John R. Carter

Bone metastasis from gynecologic carcinomas: A clinicopathologic study

Between 1948 and 1984, autopsies were performed on 305 patients with primary carcinomas of the cervix, endometrium, ovaries, fallopian tubes, vulva, and vagina. Skeletal metastases were detected premortem and at autopsy in 49 cases (16.1%): cervix, 20 (40.8%); endometrium, 17 (34.7%); ovary, 7 (14.3%); vulva, 4 (8.2%); fallopian tube, 1 (2%). There were no cases of osseous metastasis from vaginal carcinoma. The incidence and sites of metastasis from these gynecologic carcinomas were correlated with their clinical and histopathologic classifications. This clinicopathologic study, based on autopsy data, demonstrates that osseous metastases are not uncommon, are significantly greater than clinically appreciated, and correlate with advanced anatomic stage and histopathologic type and grade.

Osteogenic sarcoma: Malignant fibrous histiocytoma subtype

A distinctly different entity from the now well‐delineated malignant fibrous histiocytoma (MFH) of bone is the MFH histopathologic subtype of osteogenic sarcoma. Although uncommon, recently the authors have encountered six cases of this neoplasm, in each of which the soft tissue component was devoid of bone elements and was microscopically indistinguishable from MFH of bone or soft tissue. Neoplastic osteoid and woven bone were present in the osseous component of each tumor, however. Radiologically, the lesions generally were osteoblastic but focally osteolytic with features typical of osteogenic sarcoma. Pain was the most common presenting symptom. There was no age or sex predilection. Immunocytochemical staining showed strong positivity with alpha‐1‐antichymotrypsin within malignant bizarre giant cells and occasional neoplastic osteoblasts in five cases. The biological behavior followed a very aggressive course. Four of the six patients developed pulmonary metastases 6 to 12 months after initial surgery; one patient presented initially with pulmonary metastases. Adequate tumor sampling as well as optimal correlation with clinical and radiographic information are required to distinguish the MFH subtype of osteogenic sarcoma from MFH of bone, both being high‐grade neoplasms, however.

Misdiagnosis of bronchogenic carcinoma. The role of cigarette smoking, surveillance bias, and other factors

The effects of cigarette smoking and other factors on the accuracy of clinical diagnosis of bronchogenic carcinoma were studied retrospectively in 14,074 autopsies performed over 26 years (1948–1973) at University Hospitals of Cleveland. Within a selected study group of 415 cases diagnosed as bronchogenic carcinoma either clinically, at autopsy, or both, the disease was diagnosed accurately in 260 cases (63%), overdiagnosed in 38 cases (9%), and underdiagnosed in 117 cases (28%). Misdiagnoses occurred in female patients nearly twice as frequently as in male patients. Elderly men were over‐and underdiagnosed more frequently than were young men. An accurate diagnosis of this neoplasm was strongly associated with a history of smoking and was also related to the number of hospital admissions, the diagnostic procedures used, and surveillance bias associated with a history of smoking or coughing. In 88% of the misdiagnosed cases, the tumor was either simulated or masked by other diseases. It is estimated from these data that the rate of unavoidable clinical misdiagnosis of the disease is 32% and the true error (overt misjudgment) in clinical diagnosis, 5%. Previous estimates of causal association between smoking and lung cancer would not be affected by the findings of this study. Cancer 46:190–199, 1980.