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Biomedical subjects

G M Kleinman

Publications and source records attributed to G M Kleinman.

31 records · Page 2Linked to original sources
PubMed1980

Creutzfeldt-Jakob disease with extensive degeneration of white matter.

Degeneration of the white matter is uncommon is Creutzfeldt-Jakob disease (CJD), and when it occurs is usually mild, and limited in distribution. In the case of 77-year-old woman with CJD lasting 1 year, there was extensive degeneration of cerebral white matter in addition to severe loss of neurons and hypertrophic astrogliosis in cortex and striatum. The extent and severity of white matter lesions makes the case unusual.

Aged↗
PubMed1980

Microcystic variant of meningioma: a light-microscopic and ultrastructural study.

Meningiomas occasionally show small areas in which the cells are stellate with slender processes surrounding microscopic spaces, giving a lace-like appearance to the tissue. In the case of a 52-year-old woman with a tumor rising from the falx, virtually the entire tumor was composed of lacy reticulated tissue. Most of the tumor cells had processes that stained blue with phosphotungstic acid hematoxylin, suggesting the appearance of a glioma. However, electron microscopy showed that the extracellular space was extensive, and the tumor cells had long cytoplasmic processes which formed interdigitations with one another. Desmosomes were numerous. The immunoperoxidase method for glial fibrillary acidic protein gave negative results. On the basis of these histologic features, we suggest that this tumor was a microcystic variant of meningioma.

Female↗
PubMed1980

Management of intramedullary spinal cord tumors.

From January 1962 to May 1979, 23 patients with biopsy-proved intramedullary spinal cord tumors were treated initially with total resection, subtotal resection, irradiation, or subtotal resection and irradiation. Local control was achieved in 1/2 patients after total resection, 1/3 after subtotal resection, 8/9 after subtotal resection and radiation therapy, and 5/8 after radiation therapy alone. The patients with ependymomas exhibited a radiation dose-response relationship; of eight patients followed five or more years postirradiation, local control was achieved in 2/3 with time dose fraction (TDF) less than 55, 2/3 with TDF 55-65, and 2/2 with TDF greater than 65. The actuarial 5- and 10-year survival rates were 58% and 23% for astrocytoma, and 100% and 73% for patients with ependymoma, respectively. Neurological deficits improved or became totally normal after initial irradiation. Patterns of failure, management of recurrences, and radiotherapeutic techniques and dose recommendations are discussed.

Adolescent↗
PubMed1980

Delayed stroke following carotid occlusion.

A 60-year-old patient suffered a lethal hemispheric infarction 3 days after angiographically documented occlusion of the ipsilateral cervical internal carotid artery and while receiving anticoagulant therapy. Pathologic evidence is consistent with embolism from the distal "tail" of a propagated carotid thrombus as the mechanism of his stroke.

Carotid Artery Thrombosis↗
PubMed1980

Villonodular synovitis in the spinal canal: case report.

Villonodular synovitis is believed to be an inflammatory, proliferative reaction of synovial tissues. The case of a 65-year-old woman with a cervical epidural mass is presented in which histological examination showed that the lesion was villonodular synovitis, an extremely rare occurrence. Because of its cellularity and occasional multinucleated giant cells, villonodular synovitis may be confused with metastatic malignancies or giant-cell tumor of bone.

Aged↗
PubMed1979

Pyramidal infarction in the medulla: a cause of pure motor hemiplegia sparing the face.

We present a case with an infarct limited to the right pyramidal tract in the medulla. The lesion lay approximately 1 cm below the pontomedullary junction. On the basis of this case and three previously reported cases of medullary pyramidal infarction, there is defined a syndrome of severe hemiplegia with relative sparing of the face, tongue and articulation, minimal sensory loss, and good recovery. The hemiplegia is initially flaccid and later spastic. Transient symptoms, referable to the tegmentum of the medulla, occur at the onset, and reflect ischemia in the deeper territory of a paramedian penetrating vessel.

Brain↗
PubMed1978

Computed tomography in primary malignant lymphoma of the brain.

Primary malignant lymphoma of the brain is a rare lesion characterized clinically by varied nonspecific neurologic deficits and usually a rapid fulminant deterioration and death. This course may be altered by radiotherapy, and early diagnosis assumes major importance. Laboratory tests, EEG, radionuclide scans, angiography, and pneumoencephalography may not show definite abnormality in the early stages. This report concerns four cases in which good correlation between the location of the brain lesion and the abnormality on computed tomography scan was demonstrated.

Adult↗
PubMed1978

Computed tomography of herpes simplex encephalitis, with clinicopathological correlation.

The computed tomographic (CT), clinical, and pathologic findings in 9 patients with biopsy-proven herpes simplex encephalitis (HSE) were reviewed. Seventeen scans (5 plain, 12 contrast enhanced) were analyzed. The major CT finding was a low-absorption abnormality, present in 11 of 17 scans (64%), affecting primarily the temporal lobes. Mass effect was evident in 9 of 17 (52%). Of the 12 contrast-enhanced scans, 6 (50%) showed an abnormal enhancement pattern affecting primarily the sylvian fissure and opercular areas. CT abnormalities are characteristic enough that, in the proper clinical setting, they lend support to the correct diagnosis.

Adolescent↗
PubMed1978

Malignant transformation in benign cerebellar astrocytoma. Case report.

The authors give follow-up information on Case 59 of Cushing's 1931 series of cerebellar astrocytomas. The patient died with a malignant cerebellar astrocytoma 48 years after partial removal of a previously benign astrocytoma at the same site. Including the present one, there have been only five reported cases in which this has occurred. Ordinarily, juvenile pilocytic astrocytomas are of extremely genign character, and it is well established that even with incomplete resections patients have survived for years without progression of the tumor. Not all of the cases so reported can be wholly accepted as respresenting malignant transformation of the tumor, but may instead be instances of recurrence of an inherently benign glioma since the presence of features such as endothelial hyperplasia or nuclear atypicality in a juvenile pilocytic astrocytoma does not warrant is being classified as malignant. Features truly suggestive of malignancy are hypercellularity, frequent mitoses, necrosis, and, in some instances, a diffusely infiltrative growth pattern; all of these features were found in the present case.

Astrocytoma↗
PubMedDate not supplied

CA-125 and carcinoembryonic antigen assay vs. cytodiagnostic experience in the classification of benign ovarian cysts.

OBJECTIVE: To compare the relative strengths of two factors involved in making an accurate differentiation between functional and epithelial ovarian cysts, along with their combination: (1) the cytologist's level of experience in interpreting ovarian cytology, (2) the use of the tumor markers carcinoembryonic antigen (CEA) and CA-125 in cyst fluid, and (3) a combination of (1) and (2). STUDY DESIGN: Papanicolaou-stained sediments from fluid aspirated from 31 resected ovarian cysts (6 functional and 25 epithelial) were blindly and independently evaluated by five pathologists with varying experience in ovarian cytology. Cyst fluid supernatant was used for CEA, enzyme-linked immunosorbent assay, and CA-125 radioimmunoassay; CEA levels > 5 ng/mL or CA-125 > 5,000 U/mL were considered elevated. Cysts were categorized cytologically and histologically as functional or epithelial and by tumor markers as "neither elevated" or "either or both elevated" (EBE). RESULTS: The agreement of histologic diagnosis with each pathologist's cytologic diagnosis ranged from 53% to 84% (53%, 71%, 83%, 82%, 84%), corresponding to increasing level of experience. The percentage of agreement with EBE was 77%, whereas combined experienced pathologist's diagnosis and EBE was 87%. Kappa equaled .45 for experienced cytopathologist's diagnosis or EBE alone. Kappa equaled .53 when the pathologist or EBE diagnosed an epithelial cyst, indicating results unlikely to occur by chance. CONCLUSION: The distinction of functional from epithelial ovarian cysts is best achieved by combining measurement of the tumor markers CEA and CA-125 with a high level of cytopathology experience.

Adult↗
PubMedDate not supplied

Plexiform schwannoma.

A 33-year-old man had a multinodular tumor on his left index finger. Microscopy revealed a plexiform nerve sheath tumor resembling schwannoma. Including this case, 11 patients from 9 to 39 years old, have been reported with plexiform schwannoma. One patient had von Recklinghausen's neurofibromatosis, and all but one were free of recurrence from 1.5 to 6 years later. Plexiform schwannoma should be distinguished from plexiform neurofibroma because it appears to have neither a significant association with neurofibromatosis nor a propensity for malignant transformation.

Adult↗
PubMedDate not supplied

Malignant meningiomas: CT and histologic criteria, including a new CT sign.

Histologic features that could be correlated with malignancy were assessed by reviewing the microscopic slides of 167 meningiomas. Six tumors had shown two or more recurrences. In three having three or more recurrences, the number of mitoses counted under high power was higher than in those meningiomas showing clinically benign behavior. The radiologic and histologic features of seven meningiomas showing malignant clinical behavior and/or malignant histologic features were also evaluated and correlated. On computed tomography (CT), most of the malignant meningiomas were moderately hyperdense before contrast enhancement, but showed no or minimal calcification. Marked perifocal edema was common. Indistinct tumor margins or, occasionally, deeply extending fringes of tumor interdigitating with brain substance, marked bone destruction, or prominent pannus or tumor, extending well away from the globoid mass, termed "mushrooming," is described for the first time and seems to be the most useful correlate of histologic or clinical malignancy. This sign occurred in five of the seven cases and was absent in about 250 benign meningiomas reviewed. It was visible only at surgery in one additional case.

Adult↗