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Background. The current understanding of appendiceal epithelial tumors is based on series composed of relatively small numbers of patients and on case reports. The aim of this study was to perform clinicopathologic correlation, particularly concerning prognosis, on a relatively large series of patients with epithelial tumors and tumor-like lesions of the human vermiform appendix. Methods. One hundred eighty-four cases of simple mucoceles, hyperplastic polyps, adenomas, carcinomas, and mucinous tumors of uncertain malignant potential (UMP) were reviewed. Retrospective follow-up data were obtained in carcinoma and UMP tumor cases. Results. Most neoplasms were of the mucinous type characteristic of the appendix, but a small fraction were nonmucinous and resembled neoplasms typical of the spectrum encountered in the colorectum. Both benign and malignant conditions in some cases showed acellular mucin dissecting the appendiceal wall and mucin outside the appendix. Immunostains were sometimes helpful in identifying epithelial cells within mucus, but hematoxylin and eosin and mucin stains were adequate in most cases. Two factors were significantly associated with survival by multivariate analysis: the presence of mucin outside the right lower quadrant of the abdomen and the presence of epithelial cells in the peritoneal cavity outside the appendix. Conclusions. The distribution of mucin within the abdomen and the presence of cells outside the visceral peritoneum of the appendix are important prognostic factors that should be recorded in these neoplasms. Tumors designated as UMP lesions behave in a benign or low grade fashion.

Background. The authors undertook this study to define the clinical and histologic characteristics of spindle and giant cell carcinomas of the lung and the survival and prognostic features of these tumors. Methods. Seventy-eight cases of pleomorphic (spindle and/or giant cell) carcinoma of the lung were studied by light microscopy and immunohistochemistry to establish clinical, gross, and histologic parameters. Follow-up information was obtained from contributing physicians and analyzed by statistical means to determine prognostically significant parameters. Results. The patient population consisted of 57 men and 21 women (male to female ratio, 2.7 to 1) between the ages of 35 and 83 years (mean, 62 years). Clinically, 58 patients (80%) presented with symptoms including thoracic pain, cough, and hemoptysis, whereas 14 (18%) were asymptomatic. At the time of diagnosis, 41% of the patients had clinical Stage I lesions, 6% Stage II lesions, 39% Stage Ill lesions, and 12% Stage IV lesions. Histologically, foci of squamous cell carcinoma were present in 8% of the tumors, large cell carcinoma in 25%, and adenocarcinoma in 45%. The remaining 22% of neoplasms were completely spindle and/or giant cell carcinomas. Spindle and giant cell carcinomas were found together in 38% of the patients. In the 69 patients for whom follow-up information was obtained, 53 (77%) died within 7 days to 6 years after diagnosis, with a 23-month mean survival (median, 10 months) (Kaplan-Meier method). There was a significant shortening of survival for patients with tumor size greater than 5 cm, clinical stage greater than 1, and lymph node involvement. The presence of nodal metastases was the most significant single prognostic factor, whereas the presence of squamous or adenocarcinomatous differentiation did not have an impact on length of survival. Conclusions. The frequency with which spindle and giant cell carcinomas are found together, their frequent association with other histologic subtypes of lung carcinoma, and the similar clinicopathologic features of these tumors suggest that they are best regarded as one type of lung cancer called pleomorphic carcinoma. Cancer 1994; 73:2936-45. Key words: pleomorphic carcinoma, giant cell carcinoma, spindle cell carcinoma, sarcomatoid carcinoma.

Background. The spectrum of pulmonary fibrohistiocytic lesions (PFL) ranges from benign fibrohistiocytoma or inflammatory pseudotumor, fibrohistiocytic type (IP), to fibrohistiocytic lesions of borderline malignant appearance (B), to unequivocal malignant fibrous histiocytoma (MFH). The authors reviewed a spectrum of PFL in an attempt to define their natural history and establish independent factors of prognostic significance. Methods. Thirty-one fibrohistiocytic lesions were analyzed by multiple clinical, gross, and microscopic factors. Prognostic factors were evaluated by univariate and multivariate Cox proportional hazards models. Results. After histopathologic review, the cases were classified into IP (15 cases), B (3 cases), and MFH (13 cases). IP tended to occur in younger patients (median age, 30 years; range, 11-64 years) than did MFH (median age, 54 years; range, 12-81 years) (P = 0.03). All 15 patients with IP and 3 patients with B survived. Local recurrence developed in 2 patients with IP and 6 patients with MFH. Distant metastases occurred in 7 patients with MFH. Eight of 13 patients with MFH died of disease, with a median survival time of 16 months (range, 6-36). For all pulmonary fibrohistiocytic lesions, univariate Cox regression analysis disclosed several statistically significant prognostic factors associated with mortality: metastasis (P = 0.0005), significant necrosis (P = 0.0015), local recurrence (P = 0.003), bizarre giant cells (P = 0.0282), mitoses greater than or equal to 3 per 50 high-power fields (P = 0.0286), stage at surgery (P = 0.002), high cellularity (P = 0.0267), and poor circumscription (P = 0.0294). Other parameters (age, sex, symptoms, laterality, location, atypical mitoses, nuclear pleomorphism, degree of fibrosis, and size) were not significant prognostic factors. By multivariate Cox regression analysis, metastasis was the most significant individual parameter (P = 0.002), overriding all other prognostic factors. With metastasis removed from the model, local recurrence (P = 0.0199) and necrosis (P = 0.037) were the other significant independent prognostic factors. Conclusions. Certain individual clinical, gross, and microscopic features have prognostic relevance in determining survival time in pulmonary fibrohistiocytic lesions. Cancer 1994; 73:1817-24. Key words: lung, inflammatory pseudotumor, plasma cell granuloma, fibrohistiocytoma, malignant fibrous histiocytoma, Cox proportional hazards model, survival, prognostic factors.