PFAS contaminated asphalt and concrete - Knowledge gaps for future research and management.

Per- and polyfluoroalkyl substances (PFAS) are now widespread in the environment. Globally, airfields and paved firefighting training surfaces are particularly affected due to extensive use of aqueous film forming foams (AFFF). This PFAS contamination in exposed concrete and asphalt has not been widely addressed. This review focusses on PFAS interaction with concrete and asphalt, traversing extraction, analytical identification/quantification, PFAS fractionation via differential adsorption on organic and inorganic substrates, and reuse options for contaminated concrete and asphalt. A total of 24 knowledge gaps and management challenges for concrete and asphalt characterisation and management have been identified.

Tracking NSZD mass removal rates over decades: Site-wide and local scale assessment of mass removal at a legacy petroleum site.

Long-term estimates of natural source zone depletion (NSZD) rates for petroleum LNAPL (light non-aqueous phase liquid) sites are not available. One-off measurements are often thought valid over the lifetime of LNAPL sites. In the context of site-wide LNAPL mass estimates, we report site-specific gasoline and diesel NSZD rates spanning 21-26 years. Using depth profiles of soil gases (oxygen, carbon dioxide, methane, volatiles) above LNAPL, NSZD rates were estimated in 1994, 2006 and 2020 for diesel and 1999, 2009 and 2020 for gasoline. Each date also had soil-core mass estimates, which together with NSZD rates allow estimation of the longevity for LNAPL presence. Site-wide coring (in 1992, 2002, 2007) estimated LNAPL mass reductions of 12,000 t. For diesel NSZD, the ratio of NSZD rates for 2006 (16,000-49,000 L/ha/y) to those in 2020 (2600-14,000 L/ha/y) was ~3-6. By 2020, the 1994 diesel NSZD rates would have predicted the entire removal of measured mass (16-42 kg/m2). For gasoline, NSZD rates in 1999 were extremely high (50,000-270,000 L/ha/y) but 9-27 times lower (5800-10,000 L/ha/y) a decade later. The gasoline NSZD rates in 1999 predicted near complete mass removal in 2-12 years, but 10-11 kg/m2 was measured 10 and 21 years later which is 26% of the initial mass in 1999. The outcomes substantiate the need to understand NSZD rate changes over the lifetime of LNAPL-impacted sites.

A practical tool for estimating subsurface LNAPL distributions and transmissivity using current and historical fluid levels in groundwater wells: Effects of entrapped and residual LNAPL.

A model is presented to account for elevation-dependent residual and entrapped LNAPL above and below, respectively, the water-saturated zone when predicting subsurface LNAPL specific volume (fluid volume per unit area) and transmissivity from current and historic fluid levels in wells. Physically-based free, residual, and entrapped LNAPL saturation distributions and LNAPL relative permeabilities are integrated over a vertical slice of the subsurface to yield the LNAPL specific volumes and transmissivity. The model accounts for effects of fluctuating water tables. Hypothetical predictions are given for different porous media (loamy sand and clay loam), fluid levels in wells, and historic water-table fluctuations. It is shown the elevation range from the LNAPL-water interface in a well to the upper elevation where the free LNAPL saturation approaches zero is the same for a given LNAPL thickness in a well regardless of porous media type. Further, the LNAPL transmissivity is largely dependent on current fluid levels in wells and not historic levels. Results from the model can aid developing successful LNAPL remediation strategies and improving the design and operation of remedial activities. Results of the model also can aid in accessing the LNAPL recovery technology endpoint, based on the predicted transmissivity.

Effect of compositional heterogeneity on dissolution of non-ideal LNAPL mixtures.

The extent of dissolution of petroleum hydrocarbon fuels into groundwater depends greatly on fuel composition. Petroleum fuels can consist of thousands of compounds creating different interactions within the non-aqueous phase liquid (NAPL), thereby affecting the relative dissolution of the components and hence a groundwater plume's composition over long periods. Laboratory experiments were conducted to study the variability in the effective solubilities and activity coefficients for common constituents of gasoline fuels (benzene, toluene, p-xylene and 1,2,4-trimethylbenzene) (BTX) in matrices with an extreme range of molar volumes and chemical affinities. Four synthetic mixtures were investigated comprising BTX with the bulk of the NAPL mixtures made up of either, ethylbenzene (an aromatic like BTX with similar molar volume); 1,3,5-trimethylbenzene (an aromatic with a greater molar volume); n-hexane (an aliphatic with a low molar volume); and n-decane (an aliphatic with a high molar volume). Equilibrium solubility values for the constituents were under-predicted by Raoult's law by up to 30% (higher experimental concentrations) for the mixture with n-hexane as a filler and over-predicted by up to 12% (lower experimental concentrations) for the aromatic mixtures with ethylbenzene and 1,3,5-trimethylbenzene as fillers. Application of PP-LFER (poly-parameter linear free energy relationship) model for non-ideal mixtures also resulted in poor correlation between experimentally measured and predicted concentrations, indicating that differences in chemical affinities can be the major cause of deviation from ideal behavior. Synthetic mixtures were compared with the dissolution behavior of fresh and naturally weathered unleaded gasoline. The presence of lighter aliphatic components in the gasoline had a profound effect on estimating effective solubility due to chemical affinity differences (estimated at 0.0055 per percentage increase in the molar proportion of aliphatic) as well as reduced molar volumes (estimated at -0.0091 in the activity coefficient per unit increase in molar volume, mL/mol). Previously measured changes in activity coefficients due to natural weathering of 0.25 compares well to 0.27 calculated here based on changes in the chemical affinity and molar volumes. The study suggests that the initial estimation of the composition of a fuel is crucial in evaluating dissolution processes due to ideal and non-ideal dissolution, and in predicting long term dissolution trends and the longevity of NAPL petroleum plume risks.

Mass discharge assessment at a brominated DNAPL site: Effects of known DNAPL source mass removal.

Management and closure of contaminated sites is increasingly being proposed on the basis of mass flux of dissolved contaminants in groundwater. Better understanding of the links between source mass removal and contaminant mass fluxes in groundwater would allow greater acceptance of this metric in dealing with contaminated sites. Our objectives here were to show how measurements of the distribution of contaminant mass flux and the overall mass discharge emanating from the source under undisturbed groundwater conditions could be related to the processes and extent of source mass depletion. In addition, these estimates of mass discharge were sought in the application of agreed remediation targets set in terms of pumped groundwater quality from offsite wells. Results are reported from field studies conducted over a 5-year period at a brominated DNAPL (tetrabromoethane, TBA; and tribromoethene, TriBE) site located in suburban Perth, Western Australia. Groundwater fluxes (qw; L(3)/L(2)/T) and mass fluxes (Jc; M/L(2)/T) of dissolved brominated compounds were simultaneously estimated by deploying Passive Flux Meters (PFMs) in wells in a heterogeneous layered aquifer. PFMs were deployed in control plane (CP) wells immediately down-gradient of the source zone, before (2006) and after (2011) 69-85% of the source mass was removed, mainly by groundwater pumping from the source zone. The high-resolution (26-cm depth interval) measures of qw and Jc along the source CP allowed investigation of the DNAPL source-zone architecture and impacts of source mass removal. Comparable estimates of total mass discharge (MD; M/T) across the source zone CP reduced from 104gday(-1) to 24-31gday(-1) (70-77% reductions). Importantly, this mass discharge reduction was consistent with the estimated proportion of source mass remaining at the site (15-31%). That is, a linear relationship between mass discharge and source mass is suggested. The spatial detail of groundwater and mass flux distributions also provided further evidence of the source zone architecture and DNAPL mass depletion processes. This was especially apparent in different mass-depletion rates from distinct parts of the CP. High mass fluxes and groundwater fluxes located near the base of the aquifer dominated in terms of the dissolved mass flux in the profile, although not in terms of concentrations. Reductions observed in Jc and MD were used to better target future remedial efforts. Integration of the observations from the PFM deployments and the source mass depletion provided a basis for establishing flux-based management criteria for the site.

Multiple lines of evidence to demonstrate vinyl chloride aerobic biodegradation in the vadose zone, and factors controlling rates.

A field-based investigation was conducted at a contaminated site where the vadose zone was contaminated with a range of chlorinated hydrocarbons. The investigation consisted of groundwater and multilevel soil-gas monitoring of a range of contaminants and gases, along with isotope measurements and microbiology studies. The investigation provided multiple lines of evidence that demonstrated aerobic biodegradation of vinyl chloride (VC) was occurring in the vadose zone (i) above the on-site source zone, and (ii) above the downgradient off-site groundwater plume location. Data from both the on-site and off-site locations were consistent in showing substantially greater (an order of magnitude greater) rates of VC removal from the aerobic vadose zone compared to more recalcitrant contaminants trichloroethene (TCE) and tetrachloroethene (PCE). Soil gas VC isotope analysis showed substantial isotopic enrichment of VC (δ¹³C -5.2 to -10.9‰) compared to groundwater (δ¹³C -39.5‰) at the on-site location. Soil gas CO2 isotope analysis at both locations showed that CO2 was highly isotopically depleted (δ¹³C -28.8 to -33.3‰), compared to soil gas CO2 data originating from natural sediment organic matter (δ¹³C= -14.7 to -21.3‰). The soil gas CO2 δ¹³C values were consistent with near-water table VC groundwater δ¹³C values (-36.8 to -39.5‰), suggesting CO2 originating from aerobic biodegradation of VC. Bacteria that had functional genes (ethene monooxygenase (etnC) and epoxyalkane transferase (etnE)) involved in ethene metabolism and VC oxidation were more abundant at the source zone where oxygen co-existed with VC. The distribution of VC and oxygen vadose zone vapour plumes, together with long-term changes in soil gas CO2 concentrations and temperature, provided information to elucidate the factors controlling aerobic biodegradation of VC in the vadose zone. Based on the overlapping VC and oxygen vadose zone vapour plumes, aerobic vapour biodegradation rates were independent of substrate (VC and/or oxygen) concentration. The high correlation (R=0.962 to 0.975) between CO2 concentrations and temperature suggested that aerobic biodegradation of VC was controlled by bacterial activity that was regulated by the temperature within the vadose zone. When assessing a contaminated site for possible vapour intrusion into buildings, accounting for environmental conditions for aerobic biodegradation of VC in the vadose zone should improve the assessment of environmental risk of VC intrusion into buildings, enabling better identification and prioritisation of contaminated sites to be remediated.

The use of mass depletion-mass flux reduction relationships during pumping to determine source zone mass of a reactive brominated-solvent DNAPL.

Mass depletion-mass flux relationships usually applied to a groundwater plume were established at field scale for groundwater pumped from within the source zone of a dense non-aqueous phase liquid (DNAPL). These were used as part of multiple lines of evidence in establishing the DNAPL source mass and architecture. Simplified source mass-dissolved concentration models including those described by exponential, power, and error functions as well as a rational mass equation based on the equilibrium stream tube approach were fitted to data from 285 days of source zone pumping (SZP) from a single well which removed 152 kg of dissolved organics from a multi-component, reactive brominated solvent DNAPL. The total molar concentration of the source compound, tetrabromoethane and its daughter products was used as a single measure of contaminant concentration to relate to source mass. A partitioning inter-well tracer test (PITT) conducted prior to the SZP provided estimates of groundwater travel times, enabling parameterisation of the models. After accounting for capture of the down-gradient dissolved plume, all models provided a good fit to the observed data. It was shown that differentiation between models would only emerge after appreciably more pumping from the source zone. The model fits were not particularly sensitive to the exponent parameters and variance of groundwater travel time. In addition, the multi-component nature of the DNAPL did not seem to affect the utility of the models for the period examined. Estimates of the DNAPL mass prior to the start of SZP from the models were greatest where the log of the variance of travel time was used explicitly in the source depletion models (mean 295kg) compared to where the associated power exponent and variance was fitted freely (mean 258 kg). The estimates of source mass were close to that of 220kg determined from the PITT. In addition to the PITT, multi-level groundwater sampling from within the source zone provided important supporting information for developing the conceptual model of the source zone. It is concluded that SZP may be an effective and relatively simple means for characterising DNAPL source zones.

Modelling the fate of styrene in a mixed petroleum hydrocarbon plume.

Severe petroleum hydrocarbon contamination (styrene and the BTEX compounds: benzene, toluene, ethylbenzene and the isomers of xylene) from leaking sewers was detected in a Quaternary aquifer below a chemical plant in the Padana Plain, Italy. From 1994, active pump and treat remediation has been employed. The site is bordered by canals which, in combination with variable pumping rates and groundwater flow directions, control groundwater levels. In this study we sought to determine the fate of styrene at the site within a mixed styrene/BTEX plume where the hydraulic boundaries induced strong seasonal variations in flows. In order to determine the fate of styrene, detailed field investigations provided intensive depth profile information. This information was then incorporated into a staged flow and reactive transport modelling. Three sets of measurements were obtained from sampling multilevel samplers (MLSs) under different hydraulic conditions at the site. These included measurements of BTEX, styrene, all major ions, pH and redox potential. A three-dimensional transient flow model was developed and calibrated to simulate an unconfined sandy aquifer with a variable flow field. Subsequently a reactive, multi-component transport model was employed to simulate the fate of dissolved BTEX and styrene along a selected flow line at the site. Each petroleum hydrocarbon compound was transported as independent species. Different, kinetically controlled degradation rates and a toxicity effect were simulated to explain the observed, selective degradation of pollutants in groundwater. Calibration of the model was accomplished by comparison with the three different sets of measurements obtained from the MLS devices. The results from various scenarios show that the detailed simulation of geochemical changes can be very useful to improve the site's conceptual model.

The constitutive properties of the brain paraenchyma Part 2. Fractional derivative approach.

Fractional models have proven to be very useful for studying viscoelastic materials. We consider the fractional Zener model (also called four-parameter model) to study both the relaxation function and creep compliance. The analytical results are compared with the known experimental results of the human brain tissue to obtain the best fit and brain mechanical parameters. The results are also compared to the non-fractional Zener model and four-parameter Burgers model, indicating that the four-parameter fractional model gives a substantially better fit for the all experimental data.

Use of polymer mats in series for sequential reactive barrier remediation of ammonium-contaminated groundwater: field evaluation.

A pilot-scale field trial was undertaken to evaluate the potential of in situ polymer mats (installed in series) as permeable reactive barriers within a treatment wall remediation system to induce sequential bioremediation of ammonium-contaminated groundwater. The treatment wall consisted of 10 m wide impermeable wings on either side of a 0.75 m wide permeable reactive zone flow-through box. Two polymer mats were positioned in the flow-through box. The upgradient polymer mat within the flow-through box was used to deliver oxygen to induce bacterial nitrification of the ammonium to nitrite/nitrate as the groundwater moved past. The downgradient polymer mat delivered ethanol to induce bacterial denitrification of the nitrite/nitrate to produce nitrogen gas. The field trial was carried out at a near-shore location. Initially the flow-through box was left open; however, this resulted in substantial groundwater mixing, which inhibited sequential remediation. Once the flow-through box was in-filled with gravel, groundwater mixing was reduced, achieving a greater than 90% reduction in total N. Estimated first-order half-lives for nitrification and denitrification rates were 1.2 and 0.4 d, respectively. Field nitrification half-lives were approximately an order of magnitude greater than rates determined in large-scale columns using soil and groundwater from the site, while denitrification half-lives were similar. The results of this pilot-scale field trial indicate that sequential bioremediation of ammonium-contaminated groundwater at field scale is feasible using in situ polymer mats as permeable reactive barriers, although hydraulic conditions can be complex in such barrier systems.

The role of microbial populations in the containment of aromatic hydrocarbons in the subsurface.

A survey of soil gases associated with gasoline stations on the Swan Coastal Plain of Western Australia has shown that 20% leak detectable amounts of petroleum. The fates of volatile hydrocarbons in the vadose zone at one contaminated site, and dissolved hydrocarbons in groundwater at another site were followed in a number of studies which are herein reviewed. Geochemical evidence from a plume of hydrocarbon-contaminated groundwater has shown that sulfate reduction rapidly developed as the terminal electron accepting process. Toluene degradation but not benzene degradation was linked to sulfate reduction. The sulfate-reducing bacteria isolated from the plume represented a new species, Desulfosporosinus meridiei. Strains of the species do not mineralise 14C-toluene in pure culture. The addition of large numbers of cells and sulfate to microcosms did stimulate toluene mineralisation but not benzene mineralisation. Attempts to follow populations of sulfate-reducing bacteria by phospholipid signatures, or Desulfosporosinus meridiei by FISH in the plume were unsuccessful, but fluorescently-labeled polyclonal antibodies were successfully used. In the vadose zone at a different site, volatile hydrocarbons were consumed in the top 0.5 m of the soil profile. The fastest measured rate of mineralisation of 14C-benzene in soils collected from the most active zone (6.5 mg kg(-1) day(-1)) could account for the majority of the flux of hydrocarbon vapourtowards the surface. The studies concluded that intrinsic remediation by subsurface microbial populations in groundwater on the Swan Coastal Plain can control transport of aromatic hydrocarbon contamination, except for the transport of benzene in groundwater. In the vadose zone, intrinsic remediation by the microbial populations in the soil profile can contain the transport of aromatic hydrocarbons, provided the physical transport of gases, in particular oxygen from the atmosphere, is not impeded by structures.

Use of polymer mats in series for sequential reactive barrier remediation of ammonium-contaminated groundwater: laboratory column evaluation.

Large-scale column experiments were undertaken to evaluate the potential of in situ polymer mats (installed in series) to be used as permeable reactive barriers for delivery of oxidants and reductants to induce sequential bioremediation of ammonium-contaminated groundwater (approximately 120mg L(-1) NH4+-N), without bioaugmentation. The strategy was for the first group of polymer mats to deliver oxygen to induce bacterial nitrification of the ammonium to nitrite/ nitrate as the groundwater moved past and for the second group of polymer mats to deliver hydrogen or ethanol, to induce bacterial denitrification of the nitrite/nitrate to produce nitrogen gas. Once purging of the first polymer mat commenced, ammonium concentrations decreased downgradient from the polymer mats. Nitrification rates increased and stabilized over the 6-month experiment, with stable nitrification half-lives in the range 0.07-0.25 days. Nitrification most likely occurred in a biologically active zone at the polymer wall/aqueous interface. With hydrogen delivery via the polymer mats, a denitrification half-life (nitrate plus nitrite removal) of 3.5 days was induced. Denitrification rates were significantly enhanced when ethanol was delivered via a polymer mat, with denitrification half-lives in the range of 0.12-0.34 days. Nitrification/ denitrification rates were maintained for groundwater flow rates up to 300 m yr(-1), suggesting oxygen and ethanol delivery rates via the polymer mats were sufficient not to limit nitrification or denitrification. In soil columns, the polymer mat delivery system provided an effective and reliable technique for delivery of oxygen and hydrogen or ethanol for sequential nitrification/denitrification of ammonium-contaminated groundwater. Scale-up of this concept to a field pilot-scale is currently underway.

Using polymer mats to biodegrade atrazine in groundwater: laboratory column experiments.

Large-scale column experiments were undertaken to evaluate the potential of in situ polymer mats to deliver oxygen into groundwater to induce biodegradation of the pesticides atrazine, terbutryn and fenamiphos contaminating groundwater in Perth, Western Australia. The polymer mats, composed of woven silicone (dimethylsiloxane) tubes and purged with air, were installed in 2-m-long flow-through soil columns. The polymer mats proved efficient in delivering dissolved oxygen to anaerobic groundwater. Dissolved oxygen concentrations increased from <0.2 mg l(-1) to approximately 4 mg l(-1). Degradation rates of atrazine in oxygenated groundwater were relatively high with a zero-order rate of 240-380 microg l(-1) or a first-order half-life of 0.35 days. Amendment with an additional carbon source showed no significant improvement in biodegradation rates, suggesting that organic carbon was not limiting biodegradation. Atrazine degradation rates estimated in the column experiments were similar to rates determined in laboratory culture experiments, using pure cultures of atrazine-mineralising bacteria. No significant degradation of terbutryn or fenamiphos was observed under the experimental conditions within the time frames of the study. Results from these experiments indicate that remediation of atrazine in a contaminated aquifer may be achievable by delivery of oxygen using an in situ polymer mat system.

Modelling of physical and reactive processes during biodegradation of a hydrocarbon plume under transient groundwater flow conditions.

Numerical experiments of non-reactive and reactive transport were carried out to quantify the influence of a seasonally varying, transient flow field on transport and natural attenuation at a hydrocarbon-contaminated field site. Different numerical schemes for solving advective transport were compared to assess their capability to model low transversal dispersivities in transient flow fields. For the field site, it is shown that vertical plume spreading is largely inhibited, particularly if sorption is taken into account. For the reactive simulations, a biodegradation reaction module for the geochemical transport model PHT3D was developed. Results of the reactive transport simulations show that under the site-specific conditions the temporal variations in groundwater flow do, to a modest extent, affect average biodegradation rates and average total (dissolved) contaminant mass in the aquifer. The model simulations demonstrate that the seasonal variability in groundwater flow only results in significantly enhanced biodegradation rates when a differential sorption of electron donor (toluene) and electron acceptor (sulfate) is assumed.

Tumors of the oral cavity and pharynx.

We have compiled all the reported cases of smooth muscle (stromal) tumors of the oral cavity and pharynx from 1884 through 1996. Our collective data included 139 leiomyomas (LM) and 68 leiomyosarcomas (LMS); but because we did not have sufficient information for 13 cases of LM, we report on only 126; and we report on only 66 of 68 cases of LMS. The peak age of incidence was 40 to 49 years for benign tumors and 50 to 59 years for malignant lesions, with the incidence in men slightly predominating over that in women. The most common sites of LM of the oral cavity and pharynx were the lips, tongue, and hard and soft palate. The most common sites of LMS included the maxilla and mandible. More than 40% of LMs presented as an intraoral mass, and more than half were known to be present for longer than 1 year. About 10% presented with pain, difficulty chewing or swallowing, swelling, toothache or loose teeth, or a combination of these symptoms. Patients with LMS were much more likely to have obvious symptoms of shorter duration, and one-third presented with pain or swelling (or both). Other relatively common symptoms of LMS included tenderness, interference with dentures, or an intraoral mass. In this review, there were almost twice as many LMs as LMSs, which was consistent with smooth muscle tumors found in other areas of the gastrointestinal tract.

Tumors of the esophagus.

This collective review includes all available case reports of smooth muscle (stromal) tumors of the esophagus in the world literature. Compiling this review, we endeavored to examine cumulative and recently collected data of both benign and malignant esophageal smooth muscle tumors found in the literature spanning the period from 1875 to 1996, which totaled 1679 leiomyomas (LMs) and 165 leiomyosarcomas (LMSs). The peak age of occurrence of benign smooth muscle tumors in the esophagus was found to be between the ages of 30 and 59, whereas the highest frequency of malignant tumors was seen later in life, during the decade from age 60 to 69. The most common location of both LMs and LMSs was the lower third of the esophagus. Their patterns of growth differed; LMs were more likely to grow intramurally, and LMSs were predominantly intraluminal. Most patients with LMs presented with dysphagia and pain or discomfort; patients with LMSs additionally commonly complained of weight loss. As with smooth muscle tumors of other areas of the gastrointestinal tract, the duration of symptoms averaged 1 month to 1 year, and malignant tumors grew to larger sizes than benign neoplasms. Approximately one-third of LMSs had metastasized at diagnosis, and there was a 5-year survival rate of approximately 20%.

Tumors of the appendix and colon.

This collective review includes all available case reports of smooth muscle (stromal) tumors of the appendix and large intestine in the world literature. When compiling this review, we endeavored to examine cumulative as well as recently collected data on both benign and malignant smooth muscle tumors spanning the period 1875 to 1996. In total, there were reports of 331 leiomyomas (LMs) and 263 leiomyosarcomas (LMSs). The peak age of incidence of LM was 30 to 39 years, and the peak age of incidence of LMSs was 50 to 59 years. The female/male ratio was slightly higher for LM, and the male/female ratio was higher for LMS. The descending colon and sigmoid colon were the most common sites of both benign and malignant smooth muscle tumors. The growth of LMs most often occurred extraluminally, whereas LMSs tended to grow within the lumen of the colon. With both tumor types pain was the most frequent presenting complaint, followed less commonly by complaints of a palpable mass or gastrointestinal bleeding. LMSs tended to be larger at diagnosis than LMs, though the duration of symptoms for both types of tumor was most often reported to be between 1 month and 1 year. Finally, LMSs were found to metastasize mo

Tumors of the stomach.

This collective review includes all available case reports of smooth muscle (stromal) tumors of the stomach in the world literature from 1762 to 1996. It updates our previous review from 1767 to 1959. Overall, we identified 2189 patients with leiomyoma (LM) and 1594 with leiomyosarcoma (LMS). The peak age of incidence of LM was 50 to 59 years, while LMS was most frequently seen between ages 60 and 69. Women were more likely to develop LM, and men more commonly presented with malignant smooth muscle tumors of the stomach. Concerning the patterns of growth, LMs were more likely to grow intraluminally (endogastric), whereas LMSs were predominantly exogastric. The most common site of LMs was on the anterior or posterior wall of the body of the stomach; LMSs were most likely found along the greater curve. The presenting symptoms of both types of smooth muscle tumors were similar; in decreasing order of frequency they were bleeding, pain, palpable mass, and weight loss. Interestingly, there was no correlation between the size of the tumor and signs or symptoms of bleeding, pain, weight loss, or ulceration, although patients with LMSs were more likely to report weight loss than patients with benign tumors. For LMS, there seemed to be no correlation between tumor size or location and rate of metastasis, although the tumors that grew in a dumbbell shape (i.e., both intraluminally and extraluminally) had a higher frequency of metastasis than other growth patterns. Overall, the rate of metastasis at diagnosis was 35.4%, with the liver, spleen, and regional lymph nodes the most common sites.

Tumors of the small intestine.

This collective review includes all available case reports and series of smooth muscle (stromal) tumors of the small intestine in the world literature from 1881 to 1996. We identified 1074 patients with leiomyoma (LM) and 1689 with leiomyosarcoma (LMS). Our purpose was to update our previous review, which encompassed case reports and series from 1881 to 1959, which included 350 LMs and 257 LMSs. The peak incidence of smooth muscle tumors in the small intestine in both male and female patients was between the ages of 50 and 59. Most commonly, the presenting complaint was gastrointestinal bleeding. Computed tomography was found to detect LM and LMS most successfully and had the additional advantage of locating metastatic disease. The jejunum contained the highest numbers of smooth muscle tumors, followed by the ileum and then the duodenum, with malignant lesions in all locations typically attaining larger diameters than benign tumors. The overall rate of metastatic spread of LMS ranged from 24% to 50%, with the liver being most commonly involved. Unlike other sarcomas, both hematogenous and lymphatic spread were common. The 5-year survival of 705 patients with LMS from 22 series was 27. 8%. For both benign and malignant smooth muscle tumors of the small intestine, surgery remains the treatment of choice, with little efficacy reported for irradiation, chemotherapy, or both.

Tumors of the rectum and anal canal.

This collective review includes all available case reports of smooth muscle (stromal) tumors of the rectum and anal canal in the world literature. When compiling this review we endeavored to present cumulative and recently collected data of both benign and malignant smooth muscle tumors found in the literature spanning the period from 1881 to 1996, which totaled 432 leiomyomas (LMs) and 480 leiomyosarcomas (LMSs) of the anus and rectum. The peak age of frequency for LMs was 40 to 59 years and 50 to 69 years for LMSs; men were slightly more likely to develop both benign and malignant anorectal smooth muscle tumors than women. Intraluminal growth of both LMs and LMSs was more frequently seen than extraluminal or intramural patterns, and tumors were more likely to be found in the rectum than in the anus. Patients with LMs presented most commonly with gastrointestinal (GI) bleeding, a palpable mass, or anorectal pain. As with smooth muscle tumors in other areas of the alimentary tract, symptoms likely persisted for less than 1 year prior to diagnosis. As was also the case for these neoplasms in other GI locations, LMSs tended to be larger than LMs. Approximately 20% of LMSs reported from 1881 to 1996 had metastasized at diagnoses. The local recurrence rate for resectable tumors was more than 80%, exceeding the propensity of LMSs in other areas of the GI tract to recur.