Uma Rao

Cytogenetic studies of adipose tissue tumors. II. Recurrent reciprocal translocation t(12;16)(q13;p11) in myxoid liposarcomas

Detailed chromosome studies, briefly reported previously, from short-term cultures of tumor cells from myxoid liposarcomas are reported. A common reciprocal translocation, t(12;16)(q13;p11), was found in three cases and a complex t(1;12;16)(p11;q13;p11) in the fourth one. This nonrandom primary change, not described before in solid tumors, could characterize the myxoid form of liposarcoma. The involvement of a closely located breakpoint on chromosome #12 in a reciprocal t(3;12)(q28;q14) described in a lipoma in the previous article of this series, suggests a common basis in the biological process of proliferation of tumors sharing a common histogenesis.

Feasibility of limb salvage and survival in soft tissue sarcomas

One hundred nine consecutive patients with soft tissue sarcomas were treated in the period 1977 through 1983. Of 85 patients with extremity sarcomas, only 3 patients (4%) were managed with amputation, whereas in the previous decade, 40% of such patients were treated with amputation in our institute. The current 5‐year survival rate is 63%; in the previous decade it was 45%. In the current series, for extremity locations, patients with minimum surgical margins of 2 cm or greater and no further local therapy had a 5‐year local recurrence rate of 17%, whereas those with minimum surgical margins of less than 2 cm and who were treated with adjuvant postoperative radiation had a local recurrence rate of 7%. In the previous period, the local recurrence rate was 30% after wide resection and 66.6% after local excision. With a combination of modalities, limb salvage can be practiced currently in the majority of patients with extremity soft tissue sarcomas without any adverse effect on recurrence rates and survival.

Cytogenetic studies of adipose tissue tumors. I. A benign lipoma with reciprocal translocation t(3;12)(q28;q14).

Detailed clinical histories and cytogenetic investigations using short-term cultures are reported in three typical benign lipomas. Although a diploid (normal) karyotype was observed in two cases, a reciprocal chromosome translocation t(3;12)(q28;q14) was found in the third case, which was briefly reported previously. These data are discussed in light of a lipoma with similar karyotypic changes reported by Heim et al. and a similar translocation observed by us in malignant myxoid liposarcomas. The nonrandom involvement of segment 12q13-q14 in benign and malignant lipomatous tumors suggest a common basis for at least one of the possible multiple steps in the genesis of neoplastic processes.

Recurrent breakpoints at 9q31 and 22q12.2 in extraskeletal myxoid chondrosarcoma

A cytogenetic study of extraskeletal myxoid chondrosarcoma cells revealed a complex t(9;22;15)(q31;q12.2;q25) as a primary chromosome change. A reciprocal translocation involving identical breakpoints on chromosomes #9 and #22 in this tumor has been reported in the literature. We suggest that the breakpoints 9q31 and 22.q12.2 are associated with extraskeletal myxoid chondrosarcoma, a comparatively rare tumor of adulthood.

Groin dissection in malignant melanoma

One hundred seventeen patients with malignant melanoma who had groin dissection were reviewed. The estimated 5 year survival rate for patients with node involvement was 40 percent. For patients with involved inguinal nodes only, the 5 year survival rate was 47 percent. The estimated 5 year survival rate for patients with clinically enlarged and histologically involved nodes was 37 percent and the incidence of involved deep nodes in this group was 44 percent. For patients with clinical and histologic involvement of the inguinal and deep nodes, the estimated 5 year survival rate was 30 percent. In patients with clinical involvement of the inguinal nodes, radical groin dissection with in-continuity removal of the deep nodes appeared to improve the previously reported survival rates.

Tumor thickness and prognosis in clinical stage I malignant melanoma

The current grouping of patients with malignant melanoma into thin, intermediate, and thick melanomas provides a convenient but arbitrary classification which, although providing “average” survival values for each group, offers crude prognostication for the individual patient. A review of 371 patients with clinical Stage I malignant melanoma, treated during the period 1970 to 1985, was conducted. The estimated 5‐year survival rate for female patients with melanomas 1.0 mm thick was 94%; for each 1‐mm increment in thickness the survival rate declined by about 3%, up to the 6 mm mark, the survival rate declining thereafter by about 8% for each additional millimeter in the range of 7 to 15 mm of thickness. The estimated 5‐year survival rate for male patients with melanomas 1.0 mm thick was 80%; for each 1‐mm increment the survival rate declined by about 9%, up to the 10 mm mark. The proposed method of estimating the expected survival according to the patients sex and the thickness of the primary lesion hopefully provides a more accurate and convenient method of prognostication for the clinician dealing with specific patients with intermediate or thick melanomas.

Comparison of prognostic factors for survival and recurrence in malignant melanoma of the skin, clinical Stage I.

Potential prognostic factors for survival time, 5‐year survival rate, recurrence‐free time, and 5‐year recurrence‐free rate were explored for 262 patients with malignant melanoma of the skin, Stage I, using the log‐rank test, proportional hazards (Cox) regression, and linear logistic regression. Breslows thickness was the most important variable in each analysis. A thinner Breslows thickness was associated with a better prognosis. After adjusting for Breslows thickness, sex was the next most important variable in each analysis. Women had a better prognosis than men. After adjusting for Breslows thickness and sex, there were no additional significant prognostic factors for survival time; Clarks level was significant for 5‐year survival rate; the number of mitoses, evidence of regression, and presence of vascular invasion were significant for recurrence‐free time; and the presence of vascular invasion and number of mitoses were significant for 5‐year recurrence‐free rate. It is recommended that in future prospective studies of adjuvant therapy of Stage I melanoma, patients be stratified into treatment groups on the basis of Breslows thickness and sex.

Local recurrence and survival in soft-tissue sarcomas

AbstractBackground: There is a continuous interest in the literature concerning the management and survival after treatment of local recurrence in sarcomas because it is one of the most common types of recurrence. Design: We retrospectively reviewed 93 patients treated for local recurrence from soft-tissue sarcoma. Methods: We evaluated prognostic parameters (grade, tumor size, location) and the effect of treatment on survival. Results: Resection of all the gross tumor at first visit to our Institute for local recurrence was accomplished in 88 patients (95%). Of the 59 patients with extremity tumors, six (10%) required an amputation. At a mean follow-up of 66 months, further local recurrence was noted in 27%. The estimated 5-year survival rate was 100% for patients with grade I tumors (n=16), 77% for grade II (n=31), and 45% for grade III tumors (n=46) (p=0.0002). This value was 78% for tumors ≤5 cm and 57% for those >5 cm (p=0.03). Conclusions: Local recurrence is resectable and limb preservation is possible in the majority of patients. The overall 5-year survival rate was 65%. Survival after treatment of local recurrence is determined mainly by the grade and secondarily by the size of the tumor as for primary sarcomas.

Axillary node dissection in malignant melanoma

Axillary node dissection for nonmammary malignant lesions can be performed easily through an incision in the medial wall of the axilla. In patients with clinical involvement of the axilla with melanoma, positive nodes above the level of the axillary vein may occasionally be found.

Cytogenetic subtype involving chromosome 13 in lipoma: Report of three cases☆

We report three lipomas with rearrangements of chromosome 13. The karyotype of the tumors studied were 45,XX,-8,+der(8)t(8;13)(q22;q12),del(10)(p12),-13; 46,XY,del(13)(q12q22), and 46,XY,t(11;12)(q23;q13),del(13)(q12q22), respectively, revealing common involvement of band 13q12 in the rearrangement. Three other lipomas with aberrations of bands 13q12-q13 have been reported, suggesting that such tumors with abnormalities of chromosome 13 could represent a subgroup of lipoma in addition to those already reported with abnormalities of chromosomes 12q and 6p. The rearrangements of #13 in all these cases also involved loss of the band 13q14 to which the antioncogene associated with retinoblastoma and osteosarcoma is localized. Detailed clinical, histopathologic, and molecular studies should help to further characterize the various cytogenetically defined subgroups of lipoma.