Hyperparathyroidism in black patients: an update.

Cervical exploration with removal of the pathologic gland or glands is effective treatment for parathyroid adenomas and hyperplasia. This article reports the results of a retrospective study of 41 patients who underwent elective cervical exploration for primary hyperparathyroidism at Howard University Hospital between 1974 and 1989. Preoperative localization studies for primary neck exploration consisted of an ultrasound of the neck. Removing the diseased gland/glands resulted in the resolution of the patients' symptoms and the return of calcium levels to normal. Complications included transient hypocalcemia, a wound hematoma, and a postoperative death.

Colorectal cancer in young black patients.

A higher percentage of young black patients are discovered with a more advanced stage of colorectal cancer than is reported for white patients. To evalute this phenomenon, various prognostic factors in young colorectal cancer patients at Howard University Hospital were studied.

Extraskeletal osteosarcoma.

A retrospective study of 88 cases of extraskeletal osteosarcoma revealed that this tumor affects adults almost exclusively, with a high incidence in patients older than 50 years, and is slightly more common in males (58%) than in female patients. The tumor occurred principally as a soft tissue mass in an extremity, with a predilection for the thighs (lower extremity, 46.6%; upper extremity, 20.5%) and the retroperitoneum (17%). Most were deep-seated and were firmly attached to the fascia, but occasionally they were freely movable and confined to the subcutis or dermis. Nearly all presented as an insidiously growing mass rarely causing pain or tenderness. The preoperative duration of symptoms ranged from 2 weeks to 25 years (median, 6 months). In 17 cases, it exceeded 2 years. A history of prior trauma to the site of the tumor was stated in 11 of the 88 cases (12.5%) and of radiation in five cases (5.7%). Microscopically, the tumors contained varying amounts of neoplastic osteoid and bone, sometimes together with islands of malignant-appearing cartilage. Like osteosarcoma of bone, extraskeletal osteosarcoma showed a striking variation in histologic appearance and focally resembled malignant fibrous histiocytoma, fibrosarcoma, and malignant schwannoma. Follow-up information was available for 65 patients. Eight (12.3%) patients were alive with no evidence of recurrence; 12 (18.5%) patients were alive with one or more recurrences; and five (7.6%) were alive with metastases. Twenty-eight of the tumors (43%) recurred and 39 (63%) metastasized. Forty (61.5%) of the patients with follow-up information had died, 36 from the tumor and four from miscellaneous causes. The prevailing sites of metastases were the lung, the regional lymph nodes, and bone.

Thorotrast-associated anemia and bone marrow hypoplasia.

Two patients with chronic anemia and bone marrow hypoplasia secondary to Thorotrast deposition are described. In one case thorium dioxide was identified by histoautoradiography, scanning electron microscopy, and x-ray spectrometry.

Ultrasound contribution to diagnosis of Peutz-Jeghers syndrome.

The ultrasonographic finding of small bowel polyps is reported in a 16-year-old girl, referred for evaluation of abdominal pain. The sonographic study was of particular value in also excluding pregnancy and in documenting small bowel obstruction. We have found that distended small bowel and its contents are accessible to sonographic evaluation, in this case, the constellation of clinical and sonographic findings were of considerable value in diagnosing Peutz-Jeghers syndrome.

A follow-up study on familial polyposis coli in black patients.

We have updated our experience concerning eight families (24 patients) with FPC, 11 of whom had FPC with carcinoma and 13, FPC only. The importance of biopsy to prove the presence of an adenoma (tubular, villous or tubulovillous) was emphasized. Although we prefer total colectomy with ileorectal anastomosis as definitive treatment, total proctocolectomy also has been recommended. The value of careful follow-up examination to detect carcinoma in the retained rectal segment and the periampullary region has been stressed. No racial differences were noted.

Malignant melanoma of soft parts. A reassessment of clear cell sarcoma.

A retrospective study of 141 cases of clear cell sarcoma of tendons and aponeuroses revealed that the tumor occurred predominantly in young patients between 15 and 35 years of age, was slightly more common in female than in male patients, and originated chiefly from tendons, aponeuroses, and fascial structures of the extremities with a predilection for the feet and knees. The tumor presented as an insidiously growing mass causing pain or tenderness in slightly more than half of the patients. The preoperative duration of symptoms varied greatly, and in 29 cases the time interval between discovery of the tumor and operation exceeded 5 years. Microscopically, the tumors varied little in appearance and were composed of short fascicles of fusiform cells with a clear to granular eosinophilic cytoplasm, vesicular nuclei with prominent nucleoli, and occasional multinucleated giant cells. Melanin was demonstrated in 72% of the 92 tumors in which the Fontana or Warthin-Starry preparation for melanin was performed. S-100 protein, a neuroectodermal marker, was positive in 13 of 19 cases. Follow-up information was available in 115 patients. Thirty-four (29.6%) were alive and well with no evidence of recurrence. Twenty-four (20.9%) patients were alive with one or two recurrences, three (2.6%) were alive following pulmonary lobectomy for metastatic sarcoma, and one was alive with metastasis in the thoracic spine. Fifty-three of the 115 patients with follow-up information had died, 50 from metastatic tumor and three from miscellaneous causes. The prevailing sites of metastasis were the lung and the regional lymph nodes. The exact histogenesis remains obscure, but the presence of intracellular melanin in two-thirds of the cases supports origin from migrated neural crest cells with the capacity for producing melanin. For this reason the term, malignant melanoma of soft parts, seems preferable over the purely descriptive term of clear cell sarcoma.

Infantile myofibromatosis.

The clinical and pathologic features of 61 cases of congenital and infantile myofibromatosis are presented. The tumor affected almost exclusively infants and young children; 88% of cases occurred before the age of two years, and 60% were noted at birth or shortly thereafter. Solitary (45 cases) and multicentric (16 cases) forms of the tumor could be distinguished; the solitary form was more common in males (69%) and affected chiefly the soft tissues of the head-neck region and the trunk. The multicentric form, on the other hand, predominated in females (63%) and was found not only in soft tissues but also in bones and viscera. Fourteen of the 16 cases with multicentric lesions were present at birth, and four of them had evidence of visceral involvement. Among the 16 cases were two sets of siblings, both brother and sister. Grossly, nearly all of the tumors were well demarcated; they measured from 0.5 to 7 cm in greatest diameter. Microscopically, they formed well-circumscribed nodules consisting of short bundles of plump, spindle-shaped cells displaying staining characteristics intermediate between fibroblasts and smooth muscle cells. Necrosis or a hemangiopericytoma-like pattern was often found in the center of the tumor nodules. Intravascular growth was encountered in several instances, but this feature did not seem to affect the clinical behavior. Of the 43 patients with follow-up data (mean-follow up 5.1 years), 36 were alive and well. Of the solitary lesions, three recurred. Of the multicentric lesions, five of the 15 patients showed evidence of spontaneous regression of both soft tissue and bone lesions. Four died, three of extensive involvement of multiple viscera, especially the lung, and one of "crib-death."

Parathyroid adenoma and light chain myeloma.

An elderly patient with simultaneous hyperparathyroidism and light chain myeloma is described. The patient presented with hypercalcemia, bone pain, pathologic fractures, and cystic and lytic bone lesions. The problems of diagnosis and management are discussed. It is recommended that elderly patients with hypercalcemia and bone lesions should have not only diagnostic studies for hyperparathyroidism but also serum and urine immunoelectrophoresis to detect multiple myeloma or plasma cell neoplastic variants. Surgery is indicated for the hyperparathyroidism. Chemotherapy and localized radiotherapy usually control the myelomatous disease.

Granular cell tumor in black patients.

A 12-year review of granular cell tumors at Howard University Hospital is reported. Sixty-one cases were studied (56 patients). A female preponderance was clearly established and multicentricity of lesions constituted a higher percentage than previously reported in other series. Malignant transformation was not found. Electron microscopic studies tended to support the Schwann cell origin theory for the tumor but no conclusion could be drawn as to whether or not the lesion is neoplastic, degenerative, or metabolic in nature.

Follicular carcinoma of the thyroid with metastasis to the breast.

A 75-year-old woman with two previous neck operations for follicular carcinoma of the thyroid presented with a breast mass nine years after diagnosis. The mass recurred one month after excisional biopsy. Pathological examination revealed metastatic follicular carcinoma. The breast tumor was weakly positive for estrogen receptor and positive for progesterone receptor. Recurrences in the neck and breast were resected. Residual disease in the neck and metastasis to the lungs were resolved by (131)I ablative therapy. Previous reports of thyroid metastasis to the breast were described as papillary carcinoma. This report describes a rare site of metastasis and briefly reviews the pathology, diagnosis, and management of thyroid carcinoma.

Colorectal carcinoma in young persons: experience at Howard University Hospital, 1955--1977.

Case records of all patients 30 years of age and under with a proven pathological diagnosis of colorectal cancer at Howard University Hospital between January 1955 and December 1977 were reviewed. Over this 23-year period, 14 cases were documented. All patients were black. This study reaffirms the poor prognosis which accompanies colorectal carcinoma in the young, particularly in those patients with mucinous carcinoma.

Thyroid carcinoma in black patients.

From 680 surgical specimens of thyroid disease, 31 cases of thyroid carcinoma found at Howard University Hospital, from January 1950 to December 1975, are reviewed. Eighteen (58 percent) were females and 13 (42 percent) were males. Of the 31 patients, there were 11 patients with follicular carcinoma, 11 with papillary carcinoma, seven with mixed papillary and follicular carcinoma, one with Hurthle cell carcinoma, and one with medullary carcinoma. Thyroid carcinoma accounts for only .001 percent of all admissions during the period of study, and is indeed a rare cause of disease among blacks at this institution. Recommendations for surgery and follow-up data are presented.

Chondroma of soft parts.

The clinical and pathological features of 104 cases of chondroma of soft parts are presented. The tumor occurred predominately in the third and fourth decades, was slightly more common in male (61%) than in female patients, and affected chiefly the soft tissues of the hand (64%) and feet (20%). The presenting symptom was usually a slowly and insidiously growing mass, occasionally causing tenderness or pain. Nearly always the tumor was well demarcated and lobulated and measured between 1 and 2 cm in greatest diameter. Microscopically, most of the tumors were composed of adult-type hyaline cartilage, undergoing calcification in a large percentage of cases. In addition, histologic variants with giant cell proliferation and chondroblastic activity could be distinguished. Despite the slight cellular pleomorphism and the plump appearance of many cartilage cells in the chondroblastic variants, there was no evidence that these tumors behaved differently from the tumors composed predominately of adult-type hyaline cartilage. Of the 56 patients with follow-up information (median follow-up period, 5.7 years) 44 were alive and well with no evidence of recurrence in the follow-up period. In 10 patients the tumor had recurred once. Multiple recurrences or metastatic lesions were no observed. Two patients died of unrelated cause. Complete local excision appears to be the treatment of choice.

Carcinogenicity of some folk medicinal herbs in rats.

Twelve medicinal herbs were bioassayed to correlate a high incidence of esophageal carcinoma in natives of different places with their habitual consumption of these products. Outbred NIH Black rats were given 72 weekly sc injections of the total aqueous extracts of the plant materials. The tanninrich plant extracts from Areca catechu and Rhus copallina produced local tumors in 100 and 33%, respectively, of the experimental animals. Other materials included Diospyros virginiana and extracts from plants not rich in tannins. Diospyros and extracts of Sassafras albidum and Chenopodium ambrosiodes were tumorigenic in over 50% of the treated animals.

Familial polyposis coli in black patients.

We have presented our experience with 19 black patients who had familial polyposis coli, seven of whom had associated cancer. Four of the seven had multiple cancers. Seventeen of the 19 patients were female but most of the patients at risk in our series were female. Sixteen of the 19 had extracolonic manifestations which have been described as part of Gardner's syndrome. Although our series was quite small, larger series do not report as high an incidence of extracolonic manifestations. Follow-up was too short to make any statements concerning the development of cancer in the retained rectal stump.

Thyroid diseases in black patients.

During the 26-year period, January 1, 1950 to December 31, 1975, inclusively, there were 680 thyroidectomies for clinical evidence of primary thyroid disease performed at the Howard University Hospital (0.6 percent of routine surgicals). There were 595 female and 85 male patients (ratio 7:1). All of the patients were black. In the 680 cases, the incidence of carcinoma was 4.6 percent, adenoma 11.3 percent, nodular goiter 51.9 percent, diffuse hyperplasia 21.3 percent, various thyroiditis 7.1 percent, and miscellaneous conditions 3.8 percent. A statistical analysis, together with a brief review of the literature on each entity, will be presented.