Chiappa S

[Preliminary histological observations on systemic lymphoreticulopathies treated with Lipiodol F-I-131 by intralymphatic route].

The results of histological examination of lymph nodes in 18 cases of lymphosarcoma, reticulum-cell sarcoma, and Hodgkins disease, treated with Lipiodol F I181 through the lymphatic vessels, are reported. The most significant changes induced by this therapy consisted of optically empty cavities of different shape and size; of degenerative changes of the neoplastic cells; of stromal reactions, with hystiocites and giant cells. These changes were of various degrees, according to the type of tumor and the amount of Lipiodol F I181 injected. The authors believe that the histological data presented, together with the clinical and radiological results already published, confirm the effectiveness of the intralymphatic radiotherapy in the treatment of malignant lymphomas.

[Intralymphatic radiotherapy: preliminary results of a new method. II].

Liposoluble contrast media, used in lymph nodes x-ray examination, have some specific features, when compared with idrosoluble contrast media. They rarely diffuse through the lymphatic walls, they produce an intense and homogeneous opacity of the lymph nodes and they remain in the lymph nodes for several months. For these reasons, it was thought to substitute the iodine of the liposoluble contrast medium with I131, and to use this radioactive material for therapy in primary and secondary malignant growth of lymph nodes. Since October 1961 a series of 30 patients was treated, 22 with malignant lymphomas of various type, 8 with metastases from carcinoma of the uterus or malignant melanomas of the legs. The radioactive contrast medium was injected into the feet following the technique suggested by Kinmonth. This tecnique allowed the irradiation of lymph nodes from the inguinal to the lumbo-aortic included. Favourable results were obtained: a marked and durable reduction of the diseased lymph nodes was observed in most cases. The long permanence of the contrast medium in the lymph nodes allowed to follow the size and shape of lymph nodes up to 6 months after injection. No signs of bone marrow damage were observed. The intralymphatic radiotherapy has advantages in respect of the transcutaneous radiotherapy: 1) Irradiation of the lymph nodes from inside, without damage of other tissues; 2) simultaneous irradiation of lymph nodes in different locations, giving a high dose to each lymph node, but a low total body dose; 3) Continuous irradiation; 4) Single inoculation of the radioactive material, even without hospitalization. The limitations of the method are due to the impossibility to reach all the lymph node districts and the lymph nodes completely obliterated by carcinoma metastases, which are by-passed. As these preliminary results suggest, the intralymphatic radiotherapy is best indicated in malignant lymphomas.

Arteriography in tumors of the soft parts of the extremities

Arteriography was carried out on 54 patients with benign and malignant tumors of soft tissues of the extremities. Results are reported and the most significant angiographic pictures of 28 cases are illustrated in detail. These include 2 neurilemmomas, 1 gigantocellular tumor (sesamoid tumor), 1 synovial gigantocellular tumor, 1 venous racemose hemangioma, 1 capillary-racemose hemangioma, 8 fibrosarcomas, 1 rhabdomyosarcoma, 1 neurosarcoma, 3 synovialsarcomas, 1 malignant mesehnchimoma, 1 mixed epithelioconnectival tumor, 5 ablastic sarcomas, 2 epitheliomas. The arteriographic aspects observed are compared with those described in the literature in order to outline the present knowledge on arteriographic semeiology and diagnosis in benign and malignant tumors of soft tissues. As concerns arteriographic semieology, seven main radiological signs are recognized by the authors, or: 1) displacement of vessels surrounding the growth; 2) dilatation of centripetal and centrifugal vessels; 3) changes in the circulation time; 4) vessels neoformation. Four main angiographic aspects of the newly formed intratumoral vascular network are described; 5) tumor impregnation by the contrast medium; 6) intratumoral blood collections; 7) arterovenous shunts. The frequency and extend of the mentioned radiological features are varying, and different arteriographic pictures may be seen according to tumors type and malignancy. In the majority of benign tumors nearly similar pictures are seen, characterized by absent or scarce vessels of normal appearance. Fibromatous tumors show a homogeneous moderate retention of the contrast medium. Vascular tumors, and particularly some types of angioma, may exhibit rather typical features which consent an angiographic diagnosis of the tumor type. As concerns malignant tumors, rather polymorphic arteriographic pictures are seen in fibrosarcomas, as to tumor vascularization and structural arrangement. Occasionally, vessels are scarce and of normal appearance, and the angiographic pattern resembles that of fibroma; in other cases vessels are more abundant. with irregular caliber and course. The greatest vascular atypia seems to correspond to the histologically most malignant variety of fibrosarcoma. A characteristic common to all observed cases of fibrosarcomas was an evident homogeneous impregnation by the contrast medium. The presence of intratumoral lacune and arterovenous shunts is exceptional. Mention is given of pictures obtained in lipo- and mixosarcomas, sarcomas of muscular origin and angiosarcomas, whereas synovialsarcomas and ablastic sarcomas are more thoroughly considered. Synovialsarcomas are scarcely known in the arteriographic literature. In the three cases observed by the authors, the arteriographic picture resembled that of some types of fibrosarcoma, with abundant and rather atypical vessels, absence of blood lacunae or shunts, regular retention of the contrast medium. These angiographic features, the site, and the roent-genographically visualized skeletal changes ought to consent a radiological diagnosis of the tumor type. In ablastic sarcomas the arteriographic picture is always characterized by a very marked vascular atypia. The frequent occurrence of intratumoral lacunae and arterovenous shunts is suggestive of the high malignancy of these forms. Side effects at the level of limb circulation are also frequently encountered. Tumor impregnation by the contrast medium varies from case to case. To conclude, arteriography is claimed to be able to reveal, in many cases, the presence of a tumor, and to determine its malignancy. The type of the tumor is hardly recognizable, except for some particular cases. Caution is needed in interpreting arteriographic pictures, for the presence of several factors may invalidate the findings. Error causes are analyzed and discussed. Arteriography cannot replace biopsy, but rather complete it as a method of diagnostic ascertainment. Arteriography seems to be clinically indicated: 1) in early diagnosis of cancer of soft tissues of extremities, mainly when the lesion is still scarcely extended or deeply situated; 2) to ascertain tumor extent, to outline its limits towards healthy soft tissues and its anatomical relationships to the bone and vessels. These findings are very significant from a therapeutical, either surgical or radiological, standpoint. 3) to check therapy results. After radiotherapy, arteriography may show a gradual normalization of the angiographic picture of malignancy. In surgically treated cases arteriography may occasionally differentiate between recurrence and cicatricial hardening or granulomatous processes at the operation site. 4) to study tumor vascularization and impregnation; number, site, and course of the supplying vessels. These data are valuable not only for surgical purposes, but also for the application of modern therapeutical methods, such as the introduction of antimitotic or radioactive substances into the afferent circulation.