Biomedical subjects
Publications and source records attributed to L Deligdisch.
A postmenopausal woman on hormone replacement therapy presented with abdominal pain, a large pelvic mass and high-grade ureteral obstruction, with endometriosis found at exploration.
We report on the incidental finding of pituitary tissue in a mature teratoma on the uterosacral ligament of a 56-year-old woman who underwent exploratory laparotomy for ovarian masses. While the occurrence of pituitary tissue has been reported rarely in benign cystic teratoma of the ovary, and while pituitary adenomas can occur in ectopic sites, we have found only one report in the literature of benign cystic teratoma of extragonadal origin composed of mature adenohypophyseal and neurohypophyseal elements.
Ten cases of extrauterine malignant mixed mesodermal tumors (MMMTs), nine ovarian, and one pelvic, are presented. One patient had a purely epithelial primary ovarian tumor and MMMT in her recurrent tumors. All the other patients had MMMT in their primary and recurrent tumors. Eight patients had heterologous MMMT including cartilage, striated muscle, and adipose tissue in one case. Two patients had homologous MMMT. All cases presented with metastases involving abdominal organs that were either MMMT or epithelial neoplasms and MMMT. Five patients had recurrent tumors, one extensively involving the spleen. In all recurrent tumors, the mesenchymal components were considerably more abundant than in the primary tumors. Immunohistologic studies of intermediate filaments were performed in seven cases, revealing cytokeratin-positive epithelial structures, vimentin-positive mesenchymal (including cartilaginous) structures, as well as coexpression of cytokeratin and vimentin in anaplastic and giant tumor cells in some cases. Some anaplastic spindle cells, which on routine stains were suggestive of stromal cells, stained positive for cytokeratin, thus identifying their epithelial nature. Desmin staining performed in five cases showed positive staining of rhabdomyoblasts in only one case. Myoglobin staining performed in seven cases was positive in four. The histogenesis from primitive müllerian structures and the natural history of these uncommon neoplasms are discussed in light of the pathological and immunohistochemical data presented.
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Ninety-five patients diagnosed as having stage I endometrial carcinoma (EC) were divided into two groups, one with associated adenomatous hyperplasia (AH; group 1) and the other without (group 2). Adenomatous hyperplasia results from estrogenic stimulation of the endometrium. Therefore, patients in group 1 are considered to have an estrogen-related EC. Group 1 included 49 patients with an average age of 59; group 2 included 46 patients with an average age of 65. Review of the histologic characteristics of EC showed that group 1 tumors are better differentiated and less invasive and that their morphology is closer to the normal glandular structure of the endometrium. Group 2 tumors are less well differentiated, more often invade the myometrium, and include histologic variants such as papillary, clear cell, and anaplastic carcinoma that are dissimilar from the glandular structure of the normal endometrium. Mucinous adenocarcinomas and the presence of stromal foam cells were found to be associated with group 1 EC. Progesterone receptors (PR) were measured in a sample of 30 patients. They were present in all cases of group 1 ranging from 50 to 2,400 fmol/mg protein and absent or very low (30-190 fmol/mg protein) in group 2. All EC with stromal foam cells had high PR (380-2,400 fmol/mg protein). This study confirms that estrogen-related EC is generally a better differentiated and less aggressive tumor and suggests that there are two types of EC. The tumors not related to estrogens, which are histologically more malignant, were seen in an older age group of patients. In addition to the currently accepted methods of clinical evaluation of EC patients, defining the morphologic and biochemical characteristics of two types of EC may contribute to the management of EC, now the most prevalent cancer of the female pelvis. The patients known to be at risk for endometrial carcinoma, identifiable by abnormal hormonal manifestations (obesity, infertility, and other conditions related to hyperestrogenism) as well as those receiving exogenous estrogens are likely to develop a better differentiated and less aggressive form of neoplasia. It would be important to elaborate a system of early detection of EC in the group of elderly patients with no signs of hyperestrogenism prone to develop the less differentiated and biologically more aggressive tumors.
A previous study evaluated two types of endometrial carcinoma: one with, the other without, associated adenomatous hyperplasia (Groups 1 and 2, respectively). On the basis of histologic observations, the study concluded that Group 1 tumors were likely to be estrogen-dependent, whereas Group 2 tumors appeared to represent a hormone-independent type of cancer. The authors present quantitative biochemical data to support the proposition that Group 1 tumors are likely to be under the influence of estrogen. Progesterone receptor levels, known to be increased by estradiol, were significantly higher in Group 1 than in Group 2. Analysis of histologic variants revealed that some histologic components, such as mucinous adenocarcinoma, squamous components, and stromal foam cells, predominated in Group 1 and may, therefore, be indicative of estrogen action. Certain histologic features, however, such as papillary carcinoma, clear cells, and anaplastic carcinoma with giant tumor cells, were found exclusively in Group 2, thus suggesting a lack of estrogenic influence. These findings indicate that Group 1 and Group 2 endometrial carcinomas may constitute two different biologic entities and, thus, encourage further basic and clinical research to develop specific therapies for patients diagnosed to have endometrial cancer.
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The effects of exogenously administered testosterone were evaluated in a group of 19 female to male transsexuals who underwent bilateral salpingo-oophorectomy after a variable period of androgen therapy. The findings were compared to those in an age-matched group of 12 patients who underwent pelvic surgery for nonendocrine reasons. The most significant findings in the 19 androgen-treated female transsexuals was the finding of enlarged or borderline enlarged ovaries in 5 subjects. In addition, we found multiple cystic follicles in 17 patients (89.5%), diffuse ovarian stromal hyperplasia in 16 patients (84.2%), collagenization of the outer cortex in 13 patients, and 4) luteinization of stromal cells in 5 patients (26.3%). Findings consistent with polycystic ovaries were thus present in 13 of the 19 patients based on the presence of 3 of the above 4 findings. The data suggest that increased blood levels and presumably increased ovarian concentrations of testosterone may produce the morphological features of polycystic ovarian disease.
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The association of endometrial carcinoma (EC) with endocrinopathies manifested by obesity, nulliparity, and/or increased estrogen levels of exogenous or endogenous estrogens is now well-known. EC is also seen in patients without these findings. Are these different cancers? Seventy-four cases of EC were reviewed and classified into two groups: group I, with associated adenomatous hyperplasia (AH), 31 cases; and group II, without associated AH, 43 cases. Group I included more well-differentiated and less invasive carcinomas; histologically, the pattern was glandular in all cases. In Group II, the EC were less well-differentiated, more invasive, and included, besides adenocarcinomas, clear-cell, papillary, and anaplastic carcinomas with giant tumor cells. Squamoid features were found in both groups. The possible existence of two types of EC, a hormonal-dependent EC associated with AH (which is believed to result from hyperestrogenism, and to have a better clinical prognosis), and an "independent" EC, not associated with AH, is discussed.
The normal, identical twin sisters of patients who had been the subjects of ovarian cancer were subjected to prophylactic oophorectomy after the menopause. The finding of epithelial abnormality suggests a precancerous change similar to other genital epithelial dysplasia.
Twenty-three patients with endocervical carcinomas diagnosed at the Mount Sinai Medical Center during the last 5 years were reviewed (clinical history and histologic material). The tumors were endocervical-type adenocarcinomas, adenosquamous carcinoma, mucinous (colloid), papillary, and clear cell carcinomas. Eight associated carcinomas in situ were found. Younger patients tended to have more adenosquamous carcinomas, perhaps related to the frequency of squamous metaplasia in sexually active women. Twenty-two out of twenty-three patients were multiparous, many of them grand multiparas. In two patients the tumor followed parturition, and in two patients it was found in the cervical stump. No association with oral contraceptives was found. Multiparous women seem to be at increased risk for this malignancy. The early detection of endocervical carcinoma is based on the recognition of dysplasia and adenocarcinoma in situ in the biopsy material. This is of particular significance in the endocervical cancer because its location often prevents early detection.
Two cases of metastatic gestational trophoblastic neoplasms (MGTN) diagnosed by mediastinoscopic and gastroscopic biopsies, respectively, are presented. Both patients are young women who presented with hemorrhagic events involving the CNS in one case and the gastrointestinal tract in the other, with histories of recent pregnancies. Both cases belong to the group of high-risk MGTN because of the location of the metastatic lesions (CNS and liver) and because of the delayed onset of chemotherapy. One patient is in clinical remission, 3 years later, and the other succumbed to her disease. A review of the literature suggests that CNS involvement has a better prognosis than liver metastases. The patient diagnosed to have MGTN by a gastroscopic biopsy is the first reported, to the best of out knowledge. The outcome of MGTN, although greatly improved by chemotherapy, is still fatal in numerous cases in the high-risk group. Since an early diagnosis is critical for successful chemotherapy, it is advisable to perform HCG titers in the blood serum of young patients presenting with unexplained hemorrhagic events, especially in those with recent gestations.
In vitro responsiveness of endometrial adenocarcinoma to progestins was evaluated histologically by incubation of tissue fragments in medium containing 10(-6) M medroxyprogesterone acetate. In a series of 19 experiments, formation of sub- and supranuclear vacuoles, which reflects accumulation of glycogen in response to medroxyprogesterone acetate added to the medium, was observed in well-preserved glandular epithelial cells only when the level of cytosolic progesterone receptor was above 300 fmol/mg protein. Previously, we have reported similar results obtained in in vivo experiments. The present findings suggest that simple organ culture and histological procedures can be used to identify specimens of endometrial cancer that have functional progesterone receptors and are capable of responding to progestins. They also indicate that levels of progesterone receptor required to obtain responses to progestins are considerably higher than those necessary for analytical detection and that therefore the quantity and not merely the detectability of progesterone receptors must be taken into consideration for the prediction of responses to progestins. In addition, in vitro responses to progestins may indicate the presence in endometrial cancer tissue of functional estrogen receptors and potential responsiveness to antiestrogens, since estrogen stimulation appears to be needed for the synthesis of progesterone receptors.
Original histologic slides were reviewed from 87 patients with advanced ovarian carcinoma, all of whom had been treated with cisplatin, alone or in combination. The degree of lymphocyte infiltration in the tumor was not related to histologic or cytologic tumor differentiation. However, the degree of lymphocyte infiltration was related to improved survival.
The original histologic material of 87 patients with Stage III or IV ovarian adenocarcinoma was reviewed. These patients had been treated with cisplatin, alone or in combination. There was a significant association among the morphologic parameters of histologic differentiation, mitotic activity, and cellular pleomorphism. However, none of these was associated either with survival or with maximum response of the tumor among the cisplatin-treated patients. The possible significance of these findings is discussed.
Mycobacterium xenopi was isolated from bronchoscopic and resected lung specimens from a patient who had diabetes mellitus and chronic myelogenous leukemia. While in remission, the patient developed spreading pulmonary infiltrates and died. At postmortem examination, acid fast bacilli were found in enormous numbers in histologic preparations of pulmonary hilar and mesenteric lymph nodes. Concomitant pulmonary infection with Aspergillus, Pneumocystis carinii, and cytomegalovirus was also evident. The probable dissemination of M. xenopi to pulmonary hilar and mesenteric lymph nodes attests to its invasive potential in the immunocompromised host and reinforces its role as an agent of nontuberculous mycobacterial disease.
Cases of endometrial carcinoma reviewed for this study were divided into two groups: 1) Premenopausal, perimenopausal and postmenopausal patients in whom a history of anovulation, obesity, ovarian hyperthecosis (including Stein-Leventhal syndrome) or feminizing tumors, and/or exogenous estrogen intake were found; and 2) post menopausal, elderly patients, without known hormonal or metabolic disturbances and without any history of estrogen therapy. In the first group, frequent associated findings were precursor stages of endometrial carcinoma, such as adenomatous and atypical hyperplasia. In the majority of cases, the cancer was confined to the endometrium, rarely infiltrating the myometrium. In the second group, the cancer was associated most often with an inactive, atrophic endometrium and frequently diffusely infiltrated through the myometrium, with lymphatic and vascular involvement. The lymphatic and plasma-cell infiltrate was evaluated in both groups. It was found to be more abundant in the first group, but at the tumor-host interface and perivascularly, than in the second. As reported in other malignancies of the female reproductive system, the presence or absence of a lymphocytic infiltrate as a morphological expression of local cellular immune response of the host correlates well with the biological behavior of the tumor. A challenging question is the relationship, if any, between hormonal factors and immune mechanisms in tumors arising in tissues such as the endometrium that, even normally, are targets of hormonal stimulation.