[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.

[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.

[Results of treatment of osteosarcoma in children according to the SFOP-94 protocol in the experience of the Polish Paediatric Solid Tumour Study Group]. / Wyniki leczenia dzieci chorych na miesaka kosciopochodnego wedlug protokolu SFOP-94 w materiale Polskiej Grupy Pediatry Cznej ds. Leczenia Guzów Litych.

Between April 1994 and December 1999, 34 children aged from 5 to 20 years (23 females and 11 males) suffering from osteosarcoma, were treated according to the SFOP-94 protocol. The primary preoperative chemotherapy consists of adriamycin and high-dose methotrexate administration. There were 28 patients with non-metastatic tumours of the extremities and 6 children presented disseminated disease with pulmonary metastases. The primary localization included femur - 20 patients, tibia - 9 patients and humerus - 5 patients. In 26 patients limb-salvage surgery was applied. The programme of chemotherapy was changed in 4 children because of toxicity of methotrexate (1 patient) and progression of disease (3 patients). 26 out of 34 (76,5 %) children are alive including 24 out of 28 patients with localized disease. EFS calculated according to Kaplan-Meier analysis was 60 % at 67 months.

[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.

[The analysis of failures in therapy of osteosarcoma in children treated according to SFOP-94 protocol in the studies of Polish pediatric solid tumors treatment group]. / Analiza niepowodzen leczenia miesaka kosciopochodnego u dzieci wedlug protokolu SFOP-94 w materiale Polskiej Pediatrycznej Grupy ds. Leczenia Guzów Litych.

Between December 1989 and April 1998 twenty eight children aged from 5 to 20 years (18 female and 10 male) suffering from osteosarcoma were treated according to the OS-SFOP-94 protocol. Twenty four patients presented with localized tumor of extremities and four with pulmonary metastases. The majority of primary tumors exceeded 150 ml of volume. The primary preoperative chemotherapy consisted of adriamycin (70 mg/m2 every four weeks) and high-dose methotrexate (12 g/m2 every week). In 20 patients limb-salvage surgery was applied, in three children--amputation and in one child tibia resection with genu arthrodesis was applied. Five of 28 patients died, one because of treatment related infection, 2 non-responders with metastatic osteosarcoma due to progressive disease, and one because of local relapse with pulmonary metastasis non-responding to therapy, one because of treatment refusal. Twenty one from 25 children are alive from 5 to 51 months. Event frae survival of children with localized disease calculated according to Kaplan-Meier analysis was 64.17% in the 51st month. The main cause of failure in the treatment of osteosarcoma in children is primary and secondary progression of disease. The toleration and results of treatment for osteosarcoma in children according to the OS-SFOP-94 is satisfactory.

[The role of local surgical and radiological control in the treatment of soft tissue sarcoma sensitive to chemotherapy in children. Report of Polish Pediatric Solid Tumors Treatment Group]. / Udzial lokalnej kontroli chirurgicznej i radiologicznej w wynikach leczenia nowotworów tkanek miekkich wrazliwych na chemioterapie u dzieci. Raport PPG/GL.

In this paper the role local surgical and radiological control in the treatment of soft tissue sarcomas in children was analyzed. All children were treated according to CWS-91 and SIOP-IV protocols. Eighty three children with RMS A + E, EES/PNET, SS, UDS were included in the analysis. The primary surgery consisted of R0 (5%), R1 (18%) or R2 (16%) resection. In majority of cases (61%) primary surgical intervention was limited to diagnostic biopsy. Conventional or hyperfractionated radiotherapy was performed in 42.8%, 73.8% and 75% of children with disease stage II, III and IV, respectively. Delayed surgery was performed in 20 out of 53 (37.7%) children with stage III of the disease. In 5 patients without primary focus (urinary bladder in 3 and prostate in 2 cases) removed, progression of the disease occurred. In 5 children (stage IV) with progression of the disease no secondary surgery was performed. In 4 of them the primary tumor exceeded 10 cm in diameter. No delayed surgery was performed in 69% of relapsed children with stage III of the disease. Planned radiation therapy was not performed in 15.9% of cases. Primary local surgical control of primary tumor is of great importance for remission duration. In children who underwent delayed surgery the estimated EFS was of 0.7, in comparison with 0.5 EFS of those without secondary surgical treatment.

[Prognostic factors in neuroblastoma in children]. / Czynniki rokownicze w neuroblastoma u dzieci.

The paper presents the review of prognostic factors which were investigated from the first interests of neuroblastoma, as a model for cancer biology in pediatric oncology. The authors on the basis of other authors experiences and on the own observations, as well stress the importance of basic sciences from the field of molecular biology, cytogenetics and biochemistry, leading to better understanding of the nature of neuroblastoma and to introduction of rational treatment. The stratification of neuroblastoma patients according to the known prognostic variables influenced favourably treatment results.

[Morphologic examination of ovaries and liver after repeated administration of cyclophosphamide in therapeutic low doses to immature experimental rodents in various stages of individual maturity]. / Morfologiczna ocena jajnika i watroby po stosowaniu wielokrotnych terapeutycznych dawek cyklofosfamidu u niedojrzalych gryzoni doswiadczalnych w róznych okresach rozwoju osobniczego.

Liver and ovarian tissue samples of the immature healthy Wistar rats were examined histologically after administration of the repeated low doses of cyclophosphamide. The youngest experimental group was at the age of 7/14 days. Morphologic examination involved histochemical, histoenzymatic, morphometric and ultrastructural techniques. The observed changes in the liver tissue were minimal and totally reversible at time of animals maturity. Pathomorphological changes in ovaries were more evident and complex, concerning all structures of the gland. The dominant features of the damage included the disturbances of the physiological morphological maturation and the widespread hyperluteinization of all structures. In spite of the morphological changes, the activity of the hydroxysteroid dehydrogenases in ovaries remained unchanged.

[Malignant neoplasms and potentially malignant hyperplasia in children and adolescents from material at the Department of Pathomorphology, Institute of Mother and Child during 1978/79-1983]. / Nowotwory zlosliwe i rozrosty potencjalnie zlosliwe u dzieci i mlodziezy w materiale Zakladu Patomorfologii IMD w okresie 1978/79-1983.

531 cases of malignant neoplasms and potentially malignant hyperplasia in children and adolescents diagnosed in the Department of Pathomorphology, Institute of Mother and Child between 1978/79 and 1983 are presented. Only patients treated in this hospital were included into the study. The most common diagnoses were neuroblastoma (68 cases), rhabdomyosarcoma (62 cases), nephroblastoma (56 cases), osteogenic sarcoma (47 cases), non-Hodgkin lymphoma (41 cases). Besides neoplasms most typical for childhood and adolescence the rare less typical cases were also seen.

[Deep fascicular fibromatoses in diagnostic material from the pathomorphology department of the Institute of Mother and Child]. / Glebokie powieziowo-rozsciegnowe fibromatozy w materiale diagnostycznym zakladu patomorfologii Instytutu Matki i Dziecka.

We studied 17 cases of deep fascicular fibromatoses of various location in children and adolescents from 7 months to 16 years. Basic proliferative cells consisted of mature cells of the connective tissue slightly changed cytologic features but without atypia. We observed scanty regular mitoses. Histological structure of individual tumours and fields in the same tumours differed in the degree of collagenization, vascularization and abundance of cells. In four cases proliferations were differentiated with neurofibromatosis, in one case with fibrosarcoma of high-degree differentiation. In four cases the tumours were of desmoid structure. In two cases of mesenteric location of the proliferation we found foci of cartilagous metaplasia, which in one case after several recurrences transformed the tumour into a chondrosarcoma.

[Comparative histopathologic analysis of osteogenic sarcomas before and after initial chemotherapy]. / Porównawcza ocena histopatologiczna miesaków kosciopochodnych przed i po wstepnej chemioterapii.

We performed comparative histopathologic analysis of sections from diagnostic biopsy and surgical material obtained after antineoplastic chemotherapy. The sections were taken from 20 osteogenic sarcomas found in children and adolescents aged from 3 to 17. Chemotherapy used between samplings was based mainly on Adriamycin, and in four cases Methotrexate. Most frequent changes in histologic structure of the tumours after chemotherapy included further development of necrosis, a reduction of the structural homogeneity of the tumours and enhancement of cellular polymorphism. In many tumours we found enhancement or development of abilities to form cartilaginous foci. We did not observe maturation of the neoplasm induced by chemotherapy in the form of the development of highly differentiated bony tissue. The above-mentioned changes could be defected 3 to 4 weeks after chemotherapy initiation.

Brainstem lesions in the course of chronic fetal asphyxia.

We present a neuropathological study of brainstem involvement during the neonatal period, under the influence of prolonged fetal asphyxia. The investigation was performed on 20 brains of premature and mature newborns, who died in the course of chronic asphyxia. Ischemic cell change, neuronal loss and gliosis were present in the brainstem of all infants. Two topographic patterns of brainstem lesions in chronic anoxic encephalopathy were distinguishable in the newborns. The neurons of the cranial nerve nuclei were more severely damaged in the group of premature newborns. More severe lesions of the reticular formation were found in the group of mature newborns. The topography of brainstem damage seems to be dependent on the maturity of CNS structures at the time of injury.

Histopathological diagnosis of vaginal endodermal sinus tumors in infants.

Five cases of vaginal endodermal sinus tumors (EST) are reported. The appearance, histopathology, and main points of the differential diagnosis are discussed. The necessity of taking EST into consideration while diagnosing vaginal tumors in infants is stressed.

[Evaluation of fine-needle biopsy specimens of rhabdomyosarcoma in comparison with other neoplasms in children]. / Ocena materialu z biopsji cienkoiglowej miesaków prazkowanokomórkowych dzieci na tle badan innych nowotworów dzieciecych.

The analysis of 101 cytodiagnostic and histopathologic results of fine needle biopsy in children's neoplasms was done. It reveals the same diagnostic possibilities in rhabdomyosarcomas as compared with other children's neoplasms. On the base of our experience we constant the great value of sampling the material left after getting smears in paraffin block.