Publications by authors named "HUGHESDON P"

Six cases of squamous carcinoma arising in dermoid cysts are reported. In four out of five cases in which serum calcium was measured hypercalcemia was present and increased pari passu with increases of tumor size. The presence of hypercalcemia in association with an ovarian tumor may therefore point to the possibility of this background.

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An early dysgerminoma, found by chance in a grossly normal ovary, was completely blocked and multiply sectioned. It was found to have a mainly cortical location, being densest in the subtunical and adjacent zones where primordial follicles are normally most numerous, and to be associated with a reduction of the oocyte count in tumor-involved areas. An oocytic origin of the tumor is inferred from these findings and from other data, including the age incidence, available in the literature.

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Two cases of an unusual variant of the Stein-Leventhal syndrome and ovary are described and two similar reported cases reviewed. Clinically three of the patients had a delayed menarche followed by irregular periods and one had irregular menorrhagia. Pathologically all four had large firm nodular ovaries of 6-9 cm in diameter, showing a gross excess of stroma and distorted or fragmented atretic follicles with unusual granulosal cell persistence.

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The difficulties of a consistent Müllerian interpretation of the epithelial ovarian tumours include their inconstant hormonal responsiveness, the doubtful nature of the clear cell tumour and the apparent rarity of benign endometrioid forms. The reported frequency figures for the different types of endometrioid tumour suggest that their nature is made evident by proliferation. The appearance of indolent forms is explored by a study of inactive neoplastic areas associated with endometrioid carcinomas, or with proliferating endometrioid tumours or arising in endometriosis.

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Lipid cell thecomas of the ovary.

Histopathology

September 1983

An ovarian tumour of mixed thecomatous and lipid cell structure is described and the clinical and pathological features of this and eleven previously reported cases are reviewed. Functionally the tumours resemble lipid cell tumours in being mainly androgenic and are similar in size range and age incidence to the 'adrenal' type. Three tumours however contained hilus (Leydig) cells with Reinke crystalloids.

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The secure deduction of tumor histogenesis in vivo is notoriously difficult, owing to the retrospective form of the inquiry, which implies that no histogenetic theory makes certain-enough predictions. Deduction of a tumor's parent tissue currently relies on 1) its location relative to that of small early tumors, 2) correlation of its relative availability with tumor frequency, 3) its resemblance to the tumor tissue in various respects, and 4) its microscopic continuity with the tumor through transitional forms. Each of these criteria has pitfalls, owing to possible failure of the relevant factor to persist or to subsequent mimicry of it by other processes.

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Two unusual ovarian tumours thought to be of Wolffian identity, one of them malignant, are described. They showed packed combinations of adenopapillary, tubular, trabecular and diffuse patterns, a sharp and generalised periodic acid-Schiff (PAS)-positive basement membrane and areas of elastic network. A review of published Wolffian tumours at various sites suggests that the prototypes of the two tumours occur chiefly in the cervix and broad ligament.

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A study of 34 full-thickness Stein-Leventhal ovarian wedges and 30 age-matched control ovaries allowed comparison of the entire ovarian cross-sections and quantification of their features. As compared with controls, Stein-Leventhal ovaries showed on average (i) double the cross-sectional area, (II) the same number of primordial follicles, (iii) double the number of ripening and subsequent atretic follicles from the earliest stages, (iv) a tunica increased by 50 per cent and more collagenized, (v) cortical stromal thickness increased by a third, (vi) subcortical stroma, whether deep cortical or medullary in site, increased five times, (vii) ovarian hilus cell nests four times as frequently. The increased subcortical stroma was derived partly from the regressive conversion into stroma of the over-numerous older follicles, so augmenting steadily with duration, and partly from a concurrent stromal hyperplasia.

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The unusual pleomorphism of ovarian androblastoma calls for the definition of further subgroups and fuller use of the available interpretative ideas. A set of six cases forming a possible subgroup is presented. Functionally these were mainly estrogenic.

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Two further cases of 'female adnexal tumour of probable Wolffian origin' are described Both were retroperitoneal and presented a unique histology of uniformly close-packed bland spaces. solid islands, cords, and diffuse areas. A small hamartoma in a female fetus, part of which resembled the tumours, was traced to an area of near apposition with some paroophoron canals, providing further evidence of a Wolffian origin.

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A series of 114 ovaries form women aged 20 to 82 showed cortical islands of endometrial stroma in about two-thirds of those over 40. This identity was commonly apparent in ordinary sections and was confirmed in half the affected ovaries by the presence of K cells (endometrial granulocytes) in one or more foci; it may be masked by attenuation or conversion into smooth muscle. The islands show transitional forms to decidual foci and to cortical granulomata and related leucocytic lesions, a few of which also showed K cells: they are ultimately converted into weakly orceinophil hyaline foci which are common in later life and showed K cells in four instances and continuity with stromal islands in 20 ovaries.

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