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Biomedical subjects

J R Goellner

Publications and source records attributed to J R Goellner.

At least 109 records · Page 6Linked to original sources
PubMed1985

Assay for beta-glucuronidase in cerebrospinal fluid: usefulness for the detection of neoplastic meningitis.

The specificity and sensitivity of the assay for beta-glucuronidase in cerebrospinal fluid were evaluated to determine the usefulness of this test for the detection of neoplastic meningitis. The enzyme activity was first measured in cerebrospinal fluid from 131 patients with various disorders and was then prospectively measured in cerebrospinal fluid from 30 patients with cytologic results that were positive for or suggestive of malignant disease. Within the first group, elevated levels of beta-glucuronidase were found only among patients with neoplastic processes in the central nervous system, including neoplastic meningitis. Among 26 patients with neoplastic processes in the central nervous system, including neoplastic meningitis. Among 26 patients with positive cytologic results, 13 had elevated beta-glucuronidase activities. Elevated values were more frequent among patients with adenocarcinoma (75%) and myelogenous leukemia (60%). The patients with these two disorders also had the highest enzyme activities. The correlation of th beta-glucuronidase level with other cerebrospinal fluid values, including total protein, glucose content, and cell count, was not significant. The findings of this study indicate that measurement of beta-glucuronidase in cerebrospinal fluid can be used as an adjunctive diagnostic test for neoplastic meningitis. The results should be interpreted with caution, however, because of the possibility that the elevated enzyme levels may be due to acute or subacute bacterial or fungal meningitis.

Cerebrospinal Fluid↗
PubMed1985

Anaplastic carcinoma of the thyroid: a clinicopathologic study of 82 cases.

Anaplastic carcinoma of the thyroid accounts for about 10% to 15% of all thyroid carcinomas in the United States. Its lethality is evidenced by a 5-year survival rate of 3.6% and a median survival of 4 months. Rapid growth of a thyroid mass, frequently in a preexisting goiter, is the most common manifestation; the diagnosis should be considered and expeditiously pursued in all patients who present with this finding. Relatively favorable prognostic features seem to be unilateral tumors, a tumor diameter of less than 5 cm, no invasion of adjacent tissue, and absence of nodal involvement. For resectable lesions, thyroid lobectomy with wide margins of adjacent soft tissue on the side of the tumor seems to constitute a safe, appropriately aggressive surgical approach. Total thyroidectomy and radical neck dissection results in an increased complication rate and has no advantage over a more conservative approach. Radiotherapy, chemotherapy, immunotherapy, and combination radiotherapy and chemotherapy need further evaluation.

Adult↗
PubMed1985

Vulvar sweat gland carcinomas.

Sweat gland carcinomas constitute less than 10% of all malignant tumors of the vulva, including those associated with extramammary Paget's disease (EPD). The histopathologic diagnosis of vulvar sweat gland carcinomas is difficult because of their rarity; their resemblance to metastatic carcinomas of the internal female genitalia, kidneys, and other sites; and their diversity of microscopic appearances. We report five examples of vulvar sweat gland carcinomas, two of which were associated with EPD. The other tumors included one example each of ductal eccrine adenocarcinoma, eccrine porocarcinoma, and clear cell hidradenocarcinoma. The clinical behavior of these neoplasms is correlated with their histologic types; we also discuss differential diagnosis and treatment recommendations.

Adenoma, Sweat Gland↗
PubMed1984

Invasive Hürthle cell carcinoma of the thyroid: natural history and management.

Debate surrounds the natural history and appropriate management of Hürthle cell neoplasms of the thyroid. Some of the uncertainty stems from difficulty in the differentiation of benign from malignant lesions. We report the presentation, management, and outcome of patients with invasive Hürthle cell carcinoma who were examined at this institution between 1946 and 1971. We believe that our review allows us to make reasonable recommendations concerning the management of patients with this type of carcinoma.

Adult↗
PubMed1984

Sister Mary Joseph's nodule: a clinical and histologic study.

The clinical and histologic findings in eighty-five cases of tumors metastatic to the umbilicus were studied. Clinically, the lesions were seen as firm, indurated nodules, sometimes with fissuring or ulceration. In twelve cases, the initial presentation of the internal primary malignancy was an umbilical nodule. Histologic material from the metastatic umbilical tumor was studied in all cases but was diagnostic of the primary carcinoma in only twenty-one. In seventeen cases, the primary site was never reliably determined, while stomach, large bowel, ovary, and pancreas were the most frequent primary sites in the other cases. Most patients died within months after the appearance of the umbilical tumors, thus emphasizing the ominous significance of this sign of metastatic, usually intra-abdominal, malignant disease.

Adenocarcinoma↗
PubMed1984

Leiomyoblastomas and their relationship to other smooth-muscle tumors of the gastrointestinal tract. An electron-microscopic study.

Twelve cases of gastrointestinal leiomyoblastoma were studied by electron microscopy, and the findings were compared with those in 12 cases of leiomyoma and nine cases of leiomyosarcoma of the gastrointestinal tract. All of the "classic" ultrastructural features of smooth-muscle tumors, including subplasmalemmal dense patches, pinocytotic vesicles, cytoplasmic microfilaments and dense bodies, and focal basement membrane formation, were present in the leiomyoblastomas ; however, extensive sampling was commonly necessary to demonstrate such findings. In contrast, these features were more prominent in leiomyomas and leiomyosarcomas.

Adult↗
PubMed1984

Fine-needle aspiration biopsy of the thyroid. The problem of suspicious cytologic findings.

Cases in which thyroid nodules yielded suspicious cytologic findings on fine-needle aspiration biopsy were prospectively studied during a 3-year period. Of 1970 patients, 333 (17%) had suspicious cytologic findings; from this group, the cases of 253 patients were studied. The cytologic diagnoses were 96 (38%) H urthle cell neoplasms, 84 (33%) follicular cell neoplasms, and 73 (29%) nonspecific diagnoses. A thyroid scan was obtained in 123 of 203 (61%) patients with a solitary nodule, and the nodules were hypofunctional in 102 (83%). Malignant lesions were found in 60 (24%) of the 253 patients. Our findings are consistent with reports that 20% of patients who have a fine-needle aspiration biopsy will have suspicious cytologic findings and that of these, 20% may have a malignant lesion. Thyroid scanning will not distinguish between benign and malignant thyroid lesions that are suspicious on cytologic examination. Surgical excision of all suspicious lesions seems reasonable.

Adenocarcinoma↗
PubMed1984

Pleural lavage after pulmonary resection for bronchogenic carcinoma.

A cytologic examination of pleural fluid was performed on a pleural lavage specimen collected at the completion of operation after pulmonary resection in 135 of 599 patients undergoing curative pulmonary resection for a non-small cell carcinoma of the lung between 1977 and 1982. The cytologic results of lavage was positive for malignant cells in 12 of the 135 patients (8.9%). The incidence of positive results was correlated with lymph node status (N2 greater than N1 greater than N0), cell type (adenocarcinoma greater than other non-small cell lung cancers), stage (III greater than II greater than I), and visceral pleural status (invaded greater than not invaded). No positive cytologic results were noted in 39 patients having a diagnostic excisional pulmonary biopsy prior to more definitive resection. The disease has recurred in nine of the 12 patients with positive cytologic results (only two in the ipsilateral pleural space), and eight have died. The prognostic role of pleural lavage cytology needs more study.

Adenocarcinoma↗
PubMed1984

Proliferating pilar (trichilemmal) cyst. Report of two cases, one with carcinomatous transformation and one with distant metastases.

We examined two cases of proliferating pilar cysts of the inguinal region. One of the cases showed a transformation to epidermoid carcinoma and, despite surgical resection, the patient died by means of distant generalized metastases. The diagnosis of proliferating pilar cyst should be made in pilar cysts with epithelial proliferation that shows well-defined borders and abundant keratinization despite cytologic atypia and mitotic activity. The diagnosis of carcinoma in proliferating pilar cysts should be reserved for lesions showing poorly defined borders and clear-cut infiltrative properties with cytologic evidence of malignancy.

Aged↗
PubMed1983

Primary neuroendocrine carcinomas of the skin (Merkel cell tumors). A clinical, histologic, and ultrastructural study of thirteen cases.

Neuroendocrine carcinomas of the skin have recently been recognized, and clinicopathologic information on these tumors is accumulating rapidly. We studied 13 such lesions by light and electron microscopy, and eight were subjected to immunohistochemical analysis. The ages of the patients (five women and eight men) ranged from 24 to 84 years. Nine patients had neoplasms occurring in sun-exposed areas; one patient had metachronous symmetric lesions on the arms, and another had antecedent hypohidrotic ectodermal dysplasia. Eight tumors metastasized, and six spread to regional or distant lymph nodes. Three patients died with visceral metastases to the liver, bones, and brain. All patients had their primary tumor confined to the corium and subcutaneous tissue without involvement of overlying epidermis. Tumor cells were round and uniform in size, with delicate nuclear chromatin and a high mitotic rate. An organoid growth pattern was seen in all tumors, with focal trabeculation and rare rosette formation. Ultrastructurally, peripheral cytoplasmic dense-core granules were evident, and perinuclear filament whorls could be seen in all 13 tumors. The latter feature was stable, even in specimens taken from paraffin blocks for electron microscopy. Immunoperoxidase studies failed to reveal serotonin, calcitonin, or adrenocorticotrophin within tumor cells.

Adenocarcinoma↗
PubMed1983

Detection of chlamydial cervicitis by Papanicolaou stained smears and culture.

The ability of the cervical Papanicolaou (Pap) smear to detect cervicitis associated with Chlamydia trachomatis was investigated. Cultures and cervical cytology samples were obtained from 487 women seen at the Mayo Clinic Department of Obstetrics and Gynecology and at the Sexually Transmitted Disease clinic of the Olmsted County Health Department. Adequate pap smears contained endocervical or metaplastic cells. Thirty-seven patients had positive Chlamydia cultures; of these, 14 were cytologically suggestive of Chlamydia, 10 were negative but satisfactory, and 13 were unsatisfactory. Of the 450 patients with negative cultures, 21 had cytologic findings suggesting infection. Thus, of 35 cases suggestive cytologically, 14 (40%) were confirmed by culture. Of the 21 false-positive cytologies, eight were in postpartum women. Because of problems with specificity and inadequate smears, cervical cytology specimens should not replace culture as a means of detection, but can identify women who should be cultured for C. trachomatis.

Cells, Cultured↗
PubMed1983

High-resolution ultrasound-guided percutaneous needle biopsy and intraoperative ultrasonography of a cervical parathyroid adenoma in a patient with persistent hyperparathyroidism.

We present a case of persistent hyperparathyroidism in which high-resolution real-time ultrasonography was used to perform a percutaneous needle biopsy of a parathyroid tumor. Additionally, intraoperative ultrasonography was valuable in the precise localization of the tumor and thereby reduced the need for extensive surgical reexploration.

Adenoma↗
PubMed1982

Fine-needle aspiration biopsy of thyroid nodules. Impact on thyroid practice and cost of care.

We studied the impact of fine-needle aspiration biopsy on the management of patients with solitary thyroid nodules. Sixty-four patients were examined before the introduction of fine-needle aspiration biopsy, and 147 patients were examined after its introduction. The percentage of patients who underwent thyroid operation decreased from 67 percent to 43 percent, while the yield of carcinoma increased from 14 percent to 29 percent. Cost of medical care per patient declined by 25 percent. The results suggest that fine-needle aspiration biopsy provides valuable information to assist in the selection for surgery of patients with solitary nodules. Fine-needle aspiration appears to be safe, reliable, and cost-effective. The merits of the technique commend it for routine use in the evaluation of thyroid nodules.

Biopsy, Needle↗
PubMed1981

Dysplasia and cytologic findings in 4,589 young women enrolled in diethylstilbestrol-adenosis (DESAD) project.

This report presents the cytologic findings and the rates of dysplasia for 4,589 young women enrolled in the National Cooperative Diethylstilbestrol-Adenosis (DESAD) Project. Mucinous columnar cells and/or metaplastic squamous cells with or without mucinous droplets were encountered in 22% of vaginal scrape smears from all diethylstilbestrol (DES)-exposed participants identified by review of prenatal records and in 43% of women in whom vaginal epithelial changes (VEC) were observed by colposcopy or by iodine staining. The frequency of cellular findings in the vaginal scrape smears was closely related to the timing of the administration of the DES to the mother. With increasing age of the daughters, the overall frequencies of both the mucinous and metaplastic cells decreased; relative to each other, an increasing proportion was metaplastic squamous cells. These data suggest that, as the women grow older, vaginal adenosis regresses by the process of squamous metaplasia. Endometrial type cells were found in 2% of vaginal scrape smears. Their cyclical occurrence during the menstrual cycle and lack of correlation with the presence of VEC indicated an origin from the uterine corpus rather than the tuboendometrial type of adenosis. Squamous cell dysplasia of the vagina and cervix was detected by biopsy or scrape smear specimens in 1.8% of DES-exposed women in the record review group. The rate of unexposed women was twice as high. In general, the rates of dysplasia were higher in the cervix than vagina, and the more severe degrees of dysplasia were encountered only in those women who were referred to the DESAD Project or who themselves requested entry. Four patients who were referred or who themselves requested entry were found to have clear cell adenocarcinoma of the vagina. The vaginal smear provided the first clue to the presence of an abnormality in three of them.

Adenocarcinoma↗
PubMed1980

Desmoid tumors. An ultrastructural study of eight cases.

A prominent ultrastructural finding in eight desmoid tumors was myofibroblastic mesenchymal cells with abundant intercellular collagen. In addition, seven of the tumors had intracytoplasmic collagen fibers. These findings are discussed in relation to other tumors and to nontumorous conditions.

Adolescent↗
PubMed1980

Subcutaneous necrobiotic granulomas of the scalp.

Nine biopsy specimens taken from the scalps of five children and four adults with subcutaneous necrobiotic granulomas were reviewed. This histopathologic features were similar in both groups. Four of the five children presented clinically with multiple, firm, bound-down subcutaneous nodules limited to the scalp but no associated systemic disease. In addition to the scalp nodules, one child had typical cutaneous lesions of granuloma annulare over the acral areas. Two of the adult patients, however, had severe rheumatoid arthritis with multiple rheumatoid nodules on the arms in addition to the scalp nodules; one of them had rheumatoid vasculitis. Another adult patient had allergic granulomatosis,and one had granuloma annulare lesions involving the scalp, face, and left ankle. Excision biopsy specimens should be taken in all patients--both children and adults--with multiple, deep, bound-down nodules of the scalp. If the specimen shows subcutaneous necrobiotic granuloma, probably no treatment is indicated in children because, in our experience, there is no associated systemic disease. However, in the adult patient with similar scalp lesions, the possibility of systemic disease should be explored.

Adult↗