Search PubMed⌕ Search

Biomedical subjects

H J Norris

Publications and source records attributed to H J Norris.

At least 19 recordsLinked to original sources
PubMed1992

Expression of the HER-2/neu proto-oncogene in serous ovarian neoplasms.

BACKGROUND: It is unclear whether HER-2/neu proto-oncogene expression in ovarian epithelial neoplasms is related to prognosis. METHODS: The authors performed immunohistochemical stains on 20 serous tumors of low malignant potential (STLMP) in Stages I and II and 19 serious carcinomas in the same stages. They used three different commercial antibodies to make comparisons. RESULTS: Two of four Stage I STLMP in patients who experienced disease progression showed positive staining for the gene product, whereas none of seven Stage I nonprogressive STLMP showed positive staining. Five of the six Stage III nonprogressive STLMP showed positive staining, whereas none of three Stage III STLMP that progressed showed positive staining. Three carcinomas (one Stage I and two Stage III) also showed positive staining. CONCLUSIONS: Expression of HER-2/neu may be associated with high stage in serous ovarian neoplasms, but it is not likely to identify the small fraction of patients with STLMP who will experience disease progression.

Adult↗
PubMed1992

Flow cytometric analysis of endometrial stromal sarcoma.

Twenty-two endometrial stromal sarcomas were studied by flow cytometric analysis and the results were correlated with surgical stage, nuclear grade, mitotic index, and recurrence. Ploidy determination was not helpful in predicting recurrence in patients with Stage I disease because all 14 were diploid. Only 2 of the 22 tumors were aneuploid; both were high-stage neoplasms. Cell proliferation (%S or %S + %G2/M) did not significantly correlate with vascular invasion, nuclear grade, mitotic index, or surgical stage. Of the 13 Stage I neoplasms with follow-up data, three recurred. The mean proliferation index (%S + %G2/M) of those that recurred was 12.81 +/- 0.47, which did not differ from those that did not recur (mean 12.25 +/- 4.11).

Aneuploidy↗
PubMed1992

Fibrosarcoma-malignant fibrous histiocytoma of the breast. A clinicopathological study of 32 cases.

We report the clinical and pathologic features of 32 sarcomas of the breast with features spanning the spectrum of fibrosarcomas-malignant fibrous histiocytomas. Neoplasms were categorized as high- or low-grade lesions depending on a combination of the degrees of atypia and mitotic activity. The majority of high-grade lesions had marked (3+) nuclear atypia and at least five mitotic figures per 10 hpf. High-grade lesions with moderate (2+) nuclear atypia had a mitotic activity of six or more mitotic figures per 10 hpf. All low-grade lesions had five or fewer mitotic figures per 10 hpf, and none had a score of the nuclear grade times mitotic figures of more than 10. The average mitotic activity in low-grade lesions was two mitotic figures per 10 hpf; the high-grade lesions had 12 mitotic figures per 10 hpf. Sixty-nine percent of the low-grade fibrosarcomas-malignant fibrous histiocytomas showed mild (1+) cytologic atypia, and 69% of the high-grade lesions showed severe (3+) cytologic atypia. The herringbone pattern was associated with a more favorable prognosis than the malignant fibrous histiocytoma pattern. Compared to the high-grade lesions, low-grade fibrosarcomas-malignant fibrous histiocytomas were slow-growing, produced fewer recurrences, and did not metastasize. Of the 16 women with low-grade lesions, all were free of tumor at last contact, despite recurrence in more than half of the patients. In contrast, 31% of the patients with high-grade lesions died of tumor, and 13% were alive with disease. Twenty-five percent of women with high-grade lesions developed distant metastases.

Adult↗
PubMed1992

Amebiasis complicating carcinomas: a diagnostic dilemma.

Two black African women and one black American man had carcinomas of cervix, perineum, and sigmoid colon, respectively. In each of these patients, trophozoites of Entamoeba histolytica had invaded the surface of the tumor, and in some areas had invaded more deeply into the stroma between the tumor cells. Although it is well known that cutaneous amebiasis of anus, penis, vulva, and cervix can mimic squamous cell carcinoma, it may be, perhaps, less well known that carcinomas at these sites may be colonized by trophozoites of E. histolytica. In patients with amebiasis but without an associated carcinoma, a correct diagnosis of amebiasis spares the patient unnecessary and sometimes mutilating surgery. But a diagnosis of amebiasis, when there is an unrecognized underlying carcinoma, delays effective treatment of the carcinoma. A smear that establishes a diagnosis of cutaneous amebiasis, therefore, should be followed by biopsy to exclude or confirm an underlying carcinoma.

Adenocarcinoma↗
PubMed1991

Hamartomas of the breast.

The clinical and pathologic findings of 17 hamartomas of the breast were studied. All neoplasms were evident as clinically and mammographically discrete masses. The pathologic findings were varied and included circumscribed fibrocystic disease, adenolipoma, fibroadenoma with fat and fibroadenoma with lobules. The heterologous elements identified were cartilage and smooth muscle. All lesions were treated by simple excision. In this study, four different microscopic patterns of hamartoma are described and the necessity for a close clinicopathologic correlation is pointed out in the diagnosis of this lesion.

Adenofibroma↗
PubMed1991

The mistaken diagnosis of carcinoma of the ovary.

The primary site of carcinoma was investigated in 339 women diagnosed as having carcinoma of the ovary. After a review of medical records and microscopic slides, 43 women were discovered not to have a primary carcinoma of the ovary. Of these 43 women, 15 had benign ovarian tumors, 13 had primary carcinoma of the peritoneum and 15 had primary carcinoma of the intestines. Review of the medical records of 15 women found to have benign ovarian tumors disclosed the original pathologic interpretation of cancer was not supported by clinical or operative observations and no second opinion pathologic review was noted in the records. Until our review, 13 women who were diagnosed as having carcinoma of the ovary had primary peritoneal tumors. Nine of these women either had normal ovaries removed previously or had normal results of biopsies of the ovary done intraoperatively. Of those women entering the study with a diagnosis of carcinoma of the ovary, but in whom our review noted carcinoma of the intestines, 14 of 15 had intestinal complaints before operation. More than one-half of the patients did not have the intestine studied preoperatively, most had diffuse disease at operation and almost one-half of the women had normal sized ovaries at operation. By not performing gastrointestinal roentgenographic studies and suspecting the possibility of metastasis and by misleading the pathologist by presenting the specimen as an ovarian tumor, patients were erroneously diagnosed as having primary carcinoma of the ovary.

Adult↗
PubMed1991

Myogenous phenotype of epithelial-like areas in endometrial stromal sarcomas.

Approximately 25% of low-grade endometrial stromal sarcomas of the uterus contain areas of epithelial-like differentiation, which are often reminiscent of ovarian sex-cord tumors. It has been suggested that these areas may represent attempted differentiation toward either uterine glands or smooth muscle. To investigate these two possibilities, we examined the histologic and immunohistochemical features of 26 low-grade endometrial stromal sarcomas. Eight tumors had epithelial-like differentiation, which in some tumors was so prominent as to suggest a purely epithelial neoplasm. Areas typical of endometrial stromal sarcoma were vimentin positive, whereas epithelial-like differentiation expressed vimentin and the muscle markers muscle-specific actin and desmin, as well as cytokeratin, but not the epithelial marker epithelial membrane antigen. Epithelial-like differentiation in low-grade endometrial stromal sarcoma is not uncommon and, based on our immunohistochemical results after comparison with normal controls, epithelial-like differentiation has a myogenous rather than an epithelial phenotype.

Adult↗
PubMed1990

A comparison of the results of long-term follow-up for atypical intraductal hyperplasia and intraductal hyperplasia of the breast.

Follow-up information was obtained on 199 women with breast biopsy specimens containing intraductal epithelial proliferation. The proliferations were divided into regular or ordinary intraductal hyperplasia (IDH) (117 cases) and atypical intraductal hyperplasia (AIDH) (82 cases). The average length of follow-up was 14 years for the patients with IDH and 12.4 years for the patients with AIDH. Of the 117 patients with ordinary IDH, carcinoma subsequently developed in six (5%); three of these were invasive carcinomas (2.6%). All three invasive carcinomas were in the ipsilateral breast, but of the three intraductal carcinomas (IDCa), two were in the contralateral breast. Of the 82 patients with AIDH, invasive carcinoma subsequently developed in eight (9.8%); six of these were located in the ipsilateral breast and two in the contralateral breast. One of these six patients died of disseminated carcinoma. The average interval to the subsequent carcinoma (intraductal and invasive carcinoma) was about the same in the two groups (8.3 years for AIDH and 8.8 years for IDH lacking atypia). When considering only subsequent invasive carcinomas, the interval was 8.3 years for the AIDH and 14.3 years for the IDH lacking atypia. Of the 14 patients with IDH and a family history of breast carcinoma, invasive carcinoma subsequently developed in one (7%) as compared with two (2%) of the 91 with a negative family history. Among patients with AIDH, invasive carcinoma subsequently developed in two of the 13 (15%) of those with a family history of breast carcinoma as compared with one of 57 (1.8%) of the women with a negative family history. The presence of atypia in epithelial hyperplasia is a significant factor in increasing the likelihood of the development of subsequent invasive carcinoma (P = 0.03; two-tailed test). Of women with AIDH, invasive carcinoma subsequently developed in 17% of those with sclerosing adenosis (SA) as compared with 4.2% of those without it. Therefore, SA may be a contributing factor to increased risk. A positive family history also appears to increase the likelihood of the subsequent development of invasive carcinoma, particularly in patients with AIDH.

Adolescent↗
PubMed1990

Metaplastic carcinomas of the breast. IV. Squamous cell carcinoma of ductal origin.

The clinical and pathologic features of 22 examples of pure ductal squamous cell carcinoma (SqCC) of the breast are reported. All patients were women with a mean age of 53 years. Only two of the 19 women with axillary dissection had metastases, but one woman had a positive supraclavicular lymph node in the presence of negative axillary nodes. All metastases were squamous carcinoma. All patients were eligible for a minimum of 5 years' follow-up; the cumulative 5-year disease-specific survival rate was 63%. Eight women developed metastases and one also developed local recurrence, all within 2 years, and all eight died from tumor within 4 years of initial therapy (mean, 2 years). Prophylactic postoperative radiation therapy and radiation for lymph node metastases at initial surgery did not prolong survival as four of the five recipients died from tumor. Although there were no statistically significant gross or histologic differences between recurrent and nonrecurrent neoplasms, larger neoplasms tended to metastasize. Immunohistochemical study for S-100 protein identified an immunoreactive cell component in five of seven neoplasms tested. This and light microscopic findings suggest myoepithelial proliferation, differentiation, or origin.

Adult↗
PubMed1990

Mitotically active leiomyomas of the uterus.

Seventy-three smooth-muscle tumors of the uterus, with five to nine mitotic figures per 10 high-power fields but lacking cytologic atypia, were studied. Pathologic features assessed included necrosis, hemorrhage, vascular intrusion, abnormal mitoses, and the number of mitotic figures. Vascular ingrowth by the tumor was present in 11 neoplasms. Follow-up ranged from 23 months to 15 years, with all patients alive and well at last contact. In 14 patients, myomectomy was the only treatment. Thirteen of these patients demonstrated no subsequent residual or recurrent tumor. One woman developed a persistent or recurrent mitotically active leiomyoma 8 years after myomectomy. We conclude that mitotically active smooth-muscle tumors of the uterus, having five to nine mitoses per 10 high-power fields and no cellular atypia, have a metastatic rate too low to be regarded as sarcomas. Hysterectomy need not automatically follow myomectomy if follow-up is done.

Adult↗
PubMed1990

Metaplastic carcinomas of the breast: V. Metaplastic carcinoma with osteoclastic giant cells.

The clinical and pathologic features of 29 examples of mammary metaplastic carcinoma with osteoclastic giant cells (OGC) in the stroma are reported. A bland spindle cell or sarcomatous component dominated these neoplasms, although infiltrating duct carcinoma was present in 23 cases, and intraductal carcinoma was present in six cases. In all 29 neoplasms, the carcinoma was admixed or contiguous with the stroma. Osteoclastic giant cells were admixed within the cellular stroma, and were intimately associated with prominent thin-walled vessels. Hemorrhage and hemosiderin deposition were common. Osteoclastic giant cells were immunoreactive for vimentin and, to a lesser extent, actin, and uniformly not immunoreactive for keratins, confirming their mesenchymal nature. The stromal component of 63% of neoplasms tested was immunoreactive for keratin, 33% was immunoreactive for epithelial membrane antigen, 54% reacted for S-100 protein, 84% reacted for actin, and 100% was immunoreactive for vimentin. Nineteen neoplasms had osteoid, bone, or cartilage, but these were a prominent component in only five neoplasms and OGC were not limited to these areas. The disease-specific cumulative 5-year survival rate for patients with metaplastic carcinoma with OGC was 68%, similar to rates for patients with matrix-producing carcinoma (68%), spindle cell carcinoma (64%), and squamous carcinoma of ductal origin (63%), but notably different from that of patients with carcinosarcoma (49%). Of 17 women with axillary node dissection, only two had metastases. Eleven women developed distant metastases, most commonly to the lungs. Metastasis present at or following initial surgery was an ominous sign, as all 11 women with metastases died from tumor. Size and microscopic circumscription were significant factors in predicting disease progression.

Adult↗
PubMed1990

DNA content of juvenile granulosa tumors determined by flow cytometry.

Juvenile granulosa tumors (JGT) often exhibit worrisome morphologic features, yet usually behave in a benign fashion. Thirteen JGT were examined by flow cytometric analysis of paraffin material to determine if DNA content and cell kinetics are related to prognosis. The patients ranged in age from stillborn to 16 years. Unilateral salpingoophorectomy was the most common therapy. Eleven patients with follow-up were free of disease. Marked nuclear atypia was evident in three cases, and high mitotic counts were observed in six, but only marked atypia correlated with DNA content. Flow cytometry revealed that 46% of the JGT had abnormal DNA content and increased average growth fraction. The neoplasms with the highest DNA indices were found predominantly in postmenarchal girls. JGT may exhibit abnormal DNA content, nuclear atypia, and numerous mitoses, yet behave benignly. DNA flow cytometric studies of higher stage JGT are warranted.

Adolescent↗
PubMed1989

Flow cytometric analysis of granulosa tumors.

Paraffin blocks from 17 granulosa tumors, nonmetastatic (n = 10) and metastatic (n = 7), were analyzed by flow cytometry. Three neoplasms, one with and two without metastases, were found to have cells with an abnormal DNA (DNA aneuploid) content. The occurrence or absence of DNA aneuploid cells did not predict behavior. In addition, there was no correlation of tumor DNA content with tumor size or patient age at the time of surgery. There was no significant difference in cell proliferation (%S + %G2/M) between metastatic and nonmetastatic DNA diploid tumors, however, there was an increase in cell proliferation in tumors with a DNA aneuploid stemline. Granulosa tumors are low-grade neoplasms. At least 90% are seen in Stage I, and metastasis occurs subsequently in 5% to 15% of these cases. Features of Stage I neoplasms associated with subsequent metastasis in some reports, but not all, are involvement of the capsule (Stage IC), large size, and high mitotic rate, 1-5 Providing definitive statements about the behavior of granulosa tumors is hampered by their rarity, the subjectivity of the diagnosis, and their sluggish behavior. We attempted to determine if flow cytometric analysis of DNA could identify granulosa tumors with metastatic potential. We compared DNA histograms from ten Stage IA granulosa tumors that did not metastasize during 22 to 47 years of follow-up with seven granulosa tumors that showed malignant behavior.

Adult↗
PubMed1989

Metaplastic carcinomas of the breast. III. Carcinosarcoma.

The clinical and pathologic features of 70 examples of carcinosarcoma (CS) of the breast are reported. Thirty-three neoplasms had infiltrating carcinoma, seven had in situ carcinoma, and 28 had both admixed or contiguous with the sarcomatous component. Squamous carcinoma, present in 15 neoplasms, was the exclusive epithelial component of two. The admixed carcinoma often appeared distinct from the sarcoma component; however, at high magnification transitional differentiation zones and more subtle merging of infiltrating carcinoma with sarcoma were present in most neoplasms. A total of 40 neoplasms were studied by immunohistochemistry for keratins, EMA, vimentin, S-100 protein, and actin. The sarcomatous component in 55% of CS was immunoreactive for keratin, and 98% were immunoreactive for vimentin. A majority were also immunoreactive for actin (77%), and S-100 protein (55%). Ultrastructural examination of the sarcoma in eight neoplasms yielded variable nonspecific findings compatible with sarcoma. These findings indicate biphasic differentiation by cells possessing epithelial and mesenchymal characteristics and suggest myoepithelial origin or differentiation. The cumulative 5-year survival rate for CS was 49%, worse than for other forms of metaplastic carcinoma. The respective 5-year survivals for TNM clinical Stages I, II, and III were 100%, 63%, and 35%. Of patients with axillary dissection, 26% had metastases to axillary lymph nodes with carcinoma as the most frequent component to metastasize. Metastasis was an ominous sign as 33 of 34 patients who developed metastases died from tumor. Local recurrence was not as ominous as 40% who had only local recurrence subsequently died from tumor. Size and microscopic circumscription were also significant prognostic factors.

Adult↗
PubMed1989

A case-control study of epithelial ovarian cancer.

With data from a study of 296 patients with primary epithelial ovarian cancer and 343 patients hospitalized because of other conditions, we estimated ovarian cancer risk in accordance with reproductive and other factors. Risk was greatest among women of lower parity, especially among women who said they planned to have children but could not. The protective effect of oral contraceptives seen in other studies was observed only in subgroups of our study population. Women who had breastfed their children had decreased risk, but the number of months of breastfeeding was not related to risk. Incomplete pregnancies did not provide the protection seen for live births. A family history of ovarian cancer and a medical history of breast cancer were both strong risk factors. None of the nonreproductive factors that we examined, including childhood illnesses, tobacco and alcohol consumption, obesity, and selected adult diseases, was convincingly associated with risk.

Adult↗
PubMed1989

Metaplastic carcinomas of the breast. II. Spindle cell carcinoma.

The clinical and pathologic features of 100 examples of spindle cell carcinoma (SpCC) of the breast are reported. Eighty-three neoplasms contained overt carcinoma; 72 had infiltrating ductal or intraductal carcinoma and in 11 the carcinomatous component was purely squamous. Seventeen neoplasms lacked overt carcinoma, but were identified as SpCC by immunoreactivity for keratin and the typical bland spindle cell proliferation forming a variable complex of fibrocollagenous stroma with feathered, myxoid, angioid, and storiform patterns. Areas of epithelium merging imperceptibly with the spindle cell component were commonly observed. Sixty neoplasms were studied by immunohistochemistry for the presence of keratin, epithelial membrane antigen (EMA), vimentin, S-100, and actin. The spindle cell component in 98% of SpCC was immunoreactive for keratin. Most were also immunoreactive for vimentin and actin, and in approximately one half, S-100 immunoreactivity was noted. These findings, in conjunction with histopathologic features, and ultrastructural observations from three cases, support myoepithelium as an integral component of SpCC. The cumulative 5-year survival rate for SpCC was 64%, better than survival rates usually reported for metaplastic carcinomas. Of 47 patients with axillary dissection, only 6% had metastases to axillary lymph nodes. Development of metastasis was an ominous sign as 29 of the 30 patients who developed metastases died from tumor. Local recurrence was not as ominous as only 29% who had only local recurrence subsequently died from tumor. The difference in size between tumors that recurred (mean, 5.0 cm) and those that did not (mean 3.7 cm), and the presence or absence of complete microscopic circumscription, were both significant prognostic factors.

Adult↗
PubMed1989

A comparative morphometric and cytophotometric study of endometrial hyperplasia, atypical hyperplasia, and endometrial carcinoma.

The DNA content and nuclear measurements of five groups of endometrial proliferations--proliferative endometrium (PE), simple hyperplasia (SH), atypical hyperplasia (AH), well-differentiated carcinoma (WDC), and poorly differentiated carcinoma (PDC)--were compared using 14 descriptors in a stepwise discriminant analysis. Classification using the discriminant rules agreed with the pathologic interpretation for 78% of the specimens. All PEs were assigned to the correct group, and 97% of benign endometria and carcinomas were correctly classified as benign or malignant. Only two of 39 hyperplasias (5%) were misclassified as malignant, and only one of 36 carcinomas was classified as benign. In the difficult distinction between AH and WDC, using all descriptors for the five groups, only 68% of the AH and 60% of the WDC classifications were in agreement with the pathologist of record. However, when discriminant rules addressing only AH and WDC were used, 37 of 39 AHs and WDCs were in concordance. This suggests that a morphometric distinction between AH and WDC is feasible.

Carcinoma↗