Benjamin Castleman

Parathyroid carcinoma. A study of 70 cases

Seventy cases of carcinoma of the parathyroid collected over a 40‐year period are analyzed. The average age of the patients was 44.3 years, and there was no sex predominance. The most common presenting signs and symptoms were bone disease, a palpable neck mass, and renal stones. The initial serum calcium value averaged 15.2 mg/100 ml. The most important histologic features were mitoses and fibrous bands. Local recurrence occurred in 30% of the cases. Metastatic spread, which occurred in 30% of the cases, was usually late and to regional lymph nodes, lungs, liver, and bone. Less than half the patients died of the disease within 5 years.

Do Adenomatous Polyps of the Colon Become Malignant

OF all the problems currently facing the surgeon and pathologist, none is more controversial than the pathogenesis and proper treatment of adenomatous polyps of the colon. Until a few years ago the...

Thymoma: A Continuing Survey at the Massachusetts General Hospital

An analysis is presented of the treatment of 103 patients with thymoma, 56 with myasthenia gravis and 47 without. In a 1966 report on the first 63 patients, it was stated that the presence of myasthenia and the finding of local tumor invasion at operation were ominous prognostic indicators. The augmented series suggests that myasthenia no longer carries this stigma, possibly because of improved methods in its management in patients who have undergone operation.

Mediastinal germinoma.A study of 21 cases with an excellent prognosis

Twenty unpublished cases and one previously published case of mediastinal germinoma are analyzed. All the patients were males with a mean age of 29.8 years. None had testicular disease at any time. The pathologic criteria for the diagnosis are discussed and illustrated. The patients were treated with surgery or radiation therapy or a combination of both. Irrespective of the therapy, all the patients with follow‐up information (81%) are alive and free of disease after a mean follow‐up time of 6 years. Therapeutic and diagnostic recommendations are made.

Hodgkin's disease of the thymus gland.

Forty‐four patients with Hodgkins disease that was initially limited to the anterior mediastinum were studied by clinicopathologic analysis. In about half the cases there was involvement of the thymus gland, and in the other half there was involvement only of the anterior mediastinal lymph nodes. Evidence is presented that the thymic lesion, often called “granulomatous thymoma”4 is in fact Hodgkins disease of the thymus gland. All but 4 patients had the nodular‐sclerosis type of Hodgkins disease, and in all the cases in which the thymus gland was involved, nodular sclerosis was found. The patients with thymic involvement were younger, with a male predominance. The 5‐year survival rate of 79% was similar whether or not the thymus gland was involved, and was comparable to reported cases of Stage I Hodgkins disease elsewhere in the body. More than half the patients with followup observation have had recurrences, most of them above the diaphragm. Cancer 33:1615–1623, 1974.

THE ROLE OF THYMECTOMY IN THE TREATMENT OF MYASTHENIA GRAVIS

Vincent P. Perlo, Barry Amason,* David Poskanzer, Benjamin Castleman, Robert S. Schwab, Kermit E. Osserman, Angelo Papatestis, Lawrence Alpert and Alan Kark The Myasthenia Gravis Clinic of the Massachusetts General Hospital; the Neurology and Pathology Departments, Harvard Medical School, Boston, Mass.: the Myasthenia Gravis Clinic and Departments of Medicine, Pathology and Surgery, the Mount Sinai Hospital, New York, N . Y .

Myocardial rupture and hemopericardium associated with anticoagulant therapy; a post-mortem study.

A DISTURBING feature of the occasional case of fatal hemopericardium following anticoagulant therapy for myocardial infarction is the absence of an obvious explanation for the hemorrhage. Heretofor...

The thymus gland in elderly patients with myasthenia gravis.

This study was undertaken to determine the amount and histologic appearance of the persistent thymic tissue removed post mortem from 20 patients over 60 years of age with myasthenia gravis. One patient died several days after thymectomy. No recognizable thymic tissue on gross examination was seen in any patient. On microscopic examination, 11 patients had no thymic tissue. The other nine patients, including the one with thymectomy, all showed marked involution of the thymus. No germinal centers were seen. The thymus glands of two additional patients, still alive after thymectomy at ages 62 and 70, showed similar findings. Marked involution of the thymus also was found in each of six elderly controls. Thymectomy is not likely to be effective treatment for the elderly myasthenic patient.

Case 4-1972

Presentation of Case A 16-year-old boy was admitted to the hospital because of joint pain. He had been well until one month previously, when there was the onset of malaise, anorexia and fever. On t...

Respiratory and Circulatory Studies of Patients with Mitral Stenosis

Sixteen patients with severe mitral stenosis have been studied by means of cardiac catheterization, ventilatory and respiratory tests. A decrease in the oxygen diffusing capacity and an increase in venous admixture were observed in a majority of the cases. The degree of pulmonary arterial and arteriolar abnormality observed in lung biopsies failed to correlate with the pulmonary arteriolar resistances calculated from the hemodynamic data. It is suggested that reversible vasoconstriction plays an important role in the pathogenesis of the pulmonary hypertension associated with mitral stenosis.