Biomedical subjects
Publications and source records attributed to S C Sommers.
A squamous cell carcinoma arising in intralobar bronchopulmonary sequestration of the right lower lobe is described in a 69-year-old man. One other reported case was found. Other complications of bronchopulmonary sequestration include nonspecific infections and tuberculosis.
A retrospective study was made of 74 women who had received estrogen continuously, cycled with progesterone, for menopausal symptoms over an average 57-month period. Treated patients were compared with control patients from the same private practice. Vabra endometrial aspiration biopsies showed no statistical differences between 25 treated and 28 untreated patients in the frequency of normal, inactive, hyperplastic or neoplastic specimens. The most common finding in the treated group was a secretory response, which suggests that progesterone exerts an antiestrogen effect even when estrogen is given on a continuing basis. There is evidence that the vaginal maturation index in the postmenopausal patient, although helpful in determining the current state of her systemic estrogen activity, may not reflect the effect of estrogen on the endometrium. Estrogen therapy has no absolute predictable correlation with endometrial histology. Thus, the information from routine endometrial curettage is essential to evaluate the status of all treated patients. Among all hormone-treated patients (74), weight decreased over time, blood pressure, blood sugar and cholesterol levels were relatively unchanged, and Papanicolaou smear classes improved.
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One hundred ninety-one cases of histopathologically confirmed invasive carcinoma of the cervix were available to study. Until early diagnosis is made routinely and treatment instituted with a predictable promise for cure, attention must be devoted to studying the natural history of disease, its histologic and nuclear grading, stromal reaction, and whether lymphatics and/or blood vessels are involved. The results are impressive since patients with Stage IB carcinoma with lymphatic and/or blood vessel involvement treated by radical hysterectomy have had a 59.4% 5-year survival rate which has increased dramatically to 90% when there was no involvement. Other features which were analyzed, including tumor type, histologic and nuclear grades, size and number of nucleoli, and stromal leukocyte reactions showed no significant statistical relationship to survival. This may represent a bias because of the small number of cases in each group. This study helped identify the patient at high risk. The high-risk group as outlined by the parameters listed should receive additional therapy. Since the cancer had invaded a vascular channel, the authors selected these patients for combination anticancer chemotherapy. Those patients for combination anticancer chemotherapy. Those patients have not been followed long enough to evaluate the results of the treatment.
Ultrastructural and biochemical studies have suggested that bronchopulmonary carcinoids and oat cell carcinomas may be derivatives of neuroendocrine cells; their amine and/or peptide secretory capabilities may at times be reflected in clinical hormonal syndromes. This investigation was prompted by the hypothesis that dysplastic neuroendocrine bronchial cells may also exhibit structural and functional aberrations of their secretory apparatus. Surgical specimen samples from 5 human dysplastic bronchi were studied ultrastructurally; 7 normal bronchi served as controls. Golgi complexes of dysplastic cells were distinctly less prominent than those of the controls. Moreover, the Golgi vesicles of dysplastic cells appeared significantly smaller than their counterparts in normal cells (P less than 0.01). Also, dysplastic neuroendocrine cells displayed significantly fewer secretory granules per cell than the controls (P less than 0.05). These findings indicate structural abnormalities in the secretory apparatus of neuroendocrine cells in dysplastic bronchi and correlate with experimental observations of aberrant hormonal production associated with bronchial dysplasia. Thus, the possibility arises that bronchial epithelial dysplasias may be detected and monitored through laboratory determinations of their secretory products.
Of 99 patients with Crohn's disease whose rectal segment appeared normal on sigmoidoscopy, there was histologic inflammation in 45% and features characteristic of Crohn's disease in 30% of rectal biopsy specimens. Granulomas were found in 18% of patients, including 13% of those with ileitis, 13% of those with ileocolitis, and 37% of those with colitis. Eleven of the 17 granulomas were small undermarcated microgranulomas. Rectal biopsy specimens are of value to confirm the diagnosis in Crohn's disease and to determine the state of clinical activity even when the sigmoidoscopic appearance is normal.
A 22 year-old phenotypic female with a 45,x/46,x, r(x) mosaic complement had anovulatory cycles, histologically normal ovaries, and atypical endometrial hyperplasia which, when clinically followed by repeated biopsies, was found to progress to locally invasive endometrial carcinoma. This was successfully managed by the induction of ovulation with Clomid, which resulted in conversion of the endometrium to a normal secretory pattern for two subsequent years.
Rectal biopsies of sigmoidoscopically normal mucosa from 99 patients with Crohn's disease of the ileum, colon, or both were studied histologically, with particular reference to the presence of granulomas. Among the 14 cases of granulomas, some were of the usual sarcoid type and could easily be detected. Other microgranulomas were less well defined and were found only by mid- or high-power microscopic screening of serial sections. The morphologic characteristics, the relationship to ordinary Crohn's-disease granulomas and the possible significance of microgranulomas are discussed.
Of the many acknowledged systemic complications of inflammatory bowel disease, arthritis, iritis and erythema nodosum are observed most commonly and considered parts of the natural history. Pyoderma gangrenosum is a more ominous, less common but similarly associated complication that classically occurs in the course of ulcerative colitis. Its rarity in Crohn's disease stimulated the following report.
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Eleven endometrial adenoacenthomas were studied ultrastructurally. Special emphasis was placed on patterns of squamous metaplasia and the appearance of the basal laminae. Tonofibrils, irregular keratohyaline, abundant desmosomes, and foci of frank keratinization were observed. However, the granule population was small, with relatively scanty keratohyaline and no definite membrane coating granules. These features resemble squamous metaplasia observed in various epithelia; experimental models utilizing estrogens also resulted in similar changes. This observation appears pertinent in view of the possible etiologic role played by high estrogen levels in the development of human endometrial carcinoma. Most tumor cell clusters were surrounded by a well-defined basal lamina; focal basal lamina reduplication was also observed. These observations suggest a high level of differentiation in respect to synthetic capabilities and cell surface recognition. They correlate well with the relatively favorable prognosis generally observed in endometrial adenoacanthomas. However, these conclusions are tempered by the finding of occasionally absent or defective basal lamine, indicative of partial dedifferentiation of some neoplastic cells.
Ovarian cancer is one of the most frustrating problems in gynecology. Each year about 14,000 new cases are diagnosed in the United States and almost 11,000 patients die from their ovarian cancer. The results from treatment are no better in 1973 than they were in the previous two decades; Early diagnosis is a matter of chance rather than a scientific method. Until early diagnosis can be made and treatment instituted with predictable promise for cure, attention must be directed to study the natural history of disease, its histologic and nuclear grading, as well as the stromal reaction of the cancer. This approach should further validate end results and, in the future, help improve the survival rate in ovarian carcinoma. With these criteria, 174 fresh cases were evaluated. The study showed that undifferentiated cancers were mainly in the unfavorable histologic and nuclear grades, while the better differentiated tumors were in the more favorable group. Mucinous cancers were characterized by the greatest number of tumors with favorable histologic and nuclear grades and generally had a better survival rate. Since the potency of tumors vary within a given stage, treatment should be tailored to the cancer rather than the stage of disease; In general, stage of disease was more important than histologic or nuclear grades in determining prognosis.
Microscopic foci of multicentric cancer were detected in 121 of 904 breasts surgically removed for a clinically overt, invasive cancer. This incidence of 13.4% is regarded as a conservative estimate since examples of such lesions occurring in the same quadrant as the dominant mass, except in those instances in which the latter was present within the tail of the breast or beneath the nipple, were excluded from the analysis. Further, this data was obtained from only one randomly selected block of the quadrants, and in 41% of the cases only one or two were available for study. Multiple multicentric cancers were found in the same breast in two and three quadrants in 11.6% and 5.8% of the cases respectively. In 9.3% of the cases the multicentric cancers were designated as noninvasive (lobular in situ and/or intraductal) and in 4.1% invasive. An attempt to correlate the occurrence of multicentric cancers with a large number of pathologic and some clinical features disclosed a statistically significant association between multicentricity and grossly nonencapsulated dominant cancers with maximum diameters greater than 5 cm, the presence of a moderate or marked intraductal component and noninvasive cancer in its vicinity, and tumor involvement of the nipple. In addition, it was noted that there was a greater likelihood that the primary tumor was of the lobular invasive type and that the overlying skin was involved when the multicentric cancer was invasive rather than noninvasive. Lymphatic tumor emboli were observed in quadrants in 18 or 2.0% of the cases. Although the number of examples is small, nevertheless positive associations were noted with the occurrence of primary tumors that were in the left breast or beneath the nipple and were not grossly circumscribed, but exhibited a nuclear grade of 1, intralymphatic and blood vessel invasion, calcium, and involvement of the overlying skin as well as nipple. In addition, patients with such intralymphatic extension were more likely to have clinically detectable lymph nodes of which four or more contained metastases. The relationship of these findings to the rationale of such procedures as segmental resection in the surgical treatment of breast cancer is discussed.
The inter-relationships of 32 pathologic and 7 clinical parameters encountered in the study of 1000 examples of invasive breast carcinoma have been presented. In some instances the biological significance of these associations is at present unclear. In others it is to be noted that there is no information provided as to the rank of their significance. Nevertheless, the associations that were encountered not only help further characterize the various forms of breast cancer but also provide information regarding the possible biological significance of some of their features. Although it is not our intention to minimize the possible significance of the inter-relationships of pathologic parameters, most emphasis in the summarizing statements which follow has been placed upon those correlations which may relate to prognosis. In this regard reference has been made to short-term treatment failure, vis a vis local recurrence and/or metastases, which may not necessarily accurately reflect patient survival, although generally such a relationship exists. Information in this regard as well as to the rank of the significance of these pathologic features shall be forthcoming when sufficient time has elapsed since the inception of this study to allow for such conclusions, i.e. survival or long-term treatment failure rates. Lastly, it becomes evident that the guidelines followed in the examination of these specimens appear to represent at least the minimum requirements necessary for a meaningful pathologic evaluation of breast carcinoma.
Epithelial and connective-tissue cells were counted in rectal mucosal biopsies from 215 patients with ulcerative colitis, 98 patients with granulomatous colitis, and 50 controls. The results were analyzed statistically. Significantly decreased mucous goblet cells were found both in sigmoidoscopically abnormal ulcerative colitis and in granulomatous colitis, and they increased during the healing process. More pyknotic and karyorrhectic epithelial cells occurred in active ulcerative colitis than in granulomatous colitis. Inactive ulcerative colitis still manifested histologic evidence of acute and chronic inflammation, while sigmoidoscopically normal granulomatous colitis biopsies after previous gross rectal disease showed significantly increased macrophages in the lamina propria. Cell counts were valuable for differential diagnosis after the sigmoidoscopic appearance became normal. The acute inflammation of ulcerative colitis, as indicated by neutrophils, was decreased most notably following therapy with prednisone or 6-mercaptopurine. Chronic inflammation associated with fewer plasma cells was decreased after salicylazosulfapyridine as well as either of the other two drugs; macrophages, indicators of healing, increased most after 6-mercaptopurine combined with another anti-inflammatory agent.
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To evaluate responses to medical therapy in ulcerative colitis, rectal biopsies of patients with active untreated disease, individuals with positive and negative sigmoidoscopic findings treated with salicylazosulfapyridine, prednisone and 6-mercaptopurine, alone and in combinations and noncolitis controls were compared histologically. Predominant histological observations were analyzed statistically. There were fewer crypt abscesses but more mucosal edema after all forms of therapy. Quantitative histopathological analysis failed to demonstrate that the response to one drug was significantly different from another.