Sentinel lymph node mapping using indocyanine green in patients with uterine and cervical neoplasms: restrictions of the method.

PURPOSE: To establish the surgical, demographic and histopathological factors associated with inaccurate sentinel lymph nodes (SLNs) identification using indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging in uterine and cervical neoplasms during both open and laparoscopic surgery. METHODS: We reviewed patients with atypical endometrial hyperplasia (AEH), clinical stage I and II cervical cancer or uterine malignancies who underwent primary surgery with SLN mapping between September 2015 and January 2018. An analysis of patients' demographics, tumor factors and surgical approach was conducted. Bilateral and overall detection rates were calculated and univariate analysis was performed to estimate factors associated with failed SLN mapping. RESULTS: A total of 32 patients with uterine and cervical neoplasms were included in the study. The overall detection rate of the SLN was 84% and bilateral detection rate was 75%. There were no statistically relevant differences in overall and bilateral SLN detection rates by BMI, surgical approach or age. Regarding endometrial cancer, there were no differences in SLN detection rates when comparing tumor grade, histology nor myometrial invasion. For SLN detection failure, only the presence of metastatic lymph nodes and lack of surgical experience significantly increased the disability to detect SLNs (p = 0.03, p = 0.04, respectively). CONCLUSIONS: SLN mapping technique using NIR fluorescence imaging with ICG appears to be accurate method in most of the patients with cervical or endometrial carcinoma, regardless of demographic characteristics, tumor-related features and surgical approach. Surgeons' expertise in that field allows obtaining excellent detection rates.

Clinical utility of biochemical bone turnover markers in children and adolescents with osteosarcoma.

PURPOSE: Biochemical markers of bone turnover reflecting the intensity of all bone remodeling processes in skeleton are important for fast and non-invasive assessment of bone formation and resorption processes. They can be used in terms of both physiological and pathological states. The aim of this study was to investigate if bone metabolism markers can be clinically useful for monitoring of treatment in children and adolescents with osteosarcoma. MATERIAL/METHODS: The study consisted of 55 patients (median age 15 years) with osteosarcoma and 60 healthy age matched counterparts. Serum bone turnover markers (bone alkaline phosphatase - BALP, osteocalcin - OC and C-terminal telopeptide of type I collagen - CTX) were analyzed by immunoenzymatic methods in patients at time of diagnosis, during treatment and after therapy. RESULTS: We observed that before treatment the concentration of OC in patients with osteosarcoma was significantly lower (p<0.05) compared to that obtained in healthy children, however, BALP and CTX were at a similar level. During chemotherapy the values of bone formation and resorption markers significantly decreased by about 20-30%. After therapy we observed different concentrations of all bone turnover markers in patients with favorable and unfavorable prognosis. Median values of OC and BALP were over twofold higher in patients with progression as compared to patients with remission of disease (p<0.01 and p<0.001, respectively). Patients with poor prognosis had also higher serum concentration of bone resorption marker in comparison to patients with remission (p<0.01). CONCLUSIONS: Presented results suggest that bone turnover markers identify changes in bone metabolism in patients with osteosarcoma during anticancer therapy. These markers due to the non-invasive methods and their specificity might be useful in monitoring of clinical treatment of osteosarcoma patients.

[Flow cytometry estimate of s phase cell cycle and prognosis of osteosarcoma in children and adolescents]. / Cytometryczna ocena fazy s cyklu komórkowego a rokowanie w miesakach kosciopopochodnych u dzieci i mlodziezy.

Flow cytometry analysis has been used to measure the S phase in paraffin embedded osteosarcoma tissues of 22 children and adolescents who were surgically treated. The aim of this study was the assessment of S phase cell cycle in relation to survival, localization of tumour and histopathological grading. Our findings demonstrate the usefulness of flow cytometry determination of S phase cell cycle as a prognostic factor. Higher percentage of S phase cells predict worse prognosis.

[Clinical characteristics of osteosarcomas and cell aneuploidy in children and adolescents -- retrospective studies]. / Kliniczna charakterystyka miesaków kosciopochodnych u dzieci i mlodziezy a aneuploidia komórkowa--badania retrospektywne.

The relationship between the clinical status skeletal involvement, frequency of metastases and histopathological grading of osteosarcomas 18 children and adolescents and abnormal DNA content (aneuploidy) was analysed. Our findings demonstrate a correlation between Index DNA (DI), percentage of aneuploidy population to histopathological grading and prognosis. No significant correlation was found between aneuploidy and the site of skeletal involvement.

[Value of comparing flow cytometry examination and histopathology in prognosing of osteogenic sarcoma - preliminary report]. / Znaczenie porównazych badan cytometrycznych i histopatologicznych w prognozowaniu w miesakach kosciopochodnych--doniesienie wstepne.

Our preliminary report presents two cases of osteogenic sarcoma examined after initial chemotherapy. In both cases histological maps with morphological effects of chemotherapy and flow cytometry of DNA content in tumour cells were made. Results of flow cytometric DNA histograms were linked with an estimation of the proliferative potential of tumours. The correlations between histological grade, proliferative potential of tumours with the morphological effects of chemotherapy were confirmed in the presented cases. Flow cytometry results were ready in a few hours after surgery, when full histopathological analysis was available in 2-4 weeks. Analysis of the two methods of estimation of osteogenic sarcoma suggests that flow cytometry may be a complementary method to histological examination and estimation of proliferating rate, especially aneuploid cell population and this information can be helpful in clinical management.

[Difficulties in the histopathological evaluation of osteogenic sarcoma]. / Trudnosci oceny histopatologicznej miesaków kosciopochodnych.

The performed analysis concerned the results of the histopathological examination of 169 cases of osteogenic sarcomas with reference to diagnostic difficulties. It was found that the most difficult cases belong to the extreme groups of the classification i.e. were high or very low differentiated osteogenic sarcomas. The most difficult diagnostically cases according to the structural classification concern analogically the extreme group of cases of the non-conventional histology. However, the dominant number of the diagnosed cases did not belong to the extreme groups of classification.

[Comparative study of histopathological patterns of primary tumour and pulmonary metastases of malignant tumours in children and adolescents after complex therapy]. / Badanie porównawcze cech histopatologicznych ogniska pierwotnego i przerzutów plucnych w nowotworach zlosliwych u dzieci i mlodziezy poddanych skojarzonemu leczeniu przeciwnowotworowemu.

The histopathological features of the primary site and 102 pulmonal metastases were compared in the material from 40 malignancies in children and adolescents. All patients were treated by chemotherapy. Among the malignancies 30 were osteogenic sarcomas. A great histological variability in the multiple metastases removed at one surgical procedure and also in the metastases removed in the subsequent surgeries, were found. Summing up, the whole investigation; in 61.8% of metastatic focusses no difference was found in the histopathological patterns seen at the primary site and pulmonary metastases, in 17.6% total regression was observed, in 13.8% dedifferentiation and in 6.8% maturation of the tumours tissue were observed.

[Local recurrences after salvage operations in the therapy of osteogenic sarcoma cases - an analysis of adverse effects based on studied cases]. / Wznowy miejscowe po zabiegach oszczedza-jacych w leczeniu miesaka kosciopochodnego--analiza niepowodzen na podstawie zgromadzonych przypadków wlasnych.

Therapeutic approach in osteogenic sarcoma until 1982 was connected mainly with surgery. Introduction of chemotherapy to the therapeutic protocols of osteogenic sarcoma improved the 5 years survival of patients with osteogenic sarcoma from 20% to 60-70%. The approach to surgical treatment was also changed. The principle of this treatment is usually to perform an operation to spare the limb with an intraoperative frozen section examination of bone marrow. In our Institute during the last 14 years about 300 cases were diagnosed, out of which about 200 were treated surgically, among these about 50% underwent treatment by salvage operations. Only in 7 cases local recurrences of disease were confirmed. Five of these cases were tumours of distal metaphysis of the femur, one case of proximal metaphysis of the tibia and one case of proximal metaphysis of the humeral bone. The sex range M/F was: 5/2, the average age of onset about 14 years. Various factors playing a role in therapeutic adversities were analysed. Among these were: radical surgery, grade of differentiation of the tumour, histological subtype, soft tissue infiltration, reaction to preoperative therapy and the type of chemotherapy. The conducted analysis indicates the role played by sparing surgery in adversities in therapy (3 cases). Attention was also given to the distinct tendency of osteogenic sarcoma to produce vascular embolism which is a source of haematogenously spreading metastases. In 7 cases vascular tumour embolism caused the appaerance of metastatic focuses adjacent to the primary tumour. A certain role in therapeutic adverities is played by the lack of response to preoperative chemotherapy (4/7 cases). The influence of other factors needs further investigation.

[Analysis of DNA histograms and histopathologic assessment of necrosis after preoperative chemotherapy of osteosarcoma in children and youth]. / Analiza histogramow DNA oraz histopatologiczne badania stopnia nekrozy po przedoperacyjnej chemioterapii w miesakach lkosciopochodnych u dzieci i mlodziezy.

Analysis of nucler DNA content (DNA histograms by flow cytometry) in 26 children and youth with osteosarcoma treated at the National Research Institute of Mother and Child, was carried out. The relationship between aneuploid populations, index DNA and phases of cell cycle and the clinical course, histopathologic grading and histopathologic assessment of preoperative chemotherapy effect (% of tumour necrosis) were analysed. Osteosarcomas in children with changed schedules of chemotherapy (therapy complications) in relation to the above parameters were also examined. The results show, that increased aneuploid population and index DNA (less distinct for S phase of anueptoid population) are linked with weaker chemotherapy effect. It can indicate a bigger proliferative potential in this kind of tumours - it often occurs with a more dramatic course of disease. According to the authors flow cytometry studies are helpful and complementary to histopathologic diagnosis.

[Correlation of the histological subtype of osteogenic sarcoma with the percentage of necrosis after initial chemotherapy]. / Typ histologiczny miesaka kosciopochodnego a odsetek martwicy guza po wstepnej chemioterapii.

The material comprises 195 cases of osteogenic sarcoma in children and adolescents. The tumours were grouped in accordance with two classifications; gradual classification which incorporates three levels of morphological maturation of sarcoma and structural classification which distinguishes conventional and nonconventional types of sarcoma. In every case histological mapping of the tumour was performed with the aim to establish the percentage of necrosis and postnecrotic resorbtion of the tumorous mass after the initial chemotherapy. The purpose of this study was to establish the correlation of the tumour necrosis with both histopathological classifications. The main conclusion was, that the gradual classification is more accurate for the changes occurring in the tumour tissue after chemotherapy.

[Sacrococcygeal tumours--diagnosis-treatment strategies based on personal examinations]. / Guzy okolicy krzyzowo-guzicznej--postepowanie diagnostyczno-lecznicze na podstawie badan wlasnych.

Sacrococcygeal tumours very often appear soon after birth when they are usually benign. In older children more frequently malignant tumours are observed. The authors present diagnostic and therapeutic strategy based on clinical material consisting of 34 patients (15 benign tumours, 19 malignant tumours) treated at the National Research Institute of Mother and Child in the period 1980-1999.

[Aneuploidy and histopathological classification, according to the Musculoskeletal Tumour Society and WHO, of osteosarcoma in children and adolescents]. / Aneuploidia komórkowa a klasyfikacja histologiczna wg MSC i WHO w miesaku kosciopodnym u dzieci i mlodziezy.

A flow cytometry analysis in children and adolescents with osteosarcoma was carried out. Investigation concerned 32 fresh surgical specimens (from patients after preoperative chemotherapy) and 18 paraffin-embedded tumour tissues (archive material). The correlation of aneuploidy population parameters to malignancy grading acc. to WHO (GI-GIII) and MSC histopathological classification, was investigated. It was shown that all specimens with aneuploid populations correlated with the histophatological diagnosis of osteosarcoma. Thus cytometry analysis can be a useful and rapid complementary method to conventional histophtatological diagnosis. On the contrary, no correlation was found between the aneuploid parameters and the low grade and high-grade osteosarcoma acc. to WHO and MSC classification. The Multicycle computer system is useful in retrospective analysis of paraffin-embedded tumour tissues. It is suggested that for this kind of investigation fresh diagnostic specimens (before preoperative chemotherapy) would be more adequate.

[Results of treatment in osteosarcoma--chemotherapy with ADM and CDDP]. / Wyniki leczenia pacjentów z miesakiem kosciopochodnym z zastosowaniem chemioterapii z ADM i CDDP.

Malignant bone neoplasms contribute to about 7% of paediatric cancer. Within the last 20 years much has changed in cancer treatment. Neoadjuvant chemotherapy, as the first phase of comprehensive treatment, results in regression of the tumour and makes limb salvage surgery possible. An exact analysis of 36 patients with osteosarcoma of different localisation, treated at the National Research Institute of Mother and Child between 1991 and 1996 was carried out. Treatment was started with pre-operative adjuvant chemotherapy with ADM and CDDP, administrated during 6 weeks. The regimen and the length of administration depended on stage of disease and tumour reaction to chemotherapy. Amputations or limb salvage surgery was conducted as a second phase of therapy. Postoperative chemotherapy was given for 6 months. Tumour reaction to chemotherapy was described according to the Huvos scale - percentage map of necrosis and regression areas in the neoplastic tissue. The analysis shows good results after chemotherapy with ADM and CDDP.

[Histopathologic differentiation of tumors derived from neuroblastic cells in children depending on age]. / Zróznicowanie histologiczne guzów grupy neuroblastoma u dzieci w zaleznosci od wieku.

The histopathology of 224 tumours of neuroblastic origin was analysed in relation to the age of patients. Maturing neuroblastomas (NBS) dominated in infants, where as in the most numerous group of children 1-5 years of age, prevalence of neuroblastomas without any signs of maturation was noted. In children over 5 years of age a high incidence of tumours with evident maturation was noted (ganglioneuroblastomas and ganglioneuromas). The prevalence of maturing neuroblastomas in infants correlate well with an advantageous clinical course of neuroblastomas at this age.

Antioxidant and glutathione-associated enzymes in Wilms' tumour after chemotherapy.

The present study demonstrates the activities of antioxidant and glutathione-associated enzymes and the level of glutathione in Wilms' tumour (nephroblastoma) samples after chemotherapy (mainly actinomycin D and vincristine). We observed higher activity of superoxide dismutase in Wilms' tumour compared to adjacent morphologically unchanged kidney. On the other hand, in this tumour lower activities of catalase and the glutathione-associated enzymes glutathione synthetase, gamma-glutamyl transpeptidase, glutathione reductase and total glutathione S-transferases (GST) were found. Using isoelectric focusing we separated different forms of GST in tested tissues and revealed lower activities of the basic enzymes in Wilms' tumour, which may be responsible for the decrease of total GST activity. Moreover, we found the acidic isoenzymes to be the predominant class of GST in nephroblastoma. In Wilms' tumours with unfavourable histology a high activity of these isoenzymes together with a high level of GSH were observed. We suggest that these parameters may participate in the known phenomenon of anticancer drug resistance of tumours with unfavourable histology.