Conservative surgery and radiation therapy for soft tissue sarcoma of the wrist, hand, ankle, and foot.

Seventy-eight patients with soft tissue sarcoma (STS) arising in the distal extremities--wrist, hand, finger, ankle, foot, and toe--who were treated with conservation surgery and radiation therapy were studied retrospectively with respect to survival, local recurrence, functional limb preservation, complications, and distant metastasis. After a median follow-up of 7.9 years, actuarial 5-year and 10-year survival rates were 80% and 69%, respectively, and disease-free rates were 61% and 51% at the same times. Actuarial local control rates were 80% and 74% at 5 and 10 years, respectively. Fifteen patients (19%) had local recurrence, but 12 of these were salvaged. Ultimately, 53 patients (68%) retained a normal or fairly normal extremity, six (8%) needed amputation for complications, and 13 (17%) needed amputation to control recurrent disease. The functional outcome was significantly better for patients with upper extremity lesions than for those with lower extremity tumors; even for the latter, this treatment strategy was preferable to amputation. The incidence of hematogenous metastases from distal extremity sarcomas depends on the size of the primary tumor. It was concluded that conservation surgery and radiation therapy (XRT) is an acceptable treatment strategy for STS arising in distal extremities; it yielded a high rate of disease control and functional limb preservation.

Changes seen in lymph nodes draining the sites of large joint prostheses.

We report the histological findings seen in the lymph nodes draining the sites of large joint prostheses. Two patients underwent multiple prosthetic joint replacements. In one patient, the regional lymph nodes were enlarged during the revision of a total hip prosthesis, and a representative lymph node was resected. The other patient had undergone a pelvic lymph node dissection as part of a staging procedure for prostatic carcinoma. By light microscopy, the lymph nodes from both patients showed markedly dilated nodal sinuses filled with macrophages containing abundant eosinophilic, PAS-positive, granular material. Polarization microscopy revealed needle-like particles within the cytoplasm of the macrophages. We believe that the histological appearance of the lymph nodes represents a florid foreign body reaction to fragments of polyester or polyethylene derived from the articulating surfaces of the joint prostheses and transported to the regional lymph nodes via the lymphatic circulation. Sinus histiocytosis seen in the lymph nodes draining the sites of joint prostheses may resemble, and must be distinguished from, other conditions invoking a sinus pattern of lymphadenopathy, as well from benign and malignant diseases that involve the lymph nodes in a pattern mimicking sinus histiocytosis.

Carcinomas of the urinary bladder with deceptively benign-appearing foci. A report of three cases.

Three men, aged 53 to 77 years, had carcinomas of the urinary bladder characterized by foci with a deceptively benign histological appearance. In two cases, this feature led to a significant delay in establishing the correct diagnosis. The diagnostic difficulty in these cases resulted from the resemblance of foci of infiltrating carcinoma to von Brunn's nests, cystitis glandularis, cystitis cystica, and nephrogenic adenoma, alone or in combination. Features that helped distinguish these foci from benign processes were an irregular distribution, the presence of large numbers of closely packed epithelial aggregates, focal mild to moderate cytologic atypia, and transitions to unequivocal carcinoma. In a third case, the superficial component of a carcinoma closely resembled an inverted papilloma.

Management of preterm prematurely ruptured membranes: a prospective randomized comparison of observation versus use of steroids and timed delivery.

The use of hydrocortisone and timed delivery was compared to expectant management of pregnancies complicated by preterm prematurely ruptured membranes in a prospective randomized trial of 73 patients. The incidence of maternal and neonatal complications was compared. There was no significant difference in the incidence of respiratory distress syndrome. Steroid-treated mothers had an increased incidence of postpartum febrile morbidity. We conclude that treatment of women with preterm prematurely ruptured membranes with hydrocortisone and timed delivery offers no advantage over expectant management.