Kathryn P. Clausen

Carcinoma in a Colon Conduit Urinary Diversion

In recent years urinary diversion by means of the colon conduit has gained popularity because of the failure to exhibit reflux and the lower incidence of stomal stenosis. However, colon conduit diversion may be associated with adenocarcinoma, as is ureterosigmoidostomy. We report the first occurrence of adenocarcinoma in a colon conduit and, perhaps more important, in a colon conduit in which there had never been a fecal stream.

Fibrolamellar carcinoma of the liver. Review of three cases and the presentation of a characteristic set of tumor markers defining this tumor.

This study demonstrates the unique clinical and histologic aspects of fibrolamellar hepatic carcinoma, a rare variant of hepatocellular carcinoma. Three cases are reviewed and an extensive study of immunologic and intracellular substances defining this tumor is presented. Length of survival was considerably longer than typical hepatoma. The cause of death generally is due to a lack of control of the primary tumor. Successful treatment appears to relate to the ability to perform a total excision of the primary hepatic tumor. Chemotherapy should be used only in the presence of metastatic disease. Surgical resection of metastatic disease, unlike the usual hepatocarcinoma, may have some beneficial use. Fibrinogen was found in all tumors. It is possible that this tumor produces fibrinogen to create its unique histologic appearance. Carcinoembryonic antigen is described for the first time in this tumor. Both deposits of alpha-1 antitrypsin and copper were found in most of the tissues studied. The presence and amounts of these substances differ markedly from the common type of hepatoma. This unique composition of intracellular components may both facilitate histologic diagnosis, particularly if the amount of tissue is limited, and give further insight into the etiology of this tumor.

Chronic and recurrent appendicitis

Acute appendicitis is a well known clinical entity, but many physicians are unwilling to accept appendicitis as a chronic or recurrent illness. Of 225 patients undergoing appendectomy, sixteen (7 per cent) had findings suggestive of chronic, recurrent, or subacute appendicitis. Four patients had chronic abdominal pain and histologic findings of chronic inflammation. Nine patients had previous episodes similar to that which resulted in appendectomy. All had acute suppurative appendicitis pathologically. Three patients had only one episode of abdominal pain, but had pathologic evidence of subacute inflammation. Because this study was retrospective, we suspect that the true incidence of recurrent appendicitis is significantly greater, as reported by others. Indications for operation must be strict, for unless there are specific signs and symptoms of appendiceal disease, appendectomy will often be of no benefit.

Primary adenocarcinoma of the middle ear.

Adenocarcinoma arising from the mucosa of the middle ear is a rare tumor. This report adds four new cases to the 13 cases that have been previously reported in the literature. These neoplasms tend to have a rather slow growth pattern and have an infrequent incidence of distant metastases. The observations that local recurrence is the major problem with adenocarcinoma of the middle ear suggest that aggressive locoregional treatment should be strongly considered.

The extent of primary melanoma excision. A re-evaluation--how wide is wide?

: A retrospective review of 118 clinical Stage I melanoma patients, including the re-examination of histologic slides in 57 cases, was performed to define factors important to survival. The majority (76.7%) had excision margins of 30 mm or less (range = 6-85 mm, mean--29.3 mm). The adjusted 5-year survival was 77.3%. Local recurrences within 5 cm of the primary closure scar developed in 3.4%. The recurrences occurred in patients with satellitosis (1), unrecognized subclinical Stage II disease (1), or as the first evidence of disseminated Stage III disease (2). Margins less than 20 mm were associated with an increased risk of dying if the tumor diameter was more than 10 mm (p = 0.0105) or if the depth of invasion was more than 2.0 mm (p = 0.0491). Increasing the margin to 25 mm improved survival. However, no further protection was evident for margins over 30 mm. For smaller and shallower lesions, no optimal margin could be identified. It appears that a 30 mm margin is adequate for large and deep clinical Stage I melanomas, and mortality and local recurrences are due to factors other than the extent of excision.

Atypical Sweat Duct Hyperplasia Accompanying Keratoacanthoma

25 cases of atypical sweat duct proliferation in association with cutaneous tumors are described. 20 of these were keratoacanthomas. The compression of the duct either in its dermal or intraepidermal portion is considered to be the etiology. Similar changes are seen with decubitus ulcer and stasis dermatitis. Atypical sweat duct hyperplasia may be useful as an extra aid in the differentiation of keratoacanthoma from well-differentiated squamous cell carcinoma.

An Unusual Presentation of Intrinsic Ureteral Obstruction Secondary to Carcinoma of the Prostate: A Case Report

We report on a patient with a known diagnosis of adenocarcinoma of the prostate who had acute renal failure. An excretory urogram showed bilateral ureteral obstruction and retrograde ureteral catheterization was attempted. Because the retrograde catheters could not be passed into the bladder percutaneous nephrostomies were placed immediately. Dissection of the right ureter showed complete intrinsic occlusion by a multinodular tumor, with no evidence of secondary extension at the ureterovesical junction on the right side or circumferential spread along the involved ureter.

Reticulosarcomatosis in primary myelofibrosis

A case of primary myelofibrosis complicated by the development of extramedullary myeloid tumors and terminating in diffuse reticulosarcomatosis is reported. The possible relationship of the latter to other myeloproliferative disorders is discussed. It is suggested that clinical consideration be given to this possibility when a patient with myeloproliferative disorder shows signs of a malignant tumor or lymphoma in the course of his disease.