Carcinoma of unknown primary site: development in a single institution of a prognostic model based on clinical and serum variables.

PURPOSE: To identify clinical and biologic variables with significant impact on survival in patients with carcinomas of an unknown primary site (CUP) and to develop a simple prognostic model. PATIENTS AND METHODS: In this retrospective study, univariate and multivariate prognostic factors analyses were conducted in a population of 100 patients with CUP. Patients with features requiring well defined treatments had previously been excluded. RESULTS: Overall survival (OS) was significantly related to the following pretreatment adverse prognostic clinical factors: a poor performance status (2 or 3), weight loss more than 10% in the last six months, the presence of liver metastases and more than two metastatic sites. Two biological parameters predicted a significantly shorter survival: elevated serum levels of alkaline phosphatase and of lactate dehydrogenase. In the multivariate analysis, only two independent adverse prognostic parameters were retained: a poor performance status and the presence of liver metastases. We developed a prognostic model for OS based on the following subgroups: good prognosis (PS 0 or 1 and absence of liver metastases), intermediate prognosis (PS> or =2 or presence of liver metastases) and poor prognosis (PS> or =2 or presence of liver metastases). Median OS for the three groups was 10.8, 4 and 1.9 months respectively, p<0.0001. CONCLUSION: A simple prognostic model using performance status and presence of liver metastases was developed. It allowed the assignment of patients into three subgroups with different outcomes. Treatment strategies could be adapted for each subgroup. We think that this prognostic model could be useful and should be validated in other patient series.

[Peritoneal mesothelioma: an inusual clinical presentation in a patient without exposure to asbestos]. / Mesotelioma peritoneal: una presentación clínica inusual en un paciente sin exposición al asbesto.

Malignant mesothelioma is an insidious neoplasm arising from the mesotelial surfaces, of the pleural and peritoneal cavities, the tunica vaginalis, or the pericardium. The predominant cause is inhalation exposure to asbestos. We present a rare case of primary malignant mesothelioma of the peritoneum in a 64 year old man without history of inhalation exposure to asbestos. The initial symptoms were constitutional syndrome and right pleural effusion. Positron emission tomography combined with computed tomography (PET/TC) was useful for a supporting diagnosis and to determine the extension. The patient received treatment with systemic palliative chemotherapy, cisplatin-pemetrexed. After three cycles, partial response was observed, but the evolution was fatal due to secondary toxicity of chemotherapy.

[Meningeal myelomatosis as an exclusive form of recurrence in a case of IgA-lambda myeloma in complete systemic remission]. / Mielomatosis meníngea como forma exclusiva de recaída en un caso de mieloma IgA-lambda en remisión completa sistémica.

Meningeal myelomatosis is an extremely rare clinical presentation generally associated to terminal states of the disease and is more frequent in the presence of peripheric plasmocytosis or leukemia of the plasmatic cells. Diagnosis requires its demonstration in the cephalorhachidian liquid and its monoclonal secretion. A case of relapse of meningeal myelomatosis in a patient with multiple IgA-lambda myeloma is presented in which the systemic disease fulfilled the criteria for complete remission.

[Tetracycline pleurodesis for treatment of malignant pleural effusions. Retrospective study of 91 cases]. / Pleurodesis con tetraciclinas en el tratamiento del derrame pleural maligno. Estudio retrospectivo de 91 casos.

BACKGROUND: Malignant pleural effusions (MPE) are a common complication in patients with advanced neoplasms. Even though no large series confirming this exist, tetracycline pleurodesis has become the therapy of choice. The aim of this retrospective study was to evaluate its efficacy, adverse effects and possible factors predicting the success of the method. METHODS: Between 1985 through 1991, 91 patients with cytologically or histologically confirmed MPE were treated with 1,000-1,500 mg tetracycline pleurodesis. There were 49 females and 42 males, with a mean age of 59 years. The most common malignancies were lung, breast and unknown primary carcinomas. 85% patients complained of dyspnea and the volume of the effusion was moderate in half the cases. 12 variables were analyzed in relation with the probability of response through chi 2 test; survival and recurrence times were calculated with Kaplan and Meier's method. RESULTS: 73 patients were evaluable, with a 67% response rate (22 complete, 27 partial). Time to relapse was significantly higher for partial responses (mean 112 days) than for failures (mean 33 days). 37 patients presented mild complications (pain and fever). Karnofsky performance status (70% or greater), size of the effusion (small or moderate), chest radiograph (only effusion) and pleural LDH (600 U/l or less) attained favourable prognostic significance. Median survival was reached at 6 months. CONCLUSIONS: Tetracycline pleurodesis is an effective and well-tolerated paliative treatment for MPE. Along with other known parameters (pleural pH and glucose levels), Karnofsky performance status, size of the effusion, chest radiograph and pleural LDH allow to predict its results and optimize its indications.

[Thymomas]. / Timomas.

Thymomas are non-frequent neoplasias which are interesting because of their special association with the immune system pathology; although the pathogenic relationship has yet to be confirmed. A literature review is carried out on clinical aspects, prognosis and treatment, basically chemotherapy in advanced cases. Although they are classically categorized as benign, they are nevertheless considerably aggressive and maintain a low response to most active oncology treatment.

[Undifferentiated small cell tumor of the thoracopulmonary region]. / Tumor indiferenciado de células pequeñas de la región toracopulmonar.

The group of rounded small-cell tumors include different neoplasias involving different therapies; we can name neuroblastoma, Ewing' sarcoma, embrionary rhabdomyosarcoma, lymphoma and other pathology such as Askin's tumor or small cell tumor of the thorax area. Based on microscopic and immunohistochemistry findings, it is suggested that it originates from the neural crest or pluri-potential cells from the neuroectodermy. This has a very aggressive behaviour and is usually resistant to oncologic therapies.

[Synchronous presentation of thyroid carcinoma and malignant lymphoproliferative disease: report of 3 cases]. / Presentación sincrónica de carcinoma de tiroides y enfermedad linfoproliferativa maligna: a propósito de tres casos.

Multiple primary neoplasms are increasing in clinical practice, which is mainly due to the longer survival of cancer patients. Radiotherapy at an early stage of Hodgkin disease or lymphoma is well known to be associated with the future occurrence of secondary thyroid cancer. Nevertheless, the synchronous presentation of these two types of neoplasms is exceptional. We report here three cases of synchronic diagnosis of thyroid carcinoma and a malignant lymphoproliferative disease in patients who had not previously received radiotherapy nor chemotherapy. In malignant tumours of synchronic presentation, there is usually and underlying genetic predisposition involved in the etiology. In our patients, no carcinogenic environmental factor was demonstrated and, while this neoplastic association might be casual, an investigation on the possible individual predisposing factors would be warranted.