Biomedical subjects
Publications and source records attributed to G L Ellis.
A patient with a dual-chamber pacemaker presented with rhythmic contractions of her right hemidiaphragm. The atrial lead of her pacemaker had retracted into the right subclavian vein, causing pacing of the right phrenic nerve. The cause of the lead displacement is unknown, but may have resulted from unintentional manipulation of the pacemaker generator pouch by the patient, the so-called Pacemaker Twiddler's Syndrome.
Emergency physicians are frequently called on to treat or advise pregnant patients. When faced with a pregnant patient who has clinical evidence of or exposure to a viral illness, the emergency physician must be aware of the potential maternal and fetal risks posed by various viral agents. This review provides current, accurate information and guidance for the pregnant patient.
Detection of a soft-tissue foreign body is common yet often difficult, particularly when the foreign material is not radiopaque. Various imaging modalities have been advocated for detecting foreign bodies that are not revealed by plain radiography. The abilities of plain radiography, xerography, computed tomography, and ultrasonography to detect glass, wooden, and plastic foreign bodies in an in vitro preparation are compared. While all of these imaging techniques demonstrated a glass foreign body, only ultrasonography clearly identified wooden and plastic foreign bodies.
The presentation of subdural hematoma is often more subtle in the elderly than in younger patients, due in part to cerebral atrophy and in part to the interaction with other medical conditions to which the elderly are prone. With the advent of computed tomography, the diagnosis of subdural hematoma has become easier and noninvasive. This improvement in diagnostic capability has enhanced the understanding of the epidemiology and presentation of subdural hematomas in the elderly. The role of magnetic resonance imaging is also discussed, as is the pathophysiology, management, and prognosis in the elderly patient.
The clinical, histologic, and histomorphometric features of 42 giant cell tumors (GCT) of long bones and 49 central giant cell granulomas (CGCG) of the jaws were compared. These findings were also correlated with the clinical behavior of 25 cases of CGCG for which follow-up information was available. There was a female predilection for both lesions. The mean ages of patients with CGCG and GCT were 21 and 25 years, respectively. In contrast to CGCG, GCT rarely occurred in persons below the age of 10 years. The only statistically significant quantitative difference between the lesions at the histologic level was the greater number of nuclei in the giant cells of the GCT. There were four significant histologic differences between the two lesions, but 26% of the GCTs were histologically similar to most of the CGCGs and 10% of the CGCGs were histologically similar to most of the GCTs. Five of the 25 patients with CGCG for whom follow-up information was available had recurrences. The average age of those five patients was 11 years, compared to 29 years for those patients without recurrence. All five patients with recurrence were under 17 years of age, and they constituted 45% of the patients in this age group with follow-up. There were no quantitative or histologic differences between the recurrent and nonrecurrent CGCGs that were useful in predicting the likelihood of recurrence. Our findings suggest that the GCT and the CGCG represent a spectrum of a single disease process modified by the age of the patient and the site of occurrence.
For the most part, clear cell neoplasms of the salivary glands are adenocarcinomas of at least low-grade malignant potential. However, a rare benign clear cell tumor of major salivary glands can be distinguished as a histologic variant of oncocytoma and oncocytosis. Ten such cases have been identified in the files of the Armed Forces Institute of Pathology (Washington, DC). Eight patients were women, and nine of the lesions involved the parotid gland. All of the patients were middle-aged or older adults. The light-microscopic morphology and the phosphotungstic acid-hematoxylin (PTAH), PAS, and mucicarmine staining patterns were consistent with oncocytoma and oncocytosis. Transitions from typical eosinophilic oncocytes to clear cells were evident. Electron microscopy and histochemistry demonstrated that the clear cytoplasm seen by light microscopy was primarily due to artifact and intracytoplasmic glycogen. Mitochondria were the preponderant cytoplasmic organelles. Two patients were known to have experienced recurrent lesions.
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Fifty-five cases of primary salivary gland tumors of the tongue from the files of the Armed Forces Institute of Pathology are reported and analyzed and the results compared with the information in the literature. Five tumors were benign and 50 were malignant. The average age at presentation was 47 years for the benign tumors and 54.3 years for the malignant ones. Although the overall benign/malignant ratio was 1:10, women were more likely to have a malignant tumor than were men. The site of 80% of the benign tumors was the middle to anterior portion of the tongue, whereas over 85% of malignant tumors involved the base. Clinical signs and/or symptoms related to the site aroused suspicion in some cases but often were of short duration and in over 60% of cases did not occur. The most common benign tumor type was the myoepithelial variant of the benign mixed tumor. The most common malignant tumor type was the low-grade mucoepidermoid carcinoma (38%) followed by adenocarcinoma (20%), high-grade mucoepidermoid carcinoma (14%), adenoid cystic carcinoma (10%), and clear cell carcinoma (8%), with occasional basaloid, papillary cystadenocarcinoma, acinic cell and mucus-producing adenocarcinoma. Treatment was similar to that of other accessory salivary gland neoplasms of similar histologic type and clinical stage. Prognosis worsened with high histologic grade, old age, and advanced clinical disease at presentation.
First described in 1962, the so-called granular cell ameloblastic fibroma has been a rarely reported benign odontogenic tumor. On reviewing the literature, we have identified eight previously reported cases. All cases involved well-circumscribed radiolucencies in women who ranged in age from 53 to 65 years. Seven lesions occurred in the posterior body of the mandible, and one occurred in the premolar region of the maxilla. All lesions were treated with surgical excision, and no recurrences were identified during follow-up periods of 6 to 144 months. Two additional cases also appear to represent instances of this neoplasm, which bring the total number identified to ten. We describe the clinical, radiographic, and histopathologic features of two additional cases and suggest reasons the tumor should be referred to as central odontogenic fibroma, granular cell variant.
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.
Florid osseous dysplasia is a peculiar reactive or developmental bone disease that is known to appear only in the jaws. It has an inexplicable decided predilection for occurrence in middle-aged, black women. Extent of the disease may vary from a few isolated periapical lesions to diffuse involvement of the mandibular and maxillary alveolar processes. Radiographically, it is characterized by multiquadrant, globular, radiolucent-radiopaque lesions. Histopathologically, it is a benign fibro-osseous lesion that must be differentiated from other benign fibro-osseous lesions such as fibrous dysplasia, ossifying fibroma, Paget's disease, and sclerosing osteomyelitis on the basis of combined clinical, radiographic, and histological features. Correctly identifying this disease is important because it requires no treatment unless a secondary osteomyelitis develops. Sequestrae and osteomyelitis are complications arising when teeth are removed and removable dental prostheses are supported by diseased bone.
Epithelioid hemangioendothelioma (EH) is a recently described unusual vascular neoplasm of the soft tissues. Apparently identical tumors have also been described in the lung and and liver. Although no previous reports have described these lesions in the head and neck, twelve cases from this region are reported here. There is a wide age distribution throughout adulthood of affected patients. The 4-year-old patient in this series is the youngest thus far reported. There is no sex predilection. The submandibular region is the head and neck site most frequently involved. The unusual histologic appearance of these tumors is demonstrated by the fact that only one case was originally diagnosed as a vascular neoplasm. Nests and cords of pleomorphic epithelioid cells, spindle cells, and vacuolated cells and a hyalinized or myxochondroid stroma are features that distinguish EH. All eight of the tumors tested showed factor VIII-related antigen immunoreactivity. EH has a biologic potential intermediate between that of hemangioma and conventional angiosarcoma.
Although the calcifying odontogenic cyst (COC) is a well-established pathologic entity, it has been recognized that there is an odontogenic neoplasm with histologic features similar to the COC that has often been diagnosed as COC. Investigators have applied several terms to this neoplasm, but we prefer the term epithelial odontogenic ghost cell tumor (EOGCT). No reports have appeared previously in the literature describing either carcinoma arising in a COC or malignant EOGCT. Three cases are reported here with aggressive growth and histologic features strongly implying a malignant potential, although none is known to have metastasized. Two occurred in the maxilla and one in the mandible. One was discovered 9 years following removal of a typical COC, and another recurred rapidly after excision.
Immunohistochemical determination of the class of intermediate filaments (keratins, vimentin, desmin, neurofilaments, and glial fibrillary acidic protein) expressed by tumors has become an important diagnostic procedure for the histogenetic classification of neoplasms. A case of a poorly differentiated malignant neoplasm of the maxillary alveolar ridge which coexpressed keratin and desmin types of intermediate filaments is reported. These intermediate filaments have been associated with epithelial and muscle cell differentiation, respectively. The morphologic features of the tumor plus the expression of both these intermediate filaments indicate that this neoplasm represents a true carcinosarcoma.
Paget's disease of the jaw has the following characteristics: slow progression of jaw enlargement; bilateral jaw involvement; often polyostotic, but not generalized skeletal disease; diffuse, irregular radiopaque areas of the jaw; elevated serum alkaline phosphatase level; and a biopsy specimen showing thick, irregular bone trabeculae with a mosaic pattern of reversal lines and numerous osteoblasts and osteoclasts in a fibrovascular stroma. Management of a patient with Paget's disease of bone usually is carried out by treating the symptoms of the disease as they arise. Bone can be removed for esthetic reasons when needed.
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