Hemangioma of the esophagus.

Hemangioma of the esophagus is a rare tumor. Fewer than 100 cases have been found in the literature. The present case report describes a patient who experienced a sudden massive hematemesis and demonstrated unusual changes on the computed tomographic scan.

Lobular carcinoma in situ of the breast.

Lobular carcinoma in situ of the breast is a well defined pathologic entity which is found in about 2.5 per cent of all specimens of the breast taken for biopsy and most commonly occurs in premenopausal females. Its diagnosis is virtually always incidental due to the absence of any clinical indication of its presence. This lesion carries a significant risk for development of subsequent invasive carcinoma which applies equally to both breasts and which appears to increase with time. The appropriate treatment of this disease remains a controversial issue. Various aspects of its epidemiology, pathology and natural history which have an important bearing on the therapeutic decision as well as the many treatment options available are analyzed herein. There is certainly a perception that lobular carcinoma in situ represent the early form of a malignant process which can be cured or prevented if appropriately treated at this stage. At the very least, an understanding of this lesion holds the potential for broadening our understanding of the physiologic basis of carcinoma of the breast as a whole.

Lung lesions: cytologic diagnosis by fine-needle biopsy.

Small-bore (22- or 23-gauge) needles were used to aspirate 458 lung masses. Sensitivity for the detection of malignancy by this method was 96.6% (312 of 323 patients); accuracy was 98.7%. Surgical confirmation was available for comparison in over half of patients with malignancy. Histologic reclassification of malignancy occurred in only 6.1% of patients, with significant misclassification (misdiagnosis of small cell carcinoma) occurring in only two instances. One hundred thirteen of 117 nonmalignant conditions were properly categorized, with an overall specificity of 96.6%. No major complication occurred. While several recent studies have stressed the advantage of using larger needles, to overcome the limitation of smaller aspiration needles that provide only cytologic material, small-needle aspiration appears to be a safe, reliable, and accurate means for diagnosing lung lesions.

A morphometric study of primary adenocarcinoma of the vagina.

Primary adenocarcinoma of the vagina accounts for approximately 1% of all invasive carcinomas of the female genital tract. This paper reports on a study of four cases of primary adenocarcinoma (including one with in utero diethylstilbestrol exposure) of the vagina from the files of the Medical University of South Carolina. Both tissue sections and cytologic preparations from each case were evaluated in order to delineate the morphologic characteristics of the cells that compose the lesions. Histologically, the lesions primarily presented the tubular cystic pattern; solid and papillary growth patterns were also seen in one case. The constituent cells included clear cells, hobnail cells and secretory and nonsecretory tubular cystic cells. All specimens were examined for the following parameters: cell population, nuclear area, cytoplasmic area, nuclear/cytoplasmic (N/C) proportions, nuclear and cytoplasmic characteristics. While a fairly detailed profile of the morphologic criteria for hobnail cells was developed, the cellular profiles of the other malignant glandular cells originating in primary vaginal adenocarcinoma remain less certain.

Early endocervical glandular neoplasia. I. Histomorphology and cytomorphology.

A study is presented of 36 cases of early endocervical glandular neoplasia comprising three specific entities: endocervical adenocarcinoma in situ, microinvasive adenocarcinoma and adenocarcinoma limited to a single polypoid structure. A clinical profile is developed that reveals a typical patient population. The histomorphologic and cytomorphologic features of early endocervical glandular neoplasia are discussed in detail. The consistently reproducible cytologic appearance described may be accurately detected microscopically. Early detection of endocervical adenocarcinoma could produce a dramatic decrease in patient morbidity and mortality, such as has occurred with squamous epithelial malignancies.

Early endocervical glandular neoplasia. II. Morphometric analysis of the cells.

A morphometric analysis was performed on the cells of early endocervical glandular neoplasia, including adenocarcinoma in situ and microinvasive adenocarcinoma, in cytologic preparations. The measurements were compared with those of cells from the normal endocervix and cells from other lesions that enter into the differential diagnosis. The morphometric profile developed for the cells of early glandular neoplasia proved to be useful, reliable and reproducible. Not only could the cells of normal endocervical samples be distinguished from those of early endocervical glandular neoplasia, but the measurements also seemed capable of making the visually difficult distinction between adenocarcinoma in situ and microinvasive adenocarcinoma. The latter point requires further confirmation since only a few cases of microinvasive adenocarcinoma were available for study.

Small renal neoplasms: diagnostic imaging, pathologic features, and clinical course.

We retrospectively studied nine patients with solitary renal neoplasms that were first visible when smaller than 3 cm in diameter to determine their imaging and pathologic characteristics and clinical course. These neoplasms represented 14% of the total renal neoplasms discovered over a 6-year period, and only one-third were initially identified by screening urography. While seven of the patients had hematuria, most had associated urologic conditions (calculi, prostatism). Two patients had widespread metastases 2 and 4 years after the carcinomas first appeared. The remaining seven patients are alive and well 8 months to 6 years after undergoing nephrectomy, despite the significant delayed diagnosis in three patients. Only one lesion was pathologically benign (an oncocytoma). Two of the renal cell carcinomas were found within the walls of partially calcified renal cysts. Two (22%) of nine neoplasms exhibited aggressive biologic behavior, which suggests that these lesions may have greater metastatic potential than previously thought. We suggest that computed tomography be performed after screening urography and cystoscopy when unexplained hematuria is present.

Subcutaneous endometriosis diagnosed by fine needle aspiration cytology.

The fine needle aspiration cytology (FNAC) of two patients manifesting cutaneous/subcutaneous endometriosis is presented. Endometrial tissue sampled by the aspiration technique manifested different cytologic characteristics as compared to those of endometrial tissue obtained by standard exfoliative methods. A primary difference was the appearance of the endometrial cells in syncytial clusters in the aspirate, in contrast to the three-dimensional clusters seen in exfoliated material. These cases emphasize the need to include endometriosis in the differential diagnosis of palpable lesions of the abdominal wall, especially in women with healed surgical scars, and the role of FNAC in diagnosing such lesions.

Adhesion formation and histologic reaction with polydioxanone and polyglactin suture.

A suture material associated with a minimal inflammatory response might be expected to induce less frequent and less severe peritoneal adhesions. A comparison between polydioxanone and polyglactin 910 suture was performed in a rabbit model. Ten sexually mature virgin female New Zealand white rabbits underwent laparotomy and bilateral incisions into the distal uterine cavities. The serosa of the left uterine horn was always reapproximated with polyglactin 910 suture whereas the right uterine horn was repaired with polydioxanone suture. All animals were put to death 28 days later. An adhesion score was given for each uterine horn. Representative sections were obtained for histologic review. Similar histologic responses were found in both groups. No significant difference was noted in adhesion scores between the two sutures. The present study cannot justify the use of one of these sutures over the other with regard to adhesion formation or tissue reaction.

Papillary carcinoma of the thyroid gland seen as lateral neck cyst.

The clinical, roentgenographic, histologic, and cytologic features of four cases of papillary carcinoma of the thyroid gland seen as lateral neck cysts are discussed. Carcinoma of the thyroid gland characteristically is a solid tumor and appears as a firm, painless, and otherwise asymptomatic mass in the anterior paramedial part of the neck. A nontender fluctuant lateral neck mass commonly implies a benign lesion. The diagnostic procedures used (namely, fine-needle aspiration and ultrasound and thyroid scans) may belie the nature of the lateral neck lesion. Examination of the tissue is necessary to confirm the diagnosis.

Evaluation of the pathologic and prognostic correlates of estrogen receptors in primary breast cancer.

The presence of estrogen receptors in breast cancer tissue has been reported to correlate with improved prognosis in women after mastectomy. The prognostic value (if any) of the presence or absence of estrogen receptors (ER) in malignant breast tissue was evaluated 104 women who were treated for primary breast cancer, whose pathology was re-examined, and whose records were subjected to multifactorial analysis. Sixty patients were ER positive, and 44 were ER negative, and a total of 94 who had curative resections were available for follow-up (mean follow-up time 20 months). The presence of estrogen receptors showed significant positive correlations with age, lobular cancer, and a variant of infiltrating duct cancer that is prevalent in the elderly and characterized by the presence of cells showing granular eosinophilic cytoplasm. Of 26 cases identified as infiltrating duct cancer showing granular eosinophilic cytoplasm, 22 were ER positive, one was ER negative, and three had borderline values. There was no significant difference between the groups with regard to family history of breast cancer or hysterectomy. A striking observation was noted in the ER positive group in which there were seven cases of second primary breast cancers, whereas no such cases occurred in the ER negative patients (p=0.05). There was a higher percentage of nodal metastases in the patients who were ER positive compared with those who were ER negative; 27 of 53 (51%) of the ER positive patients has positive nodes compared with four of 40 (32%) who were ER negative, p = 0.08. There was no significant correlation of disease free survival nor time to recurrence in either the overall group nor according to stage. In patients whose tumors had been reviewed and graded, there was no prognostic relationship of ER status in high grade tumors, but in patients with low-grade tumors, improved disease-free survival was demonstrated in patients who were ER negative. Although the estrogen receptor assay is a highly useful tumor marker and guide for therapy of advanced breast cancer, its relationship to the prognostic variables of primary breast cancer is complex and controversial and merits continued study.

Cyclophosphamide-induced cardiomyopathy in the rat.

Cyclophosphamide given to ACI inbred rats produced histologic evidence of cardiomyopathy and degenerative vascular changes beginning as early as 4 days after the first of three 150-mg/kg doses (0.9 g/m2). The interval between doses was 14 days to allow bone marrow to recover after each treatment. Twofold increases in heart weight and DNA content were observed 56 days after initial treatment; compensatory hypertrophy and a marked infiltration of the myocardium by lymphocytes were observed histologically at that time. Heart weight and DNA content were again at control levels on Day 126. Hydroxyproline content, which increased along with DNA and weight, did not decrease until after Day 196, confirming a morphologic finding of increased fibrosis after cyclophosphamide which eventually decreased in severity. These data re-emphasize the necessity for considering both the acute and chronic toxic effects, as well as recovery, when developing treatment schedules employing therapeutically effective chemotherapeutic agents.

Response and recovery kinetics of a solid tumour after irradiation.

The effects of local tumour radiation over the dose range 7.5-30 Gy on the growth and cell kinetics of rat hepatoma H-4-II-E have been investigated. A plot of growth delays against log surviving fraction was linear below a fraction of 0.03, but failed to extrapolate to the origin. Following a single dose of 15 Gy to the tumour, DNA-precursor incorporation, labelling and mitotic indices were depressed for 7 days. Tumour cellularity, measured as DNA/g tumour, was reduced and the rate of increase of total clonogenic cells slower than after complete tumour recovery. From Day 7 to Day 9 all indices of proliferation recovered to about control levels, clonogenic cell numbers increased more rapidly and tumour cellularity was restored. Repopulation of the tumour therefore appeared to take place mainly after Day 7. Incorporation of [3H]-TdR into tumour DNA reached twice the control values on Day 9. The rate of tumour growth accelerated after the initial decrease, and maximum tumour growth rate was also twice the control values on Day 13. Accelerated growth rates in irradiated tumours, above those of control tumours, occurred 10-16 days after treatment. The effectiveness of sequential therapy may therefore be improved if given during this period of of accelerated tumour growth.

Percutaneous aspiration biopsy of lymph nodes.

During a period of five years, 361 patients each had cytologic examination of a specimen aspirated by percutaneous needle biopsy from a superficial lymph node. Fifty-five aspirates were considered unsatisfactory owing to scanty cellularity, and 22 were excluded because of lack of adequate follow-up. Of the remaining 284 aspirates, 81% were positive for malignant cells; 19% were considered negative. There were no cases with false-positive diagnoses. However, of 52 negative aspirates, 31 revealed tumor on subsequent excisional biopsy. Seventy-two percent of patients were admitted with prior history of malignancy. For both males and females, an apparent correlation was found between regional distribution of positive lymph nodes and the histologic types of primary tumors. Eighty-two percent of the positive cervical nodes in males and 56% in females were associated with epidermoid carcinoma. Most of the positive supraclavicular and axillary lymph nodes occurred in females and were associated with mammary carcinoma. Diagnosis of malignant neoplasms is feasible, in most instances, from nodal aspirates, but specific diagnosis of the histologic type of the tumor, e.g., malignant lymphoma, should be rendered only when the cytologic findings are supported by appropriate clinical and laboratory findings. In case of doubt, or if the aspirate contains many polymorphonuclear leukocytes, necrotic debris, or bizarre epithelioid cells, granulomatous lymphadenitis should be suspected and the diagnosis should be deferred until formal tissue biopsy can be obtained.

Intraductal carcinoma. Long-term follow-up after treatment by biopsy alone.

A follow-up period averaging 21.6 years was obtained for patients with low-grade papillary intraductal carcinoma initially treated only by biopsy between 1940 and 1950. Subsequent carcinoma was diagnosed in the same breast in seven of the ten patients after an average interval of 9.7 years. Six of the seven subsequent carcinomas were invasive. Two of the patients died of metastatic carcinoma and two were known to be alive with metastases when last contacted. Three patients were without carcinoma following mastectomy. When these results were combined with the few reports available in the literature, it appeared that at least 39% of patients with intraductal carcinoma treated by biopsy alone subsequently had clinically evident carcinoma, invariably in the same breat, with an average latent period of about ten years. This was undoubtedly a result of the multicentric nature of the disease in many patients.