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Three cases of benign lesions which mimicked malignant tumors of the esophagus are described. In all three cases, two inflammatory pseudotumors and one case of diffuse leiomyomatosis, the clinical presentations, radiologic features, and gross pathologic findings led to the mistaken diagnosis of carcinoma at thoracotomy. The benign nature of the processes was recognizable only on microscopic examination. Although most benign tumors of the esophagus are localized solitary lesions that are easily distinguished from carcinoma, occasionally benign conditions may present as infiltrative, ulcerated mass lesions. Inflammatory pseudotumor and diffuse leiomyomatosis should be included in the differential diagnosis of esophageal malignancies.

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Records of 147 patients with primary cutaneous malignant melanoma treated at the Lahey Clinic from 1955--1979 were reviewed. Complete clinical follow-up data were obtained, and all pathologic material was reviewed. Proposed new risk categories based on a modification of the Clark and Breslow categorizations are outlined. The incidence of low-risk melanoma has dramatically increased (from 23--53%) and that of high-risk melanoma has decreased (from 34--10%) over the period of this study. Dermal punch biopsy gives accurate staging information and carries no increased risk of local recurrence, nodal metastases, or death from disease. Resection of a margin of clinically uninvolved skin measuring twice the diameter of the primary melanoma minimizes local recurrence (2.5% or less), does not adversely affect survival, and reduces the need for skin grafting. Arbitrary wide margins are not justified. Regional lymphadenectomy offers no improvement in survival in patients with low-risk and moderate-risk melanoma and can play only a minor role at most in improving survival for patients with high-risk melanoma.

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Fifteen patients with nonfunctioning kidneys and complete main or segmental renal artery occlusion that was discovered on angiographic investigation for hypertension underwent renal artery revascularization. Renal blood flow was restored in all patients. Of these patients, 13 experienced excellent recovery of renal function, one patient had slight return of function, and one patient showed no evidence of improvement. Histologic evidence of intact viable glomeruli, angiographic appearance of collateral circulation, and the presence of proximal occlusion with a patent distal renal artery were necessary for successful results. Revascularization of the ischemic nonfunctioning kidney with restoration of renal function is preferable to nephrectomy when all appropriate criteria are satisfied.

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Mucoepidermoid carcinomas of the tracheobronchial tree are extremely uncommon and, as a result, opinions regarding their natural history are conflicting. In an effort to determine whether the tumors are aggressive or relatively benign, we have collected seven well-documented, previously unreported cases from among 4,250 primary pulmonary carcinomas and 116 bronchial adenomas. The two tracheal and five endobronchial lesions presented here include one high-grade and six low-grade tumors. Curative resections were performed, including segmental tracheal resections in two patients, lobectomy in three patients, and pneumonectomy in two patients, and the follow-up is complete to the time of this report. Long-term survivals ranging from 5 to 23 years, averaging 12.8 years, have been achieved in the six patients with a low-grade carcinoma. The one high-grade variant proved fatal within 28 months of diagnosis despite two surgical attempts at control and radiotherapy. It is concluded that these tumors exhibit a spectrum of virulence with low-grade lesions amenable to long-term surgical cure. The optimum treatment of high-grade lesions remains problematical.

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In samples of colonic adenocarcinomas, the mean activities of thymidine kinase, glucose-6-phosphate dehydrogenase, phosphoserine phosphatase and pyrroline-5-carboxylate reductase were several fold higher than those of nonneoplastic colon. The presence of considerable, cold labile pyrroline-5-carboxylate reductase activity provided an additional criterion for distinguishing tumors from the control tissue. Deviations from the pattern of enzymes in normal colon were much more pronounced in the five moderately well-differentiated than in the single well-differentiated adenocarcinoma.

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Carcinoma of the pancreas was diagnosed in 13 patients by percutaneous fine needle aspiration. The tumor was localized by angiography in eight, ultrasound in five, and endoscopic retrograde pancreatography in three patients. In four patients aspiration was performed using two of the three localizing techniques. Cytological diagnosis of carcinoma of the pancreas can be made accurately by percutaneous fine needle aspiration of the tumor and operative intervention avoided in those patients who do not require operative bypass procedures. Percutaneous fine needle aspiration can be used with equal facility with arteriography, ultrasound, or endoscopic retrograde pancreatography. There have not been complications due to fine needle biopsy, and one can expect a 77-86% positive diagnostic yield.

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Preoperative angiography was performed on 10 patients who had insulin-producing islet cell adenomas. Eight of the 10 islet cell tumors were localized. Seven of the eight adenomas were demonstrated only on subselective injections into the small intrapancreatic arteries, and one was demonstrated by a selective injection into a large artery. Failure to localize two islet cell adenomas was probably caused by the inability to subselect the small intrapancreatic arteries supplying the tumor. One tumor was seen only with subtraction techniques, which were used in all cases. Localization was not related to vascularity, size of tumor, or location within the pancreas. Vasoconstrictive pharmacoangiography was not helpful; magnification was helpful but not essential. The most important factor in localizing islet cell tumors is demonstrating the complete pancreatic blood supply with subselective injections into the small intrapancreatic arteries supplying the tumor (inferior and superior pancreaticoduodenal and dorsal arteries).

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We studied the pancreatic and enteric hormone profile of a 46-year-old woman who had hyperglycemia and a pancreatic tumor. Before operation, there was no evidence of overproduction of glucagon or insulin. The tumor's ultrastructure had a distinctive endocrine morphology, resembling D cells. Prompted by the recent demonstration of somatostatin in D cells of pancreatic islets, we analyzed the tumor and found a large quantity of immunoreactive somatostatin (301 ng per milligram of tissue). Insulin, glucagon, gastrin, vasoactive intestinal polypeptide and human pancreatic polypeptide were present in only trace quantities. The tumor cells were cultured in monolayers, which remained viable up to 51 days and released somatostatin into the culture medium. In seven insulinomas and two glucagonomas, we found the somatostatin content either much lower (less than 0.6 ng per milligram of tissue) or undetectable. After complete resection of the tumor, our patient became euglycemic and has remained so for the past 20 months.

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