Biomedical subjects
Publications and source records attributed to A K Raymond.
Collagenous colitis is a newly described entity that clinically manifests itself as watery diarrhea of long-standing duration. The main histopathologic characteristic is the presence of a collagen band immediately beneath the colonic surface epithelium. Ultrastructurally, the collagen is deposited beneath the basement membrane, which is intact. Pathogenetically, an aberrant function of the pericryptal fibroblastic sheath may be involved.
Since primary lymphoma of bone (PLB) exhibits morphologic diversity and variability in individual survival, we analyzed the relationship between histopathologic features and biological behavior in 33 patients treated at the Massachusetts General Hospital. Three major histologic subgroups were identified, based on a variety of criteria, the most important of which were the predominance of cells with or without nuclear clefts and the degree of pleomorphism. The probability of NED survival at five years was 64% for patients with tumor predominantly composed of cleaved cells, 13% for those with tumors classified in the noncleaved cell tumor group, and 0% (no survivors) for the pleomorphic subgroup. When tumors were subclassified according to the size of the predominant cell (small versus large), this parameter was found to be of no value in preceding NED survival. Factors that could have potentially influenced the results were analyzed. Since this is a retrospective review, the questions addressed in this study should be further studied in a prospective way.
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A retrospective review was made of the pretreatment radiographs of 20 patients with well-documented primary lymphoma of bone. Nine radiographic signs were defined, and the presence or absence of each was recorded for each patient. When the radiographic findings were compared with disease-free survival for each patient, it was found that patients who had a relapse had a higher mean number of positive radiographic signs than those who remained disease free (p less than 0.02). Also, those who relapsed early had more positive signs than those who relapsed late (p less than 0.05). Certain signs, i.e., pathologic fracture, layered periosteal new bone, broken periosteal new bone, cortical breakthrough, soft-tissue mass, and soft-tissue swelling, were more helpful than others for making a prognosis. These signs appear to be related to radiologic evidence of imminent or actual soft-tissue extension of the tumor.
A 62-year-old man presented with a grand mal seizure, progressive abdominal distention, and refractory hypotension 18 years after colonic bypass of a benign stricture of the low middle third of the esophagus. He died 3 hours after admission to the hospital. The patient had a history of liniment ingestion in childhood plus a long history of dysphagia and substernal pain. Autopsy disclosed a large ulcer of the anterior wall of the distal esophagus, which had eroded through the posterior wall of the left atrium. Histologic examination revealed chronic esophagitis with fibrous obliteration of the esophageal wall, pericardium, and left atrial myocardium near the site of perforation. Foreign material was present within small arteries of multiple viscera, and in several of these fragments transverse striations were demonstrated. Esophageal-atrial perforation is a rare but fatal complication of chronic esophageal ulceration. The clinical and pathological features of this and previously reported cases of nontraumatic esophageal-atrial perforation are reviewed.
Twenty-three patients with radiologic diagnoses of giant cell tumor of bone underwent fine needle aspiration cytology and needle biopsy for tissue diagnosis before curettage or resection. One patient had two tumors, making a total of 24 cases. The accuracy of the cytologic diagnosis was compared with that of tissue biopsy. Cytologically there were mononucleated and multinucleated cells. The former often occurred in clusters or, less often, were dispersed. They had spindle or plump cell bodies with moderate amounts of cytoplasm and well-defined cytoplasmic membranes. The oval nuclei demonstrated fine, evenly distributed chromatin and small nucleoli. The multinucleated cells were osteoclastlike and were associated with the clusters of mononucleated cells or lying freely. They had a well-demarcated cytoplasm and contained from a few to several dozen monomorphic nuclei. Cytologic diagnosis was made in 20 of 24 cases, and histologic diagnosis was made in 21 of 24. Insufficient diagnostic material for cytology was the reason for failure in 4 cases. This was attributed to faulty technique (2 cases), cystic change (1 case), and massive necrosis (1 case). As other benign and malignant bone tumors may contain benign giant cells, cytologic or histologic findings alone are not diagnostic of giant cell tumor of bone, but should be complemented with the clinicoradiologic findings. Aspiration cytology is as accurate as tissue needle biopsy, may be of high diagnostic value in deeply located lesions not amenable to cutting needle biopsy, and should be done with full knowledge of the clinicoradiographic information.
The pathologic records of 182 consecutive patients who had mandible resections were reviewed to determine the incidence of positive margins in the bone specimens and the risk factors associated with positive margins. Of the 182 cases reviewed, 82 (45%) were found to have involvement of the mandible at the time of resection and four (2%) were found to have positive margins. The predominant tumor histology was squamous cell carcinoma, 148 of 182 (81%), followed in frequency by osteosarcoma 12 of 182 (7%), salivary gland tumors 13 of 182 (7%), and miscellaneous other tumors (nine of 182 (5%). Of the four tumors with positive margins, two (50%) were squamous cell carcinomas, one (25%) was an osteosarcoma, and one (25%) was a salivary gland tumor. All four tumors were large tumors that had failed to respond to previous therapy. All obviously involved the mandible at the time of presentation. This study demonstrates that the incidence of bone margin involvement after mandibulectomy is rare and predictable and that clinical selection of candidates for immediate reconstruction is reliable in preventing inappropriate use of free bone flaps in patients at risk for positive bone margins.
The human papillomavirus class of DNA viruses are more than circumstantially related to oral and airway papillomas. Whether they are fully oncogenic, in the malignant sense, without other agents is questionable. Recent advances in molecular virology and the use of genus-specific (common) antigen-antibody reactions have identified papillomavirus in laryngeal and oral papillomas. Laryngeal and oral papillomas could be precancerous lesions, but they show a low-risk and long-time interval leading to malignancy unless significant iatrogenic or host variables--such as radiotherapy or immuno-incompetence--are added. Two different papillomas in the larynx can be recognized; a nonkeratinizing, papillomavirus-related lesion, and a keratinizing, usually solitary papilloma, which may or may not be related to a virus genesis and may be equated with a keratosis or clinical leukoplakia.
Malignant granular cell tumor is an exceedingly rare tumor and only a few cases are documented in the literature. We report a malignant granular cell tumor of the subcutaneous tissue of the thigh in a 59-year-old man, and discuss the ultrastructural and immunocytochemical findings and their diagnostic value.
Small round cell tumors involving bone can present problems in differential diagnosis by light microscopy. In exploring the role of electron microscopy in this situation, seven small cell osteosarcomas and seven mesenchymal chondrosarcomas were examined by electron microscopy and compared with typical and atypical Ewing's sarcomas. There is much overlap in the ultrastructural features of these tumors, but electron microscopy is helpful to establish or confirm a diagnosis of typical Ewing's sarcoma and, if representative matrix is present, of small cell osteosarcoma.
Three cases of intracranial dural chondrosarcoma are reported. The radiologic appearance of this slow-growing, extraaxial malignant tumor is different from the more familiar skull-base chondrosarcoma and may mimic an atypical meningioma. Dural chondrosarcoma tends to be less calcified or even to lack matrix calcification; it is associated with bone erosion but not with bone destruction or hyperostosis; and it usually appears avascular at arteriography.
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