Murray R. Abell

Ovarian neoplasms in childhood and adolescence

Abstract Seventy-five (40 per cent) of primary ovarian neoplasms in patients under 20 years of age were considered to be of non-germ cell origin. The majority of lesions in this group (53) arose from the coelomic epithelium or its derivatives and all were unilateral. Thirty-four of these were of serous cell type and 19 were of mucinous cell type; none were of endometrial cell type. Although the youngest patient of this group was 11 years of age, no patient was premenarchial. Four cystadenomatous lesions were considered histologically to have malignant areas; 2 patients are alive and well 6 years and 18 months after diagnosis; one patient died of metastatic disease after 13 months and the fourth patient had metastases at the time of diagnosis and although no survival information is available must be presumed dead. Eight neoplasms were of nonspecialized gonadal stromal origin; 3 benign fibromas, 3 supportive tissue sarcomas, and 2 lymphoblastomas that were histologically identical with lesions of so-called African lymphoma. Fourteen neoplasms were derived from specialized gonadal stromal elements; 3 were granulosa cell tumors, 3 were thecomas, 2 were mixtures of granulosa and theca cells, 3 were Sertoli cell tumors, and 3 were Sertoli-Leydig cell tumors (arrhenoblastomas). None of the granulosa-theca cell group of neoplasms occurred before puberty. One granulosa cell tumor behaved in a malignant manner, metastasizing and causing death. The 3 Sertoli cell neoplasms occurred in girls 3, 7, and 8 years of age, and 2 were associated with precocious development. The 3 arrhenoblastomas, occurring after puberty, produced masculinizing effects. None of the Sertoli-Leydig cell groups of neoplasms behaved in a malignant manner.

Carcinosarcoma of the urinary bladder

Six examples of carcinosarcoma of urinary bladder consisting of intimate mixtures of carcinomatous and sarcomatous tissues are reported. Five patients were men, 43 to 79 years of age, and one was a 71‐year‐old woman. Two neoplasms were collision tumors and consisted of leiomyosarcoma and transitional cell carcinoma with squamous and glandular foci in one. Four neoplasms were considered to be composition tumors originating from the mucosa and characterized by heterologous sarcoma. Carcinosarcomas of urinary bladder tend to be large, bulky, intraluminal tumors that grow rapidly and infiltrate widely. Irrespective of their histogenesis, the prognosis is poor, with 5 of 6 patients in this series dying of recurrent and/or metastatic disease within 33 months of diagnosis.

Gland cell carcinoma (adenocarcinoma) of the uterine cervix

Abstract 1. 1. Biopsies of uterine cervices during a period of approximately 22 years revealed 237 gland cell carcinomas; 127 (53.6 per cent) were primary in the cervix arising from glands or surface epithelium or both. 2. 2. The majority (30.8 per cent) of secondary carcinomas represented extension from the endometrium. Other primary sites were, in order of decreasing frequency, the ovary, colon and rectum, breast, and urinary tract. 3. 3. Ten examples of noninfiltrative gland cell carcinoma were encountered. Three of these represented in situ change in endocervical glands and in one instance there was also a squamous cell carcinoma in situ. Seven lesions consisted of carcinomatous change in endocervical polyps without infiltration of the cervix proper. 4. 4. The primary infiltrative gland cell carcinomas (110 cases) comprised 5.5 per cent of all infiltrative carcinomas arising in the uterine cervix. 5. 5. The average age of the patients with infiltrative gland cell carcinoma of the cervix was 53 years, with a range of 21 to 76 years. The average age for squamous cell carcinoma was 47 years and for gland cell carcinoma of the endometrium 59 years. 6. 6. The gestational histories of patients with primary gland cell carcinoma of the cervix were more closely allied to those of patients with endometrial carcinoma than to those with squamous cell carcinoma. The symptoms resembled those for squamous cell carcinoma but the duration of symptoms was appreciably longer. 7. 7. Structural and cytologic features permitted the recognition of distinctive patterns of growth in gland cell carcinoma of the cervix: adeniform, medullary, muciferous, papillary, acanthoid, and scirrhous. Two carcinomas in young women were of mesonephric origin. 8. 8. In situ change at the margins of infiltrative carcinomas was an important criterion in assigning origin to the cervix and was found in 43 per cent of cases. 9. 9. The majority of patients with gland cell carcinoma of the cervix were treated with radiation in a manner employed for squamous cell carcinoma of the cervix. The over-all 5 year survival rate for gland cell carcinoma was 29.9 per cent as compared with 40.1 per cent for squamous cell carcinoma and 54.3 per cent for gland cell carcinoma of the endometrium. 10. 10. A definite correlation was found between histologic pattern of growth and survival. The best results occurred with papillary carcinoma (57 per cent), followed by adeniform (30 per cent), muciferous (20 per cent), and medullary (14 per cent). The poorest prognoses were observed for acanthoadenocarcinoma (9 per cent) and scirrhous type (0 per cent). 11. 11. In 7 patients with primary infiltrative gland cell carcinoma of the cervix, there were second separate and distinct carcinomas in the uterus; 5 patients had infiltrative squamous cell carcinoma of the cervix and 2 had gland cell carcinoma of the endometrium. Six of these were synchronous and one metachronous.

Testicular and paratesticular neoplasms in patients 60 years of age and older

Testicular and paratesticular neoplasms from 50 patients 60 years of age or older were assessed with respect to histologic type, clinical findings and outcome. Neoplasms of germ cell origin comprised 24% of the series; there were ten seminomas and two teratocarcinomas. The seminomas were palpable many months before diagnosis and were larger than the other neoplasms. Only two deaths could be attributed to their dissemination. Both teratocarcinomas metastasized and caused death. There were five gonadal stromal neoplasms (10%), one Sertoli cell tumor, three interstitial cell tumors and one undifferentiated stromal tumor. None of the neoplasms recurred or metastasized. Eleven neoplasms (22%) were of supportive tissue or paratesticular origin and six of these arose from muscle—one leiomyoma, two leiomyosarcomas and three rhabdomyo‐sarcomas. The other tumors were two malignant mesotheliomas, one fibroma, one fibrosarcoma and one carcinoma of the epididymis. The lymphoreticular neoplasms were the most common lesion in this series and presented as primary testicular tumors in 22 patients (44%). In five patients asynchronous tumors appeared in the other testes. All but two neoplasms were reticulum cell sarcomas. All patients for whom survival information was available died with disseminated disease.

Sarcomas and carcinosarcomas of the uterine cervix

The clinical findings, pathologic characteristics, and end results of 26 primary sarcomas and carcinosarcomas of uterine cervix, excluding malignant lymphomas, embryonal rhabdomyosarcomas of infancy and childhood, and four sarcomas that could not be definitely classified as to cell type, are presented. Eight neoplasms occurring in patients 31 to 61 years of age were leiomyosarcomas. Six of these patients died with massive pelvic recurrences and/or distant metastases irrespective of type of treatment within 2 years. Two patients are alive and free of disease 6 and 10 years after surgical excisions. Six patients whose age averaged 61 years had carcinosarcomas, and all succumbed to recurrent and metastatic disease within 15 months of diagnosis. In three patients, the sarcomatous component was homologous and in the other three heterologous. One neoplasm had, in addition to adenocarcinoma and squamous carcinoma, areas of adenocystic carcinoma. Twelve endocervical stromal sarcomas in patients averaging 54 years of age comprised the largest group in the series. The better differentiated neoplasms tended to remain localized and to have a better prognosis than the more poorly differentiated lesions which pursued aggressive courses. Four patients are alive and free of disease 2, 3, 11, and 18 years after surgical excisions and a fifth died of other causes after 16 years. Six patients died of recurrent and metastatic disease 2 to 24 months after diagnosis. At the present time, surgical removal of uterus and, when indicated, contiguous tissues and viscera offers the best hope of cure for cervical sarcomas and carcinosarcomas.

Soft tissue sarcomas of vulva

Abstract Fifteen cases of vulvar sarcomas were studied. The most common neoplasm was leiomyosarcoma, which also had the least favorable prognosis with a tendency to develop local recurrences and disseminated hematogenous metastases. The second most frequent sarcoma belonged to the fibrous histiocytoma group. Although they are unpredictable, they tended to be less aggressive than the leiomysarcomas. Other sarcomas encountered were fibrosarcoma, hemangiosarcoma, malignant hemangiopericytoma, epithelioid sarcoma, neurogenous sarcoma, malignant mesothelioma, and embryonal stromal sarcoma. Local recurrences were common in the series due in part to inadequate initial treatment. It was evident from the study that wide local excision or radical vulvectomy early in the disease with bilateral lymph node resection for those sarcomas that have a potential for lymphogenous metastases is the treatment of choice and gives the most favorable results. In the presence of local recurrences, aggressive surgical treatment is indicated and increases the survival rate significantly.

Papillary adenofibroma of the uterine cervix

Abstract Three papillary tumors of the uterine cervix considered to be true fibromas of the substantia propria are described. Their clinical and histologic features are different from those of the usual endocervical mucosal polyp. The descriptive term papillary adenofibroma is used to avoid confusion with polypoid “fibroid” and fibrous polyp. There is no indication that the neoplasm has any tendency to sarcomatous change.

Carcinosarcoma of the ovary

Abstract Twenty-three cases of ovarian carcinosarcoma are assessed. Attention is given to clinical and pathologic characteristics as well as to treatment and survival information. Theories of pathogenesis and the importance of correct diagnosis are discussed. No evidence was found to support the theory that these neoplasms generally arise in areas of ovarian endometriosis. The patients were typically postmenopausal and had metastatic disease at the time of diagnosis. Unlike many other types of ovarian cancer, survival was extremely poor, irrespective of clinical stage or treatment modality.

Adenocystic (pseudoadenomatous) basal cell carcinoma of vestibular glands of vulva

Abstract Four examples of adenocystic (pseudoadenomatous) basal cell carcinoma of vestibular glands of vulva are reported. Three of these arose in the region of the Bartholin gland whereas the exact vulvar location of the fourth was not described but probably was from a major rather than a minor vestibular gland. The tumor is a histologic entiry and consists of small uniform basal cells with pseudoglandular and microcystic formations and usually considerable hyalinized acellular stroma. It pursues a slow insidious course, is prone to local recurrence and perineural spread, and has the ability to metastasize by vascular channels. The neoplasm should not be likened to mixed tumor of the salivary gland or confused with basal cell carcinoma of the skin, or adenocarcinoma of the vestibular glands.

Radiologic evaluation of soft tissue tumors. A retrospective study

The radiologists ability to evaluate soft tissue tumors is clearly limited. Features which have diagnostic significance include radiographic density, homogeneity, and alterations in the adjacent bone or adipose tissue. Relevant information is potentially available by plain film examination but requires technical excellence with special attention to soft tissue detail and choice of projections. The role of special techniques, including angiography, is discussed, and the results of a “blind” retrospective evaluation of the roentgenograms in 60 histologically verified neoplasms are presented.