Biomedical subjects
Publications and source records attributed to E Schujman.
The case of a seventy-one-year-old woman with leiomyosarcoma of the kidney capsule is presented. Despite lack of invasion into surrounding tissues and few mitoses, the tumor recurred thirteen months after nephrectomy. A full subjective response and an almost complete objective regression lasting eight months were achieved using a short course of combination chemotherapy. The literature on leiomyosarcoma of the kidney is reviewed.
Spontaneous perforation of the small intestine in the newborn is rare. In most cases the etiology is unknown. Three cases of perforation in preterm newborn infants are described. The clinical diagnosis was necrotizing enterocolitis (NEC), and an urgent laparotomy was performed. The histologic examination was compatible with the diagnosis of a congenital defect of the intestinal musculature. All three infants survived.
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We studied retrospectively 78 patients with recurrent superficial bladder tumors in an effort to determine whether transitional tumor cells implant and grow preferentially in patients who have undergone endoscopic resection of stage T1 bladder tumors in the presence of an inflamed urothelium. Of the patients 32 (group 1) had an undetected lower urinary tract infection at the time transurethral resection was performed and 46 (group 2) were free of infection. All patients had intravesical chemotherapy by thiotepa (triethylenethiophosphoramide) and were treated with appropriate antibiotics as soon as the urinary tract infection was recognized from 24 to 48 hours postoperatively. Of the patients in group 1, 37.5 per cent had tumor recurrence in less than 6 months and 15.6 per cent in less than 3 months, compared to 30.4 and 6.5 per cent, respectively, in group 2. Although the tumor recurrence rates 3 and 6 months postoperatively were higher among the group 1 patients (with urinary tract infection) the difference between the 2 groups was not significant. Because the patients were treated by intravesical chemotherapy, and antibiotics in those with urinary tract infection, our study does not allow a definite conclusion regarding the contribution of urinary tract infection on the recurrence rate of superficial bladder tumors.
An updated comprehensive classification of transitional cell carcinoma (TCC) of the prostate is presented in accordance with the current nomenclature, which is based mainly on the theory of multifocal origin of urothelial neoplasms. TCC of the prostate is classified as being primary, secondary (synchronous and metachronous) or mixed (TCC associated with adenocarcinoma). The case histories of six patients with TCC of the prostate are presented. One patient had primary TCC of the prostate without evidence of urothelial carcinoma elsewhere; one patient had primary mixed TCC associated with separate foci of adenocarcinoma; and four patients had secondary TCC either synchronously or metachronously with foci of carcinoma elsewhere in the urothelium. The importance of considering TCC of the prostate as a well-defined clinicopathological entity is discussed.
The histological and clinical features of nonpapillary bladder lesions in 53 patients are described. There were 8 patients (Group A) with atypical hyperplasia and/or carcinoma in situ, 16 patients (Group B) with nonpapillary invasive transitional cell carcinoma, and 29 patients (Group C) with nonpapillary bladder lesions and synchronous or metachronous papillary tumors. These lesions were usually represented clinically by irritative urinary symptoms, such as frequency, urgency, dysuria and hematuria. In 34 of the 53 patients (64.1%), bladder lesions were invisible, i.e., not seen on cystoscopic examinations, and were diagnosed by histological examination of random biopsy specimens or by cytological examination of the urine. The 5-yr survival rates for Groups A, B and C patients were 100, 30.2 and 80.9%, respectively, while the disease progression rate during the same period of time was 72.6, 69.8 and 26.8%, respectively. The significance of the invisible flat lesions of the bladder that are considered to give rise to most types of invasive metastasizing tumors is reviewed and discussed.
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Hepatomegaly was observed in most of the patients undergoing long-term hemodialysis treatment. This was confirmed and quantitated by isotope liver scanning. Liver size was normal in uremic nondialyzed patients. Common causes for liver enlargement were excluded in all reported cases, and there was no evidence for liver disease as judged by functional tests and liver histology.
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An aberrant adrenal, which is a supplementary to the normal adrenal, was found in the apex of hernial sacs in ten out of 350 operated children. This tissue contains adrenal cortex, which tends to atrophy and disappear during childhood, but uncommonly may persist into adult life. Rarely it may secrete abnormally or undergo neoplastic changes. The embryological development is discussed, and the literature briefly reviewed.
Five cases of cervical pregnancy collected over an 8-year period (1971--1978) are analyzed. The incidence of cervical pregnancy at this institution is 1:7040 pregnancies. All cases were diagnosed prior to 12 weeks' gestation, and conservative treatment was instituted in each case. Etiology, criteria, definition, and clinical and pathologic signs are discussed. Several unusual features are emphasized, particularly conservative treatment and the use of ultrasound as a diagnostic aid.
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