Search

To compare the performance of computed tomography (CT) and magnetic resonance (MR) imaging in diagnosis of osteoid osteoma.Nineteen patients with histologically proved osteoid osteoma underwent CT and MR imaging before excision of the lesion. CT and MR images were compared regarding lesion conspicuity and detection of marrow, soft-tissue, and/or synovial changes adjacent to the primary lesion.CT was more accurate than MR imaging in detection of the osteoid osteoma nidus in 63% of cases. MR imaging was better than CT in showing intramedullary and soft-tissue changes in all cases. This may produce a misleading aggressive appearance on MR images. There was a statistically significant correlation between presence or absence of marrow or soft-tissue changes and treatment with antiinflammatory medications (P.05).CT remains the best imaging modality for diagnosis of osteoid osteoma. MR images should not be interpreted without reference to plain radiographs and CT scans if serious errors in diagnosis are to be avoided.

Intracranial metastases were detected in 343 patients in the National Cancer Institute study of computed tomography (CT) in the diagnosis of intracranial tumors. The metastatic lesions were divided into five groups according to the organ of origin. Studies of the attenuation values of the brain lesions showed no distinctive features that would enable the identification of the site of the primary lesion. The sensitivity of CT and angiography was superior to that of radionuclide scanning. Brain metastases showed CT densities less than, equal to, or greater than the normal brain, with attenuation values ranging up to 40. They were found most frequently in the frontal region, and approximately 90% of the lesions showed necrosis. Surrounding edema was usually moderate or marked.

Of 75 patients with advanced cervical lymph node metastases from primary squamous cell carcinoma of the oral cavity, 75% had T3–4 lesions. Control of the primary lesion arrested spread in 20 of 35 cases (57%) followed for twenty-four months or more. The inability to control primary disease (chiefly in lesions of the oral tongue and soft-palate uvula) was responsible for 30 of 45 failures. Many patients were saved by radiotherapy alone or in combination with limited surgery. Irradiation to the whole neck is necessary, even when nodes are present only in the upper portion.

The natural concern of the patient and concomitant interest of the physician have served to focus attention on testicular enlargement secondary to involvement by tumor. Early attempts at cure were logically by surgical extirpation of the primary lesion. The demonstration of radiosensitivity of seminoma as early as 1905 by Beclere (1) prompted consideration of the curative possibility of roentgen rays in these cases. Surgical extirpation, however, because of its relative simplicity and effectiveness, has continued to be the treatment of choice for the primary site. With the demonstration of the mode of dissemination of these tumors via the lymphatic drainage channels in sequential fashion by Chevassu in 1906 (2), possible methods of control of extension were soon explored. The removal of adjacent lymphatics suggested by Osler (14) and the subsequent description of extraperitoneal lymphadenectomy by Chevassu (3) stimulated interest in the surgical approach to the problem. During the subsequent decades, howe...

A variety of procedures may be effective in the treatment of carcinoma of the lower lip, but the chances of control and the esthetic and functional results vary depending on the circumstances of the case. The form of treatment to be preferred is thus determined by the size of the primary lesion, the presence or absence of concomitant metastases, the degree of differentiation of the tumor, and whether or not the patient has received previous unsuccessful treatment. The following considerations and conclusions are based on the study of 531 consecutive cases of previously untreated carcinoma of the lower lip admitted to the Ellis Fischel Cancer Hospital (Columbia, Mo.) from 1940 to 1953. A second group of 103 consecutive recurrences after treatment elsewhere is reported separately. Histology In all of the 531 patients the diagnosis of carcinoma was confirmed by biopsy. Many cases of extensive ulceration of the lower lip with the clinical appearance of cancer proved to be chronic inflammatory lesions associat...

In investigating a patient with a possible intracranial process, common carotid angiography may permit a study of the major vessels leading to and feeding a neoplasm. In this way one may identify the lesions plus the tumor stain, the type, the specific diagnosis, and the extent of a tumor. Prolongation and stasis of dural circulation generally indicate either a primary lesion such as a meningioma or a blood-borne metastasis. Beading or irregularity in the arterial wall is an additional sign of direct dural involvement and is seen in dural metastases with neoplastic induration of the dura.

In the main, intracavitary radium therapy may be defined as the application of radium to the surface of a lesion occurring in any hollow place or space. Not only is it the oldest form of radium therapy of carcinoma of the uterine cervix but it also is a conservative method. Many improvements and refinements have made it most effective. Our experience with this method at the Mayo Clinic covers a period of thirty years. During that time, the technic employed has been rather constant, which permits the widest possible interpretation of the variable factors inherent in the patient and the disease. The history, bimanual palpation, inspection and sounding of the genital tract, especially in the predominating Stage III lesion, are essential for diagnosis and treatment. A general physical examination and the required laboratory tests, ineluding removal of tissue from the primary lesion for microscopic study, are absolutely essential from the standpoint of good management. A knowledge of pathology and physiology w...

IN many clinics there is a tendency to standardize the treatment of cervical cancer so that a routine method of radiation is used for all patients. No single method is suitable for all individuals, but in most instances there are certain advantages to be gained if treatment is begun with external radiation (8). By that means the amount of infection in the lesion can be reduced, which, in turn, will lessen the local reaction from radium applied at a later date. A preliminary course of x-rays also facilitates radium treatment by producing some regression in the size of the primary lesion. However, if the percentage of cures is to be increased materially, it is essential to individualize both the roentgen and radium treatment of each patient to meet the requirements of the lesion in question, rather than to apply a single method to all patients with cervical cancer. In a previous publication (2) diagrams illustrating the distribution of roentgen radiation within the average female pelvis were given for diffe...

Enthusiastic preoperative or postoperative irradiation for the cure of cancer of the breast requires a confidence in the ability of radiation(s) to eradicate the primary lesion and the regional lymph node metastases. It implies that cancerocidal doses delivered to such lesions will in some way improve the control rate. Until recently neither of these requirements could be readily satisfied. There is now indirect evidence such as that supplied by Guttmann (1963) that lymph node metastases may be controlled by vigorous irradiation. Also, microscopic studies of heavily irradiated primary cancers of the breast and of regional lymph node metastases have shown that sterilization is at times achieved. We can therefore conclude that both the primary and lymph node metastases can at times be controlled. The frequency of control and its permanency are uncertain. If we accept as fact that irradiation can in certain instances eradicate cancer metastatic to lymph nodes, we still must consider two questions. 1. Does a...

A survey of the records of the State Institute for the Study of Malignant Diseases from Jan. 1, 1926, to Dec. 31, 1935, showed 636 consecutive cases of cancer of the lip treated by irradiation. All of these cases were proved microscopically to be squamous-cell carcinoma. As a result of this study, the following pertinent facts were ascertained. Lip cancer occurred about 38 times as frequently in men as in women, and about 29 times as frequently on the lower as on the upper lip. Of the total group of patients, 619 were men and 17 were women. The upper lip was involved 22 times, in 2 cases in females; the lower lip was involved 614 times, in 15 cases in females. Multiple lesions occurred in 12 cases. Six patients had two primary lesions involving the lower lip; 5 had primary lesions involving the upper and lower lip, and 1 had a primary lesion involving the upper and lower lip and also the tongue. The youngest patient was 28 and the oldest 92 years of age. One hundred and ninety-eight cases occurred in the ...

Among 130 irradiated patients with carcinoma of the floor of the mouth, the actuarial five-year survival rate was 62%. Of these patients, 79% were free of metastatic adenopathy, and their survival rate was 75%. The curability of carcinoma of the floor of the mouth is almost independent of the size of the primary lesion if metastases are absent. Prophylactic neck dissection was not found to be necessary. The three-year survival of patients in whom cervical metastases developed after irradiation was 77%.

The incidence and causes of radiotherapeutic failures and surgical salvage were analyzed by anatomical sites, staging of the primary lesion, modalities of treatment, and clinical features in 554 patients with squamous cell carcinomas of the oropharynx treated with megavoltage irradiation from 1954 through 1967. Differences in the incidence of failures were found by T staging, depending on the anatomical site. The presence of a necrotic ulcer was correlated with poor results. Systematic causes of geographical misses or underdosed areas were found in certain techniques. Specific precautions are outlined.

THIS subject is not a new one with us—it has been presented on two previous occasions (1 and 2)—but in this communication we are giving a review of the work carried out in the years 1930, 1931, and 1932. It was prompted by a recent report from the Curie Institute (3) and its purpose is to draw some conclusions that may be of future guidance in treating patients with this disease. In order to facilitate the case analysis, patients have been segregated into two large groups: (A) Those in which there were lesions of the tongue alone, of which there were 69 cases; (B) Those in whom the malignancy was on the buccal surfaces, palate, and alveolar regions, of which there were 26 cases. For further ease in study these groups were subdivided into classes as given below: Table I Class I. Primary lesion less than 2 cm. in diameter Class II. Primary lesion over 2 cm. in diameter Class III. Primary lesion associated with enlarged lymph nodes Class IV. Recurrent lesion after operation Diagnosis.—The diagnosis of malign...

I have been asked to discuss what I regard as “reasonable indications for and contraindications to radiation therapy of bronchial cancer,” and what I “believe to be a practical palliative technic as well as a radical technic.” The following conclusions in response to these specific questions are based on experiences with the treatment of bronchocarcinoma at the Swedish Hospital, in Seattle, since 1939. The material is small but I believe permits certain conclusions in regard to future policy. Between 1939 and December 1953 we saw a total of only 130 cases (Table I). Of these, 49 per cent were rejected; 40 patients (30 per cent) received what we considered adequate radiation therapy to the primary lesion and/or mediastinum. Because of our depressing experiences, we purposely discouraged referral for radiotherapy, which explains the small number of cases. In January 1954, when our 2-MEV machine began operating, I decided to make another attempt with a selected group of patients. All of these I selected and ...

Treatment of the malignant lip is based upon the position, extent, and site of the lesion; whether or not it is ulcerated and infected; flat, indurated, and whether or not lymphatic glandular involvement is present. Lymph node involvement is important because the location, type, and condition of the lymph drainage areas considerably influence the method of procedure for their control, along with treatment of the primary lesion. In our series2 of 160 treated cases, 22 showed palpable lymph node involvement at the time of admission. The duration of the lesion before treatment determined in most instances the occurrence of lymph node invasion. Neck node involvement was uncommon in cases seen within the first six months from the onset of the local lesion. The age of the patient is important; the younger the patient the more drastic being the treatment required to control the malignant process; in older patients with localized lesion surgery is often the method of choice and may readily eliminate the entire co...

The main objective in the use of radioactive colloidal gold for the treatment of cancer of the cervix is safe, adequate, and convenient irradiation of the pelvic lymph nodes. This is in no way different from the motive behind the use of conventional x-rays, supervoltage x-rays, or the gamma rays of radium or cobalt. The treatment of the primary lesion is no problem. Supplemental therapy is necessary, however, because some patients undoubtedly have cancer in the pelvic lymph nodes which would not be destroyed by direct irradiation of the cervix or by hysterectomy. Radiogold is only an agent for providing supplemental therapy. The properties of radiogold are nearly ideal for this purpose. The short half-life of 2.8 days limits the duration of irradiation. The radioactivity is primarily beta, so that the majority of the effect is restricted to the immediate vicinity of the interstitial injection. Radiogold, however, is especially valuable because of the manner in which the tissues absorb and “fix” the gold. ...

In the neuroblastomas of infancy and childhood the physician is dealing with a multipotential tumor which may be curable. The outcome will in part depend upon the localization of the primary lesion, the presence and distribution of metastases, and the selection of the type of therapy. Neuroblastoma was first described by Virchow (1) in 1864 and classified as a glioma. The clinical picture was described by Pepper (2) in 1901 and Hutchison (3) in 1907, and their names have become associated with two clinical types based upon the distribution of the metastases, the adrenal hepatic distribution of the tumor being subsequently known as Pepper's type and the adrenal skeletal, specifically with skull metastases, as the Hutchison type. Studying the suprarenal tissues of embryos, Wright (4) in 1910 first recognized the similarity of the cells to those of these tumors and concluded that the origin must be from the sympathetic nervous system. Farber (5) in 1940 and Karsner (6) in 1942 finally dispelled the concept o...

One hundred and forty-seven cases of gross disease of the head and neck were irradiated between Jan. 1, 1963, and June 1, 1968. Nineteen patients were irradiated because the surgical specimen did not show an adequate margin. Only one patient was lost to follow-up. Tables give the relative importance of histologic type, anatomic site of primary lesion, and late recurrence, and also give the relation between prophylactic irradiation and gross recurrence and between failure above the clavicle and technique of treatment. Seven cases are reported in detail.

The usual discussion of cancer therapy primarily presents results, and only secondarily describes the method of treatment. It is generally agreed that at least five years should elapse before such a report is made. The methods of treatment described, therefore, are usually those employed five years before. To know just how other therapists actually manage their patients at the present time, we must visit their treatment rooms. Rather than offering results in this paper, we shall set forth the details of our present manner of treatment, together with our reasons for adopting the technic now in use. In treating a patient with cancer the object is to restore the patient's health by eradicating the neoplasm. This requires knowledge not only of the site of the primary lesion but also of the location of all of the structures to which it may spread. At the University of California Hospital, patients with uterine cervical cancer are treated jointly by gynecologists and roentgenologists. Those suspected of having ...

Following initial diagnostic work-up and histological confirmation of a metastatic lesion, an extensive search may fail to locate a primary cancer site. Two case reports are presented. A retrospective analysis was done of 255 patients with metastases of unknown origin; 231 patients (over 90%) have since died. Of 34 patients with autopsy information, no primary lesion was found in 20. In the remaining 14 cases, prior knowledge of the primary site would not have influenced either therapy or proganosis. A plea is made for judicious restraint in the use of diagnostic imaging procedures to search exhaustively for a primary cancer site.

To our knowledge, esophageal carcinoma that is metastatic to the gastric cardia has rarely been described in the radiologic literature. We examined seven patients who had a solitary metastasis in the gastric cardia that had spread from esophageal carcinoma. Five of the gastric lesions were synchronous with the primary lesion, and two developed after the primary tumor had been detected. Radiographically, the gastric lesion appeared as a submucosal mass in five patients and appeared to simulate a primary gastric carcinoma in the other two patients. The metastases had probably disseminated through the submucosal lymphatic system. Because the presence of a gastric metastasis may affect a patient's therapy, radiographic examination of the gastric fundus should be a routine part of the initial staging and/or follow-up evaluation of esophageal carcinoma.

Although radiation therapy has been used in the management of malignant bone tumors for many years (1), its precise role remains uncertain. Preoperative irradiation in osteogenic sarcoma, as proposed by Ferguson (5), is still of controversial value. Furthermore, the ability of radiation therapy alone to control the primary lesion in Ewing's sarcoma has been questioned (17). The problem of differentiation between Ewing's sarcoma and reticulum-cell sarcoma has led to some skepticism in respect to cures of the former. To provide insight into the proper place of radiation therapy in the management of these lesions, we reviewed their treatment at this institution. Material The records of all 87 patients treated for osteogenic sarcoma, Ewing's sarcoma, and reticulum-cell sarcoma at the University of California San Francisco Medical Center between 1945 and 1965 were studied. The 70 records of patients given primary treatment at this Center were analyzed in detail. In addition, two osteogenic sarcomas treated els...

Those who use the transvaginal attack on cervical cancer can be divided into two groups. The purpose of one group is to increase the homogeneity of radiation throughout the pelvis and to try to deliver a lethal dose of x-rays to cancer cells wherever they may be. They properly use long distances, penetrating rays, and multiple fields. The other group uses the method to administer a destructive dose to the primary lesion in the cervix and as large an area as possible immediately surrounding it. Most of the members of this group try in one way or another to deliver a large dose to the lateral vaginal fornices. They seek to avoid an extremely penetrating beam which can injure the intestines, bladder, and rectum, and they like to have a considerable amount of radiation absorbed in the first 3 or 4 cm. The object of the present study is to see how well the various modifications of the transvaginal method achieve the purpose of the second group. The method used for the study is shown in Figure 1. Measurements i...

Six factors affecting the survival of 170 patients with nasopharyngeal carcinoma are discussed: extent of the primary lesion, status of cervical lymph node metastases, histological classification, age, sex, and effect of recurrence after initial treatment. The survival period decreased with increasing primary lesion size and with more extensive lymph node metastasis. Transitional-cell carcinoma was the most favorable histological variety and squamous-cell carcinoma was the least favorable. Young patients had better survival rates than old patients; females survived better than males. Patients whose disease recurred two years after initial treatment had better survival rates than did those with earlier recurrence.

The Problem of lost radium needles or radon seeds in the practice of radiology is not uncommon (1). This report will serve to call attention to an unusual location in which such a “lost” needle or seed may be discovered and to indicate that it has not necessarily found its way into a garbage pail, sewer, crack in the floor, or city dump, or been stolen. There are many reports of such losses, but few cases are on record in which the radioactive material was “lost” in the patient. The report also proves the fallibility of instruments and the need for care and intelligence in their use Case Report A 51-year-old white male with a diagnosis of squamous-cell carcinoma of the right tonsil, with cervical node metastases, received x-ray therapy to the primary lesion and the node-bearing area in the right side of the neck. All but one node in the region of the right submaxillary gland, approximately 0.5 cm. below the skin surface, regressed. Radon seed implantation was decided upon, and with the patient in a semire...

It is fortunate that malignant tumors of the nasopharynx are of rare occurrence. Between 1932 and 1942 only 29 patients were admitted to this clinic with a nasopharyngeal cancer. Because the nasopharynx is accessible only to the most careful rhinoscopist, this lesion is frequently missed. Before admission to the clinic, more than half our patients were under the care of a physician and had one or more nasal operations directed toward the relief of symptoms without recognition of the primary lesion. Other writers have recorded a similar experience (1, 2). New (3) reports that 185 operations had been performed on 194 patients before the underlying disease was recognized. Of our 29 cases, 3 are not included in this study, since they received no x-ray therapy. Most of the cases were treated and followed by Dr. Anna Hamann. Symptoms and Signs In 16 of the 26 patients, or 62 per cent, the chief complaint on admission was a cervical mass. Others (4, 5, 6, 7) have reported an incidence of 35 to 77 per cent. Cutle...

Megavoltage irradiation was used in treating 129 patients with squamous cell carcinoma of the tonsillar fossa. The data were analyzed with time-dose scattergrams and by using the nominal standard dose (NSD) to correlate the probability of control of the primary lesion with dose and stage (tumor volume). All early lesions (T1) were controlled with 6,500 rads given in 6.5 weeks. For more advanced disease (T2), 7,000 rads in 7 weeks (or its equivalent) was required in order to obtain a high probability of local control. The largest lesions (T3 and T4) have been most effectively treated with doses of 7,500 rads in 8 weeks (or its equivalent). Complications have been correlated with dose and volume irradiated.

Since acute pancreatitis was first described by Fitz in 1889 (9) the diagnosis and treatment of this disease have presented an ever increasing challenge to internists and surgeons. On the whole, radiologists have not played a significant role in its management. Morton and Widger (14), in 1940, were the first to report the successful use of roentgen rays as a method of treatment. They described 3 cases of the acute edematous type in which 250 to 450 r (in air) were given with beneficial effect. Successful response to x-ray therapy has since been reported by others (4, 6, 8, 10, 11, 13, 16). This presentation of the results obtained in 53 cases affords additional evidence of the value of irradiation in the treatment of pancreatitis. For many years, the designation “hemorrhagic pancreatitis” was used for acute inflammatory disease of the pancreas. The term was criticized by many authors, in that it failed to indicate the tissue death which is the primary lesion in the severest form of the condition. Since th...

From a review of the literature, it seems that external roentgen therapy has not been used in a systematic way for the treatment of the primary lesion of either carcinoma of the vulva or urethra. Some radiologists have indeed expressed amazement that it can be used without deleterious by-effects. In a paper on carcinoma of the vulva by Smith and Pollack from the Gynecological Service of Memorial Hospital, we find as late as January 1947 this sweeping statement: “The inadequacy of x-ray and radium in treating either the primary or metastatic foci of this condition is well known.” A similar impression is gained from Berven's thorough discussion of the large group of vulvar carcinoma treated at the Radiumhemmet. The reason for this misconception is probably an insufficient appreciation of the importance of the quality of the radiations used. Some of these lesions, because of their superficial location, may tempt the therapist to employ low-voltage irradiation. This will not be tolerated by the vulvar mucosa ...

The well known supraclavicular shadows present on most postero-anterior films of the chest are valuable aids to diagnosis, though their use has not been previously described. These shadows, as well as the sternomastoid shadows, are pointed out only as normal features, and the student is cautioned against confusing them with pathological lesions (Fig. 1). The frequency of masses in the neck resulting from lymphomata, tuberculosis, thyroid, salivary gland, laryngeal and superior sulcus tumors, and metastatic involvement from carcinoma of the breast and testes is well known. Any of these diseases may produce masses that partially or completely obliterate the supraclavicular fossae, either as a result of metastasis from a distant primary lesion or by direct extension (Fig. 2). In the past, masses in the neck have been recognized chiefly by a bulging silhouette, displaced muscle shadows, displacement of the trachea and esophagus, erosion or invasion of bone, and by the presence of calcific deposits. This repor...

A total of 243 patients with squamous-cell carcinoma of the nasopharynx, tonsillar fossa, and base of the tongue were analyzed for frequency of distant metastases after tumor control had been achieved. Frequency of distant metastases did not increase with the size of the primary lesion. Patients with advanced nodal disease had a higher frequency of distant metastases at five years than did those with early nodal disease. The location of neck disease does not influence the frequency of distant metastases.