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Benign and malignant ovarian tumors in children and adolescents
104
ABSTRACTS
experimental group of monkeys were treated in utero by insertion of an H A V I T prosthesis and subsequent to Cesarean deliverY by a conventional VP shunt. The control group showed severe porencephaly and hydrocephalus, whereas the treated group showed well-developed brains with normal symmetry and ventrical size. Findings are illustrated by reproductions of C T scans. In an editorial by Dr Eldon Foltz in the same issue the authors' work is commended. Dr Foltz, however, concludes by saying that future research efforts should include the entire spectrum of neuroscientists whose scientific backgrounds will ensure a complete understanding of the neuroembryology and neuropathology involveC-David L. Collins NEOPLASMS Decline in US Childhood Cancer Mortality. R.W. Miller and
F.W. McKay. J A M A 1984.
25]:1567-1570,
(March
23/30),
Cancer mortality in the United States from 1950 to 1979 as evaluated by death certificates reveals dramatic declines, especially in conditions such as leukemia in which the mortality fell 50%, non-Hodgkin's lymphoma--32%, Hodgkin's disease--80%, bone sarcoma 50%, renal neoplasms--68%, and 31% for all other cancers. The author concludes that these heartening results are almost entirely due to improved therapy which should be a source of pride for those involved in this work.--David L. Collins Nauroblastoma: Mass Screening for Early Detection and Its Prognosis. T. Sawada, T. Kidowski, L Sakamoto, et al.
Cancer 53:2731-2735, (June), 1984. This is an optimistic evaluation of a screening procedure designed to provide earlier diagnosis for children with neuroblastoma. The system employs a V M A "spot test" on all 6- to 7-month-old infants, the mothers of whom simply mail a urine "spotted" filter paper to the testing center in Kyoto. The comparison in this report is between the total experience with neuroblastoma in Kyoto Perfecturate during the period July 1962 to June 1974, when no testing was employed, versus the period subsequent to July 1974 when testing became a standard procedure for the entire area. The annual incidence of neuroblastoma in the Kyoto area is approximately 2.9, including both study periods. The most significant difference between the patients seen during these two periods is the age at which neuroblastomas were detected. Before screening, only 20% of the patients with neuroblastoma were discovered when the patients were less than 12 months of age. After mass screening was instituted, this figure rose to 54.6%. Before screening, 68.6% of the children with neuroblastoma were older than 2 years of age at diagnosis; after screening, this was reduced to 31.8%. The survival rate was 17.1% before screening, and 72.7% after screening, although the "follow-up" on the latter must be much shorter. The percentage of patients in Stages I, II, and IV-s was increased in the post screening group. Historical controls m a y be deceptive, and this is particularly true when m a n y factors are changing that might influence outcome. Although there have been advances in the care of children with neuroblastoma in the past decade, these have not been dramatic, and should not produce changes of
the magnitude seen in the Kyoto study. Thus, this may be an effective screening measure that will enable the physician and surgeon to treat these patients earlier in the c o u r s e . Daniel M. Hays
Improved Survival in Infants and Children With Primary Malignant Liver Tumors. G.H. Mahout, G.U. Wogu, S.E.
Siegel, et al. A m J Surg 146:236-240 (August), 1983. During the years 1952 thru 1981, 46 patients were seen with liver malignancies, including 33 hepatoblastomas, 9 hepatocellular carcinomas, and 4 sarcomas. Seven patients with hepatocellular carcinoma and 1 with hepatoblastoma were diagnosed at autopsy. The majority of the remainder (32 of 38) had hepatoblastoma. During the first 2 decades, 15 of 19 patients died with a mean survival of 5.5 months. The other 4 were lost to follow-up. During the last decade there were also 19 patients with 2 lost to follow-up, 7 deaths, and 10 living at the time of report. Mean survival has been extended to 30 months with a 2 year survival rate of 53%. Survival according to various therapeutic modalities is compared--Thomas V. Whalen, Jr.
Benign and Malignant Ovarian Tumors in Children and A d o l e s c e n t s . I.M. Ehren, G.H. Mahour, and H. Isaacs, A m
J Surg 147:339-344 (March), 1984. Sixty-three patients aged 15 months to 17 years were seen with ovarian tumors over 21 years. Thirteen of the tumors were malignant. Forty-one of the patients had benign teratomas. There were 6 cystadenomas and three teratomas had embryonic but not malignant tissue. Three of the teratomas were malignant, and the other malignancies included 6 germinomas, 2 mixed germ cell tumors, 1 endodermal sinus tumor, and 1 cystadenocarcinoma. Two of the 3 malignant teratomas have survived in excess of 10 years, with one operative death. All 6 of the patients with germinoma have become long-term survivors, with combination therapy being used for higher-staged patients. O f the 4 miscellaneous malignancies, one was lost to follow-up and 3 died. All of the benign teratomas that were followed did well. One of the 3 patients with embryonic tissues developed frank embryonat carcinoma.--Thornas V. Whalen, Jr.
Cryptorchidism and Testis Cancer. Atypical Infantile Germ Cells Followed by Carcinoma in Situ and Invasiva Carcinoma in Adulthood. J. Muller, N.E. Skakkebaek, O.H. Nielsen, el al. Cancer, 54:629-634, (August 15), 1984.
This report concerns a boy with cryptorchidism in whom serial testicular biopsies were performed at intervals from age 10 years to 20 years, with an ultimate orchiectomy. The initial biopsy at the time of orchiopexy revealed atypical germ cells with some resemblance to adult type carcinoma in situ. Subsequent biopsies showed a gradual transition to carcinoma in situ, and the tumor was widespread in the testis at the time of orchiectomy. Microspectrophotometric D N A measurements showed aneuploidy in the prepubertal and postpubertal atypical germ cells, suggesting that this was a
ABSTRACTS
experimental group of monkeys were treated in utero by insertion of an H A V I T prosthesis and subsequent to Cesarean deliverY by a conventional VP shunt. The control group showed severe porencephaly and hydrocephalus, whereas the treated group showed well-developed brains with normal symmetry and ventrical size. Findings are illustrated by reproductions of C T scans. In an editorial by Dr Eldon Foltz in the same issue the authors' work is commended. Dr Foltz, however, concludes by saying that future research efforts should include the entire spectrum of neuroscientists whose scientific backgrounds will ensure a complete understanding of the neuroembryology and neuropathology involveC-David L. Collins NEOPLASMS Decline in US Childhood Cancer Mortality. R.W. Miller and
F.W. McKay. J A M A 1984.
25]:1567-1570,
(March
23/30),
Cancer mortality in the United States from 1950 to 1979 as evaluated by death certificates reveals dramatic declines, especially in conditions such as leukemia in which the mortality fell 50%, non-Hodgkin's lymphoma--32%, Hodgkin's disease--80%, bone sarcoma 50%, renal neoplasms--68%, and 31% for all other cancers. The author concludes that these heartening results are almost entirely due to improved therapy which should be a source of pride for those involved in this work.--David L. Collins Nauroblastoma: Mass Screening for Early Detection and Its Prognosis. T. Sawada, T. Kidowski, L Sakamoto, et al.
Cancer 53:2731-2735, (June), 1984. This is an optimistic evaluation of a screening procedure designed to provide earlier diagnosis for children with neuroblastoma. The system employs a V M A "spot test" on all 6- to 7-month-old infants, the mothers of whom simply mail a urine "spotted" filter paper to the testing center in Kyoto. The comparison in this report is between the total experience with neuroblastoma in Kyoto Perfecturate during the period July 1962 to June 1974, when no testing was employed, versus the period subsequent to July 1974 when testing became a standard procedure for the entire area. The annual incidence of neuroblastoma in the Kyoto area is approximately 2.9, including both study periods. The most significant difference between the patients seen during these two periods is the age at which neuroblastomas were detected. Before screening, only 20% of the patients with neuroblastoma were discovered when the patients were less than 12 months of age. After mass screening was instituted, this figure rose to 54.6%. Before screening, 68.6% of the children with neuroblastoma were older than 2 years of age at diagnosis; after screening, this was reduced to 31.8%. The survival rate was 17.1% before screening, and 72.7% after screening, although the "follow-up" on the latter must be much shorter. The percentage of patients in Stages I, II, and IV-s was increased in the post screening group. Historical controls m a y be deceptive, and this is particularly true when m a n y factors are changing that might influence outcome. Although there have been advances in the care of children with neuroblastoma in the past decade, these have not been dramatic, and should not produce changes of
the magnitude seen in the Kyoto study. Thus, this may be an effective screening measure that will enable the physician and surgeon to treat these patients earlier in the c o u r s e . Daniel M. Hays
Improved Survival in Infants and Children With Primary Malignant Liver Tumors. G.H. Mahout, G.U. Wogu, S.E.
Siegel, et al. A m J Surg 146:236-240 (August), 1983. During the years 1952 thru 1981, 46 patients were seen with liver malignancies, including 33 hepatoblastomas, 9 hepatocellular carcinomas, and 4 sarcomas. Seven patients with hepatocellular carcinoma and 1 with hepatoblastoma were diagnosed at autopsy. The majority of the remainder (32 of 38) had hepatoblastoma. During the first 2 decades, 15 of 19 patients died with a mean survival of 5.5 months. The other 4 were lost to follow-up. During the last decade there were also 19 patients with 2 lost to follow-up, 7 deaths, and 10 living at the time of report. Mean survival has been extended to 30 months with a 2 year survival rate of 53%. Survival according to various therapeutic modalities is compared--Thomas V. Whalen, Jr.
Benign and Malignant Ovarian Tumors in Children and A d o l e s c e n t s . I.M. Ehren, G.H. Mahour, and H. Isaacs, A m
J Surg 147:339-344 (March), 1984. Sixty-three patients aged 15 months to 17 years were seen with ovarian tumors over 21 years. Thirteen of the tumors were malignant. Forty-one of the patients had benign teratomas. There were 6 cystadenomas and three teratomas had embryonic but not malignant tissue. Three of the teratomas were malignant, and the other malignancies included 6 germinomas, 2 mixed germ cell tumors, 1 endodermal sinus tumor, and 1 cystadenocarcinoma. Two of the 3 malignant teratomas have survived in excess of 10 years, with one operative death. All 6 of the patients with germinoma have become long-term survivors, with combination therapy being used for higher-staged patients. O f the 4 miscellaneous malignancies, one was lost to follow-up and 3 died. All of the benign teratomas that were followed did well. One of the 3 patients with embryonic tissues developed frank embryonat carcinoma.--Thornas V. Whalen, Jr.
Cryptorchidism and Testis Cancer. Atypical Infantile Germ Cells Followed by Carcinoma in Situ and Invasiva Carcinoma in Adulthood. J. Muller, N.E. Skakkebaek, O.H. Nielsen, el al. Cancer, 54:629-634, (August 15), 1984.
This report concerns a boy with cryptorchidism in whom serial testicular biopsies were performed at intervals from age 10 years to 20 years, with an ultimate orchiectomy. The initial biopsy at the time of orchiopexy revealed atypical germ cells with some resemblance to adult type carcinoma in situ. Subsequent biopsies showed a gradual transition to carcinoma in situ, and the tumor was widespread in the testis at the time of orchiectomy. Microspectrophotometric D N A measurements showed aneuploidy in the prepubertal and postpubertal atypical germ cells, suggesting that this was a