Robert V. P. Hutter

Lobular carcinoma in situ. Long term follow-up

Current follow‐up information is presented on a unique group of 46 patients first diagnosed as having lobular carcinoma in situ during the period 1940‐1952 and observed from 4 to 27 years. Six patients each had radical mastectomy; the remaining 40 had no treatment after a diagnostic biopsy. Subsequent cancers developed in 33% (15/46) patients. The 15 patients developed 20 cancers; an incidence of 13% (6/46) bilaterality. Seventy‐five percent (15/20) of the cancers were infiltrating. Two patients (4%) are dead from metastatic breast cancer; 2 others (4%) are living with metastases. Only half of the 20 cancers appeared in die first decade and the remaining half appeared up to 22 years after the original diagnosis of lobular carcinoma in situ. The evidence continues to accrue proving that lobular carcinoma in situ is a preinvasive form of breast cancer which should be treated by modified radical mastectomy.

Primitive multipotential primary sarcoma of bone

This report analyzes 25 tumors designated “primitive multipotential primary sarcoma of bone.” The lesions were most common (60%) in the second and third decade and were distributed equally between males and females. Anatomically they occurred in long or flat bones; the most common site was the femur. Roentgenographically the lesions were nonspecific. Pathologically there were 10 types of histologic differentiation in addition to a basic undifferentiated pattern.

Papilloma of the urinary bladder

This is a survey of 125 patients with bladder papilloma with particular attention to the later development of unequivocal bladder carcinoma. The following conclusions were reached: conservative management for benign papilloma is justified, but close follow‐up is essential; cancer of sites other than bladder and ureter occurs with increased frequency after or concomitant with bladder papilloma; and the development of bladder carcinoma in the patient with prior bladder papilloma is a definite risk and warrants aggressive treatment.

Clinical and pathologic correlation with mammographic findings in lobular carcinoma in situ

The authors review the records of 61 patients who had clinical mammographic examination and histologic lobular carcinoma in situ in at least one breast. An analysis was done to determine the tissue counterpart of positive mammographic findings as well as the accuracy and usefulness of mammography as an adjunct in the diagnosis of in situ lobular carcinoma.

An Analysis of Thirty Patients Surviving Longer than Ten Years after Treatment for Osteogenic Sarcoma

An analysis of the clinicopathological features of thirty long-term survivors of osteogenic sarcoma has been presented. We could not identify any specific features which would separate these patients from non-survivors of osteogenic sarcoma. The one common feature shared by all thirty patients was that amputation was the only effective therapeutic method in eradicating the primary disease.

Spindle and giant cell metaplasia in papillary carcinoma of the thyroid

Abstract The preceding discussion serves to re-emphasize that metaplasia to a highly lethal form of thyroid cancer can occur in the usually indolent papillary thyroid cancer. When this happens, these patients usually have the ominous signs previously elucidated. There is recent rapid growth in the thyroid or neck nodes, a large (over 5 cm.) tumor, and recurrent laryngeal nerve palsy. However, these signs are not always present. Furthermore, metaplasia may not be manifest in the first material examined histologically. There may be a long interval from the initial treatment to the appearance of large areas of metaplasia (twelve and ten years in two of these cases). Metaplasia may be present in either or both the primary tumor, cervical, or other metastases. Its absence in the primary lesion does not preclude its appearance in subsequent metastases. This was demonstrated in two patients in this review. There was metaplasia in a submental node in one (case IV) and an axillary node in the other (case V) with no evidence of metaplasia in the primary lesion in either. Once spindle or giant cell metaplasia is evident in large amounts, the prognosis is grave; the average time until death is five months.

A clinicopathologic study of atypical lesions of the breast

Following the detection of non‐infiltrating cancer, there have been more extensive microscopic studies for various atypical lesions of the breast. At Memorial Hospital, 296 patients with these lesions were seen during the period 1960 to 1972. These lesions were found more often in middle aged women than is the case in average cancer patients, commonly seen in nulliparous women, in patients in whom breast cancer was found in the opposite breast, and in patients with a history of breast cancer in the family. The clinical and mammographic findings are quite similar to those in non‐infiltrating cancer. Occasionally, these lesions are quite difficult to distinguish from minimal breast cancer by histologic examination. In this study, the cumulative risk of breast cancer was approximately 4‐5% at 30 months and 9% at 48 months.

Parosteal fascitis. A self-limited benign process that simulates a malignant neoplasm.

Abstract 1. 1. Parosteal fasciitis is a self-limited benign process that may simulate a malignant neoplasm clinically, radiographically and pathologically. 2. 2. The salient features of four cases of parosteal fasciitis have been described in an effort to focus attention on its occurrence and, thereby, obviate the serious results of misdiagnosis.

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 problem of multiple lesions of the breast.

The concept of multicentricity of cancer of the breast is not new; however, reinvestigation of its prevalence is now necessary because of the currently wider recognition of noninfiltrating and minute cancers. A technique is described for whole organ studies correlating radiographic, subgross, and microscopic findings. Comparative studies of surgical specimens and autopsy specimens are in progress. If minimal and multicentric lesions are found to be as prevalent in autopsy specimens as in surgical specimens this would indicate either low expressivity or long latency for the development of clinical infiltrating cancers. However, if there is a significant difference in incidence of minimal lesions in autopsy specimens compared with surgical specimens, this finding would provide great incentive to develop screening programs to find and treat patients with these early lesions.