J. Mason Hundley

Epidermoid carcinoma arising in a benign cystic teratoma: A report of 15 cases

Abstract 1. 1. Fifteen cases of epidermoid carcinoma arising in benign cystic teratomas are reported, each accompanied by a short case history and photomicrograph. 2. 2. This complication, reported in about 1 per cent of all benign cystic teratomas, may be found to occur more frequently when these cysts are submitted to careful pathological examination. 3. 3. The average age at the time of diagnosis was 50.6 years, with 71 per cent of the cases diagnosed after the fortieth year. 4. 4. There are no symptoms that are indicative of malignant degeneration until extension has occurred. 5. 5. In these cases the malignancy arose in 8 cysts on the right side, in 6 cases on the left, and in one case the side is unknown. In 2 instances the malignancy arose in one of bilateral cysts. 6. 6. The pathology of the malignancy is briefly discussed and a photomicrograph of a representative area in each case is presented. 7. 7. Emphasis is placed on the necessity for careful pathological examination of each cyst. One must never allow the apparent benignity of a cystic teratoma to cause a false sense of security for the cyst cannot be labeled benign until it is submitted to careful microscopic examination. 8. 8. At the present time the treatment of choice is total removal of the uterus and adnexa in all but the very rare case. 9. 9. In 7 cases either extension of the malignancy or rupture of the cyst was noted. Each of these patients succumbed to the disease in a short length of time. 10. 10. Four patients have survived for 5 or more years—a salvage of 30.8 per cent.

Bacteriological studies in salpingitis with special reference to gonococcal viability

Abstract A bacteriological survey, with special reference to the presence of the gonococcus, has been made on 80 patients. We wished to determine whether “flare-ups” of acute salpingitis were due to reinfections arising from dormant cells in the tubal wall or from infections existing in the urethra and cervix. No chemotherapy or antibiotics were used preoperatively in this series of cases. Of the patients operated upon, uterine myomas were present in 51 instances and there were varying degrees of salpingitis noted in 73. The bacteriological findings were as follows: positive gonococcal infections of the urethra and cervix, 41.25 per cent; Fallopian tubes showed 6.25 per cent positive. Every tubal infection was associated with infection of the cervix and urethra. The Fallopian tubes were sterile in 76.1 per cent; the cervix sterile in 2.5 per cent; and the urethra sterile in 3.75 per cent. Persistent viable gonococcal infection is a disease of the lower generative tract; the Fallopian tube is not a focal point for reinfection, reinfection coming from the cervix and Bartholins glands, most likely at the time of menstruation for at this period, and also at time of ovulation, the cervical mucus is penetrable. Our preliminary observations on pH determinations of the urethra, cervix, and tubes as yet have shown nothing conclusive in relationship to the longevity of the gonococcus. In general the readings have shown slight acidity, many nearly neutral, and a few showing alkalinity. In regard to tuberculous salpingitis, no evidence of tuberculosis was found in this bacteriological study. In a survey of 1,069 patients with tubal disease, the incidence of tuberculosis was only 1.7 per cent. This infrequent occurrence we feel is due to the great decline in pulmonary tuberculosis. Puerperal infections are also infrequent, being in the order of 3.8 per cent. In conclusion, we believe that gonococcal infection of the tubes is short-lived and repeated attacks of salpingitis are due to reinfection from the lower generative tract. We also feel it would not seem too speculative to believe that there will be a decreasing incidence of these infections, brought about by lay education, ever improving obstetrical practice, and above all by the use of chemotherapy and antibiotics.