Gallbladder adenocarcinoma: the prognostic significance of histologic grade.

Gallbladder adenocarcinoma (GBA) postresection 5-year survival rates are less than 5%, but when histologically confined to the mucosa or submucosa, survival rates of 64% (5 years) and 44% (10 years) have been reported. Whether any other histologic features of GBA have prognostic significance is unknown. This investigation was conducted to determine if GBA histologic grade correlates with survival. Thirty patients with advanced stage GBA participating in Eastern Cooperative Oncology Group (ECOG) treatment protocol EST-2273 served as the study material. Using glandular tumor grade criteria recommended by others, a panel of 7 ECOG pathologists categorized the GBA as either predominantly low or high histologic grade. Each patient's GBA histologic section measured no less than 1.0 X 1.0 cm. Predominant grade was defined as being that grade present in greater than 75% of the histologic section. Patient survival times by grade were calculated from date of initiation of chemotherapy until date of death. The 13-week low grade GBA patient survival was significantly longer than the 7-week high grade GBA patient survival (p less than 0.01). Stratification of patients by either high or low predominant histologic grade is recommended in future GBA treatment studies.

Carcinoids: the prognostic effect of primary site histologic type variations.

Carcinoids are histologically classified as insular (A), trabecular (B) glandular (C), undifferentiated (D) or mixed. These have prognostic significance, i.e. Group 1 (most favorable, A + C); 2 (favorable, A, B, A + B); 3 (relatively unfavorable, all non A + C or A + B mixed types); and 4 (unfavorable, C, D). Midgut primaries have a better prognosis than either foregut or hindgut/cloacal primaries. Carcinoids from 114 Eastern Cooperative Oncology Group patients were studied to determine if primary site prognostic differences result from histologic prognostic group occurrence rate differences across primary sites. By primary site the following rates were observed: Foregut: 1 (0%), 2 (79.2%), 3 (12.5%), 4 (8.3%); midgut: 1 (26.7%), 2 (58.7%), 3 (6.6%), 4 (8.0%); hindgut/cloaca: 1 (0%), 2 (42.9%), 3 (42.9%), 4 (14.2%); nongut: 1 (0%), 2 (75.0%), 3 (12.5%), 4 (12.5%), p less than 0.01. The results demonstrate that primary site prognostic differences are highly dependent upon histologic prognostic group occurrence rate variations across primary sites. In addition multivariate analysis of survivorship by both histologic type (p less than 0.05) and primary site (p less than 0.05) demonstrated that each variable has independent prognostic significance.

Leiomyosarcoma of prostate.

Leiomyosarcoma of the prostate is a rare tumor with no established protocol of treatment in the literature. We report a case with peculiar clinical presentation and androgen receptor content supporting the origin of the tumor. The potential advantage of hormonal manipulation during progression of the disease is suggested.

Juvenile carcinoma of the breast.

A case of secretory or juvenile carcinoma of the breast is reported in a 16 year old girl. A wide local excision was performed and no recurrence or lymph node metastases were detected at follow-up. This uncommon variety of breast tumor can also occur in adults. Most reports stress the low degree of malignancy with a slow rate of growth and a minimal risk of metastatic spread. Because of the limited number of cases reported, the initial treatment of choice is debatable. Consequently we suggest that the treatment of such a lesion should be individualized.

Angiosarcoma of the breast.

The authors report a case of angiosarcoma of the breast. The patient, a 44-year-old woman, remains free of disease 7 years after biopsy and 6 years after a simple mastectomy. The authors emphasize the benign appearance of the tumour and the importance of early detection and adequate surgical treatment.

Hydatidiform mole metastasizing to the lung.

Pulmonary lesions developed in three patients with an invasive hydatidiform mole. At open thoracotomy the modules were found to contain molar tissue. Therapy with twice-weekly methotrexate induced complete clinical and biologic remission of the disease in all three patients.

Diagnosis of neuroblastoma by electron microscopy of bone marrow aspirates.

Three patients are reported in whom the diagnosis of neuroblastoma was made following electron microscopy of a bone marrow aspirate. The ultrastructure of neuroblastoma cells is distinctive, and they can be distinguished by electron microscopy from cells of the other tumors with which neuroblastoma is often confused by light microscopy. The rapidity with which the diagnosis can be obtained through use of this procedure argues for its adoption in any patient in whom the diagnosis is suspected and who has tumor cells in bone marrow. Early initiation of appropriate therapy is made possible, and elaborate diagnostic procedures may be avoided.

Kaposi's sarcoma in an Eskimo.

An Eskimo who had been treated for a nasopharyngeal carcinoma was subsequently found to have a rapidly progressive form of Kaposi's sarcoma confirmed at biopsy. No objective response was obtained by irradiation treatment of isolated nodules. However, vinblastine sulfate arrested the progression of the disease. Because this neoplasm is most prevalent in tropical climates its presentation in an Eskimo is believed sufficiently unusual to warrant this report.

Ectopic gonadotropin in a case of anaplastic large-cell carcinoma of the lung.

A case of ectopic gonadotropin production by a bronchogenic carcinoma is presented. Eleven similar cases have been previously reported. Urine gonadotropin titres appeared related to the size of the tumour mass since they decreased with response to treatment and increased when the tumour started progressing again. The hormone is most probably elaborated and secreted by the tumour cells.