Psychological impact of referral to an oncology hospital on patients with an ovarian mass.

OBJECTIVES: In patients with an ovarian mass, a risk of malignancy assessment is used to decide whether referral to an oncology hospital is indicated. Risk assessment strategies do not perform optimally, resulting in either referral of patients with a benign mass or patients with a malignant mass not being referred. This process may affect the psychological well-being of patients. We evaluated cancer-specific distress during work-up for an ovarian mass, and patients' perceptions during work-up, referral, and treatment. METHODS: Patients with an ovarian mass scheduled for surgery were enrolled. Using questionnaires we measured (1) cancer-specific distress using the cancer worry scale, (2) patients' preferences regarding referral (evaluated pre-operatively), and (3) patients' experiences with work-up and treatment (evaluated post-operatively). A cancer worry scale score of ≥14 was considered as clinically significant cancer-specific distress. RESULTS: A total of 417 patients were included, of whom 220 (53%) were treated at a general hospital and 197 (47%) at an oncology hospital. Overall, 57% had a cancer worry scale score of ≥14 and this was higher in referred patients (69%) than in patients treated at a general hospital (43%). 53% of the patients stated that the cancer risk should not be higher than 25% to undergo surgery at a general hospital. 96% of all patients were satisfied with the overall work-up and treatment. No difference in satisfaction was observed between patients correctly (not) referred and patients incorrectly (not) referred. CONCLUSIONS: Relatively many patients with an ovarian mass experienced high cancer-specific distress during work-up. Nevertheless, patients were satisfied with the treatment, regardless of the final diagnosis and the location of treatment. Moreover, patients preferred to be referred even if there was only a relatively low probability of having ovarian cancer. Patients' preferences should be taken into account when deciding on optimal cut-offs for risk assessment strategies.

External radiotherapy for carcinoma of the eyelid: report of 850 cases treated.

PURPOSE: We report a retrospective series of 850 patients treated by external irradiation for carcinoma of the eyelid at Institut Curie and we compare our results with other techniques: brachytherapy and surgery. METHODS AND MATERIALS: Eight hundred fifty patients were treated by external radiotherapy for carcinoma of the eyelid. None of these patients have been previously treated. All the patients were classified according to the TNM classification of (UICC). We distinguished five histological types and five clinical groups according to the site of the skin tumor. Three modalities of external radiotherapy were used: contact therapy, conventional radiotherapy, and electrontherapy. We reviewed the clinical files of the 850 patients who went regularly at follow-up visits. RESULTS: We report the 5-year survival results--alive with no evidence of disease: 72%; alive with progression: 2%; died from tumor progression: 0.5%; died from intercurrent disease: 19.5%; and lost to follow-up: 5%. The 5-year local control rate was 97.5%. We observed 45 failures--lymph node, metastatic, and local--and emphasize this last group by presenting the results of treatment of these local failures. We studied the complications of treatment: 2.3% of corneal complications, 2% of cataracts, and 1.4% of serious ocular complications. CONCLUSIONS: Our results concerning local failures and loss of the eye are comparable to those reported for other techniques involving brachytherapy or surgery. Overall, external radiotherapy is a safe and effective treatment, as it ensures a high local control rate and provides perfectly satisfactory functional and esthetic results. It seemed particularly useful to report this series in that few publications are available on this subject that, nevertheless, constitutes a topical issue.

Fine-needle cytology of 292 palpable orbital and eyelid tumors.

Fine-needle cytology (FNC) of 292 palpable orbital and eyelid tumors was performed with a 25-gauge (0.5-mm), 3-cm needle and compared with the histopathologic findings in 286 cases. Among these 286 cases, a concordant diagnosis of malignancy and type was achieved in 249 cases (87%). False positive diagnoses were made in four cases (1.6%) and false negative diagnoses in five cases (1.8%). No complications were encountered. These results led to the conclusion that FNC is an accurate tool in the diagnosis of orbital and eyelid tumors, especially when sampling and interpretation are performed by an experienced pathologist.

Cytogenetic forms of retinoblastoma: their incidence in a survey of 66 patients.

Sixty-six retinoblastoma patients were investigated using high resolution banding techniques, sister chromatid exchange (SCE) studies, and esterase-D phenotype determination and dosage. Seven patients (in six families) were found to be carriers of a rearrangement of band 13q14 due to de novo deletions, apparently balanced de novo translocations, or parental insertions. The possible role of submicroscopic parental insertions is suggested to explain transmission of nonchromosomal forms through unaffected carriers.

Spinal metastases with neurological manifestations. Review of 600 cases.

The authors have studied 600 cases of spinal metastasis causing a neurological syndrome. The most significant statistical data are reviewed. The cases are examined according to clinical characteristics, type of primary tumor, site of lesion, and survival. Each of these factors influenced the choice and results of treatment. As a general rule, combined treatment (surgery and radiotherapy) was used. Preliminary surgery was performed as an emergency, designed to halt progression of the neurological syndrome and to prevent its more serious manifestations. The technique and usefulness of surgery are discussed for different situations and the short-term results of treatment are related to the various factors involved.

Cytologic diagnosis of orbital and periorbital palpable tumors using fine-needle sampling without aspiration.

Sixty-two cases of orbital and periorbital palpable neoplasms were analyzed cytologically. The material was obtained by our technique of simply introducing a fine injection needle in the tumor mass without aspiration. Fifty-six of these tumors had a subsequent histologic diagnosis by surgical procedure or biopsy. Forty-nine of the 56 cytologic diagnoses (87%) were concordant with the histologic findings with regard to malignancy and its variety. In three other cases the diagnosis of malignancy was only achieved by surgical procedure or biopsy (5%). In two cases, there were false-malignant results (4%), one corresponding to a meningioma and the other related to a reactive lymphoid hyperplasia. There was one false-benign (2%) result in a case of non-Hodgkin's lymphoma. In one patient, the cytologic material was insufficient for diagnosis (2%). In six other cases, the initial cytologic examination was ultimately confirmed either by biochemical studies or by biopsies of nodal metastases. No orbital hemorrhage was observed after fine-needle sampling. This outpatient technique is highly accurate and permits diagnosis in a few minutes.

[Bone sarcoma and malignant tumors of the retina]. / Sarcomes osseux et tumeurs malignes de la rétine.

Secondary bone sarcomas are frequent among children who have been treated previously for a retinoblastoma. The main point is that these bone sarcoma occur almost always after a bilateral retinoblastoma and more often in the irradiated area; from these, the classical concept of "radiocancer" was generally admitted. However, since many authors reported bone sarcomas occurring in a different location from the irradiated area, radiotherapy cannot be by itself the causative factor of these secondary bone sarcomas. Therefore the genetical factor is probably one of the predisposing factor. The authors report 6 cases of bone sarcomas with a review of the literature of bone sarcomas occurring in the irradiated field or not, for children "cured" of retinoblastoma.

[Conservative treatment of tumors of the retina at the Curie Institute. Long-term results of 129 cases treated with Stallard's disk and electrons]. / Traitement conservateur des tumeurs de la rétine à l'Institut Curie. Résultats à long terme de 129 cas traités par disque de Stallard et électrons.

The authors report a retrospective study of 129 children with retinoblastoma treated from 1963 to 1977 at the Institut Curie by enucleation of the worst eye and conservative irradiation of the other eye; this irradiation was performed either with Stallard plaque (19 cases) or with electrons (110 cases). In 8 familial cases, no enucleation has been performed. T.E.M. was used from 1964 to 1973 and iterative photocoagulation since 1968. With a 5 years follow up, 88 children (68%) are living NED, 6 are lost. There was 34 treatment failures (26%) and 1 death from second malignant tumor. At 10 and 15 years, the results are stable despite the occurrence of two other second primary tumors. Irradiation preserved 73/94 (78%) of the irradiated eyes. The technical aspects of the radiotherapy with electrons and both ocular and vital prognostic factors are discussed.

[Conservative treatment of tumors of the retina at the Curie Institute. 5-year ophthalmologic results of 129 cases treated with the Stallard disc and electrons]. / Traitement conservateur des tumeurs de la rétine à l'Institut Curie. Résultats ophtalmologiques à 5 ans de 129 cas traités par disque de Stallard et électrons.

The authors report a retrospective study of 129 children with retino-blastoma treated from 1963 to 1977 at the Institute Curie by enucleation of the worst eye and conservative irradiation of the other eye; this irradiation was performed either with Stallard plaque (19 cases) or with electrons (110 cases). In 8 familial cases no enucleation was performed. T.E.M. was used from 1964 to 1973 and iterative photocoagulation has been performed since 1968. Five years absolute NED survival rate was 68% (88/129 children). In these 88 children, 94 eyes were irradiated. Ophthalmological results were as follows: 21 eyes were enucleate secondarily (20/21 were tumoral); the attempt of ocular conservation was succeeded in 78% of the cases: 73 of the 94 irradiated eyes were cured; among these 73 cured eyes, 4 had complications and 15 had sequelae; the others 54 eyes were normal; only 5 eyes escaped ophthalmological survey; for the other 68 eyes vision was evaluated: 2 eyes (3%) were functional but vision could not be measured; 10 (14%) had less than 1/10 of visual acuity; 14 (19%) had vision at least equal to 1/10 but less than 5/10; 42 (57%) had 5/10 or more. 62% of all irradiated eyes (58/94) and 79% of conservated eyes (58/73) had "useful vision". Results are discussed and compared with these published by other teams; the authors try to determine elements of visual prognosis.

The effect of peritoneal dialysis with and without aprotinin on acute experimental pancreatitis in rats.

Acute pancreatitis was induced in 139 Wistar rats by injection of trypsin in the common bilio-pancreatic duct. Peritoneal dialysis was performed in 93 rats. In some of these rats, aprotinin (250,000 UI/L) was added to the lavage fluid. Macroscopically, we noted the amount of steatonecrosis, pulmonary congestion and pleural effusion produced. The pancreatic and pulmonary lesions were studied microscopically. The effect of peritoneal dialysis with and without aprotinin on the survival rate was evaluated. Survival curves were established for the different groups of rats i.e. the non-treated group and the two groups of dialysed rats (with and without aprotinin). Peritoneal dialysis reduces the amount of steatonecrosis and the incidence of pulmonary complications of trypsin-induced pancreatitis in rats, but does not influence the pancreatic lesions. Peritoneal dialysis significantly improves the early survival rate. Addition of aprotinin to the dialysis fluid reduces the total mortality rate.

[Value of angiography in the surveillance of choroid melanoma treated by cobalt disk]. / Intérêt de l'angiographie dans la surveillance des mélanomes choroïdiens traités par disque de cobalt.

Conservative management of choroidal melanoma by radioactive plaques or protonbeam is widely used since 1968. The treatment of these tumors at Curie Institute has been done with cobalt plaques since 1968. Indications were first monophthalmic patients but are now much wide. We have been treating since 1981 all patients with tumor diameter less than 17 mm and tumor height less than 12 mm. The technic includes general anesthesia to place the disc with localisation of the tumor by transillumination or by indirect ophthalmoscopy. A dose of 70 to 90 grays is delivered to the apex of the tumor. We report two cases of patients treated by cobalt 60 plaque for choroïdal melanoma. The first patient has a 5 mm high choroïdal melanoma temporal to the macula. After treatment by cobalt plaque, he showed no echographic changes but angiograms revealed an hypofluorescent zone in the central part of the tumor. The second patient has an 8 mm tumor that after plaque showed only angiographic changes. Evolution after treatment of choroïdal melanoma by radioactive plaque is variable. Echographic changes are very low and it is frequent to observe no modification in the height of the tumor for a long time for this reason, repeated angiograms can be very useful in the follow up of these patients. They frequently show hypofluorescent spot in the central part of a tumor that was hyperfluorescent before treatment. Sometimes there is diffuse lowering of the fluorescence. We think that these modifications of fluorescence can be due to diminution of the vascularisation of the tumor or may be to central necrosis of the tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mucoepidermoid carcinoma of the conjunctiva. Clinical, histologic and ultrastructural study]. / Carcinome muco-épidermoïde de la conjonctive. Etude clinique, histologique et ultrastructurale.

Four cases of muco-epidermoid carcinoma of the conjunctiva are described, with an electron microscopy study in one case. Three patients were over 70 years and the fourth one 39 years old. In all cases, the tumor was primarily located close to the limbus and appeared as a quiescent corneoscleral ulcer or as a diffuse limbal thickening. Histologically, they showed an admixture of epidermoid and mucus secreting cells on alcian blue staining, and this was confirmed by electron microscopy. These tumors appear to be locally aggressive and rapidly recurring, and they invade the intra-ocular structures and/or orbit. One patient died 6 years after the onset of the disease. Prognosis is therefore poor and the lesion requires early treatment by wide local excision and a strict follow up for early detection of any recurrence.

[Enucleation technique for malignant melanoma of the choroid]. / Technique de l'énucléation pour mélanome malin de la choroïde.

The cancelling of the pulling with hooks and the dissection by thermocautery needs imperatively a coagulation of the vorticins. Cutting of the optical nerve with a tightening knot is made under cryogenic application on the tumor.

[Orbital sarcoma: results of treatment at the Curie Institute between 1922 and 1976 (author's transl)]. / Les sarcomes de l'orbite traités à l'Institut Curie de 1922 à 1976.

Analysis of the results of treatment in patients with orbital sarcoma at the Curie Institute, Paris, demonstrated that this previously incurable lesion can now be effectively treated by combined radiotherapy and chemotherapy. Late onset lesions have a better prognosis.

[Lichen of the conjunctiva]. / Le lichen de la conjonctive.

Lichen planus may occasionally involve the conjunctiva or other mucous membranes. Three new cases are described. Generally, white ridges appear on the palpebral conjunctiva, histological examination revealing inflammatory infiltration of the basal membrane, which is eroded by the infiltrate. The disease could be more frequent than indicated by the literature, but its treatment is usually disappointing.

[Allergic granulomatous nodule of the conjunctiva]. / Le nodule granulomateux allergique de la conjonctive.

Six cases of conjunctival allergic granulomatous nodules are reported. This benign lesion was described by Ashton and Cook in 1979. It is commonest in children and young people. Clinically it consists of one or more raised yellow nodules beneath the epithelium of the bulbar conjunctiva. Histologically these nodules consist of an amorphous eosinophilic material surrounded by epithelioid and giant cells arranged in a palisade; often some eosinophils are found in the inflammatory reaction. In the absence of surgical intervention these lesions can disappear spontaneously or after corticotherapy in a few weeks or months. According to Ashton and Cook these granulomas show the histologic feature of the Splendore Hoeppli phenomenon, that is, a giant cell and eosinophilic granulomatous reaction to an antigen-antibody precipitate in relation to parasite or fungi. In two cases Ashton and Cook found fragments of nematode larvae but usually no foreign bodies or parasites are identified in the lesions.

[Congenital anophthalmos. Control of osteogenesis with an expanding intraorbital prosthesis]. / Anophtalmie congénitale. Contrôle de l'ostéogenèse par prothèse expansive intraorbitaire.

Both congenital anophthalmia and severe microphthalmia lead to micro-orbit with early appearance of craniofacial hemiatrophy. There is simultaneous lack of development of the lids (which remain small but complete) and of the conjunctival sac. Use of esthetic ocular prosthesis is thus impossible. The conjunctival sac can be dilated with conformators of increasing size but this technique has no effect on the orbit. The results of repeated plastic surgery are unsatisfactory. Stimulation of ocular growth by an expandable prosthesis in early infancy would appear to be the most logical and effective therapy. The authors propose a "new" technique for the expansion of the orbital cavity of the congenital anophthalmia. They have deviced a silicone prosthesis which is progressively expanded in size. The device has now been in use for over eighteen months with really encouraging results (17 cases).

[Malignant melanoma of the conjunctiva and eyelids: analysis of prognosis in 56 cases (author's transl)]. / Le pronostic des mélanomes malins de la conjonctivite et des paupières: étude statistique sur 56 patients.

Long-term prognosis was analyzed by a retrospective study of 56 patients with malignant melanoma of the conjunctiva and the eyelids. Survival rate at 5 years was 85 p. cent, at 10 years 68 p. cent, and at 15 or 20 years 55 p. cent; neither the localization of the tumor nor the type of initial treatment had a significant influence on these rates. Local or nodal recurrences occurred in 80 p. cent of cases, and were frequent following conservative surgery; prognosis is bad after radiotherapy.

[Lymphangiomatous hyperplasia with eosinophilia; Kimura's disease (author's transl)]. / L'hyperplasie angio-lymphoïde avec hyperéosinophilie dite maladie de Kimura. A propos d'une localisation palpébrale.

Kimura's disease is a benign affection of young people in which there are non-specific subcutaneous nodules, mainly found in the region of the head. They can be identified by their particular histological appearance which includes vascular and inflammatory components, and by local and sometimes blood eosinophilia. The etiology is not known but could be allergic in nature.

[Ganglioneuroblastoma of the orbit]. / Ganglioneuroblastome de l'orbite.

Ganglioneuroblastoma a transitional tumor of sympathetic origin has not yet been described as involving orbit. It is characterized by a mixture of cells ranging from primitive neuroblast to well differentiated ganglion cells within a neurofibromatous tissue. The prognosis is uncertain, as the tumor may either undergo maturation into a ganglioneuroma or may metastasize widely and rapidly as in neuroblastoma. We may postulate a relationship between ganglioneuroblastoma and Recklinghausen's neurofibromatosis in view of the development of the tumor in conjunction with the phacomatosis.