Classification of primary gut lymphomas.
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Biomedical subjects
Publications and source records attributed to L H Sobin.
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A major revision of the tumor, nodes, metastasis (TNM) classification has been published. It eliminates previous differences between the International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC) versions. It also updates existing site classifications and adds chapters on previously unclassified tumors. This article summarizes the major changes from the past to the present editions of the TNM classification.
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In routinely collected data adenocarcinoma of the lung appeared to be 3 times more frequent in Osaka, Japan, than in the North-Western (NW) Region of England (Manchester). Before embarking on comparative epidemiological studies, it was decided to investigate the comparability of histological diagnosis. Specimens from 60 NW Region lung cancer patients and 52 Osaka patients were exchanged and reviewed. The entire material was then independently assessed by the WHO Collaborating Centre for Histological Classification of Tumours. The interpretation of the WHO Classification (WHO, 1981) by the NW Region and by Osaka was upheld by the WHO Collaborating Centre in 89% and 93% of all cases and in 97% and 100% of adenocarcinoma cases respectively. Agreement between the 2 centres was 88% for the main cell types. Differences in the frequency of adenocarcinoma of lung between the NW Region and Osaka are thus not due to diagnostic artefact and require further exploration. The aetiological implications of the finding that many Chinese and Japanese women with lung adenocarcinoma do not smoke (77% in Osaka) are discussed.
Because of the recent controversy over the histogenesis of gastrointestinal stromal tumors, 170 gastrointestinal tract tumors appearing to be of smooth muscle type with routine stains were studied immunohistochemically. Five percent were positive for S-100 ("neural") protein. These findings are compared with several recent studies. We conclude that only a small minority of gastrointestinal tract stromal tumors are neurogenic and that most are probably of smooth muscle type.
Forty-one cases of mesenteric and omental cysts are reported. Histologically, several specific types could be distinguished: lymphangioma, 19 cases; nonpancreatic pseudocyst, 11 cases; enteric duplication cyst, six cases; mesothelial cyst, three cases; and enteric cyst, two cases. A lymphangioma is usually a multiloculated cyst located in the mesentery that shows no discernible wall on computed tomography (CT) and may have characteristics of fat on CT and magnetic resonance imaging. Abnormalities in the small bowel mucosa were frequently noted on barium studies. A nonpancreatic pseudocyst is usually a unilocular or multilocular cyst located in either the mesentery or the omentum, with abundant debris sonographically and an enhancing wall on CT. An enteric duplication cyst is a unilocular cyst with an enhancing wall on CT. Mesothelial and enteric cysts are anechoic, thin-walled cysts. Emphasis is placed on the importance of identifying lymphangioma, which is more difficult to manage than the other forms of mesenteric and omental cysts.
The difficulties in predicting the biologic behavior of gastrointestinal (GI) smooth-muscle tumors (leiomyomas and leiomyosarcomas) based on the usual criteria of malignancy are discussed. In order to evaluate the prognostic importance of the nuclear DNA content and nuclear dimensions, measurements were performed on Feulgen-stained sections of GI smooth-muscle tumors from 66 patients. The best discrimination between benign and malignant tumors was obtained by using DNA index and tumor size as descriptors in a linear discriminate analysis. This method separated 79% of the benign and 97% of the malignant smooth-muscle tumors. However, as with conventional criteria for malignancy, there remained a group of tumors close to the discriminating line with an indeterminate malignant potential. In an attempt to reduce the number of such indeterminate tumors, future studies will include the use of several descriptors in a multivariate analysis system and the application of flow cytometric studies to all tumors.
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In a study of 105 gastrointestinal carcinoid tumors, 67% of the rectal carcinoids and 15% of the carcinoids at other gastrointestinal sites were positive, immunohistochemically, for prostatic acid phosphatase activity. These findings are relevant to the differential diagnosis between rectal carcinoids and prostatic carcinoma.
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Carcinomas, adenomas and nonneoplastic polyps of the large intestine were examined histopathologically for evidence of recent and old hemorrhage. Three percent of the carcinomas lacked evidence of hemorrhage, as did 7% of the adenomas. Fifty percent of hyperplastic polyps were negative for hemorrhage, but 23% had considerable hemorrhage or hemosiderin. These findings may have a bearing on the results in fecal occult blood testing for the detection of cancer. Carcinomas bleed mainly from erosions on their luminal surface, but adenomas rarely show this feature. Twisting and bending of polyps, leading to fracture of fronds, and vascular obstruction, with passive congestion and stromal hemorrhage, appear to be the main sources of bleeding in polyps. Adenomas on the left side of the large intestine showed greater evidence of bleeding than did lesions on the right, but carcinomas did not show this relationship. Factors correlated with more severe hemorrhage were size, pedunculation, and villous growth of adenomas; for carcinomas, they were size, lack of mucin content, and lower differentiation. The age and sex of the patient and the extent of spread of carcinomas did not correlate with hemorrhage.
An unusual form of hyperplastic polyp of the colon is described in which endophytic growth can simulate adenoma or carcinoma by penetration of the muscularis mucosae and a complex epithelial growth pattern. These lesions differ clinically from exophytic hyperplastic polyps by being more frequent on the right side than in the left colon and being relatively more common in women.
Oral cancer presents a serious public health problem in south-east Asian countries. In Sri Lanka and India 35-40% of all cancers are reported to be oral cancers, which are curable if detected in the early stages. The idea that, in developing countries, one of the few practical approaches to early detection of these cases could be through the utilization of primary health care workers was tested in a field study carried out in Sri Lanka. In a control area the subjects with oral lesions were identified by medical/dental officers. In the study, 34 primary health care workers were able, alongside their routine duties, to examine the oral cavity of 28 295 subjects during a period of 52 weeks; 1220 subjects were detected with lesions needing re-examination. The performance of these primary health care workers was very satisfactory in terms of the number of cases detected and the accuracy of their diagnoses, which were verified by re-examination at a specially designated referral centre. The clinical diagnoses of the three categories of lesions detected were as follows: stage 1 lesions for observation (homogeneous or ulcerated leukoplakia), stage 2 lesions for investigation (speckled leukoplakia, erythroplakia, or submucous fibrosis), and stage 3 lesions for treatment (cancer). There was 89% correspondence between the stage 1-3 diagnoses by the health workers and the clinical diagnoses made at the referral centre. However, compliance by patients was low because only 50% of the cases detected in the field attended the referral centre. The cost-effectiveness of this approach to cancer control has been demonstrated.
The World Health Organization's Histological Classification of Intestinal Tumors is presented in relation to the classification of polyps of the colon and rectum. Emphasis is placed on the terminology used to separate adenomas from tumour-like lesions because of the differences in their precancerous nature. The relevant terms are given in English, French, German, and Italian.
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