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Biomedical subjects

G F Gray

Publications and source records attributed to G F Gray.

At least 19 recordsLinked to original sources
PubMed2000

The coexistence of low-grade mucinous neoplasms of the appendix and appendiceal diverticula: a possible role in the pathogenesis of pseudomyxoma peritonei.

We examined 38 appendectomies with diagnoses of mucocele, diverticulum, or adenoma to study the coincidence of appendiceal diverticula and appendiceal low-grade mucinous neoplasms and to examine the possible role of diverticula in the pathogenesis of pseudomyxoma peritonei. Invasive adenocarcinomas and retention cysts were excluded (six cases). Cases were classified as adenomas or mucinous tumors of unknown malignant potential, with or without diverticula. Medical records were reviewed for multiple parameters, including presenting symptoms, presence of pseudomyxoma peritonei, and presence of associated malignancies. Binomial statistics were used to calculate the probability that the observed prevalence of low-grade mucinous neoplasms and diverticula together was significantly different from the expected prevalence of diverticula or low-grade mucinous neoplasms alone, using historical controls from the literature. Twenty-five percent of the total cases (8 of 32) contained both a low-grade mucinous neoplasm (7 cystadenomas and 1 mucinous tumor of unknown malignant potential) and a diverticulum. Thus, 8 of 19 low-grade mucinous neoplasms (42%) were associated with diverticula. Of the appendices with both low-grade mucinous neoplasms and diverticula, three contained dissecting acellular mucin within the appendiceal wall, four showed diverticular perforation, and one had pseudomyxoma peritonei associated with the ruptured diverticulum. A significant percentage (P < .001) of cases contained low-grade mucinous neoplasms and diverticula together. The case of coexistent low-grade mucinous neoplasm, diverticulum, and pseudomyxoma peritonei suggests that diverticula could play a role in the pathogenesis of pseudomyxoma peritonei. This could occur either by involvement of preexisting diverticula by the neoplasm or by distention of the appendiceal lumen by mucin, leading to increased intraluminal pressure and subsequent diverticulum formation at a weak area in the wall. Either mechanism might allow low-grade mucinous neoplasms to penetrate the appendiceal wall more easily.

Adult↗
PubMed1998

Alterations in colonic mucosal vessels in patients with cirrhosis and noncirrhotic portal hypertension.

Changes in intestinal mucosal microvasculature as a cause of lower gastrointestinal hemorrhage in patients with portal hypertension have been well documented clinically, but the analogous histomorphological changes have not been well characterized. The goal of this study was to evaluate qualitative and quantitative changes in colonic mucosal vessels in patients with cirrhosis or clinically evident portal hypertension and to correlate these changes with endoscopic and clinical findings. Colon biopsy or resection specimen slides from 46 patients with biopsy-proven cirrhosis (44 patients) or noncirrhotic portal hypertension (two patients) were reviewed. Immunoperoxidase stain for CD34 antigen was used to facilitate visualization of mucosal vessels, and vessel diameter was measured with a micrometer. Patients with inflammatory bowel disease were excluded. Twenty-four normal colon biopsy specimens served as controls. Mucosal vessels were divided into superficial, intermediate, and deep layers. As a group, the cirrhotic patients had a significantly higher mean diameter of vessels in all three layers. Qualitatively, increased numbers of small vessels and prominent branching were noted, especially in the superficial and intermediate layers. Tortuous, thick-walled vessels, suggesting arterialization of venules, were present in some cases. Eleven patients had endoscopic findings suggestive of vascular abnormalities, including erythematous mucosal patches, red macules, and telangiectasias. Eighteen had esophageal varices, and five had portal gastropathy. Nineteen patients had gastrointestinal (GI) bleeding, localized to the lower GI tract in 11. These qualitative and quantitative findings suggest that colonic mucosal vascular lesions are common in portal hypertension and may represent a potential source of clinically significant lower GI hemorrhage in these patients.

Adult↗
PubMed1997

Pathology of mammographically discovered breast cancer. Clinical implications of size and histologic differentiation.

The management of breast cancer is becoming increasingly complex, almost year by year. Previous paradigms have held that issues were dichotomous (e.g., good versus bad). These are being challenged constantly by more complex models that demand more than a duality of choice in therapeutic decision making. Most importantly, the determinants of local failure after conservative treatment are quite different from the determinants of survival. While we develop enhanced chemotherapy for immediate life-threatening disease, we also accepting subtypes of breast cancer that are of little threat to life and need little treatment. With the establishment of the efficacy of systemic chemotherapy, the question of whether some patients may be helped with chemotherapy becomes extremely important. The list of possible clinically useful subcategories is growing and is under active development. However, the prognostic factors in use have been validated repeatedly. The two major elements of anatomic staging--size and lymph node status--interact powerfully with histologic categories of grade and special type. In the area of small tumors, these associations indicate lesions that have almost no likelihood of association with distant failure, at least within 5 years.

Axilla↗
PubMed1996

The histologic spectrum of hepatic cat scratch disease. A series of six cases with confirmed Bartonella henselae infection.

Cat scratch disease (CSD), a common cause of regional lymphadenitis, has been linked to Bartonella henselae infection. Although rare, dissemination with hepatic involvement has been documented. Six cases of hepatic CSD were retrieved and probed for B. henselae DNA. Hematoxylin-eosin, trichrome, methenamine silver, Gram, Ziehl-Neelsen, and Warthin-Starry stained slides were reviewed by all authors, and the histologic findings were recorded. B. henselae infection was confirmed in all cases using combined polymerase chain reaction and Southern blot methods. All biopsies contained multiple granulomas, many with characteristic stellate abscesses surrounded by three distinct zones: an inner layer of palisading histiocytes, an intermediate lymphocytic rim, and an outermost zone of fibrosis. One case had noncaseating granulomas with prominent giant cells. Warthin-Starry stains were positive in two. The surrounding parenchyma in all cases contained lymphocytic infiltrates within expanded fibrotic portal triads and adjacent dilated sinusoids. There is a distinct spectrum of histologic changes in hepatic CSD. Although the unit lesion is granulomatous, the organization varies markedly. All cases show predictable nonspecific surrounding parenchymal changes. When multiple hepatic lesions are found in patients with constitutional symptoms suggesting an infectious illness, CSD should be included in the differential diagnosis.

Adult↗
PubMed1994

Tumor volume and stage in carcinoma of the prostate detected by elevations in prostate specific antigen.

We reviewed the surgical specimen from 142 men undergoing radical prostatectomy for prostate cancer detected because of an elevation in serum prostate specific antigen alone. No patient had a palpable abnormality suggestive of cancer. One patient had no identifiable tumor in the radical prostatectomy specimen, 8 (6%) had only a few high power microscopic fields showing cancer, 40 (28%) had an estimated tumor volume of less than 1 cc and 93 (65%) had a tumor volume of greater than 1 cc. Surgical margins were positive in 37 patients (26%) and negative in 105 (73%). Most patients with cancer detected because of modest elevation in prostate specific antigen, even without palpable abnormalities, have a clinically significant tumor volume and are good candidates for radical prostatectomy.

Adenocarcinoma↗
PubMed1993

Mesenchymal hamartoma of liver. A regional ischemic lesion of a sequestered lobe.

OBJECTIVE: To evaluate histologic and gross features of mesenchymal hamartoma of liver and similar lesions in relation to determining likely pathogenesis. DESIGN: Case series of patients presenting to a tertiary care hospital over 16 years. PATIENTS: Three children with mesenchymal hamartoma ranging from newborn to 11 months of age and one 12-year-old girl with torsion of an accessory lobe of liver. MAIN OUTCOME MEASURES: Similarity of gross vascular and segmented anomalies as well as apparent consequent histologic features of mesenchymal hamartoma to those of torsion of an accessory lobe of liver indicate that they are pathogenetically related. RESULTS: Dissecting microscopic examination revealed a single vascular supply in one case and remote thrombi in two cases of mesenchymal hamartoma evaluated. The histologic features of mesenchymal hamartoma (hypocellular central zone and hypercellular periphery) were duplicated in the lobe of liver with torsion. CONCLUSIONS: Mesenchymal hamartoma represents a lesion with an anomalous solitary vascular supply that may evolve into its specific pattern with stromal cysts as a result of early ischemic changes.

Adolescent↗
PubMed1989

Antibiotic therapy for cat-scratch disease?

Cat-scratch disease is usually a benign, self-limited disease that causes regional lymphadenopathy. Occasionally, it may present with systemic symptoms and have a prolonged course. To date, antibiotic therapy has not been proved to be of value. We describe three patients with cat-scratch disease who were treated successfully with gentamicin sulfate. Two patients had extensive hepatic involvement, and one patient had regional lymphadenopathy. All three patients responded within 48 hours to intravenous gentamicin. Extensive follow-up has shown no recurrence of symptoms. These cases suggest that gentamicin may be efficacious in shortening the course of cat-scratch disease. Prospective, randomized trials should be performed to confirm these results.

Cat-Scratch Disease↗
PubMed1987

Flow cytometric analysis of nuclear DNA from adrenocortical neoplasms. A retrospective study using paraffin-embedded tissue.

Nuclear DNA content of paraffin-embedded tissue from 48 adrenocortical neoplasms, 18 histologically normal control adrenal glands, and five hyperplastic adrenal glands was analyzed retrospectively using flow cytometry. Aneuploidy was compared with morphologic criteria as a predictor of recurrence. All 18 controls, five hyperplastic glands, and 39 neoplasms were diploid. Nine neoplasms were aneuploid. Compared with their diploid counterparts, aneuploid neoplasms were more likely to weigh more than 50 g (P less than 0.0001) and to have three or more histologic features of carcinoma (P less than 0.0001). Thirty-six neoplasms were followed clinically for at least 2 years (range 24 to 120 months, mean = 64.6 months) or until local recurrence, metastasis, or death. Five were clinically malignant. Neoplasms which recurred or metastasized were more apt to be aneuploid (P less than 0.005) than those showing no evidence of further disease during the follow-up period. They were also more likely to weigh more than 50 g (P less than 0.005) and to have three or more histologic features of carcinoma (P less than 0.0025). However, neither aneuploidy, large size, nor unfavorable histology result was a consistent feature in every malignant neoplasm. Flow cytometric DNA content analysis appears to be as effective a predictor of clinical outcome as size and histology and may be of particular value when the morphologic features are ambiguous.

Adenoma↗
PubMed1987

Flow cytometric determination of nuclear DNA content in benign adrenal pheochromocytomas.

Nuclear DNA content of paraffin-embedded tissue from 19 clinically benign adrenal pheochromocytomas and 18 control adrenal glands was analyzed using flow cytometry. All control adrenal glands and 6 pheochromocytomas were diploid. Four tumors were tetraploid. Nine were aneuploid with relative DNA indices in the near diploid range in 2, in the peritriploid range in 5, and in the near tetraploid range in 2. These results indicate that aneuploid DNA content is a frequent occurrence in benign adrenal pheochromocytomas. Aneuploidy per se is not a specific marker of malignancy in these tumors as has been suggested by previous reports.

Adrenal Gland Neoplasms↗
PubMed1987

Appendicovaginal fistula and primary appendiceal cystadenocarcinoma.

An elderly woman had an appendicovaginal fistula. Within the appendix was a well differentiated mucin-producing cystadenocarcinoma that extended through the fistula and onto the vaginal mucosal surface. The development of this fistula was probably related to the tumor and a previous hysterectomy, which allowed close proximity of the tip of the appendix to the vaginal vault.

Aged↗
PubMed1987

Poorly differentiated carcinoma of unknown primary site: correlation of light microscopic findings with response to cisplatin-based combination chemotherapy.

We have previously reported complete responses and long-term survival in patients with metastatic poorly differentiated carcinoma (PDC) of unknown primary site who received intensive cisplatin-containing chemotherapy regimens. We reviewed the light microscopic specimens from 113 patients with PDC in an attempt to identify common histopathologic features in the chemotherapy-responsive subgroup, and to rule out the presence of previously unrecognized germ cell tumors. Relatively few diagnoses more specific than PDC could be made. We could identify no histopathologic features by light microscopy that distinguished responsive from unresponsive neoplasms. Only one patient was found to have a previously unrecognized yolk sac carcinoma, and in five other patients the possibility of a germ cell neoplasm was considered in the differential diagnosis by at least one reviewer. The remaining tumors had no histologic features suggestive of germ cell neoplasms. Ninety-six patients had received combination chemotherapy (89 with cisplatin-containing regimens); 27 patients (28%) achieved complete remission, and 16 remain free of disease at a median of 65 months after completion of therapy. Patients with PDC of unknown primary site who are responsive to cisplatin-containing chemotherapy regimens cannot be reliably identified by light microscopy. At present, all such patients should be considered for an empiric trial of chemotherapy with cisplatin-based regimens, since cure is achievable in a minority.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Granular cell tumors.

A lesion of unknown etiology and histogenesis, the granular cell tumor usually arises in the skin or soft tissue. It has been reported, however, in other sites and can be multifocal. The authors have seen 31 such tumors in 26 patients in their institutions since 1970. Most (21) patients were females, and 12 patients were black. The average age was 41.8 years, excluding two newborns with a congenital granular cell myoblastoma of the gingiva. The most common site of occurrence was the skin; seven tumors originated from the trunk and five from the extremities. Four lesions were found in the breast, three on the vulva, two in the axilla, two in the gum, two in the buccal cavity, two in the esophagus, and one each in the stomach, gluteus muscle, eyelid, and bronchus. Two patients had multiple synchronous lesions. These were bilateral hand lesions in one patient, and lesions of the breast and axilla in the other. A third patient had three separate lesions which arose over the course of 5 years, involving the bronchus, the gluteus muscle, and the buccal mucosa. An additional esophageal lesion was an incidental finding 3 years after excision of a granular cell tumor of the breast. All of the tumors were removed with local, simple excision, except for the 2-cm lesion in the stomach for which a wedge resection of the fundus was necessary and the bronchial lesion for which a wedge resection of the left upper lobe of the lung was performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Alveolar soft part sarcoma of the uterus.

Two patients with alveolar soft part sarcoma of the uterus are described. One of the sarcomas was a submucosal nodule of the cervix, and the second was a minuscule, incidentally discovered lesion in the corpus. Both lesions contained periodic acid-Schiff-positive, diastase-resistant cytoplasmic granules, and characteristic membrane-bound crystalline inclusion bodies were demonstrated in the cervical lesion.

Adult↗
PubMed1986

Papillary cystic oncocytoma and Warthin's tumor of the parotid gland.

A 69-year-old white female had a left superficial parotidectomy for a papillary cystic oncocytoma. The histologic appearance was identical to Warthin's tumor except that it lacked a lymphoid component. This case suggests that the general morphology of a Warthin's tumor does not depend on the presence of lymphoid tissue or association with an intra-parotid lymph node. We reviewed 50 patients with Warthin's tumors to investigate the histogenesis of the lesion. We found that most Warthin's tumors (86%) appeared to be within lymph nodes, as indicated by the presence of a lymph node capsule or sinuses. The anatomy of intra-parotid lymph nodes in glands containing Warthin's tumors has been compared with that found in 11 parotid glands containing mucoepidermoid carcinomas. So-called heterotopic ductal inclusions may actually represent the normal intimate relationship of parotid gland to intra-parotid lymph nodes.

Adenolymphoma↗
PubMed1986

Herpes zoster of the larynx after intubational trauma.

Multiple or prolonged endotracheal intubations may result in laryngeal trauma. This case illustrates that recrudescence of latent varicella-zoster virus as herpes zoster of the larynx, with subsequent laryngeal paralysis, can complicate intubation. Consequently, physicians should strive to minimize laryngeal injury in this setting. It is advised that careful laryngeal examination follow extubation.

Aged↗