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D K Heffner

Publications and source records attributed to D K Heffner.

At least 19 recordsLinked to original sources
PubMed1992

Sinonasal fibrosarcomas, malignant schwannomas, and "Triton" tumors. A clinicopathologic study of 67 cases.

BACKGROUND: Sinonasal fibrosarcomatous neoplasms are uncommon tumors and there are no previous studies of a large number of such cases. The clinical and histologic features of 67 fibrosarcomatous neoplasms of the nasal cavity and paranasal sinuses are reported. METHODS: Multiple clinical and histologic parameters (including immunostain results) were analyzed to characterize the features important for histologic recognition of the tumors and for correlation with patient outcomes. RESULTS: Some tumors could be classified as malignant schwannomas or malignant "Triton" tumors, but their behavior was similar to that of the fibrosarcomas. Histologically, most tumors were very low-grade malignant neoplasms; however, 22% of patients died of their tumors. Factors that correlated with death were mitotic rate (greater than 4 mitoses per 50 high-power fields), increased tumor cellularity, and male sex. CONCLUSIONS: Many tumors originally were diagnosed as benign (by others), probably causing initial undertreatment of some patients. Proper recognition and histologic evaluation of the tumor are important to ensure the best therapy and optimal patient survival.

Adolescent↗
PubMed1992

Pitfalls in the histopathologic diagnosis of pyogenic granuloma.

The term pyogenic granuloma (PG) is a misnomer. The histopathologic appearance is fairly characteristic, the lesion being in fact a lobular capillary hemangioma. The recognition of PG as a clinically polypoid or exophytic, circumscribed lesion is of importance to both the clinician and the pathologist, as this feature distinguishes PG from most malignant vascular tumors. Although PG may be multiple, especially on the skin, and necrosis is not uncommon, invasion of adjacent structures is not seen. Diagnostic pitfalls occur histologically when the characteristic lobular configuration of PG is not recognized because of a solid growth pattern of endothelial proliferation, the presence of brisk mitosis, intervascular stromal fibrosis or spindle cell proliferation, and occasionally an epithelioid appearance of endothelial cells. The different vascular neoplasms that may be confused with PG are discussed, and the clinical and histopathologic features of PG are emphasized.

Angiolymphoid Hyperplasia with Eosinophilia↗
PubMed1992

Granular cell tumors of the trachea.

In contrast to the relative frequency of granular cell tumors (GCT) in the larynx and bronchi, the occurrence of these tumors in the trachea is rare. A 50-year review of the English-language literature disclosed only 24 described cases of tracheal GCT. This report reviews the clinicopathologic data from those 24 cases, along with the data from 2 cases obtained via a personal communication and the data from 4 previously unpublished cases obtained from a 30-year review of the Armed Forces Institute of Pathology archives. Tracheal resection was the predominant mode of therapy and often was performed as a salvage procedure for failed endoscopic excisions. Recommendations for a more uniform approach to surgical management are provided.

Adult↗
PubMed1991

Oncocytic metaplasia of the pharynx.

Oncocytic metaplasia of the pharynx has been infrequently described, with only two previous cases in the literature. With the advent of panendoscopy during the last decade, however, a better understanding of this histopathologic diagnosis is desirable. Thirty-three cases are reviewed, with thirty occurring in the nasopharynx. This was most commonly discovered as an unrelated finding during endoscopic evaluation of a head and neck mass or malignancy in twenty-two patients, either histologically after random biopsy or after biopsy of small but visible lesions. An additional eight cases manifested otitis media or eustachian tube dysfunction. The histology, terminology, and benign clinical nature of these lesions are discussed.

Aged↗
PubMed1990

Leiomyosarcoma of the sinonasal tract. A clinicopathologic study of nine cases.

The clinicopathologic features of nine cases of sinonasal tract leiomyosarcoma (SNTL) referred to the Armed Forces Institute of Pathology, Washington, DC, during the period from 1970 through 1988 are described. This report represents the largest study to date on SNTL, and our results are compared with the 21 previously reported cases of SNTL. Of the nine cases described, patients ranged in age from 22 to 86 years (mean, 55 years). The most frequent clinical presentation was nasal obstruction unilaterally. The neoplasms were limited solely to the nasal cavity in four cases (44%) and involved both the nasal cavity and paranasal sinuses in the remaining five cases. Light microscopic, immunocytochemical, and ultrastructural features served to characterize these tumors as malignant neoplasms of smooth-muscle origin. In contrast with previous studies, immunocytochemistry was employed to differentiate SNTL from other spindle cell malignancies of the region, using newly available monoclonal antibodies to smooth-muscle antigens. Treatment was surgical. Radiotherapy or chemotherapy did not appear to affect the progression of the disease. Furthermore, no relationship was found between the aggressiveness of SNTL and morphologic parameters (eg, mitotic count and tumor size). Instead, prognosis was dependent on the distribution of disease at presentation. Of all 30 patients with SNTL described to date, 10 had the neoplasm confined solely to the nasal cavity. The 10 neoplasms did not recur. We conclude that SNTL may best be regarded as a locally aggressive neoplasm with only limited metastatic potential and that it could be curable by complete surgical excision.

Adult↗
PubMed1990

Teflonomas of the larynx and neck.

Intracordal fluorocarbon (Teflon, Mentor O and O Inc, Norwell, MA) injection has been used for decades to correct paralytic dysphonia, a result of unilateral laryngeal paralysis. Infrequently, the Teflon extravasates and infiltrates into the soft tissues of the neck and larynx producing a mass that clinically simulates a malignant lesion. We report eight cases of so-called "Telonomas" of the larynx and neck that have been identified in the files of the Armed Forces Institute of Pathology Otolaryngic Tumor Registry and from the Cytopathology Service at the George Washington University Medical Center. Patients ranged in age from 31 to 72 years. Vocal cord paralysis, treated by Teflon injection, was caused by primary laryngeal carcinoma or metastatic carcinoma (breast, lung) involving the recurrent laryngeal nerve, surgical trauma to the recurrent laryngeal nerve, or postviral neuritis. Subsequent symptomatology, related to extravasation of the Teflon with a resulting "Teflonoma", included a neck mass or persistent hoarseness. Infrequently, there was associated airway obstruction or voice changes. Diagnosis was made by fine needle aspiration or by excision of the suspicious mass and subsequent identification of a foreign body granulomatous reaction with associated birefringent material. Infrared absorption spectrophotometry identified the foreign material as a fluorocarbon which was further substantiated by scanning electron microscopy and energy dispersive x-ray analysis. Surgical removal of the mass alleviated all symptoms.

Adult↗
PubMed1990

Haemangioma in a cervical lymph node.

Haemangiomas of the head and neck are mainly cutaneous or mucosal; rarely, they may be found in bone or soft tissue. Haemangiomas of lymph nodes are extremely rare; here we present such a case in a cervical lymph node. This is, to the best of our knowledge, only the second report of such an entity.

Adolescent↗
PubMed1990

Classification of human upper respiratory tract tumors.

An outline of human upper respiratory tumors is presented, based on the World Health Organization's classification of such tumors. The discussion and illustrations are devoted mainly to the nasal passages, and emphasis is placed on lesions that are potentially confusing because of problems of terminology or unusual histologic features.

Diagnosis, Differential↗
PubMed1990

Contact ulcers of the larynx. A reacquaintance with the pathology of an often underdiagnosed entity.

We reviewed the histologic features of 105 cases of contact ulcers of the larynx. Despite its characteristic clinical findings and correlative histopathology, the appropriate diagnosis was suggested in only one case. Instead, a descriptive diagnosis was most often rendered. Lesions for which this entity has been mistaken include pyogenic granuloma, hemangioma, hemangiopericytoma, Kaposi's sarcoma, angiosarcoma, spindle cell carcinoma, and granulomatous infectious diseases. Inappropriate diagnosis or failure to recognize the pathologic features of these lesions as correlating to a specific disease state deprives the patient of curative, well-established therapeutic procedures. We describe the histologic spectrum of contact ulcer of the larynx as well as its clinical findings, thereby familiarizing pathologists to an entity well recognized by otolaryngologists.

Adult↗
PubMed1990

Pathologic manifestations of acquired immunodeficiency syndrome in the head and neck.

Various diseases of the head and neck that appear in association with AIDS have been delineated. These diseases may be the initial manifestations of AIDS or may be part of systemic involvement following HIV infection. Both clinicians and pathologists must be aware of the protean manifestations of AIDS in order to establish an accurate and complete diagnosis. Once the diagnosis is established, therapy, which may potentially enhance the quality of life of the infected individual, can be initiated.

AIDS-Related Complex↗
PubMed1989

Low-grade adenocarcinoma of probable endolymphatic sac origin A clinicopathologic study of 20 cases.

The clinical and histologic features of twenty cases of a type of papillary-cystic temporal bone neoplasm are reported. Ages of the patients ranged from 15 to 71 years. The tumors destroyed a large portion of the posterior temporal bone and included a prominent extension into the posterior cranial fossa. Patient histories indicated a slow growth rate of the lesions. Awareness of the parameters of this neoplasm, including the site of origin and probably histogenesis, may enable earlier diagnosis and more successful treatment of the tumor in the future.

Adenocarcinoma, Papillary↗
PubMed1989

Penetrating injuries involving the anterior cranial fossa.

Penetrating injuries of the anterior cranial fossa may result in permanent neurologic changes or even death if injuries are unrecognized and remain untreated. The diverse etiologies of such injuries are reviewed, as well as their diagnosis, treatment and prognosis.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1989

Mucosal origin of sinonasal tract adenomatous neoplasms.

One hundred seven sinonasal tract adenomatous neoplasms on file at the Armed Forces Institute of Pathology were reviewed in order to determine what percentage of and what type of nonsquamous epithelial neoplasms arise from surface mucosa. Seventy-seven percent of tumors were localized to the nose or maxillary sinus. Fifty-nine of the 107 tumors (55%) including 32 (50%) of the 64 adenocarcinomas and 19 (59%) of the 31 adenoid cystic carcinomas arose from the surface mucosa. Five of the six mucoepidermoid carcinomas also appeared to arise from the surface in a diffuse fashion, as did both mixed tumors, one of the oncocytic adenomas and the papillary cystadenoma. One can conclude that the majority of sinonasal tract adenomatous neoplasms arise from the mucosal lining of the sinonasal tract.

Adenocarcinoma↗
PubMed1988

Moderately differentiated neuroendocrine carcinoma of the larynx. A clinicopathologic study of 54 cases.

Fifty-four cases of primary laryngeal moderately differentiated neuroendocrine carcinoma from the Armed Forces Institute of Pathology Otolaryngic Tumor Registry (AFIP-OTR) are reported. The tumors most often present in men in their sixth and seventh decades of life and are heralded by an array of symptoms, the most frequent being hoarseness. The primary site was most often the supraglottic larynx. The investigation has included light-microscopic, histochemical, immunocytochemical, and electron microscopic analyses which support expression of both neuroendocrine and epithelial differentiation. Conservative surgery alone can be utilized if early identification of the tumor and complete surgical removal are assured. The follow-up of the patients reveals 62% as remaining tumor-free after surgical extirpation over periods ranging from 1 month to 16 years (median: 3 years, 9 months). Factors adversely affecting prognosis include metastatic disease at initial presentation, incomplete surgical removal, and vascular or lymphatic invasion. There was no correlation between tumor size, morphologic pattern, mitoses or necrosis, and survival. Sixty-eight percent of the patients gave a history of long-term cigarette smoking. The classification and pathogenesis of these neoplasms remains the focus of much speculation. They are suggested as arising from the cells of the dispersed neuroendocrine system (DNES). However, a more uniform and descriptive nomenclature is necessary. This study resolves this and other issues along with a presentation of clinicopathologic data of the tumor entity.

Adult↗