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J R Goellner

Publications and source records attributed to J R Goellner.

At least 73 records · Page 4Linked to original sources
PubMed1992

Follicular thyroid carcinoma with capsular invasion alone: a nonthreatening malignancy.

BACKGROUND: The study was designed to determine whether invasion of the tumor capsule, in the absence of vascular invasion (VI), was significant in predicting cause-specific mortality in follicular thyroid carcinoma (FTC). METHODS: Seventy-two patients with FTC were treated by us during 1971 through 1985. In 65 cases the tumors could be classified as either showing capsular invasion (CI) alone (20) or VI, with or without CI, (45). Median follow-up of 45 survivors was 11 years; 12 patients died of FTC. RESULTS: The 10-year occurrence rates for cause-specific mortality and distant metastases were 28% and 19%, respectively, for patients with VI. Comparable rates for the patients with CI were 0% (p = 0.019) and 0% (p = 0.052), respectively. By univariate analysis, higher rates of cause-specific mortality were significantly associated with distant metastases at diagnosis (p < 0.0001), the presence of VI (p = 0.019), and moderate or marked microinvasion (p = 0.019). In stepwise multivariate analyses, only distant metastases at diagnosis had independent prognostic significance (p < 0.0001) in the prediction of cause-specific mortality. In a Cox model, adjusting for distant metastases at diagnosis, the presence of VI was of borderline significance (p = 0.06) in predicting cause-specific mortality. CONCLUSIONS: FTC, diagnosed on the basis of CI alone, did not result in either distant metastases or cancer-related death. The dominant determinant of cause-specific mortality was the presence of distant metastases at diagnosis.

Adenocarcinoma↗
PubMed1992

Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period.

BACKGROUND: The study aims were to characterize patients with papillary thyroid microcarcinoma and to provide data on outcome after surgical therapy. METHODS: Five hundred thirty-five patients with papillary microcarcinoma had initial treatment at Mayo Clinic from 1940 to 1989. Follow-up extended to 48 years. Median follow-up time for 400 survivors was 16 years. Recurrence and mortality details were derived from a computerized cancer database. RESULTS: Median tumor size was 8 mm. Ninety-nine percent of tumors were histologic grade 1; 98% were not locally invasive. Thirty-two percent of patients had nodal metastases at examination. TNM stages were I in 485 patients (91%), III in 49 patients (9%), and IV in one patient (0.2%). Ninety-one percent of patients underwent bilateral lobar resection. Tumor resection was incomplete in three cases (0.6%). Radioiodine remnant ablation was performed in 55 patients (10%). All-causes survival did not differ from expected; two patients (0.4%) died of papillary microcarcinoma. Twenty-year tumor recurrence rate was 6%. Higher recurrence rates were seen either with node-positive patients (p < 0.0001) or after unilateral lobectomy (p < 0.0001). Recurrence rates did not appear to be significantly altered by total thyroidectomy (p = 0.44) or radioiodine remnant ablation in node-positive patients (p = 0.99). CONCLUSIONS: These results reaffirm that papillary microcarcinoma has an excellent prognosis if managed initially by bilateral lobar resection. Routine radioiodine remnant ablation is not indicated.

Adolescent↗
PubMed1991

Gastric leiomyosarcoma. Prognostic factors and surgical management.

Information on gastric leiomyosarcoma, such as important prognostic factors, patterns of disease recurrence, and optimal methods of treatment, are derived from limited patient experience. We address these questions, with specific focus on whether an advantage could be demonstrated for radical resection compared with wide local excision, by retrospectively investigating 53 patients who underwent surgical treatment at Mayo Clinic, Rochester, Minn. Abdominal pain and/or gastrointestinal bleeding associated with an intramural or exogastric mass were typical features of this disease. Only tumor size and histologic grade were statistically significant prognostic factors. With analysis of survival curves and patterns of recurrence, neither the addition of lymphadenectomy nor the wider tumor-free margins of a radical gastrectomy seemed superior to the more conservative local excision. Therefore, wide local excision remains the preferred treatment when technically feasible.

Adolescent↗
PubMed1991

Metastatic melanoma of the gastrointestinal tract. Results of surgical management.

Between 1954 and 1989, 41 patients with melanoma metastatic to the gastrointestinal tract underwent surgical treatment at the Mayo Clinic, Rochester, Minn. The small bowel was most commonly involved (71%), followed by the stomach (27%), large bowel (22%), and esophagus (5%). Gross total excision of all intra-abdominal metastases was performed in 52% of patients. The postoperative mortality was 5% and the median patient survival was 0.8 years, with 1- and 5-year survival rates of 44% and 9%, respectively. Of the patient, tumor, and treatment variables evaluated, patients with small-intestinal metastases had a significantly worse prognosis. Although patients with melanoma metastatic to the bowel have a limited life expectancy, surgical resection of their metastases provides effective palliation. Operative treatment of selected patients with symptomatic melanoma metastatic to the gastrointestinal tract is a worthwhile undertaking.

Adult↗
PubMed1991

Prognostic significance of calcitonin immunoreactivity, amyloid staining, and flow cytometric DNA measurements in medullary thyroid carcinoma.

The proven power of DNA ploidy to predict mortality risk in medullary thyroid carcinoma (MTC) may be weakened when analyzed in conjunction with calcitonin immunoreactivity (CI) and amyloid staining (AS) of tumors. In this study 12 prognostic variables, including DNA ploidy, CI, and AS, were studied in 65 patients with MTC (57 sporadic; mean age 51 years) treated during 1946 through 1970. Cause-specific mortality rates at 10 and 15 years were 15% and 26%, respectively. By univariate analysis, TNM stages III or IV (p less than 0.0001), tumor unresectability (p less than 0.0001), male sex (p = 0.019), negative AS (p = 0.032), and low CI (p = 0.033) were significant predictors of increased mortality rates. DNA ploidy (p = 0.058) and inheritance pattern (p = 0.25) were nonsignificant. By multivariate analysis, only TNM stage, tumor resectability, and AS were independently significant (p less than 0.005). A prognostic model was created, based on presence or absence of these independent risk factors, and four risk groups were defined, capable of predictably defining mortality rates in MTC (p less than 0.0001). The model requires validation in larger series and independent verification by others. However, we believe that a risk-group scheme for MTC based on AS, disease stage, and completeness of tumor resection may have wide applicability and prove relevant to clinicians treating this disease.

Adolescent↗
PubMed1990

Frequent occurrence of cytogenetic abnormalities in sporadic nonmedullary thyroid carcinoma.

Cytogenetic studies may provide important clues to the molecular pathogenesis of thyroid neoplasia. Thus, the authors attempted cytogenetic studies on 12 thyroid carcinomas: seven papillary, three follicular, and two anaplastic. Successful cytogenetic results were obtained on all 12 tumors; nine (75%) had one or more chromosomally abnormal clones. Four of the papillary carcinomas had a simple clonal karyotype, and three had no apparent chromosome abnormality. All four abnormal papillary tumors contained an anomaly of a chromosome 10q arm. In one instance, an inv(10)(q11.2q21.2) was observed in a Grade 2 papillary carcinoma as the sole acquired abnormality. In another case, an inversion or insertion involving 10q21.2 was found in a Grade 1 papillary tumor. The karyotype of a third tumor, a Grade 1 papillary carcinoma, was 46,XX,der(5)t(5;10)(p15.3;q11),der(9)t(9;?)(q11;?). A fourth abnormal papillary carcinoma, a Grade 1 tumor, had a t(6;10)(q21;q26.1) as the sole abnormality. Each of the five follicular or anaplastic carcinomas had a complex clonal karyotype. The three follicular carcinomas contained an abnormality of 3p25-p21, along with several other chromosome abnormalities.

Adenocarcinoma↗
PubMed1990

Prognostic significance of nondiploid DNA determined by flow cytometry in sporadic and familial medullary thyroid carcinoma.

To clarify the role of DNA measurements in predicting outcome after surgical treatment of medullary thyroid carcinoma (MTC), we performed flow cytometric analysis in nuclear suspensions of 119 MTC tumors. Of the 119 patients, 63 (53%) patients had sporadic tumors and 56 (47%) patients had familial tumors; survivors were followed for a mean of 13 years. DNA content was normal in 92 (77%) patients and abnormal (nondiploid) in 27 (23%) patients. Ten-year cause-specific mortality rates were 12%, 42%, and 49% with diploid, tetraploid/polyploid, or aneuploid tumors (p = 0.0009) and were greater with nondiploid tumors both in the sporadic (p = 0.012) and multiple endocrine neoplasia (familial) cases (p = 0.114). None of 27 patients with TNM stage I disease died of MTC. In patients with TNM stages II, III, and IV disease, DNA nondiploid tumors were associated with increased deaths from MTC. In a Cox proportional hazards model involving all 119 patients and adjusted for disease stage and inheritance pattern, nondiploid DNA was independently associated with increased deaths from MTC (p = 0.008). In an identical Cox model restricted to the 92 DNA diploid tumors, an S-phase fraction of 15.0% or more remained a significant variable (p = 0.034) after adjustment for stage and inheritance pattern. We therefore conclude that DNA measurements do have a role to play in predicting outcome after surgical treatment of MTC.

Adolescent↗
PubMed1989

Recurrent pyogenic granuloma with satellitosis.

The development of recurrent pyogenic granulomas as multiple satellite lesions is rare and often associated with trauma or treatment of the primary lesion. At least 34 cases of such lesions after various treatment modalities have been reported, but none occurred in conjunction with laser therapy. We report a case of recurrent pyogenic granuloma with satellite lesions that developed after carbon-dioxide laser excision of a previously recurrent lesion.

Cephalexin↗
PubMed1989

Cytologic features of fine-needle aspirates of hyalinizing trabecular adenoma of the thyroid.

The cytologic features of five cases of hyalinizing trabecular adenoma of the thyroid are reviewed. All of these cases had been initially interpreted as either suspicious or positive for malignancy. On retrospective review, many of the cytologic features did mimic those of other lesions, particularly papillary carcinoma. The smears tended to hypercellularity, and nuclei were often slightly enlarged with pale chromatin, intranuclear holes, and longitudinal grooving of the nuclear membrane. On the other hand, some cytologic features were more suggestive of medullary carcinoma--poor cohesion of cells with elongated and spindle cell forms and hyaline acellular areas. Awareness of the histologic and cytologic features of hyalinizing trabecular adenoma may enable the cytopathologist to avoid a false positive diagnosis of papillary carcinoma or medullary carcinoma, although it is unrealistic to expect a definitive diagnosis of hyalinizing trabecular adenoma.

Adenoma↗
PubMed1989

Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses.

Reliance on fine-needle aspiration (FNA) of the thyroid as the key determinant whether to observe only or proceed surgically is predicated on achieving a minimal false-negative error rate (the incidence of malignant disease in nodules diagnosed benign by means of FNA). To provide convincing data that malignant disease has not been overlooked requires extended follow-up on a large number of patients with cytologically benign lesions. The intent of our study was to assess the long-term accuracy of thyroid FNA-based diagnoses--particularly with respect to false-negative errors. From our total experience of more than 8000 patients, we reviewed the cases of 680 patients who underwent FNA in 1980, the first year we used it clinically. Follow-up information was obtained on 641 (94%) of the patients with a mean time since FNA of 6.1 years. Benign cytologic findings were reported on 439 (68%) of these patients, and only three (0.7%) had false-negative diagnoses. The false-positive rate was 0% for the 24 (4%) patients with positive aspirates. FNA is a safe, reliable, effective means of accurately discriminating benign from malignant thyroid lesions.

Biopsy, Needle↗
PubMed1988

Mortality from papillary thyroid carcinoma. A case-control study of 56 lethal cases.

To document the presentation, findings, therapy, and postoperative course of lethal papillary thyroid carcinoma (PTC), 56 fatal cases were studied in a retrospective case-matched control fashion. These patients and their controls were taken from a larger series receiving their primary treatment at one institution (Mayo Clinic; 1946-1970). Mean follow-up for the lethal cohort was 8.5 years and 16.6 years for controls. Age, sex, tumor size, histologic grade, extent of disease at presentation, European Organization for Research on Treatment of Cancer (EORTC) and AGES scores (patient's age, tumor grade, tumor extent, and tumor size), and DNA ploidy pattern were found to be significant prognostic factors. The immediate causes of death were most frequently either local airway obstruction or respiratory insufficiency from pulmonary metastases. The results suggest that it is possible, at the time of initial treatment, to assess an individual patient's risk of dying from PTC. Aggressive postoperative adjunctive therapy should be restricted to that minority of patients who are at highest risk of death from PTC.

Adolescent↗
PubMed1988

Bowenoid papulosis of the penis: successful management with neodymium:YAG laser.

Bowenoid papulosis of the penis is a recently described entity that clinically resembles benign verruca-like papular lesions but, histologically, it is identical to carcinoma in situ, Bowen's disease or erythroplasia of Queyrat. Although a few cases of spontaneous regression of bowenoid papulosis in men have been reported, conservative therapy, consisting of topical 5-fluorouracil, electrodissection or excision, is recommended. With these treatment modalities recurrences are not uncommon. We report 2 cases of extensive bowenoid papulosis of the penis treated successfully without scarring with the neodymium-yttrium-aluminum-garnet laser.

Adult↗
PubMed1988

Amelanotic melanoma: cases studied by Fontana stain, S-100 immunostain, and ultrastructural examination.

We studied 15 cases of amelanotic melanoma by using light microscopy (in conjunction with Fontana staining and S-100 immunostaining) and electron microscopy. In 14 of the 15 cases, metastatic melanomas were present; 11 were associated with a history of pigmented primary melanoma. The Fontana stain was positive in 4 cases and negative in 11. The S-100 stain was positive in 13 cases and negative in 2. Of the 11 cases with negative Fontana stains, 9 were positive with the S-100 immunostain and 2 were negative. Electron microscopy showed melanosomes in 13 cases. Melanosomes were seen in the two cases with negative Fontana and S-100 staining. Although all stages of melanosomes were identified, generally the majority were immature melanosomes. This study demonstrates the difficulties associated with the histologic diagnosis of amelanotic melanoma. The Fontana stain may be helpful, and the S-100 stain is generally positive. Electron microscopy provided the only evidence for melanoma in two cases and is considered the most definitive method of diagnosis of amelanotic melanomas. These tumors generally produce some pigment and thus are called amelanotic by convention, not because pigmentation is totally absent.

Adult↗
PubMed1988

Evaluation of nodular thyroid disease.

There is no doubt that FNA biopsy is the best initial diagnostic step for the evaluation of a nodular thyroid. The successful use of FNA biopsy depends greatly on the experience of the clinician performing the aspiration and the expertise of the cytopathologist. The procedure is safe, expedient, and cost-effective. Complications are extremely rare. The accuracy of the technique in experienced hands is better than 95 per cent.

Goiter, Nodular↗