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Biomedical subjects

W H Kern

Publications and source records attributed to W H Kern.

At least 37 records · Page 2Linked to original sources
PubMed1980

The determination of unknown primary sites based upon the histologic appearance of metastases.

One hundred instances of lymph node metastases, including 61 per cent metastatic adenocarcinomas, 20 per cent squamous cell carcinomas and 19 per cent undifferentiated carcinomas, were examined by four pathologists on a blind review and, then again, by two with knowledge of the anatomic site and the sex of the patients. In 57 per cent, all reviews agreed with the final histologic classification, but in undifferentiated and nonkeratinizing squamous carcinomas, disagreements were common. In 59 per cent of the 77 instances of tissue confirmation, the most likely primary site was correctly indicated on the blind review, sometimes even if there was disagreement as to the histologic type. The additional information was helpful in improving the prediction of the primary site, especially for poorly differentiated carcinomas of the lung and breast. The histologic pattern of metastases can provide important information for the management of patients with metastatic carcinoma of unknown origin.

Adenocarcinoma↗
PubMed1979

The diagnosis of breast cancer by fine-needle aspiration smears.

Forty-eight percent of 93 breast carcinomas that were aspirated with a fine needle were found to be cytologically positive for carcinoma, and in another 31% this diagnosis was suspected. Care of most breast cancer patients with abnormal or questionable aspiration smears was affected by cytological diagnosis. Thirty-seven patients with a positive diagnosis for carcinoma and with consistent clincal findings were informed of the diagnosis prior to surgery and underwent modified radical mastectomies without further frozen-section examination. Twelve other patients with suspect or abnormal cytological reports had biopsies performed earlier because of these findings. A cytopathological diagnosis of carcinoma based on aspiration smears of the breast is highly accurate if strict criterions of malignancy are applied, but normal smears from solid breast masses do not exclude malignancy.

Adenofibroma↗
PubMed1979

Malignant fibrous histiocytoma of the lung.

Two malignant fibrous histiocytomas arising primarily in the lung are described. The first was a large tumor of the right lower lobe in a 53-year-old man. The other tumor was found incidentally on routine roentgenograms in a 25-year-old woman and involved the left main pulmonary artery. The lesions could be resected but both patients developed early cerebral metastases. The neoplasms were predominantly fibroblastic, had a characteristic storiform pattern, and included large histiocytes with bizarre nuclei and a vacuolated cytoplasm. The ultrastructure of the cells in the fibroblastic areas was characterized by irregular nuclei and a cytoplasm with a well-developed endoplasmic reticulum and dilated cisternae. Some cells lacked the prominent endoplasmic reticulum of fibroblasts and others were characteristic histiocytes with numerous cytoplasmic lysosomes. The cases appear to be the first reported primary malignant fibrous histiocytomas of the lung.

Adult↗
PubMed1979

It's time to set national health care priorities.

The chairman of a hospital cost containment committee faces the fact that the national concern over health care costs will mean reducing the quality and quantity of U.S. medical care. He suggests that instead of setting general constraints, the government and health experts should advise eliminating or reducing specific services based on their relative merits. To facilitate this decision-making process, he groups medical services into six categories for review.

Cost-Benefit Analysis↗
PubMed1979

Morphologic and clinical aspects of estrogen receptors in carcinoma of the breast.

Morphological and cytologic features and preliminary survival data were correlated with the presence or absence of estrogen receptor protein in tissues from 123 primary and 26 metastatic carcinomas of the breast. The estrogen receptor positive tumors were somewhat smaller, 2.8 centimeters in diameter, than the estrogen receptor negative tumors, 3.2 centimeters, but the rate of axillary lymph node metastasis was similar. Fifty-eight per cent of the infiltrating ductal carcinomas, 64 per cent of 11 infiltrating lobular carcinomas and all eight less common cell types including: four mucinous; two papillary; one adenoid cystic, and one tubular carcinoma were estrogen receptor positive. Twenty-one of 33 aspiration smears performed were cytologically positive, the remaining 12 suspected of being carcinoma. Eleven of the 13 estrogen receptor negative tumors that were aspirated were positive possibly due to a lesser differentiation. Sixty per cent of the patients who nine to 40 months after operation are living without known recurrent disease had estrogen receptor positive tumors, but only 28 per cent of the 18 patients who have died of carcinoma of the breast or are living with known recurrent disease were in this category, suggesting that, in spite of a similar rate of axillary lymph node metastasis and without regard to the modality of treatment, estrogen receptor negative tumors tend to have a less favorable course.

Biopsy↗
PubMed1978

Well differentiated adenocarcinoma of the prostate.

One hundred and one adenocarcinomas of the prostate that over a five-year period had been classified as being "well differentiated" or "grade 1" were reviewed and reclassified. Thirty-eight of the cases met strict criteria for such a classification. Twenty-six patients died of prostatic carcinoma. Seventy-five patients (74%) survived for five years, including 87% of the patients with clearly well differentiated carcinomas and 67% of those with somewhat less differentiated tumors. Forty-six percent of all patients including 22 of the 38 well differentiated review cases (58%) are now alive 7-11 years after prostatectomy without evidence of residual disease. Grading appears to be useful and the prognosis of well differentiated carcinomas is better than average but some cases even if focal and incidentally found will terminate with disseminated disease, usually more than five years after the original diagnosis.

Adenocarcinoma↗
PubMed1976

Local recurrence of breast cancer.

Pathologic and surgical aspects of 1,027 breast cancer cases treated between 1961 and 1972 were reviewed. Sixty-eight (7%) of the cases recurred locally. This low rate of recurrence is associated with the small average diameter of 2.7 cm of all carcinomas and the correspondingly low rate of axillary lymph node metastasis of 40%. Subsequently recurring tumors had a higher incidence of axillary lymph node metastasis (68%). Eight hundred eighty-eight infiltrating duct carcinomas represented the largest group of cases and had a recurrence rate of 5.7%. Comedo, infiltrating papillary, and infiltrating lobular carcinomas recurred locally more frequently, but none of 26 mucinous carcinomas recurred. In eight cases, the recurrent tumor was of a more malignant histologic type than the primary lesion. The average width of the excised segments of skin decreased from 9.8 cm during the first three-year period (1961 to 1963) to 8.4 cm during the last period (1970 to 1972). The average width for the entire period was 9.1 cm, identical for locally recurring and nonrecurring tumors.

Breast Neoplasms↗
PubMed1976

Pulmonary blastoma.

Two cases of pulmonary blastoma are reported. One occurred in a 29-year-old man 31 months after a cyst had been excised from the same pericardial-pleural area. The cyst appeared to be of mesothelial origin and, although supported by a cellular stroma, was originally considered to be benign. The morphologic features, location, and possible relationship to a mesothelial lesion suggest an embryonal-mesothelial origin of the tumor. The patient died of recurrent and metastatic disease 9 years after the first resection. The second case is that of a now 74-year-old woman who, over a period of 19 years, has had six separate small peripheral lung tumors excised. They originally resembled fibrous hamartomas but included embryonal-type immature areas and became increasingly more cellular and sarcomatous. The fine structure of the recurrent tumors is that of primitive stroma with few fibrils but no other differentiating features.

Adult↗
PubMed1975

Long-term survival in bronchogenic carcinoma.

In this report, we shall review the clinical and pathological features of 64 patients who survived 10 years or longer after resection for bronchogenic carcinoma. Most of these patients had either adenocarcinoma or bronchioloalveolar carcinoma. None of them had oat cell carcinoma. In many of the long-term survivors, there were pathological findings generally considered to indicate a poor chance for survival. Thus we believe that curative resection for bronchogenic carcinoma should be attempted whenever feasible to offer the patient every hope of long-term survival.

Adenocarcinoma↗