Biomedical subjects
Publications and source records attributed to J D Woodruff.
Four women were treated for erythematous lesions of the vulva, which vary from acute dermatitis to invasive cancer. Often a positive diagnosis can be made only with biopsy, and interpretation of the tissue is very important.
Southern transfer analysis for human papillomavirus genomic sequences was conducted on 152 vulvar and vaginal tissue specimens obtained from 86 patients. Histopathologic diagnoses included condyloma acuminatum, intraepithelial neoplasia, and invasive cancer. In six patients, lesions of more than one pathologic type were identified. Vaginal lesions constituted less than 5% of tissues examined. Distribution of lesions was as follows: condyloma, 93 lesions from 57 patients; intraepithelial neoplasia, 47 lesions from 29 patients; and invasive carcinoma, 12 lesions from six patients. Seventy-five percent of the patients were white. The mean age of the patients increased from 25 years for condyloma to 38 years for vulvar intraepithelial neoplasia III to 56 years for invasive cancer. A viral diagnosis was made in 81% of condylomas, 84% of vulvar intraepithelial neoplasia III, and 58% of invasive carcinomas. Distribution of viral types differed markedly for the various histopathologies. Types 6/11 accounted for 77% of condylomas and 0% of vulvar intraepithelial neoplasia III. Type 16 was recovered from 12% of condylomas and 81% of vulvar intraepithelial neoplasia III. Type 18 was identified in a small proportion in both categories; type 31 was seen in a few vulvar intraepithelial neoplasia III lesions. In invasive carcinomas, type 16 was the predominantly identified virus. Papillomavirus type 16 emerges as the dominant oncogenic virus in vulvar neoplasms. Its presence in a large percentage of condylomas raises the issue of an "atypical condyloma" as a precursor of neoplasia.
Trichoepithelioma usually presents clinically as single or multiple nodules on the face, scalp, neck and trunk, and no cases of it on the vulva have been described before. Vulvar trichoepithelioma has complex histologic patterns and originates in appendages that simulate malignancy.
Both aluminum and calcium are present in many pelvic concretions that have traditionally been attributed to calcium and phosphorus alone. There is considerable variation in both the amount and the distribution of aluminum when it is present.
Reports in the literature stress the premalignant potential of vulvar melanocytic lesions and the unusual histologic features associated with some vulvar nevi in premenopausal women. We examined biopsies of 85 pigmented vulvar lesions taken from women 13 to 73 years of age. There were 59 nevocellular nevi, 16 lentigines, 4 melanomas, and 6 miscellaneous lesions. The nevocellular nevi were compared to a control series of 200 nevi from the torsos of women 20 to 60 years old. Three vulvar nevi were considered to be unusual, but not dysplastic. These histologically unusual nevi occurred in women 20 to 30 years old. The lesions exhibited notable enlargement of junctional melanocytic nests with variability in the size, shape and position of the nests. Similar changes were not observed in the control group. There was a significant association (p less than 0.05) between the occurrence of these unusual lesions and their presentation on the vulva; however, these lesions showed no predilection for any particular site on the vulva. There was no evidence of an increased incidence of vulvar dysplastic nevi when compared with the control series.
All 190 cases of gestational trophoblastic neoplasia diagnosed in the Baltimore metropolitan area from 1975-1982 were identified. Histologic slides were requested and reviewed independently by two pathologists who agreed upon uniform criteria for the diagnosis of hydatidiform (complete) mole, invasive mole, and choriocarcinoma. A representative sample of the slides was selected and resubmitted to one of the study pathologists for a second review. The inter- and intra-pathologist variability in the diagnosis of gestational trophoblastic neoplasia was calculated using the kappa statistic (K). Our findings indicated that the variability in the diagnosis of gestational trophoblastic neoplasia was low whereas that for the related tumor of incomplete mole was high.
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A very rare case of fibro-osteochondroma arising in uterine musculature was studied histologically. The tumor exhibited three types of cellular proliferation--fibroblastic, cartilaginous, and osseous--all within an abundant collagenous matrix. The three components were intermingled, and varied in the degree of differentiation of cartilaginous and osseous tissue. The more differentiated tissues were usually circumscribed by fibrocellular bands of spindle-shaped cells that seemed to have transformed into rounded cartilaginous cells. Presumably this tumor arose from undifferentiated mesenchymal cells in the myometrium, which proliferated to form fibroblasts, chondrocytes, and osteoblasts. The tumor may be designated fibrio-osteochondroma. It is histologically benign and exceedingly rare.
In a clinicopathologic analysis of previously unreported uterine hemangiopericytomas, malignant behavior was observed in four of 21 followed patients. Recurrent disease occurred in the pelvis, abdomen, and lungs. The role of chemotherapy in the treatment of recurrences was not substantiated. No specific histologic features could be identified that correlated with malignant potential.
Uterine epithelioid leiomyosarcoma is an unusual smooth muscle neoplasm. It is distinguished on cytoarchitectural grounds from the majority of leiomyosarcomas that arise in the uterus. Three cases of this atypical lesion are presented and the pathologic features are discussed. One patient is alive with no evidence of disease at 3.5 years, one patient has persistent disease at 4 years, and the third patient died of disease at 8 months. Fundamental differences in biologic behavior of this subset of uterine smooth muscle tumors cannot be discerned.
During the 5-year period 1976-1980, seven cases of emergent surgical disease of the adnexae during pregnancy were encountered. The incidence of 1:1832 deliveries approximated that of appendicitis (1:1603 deliveries) during the same period. There were three cases of adnexal torsion, two ruptured ovarian cysts with hemorrhage, one heterotopic pregnancy, and one ruptured endometrioma. The right side was more commonly the site of the pathology, and abdominal pain the only consistent presenting symptom. Fever, tachycardia, and leukocytosis were inconsistent findings. Culdocentesis was positive in two cases. Four desired pregnancies were carried successfully to term postoperatively. Surgical emergencies of the adnexae will be encountered during pregnancy more commonly than is generally recognized. Aspects of obstetric management are described. If prompt surgical intervention is undertaken in pregnancy when the clinical picture suggests an acute abdomen, a satisfactory outcome can be expected.
Genital tract papillomas in five children were examined for the presence of human papillomavirus (HPV) DNA by molecular hybridization. Papillomavirus DNA was detected in each sample and was identified as HPV-6 (three cases), HPV-6 or HPV-11 (one case), or HPV-16 (one case). These viruses are the same as are responsible for genital papillomas (condylomata) of adults. The transmission of adult genital tract viruses to children occurs primarily by a venereal route but may occur by a nonvenereal route.
Sixty-four patients were treated by minor vestibular adnexectomy for persistent dyspareunia and vulvar pain and burning between 1982 and 1984. The incidental finding of vestibular gland adenomas was found in 12 cases. These masses were 1 to 2 cm in size and composed of mucous secreting glands characteristic of the vestibular glands. These lesions were benign and were associated with previous surgical manipulation and chronic inflammatory reaction of the vestibular tissues. Previous recognition of vestibular adenomas in the literature is rare.
Adenocarcinoma in adenomyosis is unusual and in most cases is associated with adenocarcinoma in the surface endometrium. In the latter, the diagnosis is made in the removed specimen because of the finding of adenocarcinoma in curettings. In contrast, adenocarcinoma arising in adenomyosis without surface endometrial changes is extremely rare and presents major diagnostic problems. The two cases reported herein demonstrate the significance of atypical vaginal cytology in the recognition of such lesions.
A case-control study to determine the gynecologic and reproductive risk factors for gestational trophoblastic neoplasia was conducted in the Baltimore Metropolitan Area. All cases (N = 190) that were pathologically diagnosed from 1975 to 1982 as hydatidiform mole, invasive mole, or choriocarcinoma were ascertained. Slides were independently reviewed by two pathologists. Cases were matched by age, race, and last menstrual period to controls who were delivered of normal pregnancies at term. In the analysis of medical record and interview data, factors found to be positively associated with gestational trophoblastic neoplasia included professional occupations (odds ratio = 2.56, p less than 0.0001), prior spontaneous abortions (odds ratio = 2.32, p = 0.02), and the mean number of months from the last pregnancy to the index pregnancy (cases = 35.9, controls = 28.2; p = 0.03). Factors found not to be associated with disease included contraceptive history, irradiation, ABO blood group, and smoking factors of the male partner. The findings suggest that gestational trophoblastic neoplasia may be part of a continuum of early (first-trimester) reproductive abnormalities.
Warty lesions of the oral cavity were examined for etiologic association with genital tract papillomaviruses HPV-6, HPV-11, and HPV-16. DNAs extracted from ten oral biopsies were screened for HPV genomic sequences by Southern transfer hybridization with 32P-labeled viral DNA probes. Nonstringent hybridization with an HPV-6 probe revealed papillomavirus DNA sequences in four of seven tissues with histologic evidence of papillomatosis, in none of two tissues without histologic evidence of papillomatosis, and in one tissue that was not examined by histology. Stringent hybridization tests with HPV-6 and HPV-16 probes identified the genome in one tissue as being HPV-16, in a second tissue as being HPV-6 subtype a, and in a third tissue as HPV-6 (subtype unidentified); papillomavirus DNA sequences in two tissues are as yet not identified. An additional case of HPV-6 or HPV-11 related oral cavity lesion was diagnosed by in situ hybridization of paraffin sections with a 35S-labeled, mixed HPV-6 + HPV-11 probe. The hybridization in the positive section was extensive and confined to epithelial nuclei. The oral lesions associated with genital tract papillomaviruses were asymptomatic, multiple or single, and were located in different parts of the oral cavity, for example, on the gingivae, on the tongue, on the lip, on the tonsillar pillar, and on the floor of the mouth.
The vestibule, or introitus, is a unique area in the lower genital canal. Of major importance is the understanding of the embryology of the area if the lesions are to be interpreted adequately. It is a "collision zone" formed at the junction of different germ layers. The newly recognized syndrome of severe dyspareunia caused by inflammation of the minor vestibular glands affects many women. At present, ablative therapy is all that can be offered to these patients. While excisional surgery is highly successful, medical therapy awaits the elucidation of the true cause of this disorder. Vestibular mucous cysts and vestibular papillae are common benign conditions which must be recognized as such, lest inappropriate therapy be recommended.
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