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Biomedical subjects

H D Feiner

Publications and source records attributed to H D Feiner.

At least 37 records · Page 2Linked to original sources
PubMed1990

IgM monoclonal gammopathy/Waldenström's macroglobulinemia: a morphological and immunophenotypic study of the bone marrow.

The presence of a monoclonal paraprotein in the serum or urine raises the possibility of myeloma or lymphoma/leukemia. Yet, in a significant proportion of individuals with serum paraproteins, particularly those with low levels of paraprotein, clinical and routine bone marrow evaluation is not diagnostic of an underlying neoplasm. The purpose of this study was to define the pathologic basis for macroglobulinemia in patients whose routine bone marrow biopsies were not diagnostic of a lymphoplasmacytic neoplasm. We used immunofluorescence microscopy and flow cytometry of cell suspensions prepared from aspirated marrow, as well as immunohistochemistry of core biopsies, to perform immunopathologic evaluations of the bone marrow from 16 such patients. Seven individuals without a monoclonal serum paraprotein, who were similarly studied, served as controls. Our data indicate that 13 of the 16 patients with monoclonal serum IgM paraproteins whose routine bone marrow biopsies were normal or showed nondiagnostic changes morphologically had a dispersed monotypic B lineage population of concordant immunoglobulin heavy and light chain type in the bone marrow. The immunophenotype of these cells spanned the range from mature B cell to plasmacytoid B cell to plasma cell. In four of these 13 patients a diagnosis of lymphoplasmacytic lymphoma could be made on the basis of greater than or equal to 20% monoclonal B lineage cells among bone marrow mononuclear cells.

Aged↗
PubMed1989

Renal vascular effects of antihypertensive therapy in uninephrectomized SHR.

Serial determinations of protein excretion rate and systolic blood pressure (SBP) were made in spontaneously hypertensive rats (SHR) uninephrectomized (UNX) at six weeks of age and given tap water (CON), or water with hydrochlorthiazide, hydralazine and reserpine (HHR), captopril (CAP) or enalapril (ENP). Compared to CON, significant hypertension was prevented, kidney weight was lower and there was less proteinuria in HHR, CAP and ENP rats followed for 30 weeks after UNX. Morphologic studies of these four groups revealed that antihypertensive therapy reduced the incidence of glomerular sclerosis in UNX SHR by 50%. Despite complete absence of systemic hypertension, there was striking medial thickening of lobular arteries and arterioles of rats given the angiotensin converting enzyme (ACE) inhibitor, captopril. These vascular abnormalities were present to a lesser degree in rats given ENP, but were entirely absent in untreated animals or in those ingesting the HHR combination. Micropuncture studies performed five weeks after UNX in four additional groups of CON, HHR, CAP and ENP rats revealed that glomerular capillary pressure was elevated in CON and reduced by all three drug regimens. These studies support the hypothesis that glomerular capillary hypertension and/or nephron hypertrophy predispose to glomerular injury in this model of hypertension and reduced renal mass. ACE inhibitors and HHR are equivalent in their ability to prevent glomerular hypertension and damage in these rats, but the former, and in particular captopril, produce abnormalities of cortical vessels via a mechanism not dependent on the presence of systemic hypertension.

Animals↗
PubMed1989

Circumscribed intraductal carcinoma of the breast.

In a retrospective evaluation of 350 cases of proved intraductal carcinoma detected over a 3-year period, 13 had mammographic features similar to those of benign tumors. The carcinomas were sharply circumscribed, round or oval lesions that contained microcalcifications. These calcifications were smaller and more likely to be asymmetrically located within the nodule than those of the fibroadenomas that they mimicked. While the carcinomas appeared circumscribed on mammograms, microinvasion of surrounding tissue was proved histologically in five of 13 cases, and in another case biopsy revealed metastasis to an axillary lymph node. Although these carcinomas are relatively rare, mammographic detection is important as none were palpable at the time of diagnosis.

Breast Neoplasms↗
PubMed1988

Pathology of dysproteinemia: light chain amyloidosis, non-amyloid immunoglobulin deposition disease, cryoglobulinemia syndromes, and macroglobulinemia of Waldenström.

This review has dealt with four syndromes associated with dysproteinemia, and has emphasized studies of the tissue deposits and forms of tissue injury which occur in such patients. However, similar tissue deposits and tissue damage occasionally occur in the absence of a serum or urine paraprotein, in which case other clinical data are necessary to suggest the need for examination of tissue for Ig heavy and light chain determinants in order to provide a correct diagnosis of dysproteinemia. In such cases, one may speculate that there is a low rate of paraprotein production and secretion, in addition to tissue tropism. Some paraproteins are antibodies, in which case they may circulate and/or deposit as immune complexes, or bind to tissue antigens with immune complex formation in situ. Some paraproteins are also cryoproteins, and clues to this property can also be found in the tissue, particularly at the ultrastructural level. Thus, a wide spectrum of clinical manifestations of a B cell proliferative disorder may be associated with any of a variety of circulating paraproteins and a variety of forms of tissue deposit and injury. Consequently, the best understanding of an individual patient requires correlation of the clinical features of the disorder, the immunochemical characterization of the circulating and excreted paraproteins, and an immunohistochemical analysis of the tissue deposits and associated morphologic abnormalities. This should be correlated with histologic and immunohistologic assessment of bone marrow, looking for overt B cell neoplasia, the more difficult to define "lymphoproliferative disorders," or alterations in kappa to lambda plasma cell ratios which may correlate with the deposited material. Studies of the Ig synthesized by cultured bone marrow plasma cells, and biochemical analyses of the deposited material, have demonstrated structural abnormalities of paraproteins which may be responsible for their tissue deposition.

Agammaglobulinemia↗
PubMed1988

Congenital anomalies of the lungs in adults: MR diagnosis.

Over an 18-month period, 11 adults with congenital pulmonary anomalies within the sequestration spectrum, identified either surgically or radiographically by CT and/or angiography, were evaluated with MR. These included seven patients with bronchogenic cysts, two with intralobar pulmonary sequestrations, one with scimitar syndrome, and one with bronchial atresia. In each case, MR showed at least some findings indicative of the correct diagnosis. MR proved especially effective in the detection of abnormal fluid collections (nine cases) and the identification of anomalous vessels (three cases). Fluid collections were easily identified in all cases, including four cases with high-density collections on CT (two with bronchogenic cysts and two with intralobar pulmonary sequestration), especially when single-level, multiecho T2-weighted sequences were obtained. Calculated T2 values ranged from 78 to 439 msec (average, 223 +/- 123 msec). Although T2 values were statistically significant for differentiating fluid from muscle (p = .0012) and fat (p = .0046), they were not sufficiently specific to allow precise fluid characterization. Significant limitations were also apparent, such as an inability to detect alterations in the parenchymal architecture of the lungs (three cases) or intrapulmonary vascularity (one case). Despite this, we conclude that MR may be of considerable value in the assessment of congenital pulmonary anomalies and in select cases obviate more invasive diagnostic procedures.

Adolescent↗
PubMed1987

Glomerular hypertension and injury in desoxycorticosterone-salt rats on antihypertensive therapy.

Uninephrectomized male Munich-Wistar rats received either weekly subcutaneous injections of vehicle and water for drinking; injections of desoxycorticosterone (DOC) and 1% saline (SALT) for drinking; or DOC and SALT with hydrochlorthiazide, hydralazine, reserpine and KCl added. All studies were performed six weeks after UNX. At that time, rats receiving DOC and SALT alone were hypertensive and had significantly more proteinuria and morphologic evidence of glomerular injury than rats given vehicle and tap water which were normotensive. Antihypertensive therapy normalized mean arterial pressure in DOC-SALT rats, but failed to prevent proteinuria, mesangial expansion or focal segmental glomerular lesions. Micropuncture studies revealed that glomerular capillary pressure was elevated in both untreated and treated DOC-SALT animals. We conclude that drugs which successfully reduce systemic blood pressure may fail to correct glomerular capillary hypertension in DOC-SALT rats. As persistence of intrarenal hypertension is associated with significant glomerular injury, normalization of glomerular capillary pressure rather than systemic arterial pressure is crucial to the prevention of glomerular injury in this model.

Animals↗
PubMed1987

The existence of a protracted course in crescentic glomerulonephritis.

We describe a spectrum of clinical and morphologic features which may occur in idiopathic crescentic glomerulonephritis. Of note are patients who pursue a more indolent course to renal failure in contrast to typical rapidly progressive glomerulonephritis (RPGN). Patients following this protracted course have an insidious presentation with hematuria and renal insufficiency, and at the time of renal biopsy (usually after many months of clinical illness) show less extensive involvement with crescents, which are often in both cellular and fibrous stages. This form of crescentic glomerulonephritis is further distinguished from RPGN by frequent hypertension and the nephrotic syndrome, the absence of oligo-anuria and progression to renal failure over many months or even years.

Adolescent↗
PubMed1987

Breast sarcoma with giant cells and osteoid. A case report and review of the literature.

Breast sarcomas with giant cells and osteoid are rare and usually fatal. They should be distinguished from carcinomas with sarcomatous metaplasia. Our case is presented together with eight similar ones reported in the English literature. Their clinical, radiologic, gross, and histologic characteristics are analyzed. Most patients died within 1 1/2 years of diagnosis, survival apparently being related to the size of the tumor. Diagnosis is delayed because the tumor can be confused clinically and radiologically with a large fibroadenoma. Awareness of this problem, fine-needle aspiration, and computerized tomography may lead to earlier diagnosis and, consequently, improved survival. In our case, immunohistochemical studies supported the notion that the lesion was a primary sarcoma, rather than a carcinoma with sarcomatous metaplasia.

Adult↗
PubMed1986

Characterization of tissue amyloid by immunofluorescence microscopy.

Immunohistochemical classification of amyloid type was possible in 44 of 50 (88%) patients as judged by the concordance of immunofluorescence, clinical, serum, and urine immunoelectrophoresis, and bone marrow data. In frozen tissue sections incubated with a panel of antisera monospecific for immunoglobulin heavy chains, kappa and lambda light chains, and amyloid-A-related protein, the amyloid was classified as AL in 20 and AA in 24. In 6 patients the amyloid could not be classified because of the absence of reactivity in 2 and overlap staining in 4. The findings indicate that routine immunofluorescence examination of diagnostic biopsies is an important adjunct in the classification of amyloid.

Adult↗
PubMed1986

Glomerulonephritis in congenital cytomegalic inclusion disease.

Except for renal transplant recipients, glomerulonephritis has only very rarely been associated with renal cytomegalovirus (CMV) infection. The kidneys of five infants with congenital cytomegalic inclusion disease, including renal infection, were examined at autopsy. Two of the infants had glomerulonephritis. The younger, a 4-month-old female, had diffuse proliferative and necrotizing glomerulonephritis; virus was present in nuclei and cytoplasm of glomerular endothelial cells and, possibly, in leukocytes as well. There were no electron-dense deposits. The other infant, a 5-month-old male, had diffuse mesangial and focal segmental proliferative and sclerosing glomerulonephritis; electron-dense mesangial deposits were seen ultrastructurally. Three additional infants (a newborn male, a 2-day-old male, a 6-week-old female), all with CMV in tubules and one with a single glomerular inclusion, had only rare glomerular abnormalities, i.e., mesangial proliferation in less than 10 per cent of glomeruli (one infant) and segmental sclerosis in less than 1 per cent of glomeruli (all three infants). Thus, congenital renal CMV infection was associated with proliferative glomerulonephritis in the two infants who survived the longest. The three with shorter survival times had only minor glomerular alterations.

Cytomegalovirus Infections↗
PubMed1986

Carcinoma of the prostate with atypical immunohistological features. Clinical and histologic correlates.

In seven patients with undifferentiated carcinoma of the prostate, the immunohistochemical stain for prostate-specific antigen was negative. The stain for prostatic acid phosphatase done on the same tissue samples was diffusely positive in three, focally positive in three, and negative in one. Only the three with diffusely positive immunostaining had elevated serum acid phosphatase levels, although five had evidence of metastatic disease. All seven neoplasms were histologically similar, being composed of large cells with large nuclei, a moderate amount of cytoplasm, and indistinct cell borders. All tumors grew as broad sheets within the prostatic stroma as well as in the prostatic urethra; in six cases. Thus, prostatic carcinoma with this histologic pattern frequently loses prostate-specific antigen immunoreactivity. Awareness of this occurrence should prevent a misdiagnosis of urothelial carcinoma in such cases. The prostatic origin of these neoplasms can usually be verified by prostatic acid phosphatase immunostaining, which proves to be more sensitive in this particular setting.

Acid Phosphatase↗
PubMed1986

Glomerular injury in uninephrectomized spontaneously hypertensive rats. A consequence of glomerular capillary hypertension.

Micropuncture and/or morphologic studies were performed in intact Wistar-Kyoto rats (WKY) (group 0), intact spontaneously hypertensive rats (SHR) (groups 1 and 5), uninephrectomized (UNX) WKY (groups 2 and 6), and UNX SHR (groups 3 and 4, 7 and 8). UNX was performed when rats were 5 wk of age. Groups 0-4 were observed for 34 wk after which whole kidney clearance and morphologic studies were performed. Groups 5-8 underwent micropuncture study at 10 wk of age. Groups 4 and 8 were fed a diet containing 6% protein. All other rats ingested standard laboratory diet. 5 wk after UNX, normotensive group 6 had higher single nephron glomerular filtration rate (SNGFR) and initial glomerular plasma flow rate (QA) than intact, hypertensive group 5. Glomerular transcapillary hydraulic pressure difference (delta P) was similar in these two groups. Hypertensive group 7 exhibited less elevation in SNGFR and QA than group 6, but delta P was significantly increased. The presence of glomerular capillary hypertension in UNX SHR at 10 wk was associated with the development of significant proteinuria and an increased incidence of mesangial expansion and glomerular sclerosis at 7 mo (group 3) as compared with groups 0, 1, and 2. Protein restriction prevented the development of increased delta P in UNX SHR (group 8) and also conferred long-term protection from increased urinary protein excretion and glomerular injury (group 4). These studies suggest that glomerular capillary hypertension predisposes to glomerular injury in this model of hypertension with reduced renal mass.

Animals↗
PubMed1986

Oncocytic adenoma of the parotid gland with psammoma bodies.

An unusual slow-growing tumor was found in the superficial lobe of the right parotid gland. It was multilobulated and encapsulated and consisted of sheets of epithelial oncocytes and minor foci of myoepithelium and ducts. Psammoma bodies were abundant. An antibody directed against keratin protein was localized in all tumor cells and in ductal but not acinar elements of adjacent parotid tissue. Ultrastructurally, the neoplastic cells proved to be ductal epithelial and myoepithelial oncocytes.

Adenoma↗
PubMed1985

Small intestinal lymphoma in three patients with acquired immune deficiency syndrome.

Three cases of small bowel lymphoma in young homosexual men are presented. All three had acquired immune deficiency syndrome as demonstrated by demography, sexual history, cachexia, opportunistic infections by Cytomegalovirus, Pneumocystis carinii, atypical Mycobacterium, Candida, and/or evidence of immune deficiency, such as skin test anergy, lymphopenia, inversion of T-helper/T-suppressor ratio, and diminished lymphocyte response to either phytohemmaglutinin or pokeweed mitogen. All had peripheral and/or abdominal lymphadenopathy, and gastrointestinal symptoms, e.g., diarrhea, spasms, constipation, and oral candidiasis. The diagnosis of lymphoma was made at laparotomy in all cases. All three had complete removal of localized tumor (stage Ie or IIe), yet died within 6 months of surgery and/or chemotherapy. Thus gastrointestinal complaints may not always be related to "gay bowel" syndrome, or other infectious diseases in patients with acquired immune deficiency syndrome. Small intestinal lymphoma should be added to the list of neoplasms to which this group is susceptible.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Inflammatory abdominal aortic aneurysm: report of six cases.

Six cases of inflammatory aneurysm of the abdominal aorta are described. All patients were male, aged 59 to 80 years, and five had symptomatic atherosclerotic cerebrovascular or cardiovascular disease. In three the diagnosis of inflammatory aneurysm was suggested preoperatively on the basis of computed tomographic or ultrasonographic scanning. On gross examination the aneurysm wall was about 1 cm thick and included an inner narrow layer of atherosclerotic plaque, which was contiguous with the outer thick fibroinflammatory component. Microscopically, this component consisted of fibroblasts and collagen, which entrapped fat, nerves, and lymph nodes and was infiltrated by lymphocytes and plasma cells. Plasma cells, lymphocytes, and fibroblasts predominated in four patients, while two showed abundant dense collagen with fewer inflammatory cells and fibroblasts. There was associated vasculitis, predominantly phlebitis, in three. Inflammatory aneurysms represent a distinct group of abdominal aortic aneurysms.

Aged↗
PubMed1984

Testicular stromal tumor with myofilaments: ultrastructural comparison with normal gonadal stroma.

The ultrastructural features of two testicular stromal tumors were compared with those of normal gonadal stroma. The two patients with tumor were 28 and 48 years old and had no endocrine abnormalities. No metastases or recurrences occurred after 32 and 12 months of follow-up, respectively. The tumors were composed of bundles of oval to spindle-shaped cells. Ultrastructurally, intracytoplasmic myofilaments were characteristic of the tumor cells, which resembled the contractile peritubular and interfollicular cells of normal testis and ovary. In normal testicular tissue, an intertubular mesenchymal cell may differentiate into a peritubular contractile cell or into an interstitial (Leydig) cell. Therefore, testicular stromal tumors with myofilaments may originate from an intertubular mesenchymal cell that is capable of differentiating into a cell with contractile elements.

Adult↗