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D W Crocker

Publications and source records attributed to D W Crocker.

At least 19 recordsLinked to original sources

Occult congenital syphilis in macerated stillborn fetuses.

Five cases of macerated stillborn fetuses with congenital syphilis were studied. Despite severe maceration with visceral autolysis, spirochetes could be easily detected using Warthin-Starry stains. Clues that led to performing silver stains included the presence of an enlarged liver, spleen, chorioamnionitis, and nucleated red blood cells in villous capillaries. In a patient population where prenatal care is not always obtained, and maternal serologic tests results are not available at the time of delivery, these pathologic clues are very helpful in detecting congenital syphilis in macerated stillborn fetuses where the classic findings of syphilitic infection, including hydrops fetalis and plasma cell infiltrates, may be masked.

Adolescent

Cervical cancer occurrence in Memphis and Shelby County, Tennessee, during 25 years of its cervical cytology screening program.

This review of the cytologic history of 430 women with histologically proved invasive cancer of the uterine cervix indicates that several significant subgroups can be defined. One major subgroup consists of 142 patients or 33% of the total group in whom invasive cancer developed within 1 to 5 years, with an average of 2.6 years, after one or more negative cytologic findings. This appears to be a significant proportion of the occurrence of invasive cervical cancer and warrants consideration in the recommendation of screening intervals. The second major subgroup, consisting of 88 patients (20.5%), had a delay in diagnosis averaging 9.9 years after the first abnormal cytologic finding. In some of these patients either the cytologic examination results reverted to negative for a period or the biopsy material did not confirm the cytologic abnormalities. The disease progressed to invasion. These findings appear to bear out the importance of close follow-up of patients with any abnormal cytologic finding in the intraepithelial neoplasia category even though intermittent cytologic studies may appear negative.

Adult

Rapid onset of cervical cancer in an upper socioeconomic group.

In this series of 130 patients with cervical cancer, 25% had a short interval of less than 3 years from negative cytologic screenings to finding of cancer. In the short interval group, the peak age was 30 to 35 years, but lesions also developed in younger women and in women aged 60 years and older. The majority of lesions were still in situ, a lesser number had microinvasion and two had invasive squamous carcinoma. The usually accepted risk factors, low socioeconomic group, multiparity, and poor hygiene, did not prevail in all cases. Some patients had no history of pregnancy. They were not considered to be in a low socioeconomic group and poor hygiene was not an apparent feature. In view of the rapid onset of cervical cancer in some patients, even those not considered to be at high risk, annual screening is recommended for all age groups.

Adult

Ultrastructural studies on neuroblastoma: evaluation of cytodifferentiation and correlation of morphology and biochemical and survival data.

Fifteen cases of neuroblastoma, ganglioneuroblastoma and ganglioneuroma were studied by electron microscopy. Ultrastructural features of cytodifferentiation, including numbers of dense core neurosecretory granules (NSG) and neuritic processes, were used to evaluate variation within the neuroblastoma group to determine whether differences in cytodifferentiation exist where light microscopic variations are not evident. These studies revealed that undifferentiated neuroblastomas do show ultrastructural variations not evident by light microscopy. The ultrastructural findings for each case were compared with initial urinary catecholamine excretory patterns, the latter having recently been shown to have valuable prognostic significance. There was a positive correlation, in the undifferentiated neuroblastomas, between increased numbers of NSG and prognostically favorable biochemical excretory patterns. Conversely, low numbers of NSG were associated with an unfavorable biochemical pattern and fatal clinical course. These correlations between ultrastructural differentiation and the biochemical secretory pattern indicate that ultrastructural evaluation of undifferentiated neuroblastomas would appear to have prognostic value, particularly in cases lacking initial biochemical data or as an adjunct to biochemical studies.

Abdominal Neoplasms

Lipomatous infiltrates of the heart.

Fatty masses of the heart usually arise in the interatrial septum and are uncommon. The autopsy files from LAC-USC Medical Center contain 15 such cases from 1952 through 1972. Although these masses are yellow and attain a large size, most are considered to represent lipomatous infiltrations rather than true lipomas since they usually lack encapsulation and do contain cardiac muscle in varying amounts. The lesion is most often associated with obesity. Surprisingly, even the large masses produce few clinical symptoms and none was suspected clinically, each being an incidental finding at necropsy. However, these masses do infiltrate the conduction system and can cause arrhythmias and sudden death. Echocardiography or other noninvasive techniques may bring attention to a lipomatous mass that may or may not be asymptomatic. This can result in a clinical dilemma in differential diagnosis and treatment since myxomas, rhabdomyomas, and sarcomas also arise in the interatrial septum.

Adult

Thyroid carcinoma.

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Adenocarcinoma