Bernard F. Fetter

Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus: a gynecologic oncology group pathologic study of 203 cases

We report on the pathologic findings in primary tumors and metastases in 203 cases of stage I and II endometrial carcinosarcoma (malignant mixed mesodermal tumor) subjected to hysterectomy and staging laparotomy. Metastases were studied in 40 of these cases, including 34 with positive findings in the pelvic and/or para-aortic lymph nodes. Features of the stromal component of the primary tumors, including grade, mitotic index, and the presence and types of heterologous elements, showed no relation to the presence of metastases at operation. High-grade, serous, and clear cell carcinomatous components, on the other hand, were associated with a higher frequency of metastases, as were deep myometrial invasion, lymphatic or vascular space invasion, and involvement of the isthmus or cervix. The current concepts of histogenesis and differentiation of these tumors are discussed, and the suggestion is made that they might represent metaplastic carcinomas.

Adenosarcoma of the uterus : a gynecologic oncology group clinicopathologic study of 31 cases

SummaryWe report on the clinical and pathologic findings in 31 cases of adenosarcoma of the uterus subjected to hysterectomy and staging laparotomy. Nine of 30 patients (30%) have had recurrent tumor and six of 30 (20%) have already died of tumor in a relatively short follow-up period (mean, 38.3 months). Seventeen of 31 cases were diagnosed as adenosarcoma with sarcomatous overgrowth (SO). Ten of these 17 with SO contained focal or extensive rhabdomyosarcoma. In six cases, extrauterine spread was identified as follows (two patients had two sites each): vaginal involvement (two cases), pelvic lymph node metastases (two), positive peritoneal cytologic findings (two), parametrial invasion (one), and ovarian metastasis (one). Extrauterine spread (stage III) (p < 0.001) and myometrial invasion (p = 0.04) were associated with higher rates of recurrence. The presence of lymphatic and/or vascular invasion, SO, and rhabdomyosarcomatous differentiation also indicated poor prognosis but did not attain statistical significance. Based on this experience, staging laparotomy including peritoneal cytology is suggested in cases of clinical stages I and II adenosarcoma. The differential diagnosis of these tumors is also discussed.

Management of Stage IA carcinoma of the cervix

One hundred fourteen patients with Stage IA carcinoma of the cervix were retrospectively reviewed in regard to depth of invasion, capillary-like space involvement, stromal reaction, status of conization margins, and the incidence of lymph node metastasis. Type of treatment, recurrences, and deaths were also evaluated. Patients with less than 3 mm invasion can be treated conservatively, including conization, if fertility is desired. No lymph node metastasis or recurrence appeared in this group of patients irrespective of type of treatment. Patients with 3 to 5 mm invasion do appear to be at higher risk for recurrence, but conservative therapy may be used in individualized situations. Size of conization and status of surgical margins appear to be important determining factors in regard to conservative therapy. Data in the literature, as well as our experience, although limited, suggest that the status of capillary-like space involvement does not influence lymph node metastasis or recurrence. Invasion of 5 mm or more in depth should be treated as a Stage IB occult lesion.

Correlation of estrogen and progesterone receptors with histologic differentiation in mammary carcinoma.

Using a modification of the histologic grading system of the NSABP, we observed a trend towards higher levels of estrogen (E2R) and progesterone receptor (PR) content in well (grade I) and moderately (grade II) differentiated mammary carcinomas. This relationship between receptor content and histologic grade is enhanced by considering estrogen and progesterone receptor simultaneously. The rank correlation between the quantitative levels of E2R and PR was 0.74 among histologic grade I tumors and 0.64 among histologic grade II tumors. Among the grade III carcinomas, the majority of tumors displayed either a paucity of measurable receptor or a divergence between levels of estrogen versus progesterone receptor (r = 0.19). The use of ultrastructural evaluation of features of differentiation is discussed in the evaluation of grade III tumors and in the evaluation of specific histologic types of mammary carcinoma.

Malignant Syringoma of the Eyelid

Two cases of malignant syringoma of the eyelid are reported. The first patient, a 20-year-old woman, presented with a one year history of a slowly growing nodule in the left lower eyelid. The lesion recurred five months after excision, slowly grew over the ensuing two and one-half years, and was reexcised. The second case was an 18-year-old man who was first examined by an ophthalmologist because of a slowly enlarging, painless induration of his right lower eyelid for two years. Histologic examination of the excised lesions from both patients disclosed proliferated ducts lined by two layers of epithelium infiltrating the dermis and subcutaneous tissue; there was skeletal muscle and perineural invasion, but only minimal cellular atypia. Malignant syringomas are rare forms of sweat gland carcinoma, which most often occur on the upper lip and to our knowledge have not been reported on the eyelid. These tumors probably arise from eccrine ducts, are more common in women, and have a peak incidence in the fifth decade. The histologic feature that best indicates prognosis is the degree of cellular atypia. Patients with cytologically well-differentiated tumors do well following complete local excision. Features that help to distinguish malignant syringoma from its benign counterpart are the larger size, solitary nature, and subcutaneous, muscular, and perineural invasion.

Clinicopathologic studies in feminizing tumors of the ovary. I. Some aspects of the pathology and therapy of granulosa cell tumors.

Abstract Clinical and pathologic data from a series of 41 patients with granulosa cell tumor are reviewed. An attempt is made to correlate these data with basic research data which relate to the pathogenesis, pathophysiology, and experimental production of these tumors. The pathologic factors related to survival are the degree of anaplasia of the tumor and the stage of the disease. The treatment of choice is complete surgical extirpation of the internal genitals, followed by irradiation in cases beyond Stage I. Conservative operation is justified only in patients with Stage I disease, who desire further childbearing. On the basis of animal experiments, it appears that postoperative estrogen administration may be useful adjunctive therapy, and this is recommended.

Wegener's Granulomatosis: Two Patients Presenting with Solitary Pulmonary Lesions and Review of Eleven Other Cases

Abstract The case histories are reported of 2 patients with Wegeners granulomatosis who presented with solitary lung lesions. Eleven additional cases of Wegeners granulomatosis diagnosed at this institution are reviewed. Five of the 13 patients have been classified as having a limited form of the disease with no evidence of renal involvement and a more benign and prolonged course. The age, sex, and race factors were essentially the same in patients with limited disease as they were in patients with renal involvement. Gastrointestinal bleeding was a prominent symptom in 4 patients. The bleeding was found to be due to vasculitis involving the large bowel with mucosal ulceration in 1 patient and was due to regional enteritis in another patient. The association of lower gastrointestinal bleeding with Wegeners granulomatosis has not heretofore been made. Steroid therapy has been beneficial in patients with disease limited to the respiratory tract. The patients with renal involvement had a rapid downhill course except for 1, who has survived more than two years on a combination of steroid and 6-mercaptopurine therapy.

The Abnormal Ureteropelvic Junction: A Muscle Deficit

Five patients demonstrated a deficient area of muscle in the upper ureter. Such an adynamic ureteral segment can produce proximal dilatation and a picture consistent with obstructive uropathy. This should be included along with other types of abnormalities which may obstruct urine flow at the ureteropelvic junction.