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W R Welch

Publications and source records attributed to W R Welch.

88 records · Page 5Linked to original sources
PubMed1979

Epidemiologic aspects and factors related to survival in 384 Registry cases of clear cell adenocarcinoma of the vagina and cervix.

Three hundred and eight-four cases of clear cell adenocarcinoma of the vagina and cervix accessioned in the Registry as of December 31, 1978, have been analyzed. The annual incidence of these tumors has been found to correspond closely to the estimated usage of diethylstilbestrol (DES) for pregnancy support in the United States. The annual incidence of the DES-associated cases appears to have dropped in the United States in the past 2 years in comparison to 1973 to 1975. The risk of tumor development appears to be higher in young women exposed to DES early in intrauterine life than in those exposed later. The carcinomas are rare before the age of 14 years and an irregular peak in the age-incidence curve appears between 17 and 21 years followed by a decline. The 5-year survival rate is better for women over the age of 19 years than for younger patients, and a higher frequency oral contraceptive usage did not appear to influence the behavior of the tumor and the improved survival in those using this medication appears to be related to greater medical surveillance.

Adenocarcinoma↗
PubMed1979

Adenocarcinoma of the endometrium in pregnancy.

Adenocarcinoma of the endometrium with intrauterine pregnancy is extremely rare. This report presents the finding of an adenoacanthoma of the endometrium discovered during therapeutic abortion and compares it with 6 other cases previously published. Four of the 7 tumors were adenocanthomas, a neoplasm that accounts for 20-30% of endometrial adenocarcinoma in the general population. Follow-up on 4 of the 6 previously reported patients indicates that 3 are well more than 5 years after diagnosis. The 1 patient who died of disease had an adenoacanthoma and was the only patient with extensive myometrial invasion at hysterectomy. The patient described in the present report is well 2 1/2 years after hysterectomy.

Abortion, Therapeutic↗
PubMed1979

Brenner tumor and mucinous cystadenoma of borderline malignancy in a patient with Turner's syndrome.

A 64-year-old woman with a 45,X karyotype and Turner's syndrome and recent onset of right lower quadrant pain was found to have a mucinous cystadenoma with focal areas of borderline malignancy and a typical Brenner tumor in the right adnexa. Ovarian tumors in patients with a 45,X karyotype and Turner's syndrome are extremely rare. The present paper is the first report of concurrence of these 2 tumors in an affected individual. The simultaneous occurrence and intimate admixture of these tumors in a patient believed to be devoid of germ cells would seem to favor a common histogenesis from the germinal epithelium.

Adnexal Diseases↗
PubMed1978

Urogenital sinus origin of mucinous and ciliated cysts of the vulva.

The origin of mucinous and ciliated cells in the vulva and the pathogenesis of cysts lined by these epithelia were investigated. Small mucinous glands numbering from one to more than a hundred were encountered in 9 of 19 vulvas (53%) that were consecutively examined at autopsy. Eleven other cysts were encountered clinically. Six were lined by mucinous epithelium, three by pseudostratified cells with cilia plus small foci of mucinous epithelium, and two by ciliated epithelium only. Four of the cysts with ciliated epithelium were otherwise typical Bartholin's gland cysts. It is concluded that glands lined by either mucinous or ciliated epithelia are normal constituents of the vulvar vestibule, are derived from urogenital sinus, and develop into cysts when the neck leading to the vulvar surface becomes inflamed and obstructed.

Adult↗
PubMed1978

Squamous cell dysplasia and carcinoma in situ of the cervix and vagina after prenatal exposure to diethylstilbestrol.

Squamous cell abnormalities of the vagina and cervix were evaluated in 1424 women exposed to diethylstilbestrol (DES) in utero. The prevalence of dysplasia was 2.1% and the incidence 0.85/100 person-years of followup. The dysplastic epithelial changes were almost always mild in women with no prior history of dysplasia and was slightly more frequent in the cervix than the vagina. Severe dysplasia and carcinoma in situ (CIS) were encountered only in those subjects specifically referred because of those abnormalities. The most common problem in the diagnosis of these squamous cell changes was the misinterpretation of mature and immature metaplastic cells for dysplastic squamous cells. Discordance between biopsy and cytology was common-place in the detection and followup of dysplasia, especially when it was mild. There were no instances in the study where cytology and biopsy samples from the vagina were both abnormal concurrently. Colposcopically directed biopsies did not increase the frequency of confirmation of cytologic findings. These data suggest that both cytology and biopsy of abnormal segments of the vagina and cervix remain an integral part of the examination of the DES-exposed female during long-term follow-up studies.

Adolescent↗
PubMed1978

Comparison of histologic and colposcopic findings in DES-exposed females.

A study was undertaken to evaluate the histologic alterations associated with two of the most abnormal colposcopic findings, mosaicism and punctation, that are commonly found in the vaginas and cervices of young women who have been exposed prenatally to diethylstilbestrol (DES). Four-fifths of 215 biopsy specimens from 171 exposed subjects with mosaicism or punctation disclosed metaplastic squamous epithelium, the presence of which is thought to reflect the repair of vaginal adenosis and cervical ectropion. Hyperkeratosis was observed in one-fifth of the specimens and was more frequent in lesions colposcopically graded I than II. Mild dysplasia was encountered in only one specimen. The findings indicate that the presence of squamous cell dysplasia cannot be predicted by the finding of Grade I or II mosaicism or punctation in the DES-exposed female despite the fact that these abnormal colposcopic patterns are associated with dysplasia in about 10% of cases when encountered in the cervix of the unexposed woman.

Colposcopy↗
PubMed1977

Precancerous lesions of the endometrium.

The existence of precancerous lesions of the endometrium is well established, but differences in terminology and difficulties in the interpretation of published studies have complicated quantitation of the malignant potential of the descibed subtypes. Clinical investigations, cellular studies, chromosome and DNA analyses, and animal experiments suggest that the malignant potential of cystic hyperplasia is low in contrast to that of the more complex types of hyperplasia. The significance of atypical secretory hyperplasia, squamous metaplasia, and endometrial polyps in the evolution of endometrial cancer has not been investigated adequately. Artifactual crowding of glands due to fragmentation and benign processes such as the epithelial regeneration in late menstrual endometrium and the Arias-Stella reaction should not be confused with precancerous changes. A classification of precancerous lesions is presented and the need for adoption of a uniform terminology for future investigations and communication with gynecologists is emphasized.

Adult↗
PubMed1977

Intrauterine diethylstilbestrol exposure and its consequences: pathologic characteristics of vaginal adenosis, clear cell adenocarcinoma, and related lesions.

In 1971, the development of clear cell adenocarcinoma of the vagina in young females was first linked to a history of intrauterine exposure to diethylstilbestrol (DES). This communication reviews data on cases accessioned in the Registry of Clear Cell Adenocarcinoma of the Genital Tract in Young Females, findings in exposed female and male subjects without cancer, and discusses current concepts of the pathogenesis of the DES-related anomalies of the lower genital tract.

Adenocarcinoma↗
PubMed1977

Microglandular hyperplasia in vaginal adenosis associated with oral contraceptives and prenatal diethylstilbestrol exposure.

Eight cases of microglandular hyperplasia arising in vaginal adenosis are presented. Five of the patients were known to have taken oral contraceptives and a sixth was pregnant at the time the lesion was discovered; a history of prenatal exposure to diethylstilbestrol (DES) was present in 5 cases. It is important to differentiate microglandular hyperplasia, which is benign, from clear cell adenocarcinoma, which also arises in a background of vaginal adenosis.

Adenocarcinoma↗
PubMed1976

Cytology of 575 young women with prenatal exposure to diethylstilbestrol.

The vaginal and cervical cellular changes encountered in 575 postpubertal females exposed prenatally to diethylstilbestrol (DES) were compared with those of an unexposed population with particular reference to the role of cytology in the detection of vaginal adenosis and cervical ectropion (erosion). Several methods of obtaining specimens were utilized, the most effcacious of which was scraping of the vagina, especially the fornices, and the portio vaginalis of the cervix. With this technic, columnar cells of the mucinous type and metaplastic squamous cells were observed in 34% of the vaginal scrapes and 54% of the scrapes of the cervical portio. A higher incidence was apparent among those patients in whom iodine staining of the vaginal mucosa was abnormal or vaginal adenosis was proven by biopsy. Moderate to severe dysplasia of the squamous cells or atypical glandular cells were found in 1% of the exposed subjects. This study indicates that the presence of mucinous columnar or metaplastic squamous cells in vaginal scrapes is suggestive of vaginal adenosis but that vaginal cytology cannot be considered a uniformly reliable screening technic for detecting the presence of this disorder.

Adolescent↗