No abstract

The clinical and pathologic findings in 94 patients with cystosarcoma phyllodes were studied to determine which pathologic characteristics were related to clinical behavior. The neoplasm recurred in 28 patients and 15 patients (17%) died of metastatic cystosarcoma. Most recurrences occurred within 2 years of initial surgery and all patients who died of cystosarcoma did so within 6 years. No tumor less than 4 cm in diameter or having fewer than 3 mitotic figures per 10 hpf in the areas of greatest mitotic activity proved fatal. Other microscopic features associated with a low risk of recurrence or of death were pushing margins (one death in 39 examples) and minimal cytologic atypism of the stromal cells (two deaths in 30 examples). No one feature was wholly reliable and a clearcut separation of benign from malignant tumors could not be made. Although axillary lymph nodes were enlarged in 17% of patients, metastasis to them occurred in not more than three instances (one histologically proved) and therefore radical mastectomy or routine axillary lymph node dissection is not worthwhile. Wide local excision for small cystosarcomas and simple mastectomy for larger ones is recommended. In addition, low axillary dissection should be considered in patients having clinically enlarged axillary lymph nodes and tumors larger than 4 cm if there is marked atypism of stromal cells or high mitotic activity, as determined by microscopic evaluation of the cystosarcoma.

The clinical and pathologic features of 53 endometrical stromal tumors were studied to determine which pathologic characteristics were related to the clinical behavior. Morphologically, stromal tumors were divided into 2 groups: 18 tumors with pushing margins (stromal nodules) and 35 tumors with infiltrating margins (endolymphatic stromal myosis or stromal sarcoma). Stromal nodules, which were expansile, noninfiltrating lesions composed of cells similar to those found in normal endometrial stroma, were considered benign. The tumors with infiltrating margins were separated on the basis of mitotic activity. Patients with endolymphatic stromal myosis had 100% survival at 5 years and those with stromal sarcoma had 55% survival. The size of the primary tumor and presence of vein invasion showed a slight correlation with the patient's prognosis but no correlation was found with increasing degrees of cellular atypism. For patients whose disease was not controlled by hysterectomy and who had symptomatic extra‐uterine tumor, x‐ray irradiation appeared to be of benefit. The patients' symptoms and physical examination findings were not different from those of patients having other uterine tumors.

A critical review of over 900 mammary carcinomas treated at St. Louis University Hospitals disclosed 13 that fulfilled the histologic picture of lipid‐rich carcinoma. All clinical and pathologic data were tabulated; 1 case was studied by electron microscopy. Five of the patients were dead within 2 years, and 2 others had evidence of metastatic tumor within 2 years. One patient died 6 years after treatment. On the basis of the following characteristics we believe lipid‐rich carcinomas should be regarded as a specific type of mammary carcinoma: 1. The presence of non‐degenerative lipid material within the cytoplasm of tumor cells; 2. The presence of intramitochondrial crystals; 3. The pattern of metastatic involvement of lymph nodes and the orbit; 4. The presence of intraductal and lobular carcinoma in situ associated with this type of tumor; and 5. The more aggressive clinical behavior.

This clinical and pathologic study of 24 vaginal polyps, 22 from adults and 2 from infants, was prompted by the need for recognition of a benign polypoid vaginal lesion which must be distinguished from sarcoma botryoides, rhabdomyosarcoma and mixed mesodermal tumor. Twelve of the 22 polyps from adults contained atypical cells within the stroma. Five of these patients were pregnant when the polyp was discovered. Follow‐up showed that the polyps are benign and adequately treated by local excision. The polyps from the 2 newborn infants were present at birth and were characterized by diffuse edema but contained no atypical stromal cells. One of the polyps regressed after biopsy. The other was locally excised and did not recur. Maternal hormones are thought to induce the intra‐uterine development of the polyps in infants. The criteria for distinguishing vaginal polyps from sarcoma botryoides, rhabdomyosarcoma and mixed mesodermal tumor are discussed.