Biomedical subjects

W R Hart

Publications and source records attributed to W R Hart.

At least 73 records · Page 4Linked to original sources

PubMed1982

Metastases to the uterine corpus from extragenital cancers. A clinicopathologic study of 63 cases.

This report is an analysis of 63 cases of metastatic cancers to the uterine corpus from extragenital neoplasms. The patients' ages ranged from 34-88 years (mean, 59.7 years). Twenty lesions were discovered in surgical specimens and 43 were detected at autopsy. The primary tumors arose in the breast (42.9%), colon (17.5%), stomach (11.1%), pancreas (11.1%), gallbladder (4.8%), lung (4.8%), cutaneous melanoma (3.2%), urinary bladder (3.2%), and thyroid (1.6%). In five (25%) of the surgical cases, uterine metastases were the first indication of the presence of an extragenital primary cancer. Metastases to leiomyomas were found in 13 instances. The myometrium was more often involved than the endometrium, but endometrial curettings contained the metastatic tumor in numerous cases. Metastases to the ovaries were detected in almost two thirds of cases. Although an infrequent event, abnormal uterine bleeding may result from secondary spread to the uterine corpus from an extragenital primary neoplasm.

Adult↗

PubMed1982

Multiple squamous-cell carcinomas in Fanconi's anemia.

Fanconi's anemia is one of the chromosome instability syndromes that may predispose to the development of cancer. A 20-year-old woman is reported in whom microinvasive squamous-cell carcinomas of the vulva and tongue developed sequentially. The clinicopathologic findings of 13 other cases of Fanconi's anemia associated with squamous-cell carcinomas are reviewed. Anogenital and oral mucosal surfaces appear to be sites of predilection for these cancers. Patients with relatively mild bone marrow problems or the preanemic phase of the illness who are able to survive several decades appear to be at greatest risk for the development of squamous-cell carcinoma.

Adult↗

PubMed1982

Ovarian germinoma (dysgerminoma) with elevated serum lactic dehydrogenase: case report and review of literature.

lactic dehydrogenase (LDH) is a glycolytic enzyme that may be elevated in the serum of patients with gonadal and extragonadal germinomas. In this report, the authors describe a young woman with a unilateral ovarian pure germinoma (dysgerminoma) who had greater than a sixfold elevation of serum LDH levels with increases in LDH isoenzymes 1, 2, and 3. Two weeks after operation, the serum LDH level had returned to normal. Four additional examples of ovarian germinoma with elevated serum LDH levels have been recorded in the literature. The germinoma cells are the likely source of the elevated LDH activity in such cases. Lactic dehydrogenase and its isoenzymes may serve as a useful tumor marker for diagnosis and posttherapy surveillance in patients with germinomas (dysgerminomas, seminomas). The association of elevated serum LDH in patients with other neoplasms is also reviewed.

Adolescent↗

PubMed1982

Endometrial cancers occurring 10 or more years after pelvic irradiation for carcinoma.

Fifteen patients who developed cancer of the endometrium 10 or more years after pelvic irradiation for carcinoma were selected for study from a group of 64 cases of postirradiation malignant pelvic tumors diagnosed during a 48-year span. The average interval between radiotherapy and diagnosis of the subsequent endometrial cancer was 17.2 years. Irradiation initially had been done for squamous cell carcinoma of the cervix in 13 cases (87%) and for ovarian tumors in two instances. Almost all patients had received megavoltage external radiation combined with radium implants. Two-thirds of the tumors were adenocarcinomas and one-third were carcinosarcomas (either homologous or heterologous). Although the risk of second primary malignant tumors following therapeutic irradiation for pelvic tumors probably is very low, the emergence of new genital tract cancers in long-term survivors must be anticipated, regardless of whether the postirradiation cancers are spontaneous or radiation-induced.

Adenocarcinoma↗

PubMed1982

Arthropathy in calcium pyrophosphate dihydrate crystal deposition disease. Pathologic study of 12 cases.

The pathologic features of calcium pyrophosphate crystal deposition disease (CPDD), particularly the synovial abnormalities, have not been adequately described or depicted in textbooks or journals; this report details the findings in 12 cases. Attention is drawn to the practical reasons for distinguishing CPDD arthropathy from other arthropathies, particularly osteoarthritis; clinical and gross pathologic features that should suggest CPDD arthropathy in cases that are not suspected preoperatively; and characteristics of the tophaceous deposits in CPDD.

Aged↗

PubMed1981

Carcinomas of the cervix with intense stromal eosinophilia.

Stromal inflammatory reactions dominated by eosinophilic leukocytes have been reported in a small number of invasive cervical carcinomas. The clinicopathologic features of six patients whose cervical carcinomas were accompanied by an intense infiltrate of eosinophils were analyzed. Several patients also manifested an eosinophilia of peripheral blood and regional lymph nodes. The cervical carcinoma cells were regarded as the most likely cause of the tissue and blood eosinophilia since other etiologic factors were not identified. Eosinotactic and eosinopoietic substances probably either were produced directly by the carcinoma cells or resulted from immunologic interactions of inflammatory lymphoid cells and mast cells with antigens of the tumors. While stromal eosinophilia alone may not be of prognostic significance, eosinophilia of the peripheral blood may be an adverse sign in some patients with cervical carcinoma.

Adult↗

PubMed1981

Ovarian sex cord tumors with annular tubules. An ultrastructural study of three cases.

The ultrastructural features of three ovarian sex cord tumors with annular tubules were analyzed. The cells had deeply indented nuclei, interdigitating plasma membranes joined by abundant desmosomes, and numerous randomly distributed microfilaments that often complexed with desmosomes. Charcot-Bottchner crystalloids were absent. None of the tubular structures had true lumens. The characteristic central hyaline bodies resembled some forms of Call-Exner bodies and were composed of concentric layers of basal lamina, which often were continuous with redundant basal lamina of the peripheral basement membrane. Because of the clinical, histologic, and ultrastructural similarities to granulosa cell tumors and normal preovulatory granulosa cells, classification of the sex cord tumor with annular tubules is proposed as a distinctive annular and membranous variant of granulosa cell tumor.

Adult↗

PubMed1981

Adenomatoid tumors of the uterus.

Adenomatoid tumors arising in the uterus are not well-recognized and are sometimes mistaken for other benign or malignant neoplasms. This study is a clinicopathologic analysis of 12 uterine adenomatoid tumors. Characteristically, they were small nodular lesions (mean diameter 2.1 cm) in the subserosa or outer wall of the myometrium. Four distinctive histologic types (adenoid, angiomatoid, solid, and cystic) were identified; each tumor consisted of a combination of one major and at least one minor type. The nodular proliferation of smooth muscle which accompanied some tumors was regarded as a non-neoplastic hyperplasia of myometrium. In two cases, small foci of serosal endosalpingiosis were adjacent to the tumor. Theories of histogenesis are discussed, and classification of the adenomatoid tumor as a type of benign mesothelioma is endorsed.

Adult↗

PubMed1981

Further observations on the arthropathy of calcium pyrophosphate crystal deposition disease.

The arthropathy of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is distinctive and may affect lumbar spinal and sacroiliac joints, as well as appendicular joints. Subchondral pseudocysts that are a hallmark of the disease have a variable appearance, but often occur as a typical cluster of subchondral, coalescent lucencies with smudged, sclerotic margins. Structural joint collapse with fragmentation of cartilage and bone may occur and appear to be related, at least in some cases, to antecedent pseudocysts. Characteristic intra-articular osteochondral bodies are often extensive and may affect multiple joints; their pathogenesis is discussed. Articular synovial calcification is common and may be due to calcium hydroxyapatite, as well as CPPD, particularly if advanced degenerative changes are present. Recognition of the radiologic features may be encountered in CPPD crystal deposition disease is important for differential diagnosis.

Aged↗

PubMed1980

Ovarian neoplasms resembling sex cord tumors with annular tubules.

A clinicopathologic analysis of 6 patients with ovarian neoplasms resembling sex cord tumors with annular tubules (SCTAT) was performed. The patients' ages ranged from 20 to 43 years. Most had signs and symptoms of estrogenic hormonal imbalance; none had evidence of the Peutz-Jeghers syndrome. The tumors were unilateral in all cases and, except for one lesion of microscopic size, were from 3 to 18 cm in greatest dimension. One tumor was combined with a germinoma. Surgery alone was the primary mode of therapy in all cases. Lymph nodal metastases developed in 2 patients 7.5 and 10.5 years postoperatively. They are the first documented examples of malignant behavior recorded. At the time of last known contact, all patients were alive without demonstrable tumor for intervals from 1.5 to 16.3 years (mean, 7.8 years) after initial treatment. While the annular patterns of growth have often been attributed to Sertoli cell differentiation, histologic and cytologic features of granulosa cell tumor were observed in areas of the primary tumors and in metastatic lesions. True lumen formation was never observed in the so-called tubules. We propose classification of SCTAT as a distinctive annular and membranous variant of granulosa cell tumor in view of the morphologic similarities and comparable clinical behavior of these two neoplasms.

Adult↗

PubMed1980

Liposarcoma of the lower extremity.

Twenty patients with primary liposarcoma of the lower extremity were treated over a 25-year period. The adequacy of the initial surgical procedure and histological grade of malignancy both influenced survival rates. In addition local recurrence was noted only in patients who had undergone "inadequate" initial excision. Inguinal lymph nodes were uninvolved by tumor in all cases. In general, patients with liposarcomas of myxoid and/or round cell type survived for long periods of time. However, even patients with myxoid lesions occasionally exhibited evidence of early blood-borne metastases. This study suggests an important relationship between an inadequate primary resection, local recurrence, and eventual retroperitoneal spread. In the majority of cases, this may have resulted from failure to control the primary distal extremity tumor, with subsequent contiguous spread of metastases into the ipsilateral retroperitoneal space. If feasible, radical soft part resection should be performed as the primary surgical therapy of these neoplasms. Tumors contiguous to the knee or ankle joint should be treated by primary amputation. Failure to control local disease may result in blood-borne dissemination or local spread along musculoaponeurotic planes to involve proximal groin or retroperitoneal space.

Histiocytoma, Benign Fibrous↗

PubMed1979

Germ cell neoplasms arising in gonadoblastomas.

Gonadoblastomas have a propensity to give rise to germ cell neoplasms. This study analyzes the clinicopathologic findings in six phenotypic females with features of 46,XY pure gonadal dysgenesis who developed germinomas and other germ cell tumors in gonadoblastomas. All stages in the evolution of germinoma from the germ cells of gonadoblastoma were observed, including in situ, incipient, microinvasive, and metastatic varieties. Admixtures with teratoma and endodermal sinus tumor occurred in two patients. Germ cell tumors which originate in gonadoblastomas appear to have the same clinical behavior and response to therapy as those that arise de novo in the ovary, testis or extragonadal sites. Although it is debatable whether gonadoblastomas are true neoplasms or blastomatoid dysgenetic malformations, their potential for giving rise to fully malignant germ cell neoplasms must be recognized.

Adolescent↗

PubMed1979

Extragenital adenomatoid tumor: Evidence for the mesothelial theory of origin.

The histogenesis of so-called adenomatoid tumors has been contested. Doubts as to a mesothelial derivation often have been based on the belief that adenomatoid tumors originate exclusively in or nearby genital tract organs. This report documents a histologically typical adenomatoid tumor which developed in the mesentery of the small intestine. Extensive clinical investigations and an uneventful 3-year postoperative follow-up interval confirmed that the tumor was not a metastatic adenocarcinoma or malignant mesothelioma. The extragenital site of origin of this neoplasm provides additional corroborative evidence for the mesothelial origin of adenomatoid tumors. Regardless of their anatomic location, these distinctive neoplasms should be classified as benign adenomatoid mesotheliomas.

Adenoma↗

PubMed1978

A reassessment of uterine neoplasms originally diagnosed as leiomyosarcomas.

Twenty-eight uterine tumors originally diagnosed as leiomyosarcomas were histologically reclassified without prior knowledge of follow-up or clinical data. Thirteen (46%) neoplasms were reinterpreted as cellular or pleomorphic leiomyomas. They had sparse mitotic activity with three or fewer mitotic figures per 10 high power microscopic fields (MF/10 HPF). None recurred or metastasized, and all patients were alive from 6.3 to 23 years after operation (median of 14.2 years). In 15 cases the diagnosis of leiomyosarcoma (LMS) was confirmed. All showed hypercellularity, nuclear atypism and high mitotic activity. Mitosis counts ranged from 6 to more than 50 MF/10 HPF with 93% of LMS having at least 15 MF/10 HPF. These patients all died of LMS after post-operative intervals of 3 months to 7.5 years (median survival of 13 months). No consistent correlation was found between length of survival and the patient's menopausal status or histologic grade of LMS. The degree of mitotic activity is the single most reliable diagnostic criterion of malignant potential, albeit not the only one. Surgery alone is ineffective treatment for LMS and combination therapy with radiation therapy and/or chemotherapy should be considered.

Adult↗

PubMed1978

Strumal carcinoid of the ovary: ultrastructural observations and long-term follow-up study.

Herein is reported an ovarian strumal carcinoid in a mature tetratoma from a 54-year-old women. Ultrastructural examination revealed numerous electron-dense intracellular granules, which were intrepreted as neurosecretory granules. They corresponded to argyrophil granules observed by light microscopy and were identified within neoplastic cells arranged in both follicular and trabecular patterns. These findings corroborate the contention that the strumal carcinoid itself is a pure neuroendocrine tumor devoid of thyroid follicular epithelium, but do not disprove its possible origin from parafollicular cells of adjacent teratomatous thyroid tissue. There was no recurrence of tumor during the 20 1/2 years the patient was followed.

Carcinoid Tumor↗

PubMed1978

Cystosarcoma phyllodes. A clinicopathologic study of twenty-six hypercellular periductal stromal tumors of the breast.

A series of 26 hypercellular periductal stromal tumors of the breast, commonly referred to as cystosarcoma phyllodes, is reported. Twelve neoplasms were classified histologically as benign and 14 (54%) as maligant after microscopic assessment of the stromal elements. None of the histologically benign cystosarcomas metastasized, although two recurred locally. Malignant transformation was not observed in the recurrent tumors. Local recurrences developed in four women with histologically malignant cystosarcomas and caused the death of one by direct extension into the lung. Pulmonary metastases of the sarcomatous element occurred in three. Two of these women died and one has survived 16 years after pulmonary lobectomy. Separation of cystosarcomas into benign and malignant categories on the basis of their histopathologic features is advocated. It is likely that overgrowth of the sarcomatous stroma is a prerequisite for metastasis.

Adult↗

PubMed1978

Rhabdomyosarcomas of the uterus.

The authors report the clinicopathologic findings in four cases of adult women with rhabdomyosarcomas that originated in the endometrium or cervix, or both. All tumors were pure sarcomas and not components of carcinosarcomas or malignant mixed mesodermal tumors. In two patients, the tumors were typical botryoid embryonal rhabdomyosarcomas. Both patients were alive and well following combined treatments with surgery and chemotherapy or irradiation 3.0 and 2.7 years after operation, respectively, although one had a solitary pulmonary metastasis resected. The other two women had pleomorphic rhabdomyosarcomas, and both died rapidly of widespread tumor. Combination therapy rather than surgery alone probably should be used initially for patients with rhabdomyosarcomas of the uterus.

Adult↗

PubMed1978

Ovarian germinomas (dysgerminomas).

The clinicopathologic findings of 13 patients with ovarian pure germinomas (dysgerminomas) were studied to assess modes of therapy. The patients' ages ranged from 12 to 40 years. Ten patients had unilateral tumors clinically confined to the ovary (Stage I), including 1 patient who had an unsuspected microscopic germinoma in a normal-appearing ovary. Of those with Stage I tumors, only 1 patient developed metastases and died; however, the presence of other elements in the mestases suggested that her primary ovarian neoplasm actually may have been a malignant mixed germ cell tumor. The other 9 patients are alive without tumor after postoperative intervals of 0.3 to 29 years. Three patients had more advanced lesions (Stages II-IV) and 2 died of metastases following orthovoltage irradiation. The results of this study support the concept of individualized therapy for patients with ovarian germinomas.

Adolescent↗