ABSTRACT
BACKGROUND: The aim of this study was to evaluate the prognostic significance of clinical-pathologic variables in melanoma of the vulva. METHODS: From 1979 through 1995, 40 women with a diagnosis of vulvar melanoma underwent radical surgery. Patient age, tumor size and site, histologic type, ulceration, tumor thickness, lymph node status, and number of positive lymph nodes were assessed for prognostic significance by multivariate analysis. RESULTS: Tumor thickness was a significant predictor of lymph node involvement, but not of survival. The most powerful predictors of survival by multivariate analysis were the lymph node status (P = .002) and the number of positive lymph nodes (P = .00003). CONCLUSIONS: The number of positive lymph nodes represents the strongest prognostic factor in melanoma of the vulva. Because of the lack of effective adjuvant therapies, such prognostic indicators might be used to define the timing and extent of the surgical approach.
Subject(s)
Melanoma/pathology , Vulvar Neoplasms/pathology , Adult , Aged , Female , Humans , Lymph Node Excision , Lymphatic Metastasis , Melanoma/mortality , Melanoma/secondary , Melanoma/surgery , Middle Aged , Multivariate Analysis , Prognosis , Retrospective Studies , Survival Analysis , Vulvar Neoplasms/mortality , Vulvar Neoplasms/surgeryABSTRACT
We describe the FNA features of five cases of malignant parotid myoepithelioma, the majority of which were thought clinically to be recurrent pleomorphic adenomas. A major finding was cell shape variation: round-oval, polygonal or spindle-shaped, with basophilic cytoplasm. Many were epithelial and plasmacytoid-like and had nuclear grooves, pseudoinclusions, and multinucleation. The true myoepithelial nature of the neoplastic cells was identified in all cases, but only two showed obvious cytological malignant features, both initially and on re-examination. FNA of malignant myoepithelioma may thus show overt features of malignancy, or may lack atypia and malignancy can only be identified on histology. The correct diagnosis can be predicted in FNA samples in certain cases, both in terms of typing and malignancy, whilst sometimes only the myoepithelial nature of the lesion can be assessed.
Subject(s)
Myoepithelioma/diagnosis , Myoepithelioma/pathology , Parotid Neoplasms/diagnosis , Parotid Neoplasms/pathology , Biopsy, Needle/methods , Humans , MaleABSTRACT
The sensitivity and specificity of skin-test antigens were assessed, and the prevalence of anergy was determined in a group of hospitalized patients receiving aggressive nutritional therapy. All patients referred to a nutritional support service during a nine-month period were assessed for intact cellular immunity using Candida albicans, mumps, streptokinase/streptodornase, and tetanus toxoid skin tests for delayed cutaneous hypersensitivity. Some patients were retested at two-week intervals while they were receiving nutritional support. A total of 195 patients (97 men) ranging from 15 to 92 years old were tested; 68 patients received repeat skin tests. Of the 195 patients, 181 (92.8%) reacted positively to one or more antigens when tested initially; all patients (including anergic ones) who were retested reacted positively. Candida and mumps tests produced the highest percentages of positive responses (80 and 75%, respectively); the use of these two antigens concurrently produced a 92.3% response rate. Nonresponding patients to a nonresponding antigen converted to responders to that antigen upon second testing more frequently than responders converted to nonresponders. Candida and mumps skin tests detected anergy and demonstrated that immune responses were maintained and often restored by aggressive nutritional support.
