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Background and Objectives: This small series documents the clinical and pathological features and the rarity of distant skin and soft tissue metastases from sarcomas., Materials and Methods: Five cases of sarcomas from different anatomical locations that had metastasized to skin and subcutaneous soft tissue were identified in three women and two men. The age range was 41-77 years. The primary tumors had wide excisions, followed by either radiation or chemotherapy, or both. The histological types were epithelioid sarcoma, malignant fibrous histiocytoma, malignant peripheral nerve sheath tumor, and leiomyosarcoma. Metastases occurred to the skin and soft tissue of the chest wall, leg, breast, and abdominal wall. The diagnosis was established by excision biopsies for three cases and by needle biopsy and fine-needle aspiration for two cases., Results: Three patients died within 7 months of the diagnosis of soft tissue metastases that were always histologically high grade and never solitary. One patient is alive with lung metastasis discovered 17 months after excision of primary. Lung metastases occurred either simultaneously or within a short period after soft tissue metastases., Conclusion: Distant skin and soft tissue metastases from sarcomas are very rare and often occur as a terminal event.

Twenty-three patients with liver metastases from soft tissue sarcoma were reviewed. Patients with metastases to the liver first had poorer survival than those who developed spread to other sites first (P = .0035). The median time from diagnosis of the primary tumor to diagnosis of liver metastases was 14 months; the median time from diagnosis of liver metastases to death was 7 months. The median survival from diagnosis for four patients who underwent liver resection was 54 months compared to 20 months for those who did not undergo resection (NS). Soft tissue sarcomas rarely metastasize to the liver; when this occurs it is usually late in the course of the disease and after it has spread to other sites. The opportunity for successful liver resection is infrequent but may prolong survival.

Eccrine porocarcinoma, a malignancy of the eccrine sweat glands, is extremely rare. Our report and a review of the literature (70 cases) emphasize the features of this tumor. Age at time of treatment ranged from 19 to 94 years (mean 67 years). Duration of the lesion ranged from two months to 50 years; 31 (44%) had the lesion present > or = 5 years. Forty-four patients (62%) had tumors located on the extremities, 13 (19%) on the head and neck region and 12 (17%) on the trunk. All patients whose race is known were white. Primary treatment should consist of wide local excision and regional lymphadenectomy, if clinically indicated. Although there is a significant risk of cutaneous, regional lymph node, or visceral metastases, the value of elective or therapeutic regional lymphadenectomy is unknown, as is the role of adjunctive therapy.

In this paper the results of a retrospective review of 58 patients with malignant pleural mesothelioma treated at our Institute are reported. There were 50 males and 8 females; the mean age was 56.3 years (range: 13-77). History of asbestos exposure was ascertained in 25 patients (43%). The most common finding in chest X-ray was pleural effusion which was seen in 47/58 patients on presentation. The cytological examination of pleural effusion was most of the time nondiagnostic. Pleural biopsy was needed for the correct diagnosis. Pathologically, 26 patients (44.8%) had epithelial type, 24 patients (41.4%) had mixed type, and 8 patients (13.8%) had fibrous or sarcomatous type of pleural mesothelioma. Most of the patients on presentation had Stage I disease by Butchart's classification. The overall survival time ranged from 1 month to as long as 17 years with a median of 12.5 months. The mean survival of patients who received nonsurgical therapies was 7-13.4 months. Thirteen patients were treated surgically: three patients survived over 5 years, but the median survival was 15 months. Six patients received no treatment, and the median survival was seven months.

In 1976 Stewart et al. (Annals of the New York Academy of Sciences 277:436-466) reported the effectiveness of adjuvant specific active immunotherapy of lung carcinoma in improving the postoperative survival of stage I lung carcinoma patients in a phase II study using lung carcinoma-associated antigen (TAA) and complete Freund's adjuvant (CFA). A phase III study was then designed by the authors to see the effects of specific active immunotherapy compared to the conventional management (no treatment) and to nonspecific immunotherapy. From 1976 to 1981, 85 patients with resectable (stages I and II) squamous cell lung carcinoma were entered into a randomized study: 1) control group; 2) specific immunotherapy group--three monthly doses of 500 micrograms of TAA emulsified with CFA; 3) nonspecific immunotherapy group--three monthly doses of CFA emulsified in saline. All the patients in the study received skin tests with 100 micrograms of the same TAA used for the immunotherapy. Recently, a 5-year follow-up of all the patients became available: The life table 5-year survival of group 1 was 34%, of group 2 was 75%, and of group 3 was 53%. The median survivals for the three groups were group 1, 38 months; group 2, 106 months; and group 3, 71 months. The difference was significant at P = .007 (Cox-Mantel test).

Herein we present the case of a woman who is now 19 years post abdominoperineal resection for a Dukes' C1 rectal carcinoma, 10 years post right hemicolectomy for a Duke's C1 carcinoma of the ascending colon and removal of a solitary hepatic metastasis and now 9 years post resection of an ovarian metastasis. She had 5-fluoracil, postoperatively. This is the ninth case reported in the literature of a 5-year survivor free of disease following oophorectomy for metastatic adenocarcinoma of the large bowel. The finding of ovarian and hepatic metastases from her colorectal carcinoma would have indicated a poor prognosis. We feel that those rare patients who have an unexpected long survival should be reported for accumulation of clinical data, illustration of their clinical management, and analyses of the applied therapeutic interventions.

Fibrin Seal (FS) (a natural adhesive material composed of fibrinogen, cold insoluble globulin, factor XIII, platelet growth factor, antiplasmin thrombin, and calcium chloride) was utilized in the construction of vascular anastomosis of the femoral artery of mongrel dogs. A significant decrease in the number of sutures necessary to achieve adequate anastomosis and minimize the likelihood of postoperative bleeding was noted. There was no long-term increase in tissue reaction or decrease in arterial patency. On the basis of these preliminary results the role of FS as a hemostatic agent in vascular and especially microvascular surgery warrants further investigation.

The circumferential resection of the trachea with end-to-end anastomosis is a well-established clinical procedure. Still, some problems remain to be solved, such as the choice of optimal suture material. Dogs are primarily used for experimental work in this field, but are difficult to obtain. This operation was performed on nine rabbits, eight of whom survived to the preplanned date of sacrifice. Two of the survivors were found to have severe stricture at the anastomosis. This study indicates that the rabbit is a suitable experimental animal for circumferential resection and anastomosis of the trachea.

Since February, 1977, 735 patients having a history of receiving radiation therapy for benign conditions of the head and neck areas during infancy and childhood were examined in a thyroid screening program, and 159 patients were found to have palpable thyroid nodules. These patients had thyroid function tests and indirect laryngoscopy and were followed closely on suppression therapy consisting of either Cytomel or thyroid extract. Thyroidectomy was advised in those in whom the nodules persisted or increased in size. This study documents the incidence of carcinoma and other benign pathological changes and postoperative complications in this group of patients. So far, 49 patients had either a lobectomy with isthmusectomy or a total thyroidectomy. Eleven patients were found to have carcinoma (six had papillary, four had mixed papillary and follicular, and one had follicular carcinoma). Three patients had a therapeutic modified neck dissection following the documentation of microscopic involvement of paratracheal lymph nodes. A high incidence of chronic nonspecific thyroiditis, postradiation fibrosis, and follicular adenomas were also found in these patients. Three patients had temporary hypocalcemia (two weeks) and none had wound infection, hematoma, or postoperative nerve palsy. Of patients who had surgical resection, 22.4% showed thyroid carcinoma.

Benign cysts of the parotid gland are rare. They present with equal distribution between males and females as unilateral painless swelling in the area of the parotid gland without fixation to the overlying skin or involvement of the facial nerve. These cysts can be congenital, acquired, or occasionally may arise from surrounding structures. The preoperative diagnosis is very difficult and the treatment of choice consists of superficial parotidectomy. Our 10-year experience with benign cyst of the parotid gland at Roswell Park Memorial Institute is presented in this paper.

Of 191 case reports submitted to the National Soft Tissue Sarcoma Registry, 131 qualified for inclusion. Fifty-two percent were males; 80% were whites. Twenty-one different histologies were assigned, with leiomyosarcoma most frequently represented. Localized disease was reported for 29% of patients. Surgery in combination with radiotherapy and/or chemotherapy was reported as the treatment for 45% of patients, and surgery only was reported for 31%. These data reflect increasing used of adjuvant therapy in the treatment of soft tissue sarcoma.