Fifty-one evaluable patients with liposarcomas were reviewed. Two-thirds of the patients were referred after local recurrence. One-third with primary surgery at RPMI had local recurrence rate of 31.6%. Overall, one or more local recurrences presented in 78% of patients. Pulmonary metastases, occurred in 45%, while liver metastases in 13.6%. Most common primary sites were the lower extremity, followed by the retroperitoneal area and upper extremity. Median survival is better for upper and lower extremities than other areas (P less than 0.01). The medium survival was longer in the group that received radiation after resection although the difference was not statistically significant. The high rate of local recurrences suggests the adjuvant use of radiation postoperatively when the surgical margins have not been adequate. Sixteen patients are alive and disease-free, with 10 of them having had five years or longer follow-up.

Polypoid epithelial tumors of the duodenum and ampulla of Vater are rarely diagnosed preoperatively without wide application of fiberoptic endoscopy. The symptoms are nonspecific. Only a high index of suspicion will lead to early diagnosis. Life-threatening complications and increased incidence of malignant transformations are associated with delayed diagnosis. This paper reviews 11 patients (nine previously unreported) with villous tumor of the ampulla of Vater and two with this neoplasm in the duodenum. It also reviews the important principles of management illustrated by the behavior of the tumors of these 11 patients compared to those of previous reports. For favorable results, all lesions must be excised in toto and evidence of invasive malignancy must lead to aggressive treatment whenever feasible.

Retrospective studies of twelve patients with advanced gastric leiomyosarcomas were undertaken to evaluate radical surgical resection and combined modality treatment with regard to the patient survival and symptom palliation. All but one patient were found to have metastases or involvement of adjacent organs at the initial operation. Despite radical resection, multidrug chemotherapy, and radiation therapy, no patient survived beyond the third year. Patients with objective response to chemotherapy and radiation and chemotherapy had a mean survival of 27 months, while those who did not respond survived only 7 months. The longest survival among untreated group was 8 months. Successful palliation of advanced gastric leiomyosarcoma requires early diagnosis, surgical resection and multimodal therapy.

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Although early studies in germ-free rats showed almost complete dependence on dimethylhydrazine (DMH) colon carcinogenesis upon the presence of colon bacteria, no adequate explanation was given for the 20% tumor incidence observed in germ-free animals. Bacterial activation of liver microsomal products releasing active proximate carcinogens has been the accepted reason for the exquisite specificity DMH has for the colon. Recent work, including the present study, show the colon mucosa is capable of metabolizing carcinogens and activating conjugating forms metabolized in the liver independent of the intestinal microflora. Mucosal beta-glucuronidase production was assayed in coded, scraped mucosa samples from the duodenum/jejunum, ileum, right colon, and left colon of normal and DMH-treated rats. Normal mucosal beta-glucuronidase production was highest in the left colon followed by the right colon, duodenum, and ileum, respectively. Enzyme production in the left colon was significantly increased 24 hours after injection of 25 mg/kg body weight DMH. No elevation was seen in other mucosal samples. Metabolism of DMH to oxidated forms conjugated to glucuronic acid is well established. Thus, this study offers a possible role for carcinogen, induction of a metabolic enzyme in its target tissue.