Tumori Journal

Probabilities of cancer death in Italian males and females over the calendar period 1955 to 1980 were computed from age-specific death certification rates for various neoplasms and contemporary general life tables of the whole Italian population. There were substantial increases in eventual probabilities of total cancer mortality: from 16.9 to 27.1 % for males and from 15.2 to 19.3 % for females. The upward trends were particularly large for lung (from 1.9 to 7.2 %) and other tobacco-related sites in males. In females, the largest increases were for neoplasms of the intestines (from 1.6 to 3.0 %) and breast (from 1.9 to 3.1 %). Separate analyses of probabilities of cancer death in specific age intervals showed more limited changes in middle age, and some moderate decrease at younger ages, probably attributable to improved treatment. The probability estimates presented are clearly based on criticizable assumptions, since they do not allow for any potential subsequent change in mortality and are inappropriate for analyzing the evolution of cancer rates because they reflect (in opposite directions) trends in cancer mortality and in all other causes of death. Nonetheless, a correct interpretation of these estimates does provide some important information from a public health viewpoint, in terms of resource allocation and health care planning, and can help quantify the increasing demand for oncologic services and structures over the next few decades.

An infantile carcinogenesis assay was carried out with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) injections administered intraperitoneally at 0, 1, 30 and 60 μg/kg b.w. doses to (C57BL/6J × C3Hf)F1 (B6C3) and to (C57BL/6J × BALB/c)F1 (B6C) mice, starting from the 10th day of life, once weekly repeated 5 times. Animals were then observed until 78 weeks of age. The induction of thymic lymphomas was related to treatment at 60 μg/kg dose level in both sexes of both hybrids, and at 30 μg/kg dose level in both sexes of B6C mice and in male but not female B6C3 mice. The incidence of hepatocellular adenomas was increased by TCDD treatment at 60 μg/kg dose level in B6C3 of both sexes but not in B6C mice. Hepatocellular carcinomas were seen at increased incidence at 30 and 60 μg/kg doses in B6C3 males but not in B6C3 females or in B6C mice of both sexes. The incidence of other tumor types was not related to treatment in both hybrids. A long-term carcinogenesis bioassay with TCDD was carried out in B6C3 mice treated by gavage at 0, 2.5 and 5.0 μg/kg b.w. doses from 6 weeks of age, once weekly for 52 weeks. The animals were observed until 110 weeks of age. An increased incidence of hepatocellular adenomas and carcinomas was related to treatment, at both doses and in both sexes. The incidence of other tumor types was uniformly low in treated and control groups, without any association with treatment, in both sexes.

Cell survival in response to doxorubicin (Dx) and cis-diammine-dichloroplatinum (cis-Pt) administration, either alone or combined with hyperthermic treatment, was analyzed in human osteosarcoma (U-2-OS), murine melanoma (B16V) and murine leukemia (P388) cell lines and in Dx-resistant sublines derived from B16V and P388. In all cell lines tested there was an enhancement of drug toxicity by hyperthermia. In U-2-OS, the increase was more pronounced for cis-Pt than for Dx. In B16V and in P388, the increase in Dx toxicity was of the same degree in Dx-senstitive and Dx-resistant sublines, whereas heat-induced sensitization to cis-Pt was higher in Dx-resistant sublines than in their Dx-sensitive counterpart. Analysis of the protein pattern in the various cell lines showed that the synthesis of heat-shock proteins induced by heat was not influenced by the combined use of drugs and heat. Moreover, in spite of some differences in the overall protein pattern, no significant differences in the basal levels of heat-shock protein synthesis or in the extent of its induction after heat shock were observed between murine cell lines relatively sensitive to Dx and their corresponding selected resistant cells.

A 54-year-old woman presented with hepatosplenomegaly, anemia, neutropenia and lymphocytosis. Most peripheral blood lymphocytes had the surface antigens T3+, Leu11+ and were morphologically large granular lymphocytes. Bone marrow presented 60 % lymphoid infiltration. Treatment with chlorambucil produced complete reversal of hepatosplenomegaly, anemia, neutropenia and lymphocytosis, and reduction of marrow infiltration. The patient is well 12 months after discontinuation of therapy.

Between February 1982 and June 1984, 36 previously untreated patients with high-grade non-Hodgkin's lymphomas (NHL) according to the Kiel classification were treated with an intensive therapeutic regimen including cyclophosphamide, vincristine, doxorubicin, prednisone, cytarabin, VM 26 and local radiotherapy on bulky disease. Twenty-three patients (64 %) achieved a complete remission and 11 patients (30 %) had a partial response. Over a median follow-up from the diagnosis of 32.5 months, the overall survival was 55 %; relapse-free survival for complete responders was 56.5 %. Toxicity was irrelevant. This regimen was effective in the treatment of high-grade NHL, but probably needs intensification and rotation of different drugs.

The follow-up data on 39 cases of stage I malignant melanoma treated with CO₂ laser are compared to those of an analogous group of cases treated by traditional surgical methods and selected for their clinical and pathologic similarities with the laser-treated group. The findings were expressed in terms of tumor-free time and were evaluated by variance analysis. The data showed that traditional methods gave better results. CO₂ laser surgery requires longer healing time, which may have a negative effect on the course of the disease.

Three hundred and thirty consecutive cases of resected Stage Ia (TNM UICC classification) lung carcinomas were retrospectively reviewed with the aim of evaluating actuarial probabilities of recurrence within the 5th year from operation, according to the extent of resection, the cell type, and the T number. The probabilities of recurrence according to the pattern of failure were also assessed. Five-year overall probability of recurrence was 46.3 %. Pneumonectomies showed a lower rate of relapse (37.4 %) than lobectomies (49.2 %), even though non significant. However, patients submitted to a lobectomy had a higher rate of 5-year survivors. Cell type had no significant impact on the probability of recurrence. 35.5 % of patients with T1 carcinomas had evidence of relapse compared with 51.1 % of patients with T2 tumors. This datum is explained by the presence in T1 group of a high share of squamous cell cases. Patients with T1 squamous cell carcinomas had, in fact, the best prognosis (26.5 % recurred) among the subgroups obtained by stratification of T number and cell type together; loco-regional failure as exclusive modality of relapse had a 5-year rate of 19.7 % and metastatic failure of 30.0 %. Adenocarcinomas had a significantly higher impact on the occurrence of brain metastases.

This paper represents a historical analysis of the results achieved by esophageal cancer surgery over the last three decades, as they appear in the literature of the years 1954–1985, and in our own experience between 1965 and 1985, with the aim of assessing the evolution of operative mortality and long-term survival. In a review of 4930 resections reported in western literature, mean values of perioperative mortality went down from 30 % to 9 %, while the five-year survival increased from 8 % to 19 %. Similar changes were evident in Japanese and Chinese literature where the survival rose from 9 % to 23 % in unscreened populations and up to 90 % in early cancers. In our experience, dividing the series in two decades (1965–74 and 1975–85), the overall perioperative mortality changed from 28 % to 13 %. The actuarial survival for the two periods was 8 % vs 18 % at 5 years, with a median survival of 9 and 18 months. A greater difference was evident for NO patients where the survival rose from 15 % to 35 % at 5 years, with a median survival of 15 vs 38 months.

A total of 1652 endoscopic cytologic brushings from 1181 patients, 823 males aged 15 to 87 years and 358 females aged 21 to 88 years, were examined. From these we diagnosed 96 carcinomas, 69 in males and 27 in females. In 1621 samplings from 1151 patients it was possible to compare the cytologic and histologic diagnoses. To evaluate the diagnostic accuracy of both methods, brushing and biopsy, used separately or in association, we analyzed 81 cases where gastric cancer was confirmed by histologic examination of the removed stomach. The sensitivity rate of the cytodiagnosis was 88.3 % and that of histology was 93.4 %. Combining the two methods gave a sensitivity yield of 96.2 %. These values are among the highest reported in the literature and confirm the utility of combining both methods for diagnosing gastric carcinoma.

Sixteen patients affected by epidermoid carcinoma of the anal canal were treated preoperatively by means of an i.v. infusion of mitomycin C (15 mg/m²) on day 1 and 5-fluorouracil (750 mg/m²) days 1 to 5, followed by radiotherapy (3000 R in 3 weeks). Four to 6 weeks after the end of radiotherapy the response to the preoperative treatment was evaluated by means of biopsy. A reduction of the neoplastic mass was observed in 13 of the 16 patients. An evident correlation exists between the stage of the tumor and 1) the response to preoperative treatment, 2) local recurrence, and 3) long-term survival. In fact: 3/4 T1 patients reached a complete response (CR), and 1/4 T1, 5/5 T2 and 4/7 T3 patients achieved a partial response (PR); only 3/7 T3 patients never responded to preoperative treatment. After the initial surgery, only T2 (3/5) and T3 (4/7) patients underwent a second operation for a recurrence. Overall survival at 42 months was 62.5 % (T1, 100 %; T2, 80 %; T3, 28.5 ²%).

Forty-nine patients classified after surgery and complete non-surgical restaging as « no residual disease » were treated with adjuvant chemotherapy. Thirty-nine patients had ovarian carcinoma and 10 borderline tumors. All patients had geographic inaccessibility. Domiciliary treatment with melphalan at the dose of 10 mg/day p.o. for 5 consecutive days every 4 weeks for 12 cycles was used. Within 6 months from the end of adjuvant treatment a second restaging with peritoneoscopy and peritoneal cytology was performed. The median administered dose of melphalan was 575 mg. No patient with a borderline tumor relapsed. Nine patients with ovarian carcinoma relapsed (23 %): 4/10 at stage II-III and 5/29 (17 %) at stage I. The relapse-free survival at 96 months was 77 % for stage I patients and 73 % for all patients. The overall survival was 87 % for stage I patients and 81 % for all patients. Mild myelodepression was evident in 65 % of patients. No case of acute nonlymphocytic leukemia was observed.

A case of lung cancer presenting with cardiac tamponade is reported. Lasting control of the malignant effusion was achieved by means of intracavitary cisplatin following pericardiocentesis. The patient presented an objective response to subsequent systemic chemotherapy and died 10 months after the diagnosis because of disseminated cancer, without clinical or instrumental findings of pericardial effusion.

The authors describe a case of a female patient, who presented with a rapidly expanding mass of the right breast as the first clinical sign of a Burkitt-like lymphoproliferative disorder. Massive bone marrow infiltration with leukemic spillover and limited lymph node involvement were subsequently detected. The difficulties encountered in classifying, according to current schemes, the observed lymphoid neoplasm are emphasized. Moreover, an evaluation of the true rarity of mammary localizations at the onset of lymphoid malignancies, based on a review of the literature, suggests, especially for the most malignant varieties, a higher frequency than supposed.

A case of focal severe atypical hyperplasia-carcinoma in situ discovered during voluntary abortion is described. The patient did not undergo hysterectomy; after abortion, menses were regular and the endometrium was histologically normal at a control. Ten cases of endometrial epithelial neoplasia in pregnancy (9 cases) or in puerperium (1 case) found in the literature were reviewed. Although in some of them stromal invasion, which actually is the main prognostic indicator of endometrial neoplasia, was absent or not documented, all lesions were designated as adenocarcinoma. There is evidence that young women with a noninvasive neoplasm and desiring children or preservation of the uterus may be treated conservatively even if the lesion is detected in pregnancy or puerperium.

It is known that prolonged therapy with cytotoxic drugs may affect the endocrine system. The present study was carried out to establish whether administration of chemotherapeutic drugs acutely influences hypophyseal and pineal activities. Nineteen patients affected by solid tumors were included in the study, 5 of whom were treated with CMF, 4 with FEC, 4 with CEV, and 6 with CDDP. Cytotoxic drugs were intravenously administered. Venous blood samples were collected at zero time and at 30, 60, 120 and 180 min after drug administration. On a separate occasion, venous blood samples were drawn during a saline infusion only. In each sample FSH, LH, GH, PRL, TSH, Cortisol, melatonin and β-endorphin were determined by the RIA method. The only significant changes observed in this study were a rise in PRL and a decrease in β-endorphin after CDDP administration. Melatonin was enhanced after CDDP and CMF, and Cortisol decreased after CMF and FEC, but their variations were not statistically significant with respect to those seen during saline infusion.

A case of renal clear-cell carcinoma presenting as a nodular thyroid metastasis is reported. The possibility of a metastatic lesion from the kidney should be taken into account in each case of clear-cell thyroid lesion. Fine needle aspiration cytology may be unable to discriminate between the renal or thyroid origin of such lesions unless PAS staining is performed.

A 41-year-old woman was operated on for severe hyperparathyroid syndrome. At surgery a parathyroid tumor with the histopathologic pattern of carcinoma was found. After surgery serum calcium settled within normal limits (10.5 mg/dl, N.V. 8.5–10.8), whereas parathormone and calcitonin reached progressively high levels, respectively 400 ng/dl (N.V. up to 250) and 500 pg/ml (N.V. up to 100 ng/ml). Serum ultrafiltration analysis for parathormone and calcitonin showed many peaks of immunoreactivity with high molecular weight of both hormones. One year after surgery, metastases developed in the lymph nodes of the neck and the mediastinal, pleural and pancreatic regions. After death for tumor wasting, immunohistochemical study of the tumoral tissue with the peroxidase-antiperoxidase technique showed a relatively high density of calcitonin-containing cells. The findings in this case suggest that: a) several cells in this parathyroid cancer could secrete both parathormone and calcitonin; b) the hormonal secretion was impaired as suggested by the high molecular weight of both hormones found at gel-filtration analysis; c) the macromolecular profile of parathormone could explain the apparent function of the parathyroid cancer.

Spindle-cell hepatocellular carcinoma is an unusual morphologic variant of hepatocellular carcinoma with a typical sarcomatous appearance. The exact diagnosis of this tumor may be difficult when only small biopsies are available and in the absence of ultrastructural studies. We describe two cases of hepatocellular carcinoma: one was entirely composed of spindle-shaped cells, and the other was a typical hepatocellular carcinoma with only a small area of sarcomatous, fusiform cells. In the first case, ultrastructural studies demonstrated desmosomes and many Mallory bodies and confirmed the epithelial nature of the neoplasm. In the second case, no ultrastructural studies were available, but the presence of gradual transition from liver cell carcinoma to spindle-cell carcinoma excludede the diagnosis of carcino-sarcoma.

A case of hepatocellular carcinoma that underwent total necrosis without previous chemotherapy is described. Histologic examination of the neoplasm revealed massive thrombosis of numerous peritumoral venous vessels in the adjacent normal liver. Although the importance of a newly formed arterial blood supply for the maintenance of the viability of hepatocellular carcinoma is unquestionable, this case suggests a similar importance of the venous drainage of the surrounding liver.