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Biomedical subjects

R E Scully

Publications and source records attributed to R E Scully.

At least 235 records · Page 13Linked to original sources
PubMed1985

Clinical, biochemical, and ovarian morphologic features in women with acanthosis nigricans and masculinization.

Nine women with acanthosis nigricans and masculinization, who did not appear to have any of the reported syndromes associated with acanthosis nigricans, were studied to characterize the clinical, biochemical, and ovarian morphologic features of their disorders. These patients had the clinical and biochemical profiles of polycystic ovarian disease. All acanthosis nigricans subjects had significant insulin resistance when insulin binding to both circulating monocytes and erythrocytes was compared to the control subjects. Microscopic examination of the ovaries revealed no evidence of recent normal ovulation, sclerosis of the ovarian cortex, follicle cysts, and stromal hyperthecosis. The authors conclude that ovarian stromal hyperthecosis and insulin resistance are consistent findings in the present type of patient. This study provides further evidence supporting a relationship between insulin resistance and human ovarian function.

Acanthosis Nigricans↗
PubMed1984

Low-dose preoperative radiation therapy for adenocarcinoma of the endometrium. A pilot study.

A pilot study using low-dose preoperative radiation therapy, i.e., 10 Gy in 3 to 4 days as an adjuvant preoperative procedure for grade 2 or 3 (FIGO classification) endometrial carcinoma, was done. The concept of low-dose preoperative radiation therapy is to administer treatment, either surgical or radiotherapeutic, postoperatively according to the surgical and pathologic findings, allowing identification of those patients with previously undiagnosed extensive metastatic disease outside the pelvis found at laparotomy in whom routine pelvic radiation therapy is futile, as well as those patients with relatively low risk of recurrence who may not require further radiotherapy. Forty-four patients with clinical Stage I, grade 2 or 3 with adenocarcinoma of the endometrium were entered into the pilot study. Following surgery, 68% remained Stage I by pathologic examination, and in the remaining patients the stages were changed to II in seven, III in three, and IV in four. Postoperative treatment was administered according to extent of the disease found at surgery. The 4-year actuarial probability of survival rate for the entire group of patients with clinical Stage I disease was 80%; corresponding disease-free rate was 77%. For the Stage I disease confirmed by pathologic examination, the corresponding rate was 96%. The rates for Stages II through IV, as shown by pathologic findings at laparotomy, were 53% and 42%, respectively. In this pilot stud, a treatment policy for clinical Stage I, grade 2 or 3 adenocarcinoma of the endometrium using low-dose preoperative radiation therapy is recommended.

Adenocarcinoma↗
PubMed1984

Atypical vaginal adenosis and cervical ectropion. Association with clear cell adenocarcinoma in diethylstilbestrol-exposed offspring.

Knowledge of the evolution of clear cell adenocarcinomas of the vagina and cervix in diethylstilbestrol-exposed progeny has remained elusive despite the known topographical association of these tumors with the tuboendometrial form of vaginal adenosis and cervical ectropion. Twenty radical hysterectomy or radical hysterectomy and vaginectomy specimens of clear cell adenocarcinoma of the vagina or cervix were serially blocked in toto; tuboendometrial epithelium was found in the vagina in 19 (95%) of the cases, usually in greatest concentration at the margin of the tumor, particularly inferiorly. Foci of atypical tuboendometrial epithelium were identified in 16 (80%) of the cases, almost always immediately adjacent to the tumor. Twenty-five of a second group of 47 specimens in which only substantial portions of the vagina or cervix adjacent to a clear cell adenocarcinoma were available for examination also had foci of atypical tuboendometrial epithelium. The frequency with which atypical tuboendometrial glands in the vagina and cervix were associated with the carcinomas and the proximity of the former to the latter provide strong evidence that atypical vaginal adenosis and atypical cervical ectropion of the tuboendometrial type are precursors of clear cell adenocarcinoma.

Cervix Uteri↗
PubMed1984

Malignant lymphoma and granulocytic sarcoma of the uterus and vagina. A clinicopathologic analysis of 27 cases.

Twenty-five cases of malignant lymphoma of the uterine corpus or cervix and the vagina, and one case of granulocytic sarcoma of the cervix were analyzed. The patients typically presented with vaginal bleeding and a subepithelial mass without obvious ulceration or other epithelial abnormality. Twenty-one of the 27 tumors appeared to originate in the cervix, 4 in the vagina, and 2 in the endometrium. Seven of them were nodular lymphomas, 17 diffuse large cell, or "histiocytic" lymphomas, 1 was a Burkitt's tumor, and 2 were granulocytic sarcomas. Sclerosis was a prominent histologic feature in lymphomas of the cervix and vagina. Twenty-one patients had disease confined to a single extranodal site (Ann Arbor Stage IE), and six had lymph node or ovarian involvement (Stages IIE + IV). The overall actuarial 5-year survival was 73%. The survival of patients with Stage IE tumors was 89%, compared with 20% for patients with lymph node or ovarian involvement. None of the 12 patients with Stage IE lymphoma of the cervix or vagina who received definitive initial local treatment (surgical and/or radiation therapy) relapsed. Nodular lymphomas and diffuse lymphomas with a preponderance of large cleaved cells were more often localized and had a better prognosis than large or small noncleaved and immunoblastic types. Lymphoma of the lower female genital tract is a rare, but treatable malignancy, which must be distinguished microscopically from inflammatory lesions and nonlymphoid tumors arising in this site.

Adult↗
PubMed1984

Correlation of ascitic fluid cytology with histologic findings before and after treatment of ovarian cancer.

One hundred thirteen specimens of ascitic fluid from 97 patients with primary, persistent, or recurrent ovarian cancer were examined cytologically. Advanced stage of disease, involvement of the ovarian surface, a moderate or large volume of fluid, and nonbloody serous ascites were factors that correlated with a high rate of positive findings in ascites in these patients. Other factors influencing the positive rate appeared to be the invasive as opposed to borderline malignant histology of the tumor. Involved external surface and volume of ascites were influencing factors only in advanced cases. Therefore, the most important factor influencing the positive rate of ascites cytology was the proportion of cases in advanced stages to total cases.

Ascitic Fluid↗
PubMed1984

Endometrioid stromal sarcomas of the ovary. A clinicopathologic analysis of 23 cases.

The clinical and pathologic features of 23 endometrioid stromal sarcomas of the ovary were analyzed. The patients' ages ranged from 20 to 76 years (average, 54 years). The most common presenting symptom was abdominal swelling or pain. In 12 cases the tumors were unilateral and in 11 cases they involved both ovaries. Four of the tumors were Stage I, nine Stage II, and eight Stage III; two were Stage IV because of the presence of pulmonary metastases. In nine of the cases there was a prior, synchronous or subsequent endometrial stromal sarcoma of the uterus. Nineteen tumors with less than 10 mitotic figures (MF) per 10 high power fields (HPF) were classified as low grade and the remaining four tumors with 12 to 30 MF per 10 HPF were designated as high grade. Only 2 of the 19 patients with low-grade tumors are known to have died of their disease and 9 of those whose tumor had spread beyond the ovary at the time of presentation were alive one or more years postoperatively. Three of the four patients with high-grade tumors died of their disease within 4 years.

Adult↗
PubMed1984

Granulosa cell, Sertoli-Leydig cell, and unclassified sex cord-stromal tumors associated with pregnancy: a clinicopathological analysis of thirty-six cases.

Seventeen granulosa cell, thirteen Sertoli-Leydig cell and six unclassified sex cord-stromal tumors diagnosed during pregnancy or the puerperium were reviewed. Eleven patients presented with abdominal pain or swelling, five in shock, two with virilization, and one with vaginal bleeding. Three asymptomatic patients were explored because of a palpable mass and one because of an adnexal mass found on ultrasound examination. In thirteen patients the tumor was discovered during a cesarean section; five of them had had dystocia and in eight of them the tumor was an incidental finding. All the tumors were Stage I but 13 of them had ruptured; all but one were unilateral. Hemoperitoneum was present in seven cases. On microscopical examination many of the tumors differed from tumors in the same diagnostic categories occurring in the absence of pregnancy by having a disorderly arrangement of their cells, lacking recognizable differentiation in many areas, showing prominent edema, and containing unusually large numbers of lutein or Leydig cells. The last two features were most obtrusive in tumors removed at term. With one exception the patients were initially treated by conservative surgical procedures. Two of them received chemotherapy and two radiation therapy postoperatively. A hysterectomy and salpingo-oophorectomy was performed at a second operation in eight cases; no residual tumor was found in any of the specimens. Only one patient had a recurrence, which was treated surgically. Follow-up for an average of 4.7 years is available for 30 of the 36 patients; all of them were alive and free of disease at the time of the last examination.

Adolescent↗
PubMed1984

Endodermal sinus tumor of the vagina: a report of nine cases and review of the literature.

Nine cases of endodermal sinus tumor of the vagina from children 6 months to 2 years of age are reported. The two patients treated before the advent of modern chemotherapy died 6 to 13 months postoperatively despite attempted complete surgical resection of the tumor in one of the cases. One patient who was treated initially by hysterectomy and vaginectomy had lung metastases 6 months postoperatively and died despite chemotherapy. Six patients who were treated by a surgical procedure and received vincristine, actinomycin D, and cyclophosphamide, with radiation therapy in two cases, were alive and free of disease from 2 to 9 years postoperatively.

Age Factors↗
PubMed1984

Peritoneal fluid cytology in patients with ovarian cancer.

Peritoneal fluid was examined for the presence of tumor cells in 94 patients with ovarian cancer. The findings were correlated with the type, grade, and stage of the tumor. Fluids that were positive for malignant cells were associated with serous and endometrioid carcinomas more often than with carcinomas of other types. Patients with high-stage tumors of all types had positive fluids more often than those with low-stage tumors. The presence of tumor cells in the fluid indicated a worse prognosis at 2 years. Analysis of other factors that influence prognosis, however, revealed that this difference was related more specifically to the stage of the disease. Since the presence of tumor cells in abdominal fluid is a factor in the subclassification of Stage I and Stage II ovarian cancer, analysis of a larger group of patients with tumors in these stages is needed to establish the prognostic significance of positive cytological findings independent of other prognostic factors.

Ascites↗
PubMed1984

Endometrial carcinoma with argyrophil cells: a histochemical and immunohistochemical analysis.

Fourteen of fifty-three cases of endometrial carcinoma (26 per cent) contained varying, usually small numbers of argyrophil cells, as demonstrated by Grimelius silver nitrate staining of formalin-fixed paraffin-embedded sections. In eight cases the argyrophilia was present in the apical region of glandular cells (type 1 cells) or throughout the cytoplasm of glandular or squamous cells (type 2 cells). The distribution of argyrophilia in these cells closely paralleled that of mucin or glycogen, and pretreatment of the sections with disease resulted in a loss of argyrophilia in the glycogen-rich tumors. In six cases individual round, ovoid, and flask-shaped argyrophilic cells were present also within the glandular epithelium (type 3 cells). In all six cases, similarly distributed cells were positive immunohistochemically for serotonin. Immunohistochemical staining for a battery of polypeptide hormones (calcitonin, gastrin, somatostatin, adrenocorticotropin [ACTH], and neurotensin) revealed positive staining for ACTH in one of the six tumors that contained type 3 cells and positive staining for somatostatin in another. Ultrastructural examination of the ACTH- and serotonin-positive tumor disclosed cells with granules 80 nm in diameter. Types 1 and 2 argyrophil cells were found in small numbers in several specimens of normal proliferative and secretory endometrium, but type 3 argyrophil cells were not identified in these specimens. Although focal argyrophilia is a frequent feature of endometrial carcinomas (26 per cent), the presence of type 3 argyrophil cells containing hormones, as evidenced by the immunohistochemical demonstration of serotonin and occasionally polypeptide hormones, is much less common (11 per cent).

Adenocarcinoma↗
PubMed1984

Ependymoma of the ovary: report of three cases.

Three apparently pure ependymomas of the ovary occurred in young women 25 to 35 years of age who presented with abdominal swelling or pain. At operation one tumor was stage IC, and two were stage III. On microscopic examination the tumors contained cells with fibrillary cytoplasmic processes, often arranged around blood vessels to form perivascular pseudorosettes. Immunohistochemical staining for glial fibrillary acidic protein confirmed the nature of the tumor in each case. The patient with the stage IC tumor was alive and well five years postoperatively. One patient with stage III disease died of tumor six years postoperatively, and insufficient time elapsed after treatment of the second to allow meaningful follow-up data. These cases illustrate the rare occurrence of ovarian tumors resembling differentiated tumors of the central nervous system. Recognition and distinction of these tumors from common epithelial tumors, which they may resemble, have important prognostic and therapeutic implications.

Adult↗
PubMed1984

Postoperative spindle cell nodules of genitourinary tract resembling sarcomas. A report of eight cases.

Eight cases of proliferative spindle cell nodules that developed 5 weeks to 3 months after operations on the lower genital tract of four women, and the lower urinary tract of four men, are described. The lesions ranged up to 4 cm in diameter, resembled spindle cell sarcomas on microscopical examination, and were initially interpreted as such in most of the cases. Six of the lesions were treated by local excision alone, and two by a radical surgical procedure, followed by radiation therapy in one case. The six patients whose lesions were treated inadequately on the assumption that they were sarcomas were free of disease 9-60 months (average, 28 months) postoperatively, and the two men who were treated by radical procedures were well 18 and 60 months later. The microscopic features, the unusual clinical setting, and the favorable prognosis of these lesions suggest that they were examples of a hitherto undescribed form of benign reactive lesion resembling a sarcoma.

Adult↗
PubMed1984

Ependymoma of the broad ligament. A report of two cases.

The clinical and pathological features of two cases of ependymoma that originated in the broad ligament are reported. Metastases developed in both patients. The tumors had the distinctive features of ependymoma on light-microscopical examination, and the diagnosis was confirmed by ultrastructural study in one case and immunoperoxidase staining for glial fibrillary acidic protein in both cases. The tumors presented diagnostic difficulties because of their close resemblance to serous papillary carcinomas of the ovary and the absence of published reports of ependymoma occurring in the female genital tract.

Adnexa Uteri↗
PubMed1984

Mucinous tumors of the ovary with argyrophil cells. An immunohistochemical analysis.

Forty-five cases of mucinous tumors of the ovary were studied for argyrophilia. Argyrophil cells were identified in seven of the 22 cystadenomas (32%), five of the 11 borderline tumors (45%), and two of the 12 carcinomas (17%). These 14 tumors and two additional mucinous tumors known to contain argyrophil cells were studied further by immunohistochemical methods for the localization of calcitonin, gastrin, somatostatin, adrenocorticotropin (ACTH), serotonin, neurotensin, and lysozyme. Serotonin immuno-reactivity was identified in 15 of the 16 cases. Among the peptide hormones, there was a high frequency of positivity for ACTH, gastrin, and somatostatin. Despite the demonstration of reactivity for these hormones, there was no clinical evidence of syndromes of hormone excess in the patients. Lysozyme was present in all but one of the benign and borderline tumors, but was not identified in the carcinomas. Lysozyme was also found in normal and neoplastic gastric and endocervical epithelium, indicating that its presence is not useful in differentiating gastrointestinal and müllerian-type epithelium. The results of this study confirm the previously recognized intestinal characteristics of the epithelium of many mucinous tumors, but also raise the question whether the simple, uniformly mucinous epithelium that is most common within these tumors and is generally regarded as endocervical in type may occasionally be gastric in nature.

Adrenocorticotropic Hormone↗
PubMed1984

Juvenile granulosa cell tumor of the ovary. A clinicopathological analysis of 125 cases.

The clinical and pathological features of 125 juvenile granulosa cell tumors of the ovary were analyzed. The patients ranged in age from newborn to 67 years (average 13 years). Forty-four percent were 10 years of age or younger, 34% between 11 and 20 years, 18% between 21 and 30 years, and 3% over 30 years of age. Eighty-two percent of the prepubertal patients presented because of isosexual pseudoprecocity. In the remainder of the children and in most of the older patients, the presenting manifestation was usually abdominal pain or swelling. Fifteen patients in the reproductive age group had menstrual irregularities or amenorrhea, and one of the two postmenopausal women presented with uterine bleeding. Two patients had Ollier's disease and two had Maffucci's syndrome. Laparotomy revealed unilateral involvement in 122 cases and involvement of both ovaries in two cases; bilateral tumors were found at autopsy in one case. Two tumors were Stage IIb and one Stage IIc; the remainder were Stage I. In 13 cases (11%), rupture had occurred before or during operation and ascites was present in 11 cases (9%). The tumors ranged from 3 to 32 cm in diameter (average 12.5 cm). Forty-nine percent of them were solid and cystic, 37% solid, and 14% cystic. Microscopic examination disclosed diffuse and follicular patterns, with the former predominating in most of the cases. The follicles varied in size and shape and characteristically contained basophilic or eosinophilic secretion, which often stained positively for mucin. The granulosa cells were typically luteinized to varying degrees and had dark round nuclei without grooves; a theca cell component of variable extent was present in many of the cases. The mitotic rate ranged from less than 1 to 32/10 high-power fields, with an average of 7. Nuclear atypicality varied from Grade 1 to 4. Follow-up information of at least 1 year's and up to 21 years' (average 5 years') duration was available for 95 patients, 87 of whom (92%) were alive and free of disease. One patient with Maffucci's syndrome died of chondrosarcoma 11 years after removal of the ovarian tumor (corrected survival--93%). The seven remaining patients died as a result of their tumor from 7 months to 3 years postoperatively; one of the clinically malignant tumors was Stage Iai, one Stage Iaii, two Stage Ic, two Stage IIb, and one Stage IIc.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

Ovarian Sertoli-Leydig cell tumor with retiform and heterologous components. Report of a case with hepatocytic differentiation and elevated serum alpha-fetoprotein.

A 13-year-old girl had an ovarian Sertoli-Leydig cell tumor associated with marked elevation of the serum alpha-fetoprotein level. On microscopic examination, the tumor had a predominantly retiform pattern and in addition contained heterologous elements in the form of mucinous epithelium, skeletal muscle, and liver cells; alpha-fetoprotein was demonstrated within the liver cells by immunohistochemical techniques. The serum alpha-fetoprotein level fell postoperatively, but rose again when the tumor recurred. Despite radiation therapy and chemotherapy, the tumor pursued a rapidly malignant course and the patient died 9 months postoperatively.

Adolescent↗
PubMed1984

Fibromatosis and massive edema of the ovary, possibly related entities: a report of 14 cases of fibromatosis and 11 cases of massive edema.

Twenty-five cases of ovarian enlargement secondary to massive edema, to a hitherto undescribed lesion that we have designated fibromatosis, or to both processes were reviewed to explore the possibility of a relation between them. The patients ranged in age from 13 to 39 years. The 14 patients with pure or predominant fibromatosis usually presented because of menstrual abnormalities; two had evidence of androgen excess and three had abdominal pain. At laparotomy two involved ovaries were observed to have twisted on their pedicles. There was definite bilateral ovarian involvement in two cases and probable bilateral involvement in two others. The excised specimens measured up to 12 cm in diameter and typically had firm, white sectioned surfaces. Microscopic examination showed a proliferation of spindle cells usually separated by dense collagen, which surrounded normal follicular structures. Lutein cells were present in the fibromatous areas in one patient, who was masculinized, and in the adjacent ovarian stroma in another patient, who was hirsute; a proliferation of cells of sex cord type was observed in the fibromatous areas in three cases. Six of the specimens contained focal areas of edema similar in appearance to that seen in cases of massive edema. The features of the 11 cases of massive edema were, in general, similar to those of the 40 examples of this entity reported in the literature. Six of the 11 patients had menstrual abnormalities and/or evidence of androgen excess, but most of them presented because of abdominal pain. At operation an involved ovary was observed to have undergone torsion in five of the cases; bilateral ovarian enlargement due to massive edema was present in two cases. The excised specimens, which measured up to 15 cm in diameter, typically had a watery appearance on sectioning. Microscopic examination showed edematous stroma surrounding residual normal ovarian structures. Lutein cells were identified in the edematous stroma in four cases and in the adjacent ovarian stroma in three of these cases. One of these patients was masculinized and another was hirsute. Small foci of fibromatosis similar to that seen in cases of pure fibromatosis were present in eight cases. The similar age range and clinical manifestations of these two processes and the overlap in their histologic features suggest that they are closely related and may reflect differing morphologic expressions of the same underlying disorder. Some of the cases of massive edema, however, may result from the development of stromal edema in ovaries involved by hyperthecosis.

Abdomen↗