Tumori Journal

The WHO Histological Classification of Breast Tumors, published in 1968 has been completely revised. This second edition provides a recommended nomenclature, definitions and code numbers for both tumors and tumor-like lesions. It aims at promoting uniformity in recording and reporting diagnoses in order to facilitate international and other comparisons.

The morphologic patterns of mammary tumors induced by milk-transmitted C3H and RIII murine mammary tumor viruses (MuMTVs) in BALB/c hosts infected by foster nursing were investigated further and compared taking into account several tumor and host variables. Comparison of BALB/cfC3H and BALB/cfRIII mammary tumors under identical tumor and host conditions showed highly significant differences in subgross morphology and histologic structure. Differences in cytology were also observed. Data suggest that mammary tumor morphology in high cancer strain mice is controlled by the causative MuMTV.

Antithrombin III (AT III), the primary inhibitor of plasma protease coagulation proteins, was evaluated in groups of patients with different neoplastic disease. When compared with that of 25 healthy subjects, the mean value of AT III biologic activity was elevated in all groups, significantly in gastrointestinal (p < 0.02) and lung (p < 0.001) tumors, lymphoma (p < 0.02) and in the group with various primary cancers (p < 0.05). No difference was found between 46 patients tested under chemoradiotherapy and 216 patients who had not undergone therapy for at least 1 month. Four patients with clinical thrombosis had normal AT III biologic activity. Of the 262 patients studied, 14 had low AT III biologic activity without clinical thrombosis and normal protein concentration. In 71 patients (27%) an excess of immunoassayable protein of 20% or more over biologic activity was found. Double immunoelectrophoresis performed in 5 of these showed for 3 patients an enlarged second arc of precipitation. Moreover, no correlation was observed between the activity and protein AT III concentration (r = 0.05). The likelihood of the presence of circulating AT III-protease complexes is discussed.

The radiograms of the chest and skeleton of 49 patients with advanced breast cancer treated with bilateral ovariectomy were reviewed. The modifications in the secondary localizations and/or their appearance after castration were compared with the findings of the clinical examination. Appearance or progression of intrathoracic lesions, like the appearance or progression of osteolytic lesions, corresponded to a progression of the disease in other sites. Osteoblastic evolution of osteolytic lesions and the appearance of osteoblastic lesions in bones undamaged before ovariectomy were signs of a favorable response to therapy. The response of chest and bone metastases is usually rather early, and the first radiographic survey should be performed about 3 months after ovariectomy.

The possible correlations between steroid receptor systems, 17-β-HSD and histopathologic examinations were investigated. The well-differentiated tumors showed higher steroid receptor and 17-β-HSD values than undifferentiated carcinomas. The steroid receptors did not present a statistically significant correlation with 17-β-HSD. Nevertheless, some neoplastic endometria (29%) show higher values of progestin receptors and 17-β-HSD, with a progestin: estrogen receptor ratio greater than one.

The incidence as well as the morphologic features of early gastric cancer observed in 41 cases during the last 5 years are reported. The incidence of early gastric cancer was 9.11% among the total gastric carcinomas seen during the above period. As regards age and sex, the patients suffering with early as well as advanced gastric cancer revealed insignificant variation. With gastric biopsies, the diagnostic accuracy was 88.5%. There were multifocal lesions in 29.2% of cases with a total of 85 foci. Type IIc was the predominant macroscopic lesion, followed by type III. The antrum and the angularis of the lesser curvature were the main sites for early gastric cancer. The intestinal and well-differentiated types of early gastric cancer were the main histologic features seen. Diffuse type and submucosal lesions were more frequent in 6 (14.6%) cases observed with regional lymph node metastases. Our study revealed that there has been a gradual increase in the number of gastric biopsies, early gastric cancer, and the early: advanced gastric cancer ratio.

In recent years whole lung tomography (WLT) has been considered mandatory in the staging of some neoplastic diseases, particularly of soft tissues and bone tumors. Since WLT is an exacting roentgen examination, its usefulness was evaluated by analysing 132 consecutive patients submitted to orthogonal chest roentgenograms and WLT, from January 1979 to October 1981 at the National Cancer Institute of Milan. A comparison between WLT and traditional chest X-ray examination was performed in order to evaluate how much tomography is significantly useful in improving diagnosis of lung metastases. From this analysis, the authors conclude that WLT is generally unnecessary when chest roentgenograms are negative, whereas it is useful when single or multiple lung metastases are already evident by traditional X-ray examination. In these cases WLT allows a more accurate identification of the metastases from the point of view of their number and site, which is important not only for the treatment choice but also for the check of its effectiveness.

Our retrospective and unrandomized clinical study covers 317 squamous cell carcinomas of the oral cavity initially N0 and treated with curietherapy from January 1959 to December 1970. Upon conclusion of the treatment on T, a radical dissection of the neck was performed only on 110 patients (34.7%) and the other 207 were not submitted to surgery. The incidence of N0 N+ cases was 27.3% (30/110). The clinical evolution showed that in the group not submitted to radical dissection 53 of 179 cases (29.6%) with adequate follow-up had lymph nodal relapses; 15/69 of these were initially T1 (21.7%) and 38/110 initially T2,3 (34.5%). The data concerning clinical evolution and analysis of the survival curves for the 2 groups supply arguments in favor of the systematic treatment of the lymphatic areas of the neck in initially N0 oral carcinomas.

From February 1981 to September 1981, 16 patients (19 fields) with histologically proven malignancy (10 squamous carcinoma, 4 melanoma, 1 adenocarcinoma, 1 chordoma) were treated with hyperthermia combined with radiotherapy or chemotherapy (1 patient). There were 5 females and 11 males; average age was 65 years, range 45 to 94 years; 15 patients had a Karnofsky index greater than 50%. Hyperthermia (42.5 44.0 °C) was induced by 250 MHz to 1 GHz microwaves (BSD - 1000 Unit). Thermometry was performed by means of non-perturbing probes placed in intratumorally inserted catheters and by measurement of skin temperatures. After hyperthermia plus radiotherapy (18 fields), 9 patients showed 100% response, 5 a volume regression of more than 50%, 3 less than 50% and 1 no change. After chemotherapy plus hyperthermia, 1 patient showed no change. No significant side effects were observed (3 skin burns in 147 hyperthermia treatment sessions).

Two cases of acute lymphatic leukemia treated with VM 26 underwent a severe cardiovascular syndrome with hypertension and cardiac failure. The first patient, a 9-year-old boy, after the appearance of hypertension suffered from serious cerebral hemorrhages which were lethal. The second patient, a 12-year-old boy, also developed hypertension with retinal hemorrhages and cardiac failure. Hypertension was, however, controlled, the patient recovered, and at present he is in remission. Although cardiovascular toxic effects are not frequent after administration of VM 26, they should be known to the medical oncologist so that treatment of this side effect may be introduced at the first appearance of the symptoms.

Five of 40 patients with chronic myeloid leukemia (CML) had lymphoid blast crisis and 4 of them achieved complete remission of metamorphosis with vincristine and prednisone. While in hematologic remission, two of these subjects developed meningeal leukemia. Clinical and biologic data indicated that the course of the disease after lymphoid blast crisis was very similar to that of acute lymphoblastic leukemia (ALL). It is suggested that patients with CML who develop lymphoid blast crisis should be treated with an intensive therapeutic protocol including early prevention of meningeal leukemia.

A case of angioimmunoblastic lymphadenopathy with transformation into a lymphoplasmacytoid malignant lymphoma is reported. The immunoperoridase method showed the polyclonality of the cells of the angioimmunoblastic lymphadenopathy and the monoclonality of the cell population of the malignant lymphoma.

The clinical features and the treatment results of 15 patients with solitary plasmacytoma of the spine observed in a 28-year period (1950–1977) are reported. The signs at presentation were back pain in 4 cases and spinal cord compression in 11 cases. Three of these patients had paraplegia. Radiologically, the alteration encountered was an osteolytic lesion in all cases. The local treatment was radiotherapy in 11 cases and surgery plus radiotherapy in 4 cases. In 3 patients systemic chemotherapy was also employed. Seven patients are alive without signs of disease 3 to 9 years (mean 6 years) after diagnosis. Eight patients developed multiple myeloma in a period ranging from 1 to 8 years (mean 3.5 years). The relationship between multiple myeloma and solitary plasmacytoma of the spine, as well as the best treatment for the latter, are discussed.