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Biomedical subjects

A Talerman

Publications and source records attributed to A Talerman.

At least 91 records · Page 5Linked to original sources

Heterologous sarcomas of the uterus.

Three cases of heterologous sarcomas of the uterus are presented. Two were mixed tumors; one was a lipoleiomyosarcoma; and one was an osteogenic sarcoma with leiomyosarcoma. The third was a rhabdomyosarcoma. These tumors are believed to behave more aggressively than mixed mesodermal tumors. Six months after initial diagnosis, the lipolieomyosarcoma had metastasized to a vertebra. Following radiation therapy, the metastases recurred at the same site. The rhabdomyosarcoma of the uterus produced lung metastases 4 months following surgery, and the patient died 14 months after initial diagnosis despite extensive chemotherapy. The patient with osteogenic sarcoma of the uterus with leiomyosarcoma had been treated with Adriamycin and is alive and well 1 year following initial diagnosis. The histogenesis of these tumors is reviewed.

Aged

Serous surface papillary carcinoma of the ovary: a clinicopathologic study of 16 cases.

Sixteen cases of serous surface papillary carcinoma of the ovary are analyzed. The patients were 45 to 75 years of age. The most common presenting symptoms were malaise, weight loss, and abdominal enlargement. Ascites was a common finding on physical examination. Bilateral ovarian involvement was seen in all cases. Gross examination revealed tumor growing exophytically from the surfaces of the ovaries, with slight to moderate invasion of the underlying parenchyma. Microscopic examination showed serous papillary carcinoma. In most of the cases, tumor was widely disseminated throughout the abdominal cavity. It could not be determined with certainty whether the extraovarian tumor represented metastatic spread or synchronous tumor formation. The survival of the patients was shorter than that of patients with ovarian serous papillary carcinoma of the same grade without predominant surface involvement. The authors believe that the carcinoma in the ovary is a distinct subtype of serous papillary carcinoma of the ovary, rather than a primary carcinoma of the peritoneum with secondary ovarian involvement.

Aged

Gunnar Teilum.

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Denmark

Primary chondrosarcoma of the ovary.

A case of a large, completely excised left-sided primary ovarian chondrosarcoma occurring in a 61-year-old woman is described. There was no evidence of metastases. Histologically the tumour was a pure chondrosarcoma, which was mainly well differentiated. The patient is well and disease free at 4 years. Review of the literature revealed no other reported cases of pure chondrosarcoma of the ovary. The possible histogenetic origin of this neoplasm is discussed.

Chondrosarcoma

Endodermal sinus (yolk sac) tumor elements in testicular germ-cell tumors in adults: comparison of prospective and retrospective studies.

The incidence of endodermal sinus tumor (EST) or yolk sac tumor (YST) elements has been studied in two series of testicular germ-cell neoplasms in adults. One series, consisting of 200 germ-cell neoplasms seen from 1053 through 1968, was studied retrospectively, and the other, consisting of 147 cases seen from May 1974 through February 1979, was studied prospectively. Excluding the cases of pure seminoma, EST(YST) elements were found in 21 (28.7%) of 73 cases in the retrospective series and in 27 (44.4%) of 61 cases in the prospective series. The EST(YST) elements were in all cases admixed with other neoplastic germ-cell elements and varied from microscopic foci to being the predominant element within a tumor. The EST(YST) elements were histologically similar to infantile EST(YST) and EST(YST) in other locations. Serum alphafetoprotein (AFP) was determined in the majority of patients in the prospective series, and there was good correlation between the presence of EST(YST) elements within the tumor and elevated levels of AFP. The results of the present study indicate that EST(YST) elements occur quite frequently in testicular germ-cell neoplasms in adults and provide an explanation for the raised levels of serum AFP found in many adults with testicular germ-cell tumors. The results emphasize the importance of a thorough and careful pathologic examination of testicular germ-cell tumors, and the value of AFP as a tumor marker in patients with EST(YST). The results also lend further support to the view that EST(YST) elements found in testicular germ-cell tumors in adults are homologous with infantile EST(YST) and that EST(YST) is a distinctive and specific type of germ-cell neoplasm and should be included as such in the classification of testicular tumors.

Adolescent

Serum alphafetoprotein (AFP) in patients with germ cell tumors of the gonads and extragonadal sites: correlation between endodermal sinus (yolk sac) tumor and raised serum AFP.

During the last 6 1/2 years, serum AFP has been determined by radioimmunoassay in 387 patients with germ cell tumors of the gonads and extragonadal sites. The histological appearances of all these neoplasms were carefully reviewed. Highly elevated levels of serum AFP were noted in patients with tumors containing endodermal sinus (yolk sac) tumor elements irrespective of the location of the neoplasm or presence or absence of metastatic disease. There was good correlation between the presence and quantity of endodermal sinus (yolk sac) tumor elements within the primary tumor or its metastases and elevated levels of serum AFP. All patients with tumors composed of pure seminoma or dysgerminoma, and teratoma, had normal serum AFP levels. Slightly elevated levels of serum AFP up to 60 ng/mg (upper limit of normal 20 ng/ml) were noted in a few patients with testicular tumors composed of pure embryonal carcinoma, whereas patients with tumors composed of or containing endodermal sinus (yolk sac) tumor elements had serum AFP levels that could be measured in 100's or 1000's of ng/ml. Serum AFP was elevated only in patients with active disease. Serum AFP was determined in 81 patients with gonadal tumors of non germ cell origin and was normal in all these patients. Serum AFP is a very good tumor marker in patients with germ cell tumors composed of or containing endodermal sinus (yolk sac) tumor, irrespective of their location. Serial serum SFP determinations can be used for diagnostic purposes, for monitoring the results of treatment, and for early detection of metastases and recurrences. Serial serum AFP determination is a useful procedure in all patients with germ cell neoplasms and is highly recommended.

Adult

Spermatocytic seminoma: clinicopathological study of 22 cases.

Twenty-two cases of spermatocytic seminoma are reported. This neoplasm comprises 4.4% of all seminomas seen during the period under study. Nineteen patients were older than 40 years. Painless testicular enlargement was the presenting symptom in 19 patients. The duration of symptoms was more than six months in 12 patients. Macroscopically the tumor was soft, friable, grey, and edematous. Microscopically it is characterized by cellular pleomorphism, round cells and nuclei, scanty stroma, and absence of lymphocytes and granulomas. In none of the cases was the tumor associated with other neoplastic germ cell elements or with classical seminoma. Metastases were not encountered in any of the cases. Apart from 3 patients who died from unrelated causes, all the patients were alive and well for periods varying from two months to 27 years. Spermatocytic seminoma is a distinctive clinicopathological entity. It is unique among germ cell neoplasms because it occurs only in the testis and is not associated with other neoplastic germ cell elements. It has good prognosis and is not associated with metastases. Orchidectomy is the treatment of choice and there is no good evidence indicating that it should be followed by radiotherapy.

Adult

Radiation pancreatitis: a necropsy study.

The responses of the normal pancrease to radiation administered to the abdomen, sacro-iliac joints and thoraco-lumbal vertebrae was studied in necropsy material. Changes were observed in every case. They consisted of vascular damage, oedema, fibrosis and inflammatory cell infiltration of the interstitial tissue. There were changes affecting the secretory cells of the pancreatic glands and the epithelial lining of the intercalated ducts. Hyalinization of the islets of Langerhans was seen and there were scattered foci of necrosis. It is suggested that the type of histological changes may be correlated with the duration of survival after the exposure to radiation. The normal pancreas shows considerable damages on exposure to radiotherapy, but owing to its large reserve capacity clinical manifestations of the damage are infrequent

Arteries

The value of a sensitive assay of carcino-placental alkaline phosphatase (CPAP) in the follow-up of gynecological cancers.

Using a sensitive enzyme immunoassay, carcinoplacental alkaline phosphatase (CPAP) was determined in sera of 1266 patients with gyneocological cancers. All these patients were referred after initial surgical treatment elsewhere. There were 95 patients with evidence of disease at the time of the study and 1171 without evidence of disease. Of the 95 patients with active disease, 47 were treated for ovarian carcinoma, 36 for carcinoma of the cervix and 12 for endometrial carcinoma. Raised levels of CPAP were seen in 40% of patients with ovarian carcinoma, in 22% with carcinoma of the cervix and in 41% in the small group with endometrial carcinoma. In patients without evidence of disease, raised levels of CPAP were seen in 12% of patients with carcinoma of the cervix, in 6% of endometrial carcinoma and only in 2% of patients with carcinoma of the ovary. Therefore it was considered that in the latter group CPAP studies would prove of some value. In the group of patients with carcinoma of the ovary and evidence of disease, raised levels of CPAP were seen almost exclusively in patients with epithelial tumors. It is considered that CPAP may be of value as a tumor marker in this group of patients. When compared with CEA, CPAP tends to give fewer false positives and correlates better with the presence of disease.

Adult

Muscle spindles in rheumatoid arthritis. An ultrastructural study.

Ultrastructural features of muscle spindles were studied in biopsy material from 100 patients suffering from classical rheumatoid arthritis. Thickening of the outer capsule, increased amount of extracellular ground substance within the inner capsule, and marked thickening of the basement membrane of capillary blood vessels supplying the muscle spindles were observed. Chronic inflammatory cells and macrophages were present within the spindles. Changes affecting the intrafusal muscle fibres were also seen. They were manifest as atrophy and degeneration of the intrafusal muscle fibres, absence of the specialised junctional complexes, and of the intercellular bridges, microladders and satellite cells. It is suggested that the changes affecting the intrafusal muscle fibres are probably secondary. Damage to the myelinated nerves was present, while the sensory and motor nerve endings were well preserved.

Arthritis, Rheumatoid

Demonstration of calcitonin and carcinoembryonic antigen (CEA) in medullary carcinoma of the thyroid (MCT) by immunoperoxidase technique.

The presence of calcitonin and of carcinoembryonic antigen (CEA) was studied in six cases of medullary carcinoma of the thyroid using an immunoperoxidase technique. In five cases the material was obtained surgically and in one at autopsy. Tissue from primary tumours as well as from metastases was studied. Calcitonin and CEA were identified within all the tumours studied, although their pattern of distribution and staining intensity varied both within the cells and within the tumour. Some parts of the tumour contained both CEA and calcitonin, while others stained positively only for one of these substances. In some parts of the tumour there was no positive staining for either substance. Within the cells, CEA showed a typical linear distribution along cell surfaces, while calcitonin showed a more even cytoplasmic distribution and the deposits were more granular. Normal tissue surrounding tumour deposits did not show positive staining. It is considered that cells of medullary carcinoma of the thyroid contain both calcitonin and CEA. Identification of CEA and calcitonin in tumour tissue can be used as a diagnostic aid to identify medullary carcinoma of the thyroid. Iit is considered that these substances are being produced by this tumour and can be used as tumour markers.

Adult

Serum alphafetoprotein (AFP) in diagnosis and management of endodermal sinus (yolk sac) tumor and mixed germ cell tumor of the ovary.

Serum AFP was determined serially by radioimmunoassay in 13 patients with ovarian germ cell tumors and in one patient with bilateral pure gonadoblastoma. There were 4 patients with pure dysgerminoma, one with pure endodermal sinus tumor (EST) and 8 with mixed germ cell tumors, all containing EST. The patients with dysgerminoma and gonadoblastoma had normal serum AFP at all times. All patients with tumors containing EST had raised serum AFP, although in most cases it was first determined between 1 and 3 weeks after operation and there was no evidence of metastases. Serum AFP became normal 5 to 7 weeks after operation and began to rise when disease recurred. Serum AFP determinations detected presence of recurrent disease long before it became detectable by other methods. Serum CEA was determined serially by radioimmunoassay in 8 of these patients, including 2 who dies with metastases, and was normal on all occasions.

Adolescent

Primary carcinoid tumor of the testis: case report, ultrastructure and review of the literature.

A case of primary pure carcinoid tumor of the testis which occurred in a 71-year-old male is reported. The patient was treated by radical orchiectomy and remains well and symptom free 10 months after operation. Histologically as well as ultrastructurally the tumor showed typical appearances of carcinoid tumor of midgut derivation. 23 cases of carcinoid tumors of the testis were discovered in the literature. Of these 17 were primary testicular carcinoids, and 6 were metastatic to the testis. Of the 17 cases of primary carcinoid tumors, 14 were pure carcinoids and only 3 were associated with teratoma. None of the primary testicular carcinoids were associated with metastases and the prognosis after orchiectomy was excellent, thus indicating that no further therapy is necessary. The prognosis of patients with carcinoid metastatic to the testis is poor. In view of this it is very important to determine whether the tumor is primary or metastatic.

Aged

The cytology of medullary carcinoma of the thyroid with spindle cell pattern.

The cytological picture of medullary carcinoma of the thryoid is characterized by so-called triangular cells with abundant cytoplasm and eccentrically situated nuclei. In the May-Grünwald-Giemsa stained smear the cytoplasm may contain azurophilic granules. Amyloid can usually be demonstrated. In this paper cytological features of medullary carcinoma of the thyroid showing spindle cell pattern are presented. The cytological smears, obtained by thin needle aspiration did not contain amyloid. The diagnosis medullary carcinoma was confirmed by the demonstration of amyloid in the histological sections of the tumour and by raised serum calcitonin levels.

Aged

Alpha-1 antitrypsin (AAT) and alphafoetoprotein (AFP) in sera of patients with germ-cell neoplasms: value as tumour markers in patients with endodermal sinus tumour (yolk sac tumour).

Serum alphafoetoprotein (AFP) and serum alpha-1 antitrypsin (AAT) were determined in 24 patients with germ-cell neoplasms of the gonads and extragonadal sites and in two patients with hepatocellular carcinoma. In the majority of the patients serial determinations were performed. All seven patients with testicular seminoma and four patients without evidence of active disease had normal levels of serum AAT and AFP. The remaining 13 patients with germ-cell neoplasms had tumours containing endodermal sinus tumour (yolk-sac tumour) elemetns. All these 13 patients had elevated levels of serum AFP and the levels were high or very high in most cases. Nine of these 13 patients had raised serum AAT, although the elevation above normal levels was only slight in a number of cases. When serial determinations were performed serum AAT levels frequently followed the pattern of serum AFP levels, but the AAT levels were frequently within normal limits and therefore the interpretation of the results was difficult, and much less reliable as compared with those for serum AFP. The elevation of serum AAT levels following the recurrence of the tumour was found to occur much later and was much less marked than elevation of serum AFP, which occurred early, showed a large rise and was a reliable marker of tumour recurrence in patients with germ-cell neoplasms containing endodermal sinus tumour elements. It is therefore considered that, although there is good evidence that serum AAT is produced by endodermal sinus tumour elements, serum AAT is not a useful monitor of disease activity in these patients, especially when compared with serum AFP, the value of which is well recognized. Serum AAT may be a useful tumour marker in patients with hepatocellular carcinoma, and this aspect should be investigated further.

Adolescent