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J E Szakacs

Publications and source records attributed to J E Szakacs.

12 recordsLinked to original sources
PubMed1994

Atypical beta 2-microglobulin amyloidosis following short-term hemodialysis.

A 47-year-old white female renal transplant recipient presented complaining of "wrinkles" that predominantly involved the palmar aspect of her fingers. Light-microscopic examination of biopsy material obtained from affected areas revealed deposits of amorphous, hyaline material in the reticular dermis that contrasted sharply with collagen and elastic fibers. Examination by transmission electron microscopy disclosed a mass of fibrils recognizable as amyloid, despite negative histochemical staining with both Congo red and crystal violet. Immunoperoxidase staining for beta 2-microglobulin was positive. Along with an elevated serum beta 2-microglobulin level, this finding supported the diagnosis of hemodialysis-induced amyloidosis (HIA). Unusual features of our case include lesion location, short duration of antecedent hemodialysis therapy, and negative staining for amyloid using conventional staining techniques.

Amyloidosis↗
PubMed1993

Multiple pathogens may induce growth factor cascade resulting in KS.

While lipopolysaccharide endotoxin is the most prominent inducer of the kinecascade (TNF alpha, IL-1, 4, 6, 8) that leads to shock and multiple organ failure, bacterial exotoxins and products of certain gram positive bacteria can induce the same end results. We theorize that more than one pathogen can induce the sequence of protooncogene activation and growth factor release that results in the formation of KS. If KS has its own unique viral etiology, this virus has not as yet been isolated or identified but we continue to search for it. However, it is entirely possible that these lesions do not have a single well-defined etiologic agent but are the result of multiple agents cooperating in a set sequence. An endogenous, or apathogenic exogenous, retrovirus may replace HIV for initiator growth factor induction in CD4 cells in the classical (Mediterranean) or iatrogenic disease; and other pathogens co-exist or sequentially replace each other in the African endemic disease; whereas an array of viral pathogens (prominent among them CMV) take over growth factor induction in endothelial cells proliferating in response to the initiator growth factor (oncostatin M) released from HIV-infected CD4 lymphocytes in AIDS-KS.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Progress in diagnosis of hepatitis and the cirrhotic liver.

History of the concept and definition of hepatitis is briefly reviewed. The landmarks of progress are based on better understanding of liver structure and introduction of biopsy techniques to follow the pathologic alterations in acute and chronic hepatitis, cirrhosis, dysplasia and hepatoma. Modern achievements are recognition of the etiologic agents of viral hepatitis A through G, viral nucleic acid sequencing, viral genome and gene products leading to development of immunologic tests to etiologic diagnosis. Viral particles are visualized by electron microscopy. In tissue, localization of viral products is obtained by histochemical, immunologic and by in situ hybridization methods. Diagnostic criteria for each of the viral etiologic agents is reviewed, as is cirrhosis and its occurrence in viral hepatitis and alcohol abuse.

Hepatitis↗
PubMedDate not supplied

Soft tissue sarcoma with complex membranous and microtubular inclusions.

Cytoplasmic inclusions of great complexity are encountered in an undifferentiated sarcoma of a 67-year-old woman. The tumor arising in adipose tissue between muscles of the parspinous musculature contains inclusions in most tumor cells represented by four different morphologic types. Two are intracisternal, designated microtubular reticular structure (TRS) and tubular confronting cisternae (TCC). Two others are cytoplasmic and consist of crystalline microtubular arrays and of confronting cisternal complexes of smooth endoplasmic reticulum (SER). This latter is uniquely complex and not found in previous descriptions. Tumors of mesenchymal origin and experimental virus-induced tumors are known to contain short segments of confronting cisternae and TRS. Tubuloreticular structures and TCC are well documented in cases of lupus, in human immunodeficiency virus infections, in T-cell leukemia, and in experimental viral hepatitis in chimpanzees. The patient presented has none of the coincidental pathologic condition associated with occurrence of TRS and TCC. The morphology of the inclusions and their relationships are illustrated although their biological significance remains obscure.

Adipose Tissue↗
PubMedDate not supplied

Surgical resection versus perfusion in the treatment of metastatic and primary liver tumors.

The involvement of the liver by malignancy, whether it be primary or metastatic, carries a grave prognosis. At this time, chemotherapy is solely palliative, and no survival advantage has been established. Resection of metastatic or primary carcinoma of the liver in a select number of patients may provide a survival advantage and an occasional cure. However, studies are difficult to control, and claims of survival benefits have been based on historical data of untreated disease prior to 1978. Currently, clinical trials are underway combining modes of therapy in the hope of increasing patient survival. Reduction of operative mortality to below five percent for liver resection is attributable to a major advance in operative technique. Other advances are improved diagnostic techniques for detection of liver metastases and selection of patients for resection. Finally, newer strategies for chemotherapy made practicable continuous infusion by implantable or external pumps, redoubling response rates to fluorodeoxyuridine (FUDR) in regional and 5-fluorouracil (5-FU) in systemic chemotherapy. A review of the current literature is presented along with data accumulated over the three-year experience of the Moffitt Cancer Center, Tampa, Florida. The case material from Moffitt Cancer Center is included to illustrate progress and limitations of combined surgical, regional, and systemic chemotherapy for primary and metastatic liver cancers.

Adenocarcinoma↗
PubMedDate not supplied

Ewing's sarcoma, extraskeletal and of bone. Case report with ultrastructural analysis.

Ewing's sarcoma is considered a primary malignant tumor of bone. Histologically, it is characterized by small round cells with poorly delineated borders. Ultrastructural studies reveal large amounts of glycogen aggregated in the undifferentiated cytoplasm of the tumor cells which show variable amount of organelles. The cell membrane shows desmosomes in some cases but not in others. Intercellular argentophylic fibers are by and large absent. In a survey of human sarcomas for the possible presence of viral agents, a sarcoma has been encountered in a 15 year old male originating in the area of the posterior bladder wall and prostate that satisfies morphologic criteria for the diagnosis of Ewing's sarcoma but is extraskeletal in origin. Histology and ultrastructure as well as tissue cultural characteristics of this tumor were studied in comparison with a second patient (age 14) with Ewing's sarcoma originating in the right clavicle. None of the two tumors yielded virus particles in culture.

Adolescent↗
PubMedDate not supplied

Search for C-type particles in human neoplasia.

The salient biologic and morphologic characteristics of RNA tumor (oncornavirus) virus are reviewed. The ultrastructure of replicating oncornaviruses is illustrated in detail. C-type particles wide spread in at least three orders of animals were sighted in human sarcomas and leukemias. One case, an infantile fibrosarcoma, is presented from our cases surveyed for the presence of C-type particles. Tissue cultures derived from this tumor contained viral particles and had an elevated reverse transcriptase activity associated with the presence of 70 S RNA. The particles were larger (125 to 150nm) than those of the murine or avian Type C particles.

Animals↗
PubMedDate not supplied

Ultrastructure of parathyroid adenomas.

The ultrastructure of 12 cases of parathyroid adenomas is analyzed in the light of recent discoveries of biochemical functions of the parathyroids. Variants of parathyroid chief cells forming the adenomas are illustrated and cytologic details are explored. The correlation of cytoplasmic structures with hormone synthesis, transfer, secretion and intracellular lysosomal degradation is reviewed. A hormone secretory cycle in parathyroid adenomas is not observed. Current knowledge of parathyroid biochemistry does support modulation of hormone production and degradation by parathyroid chief cells rather than a cyclic secretory activity. Unusual structures and alterations of the normal organelles found in parathyroid adenomas are described and illustrated. Contrary to detailed knowledge of hormone synthesis, little is known about other metabolic and structural alterations in these adenomas. The reasons for massive accumulation of lipid, glycogen and mitochondria remain to be explored. As yet, neither ultrastructural investigation nor better understanding of biochemical processes of hormone production have led to recognition of etiologic factors inducing parathyroid adenomas.

Adenoma↗
PubMedDate not supplied

The pathologist's role in multidisciplinary management of bladder cancer.

The pathologist plays an important role in management of bladder cancer, as a member of the multidisciplinary team of urologists, radiation therapists, and medical oncologists. The therapeutic goal is saving the bladder function as long as possible. The pathologic determinants utilized for selection of therapeutic modalities are described in 172 consecutively treated patients with transitional cell carcinoma and 20 patients with other forms of bladder tumors during a five year period. Based on histologic type, pathologic stage, and status of the urothelium, 100 patients were treated by resection and intravesical instillation of cytostatic drugs or bacille Calmette-Guérvin (BCG). Seventy patients underwent radical cystectomy and bladder substitution by continent urinary diversion. Serial transurethral resection (TUR) biopsies and cytologic evaluations were found adequate in evaluating pathologic determinants for progression and for survival except in cases of Grade 2 papillary transitional carcinomas where additional experimental studies need to be further developed, such as nuclear ploidy and molecular genetic studies, to identify patients at high risk for progression. Of the 70 patients with radical cystectomy and 5 with partial cystectomy, 49 are living, a median of 36.8 months since surgery. There was one intraoperative death and one post-operative death within 30 days post-operatively.

Adult↗
PubMedDate not supplied

Malassezia furfur folliculitis in cancer patients. The need for interaction of microbiologist, surgical pathologist, and clinician in facilitating identification by the clinical microbiology laboratory.

Malassezia furfur (MF) is a lipophilic yeast which can be found as a member of the indigenous microbiota of human skin. In immunocompromised transplant patients, MF can cause a distinctive folliculitis which is a clinical look-alike to Candida folliculitis, the latter of more potentially devastating significance. Recovery of MF in culture is dependent upon the addition to culture media of an exogenous source of fatty acids, such as olive oil. The addition of an extra Sabourauds plate with an olive oil overlay to the routine set of media used to inoculate all skin biopsy specimens in order to detect MF is labor-intensive and not cost-effective. Thus, MF may not be isolated in cases of MF folliculitis unless the clinical microbiology laboratory is put on alert by the clinical suspicions of the attending physician, or by histopathologic findings suggestive of folliculitis revealed by review of surgical pathology slides. The clinical, pathological, and microbiological findings of two cases of MF folliculitis are presented where an interactive approach featuring communication between the microbiologist, the surgical pathologist, and the clinician guided the microbiology laboratory to the isolation and identification of isolates of MF that were clinically-relevant. These cases underscore how a combined approach which features communication between the laboratory and the clinical services always provides superior guidance in the diagnosis and therapy of infectious diseases.

Adult↗