Bradley Bigelow

Strumal carcinoid of the ovary: an analysis of its components.

A strumal carcinoid of the ovary was studied by light and electron microscopy. Thyroglobulin was demonstrated within the strumal element by immunofluorescence, thus establishing the identity of the thyroid tissue. The carcinoid fulfilled the light and electron microscopic criteria for a mixed insular and trabecular example of this tumor. Intermediate zones between the two tissue elements showed mixed characteristics. No amyloid was found. Immunoreactive calcitonin was demonstrated in the tumor, suggesting the presence of C‐cells or medullary carcinoma of the thyroid.

Ultrastructural study of a female adnexal tumor of probable wolffian origin

A broad‐ligament tumor, of probable wolffian origin, is presented. The ultrastructural features of this histologically benign tumor have not been previously described. The fine structure of this tumor is compared with normal structures and tumors derived from wolffian and müllerian anlage. The findings are consistent with derivation from wolffian duct.

The evaluation of the omentum in ovarian cancer.

Little published data exists on omental evaluation in ovarian cancer. In a retrospective study we reviewed 334 consecutive operations for adnexal masses; 159 had ovarian cancer, and 119 omentectomies were performed, with complete information available on 109. Mean omentectomy was 203.5 cm2 (normal omentum = 792 cm2) and 190 g, with a significant correlation of weight to size. Secondary ovarian cancer was present in 66 omenta (61%). All 32 omenta examined in the pathology laboratories and described as grossly involved with tumor had ovarian cancer histologically. Of the 55 grossly negative omenta, 12 had histologically proven tumor (22%). Slide review of the grossly negative, histologically positive omenta revealed the mean tumor diameter to measure 6.7 mm. Lymph node dissection occurred in 16 patients and was positive in 10, with simultaneous absence of tumor in the omenta of 3 of these patients. Conversely, 2 patients with positive omenta had negative lymph nodes. The optimal extent of omental resection and histological examination remains undetermined.

Extragenital mixed heterologous tumor of müllerian type arising in the cecal peritoneum: Report of a case

SummaryA mixed heterologous tumor of müllerian type arising in the cecal serosa of an elderly woman is reported. There was no history of endometriosis, and no evidence of the latter was found in the surgical specimen or at autopsy. Evidence of mesothelial origin was found microscopically in the adjacent cecal peritoneum. A review of medical literature on mixed heterologous tumors of müllerian type reveals that heretofore they have originated only in the genital system.

Isolated endometriosis in an inguinal hernia

Presented is the case of a patient with inguinal endometriosis adjacent to a hernia sac in whom laparoscopy revealed no evidence of pelvic endometriosis.

Carcinoid tumor within a squamous cell carcinoma of the cervix

Abstract A small focus of carcinoid tumor within an otherwise typical, poorly differentiated squamous cell carcinoma of the cervix in a 37-year-old female is described. This focus was argyrophilic, but argentaffin negative. There are several papers dealing with primary carcinoid or hormone-secreting tumors of the cervix and, although some of these have shown small foci of epidermoid differentiation, this is the first example in which a small carcinoid focus occurred within and in continuity with a large squamous cell tumor. This may support the theory that APUDomas of the cervix arise from undifferentiated basal stem cells.

Colposcopy and the management of cervical intraepithelial neoplasia.

Abstract The accuracy of the colposcopically directed punch biopsy and its value in the management of cervical intraepithelial neoplasia (C.I.N.) was evaluated among 272 consecutive patients with abnormal Pap smears who were followed in a cervical dysplasia clinic (Bellevue Hospital, New York University Medical Center). The authors conclude that many unnecessary surgical operations were eliminated with this technique. One hundred and eighty-five patients (68%) underwent a colposcopically directed punch biopsy, usually followed by endocervical curettage. Only 22 patients (8%) had subsequent surgical conizations and 11 patients (4%) underwent hysterectomies. All cases diagnosed as mild or moderate dysplasia were treated by cryocauterization. For the cases with severe dysplasia or C.I.N. the treatment was individualized. Surgical conization or hysterectomy was performed in those cases with additional indications such as uterine prolapse, desire for sterilization, or advanced age. To minimize the risk of a later invasive carcinoma, a continuous follow-up with colposcopy and cytology is necessary.

Effects of the progestasert® on the menstrual pattern, ovarian steroids and endometrium

193 women were fitted with a progesterone-releasing IUD (Progestasert) and followed for a total of 1823 woman-months (minimum 1 year use); 108 were nulliparous and 84 parous. Patients were examined at 1, 6, and 12 months and were interviewed to assess length of cycle, duration of flow, amount of flow, pain associated with menstruation, and intermenstrual bleeding and pain. Endometrial biopsies were performed on 45 patients and serum estrogens and progesterone measurements were made. There were .5 pregnancies/100 woman-years during the first 12 months of use. Overall expulsion rate was 7.4/100 woman-years; 4.8 and 10.7 corresponding to nulliparous and parous, respectively. 77% of expulsions occurred within 1 month of insertion. Intermenstrual bleeding occurred in small amounts and during the first 2 months of use. Menstrual flow and dysmenorrhea were significantly reduced. The overall continuation rate was 76.0 + or -3.2. Normal ovulatory function continued after insertion. Endometrial biopsies demonstrated glandular atrophy and decidual reaction after 12 months use.

Epithelial carcinoma of the ovary in the reproductive years: Clinical and morphological characterization

In the 10-year interval from 1972 through 1981, 247 patients were treated for epithelial ovarian carcinoma at New York University Medical Center. Of this group, 31 patients (12.6%) were below age 40, and this group had distinctive features favoring longer survival. Of these patients 12 (38.7%) had borderline tumors, compared to 9 of 216 patients (4.2%) over 40 years of age (P less than 0.001). Stage I disease and well differentiated lesions were also common in the younger group. Early symptomatology and frequent gynecologic examinations during the childbearing years may also contribute to early detection of these tumors. The median survival in this group (7 years) was better than that reported for all ages. After careful evaluation, conservative surgical management can be considered for patients with Stage Ia disease which is either borderline or grade 1 carcinoma.

Early Osseous Metastasis of Stage 1 Endometrial Carcinoma: Report of a Case

Abstract Osseous metastasis of endometrial carcinoma is rare and is usually seen in advanced disease. A case of early metastasis to the femur following radical hysterectomy for a stage 1 cancer is presented with a review of the literature.