Horatio T. Enterline

Lobular carcinoma in situ of the breast(Long‐term followup

Ninety‐eight women with lobular carcinoma in situ (LICS) of the breast were identified over a 16‐year period. Consecutive slide review of all breast material over a 12‐year period identified 25 women with LCIS on biopsy who did not undergo mastectomy. Only 1 woman (4%) in a complete followup averaging 17.5 years developed ipsilateral invasive carcinoma. of 32 women with a contralateral breast at risk, 3 (9.7%) developed infiltrating carcinoma. LCIS was found with infiltrating carcinoma, especially of the lobular (small cell) type, with such frequency as to indicate a close relationship. However, the risk of subsequent development of infiltrating carcinoma in the breast with biopsyproven LCIS is shown to be substantially less than indicated by previous authors. This suggests that careful and prolonged followup may suffice for the woman whose breast biopsy contains lobular carcinoma in situ.

Lymphangiomyoma, a benign lesion of chyliferous lymphatics synonymous with lymphangiopericytoma

Six cases are presented of an entity which previously had been described as lymphangiopericytoma, but which now are considered to be more correctly termed “lymphangiomyoma” An additional 14 cases from the literature are reviewed. The lesion, which shows a striking female sex predominance, often involves the thoracic duct, has an almost constant association with chylothorax and a frequent one with pulmonary disease consisting of lymphangiectasis, honeycombing with proliferation of smooth muscle and atypical lipid pneumonia, possibly of chylous origin. No lesion has metastasized to distant organs or invaded organs locally and the authors conclude that the lesion is best considered as a hamartoma, often of multifocal origin. A close relationship is noted between lymphangiomyoma and certain secondary lesions associated with tuberous sclerosis. The clinical course and response to therapy are described.

Clear-cell carcinoma of the ovary. A clinicopathologic analysis of pure and mixed forms and comparison with endometrioid carcinoma

A clinicopathologic analysis of 39 primary ovarian carcinomas wholly or partially composed of clear cells was carried out. The histologic concept of “clear cell” was redefined and the ratio of clear to nonclear cell components was evaluated in each case. The tumors were accordingly subdivided into “pure” (12 cases), “predominantly” (7 cases), and “focal” (20 cases) clear‐cell groups. The pathologic and clinical features of each group were then compared to each other. Follow‐up data were also compared with 45 patients with ovarian endometrioid carcinoma. Because of the frequent admixture and transitions of clear‐cell tumors with nonclear‐cell neoplasms of müllerian derivation, it was concluded that the clear‐cell tumors of the ovaries are most likely of müllerian rather than mesonephric origin. Cumulative survival figures in the various groups of clear‐cell carcinoma and in patients with endometrioid carcinoma were similar with a mean 5‐year survival of about 38%. The single most significant feature determining survival in all these patients was the extent of the neoplasm at time of surgery.

The macroscopic appearance of colorectal polyps.

The macroscopic (10 to 30 times magnification) surface features of 187 colonic lesions are described. The lesions were studied using a dissecting microscope and a 1% trypan blue solution as a contrast agent. Using five criteria, lesions were evaluated for the presence or absence of adenoma, the type of adenoma present, the presence of dysplasia or carcinoma‐in‐situ, and the presence of invasive carcinoma. The technique has proven to be a rapid, sensitive, and relatively specific means of separating tumors in the adenoma—carcinoma sequence from nonadenomatous lesions (sensitivity, 99%, specificity 90%). The technique is accurate in differentiating tubular, tubulovillous, and villous lesions. It is suggested that areas of dysplasia (sensitivity 100%, specificity 93%), carcinoma‐in‐situ, and microinvasive carcinoma may also be differentiated, but need further investigation.

Evaluation of 5′‐nucleotide phosphodiesterase isozyme‐V as a predictor for liver metastasis in breast cancer patients

5′‐nucleotide phosphodiesterase isozyme‐V (5′‐NPD‐V) was evaluated in 85 biopsy proven breast cancer patients as a potential marker for early liver metastasis. It correctly predicts liver metastasis in 6/7 (85.7%) patients with abnormal radiologic liver scan and 2/2 other patients with palpable liver. Serum glutamic‐oxaloacetic transaminase (SGOT), lactic dehydrogenase (LDH), alkaline phosphatase (AP) and total bilirubin (B) were also determined in 79 of these patients as routine liver function tests (LFT). Forty‐one out of 79 from this group had all four markers all within normal limits. Yet of the 41 patients, 12 patients were found positive for 5′‐NPD‐V. Of these 12, one was found to have liver metastasis at surgery and one had abnormal liver scan. Five other patients had liver dysfunction and one had been diagnosed as an alcoholic. Four others had no evidence of either liver problems or liver metastasis, but follow‐up data were lacking. This retrospective study, therefore, suggests that there is a definite advantage to include the 5′‐NPD‐V in the liver profile studies for breast cancer patients, although a positive 5′‐NPD‐V may only indicate liver repair or liver regeneration. Long‐term prospective studies of these tests with breast cancer patients should be worthwhile. No relation was found between 5′‐NPD‐V and axillary lymph node involvement or the estrogen receptor status of the excised tumor. Thus there is no evidence currently that the appearance of the 5′‐NPD‐V in serum is related to lymph node metastases or hormonal control.