Papillary adenocarcinoma of the endometrium with psammoma bodies.
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Biomedical subjects
Publications and source records attributed to C E Platz.
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Twelve surgical specimens from radical vulvectomy and bilateral groin dissection were examined by xeroradiography to identify lymph nodes. Eight of the specimens were handled in a routine fashion, and four were chemically cleared. The xeroradiograph was not helpful in identifying small lymph nodes in the specimen, nor could any xeroradiographic characteristics specific for tumor-involved lymph nodes be identified.
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An analysis of non-Hodgkin's lymphoma involving the orbital structures was performed at the University of Iowa between 1937 and 1975. Sixteen cases of primary orbital lymphoma were diagnosed. Histopathologic reclassification according to the Rappaport scheme and the clinical course of each histologic sub-category was described. There were 5 patients with reactive hyperplasia, 2 patients with well-differentiated lymphoid proliferation with Dutcher bodies which were also felt to be reactive, 3 patients with diffuse poorly differentiated lymphocytic lymphoma, 4 patients with nodular poorly differentiated lymphocytic lymphoma, and 2 patients with diffuse histiocytic lymphoma. It was concluded that the Rappaport classification is applicable to orbital lymphoid tumors and that those lymphomas which do present as primary tumors should be staged as one would stage the same histologic category of lymphoma presenting in other sites. Radiation therapy appears to be an effective treatment for local control; however, patients with primary orbital lymphoma should undergo observation for systemic disease similar to patients with lymphoma presenting in other sites. Excisional biopsy is recommended to facilitate precise classification.
Thirty-one patients with stage III and IV diffuse histiocytic lymphoma (DHL) were treated uniformly with cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP). The patients were subclassified independently by two hematopathologists into groups with predominantly large noncleaved cells (eight patients), predominantly large cleaved cells (seven patients), a mixture of large cleaved cells and large noncleaved cells (11 patients), tumors with the characteristics of immunoblastic sarcomas (two patients) and unclassified (three patients). The concurrence rate on applying the subclassification was 85 per cent. Survival in patients with large noncleaved cells was superior to that of the other patients as a group (p less than 0.001), and to that of those with large cleaved cells (p less than 0.05) and large cleaved and large noncleaved cells (p less than 0.025). All the patients with large noncleaved cells are alive and "off" therapy without evidence of progressive disease. This histologic subclassification seems to identify a subgroup of patients with advanced diffuse histiocytic lymphoma having large noncleaved cells who have an excellent prognosis when treated with CHOP.
Evidence is presented for the coexistence of smooth muscle and decidual cells in nodules on and within the ovarian tunica albuginea at term. Routine histologic techniques and electron microscopy have been employed in characterizing the morphology of the nodules. Recent literature concerning the frequency of ovarian decidualization during pregnancy is discussed with respect to the possible relationship of such decidualization to the histogenesis of leiomyomatosis peritonealis disseminata (LPD). The hypothesis that LPD may represent "disseminated fibrosing decidua" is discussed in light of finding collagen fibrils, secretory decidual cells, and smooth muscle cells in these nodules. It is concluded that the present case does not represent "fibrosing decidua." The authors agree with others who have proposed that the smooth muscle in ovarian decidua and LPD result from proliferation of stem cells which may reside in the subperitoneal stroma in association with ectopic endometrial stroma and which may respond to the hormones of pregnancy.
A study was undertaken to evaluate the use of lymphograms as a method of diagnosing cancer of the cervix metastatic to the paraaortic lymph nodes. Twenty-one patients underwent lymphograms, surgical biopsy, and histologic examination of the paraaortic nodes. The specificity of lymphangiographic examinations is not accurate enough to be of clinical significance in the detection of paraaortic lymph node metastasis from carcinoma of the cervix. Lymphangiography can be of assistance in locating suspicious lymph nodes. These nodes should then be biopsied. The final therapeutic decisions should be based on tissue diagnosis.
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The traditional radical neck dissection involves excision of the spinal accessory nerve en bloc with the soft tissue of the posterior triangle in an effort ot remove completely all node-bearing tissue. The resultant decrease in range of motion of the involved extremity and subsequent pain have prompted some surgeons to seek alternatives. The purpose of this study is to review prospectively radical neck specimens with the specific intent of evaluating the frequency of metastatic involvement of the spinal accessory lymph nodes with head and neck malignancies. Fifty neck specimens were studied and the frequency of cancerous involvement of the spinal accessory nodes was not found to be significantly different from nodal involvement of the entire neck specimen. The location of accessory nerve involvement was predominantly in the proximal portion which is not within the posterior triangle. The results are further evaluated with the subsequent conclusion that preservation of the spinal accessory nerve cannot be justified on the basis of infrequent involvement with metastatic lymph nodes.
A plethora of case reports of women on birth control agents who present with hepatic masses and who are ultimately found to have liver neoplasms have overshadowed the clinicians' awareness of other possible diagnoses in patients who present in a similar fashion. Hematomas of the liver, secondary to vascular lesions induced by these agents, must be considered and preoperative attempts to make the diagnosis must be ensured by obtaining appropriate studies.
A 72-year-old female with ulcerative colitis of 30 years duration underwent total proctocolectomy for a cecal mass thought to be an adenocarcinoma. Pathologic examination of the colon revealed 22 tumors, all of which proved to be malignant lymphoma, histiocytic type. Thirteen cases of non-Hodgkins malignant lymphoma and 2 cases of Hodgkins disease of the colon arising in ulcerative colitis are reviewed and discussed.
Melanomas of the skin of the breast are uncommon lesions which are amenable to cure with standard mastectomy techniques, even when lymphatic spread has occurred. Of six patients treated at the University of Iowa, two have died of metastatic melanoma, one treated by wide excision and subsequent axillary dissection and the other by radical mastectomy initially. Of the remaining patients, one with positive axillary nodes at the time of mastectomy died 28 years following operation of unrelated causes, one with axillary nodes involved is 5 years without evidence of recurrence, and two who have been followed for less than 2 years, are without evidence of recurrent disease in spite of having had positive nodes at the time of initial treatment. All six patients had had pigmented lesions of the skin of the breast for many years, suggesting that such lesions in this location should be considered premalignant.
Laryngeal rhabdomyosarcomas are very rare, extremely malignant tumors. Approximately half of the reported cases have occurred in children. Diagnosis may be difficult, and adequate biopsy material is crucial in the identification of these lesions. Unil recently, rhabdomyosarcomas carried a dismal prognosis; however, combined treatment with surgery, irradiation, and triple chemotherapy appears to have improved the outlook. This should probably be the treatment for laryngeal rhabdomyosarcomas, and was successfully used in the case reported herein.
Four cases of desmiod tumors of the anterior abdominal wall recently treated at the University of Chicago Hospitals and Clinics are presented. From our experience we conclude: 1. Inadequate excision of desmoid tumors results in local recurrence. 2. Adequate excision of desmoid tumors ot the abdominal wall sometimes necessitates creation of an abdominal wall defect too large for primary closure. 3. Marlex mesh has been used successfully in reconstruction of the abdominal wall following adequate excision of desmoid tumors. 4. One patient (Case 4) with an abdominal wall desmoid tumor associated with familial polypisis and mesenteric fibromatosis has benefited greatly following wide excision of abdominal wall and reconstriction using Marlex mesh, despite the fact that the mesenteric fibrous tumor was unresectable.
Acute dilatation of the colon with signs of systemic toxicity developed in an elderly man with malignant lymphoma. Although barium contrast X-rays taken previously were interpreted as consistent with granulomatous colitis, rectal biopsy had revealed features characteristic of malignant lymphoma, poorly differentiated lymphocytic type. Bone marrow and lymph nodes were also involved. The onset of dilatation was temporally related to therapy with opiates and anticholinergics, and the acute episode was resolved with nasogastric suction, intravenous fluids, albumin, and antibiotics.
One hundred and fifty-two patients who underwent abdominoperineal resection for cancer of the rectum and rectosigmoid are reviewed. Six physicians were selected to predict which of these patients would have a local recurrence. All information available at the end of the operation was duplicated and submitted to the observers. None of the physicians was able to predict local recurrence significantly better than random. There were 31 local recurrences, i.e. an incidence of 20-4 per cent. Low level of tumour in the rectum, local spread into perirectal fat or serosa, lymph node involvement and age below 60 years at time of operation were the only factors that were statistically related to local recurrence. The strategy for careful follow-up of patients at risk is outlined and a plea is made for a controlled trial of postoperative radiotherapy.
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