Biomedical subjects
Publications and source records attributed to R J Stock.
Ten cases of adnexal torsion were analyzed to review the spectrum of clinical and pathologic problems that may be encountered. Included were two cases representing the earliest changes to be seen and a case of ovarian fibrosis thought to be secondary to intermittent or incomplete torsion with prolonged stromal edema.
Two recent pathologically oriented reports suggest that surgically significant parovarian cysts are most often of mesothelial origin rather than mesonephric or paramesonephric origin, as traditionally thought. In a series of eight large intraligamentous parovarian cysts, seven were considered to be of paramesonephric origin on the basis of both surgical and histologic observations. Determining the origin of these cysts has relevance from a surgical point of view in the younger patient.
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A large asymptomatic first-trimester liver cell adenoma was diagnosed by fine-needle aspiration cytology. Therapeutic abortion was performed to reduce the rate of growth and achieve reduction in size before resection. Computed tomography scan evidence suggested that abrupt necrosis occurred after the therapeutic abortion, which might have precipitated an emergency partial hepatectomy. The tumor did not regress in size and was estrogen and progesterone receptor-assay negative.
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From 1 July 1974 to 31 December 1982, 127 patients with primary carcinoma of the cervix were assessed to determine the prognosis of patients with adenosquamous cell carcinoma. Of all patients, 34 are dead of disease for an overall corrected survival rate of 73.2%. The survival of 20 patients with adenosquamous cell carcinoma is 20%. Seventy-five percent of the adenosquamous cell patients had stage IB lesions. When patients with adenosquamous cell carcinoma were compared with patients with squamous cell carcinoma or adenocarcinoma, there was a statistically significant decrease in survival. Patients with adenosquamous cell carcinoma were relatively young with a mean age of 41.1 years. A normal appearing cervix was noted in 30% of all patients with adenosquamous cell carcinoma. The majority of adenosquamous cell patients (87.5%) dead from cancer had distant metastases. This report emphasizes that, independent of stage, adenosquamous cell cervical carcinoma is an extremely aggressive neoplasm and carries a poor prognosis.
The histopathology of 110 cases of tubal gestation was reviewed. No evidence was found of the development of the gestation into the tubal muscularis and beneath the overlying peritoneum. The localized tubal mass identified clinically was secondary to luminal distention. It was clear that tubal rupture occurred secondary to localized distention and vascular compromise with hemorrhagic necrosis and was not secondary to invading chorionic villi. With conservative linear salpingostomy, the localized tubal damage histologically appeared to be about the same as that seen in spontaneous rupture. Difficulty in controlling bleeding in conservative surgical procedures may well be a reflection of the viability of the villi and implantation of the more vascular, mesenteric side of the tubal lumen.
Mesothelioma of the peritoneal cavity after irradiation is rare, and the diagnosis is sometimes difficult to establish. The following case is a report of a mesothelioma occurring 9 years after radiation therapy for carcinoma of the cervix. In this patient, who had a hysterectomy and bilateral oophorectomy 7 years prior to the mesothelioma diagnosis, the histologic, histochemical, and ultrastructural findings were all consistent with a diagnosis of malignant peritoneal mesothelioma. It is believed that this case is one of the first well-documented cases of peritoneal mesothelioma in a female who was treated by pelvic irradiation for another neoplasm.
Seventy-five consecutive patients undergoing hysterectomy subsequent to elective sterilization were studied regarding the occurrence of the post-tubal-ligation syndrome of pelvic pain and/or menorrhagia. Twenty patients were clinically considered to have the syndrome. In none of the patients operated on specifically for menstrual abnormalities could the findings be remotely attributed to the sterilization procedure. Five of the 20 patients had pelvic varicosities and one had pelvic adhesions that may have been a consequence of previous sterilization and conceivably the cause for the pelvic pain for which the patients were undergoing hysterectomy. I question the legitimacy of the post-tubal-ligation syndrome as a reason for hysterectomy.
Excluding cases associated with oral sequential contraceptives, adenocarcinoma of the endometrium in young women is rare, constituting about 3% of endometrial carcinomas. The present report, based on findings from one institution, notes that women 40 years of age or younger comprised 14.4% of the 111 patients with adenocarcinoma of the endometrium. Factors analyzed in patients 40 years of age or younger (group A) as compared with those 41 years of age or older (group B) include the following: obesity 43.8% (A) versus 17.9% (B), nulliparity 44% (A) versus 10.5% (B), hypertension 31.2% (A) versus 42.1% (B), and diabetes 6.2% (A) versus 21.1% (B). Patients in group A tended to have a well-differentiated tumor, and 31.2% had polycystic ovaries. Awareness of risk factors in young women who develop endometrial adenocarcinoma leads to earlier diagnosis and will preserve the historically excellent survival rate of young women.
Ten ectopic pregnancies subsequent to tubal sterilization were histologically evaluated. In seven of the ten cases, the sites for the ectopic implantation appeared to be related to the presence of a distal remaining tubal segment that had a tuboperitoneal fistula on the medial side. As against a currently held opinion that the ectopic implantation occurs secondary to a relative disparity in the size of the sperm, the fertilized ovum, and the proximal tuboperitoneal fistula, we believe that the implantations are influenced by probable fluid movements within the remaining tubal segments. The need to consider conservative surgical approaches and good intraoperative notations in patients with an ectopic pregnancy subsequent to sterilization is stressed.
Longitudinal serial and serial step sections of fallopian tubes from more than 100 patients, subsequent to tubal sterilization procedures, were examined. Thirteen of these patients had pregnancies following their sterilizations. The histologic findings at the previous surgical sites were compatible with what would be expected for a normal healing process. Evidence for a unique tubal epithelial process, as suggested by the terms "endosalpingiosis" or "recanalization," was lacking. Likewise, the author found no evidence of tuboperitoneal fistula formation and/or the subsequent occurrence of pregnancy secondary to localized endometriosis. The histologic notations of proximal luminal dilatation, plical attenuation, chronic inflammatory infiltrates with pseudopolyp formation, and the findings of plical thickening in the distal segment of remaining tube after an interruption type of procedure seem to be associated with the length of time from the sterilization procedure. These may be factors related to the apparent reduced success rate, with time, of microsurgical reanastomotic procedures.
Isolated, acellular washout experiments of 125I-labeled bovine serum albumin (BSA) from control, anemic, and polycythemic rat spleens were used to develop a model of the splenic plasma circulation. The results indicated that the plasma circulation can be described adequately by two compartments. As in red blood cell (RBC) washouts [Am. J. Physiol. 239 (Heart Circ. Physiol. 8): H272-H277, 1980] the fast compartment represents intrasplenic vessels that bypass the red pulp, whereas the intermediate/slow compartment represents plasma flow through the red pulp (filter). The combined plasma and RBC parameters suggest the rat spleen is not an RBC reservoir and that splenic RBC filtration capacity decreases during polycythemia and anemia. The ratio of fast compartment to systemic hematocrit indicates hemodilution occurs, supporting the concept of plasma skimming. A small plasma holdup occurs in the red pulp of anemic and polycythemic spleens probably due to RBC congestion. This congestion, in turn, might be due to reticulocyte sequestration and/or erythropoiesis in anemic spleens and RBC sequestration and/or destruction in polycythemic spleens. There is plasma redistribution in polycythemic spleens possibly to meet the increased metabolic demand.
The practicality of endometrial histology for suggesting the possibility of ectopic gestation was evaluated by a review of two years' experience at the Naval Regional Medical Center, Portsmouth, Virginia. Using various histologic criteria, we could not predict the presence of ectopic pregnancy. The false-positive rate when we used standard histologic criteria was 97%. The effort on the part of the pathology department to exclude intrauterine pregnancy by through examination of endometrial material was a fruitless exercise and also unnecessarily raised medical costs.
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We have described a case of massive edema of the ovary, with recurrence of surgical fixation. Massive edema of the ovary appears to be only an earlier stage of what has been previously reported as torsion and infarction of the normal adnexa.
Sampson's concept of endosalpingiosis is reexamined in light of histologic findings in the fallopian tubes of 54 women who underwent elective sterilization and subsequent hysterectomy and bilateral salpingo-oophorectomy. It was not possible by careful examination of the proximal and distal lumens to identify islands of epithelium consistent with surviving transplanted elements of surgically fragmented tubes or proliferating tubal epithelium (endosalpingiosis). Lesions compatible with endometriosis were found in 20 of the 54 patients (22 of 106 tubes, or 21%) but could not be related to post-tubal ligation pelvic pain.