Question Of Malignancy Research Articles

Granular Cell Tumor of the Parotid Gland: An Exceptionally Rare Occurrence

The authors report on a case of a granular cell tumor of the parotid gland, which constitutes an extremely rare neoplasm. The infiltrative growth of the tumor may pose the question of malignancy, especially on frozen section. The objective of this report was to function as a reminder of this entity for every pathologist that deals with a biopsy from a lesion of the parotid gland, and furthermore, to keep the unwary away from a possible diagnostic pitfall. A meticulous search of the literature revealed only 4 similar cases.

„Benignes fibröses Histiozytom“ der distalen Femurmetaphyse

The typical radiologic finding of a "non-ossifying fibroma" of the distal femoral metaphysis was seen in a 17-year-old female patient with pain in the distal femur. The rapid development of this lesion was confirmed on the basis of earlier radiographs performed to clarify other complaints. Since the lesion had developed in no more than 34 months, with pronounced scintigraphic and MRI signal intensity, particularly in the late phase, and pain had prompted the patient to seek examination, the cause was assumed to be a neoplasia rather than a growth disorder. Histopathological examination revealed a proliferative fibrohistiocytic lesion which was histologically different from a malignant fibrous histiocytoma. The finding indicates that in the differential diagnosis between non-ossifying fibroma and benign fibrous histiocytoma in cases with identical localization, pain and the intensity of the scintigraphic signal may well be the key to further action: since benign fibrous histiocytomas may be regarded as genuine neoplasias, the question of malignancy should also be clarified beyond doubt.

Thyroid Isthmusectomy: A Rarely Used but Simple, Safe, and Efficacious Operation

R A l p F p hyroid nodules are a common entity. Up to 67% of the opulation was found to have at least one incidental hyroid nodule during a study on asymptomatic patients ith high-resolution ultrasonography. The majority of hese nodules are not palpable and are increasingly disovered incidentally with ultrasonography or radioraphic imaging. When an abnormality is found, a iagnostic investigation often ensues, with dedicated eck ultrasonography and fine-needle aspiration biopsy FNA) if the lesion meets size or other criteria for interogation. Although the vast majority of these lesions will rove to be benign, the question of malignancy must be nswered. In the case of indeterminate results from NA, the next step in diagnosis is typically resection for ull pathologic evaluation. For solitary nodules residing n the thyroid lobes, an ipsilateral lobectomy will suffice or diagnosis. If a lesion exists in the thyroid isthmus, xtirpation of the entire lobe and isthmus is unnecessary nd sacrifices 50% of the thyroid parenchyma. In hese patients, resection of the isthmus alone would proide adequate tissue to achieve diagnosis, protect imporant structures, and preserve adequate functional thyoid tissue. We propose that in the case of isolated odules of the isthmus, limited resection with a small argin of normal thyroid tissue is the optimal procedure n that it is safe, efficacious, and can be performed as an utpatient procedure under local or regional anesthesia.

Colonic Obstruction Due To Localized Giant Pseudopolyposis Complicating Ulcerative Colitis

Localized giant pseudopolyposis is an interesting but extremely rare feature of pseudopolyposis complicating ulcerative colitis or Crohn's disease. The lesion represents a localized exuberant collection of pseudopolyps giving rise to a large discrete intraluminal colonic mass, which may simulate neoplasms such as villous adenoma or polypoid cancer. Our case concerns a 50 year old man, with a 10 year history of pancolonic ulcerative colitis under medical treatment, who presented with symptoms of subacute large bowel obstruction. At colonoscopy a large polypoid lesion was found in the distal transverse colon, causing almost complete luminal obstruction. In abdominal CT scan an obstructive thickening of the distal transverse colon, just before the splenic flexure, was seen, with the question of malignancy. The patient went on surgery and a total colectomy with ileorectal anastomosis was performed. The giant polypoid mass was located in the distal transverse colon and extended circumferentially in a distance of 15cm, causing almost complete luminal obstruction. Its macroscopic features were highly suspicious of malignancy. The microscopic examination revealed multiple pseudopolyps on a background of active ulcerative colitis changes, confirming the diagnosis of localized giant pseudopolyposis. The patient's postoperative recovery was uneventful.

An analysis of 136 groups of microcalcification of benign origin. How specific is the "triangle principle" (author's transl)

Amongst 107 localised groups of microcalcification of benign origin and not intraductal in localisation, there were 79 which showed round, oval or amorphous configuration, and 28 which were triangular. Of 29 intraductal areas of microcalcification, 26 showed appearances resembling an intraduct carcinoma. The "triangle principle" is therefore specific for the intraductal location of the lesion, but is unrelated to the question of malignancy. If the shape of the lesion had been used as the sole indication for biopsy, ie. had one operated only on those groups of microcalcification showing a triangular shape, it would have been possible to avoid biopsy in benign lesions in 79 patients and only three harmless intraductal lesions would have been overlooked. It is the task of the radiologist to distinguish intraductal calcification from that which is not intraductal.

Juvenile Aponeurotic Fibroma

Three cases of a distinctive soft tissue fibrous tumor with spotty calcification demonstrate the lesion originally described by Keasby as Juvenile Aponeurotic Fibroma. The tumor tends to occur on the volar surface of the hands and feet in children and adolescents but may be seen in other areas in all age groups. Size rarely exceeds 3.0 cm. The tumors are fixed to the fascial layers. In previously reported patients pain was not described as an important factor, but both pain and tenderness were striking in all 3 of our cases. Microscopically the dominant feature is a fribrous stromal pattern of fusiform cells with inclusions of mast cells. Spotty calcification is a constant finding and appears to increase with duration of tumor. Local recurrence after excision and an aggressive histologic appearance may raise the question of malignancy. However, neither destruction of normal tissue surrounding the tumor nor metastases have occurred. Local exicision is the treatment of choice.

Elektronenmikroskopische Untersuchungen zur Zelldifferenzierung in Prostata-Carcinomen

20 confirmed human prostatic carcinomas of various histological types were studied by electron microscopy. As a result of the ultrastructural findings it was possible to define characteristic cell types which are normally present in prostatic carcinomas irrespective of their histological differentiation. As these cell types are frequently situated side by side, the prostatic carcinoma acquires a characteristic variegated appearance. Three main cell types can be distinguished. 1. A cell with a pale, euchromatic, round nucleus, very prominent nucleolus, and a narrow layer of bright cytoplasm with few organelles. This cell shows no secretory activity and has to be classified as a poorly differentiated or embryonic cell. It may be assumed that these cells have a high proliferative activity. 2. A cell with dark, pleomorphic, heterochromatic nucleus and a broad layer of dark cytoplasm containing numerous organelles. This cell type is apparently functionally stimulated and active. The disproportionate increase and arrangement of the organelles, however, makes it morphologically atypical: These alterations seem to result from an irregular process of enzyme synthesis and secretion. 3. A vacuolated cell: this cell has a dark, pyknotic nucleus and a broad layer of subtotally vacuolated cytoplasm. Probably it refers to a nonfunctional, hypersecretory and degenerative tumour cell. Transitional cell forms are not unusual. Sometimes carcinoma cells are visible in tumourous glands, and are so highly developed and well differentiated that the ultrastructural findings by themselves give no answer in the question of malignancy. Basal cells were seen in five of the carcinomas investigated, mainly in tumours with cribriform or solid patterns. The cytoplasm of these cells shows few organelles. Bundles of cytoplasmatic filaments are often present. It is uncertain whether these cells are of myoepithelial type. The knowledge of the described cell variants will be of clinicopathological importance if therapeutic effects on prostatic carcinoma are estimated cytomorphologically at the ultrastructural level.

CYTOGENETIC DIAGNOSIS OF MALIGNANCY IN RECURRENT MENINGIOMA

Chromosome studies were done on a meningioma in which it was impossible to determine histologically whether or not the tumour was malignant. Eighty-four metaphases were studied and a mode of 38 chromosomes with 3 marker chromosomes was found. These findings suggested that the tumour was malignant. The tumour recurred 18 months later and was then confirmed histologically to be malignant. Cytogenetic analysis showed a similar chromosomal pattern although clonal evolution had occurred. It is felt that chromosome studies may be a useful supplement to histological examination when the question of malignancy is in doubt.

The Gastrocamera in the Diagnosis of Stomach Disease

Three hundred consecutive patients were studied with the gastrocamera and the findings were analyzed. Forty-six ulcers and eight cancers of the stomach were photographed. Only one third of roentgenographically diagnosed antral ulcers were photographed, but 11 gastric ulcers not noted by the radiologist were found. Lesions at the cardia or in the fundus, suspected on x-ray study, were more clearly defined by a complementary gastrocamera examination. Pictures of an ulcer were often decisive in instances where the question of malignancy was raised. Gastritis was the most frequent abnormality of the group with normal findings from x-ray examination of the upper part of the gastrointestinal tract. The technique is well tolerated, very safe, and can be performed in a few minutes. The photographs are of excellent quality and provide a permanent record for consultation with colleagues and for a teaching file of gastric pathology.

TORSION OF AN INTRA-ABDOMINAL SEMINOMA OF THE TESTIS.

Abstract In 1927 Wangensteen wrote, ‘No greater diversity of opinion probably exists concerning anything in medicine than the question of malignancy in the undescended testicle.’ Since this was written a great number of papers has been published on this subject, and now it is generally accepted that the maldescended testis is more liable to undergo malignant change than the normally descended organ. The main factors which swayed opinion to this view were Campbell's analytical papers of 1942 and 1959. His conclusions were that malignancy was eleven times more frequent in the inguinal testis and sixty times more frequent in the intra-abdominal testis. The maldescended testis is also known to be more liable to torsion and trauma than is the normal organ. The following case illustrates two of the dangers to which an intra-abdominal testis is exposed.

INCIDENCE OF MALIGNANT GROWTH OF THE UNDESCENDED TESTICLE

the undescended testicle is more liable to become the seat of malignant change than the scrotal testicle and whether, of undescended testicles, the inguinal is more likely to be affected than the abdominal are two questions which have not been satisfactorily answered. In 1927 Wangensteen wrote, No greater diversity of opinion probably exists concerning anything in medicine than the question of malignancy in the undescended testis. In 1936 Hinman said, Whether tumor is relatively more frequent with inguinal than with abdominal retention is uncertain. From the data recorded in the literature it can now be stated unequivocally that the undescended testicle is more liable to malignant change than the normally placed testicle and that the abdominal testicle is more liable to malignant change than the inguinal. There are at least six main reasons why these truths have so long remained obscure: 1. The medical profession has neglected the science

Surgery of Peptic Ulcer

PEPTIC ULCER is a term used commonly to include both gastric and duodenal ulceration. It seems best to consider both these forms of ulceration together, although the problem is different in some respects. The point where these two types of ulcer differ is where the question of malignancy influences operation and, of course, this question only enters our minds when gastric ulcer is found. Malignancy is, for practical purposes, non-existent in duodenal ulcer. Figure 1 shows the areas most frequently affected by peptic ulcer. In the last twenty years the use of the x-ray, and in the last ten to fifteen years the use of the fluoroscope, have entirely changed our ideas as to the frequency of peptic ulcer. The x-ray has given us a means of diagnosis which has proved in large groups of cases to be exceedingly accurate. The etiology, anatomy and pathology, and symptoms of peptic ulcer were discussed in a paper by Dr. L. C. Gatewood, published in this Journal in December, 1931, and will, therefore, not be considered again here.

SARCOMA OF VERMIFORM APPENDIX.-SARCOMA OF THE EXTERNAL URETHRAL ORIFICE.

I. H., male, aged 51 years, blacksmith, had for more than a year recurrent attacks of pain in the right iliac fossa, becoming more severe, so that five weeks before entering Bridgeton Hospital, for operation, he had been confined to the house for three weeks by an attack. The question of malignancy was considered, because his father had died of cancer, and on tracing history of father's case, I find that the cecum was much thickened and softened, but no microscopic examination was made. I mention this because Hollender has recently stated that cancer of intestine is apt to recur in families. Having opened the abdomen, by the usual incision, we found the appendix lying posterior of cecum, pointing upward and slightly outward, firmly adherent and bound down by results of previous inflammation. It was severed near the cecum, and peritoneum closed over stump by mattress sutures; the cecum did