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Biomedical subjects

I Ramzy

Publications and source records attributed to I Ramzy.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Lymph node aspiration biopsy. Diagnostic reliability and limitations--an analysis of 350 cases.

The results of fine needle aspiration biopsy of lymph nodes in 350 patients and the modified biopsy technique used at our institution are discussed. Of the 350 cases, 209 aspirates were categorized as cytologically malignant, 102 as benign, 30 as suspicious for malignancy, and 9 as unsatisfactory. Cervical lymph nodes were most commonly sampled (58%), and supra-clavicular nodes were most likely to be malignant (90%). The overall diagnostic accuracy achieved was 94%. One false-positive and 9 (2%) false-negative results were observed in the 350 cases. In 3% of the 30 cases diagnosed as suspicious for malignancy, follow-up open biopsy of the lymph nodes in question proved them benign. The advantages and limitations of the procedure are discussed, as well as some of the possible sources of error, particularly in the diagnosis of lymphomas.

Biopsy, Needle↗
PubMedDate not supplied

Schistosoma haematobium infection in Egyptian schoolchildren: demonstration of both hepatic and urinary tract morbidity by ultrasonography.

Parasitological, clinical and ultrasonographical studies were performed upon 422 schoolchildren aged 12-16 years living in a village in the Fayoum where Schistosoma haematobium, but not S. mansoni, was transmitted. Over half of the children gave a history of receiving praziquantel therapy during the preceding 2 years. Symptoms (e.g., haematuria, burning micturition), signs (e.g., hepatomegaly, splenomegaly) and urinary findings (e.g., haematuria, proteinuria) correlated better with the presence and intensity of S. haematobium infection after correcting for this variable. Renal obstructive lesions detected by ultrasound were 2 and 3 times as common in those with moderate and heavy infections as in those with no or light infections, and urinary bladder wall lesions were far more frequent in those with moderate and heavy infections. A mild grade of periportal fibrosis, hepatomegaly and splenomegaly were present in some children in all groups. However, the prevalence of splenomegaly correlated directly with the intensity of infection; liver lesions occurred much more frequently in children with infection or a history of treated infection than in non-infected children denying recent treatment; and no child had hepatomegaly or splenomegaly in the absence of periportal fibrosis.

Adolescent↗
PubMedDate not supplied

Histologic and immunohistochemical analysis of tissue response to adenovirus-mediated herpes simplex thymidine kinase gene therapy of ovarian cancer.

Herpes simplex virus (HSV) thymidine kinase (tk) gene incorporated into adenovirus was delivered intraperitoneally (ip) followed by an antiherpetic prodrug and topotecan in patients with recurrent epithelial ovarian cancer. Tissue response was evaluated. Ten patients underwent secondary debulking with subsequent delivery of ADV-HSV-tk therapy. Two patients each were treated at dose level 1 (2 x 10(10) vector particles = VP), 2 (2 x 10(11) VP), and 3 (2 x 10(12) VP); four patients were treated at dose level 4 (2 x 10(13) VP). Five patients underwent second-look surgery about one month after gene therapy (GT). Treatment response, presence of vector DNA, protein expression of steroid hormone receptors, p53, c-erbB2 and Ki67 protein were analyzed. At second-look, two out of five patients were tumor-free and none of their peritoneal biopsies showed vector DNA. After GT, the vital tumor mass was smaller, desmoplastic reaction had increased, and tumors were less differentiated with an increase of Ki67 expression. There was no change in expression of hormone receptors, p53, or c-erbB2. ADV-HSV-tk GT appears to eliminate cells with higher differentiation first and might induce fibrosis. Dedifferentiation might render residual cells more sensitive to chemotherapy secondary to their subsequent higher mitotic activity.

Adenoviruses, Human↗
PubMedDate not supplied

Clindamycin and ibuprofen effects on chlamydial salpingitis in mice.

To evaluate the effects of clindamycin and ibuprofen on a model of upper genital tract chlamydial infection in mice, 64 Swiss Webster white mice were inoculated in the left ovarian bursa with a mouse pneumonitis strain of Chlamydia trachomatis. Chlamydia-inoculated mice received clindamycin, ibuprofen, clindamycin and ibuprofen, or no treatment. Mice were killed at intervals, and their genital tracts were examined grossly and microscopically for evidence of infection and cultured for Chlamydia. Sixty-seven per cent of inoculated, untreated mice manifested gross evidence of inflammation compared with 22.4% of mice in any treatment group (P less than .025). C. trachomatis was isolated in 10.2% of mice treated with any drug regimen, whereas 46.7% of untreated mice were culture-positive (P less than .025). In this model, therapy with clindamycin, ibuprofen, or both drugs in combination decreased gross and histologic evidence of inflammation as well as the rate of recovery of C. trachomatis from the genital tract.

Animals↗
PubMedDate not supplied

Aspiration biopsy of osseous metastasis of retroperitoneal paraganglioma. Report of a case with cytologic features and differential diagnostic considerations.

BACKGROUND: Paragangliomas are uncommon tumors, only 10% of which are malignant, as evidenced by metastatic disease. It is rare for paraganglioma to present with symptomatic osseous metastases. CASE: A retroperitoneal paraganglioma presented in a 52-year-old man as painful metastases in the rib and vertebrae. Fine needle aspiration (FNA) of a lumbar vertebral lesion showed cells arranged singly and in loose clusters with fragile, vacuolated or finely granular cytoplasm, marked anisonucleosis and mitoses. Rare zellballen-type structures and intranuclear inclusions were present. Immunohistochemical studies of a subsequent FNA core biopsy of the retroperitoneal mass showed strong immunoreactivity with chromogranin and negative staining for keratin; that was helpful in differentiating this tumor from others in the differential diagnosis. CONCLUSION: The cytologic diagnosis of paraganglioma is difficult as these tumors exhibit a plethora of features that overlap those of many other neoplasms. The diagnosis can be confirmed with appropriate immunohistochemical studies of corresponding core biopsies.

Biomarkers, Tumor↗
PubMedDate not supplied

Gynecomastia: cytologic features and diagnostic pitfalls in fine needle aspirates.

OBJECTIVE: To illustrate some of the uncommon cytologic findings of gynecomastia, such as apocrine metaplasia, cellular atypia and foamy macrophages, that can be misinterpreted as evidence of malignancy. STUDY DESIGN: The clinical data and fine needle aspiration (FNA) cytologic material from 100 men with the diagnosis of gynecomastia were retrospectively reviewed. The excisional biopsy slides were available for 16 cases. For comparison, FNA smears from five men with breast lesions other than gynecomastia were studied. RESULTS: The patients ranged in age from 23 to 91 years. Cytologic findings were as follows: cohesive sheets of cells containing 20-1,000 cells (98%); scattered, single, bipolar cells (78%); spindle cells (68%); ductal epithelial atypia (26%); apocrine metaplasia (8%); and foamy histiocytes (12%). In nine cases the atypia was marked, and in two of them the possibility of malignancy could not be ruled out. Surgical follow-up on 16 patients, including the cases with marked atypia, showed gynecomastia. In one case, gynecomastia was associated with intraductal papilloma. No correlation between the underlying etiology and atypical cytologic features of gynecomastia was identified. CONCLUSION: Apocrine metaplasia and epithelial atypia are common findings in gynecomastia. Attention to the cell patterns, the presence of sheets of ductal cells and absence of atypical single cells will point to the correct diagnosis.

Adult↗
PubMedDate not supplied

Proliferative activity in invasive breast carcinoma: a comprehensive comparison of MIB-1 immunocytochemical staining in aspiration biopsies to image analytic, flow cytometric and histologic parameters.

OBJECTIVE: To use MIB-1 antibody to assess proliferative activity in fine needle aspiration (FNA) samples of invasive breast carcinoma and compare these results to multiple other measures of proliferative activity. STUDY DESIGN: FNA slides from 62 patients with invasive breast carcinoma were subjected to staining with MIB-1. Quantitative MIB-1 values were compared to image analytic proliferative fractions (IPF) obtained from the same FNAs. MIB-1 values were also compared to flow cytometric S-phase fractions (SPF) and S + G2/M-phase fractions (FPF) and to histologic assessment of mitotic count (MC) in resected tumors. RESULTS: MIB-1 values, IPF, SPF, FPF and MC were suitable for evaluation in 55, 53, 50, 50 and 56 cases, respectively. MIB-1 values showed good correlation with IPF in FNAs (correlation coefficient = .57, P <.00001). MIB-1 values also showed correlation with SPF (correlation coefficient =.447, P = .003), FPF (correlation coefficient = .325, P = .023) and MC (correlation coefficient = .402, P = .01) in resected tumors. CONCLUSION: This study supports the use of MIB-1 values obtained from FNA samples for assessment of proliferative activity in invasive breast carcinoma, based on correlation of these values with multiple other parameters of proliferative activity. Assessment of these values can play a role in predicting prognosis and in selecting patients with invasive carcinoma of the breast for preoperative or adjuvant chemotherapy.

Adenocarcinoma↗
PubMedDate not supplied

Cryptococcal osteomyelitis. Report of a case with aspiration biopsy of a humeral lesion with radiologic features of malignancy.

BACKGROUND: Osteomyelitis due to Cryptococcus neoformans typically exhibits lytic lesions on radiographs. Extensive periosteal reaction is an uncommon feature. CASE: A 68-year-old man presented with pain and swelling in the left elbow. Radiologic studies exhibited a lytic humeral lesion with extensive periosteal reaction, interpreted as a malignant neoplasm. Fine needle aspiration biopsy (FNA) revealed abundant cryptococcal organisms. CONCLUSION: Cryptococcus is an uncommon cause of lytic osseous lesions that may mimic malignant neoplasms. Extensive periosteal reaction may support a radiologic diagnosis of primary osseous malignancy in rare cases. FNA with examination of Diff-Quik-stained slides may be employed for distinguishing cryptococcal osteomyelitis from malignant tumors and for prompt identification of the organisms.

Aged↗
PubMedDate not supplied

Fine needle aspiration diagnosis of transitional cell carcinoma metastatic to the brain. A case report.

BACKGROUND: Transitional cell carcinoma (TCC) rarely metastasizes to the brain. In this case, aspiration of a cystic brain lesion was performed and a cytologic diagnosis made. To the best of our knowledge, this is the first reported case of TCC metastatic to the brain diagnosed by fine needle aspiration. CASE: A 72-year-old male with a past medical history of invasive TCC, colonic adenocarcinoma and prostatic adenocarcinoma presented with a large, right, temporal, cystic mass. Fine needle aspiration was performed intraoperatively, and a cytologic diagnosis of metastatic TCC was rendered and confirmed by subsequent tissue examination. CONCLUSION: Intraoperative fine needle aspiration of cystic tumors can be useful in identifying the primary site. The cytologic features of intracerebral metastatic TCC can differ significantly from those observed in urinary tract specimens of high grade TCC. A predominance of large fragments of malignant cells with numerous mitotic figures and apoptotic bodies was seen in the former. The background showed high grade, single transitional cells similar to those observed in urinary tract samples of TCC.

Aged↗
PubMedDate not supplied

Cell preparation methods and criteria for sample adequacy. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: Cell Preparation Methods Standardized fixation and optimal staining Sampling of cervix, sampling error, homogenization of sample, subsampling Assessment of liquid-based preparations: efficacy and economic impact Training and transitional procedures before full implementation of new technologies Criteria for Sample Adequacy Clinician responsibility for collecting and providing representative sample to laboratory Collection instruments, number of slides Cellular content of samples: evidence of transformation zone (TZ) sampling, number of squamous cells present, obscuring factors Screening issues CONSENSUS POSITION The conventional cervical smear remains the standard method of cervical cancer screening but has limitations in individual test sensitivity and specificity. Sample takers should: (1) receive appropriate training in sample collection, (2) be held responsible for providing the laboratory with appropriate samples, and (3) have their performance monitored. The instruments used for sampling should collect cells from both the ectocervix and endocervix; optimally, TZ sampling, represented by the presence of endocervical or squamous metaplastic cells, should be identifiable in samples other than atrophic specimens. The adequacy of a specimen (as judged microscopically) does not guarantee that it is representative of the cervix. Each cytology report should include a comment on cellular content/adequacy of the specimen. Liquid-based preparations may overcome many of the inherent problems with the conventional cervical smear. ONGOING ISSUES: We need further data on the cost-effectiveness of making two slides from cervical specimens and/or using two samplers rather than a single one. Do we have enough information to make recommendations as to the appropriate type of sampler to be used in particular situations, such as routine screening? What is the best method of screening for/detecting endocervical glandular neoplasia? How are such terms as unsatisfactory and inadequate defined in cervical cytology classifications other than the Bethesda System? What number and types of epithelial cells should be present (visualized) in a cervical smear or liquid-based preparation for it to be considered adequate? Do we need to have evidence of TZ sampling in specimens taken during the follow-up period after treatment of squamous intraepithelial lesion or after detection of endocervical glandular neoplasia? What criteria for obscuring factors, such as blood and inflammation, should be used in assessing adequacy? Cost-benefit analyses of utilizing liquid-based preparations are needed. Should we inform women about the technical details of the test methods available or chosen by the laboratory? Are women in a position to decide which method is the most appropriate to assess their cervical scrape sample? We need to obtain more information about the properties of proprietary liquid fixative/transport media with respect to inactivation of viral pathogens, tuberculosis and other bacterial pathogens and suitability for immunobiologic and molecular tests, etc. We need to obtain more information on the use of stoichiometric stains and the limitations of Papanicolaou stain for image analysis systems. The use of liquid-based preparations for nongynecologic cytopathology and ancillary tests must be considered, including criteria for adequacy. We need to obtain more information on the time required for and best methods of training experienced cytotechnologists to become competent at assessing liquid-based cervical preparations.

Cell Biology↗
PubMedDate not supplied

Increased detection of epithelial cell abnormalities by liquid-based gynecologic cytology preparations. A review of accumulated data.

OBJECTIVE: To review published and other available data comparing the effectiveness of liquid-based cytology preparations in detecting epithelial cell abnormalities in cervicovaginal (gynecologic) cytology as compared to the conventional Papanicolaou test. STUDY DESIGN: Available split-sample data comparing liquid-based gynecologic cytology preparations with the conventional cervical cytologic test were collated from published studies, unpublished studies reported on at professional meetings or in the press, and from Food and Drug Administration Premarket Clinical Trials on ThinPrep and AutoCyte PREP. Data were stratified with regard to use of newer preparatory instrument models, use of varying collection devices and different split-sample protocols. RESULTS: Available data from split-sample studies of liquid-based methods showed overall increased detection of epithelial cell abnormalities. Results have varied considerably from study to study and appear to be influenced by collection protocol methods and probably by collection devices' different delivery of cellular material in split-sample studies, first to the conventional smear and second to the liquid-based medium. Newer preparatory instrument models may also enhance detection. CONCLUSION: Liquid-based gynecologic cytology preparations increase detection of epithelial cell abnormalities, as compared to the conventional, single-slide cervical cytologic smear, based on available data from split-sample studies. The true potential impact of these methods in enhancing detection of epithelial cell abnormalities awaits accumulation of data from direct-to-vial studies, especially data on detection of biopsy-confirmed high grade squamous intraepithelial lesions from a wide variety-of clinical practice settings.

Automation↗
PubMedDate not supplied

Serous surface carcinoma of the peritoneum: useful role of cytology in differential diagnosis and follow-up.

OBJECTIVE: To determine the role of cytology in differentiating serous surface carcinoma of the peritoneum (SSCP) from other morphologically similar tumors, including ovarian carcinoma and other peritoneal lesions, and to define the value of cytology in the follow-up of patients with SSCP. STUDY DESIGN: Twenty-one ascitic fluids and seven peritoneal washings obtained from 19 patients with histologically confirmed SSCP were reviewed and their cytologic features tabulated and analyzed. RESULTS: Eighteen of the specimens were from initial diagnostic paracenteses or exploratory laparotomies. These showed mostly three-dimensional tumor cell clusters, as well as single malignant cells, with occasional papillae. The cytoplasm was abundant and often vacuolated. The cytomorphologic features of SSCP enabled differentiation from other conditions involving the peritoneal surface, including mesothelial hyperplasia, malignant mesothelioma, endometriosis and endosalpingiosis. However, there were no characteristic features that differentiated SSCP from metastatic serous carcinoma of the ovary. Four of the peritoneal washings were from second-look operations; in each of these cases the presence of tumor cells in the cytologic preparations correlated with positive biopsy results. Furthermore, six of the paracenteses were performed for recurrent ascites and enabled detection of recurrent disease, obviating the need for invasive procedures. CONCLUSION: Cytomorphologic examination of ascitic fluids and peritoneal washings serves a valuable role in the initial diagnosis of SSCP, in the detection of recurrent disease and as a useful adjunct to multiple biopsies in the second-look operation. It can differentiate SSCP from several other lesions but not from serous carcinoma of the ovary.

Adult↗
PubMedDate not supplied

Glandular lesions of the cervix. Validity of cytologic criteria used to differentiate reactive changes, glandular intraepithelial lesions and adenocarcinoma.

OBJECTIVE: To determine the validity and reproducibility of various cytologic criteria as discriminators between different glandular lesions of the cervix. STUDY DESIGN: Seventy-three cervicovaginal smears with glandular lesions and a documented histologic and/ or clinical correlation were studied. The lesions included reactive changes, low grade glandular intraepithelial lesion (LGIL) (encompassing endocervical glandular dysplasia), high grade glandular intraepithelial lesion (HGIL) (encompassing adenocarcinoma in situ) and invasive adenocarcinoma (IA). Twenty-three cytologic criteria were used to evaluate the smears, and the results were scored and statistically analyzed. RESULTS: Reactive lesions consistently showed well-defined cell borders, normal nuclear/cytoplasmic (N/C) ratio, minimal or absent nuclear overlapping, round to oval nuclei with fine chromatin and prominent nucleoli. HGIL (adenocarcinoma in situ) showed feathered edges, rosettes, cell strips, increased N/C ratio, elongated nuclei, marked nuclear overlapping and nuclei with hyperchromatic, coarse chromatin. IA shared features with HGIL but had a greater tendency to show a dirty background, single cells, mitotic figures, nuclear pleomorphism and large nucleoli. Logistic regression studies indicated that the presence of mitotic figures, a dirty background and single cells increases the odds ratio for predicting invasion. LGIL showed features similar to those of high grade lesions, but the changes were more subtle. These lesions were also less cellular and less likely to show cell strips, feathered edges and rosettes. Similar to HGIL and IA, LGIL showed nuclear overlapping, increased N/C ratio, oval to elongated nuclei and nuclear hyperchromasia. CONCLUSION: There is overlap between the cytologic criteria for the various glandular lesions of the cervix. However, some of these criteria can consistently distinguish clinically significant lesions from reactive benign changes seen in the glandular epithelium.

Adenocarcinoma↗
PubMedDate not supplied

Ber-EP4 for differentiating adenocarcinoma from reactive and neoplastic mesothelial cells in serous effusions. Comparison with carcinoembryonic antigen, B72.3 and Leu-M1.

OBJECTIVE: To evaluate the efficacy of Ber-EP4 in distinguishing epithelial cells from mesothelial cells in routine cytologic preparations. STUDY DESIGN: Paraffin-embedded cell blocks of serous effusions from 32 patients (11 metastatic adenocarcinomas, 16 reactive mesothelial proliferations and 5 malignant mesotheliomas) were immunostained with Ber-EP4. For comparison, cell block preparations of adenocarcinomas and mesotheliomas were also immunostained with the most commonly applied markers of adenocarcinoma: carcinoembryonic antigen (CEA), B72.3 and Leu-M1. In addition, cytocentrifuge preparations of 14 reactive effusions and 2 metastatic adenocarcinomas were stained prospectively with Ber-EP4. RESULTS: All adenocarcinomas showed intense membrane staining, while all mesothelial proliferations, both benign and malignant, were negative. The Ber-EP4-positive immunostaining was remarkably clean, with very minimal nonspecific staining. CEA stained 11/11 adenocarcinomas, B72.3 stained 10/11, and Leu-M1 stained 8/11; mesotheliomas were negative with all three antibodies. CONCLUSION: Ber-EP4 is at least as useful as CEA, B72.3 and Leu-M1 in the diagnosis of serous effusions. It has the advantage of high sensitivity and ease of interpretation because of the high percentage of tumor cells stained, characteristic membranous staining and lack of cross-reaction with background inflammatory cells.

Adenocarcinoma↗
PubMedDate not supplied

p53 gene product in pleural effusions. Practical use in distinguishing benign from malignant cells.

OBJECTIVE: To determine the utility of positive p53 immunostaining as an adjunct in the diagnosis of malignancy in pleural effusions, we reviewed 103 effusions representing the typical range of diagnoses encountered in the evaluation of pleural fluid cytology. STUDY DESIGN: Immunohistochemistry was performed on paraffin-embedded cell blocks using a monoclonal antibody to the p53 suppressor gene product clone BP53-12 and a standard avidin-biotin complex technique with a citrate buffer antigen retrieval solution. RESULTS: Forty-one of 75 effusions with an unequivocal cytologic diagnosis of malignancy were immunopositive for p53 protein (55%). One of nine effusions cytologically interpreted as showing reactive mesothelial cells showed immunopositivity; that case was subsequently diagnosed as a mesothelioma on pleural biopsy. Nineteen cases were interpreted as suspicious for malignancy. Of these, 16 were negative, and 3 were positive for p53 protein. Of the three positive cases, two showed the presence of non-small cell and poorly differentiated large cell carcinoma. CONCLUSION: These findings suggest that p53 protein immunostaining is relatively sensitive and highly specific in differentiating benign mesothelial cells from malignant cells in pleural effusions. While negative p53 protein immunostaining does not exclude malignancy, positive staining in reactive or suspicious cells warrants further diagnostic evaluation of the patient.

Evaluation Studies as Topic↗
PubMedDate not supplied

Thymidine kinase (TK) gene therapy of solid tumors: valacyclovir facilitates outpatient treatment.

BACKGROUND: In a Phase I study replication-deficient adenovirus containing the herpes simplex virus (HSV) thymidine kinase (TK) gene (AdV-HSV-TK) was instilled intraperitoneally in patients with recurrent ovarian cancer. Patients were treated with Acyclovir (ACV) or Valacyclovir (VCV) as enzymatic substrates. The purpose of this study was to compare serum levels of ACV and VCV. PATIENTS AND METHODS: The antiherpetic prodrug and Topotecan (1.0 mg/m2 over 30 minutes each day for 5 days) were started 24 hours after vector application. Eight patients received ACV (15 mg/kg i.v. over one hour every 8 hours for 42 doses), two patients were started on ACV for 5 days and then switched to oral VCV (2 g every 8 hours for a total of 42 doses). Blood samples were obtained 20 minutes prior to each drug. RESULTS: Serum levels of ACV and VCV (converted to ACV) were comparable. CONCLUSIONS: Suicide gene therapy with TK is under investigation in a variety of solid tumors. Replacing ACV by VCV will offer a cost-effective alternative and will significantly reduce duration of hospital stay improving quality of life and facilitating an outpatient gene therapy concept.

Acyclovir↗
PubMedDate not supplied

Pulmonary hamartomas: cytologic appearances of fine needle aspiration biopsy.

The cytologic findings in specimens obtained from pulmonary hamartomas by fine needle aspiration biopsy are presented. The following are the main characteristics: 1. In spite of the fact that the lesions are usually hard and cartilaginous, find needle aspiration is possible and can obtain diagnostic material. 2. The material obtained usually has few cells. 3. The cells aspirated include columnar ciliated cells, lymphocytes, histiocytes as well as fragments of cartilage which are quite characteristic. 4. The differential diagnosis is discussed.

Adult↗