Cystadenoma of the liver with ovarian-like stroma: case report.

Cystadenomas are rare benign tumors with malignant potential. A 36-year-old woman presented with a 20-cm cystic mass in the left lobe of the liver. Surgery confirmed the diagnostic imaging findings. We present a case of cystadenoma of the liver with ovarian-like stroma and its associated radiologic characteristics.

[Reirradiation with brachytherapy for recurrent tongue cancer after initial brachytherapy].

The purpose of this study was to assess the efficacy of reirradiation with brachytherapy in the treatment of patients with tongue cancer that had recurred after initial brachytherapy. A retrospective analysis was performed in 12 patients with tongue cancer treated by reirradiation with brachytherapy using rigid linear sources such as the 226Ra-needle or 192Ir-hairpin at Kyushu University Hospital from 1978 to 1998. The patients included 8 men and 4 women, who ranged in age from 30 to 69 years (mean, 52 years). At the time of reirradiation, 7 patients had stage I cancer, and 5 had stage II cancer, according to the UICC (1997) classification. The median follow-up time of the surviving patients was 92 months. The 5-year relapse-free and cause-specific survival rates were 31% and 64%, respectively. The 5-year cause-specific survival rate varied according to the interval between the first and second course of brachytherapy and was 25% for intervals of less than 12 months and 83% for intervals of more than 12 months. Only 4 patients with local recurrence were recognized after their second course of brachytherapy. Among the 6 patients who survived more than 2 years after reirradiation without local recurrence, symptomatic complications such as soft tissue necrosis and minimal bone necrosis were found in 3 patients, but these side effects were not serious enough to require surgery. Reirradiation with a second course of brachytherapy may be useful in the treatment of patients with tongue cancer that recurs more than 12 months after initial brachytherapy.

Relapse patterns of localized non-Hodgkin's lymphoma of the head and neck after clinical remission: results of a strict follow-up procedure.

BACKGROUND: No effective follow-up strategy for non-Hodgkin's lymphoma (NHL) has been identified to date. The aim of this study was to assess the value of a strict follow-up procedure in patients with NHL after they showed clinical remission. METHODS: One hundred and twenty-one patients with localized NHL of the head and neck who had achieved clinical remission after radiation therapy and/or chemotherapy were followed with a strict follow-up strategy (consisting of a schedule of frequent office visits, imaging studies, and blood tests, even if the patient was asymptomatic). RESULTS: Thirty-nine patients relapsed after remission. Twenty-two (56.4%) of the relapses were associated with symptoms. In the 17 patients with asymptomatic relapses (43.6%), an abnormal physical examination result initially indicated relapse in 10 patients. The other tests that initially indicated relapse included scheduled computed tomography scans (3 patients), scheduled gallium scans (2 patients), and serum lactate dehydrogenase levels (2 patients). According to the Ann Arbor stage at relapse, 72.7% of the patients with symptomatic relapses were stage III or IV, while 70.6% of the patients with asymptomatic relapses were stage I or II. CONCLUSIONS: These results indicate that a strict follow-up procedure is effective in detecting asymptomatic relapses, which generally involve a smaller tumor load than symptomatic relapses.

Sonography for the detection of cervical lymph node metastases among patients with tongue cancer: criteria for early detection and assessment of follow-up examination intervals.

BACKGROUND AND PURPOSE: Because the presence of cervical metastasis is one of the factors influencing the outcome of patients with carcinoma of the head and neck, its early detection is potentially very important. The purpose of this study was to evaluate the characteristic changes of cervical metastasis revealed by sonography during follow-up and to assess an adequate interval for follow-up sonography of the neck among patients with tongue cancer. METHODS: Forty-three of 44 consecutive patients with squamous cell carcinoma of the tongue, who had undergone interstitial brachytherapy, were examined with sonography of the neck during the posttherapeutic follow-up period. RESULTS: Seventeen cervical lymph node metastases were found in 12 of 43 patients during follow-up. Of these 17 cervical metastases, 16 (94.1%) were accurately diagnosed and one (5.9%) was misdiagnosed as nonmetastatic based on sonographic findings. Sonography of the neck performed in seven patients at an interval of less than 1 month since the last follow-up imaging showed 9 (90.0%) of 10 metastases increased by up to 2 mm in short-axis diameter. Five patients who were followed up at an interval of more than 1 month since the last follow-up imaging had seven metastases increase by 3 to 8 mm in short-axis diameter or a change of echogenicity in the internal structure of lymph nodes or both. Pathologic examinations showed extranodal spread in 3 (42.9%) of these 7 metastases. CONCLUSION: Changes both in size and internal echogenicity can occur as quickly as 2 to 4 weeks between sonographic examinations. Therefore, in high-risk patients, or in those with suspicious sonographic findings, short-interval follow-up sonographic examinations are recommended at least during the first posttherapeutic year. Our findings suggest that follow-up sonography of the neck should be performed monthly, at least during the first posttherapeutic year.

A new, simple method of making a spacer in interstitial brachytherapy for mobile tongue cancer.

OBJECTIVES: This article demonstrates a new method of making a spacer that increases the distance between the mandible and implanted radioactive sources in interstitial brachytherapy for patients with mobile tongue cancer. STUDY DESIGN: Fifty-three patients with mobile tongue cancer underwent interstitial brachytherapy with spacers made by this new technique. RESULTS: Our spacer is not difficult to create or to use. The spacer was made from a plastic splint by using thermoforming techniques and quick self-curing resin, which did not need waxing, wiring, or casting. The surface of the spacer, which comes in contact with the tongue, is smooth because it is covered with tissue-conditioning material. There were no complaints of pain from the patients. Osteoradionecrosis of the mandible developed in only 1 (1.9%) of these patients. CONCLUSIONS: This spacer is simple to make and prevented osteoradionecrosis.

Relapsed non-Hodgkin's lymphoma: detection and treatment.

PURPOSE: To evaluate the optimal management strategy during clinical remission and after relapse in patients with non-Hodgkin's lymphoma (NHL). METHODS: Sixty-six patients with relapse of NHL from a state of clinical remission between 1987 and 1997 were analyzed retrospectively. The pattern of relapses, diagnostic methods used for relapses, and clinical outcome of salvage treatment were analyzed with attention to time after the achievement of clinical remission. RESULTS: Thirty-three relapses (50%) occurred within 12 months, and the remainder occurred gradually from 12-48 months after the first remission. Diagnosis of relapse in 61 of the 66 patients (93%) was made at unscheduled evaluations prompted by symptoms, on physical examinations, or because of high LDH levels. The 1- and 5-year cause-specific survival rates after relapse were 56.7% and 39.4%, respectively. The 1- and 5-year relapse-free survival rates were 50.1% and 35.0%, respectively. The 5-year relapse-free survival rate in patients with late relapse (49.5%) was significantly better than in those with early relapse (21.2%) (p<0.01). CONCLUSION: Time to relapse may be a useful factor to determine optimal management strategy in NHL patients.

Radiotherapy for localized relapse in patients with non-Hodgkin's lymphoma: a preliminary report.

PURPOSE: To evaluate the usefulness of radiotherapy for relapse of non-Hodgkin's lymphoma (NHL) at a localized site. METHODS: Of 79 patients with relapsed intermediate- or high-grade NHL, 13 patients (16.5%) with a localized relapse were analyzed retrospectively. RESULTS: Five patients were treated with radiotherapy alone and eight were treated with radiotherapy plus conventional chemotherapy (CHOP or other combinations). Radiotherapy was delivered to the involved field to a mean total dose of 34.1 Gy (range, 21-51 Gy). The 5-year overall and disease-free survival rates were 80.2% and 76.2%, respectively. Four patients relapsed subsequently. After further salvage therapy, two patients died of NHL and two were alive without active disease. CONCLUSION: Radiotherapy may be an important component of treatment for selected patients with NHL who relapse at a localized site.

Non-Hodgkin lymphoma and coexisting primary cancers: a retrospective clinical analysis of 10 patients.

The simultaneous occurrence of non-Hodgkin lymphoma (NHL) and primary cancers is rare, and the treatment strategy for both malignancies is unclear. The authors analyzed the clinical records of 10 patients with NHL and coexisting primary cancers. All patients initially had symptoms of NHL, and all carcinomas were found at the initial workup of NHL by chance. The most common primary sites of coexisting cancers were the stomach (six patients) and the colon (two). Histologically, the majority of NHLs were intermediate grade, and all lesions were B-cell type. All primary cancers were adenocarcinoma. Initially, NHL was treated with radiotherapy or chemotherapy. Six primary cancers were resected surgically or endoscopically after the remission of NHL. The remaining four patients received no treatment for primary cancers because of advanced stages or early relapse of NHL. Three patients died of NHL, one died of cancer, and six were still alive, five without evidence of disease and one with disease. The authors conclude that early detection of a coexisting cancer and appropriate treatment after the remission of NHL may increase the possibility of a cure.

Primary non-Hodgkin's lymphoma of the lacrimal sac: a case report and a review of the literature.

BACKGROUND: Primary non-Hodgkin's lymphoma of the lacrimal sac is extremely rare, with most reported cases representing secondary involvement of a systemic malignancy. METHODS: The clinical record of a 70-year-old female who presented with epiphora and swelling of the lacrimal sac area is described. A review of the literature of patients with primary lacrimal sac lymphoma also is presented. RESULTS: Computed tomography demonstrated a lacrimal sac mass involving the nasolacrimal canal. Histopathologic examination of a biopsy specimen revealed a diffuse large cell lymphoma. Using immunohistologic staining, the tumor was a B-cell type, similar to those described in the literature. The patient was treated with 50 gray of irradiation and chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone. The patient remained free of lymphoma 26 months after initial treatment. An ocular examination was unremarkable except for epiphora. CONCLUSIONS: Radiotherapy and/or chemotherapy can treat localized lymphoma of the lacrimal sac successfully.

Primary non-Hodgkin lymphoma of the sinonasal cavities: correlation of CT evaluation with clinical outcome.

PURPOSE: To determine retrospectively the primary site of origin of sinonasal lymphomas with computed tomography (CT) and correlate the CT findings with histologic phenotype and clinical outcome. MATERIALS AND METHODS: In 24 patients with stage I and II non-Hodgkin lymphomas of the sinonasal cavities, the CT appearances and clinical data were reviewed retrospectively. RESULTS: The sites of primary tumor determined at CT were the nasal cavity in 13 patients, the ethmoidal sinus in three patients, and the maxillary sinus in eight patients. B-cell lymphomas were found mainly in the maxillary sinus, while T-cell lymphomas were found in the nasal cavity and ethmoidal sinus (P < .005). The 5-year survival rates in relation to the primary site of the tumor were 64% for the nasal cavity, 50% for the ethmoidal sinus, and 100% for the maxillary sinus (P = .26). CONCLUSION: Patients with B-cell primary lymphoma of the maxillary sinus tended to have a good prognosis in contrast to those with T-cell lymphomas that originated from midline structures. The primary site determined at CT appears to be correlated with the histologic phenotype and clinical outcome.

Primary non-Hodgkin's lymphoma of the maxillary sinus.

Primary non-Hodgkin's lymphoma of the maxillary sinus is a rare lesion. We studied nine patients with malignant lymphoma involving the maxillary sinus, treated between 1980 and 1994 in the Kyushu University Hospital. All lymphomas had a diffuse pattern; five were the large-cell type, two the mixed type, and one the small lymphatic and small cleaved type. Immunohistologically, all tumors were B-cell type. Using the Ann Arbor staging system, six patients were classified as stage I, two stage II, and one stage IV. Two patients received only radiotherapy because of advanced age; the remaining seven received a combination of radiotherapy and chemotherapy (CHOP or VEPA). The tumor doses ranged from 30 to 51 Gy (mean, 46.7). The mean follow-up was 51 months. Only one patient (stage IV) died of disease, and eight stage I-II patients were rendered disease-free. The 5-year survival rate was 80%, suggesting that primary lymphoma of the maxillary sinus has a relatively good prognosis.