Marian Waxman

Prognostic factors in malignant mesodermal (mullerian) mixed tumors of the uterus.

Clinicopathologic studies of 16 homologous and 19 heterologous malignant mesodermal (Mullerian) mixed tumors of the corpora uteri showed that homologous tumors were more common in black women than in white women; in the former, tumors were diagnosed at a younger age and in more advanced stages than in the latter. Fifty-five percent of women with clinical stage I disease had a higher surgicopathologic stage. The most significant prognostic factors were pathologic extent of disease and vascular invasion in the myometrium. There was no difference in outcome between homologous and heterologous tumors. Initial surgery for staging is essential for the adequate evaluation and treatment of these patients.

Malignant germ cell tumor in situ in a cryptorchid testis

A case of a malignant undifferentiated germ cell tumor in situ of an undescended testis diagnosed by needle biopsy is described. Four similar cases have been so far recorded in the literature, all of them in the infertile men with normally descended testes. Two of them developed embryonal carcinoma of testis 4 1/2 later and one had a concomitant seminoma. In a high‐risk group of patients (atrophic testis, cryptorchidism), a needle biopsy of a testicle may discover malignancy in its very early phase of development (Stage 0), at which time an orchiectomy alone may be a curative treatment.

Fatal hemorrhage from rectal varices. Report of two cases.

We report two cirrhotic patients who succumbed to massive rectal bleeding. The source of this hemorrhage remained undiscovered clinically despite endoscopy, a bleeding scan, and celiac angiogram in one patient. Autopsy revealed that the source of the bleeding was rectal varices in both cases.

Testicular atrophy in homosexual AIDS patients: An immune-mediated phenomenon?

An immunopathologic analysis of the testes of 20 homosexual acquired immune deficiency syndrome (AIDS) patients was performed to investigate the hypothesis that the testicular atrophy of these patients represents an immune-mediated process. The findings were compared to those in a control group of heterosexual men without AIDS. The testes of the homosexual AIDS patients showed an overall lower degree of spermatogenesis with more prominent interstitial inflammation and thickening of the tubular basement membrane. However, direct immunofluorescence and immunoperoxidase studies failed to demonstrate significant differences in the prevalence of immune complex deposits along the tubular basement membrane in the two study groups. No electron-dense deposits were demonstrated in cases examined ultrastructurally. Therefore, this study does not support the hypothesis that the testicular atrophy of homosexual AIDS patients is a manifestation of autoimmune orchitis. Further studies are needed to elucidate the pathogenesis of the testicular atrophy in AIDS, as this appears to be a specific manifestation of the disease.

The significance of residual disease after radiotherapy in endometrial carcinoma: Clinicopathologic correlation

The extent and location of residual disease after radiotherapy in 91 patients with early invasive endometrial carcinoma was related to tumor grade, clinical stage, and outcome. In 20% the grade (according to the International Federation of Gynecology and Obstetrics) differed in curettage and hysterectomy specimens. In at least 12% the clinical stage was unreliable. Death from endometrial carcinoma was significantly more frequent in patients with residual disease after radiotherapy than in those without residual disease. The poorest prognostic features were blood vesel invasion in the myometrium, irrespective of depth of invasion, and residual disease outside the uterus. Treatment of endometrial carcinoma should be based on accurate knowledge or prognostic features determined by initial surgery.

Ovarian low‐grade stromal sarcoma with thecomatous features. A critical reappraisal of the so‐called “Malignant Thecoma”

A case of low‐grade ovarian stromal sarcoma in a postmenopausal woman is described. Although pelvic recurrences of the tumor followed 5 and 7 years after the original surgery, the patient has remained well and without evidence of tumor 3 years since the last operation. Histopathologic, electronmicroscopic, and hormonal studies are described. There was evidence of estrogenic stimulation by the theca elements of the tumor in this patient. Cases previously reported in the world literature as malignant thecoma were analyzed, and most of them were considered inadequately documented; indeed most of them were probably either sarcomatoid granulosa cell tumors, stromal sarcomas, or fibrosarcomas. If a thecoma ever becomes malignant, the tumor cells dedifferentiate so that they cannot be recognized any longer as theca cells; instead, they proliferate as a stromal sarcoma or fibrosarcoma. It is proposed, therefore, that the term “malignant thecoma” not be used. On the other hand, very rare malignant ovarian stromal tumors do exist, consisting of undifferentiated stromal cells, fibroblasts, and theca cells, which can show evidence of hormonal activity.

Radiological manifestations ofStrongyloides stercoralis

Nine patients with radiological changes due toStrongyloides stercoralis (SS) are described. A wide variation in appearance exists ranging from mild edema of the duodenal and small bowel mucosa to grossly enlarged, prominent valvulae conniventes. Small bowel dilatation is significant, and in overwhelming infestation toxic dilatation with paresis results. Spasm, ulceration, and stricture are encountered in addition. The appearances usually improve and reverse with treatment. Ampullary involvement is responsible for reflux of barium into the pancreatic duct and biliary tree through a patulous sphincter. In 1 patient the colonic changes resembled ulcerative colitis.

Primary carcinoma of the duodenum producing a malignant duodenocolic fistula.

SummaryA unique case of primary duodenal carcinoma with a malignant duodenocolic fistula is reported.En-bloc resection of the lesion with pancreatico-duodenectomy and right hemicolectomy resulted in a 15-month disease-free interval.

Colonic necrosis complicating pancreatitis.

Bowel necrosis is an uncommon complication of pancreatitis. Two patients are reported who developed ileocecal and descending colon changes as a result of ischemia following severe pancreatitis. Arteriography in one patient confirmed the presence of intraluminal thrombi.

Leiomyoma of the fallopian tube: a cause of tubal pregnancy.

nal bleeding, and where the uterine size is larger than expected for an ectopic. In both cases presented, the diagnosis could have been made by preoperative ultrasonic examination. With the increased availability of diagnostic ultrasound, I suggest that all such patients receive such scans as part of their routine workup, in addition to postoperative monitoring of serum HCG levels, which is useful in those early cases where the results of the intrauterine scan can be inconclusive.