Biomedical subjects
Publications and source records attributed to E J Wilkinson.
Major changes in the terminology for vulvar disease have taken place in the past 20 years under the influence of the members of the International Society for the Study of Vulvar Disease. Major terminology changes have been made for vulvar nonneoplastic disorders, vulvar intraepithelial neoplasia and superficially invasive squamous cell carcinoma.
A single 4.7 x 3.3 x 1.5 cm solid nodule was removed from the bladder of a 24 years old white female who had lost an intrauterine contraceptive device (IUD) installed approximately four years ago. The nodule showed no external evidence of an IUD or its string. An examination of the nodular surface by scanning electron microscopy (SEM) showed mostly amorphous material with some adherent filamentous structures. Its energy dispersive x-ray microanalysis revealed the presence of calcium and phosphorus suggesting that the nodule was actually a urolith. Fracturing the nodule exposed an embedded entity consistent with being a copper IUD. Apparently, the lost IUD had migrated from the uterus into the bladder where it became mineralized. Thus the solid nodule was actually a foreign body stone.
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This is an analysis of 266 patients with clinical stage I and II endometrial carcinoma treated with curative intent at the University of Florida between October 1964 and December 1980. There was a minimum 5-year follow-up. Thirty-nine patients who died of intercurrent disease less than 5 years from treatment were excluded from analysis of pelvic disease control and determinate disease-free survival. All patients were included in the analysis of complications. Pelvic disease control and determinate disease-free survival rates at 5 years were 91 and 88%, respectively, for stage I and 84 and 68% for stage II. There was no apparent difference in the rates of local control and survival or in the incidence of complications when comparing preoperative with postoperative radiation therapy. Tumor grade, stage, depth of myometrial invasion, and history of exogenous estrogen use or abnormal estrogen balance were of prognostic significance. Data on pelvic disease control, survival, and treatment complications are outlined, and management guidelines are discussed.
Cystic mesothelioma (CM) of the peritoneum is a rare, benign neoplasm that occurs predominantly in women and tends to recur locally. It has received little attention (to our knowledge, a single case report) in the radiology literature. Five cases of CM are presented. Computed tomography (CT) was performed in three cases, ultrasound (US) in four cases, and magnetic resonance (MR) imaging in one case. Twenty-eight cases reported in the literature are reviewed for comparison. CM shows a clear predilection for the surfaces of the pelvic viscera but is seen in other areas of the peritoneum and retroperitoneum. The neoplasm was intraperitoneal in three cases and primarily retroperitoneal in the other two cases. In all CT and US studies performed, a single large, multilocular cystic mass was demonstrated. MR imaging, performed in one case, showed that the lesion had signal characteristics typical of a watery collection low in solute concentration. It is concluded that CM of the peritoneum has a nonspecific multilocular cystic appearance on images, which does not permit it to be differentiated from other cystic lesions.
Vulvar intraepithelial neoplasia may extend into the pilosebaceous units of the hairy and non-hairy skin of the vulva, and inadequate removal may cause treatment failure. We measured with a calibrated microscope the thickness of vulvar intraepithelial neoplasia and the depth to which it extended into the underlying pilosebaceous units of the vulvar skin. The mean thickness of vulvar intraepithelial neoplasia in 329 histologic sections from 62 cases was 0.38 mm; 99.5% of all vulvar intraepithelial neoplasia measured less than 0.77 and 0.69 mm in the hairy and non-hairy skin, respectively. Sebaceous-gland and hair-follicle involvement by vulvar intraepithelial neoplasia was 21 and 32%, respectively. The mean depth of sebaceous-gland involvement was 0.77 mm in the hairy skin and 0.50 mm in its non-hairy counterpart; 99.5% of all vulvar intraepithelial neoplasias extended less than 2.03 and 1.07 mm in the hairy and non-hairy skin, respectively. The mean depth of hair-follicle involvement was 1.04 mm; 99.5% of all hair follicles were involved less than 2.55 mm. Our findings suggest that removal of vulvar intraepithelial neoplasia to a depth of 1.0 and 2.0 mm in the non-hairy and hairy skin, respectively, is appropriate for successful treatment.
Gynecologic pathology is a discipline that encompasses the pathologic changes of the female genital tract and placenta. As a field, it may encompass 30-50% of the overall case load of surgical pathology. Five pathways of study that may lend to a career concentrated in gynecologic pathology are reviewed. Pathology training, with pathology board certification in anatomic or anatomic and clinical pathology, with fellowship training in gynecologic pathology, is the course of training taken by those in active concentrated practice in this field. The advantages and disadvantages of the various training options in gynecologic pathology are discussed. The advantages of additional training and experience in cytopathology as well as the advantages of clinical experience in gynecology and obstetrics are discussed.
Forty-one cases of vulvar vestibulitis syndrome are presented. All cases were studied to provide a histopathological description of this condition in terms of location, intensity, and characterization of the inflammatory response. Alterations of the normal histology of minor vestibular glands forming vestibular clefts are described. The association of this condition with other disease processes, and special studies done to elucidate an etiology, are discussed.
Giant cell carcinoma of the vulva has been described as a distinctive primary tumor of the vulva associated with multinucleated tumor giant cells and nuclear pleomorphism. These tumors have been reported to have a poorer prognosis than does squamous cell carcinoma, to which they are thought to be related. Two women were treated for primary vulvar malignancies possessing the morphologic features of giant cell tumor. Electron microscopy was not beneficial in distinguishing the tumors. A panel of immunoperoxidase procedures, including AE 1/3, 35 beta H-11, carcinoembryonic antigen, epithelial membrane antigen, HMB-45, S-100, leukocyte common antigen, placentalike alkaline phosphatase, alpha-1-antichymotrypsin and vimentin made it possible to distinguish the two tumors and characterized one as a nodular amelanotic melanoma with multinucleate tumor giant cells and the second as a squamous cell carcinoma with tumor giant cells. The latter term should replace the term giant cell carcinoma. Histologic criteria can help define this tumor.
Fifty women whose clinical vulvar appearance was compatible with that of hyperplastic or mixed vulvar dystrophy were evaluated in the Vulvovaginal Referral Unit, University of Florida, from 1980 through 1986. Histologic material from biopsies performed on these patients was reviewed. The histologic picture was consistent with the clinical diagnosis in 33 cases. Fifteen patients had lichen sclerosus with various degrees of hyperkeratosis, while one had human papillomavirus-associated vulvar intraepithelial neoplasia and another had only mild chronic inflammation. Three patients in the mixed dystrophy group developed squamous carcinoma of the vulva. Women with squamous cell hyperplasia occurring in a background of lichen sclerosus (mixed dystrophy) constitute a distinct group at higher risk of developing invasive cancer and require histologic assessment.
Deposits found intrauterine contraceptive devices (IUDs) were studied by scanning electron microscopy, x-ray diffraction, and energy dispersive x-ray microanalysis. All seven devices, including five plastic and two copper IUDs, were coated with a crust containing cellular, acellular, and fibrillar material. The cellular material was composed of erythrocytes, leukocytes, cells of epithelial origin, sperm, and bacteria. Some of the bacteria were filamentous, with acute-angle branching. The fibrillar material appeared to be fibrin. Most of the acellular material was amorphous; calcite was identified by x-ray diffraction, and x-ray microanalysis showed only calcium. Some of the acellular material, particularly that on the IUD side of the crust, was organized in spherulitic crystals and was identified as calcium phosphate by x-ray microanalysis. The crust was joined to the IUD surface by a layer of fibrillar and amorphous material. It is suggested that the initial event in the formation of calcific deposits on IUD surfaces is the deposition of an amorphous and fibrillar layer. Various types of cells present in the endometrial environment adhere to this layer and then calcify. Thus, the deposition of calcific material on the IUDs is a calcification phenomenon, not unlike the formation of plaque on teeth. Hum Pathol 16:732-738, 1985.
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Thirty-four patients with primary endometrial papillary adenocarcinoma diagnosed in our institution from 1970 to 1982 were studied. Papillary adenocarcinomas represented 10% of all endometrial adenocarcinomas seen during this period. Papillary neoplasms were morphologically subclassified as either papillary serous adenocarcinoma or well-differentiated papillary adenocarcinoma, following review of the histological sections obtained prior to radiotherapy or chemotherapy. Twenty-five patients were found to have papillary serous adenocarcinoma, and nine had well-differentiated papillary adenocarcinoma. A control group of 305 patients with endometrial adenocarcinoma of nonpapillary type was compared with respect to age, race, and survival. Fifty percent of the patients with papillary serous adenocarcinoma were black and they were significantly older (p = 0.001) than the control group, with a mean age of 71 years. Thirty percent of the papillary serous adenocarcinoma group had deep myometrial invasion and peritoneal surface involvement by tumor. In 20% of these patients there was a discrepancy between the clinical stage and the surgical stage at laparotomy. Survival was markedly worse (p = 0.01) than that of the control group. Patients with well-differentiated papillary adenocarcinomas were similar to control patients with respect to age and racial status and had similar clinical survival outcome. We conclude that well-differentiated papillary adenocarcinoma of the endometrium is a distinct form of papillary adenocarcinoma, and must be morphologically and clinically distinguished from papillary serous adenocarcinomas because of its better prognosis. Morphological differentiation of these two papillary variants of endometrial adenocarcinoma is presented.
Seventeen patients with suspected ovarian masses were evaluated by magnetic resonance imaging (MRI). MRI findings were confirmed by surgery (13 patients) or sonography and clinical follow-up (four). The study evaluated MRI characteristics of ovarian lesions using recently developed multislice and multiecho pulse techniques for a 0.15-T system. T1 and T2 relaxation times were calculated in 12 patients and although a range of values was obtained in several disease categories, diagnostic accuracy was frequently improved. MRI appearances tended to vary considerably with different pulse sequences and were particularly complex in patients with endometriosis and cystic ovarian tumors. Shortest calculated T1 and T2 values were found in hemorrhagic cysts in patients with endometriosis. Benign tumors with thick fibrous pseudocapsules had longer T1 values. Inflammatory masses and malignant ovarian tumors had significantly longer T1 and T2 values and relaxation times in a patient with mucinous cystadenoma varied within the complex mass.
Laryngeal papillomatosis is a disease that can lead to many surgical procedures, especially in children, and is potentially lethal. In this study, we reviewed 83 cases that yielded 902 separate laryngoscopy specimens to determine if any clinical or histologic findings were prognostic. "Juvenile" (n = 73) and "adult" (n = 10) cases were classified according to the number of separate lesions and the number of recurrences, but not necessarily according to age. Four prognostic indicators were constructed for the juvenile group and were analyzed by linear regression. Three new microscopic classifications were used: papillary, acanthomatous, and angiokeratotic. In juvenile cases, the last two categories appeared to be somewhat prognostic, along with several other factors. Some histopathologic findings contradicted classic descriptions. Differences in clinical manifestation and similarities in histopathology may suggest differential responses to the same causal agent.
Within the endometrial cavity intrauterine contraceptive devices (IUDs) become encrusted with cellular, acellular, and fibrillar substances. Scanning electron microscopy was used to study the crust. Cellular material consisted mainly of blood cells and various types of bacteria. The fibrillar material appeared to be fibrin which was omnipresent in the crust and formed a thin layer immediately over the IUD surface. X-ray microanalysis of the acellular component of the crust revealed the presence of calcium. No other major peaks were identified. Near the IUD surface characteristic calcium phosphate crystals were present. Their microanalysis showed peaks for calcium and phosphorus. X-ray diffraction of the crust however, showed it to contain only calcite. It is through the use of scanning electron microscopy that calcium phosphate has been detected in the IUD crust and a fibrillar layer has been visualized on the IUD surface. This study further demonstrates the effectiveness of SEM analytical techniques in the area of biomedical research.
Von Recklinghausen's neurofibromatosis is an unusual disorder with a wide variety of manifestations. The initial findings may at times involve the female genitalia. When the vulva is affected, the obstetrician-gynecologist has an opportunity for the establishment of an accurate diagnosis as well as for cosmetic correction. Two cases are presented which illustrate these concepts.
Two young women had Fanconi's anemia and genital human papillomavirus infection associated with multicentric genital neoplasia. One of these women represented the first documented case of death from vaginal squamous carcinoma associated with Fanconi's anemia. In these two women an apparent biologic compression of the natural history of vulvar and vaginal carcinoma was observed. The finding of condyloma acuminatum in both of them prior to the onset of carcinoma suggests a partial causal association. Involvement of the cervix, vagina, vulva and perianal epithelium by the oncogenic process implies that a field effect occurred in those areas.