Biomedical subjects
Publications and source records attributed to K J Fortier.
An infertile woman with an enlarged uterus was thought to have leiomyoma. At laparotomy two large, vascular uterine tumors were removed; the remainder of the uterus was preserved. Evaluation of histologic sections with antibody to human factor VIII and electron microscopy were necessary to confirm the diagnosis of hemangioma.
The postmenopausal endometrium possesses the potential for development of endometrial adenocarcinoma, the most common female genital tract malignancy. An understanding of this tissue and its response to hormone stimulation is essential for the establishment of rational plans for clinical management. Recently, new techniques for in-office endometrial sampling have been described and advocated. These methods have proven to be fairly accurate diagnostic methods and have potential value for screening, especially among high-risk patients. Patients with postmenopausal bleeding are at such great risk for carcinoma that definitive, more traditional methods, particularly D & C, must usually be employed before the malignancy can be adequately ruled out.
Fine-needle aspiration for suspicious extrapelvic lesions is documented in 82 specimens from patients with known pelvic malignancy. Specimens were obtained from lung (39%), supraclavicular lymph nodes (24%), paraaortic lymph nodes (11%), liver (7%), and other sites. Three of 32 (9.4%) patients with transthoracic aspirates experienced pneumothoraces requiring chest tube placement, and three others had smaller pneumothoraces that resolved spontaneously. Fifty-nine (72%) specimens were positive for malignancy. There were no known false positives. Of six negative aspirates that had follow-up histology, there were two false negatives. When the subsequent course was used as an indication of accuracy, specificity was 100%, and sensitivity was 91%. Fifty-eight (71%) patients had therapeutic alterations as a direct result of aspiration diagnosis. Thirty-nine major operative procedures and 28 open biopsies were spared. Fine-needle aspiration is a reliable and cost-effective diagnostic method that should become an increasingly routine component of the diagnostic armamentarium and may have broader roles defined through continuing study.
Excised tubal segments from 42 women with uterotubal junction obstruction were studied histologically to evaluate the pathologic spectrum of disease and correlate this with clinical data. The most frequent lesion encountered was obliterative fibrosis (38.1%), confirmed by connective tissue stains, which was not associated with cornual nodularity. Other pathologic entities included salpingitis isthmica nodosa (23.8%), intramucosal endometriosis (14.3%), and chronic tubal inflammation (21.4%). Intramucosal endometriosis was distinguishable from salpingitis isthmica nodosa by virtue of its unique stroma confirmed by connective tissue staining. Women with previous pregnancies were included in all the groups. In all instances, the obstruction was present in the transmural portion of the tube and extended a variable distance into the isthmic segment. These observations on uterotubal junction obstruction demonstrate that: 1) There are multiple distinct histologic patterns, 2) Intraabdominal findings do not predict the histology of the uterotubal junction pathology, 3) Any histologic pattern can be associated with a previous intrauterine or ectopic pregnancy, and 4) The obstruction begins within the transmural portion of the oviduct, extends a variable distance into the isthmic segment, but does not obstruct the ampullary segment. These data suggest that the initiating process originates within the uterus and that fibrosis may represent a nonspecific response to chronic injury of the transmural and isthmic segments of the oviduct.
A retrospective survey was performed in 205 cases of gestational trophoblastic neoplasia with the use of routine tissue sections and quinacrine stain after hydrolysis and pronase pretreatment. The method allows scoring of nuclei simultaneously for either Y chromatin or X chromatin (Barr body) and has proved to be a valid test for sex assignment in tissue sections. Y-chromatin positivity (indicating gamete heterozygosity) was found in 16 of 182 cases (9%) of hydatidiform mole, two of four cases (50%) of invasive mole, and 14 of 19 cases (74%) of choriocarcinoma. The cytogenetic literature of 173 cases of complete hydatidiform mole indicates 8.1% have been 46,XY. Our unexpectedly high incidence of Y chromatin in malignant gestational trophoblastic neoplasia would suggest that homozygosity for a recessive mutant oncogene is not an important factor in pathogenesis of choriocarcinoma. The partial allograft theory of pathogenesis after nonmolar antecedents with attendant diminished host immunoreactivity remains a plausible consideration.
Necrotizing fasciitis is a rare, rapidly progressive, and often fatal infection of the superficial fascia and subcutaneous tissues. The integrity of the deep muscle fascia is usually not breeched, thus limiting the depth of involvement. Centrifugal spread within the planes of the superficial fascia and subcutaneous tissues is characteristic. Patients with diabetes mellitus constitute the group most vulnerable to necrotizing fasciitis, and a vulvar or perineal origin is associated with particularly high mortality. The authors report four such patients. Other apparent predisposing factors are advancing age, peripheral vascular disease, chronic debilitating illness, malnutrition, and possibly other states predisposing patients to immunodeficiency. None of these factors is an absolute prerequisite to the development of necrotizing fasciitis.
Management of a normal-appearing ovary at the time of hysterectomy in a patient with endometriosis externa is controversial. Our experience supports the contention that such ovaries should not be conserved at the time of surgery intended to cure endometriosis.
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