Myron Arlen

MALIGNANT TUMORS OF THE SPERMATIC CORD

The present study deals with 11 malignant tumors arising from the spermatic cord. Ten of the tumors were of mesoblastic origin and one was a teratoma. Local recurrence appeared to be a common problem and was attributed to inadequate removal of the primary tumor at biopsy. Distant metastasis occurred only in the late stages of disease after local recurrence could not be controlled or when retroperitoneal disease had become extensive. Radical orchiectomy followed by retroperitoneal node dissection was considered the treatment of choice for this disease.

Chondrosarcoma of the head and neck

Summary Eighteen primary chondrosarcomas of the head and neck were reviewed at the Memorial and James Ewing Hospitals. Twelve patients presented with a painless mass arising within the oral cavity. Headache, blurred vision, proptosis, swelling, and numbness of the face were the other prominent complaints. The maxilla was involved in ten of the eighteen patients; the lower jaw was involved in four of the other cases studied. Surgery was the prime method of treatment in all cases; additional surgery and radiation therapy were employed for recurrent tumor. Eight of the eighteen patients were alive and free of disease more than five years. Tumor recurrence at or near the region of primary resection was the major factor leading to the patients death. A comparison of lesions arising in the axial skeletal system with lesions originating in the head and neck indicated that lesions of the head and neck occur in much younger persons and that these tumors are not as aggressive.

Pilot studies using melanoma tumor-associated antigens (TAA) in specific-active immunochemotherapy of malignant melanoma

Highly purified melanoma TAA which induce melanoma‐related cellmediated immune responses have been further characterized using hyperimmune TAA antisera after affinity chromatography for double immunodiffusion‐immunoelectrophoresis and indirect immunofluorescence studies. An additional study of antigenic modulation was performed in 23 nonanergic and seven anergic melanoma patients, tested simultaneously with melanoma TAA prepared from primary and metastatic tumors, which had been obtained from one patient at different time periods. The results of pilot clinical trials are reported, including toxicity, timing and dosage studies in 20 patients and subsequent studies of patients with metastatic melanoma treated at three separate centers, using a single lot of purified, allogeneic melanoma TAA. The results of these latter studies in 51 patients with Stage III (distantly metastatic) melanoma and in five patients with earlier stages of disease indicate that: (1) when the interval from primary therapy to recurrence is greater than one year and when liver, bone and brain are not involved, partial or total clinical regression may be noted in up to 25% of patients with metastatic disease receiving immunochemotherapy; (2) when total regression does occur, the effect usually lasts from one to three years; (3) cytoreductive (debulking) surgery, when possible, in cutaneous, nodal retroperitoneal, and visceral regions may enhance the response to specific active immunochemotherapy, although some debulked patients had less tumor burden and this factor alone may lead to an improved prognosis in patients undergoing any subsequent treatment; (4) when circulating inhibitory factors are modified through preimmunization chemotherapy, an enhanced host response may be seen; and (5) Cancer Serum Indices (CSI) may be useful in predicting recurrence and in following tumor load and response to therapy. Information obtained from these studies suggests the need for further trials to determine the effect of immunization on patients with earlier stages of disease where recurrence rates remain high, and to evaluate the mechanisms of tumor rejection or tumor progression in the face of immune stimulation.

Combined radiation-methotrexate therapy in preoperative management of carcinoma of the head and neck☆☆☆

Fifty patients with primary carcinoma of the head and neck were treated preoperatively with 2,000 r and 500 mg/m2 of methotrexate. This combination reduces the tumor size in more than 90 per cent of patients, converts many of the tumors to a more manageable state, and appears to indicate that improved survival will occur.

Immunoglobulin allotypes in patients with squamous cell carcinoma of the head and neck

Gm, A2m, and Km allotypic markers were examined in 40 Caucasian patients with squamous cell carcinomas of the head and neck. Serum IgA levels, the A2m(I) allotypic marker, and antibodies against IgA1, A2m(I), and A2m(2) were measured quantitatively. The frequency of Km(1) was found to be significantly increased in patients with head and neck cancer as compared to the control population.

Nodal response in medullary carcinoma of the breast

From 1954 to 1970, ninety-five patients with medullary carcinoma of the breast were evaluated in terms of immunologic activity based on the histologic changes seen within the tumor and regional nodes. Each patient was studied for the degree of lymphocytic infiltration in the tumor as well as the extent of sinus histiocytosis present within the regional nodes. Contrary to what would normally be expected, those nodes with increased sinus histiocytosis were associated with the larger tumors. In addition, lymph node metastasis increased from 26 to 75 per cent as the degree of sinus histiocytosis became more pronounced. There was no evidence that increased lymphocytic infiltration in the tumor resulted in a statistically significant improvement in the five and ten year survival rates. Similarly, sinus histiocytosis activity did not seem to enhance the survival rate among this particular group of patients. There is a suggestion that a correlation exists between sinus histiocytosis and lymphocytic infiltration in the tumor and that, whatever the stimulus present, its effect is on both the lymph node and the degree of lymphocyte response within the tumor. The antigenic substance in the tumor, which initiates the immune response, possibly produces an abortive reaction, which may result in the induction of blocking factors rather then those factors necessary for destruction. It appears that histologic evidence of immunologic enhancement does not necessarily signify improved survival, at least with those patients having carcinoma of the breast.

Clinical manifestations of carcinoma of the tail of the pancreas

Carcinoma arising within the tail of the pancreas appears to have a distinct clinical picture which could lead to early diagnosis and an increased salvage rate. Two cases presenting with the manifestations of this disease are offered. Gripping upper abdominal pain, constipation, splenomegaly, upper GI bleeding, migratory phlebitis, arterial emobolization and local bruit are some of the findings which should lead to suspecting a neoplasm of the distal most portion of the pancreas. Even though confirmatory diagnostic studies are negative, exploratory laparotomy is indicated.

Surgical treatment of soft tissue sarcomas

The management of soft tissue sarcomas of the lower extremity can be considered to represent the standard by which we plan for the management of most of the sarcomas arising elsewhere in the body. These tumors not only are found to occur more frequently in the lower extremity, which adds to the importance of this site, but in terms of management the techniques employed here can be, and frequently are translated to other body sites. The use of muscle group dissection needed to surgically encompass most of the lesions that are encountered, and the techniques for vessel dissection especially in the region of the groin, can be paralled for the arm-axillary region and may even be extended to the muscles and blood vessels of the head and neck. We feel that the ability to become familiar with the natural history of, and master the surgery needed to control soft tissue sarcomas arising in the lower extremity, offers a broad base from which to understand and manage most of the sarcomas found at other sites.