George A. Hahn

Cervical carcinoma in situ: Difficulties in differential diagnosis

Abstract 1. Existing confusion regarding carcinoma in situ of the cervix and reasons for delay in clarification of the problem are discussed. 2. Our findings among 4,152 cervical biopsy specimens, obtained between 1930 and 1946 and previously reported, are briefly summarized, with particular emphasis on 9 invasive carcinomas with previous biopsy specimens, among which 1 true intraepithelial carcinoma was found. 3. The findings among 4,187 cervical biopsy specimens obtained between 1946 and 1952 are presented, with particular emphasis on 6 cases diagnosed “carcinoma in situ” and followed by repeat cervical biopsies without treatment other than the repeat biopsies, which, to date, showed the lesions to be reversible. 4. The etiology of benign carcinomimetic cervical lesions is discussed and the difficulties of differential diagnosis between them and genuine incipient carcinoma are emphasized. 5. Attention is directed to the extreme atypism of such lesions and the suggestion is made that it is not pathognomonic of incipient carcinoma but represents a nonspecific reaction of normal cells to injurious influences in the environs. 6. The desirability of a policy of watchful waiting in the doubtful case, particularly if the patient is young, and the comparative safety of such a policy are stressed.

Gynecologic considerations in malignant lymphomas

Abstract 1. 1. The rarity of gynecologic involvement by malignant lymphoma is stressed. 2. 2. A case of apparent primary Hodgkins disease of the Bartholin gland is described with details of treatment. 3. 3. A case of lymphoblastoma affecting the pelvic organs is described and the type of therapy outlined. 4. 4. A case of follicular lymphoblastoma is described with survival for 11 years. 5. 5. A case of lymphocytic leukemia with extension to the pelvis and the method of treatment utilized are outlined. 6. 6. A case of generalized Hodgkins disease and the type of therapy employed are contrasted with the localized Hodgkins disease. 7. 7. A patient in whom the diagnosis of malignant lymphoma was suspected on periodic pelvic examination is eited.

End results in adenocarcinoma of the endometrium managed by preoperative irradiation

Abstract 1. 1. Table XV presents a summary of the 5 year results in 297 patients seen during the 34 years, 1921 to 1954. 2. 2. Irradiation, especially with intrauterine radium, has played a prominent part in the therapy. In operable cases it has been used primarily to devitalize the carcinoma and thereby prevent manipulative spread and local recurrence. 3. 3. The preferred method of treatment has been intrauterine radium followed in 6 weeks by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Sixty per cent of the patients were treated by less satisfactory methods, usually because the carcinoma was advanced or the patient was a poor operative risk.

Variables in the diagnosis and management of vulvar carcinoma as observed by the Philadelphia Committee for the Study of Pelvic Cancer

Abstract 1. 1. The diagnosis and management of 131 patients with proved vulvar carcinoma, in twenty Philadelphia hospitals, are reviewed. 2. 2. The patients were predominantly white (71.55 per cent) and the aver-age age was 53.5 years. The series was about equally divided between nulliparous and parous patients. 3. 3. The most common symptoms were pruritus, presence of a lump, bleeding, and urinary symptoms. 4. 4. There was a total patient delay of 66.41 per cent with an average delay of 2.35 years. Procrastination as a cause of patient delay is emphasized. 5. 5. The total physician-institution delay was 52.67 per cent with an aver-age of 1.2 years. In 12 cases more than one physician was involved in delay. 6. 6. Failure to examine the patient was the most common cause of physician delay. 7. 7. Improper diagnosis was the next most common cause of physician delay. 8. 8. Sixteen different types of treatment, or treatment combinations, were employed in the 127 patients who were treated. 9. 9. Radical vulvectomy with node dissection was most frequently used. followed by radical vulvectomy alone, and then by x-ray therapy. 10. 10. Twenty-two patients had other surgery at the time of their operation for vulvar carcinoma. 11. 11. Fifty-seven patients observed five or more years had a survival rate of 47.37 per cent. The patients who had been treated by radical vulvectomy and bilateral groin dissection had a five-year survival rate of 78.94 per cent in spite of the delay in diagnosis. 12. 12. The most important factor bringing about a favorable five-year survival rate is the type of therapy rather than the delay involved. 13. 13. The type of treatment employed depends more upon the plan of the physicians in charge of the case than on the stage of the disease.

Carcinoma of the vesicovaginal septum; case report.

Abstract 1. 1. A case history is presented of a 52-year-old patient with a carcinoma of the vesicovaginal septum and no readily evident source of the primary tumor. Treatment by supervoltage irradiation is described. 2. 2. Possible points of origin, from the embryological standpoint, are mentioned. 3. 3. The necessity of complete pelvic exenteration or postmortem examination for final determination of the site of origin of the primary tumor is stressed.

Rupture of the mid-colic artery (abdominal apoplexy) producing signs of pelvic hemorrhage.

Abstract 1. 1. A case is reported of abdominal apoplexy due to rupture of the mid-colic artery in a 45-year-old woman. The signs and symptoms suggested intra-abdominal bleeding of pelvic orgin. The patient was operated upon, the bleeding source ligated, and recovery was uneventful. 2. 2. The 38 previously reported cases are discussed briefly. 3. 3. An operative mortality of 29 per cent in the previously reported cases is stressed. 4. 4. A history of crampy generalized abdominal pain with signs of intraperitoneal hemorrhage without localization, particularly in the older hypertensive patient, should lead one to suspect abdominal apoplexy. 5. 5. The management is ligation of the bleeding blood vessel and bowel resection if indicated.

Vaginal calculus not due to urinary leakage or foreign body

Abstract Vaginal calculus is a rare condition. The cases that have been mentioned in the literature were thought to be caused by vaginal cysts, calcified fibroid tumors, or urinary leakage into the vagina. One case (Reeb 3 ) was thought to be due to calcification of mucous cells. A case of vaginal calculus is reported apparently caused by stagnation of the menstrual flow due to an almost imperforate hymen and an apparent congenital stenosis at the midportion of the vagina.