chondroitin-sulfates and Sarcoma

Pleomorphic dermal sarcoma is a rare neoplasm of mesenchymal origin that most commonly affects the head. We describe the presentation of a 61-year-old man with a 10-week history of an exophytic lesion affecting the occipital scalp, demonstrating rapid growth. The final histopathology revealed a completely excised 9cm pleomorphic dermal sarcoma (pT2aN0M0, Stage 3), one of the largest such lesions reported in the literature to date. This patient's management involved a wide local subperiosteal excision onto the cranium, with a reconstruction with an Integra dermal regeneration template (Integra LifeSciences, Princeton, NJ, USA) and healing with secondary intention. This was mainly due to poorly defined clinical margins on primary excision, the potential for further excision of involved margins (later confirmed as not needed) and the patient's comorbidities, making a return to theatre for definitive reconstruction undesirable.

Topics: Chondroitin Sulfates; Collagen; Humans; Male; Middle Aged; Sarcoma; Scalp; Skin Neoplasms; Skin, Artificial

Cutaneous sarcomas are primarily treated with extensive surgery, and occasionally require adjuvant radiation therapy following complete wound healing. Thus, sarcoma surgery leads to large and deep wounds, and the initiation of adjuvant radiation therapy depends on the time required for defect closure. We present the case of a male patient with pleomorphic sarcoma of the temporal skin, which was treated with multiple wide and deep excisions, instant application of an Integra(®) bilayer, and immediate radiation therapy prior to wound closure. The objective was to investigate the usefulness of a dermal substitute (Integra(®) ) in accelerating the effect of adjuvant radiation therapy on scalp defects after tumor surgery. A ring-shaped skin area - at risk for recurrence - around the Integra(®) bilayer was irradiated with a total of 59.4 Gy. No necrosis, infection, or major radiotoxicity was observed, and a subsequent split skin graft following radiation therapy remained fully vital until complete healing. In conclusion, a combined procedure consisting of sequential tumor surgery and subsequent application of a dermal substitute in conjunction with immediate initiation of adjuvant radiation therapy is, in principle, possible, and may permit innovative therapeutic options in dermatooncology and dermatosurgery.

Topics: Chondroitin Sulfates; Collagen; Humans; Male; Neoplasm Recurrence, Local; Sarcoma; Scalp; Skin Neoplasms; Skin Transplantation; Skin, Artificial

In 23 cases of carcinoma of the head and neck, the combined use of Somatostatin and/or its analogue Octreotide, prolactin inhibitors, Melatonin, Retinoids, Vitamin E, Vitamin D3, Vitamin C, Calcium, chondroitin-sulphate, and minimal oral doses of cyclophosphamide (50-100 mg/day) led to a decided increase in survival with respect to the median values reported in the literature for the same tumours and stages, together with an evident improvement in the quality of life, partial or complete objective responses and, in some cases, complete and stable cure with functional recovery. The rationale and the mechanisms of molecular biology of the treatment are discussed, showing that the treatment has a differentiating, apoptotic, antiproliferative, antiangiogenic and antimetastatic effect, and, unlike chemo- and/or radiotherapy, preserves and enhances the trophism and functionality of organs, tissues and immunitary and antitumoral homeostasis. This result, achieved without toxicity, demonstrates the efficacy of this biological multitherapy (Prof. Luigi Di Bella's method or DBM) and is in agreement with the positive results already published on the use of the DBM in various neoplastic diseases. We believe it is of use to report these cases to invite greater interest in the possibilities opened up by this biological multitherapy.

Topics: Antineoplastic Agents, Alkylating; Antineoplastic Agents, Hormonal; Antioxidants; Calcium; Carcinoma, Medullary; Carcinoma, Squamous Cell; Chondroitin Sulfates; Cyclophosphamide; Drug Therapy, Combination; Esophageal Neoplasms; Head and Neck Neoplasms; Humans; Melatonin; Octreotide; Retinoids; Retrospective Studies; Sarcoma; Vitamins

Scalp reconstruction after wide tumor excision is particularly challenging. Free tissue transfers, local flaps, or skin grafts can be used but present some disadvantages especially with old patients with local advanced cancers, systemic diseases and in patients with a prior history of recurring scalp skin cancers in which the risk of burying a recurring tumor with a flap is likely. The Authors expose their early experience with Integra dermal regeneration template for scalp reconstruction after scalp tumor excision.. Eight patients with primary or secondary scalp tumor underwent a first surgical procedure under local anaesthesia for tumor removal and Integra positioning followed by a second operation performed three weeks later to reconstruct the defect by removing the superficial silicon layer of Integra and by covering the defect with a split thickness skin graft. The average surface area of the defect was 143.27 cm(2). The average operating time was 30.4 minutes for the first operation and 45.6 minutes for the second operation. In six cases Integra was grafted as a classic full-thickness skin graft. In the remaining two cases the Integra template was meshed. The artificial derma was attached to the edge of the wound by either sutures or staples.. There was a full graft take on all cases. The mean follow-up was 24 months. In two cases we were able to detect early tumor recurrence two months after the operation. Satisfactory cosmetic and functional results were obtained in all patients.. In the scalp defect reconstructions after tumor excision, Integra allows to obtain a thicker and more durable coverage than skin graft on the skull, allowing to detect a tumor recurrence earlier than a flap reconstruction with no risk of burying an eventual underlying residual tumor. These operations are performed under local anaesthesia and are therefore suitable for elderly patients.

Topics: Aged, 80 and over; Carcinoma, Squamous Cell; Chondroitin Sulfates; Collagen; Humans; Melanoma; Plastic Surgery Procedures; Sarcoma; Scalp; Skin Neoplasms; Skin, Artificial; Wounds and Injuries

In order to analyze the mucoid substance in the epithelial component of synovial sarcoma, electron microscopic and cytochemical studies were made on three of these neoplasms. The mucoid substances in the glandular lumen were intensely stained with ruthenium red (RR), appearing as granular, fibrillar and amorphous structures. RR staining of proteoglycans was diminished after treatment with chondroitinase AC or ABC, and was partially diminished by exposure to streptomyces hyaluronidase. Trypsin treatment did not affect RR staining of proteoglycans in the lumen. On thin sections stained with periodic acid-thiocarbo-hydrazide-silver proteinate (PA-TCH-SP), deposits of reaction product were observed on the mucoid substances within the lumen, and were localized in the Golgi complex, including the rough endoplasmic reticulum, small vesicle and lysosome-like dense body. Trypsin digestion decreased the stain intensity of PA-TCH-SP. These results indicate that the lumen of the gland-like component contains glycoproteins as well as proteoglycans mainly consisting of chondroitin sulfate and hyaluronic acid, and suggest that GERL (Novikoff) is closely related to production, storage and transport of glycoproteins in the cytoplasm of tumor cells.

Topics: Adolescent; Adult; Bone Neoplasms; Chondroitin Sulfates; Epithelium; Female; Glycoproteins; Histocytochemistry; Humans; Proteoglycans; Sarcoma; Synovial Membrane

The case of a 22-year-old female suffering from glioblastoma with sarcomatous component (WHO; gliosarcoma) is presented. The tumor consisted of glioblastomatous and sarcomatouos components, and in part of the pleomorphic astrocytomatous region of the glioblastoma there was a prominent production of myxoid matrix. On the basis of its histochemical and immunohistochemical characteristics, the present case strongly suggested that glial cells of neuroectodermal origin assume part of the responsibility for production of myxoid material.

Topics: Adult; Brain Neoplasms; Chondroitin Sulfates; Female; Glioma; Histocytochemistry; Humans; Immunochemistry; Microscopy, Electron; Sarcoma

Six cases of synovial sarcoma were examined histochemically in order to clarify the components of mucosubstances in the tumor tissues. The tumors were classified into 1) monophasic type, 2) predominantly monophasic type with focal biphasic differentiation, and 3) biphasic type. The former two groups and sarcomatous areas in the biphasic tumors contained various amounts of hyaluronic acid, chondroitin sulfate, and, in some cases, heparitin sulfate. By contrast, the epithelioid regions in the biphasic-type tumors had periodic acid-Schiff-positive glycoproteins which contained various amounts of sialic acid, in addition to hyaluronic acid and chondroitin sulfate. The significance of the presence of glycoproteins in the mesenchymal tumors is emphasized. It seems likely that the synovial sarcomas contain various kinds of mucosubstances and that sensitivity to hyaluronidase treatment is not necessarily the diagnostic criterion of synovial sarcoma.

Topics: Adult; Chondroitin Sulfates; Female; Glycoproteins; Heparitin Sulfate; Histocytochemistry; Humans; Hyaluronic Acid; Male; Middle Aged; Mucous Membrane; N-Acetylneuraminic Acid; Sarcoma; Sialic Acids; Staining and Labeling; Synovial Membrane

Using a modified papain digestion cetylpyridinium salt precipitation method, glycosaminoglycans were isolated from 21 mesotheliomas, 34 primary lung carcinomas, 12 carcinomas of other sites, and 7 soft tissue sarcomas. Qualitatively, hyaluronic acid (HA) was present in 20 of 21 mesotheliomas, about half of the primary lung adenocarcinomas, and all of the soft tissue sarcomas. On the average, HA constituted 45% of the total glycosaminoglycans in the mesotheliomas and 28% of the total in the lung cancers. Quantitatively, mesotheliomas contained statistically greater amounts (mean value, 0.74 mg/g) of HA than primary lung adenocarcinomas (mean value, 0.08 mg/g), but were not statistically different from soft tissue sarcomas (mean value, 2.01 mg/g) or primary ovarian serous neoplasms (mean value, 0.92 mg/g). The study concludes that, contrary to previous reports, HA is neither the sole nor the predominant glycosaminoglycan in most mesotheliomas, but, given the proper clinical and histologic setting, the finding of sufficiently high levels (greater than 0.4 mg/g dry tissue extract) supports the diagnosis of mesothelioma when the alternative diagnosis is primary adenocarcinoma of lung.

Topics: Adenocarcinoma; Carcinoma; Chondroitin Sulfates; Dermatan Sulfate; Diagnosis, Differential; Electrophoresis, Cellulose Acetate; Female; Glycosaminoglycans; Heparitin Sulfate; Humans; Hyaluronic Acid; Lung Neoplasms; Mesothelioma; Ovarian Neoplasms; Sarcoma