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Biomedical subjects

A Tiltman

Publications and source records attributed to A Tiltman.

13 recordsLinked to original sources
PubMed2004

Virilisation in a case of transitional cell carcinoma of the ovary.

A 52 year old woman presented with a five month history of emotional changes, voice changes, and of abdominal discomfort. Clinical, biochemical, and radiological examinations showed evidence of virilisation, raised testosterone, and a complex ovarian mass. Microscopy of the resection specimen showed the tumour to be a transitional cell carcinoma of the ovary with luteinisation and hyperplasia of the intervening stromal cells. This is a unique case of virilisation caused by transitional cell carcinoma of the ovary. Theories as to the origin of testosterone production in non-functioning ovarian tumours are discussed.

Carcinoma, Transitional Cell↗
PubMed2001

Primary mucinous adenocarcinoma of the vagina.

OBJECTIVE: Our goal was to report the management and symptoms of a patient who presented with primary mucinous adenocarcinoma of the vagina with an unusual histologic pattern. METHODS: Our methods included a retrospective description of the management, a review of the literature, and critical evaluation of the treatment modalities available for this very uncommon tumor. RESULTS: Initially posterior partial vaginectomy and abdominoperineal resection was performed with the creation of a permanent colostomy. A bilateral inguinal lymphadenopathy was performed 6 months later on the basis of a palpable enlarged lymph node. Radiotherapy was instituted thereafter. The patient remains disease-free 48 months after initial surgery and is satisfied with her quality of life. CONCLUSIONS: Primary mucinous adenocarcinoma of the vagina is a very rare tumor. Therefore individualized treatment is justified until larger series have been published.

Adenocarcinoma, Mucinous↗
PubMed2001

Large-cell neuroendocrine carcinoma of the uterine cervix--a clinicopathological study of five cases.

OBJECTIVE: The present study describes 5 cases of large-cell neuroendocrine carcinoma (LCNEC) of the uterine cervix, evaluating their clinical features and pathological profiles. METHODS: Clinical data were obtained from the patients' clinical files at the combined gynaecological-oncology unit of Johannesburg Hospital and the University of the Witwatersrand Medical School, Johannesburg, South Africa. A histopathological diagnosis was obtained after biopsy material from all 5 patients was examined microscopically and subjected to immunohistochemical staining with MNF116 (pankeratin) synaptophysin and chromagranin A, all of which are neuroendocrine markers. Two patients received pelvic radiotherapy only. None of the 5 patients in this series received chemotherapy or underwent surgery. RESULTS: All 5 patients were adult females, with an average age of 57.3 years. The majority were multiparous, with the most common presenting complaint being vaginal bleeding. Three of the 5 patients presented with advanced-stage cervical carcinoma, with evidence of metastases in 2 of them. Treatment responses and long-term survival in our series proved to be disappointing as 3 of the 5 patients died in less than 6 months. On histopathological examination, all 5 tumours showed features of a high-grade poorly differentiated malignant neoplasm with ulceration and extensive tumour necrosis including trabecular and organoid growth patterns. All 5 neoplasms also showed strong immunoreactivity for MNF116, while their endocrine nature was confirmed by staining for synaptophysin in all cases. None of the tumours showed positive straining for chromagranin A. CONCLUSIONS: LCNECs are rare tumours and distinct from other neoplasms of the uterine cervix. The results of this study reaffirm the biologically aggressive nature of this uncommon tumour and its very unfavourable prognosis.

Aged↗
PubMed1995

Combined assessment (aspiration cytology and mammography) of clinically suspicious breast masses.

We examined the safety and utility of the combined assessment of aspiration cytology and mammography in 705 women who had clinically suspicious or malignant palpable breast masses. Histological assessment confirmed 176 benign and 529 malignant lesions. There were no incorrect (false positive) diagnoses made in the 176 benign masses when combined assessment was used (specificity 1.0; predictive value 0.86); in isolation, however, there was a false positive cytological diagnosis ('papillary carcinoma') and 3 false positive mammographic diagnoses. Benign disease (false negative) was incorrectly diagnosed by combined assessment in 4 of the 529 malignant masses (sensitivity 0.99; predictive value 0.98): cytological diagnoses were of fat necrosis (2) and benign cells on cytospin (1) and aspiration biopsy (1); mammographic diagnoses were of benign disease (2) and normality (2). Indeterminate ('atypical', 'suspicious') diagnoses were problematic and frequent (overall 223 (31.6%), malignant masses 137 (25.9%), benign masses 86 (48.9%); cytology 117 (16.6%), mammography 141 (20%). Thus, with the combined assessment of mammography and cytology in clinically suspicious breast masses, a decisive diagnosis was made in about two-thirds of cases allowing the safe commencement of therapy; the balance of patients required core or excision biopsy.

Adult↗
PubMed1991

Placental bed spiral arteries in the hypertensive disorders of pregnancy.

OBJECTIVE: The investigation of the histology of the placental bed spiral arteries in normal pregnancy and in pregnancies complicated by hypertension, with or without proteinura. DESIGN: An observational study, based on women having caesarean sections for clinical reasons. SUBJECTS: 17 normal pregnant women, 43 with gestational hypertension, of whom 39 had proteinuria, 17 with chronic hypertension, of whom 6 had proteinuria, and 5 with unclassified hypertension. INTERVENTIONS: Placental bed biopsies obtained during caesarean section. MAIN OUTCOME MEASURES: Histological appearance of sections stained with haematoxylin and eosin PAS and Lendrum's MSB. RESULTS: Biopsies containing spiral arteries were obtained from 6 normotensive and 44 hypertensive women. Trophoblastic invasion was present in 5 of the 6 normotensive biopsies but absent in the majority of those with hypertension. Subintimal proliferation was seen in all the normotensive biopsies but in only 8 of 28 from those with gestational hypertension and proteinuria. Other features seen predominantly or only in the hypertensive biopsies, in order of frequency, were medial hyperplasia, fibrin deposits, acute atherosis, endothelial vacuolation and thrombosis. CONCLUSION: Absence of physiological changes may not be peculiar to preeclampsia but may be associated or even a result of various forms of hypertension in pregnancy. Spiral arteries show a spectrum of changes in hypertensive pregnancies that do not appear to bear a clear-cut relation to the clinical signs.

Arteries↗
PubMed1989

A clinical appraisal of stage 1 mucinous carcinoma of the ovary.

Thirty patients with stage I mucinous carcinoma of the ovary are reviewed with special reference to possible prognostic factors. The role of adjuvant therapy is discussed. Adjuvant therapy is recommended only for patients with poorly differentiated tumours and with stage Ic disease.

Adenocarcinoma, Mucinous↗
PubMed1986

Ovarian Sertoli-Leydig cell tumour with raised serum alpha fetoprotein. A case report.

A case of ovarian Sertoli-Leydig cell tumour with a raised serum alpha fetoprotein is reported. The patient first presented at the age of 27 years with a history of 6 years' amenorrhoea followed by 3 months irregular vaginal bleeding. A ovarian tumour was found and excised and shown microscopically to be a spindle cell malignant tumour. The patient was treated with chemotherapy and had a complete response. Thirty months after first presentation there was a recurrence in the pelvis which microscopically showed the typical features of a Sertoli-Leydig cell tumour. Six months later a second recurrence had the microscopic appearance of a lipid cell tumour. A raised serum alpha fetoprotein was found at the time of the second recurrence and immunohistochemistry showed this protein in the Leydig and luteinized cells of the recurrent tumours but not in the spindle cells of the original ovarian neoplasm.

Adult↗
PubMed1985

Endometrial lymphoid tissue: an immunohistological study.

Lymphoid tissue of the endometrium was analysed by histological, immunohistological, and electron microscopical methods in 10 healthy uteri. A panel of monoclonal antibodies recognising macrophages (OKMI), HLA-DR antigen, B lymphocytes, T lymphocytes and their subsets, and dendritic reticulum cells was used in a two stage indirect immunoperoxidase labelling technique. Endometrial lymphoid tissue showed a remarkably consistent pattern of labelling in all cases. Lymphoid tissue was present in three sites: namely, (i) intraepithelial lymphocytes (predominantly T lymphocytes with occasional macrophages) associated with periglandular and sub-epithelial HLA-DR+, OKMI+ macrophages; (ii) interstitial lymphocytes and macrophages; (iii) lymphoid aggregates in the stratum basalis. These were composed mainly of T lymphocytes with a few B lymphocytes. Dendritic reticulum cells were found in those occasional lymphoid aggregates in which germinal centres were present. These features suggest that endometrial lymphoid tissue has many of the hallmarks of mucosal associated lymphoid tissue as found elsewhere in the body--for example, the bronchus and intestine. Endometrial lymphoid tissue appears to be unique, however, in that most of the stratum functionalis in which it is situated shows cyclical shedding during the menstrual cycle.

Adolescent↗