Hemangiopericytoma of greater omentum.

A 67-year-old man presented with a painless abdominal lump. CT scan revealed a large vascular intraperitoneal mass. At laparotomy, a large, vascular tumor was seen to arise from the greater omentum, which was resected. At histology, this tumor was a benign hemangiopericytoma.

Histologic trends in thyroid cancer 1969-1993: a clinico-pathologic analysis of the relative proportion of anaplastic carcinoma of the thyroid.

BACKGROUND: It was observed that new presentations of anaplastic carcinoma of the thyroid had become infrequent in the last two decades. METHODS: All cases of thyroid cancer seen at our centre between 1969-1993 (n = 2921) were classified as papillary 49%, follicular 34%, medullary 7.5%, anaplastic 4.7%, and other 4.8%. The total number of thyroid cancers show a 3.5-fold rise. RESULTS: The differentiated thyroid cancers show a significant rising trend as against the relative proportion of anaplastic carcinoma, which shows a significant decline (P = 0.002). Clinicopathologic data on 124 patients of anaplastic carcinoma revealed 50% patients had either long-standing goitres, previous thyroid abnormalities, or associated differentiated thyroid carcinoma on histology. CONCLUSIONS: The decline in the relative proportion of anaplastic carcinoma may in part be explained by the clinicopathologic findings or it may be attributed to histological reclassification.

Bilateral renal angiomyolipoma.

Bilateral renal angiomyolipoma is a rare entity, usually associated with tuberous sclerosis. Five cases of bilateral renal angiomyolipoma, all females, with a mean age of 34.6 years, are reported. All patients had symptoms attributable to lesions only on one side, with flank pain and mass the commonest symptoms encountered. Only one case had clinical evidence of stigmata of tuberous sclerosis. The mean size of the lesions on the symptomatic side was 17 cm, while that on the asymptomatic side was 2 cm. Three patients were diagnosed correctly as having angiomyolipomas preoperatively with the use of ultrasonography and computed tomography (CT); two of these were treated with total nephrectomy and the third with partial nephrectomy. The other two cases were seen before the availability of CT and were only diagnosed intraoperatively. Both patients were treated with total nephrectomy. The lesions on the asymptomatic side were kept on close surveillance. Two patients developed an increase in the size of the lesions in the contralateral kidney 1 year and 3 1/2 years after the first surgery. Both patients were treated with partial nephrectomy. All patients are alive at 3-14 years (mean 6.6 years) after operation.

Inhibin (10.7 kD prostatic peptide) in normal, hyperplastic, and malignant human endometria: an immunohistochemical study.

The expression of inhibin, a 10.7 kD follicle-stimulating hormone (FSH)-suppressing prostatic peptide of 94 amino acids, was investigated in normal human endometrium, endometrial hyperplasia, and adenocarcinoma, employing the avidin-biotin immunoperoxidase technique. The antiserum used was raised in rabbits against prostatic inhibin isolated from human seminal plasma. The study included 15 well differentiated, 32 moderately differentiated, and 21 poorly differentiated endometrial adenocarcinomas; 26 simple, five complex, and two complex atypical endometrial hyperplasias; and, for comparison, 25 normal proliferative and 30 normal secretory endometria. In malignant and hyperplastic endometrial tissues, inhibin was localized in the epithelial cytoplasm of endometrial glands while the stroma showed weak reactivity. On the other hand, inhibin was undetectable in the early proliferative phase, but was present on the luminal border of the glandular epithelium in the mid- and late proliferative phases. Secretory endometrium displayed strong inhibin reactivity in the cytoplasm of glandular epithelium and in the stroma. The increased inhibin reactivity in secretory endometrium as compared with the proliferative phase is indicative of a functional role for inhibin in the uterus. In addition, its localization in proliferative, hyperplastic, and malignant endometria suggests a possible regulatory role for inhibin in endometrial proliferation and growth.

DNA analysis of breast cancer by flow cytometry & correlation with other prognostic parameters.

Flow cytometric estimation of DNA content (ploidy and S-phase fraction--SpF) was done on breast cancer tissues from 171 patients. Twenty eight per cent of the tumours were diploid and 72 per cent were aneuploid. SpF was measurable in 82 DNA histograms; of these 22.4 per cent had SpF less than 10 per cent, 34.1 per cent had SpF between 10-20 and 43.5 per cent had SpF greater than 20 per cent. The mean SpF of the measurable histograms was 19.01 per cent with a range 1.78 to 45.19 per cent. A significant correlation between DNA ploidy and SpF was observed (P less than 0.01). Eighty nine per cent of diploid tumours had SpF less than 10 per cent and 73 per cent of aneuploid tumours had SpF greater than 20 per cent. A significant correlation was also found between ploidy and SpF and oestrogen receptor (ER) status of the tumours (P less than 0.05) and between SpF and progesterone receptor (PgR) status of the tumours (P less than 0.05), but not between ploidy and PgR status of the tumours. A significant direct correlation was observed between SpF and tumour grade (P less than 0.05), but not between ploidy and tumour grade. No correlation was observed between DNA ploidy and SpF and tumour type, tumour size, axillary lymph node involvement, age and menopausal status of the patients. Although the incidence of breast cancer is one-third of that reported in the Western countries, there is apparently no biological difference between the various parameters studied.

Differences in oestrogen receptor status and histological grade of breast cancer in different religious communities in Bombay.

The various religious communities in India viz.Hindu, Muslim, Christian, Parsi have different breast cancer incidence rate. It is not known whether there might also exist differences in biological properties of breast cancer between these communities. To investigate this possibility we have studied the distribution of oestrogen receptor (ER) status and histological grade of tumour in these four communities. Significant differences were observed in the overall distribution of ER positivity and histological grade between the communities P less than for both parameters). Christians had the highest incidence of ER +ve (65.2%) and grade I + II tumours (16.0%), while Muslims had the lowest incidence of ER +ve (35.8%) and Grade I + II tumours (4.7%). In general, we found a significant positive relationship between ER status and age of the patient (p less than 0.0.1). The mean age of the christians was slightly but significantly higher than that of the Hindus and Muslim. The difference ER positivity between the communities might, therefore, be partly (but probably not wholly) explained by difference in age of the patients. However, the difference with respect to grade of tumour cannot be explained as a function of age since no significant association was found between grade of the tumour and age of the patient. Further investigation with respect to difference in the biology of the breast cancer between the communities are warranted.

Observations on Indian node-negative breast cancer patients: a multivariate analysis.

The modern treatment of breast cancer has evolved over the past 100 years based on clinical observations. Therapeutic principles, from the choice of surgical procedure to the management of disseminated disease, have also changed. The axillary tumour burden, that is, the number of histologically positive nodes (N+) plays an important role as a prognostic factor. However, in histologically Negative nodes (N-), it is necessary to discriminate individuals at high risk despite negative nodes. This presentation analyses retrospectively the prognostic factors for long-term failures in N- patients. These prognostic factors need to be studied in detail, and controlled clinical trials should be carried out to detect high risk N- patients and consider them for adjuvant chemotherapy.

Simultaneous endometrioid carcinoma of the uterine corpus and ovary: a clinicopathologic study of 15 cases.

The clinical stage assigned to simultaneously presenting carcinomas of the uterine corpus and ovary remains variable, depending on which of the two sites is considered to be the primary. Simultaneous involvement may occasionally represent independent primaries, a fact often overlooked. A review of all cases with a tissue diagnosis of carcinoma involving uterus and ovary was undertaken to identify those cases which possibly represent independent primaries. Seventeen such cases were identified on the basis of pathologic features, 15 of which revealed endometrioid type carcinoma at both sites. These 15 patients, who constitute the study group, were treated surgically with or without adjuvant therapy. Thirteen patients have been followed up for 1 to 12 years. Twelve patients are alive and free of disease. Vaginal vault recurrence occurred in a single patient. This was treated successfully. One patient died of an unrelated cause. The good survival fortifies the pathological impression that these cases represent independent primaries.

Inhibin-like material--an immunohistologic marker for prostatic origin of metastases.

Immunocytochemical localization of inhibin-like material (ILM) using a specific antiserum generated against ILM of prostatic origin was carried out in metastatic lymph nodes of known primary prostatic tumours and in rectal biopsies showing direct invasion with known prostatic carcinoma. Nine of the 11 metastatic lymph nodes gave positive reaction, which was readily apparent in differentiated tumours showing micro-acinar formation. In poorly differentiated tumours it was often focal and indicated intracytoplasmic staining within randomly scattered cells. Rectal biopsies showing invasion of prostatic carcinoma (4 cases) also showed positive reaction for ILM. Using this experimental protocol, the reaction for metastatic lesions from patients with non-prostatic carcinomas was completely negative indicating the specificity of the test for prostatic origin of metastasis. In conclusion, the present investigation indicates the potential application of ILM in confirming or excluding the prostatic origin of invasive tumour in metastatic lesions.

Prediction of biological behaviour of human breast cancer using multiple parameters. A preliminary study.

Prediction of early metastases in individual patients has been attempted by combined evaluation of a battery of recognised parameters such as blood vessel invasion (BVI) of tumor cells, Barr body frequency (BBF), plasminogen activator (PA), collagenase, estradiol receptors (ER), progesterone receptors (PgR), and peroxidase activity (PRA) in 18 malignant and 3 benign (control) breast tumors. Since breast tumor cells spread through the blood vessels, the cases were divided into BVI (+) and BVI (-) groups. Results show that in the former group, all the cases had poor prognosis and two even had distant metastases within one year. In BVI (-) group, 9 out of 12 appeared to have good prognosis.

Hodgkin's disease in Western India: review of 1082 cases.

Hodgkin's disease (HD) had a low overall incidence rate in Bombay when compared to western countries. However, the incidence rate in childhood was quite high. Review of 1082 cases of Hodgkin's disease recorded at the Tata Memorial Hospital, Bombay. India during a period of 35 years showed that mixed cellularity, with 54% of the total, was the most frequent histologic subtype and this, together with lymphocyte depleted type formed 68% of all HD. The nodular sclerosis type formed only 9%. A bimodal character of the age pattern with a young age peak in the second decade of life, a male preponderance, a high incidence in childhood, and the predominance of low survival types, are the major features of the disease in India. The current data, which are the largest series reported from Bombay and other parts of India, indicate that the type-I pattern as described by Correa and O'Connor may be the characteristic feature of the Hodgkin's disease in India.

Further studies on the prognostic importance of Barr body frequency in human breast cancer: with discussion on its probable mechanism.

Based on the Barr body frequency, a total of 285 unselected breast cancer tissues were categorised as negative and positive tumours; incidence of these two groups in our series was 2:1, respectively. When 2-years' disease-free interval and 10-years' survival were considered, it was seen that patients harbouring negative tumours had significantly early recurrence and shorter duration of survival as compared to those having positive tumours. As vascular spread is the prerequisite of early recurrence, the shorter survival in the patients having negative tumours could be explained on the basis of blood vessel invasion, in that 73% of the negative tumours had blood vessel invasion, in contrast to only 24% in the positive tumours.