Biomedical subjects
N F Gowing
Publications and source records attributed to N F Gowing.
Adult Wilms' tumour: review of 14 patients.
Wilms' tumour, or nephroblastoma, is the commonest renal neoplasm found in children, but is rarely found in adults, the world literature recording only approximately 200 cases. Individual case reports continue to be published but only within the last 10 years have definitive treatment regimes been suggested. In order to determine the UK experience of adult Wilms' tumour, members of the British Association of Urological Surgeons were circulated with a questionnaire, and from 141 replies, 13 members reported 17 cases. Critical review of the original histology slides excluded 3 of these; the 14 remaining cases are described and their management discussed in the light of current recommended treatment.
Quadrantic excision and axillary node dissection without radiation therapy: the long-term results of a selective policy in the treatment of stage I breast cancer.
The results of a selective policy of conservative surgery without radiation over a 14-year period with a minimum 5 year follow-up indicates that routine postoperative radiotherapy can be safely omitted in certain cases. Eighty-one patients were studied, the overall survival at 5 years and 10 years was 88% and 73% respectively. The risk of local recurrence within the treated breast or axilla was 10% at 5 years and 11% within the total follow-up period. Most (91%) local recurrences were noted within 5 years. The rate of dying from breast cancer did not change over 10 years of follow up. The risk of recurrence was significantly higher in younger (less than 46 years) patients (P less than 0.05) and premenopausal patients (P less than 0.005) compared with older, post menopausal patients. The risk of dying from breast cancer was also significantly greater in the younger premenopausal women. At 10 years the rate of dying from breast cancer was unchanged from that seen soon after diagnosis. In postmenopausal patients with tumours less than 2 cm and uninvolved axillary nodes after pathological assessment, radiotherapy can be safely omitted. In these patients there is a low risk of local recurrence (10%), similar to that reported following segmental mastectomy and radiation.
High-dose alkylation therapy using ifosfamide infusion with mesna in the treatment of adult advanced soft-tissue sarcoma.
In a phase II study, 42 patients with advanced soft-tissue sarcoma were treated with ifosfamide by 24-h infusion and mesna by 4-h IV bolus, repeated every 3 weeks. Ten patients received ifosfamide 5.0 g/m2, 20 had the dosage increased to 8.0 g/m2, and 12 received 8.0 g/m2 from the outset. Mesna was given in doses of 400 mg/m2 or 600 mg/m2. Of 40 patients evaluable for response, six (15%) achieved complete response and nine (23%) partial response. The overall response rate was 38%. The median duration of response was 11 months. Treatment was associated with falls in peripheral WBC and alopecia in all patients. Most experienced severe nausea and vomiting. In seven nephrotoxicity developed, and two of these died of renal failure. Renal tubular defects and cerebral effects also occurred. Mesna largely prevented haemorrhagic cystitis. Ifosfamide offers a new alternative to previous chemotherapy for advanced soft-tissue sarcoma, but alterations in dose or method will be necessary to reduce toxicity.
Chemotherapy of endodermal sinus tumour (yolk sac tumour) of the ovary: preliminary communication.
Eight patients presenting with endodermal sinus tumour of the ovary have been treated with combination chemotherapy using cisplatin, bleomycin and vinblastine (PVB). Complete remission occurred in 7 out of 8 cases, all of whom are alive and well 3 to 33 months later. These preliminary results are compared with our own past experience and recent reports in the literature. It is concluded that the PVB regimen is probably as effective in female germ cell tumours as it is in testicular teratoma.
Sertoli-Leydig cell tumors: a clinicopathologic study of 34 cases.
Thirty-four cases of Sertoli-Leydig cell tumor were studied. All tumors were limited to the ovary at the time of initial surgery. Eight tumors were well differentiated, 15 were of intermediate differentiation, and 11 were poorly differentiated. Six cases contained heterologous elements. The less differentiated tumors occurred in patients with a lower median age and were more likely to produce androgenic manifestations. Follow-up of one year or longer was obtained in 15 patients, with an average follow-up in these patients of 6.1 years. Only one patient, who had a poorly differentiated tumor, died of the neoplasm in this series. Although follow-up was limited in this study, our findings suggest that the better differentiated tumors have a relatively favorable prognosis. This neoplasm is composed of sex-cord and stromal elements, and its components have the capacity to a greater or lesser extent to recapitulate the cells of the testis at different stages of development.
Yolk sac and allied tumours of the ovary.
A review is presented of the histological appearances of 38 yolk sac tumours of the ovary and four so-called embryonal carcinomas together with the associated clinical features. It is suggested that these neoplasms belong to a single taxonomic group of embryonal ovarian tumours differing only in the concomitant types of differentiation. One yolk sac tumour occurred in an individual of 46 XY chromosome constitution and another in a patient with a gonadoblastoma in the contralateral ovary. The value of post-operative serial assays of serum AFP is stressed.
Extranodal non-Hodgkin's lymphoma presenting in the testicle: a clinical and pathologic study of 24 cases.
Twenty-four cases of extranodal non-Hodgkin's lymphoma presenting in the testicle are reviewed. All cases are diffuse lymphoma by the Rappaport classification. Cases clinically stages as I/II, (18/24) show a prolonged survival compared with those clinically staged as III/IV (6 of 24). Progressive involvement of either the lymphoid tissue in Waldeyer's ring or adjacent structures in the nasopharynx or oropharynx was noted in 22% (4 of 18) of Stage I/II cases. In 2 of the 24 (8%), there was asynchronous involvement of the opposite testicle. In patients with Stage I/II disease radiation therapy to the pelvic and paraaortic lymph nodes following inguinal orchidectomy is recommended. Systemic chemotherapy is recommended to follow radiation therapy unless bulky abdominal disease is present in which case it should precede radiation therapy. Prophylactic radiation of the opposite uninvolved testis is not recommended.
Fast neutrons compared with megavoltage x-rays in the treatment of patients with supratentorial glioblastoma: a controlled pilot study.
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A report of the histological features in 12 cases of gonadoblastoma.
This report deals with 12 cases of gonadoblastoma submitted to the Ovarian Tumour Panel of the Royal College of Obstetricians and Gynaecologists. These tumours are found in children and young adults. Children may present with obvious genital malformation, retarded growth or precocious puberty. In adults the main compliant is amenorrhoea but sometimes there is associated masculinization. Histologically the gonadoblastoma has a distinctive structure, easily recognized in most instances. The most important feature is the instability of the germ cells in these tumours. Nine of these cases showed an associated dysgerminoma, bilateral in 4. In any cases of suspected gonadal dysgenesis presumptive evidence of diagnosis is suggested by the presence of a Y chromosome, raised gonadotrophin output and pelvic calcification on X-ray examination. At operation, streak tissue on both sides must be removed since these tumours are frequently microscopic in size. For the same reason the tissue removed should be serially sectioned.
Treatment of breast cancer by quadrantic excision with axillary dissection.
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A clinico-pathological study of gonadoblastoma.
The clinico-pathological features of 12 patients with a gonadoblastoma are analyzed.
Infectious mononucleosis: histopathologic aspects.
The main histopathologic features of infectious mononucleosis are described. In the lymph nodes, the principal change is the appearance of numerous large pyroninophilic cells (immunoblasts), initially expanding the paracortical zone but later extending throughout the node. Similar, large lymphoid cells appear as infiltrates in many other organs and tissues. Cells morphologically similar to Sternberg-Reed cells may be found in the lymph nodes of patients with infectious mononucleosis and other conditions apart from Hodgkin's disease. The diagnostic importance of considering not only the Sternberg-Reed cells but their milieu is stressed. A possible relationship between infectious mononucleosis and lymphoreticular malignancy is suggested by a number of observations, but a definite etiologic link is yet to be established.
Surgical treatment of urethral tumours associated with bladder cancer.
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Tumours of the lymphoreticular system: nomenclature, histogenesis, and behaviour.
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Morbid anatomical and histological features of unusual infections.
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The pathology and natural history of thyroid tumours.
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Observations upon the behaviour of human tumor cells when inoculated into the hamster cheek pouch using the Sanders-Shubik cheek pouch system for direct observation.
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