely reported tumor. With the increasing awareness of this specific pathological entity, its clinical importance cannot be overlooked.

The occurrence of rare cancers in U.S. adults, 1995-2004.

Objective. Rare cancers have been traditionally understudied, reducing the progress of research and hindering decisions for patients, physicians, and policy makers. We evaluated the descriptive epidemiology of rare cancers using a large, representative, population-based dataset from cancer registries in the United States. Methods. We analyzed more than 9 million adult cancers diagnosed from 1995 to 2004 in 39 states and two metropolitan areas using the Cancer in North America (CINA) dataset, which covers approximately 80% of the U.S. population. We applied an accepted cancer classification scheme and a published definition of rare (i.e., fewer than 15 cases per 100,000 per year). We calculated age-adjusted incidence rates and rare/non-rare incidence rate ratios using SEER*Stat software, with analyses stratified by gender, age, race/ethnicity, and histology. Results. Sixty of 71 cancer types were rare, accounting for 25% of all adult tumors. Rare cancers occurred with greater relative frequency among those who were younger, nonwhite, and of Hispanic ethnicity than among their older, white, or non-Hispanic counterparts. Conclusions. Collectively, rare tumors account for a sizable portion of adult cancers, and disproportionately affect some demographic groups. Maturing population-based cancer surveillance data can be an important source for research on rare cancers, potentially leading to a greater understanding of these cancers and eventually to improved treatment, control, and prevention.

A clinicopathologic study of orbital and adnexal non‐Hodgkin's lymphoma

An analysis of non‐Hodgkins lymphoma involving the orbital structures was performed at the University of Iowa between 1937 and 1975. Sixteen cases of primary orbital lymphoma were diagnosed. Histopathologic reclassification according to the Rappaport scheme and the clinical course of each histologic sub‐category was described. There were 5 patients with reactive hyperplasia, 2 patients with well‐differentiated lymphoid proliferation with Dutcher bodies which were also felt to be reactive, 3 patients with diffuse poorly differentiated lymphocytic lymphoma, 4 patients with nodular poorly differentiated lymphocytic lymphoma, and 2 patients with diffuse histiocytic lymphoma. It was concluded that the Rappaport classification is applicable to orbital lymphoid tumors and that those lymphomas which do present as primary tumors should be staged as one would stage the same histologic category of lymphoma presenting in other sites. Radiation therapy appears to be an effective treatment for local control; however, patients with primary orbital lymphoma should undergo observation for systemic disease similar to patients with lymphoma presenting in other sites. Excisional biopsy is recommended to facilitate precise classification.

Incidence of surgical margin involvement in various forms of radical prostatectomy

The pathologic specimens of 64 patients who underwent radical prostatectomy for clinical Stage A or B carcinoma of the prostate were reviewed retrospectively for surgical margin involvement with cancer. Fourteen of the operations were performed by the radical transperineal method, 30 by the standard radical retropubic approach, and 20 by the nerve-sparing radical retropubic technique. Seventy-eight percent of the radical transperineal group had resection margin involvement, as opposed to 30 percent of the standard radical retropubic cases, and 45 percent of the nerve-sparing radical retropubic cases. The average tumor burden of the transperineal group was larger than that of the other two groups. Resection margin involvement in all groups was associated with a higher Gleason histologic score. No significant difference was noted between the two retropubic groups in terms of resection margin involvement (P = 0.28), suggesting that nerve-sparing radical retropubic prostatectomy does not compromise the surgical goal of radical prostatectomy for carcinoma over that of the standard radical retropubic prostatectomy.

Mucin production in defining mixed carcinoma of the uterine cervix: a clinicopathologic study.

SummaryEighty-seven Stage I cervical carcinomas treated by radical hysterectomy between 1970 and 1979 were reviewed for histotogic type, outcome, and factors predicting behavior. Initially, the cases were histologically classified by the Wentz and Reagan system and graded according to the Broders method. Stains for intracellular mucin were then examined in 69 cases and 39% were shown to contain intracellular mucin. Using intracellular mucin as an indicator of mixed carcinoma, this study showed a distribution of 35% keratinizing, 16% nonkeratinizing, 3% small cell, 16% adeno-, 3% undiffer-entiated, and 26% mixed carcinoma. The mixed carcinomas were derived from the traditional keratinizing, nonkeratinizing and small cell categories. Mixed carcinoma was the only histologic type that predicted lymph node metastasis (p = 0.009). The presence of lymph node metastasis predicted death due to disease or recurrence (p = 0.014} as did pure adenocarcinoma histology (p = 0.025). Overall 5 year survival was 92%. Survival at 5 years for adenocarcinoma was 85%, but one additional death occurred at 12 years and a first recurrence occurred at 7 years. An additional patient with a collision tumor (adenocarcinoma and squamous carcinoma) died at 8 years. Mixed carcinoma is relatively common and appears to be associated with a higher incidence of lymph node metastasis. Adenocarcinoma appears to have a poorer prognosis and a tendency for late recurrence in distant sites.