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Biomedical subjects

H J Norris

Publications and source records attributed to H J Norris.

At least 55 records · Page 3Linked to original sources
PubMed1988

Hemorrhagic cellular leiomyomas ("apoplectic leiomyoma") of the uterus associated with pregnancy and oral contraceptives.

The clinical and pathological findings in 22 women with a distinctive hemorrhagic cellular (HC) leiomyoma of the uterus are described. Characterized by a dense cellularity accompanied by hemorrhage and edema, 17 occurred in women taking oral contraceptives, three occurred in pregnant women, and one was found in a woman 3 days postpartum. One woman, not pregnant or taking steroids, was using hydrochlorothiazide. Recognition of this special form of leiomyoma associated with the use of reproductive steroids is needed to avoid confusing it with leiomyosarcoma. The major differences with leiomyosarcoma are that HC leiomyomas are generally small, often multiple, and have discrete areas of hemorrhage and tearing artifact, but little or no atypia. Also, their mitotic activity is confined to a narrow zone adjacent to the hemorrhage.

Adult↗
PubMed1988

A comparative morphometric and cytophotometric study of intraductal hyperplasia and intraductal carcinoma of the breast.

The Feulgen DNA content and the nuclear measurements of four groups of intraductal proliferations of the breast (hyperplasia, atypical hyperplasia, well-differentiated carcinoma without cytologic atypia and intraductal carcinoma with cytologic atypia) were compared. Intraductal carcinoma with atypia was the only group distinct from the others on the basis of DNA content, nuclear area and perimeter. Although the other groups were separable from intraductal carcinoma with atypia, they could not be reliably distinguished from each other by any combination of measurements. At best, 69% of well-differentiated intraductal carcinomas could be distinguished from atypical hyperplasias using a combination of DNA content and nuclear perimeter measurements. Thus, the difficult distinction of atypical hyperplasia from well-differentiated intraductal carcinoma by light microscopy was not aided by DNA analysis or by nuclear measurements.

Breast↗
PubMed1988

The morphologic effects of synthetic reproductive steroids on the mammary gland of rhesus monkeys. Mestranol, ethynerone, mestranol-ethynerone, chloroethynyl norgestrel-mestranol, and anagestone acetate-mestranol combinations.

A total of 213 treated and 16 control monkeys comprising 12 experimental groups was evaluated for determination of the long-term (10 years) effects of various dosages of a variety of synthetic oral contraceptive steroids on the mammary glands of rhesus monkeys. The steroid hormones included mestranol, ethynerone, a combination of mestranol and ethynerone, chlorethynyl norgestrel plus mestranol, and anagestone acetate plus mestranol. Various degrees of physiologic lobular hyperplasia and lactational changes were observed in association with all of these steroid hormones; these changes appeared dose-dependent. Mestranol caused a proliferative atypia ranging from a minimal to a moderate degree in 8 of 34 (23%) animals, but it was not dose-related. Eleven of 15 monkeys (73%) administered ethynerone developed proliferative atypia, ranging in degree from minimal to severe, including one invasive carcinoma and 2 lesions resembling intraductal carcinoma in the human. The mestranol and ethynerone combination produced a proliferative atypia in 22 of 52 animals (42%), including five identical to intraductal carcinoma in the human and one identical to lobular neoplasia. Of the 40 monkeys administered anagestone acetate and mestranol, 20 (50%) developed proliferative atypias; the atypias ranged from mild to severe and included five resembling intraductal carcinoma in human breast. The chloroethynyl norgestrel and mestranol combination induced proliferative atypia in 25 of 52 monkeys (49%); six of these atypias were severe and indistinguishable from intraductal carcinoma of the human breast; and one, if in the human breast, would reflect a solid variant of an invasive carcinoma. Only 2 of the 16 control monkeys (12%) developed proliferative atypias, and these were of minimal to mild degree. The occurrence of severe degrees of atypia identical to intraductal carcinoma in the human breast and invasive carcinoma associated with hormone administration suggests a carcinogenic effect.

Animals↗
PubMed1988

Risk factors in ovarian cancer.

For 50 years, the three- and five-year survival rates of under 40% for invasive ovarian cancer in the USA have not significantly changed. Identifying those women who have a greater probability of developing the disease should contribute to improving survival. Our 3-year case-control study of 298 women from the metropolitan Washington, DC, area with primary epithelial ovarian cancer revealed a woman is at greater risk of developing ovarian cancer if she has a family history of the disease, experiences difficulty becoming pregnant, and has a normal menopause with hot flashes. Her risk for the disease is diminished with multiparity, a history of dysmenorrhea, and hysterectomy. Physicians should consider these risk factors when performing pelvic examinations in women and coordinate them with known changes in ovarian size and procedures to view the ovaries which may permit earlier recognition of ovarian cancer.

Adult↗
PubMed1987

Fibromatosis of the breast. A clinical and pathological study of 28 cases.

The clinical and pathologic findings of 28 examples of fibromatosis of the breast not involving the deep fascia or chest wall are reported. Five of the 20 lesions treated by local excision recurred. Recurrences developed within a 4 to 8 month period following surgery in four of the five instances, and 6 years after surgery in one instance. One lesion recurred five times over a period of 3 years. None of the patients died from their disease, and none developed a metastasis. Those lesions that recurred had been inadequately excised initially, since surgical margins showed fibromatosis. Specific histological features, such as size, cellularity, atypia, and mitotic figures, were not helpful in predicting recurrence. Although local excision appears to have been adequate in the majority (75%) of the patients, the infiltrative nature of fibromatosis necessitates documentation of tissue margins in order to avoid the possibility of recurrence. The differential diagnosis includes benign reactive processes (such as keloid and nodular fasciitis), fibrous histiocytoma, low-grade spindle-cell (metaplastic) carcinoma, and fibrosarcoma.

Adolescent↗
PubMed1987

Myofibroblastoma of the breast. Sixteen cases of a distinctive benign mesenchymal tumor.

The clinical and pathologic findings of 16 examples of a distinctive stromal tumor of the breast designated as "myofibroblastoma" are reported. Eleven of the 16 patients were men, and the average age at presentation was 63 years. Fourteen were treated by local excision and two by simple mastectomy. None of the lesions recurred or metastasized. The tumors were grossly nodular and well-demarcated from the surrounding mammary tissue. Ducts and lobules were not engulfed by the neoplasm. Microscopically, the lesions were formed by uniform, slender, bipolar spindle cells haphazardly arranged in fascicular clusters separated by broad bands of hyalinized collagen. Ultrastructural examination of four lesions identified a predominance of myofibroblasts. Immunoreactivity for S-100 protein and cytokeratin was absent in the 10 tumors examined, but desmin immunoreactivity was focally present in three lesions. The differential diagnosis of myofibroblastoma includes reactive processes and benign neoplasms such as nodular and proliferative fascititis, fibromatosis, spindle-cell lipoma, neurofibroma, neurilemmoma, and leiomyoma. Malignant neoplasms such as stromal sarcoma, malignant fibrous histiocytoma, and spindle-cell or metaplastic carcinoma should not be confused with a myofibroblastoma. The clinical significance of this entity lies primarily in its recognition as a distinctive benign neoplasm.

Adult↗
PubMed1987

Malignant Brenner tumor and transitional cell carcinoma of the ovary: a comparison.

The clinical and pathologic features of 16 malignant Brenner tumors (MBT) having an associated benign Brenner component were compared with 29 primary ovarian transitional cell carcinomas (TCC), neoplasms differing from MBT only in that a benign Brenner component was absent. Transitional cell carcinoma represented a more aggressive neoplasm. Twenty of twenty-nine (69%) presented in advanced stages (II-IV) compared with only three of sixteen (19%) MBT. Among stage IA tumors, only three of seven (43%) patients with TCC were well at last contact, compared with nine of eleven (88%) patients with Stage IA MBT. In addition to not having a benign Brenner component, TCC lacked the prominent stromal calcification common in most benign and malignant Brenner tumors. Transitional cell carcinoma is sufficiently different from MBT in that it is reasonable to suppose that ovarian TCC arises directly from pluripotential surface epithelium of the ovary and from cells with urothelial potential, rather than from a benign or proliferative Brenner tumor precursor.

Adult↗
PubMed1986

Breast carcinoma with osteoclastlike giant cells.

Seven carcinomas of the breast with osteoclastlike giant cells were studied. Recurrences and lymph node metastases also contained osteoclastlike giant cells. Judging from ultrastructural and histochemical studies, the osteoclastlike giant cells are not epithelial, but are of mesenchymal origin. They may appear in a variety of different types of carcinoma.

Adult↗
PubMed1986

Mammary adenoid cystic carcinoma with sebaceous differentiation. A morphologic study of the cell types.

Nine examples of mammary adenoid cystic carcinoma with sebaceous differentiation were studied. Each one of the nine tumors contained basaloid, eosinophilic, and sebaceous cells. Two of these tumors were examined by electron microscopy and compared with four mammary adenoid cystic carcinomas without sebaceous differentiation. The sebaceous cells were similar to normal adnexal sebaceous cells. The eosinophilic cells reflected adenosquamous differentiation and were identical to superficial cells of eccrine sweat ducts. The basaloid cells showed no distinctive cytoplasmic differentiation. Cells with features between the basaloid, sebaceous, and adenosquamous cells were present, indicating that basaloid cells have the potential to differentiate toward skin adnexal structures giving rise to both sebaceous and adenosquamous cells. Myoepithelial cells were not identified in any of the six tumors evaluated by electron microscopy.

Breast Neoplasms↗
PubMed1986

Preinvasive lesions of the endometrium.

Endometrial glandular proliferations form a morphological and biologic continuum. The new definition of stromal invasion provides a means of identifying lesions with a relatively high probability of myometrial invasion and malignant behavior. With more standardized terminology and classification, the natural history of preinvasive lesions is better understood. Caution must be exercised because confusion is hard to avoid completely. It is now apparent that the presence of cytological atypia in a preinvasive lesion identifies a lesion at high risk to develop carcinoma. Glandular hyperplasia without cytological atypia identifies a patient likely to have an abnormal endocrine milieu, but it is not a significant preinvasive lesion and has little tendency to develop into one. The presence of cytological atypia provides the basis for selection of therapy.

Carcinoma↗
PubMed1985

The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients.

Endometrial curettings from 170 patients with all grades of endometrial hyperplasia, who did not undergo a hysterectomy for at least 1 year were evaluated in order to correlate the histopathologic features with behavior. Follow-up ranged from 1 to 26.7 years (mean, 13.4 years). Cytologic and architectural alterations were analyzed separately in order to assess their respective roles in predicting the likelihood of progression to carcinoma. Classification of proliferative lesions based solely on the presence of cytologic atypia revealed that atypia was a discriminant factor. Proliferations lacking cytologic atypia were designated hyperplasia and those displaying atypia were designated atypical hyperplasia. Only 2 (1.6%) of 122 patients with hyperplasia progressed to carcinoma compared with 11 (23%) of women with atypical hyperplasia (P = 0.001). Subclassification of the two forms of hyperplasia (those with cytologic atypia and those without) was performed using the degree of architectural abnormalities. Hyperplasia and atypical hyperplasia displaying marked glandular complexity and crowding producing a back-to-back appearance were designated complex hyperplasia (CH) and complex atypical hyperplasia (CAH), respectively. Hyperplasia and atypical hyperplasia with lesser degrees of glandular complexity and crowding were designated simple hyperplasia (SH) and simple atypical hyperplasia (SAH), respectively. Progression to carcinoma occurred in 1 (1%) of 93 patients with SH, in 1 (3%) of 29 patients with CH, in 1 (8%) of the patients with SAH, and in 10 (29%) of the patients with CAH. The differences between the four subgroups suggest a trend but are not statistically significant. The findings in this study provide a rationale for classifying noninvasive endometrial proliferations primarily on the basis of cytologic atypia since this is the most useful criterion in predicting the likelihood of progression to carcinoma. In addition, the presence of concommitant architectural alterations appears to identify a particularly high-risk subgroup.

Adenocarcinoma↗
PubMed1985

Misstaging of ovarian cancer.

The thoroughness of intraoperative evaluation of the extent of disease in 291 women with primary ovarian cancer was investigated. Notable differences among physician specialties but not types of hospitals where initial surgery was performed were observed. A review of medical record documentation revealed that 97% of the cases operated on by gynecologic oncologists had complete staging evaluations performed intraoperatively, but only 52 and 35% of cases operated on by obstetricians/gynecologists and general surgeons, respectfully, were adequately evaluated. Roughly one-half of the cases diagnosed in community hospitals and in hospitals with teaching affiliations were found to be completely studied, and 66% of those operated on in university hospitals received complete intraoperative evaluations.

Diagnostic Errors↗
PubMed1984

Sertoli-Leydig tumors of the ovary. A clinicopathologic study of 64 intermediate and poorly differentiated neoplasms.

The clinical and pathologic features of 64 Sertoli-Leydig tumors of the ovary with intermediate and poor differentiation were studied. The neoplasms occurred mainly in young women. Fifty-four percent of the patients presented with clinical evidence of a hormonally active tumor, and 38% were virilized. The remaining 46% had nonspecific symptoms. Sixty-two patients had tumors confined to one ovary at operation (Stage Ia), while only two patients presented with pelvic metastases (Stage III). The prognosis was generally favorable; the 5- and 10-year actuarial survival rates were 92%. Unilateral salpingo-oophorectomy was effective treatment for Stage Ia Sertoli-Leydig tumors in young women. Microscopically, 44 of the neoplasms were of intermediate differentiation and 20 were poorly differentiated. Heterologous elements (mucinous epithelium, striated muscle, cartilage) were present in 16 neoplasms. The pathologic features that correspond with development of metastases were poor differentiation, the presence of heterologous mesenchymal elements, frequent mitotic figures in stromal cells, and rupture of the neoplasm.

Adolescent↗
PubMed1984

Immunocytochemical localization of placental lactogen and chorionic gonadotropin in the normal placenta and trophoblastic tumors, with emphasis on intermediate trophoblast and the placental site trophoblastic tumor.

This report presents preliminary observations on the immunocytochemical localization of human chorionic gonadotropin (hCG) and human placental lactogen (hPL) in placental site trophoblastic tumors, hydatidiform moles, and choriocarcinomas and compares the findings with those of a similar immunocytochemical analysis of the placenta at various stages of development. In addition to cytotrophoblast (CT) and syncytiotrophoblast (ST), a third form of trophoblast designated "intermediate trophoblast" (IT) is present during normal pregnancy and in trophoblastic disease. Intermediate trophoblastic cells are mononucleate, larger than CT, and contain more abundant eosinophilic cytoplasm, resulting in a partial resemblance to ST. Intermediate trophoblast has distinctive immunocytochemical features that distinguish it from CT and ST. The localization of hPL and hCG in both IT and ST varies with the age of the placenta, with the type of trophoblastic neoplasm, and from one specimen to another within each category of tumor. Syncytiotrophoblast may contain both hormones in large amounts, whereas IT contains hPL predominantly and hCG focally. Cytotrophoblast is devoid of hCG and hPL except in choriocarcinoma, which may show focal weak staining for hCG. Immunocytochemical identification of hCG and hPL has proved helpful in clarifying the histogenesis of trophoblastic neoplasms and may also be of value in establishing their diagnosis and in determining their prognosis.

Adult↗
PubMed1984

Coexistence of ovarian neoplasms and endocervical adenocarcinoma.

The coexistence of ovarian neoplasms and adenocarcinoma of the cervix occurs more often than generally realized. Of 390 women with adenocarcinoma of the cervix, the ovaries were available for histologic review in 161. Neoplasms were present in the ovaries of 25 of the 161 women (16%). Eleven carcinomas were metastatic to the ovary, and 14 (9%) were independent primary tumors. These included four benign cystic teratomas, four benign epithelial tumors, and six primary carcinomas. The 54 women with endometrioid adenocarcinomas of the cervix were especially prone to ovarian carcinoma because four (7%) had coexistent or subsequent endometrioid carcinoma in the ovary.

Adenocarcinoma↗
PubMed1983

Predicting the outcome of endometrial hyperplasia by quantitative analysis of nuclear features using a linear discriminant function.

Nuclear parameters from 24 cases of atypical endometrial hyperplasia were determined by means of graphic tablet and microcomputer. Eight of the 24 hyperplasias progressed to carcinoma, but the remaining 16 did not progress during a mean follow-up period of 11.8 years. A linear discriminant function selected the mean and standard deviation of maximal nuclear diameter as useful predictors of clinical outcome. The linear discriminant function predicted the correct outcome in 83% of the cases. This study suggests that measurement of nuclear parameters in atypical endometrial hyperplasia may provide a more objective means of predicting the behavior of the various forms of hyperplasia.

Cell Nucleus↗