New techniques. Definitive answers to old questions about the pathology of non-small cell carcinoma of the lung?
Explore the source record for details and available documents.
Antibodies, Monoclonal↗
Biomedical subjects
A M Marchevsky
Publications and source records attributed to A M Marchevsky.
Pulmonary cytology in lung transplant recipients: recent trends in laboratory utilization.
The value of bronchoscopy for the diagnosis of rejection and opportunistic infection in lung transplant recipients is controversial. We review our experience with pulmonary cytology obtained from 10 lung transplant recipients during the first 15 mos of the transplantation program at Cedars-Sinai Medical Center and compare the efficacy of pulmonary cytology for the diagnosis of opportunistic infectious agents with that of histology and microbiology. Our study encompasses 1,465 post-transplant days during which 70 bronchoscopies were performed yielding 94 cytologic specimens (44 bronchial washes, 25 bronchial brushings, and 25 bronchoalveolar lavages) and 55 transbronchial biopsies. The major advantages of cytology in this setting are short turn around time and high specificity for nonbacterial agents. All of the patients experienced episodes of bacterial pneumonia as well as fungal and viral infections. None developed Pneumocystis carinii infection during the study period. Simultaneous and concurrent infections were diagnosed. The initial diagnosis of bacterial pneumonia and herpes simplex virus preceded the diagnosis of cytomegalovirus; the former infections tended to persist and/or recur. Cytology was more effective than histology in establishing the diagnosis of Candida sp. and herpes simplex virus, while histology was more effective in establishing the diagnosis of cytomegalovirus. Increased numbers of polymorphonuclear cells did not constitute a consistent finding in cytologic or histologic samples during episodes of bacterial infection; cultures were most sensitive for detection of bacterial infection. Histochemical and immunohistochemical stains as well as in situ hybridization studies confirmed diagnoses rendered on routine Papanicolaou and hematoxylin and eosin stained material but did not provide additional diagnoses.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Vascular rejection and graft eosinophilia in rat lung allografts.
Allogeneic lung transplantation was performed using a rat model in order to assess the pathologic changes that developed during the process of rejection. The left lungs of 38 BN rats (RT-1n) were orthotopically transplanted into LEW rats (RT-1). The allografts developed the well-known changes of perivascular, peribronchial, and interstitial lymphocytic infiltrates resulting in necrosis of the pulmonary parenchyma at 7-8 days after transplantation. In addition, we document two findings that have not been reported previously in lung transplantation: vasculitis and eosinophilic infiltrates. Vasculitis with swelling and vacuolization of the endothelial cells was observed in transplants as early as 3 days following transplantation. Vasculitis with fibrinoid necrosis of the vessel wall was prominent at 7-8 days after grafting. The allografts also exhibited eosinophilia at 2 to 4 days following transplantation. The density of eosinophils in the inflammatory infiltrate reached a peak of 20% on Day 3 post-transplantation. These findings suggest an important role of humoral immunity and a possible involvement of eosinophils in lung allograft rejection.
Animals↗
Evidence of complete tolerance in a model of rat lung allografts.
Explore the source record for details and available documents.
Animals↗
Expert systems for efficient handling of medical information. I. Lung cancer.
Rule-based expert systems offer the ability to quickly retrieve considerable amounts of information relevant to specific situations; the technology can be potentially very useful to physicians in an era characterized by an explosion of medical data. A simple rule-based expert system that allows a microcomputer user to obtain staging, prognostic and therapeutic information relevant to patients with lung cancer is presented. The program was constructed by utilizing an inexpensive expert system development package (EXSYS). Using information from the literature, 194 rules were formulated; these rules can be expanded or updated at any time. The computer user interacting with the system is asked sequential questions regarding the characteristics of the tumor (T) of a particular patient, the nodal status (N), the presence or absence of metastasis (M), how the staging information was derived (clinically or at surgery), the tumor cell type and the therapeutic options being considered (different surgical procedures, radiotherapy, chemotherapy and others). The system selects the appropriate answers and displays the stage of the tumor and relevant prognostic information. The microcomputer user can also examine the rules that were selected by the system. These rules have relevant comments that apply to the specific condition, as well as appropriate references. The microcomputer user can change all or some of the conditions (i.e., therapeutic options) and compare the results of the various "WHAT-IF" simulations.
Expert Systems↗
Computerized interactive morphometry. An expert system for the diagnosis of lymphoid-rich effusions.
The authors present experimental techniques for the diagnosis of malignant lymphoma and benign lymphocytosis in lymphoid-rich effusions with the use of an inexpensive microcomputer-based video system for computerized interactive morphometry (CIM). Lymphoid cells were randomly selected by a trained observer from real-time images of Papanicolaou-fixed and -stained cytospin smears prepared from pleural, peritoneal, or pericardial effusions. The lymphoid cells were classified by the instrument, based on the size and shape of their nuclear profiles. The morphometric data collected by the instrument were interpreted by a simple rule-based expert system that classified the smears as benign or malignant. One hundred four cases, including 28 malignant lymphomas, 63 benign lymphocytoses, 8 chronic lymphocytic leukemias, and 5 cases with incomplete immunopathologic data, were studied retrospectively. Sixty-three of these effusions had been stained to detect light chain monoclonality. Ninety-one effusions were correctly classified by the expert system. There were four potential false negative diagnoses and one potential false positive diagnosis by the CIM system. Eight effusions from patients with chronic lymphocytic leukemia (CLL) were consistently classified as benign. Although the author's series of patients with a history of CLL is small, their results suggest that CIM is unsuitable for the diagnosis of malignancy in these effusions. If only those effusions from patients with a history of CLL are excluded, the predictive value of a diagnosis of malignant lymphoma was 96.5%, whereas the predictive value of a diagnosis of benign lymphocytosis was 94.0%.
Algorithms↗
Septal thickness in human lungs assessed by computerized interactive morphometry.
We have studied the feasibility of using interactive computerized morphometric methods for the quantitation of septal thickness in the lung with the goal of introducing objective criteria for the diagnosis and grading of pulmonary fibrosis and edema. After reviewing available methods, we have decided in favor of linear intercept measurements of septal profiles which are limited to the tissue and therefore not affected by the level of lung inflation. Our method consisted in generating a graphic overlay of parallel lines over a real time video display of lung tissue. We had the options of measuring either uniformly oriented (random) or orthogonal intercepts. Randomly oriented intercepts (i.e., those with incidence angles ranging between 0 and 90 degrees) resulted in poor statistics because of excessive scattering of primary data; we resolved this difficulty by limiting the incident angle to the range of +/- 45 degrees from the normal to the septum at the point of sampling. This results in marked increase in consistency and reproducibility of the results with fewer measurements. Alternatively, we used intercepts measured over a line generated perpendicularly to the septal axis which approaches orthogonal thickness measurements. We found that both approaches yield acceptable results after as little as 50 measurements.
Computer Simulation↗
Computerized interactive morphometry in pathology: current instrumentation and methods.
This review is concerned with the current applications of interactive computerized morphometry for diagnostic applications. "Interactive" differs from fully automatic procedures in that the essential function of cell recognition is performed by a trained observer, assisted by a computerized instrument that performs all desirable measurement and processing tasks. This article describes the instrumental needs (video systems, computer, and specialized hardware) and interactive peripherals, in particular, high-resolution touch screens for most common and currently useful video analysis tasks. The authors describe a number of general instrumental procedures with widespread applications (point counting, tracing of contours, graphic standards of size and length, shape analysis, automatic edge detection). Diagnostic procedures are based on the generation of multiple data followed by either multivariate statistical analysis that allows diagnosis of individual cases or hierarchical algorithms. The best current application is the objective study of controversial or difficult cases; there is a possibility that in the future interactive computerized morphometry may become useful for the mass screening of cytologic specimens.
Analog-Digital Conversion↗
Fetal giant hemangiolymphangioma: report of a case.
A hemangiolymphangioma is a malformation of both lymphatic and blood vessels. A case of giant hemangiolymphangioma with extensive fetal involvement is presented and considerations in the antenatal diagnosis of this anomaly are discussed.
Female↗
Computerized classification of nuclear profiles in non-Hodgkin's lymphomas.
The authors present experimental technics for the diagnosis of non-Hodgkin's lymphomas, based on instrumental classification of nuclear profiles using a video-based system for computerized interactive morphometry (CIM). In their system, the real time video image of a specimen is superimposed to a graphics overlay generated by a computer, consisting of a test area with four visual markers for random sampling of cells and a menu with several options to send direct commands to the system. Using a touch-sensitive screen mounted on a video monitor as an interactive peripheral, a trained observer traces 100 randomly selected lymphoid cells, counts mitoses in 25 microscopic fields, and categorizes the lesion as diffuse or nodular. Each cell is instrumentally classified into either small cell noncleaved, small cell cleaved, or large, based on the length of their nuclear profiles, their enclosed nuclear area, and a circularity factor. Thereafter the computer provides a "diagnosis," based on hierarchic analysis of the data. The morphometric data are also interpreted by alternate statistical methods of discriminatory classificatory analysis that provide a diagnosis and a probability statement derived from matching unknown cases with a data base. Forty-two lymphoid lesions have been categorized with the CIM system. Studies of interobserver and intraobserver variations in data collection are discussed. The potential advantages of CIM for the objective classification of non-Hodgkin's lymphomas are discussed.
Cell Nucleus↗
Inflammatory pseudotumor of the thymus.
A 44-year-old man with inflammatory pseudotumor of the thymus is reported. The patient was seen with fever, myalgia, and dyspnea and was found to have an anterior mediastinal mass and bilateral pleural effusions. The resected lesion consisted of a well-circumscribed mass of chronic inflammatory and fibrous tissue that virtually replaced the thymus. There was no morphological evidence of neoplasia. The patient's symptoms and roentgenographic abnormalities resolved with excision of most of the mass. To our knowledge, this report is the first instance of inflammatory pseudotumor of the thymus.
Adult↗
Applications of computerized interactive morphometry in pathology. II. A model for computer generated diagnosis.
We present a model for the analysis and tentative diagnosis of pathologic problems by a trained observer utilizing data generated by a video based computerized interactive morphometry system in conjunction with multivariate methods of discriminant classificatory analysis that separate classes based on unweighted numerical values and with adhoc algorithms based on hierarchical analysis. The model was tested with two diagnostic problems that could benefit from a morphometric approach: the classification of non-Hodgkin's lymphomas from routine histologic slides and the distinction of malignant mesotheliomas from benign effusions in smears prepared from pleural effusions. The touch-sensitive screen of the computerized interactive morphometry system enables trained observers to measure the real time image of profiles of interest either by using graphic standards or simply by touching the two extreme points of the diameter of interest. This procedure generates multiple data in the form of classes that can be effectively used toward the more objective discrimination of lesions of difficult classification by analysis with a combination of adhoc diagnostic algorithms and multivariate statistical methods.
Computers↗
Applications of computerized interactive morphometry in pathology: I. Tracings and generation of graphic standards.
We have studied the use in anatomic pathology of a computerized interactive morphometry system and conditions for reliability and proper interpretation of data obtained by tracings. Because of the ease of operation and direct visualization of the tracings, we prefer touch-sensitive screens to digitizing tablets as optimal interactive peripherals. Because touch screens have fewer sampling points (256 X 256) than tracing tablets, we studied the relationship between point density and accuracy of length and area measurements by tracing models of known dimensions on the touch screen by experimenting with different step sizes ranging from every second to every sixth valid sampling point; we obtained excellent results with step size 6 followed by two-fold smoothing by two-dimensional filtering. We conclude that because of staircase formation, a high point density may be more of a liability than an asset and that the touch screen is satisfactory. By tracing closed figures of variable shapes but known areas we observed that area measurements may be unreliable with certain irregular shapes and we discuss how perimeter to area ratios can be used to compute surface to volume ratios. Finally, the generation of simple calibrated graphic standards over routine pathologic slides makes the system useful for fast diagnostic applications.
Computers↗
Computerized interactive morphometry. A study of malignant mesothelioma and mesothelial hyperplasia in pleural biopsy specimens.
A morphometric study of 11 pleural malignant mesotheliomas and 11 pleural reactive mesothelial proliferations is reported. Pleural biopsy specimens of these lesions were studied with a new system of video-based computerized interactive morphometry that allows the comparison of real-time images of nuclear profiles with computer-generated graphic standards for the purpose of estimating their diameters. Malignant mesotheliomas had nuclear profile diameters (NPDs) ranging from 4 to 14 micron and a mean NPD of 9.6 +/- 0.5 micron. Reactive mesothelial proliferations had NPDs ranging from 4 to 12 micron, but exhibited a significantly smaller mean NPD of 6.4 +/- 0.2 micron. The potential technical advantages of computerized interactive morphometry over other morphometric methods are discussed.
Biopsy↗
The clinicopathological spectrum of non-tuberculous mycobacterial osteoarticular infections.
We studied the clinicopathological features of eight patients in whom a non-tuberculous mycobacterium was unexpectedly isolated from osteoarticular material obtained at operation. Three distinct types of infection with non-tuberculous mycobacteria were found: tenosynovitis, synovitis, and osteomyelitis. Tissue specimens from these sites showed a spectrum of pathological findings, including (1) virtually no inflammation, (2) mild to severe non-specific chronic inflammation, (3) granulomas without necrosis, and (4) caseating epithelioid granulomas that were indistinguishable from those of tuberculosis. In six patients the infection responded well to adequate surgical excision alone. In the remaining two the infection responded to surgical intervention and antituberculous therapy.
Adolescent↗
Mediastinal carcinoid with an incomplete Sipple's syndrome.
A 60-year-old woman with a mediastinal carcinoid of probable thymic origin, widely metastatic, had associated parathyroid hyperplasia, medullary carcinoma of thyroid with amyloid stroma and an adrenal neuroma. This case demonstrated features of an incomplete Sipple's syndrome (MEA II). The relationship of these diverse tumors is consistent with the concept of the APUD system and neurocristopathies.
Carcinoid Tumor↗
Bilateral ovarian endometriosis associated with carcinosarcoma of the right ovary and endometrioid carcinoma of the left ovary.
The case of a 44-year-old woman wih bilateral ovarian malignancies in association with endometriosis is presented. A carcinosarcoma was present in the right ovary, and a well-differentiated endometrioid carcinoma in the left ovary. This case is, to the authors' knowledge, unique.
Adenocarcinoma↗
Computerized interactive morphometry of brushing cytology specimens.
Forty-two bronchial brushing cytology specimens were evaluated by a video-based computerized interactive morphometry (CIM) system with an interactive peripheral consisting of a touch-sensitive screen mounted over a high-resolution video monitor. The system was programmed to allow a trained observer to rapidly measure nuclear and cytoplasmic profile diameters of randomly selected cells and to calculate their nuclear-cytoplasmic ratios. The specimens included 13 cytologic slides with no malignant cells present, 14 with non-small cell carcinoma cells and 15 with small cell carcinoma cells. The cases were divided into two groups: a training set composed of slides with "known diagnosis" and a test set of slides with "unknown diagnosis". A data set was constructed with the measurements from the cases with "known diagnosis," and an algorithm that allowed the classification of cases by hierarchical analysis was developed. The data was also analyzed with statistical methods of classificatory discriminant analysis. Utilizing the information in the data base, the slides with "unknown diagnosis" were classified individually; all cases were correctly classified by the procedures. Potential applications of CIM in cytology are discussed.
Bronchi↗