Biomedical subjects

T A Gaffey

Publications and source records attributed to T A Gaffey.

At least 37 records · Page 2Linked to original sources

PubMed1990

Renal cell carcinoma associated with sarcoidlike tissue reaction.

A 60-year-old man was referred to our institution with the diagnosis of sarcoidosis. Because of several months' complaint of right flank pain and weight loss, the patient had consulted his local physician. After an extensive workup revealed only cholelithiasis, he underwent a cholecystectomy for presumed chronic cholecystitis. At the time of operation, biopsy of several liver nodules and peripancreatic nodes revealed noncaseating granulomas, consistent with sarcoidosis. On initial examination at our institution, the patient had microhematuria. A chest roentgenogram demonstrated multiple pulmonary nodules, an abdominal computed tomographic scan showed an indeterminate left renal mass, and magnetic resonance imaging of the spine revealed abnormal signals in the body of T-12. Open-lung biopsy showed an adenocarcinoma with clear cell features, likely of renal origin. The patient was diagnosed as having a metastatic renal carcinoma associated with a sarcoidlike tissue reaction. Although noncaseating granulomas have been reported in association with other malignant lesions, to our knowledge this is the first report of such an association with renal carcinoma. In addition, this case illustrates several points. First, sarcoidosis is a multisystem disorder with protean extrapulmonary manifestations. In fact, all our patient's findings could have been attributed to sarcoidosis. Second, noncaseating granulomas occur with many types of processes, including infections, chemical exposures, and, as in this case, neoplasms. Thus, noncaseating granulomas are not pathognomonic for sarcoidosis. Third, sarcoidosis is a clinical diagnosis that cannot be based on histologic findings alone.

Carcinoma, Renal Cell↗

PubMed1990

DNA ploidy in endometrial carcinoma: major objective prognostic factor.

Paraffin-embedded tissue samples from 256 patients who received primary treatment (surgical staging, reduction of tumor size, and adjuvant therapy based on surgical and pathologic risk factors) for endometrial carcinoma at the Mayo Clinic between 1979 and 1983 were analyzed by flow cytometry to determine DNA ploidy characteristics. Diploid patterns constituted 78% of the cases, whereas aneuploid and tetraploid patterns accounted for 17% and 5%, respectively. Only 10% of patients with diploid tumors had a relapse in comparison with 39% of those with nondiploid lesions (34% with aneuploid; 58% with tetraploid). Significant differences (P less than 0.001) were noted in estimated 4-year progression-free survivals--88% for patients with diploid and 57% for those with nondiploid tumors. Stage, grade, depth of myometrial invasion, histologic subtype, peritoneal cytology, and DNA ploidy all demonstrated independent prognostic significance (P less than 0.001) in this study population. When subjected to multivariate analysis, however, grade and depth of myometrial penetration failed to retain prognostic significance (P greater than 0.15) and surgical stage was marginally significant (P = 0.05), whereas histologic subtype and DNA ploidy maintained significant predictive powers (P less than 0.001 and P less than 0.01, respectively). We conclude that DNA ploidy is a major objective prognostic factor and therapeutic determinant for endometrial carcinoma.

Adult↗

PubMed1990

Primary pulmonary artery sarcoma. A method of resection.

Primary pulmonary artery sarcoma classically presents with symptoms and findings suggestive of acute pulmonary artery occlusion. An angiocentric mass or the finding of spindling neoplasm on needle biopsy should suggest this neoplasm. The rare unilateral location in the present case permitted resection by pneumonectomy. An endarterectomy technique was used to extract loosely adherent tumor-thrombus from the more proximal portions of the left pulmonary artery.

Female↗

PubMed1989

Endometrial stromal sarcoma: review of Mayo Clinic experience, 1945-1980.

Uterine sarcomas are uncommon malignancies. We retrospectively examined 24 cases of "high grade" endometrial stromal sarcomas (ESS). The histologic diagnosis was made if there was a high grade sarcoma with a high mitotic index and nuclear anaplasia. Heterologous elements could be present, if focal only. Leiomyosarcomas, mixed mesodermal sarcomas, and carcinosarcomas were excluded. Mitotic index was expressed as the number of mitoses per 10 high-power fields in active areas. Tumor grade was based on nuclear anaplasia. ESS were 5.7% of all uterine sarcomas. Median age was 58.2 years; median duration of symptoms was 67.5 days. Abnormal bleeding was the presenting complaint in 91.7%. Uterine enlargement was seen in 33%; protrusion through the cervical os was seen in 9 cases. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed in 95.8%. Twenty patients had myometrial involvement; 5 patients had serosal spread and extrauterine disease; residual disease was seen in 3 patients. Adjuvant radiation was not beneficial. Ten patients had recurrences: 60% in the pelvis, 50% each with subcomponent of abdominal or distant disease. Overall survival was 3.4 years and was significantly associated with extent of disease, size of the primary tumor, and grade.

Adult↗

PubMed1989

Flow cytometric DNA analysis of stage I endometrial carcinoma.

Flow cytometric DNA analysis was performed on 203 paraffin-embedded archival specimens obtained from patients with surgical stage I endometrial carcinoma. Primary therapy for those patients (1979-1983) had been definitive extirpation with adjuvant therapy determined by histologic grade, histologic subtype, myometrial invasion, and peritoneal cytologic findings. Diploid DNA patterns were identified in 171 (84%) specimens and nondiploid characteristics were observed in the remaining 32 (25 DNA aneuploid, 7 DNA tetraploid). Although DNA nondiploid specimens accounted for only 16% of all stage I patients, they accounted for 50% of all relapses. Regardless of treatment or other pathologic features, progression-free 5-year Kaplan-Meier survival estimates were 92 and 63% for patients with DNA diploid and DNA non-diploid patterns, respectively (P less than 0.001). Overall 5-year progression-free survival for patients with grade 1 or 2 lesions was 90%; stratification by DNA diploid and DNA nondiploid patterns revealed progression-free survivals of 94 and 64%, respectively (P less than 0.001). Peritoneal cytologic study was positive in seven patients; none of the five with a DNA diploid pattern had a relapse and both with the DNA nondiploid pattern had relapses. These studies suggest that DNA ploidy status may be an objective prognostic determinant for patients with stage I endometrial carcinoma.

DNA, Neoplasm↗

PubMed1989

Amyloid localized to tenosynovium at carpal tunnel release. Natural history of 124 cases.

One hundred fifty-two patients with amyloid in the tenosynovium who had carpal tunnel release were identified. Twenty-eight patients were excluded because of systemic amyloidosis: primary systemic amyloidosis (AL) in 24, secondary amyloidosis (AA) in 3, and familial amyloidosis (AF) in 1. The remaining 124 patients (82%) had carpal tunnel syndrome with local deposition of amyloid and no evidence of systemic amyloidosis. Median survival of the 124 patients from diagnosis of amyloidosis was 12 years. Only two patients had systemic amyloidosis develop--9 and 10 years after recognition of tenosynovial amyloid. Of particular interest were 12 patients who had an M-protein in the serum or urine. None of the 12 patients have had evidence of systemic amyloidosis or multiple myeloma during the median follow-up of 14 years. The authors conclude that amyloid may be localized to the tenosynovium and that systemic amyloidosis rarely develops during long-term follow-up.

Aged↗

PubMed1989

High-grade carcinoma of the oral cavity.

High-grade carcinoma of the oral cavity is considered to be an aggressive malignancy associated with a poor prognosis. The tumors are often considered to be relatively radiosensitive. Because previous reviews of oral cavity cancer have contained few patients with grade 4 lesions, little is known about the true behavior of these tumors. Information was collected on 80 patients with high-grade carcinoma of the oral cavity to determine the clinical findings and optimal treatment of this tumor. Primary tumor location, presence of neck metastasis, and clinical stage did not affect survival. Tumor size was a significant risk factor. The 5-year survival rate for patients with high-grade carcinoma treated by combination surgery and radiation (52%) was significantly greater (p less than or equal to 0.05) than that for patients treated by radiation alone (28%) or surgery alone (24%). This study is the first to describe the clinical course of a large number of patients exclusively with high-grade carcinoma of the oral cavity.

Adult↗

PubMed1989

Lymphoepithelioma of the oropharynx.

Lymphoepithelioma is common in the nasopharynx, but its presence elsewhere in Waldeyer's ring is rare. Thirteen patients with lymphoepithelioma in the tonsil and base of the tongue have been treated at our institution. At initial examination, all 13 patients had advanced clinical disease. Five years after their initial treatment, seven patients were alive and free of disease. Radiation therapy controlled local and regional disease in 10 (77%) patients, yet three of these died of distant metastasis. Patients with lymphoepithelioma have a significantly better prognosis (p less than 0.05) than do patients with either nonkeratinizing or keratinizing high-grade oropharyngeal carcinoma. Early recognition and combined therapy may further improve the prognosis. Differentiation of lymphoepithelioma from other high-grade squamous cell carcinomas of the oropharynx is important to guide treatment and to provide prognostic information.

Adult↗

PubMed1988

Malignant melanoma of the penis.

Malignant melanoma of the penis is rare and accounts for only a small percentage of penile carcinomas. We report the largest series and the longest followup of patients with this disease. The tumor usually presents as a small, brown or black lesion, often ulcerating, on the glans penis. Stage I disease (confined to the penis) can be treated conservatively by distal penectomy and results in excellent survival. Palpable inguinal lymph nodes and nodes associated with thick cutaneous lesions require surgical exploration. Stages II (node positive) and III (metastatic) diseases carry a poor prognosis, mainly because of the lack of effective adjuvant systemic therapy.

Aged↗

PubMed1988

Uterine leiomyosarcomas and benign smooth muscle tumors: usefulness of nuclear DNA patterns studied by flow cytometry.

Flow cytometry was used to determine the DNA ploidy pattern of paraffin-embedded archival tissue specimens from 90 surgically resected uterine smooth muscle tumors (49 leiomyosarcomas and 41 leiomyomas). The technique of Hedley was used for preparation of paraffin-embedded tissue into single dissociated nuclei, and the method of Vindeløv was used for staining with propidium iodide. Among the 41 leiomyomas, most tumors (88%) had a DNA diploid pattern; the exceptions were two DNA tetraploid/polyploid and three DNA aneuploid samples. The DNA histograms of the 49 leiomyosarcomas (including 6 epithelioid leiomyosarcomas) were classified as follows: 9 cases (18%) exhibited a DNA diploid pattern, 29 cases (59%) had a DNA tetraploid/polyploid pattern, and 11 cases (23%) had DNA aneuploid peaks. Although DNA ploidy pattern cannot be used diagnostically to distinguish malignant from benign uterine smooth muscle tumors, the nuclear DNA ploidy pattern is an easily measured, objective determination that may have important prognostic significance for patients with uterine leiomyosarcomas.

Adult↗

PubMed1988

Pelvic mass causing vesical compression after total hip arthroplasty. Case report.

A 59-year-old woman developed a histiocytic response to methylmethacrylate debris in a loose total hip arthroplasty. This reaction eroded through the medial wall of the acetabulum, producing a pelvic mass and presenting with urinary symptoms. A combination of an abdominal approach for removal of the pelvic mass and a lateral approach for revision of the total hip arthroplasty was required. This condition should be considered in the differential diagnosis of a mass adjacent to a loose prosthesis.

Arthritis, Rheumatoid↗

PubMed1988

Prevalence of ovarian cancer found at the time of infertility microsurgery.

We found the prevalence of ovarian cancer in infertile women less than 40 years at the time of planned microsurgery for infertility to be 1 in 95. This may represent a greater prevalence of ovarian cancer than that of all women less than 40 years. Importantly, laparoscopy did not find the ovarian cancer in these women. In conclusion, laparoscopists and microsurgeons need to be aware of the possibility of finding ovarian cancer in these young, infertile women, and this knowledge should be used to counsel and manage the patient appropriately.

Adolescent↗

PubMed1987

Ovarian dysgerminoma: a retrospective analysis of results of treatment, sites of treatment failure, and radiosensitivity.

Thirty-five patients with a diagnosis of pure ovarian dysgerminoma underwent assessment at our institution between 1950 and 1984. The median age of these patients was 21 years (range, 8 to 41 years). The surgical pathologic stages of the tumors were as follows: stage IA1 in 18 patients, stage IA2 in 2, stage IB1 in 2, stage IC in 1, stage IIB in 2, stage III in 9, and stage IV in 1. The overall survival at 5, 10, and 20 years was 94.3%, 82.9%, and 82.9%, respectively, for all 35 patients and 100%, 83.9%, and 83.9%, respectively, for the 18 patients with stage IA1 lesions. The maximum interval from diagnosis to relapse was 3.7 years. All patients were under surveillance for a minimum of 2 years (median follow-up, 15.9 years). Of the 18 patients with stage IA1 disease, 16 did not receive prophylactic radiation therapy to the para-aortic lymph nodes, and in 6 of the 16 (38%) recurrent disease developed in this region. Five of these patients were salvaged with radiation therapy and one with radiation therapy and subsequent chemotherapy. No definite correlation was noted between the size or mass of the resected unilateral encapsulated tumor and the risk of development of recurrent disease. For patients with stage IA1 dysgerminoma who have undergone unilateral oophorectomy, two treatment options seem reasonable: (1) observation, with radiation therapy reserved for subsequent recurrence, or (2) prophylactic radiation therapy (2,000 cGy) to para-aortic and ipsilateral common iliac lymph nodes, which would preserve fertility.

Adolescent↗

PubMed1986

Is modified radical mastectomy really equivalent to radical mastectomy in treatment of carcinoma of the breast?

Evaluation of any therapeutic modality for carcinoma of the breast requires prolonged follow-up. Between 1965 and 1968, 870 women with primary unilateral breast cancer were treated surgically at our institution. To achieve a study group that could be meaningfully analyzed, the authors identified and excluded all patients with pre-existing life-threatening disease, incomplete (palliative) operation, multiple lesions, or fixed lesions. There remained 530 patients (322 treated with radical and 208 treated with modified radical mastectomy). No overall statistical difference in 5-year survival to death from breast cancer was noted between the radical (82.1%) and the modified radical (87.0%) mastectomy group. Recently, the authors updated that series, now with 10 to 16 years of follow-up (minimum, 10 years). Two hundred eighty-one patients were alive at 10 years. The 10-year survival from breast cancer after radical (74.5%) and modified radical (74.2%) mastectomy was almost identical. The 10-year node-negative survival was 86.0% and the node-positive survival was 56.3% (P = 0.0001). Results were compared according to age, tumor site, absolute number of involved nodes, histologic features, grade, size, and adjuvant treatment. A numeric combination of these variables was constructed and used as a prognostic score. These results suggest that, with equal long-term efficacy in the treatment of breast cancer, the cosmetically and functionally superior modified radical mastectomy should remain the procedure of choice in the surgical treatment of carcinoma of the breast.

Adult↗

PubMed1986

Angiosarcoma of the breast.

The clinical histories, operative reports, and pathologic slides of 20 patients seen between 1907 and 1984 with diagnoses of angiosarcoma, hemangiosarcoma, and hemangioendothelioma were reviewed. The mean age of the 19 female patients and one male patient was 40.05 years (range, 16 to 67 years). Ten patients had the right breast involved, and five patients had contralateral breast involvement. Presenting symptoms included a mass in 20 patients, pain in ten patients, and breast discoloration in six patients. Before referral, ten patients had the misdiagnosis of a benign breast lesion. Because of the deceptively benign appearance of many angiosarcomas, these lethal tumors are often misdiagnosed as benign hemangiomas. Simple mastectomy is the treatment of choice, while adjuvant therapy remains to be evaluated.

Adolescent↗

PubMed1986

Primary carcinoma of the fallopian tube.

From 1964 through 1983, 47 patients with a mean age of 63 years underwent primary treatment of fallopian tube carcinoma. Vaginal bleeding, abdominopelvic pain or pressure, and a palpable pelvic mass (or masses) were frequent retrospective clinical associations. Survival analysis demonstrated a rapid initial rate of patient attrition with stabilization after 3 years, resulting in an overall 5-year survival rate of 41%. While independent of age, histologic grade, or original tumor size, patient longevity was significantly decreased (p less than 0.01) by the presence of disease beyond the pelvis, neoplastic cells in the peritoneal washings, and size of residual disease. Therapy consisted of primary surgical resection, usually followed by adjunctive radiotherapy or chemotherapy. Initial sites of relapse were predominantly (88%) within the intraperitoneal cavity. The study supports definitive surgical staging and tumor reduction, as well as more selective adjuvant therapy based on surgical stage and residual tumor size and location.

Adenocarcinoma↗

PubMed1986

Immature ovarian teratoma: a review of 14 cases.

We conducted a clinical and pathologic review of 14 patients with immature ovarian teratoma. In this series of patients, one had monodermal malignant neuroectodermal teratoma and two others had immature ovarian teratoma in association with immature presacral teratoma. Because of the small number of cases of immature ovarian teratoma and the diverse therapeutic modalities used in this study, we cannot recommend a specific treatment for patients with this tumor on the basis of our findings. The histologic grade of the tumor seemed to be a reliable indicator of prognosis. Grade 0 metastatic lesions should be considered benign and are associated with a favorable prognosis.

Adolescent↗

PubMed1986

Surgical considerations after chemotherapy and radiation therapy for inflammatory breast cancer.

Eighteen patients seen between 1974 and 1982 with the clinical diagnosis of inflammatory breast carcinoma underwent modified radical mastectomy after preoperative chemotherapy and radiation therapy. In 17 of the 18 patients (94%), residual carcinoma was detected in either the resected breast or the axillary nodes. All mastectomies were accomplished without major technical difficulty. Seven wound complications, including three infections, occurred. Local recurrence was noted in 29% (five of 17 patients) and distant metastasis was detected in 89% (16 of 18 patients). Only three patients are presently alive without evidence of disease 19, 21, and 21 months since the onset of symptoms. Eleven patients have died, the median survival being 23 months since the development of symptoms, and four are alive with distant metastasis. Modified radical mastectomy can be accomplished in patients with inflammatory breast cancer after preoperative chemotherapy and radiation therapy and may have a role in reducing local tumor burden.

Adult↗