Clinicopathological characteristics and treatment outcomes of adult

Introduction: We report our experience with 8 consecutive adults treated for paratesticular rhabdomyosarcoma (RMS) at a single institution between 2000 and 2010.Methods: After primary surgical excision, 7 patients were classified into group I according to the Intergroup Rhabdomyosarcoma Study Group (IRSG) Postsurgical Grouping Classification, and 1 patient into group IIB. Retroperitoneal node dissection was not a required staging procedure. Adjuvant chemotherapy was administered to 7 of the 8 patients. No additional radiotherapy was administered.Results: The median age at diagnosis was 24 years (range: 18-60). Embryonal histology was the most common (75%) subtype. During follow-up, 3 patients experienced local relapse and 5 distant relapse. The median progression-free and overall survival times were 17.0 ± 9.9 months (range: 5-31) and 27.3 ± 1.3 months (range: 16-58), respectively.Conclusion: Paratesticular RMS is an uncommon malignancy inadults. We confirm that patients with localized paratesticular RMS may have different prognoses. Retroperitoneal lymphadenectomy can be avoided as a treatment for paratesticular RMS after radical inguinal orchiectomy.

Prognosic value of lower uterine segment involvement in high-grade endometrial cancers.

5092 Background: To determine the relationship of lower uterine segment (LUS) involvement and clinical-pathologic outcomes in high grade endometrial cancers (EC). Although LUS and prognosis has been previously reported in the literature, the results have been conflicting and limited to early stage cases without focus upon the highest risk histologies. Methods: A single-institution retrospective cohort analysis of all grade 3 EC from Jan 2005- Sept 2010 was performed. Clinical-pathologic data were abstracted. LUS status was determined based on permanent-section pathology. Statistical analyses were performed using univariate and bivariate analyses with t-tests, X2, and log-rank tests. Multivariate regressions were performed by cox modeling. Two sided p-values<0.05 were considered significant. Results: Of 329 cases, 52% were LUS+. Mean age was 66.1(SD 10.8) and BMI 31.7(SD 8.3). The majority were Caucasian (63.2%) and 30.1% were African-American (AA). Most women (80.2%) were overweight or obese, 58.7% had hypertension, and 22.5% were diabetic. Most women had stage I disease (54.8%), but 8.6% had stage II disease, and 36.6% had stage III-IV disease. Histologic subtypes included 32.2% endometrioid, 47.4% serous/clear cell, and 17% carcinosarcoma. Thirty-nine percent had > 50% myometrial invasion (MI) and 43.2% had LVSI. Most of the women (80.8%) underwent retroperitoneal node dissection (77.9% pelvic, 70.0% periaortic). Mean follow-up time was 24.5 months (range 0.13, 73.3). Age, HTN, and DM did not differ by LUS status. Statistically significant factors associated with LUS positivity included race AA (38.3 v 26.5%), obesity (57.5 v 46.7%), serous/clear cell (65.7 v 53.8%), LVSI (56.2 v 30.5%), deep MI (52.1 v 25.3%), and positive nodes (42.4 v 12.7%). LUS+ was significantly associated with an increased rate of recurrence (HR 2.3, CI 1.16-4.47, p =0.02) after adjusting for obesity, deep MI, LVSI, nodal status, stage, serous/clear cell histology, and adjuvant therapy. Conclusions: Lower uterine segment was independently associated with an increased rate of recurrence in high grade EC. This should be confirmed in prospective endometrial trials to see if this remains an independent predictor of recurrence.

Role of Retroperitoneal Lymph Node Dissection in the Management of Testicular Cancer

Background Retroperitoneal lymph node dissection is an important component of staging and management of nonseminomatous germ-cell carcinoma of the testis. Ejaculatory impotence has been a dominant aspect of operative morbidity. Methods The author has led the investigation of a series of modifications of operative techniques with the aim of reducing morbidity while retaining the prognostic and therapeutic benefits for retroperitoneal lymph node dissection. Results The advances in surgical techniques have reduced the incidence of ejaculatory impotence to less then 5%. Guidelines for the type of retroperitoneal lymph node dissection for different clinical stages of disease are presented. Conclusions The advances in surgical techniques for retroperitoneal node dissection have minimized morbidity. The procedure plays a role in many clinical stages of testicular cancer.

Recombinant interferon alpha-2 in advanced renal cell carcinoma

From January 1985 to December 1987, 26 patients (20 men, 6 women, median age 62 years, range 26–76 years) with advanced renal cell carcinoma were included in the study. In 8 cases (6 patients no surgery, 2 patients with retroperitoneal node-residual disease after nephrectomy) metastases were identified at initial diagnosis, and in the remaining 18 the occurrence of metastases was delayed by a mean disease-free interval of 12 months after radical nephrectomy. Recombinant interferon alpha-2 was administered subcutaneously at a dose of 9 milion IU three times a week for a period of at least six months. Informed consent was obtained from all patients before starting therapy. No patients achieved complete regression of tumors; two cases showed a partial response (one relapsed six months later, while in the other response continues at 38 months after discontinuation of therapy); 10 patients showed stabilization of disease for 6–10 months and in 14 the disease progressed immediately. In our experience immunotherapy with recombinant interferon alpha-2 did not significantly change the natural history of renal cell carcinoma.