ABSTRACT
Among a series of 740 spinal tumours treated in the Department of Neurosurgery at the Nordstadt Hospital in Hannover, Germany, between September 1977 and December 1996, 106 spinal metastases in 101 patients were operated on. After an average period of 4.0 +/- 6 months (2 days to 5 years) patients presented at an average age of 62 +/- 12 years. 79% of the tumours were operated on by a posterolateral approach, 12% by an anterior and the remaining 9% by an anterior and posterior approach. A complete resection was achieved for 43.4% of the metastases while 48.1% were removed partially, 7.5% were biopsied and one patient received an opiate pump. Operations were followed by radiotherapy, chemotherapy or hormone treatment. The overall local recurrence rates as determined by the Kaplan Meier method were 57.9% after 6 months, 69.3% after 1 year and 96% after 4 years. Multiple regression analyses revealed that an independent preoperative status of ambulation, favourable tumour histology, cervical level, complete resection, low number of affected vertebral bodies, and elective surgery were significant, independent predictors of a low rate of local metastatic recurrence. Postoperative neurological outcome was related to preoperative neurological deficits. 96% of patients walking preoperatively kept this ability for at least 3 months postoperatively. However, only 22% of patients unable to walk regained walking capacity for 3 months. Correspondingly, 89% of patients remained continent of urine postoperatively for 3 months while only 31% regained sphincter control for this amount of time postoperatively. In terms of postoperative survival, multiple regression analyses showed longer survival times for patients with a favourable tumour histology, independent ambulation, long history, male sex, cervical level, complete resection, posterior approach, no additional metastases in other organs, and no instability. The overall survival rates were 58.8% after 6 months, 48% after 1 year and 19.5% after 5 years postoperatively. In conclusion, surgery has a place in the treatment of patients with metastatic disease of the spine and neurological symptoms and/or spinal instability. The surgical strategy should be tailored according to the general health of the patient and expected time of survival. Primary radiotherapy should be administered to patients without neurological deficits or instability and to patients who cannot undergo or do not accept surgery.
Subject(s)
Spinal Neoplasms/secondary , Analgesia, Epidural , Biopsy , Diagnostic Imaging , Emergencies , Female , Humans , Male , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neurologic Examination , Outcome Assessment, Health Care , Palliative Care , Reoperation , Spinal Fusion , Spinal Neoplasms/mortality , Spinal Neoplasms/pathology , Spinal Neoplasms/surgery , Survival Rate , Treatment OutcomeABSTRACT
81 untreated malignant lymphomas of the neck were classified morphologically according to the German Kiel classification and to the American classification of Rappaport and Berard and these tumors were typed immunologically as to their T- or B-cell nature. Cells from 16 of these patients were subsequently grown in tissue culture for periods up to seven months. Tissue culture cells were monitored as to spontaneous variations in the morphologic cell type and to the expression of T- or B-cell surface determinants. In addition in 10 patients sera were tested for anti-Epstein-Barr virus (EBV) antibodies. The results of these investigations were correlated with the course of the individual neoplastic disease. Significantly elevated titers against EBV antigens were detected primarily in 8 of 10 patients, mainly in lymphocytic lymphomas respective lymphoplasmacytoid immunocytomas. All such neoplasms belonged immunologically to B-cell lymphomas and were readily grown in tissue culture. The morphological cell type and the expression of B-cell determinants showed some variation during the culture period. In contrast,lymphomas of EBV-negative patients or patients with low EBV-titers grew poorly in tissue culture and remained morphologically more stabile. Immunocytologically they belonged to tumors with B- and T-cell deficiency and were classified primarily as histiocytic lymphomas and as Hodgkin's lymphomas. The clinical course in slow proliferating tumors seemed to be rather disadvantageous.
Subject(s)
Head and Neck Neoplasms/classification , Lymphoma/classification , Antibody Formation , Antigen-Antibody Complex , B-Lymphocytes/immunology , Head and Neck Neoplasms/immunology , Head and Neck Neoplasms/pathology , Hodgkin Disease/immunology , Humans , Immune Adherence Reaction , Immunoglobulins/isolation & purification , Lymphoma/immunology , Lymphoma/pathology , T-Lymphocytes/immunologyABSTRACT
The results of T- and B-cell determinations are described in 105 cases of lymphoreticular and lymphoepithelial neoplasia, and are compared to similar investigations of 582 cases as published in the literature. In addition, T- and B-cell values are determined in blood of 35 healthy individuals, in 12 normal lymph nodes, as well as in hyperplastic conditions of lymph nodes from 30 patients and of tonsils from 85 patients. Cell characterizations are done by immunofluorescence and use of monospecific anti-immunoglobulin antisera (H chain specific), anti-thymus antiserum, as well as by the E-rosette test. While normal blood and normal and hyperplastic tissues show a polyclonal distribution or proliferation of lymphoreticular cells, neoplastic conditions are often characterized by an exuberant, possibly monoclonal proliferation of one cell type. According to this, lymphoreticular neoplasias are immunologically grouped into four main classes: B-cell neoplasias comprising most of the chronic lymphocytic leukemias, well differentiated lymphocytic lymphomas, BURKITT's tumor, follicular lymphoma BRILL-SYMMERS, and hairy cell leukemia. T-cell lymphomas represent a large part of poorly or undifferentiated leukemias of children, poorly differentiated lymphocytic lymphomas, prolymphocytic leukemia, and Sézary's syndrome. Monocytic neoplasias are malignant histiocytoses and leukemic reticuloendothelioses. A fourth group, which probably is not homogeneous and might be further classified in the future by use of more sophisticated methods, consists of tumors with T- and B-cell lack. Such tumors are histologically classified as Hodgkin's lymphomas, a certain number of histiocytic lymphomas, and mycosis fungoides. The prognostic and pathogenetic implications of a combined morphological and immunological classification of lymphoreticular neoplasias are briefly outlined.
