Implications of precancerous rectal biopsy in patients with inflammatory bowel disease.

Sixty-five patients with an initial diagnosis of ulcerative colitis who underwent total proctocolectomy between 1955 and 1973 were studied retrospectively. Rectal mucosa in each patient was examined microscopically for the presence or absence of "precancerous" alterations as described by Morson and Pang. Histologic examination was made with no knowledge of concomitant colon carcinoma or the patients' clinical courses. Three of ten patients with precancerous rectal mucosa had invasive colon carcinoma, while none of the 55 patients without such changes had colon cancer (P less than .05, Fischer exact test). The duration of disease was significantly greater in those patients with rectal precancer (P less than .05). Reexamination changed the pathologic diagnosis in 15 patients from ulcerative colitis to granulomatous or "mixed" colitis. Two of three invasive cancers occurred in the reclassified group. Results support previous contentions that careful histologic evaluation of rectal biopsy specimens from individuals with inflammatory bowel disease may better define that population of patients with an increased risk of colonic carcinoma.

Gastric epithelioid leiomyoma and leiomyosarcoma (leiomyoblastoma).

A series of 127 surgical specimens of epithelioid leiomyomatous tumors (leiomyoblastomas) of the gastric wall from the files of the Armed Forces Institute of Pathology (AFIP) were studied as to biologic behavior, morphogenesis, and histologic features of value in distinguishing benign and malignant variants. These tumors affect middle-aged men primarily and usually present with upper gastrointestinal bleeding or peptic ulcer-like symptoms. They are composed of a mixture of round epithelioid and spindle cells, many of which have clear cytoplasm. The cells are ensheathed by delicate reticular fibers. The presence of a perithelial or glomoid pattern in some tumors suggests a possible relationship to angiomyoma, glomus tumors, and "pericytoma." The epithelioid leiomyoma, the benign form, often arises in the mid- and distal stomach, especially on the anterior wall. Microscopically, it is recognized by the presence of large epithelioid cells and infrequent mitotic figures. Of 103 epithelioid leiomyomas, only one metastasized and thus was biologically malignant. The epithelioid leiomyosarcoma often arises in the proximal stomach and also distally, especially on the posterior wall. Two histologic types of epithelioid leiomyosarcoma are distinguished from the benign epithelioid leiomyoma by the small size of the cells and occasional higher mitotic counts. One sarcoma variant is a small cell caricature of the leiomyoma. The other is more anaplastic, assoicated with a loss of reticular fibers surrounding the cells and an alveolar arrangement. Epithelioid leiomyosarcomas are the most common type of gastric sarcoma. They are aggressive neoplasms; 63% metastasized, usually within 2 years after diagnosis.

Polypropylene suture in esophageal and gastrointestinal operations.

A comparison was made of the gross and microscopic wound healing and tissue reactivity between stainless steel wire, polypropylene and silk in anastomoses in the u-prepared colon of the dog. While all anastomoses healed irrespective of the suture material used, wire was associated with the least inflammatory response, silk the most and polypropylene intermediate, its low reactivity approaching that of wire. A clinical trial of Prolene for 71 varied anastomoses between pharynx, esophagus, stomach and colon in 47 patients undergoing esophageal resection and reconstruction or bypass was done. In four of the seven anastomotic disruptions which occurred, causative factors unrelated to the suture material could factorily in the remainder of these patients. Monotive suture which works well in esophageal and gastrointestinal anastomoses.