Postirradiation angiosarcoma of the chest wall and breast: issues of radiogenic origin, diagnosis and treatment in two cases.

The authors report two cases of postradiation angiosarcoma (AS) among 5,100 breast cancer patients treated in the period 1980-1994 at the National Institute of Oncology, Budapest. Relevant data in the literature is also reviewed to analyze the questions of radiogenic origin, diagnosis and treatment. Secondary AS occurred in these cases in a previously irradiated field after a 6- and 8-year latency period, respectively. Detailed histopathological and immunohistochemical examinations from the biopsy specimens confirmed the diagnosis as AS. The first patient was treated successfully with radical surgery. The second patient, with unresectable AS, died of rapid local progression within 4 months. The incidence of chest wall and breast AS after radiotherapy was found to be 0.46 per 1,000 in our patient population, which means an estimated odds ratio of 2.9 for secondary AS. Patients treated with radiotherapy for primary breast cancer are at higher risk for developing secondary AS compared to the healthy population. An etiological relationship between radiotherapy and subsequent AS of the chest wall and breast is likely, but still controversial. Initial radical surgery is the only effective treatment for achieving long-term survival. These very rare cases deserve special attention due to the atypical clinical appearance, difficulties of differential diagnosis and poor prognosis.

[Prognostic value of cell heterogeneity in cervical cancer determined by digital image analyzer of DNA content]. / A cervixdaganatok citometriai heterogenitásának vizsgálata sejtenkénti DNS-analízissel, a daganatheterogenitás prognosztikai értékének meghatározása céljából.

Frequency and prognostic value of cell heterogeneity in FIGO 1a-2a cervical cancer was examined, in 66 of patients underwent Wertheim type hysterectomy between 1989 and 1995 in National Institute of Cancer, Budapest, Hungary. A newly developed DNA image analyses (DNACE) was used in paraffin embedded tissues after enzymatic hydrolyses for evaluation of the DNA content in cervical cancer. In 30.3% of examined tissues (20/66) two subgroups was found. There was significant differences in the DNA indexes (DI) between the subgroups (p = 0.0001). In the remaining 69.7% of the cases only one subgroup was present. The frequency of two subgroups was higher between aneuploid (78.4%), or hyperploid (81.5%) type cervical cancer, however there was no significant difference between the two groups. On the other hand there was significant difference in the presence of two subgroups between the well and less differentiated cervical cancer. The frequency was higher between the less differentiated groups (p = 0.02). Looking at the prognostic value of subgroups, there was no significant correlation between the heterogeneity of cervical cancer and FIGO stage, or lymph node metastasis (p = 0.6855), or vascular/lymphatic space infiltration (p = 0.2558), or invasiveness of cancer (0.0823). There was neither significant value found between the outcome of disease and the number of subgroups present (p = 0.8738). It is though that the present of cellular heterogeneity in cervical cancer is connected with the differentiation of the cancer cells, and can be a good prognostic value in the anticipation of the aggressiveness of cervical cancer. Looking at the present result, there was no significant connection between the heterogeneity of cervical cancer and the outcome of the disease, so further examination should be done.

Polymorphous low-grade adenocarcinoma of the nasopharynx. Case report and review of the literature.

BACKGROUND: The polymorphous low-grade adenocarcinoma of the nasopharynx is a rare disease. Polymorphous low-grade adenocarcinoma is a minor salivary gland neoplasm which occurs frequently in the mucosa of the soft and hard palates, in the buccal mucosa and in the upper lip. To date this entity has been identified within the oral cavity and only one case within the nasopharynx and some cases in the parotid gland. It has a slow infiltrating growing pattern with frequent perineural invasion and low metastatic potential. CASE REPORT: We report on a patient with non-papillary polymorphous low-grade adenocarcinoma in the nasopharynx which extended intracranially. The patient underwent primary radiotherapy. The CT showed partial response to radiotherapy and the patient is alive 51 months after the diagnosis his state being unchanged. CONCLUSION: The treatment for minor salivary gland tumor is primarily surgical. It is reported that the polymorphous low-grade adenocarcinoma has been known to have poor response to radiotherapy. However, we believe that in addition to its favorable biological behavior, the radiotherapy in this localization may result in longer survival.