H.Stephens Moseley

Breast carcinoma in situ: A retrospective review of 112 cases with a minimum 10 year follow-up☆☆☆

We have retrospectively reviewed 112 cases of in situ carcinoma of the breast treated between 1960 to 1972, with a minimum 10 year follow-up to correlate treatment with outcome. We concluded that bilateral simple mastectomy with low axillary dissection is the treatment of choice for intraductal or lobular carcinoma in situ. This conclusion was based on the early age at diagnosis, the high incidence of bilaterality, and the long latency and probable progression from the in situ stage to the invasive stage. Lesser procedures can be endorsed for those patients of advanced age or who have associated medical problems whose life expectancy is estimated to be 10 years or less. Patients who refuse bilateral mastectomy should undergo biopsy of the involved or opposite breast at 3 to 5 year intervals regardless of physical findings or mammographic suspicions, especially when severe epithelial dysplasia is encountered in the biopsy specimens. This nonpalpable but potentially curable lesion remains difficult to detect even by mammography.

Problems in diagnosis and management of desmoid tumors

Thirty-two primary desmoid tumors occurred in 29 patients. The median patient age was 32 years, and 55% of the patients were females. An antecedent history of trauma at the tumor site was elicited from 28% of patients. Thirty-one of 32 primary tumors were completely excised at initial presentation. Five tumors were treated with adjuvant radiotherapy. The overall recurrence rate for primary and recurrent lesions was 60%. The recurrence rate in children (88%) was more than twice that found in adults (38%). A single recurrence did not significantly increase the likelihood of a subsequent recurrence. Greater than 90% of all recurrences took place within 3 years of treatment. The rate of recurrence was not clearly influenced by the status of histologic margins, although this was examined in less than half the tumors. Desmoid tumors are aggressive neoplasms that exhibit a strong propensity for local recurrence. They should be treated as low-grade malignancies with documentation of histologic margins and close clinical follow-up within the framework of a tumor registry.

Pharmacokinetics, toxicity, and short-term results of cisplatin hyperthermic isolated limb perfusion for soft-tissue sarcoma and melanoma of the extremities

Fifty-nine patients with melanoma or soft tissue sarcoma of the extremities underwent hyperthermic isolated limb perfusion utilizing cisplatin and wide local excision. Doses of cisplatin ranged from 0.75 to 2 mg/kg. The mortality and morbidity rates were 0 and 6.8 percent, respectively. Pharmacokinetic studies indicate that cisplatin is rapidly bound to perfused tissues and remains bound for 1 month. Maximum tumor response in sarcomas occurs 1 to 2 weeks after perfusion, compared with 1 month after perfusions with l-phenylalanine mustard and actinomycin D. Local and regional recurrence rates were 0 and 3.4 percent, respectively, at 1 year. Further studies of hyperthermic limb perfusions with cisplatin are warranted.

Predictive criteria for the selection of breast cancer patients for adrenalectomy

The influence of hormones on the growth of malignant neoplasms has been appreciated since 1896 when Beatson [1] first described two women with advanced breast cancer who responded to oophorectomy. In 1952 Huggins and Bergenstal [2] established the role of bilateral adrenalectomy for palliation of disseminated breast cancer in certain patients. Even though endocrine ablation currently offers the best hope for palliation, only 25 per cent of women with metastatic breast cancer benefit from this procedure [3]. It is probably not applied as frequently or appropriately as it might be because of the lack of an accurate test to predict response and the reluctance of surgeons to perform oophorectomy, adrenalectomy, or hypophysectomy unnecessarily in an already ill patient. At the University of Oregon Medical School, adrenalectomy has been performed for the palliation of breast cancer since 1952. Responses to endocrine ablation have increased steadily over the past twenty-one years as criteria have evolved from random selection to the use of various clinical indexes of hormonal susceptibility and most recently to the development of a biochemical assay specific for estrogen binding in the Cytoplasm of the tumor cell. A retrospective analysis of the clin-

The role of stereotactic biopsy in assessment of nonpalpable breast lesions.

BACKGROUND When mammography identifies a lesion suspicious for cancer, stereotactic needle core biopsy (SCNB) and needle localization (NL) surgical biopsy are options for obtaining tissue. This study compared the results of these two biopsy methods in evaluating nonpalpable radiologically suspicious breast lesions. METHODS Records of 292 women who underwent SCNB or surgical biopsy at two institutions were reviewed over 28 months. The women were separated into two groups, under 50 years of age and 50 years of age and older. RESULTS A total of 70 women over the age of 50 had stereotactic biopsy. One hundred and three had NL biopsies. The rate of positivity was 37% and 33% for stereotactic and NL biopsy respectively (P = 0.693). A total of 44 women under the age of 50 had stereotactic biopsy. Seventy had NL biopsies. The rate of positivity was 7% and 21%, respectively, for stereotactic and NL (P = 0.082). NL surgical biopsy costs on average

Healing of the Canine Aorta After Endarterectomy: A Scanning Electron Microscopy Study

2354.00. SCNB averages

Advanced squamous cell carcinoma of the maxillary sinus: Results of combined regional infusion chemotherapy, radiation therapy and surgery

949 including follow-up mammogram. CONCLUSION SCNB is a cost-effective, accurate method of breast biopsy. This report retrospectively compares SCNB with surgical open biopsy aided by NL. The cost savings occurred primarily in surgeons fees and anesthesia fees. We found no statistical difference in < 50- or > 50-year-old patients in the frequency of the diagnosis of breast cancer when comparing the two types of biopsies.

Multiple simultaneous and sequential estrogen receptor values in patients with breast cancer.

Endarterectomy sections of canine aorta were examined in various stages of healing by scanning electron microscopy. In all specimens the endarterectomy site was quickly covered by a thin fibrin-platelet coagulum with varying amounts of thrombus. Neoendothelization began before one week and was virtually completed by one month except on areas of heavy thrombus deposition. While this study does not prove the origin of the neoendothelial cell, it suggests that neoendothelial cells are derived from pre-existing endothelium and advance over the endarterectomy site from the junction zone of the normal aorta and to a lesser extent from the orifices of brancing vessels.

Liposarcoma of the leg

Sequential intraarterial chemotherapy using bleomycin and methotrexate followed by high dose radiation and surgery was evaluated in 10 patients with stage III and IV squamous carcinomas of the maxillary sinus. Seven of 10 patients had extensive tumor necrosis in the surgical specimen, and no evidence of residual tumor was found in 4 of these patients. After a median follow up period of 24 months, there has been only one local recurrence in resected patients. Three patients died from pulmonary metastases. Although many unanswered questions remain regarding the efficacy of triple therapy for maxillary sinus malignancy, these results are encouraging and establish that surgical resection and healing are not compromised by preoperative chemotherapy and radiation.

Endocrine ablation for metastatic breast cancer: A reappraisal of hormone receptors☆

Fifty-nine women had multiple estrogen receptor assays done, either simultaneously or sequentially. Eighty-six percent of the patients who had multiple synchronous estrogen receptor assays from various metastatic sites showed no significant discrepancy in estrogen receptor values. When estrogen receptor assays were done sequentially without intervening therapy, 83.5 percent of the patients maintained their initial positivity or negativity. However, when the second estrogen receptor determination was preceded by either chemotherapy or hormonal therapy, 33 percent of the patients had a significant discrepancy in estrogen receptor values. The most common discrepancy was estrogen receptor-positive tumors becoming estrogen receptor-negative, although a small number of patients were found whose receptor values became more positive after hormonal ablation.