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Biomedical subjects

B M Shmookler

Publications and source records attributed to B M Shmookler.

At least 37 records · Page 2Linked to original sources
PubMed1996

Parosteal osteosarcoma: value of MR imaging and CT in the prediction of histologic grade.

PURPOSE: To evaluate the use of magnetic resonance (MR) imaging and computed tomography (CT) for predicting the histologic grade of parosteal osteosarcomas. MATERIALS AND METHODS: Sixty parosteal osteosarcomas were analyzed for tumor size and location, presence of a cleavage plane, intramedullary extension, soft-tissue mass (distinct from ossified mass), and the presence and pattern of ossification. Axial and longitudinal views were evaluated for specific osseous sites within the bone. Tumors were classified as low grade (grade 1) or high grade (grades 2-3). RESULTS: There were 32 low-grade lesions and 28 high-grade lesions. Average maximal lengths of low- and high-grade tumors were 7.7 and 15.0 cm, respectively. A cleavage plane was present in 20 (62%) low-grade and 19 (68%) high-grade lesions. On cross-sectional images, intramedullary extension was present in 13 (41%) low-grade and 14 (50%) high-grade lesions. A focal soft-tissue mass distinct from the ossific matrix was identified in 25 (89%) high-grade lesions and in only two (6%) low-grade lesions. All 17 high-grade lesions evaluated with MR imaging were of predominantly high signal intensity on T2-weighted images. CONCLUSION: A poorly defined soft-tissue component distinct from the ossific matrix is the most distinctive feature of high-grade parosteal osteosarcoma and may be an optimal site for biopsy.

Adolescent↗
PubMed1995

Pseudomyxoma peritonei in women: a clinicopathologic analysis of 30 cases with emphasis on site of origin, prognosis, and relationship to ovarian mucinous tumors of low malignant potential.

Pseudomyxoma peritonei (PMP) is a poorly understood condition characterized by the accumulation of abundant mucinous material within the peritoneal cavity and associated with a mucinous tumor of the gastrointestinal tract or ovaries. Recently there has been considerable debate over the primary site of origin of the tumor associated with PMP in women. Some investigators have proposed a primary site in the ovaries, whereas others favor the gastrointestinal tract or the peritoneum. Another confusing issue has been the nature of the ovarian mucinous tumors associated with PMP. Although these neoplasms may be frankly malignant, more often they show minimal cytologic atypia and epithelial proliferation and have been classified as borderline or low malignant potential tumors. In order to address the issues of site of origin and nature of the associated ovarian mucinous tumors, we studied 68 cases of PMP in women, 30 of whom had mucinous tumors involving the ovaries. All 30 of these cases had an associated mucinous appendiceal or intestinal tumor. The PMP cases with ovarian tumors were compared with 30 ovarian mucinous tumors of low malignant potential (LMP). Based on the analysis of the primary ovarian mucinous LMP tumors, a set of criteria was formulated and used to determine the probable site of origin of PMP in the 30 women with mucinous tumors involving the ovaries. The following gross and microscopic features of the ovarian tumor were considered to be inconsistent with a primary ovarian origin: (1) surface involvement with or without superficial stromal involvement only; (2) adenocarcinoma with signet ring cell differentiation, with a previously diagnosed or concurrent appendiceal tumor of similar morphology; (3) bilateral adenocarcinoma consistent with colonic or appendiceal morphology; and (4) unilateral adenocarcinoma consistent with colonic or appendiceal morphology with a history of a colonic or appendiceal adenocarcinoma. When any one of these features was present the ovarian tumor was diagnosed as secondary. The following additional features also were considered to be more typical of secondary ovarian involvement: (1) normal or only slightly enlarged ovaries; (2) bilateral ovarian involvement; (3) simple or only focally proliferative mucinous epithelium with abundant extracellular mucin in cases with predominantly surface involvement of the ovaries, with or without a history of/or concurrent appendiceal adenoma; (4) multifocal or extensive pseudomyxoma ovarii in cases with stromal involvement, with or without a history of/or concurrent appendiceal adenoma; (5) ruptured appendiceal adenoma and unruptured ovarian tumor of similar histology; and (6) presence of an associated mucinous intestinal tumor.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1995

Amyloid goiter. A clinicopathologic study of 14 cases and review of the literature.

The authors report the clinicopathologic features of 14 cases of amyloid goiter (AG). Eleven patients were males and three females with ages ranging from 23 to 75 years (median, 54 years). Eight patients had secondary amyloidosis and six had primary amyloidosis. Nine cases were identified at autopsy. In symptomatic patients (n = 5), the clinical presentation included a nontender, rapidly enlarging neck mass with associated dysphagia, dyspnea or hoarseness. Clinical or laboratory evaluation failed to detect evidence of thyroid dysfunction. The histologic appearance of the thyroid predominantly consisted of diffuse amyloid deposition surrounding thyroid follicles. In two cases, a nodular pattern of amyloid deposition was seen resulting in compression and distortion of the follicular architecture. Areas of mature adipose tissue and focal lymphocytic thyroiditis with or without foreign-body type-giant cells were seen in approximately one third of the cases. Confirmation of amyloid was made by the presence of congophilia and apple-green birefringence under polarized-light microscopy. Immunohistochemical evaluation demonstrated the presence of amyloid A immunoreactivity. No Immunoreactivity was seen with calcitonin or thyroglobulin. Fine-needle aspiration may facilitate the diagnosis, as occurred in one the patients. In symptomatic patients, thyroidectomy is warranted to alleviate pressure symptoms.

Adult↗
PubMed1995

Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to "pseudomyxoma peritonei".

Pseudomyxoma peritonei (PMP) is a poorly understood condition characterized by mucinous ascites and mucinous implants diffusely involving the peritoneal surfaces. There is considerable debate regarding the definition, pathology, site of origin, and prognosis of PMP. We analyzed the clinicopathologic features of 109 cases of multifocal peritoneal mucinous tumors to develop a pathologic definition of cases characterized by the clinical condition PMP. Cases were separated into two diagnostic categories: disseminated peritoneal adenomucinosis (DPAM) and peritoneal mucinous carcinomatosis (PMCA). Cases classified as DPAM were characterized by peritoneal lesions composed of abundant extracellular mucin containing scant simple to focally proliferative mucinous epithelium with little cytologic atypia or mitotic activity, with or without an associated appendiceal mucinous adenoma. Cases classified as PMCA were characterized by peritoneal lesions composed of more abundant mucinous epithelium with the architectural and cytologic features of carcinoma, with or without an associated primary mucinous adenocarcinoma. Sixty-five of the 109 cases (59.6%) were classified as DPAM consistent with origin from an appendiceal mucinous adenoma. Thirty-seven of the 65 cases (56.9%) had a documented appendiceal mucinous adenoma. Thirty cases (27.5%) were classified as PMCA consistent with origin from an appendiceal or intestinal mucinous adenocarcinoma. Fourteen cases (12.8%) were classified as PMCA with features intermediate between DPAM and PMCA or with discordant features based on the finding of at least focal areas of carcinoma in the peritoneal lesions, whether or not the primary site demonstrated carcinoma. The cases with intermediate features were derived from well-differentiated appendiceal or intestinal mucinous adenocarcinomas and had peritoneal lesions displaying features of DPAM as well as focal areas of mucinous carcinoma. The cases with discordant features were derived from atypical appendiceal adenomas with little or no histologic evidence of a transition from adenoma to carcinoma and had peritoneal lesions uniformly composed of mucinous carcinoma. There was a statistically significant difference in survival between cases classified as DPAM, those classified as PMCA with intermediate or discordant features, and those classified as PMCA (p < 0.0001). The age-adjusted 5-year survival rates were 84% for patients with DPAM, 37.6% for patients with PMCA with intermediate or discordant features, and 6.7% for patients with PMCA. The term DPAM should be used to diagnose the histologically benign peritoneal lesions associated with ruptured appendiceal mucinous adenomas and those that are pathologically identical but lack a demonstrable appendiceal adenoma. Cases with the pathologic features of adenocarcinoma should be designated PMCA because they have recognizably different pathologic features and a significantly worse prognosis.

Adenocarcinoma, Mucinous↗
PubMed1994

Giant cell tumor of the tendon sheath: MR findings in nine cases.

OBJECTIVE: The purpose of this study was to determine the MR findings in patients with giant cell tumors of the tendon sheath. MATERIALS AND METHODS: MR imaging findings in nine surgically proved cases of giant cell tumors of the tendon sheath were evaluated on both T1- and T2-weighted images. Of nine lesions, three involved the foot, two involved the thumb, two involved the knee, one involved the proximal part of the tibia, and one involved the proximal part of the femur. RESULTS: All nine lesions were hypointense on T1-weighted images; the signal intensity of most of the tumors was approximately equal to that of skeletal muscle. On the T2-weighted images, three lesions were hypointense relative to skeletal muscle, two lesions were approximately isointense relative to skeletal muscle, and two lesions were slightly hyperintense relative to skeletal muscle but hypointense relative to fat. The remaining two lesions had a more heterogeneous appearance on T2-weighted images. CONCLUSION: On both T1- and T2-weighted images, giant cell tumor of the tendon sheath has a signal intensity similar to that of its pathologic counterpart, pigmented villonodular synovitis. The decreased signal intensity on both T1- and T2-weighted images is an uncommon appearance of extraarticular soft-tissue masses, in particular when they occur in the hands or feet, and this may suggest the diagnosis of giant cell tumor of the tendon sheath.

Adult↗
PubMed1994

Oncocytic mucoepidermoid carcinoma of the parotid gland.

Oncocytic mucoepidermoid carcinoma of the salivary gland is rare. We describe a 60-year-old woman who presented with a slowly growing left parotid mass. The patient underwent a total parotidectomy, and her postoperative course was uneventful. The gland was enlarged and showed a partially cystic mass containing clear mucoid material. Microscopically, the entire mass showed variably sized cysts lined predominantly with oncocytes and a few mucous goblet cells. Histochemical stains for mitochondria, such as phosphotungstic acid-hematoxylin, confirmed the presence of oncocytes. The recognition of this variant is important, since most of the other primary oncocytic lesions of the salivary glands are benign. The tumor in this case is considered to be a low-grade carcinoma; therefore, complete surgical excision and long-term clinical follow-up are adequate management.

Carcinoma, Mucoepidermoid↗
PubMed1993

Liposarcoma of the extremities: MR and CT findings in the histologic subtypes.

The findings on images of liposarcomas of the extremities in 48 patients (26 men and 22 women aged 20-85 years) were reviewed to correlate the histologic subtypes with radiologic appearance. Computed tomographic scans were obtained in 36 patients; magnetic resonance (MR) images, in 27 patients. The study group had 19 myxoid, 12 well-differentiated, nine round cell, and eight pleomorphic liposarcomas. Well-differentiated liposarcomas were predominantly composed of fat, typically with thick septa, which were hyperintense on T2-weighted spin-echo MR images. The heterogeneity of tumor helped differentiate tumor subtypes. Eleven of 19 myxoid tumors were mildly heterogeneous. Round cell and pleomorphic subtypes, which tend to be aggressive, were generally heterogeneous. Well-differentiated liposarcomas may be confidently differentiated from other subtypes of liposarcoma. Except for the well-differentiated subtypes, liposarcomas often contain no fat. Moderate to marked heterogeneity is common in high-grade liposarcomas; myxoid liposarcomas tend to be homogeneous and may mimic cysts.

Adult↗
PubMed1991

Increased expression of the laminin receptor in human colon cancer.

It has been proposed that among the various cell-surface proteins capable of interacting with laminin, the 67-kd high-affinity laminin receptor plays a crucial role during tumor invasion and metastasis. In this study, the expression of laminin-receptor-precursor messenger RNA (mRNA) and 67-kd protein was analyzed in human colon adenocarcinoma. In 22 of 23 patients with colon cancer, we found a 2- to 23-fold increase in levels of laminin-receptor-precursor mRNA in the cancer tissues compared with those in matched normal adjacent colonic mucosa. In 10 of 11 cases studied, the level of 67-kd laminin receptor, detected by affinity-purified anti-laminin-receptor synthetic peptide antibodies on immunoblots of matched tumor and normal tissue extracts, was higher in the colon carcinoma tissue. Immunodetection of laminin receptor in tissue sections using anti-laminin-receptor-peptide antibodies confirmed that the increased expression of laminin receptor was specifically associated with the cancer cells. In a series of 72 paraffin sections of colon lesions, we observed a correlation between the expression of the laminin receptor and the Dukes' classification. Our observations indicate that increased expression of laminin-receptor-precursor mRNA is associated with enhanced levels of the 67-kd laminin receptor as well as with the invasive phenotype of colon carcinoma. Detection of this metastasis-associated gene product may be a valuable adjunct in the evaluation of human colon cancer.

Adenocarcinoma↗
PubMed1991

Well-differentiated extraskeletal osteosarcoma. A soft-tissue homologue of parosteal osteosarcoma.

We describe a unique case of a low-grade extraskeletal osteosarcoma revealing both histologic and radiologic features reminiscent of parosteal osteosarcoma. The tumor, which had been present for 10 years, occurred in the left axilla of a 74-year-old black woman. To date, all the published cases of extraskeletal osteosarcoma have been high-grade neoplasms; to our knowledge, this is the first reported case of a low-grade extraskeletal osteosarcoma.

Aged↗
PubMed1990

Benign fibrous histiocytoma of the skin with potential for local recurrence: a tumor to be distinguished from dermatofibroma.

We studied eight patients with benign fibrous histiocytoma (BFH) of the skin that differed, morphologically and biologically, from ordinary dermatofibroma (DF) and compared their tumors with a consecutive series of 141 DF. The patients ranged in age from 13 to 49 yr. Their lesions consisted of cutaneous nodules, 2 cm or less in size, that had been present for less than 1 yr. Seven were located on an extremity. Three of six patients (50%) who could be followed had recurrences 2, 5, and 8 mo following excision of their tumors. Microscopically, seven of the eight cutaneous BFH (CBFH) involved both dermis and subcutis. Five were distinctly multinodular. Subcutaneous involvement and/or multinodularity were present in each case. Fibroblastic and histiocytic cells were arranged in a monotonous storiform pattern throughout most or all of each lesion. There was moderate nuclear variability, but pleomorphism was absent. Several of the tumors contained sparse inflammatory, multinucleate, and foam cells and hemosiderin deposits. Vascularity was prominent. We believe that the multinodular architecture of CBFH and its involvement of both dermis and subcutis usually allow distinction from DF. The latter is uninodular, centered in the dermis, and exhibits only minor subcutaneous extension. Most DF lack the diffuse, well developed storiform appearance of CBFH. Local recurrence further distinguishes CBFH from DF, which rarely recurs. Rather than representing an aberrant form of DF, the clinical and microscopic features of CBFH suggest that it is closely related to, if not identical with, BFH of other tissues and organs.

Adolescent↗
PubMed1989

Giant cell fibroblastoma. A juvenile form of dermatofibrosarcoma protuberans.

A clinicopathologic analysis of 28 cases of giant cell fibroblastoma (GCF), a rare mesenchymal tumor occurring predominantly in the first decade of life, is presented. This disease presented as a painless, slowly enlarging, subcutaneous mass. The tumor recurred locally in 47% of the patients; however, metastasis was not detected. On microscopic examination, GCF showed an unique combination of spindle cell patterns, pleomorphic and multinucleated giant cells, myxoid areas, and distinctive sinusoid-like spaces. This unrecognized histomorphologic picture led to a misdiagnosis of sarcoma in 40% of the cases. The histogenesis of this lesion remains uncertain; however, based on both clinical and morphologic similarities, it is proposed that GCF is a juvenile form of dermatofibrosarcoma protuberans (DFSP).

Adolescent↗
PubMed1989

Localized amyloidosis of seminal vesicles: report of three cases in surgically obtained material.

Localized amyloidosis of the seminal vesicles (ASV) is reported as an incidental finding in surgical specimens from three elderly men. In two cases, the amyloid deposits were bilateral, subepithelial, and clinically inapparent, features similar to other cases in the literature. In one case, the diagnosis was made on a transrectal prostatic needle biopsy that included a small portion of seminal vesicle; to our knowledge, this has not been previously reported. Electron microscopy in one case demonstrated nonbranching fibrils characteristic of amyloid, and pretreatment of tissue sections using the permanganate method in two cases showed almost complete ablation of congophilia. Evidence suggests that ASV is a permanganate-sensitive, non-AA (amyloid, protein A) type of amyloid that may be different from all other types of amyloid previously characterized.

Aged↗
PubMed1988

Malignant epithelioid schwannoma: a light microscopic and immunohistochemical study.

Malignant epithelioid schwannoma is a rare variant of malignant nerve sheath tumor that can be confused with both other neuroectodermal neoplasms and carcinomas. The light microscopic and immunohistochemical findings of a malignant epithelioid schwannoma arising in the mandibular region of a 27-year-old female are described. The differential diagnosis of this unusual neoplasm from malignant melanoma and poorly differentiated carcinoma is discussed.

Adult↗
PubMed1988

Fibrosarcomatous change in dermatofibrosarcoma protuberans.

This report describes six patients with dermatofibrosarcoma protuberans (DFSP) that contained fibrosarcomatous areas (FS). The clinical signs and symptoms, ages of the patients, and anatomic distribution of the tumors were similar to those of uncomplicated DFSP. FS was concentrated in the subcutis in each case and comprised more than 50% of the tumor in four cases. The characteristic storiform cellular arrangement of DFSP was replaced by long, gently sweeping fascicles of spindle cells that intersected at various angles, forming the so-called herringbone pattern. Trapped fat cells, characteristic of DFSP when it infiltrates subcutaneous tissue, were absent in five of the six FS and only focally present in one. Two FS were grade 1; their cytologic features were similar to those of DFSP. Four FS were grade 2 and had cytologic atypia exceeding that of DFSP. There was a statistical difference between the mitotic rates of DFSP and FS. Five patients were alive and well at the time of last follow-up (median, 2 years), and one patient had an unexcised recurrence when last examined. Six similar cases from the literature are reviewed; in one of them, the FS metastasized.

Fibrosarcoma↗
PubMed1988

Cystic hypersecretory duct carcinoma of the breast. Report of a case with fine-needle aspiration.

A patient with a recently described rare histologic variant of ductal carcinoma of the breast, so-called cystic hypersecretory duct carcinoma, is described. The findings on fine-needle aspiration biopsy, and to our knowledge, the first cytologic study of this entity reported in the literature, are described and differentiated from mucinous carcinoma and benign mucocelelike lesions. The histologic differential diagnosis, with an emphasis on benign lesions that may have a predominant cystic component, is also discussed.

Aged↗