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Biomedical subjects

J R Goellner

Publications and source records attributed to J R Goellner.

At least 91 records · Page 5Linked to original sources
PubMed1988

Papillary thyroid carcinoma in children and adults: long-term follow-up of 1039 patients conservatively treated at one institution during three decades.

Fifty-eight children (18 boys, 40 girls) less than 17 years of age, undergoing initial surgery because of papillary thyroid carcinoma (PTC) at Mayo Clinic from 1946 through 1975 and followed up for a median time of 27.6 years were compared with 981 adults (323 men, 658 women) treated during the same period and followed up for a median period of 19.5 years. At initial evaluation, mean tumor size (+/- SD) was greater in children (3.1 +/- 1.7 cm) than in adults (2.1 +/- 1.7 cm) (p less than 0.001); tumor DNA content was nondiploid in 10% of 39 children and in 25% of 110 adults (p = 0.047). Neck node metastases at diagnosis were detected in more children (89.7%) than adults (34.7%) (p less than 0.0001), but extrathyroidal invasion was not significantly more frequent in children (24.1%) than adults (15.8%) (p = 0.095). Distant metastases at diagnosis were detected in more children (6.9%) than adults (2.1%) (p = 0.022). Postoperatively, neck node metastases recurred more frequently in children (30%) than in adults (7%) (p less than 0.001), but local neck recurrences were not significantly more frequent in children (12%) than in adults (5%) (p = 0.083). Postoperative distant metastases occurred with similar frequency in children (6%) and adults (5%) (p = 0.98). Survival (all causes of death) for both adults and children up to 30 years after the initial surgery was no different from expected survival rates. Only adults aged more than 40 years had a significantly higher mortality from PTC than did children (p less than 0.0001). Fourteen percent of children had died of PTC by 15 years after diagnosis of distant metastases, whereas 68% of similarly affected adults were dead at 15 years (p = 0.014). PTC was more often metastatic to neck nodes and lungs before initial surgery and more often recurrent in neck lymph nodes postoperatively. However, PTC tended to be less fatal in children, and this may be related to the infrequency of nondiploid DNA content in the childhood PTC tumors.

Adolescent↗
PubMed1988

Local recurrence in papillary thyroid carcinoma: is extent of surgical resection important?

From a multivariate analysis of more than 20,600 patient-years' experience with papillary thyroid carcinoma (PTC), we devised a prognostic scoring system based on patient age, tumor grade, extent, and size (AGES). This scoring system was used as an adjustment variable for analyzing the role of different types of surgical treatment in the development of local recurrence (LR) in 963 PTC patients who underwent unilateral (15%), bilateral subtotal/near-total (69%), or total thyroidectomies (16%) from 1946 through 1975 at the Mayo Clinic. In 866 patients with AGES scores of 3.99 or less, the risk of LR developing at 10, 20, and 30 years was 7%, 14%, and 14% after unilateral resection and 1.5%, 2%, and 4% after bilateral resection (p less than 0.001). In 97 patients with AGES scores of 4 or more, the comparable rates were 26%, 45%, and 59% after unilateral resection and 13%, 20%, and 20% after bilateral resection (p less than 0.001). In neither the low- nor the high-risk group was there a significant difference in the frequency of LR comparing total thyroidectomy with bilateral subtotal/near-total thyroidectomy. At 30 years after diagnosis of LR, mortality from PTC was 48%; the risk of cancer death with an LR located outside the thyroid remnant was much greater than with a remnant recurrence alone. In this series of 52 patients, followed up for as many as 41 years, no patient with tumor recurrence limited to the thyroid remnant died of thyroid cancer.

Adolescent↗
PubMed1987

Desmoplastic melanoma of the head and neck.

The pathologic and clinical findings in cases of desmoplastic melanoma of the head and neck seen at the Mayo Clinic in Rochester, Minnesota, during the past 20 years were analyzed. The nine cases acceptable for study included six usual and three neurotropic variants as defined by light microscopic criteria. Immunopathologic studies of all cases using S-100 protein and desmin, and electron microscopy in four cases, were unsuccessful in distinguishing between the two subtypes. Clinical behavior was aggressive regardless of histologic subtype. Extensive surgical treatment when the diagnosis is made is advocated. The combination of the rarity and the subtle histologic features of desmoplastic melanoma continues to make the correct diagnosis of this entity a challenge for the clinician and pathologist.

Aged↗
PubMed1987

Fine-needle aspiration. Usefulness for diagnosis and management of metastatic carcinoma to the thyroid.

The usefulness of fine-needle aspiration (FNA) for the diagnosis and management of metastatic carcinoma to the thyroid was determined by reviewing the records of 19 patients identified during a six-year period. Fine-needle aspiration was able to document metastatic cancer to the thyroid in 14 patients with, and five patients without a history of prior nonthyroidal cancer. Breast, kidney, and lung were the most frequent carcinomas metastatic to the thyroid. Age range and time from diagnosis of the primary carcinoma to documentation of metastasis were similar to those in prior surgical series from this institution. The finding of metastatic disease on FNA was totally unexpected in four patients. The possibility of metastasis was not mentioned before FNA in six patients with a known history of nonthyroidal cancer. Only six patients underwent a thyroid operation after FNA. Fine-needle aspiration was able to direct appropriate surgical or conservative management without adversely affecting survival among patients.

Biopsy, Needle↗
PubMed1987

Prostate shape, external striated urethral sphincter and radical prostatectomy: the apical dissection.

In an anatomical study of 64 gross specimens the external striated urethral sphincter was reconfirmed to extend as a single unit from the proximal penile urethra to the bladder base. The configuration of the external striated urethral sphincter was variable and was related to the shape of the apical prostate. Two basic prostatic shapes were recognized, distinguished by the presence or absence of an anterior apical notch. Whether a notch existed depended upon the degree of lateral lobe development and the position of its anterior commissure. In radical prostatectomy knowledge of the variation in the shape of the prostatic apex can help the surgeon to achieve optimal urethral transection with maximal preservation of the external striated urethral sphincter and other tissues of the continence mechanism.

Aged↗
PubMed1987

Leiomyosarcomas and benign smooth muscle tumors of the stomach: nuclear DNA patterns studied by flow cytometry.

Paraffin-embedded archival tissue samples were used for determination of DNA ploidy by flow cytometry on 117 surgically resected gastric smooth muscle tumors (44 leiomyosarcomas, 53 leiomyomas, and 20 benign leiomyoblastomas). The technique of Hedley was used for preparation of paraffin-embedded tissue into single dissociated nuclei, and the method of Vindeløv was used for staining with propidium iodide. Among the 53 leiomyomas, the DNA ploidy pattern was diploid in most tumors (87%), except for 2 DNA tetraploid/polyploid and 5 DNA aneuploid samples. In comparison, the 20 benign leiomyoblastomas had more frequent abnormal DNA histograms: DNA tetraploidy/polyploidy in 5 (25%) and DNA aneuploidy in 2 (10%). The DNA histograms of the 44 leiomyosarcomas (including 4 epithelioid leiomyosarcomas) were classified as follows: 20 cases (45%) exhibited a DNA diploid pattern, 14 cases (32%) had a DNA tetraploid/polyploid pattern, and 10 cases (23%) had DNA aneuploid peaks. For the patients with leiomyosarcomas, the DNA ploidy pattern was significantly correlated with survival (P less than 0.001), as were tumor grade (P less than 0.001) and tumor size (P less than 0.05). Furthermore, both benign and malignant gastric smooth muscle tumors with DNA tetraploid/polyploid patterns were significantly larger than those with a DNA diploid histogram (P less than 0.05). DNA ploidy pattern cannot be used for diagnosis--that is, to distinguish malignant from benign gastric smooth muscle tumors. For gastric leiomyosarcomas, however, nuclear DNA ploidy pattern is an easily measured objective determination with important prognostic significance.

Adolescent↗
PubMed1987

Pathology of the thyroid in amiodarone-associated thyrotoxicosis.

Among 83 consecutive patients operated on for thyrotoxicosis at the Mayo Clinic between January 1, 1980 and May 1, 1986, four had a combination of pathologic findings that were similar and unexpected: involutional changes; degenerative and destructive follicular lesions; and zones of fibrosis. These four, but none of the remaining 79, were being treated with amiodarone for cardiac tachyarrhythmias; this drug is known to be taken up by the thyroid gland. Characteristically, small groups of involuted follicles exhibited varying degrees of damage ranging from degenerative changes in a few lining cells to total follicular destruction. Damaged follicular cells were swollen and featured granular or vacuolated cytoplasm. This type of cytoplasmic alteration has been reported to occur in pneumocytes and hepatocytes damaged by amiodarone. Therefore, the drug probably is the cause of the thyroid cell damage, and follicular disruption (with consequent release of iodothyronines into the circulation) is likely to be an important contributor to the associated thyrotoxicosis.

Adult↗
PubMed1987

Hyalinizing trabecular adenoma of the thyroid gland.

The hyalinizing trabecular adenoma, a distinctive lesion, is important because it may mimic medullary and papillary carcinoma microscopically. We describe 11 such tumors obtained from women ages 27-72 years (mean, 46 years). The initial pathologic diagnoses were carcinoma (five cases), adenoma (two cases), paraganglioma (one case), and "indeterminate" (three cases). None of the tumors recurred or metastasized (mean follow-up, 10 years). Grossly, the neoplasms measured 0.3-4 cm in diameter, and were yellow-tan and circumscribed. Microscopically, they were encapsulated or circumscribed and solid, or vaguely lobulated. The polygonal, oval, and elongated tumor cells were arranged in trabeculae, clusters, or both, and were often inserted vertically into capillaries. The sharply outlined cells had finely granular cytoplasm that was either acidophilic, amphophilic, or clear. Typical features included oval and elongated nuclei, perinucleolar vacuoles, acidophilic nuclear inclusions, fine nuclear grooving, and infrequent mitotic figures. Perivascular hyaline fibrosis and cell degeneration mimicked amyloid, but these tumors were Congo red-negative. Occasional trabeculae featured round or irregularly shaped follicles, sometimes with papillary infoldings, that were either empty or contained colloid-like material and psammoma bodies. Immunostaining of tumor cells was positive for thyroglobulin and negative for calcitonin. Among six tumors analyzed by flow cytometry, five displayed a diploid pattern and one showed an aneuploid peak.

Adenoma↗
PubMed1986

Cytologic findings in stage I adenocarcinoma of the lung: implications for the detection of early lung cancer.

Preoperative cytologic examinations were performed on bronchial material from 92 patients with postsurgical (pathologic) stage I (American Joint Committee) adenocarcinoma of the lung. All patients were followed up for at least 5 years or until death; thus, cases of adenocarcinoma metastatic to the lungs were virtually excluded. Only 22 patients (24%) had abnormal preoperative cytologic findings. This low cytologic sensitivity is ascribed to the small size and peripheral location of the tumors. Large lesions of high histologic grades were more likely to have positive preoperative cytologic findings than small, well-differentiated ones.

Adenocarcinoma↗
PubMed1986

Elevation of carcinoembryonic antigen in cerebrospinal fluid among patients with meningeal carcinomatosis.

The concentration of carcinoembryonic antigen (CEA) in cerebrospinal fluid (CSF) was determined by using an enzyme immunoassay for 204 patients with various nonneoplastic neurologic disorders, 8 patients with systemic infectious diseases, 19 patients with systemic neoplastic diseases without involvement of the nervous system, and 35 patients with neoplastic neurologic disorders. The highest CEA level in CSF among patients without neoplastic neurologic disorders was 0.6 ng/ml. Of 35 patients with neoplastic neurologic disorders, 10 had CEA levels in CSF that exceeded 0.6 ng/ml, the highest level being 70.5 ng/ml. All 10 patients had carcinomas. Among 14 patients with neoplastic meningitis, 5 of 8 patients with meningeal carcinomatosis had elevated CEA concentrations. Although the efficacy of the assay for CEA in CSF must be compared with that of other laboratory tests such as cytologic examination and the assay for beta-glucuronidase--and any potentially false-positive results should be ruled out by determination of the serum CEA level--the CEA concentration in CSF can be used as an adjunctive diagnostic procedure for detection of meningeal carcinomatosis.

Carcinoembryonic Antigen↗
PubMed1986

Fine-needle aspiration of the breast.

One of the numerous controversial issues related to the clinical management of breast cancer is the role of fine-needle aspiration (FNA). Despite its enthusiastic use in the diagnosis of thyroid nodules, its application to breast abnormalities has been accepted reluctantly. Breast FNA necessitates technical and interpretative skill and continual practice and is not 100% accurate. It also entails an additional, although moderate, expense. To assess the accuracy and determine the possible role of FNA at our institution, we performed both FNA and excisional biopsy in 100 unselected women with palpable breast nodules and correlated the cytologic and histologic findings. Our results were similar to those in previously published studies. FNA had a false-negative rate of 6%, no false-positive results, and an accuracy of 94%. After reviewing the potential assets and liabilities of this technique, we believe that breast FNA may add a measure of confidence in the diagnosis of benign breast lesions, provides a safeguard for preventing misdiagnosis of malignant lesions, and might expedite and reduce the cost of managing both primary and recurrent breast cancer.

Biopsy, Needle↗
PubMed1986

Abdominal fluid cytology in patients with gastrointestinal malignant lesions.

In a group of 76 patients with various gastrointestinal malignant lesions, we found that peritoneal washings contained tumor cells in 43% of patients with gastric cancer, 22% of those with pancreatic cancer, and 3% of those with colonic cancer. Aside from tumor site, we were unable to identify any criteria that would help to predict the presence of malignant cells in peritoneal fluid specimens. We found no malignant cells on cytology in patients with early localized cancer. The ease of obtaining such data, coupled with the fact that the test is inexpensive, makes cytologic assessment attractive. Furthermore, the results of cytology have been shown to bear a direct relationship to prognosis in some cancers and may serve as an indication for more intensive therapy. The results of sequential cytology tend to support the theory that tumor manipulation may be a source of intraperitoneal spread in certain tumors.

Adenocarcinoma↗
PubMed1986

Spitz naevi and malignant melanomas of childhood and adolescence.

We reviewed 33 cases of Spitz naevus and 19 of malignant melanoma in patients aged 20 years or less who were evaluated at our institution from 1950 to 1975 and followed-up for up to 32 years. The histological findings were studied prior to review of clinical data. There were no malignant melanomas in patients less than 9 years old; almost half (15/33) of the Spitz naevi were in this age group. Among the 25 histological criteria evaluated in the 52 lesions, the most striking differences between malignant melanomas and Spitz naevi were a higher degree of pagetoid spread, cellular pleomorphism, nuclear hyperchromasia and mitotic activity in the malignant melanomas, and a more prominent spindle cell component in Spitz naevi. We stress the importance of cytological as well as architectural criteria in distinguishing between Spitz naevi and malignant melanomas and emphasize the pitfalls that may be encountered because of overlap in histological features between the two groups.

Adolescent↗
PubMed1986

Hashimoto's thyroiditis. An uncommon cause of painful thyroid unresponsive to corticosteroid therapy.

The records of eight patients with thyroid tenderness secondary to Hashimoto's thyroiditis were reviewed. The pathologic characteristics of thyroid tissue sections from these patients were compared with those from patients with nontender Hashimoto's thyroiditis, and no difference was identified. Laboratory features helpful in distinguishing tender Hashimoto's thyroiditis from subacute (de Quervain's) thyroiditis include normal erythrocyte sedimentation rate, significant 131I uptake, and significant antithyroid antibody titer. Diagnosis should be confirmed by fine-needle aspiration biopsy. Corticosteroid therapy was unsuccessful in treating these patients; L-thyroxine and aspirin were successful more often. Two patients required thyroidectomy to control pain.

Adrenal Cortex Hormones↗
PubMed1985

Adnexal carcinomas of the skin. I. Eccrine carcinomas.

The diagnostic identification of sweat gland carcinomas is hampered by their rarity and their histologic resemblance to various visceral tumors, leading to confusion with metastatic lesions. In this series, 14 cases of eccrine carcinoma in five male and nine female patients, ranging in age from 13 to 84 years, are described. Ten tumors strongly resembled infiltrating ductal adenocarcinomas of the breast, and were thus classified as ductal. Three had a prominent mucinous matrix, similarly explaining their categorization as mucinous carcinomas. Finally, one neoplasm was a classic eccrine porocarcinoma. Four patients with ductal eccrine carcinomas suffered metastasis, and a 50% mortality rate was observed among this group of ten cases. In contrast, only one of three mucinous carcinomas metastasized, although all of these lesions recurred locally, as did the single porocarcinoma. None of the latter four neoplasms proved fatal. The results of conventional special stains in these 14 cases are discussed, and histologic features that they shared, and which may be utilized in distinguishing eccrine carcinomas from benign sweat gland tumors, are presented.

Adenocarcinoma↗
PubMed1985

Adnexal carcinomas of the skin. II. Extraocular sebaceous carcinomas.

Extraocular sebaceous carcinomas are uncommonly seen neoplasms, and have been confused in the past with basal cell carcinomas showing sebaceous differentiation. In contrast to the latter tumors, however, sebaceous carcinomas have a distinct risk of aggressive behavior. This study presents clinicopathologic data on five cases of sebaceous carcinoma arising in cutaneous locations outside of the ocular adnexae. Four of five patients were men, and the average age at diagnosis was 63 years. Three tumors occurred on the face, one arose in the skin of the neck, and another occurred on the penis, an anatomic site that is extremely rare for sebaceous carcinoma. Three tumors metastasized, and two patients died of tumor or with residual tumor growth. In light of this behavior, the premise that extraocular sebaceous carcinomas rarely spread to distant sites may need reexamination.

Adenocarcinoma↗
PubMed1985

Hashimoto thyroiditis associated with thyroid cancer in adolescent patients.

Three girls had Hashimoto thyroiditis and thyroid cancer. Cervical exploration revealed a follicular carcinoma in one, an oxyphilic cell carcinoma in another, and a papillary carcinoma in the third. These cases add clinical and pathologic data to the previously debated concept that Hashimoto thyroiditis coexists with thyroid carcinoma.

Adenocarcinoma↗