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Biomedical subjects

J J Kepes

Publications and source records attributed to J J Kepes.

At least 73 records · Page 4Linked to original sources
PubMed1987

Cerebellar medulloblastoma in a 73-year-old woman.

A case of a 73-year-old woman with cerebellar medulloblastoma is described. The patient presented with the classical symptoms and signs of a medulloblastoma, and radiological findings were also consistent with this entity. Nevertheless, because of the patient's advanced age, the possibilities of metastatic tumor involving the cerebellum or a primary cerebellar lymphoma were considered before operation. Pathological examination of the operative specimen showed a classical medulloblastoma with occasional areas of early neuroblastic differentiation. Immunoperoxidase strains for neurofilaments were of help in confirming the neurogenic origin of the neoplastic cells. Although medulloblastomas in adults are not rare, onset after the age of 50 is exceptional, with only two cases on record in patients 65 or older. The present patient seems to be the oldest individual with a cerebellar medulloblastoma thus far reported.

Aged↗
PubMed1987

Polymyositis with hypokalemia: correction with potassium replacement in the absence of steroids.

A patient presented with typical polymyositis, but also with hypokalemia. Correction of potassium deficit without corticosteroids led to complete resolution of symptoms and laboratory abnormalities. Muscle biopsy performed after correction of the hypokalemia revealed focal fiber necrosis with regeneration and inflammatory infiltrate that contained, among others, many eosinophils. Hypokalemia should be considered in the differential diagnosis of polymyositis even in the face of an inflammatory muscle infiltrate.

Administration, Oral↗
PubMed1986

Meningioma with multiple rheumatoid nodules. A case report.

A case of a left tentorial meningioma in a 42-year-old man with a 12-year history of widespread manifestations of active rheumatoid arthritis, is reported. The patient had numerous subcutaneous rheumatoid nodules involving among other areas, the nuchal scalp. The surgically removed meningioma contained many classical rheumatoid nodules with gradual transitions seen from tumor cells to the pallisading peripheral cell layer of the nodules. Although intracranial rheumatoid nodules of the dura mater, leptomeninges, and of the choroid plexus have been described earlier, this appears to be the first reported case of rheumatoid nodules found within the substance of a meningioma. The participation of the tumor cells in the formation of rheumatoid nodules attests to the potential of neoplastic meningothelial cells to behave as mesenchymal elements under certain circumstances.

Adult↗
PubMed1986

A case of thalamic aphasia with postmortem verification.

This study discusses a case of aphasia after dominant thalamic lesion, a hemorrhagic infarction. Unlike other such cases, both repeated standardized assessment and postmortem verification were available. The patient was assessed at 3 weeks and again at 9 weeks postonset. The aphasia demonstrated the syndrome common to dominant thalamic hemorrhage: fluent but paraphasic output sometimes deteriorating to jargon, comprehension less impaired than this type of output usually indicates, and the least impairment in repetition. As sometimes reported in previous cases, semantic paraphasias were more common than phonemic paraphasias. The lesion was located in the dorsal aspect of the lateral nucleus, but it extended into the pulvinar, including the anterior superior lateral aspect which has been implicated in language by previous studies. Thus, data from this case are consistent with an involvement of the dominant pulvinar in language and suggest that this role involves the semantic aspects of language.

Aged↗
PubMed1986

Presidential address: the histopathology of meningiomas. A reflection of origins and expected behavior?

Meningiomas and their principal cells of origin, the arachnoidal "cap" cells are unique in their morphology with multiple and sometimes seemingly contradictory features related to their origins and basic character. Some meningiomas express mesenchymal features either in histologic pattern (fibroblastic, lipo-myxochondro-osteoblastic differentiation), participation in other disease processes, e.g. taking part in the formation of rheumatoid nodules, or in storage phenomena shared with other mesenchymal cells of the body. At the same time they may display epithelial features, such as well-formed desmosomes ultrastructurally, papillary formations and intracellular lumina in cells that stain positively for various cell markers usually considered to characterize epithelial cells. Histologic similarities of meningiomas to various gliomas, schwannomas, neuroblastomas, fibrous histiocytomas, myxomas, chordomas, metastatic carcinomas, and in the cases of meningiomas with marked inflammatory infiltrates, to benign or malignant lymphoproliferative disorders involving the meninges may pose serious diagnostic problems. The localization and resectability of meningiomas are important factors related to long-term prognosis. Of the histologic features hemangiopericytomatous pattern, papillary formations, high cellularity (focal or diffuse) and invasion of the brain appear to correlate with potentially aggressive behavior, whereas cytologically aneuploidia, large number of mitoses, prominent nucleoli and cell necrosis suggest a guarded prognosis. However, some meningiomas with no detectable histologic features of malignancy may nevertheless metastasize to distant sites.

Astrocytoma↗
PubMed1986

Eosinophilic fasciitis presenting as inflammatory polyarthritis.

Eosinophilic fasciitis is an uncommon disorder characterized by peripheral blood eosinophilia, hypergammaglobulinemia, and scleroderma-like inflammation of skin and fascia. Joint contractures occur but typically without synovitis and effusion. Our patient presented with symmetric polyarthritis and subsequently characteristic features of eosinophilic fasciitis developed. It is important to consider this disorder in patients presenting with arthritis as well as those presenting with skin changes because prior treatment with corticosteroids can alter biopsy findings, leading to diagnostic confusion, and possible adverse effects on the long-term treatment regimen.

Arthritis↗
PubMed1985

Intracellular mucoid changes in tumor cells of meningiomas: a manifestation of polyvinylpyrrolidone (PVP) effect on tissues with mesenchymal characteristics.

In two cases of meningiomas in Taiwanese patients, extensive intracellular mucoid changes were found within tumor cells, together with deposits of polyvinylpyrrolidone (PVP) granules. Both patients had in the past received intravenous PVP as a plasma expander. Recipients of PVP have previously been reported to develop a form of PVP thesaurismosis with concomitant mucoid changes in the cells storing this substance. Such changes, as a rule, were limited to cells of mesenchymal origin. By storing PVP granules and undergoing mucoid changes as a result, meningioma tumor cells behave as cells with mesenchymal characteristics.

Female↗
PubMed1984

Tumors of the central nervous system in Taiwan, Republic of China.

A series of 1012 surgically removed tumors of the central nervous system from two hospitals in Taiwan were reviewed, tabulated, and compared to series from the United States, Europe, and Asia. Among gliomas, a relatively high incidence of glioblastomas was found in patients less than 20 years old. The percentage of meningiomas in the two hospitals was very high: 20.22% and 26.72%, respectively. Neurilemmomas, as reported from Japan and mainland China, were also more common than in the United States or Europe. Germinomas and teratomas were more frequent than in Western countries, but less so than in Japanese series. Pituitary adenomas constituted 21.8% of cases from the Veterans General Hospital in Taipei, a percentage higher than that in any comparable series.

Adenoma↗
PubMed1984

The role of astrocytes in the formation of cartilage in gliomas. An immunohistochemical study of four cases.

The occasional presence of focal cartilage in gliomas is generally attributed to metaplasia of the mesenchymal supportive elements. While this mechanism undoubtedly exists, the present report describes a different mode of development of cartilage in four gliomas occurring in young individuals. Two of the tumors were pontine astrocytomas, one was a mixed ependymoma and astrocytoma involving the fourth ventricle and the brainstem, and one was an extraspinal malignant astrocytoma in the lumbar region of a young boy who earlier had been diagnosed as having a pontine glioma for which he received radiation treatment. In all four tumors, transitions from astrocytic to cartilaginous elements were seen, characterized by an increasing deposition of chondroid ground substance between the astrocytes and a gradual morphologic changes of the glial cells to more rounded forms with a vacuolated cytoplasm, indistinguishable from chondrocytes of mesenchymal origin. Many of these cells retained positive staining for glial fibrillary acidic protein by the immunoperoxidase method, attesting to their astrocytic nature. The production of cartilage by neoplastic astrocytes may be related to their ability to secrete, in certain circumstances and occasionally in large amounts, basement membrane material and other forms of mucopolysaccharides, which may become condensed to form a chondroid ground substance. The process appears analogous to that of cartilage formation by epithelial cells in pleomorphic adenomas of the salivary glands.

Adolescent↗
PubMed1983

Oncocytic transformation of choroid plexus epithelium.

In a 27-year-old woman who died of Leigh's disease, adult form, autopsy revealed in addition to the usual morphological changes of that condition, marked oncocytic transformation of choroid plexus epithelium in all cerebral ventricles: the cytoplasm of epithelial cells was enlarged, eosinophilic, and filled with fine granules. By electron microscopy the granules were identified as closely packed mitochondria that appeared to proliferate at the expense of other cytoplasmic organelles. This appears to be the first report of oncocytic transformation involving the epithelium of the choroid plexus. The relationship between the oncocytic changes and the patient's underlying Leigh's disease remains speculative at this time.

Adult↗
PubMed1983

Meningioma with pseudoglandular pattern. A case report.

A falx meningioma in an 11-year-old girl had a hemangiopericytomatous and papillary pattern, but the dominant histologic feature was a pseudoglandular arrangement of the tumor cells, closely imitating an adenocarcinoma. The gland-like spaces resulted mainly from dissolution of the centers of cell nests, and to a lesser extent from the fusion of papillary processes. The tumor-recurred locally five years after surgery and maintained its pseudoglandular pattern. Recognition of the existence of a pseudoglandular variant of meningiomas can prevent the mistaken diagnosis of a metastatic adenocarcinoma and other similar tumors.

Child↗
PubMed1982

Squamous metaplasia following necrosis of the adenohypophysis and of a chromophobe adenoma of the pituitary.

Two cases of pituitary necrosis was presented, one occurring post partum in an otherwise normal gland, the other in a large chromophobe adenoma. In both cases the necrotic tissue became surrounded by squamous epithelial nests that developed through metaplasia from glandular cells of the adenohypophysis and adenoma cells respectively. The squamous elements were seen 6 days after the clinical events leading to pituitary necrosis in the first case and 20 days after pituitary apoplexy (hemorrhagic necrosis of an adenoma) in the second case. In contradistinction to the commonly found squamous nests which are usually located in the pars tuberalis and presumably develop through a slower process, the changes in the present two cases indicate that squamous metaplasia can develop quite rapidly at the margins of a necrotic process of the pituitary, either deep in the gland as in case 1 or occupying the entire circumference of a necrotic tumor as in case 2.

Adenoma, Chromophobe↗
PubMed1982

The clinical significance of "adenoid" formations of neoplastic astrocytes, imitating metastatic carcinoma, in gliosarcomas. A review of five cases.

Five cases of supratentorial gliosarcomas occurring in middle-aged and elderly patients are reported. In the gliomatous portions of the tumors there were areas with clusters and ribbons of cuboidal cells forming a cribriform pattern and structures resembling ducts and glands of a metastatic adenocarcinoma. Where the adenoid structures were embedded in a mucoid matrix, an imitation of mucus-producing ("colloid") carcinoma was created. In one patient who had a large pelvic mass (later identified as a benign leiomyoma) the histology of the brain tumor suggested a metastatic müllerian carcinosarcoma. The pseudoglandular elements in each case could be identified as being composed of primitive astrocytes, partly by finding transitions to more mature and typical astrocytes and partly by positive staining with the immunoperoxidase method for glial fibrillary acidic protein (GFAP). The recognition of this morphologic variant of malignant glial tumors is important, particularly in patients of the age group in which primary carcinomas elsewhere in the body occur with increasing frequency. In such patients the correct diagnosis of their brain tumor can avoid the added post-craniotomy discomfort and expense of a "workup for a primary tumor."

Adenocarcinoma↗