Biomedical subjects
Publications and source records attributed to D K Heffner.
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.
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.
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.
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.
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.
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.
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.
We present the clinicopathologic features of nine cases of a primary nasopharyngeal (NP) papillary adenocarcinoma. Patients ranged in age from 11 to 64 years (median, 37). The ratio of male to female patients was 5:4. They most frequently presented with airway obstruction. Histomorphologic evaluation showed an invasive carcinoma with papillary and glandular features. The tumor displayed transition from normal surface epithelium to neoplasm. Cytologically it was composed of moderately pleomorphic, columnar, and pseudostratified cells with eosinophilic cytoplasm. The nuclei were round to oval and had vesicular or optically clear chromatin. Histochemical analysis confirmed production of epithelial mucin. Immunohistochemical study demonstrated diffuse keratin and epithelial membrane antigen reactivity and focal carcinoembryonic antigen reactivity. No immunoreactivity was seen with S-100 protein, glial fibrillary acidic protein, or thyroglobulin. Taken together, these findings indicate derivation from the nasopharyngeal surface epithelium and help to differentiate these tumors from seromucous gland lesions and metastatic papillary thyroid carcinoma. The biologic potential was that of a low-grade malignant tumor. Simple and complete surgical excision was the treatment of choice. All patients are presently alive and well, free of recurrent or metastatic tumor (median follow-up, 6 years, 9 months).
Immunohistochemical analysis of 21 prototypic mucosal spindle-cell carcinomas of the aerodigestive tract was performed at the Armed Forces Institute of Pathology (AFIP) to establish the usefulness of selected immunohistochemical markers in distinguishing spindle-cell carcinoma from other mucosal spindle-cell neoplasms. Immunoreactive keratin could be demonstrated in only 13/21 (62%) of cases. Coexpression of keratin and vimentin was demonstrated in 10/17 (59%) of the tumors evaluated for both of these intermediate filaments. All spindle-cell carcinomas lacked S100 protein, which is an immunoreactivity we would expect to find in spindle-cell malignant melanoma, one of the principal considerations in a differential diagnosis. Both alpha-1-antitrypsin (AAT) and alpha-1-antichymotrypsin (ACT) were demonstrated in the tumor cells in all cases. However, albumin had a similar distribution in the tumors, which suggested that passive uptake was a serious confusing factor. The results of this study indicate that AAT and ACT are unreliable markers for distinguishing spindle-cell carcinomas from malignant fibrous histiocytomas.
Computerized nuclear morphometry (CNM) has been compared with the standard histopathologic grading of squamous cell carcinoma in patients who have undergone chemotherapy for head and neck cancers. Statistics were significant between the histopathologic and CNM readings that were done. CNM represents an objective method of quantitating the histopathologic readings of nuclear pheomorphism and cancer differentiation to allow these criteria to be used as prognostic indicators in squamous cancers. CNM readings of individual biopsy specimens from patients were shown to characterize each tumor. This may represent a cytopathologic method for tracking a cancer through whatever course of therapy is given.
Some conditions of the tonsils and adenoids often present problems in diagnosis for the surgical pathologist. These include variations of normal histologic features, atypical reactive and metaplastic lesions, hamartomas, papillomas, carcinomas, and some types of lymphomas. The reasons for errors in histopathologic diagnosis have been emphasized, and the clinicopathologic features that can help to prevent misdiagnoses are discussed.
Pseudocyst of the auricle (benign idiopathic cystic chondromalacia) is rare. Only 20 cases have been previously reported in the literature. Our study retrospectively reviews 21 additional cases. We conclude that idiopathic cystic chondromalacia can occur in both sexes, in all races, and at any age. The differential diagnoses for idiopathic cystic chondromalacia are relapsing polychondritis and chondrodermatitis nodularis chronica helicis. Recurrence of idiopathic cystic chondromalacia is uncommon following adequate local treatment.
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We reviewed and studied the histologic features of 23 cases of pseudocysts of auricular cartilage. Our aim was to determine and describe the histologic spectrum of this condition and to delineate the histologic differential diagnostic points. Lesions for which this condition has been mistaken include relapsing polychondritis, chondrodermatitis nodularis helicis, traumatic perichondritis, hemangioma, chondroma, angiosarcoma, and chondrosarcoma. The pathologist who is familiar with the histologic patterns of this condition usually can recognize it readily. When biopsy specimens are small, and the diagnosis is uncertain, clinical features can often suggest the correct diagnosis.
Teratomas of the tongue are extremely rare neoplasms, with only five reported cases in the literature. We report an additional case here and review the literature on this rare entity.
Twenty cases of a unique type of sinonasal tract neoplasm with combined histologic features of carcinosarcoma and teratoma are described and discussed. The term "teratocarcinosarcoma" is proposed and justified. Patients were adults (age range, 18-79 years; median age, 60 years). The variegated histologic components are illustrated and differences from gonadal germ cell neoplasms are delineated. This neoplastic entity is clearly malignant, with 60% of patients not surviving beyond 3 years (average survival, 1.7 years) following diagnosis, regardless of type of therapy. Aggressive therapy (combined surgery and irradiation) seems justified, however, since 40% of patients survived 3 years or longer with no current evidence of neoplasm (average follow-up, 6.1 years).
The autopsy and surgical pathologic diagnosis of lesions of the laryngotrachea of young persons can be difficult. The clinical and histopathologic features that aid differential diagnosis are discussed.
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