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Biomedical subjects

H J Bussey

Publications and source records attributed to H J Bussey.

At least 37 records · Page 2Linked to original sources
PubMed1981

Invasion of veins by carcinoma of rectum: method of detection, histological features and significance.

Histopathological material from operation specimens of rectal adenocarcinoma was reviewed and invasion of veins identified in 51.9% of 703 cases. The extent of venous invasion, thickness of the walls of invaded veins and various other histological features were examined in detail. By follow-up studies recurrence rates, incidence of distant metastases and corrected 5-year survival rates were obtained; correlation with the histopathological results showed that invasion of extramural and thick-walled veins is associated with a poor prognosis independent of the degree of differentiation of the adenocarcinoma. Prognosis is not significantly related to the presence of necrosis of intravenous tumour and a clearly defined stroma in the intravenous growth all appear to exert a protective influence on patient survival. Whereas permeation of capillaries in vein walls, the presence of loose clumps of tumour cells in veins and direct contact between tumour cells and venous blood appear to adversely affect survival. Venous invasion is shown to be related to local invasiveness of rectal carcinoma. Suggested modes of venous spread and interaction with host tissues are proposed, with implications for general attitudes to the spread of cancer and metastasis.

Adenocarcinoma↗
PubMed1980

The clinical significance of invasion of veins by rectal cancer.

A histopathological study of 703 surgical specimens from patients with adenocarcinoma of the rectum revealed invasion of veins by primary growth in almost 52 per cent. Follow-up studies on the patients showed that the corrected 5-year survival rate was significantly worse and liver metastases developed more frequently when venous invasion was present. Invasion of extramural veins was particularly significant whereas spread confined to intramural veins was less important. Invasion of large (thick-walled) veins was of greater consequence than invasion of small (thin-walled) veins and spread into thick-walled extramural veins had the greatest adverse influence of all. Venous spread of tumour takes place in parallel with local spread as measured by the Dukes' stage but exerts an influence on prognosis independent of the Dukes' stage. Similarly, vein invasion parallels the number of lymph node metastases but appears to exert an independent influence on prognosis. Observation of venous spread provides a precise assessment of the likely behaviour of rectal carcinoma and supplements, but does not replace indices such as the Dukes' stage or the number of lymph node metastases in routine use. The implications for surgical technique and management are discussed.

Adenocarcinoma↗
PubMed1980

Metaplastic polyps and polyposis of the colorectum.

Five hundred and fifty-four colorectal metaplastic polyps have been studied histologically. Whilst most lesions were small and sessile, 16.1% measured greater than 0.5 cm in diameter and 0.9% were greater than 1 cm. The larger polyps were frequently pedunculated and occasionally showed a tubulo-villous or villous pattern. A structural similarity between the larger metaplastic polyps and colorectal adenomas is illustrated and the importance of the distinction of metaplastic from dysplastic epithelium in the differentiation of these lesions is stressed. Other unusual features of metaplastic polyps are described. Evidence is given to suggest that males have a greater propensity to develop metaplastic polyps than females. A search for men adenomas, but relatively frequent (20.8%) in juvenile polyps. Finally, seven patients with multiple metaplastic polyps of the colorectum are described, in whom a diagnosis of adenomatous polyposis had been made at some stage in their management. Six of the seven patients were males and the mean age at presentation was 37.4 years. Larger metaplastic polyps were frequent in these cases. The necessity for histological confirmation in all cases of intestinal polyposis is stressed, and the possibility that 'metaplastic polyposis' is a pathological entity is discussed.

Adenoma↗
PubMed1979

Ileal adenomas after colectomy in nine patients with adenomatous polyposis coli/Gardner's syndrome.

Adenomas of the ileal mucosa are an uncommon finding in adenomatous polyposis coli/Gardner's syndrome. We report 9 patients who were found to have ileal adenomas 1 yr 11 mo to 25 yr 11 mo after colectomy. The ileal adenomas occurred proximal to an ileorectal anastomosis in 7 patients, both proximal to a cecoproctostomy and later proximal to an ileostomy in 1 patient, and in an ileostomy in 1 patient. The cases confirm that ileal mucosa is susceptible to adenoma formation in adenomatous polyposis coli/Gardner's syndrome and thus provide additional evidence that adenomas are not confined to the colon in these patients. In addition, the findings in the cases suggest that the ileal adenomas developed after colectomy. Thus, our cases suggest that the small intestine should be studied for the presence of adenomas after colectomy with either ileoproctostomy or ileostomy, as well as before resection. On the other hand, aggressive management does not seem warranted as carcinoma of the jejunum and ileum has been reported only rarely.

Adult↗
PubMed1978

Aetiology of adenoma--carcinoma sequence in large bowel.

A hypothesis, based on epidemiological and histopathological data, is proposed to account for the aetiology of colorectal adenomas and carcinomas. Adenomas are initially caused by an environmental agent which acts on the colorectal cells of adenoma-prone persons, a further environmental agent causes small adenomas to grow, and a carcinogen causes malignancy in a high proportion of large adenomas.

Adenoma↗
PubMed1978

Genetics of gastrointestinal polyposis.

This review deals with the types of gastrointestinal polyposis in which genetic factors play an essential part, namely, the hamartomatous lesions of Peutz-Jeghers syndrome and multiple juvenile polyposis and the neoplastic tumors of familial polyposis coli and multiple adenomas. The mode of inheritance, associated lesions, malignancy potential, and possible interrelationships between the various types of polyposis are discussed. The knowledge that the lesions are inherited should enable other family members to be investigated and treated at an early stage, a matter of considerable importance in the prevention of cancer when there is an associated risk of gastrointestinal carcinoma.

Adenoma↗
PubMed1977

Ultrastructural features of the colonic epithelium in familial polyposis coli.

Colectomy specimens from 6 cases of familial polyposis coli (FPC) were examined. Macroscopically normal mucosa between polyps was taken at intervals along the ascending, transverse and descending colons and studied at EM level. All three regions show the same cell populations varying only in their ratio and height of the epithelium. The same cell types seen in the normal crypt epithelium are present in the mucosa from FPC. As in the normal, 'intermediate' cells are present in FPC but they are less conspicuous than in the mucosa adjacent to colonic carcinoma. However, there are ultrastructural features which distinguish the "normal" mucosa in FPC from the true normal: (a) the presence of "clear columnar" cells; (b) increased vesiculation in the absorptive cells; (c) large number of lysosomes; and (d) the presence of small electron-dense bodies. The ultrastructure of the "clear columnar" cells suggests their being incompletely differentiated cells, thus raising the possibility that their presence in the upper crypt and surface epithelium may represent an early stage in the process of polyp and cancer formation.

Adolescent↗
PubMed1977

Policy of local excision for early cancer of the colorectum.

A policy of local excision or total biopsy for early cancer of the colorectum, when this is technically possible, has been described. This is based on thorough histological examination of the excised specimen with special reference to the completeness of surgical excision, the depth of spread of the cancer into the bowel wall, and the histological grade of malignancy. The results of this policy in 119 patients treated by local excision only have been studied. There have been 10 recurrences but only five of these are regarded as policy failures. Because of these good results it is suggested that the policy as described should be regarded as an established alternative to partial colectomy, anterior resection, and abdominoperineal excision in carefully selected patients.

Adult↗
PubMed1975

Epidermoid cysts, polyposis coli and Gardner's syndrome.

One hundred and ninety-six members of 15 families with Gardner's syndrome were investigated to determine the type of skin cyst that is part of this syndrome. These were shown to be epidermoid cysts and not pilar cysts or steatocystoma multiplex. They were solitary or multiple and seldom large and disfiguring. The skin cysts often occurred before the intestinal polyps were detectable. The presence of epidermoid cysts in children should be an indication for sigmoidoscopy when the child reaches the age of 14 years, and at 3-yearly intervals thereafter up to the age of 30 years, whether or not there is a family history of polyposis coli. At present it is not possible to say if Gardner's syndrome is the same as, or different from, familial polyposis. Until all patients with colonic polyps have a full clinical examination, looking for skin cysts and osteomas, X-rays of the skull and long bones to detect osteomas and dental X-rays for abnormalities of the teeth this question will remain unanswered.

Adolescent↗
PubMed1975

The evolution of cancer of the colon and rectum.

The malignant potential of adenomas of the colon and rectum varies with size, histological type and grade of epithelial atypia. The adenomatous polyp is usually small and has a low malignant potential, whereas tumors with a villous structure are usually larger and have a much higher cancer rate. Severe atypia is more common in villous adenomas than in adenomatous polyps. Evidence is presented which suggests that most cancers of the colon and rectum have evolved through the polyp-cancer sequence although the majority of adenomas do not becoma cancerous during a normal adult life span. The slow evolution of the polyp-cancer sequence is stressed. The implications of the polyp-cancer sequence for the design of cancer prevention programmes and the study of the aetiology of large bowel cancer are discussed.

Adenoma↗
PubMed1973

Pseudo-carcinomatous invasion in adenomatous polyps of the colon and rectum.

The histology of pseudo-carcinomatous invasion in adenomatous polyps of the colon and rectum is described and the appearances are contrasted with those seen in malignant polyps. The recognition of pseudo-carcinomatous invasion is important in the differential diagnosis of benign and malignant polyps of the large bowel. Failure to distinguish it from carcinoma may lead to wrong treatment and false reports of the incidence and prognosis of cancer of the colon and rectum. The evidence suggests that pseudo-carcinomatous invasion may be the result of repeated twisting of the stalk of a polyp which causes haemorrhage and this facilitates the passage of non-malignant adenomatous epithelium through the muscularis mucosae.

Adenocarcinoma↗