Radiotherapy and conservative surgery in the management of musculo-aponeurotic fibromatosis.

Fifty-four patients with musculo-aponeurotic fibromatosis treated with surgery, surgery and planned post-operative radiotherapy, or radiotherapy alone between 1936 and 1982 have been retrospectively reviewed. Twenty-seven patients had a previous excision before definitive treatment. All patients in whom surgery was known to be incomplete and who had no further treatment relapsed. Nine patients had a complete surgical excision alone and 1 relapsed. Twenty-nine patients were treated with surgery and post-operative radiotherapy and 7 relapsed. Relapse was associated with small field size, orthovoltage irradiation, and doses less than 50 Gy. Radiotherapy was effective in preventing relapse in 6 of 8 cases incompletely excised and in all of these cases the total dose was more than 50 Gy. In 13 assessable patients with clinically evident disease, 14 fields were treated with radiotherapy. Complete response was achieved in 9 fields (although one subsequently relapsed and 2 had a marginal relapse), partial response in 4, and disease stasis in one. Complete resolution took up to 21 months and total doses ranged from 35.2 Gy to 64 Gy. Radiotherapy is indicated in cases of incomplete excision and inoperable disease. Doses should be radical and fields should be sufficiently generous to encompass the anatomical limits of the infiltrated tissues.

The myxoid tumors of somatic soft tissues.

Tumors and tumorous conditions of superficial and deep soft tissues may owe their naked-eye appearance and much of their bulk to the accumulation of mucopolysaccharide material or, on rare occasions, to edema. The so-called myxoid tumors may be chondroblastic, fibroblastic, lipoblastic, myoblastic, or neurogenic. Benign and malignant tumors may be encountered. Naked-eye and microscopic appearances are described. Pseudotumors such as bursae, ganglia, cutaneous mucinoses, fasciitis, and myxoid cysts may enter the differential diagnosis. The value of accurate documentation is stressed. Histochemistry can make a limited contribution to diagnosis. The entities described have been examined with regard to alcian blue staining with and without pretreatment with hyaluronidase. Alcian blue staining in the presence of increasing concentrations of magnesium chloride has been investigated and found to be of value in the identification of tumors of chondroblastic origin.

Lymphangiosarcoma arising in chronic congenital and idiopathic lymphoedema.

A case of lymphangiosarcoma arising in chronic congenital and idiopathic lymphoedema is presented. The literature is reviewed and the diagnosis discussed.

Malignant granular cell myoblastoma.

A case of granular cell myoblastoma which metastasized with fatal results is described. The literature relating to similar cases is reviewed and a total of 13 acceptable cases is listed.

Elastofibroma.

Three cases of elastofibroma are described and the literature is reviewed. It is suggested that they are non-neoplastic lesions resulting from trauma. Their staining reactions and the response of the elastic type fibres to enzyme digestion suggest that these fibres are either true elastin or very closely related to it.

Monophasic synovial sarcoma--a histological entity?

Consideration is given to the concept of a histologically identifiable monophasic type of synovial sarcoma. It is accepted that a sarcomatous tumour may be encountered where the spindle cells assume a somewhat epithelioid appearance associated with a reticulin pattern unlike that of most other spindle cell sarcomas. The appearance should alert a hsitopathologist to the possibility of a synovial sarcoma and prompt the examination of multiple additional sections in an attempt to find the pathognomonic biphasic pattern. It is not, however, believed that an entire tumour composed of cells of a single type could be identified with certainty as a synovial sarcoma by light microscopy. The term monophasic synovial sarcoma is worthy of retention, but only as a guide towards the establishment of a definite diagnosis by further sampling of the specimen. Other features suggestive of this diagnosis are discussed.

Two types of soft tissue sarcoma of uncertain histogenesis.

A brief account is given of two types of rare soft tissue sarcoma of uncertain histogenesis. The danger of mistaking the epitheloid sarcoma for a benign lesion is emphasized.

The unsuspected soft tissue chondrosarcoma.

Five cases of undifferentiated soft tissue sarcomas have been studied with particular reference to the identification of their mucosubstances. The use of alcian blue in solutions of magnesium chloride is described. It is suggested that undifferentiated soft tissue chondrosarcomas may be missed owing to inadequate investigation.

Histochemical characteristics of muco-substances in three soft-tissue tumours.

The mucosubstances present in myxoid liposarcomas, malignant fibrous histiocytomas and intramuscular myxomas were investigated. The results suggest that such investigations are unlikely to provide a useful diagnostic aid in these three lesions.

Liposarcoma. A review of 60 cases.

Sixty cases of liposarcoma are presented. The pathological appearances, clinical features and methods of treatment are described. The overall 5-year survival was 64%.

Cytophotometric investigation of the Feulgen-DNA content of cell nuclei of fibrous histiocytomas.

The cytophotometric determination of the Feulgen-DNA content of cell nuclei was performed on 72 fibrous histiocytomas. From the histograms, three variants of this neoplasm could be delineated and there was a fairly good correlation between the type of histogram and prognosis. With the exception of the benign dermal fibrous histiocytomas there was no correlation with the histological sub-types.

Hodgkin's disease. A clinico-pathological study of 250 cases with a 5-year follow-up.

Two hundred and fifty cases of histologically proven Hodgkin's disease have been reviewed. These cases were classified according to the Rye Conference histological classification (Lukes et al., 1966a) and according to the Cross classification (Cross, 1969). Overall, both classifications were reasonably effective in predicting prognosis but that of Cross with its seven sub-groups proved more difficult to use than the simpler Rye classification. In all cases the follow-up period exceeded 5 years. A study was made of the influence of clinical symptoms on survival with particular reference to night sweats, fever, pruritus, anorexia, lassitude, weight loss, haematological abnormalities and splenic enlargement. The presence of these abnormalities adversely affected prognosis. The spread of the disease from one group of nodes to the next was also documented. Considering all cases the 5-year survival was 54%. The 5-year survivals according to histological type were: lymphocytic predominance 69%, nodular sclerosis 57%, mixed cellularity 41%, lymphocytic depletion 40%. The 10-year survival was 23% which, when corrected by the actuarial method (Berkson and Gage, 1950), rose to 36%. The importance of symptomatology as well as histological grading in the prognosis of Hodgkin's disease is confirmed.