Frank W. Foote

Fatal carcinoma of the thyroid: Histology, metastases, and causes of death

The lethal potential of thyroid carcinoma is emphasized by this study of 54 autopsied cases. The anaplastic cancers rapidly produced death by extensive local and metastatic disease, while the well‐differentiated forms were associated with more protracted courses, and death from local disease was less common. The ominous significance of the infrequent conversion of well‐differentiated papillary or follicular carcinoma to an anaplastic variant is noted. Sites of metastases are analyzed both for the entire series and individually for each histologic type of tumor. The data presented in this report emphasize the fact that the histologic differences among the various types of thyroid carcinoma signify important clinical differences as well, and point out the need for individualization of therapy in each case.

Carcinoma of the trachea. Clinicopathologic study of 41 cases

During a period of 33 years, 41 patients with primary carcinoma of the trachea were treated at Memorial and James Ewing Hospitals. Thirty of these patients had epidermoid carcinoma, 7 had adenoid cystic carcinoma, and 4 had mucus‐secreting adenocarcinoma. In view of the cryptic symptomatology, tracheal carcinoma must be considered in the differential diagnosis in patients with chronic cough, hemoptysis, and negative chest roentgenogram. The prognosis of tracheal carcinoma appears to depend mainly upon size and histologic type of the primary tumor. The prognosis of epidermoid and mucus‐secreting adenocarcinoma appears to be grave. Less than 25 percent of the patients with epidermoid carcinoma survived one year or longer. Adenoid cystic carcinoma carried a much better prognosis, however. These tumors have a slow and insidious course, usually recur, and metastasize several years after initial treatment. Small tracheal tumors can be treated either by endoscopic excision or partial resection of the trachea. In the case of extensive localized disease, the combination of surgery and irradiation is the treatment of choice.

Lobular carcinoma in situ. Long term follow-up

Current follow‐up information is presented on a unique group of 46 patients first diagnosed as having lobular carcinoma in situ during the period 1940‐1952 and observed from 4 to 27 years. Six patients each had radical mastectomy; the remaining 40 had no treatment after a diagnostic biopsy. Subsequent cancers developed in 33% (15/46) patients. The 15 patients developed 20 cancers; an incidence of 13% (6/46) bilaterality. Seventy‐five percent (15/20) of the cancers were infiltrating. Two patients (4%) are dead from metastatic breast cancer; 2 others (4%) are living with metastases. Only half of the 20 cancers appeared in die first decade and the remaining half appeared up to 22 years after the original diagnosis of lobular carcinoma in situ. The evidence continues to accrue proving that lobular carcinoma in situ is a preinvasive form of breast cancer which should be treated by modified radical mastectomy.

Gastric and extragastric leiomyoblastomas. Clinicopathologic study of 44 cases

Forty‐four cases of leiomyoblastomas are presented and their clinicopathologic characteristics discussed. Most of the tumors were located in the stomach (26 cases). Biologic behavior correlated with the duration of symptoms, anatomic location, and the size of the tumor. Prognosis cannot be predicted with certainty on the basis of histologic characteristics. Thirty‐eight per cent of the gastric and 55% of the extragastric tumors proved fatal. Treatment of choice depends on location and extent of disease but, in general, ought to be similar to that of leiomyosarcoma.

Primitive multipotential primary sarcoma of bone

This report analyzes 25 tumors designated “primitive multipotential primary sarcoma of bone.” The lesions were most common (60%) in the second and third decade and were distributed equally between males and females. Anatomically they occurred in long or flat bones; the most common site was the femur. Roentgenographically the lesions were nonspecific. Pathologically there were 10 types of histologic differentiation in addition to a basic undifferentiated pattern.

Adrenal cortical carcinoma. Clinicopathologic study of 34 cases

The clinicopathologic findings in 34 patients with primary adrenal cortical carcinoma treated at Memorial and James Ewing Hospitals, from 1935 to 1967, have been analyzed and compared with cases in the literature. This tumor predominantly afflicts women. The average admission age (38 years) of the female patients studied was approximately 7 years younger than that of the males. The female patients survived 0.9 years longer on an average than the males. Thirty of the 34 patients died with the disease. Of the remaining 4 patients, 3 are still alive with the disease more than 5 years after the initial diagnosis and one patient was lost to follow‐up. The 30 patients who died with the disease lived on the average of 3 years from the time of first presenting symptoms. Symptomatology, treatment, laboratory data, the gross and microscopic findings, and progression of the disease are discussed.

Clinical and pathologic correlation with mammographic findings in lobular carcinoma in situ

The authors review the records of 61 patients who had clinical mammographic examination and histologic lobular carcinoma in situ in at least one breast. An analysis was done to determine the tissue counterpart of positive mammographic findings as well as the accuracy and usefulness of mammography as an adjunct in the diagnosis of in situ lobular carcinoma.

An Analysis of Thirty Patients Surviving Longer than Ten Years after Treatment for Osteogenic Sarcoma

An analysis of the clinicopathological features of thirty long-term survivors of osteogenic sarcoma has been presented. We could not identify any specific features which would separate these patients from non-survivors of osteogenic sarcoma. The one common feature shared by all thirty patients was that amputation was the only effective therapeutic method in eradicating the primary disease.

Embryonal adenocarcinoma in the prepubertal testis. A Clinicopathologic Study of 18 Cases

The clinicopathologic findings in 18 children with embryonal adenocarcinoma of the testis seen at the Memorial and James Ewing Hospitals are reviewed and discussed in the light of current concepts of treatment and histogenesis. the majority of these uncommon tumors occur prior to 4 years of age, but they are occasionally seen in older children and in adults, either in a pure form or in conjunction with other germinal tumor patterns. This series includes 2 cases in which, for the first time, distinct teratomatous elements are seen in association with the embryonal adenocarcinoma in prepubertal testes. Presenting as an asymptomatic testicular mass, this tumor requires careful differential diagnosis from the more common causes of scrotal enlargement. Two unique cases in which maldescent was present are reported; in one of these, bilaterality was suggested. Prophylactic retroperitoneal lymph node dissections were carried out in 8 cases, and, in all cases, the nodes were negative. Factors affecting survival are discussed with particular reference to the occurrence of solitary metastasis. Five of the 18 patients died of their disease. the highly reliable correlation of pathologic stage with clinical stage in these tumors renders questionable the need for retroperitoneal lymph node dissection in children with this tumor, although the small number of cases precludes final resolution of this question. the term “embryonal adenocarcinoma” is preferred for these childhood testis tumors which are felt to represent a single germinal tumor of varying form which differs from the adult émbryonal carcinoma in appearance and behavior although probably not in histogenesis.

Mucoepidermoid tumors of bronchial glands

Mucoepidermoid tumors of bronchial gland origin are extremely rare, and little is known about their natural history. Clinically, their behavior in salivary glands where they were first described is characterized by a low, intermediate, or high degree of malignancy which may be predicted by the histologic appearance of the tumor. The few available reports of these tumors occurring in the lung suggest that they are either clearly benign or of intermediate malignancy, characterized mainly by local invasion. A review of approximately 5,000 patients with cancer of the lung, seen at Memorial Hospital between 1949 and 1968, was undertaken and 12 patients were found whose tumors satisfied the histologic criteria for this diagnosis. This represents one thiord as many cases as have been reported to date. All were considered to be of high‐grade malignancy. The information collected suggests that these patients follow a clinical course comparable to that of high‐grade mucoepidermoid carcinomas of salivary glands. All were dead of disease regardless of treatment within 18 months of the onset of their first discernible symptom.