Frank Vellios

The pathology of invasive breast cancer. A syllabus derived from findings of the National Surgical Adjuvant Breast Project (protocol no. 4).

The inter-relationships of 32 pathologic and 7 clinical parameters encountered in the study of 1000 examples of invasive breast carcinoma have been presented. In some instances the biological significance of these associations is at present unclear. In others it is to be noted that there is no information provided as to the rank of their significance. Nevertheless, the associations that were encountered not only help further characterize the various forms of breast cancer but also provide information regarding the possible biological significance of some of their features. Although it is not our intention to minimize the possible significance of the inter-relationships of pathologic parameters, most emphasis in the summarizing statements which follow has been placed upon those correlations which may relate to prognosis. In this regard reference has been made to short-term treatment failure, vis a vis local recurrence and/or metastases, which may not necessarily accurately reflect patient survival, although generally such a relationship exists. Information in this regard as well as to the rank of the significance of these pathologic features shall be forthcoming when sufficient time has elapsed since the inception of this study to allow for such conclusions, i.e. survival or long-term treatment failure rates. Lastly, it becomes evident that the guidelines followed in the examination of these specimens appear to represent at least the minimum requirements necessary for a meaningful pathologic evaluation of breast carcinoma.

Pathologic findings from the national surgical adjuvant breast project (protocol no. 4). I. Observations concerning the multicentricity of mammary cancer

Microscopic foci of multicentric cancer were detected in 121 of 904 breasts surgically removed for a clinically overt, invasive cancer. This incidence of 13.4% is regarded as a conservative estimate since examples of such lesions occurring in the same quadrant as the dominant mass, except in those instances in which the latter was present within the tail of the breast or beneath the nipple, were excluded from the analysis. Further, this data was obtained from only one randomly selected block of the quadrants, and in 41% of the cases only one or two were available for study. Multiple multicentric cancers were found in the same breast in two and three quadrants in 11.6% and 5.8% of the cases respectively. In 9.3% of the cases the multicentric cancers were designated as noninvasive (lobular in situ and/or intraductal) and in 4.1% invasive. An attempt to correlate the occurrence of multicentric cancers with a large number of pathologic and some clinical features disclosed a statistically significant association between multicentricity and grossly nonencapsulated dominant cancers with maximum diameters greater than 5 cm, the presence of a moderate or marked intraductal component and noninvasive cancer in its vicinity, and tumor involvement of the nipple. In addition, it was noted that there was a greater likelihood that the primary tumor was of the lobular invasive type and that the overlying skin was involved when the multicentric cancer was invasive rather than noninvasive. Lymphatic tumor emboli were observed in quadrants in 18 or 2.0% of the cases. Although the number of examples is small, nevertheless positive associations were noted with the occurrence of primary tumors that were in the left breast or beneath the nipple and were not grossly circumscribed, but exhibited a nuclear grade of 1, intralymphatic and blood vessel invasion, calcium, and involvement of the overlying skin as well as nipple. In addition, patients with such intralymphatic extension were more likely to have clinically detectable lymph nodes of which four or more contained metastases. The relationship of these findings to the rationale of such procedures as segmental resection in the surgical treatment of breast cancer is discussed.

Lesions of the circulatory system of the placenta

Summary Lesions of the circula tory sys tems of the plac nta have been studied in a series of placentas delivered during the third trimester of pregnancy or at term. Fiv types of lesions were recognized in the 100 placentas used for sta tistical frequency: 1. Intervillous fibrin deposition was encountered in varying degrees in all of the placentas studied. The lesion is found in areas of the in tervillous space where the circulation wou ld tend to be slow. 2. Thirty-seven infarcts resuiting from obstruction of a maternal artery in the decidual plate were seen. There was usually only one in a placenta, but occasionally several such lesions were present. 3. Ninety-two intervillous thrombi were found. Sometimes multiple lesions of this type were present, but usually less than 3 were present in a placenta. The lesion is probably du to slowed eddying currents in the intervillous space as a result of obstruction of maternal veins in the decidual plate. 4. A lesion following partial premature separation of the placental site was found in two of the placentas. This lesion is due to separation of both maternal arterioles and veins in the decidual plate. 5. Fetal vessel thrombosis involving a major villous stalk was encountered in six of the placentas. A diffuse lesion of the same type is seen in the placenta fo lowing intrauterine death. The lesions demonstra ted and the points of obstruction of the circulation are consistent with current concepts of placental circulation.

Portal hypertension without cirrhosis or extrahepatic obstruction: Report of a case☆

Abstract A fifty-two year old man with bleeding esophageal varices secondary to portal hypertension but without evidence of intrahepatic or extrahepatic obstruction is presented. Although there was no arteriovenous fistula found, there was indirect evidence that in this case the portal hypertension was secondary to increased portal flow. He was treated successfully by portacaval anastomosis. A discussion of the pathology of the liver with increased portal flow is presented.

Perforating ulcer in a duodenal duplication

Abstract The case of a nine year old child with a duodenal duplication containing gastric mucosa and an acute, perforating ulcer is presented. Successful therapy consisted of resection of the duplication. Treatment of this lesion should be individualized. When resection is dangerous, internal drainage is acceptable. The latter approach may lead to the development of a peptic ulcer, however, if gastric mucosa is present in the anomaly.

Surgical treatment of skin cancer of the nose

Abstract Principles to be observed in the treatment of cancer of the nasal skin are outlined and discussed. The primary and dual aims include eradication of the disease with careful histologic control, and restoration of the nasal appearance and architecture (with free full thickness skin grafts for superficial lesions, and regional pedicle flaps when the loss is more extensive). In selected alar lesions, auricular composite grafts give a satisfactory result. Pedicle flaps from a distant part of the body are used only when other methods of reconstruction are not feasible.

New tissue culture cell lines derived from human squamous cell carcinoma of the cervix and vagina: Squamous cells in tissue culture☆

Abstract Two new cell lines of human squamous cell carcinoma have been established in culture. One line, designated EC-50, was derived from cells of the ascitic fluid in a woman with recurrent carcinoma of the uterine cervix. The other line (EC-82) was derived from tissue obtained by biopsy of a primary vaginal carcinoma. Cells from ascitic fluid and vaginal carcinoma were grown in culture as monolayers, with the use of enriched Waymouths medium (MB 752/1) containing serum. When cells from the thirteenth passage of the EC-50 line and seventeenth passage of the EC-82 line were injected subdermally into the cheek pouches of cortisone-treated hamsters, tumors developed. The histologic pattern of tumor grown from EC-50 cells and that of the biopsy of the original carcinoma of the uterine cervix were indistinguishable. In addition, the histologic pattern of tumor grown from EC-82 cells was indistinguishable from that of the biopsy of the original vaginal carcinoma. When cells from passage 54 or 72 of the EC-50 line or from passage 47 or 70 of the EC-82 line were injected subcutaneously into nude (athymic) mice, tumors developed. The histologic pattern of each tumor was indistinguishable from that of the biopsies of the original tumors. The EC-50 cells had 65 to 70 chromosomes; the EC-82 cells had 83 to 87 chromosomes. The doubling times of the EC-82 cells in culture were 16 and 20 hours, respectively. The EC-82 cells produced chorionic gonadotropin. When an ultrastructural analysis of EC-50 cells at passage 82 and of EC-82 cells at passage 78 was performed, the squamous epithelial origin of these cell lines was confirmed. At present, the EC-50 cells have undergone 123 passages; the EC-82 cells have undergone 114 passages. These cells have maintained their tumorigenic capacity despite prolonged maintenance in culture and may be of utility in investigations of sensitivity to radiation and chemotherapeutic agents, immunotherapy and immunodiagnosis, ectopic hormone production, and tumor-specific antigens.

Ovarian tumors in infants and children

Abstract 1. 1. Ovarian tumors are unusual in patients in the pediatric age group and can be diagnosed if the attending physician is cognizant of their possible occurrence. 2. 2. Nineteen patients with ovarian tumors are reviewed. Eleven teratomas, four cystadenomas, two dysgerminomas, one papillary adenocarcinoma, and one lutein cyst were encountered. Six of these tumors were malignant. 3. 3. The most common symptoms were abdominal pain, vomiting, and the presence of an abdominal mass. 4. 4. Physical examination of the patients with ovarian tumors will usually reveal an abdominal mass which can be confirmed by rectal examination. Roentgenographic studies offer additional information about these tumors. 5. 5. The pathology of the most common ovarian tumors is reviewed. 6. 6. Treatment for these tumors is surgical. Radiation therapy after surgery is indicated for dysgerminoma and may enhance the survival rate with cystadenocarcinoma.

Experimental Production of Ventricular Septal Defects

From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana. Aided by a grant from the James Whitcomb Riley Memorial Association and a contract between the Office of Naval Research, the United States Navy and Indiana University. It is apparent that much useful information about various problems concerning ventricular septal defects might be obtained if a reliable method for the production of such defects in experimental animals were available,. It is the purpose of this communication to present a technique which permits one to create defects of known size in the ventricular septum, to comment about