Valerie Miké

Medullary carcinoma of the breast: a clinicopathologic study with 10 year follow-up.

Primary breast carcinomas from 192 patients treated between 1955 and 1965 for medullary carcinoma or duct carcinoma with medullary features were reviewed and reclassified using strictly defined pathologic criteria. Tumors that fulfilled requirements for medullary carcinoma were identified in 57 patients. Another 79 tumors that varied slightly from these criteria were termed “atypical” medullary carcinoma and 56 were characterized as nonmedullary carcinoma. When compared with the patients with nonmedullary infiltrating duct carcinoma, patients with medullary carcinoma had a significantly higher survival rate at 10 years, (84% vs. 63%), similar frequency of axillary lymph node metastases, and a more favorable prognosis when nodal metastases were present. Within the medullary carcinoma group, patients had a significantly better survival rate if their primary tumors were smaller than 3 cm in diameter. The average size of medullary carcinomas was 2.9 cm and that of nonmedullary carcinomas, 4.0 cm. Bilaterality was not more common in patients with medullary carcinoma, but the interval between diagnosis of the tumors was twice as long when one lesion was medullary (8.8 years) than when both were infiltrating duct carcinomas (4.6 years). Bilaterality was significantly more common among patients with medullary carcinoma who had a positive family history. The medullary lesion was most often the second one to be diagnosed. The 79 patients with atypical medullary carcinoma had a 10‐year survival rate of 74%. Patients in this group whose tumors had a sparse lymphoid infiltrate had a relatively poor prognosis. Intraductal carcinoma at the periphery of the lesion was not associated with a less favorable prognosis. It was concluded that intraductal carcinoma was consistent with the diagnosis of medullary carcinoma if all other criteria for the diagnosis were satisfied. With these exceptions we were unable to draw any firm conclusions about favorable or unfavorable effects of other morphologic features on survival in the group with atypical medullary carcinoma. Until further study of this group reveals that some or all of the lesions form a distinct clinicopathologic entity they are best included under the heading of infiltrating duct carcinoma. When the criteria described in this report were used, medullary carcinoma proved to be a specific lesion associated with a significantly better prognosis than ordinary infiltrating duct carcinoma.

Osteogenic sarcoma under the age of twenty-one. A review of one hundred and forty-five operative cases.

A consecutive series of 145 central-type osteogenic sarcomas in the long bones of patients under the age of twenty-one years was studied by analysis of the interval from surgery to onset of pulmonary metastasis and the interval from the onset of pulmonary metastasis to death. The effects of the time of surgery, age, sex, race, preoperative duration of symptoms, location of tumor, and preoperative radiation on the course of the disease were analyzed. One hundred and twenty-one patients had pulmonary metastasis prior to the end of the study and died of their disease. Twenty-four patients were free of metastasis at the end of the study. The five-year survival rate was 17.4 per cent. Age and location of the tumor were found to affect the time of onset of pulmonary metastasis but not the five-year survival figure. The first two years after definitive surgery were shown to be the critical period for studying the course of the disease. The data analyzed in this study may offer a valuable control series against which future methods of treatment can be evaluated.

Association of Kaposi's sarcoma with second primary malignancies possible etiopathogenic implications

The association of Kaposis sarcoma (KS) with second primary cancers, especially of the lymphoreticular system, has been frequently noted. To confirm these reports in a systematic way, data on a series of 92 patients with KS treated at Memorial Sloan‐Kettering Cancer Center (MSKCC) 1949–1975 were subjected to extensive statistical analysis. Use was made also of 4517 double primaries including all sites, diagnosed at MSKCC 1949–1974, and 1959 simultaneous double primaries from the Third National Cancer Survey. Some key results: (1) 37% of KS patients had toher primary malignancies; (2) there was a 20‐fold increase in the incidence of lymphoreticular malignancies after diagnosis of KS; (3) in the MSKCC series of double primaries, lymphoreticular malignancies were involved in 8% of cases; for KS alone the corresponding figure was 58%. Our findings provide evidence in support of possible etiopathogenic mechanisms that may be involved in the natural course of KS.

Multiple Pulmonary Resections in the Treatment of Osteogenic Sarcoma

Abstract More than 80% of patients with osteogenic sarcoma develop pulmonary metastases within two years and, if untreated, die from their disease within a few months. With surgical resection of pulmonary metastases, solitary or multiple, nearly half the patients we treated were alive and free of disease two years after resection. Radiotherapy and chemotherapy have been of limited value in treating metastatic osteogenic sarcoma. Early detection of pulmonary metastases by roentgenographic follow-up examination at frequent intervals and surgical excision of all metastases, by repeated thoracotomies if necessary, appear to be the treatment of choice.

Incidence of second malignant neoplasms in children: results of an international study.

The incidence of second malignant neoplasms (SMNs) in children was estimated from data provided by ten paediatric oncology centres. During 1950-70 nearly 15 000 new patients were seen at these institutions. With follow-up through 1979, 113 eligible cases of SMN were reported. To estimate the number of person-years at risk, a common set of survival distributions, specific for tumour type and calendar period, was applied to the patient entry data at each institution. The annual incidence of SMNs 5-15 years after diagnosis of first tumour was found to be 188/100 000; this represents an approximate ten-fold increase over the age-adjusted expected rate of cancer in the general population. The corresponding incidence during the first 5 years was 85/100 000/year, a seven-fold increase in risk. The estimated cumulative probability of SMN reached 3.3% at 20 years.

Multidisciplinary treatment of embryonal rhabdomyosarcoma in children

Twenty‐nine children under 15 years of age with embryonal rhabdomyosarcoma were treated according to a multidisciplinary protocol (T‐2). The protocol consisted of surgical removal of the tumor if possible, followed by chemotherapy, and also with radiation therapy in patients with gross or microscopic residual disease. Radiation therapy was given in the 4500–7000 rads range. The chemotherapy consisted of cycles of sequential administration of dactinomycin, Adriamycin, vincristine, and cyclophosphamide, with obligatory periods of rest. The drug therapy was continued for 2 years. Following surgery, clinicopathologic staging of the disease revealed 10 patients with no residual disease (I‐A), 5 with microscopic residual disease (I‐B), 5 with unresectable tumors (II), 6 with unresectable tumors plus regional lymph node involvement (III), and 3 with disseminated tumors (IV). Twenty‐four (82%) of the patients (20 Stages I‐II, 4 Stage III) are alive with no evidence of disease for 4+ to 42+ months. These results are superior to those achieved between 1960–1970 among 108 children treated at Memorial Sloan‐Kettering Cancer Center.

Prognostic significance of serum lactate dehydrogenase in malignant lymphoma

The pretreatment serum lactate dehydrogenase level (LDH) was the single most important prognostic variable in 30 patients with diffuse histiocytic lymphoma treated between January 1973 and January 1977 with a poly‐drug chemotherapy program called the cyclophosphamide L2 protocol at the Memorial Sloan‐Kettering Cancer Center. A highly significant difference was found between the survival patterns of patients with LDH levels of 500 U or less and those with LDH levels greater than 500 U. (Two‐year survival rates were 67% and 13%, respectively.) A similar trend was observed for 25 patients with diffuse, poorly differentiated lymphocytic lymphoma treated with the same protocol, although this difference was not statistically significant. (Corresponding two‐year survival rates were 74% and 33%, respectively.) The association of LDH level with survival was evident even after adjustment for other factors of potential prognostic significance. Pretreatment serum LDH determinations may provide a useful means of stratifying patient populations when comparing treatment programs for advanced stage non‐Hodgkins lymphoma. Cancer 46:139–143, 1980.

Chondrosarcoma of the Pelvis and Upper End of the Femur: An Analysis Of Factors Influencing Survival Time In One Hundred And Thirteen Cases

Between January 1, 1931, and January 31, 1970, 121 patients were treated for chondrosarcoma of the pelvis and proximal end of the femur. Of these 121 patients, 113 with 152 operations met stated criteria and were used to study factors influencing survival rate. At the time of follow-up, forty patients were alive and seventy-three were dead. Of the forty living patients, five had disease and thirty-five showed no evidence of disease—eleven of the thirty-five more than fifteen years after their last surgical procedure. Of the seventy-three dead patients, fifty-nine had died from their chondrosarcoma and fourteen, from other causes. The data analyzed were sex, age, preoperative duration of a recognized mass, preoperative duration of pain, site and size of the lesion, histological grade of the tumor, and date and type of surgical treatment. The basic method of analysis was by means of survival curves. The significance of the differences between curves was tested by the Wilcoxon-Gehan test. The findings in this study indicate that histological grading is of prognostic importance and that in the surgical treatment of chondrosarcomas in this region there must be a wide margin of normal tissue between the tumor and the line of resection if the best cure rate is to be attained.

Oncogenesis and Other Late Effects of Cancer Treatment in Children

Review of hospital charts of 168 patients surviving two or more years following the diagnosis of cancer and subsequent-examinations of 40 of these patients yielded these observations: (a) Hospital charts were adequate to ascertain the number of second primary neoplasms. Three malignant and eight benign tumors were found, an incidence of 6.5%. (b) The three patients with second malignant neoplasms did not receive chemotherapy and two of three were treated with radiation. (c) Abnormalities other than second neoplasms, which may have been delayed consequences of treatment, were infrequently noted in hospital records, but were subsequently detected on specific examinations.

Chondroblastoma of bone. A clinicopathologic and electron microscopic study

Twenty‐five patients with benign chondroblastoma of bone were treated at Memorial Sloan‐Kettering Cancer Center, from 1920 to 1970. The 15 male and 10 female patients, with an age range of 9 to 51 years, were treated by amputation, block excision, curettage, cryosurgery, and irradiation. The follow‐up period ranged up to 35 years with extremely slow gradual healing as demonstrated by sequential roentgenograms. No malignant transformation had occurred; however, one case exhibited soft tissue implantation. The lesion was characterized by a high recurrence rate of 38%. In 24% of all cases, aneurysmal bone cyst was engrafted on the tumor, resulting in a significantly higher recurrence rate. In 2 cases, electron microscopic examination revealed multiple small Golgi complexes, numerous electron‐lucent mitochondria, dilated segments of rough endoplasmic reticulum, and small bundles of cytoplasmic filaments, in the cytoplasm of the tumor cells. Patches of glycogen were also seen in some of the chondroblasts. The nuclei were irregularly shaped, and some were also multilobulated. A fibrous lamina was closely applied to the inner surface of the nuclear envelope of the chondroblasts.