A light and electron microscopic study of lung cancers. Clinical implications.

This study consists of 71 consecutive surgically resected specimens of lung cancer which were submitted for both light and electron microscopic studies. Eleven of the 71 cancers found in the resected specimens and originally diagnosed by light microscopy had to be reclassified when studied by electron microscopy. All of the reclassified cancers were either poorly differentiated or undifferentiated tumors. This finding enables one to better select and suspect those cancers which are more likely to be in need of electron microscopic study.

Primary lymphoma of the spleen.

Primary lymphoma of the spleen is a relatively rare clinical entity. The majority of patients reported with this entity not only have splenic involvement but also have had lymph node and/or liver involvement. The patient reported presented with splenomegaly and was otherwise asymptomatic. Only splenic involvement was noted at operation and no other manifestation of the disease has become apparent, some 24 months post-splenectomy.

Pulmonary metastasis in nevoid basal cell carcinoma syndrome.

Nevoid basal cell carcinoma syndrome is a relatively uncommon clinical entity. It is essentially characterized by the early onset of multiple basal cell carcinomas of the skin generally above wrist-line level, by the presence of jaw cysts, musculoskeletal and other anomalies. Metastatic disease secondary to ordinary basal cell carcinoma is indeed rare. What is even more rare is pulmonary metastases from basal cell carcinoma. Very few cases have been reported in which pulmonary resection was performed for metastatic basal cell carcinoma. We were unable to find a reported case in which pulmonary resection was performed for a pulmonary nodule metastatic from the nevoid basal cell carcinoma syndrome. Herein is reported what we believe to be the first case of pulmonary resection performed for a metastatic nodule in this syndrome.

Goblet cell carcinoid of the appendix.

Goblet cell carcinoid of the appendix is a relatively uncommon clinical condition. Although its histogenesis remains controversial, its histological characteristics are distinctive enough not to pose a serious problem for diagnosis. The clinical behaviour of the tumor appears to lie between the typical behaviour of an ordinary carcinoid and that of a well differentiated adenocarcinoma of the appendix. Clinical diagnosis of this condition is seldom made pre-operatively, most patients presenting with signs and symptoms of an acute appendicitis. In a number of patients the tumor is identified incidentally during an operation performed for some unrelated entity. Treatment of this tumor is generally by simple appendectomy, although in some patients a more radical procedure is indicated. Prognosis for the most part is quite favorable with the exception of those few patients who present with the more virulent form of the disease.

Perianal extramammary Paget's disease.

This study has reviewed extramammary Paget's disease. The etiopathogenesis of this interesting clinical entity, although still speculative, may entail more than one process. An attempt has been made to update the natural history of this disease so that its treatment may be facilitated.

Goblet cell carcinoids of the appendix.

A review of goblet cell carcinoid of the appendix was undertaken. This interesting tumor appears to lie somewhere between an ordinary carcinoid and a well differentiated adenocarcinoma of the appendix in regard to its biologic behavior. The histologic features of the goblet cell carcinoid of the appendix are distinctive enough to facilitate a diagnosis, although the histogenesis remains controversial and unsettled. The prognosis is generally good in a patient treated by simple appendectomy, the treatment of choice in the majority of patients.

Stercoraceous and spontaneous perforations of the colon.

The natural histories of stercoraceous and spontaneous perforations of the colon have many similarities which justify their being considered in the same treatise. Both entities are infrequently diagnosed preoperatively, and both entities are associated with a high mortality. Although the incidence of stercoraceous and spontaneous perforations of the colon is difficult to determine, their occurrence demands a high index of suspicion for early diagnosis and treatment. A critical review of available cases emphasizes the importance of a better understanding of the natural history of both entities, for it is only in this way that the high mortality associated with both can be improved upon. At least stercoraceous perforations of the colon appear to be preventable, and consideration is given to this aspect.

Squamous cell carcinoma of the colon and rectum.

Squamous cell carcinoma of the colon and rectum is a relatively rare entity. Although much of this disease entity remains enigmatic, treatment tenets are the same as those accepted for adenocarcinoma of the colon and rectum. Although prognosis of squamous cell carcinoma of the colon and rectum appears to be worse than that of adenocarcinoma, an aggressive approach to this neoplasm is indicated in order to improve survival rates.

Giant pseudopolyps in granulomatous colitis. Report of a case.

A case of giant localized pseudopolyp causing partial large-bowel obstruction and occurring in granulomatous colitis is reported. This represented the first manifestation of the patient's disease. The role of surgery in certain patients is discussed.

Inflammatory pseudotumor of the lung. Ultrastructural and light microscopic study of a myxomatous variant.

A case of a myxomatous variant of an inflammatory pseudotumor of the lung is reported with clinicopathologic findings including its ultrastructure. The pathologic features of inflammatory pseudotumor of the lung are compared with similar tumors arising elsewhere and bear a close resemblance to granulation tissue, which suggests that inflammatory pseudotumors represent a reparative process rather than a neoplastic process. Recognition of this entity is imperative for a correct diagnosis and in order to differentiate it from malignant neoplasm, since only conservative management is necessary for its treatment.

Barrett's esophagus.

Barrett's esophagus remains an interesting but incompletely understood entity. Although most authors contend that it is of acquired origin, evidence is presented to substantiate either an acquired or a congenital origin. The possibility exists that Barrett's esophagus may be acquired in some instances and congenital in others. The most characteristic, albeit not exclusive, histologic features of Barrett's esophagus are defined by the presence of three types of columnar epithelium: an atrophic gastric fundic type of epithelium, a junctional type of epithelium and a specialized columnar epithelium. Reversion of columnar epithelium to squamous epithelium after successful antireflux operation demands further confirmation and study. Dysplastic, metaplastic and adenomatous changes in Barrett's esophagus do occur and must be observed carefully with endoscopy during the follow-up period. The possible relationship between these changes and malignant degeneration requires further study. Although the clinical presentation of benign complications occurring in a Barrett's esophagus simulates those occurring with reflux peptic esophagitis, distinctive roentgenographic and endoscopic features suggest the diagnosis. Treatment of the complications of Barrett's esophagus is essentially surgical, although cimetidine has been shown to be effective for healing of Barrett's ulcer. The need remains for further definition and clarification of the natural history of Barrett's esophagus so that its management can be based upon more definitive grounds.

Stercoraceous perforation of the colon. Report of a case.

Stercoraceous perforation of the colon is seen infrequently clinically, but the mortality of this entity remains high. Early diagnosis and treatment are essential if mortality is to be reduced. Emphasis is placed on the potential prevention of this entity. The case presented involves four confined stercoraceous perforations of the colon which were treated by resection and colostomy and from which the patient made a complete recovery.