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  • 1
    Electronic Resource
    Electronic Resource
    Kleinzelliges Bronchialkarzinom nach Chemotherapie Morphologische Befunde (1995)
    Springer
    Der Pathologe 16 (1995), S. 217-222 
    Details
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Kleinzelliges Bronchialkarzinom ; Neoadjuvante Chemotherapie ; Therapieinduzierte Tumorregression ; Spontanregression ; Regressionsgrading ; Key words Small cell lung cancer ; Neoadjuvant chemotherapy ; Therapy induced tumor regression ; Spontaneous tumor regression ; Regression grading
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Resection specimens of 14 patients with small cell bronchial carcinoma after neoadjuvant chemotherapy were processed histologically and graded according to a three-step regression grading system: grade I, no or only slight tumor regression; grade II, incomplete tumor regression; grade III, complete tumor regression without vital tumor tissue. In five patients with either no vital tumor tissue or only small tumor remnants in the resection samples, a typical sequence of central fresh tumor necrosis, foam cell rim, vascular granulation tissue and peripheral scar formation was seen. This morphological finding may be interpreted as a characteristic, but unspecific parameter of good response to preoperative chemotherapy. The presence of vital tumor rims surrounding the capillary bed with intermingled necrotic foci, however, argues in favor of spontaneous tumor regression, which is commonly observed in small cell lung cancer.
    Notes: Zusammenfassung Resektionspräparate von 14 Patienten mit kleinzelligen Bronchialkarzinomen nach neoadjuvanter Chemotherapie wurden histologisch aufgearbeitet und nach einem 3 stufigen Regressionsgrading klassifiziert. Regressionsgrad I: keine oder nur geringe Tumorregression, Regressionsgrad II: unvollständige Tumorregression und Regressionsgrad III: vollständige Tumorregression ohne Nachweis vitalen Tumorgewebes. Bei 5 Patienten, deren Resektate kein vitales Tumorgewebe oder nur kleine Tumorreste aufwiesen, konnte eine typische Abfolge von zentraler frischer Tumornekrose, Schaumzellsaum, gefäßreichem Granulationsgewebe und peripherer Vernarbung nachgewiesen werden. Dieser Befund kann als charakteristischer, aber letztlich unspezifischer Ausdruck eines guten Ansprechens auf die präoperative Chemotherapie angesehen werden. Dagegen spricht der Nachweis von kapillarbezogenen vitalen Tumorsäumen mit dazwischen liegenden, schmalen Nekrosen für die beim kleinzelligen Bronchialkarzinom häufig auftretende spontane Tumorregression.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002920050094
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  • 2
    Electronic Resource
    Electronic Resource
    Tumour regression in non-small-cell lung cancer following neoadjuvant therapy. Histological assessment (1997)
    Springer
    Journal of cancer research and clinical oncology 123 (1997), S. 469-477 
    Details
    ISSN: 1432-1335
    Keywords: Non-small-cell lung cancer ; Neoadjuvant therapy ; Regression grading ; Therapy-induced tumour regression ; Spontaneous tumour regression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In the scope of a prospective multi-centre study after neoadjuvant combined chemotherapy (carboplatin, ifosfamide, etoposide, vindesine) and radiotherapy (45 Gy) 40 resection specimens of locally advanced non-small-cell lung cancer were analysed in order to establish reproducible pathological/anatomical results of tumour regression. Resection specimens of 28 squamous cell carcinomas and 12 adenocarcinomas were investigated using serial sections of the primary lesion. The mean age of the patients was 57 years. The results were compared to spontaneous regressive changes in a control group of 50 untreated non-small-cell lung cancers. Marked scarry fibrosis in the region of the former primary tumour, concentric foci of fresh tumour necroses and surrounding foam cell clusters with transition into vascular granulation tissue could be established as characteristic features of therapy-induced tumour regression, whereas untreated carcinomas revealed necroses with adjoining vital tumour tissue. Using a threestep regression system, 3 tumours could be classified as grade I (no or only slight tumour regression), 10 tumours as grade IIA (marked but incomplete tumour regression, more than 10% vital tumour tissue), 20 tumours as grade IIB (less than 10% vital tumour tissue) and 7 tumours as grade III (complete tumour regression without vital tumour tissue). After a median follow-up period of 32.3 months in patients with grade IIB or III tumour regression (“responders”) the median survival time of 27.9 months was found to be significantly longer than in patients with grade I or IIA tumour regression (“non-responders”) with a median survival period of 13.7 months (log-rank test,P=0.020). The resection specimens analysed, which were obtained 7 weeks (on average) after the end of radiochemotherapy, did not show specific changes due to preoperative therapy, but quite characteristic histological alterations in the former tumour area were registered, which had been induced by combined neoadjuvant radiation and chemotherapy. The grade of therapy-induced tumour regression could be shown to be a significant prognostic factor in non-small-cell lung cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01192200
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  • 3
    Electronic Resource
    Electronic Resource
    Calcified cerebral necrosis following ALL therapy (1981)
    Springer
    Journal of cancer research and clinical oncology 102 (1981), S. 81-91 
    Details
    ISSN: 1432-1335
    Keywords: Cerebral necrosis ; Calcification ; ALL ; Chemotherapy ; Irradiation ; Cerebrale Nekrosen ; Verkalkung ; ALL ; Chemotherapie ; Irradiation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Es wird über ungewöhnliche cerebrale Verkalkungen nach Behandlung einer akuten lymphatischen Leukämie bei einem 13 Jahre alt gewordenen Mädchen berichtet. Im Anschluß an einen zweiten Zyklus prophylaktischer intensiver Zytostatikatherapie in Kombination mit einer zweiten Schädelbestrahlung traten Symptome einer progressiven cerebralen Schädigung auf. Pathologisch-anatomisch fanden sich bei einem ausgedehnten frischen Rezidiv einer Meningosis und Encephalosis leukämica bis 5 cm im Durchmesser große, girlandenförmige, verkalkte Nekrosen im Marklager von Groß- und Kleinhirn. In den bindegewebig abgekapselten, bevorzugt in Ventrikelnähe gelegenen Nekrosearealen waren zahlreiche fibrotisch wandverdickte Gefäße mit stenosierten und obturierten Lichtungen nachzuweisen. Die Hirnrinder war von dem Gewebsuntergang weitgehend unberührt. Neben der von anderen Autoren angenommenen lokalen Toxizität des Methotrexat als auslösender Ursache der Hirnnekrosen und einer potenzierenden Wirkung der Schädelbestrahlung erscheint uns die nachgewiesene Gefäßkomponente besonders bedeutungsvoll. Formalpathogenetisch wurde das Krankheitsbild durch die kombinierte Chemo- und Strahlentherapie bei leukämischer Gefäßwandinfiltration und partieller Gefäßverlegung durch intravasale Tumorzellthromben ausgelöst. Eine gleichzeitige Schädigung der Gefäßwände mit starker Gefäßwandfibrose und konsekutiver Ernährungsstörung führte zum umschriebenen Hirngewebsuntergang. Die bevorzugte Lokalisation im rindennahen Marklager erklärt sich aus der relativ ungünstigen Durchblutungssituation dieses Gebietes als Grenzbereich meningealer und intracerebraler Gefäße. Allein aus dem Endzustand mit multiplen verkalkten Hirngewebsnekrosen sind pathologisch-anatomisch keine sicheren Rückschlüsse auf die entscheidene Noxe —leukämische Gefäßwandinfiltrate, Chemotherapeutika, Bestrahlung — zu ziehen. Die nachgewiesenen Veränderungen sprechen aber für eine polyätiologische Genese der Hirnverkalkungen, die intravital auch computeromographisch nachweisbar sind.
    Notes: Summary Calcified cerebral necrosis was an unusual finding at the autopsy of a 13-year-old girl who died after prolonged therapy for ALL. The patient had shown symptoms of progressive cerebral damage subsequent to a second cycle of prophylactic high-dose cytostatic therapy combined with cranial irradiation. Pathoanatomic examination revealed extensive florid recurrency of meningosis and leukemic encephalosis with scalloped calcified necroses measuring up to 5 cm, in the medullar layer of brain and cerebellum. Located predominantly near the ventricular area, encapsulated necroses showed many fibrous vessels with thickened walls and stenosed or obstructed lumina. The cerebral cortex remained largely unaffected by tissue destruction. Besides methotrexate toxicity and the enhancing effect of irradiation the vascular involvement was interpreted as a particularly important factor. Formal pathogenesis is attributed to combined chemo- and radiotherapy in parallel to leukemic infiltration of vascular walls and partial obstruction of lumina by tumor emboli. Wall damage, severe fibrosis, and consecutive nutritional defects result in the destruction of cerebral tissue. The preferential occurrence of necroses in cortex-adjacent medullar layers is explained by the relatively poor blood supply of this border zone between meningeal and intracerebral vasculature. From the terminal pattern of multiple calcified necroses in cerebral tissue, no safe conclusion can be drawn pathoanatomically with regard to the actually fatal factor, whether it is the leukemic infiltration of vascular walls, the effect of cytostatic agents, or that of irradiation. The proposed multifactorial pathogenesis of cerebral calcification may be supported by computed tomography (CT) intra vitam.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00410537
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Tumour regression in non-small-cell lung cancer following neoadjuvant therapy. Histological assessment (1997)
    Springer
    Journal of cancer research and clinical oncology 123 (1997), S. 469-477 
    Details
    ISSN: 1432-1335
    Keywords: Key words Non-small-cell lung cancer ; Neoadjuvant therapy ; Regression grading ; Therapy-induced tumour regression ; Spontaneous tumour regression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In the scope of a prospective multi-centre study after neoadjuvant combined chemotherapy (carboplatin, ifosfamide, etoposide, vindesine) and radiotherapy (45 Gy) 40 resection specimens of locally advanced non-small-cell lung cancer were analysed in order to establish reproducible pathological/anatomical results of tumour regression. Resection specimens of 28 squamous cell carcinomas and 12 adenocarcinomas were investigated using serial sections of the primary lesion. The mean age of the patients was 57 years. The results were compared to spontaneous regressive changes in a control group of 50 untreated non-small-cell lung cancers. Marked scarry fibrosis in the region of the former primary tumour, concentric foci of fresh tumour necroses and surrounding foam cell clusters with transition into vascular granulation tissue could be established as characteristic features of therapy-induced tumour regression, whereas untreated carcinomas revealed necroses with adjoining vital tumour tissue. Using a three-step regression system, 3 tumours could be classified as grade I (no or only slight tumour regression), 10 tumours as grade IIA (marked but incomplete tumour regression, more than 10% vital tumour tissue), 20 tumours as grade IIB (less than 10% vital tumour tissue) and 7 tumours as grade III (complete tumour regression without vital tumour tissue). After a median follow-up period of 32.3 months in patients with grade IIB or III tumour regression (“responders”) the median survival time of 27.9 months was found to be significantly longer than in patients with grade I or IIA tumour regression (“non-responders”) with a median survival period of 13.7 months (log-rank test, P=0.020). The resection specimens analysed, which were obtained 7 weeks (on average) after the end of radiochemotherapy, did not show specific changes due to preoperative therapy, but quite characteristic histological alterations in the former tumour area were registered, which had been induced by combined neoadjuvant radiation and chemotherapy. The grade of therapy-induced tumour regression could be shown to be a significant prognostic factor in non-small-cell lung cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050090
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 5
    Electronic Resource
    Electronic Resource
    Morphology of pulmonary metastases from osteosarcoma during chemotherapy (1987)
    Springer
    Journal of cancer research and clinical oncology 113 (1987), S. 241-248 
    Details
    ISSN: 1432-1335
    Keywords: Osteosarcoma ; Chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Osteosarcoma is known to metastasize rather early, and even after surgical resection of the primary metastases may occur predominantly in the lung. Administration of polychemotherapy for destruction of micrometastases has served to improve prognosis. Preoperative chemotherapy facilitates the evaluation of regression, another factor of high prognostic relevance. Morphologic analysis of pulmonary metastases developing during chemotherapy is of considerable interest on account of the potential therapy resistance of certain histologic subtypes of osteosarcoma. In the present study pulmonary metastases resected in 20 thoracotomies of 15 osteosarcoma patients were investigated by light microscopy and compared, if possible, to the respective primaries. All patients had received chemotherapy, predominantly according to the COSS 80 and COSS 82 protocols. The histologic picture of a tumor was found to change from the primary to the pulmonary metastasis, a pattern also verified in the lung metastases collected in consecutive thoracotomies from the same patient. Several different subtypes were regularly found side by side in the metastases, but generally no special sensitivity or resistance to chemotherapy could be attributed to any of these subtypes. Our results nevertheless do indicate an increased resistance of anaplastic tumor tissue. The response to chemotherapy agreed in 9 of 10 primaries with that of their metastases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00396380
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    Paper (German National Licenses)
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