John S. Lewis

Esthesioneuroblastoma: A clinical and pathological study

Abstract Esthesioneuroblastoma is a rare and peculiar low grade malignant neurogenic tumor of the olfactory region that occasionally metastasizes (14 per cent). A single series of eighteen cases is added to the previous sixty-one in the literature, permitting a comparative analysis of seventy-nine cases. The tumor is most common in the second decade, and somewhat more common in male subjects than female subjects. Symptoms are nonspecific and are usually those of nasal obstruction and epistaxis. Histologically the tumors are composed of neuroblasts and neurocytes; in addition, neurofibrils, pseudorosettes, and rarely true neuroepithelial rosettes may be present. The over-all survival in this series of eighteen is 50 per cent. Although the five year survival is 50 per cent, five of nine patients surviving five years subsequently died. Only one of nine surviving patients is thought to be completely free of disease, although seven others are clinically quiescent. Multiple recurrences over a long period of time is the usual course. Neither radical surgery nor irradiation has been completely effective in the management of the disease. The esthesioneuroblastoma appears to be the only neuroblastic tumor occurring in the region of the olfactory mucosa. The histologic appearance is quite characteristic when the lesion is small and within the mucous membrane. However, when large and invasive it is not readily distinguished from neuroblastomas of other sites. Nevertheless, the 50 per cent, five year survival and slow local growth is different from other neuroblastomas that range closer to a 10 per cent, five year survival and disseminate widely. There does not appear to be any useful histologic guide in prognosis. Tumors with true rosettes have not as yet metastasized, but there have been very few of these. The tumors that did metastasize were not strikingly different histologically from many that did not.

The upper urinary tract during normal pregnancy

Abstract 1. 1. Dilatation of the upper urinary tract accompanies normal pregnancy as a result of mechanical pressure exerted by the pregnant uterus on the ureters as they cross the pelvic brim. 2. 2. The position of the fetus or the number of pregnancies does not influence the degree of dilatation. 3. 3. The period of gestation, due to the size and position of the uterus, influences the degree of dilatation to some extent, the greater degrees of dilatation occurring during the sixth, seventh and eighth months of pregnancy. 4. 4. Right-sided preponderance is due to the protection of the left ureter by the sigmoid, plus the added pressure on the right as a result of the forward thrust exerted by the sigmoid on the left side of the uterus. 5. 5. Uniform fibromas of the uterus and ovarian cysts produce the same phenomenon.

Multiple Urograms: An Aid in Urological Diagnosis

WITH the growth of work in urographic diagnosis many short comings in our methods have become increasingly noticeable. Our roentgen and other medical journals contain innumerable articles which deal with pathologic function in the other tracts of the body, notably the gastro-intestinal tract. From the roentgenologic aspect, there is a marked paucity of work dealing with pathologic function of the urinary tract. The work published along this line is largely of an experimental nature and carries little significance to those of us doing routine work in a situation in which experimental work is almost out of the question. It has seemed to the writers that, in urology, we, as roentgenologists, were content to drift easily along the lines of least resistance. In other fields we have dared to create, and actually have created, an ever-growing field of usefulness. A great amount of our information in medicine has come through our study and interpretation of the pathologic function. In this field roentgenologic me...