Cancer
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A 14-month-old infant had a classical Wilms' tumor of the left kidney and subsequently developed a tumor showing predominantly mature mesenchymal elements and lack of cellular atypia in the right kidney. His father had classical Wilms' tumor of the left kidney. ⋯ The possible relation of chemotherapy to mesenchymal differentiation and maturation in Wilms' tumor is considered. The possibility of an unusual, histologically benign, mesenchymal variant in the spectrum of infantile nephroblastic neoplasia is also suggested.
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A case of fatal myeloencephalopathy secondary to accidental intrathecal administration of vincristine is reported in a 16-year-old boy. He underwent a progressive ascending chemical meningoencephalitis leading to coma, and died 36 days after the injection. Multiple samples of cerebrospinal fluid (CSF) and serum were assayed for vincristine sulfate. ⋯ The presence of numerous gemistocytic astrocytes, some in arrested mitosis, was a conspicuous feature in these areas. Three previous reports of intrathecal vincristine instillation are reviewed. No treatment for this devastating iatrogenic error exists, underscoring the importance of preventive measures in chemotherapy administration.
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Vasitis nodosa is a benign reactive condition characterized by nodular thickening of the vas deferens which usually develops following vasectomy. In addition to chronic inflammation, fibrosis and sperm granulomas, an exuberant proliferation of ductules resembling invasive adenocarcinoma is seen. A review of vasa deferentia from 210 patients submitted to the surgical pathology service at Arizona Health Sciences Center yielded ten cases of vasitis nodosa. ⋯ Two additional cases were referred to us, one of these showing ductular epithelium around a small peripheral nerve. The aggressive and infiltrative nature of the proliferating ductules in this relatively common benign lesion is important to recognize. Since nerve involvement has also been reported in fibrocystic disease of the breast, normal and hyperplastic prostate, and normal pancreas, it cannot be used as evidence for malignancy in these situations.
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Ten of 16 consecutive patients (63%) with Stages III-IVA soft tissue sarcoma presenting between 1975 and 1978 and treated with surgery, radiotherapy and adjuvant chemotherapy have remained disease-free with a median follow-up of three years (range, 28-68 months). Survival at three years was 86%. However, in the American Joint Committee (AJC) soft tissue sarcoma staging system published in 1977, Grade 3 soft tissue sarcomas were associated with a three-year survival of 35% and almost 90% of the patients destined to fail did so within three years of diagnosis (8). ⋯ Cases survived significantly longer than controls at three years (p less than 0.001) and, in fact, disease-free survival of cases (63%) was superior to overall survival of controls (27%) (p less than 0.01). Our data support the conclusion that patients with high-grade soft tissue sarcoma treated by an experienced multimodality team have a three-year disease-free survival of approximately 63%. The impact of each component of multimodality therapy cannot be determined, and improved survival may result, in addition, from improved diagnostic and staging techniques currently available.
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The basement membrane of basal cell carcinoma was characterized by indirect immunofluorescence using antibodies to laminin, type IV collagen, and bullous pemphigoid antigen, three distinct protein components of basement membrane. Aggregates of basal cell carcinoma in the dermis were surrounded by a continuous basement membrane containing laminin and type IV collagen; however, bullous pemphigoid antigen was either completely undetectable or faint and discontinuous rather than linear. ⋯ Basal cell carcinoma was the only tumor examined in which there was a specific antigenic defect in the basement membrane. This defect in bullous pemphigoid antigen may be due to abnormal synthesis by the tumor cells and could be related to the absence of differentiation of these cells.