Acute interstitial pneumonia: histopathologic patterns of acute lung injury and the Hamman-Rich syndrome revisited.
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Acute Disease↗
Biomedical subjects
F B Askin
Publications and source records attributed to F B Askin.
Acquired lobar emphysema (overinflation): clinical and pathological evaluation of infants requiring lobectomy.
Acquired lobar "emphysema" (overinflation) (ALE) is an increasingly recognized complication of advanced bronchopulmonary dysplasia (BPD). To refine current concepts regarding patient management and pathogenesis, we examined clinical and pathological features of six infants with ALE who did not have obstructing intraluminal lesions and who underwent lobectomy after failing nonoperative management. All had severe neonatal respiratory distress and required prolonged ventilatory support (average, 2 months) with peak inspiratory pressures greater than 30 mm Hg and 100% oxygen. ALE developed between 3 weeks and 20 months of age (median, 5 months), with lobar hyperinflation, atelectasis, and mediastinal shift. Selective bronchial intubation provided only transient benefit. Videobronchoscopy demonstrated no intraluminal obstructing lesions in five patients. In one child, ALE became clinically apparent only after laser excision of an endobronchial cicatrix. All infants had bronchomalacia with the involved lobar bronchus being most severely affected. Ventilation-perfusion scans demonstrated severe impairment of both ventilation and perfusion in the involved lobes. The decision to perform lobectomy was based on clinical parameters and failure of non-operative management. After lobectomy, all children dramatically improved. However, only three of six were alive 2 to 3 years later; one infant died of unrelated causes at 6 weeks; and two died of progressive respiratory insufficiency 13 and 24 months postlobectomy. Microscopic evaluation of the lung demonstrated findings of late-stage BPD with peribronchial and interstitial fibrosis, parenchymal overinflation, and alveolar septal disruption.(ABSTRACT TRUNCATED AT 250 WORDS)
Bronchi↗
The importance of the eosinophil in head and neck cancer.
In a previous study, we found tumor-associated tissue eosinophilia (TATE) to be a favorable prognostic indicator for squamous cell carcinoma of the head and neck (p less than 0.05). The present expanded study was undertaken to confirm this finding. The pathology of 120 head and neck tumors was examined for histologic features suggestive of poor prognosis. Ten descriptive histopathologic variables, including two malignancy grading scales, were correlated with DNA flow cytometric data and clinical outcome. No correlation was found between the malignancy grading scales and DNA flow cytometric data or clinical outcome. The present expanded study confirmed with greater statistical significance (p less than 0.001) that high-grade TATE is a favorable prognostic indicator for head and neck cancer. Furthermore, high-grade TATE was associated with the absence of distant metastasis (p less than 0.05). Using a stepwise logistic regression analysis of the clinicopathologic variables in the study, high-grade TATE was the most influential variable affecting clinical outcome, followed by border, stage, and perineural invasion. We conclude that the grade of TATE is a significant prognostic indicator for head and neck cancer. The significance and possible role of the eosinophil in the tumor-host interaction are discussed.
Eosinophils↗
Virus-associated RNAs (VA-I and VA-II). An efficient target for the detection of adenovirus infections by in situ hybridization.
The identification of adenovirus in tissue can be difficult. In situ hybridization for adenovirus nucleic acids may aid in the demonstration of adenovirus infections. To develop a probe against adenovirus, a 978 bp fragment of DNA containing the VA-I, VA-II, and a portion of the L-1 regions of the adenovirus type 2 genome was cloned into the SK+ vector. These regions were selected because they are generally conserved among adenoviruses and are abundantly transcribed during the lytic cycle. Sense and antisense tritium or Digoxigenin-labeled riboprobes were generated using in vitro transcription and applied to formalin-fixed paraffin-embedded sections of HeLa cells infected with adenovirus type 2. Extensive in situ hybridization of the antisense riboprobe to HeLa cells with cytopathic changes was found. The number of cells to which the probe hybridized decreased proportionately with dilution of infected with noninfected cells. The control sense riboprobe showed only scattered breakthrough hybridization and in these cells hybridization was mainly located in the nucleus. Northern blot analysis of RNA from infected HeLa cells confirmed the in situ hybridization results. No hybridization was detected when cultured cells infected with herpes simplex virus, Epstein-Barr virus, cytomegalovirus, or human immunodeficiency virus were examined. Specific hybridization was detected in tissues obtained at autopsy from four patients with culture proven adenovirus infection. These observations suggest that this probe is useful in the diagnosis of adenovirus in formalin-fixed paraffin-embedded material.
Adenoviridae Infections↗
Multimodal therapy for the management of localized Ewing's sarcoma of pelvic and sacral bones: a report from the second intergroup study.
A total of 59 eligible patients with localized Ewing's sarcoma of the pelvic and sacral bones were entered into a multimodal Intergroup Ewing's Sarcoma Study (IESS-II) (1978 to 1982) and compared with a historical control series of 68 patients entered into an earlier multimodal Intergroup Ewing's Sarcoma Study (IESS-I) (1973 to 1978). High-dose intermittent multiagent chemotherapy (vincristine, cyclophosphamide, Adriamycin [doxorubicin; Adria Laboratories, Columbus, OH], and dactinomycin) was given to all patients for 6 weeks before and for 70 weeks following local therapy. All patients who had a tumor biopsy or incomplete resection performed received a dose of 55 Gy to the tumor bed. With a median follow-up time of 5.5 years, two of 59 patients (3%) had a local recurrence, five patients (8%) had a local recurrence and metastases, and 17 patients (29%) developed metastases only. There was significant statistical evidence of an advantage in relapse-free survival (RFS) and survival (S) for patients on IESS-II versus IESS-I, P = .006 and P = .002, respectively. At 5 years, the comparison between IESS-II versus IESS-I was 55% versus 23% for RFS and 63% versus 35% for S.
Adolescent↗
Diagnostic efficacy of pleural biopsy as compared with that of pleural fluid examination.
Previous studies compared the diagnostic value of pleural fluid cytology versus pleural biopsy. No direct comparison of the procedures including data from a combination of all diagnostic tests performed on each specimen appears to have been done. A total of 385 patients with concurrent pleural biopsy and fluid examination were identified from 1973 to 1986. Clinical records, histologic and cytologic preparations, and microbiologic and chemical data were reviewed. A total of 109 patients had a final diagnosis of malignancy. Cytology was diagnostic in 71% and "suggestive" in an additional 8%. There were no false-positives but, in two patients with pulmonary infarcts, the effusions were reported as "suspicious." Pleural biopsy was positive in 45%, including three cases with negative cytology. In 71 patients with tuberculosis, the pleural biopsy was diagnostic in 49%. A cytologic picture suggesting the diagnosis was present in 68%. Cultures of the biopsy yielded Mycobacterium tuberculosis in 23% of cases, while pleural fluid was positive in 30%. In six cases, the only confirmatory evidence of tuberculosis was pleural culture. In 205 patients, none of the above procedures provided specific diagnoses. A combination of biopsy and fluid examinations improves the diagnostic sensitivity. Pleural biopsy increases the rate of complications and did lead to fatal hemothorax in two patients. These results support the superiority of pleural fluid examination in the diagnosis of malignancy. In addition, they demonstrate the value of pleural fluid examination in the diagnosis of tuberculosis.
Adolescent↗
Pulmonary disorders in the collagen vascular diseases.
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Collagen Diseases↗
Back to the future: the Hamman-Rich syndrome and acute interstitial pneumonia.
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Acute Disease↗
Metastasizing pleomorphic adenoma with myoepithelial cell predominance.
The biological behavior of pleomorphic adenomas (mixed tumors) of salivary gland origin is complex. Tumors with benign histologic features may exhibit recurrence and locally aggressive behavior especially after incomplete excision. A small percentage of pleomorphic adenomas have obvious malignant components in epithelial or in both epithelial and mesenchymal components and can metastasize. There are also rare case reports which appear to document typical pleomorphic adenomas of salivary gland with histologically identical visceral and lymph node metastases. Recently myoepithelial cell proliferation has been identified as a possible predictor of aggressive clinical behavior in otherwise histologically benign pleomorphic adenomas. We report such a parotid gland lesion with local recurrence and retroperitoneal spread. DNA-flow cytometry of cells from the paraffin-embedded primary and metastasis showed similar aneuploid populations. Aneuploidy appeared to reflect the malignant potential of this particular pleomorphic adenoma and suggests that DNA-flow cytometry of salivary gland tumors may yield important prognostic information.
Adenoma, Pleomorphic↗
Pulmonary blastoma.
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Antigens, Neoplasm↗
Clear cell tumor of the lung. A clinicopathologic, immunohistochemical, and ultrastructural study of eight cases.
We studied eight clear cell tumors of the lung (CCTL) to better define their clinical, immunohistochemical, and ultrastructural features, and to clarify their distinction from other neoplasms, particularly metastatic renal cell carcinoma. Patients ranged in age from 31 to 67 years (mean, 51 years). Seven patients had clinically benign, asymptomatic lesions measuring less than 2 cm in diameter that were devoid of necrosis. The eighth patient had a symptomatic, partially necrotic CCTL 4.5 cm in diameter that metastasized to the liver and peritoneum; the patient died of tumor 17 years after diagnosis. Ultrastructural study of seven CCTL showed interdigitating cell processes (all cases), primitive cell junctions (five of seven cases), intracytoplasmic glycogen (all cases), and rare dense core granules (two of seven cases). Immunohistochemically, paraffin-embedded sections from all eight CCTL were negative for cytokeratin (CK), epithelial membrane antigen (EMA), chromogranin, and vimentin. Focal staining was seen for S-100 protein (three of eight cases), neuron-specific enolase (three cases), synaptophysin (one case), and Leu 7 (one case). Although these findings suggest that at least some CCTL exhibit neuroendocrine differentiation, the tumor's histogenesis remains uncertain. Of more practical importance, the combined absence of CK, EMA, and vimentin in formalin-fixed, paraffin-embedded CCTL virtually precludes confusion with renal cell carcinoma. Although traditionally considered benign, CCTL larger than 2 cm that are symptomatic, and focally necrotic should be regarded as potentially malignant neoplasms.
Adenocarcinoma↗
Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus. A Gynecologic Oncology Group pathologic study of 203 cases.
We report on the pathologic findings in primary tumors and metastases in 203 cases of stage I and II endometrial carcinosarcoma (malignant mixed mesodermal tumor) subjected to hysterectomy and staging laparotomy. Metastases were studied in 40 of these cases, including 34 with positive findings in the pelvic and/or para-aortic lymph nodes. Features of the stromal component of the primary tumors, including grade, mitotic index, and the presence and types of heterologous elements, showed no relation to the presence of metastases at operation. High-grade, serous, and clear cell carcinomatous components, on the other hand, were associated with a higher frequency of metastases, as were deep myometrial invasion, lymphatic or vascular space invasion, and involvement of the isthmus or cervix. The current concepts of histogenesis and differentiation of these tumors are discussed, and the suggestion is made that they might represent metaplastic carcinomas.
Carcinosarcoma↗
Multimodal therapy for the management of primary, nonmetastatic Ewing's sarcoma of bone: a long-term follow-up of the First Intergroup study.
A total of 342 previously untreated eligible children were entered into the first Intergroup Ewing's Sarcoma Study (IESS) between May 1973 and November 1978. In group I institutions, patients were randomized between treatment 1 (radiotherapy to primary lesion plus cyclophosphamide, vincristine, dactinomycin, and Adriamycin [doxorubicin; Adria Laboratories, Columbus, OH] [VAC plus ADR]) or treatment 2 (same as treatment 1 without ADR), and group II institutions randomized patients between treatment 2 or treatment 3 (same as treatment 2 plus bilateral pulmonary radiotherapy [VAC plus BPR]). The percentages of patients relapse-free and surviving (RFS) at 5 years for treatments 1, 2, and 3 were 60%, 24%, and 44%, respectively. There was strong statistical evidence of a significant advantage in RFS for treatment 1 (VAC plus ADR) versus 2 (VAC alone) (P less than .001) and 3 (P less than .05) and also of treatment 3 versus 2 (P less than .001). Similar significant results were observed with respect to overall survival. Patients with disease at pelvic sites have significantly poorer survival at 5 years than those with disease at nonpelvic sites (34% v 57%; P less than .001). Among pelvic cases, there was no evidence of differing survival by treatment (P = .81), but among nonpelvic cases, there was strong evidence of differing survival by treatment (P less than .001). The overall percentage of patients developing metastatic disease was 44%; the percentages by treatments 1, 2, and 3 were 30%, 72%, and 42%, respectively. The overall incidence of local recurrence was 15%, and there was no evidence that local recurrence rate differed by treatment. Patient characteristics related to prognosis, both with respect to RFS and overall survival experience, were primary site (nonpelvic patients were most favorable) and patient age (younger patients were more favorable).
Adolescent↗
Pediatric thyroid cancer.
A review was undertaken of the clinical, gross, and microscopic features of thyroid carcinoma in all patients younger than 21 years of age seen at North Carolina Memorial Hospital from 1952 to 1987 (N = 32). These patients had papillary carcinoma, well-differentiated follicular carcinoma with Hürthle cell change, medullary carcinoma, and an unclassifiable aggressive malignancy. In spite of the presence of lymph node metastases at diagnosis in more half the patients with papillary carcinoma, the prognosis of pediatric papillary thyroid carcinoma appears to be excellent with treatment by surgical debulking and hormonal thyroid suppression. Flow cytometric study of 26 cases showed tumor aneuploidy in 8 of 21 papillary carcinomas and 2 of 3 follicular carcinomas. Aneuploidy did not, however, correlate with clinical outcome in this group of pediatric patients, who were followed for 1 to 29 years. Analysis of multiple tissue blocks of tumor does appear to increase the probability of identifying aneuploid populations.
Adenocarcinoma↗
Nodular form of bleomycin-related pulmonary injury in patients with osteogenic sarcoma.
Bleomycin (BLEO), an antitumor antibiotic effective against a variety of malignancies, has been associated classically with a pulmonary toxic reaction producing diffuse interstitial fibrosis. However, BLEO-related pulmonary nodules have been reported recently, mostly in children and young adults treated for germ cell tumors. A different, apparent hypersensitivity reaction with prominent eosinophilic infiltrates has been seen in other patients. This report details the clinical history, radiographic features, and histopathologic condition of three patients with osteogenic sarcoma in whom pulmonary nodules developed during the course of their multiagent, BLEO-containing chemotherapy. The predominant histopathologic lesion was bronchiolitis obliterans-organizing pneumonia (BOOP); one patient had a significant eosinophilic infiltrate also. Pulmonary lesions developed in all of these patients after relatively low doses of BLEO (less than 200 mg). All of these patients underwent open lung biopsy to establish the diagnosis. Reported cases of BLEO-induced pulmonary injury other than diffuse fibrosis are reviewed and comparisons are made with those in the current report. Also, suggestions are made for the management of these patients.
Adolescent↗
Isolated extramedullary relapse of acute myelogenous leukemia in a tooth.
We report a case of isolated extramedullary relapse of acute myelogenous leukemia in a tooth following bone marrow transplantation. The patient was a 4-yr-old child who developed gingival swelling and bleeding while in bone marrow remission. Crush artifact prevented definitive diagnosis of leukemic relapse in a biopsy of the gingival soft tissue, but decalcification of the tooth showed an unequivocal leukemic infiltrate in the dental pulp. Decalcification and sectioning of extracted teeth are recommended when equivocal findings are present in the gingival soft tissue or when there is a history of lymphoreticular malignancy.
Bone Marrow Transplantation↗
Minute pulmonary meningothelial-like nodules. A clinicopathologic study of so-called minute pulmonary chemodectoma.
The clinicopathologic features of 23 so-called minute pulmonary chemodectomas from nine patients are presented. Eight patients were women and one was a man; age range was 34-75 years (mean, 61). Two specimens were surgical resections and seven were autopsies (incidence, one per 60 autopsies). There was no association with a specific disease process or pathologic condition. Grossly, the lesions were 1-3 mm, tan to yellow, pleural or parenchymal nodules. Six of nine cases had multiple lesions; upper lobes were more often involved. Microscopically, characteristic cell nests expanded alveolar septa. Larger lesions were connected by intervening collagen, often imparting a stellate configuration. Smaller lesions had closely apposed nests with mildly thickened alveolar septa. The nodules were strongly reactive for epithelial membrane antigen (12 of 14) and vimentin (10 of 14), and were uniformly negative for cytokeratin, S-100, neuron-specific enolase, and actin. Ultrastructurally, complex interdigitating cell processes were connected by desmosomes. Occasional cytoplasmic filaments were seen. These nodules lack neuroendocrine features, differ from mesothelium, and strongly resemble meningothelial cells. A more accurate term for these lesions is minute meningothelial-like nodules. Their relationship to larger, solitary pulmonary meningiomas is unclear.
Adult↗
Yolk sac calcification: a sonographic finding associated with intrauterine embryonic demise in the first trimester.
Two cases of the sonographic demonstration of yolk sac calcification associated with first-trimester intrauterine embryonic demise are reported. Histologic verification was obtained in one case. Yolk sac calcification may reflect typical dystrophic changes or be more specifically related to a yolk sac calcium-binding protein. Awareness of this sonographic finding--which the authors believe to be previously undescribed--may prevent diagnostic errors.
Adolescent↗