Biomedical subjects
Publications and source records attributed to G F Gray.
An instance of malignant peritoneal mesothelioma that appeared to arise from an inguinal hernia sac is reported. This lesion appeared to be different from nodular mesothelial hyperplasia of hernia sacs.
Malignant melanoma of the penis and male uretha are unusually aggressive tumors which only rarely are cured by radical surgery. Melanosis of the penis may be confused with malignant melanoma, and we report a case of melanosis originally diagnosed and treated as melanoma with survival for twenty years. We contrast this with another case of malignant penile melanoma with a fatal outcome.
One of 3 patients with peiomyosarcomas of the epididymis and spermatic cord treated by inguinal orchietomy was cured, 1 died 18 months after diagnosis and 1 was living but had a pulmonary metastasis 4 years after excision of the primary tumor. All 3 patients with leiomyoma of the testicular adnexa were cured. The literature concerning smooth muscle tumors of the adnexa is reviewed.
Chromaffin-reacting pheochromocytomas of the adrenal medulla are the most frequently encountered functional paraganglionic neoplasms. However, extra-adrenal pheochromocytomas as well as non-chromaffin paragangliomas, including those of the carotid body and glomus jugulare, may produce symptoms from catecholamine secretion. One of the extra-adrenal sites from which these tumors arise is from a collection of para-aortic, paraganglion cells around the origin of the inferior mesenteric artery. This collection of paraganglia was described in fetuses by Zuckerkandl in 1901 and has subsequently been referred to as the organ of Zuckerkandl. The diagnosis and management of these neoplasms differ somewhat from that of adrenal pheochromocytomas, but excellent results are often obtained by excision of these lesions. Four patients with functional tumors of the organ of Zuckerkandl are reviewed together with the other reported cases in the literature.
Four cases of oxyphilic cortical renal adenomas identified by angiography are described. A suggestive angiographic appearance is outlined for adenomas limited to the cortex: avascularity or hypovascularity; renal vessels splayed and stretched around tumor base; faint parenchymal blush during nephrograpm phase; and tumor well marginated, appearing to arise from the renal cortex. Masses that fulfill the above criteria are adequately treated with excisional biopsy if frozen section confirms their benignity.
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The cause of bleeding was found in 8 of 10 cases of colonic diverticulosis associated with severe rectal hemorrhage by using arteriographic and microangiographic techniques to localize the site and serial histological sections to study the lesion. Strikingly consistent changes were identified. These are related to the characteristic angioarchitecture of colonic diverticula. These changes include asymmetric rupture of the vas rectum toward the lumen of the diverticulum precisely at its dome or antimesenteric margin; conspicuous eccentric intimal thickening of the vas rectum, often with medial thinning of duplication of the internal elastic lamina at and near the bleeding point; and general absence of diverticulitis. Control colonic diverticula demonstrated normal structures or, only occasionally, minimal eccentric intimal thickening in their associated vasa recta. This suggests that traumatic factors arising within the diverticular or colonic lumen induce asymmetric intimal proliferation and scarring of the associated vasa recta, predisposing to rupture and massive bleeding.
Carcinoma of the cardia of the stomach in patients with sliding hiatal hernia is a disease of poor prognosis, since symptoms nearly always occur late in its course at an already incurable stage. Eleven cases are reviewed from the records of The New York Hospital-Cornell Medical Center from 1932 to 1975. Resectability of tumor appeared related to shorter interval between onset of symptoms and diagnosis. Barium studies combined with esophagoscopy led to correct preoperative diagnosis of malignancy in all cases.
A patient with extensive perianal extra-mammary Paget's disease was treated by wide local excision of the perianal skin. No underlying associated adenocarcinoma was identified, and the patient is clinically free of disease five years after treatment. A second patient had a small focus of Paget's disease confined to a hemorrhoid. The necessity for histologic evaluation of all anal lesions is emphasized.
Hemorrhage from intestinal neurofibromas or leiomyomas is an infrequent but often life-threatening complication of neurofibromatosis. Despite typical cutaneous findings, the bleeding tumor usually cannot be demonstrated because of its inaccessible location in the jejunum or ileum. In the present case, superior mesenteric arteriography successfully demonstrated hemorrhage from a jejunal leiomyoma. Review of the literature demonstrates the difficulty of establishing the correct diagnosis by other means. Arteriography should be the contrast procedure of first choice in the patient with neurofibromatosis and gastrointestinal bleeding.
The clinical data and morphologic findings in 16 cases of adrenocortical carcinoma were compared with those in 11 cases of surgically removed functional adenomas and 12 cases of nonfunctional adenomas found at autopsy. Histopathologic changes of architectural disarray, pleomorphism, increased mitotic activity, vascular invasion, hemorrhage, or necrosis were generally reliable criteria for diagnosis of malignancy. However, weight was the parameter that most consistently correlated with outcome, since all patients with tumors under 50 Gm. survived and all lesions of 95 Gm. or over proved to be malignant.
A case of renal transplantation between HL-A identical siblings is reported in which the donor kidney was found to have a calcified mass in the upper pole. Because an immediate pathologic diagnosis could not be made at the time of nephrectomy, the kidney was preserved with pulsatile perfusion for fifty-four hours after excision of the upper pole. At that time the diagnosis was still not available, and transplantation was performed only to have the report of ossified renal cell carcinoma established the following day.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.