In memoriam James N. Patterson, M.D. (1902-1986).
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Florida↗
Biomedical subjects
M R Abell
Publications and source records attributed to M R Abell.
The American Board of Pathology. 50 years of service.
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Certification↗
Brenner tumors of the ovary.
The clinicopathologic findings in 24 cases of Brenner tumors of the ovary, seen at the University of Michigan Medical Center between 1941 and 1975, are reported. Abnormal uterine bleeding was the most common presenting symptom. Associated endometrial changes ranging from glandular hyperplasia to invasive adenocarcinoma were found in 5 cases. No consistent relationship was found between the thecomatous appearance of the stoma of the tumor and endometrial changes suggestive of estrogen stimulation. Seven patients had other types of ovarian neoplasms. Four patients had bilateral brenner tumors. Three Brenner tumors were histologically and clinically malignant. This study suggests that the presumed potential steroidogenesis of the Brenner tumors of the ovary may not always be a product of the thecalike cells of the stroma. The need for further biosynthetic studies is reemphasized. Furthermore, when conservative therapy of a benign tumor is attempted, the contralateral ovary should be carefully examined and a wedge resection considered. The optimal therapy of malignant Brenner tumors has not been established; adequate surgery and careful staging followed by individualized adjuvant therapy is recommended.
Adult↗
Lymphomatoid granulomatosis clinically confined to the CNS. A case report.
A 38-year-old man developed pain and peripheral-type weakness on the right side of his face and was discovered to have decreased hearing bilaterally, as well as optic nerve swelling on the right. The pain and optic nerve swelling subsided over a period of six weeks, but hearing loss and facial weakness persisted. Thirty months later, he developed dysphagia, ataxia, dysarthria, nystagmus, and progressive spastic quadriparesis. He died approximately four years after the onset of the illness. Although no evidence of disease was found other than in the central nervous system during life, two nodules in the right lower lung were found on autopsy. The examination of these nodules, as well as the brain stem, showed an angiocentric and angionecrotic process with lymphoreticular and plasmacytoid invasion.
Adult↗
Thymomas.
Forty-six thymomas, defined as neoplasms of thymic epithelium, were assessed in respect to histologic type, clinical manifestations and end results. Twenty-three were lymphoepithelial, 12 epithelial, and 11 spindled cell tumors. The sex distribution for all thymomas was approximately equal for males and females but the lymphoepithelial tumors were more common in females and the epithelial tumors more common in males. There was no distribution difference in sex for the spindled cell thymomas which occurred much later in life than the other types. Twenty-five percent of patients were asymptomatic, the tumors being discovered on roentgenograms done on a routine basis or for an unrelated purpose. The most common presenting symptoms were related to myasthenia gravis, and symptoms due to pressure on mediastinal structures were next in frequency. Other endocrine abnormalities were present in 20% of patients. Two male patients also had carcinomas of the thyroid gland. Twenty thymomas were infiltrative tumors having invaded the adjacent mediastinum. There were no examples of extrathoracic spread. Twelve of 16 patients with myasthenia gravis had lymphoepithelial thymomas and four epithelial thymomas. There were no cases of myasthenia gravis in patients with spindled cell thymomas. The crude five-year survival rate was 65%. Only 17% of patients died as a result of recurrent and infiltrative thymomas; the other 18% of patients died from a variety of causes not directly related to the thymomas. The epithelial type of thymoma tended to be more extensive and to pursue a more aggressive course but histologic classification was of little value in predicting final outcome. Poor prognosis is more closely associated with tumors having an infiltrative character. Classification is of importance, however, in alerting the clinician to certain associated diseases.
Addison Disease↗
Invasive adenocarcinoma of the uterine cervix.
A series of 33 infiltrative adenocarcinomas of the uterine cervix treated during the period from 1965 to 1970 is assessed and compared with a previous series from this institution and with series reported in the literature. The findings indicate that adenocarcinomas constitute and increasing proportion of cervical carcinomas and in this series make up 9.6% of all cervical carcinomas as compared with a previous figure of 5.5%. Five patients in the series were 32 years of age or less, and all had been receiving oral contraceptives for varying periods of time prior to the diagnosis of carcinomas. Radical surgery or irradiation treatment followed by extrafascial conservative hysterectomy in appropriate cases may offer increased survival for operable stages of adenocarcinoma, particularly in the presence of bulky lesions.
Adenocarcinoma↗
Microinvasive squamous carcinoma of the cervix: definition, histologic analysis, late results of treatment.
The surgical tissues and clinical records of 54 surgically treated patients with microinvasive carcinoma of the cervix were retrospectively analyzed. Utilizing a definition that limited microinvasion to a depth of 3 mm, and excluded lymphatic and blood vascular involvement, the incidence of regional metastases in 37 patients for whom lymph nodes were available for study was 0%. Confluence of microinvasion did not imply a greater potential for metastatic spread or a worse prognosis. Lymphatic and blood vascular permeations were associated with nodal metastasis in one of four lesions which otherwise were microinvasive. Random cervical biopsy alone was inadequate for the diagnosis of microinvasion. Cone biopsy demonstrated an accuracy of 83% in diagnoses, but failed to eliminate intraepithelial or microinvasive carcinoma in 78% of the hysterectomy specimens. It is concluded that microinvasive carcinoma, as defined in this study, can be effectively treated by conservative rather than radical means.
Adult↗
Soft tissue sarcomas of vulva.
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Adolescent↗
Loss of colonic haustration in progressive systemic sclerosis.
Complete loss of colonic haustration was observed in six cases of progressive systemic sclerosis. Varying degrees of haustral loss or sacculation were noted in twelve others. An increase in colonic length was characteristic and, occasionally, there was slight to moderate generalized dilatation. Correlation of these findings with the microscopic appearance of the colon showed that muscular atrophy and fibrous replacement were consistent findings, varying in degree. Although the data are insufficient to permit definite conclusions, it is suggested that these changes may be responsible for colonic lengthening and loss of haustration. Attention is drawn to the importance of not confusing this appearance with other conditions, particularly chronic ulcerative colitis.
Adult↗
Lymphoreticular hyperplasia of the stomach (pseudolymphoma).
Three histologically proved cases of gastric lymphoreticular hyperplasia with long term follow-up are reported. This condition is often confused radiologically with ulcerating carcinoma and pathologically with malignant lymphoma. The presence of a large ulcer surrounded by a mass and associated with thick rugal folds and additional gastric or duodenal ulcers is not diagnostic but should suggest the possibility of this condition.
Adolescent↗
Sarcomas of the vagina.
The clinical and patholgic features of 16 cases of vaginal sarcoma are assessed. There were 5 embryonal rhabdomyosarcomas, 5 leiomyosarcomas, 2 reticulum cell sarcomas, 1 malignant schwannoma, 1 müllerian stromal sarcoma, and 2 pleomorphic sarcomas that could not be classified as to cell type. The rhabdomyosarcoma occurred exclusively in infants and children, and all 5 patients died of their disease with locally infiltrative recurrences and/or disseminated metastases. The commonest sarcoma in adults was leiomyosarcoma, there being 5 examples in the series. Three of the 4 patients with survival information were clinically free of disease 2 years, 4 years, and 8 years after diagnosis and treatment. Two patients with reticulum cell sarcoma succumbed to their disease within a few months. Local recurrences were common for all types of sarcoma in this series, suggesting that more aggressive initial treatment is mandatory if recurrences are to be prevented and the survival rates improved. In general, the vaginal sarcomas in adults pursued a less aggressive course than the rhabdomyosarcomas of infancy and childhood.
Adult↗
Epithelioid sarcoma of the vulva.
An example of epithelioid sarcoma of the vulva in a 31-year-old female is reported. Treatment consisted of a radical vulvectomy and bilateral inguinal lymphadenectomy. Bilateral inguinal lymph node metastases were present. Criteria for the diagnosis of this unusual neoplasm are considered, and guidelines are suggested for its treatment.
Adenocarcinoma↗
Cutaneous basal cell carcinoma of vulva.
Eleven cases of basal cell carcinoma of the vulvar skin are reported. There was fairly close correlation between the histologic type and the gross appearance of the lesion. The average age of the patients was 59 years, and the presenting complaint was usually that of a nodule with associated irritation or pruritus. All patients were treated surgically and none have had recurrent or metastatic disease; six patients have been followed for 12 to 25 years. The treatment of choice is wide local excision. One tumor was of particular interest in that it represented a carcinomatous change in a pre-existing premalignant fibroepithelial tumor. Basal cell carcinoma of the skin must be distinguished from adenoid cystic (basal cell) carcinoma of vestibular glands, which is a more aggressive neoplasm and which metastasizes by the lymphatic and blood vascular systems.
Aged↗
Benign metastasizing uterine leiomyoma. Multiple lymph nodal metastases.
A case of histologically benign lymph nodal metastases from a uterine leiomyoma in a 27-year-old woman is reported. It is postulated that fragments of a leiomyoma, detached at the time of endometrial curettage, entered dilated lymphatic channels in or adjacent to a large projecting submucous leiomyoma, and seeded several pelvic and para-aortic lymph nodes. During an interval of 8 years, these grew slowly and did not infiltrate the perinodal tissues or give rise to secondary metastases.
Adult↗