Nils O. Berg

SIZE, SITE AND CLINICAL INCIDENCE OF LIPOMA Factors in the Differential Diagnosis of Lipoma and Sarcoma

All 428 patients who had a non-visceral lipoma histopathologically diagnosed during 1 year in a defined population (0.74 million inhabitants) were analysed retrospectively as regards the age, duration of symptoms, size, site (location and depth) and multiplicity of the lipomas. Solitary subcutaneous lipomas were uncommon in the hand, thigh, lower leg and foot, and four-fifths of them (264/338) were smaller than 5 cm. Multiple subcutaneous lipomas were found in 61 patients, most of them young males. Subfascial lipomas, with a mean size (6 cm) double that of solitary subcutaneous lipomas, were found in 13 patients. A subgroup of 192 lipomas (153 patients) was reexamined histologically and the tumours were classified as either simple lipoma or angiolipoma. Angiolipomas were significantly more common in patients with multiple lipomas. To assess the reliability of a clinical diagnosis of lipoma as well as the proportion of clinically diagnosed lipomas not verified by histology, the records of patients seen in one department of surgery and in one health care centre were examined. Based on these data, the annual clinical incidence of lipoma (number of patients consulting a doctor for a lipoma, even if not histologically verified) was estimated to be 1/1000. When the data for solitary lipomas were compared to those for soft-tissue sarcoma, it was found that patient age and duration of symptoms were of minor value in the clinical differential diagnosis. However, if a tumour were (a) larger than 5 cm, irrespective of depth and location, (b) located in the thigh, irrespective of depth and size, or (c) deep, irrespective of location and size, it was more likely to be a sarcoma.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

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.

Fine Needle Aspiration Biopsy in the Evaluation of Tumor-Like Lesions of Bone

A consecutive series of bone lesions suspected to be tumors and examined by fine needle aspiration biopsy at the University Hospital Cytology Laboratory in Lund, Sweden, is reported. From 1966 to November 1974, 150 cases were examined. In 123, sufficient cellular material was obtained through aspiration by a needle with an outer diameter of 0.8 mm. The method is described. The reliability of cytology is compared with the results of the definite pathology after open biopsy or extirpation of the lesion. In the series of primary benign lesions 28 out of 39 were correctly diagnosed; among primary malignant 27 out of 38 were correct and among metastases 57 out of 73 were correctly diagnosed including those where insufficient cellular material was aspirated. In cases where sufficient material was achieved the reliability of the cytological diagnosis was around 90 per cent. There was one false positive and two false negative reports of malignancy. Fine needle aspiration biopsy with cytology is recommended as a standard step in orthopedic oncological examinations. It has at least the same degree of diagnostic reliability as other diagnostic methods, such as X-ray, for instance; however, it does not replace open biopsy and histology when mutilating surgery is in question.

Relation between Field Size and Tolerance of Rabbit's Brain to Roentgen Irradiation (200 kV) via a Slit-Shaped Field

The relation between field size and tolerance of rabbits brain to roentgen irradiation via slit-shaped field, 12 mm to 1 mm wide, was studied. Single skin doses between 2,100 r and 27,000 r were given. After 52 weeks the morphology of the lesions was analyzed. The frequency of injuries as well as the lowest focal dose which produced lesions were determined. The effect of irradiation decreased markedly with reduced width of slit. Resulting curves for the occurrence of necrosis and for discrete lesions are both S-shaped. The shape of the curves is discussed, especially the influence of diffusion processes. Published data on the area factor make it likely that the tolerance curve for the skin will be S-shaped too.

Prognosis in high-grade soft tissue sarcomas: the Scandinavian Sarcoma Group experience in a randomized adjuvant chemotherapy trial

From 1981 to 1986, 240 patients with primary, malignancy grade III or IV soft-tissue sarcoma were entered into a randomized adjuvant chemotherapy multicenter trial, conducted by the Scandinavian Sarcoma Group. After a median follow-up time of 46 (2-97) months, a multivariate analysis of risk factors for metastases was performed in 138 radically operated on patients with tumors of the extremities. Adjuvant single-agent doxorubicin did not improve the metastasis-free survival. Histologic malignancy grade IV, tumor size greater than 10 cm, vascular invasion by tumor, and male sex were identified as risk factors. Patients with no or one risk factor had a 5-year metastasis-free survival of 0.7, with two risk factors 0.5, and with three or four risk factors 0.2. The combination of different risk factors provides a prognostic model for soft tissue sarcomas, which could be a basis for therapeutic trials.

Treatment of Soft-Tissue Sarcoma Should Be Centralised

New concepts regarding surgical margins and new modalities of preoperative examination make centralized care advantageous for patients with soft-tissue sarcomas. This study describes how the organizational level of surgical service and surgical technique have changed with time in southern Sweden. After reviewing all cases of soft-tissue sarcoma in the trunk and extremities registered during 1964-81, 261 patients remained for analysis. The material was divided into patients treated within or outside the Orthopaedic Oncology Group (OOG) for southern Sweden, which started in 1970. Patients treated by the OOG were separated into patients referred before and after surgery. In 1964-69, one-third (25/73) of the patients had a wide or compartmental excision at final surgery of the primary tumour compared with two-thirds (126/188) in 1970/81. Further, four-fifths (111/142) of the patients treated by the OOG finally had wide or compartmental excisions, whereas only one-third (15/46) of the patients treated outside the OOG over the same time period had obtained this type of surgery. When recorded, the tentative pre-operative diagnosis was a benign lesion in more than one-half of the patients treated outside the OOG. In two-thirds of the patients referred before surgery the biopsy and treatment, a wide or compartmental excision, were combined into one surgical procedure. Over the years the number of patients referred increased. During 1980-81, 35 of 38 patients with soft-tissue sarcomas were referred to the OOG: 11 before any biopsy, 14 after a malignant cytodiagnosis and 10 following marginal excisions.

Radiotherapy and Surgery in 50 Cases of Osteosarcoma Treated without Adjuvant Chemotherapy

A consecutive series of osteosarcoma patients from one hospital is described. In 1962 radiotherapy with delayed surgery according to Cade was replacing surgery alone as the adopted treatment programme. Statistically the results were the same before and after this time with 5 out of 29 and 6 out of 21 patients, respectively, surviving 5 years. With radiation alone none out of eight survived. Surgery alone produced 3 out of 14 and radiation with delayed surgery 6 survivors out of 15. As surgery with or without radiotherapy is equally ineffective in controlling osteosarcoma a prospective randomized trial of the relative merits of chemotherapy and interferon as adjuvant therapy seems highly desirable.