Charles W. Sewell

Carcinoma of the parathyroid gland: is it overdiagnosed?: A report of three cases

The true incidence of carcinoma of the parathyroid gland is probably about 1 percent of cases of primary hyperparathyroidism. Overreporting may occur if the diagnosis is based on histologic appearances alone because the histologic criteria are less than definitive. Carcinoma of the parathyroid gland, if diagnosed early and treated with adequate surgical excision, is associated with a satisfactory long-term prognosis. However, the possibility of distant metastases or locally recurrent disease is not necessarily excluded by a prolonged interval of disease-free status, and the physician should continue to follow the patient on a regular basis by physical examination and routine serum calcium analysis.

Approach to the spectrum of Budd-Chiari syndrome: Which patients require portal decompression?***

Budd-Chiari syndrome (occlusion of the hepatic veins) represents a spectrum disorder. From 1974 to 1984, 20 patients with the syndrome were managed. Eleven required shunt surgery (Group 1) and 5 were managed with nonshunt therapy (Groups 2 and 3). Results have been good. Retrospective review of the liver biopsy specimens showed that Group 1 patients had a greater degree of zone 3 necrosis than Group 2 and 3 patients. We submit that presence of zone 3 necrosis on an initial liver biopsy specimen may define the failing liver of Budd-Chiari syndrome that requires conversion of the portal vein to an outflow tract by shunting.

The computed tomography‐guided adrenal biopsy: An alternative to surgery in adrenal mass diagnosis

A series of 16 patients with adrenal masses were biopsied percutaneously under computed tomography (CT) guidance with 18‐ to 22‐gauge modified Chiba needles. Adrenal adenomas, cysts, metastases, melanoma, and adrenal hemorrhage were identified. Of nine oncologic patients, four had adrenal metastases, while five had other nonmalignant adrenal masses. Thus, an adrenal mass in an oncologic patient is not always metastases. No complications occurred. The diagnostic evaluation of an adrenal mass in selected cases should include CT‐guided percutaneous aspiration as a safe and reliable alternative to open surgical biopsy. CT‐guided biopsy can be performed as an outpatient procedure, avoiding the cost of hospitalization and the morbidity of surgery.

Relationship between survival and histologic type in small cell anaplastic carcinoma of the lung.

Survival and histologic subtype were compared in 61 patients with small cell anaplastic lung cancer. Patients with lymphocyte‐like (oat cell) and fusiform histologies treated with chemotherapy had longer median survivals than the polygonal and other varieties on the same treatment. Likewise, when detectable disease was confined to the chest and supraclavicular nodes, the patients with lymphocyte‐like and fusiform types lived longer. The improved survival in the lymphocyte‐like and fusiform categories accounted for most of our improved overall median survival rates with the COPP regimen in small cell lung cancer. Survival in the polygonal and other types was not appreciably different from that seen in non‐small cell lung cancer (squamous and adenocarcinoma). It may be possible to refine treatment plans on the basis of cell type so as to further increase survival in small cell anaplastic lung carcinoma.

Bilateral Clear Cell Papillary Cystadenoma of the Epididymides Presenting as Infertility: An Early Manifestation of Von Hippel-lindau’s Syndrome

Papillary cystadenoma of the epididymis is a rare benign tumor, accounting for only 4 per cent of all epididymal tumors. Histologically, it can be confused with metastatic renal cell carcinoma. We report a case of bilateral involvement of the epididymides and infertility. Its diagnostic significance is its association with the von Hippel-Lindau syndrome, necessitating close surveillance.

Imaging Guided Percutaneous Hepatic Biopsy: Diagnostic Accuracy and Safety

During the 3-year period from May 1981 to June 1984, 145 patients with hepatic abnormalities demonstrated by computed tomography (CT) or ultrasonography (US) underwent 151 imaging guided percutaneous hepatic biopsies. These biopsies were performed with needles ranging in size from 21-gauge aspiration to 14-gauge cutting type. Histologic and cytologic results were correlated with subsequent surgical, autopsy, and clinical follow-ups ranging from 2 months to 3 years. The overall accuracy for imaging-guided biopsies was 92.1% and 98% for diagnosis of malignant lesions. Our complication rate of 1.3% is comparable to that reported in other studies. We discuss indications, techniques, and risks for imaging-guided percutaneous hepatic biopsy.

Percutaneous Biopsy of Pancreatic Masses

Forty-five percutaneous needle biopsies of pancreatic masses were performed in 41 patients in whom there was clinical or radiological concern for the diagnosis of cancer. Computed tomography (CT) was the imaging technique used in 41 of the 45 biopsies. An overall sensitivity of 85%, specificity of 100%, and accuracy rate of 88% were achieved, with serious complications in three of the 45 attempts (6.7%). These figures show that percutaneous pancreatic biopsies have the potential for greater accuracy than has been previously reported and are relatively safe when compared with surgery.

An atypical presentation of Paget’s Disease of the breast without nipple involvement: Case report and review of the literature

We present a case of a 63 year-old Caucasian female who developed a right breast skin lesion discrete from the nipple that was subsequently diagnosed as Pagets Disease of the breast (PDB). Imaging did not reveal an underlying breast cancer or involvement of the nipple. The patient underwent a segmental mastectomy preserving the nipple and final pathology demonstrated residual Pagets disease of the skin and did not reveal any additional underlying breast carcinoma. To our knowledge, this case represents the first reported diagnosed case of isolated PDB without nipple involvement.