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R E Scully

Publications and source records attributed to R E Scully.

At least 145 records · Page 8Linked to original sources
PubMed1990

Mesonephric remnants, hyperplasia, and neoplasia in the uterine cervix. A study of 49 cases.

Hyperplasia of mesonephric remnants in the uterine cervix is an unusual condition that is often misdiagnosed as adenocarcinoma. The rare mesonephric carcinoma can be confused with more common forms of cervical adenocarcinoma. We studied 49 specimens of cervix containing mesonephric remnants, or lesions derived from them, in women 21 to 72 (mean, 38) years of age. Four cases were classified as mesonephric remnants, 31 as lobular mesonephric hyperplasia, eight as diffuse mesonephric hyperplasia, two as mesonephric ductal hyperplasia, and four as mesonephric carcinoma. In the nonneoplastic cases, the lesion was unrelated to symptoms that resulted from excision of cervical tissue and, except in one case, did not produce a detectable mass. In two cases of carcinoma, the patient presented with bleeding; in one case, the patient presented with pelvic relaxation. The manner of presentation was not known in the fourth case of carcinoma. Twenty-eight patients with mesonephric remnants or hyperplasia underwent hysterectomy; 15 had a cone biopsy; one underwent excision of the cervical stump; and one had only a cervical biopsy. None of these patients has had a recurrence. All four patients with carcinoma had a hysterectomy; three of them died of carcinoma 2 years and 10 months, 7 years, and 9 years after diagnosis, respectively. Correct classification of mesonephric lesions is imperative for appropriate patient management.

Adenocarcinoma↗
PubMed1990

Ovarian metastases from carcinoma of the gallbladder and extrahepatic bile ducts simulating primary tumors of the ovary. A report of six cases.

Six cases in which ovarian metastases from carcinoma of the gallbladder or bile ducts were discovered during the life of the patient are described. The patients ranged from 33 to 72 (average, 57) years of age. In one case, the ovarian tumor was discovered 5 weeks before a gallbladder carcinoma was detected: in three cases, gallbladder tumors and ovarian metastases were discovered simultaneously; and in two cases, ovarian metastases were recognized 1 and 2 years after the biliary tumors. The ovarian tumors were bilateral in five cases. One of them was a 13-cm multiloculated, cystic neoplasm that simulated a primary mucinous tumor of the ovary. The remaining neoplasms were uniformly or predominantly solid and ranged up to 6.5 cm in diameter. They typically had lobulated external surfaces and were often multinodular on sectioning. Three ovarian tumors posed significant problems in differential diagnosis on microscopic examination. One of them closely simulated an endometrioid carcinoma, another simulated a mucinous cystadeno-carcinoma, and a third suggested the possible diagnosis of a Sertoli-Leydig cell tumor. Features helpful in establishing the metastatic nature of the ovarian tumors in these and the other cases included bilaterality, surface implants, multinodularity, and extraovarian spread. The gallbladder and bile ducts are rare sources of metastatic tumors, which may simulate primary ovarian neoplasms.

Adenocarcinoma↗
PubMed1990

Serous psammocarcinoma of the ovary and peritoneum.

We report 11 cases of serous psammocarcinoma, a rare variant of serous carcinoma characterized by massive psammoma body formation and low-grade cytological features. The patients ranged in age from 36 to 76 (mean of 57) years. The tumors were stage three in every case (three stage IIIA, seven stage IIIB, and one stage IIIC). Eight of the patients had ovarian psammocarcinomas with ovarian tumors measuring 5-22 (mean of 11) cm in diameter; the other three patients had primary peritoneal psammocarcinomas. The surfaces of the ovarian tumors were smooth and intact in seven of eight ovarian psammocarcinomas. Cysts were present in six of eight ovarian tumors, and the solid portions were typically gritty or granular. Necrosis was not seen. Microscopically there was destructive invasion of ovarian stroma or vascular invasion in the ovarian tumors; the extraovarian tumor implants were invasive of intraperitoneal viscera in five cases. The epithelium was arranged in small nests with no areas of solid epithelial proliferation, and at least 75% of the epithelial nests were associated with psammoma body formation. No more than moderate nuclear atypicality was identified in any case. No mitotic figures were found in 10 of the tumors, with a single mitotic figure identified in the other tumor. Follow-up data for more than 1 year was available for six patients, with two patients lost to follow-up and three patients followed without evidence of recurrence for less than 1 year. One patient died of tumor 6 1/2 years after presentation, and five patients were alive without evidence of recurrent tumor 3-10 (mean of 8.3) years after presentation. Although based on a small number of cases, these data suggest that the clinical behavior of psammocarcinoma more closely resembles that of borderline serous tumors than of serous carcinomas of the usual type, following a protracted course and being associated with a relatively favorable prognosis.

Adenocarcinoma, Papillary↗
PubMed1990

Sarcomas metastatic to the ovary: a report of 21 cases.

Twenty-one cases in which sarcomas metastasized to the ovaries are reported. The patients ranged from 18 to 79 (average 42) years of age; only five of them were over 50 years old. Eleven tumors were primary in the uterus and 10 outside the genital tract. Three uterine tumors were leiomyosarcomas, and eight, endometrial stromal sarcomas. The extragenital primary tumors were leiomyosarcoma of the stomach (1) and small intestine (2), retrovesical leiomyosarcoma (1), fibrosarcoma of the anterior abdominal wall (1), sarcoma of the mesentery of smooth muscle or neural type (1), hemangiosarcoma probably primary in the heart (1), osteosarcoma of the maxilla (1), chondrosarcoma of the rib (1), and Ewing's sarcoma of the pubic bone (1). The ovarian tumors, most of which were large, were discovered at the same time as the primary tumors in 11 cases; in seven cases, the ovarian tumor was discovered 7 months to 9 years after diagnosis of the primary tumor. In three cases, the ovarian tumors were discovered 4, 7, and 10 months before detection of the primary neoplasm. Two of these tumors were endometrial stromal sarcomas, and one, an epithelioid leiomyosarcoma of the stomach. Eleven ovarian metastases were bilateral. On microscopic examination, the greatest difficulty in pathologic interpretation was posed by the metastatic endometrial stromal sarcomas because of their simulation of sex cord-stromal tumors. Features helpful in their distinction from these tumors included the frequent presence of extra-ovarian disease, bilaterality, and a characteristic content of small arteries resembling the spiral arteries of the late secretory endometrium. The other tumor that caused major diagnostic difficulty was the metastatic epithelioid leiomyosarcoma from the stomach, which had a pattern that initially suggested the solid-tubular pattern of a Sertoli cell tumor.

Adolescent↗
PubMed1990

Müllerian adenofibroma of the uterus with invasion of myometrium and pelvic veins.

Two cases of müllerian adenofibroma of the uterus with unusual features are described. The tumors were encountered in patients 51 and 70 years of age who presented with abdominal pain and postmenopausal bleeding, respectively; both patients were found to have a pelvic mass. Intraoperative findings included an enlarged uterus in each case, and in one of them, uterine rupture and worm-like plugs of tumor within veins of both broad ligaments. Examination of the hysterectomy specimens revealed polypoid endometrial tumors that deeply invaded the myometrium. On histologic examination, both tumors were composed of an intimate admixture of benign endometrial-type glands and a moderately cellular stroma containing fibroblasts with benign nuclear features and very low mitotic activity (less than one mitotic figure per 10 high-power fields). Both tumors infiltrated the myometrium almost to the serosa, and one of them grew within the lumens of large myometrial veins. The patients had uneventful postoperative follow-up periods of greater than 3 years. This report indicates that rare, otherwise typical uterine adenofibromas can exhibit invasive properties and may have a malignant potential.

Adenofibroma↗
PubMed1990

Invasive adenocarcinoma and related tumors of the uterine cervix.

Adenocarcinomas and related tumors now account for approximately 15% of carcinomas of the uterine cervix. In this review, the features of these neoplasms are reviewed with emphasis on their microscopic features, differential diagnosis, and subtypes about which there is new information such as adenoma malignum, and villoglandular, mesonephric, adenoid basal, and adenoid cystic carcinomas. These tumors may cause considerable diagnostic difficulty, sometimes being difficult to distinguish from nonneoplastic glandular proliferations. Their correct identification has major prognostic implications.

Adenocarcinoma↗
PubMed1990

Prolactinoma in wall of ovarian dermoid cyst with hyperprolactinemia.

A 41-year-old woman with long-standing amenorrhea and hyperprolactinemia that disappeared after hysterectomy and bilateral salpingo-oophorectomy was found to have a prolactinoma in the wall of a dermoid cyst. Prolactin was demonstrated in the tumor cells by immunohistochemical staining.

Adult↗
PubMed1989

Primary carcinoma of the broad ligament. Report of four cases and review of the literature.

The clinical and pathologic features of four new and eight previously reported primary carcinomas of the broad ligament have been reviewed. The patients' ages ranged from 29 to 70 years (average, 46) and the most common clinical presentations were vague lower abdominal pain, a palpable pelvic mass, and an associated disorder such as pelvic endometriosis. The tumors ranged from 4.5 to 13 cm in greatest dimension and were solid, cystic, or mixed. All of them were unilateral. Review of the pathologic descriptions and illustrations of the cases in the literature and microscopic review of one reported case revealed that four of the tumors were endometrioid carcinomas, four were clear cell carcinomas, one was probably a mucinous adenocarcinoma, two were papillary adenocarcinomas of undetermined cell type, and one was a serous papillary cystadenoma of borderline malignancy with microinvasion. Three patients were treated by excision of the tumor alone. Seven of them were treated by total abdominal hysterectomy and salpingo-oophorectomy; three patients received postoperative radiation therapy, and one of them also received chemotherapy. Eight patients were free of disease 6 months to 7 years postoperatively, and one patient with distant metastasis (rib) at the time of operation lived for 27 months. In three cases no follow-up data were available. Three of the four patients in current series were found to have pelvic endometriosis at the time of operation. Three of their carcinomas were endometrioid and one was of clear cell type, suggesting the possibility of an origin from endometriotic tissue in the broad ligament.

Adenocarcinoma↗
PubMed1989

Multilocular peritoneal inclusion cysts (so-called cystic mesotheliomas).

Twenty-five cases of multilocular peritoneal inclusion cysts (MPIC) were investigated. All but four cases were associated with a history of a previous abdominal or pelvic operation, or evidence of endometriosis or pelvic inflammatory disease, or combinations of these findings. All of the lesions were attached to pelvic organs, 44% also occupied the upper abdominal cavity, and 16% involved the retroperitoneum. In three cases free-floating cysts were present as well. The median diameter of the lesions was 13 cm. The cyst locules were lined by one to several layers of flat to cuboidal mesothelial cells that occasionally formed papillae, had a hobnail shape, or had undergone squamous metaplasia. The stroma was characterized by chronic inflammation and often acute inflammation. In most of the cases there was mural proliferation of the mesothelial cells, occasionally simulating a malignant mesothelioma. Twelve lesions were complicated by postoperative local recurrence; in four of these cases the recurrences were multiple; neither the size of the lesion nor the presence of mural mesothelial proliferation influenced the outcome. The clinical and pathologic data in this series suggest that the MPIC is a nonneoplastic reactive mesothelial proliferation.

Adolescent↗
PubMed1989

Alveolar rhabdomyosarcoma metastatic to the ovary. A report of two cases and a discussion of the differential diagnosis of small cell malignant tumors of the ovary.

Two young women with alveolar rhabdomyosarcoma metastatic to the ovary are reported. In each case, the ovarian involvement was detected within a few weeks of the discovery of a soft tissue mass by the patient. Symptoms attributable to the ovarian tumor dominated the initial clinical picture in one case. In the other case, the soft tissue mass was not appreciated by the treating physicians until after the diagnosis of rhabdomyosarcoma had been established by examination of the ovarian tumor. The ovarian tumor was unilateral in one case and bilateral in the other. One primary site was the right foot and the other primary site was the left forearm. These cases illustrate that metastatic alveolar rhabdomyosarcoma rarely enters into the differential diagnosis of a small cell malignant tumor of the ovary. Both patients experienced progression of their disease and died, despite aggressive chemotherapy, within 1 year of presentation.

Adolescent↗
PubMed1989

Galactose consumption and metabolism in relation to the risk of ovarian cancer.

In a case-control study, consumption of dairy foods by 235 white women with epithelial ovarian cancer and by 239 control women, and activity of red blood cell galactose-1-phosphate uridyl transferase (transferase) in a subset of 145 cases and 127 controls were determined. Yogurt was consumed at least monthly by 49% of cases and 36% of controls. The mean transferase activity of cases was significantly lower than that of controls. When a ratio of lactose consumption to transferase (L/T) was calculated, cases had a mean L/T of 1.17 compared with 0.98 for controls; there was a highly significant trend for increasing ovarian cancer risk with increasing L/T ratio. Lactose consumption may be a dietary risk factor and transferase a genetic risk factor for ovarian cancer.

Adult↗
PubMed1989

Villoglandular papillary adenocarcinoma of the uterine cervix. A clinicopathologic analysis of 13 cases.

The clinical and pathologic features of 13 cervical papillary adenocarcinomas of villoglandular type were reviewed. They occurred in patients 23 to 54 years of age, with ten patients younger than 40 years of age. Microscopic examination revealed surface papillae that ranged from tall and thin to short and broad and contained central fibrous cores typically containing numerous inflammatory cells. The papillae were usually lined by stratified epithelial cells with slight to moderate nuclear atypicality and mitotic activity and no more than a minor degree of cellular budding. The deeper portions of the tumors were composed of branching tubular glands separated by a fibrous or fibromatous stroma and were more or less sharply demarcated from the adjacent cervical stroma. A hysterectomy was performed in 12 cases and only a cone biopsy in one case. The cone biopsy specimen and four of the hysterectomy specimens contained no residual carcinoma. In six uteri adenocarcinoma was confined to the inner third of the cervical wall whereas in two there was deep invasion. Follow-up of 2 to 14 years' duration including more than 5 years in ten cases has revealed no evidence of recurrent tumor. The excellent prognosis of the patients in this small series and the young age of many of them suggest that this tumor may be managed by a procedure less radical than a hysterectomy provided the tumor is superficial, has been completely excised, does not exhibit vascular space invasion, and close follow-up examination is possible.

Adenocarcinoma, Papillary↗
PubMed1989

Müllerian adenosarcomas of the uterus with sex cord-like elements. A clinicopathologic analysis of eight cases.

Eight cases of uterine müllerian adenosarcoma with sex cord-like elements (SCEs) occurred in patients 22-85 years of age (median, 41) who presented with abnormal uterine bleeding. Seven patients had hysterectomy; one had curettage and radiation only. The polypoid endometrial tumors were composed of adenosarcoma admixed with SCEs; the latter accounted for 5-50% of the tumor. The SCEs were multifocal in six cases and formed a solitary mass at the base of the adenosarcoma in the remaining two cases. Benign-appearing epithelial-type cells, often containing abundant eosinophilic or foamy, lipid-rich cytoplasm, were arranged in solid nests, trabeculae, and solid or hollow tubules. Myometrial invasion was observed microscopically in six cases. Of seven patients with postoperative follow-up information, six were alive with no evidence of recurrent tumor at postoperative intervals of 3-11 years. The patient treated only by curettage and radiation had persistent intrauterine tumor at 7 months and died of an unrelated illness at 16 months. This study indicates that occasional uterine adenosarcomas contain SCEs similar to those described in endometrial stromal tumors and uterine tumors resembling ovarian sex cord tumors. The clinical and pathologic features of these tumors are otherwise similar to those of typical uterine adenosarcomas.

Adult↗
PubMed1989

Ovarian small cell carcinoma. Histogenetic considerations based on immunohistochemical and other findings.

Small cell carcinoma of the ovary is a rare, poorly understood aggressive tumor of young women, associated with paraendocrine hypercalcemia in two-thirds of the cases. Immunohistochemical staining of 15 small cell carcinomas, one-third of which were associated with hypercalcemia, 15 adult granulosa cell tumors, 15 juvenile granulosa cell tumors, and 5 Sertoli cell tumors, was performed with the use of antibodies against cytokeratins (AE-1/AE-3, CAM 5.2, 902), epithelial tumor-associated antigens (B72.3, epithelial membrane antigen [EMA]), vimentin, S-100, neuron-specific enolase (NSE), lysozyme, parathyroid hormone, and chromogranin-A in an attempt to define histogenetically this tumor type. One-third of the small cell carcinomas were positive for EMA, whereas all of them were negative for B72.3 and S-100. In contrast, one-third of the granulosa cell tumors were positive for S-100 and all of them were negative for EMA and B72.3. One of five Sertoli cell tumors were positive for EMA and two were positive for B72.3, but all were negative for S-100. Differences existed in the frequency, intensity, and/or pattern of staining for cytokeratin, vimentin, lysozyme, and NSE among the various tumor types. A single small cell carcinoma from a patient with hypercalcemia stained focally for parathyroid hormone, whereas all 30 granulosa cell tumors and 4 of 5 Sertoli cell tumors were nonreactive. Chromogranin-A staining was noted in four of five small cell carcinomas, none of ten granulosa cell tumors, and two of five Sertoli cell tumors. These immunohistochemical findings, as well as previous light and electron microscopic data, do not clearly indicate any specific cell as the cell of origin of the ovarian small cell carcinoma.

Adult↗
PubMed1989

Atypical forms of microglandular hyperplasia of the cervix simulating carcinoma. A report of five cases and review of the literature.

We report five cases of microglandular hyperplasia with unusual histologic features. The diagnosis of carcinoma--usually clear cell adenocarcinoma--was seriously entertained in all the cases. Three of the patients were premenopausal; two were postmenopausal. Two of them were on oral contraceptives; one was on estrogen and progesterone replacement therapy. The histologic features that caused diagnostic difficulty were: a solid, sheet-like proliferation of cells (four cases), a pseudoinfiltrative pattern (one case), abundant stromal hyalinization (one case), signet ring cells (two cases), hobnail cells (two cases), and the presence of moderate degrees of nuclear atypicality (two cases) and occasional mitotic figures (two cases). However, foci with these features usually merged with areas of typical microglandular hyperplasia. After conservative therapy in four cases, follow-up of up to 12 years has been unremarkable. It is important for pathologists to be aware of these unusual histologic appearances of microglandular hyperplasia to avoid its misinterpretation as a malignant tumor.

Adenocarcinoma↗
PubMed1989

Adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. A clinicopathological and immunohistochemical analysis of 26 cases.

We reviewed 26 examples of the rare variant of cervical adenocarcinoma that has been designated "adenoma malignum." The patients, three of whom had Peutz-Jeghers syndrome, ranged in age from 25 to 72 years (average, 42 years). The most common presenting symptom was menometrorrhagia, followed by vaginal discharge, postmenopausal bleeding, and abdominal swelling in decreasing order of frequency. In 12 of the patients, the diagnosis was established on the basis of the examination of a cervical biopsy specimen, endocervical curettage specimen, or both. In three of these cases, however, up to four biopsies were performed before the diagnosis was established. In the remaining 14 patients, the diagnosis was not made until the time of operation or pathologic examination of a hysterectomy specimen. On gross examination, the cervix usually appeared abnormal, but occasional specimens were considered unremarkable. The cervix was typically described as firm or indurated. Microscopic examination showed glands that were irregular in size and shape and lined predominantly by mucin-containing columnar epithelial cells with basal nuclei. The tumors typically exhibited deep invasion of the cervical wall, and a portion of the infiltrating tumor was associated with a stromal response in most cases. Minor foci of tumor with a less well-differentiated appearance were present in 15 of the 26 tumors. Argyrophil cells were present in six of 15 tumors. Five of the six tumors containing argyrophil cells stained immunohistochemically for serotonin and peptide hormones. Positive staining for serotonin was seen in four tumors; one of these also contained a few cells positive for neurotensin. Cytoplasmic staining of the tumor cells for carcinoembryonic antigen (CEA) was seen in five of six cases. CEA reactivity was very focal in two of the positive tumors. Microscopic features that were most helpful in distinguishing adenoma malignum from normal endocervix or benign endocervical glandular proliferations were the presence of markedly irregular, abnormally shaped glands; invasion of the cervical wall; a loose edematous or desmoplastic stromal response; foci of less well-differentiated tumor; vascular invasion; perineural invasion; and positive staining for CEA. Despite radical therapy in most of the cases, the prognosis was poor. Follow-up data were available for 22 patients. Thirteen of them died of recurrent tumor, four were alive with recurrent tumor at the time of last follow-up examination, and only three patients were disease free for 2 years or more.4+ tumor of the

Adenocarcinoma↗
PubMed1989

Complex endometrial hyperplasia and carcinoma in adolescents and young women 15 to 20 years of age. A report of 10 cases.

The clinical and histologic findings in 10 patients, 15-20 years of age, with complex hyperplasia or well-differentiated adenocarcinoma of the endometrium are presented. The morphologic distinction between the two lesions is discussed, and the frequency of misdiagnosis of this form of hyperplasia as carcinoma in this age group is emphasized. No difference was found in the behavior of the two lesions in this series of cases whether or not a hysterectomy was performed.

Adolescent↗