Fred Holtz

Carcinosarcoma of the urinary bladder

Six examples of carcinosarcoma of urinary bladder consisting of intimate mixtures of carcinomatous and sarcomatous tissues are reported. Five patients were men, 43 to 79 years of age, and one was a 71‐year‐old woman. Two neoplasms were collision tumors and consisted of leiomyosarcoma and transitional cell carcinoma with squamous and glandular foci in one. Four neoplasms were considered to be composition tumors originating from the mucosa and characterized by heterologous sarcoma. Carcinosarcomas of urinary bladder tend to be large, bulky, intraluminal tumors that grow rapidly and infiltrate widely. Irrespective of their histogenesis, the prognosis is poor, with 5 of 6 patients in this series dying of recurrent and/or metastatic disease within 33 months of diagnosis.

Testicular and paratesticular neoplasms in patients 60 years of age and older

Testicular and paratesticular neoplasms from 50 patients 60 years of age or older were assessed with respect to histologic type, clinical findings and outcome. Neoplasms of germ cell origin comprised 24% of the series; there were ten seminomas and two teratocarcinomas. The seminomas were palpable many months before diagnosis and were larger than the other neoplasms. Only two deaths could be attributed to their dissemination. Both teratocarcinomas metastasized and caused death. There were five gonadal stromal neoplasms (10%), one Sertoli cell tumor, three interstitial cell tumors and one undifferentiated stromal tumor. None of the neoplasms recurred or metastasized. Eleven neoplasms (22%) were of supportive tissue or paratesticular origin and six of these arose from muscle—one leiomyoma, two leiomyosarcomas and three rhabdomyo‐sarcomas. The other tumors were two malignant mesotheliomas, one fibroma, one fibrosarcoma and one carcinoma of the epididymis. The lymphoreticular neoplasms were the most common lesion in this series and presented as primary testicular tumors in 22 patients (44%). In five patients asynchronous tumors appeared in the other testes. All but two neoplasms were reticulum cell sarcomas. All patients for whom survival information was available died with disseminated disease.

Chemodectomas (nonchromaffin paragangliomas) of the head and neck. A clinicopathologic study

Forty patients with chemodectomas arising in carotid body, vagal body or glomus jugulare are reported. These tumors pursued a slowly progressive clinical course, resulting in a long interval between onset of symptoms and diagnosis, and an even longer average interval between treatment and onset of recurrent neoplasm. Whereas the sex incidence of carotid body and vagal body tumors was approximately equal, the majority of patients with glomus jugulare tumors were women. The histologic features and anatomic location of these tumors was distinctive; nevertheless, initial biopsy material from one fourth of these patients was misinterpreted. Four of these patients died as a result of their neoplasm; in three patients local extension of chemodectoma proved fatal while metastatic neoplasm resulted in the fourth patients death. It was not possible to correlate the histologic features of these tumors with their clinical course. Although total excision was the most successful treatment for readily accessible neoplasms, biopsy or partial excision followed by radiation therapy proved almost as effective for tumors which could not be completely resected.

POSSIBLE ASSOCIATION BETWEEN BENIGN HEPATOMAS AND ORAL CONTRACEPTIVES

7 case reports of women with benign hepatic adenoma suggest that, since all of the women were taking oral contraceptives (OCs), there may be an association between ingestion of exogenous hormones and development of benign hepatoma of the liver. The cases were rapidly diagnosed by using hepatic arteriography; prompt, precise diagnosis is emphasized because, though the tumors are benign, they may cause serious, if not fatal, hemorrhage if left unchecked. Case 1 was a 26-year-old woman who had taken Enovid for 2 years, who presented with acute abdomen and impending shock. Coliotomy was performed, in which a left-lobe hepatic tumor was found; she underwent left hepatectomy and cholecystectomy and no evidence of recurrence was found 1 year later. Case 2 had been taking Oracon for a unknown time. Case 3, on OCs for 6 years, had a pedunculated mobile tumor removed. Case 4, 25 years old, had been taking Ovral for 6 months before diagnosis and excision of a right lobe liver tumor. Case 5, 5 years on combined OCs, required surgical intervention for a hypervascular mass. Case 6, taking a total of 8 years of OC therapy, was operated on for an hepatic mass which was a white-to-yellow hemorrhagic mass. Case 7, taking Enovid for 7 years, yielded a surgical specimen that was hemorrhagic, partly necrotic, and yellow-tan, about 10 cm in diameter.