Multiple primary neoplasms in association with prostate cancer in black and white patients.

The current study follows up the 983 patients who were diagnosed as having prostate cancer at the Columbia-Presbyterian Medical Center in New York City between 1970 and 1979 and of whom 106 (11.5%) developed a multiple primary malignant neoplasm (MPMN) in addition to their prostate cancer by January 1, 1986. Of the 283 black patients, 32 (11.3%) developed an MPMN involving 35 sites excluding prostate. Of the 636 white patients, 74 (11.6%) developed an MPMN in association with their prostate cancer. Comparing observed incidence rates to expected on the basis of SEER incidence data, two malignant tumors, urinary bladder cancer and malignant lymphoma, appeared to occur in excess in the present series of patients. The excess of urinary bladder cancer in our series could be explained by detection bias due to the routine use of cystoscopy. The excess incidence of lymphoma in our series appears significant but its etiology is unexplained.

Epidural cord compression in association with genitourinary neoplasms.

The epidural compression secondary to genitourinary malignancies is relatively uncommon. Of 2118 patients who were diagnosed as having a genitourinary malignancy at the Columbia-Presbyterian Medical Center from 1970-1979, 21 are known to have developed an epidural cord compression by June 30, 1985 (16 from prostate, 1 from urinary bladder, and 4 from renal origin). The following items were reviewed in these 21 patients: age of the patient at diagnosis of the primary tumor; primary site of the genitourinary primary; time in months from the date of diagnosis of the genitourinary primary to the data of diagnosis of the spinal cord compression; methods of diagnosis; presenting symptoms and signs; treatment methods; and survival following the date of diagnosis of the compression. The distribution of location of the epidural metastasis in the current series is as follows: cervical-thoracic, 7%; thoracic, 73%; and lumbosacral, 20%. Skip metastases to the epidural space was the initial sign of malignancy in six patients (31.5%). Five patients (26%) with epidural cord compression survived at least 24 months following the date of diagnosis of their compression. Only two patients in this series with paraplegia (secondary to their compression) had improvement in ambulation following treatment of their compression: of these two patients, one had a prostate primary and the other a renal primary. The indications and techniques for surgery and radiotherapy are briefly described and early diagnosis and treatment are stressed.

Multiple primary tumors in association with prostatic cancer.

One hundred forty-six patients with clinically nonmetastatic carcinoma of the prostate were treated at Columbia-Presbyterian Medical Center from 1964 through 1976. Of these 146 patients, 24 (16.4%) had developed at least one additional primary cancer. This review contrasts the 122 patients who had a single primary prostate cancer only with the 24 patients who had additional primary carcinomas with respect to age, racial distribution, clinical stage, and prostate cancer histology including Gleason's score, patterns of failure of prostate cancer, and survival data. Local failure and distant failure were less in the multiple primary group. Patients with high Gleason's scores appear to be at greater risk for second primaries. Five-year observed survival (by actuarial life table method) for the single prostate primary group was 76.5%, and 5-year observed survival of the prostate multiple primary group where prostate cancer appeared first was 71%.

Vulvar intraepithelial neoplasia (severe atypia and carcinoma in situ). A clinicopathologic analysis of 41 cases.

Forty-one cases of vulvar intraepithelial neoplasia (VIN) were analyzed clinicopathologically with emphasis on the changes in age-specific incidence rates, coexisting condylomata, coexisting koilocytotic atypia, subsequent invasive carcinoma and response to therapy. The number of cases referred to in the interval from 1975 to 1982 was 26 compared with 15 in the interval from 1966 to 1974. In addition, the percentage of patients in each group younger than 45 years of age was 66% after 1975 versus 33% prior to 1975. The yearly incidence of patients older than 45 years of age remained constant. The association of condyloma or marked koilocytosis in the neoplastic epithelium per se correlated with a younger mean age (31.1 and 31.8 years, respectively) than the absence of condyloma or marked koilocytosis (45.5 years and 47.5 years, respectively). Carcinoma developed in five patients (10.2%), and the mean age of the group was 55 years. Four of the five developed carcinoma within 3 years of diagnosis of the VIN. The incidence of persistence of the VIN lesion or recurrence following local excision was 22% over a mean following of 6.1 years. Spontaneous regressions were not reported in this patient population. Vulvar intraepithelial neoplasia appears to be a disease of multiple etiology which affects at least two populations. The younger patients are associated with papilloma-virus infection, and have a low risk of progression to cancer. The older patients have a variable history of condylomata, and a higher risk of developing invasive cancers of the anogenital region. The most important risk factor from the clinicopathologic standpoint appears to be age.

Uterine sarcomas: a clinicopathologic study, 1965-1981.

Forty-six cases diagnosed as uterine sarcoma from 1965 to 1981 were analyzed. Using mitotic count, 7 of 21 leiomyosarcomas (LMS) were redesignated leiomyomas and all are NED. The actuarial survival rates for the 38 considered sarcomas were 55 and 27% at 2 and 5 years. (The 22 patients eligible for 5-year follow-up had a 27% absolute survival, with 3 of 22 NED.) Fourteen LMS patients had a superior 5-year actuarial survival (42%) than 18 malignant mixed mesodermal (MMM) patients (15%), but the difference disappears when only patients under 70 are considered. Stage and age were the most important prognostic indicators. Complete surgical resection was essential for long-term survival. Six resected patients given adjuvant chemotherapy (mostly VAC) had an improved actuarial survival (61 vs 15% for the 23 resected patients not receiving chemotherapy). Seventy percent of 23 recurrences occurred within 2 years and average survival post-recurrence was 7.6 months. Survival post-recurrence for 8 patients was not improved by chemotherapy. Seventy-eight percent of recurrences had a distal component, with lung being the most common site.