Simultaneous malignant squamous metaplasia of the cervix and ovary.
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Biomedical subjects
Publications and source records attributed to T Parmley.
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The preinvasive stage of cervical cancer is usually so prolonged and the techniques for its diagnosis and treatment are so well advanced that aggressive surgical treatment should rarely be necessary and the disease should rarely be fatal. That these results have not yet been realized is due largely to the failure of screening programs to reach at-risk populations. At the same time, the widespread use of cytologic screening in some populations has revealed a large number of women with atypical findings who require evaluation and treatment. It is an ongoing clinical concern to protect these patients from the development of invasive disease without overtreating foci of disease that can be destroyed by simple techniques.
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Reports of 78 cases of mucinous cystadenocarcinoma of the ovary were collected from the Emil Novak Ovarian Tumor Registry and the files of the Gynecologic Pathology Laboratory of the Johns Hopkins Hospital between the years 1942 and 1966. Two-year and 5-year followups were available for 91 and 83% of the cases, respectively. The prognosis was related to the most aggressive area of the tumor as the histologic grade was based on the maximum number of mitoses per high-powered field. In view of the clinical and histopathologic differences between these lesions and the serous and endometrioid varieties, it is suggested that each tumor be considered on its own merits in order to offer an accurate prognosis.
The light and electron microscopic characteristics of the distinct eosinophilic microinvasive cell in the lower genital tract epidermoid neoplasia are described. The eosinophilic quality of the invasive cell is associated with an accumulation of contractive protein seen at the ultrastructural level. The presence of these differentiated cells near the basement membrane should be viewed with more concern as they contain the cytoplasmic machinery with which to invade.
This study of 132 benign parovarian cysts and eight parovarian neoplasms demonstrated that the majority of such lesions are of paramesonephric or mesothelial origin. Furthermore, adnexal neoplasms, not histologically associated with the tube or ovary, may arise in such parovarian structures or de novo from the pelvic mesothelium.
Adenomatous hyperplasia of the endocervix or "tunnel clusters" have long been felt to be the result of obstruction of endocervical gland-like clefts. However, in some instances it is possible to demonstrate that obstruction is not present. The histologic features of this entity are similar to those of benign mucinous neoplasms of the upper genital tract, and therefore it seems reasonable to suspect that adenomatous hyperplasia is, in fact, a proliferative metaplasia or neoplasia of the endocervical gland epithelium. While clinically unimportant, we believe that this is an additional example of the fundamental embryologic kinship of the entire genital tract epithelium.
Fourteen examples of intravenous leiomyomatosis in the FIP files were studied. Growth beyond the uterus occurred in 10 of the 14 examples, largely in vessels in the broad ligament and in uterine and iliac veins. Metastasis to the heart occurred in 1 example. The study provides evidence that is consistent with both theories of origin of intravenous leiomyomatosis; namely, that it may arise either from the wall of veins within the myometrium or be a result of unusually extensive vascular invasion from a leiomyoma of the myometrium. Intravenous leiomyomatosis should be distinguished from a leiomyoma with vascular invasion by arbitrarily limiting the designation of leiomyoma with vascular invasion to neoplasms in which the vascular growth is a microscopic finding and confined within the leiomyoma. Criteria are given for distinguishing intravenous leiomyomatosis from endometrial stromal sarcoma, leiomyosarcoma, leiomyoma with vascular invasion, and leiomyomatosis peritonealis disseminata.
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