Malcolm B. Dockerty

Primary squamous cell carcinoma and adenoacanthoma of the colon

Squamous cell carcinoma and adenoacanthoma rarely occur in the colon or upper rectum and are seen 0.05% as frequently as adenocarcinoma. At the Mavo Clinic, 20 patients with these lesions were seen during a 60‐year period. The most plausible explanation for the occurrence of these lesions is that glandular epithelioma is destroyed by deleterious influences and replaced by proliferation of basal cells which, with repeated destruction, undergo anaplasia and loss of ability to redifferentiate normally. The surgical treatment of these tumors is the same as that for adenocarcinoma. The 5‐year survival rate for patients with adenoacanthoma and squamous cell epithelioma is 30%, compared to 50% for patients with glandular cancers.

The natural history of carcinoma of the colon and rectum

Abstract Review was made of 583 cases of adenocarcinoma of the colon or rectum in which no treatment or only palliative treatment (exclusive of radiation) was given. The average survival time from diagnosis of incurable disease to death was 9.8 months. Longer survivals were observed in females, in patients with low-grade malignancy and in cases with only local spread of the carcinoma. There was little correlation with duration of symptoms prior to diagnosis or time elapsed before recurrence, with age of the patient at the time of diagnosis or with location of the primary tumor. Shorter survivals were seen in patients who had chronic ulcerative colitis with secondary malignancy.

Carcinoma of the Extrahepatic Bile Ducts* A Clinicopathologic Study

Abstract Seventy-eight cases of carcinoma of the extrahepatic bile ducts were reviewed, including seven diagnosed at autopsy. Diabetes mellitus was associated in 10 per cent. Jaundice and pain were presenting complaints in 62 and 58 per cent, respectively. The serum bilirubin value was generally in accord with obstructive jaundice, and usually the serum alkaline phosphatase value had the same trend. Seventy-three patients underwent surgery at the Mayo Clinic, but in 59 per cent it was only exploratory or palliative. At operation, involvement had reached beyond the primary site in 71 per cent. Lithiasis was associated in only 18 per cent. Radical pancreatoduodenectomy in five traced cases resulted in two relatively long survivals. Complete follow-up information was obtained in sixty-seven cases, of which sixty-two were surgical. Average survival after surgery was 11.4 months. Three year survival was 8.1 per cent, and five year survival 1.6 per cent.

Diffuse infiltrating scirrhous carcinoma of the breast. Special consideration of the single‐filing phenomenon

The phenomenon of single filing in carcinoma of the breast was demonstrated in 140 (3.2%) of 4320 patients seen at the Mayo Clinic between 1943 and 1957. The age distribution, symptoms and signs, gross pathologic findings and size of the tumors did not show different features from mammary carcinoma in general. Bilaterality was present in 15 patients (11%), which is a higher rate than in mammary carcinoma in general. Regional lymph nodes were metastatically involved in 51% of the group. Single filing is formed by desmoplastic strands of mostly medium‐sized cells followed in frequency by small and large cells. Mitotic figures are rare. Single filing was found in connection with infiltrating or noninfiltrating lobular carcinomas in 21.2% and with areas of intraductal carcinomas in 36%. The prognostic outlook for patients without lymph node involvement is somewhat similar to that of patients having carcinoma of the breast in general; that for patients with positive lymph nodes is poor, with a 9% chance of 10‐year survival.

Papillomas (so-called) in the non-calculous gallbladder

Abstract Seventy cases of benign intraluminal lesion occurring in noncalculous gallbladders are reported. The type most commonly encountered was the cholesterol polyp, of which there were forty-three cases (62 per cent). The adenomatous polyp was the most rare (three cases, or 4 per cent) and is thought to be the only type capable of becoming malignant. No evidence of transition from the more common types of lesion into true neoplastic adenoma was found. It appears that so-called papillomas of the gallbladder are rarely malignant or premalignant in the absence of gallstones.