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Biomedical subjects

K Devaney

Publications and source records attributed to K Devaney.

35 records · Page 2Linked to original sources
PubMed1993

Small cell osteosarcoma of bone: an immunohistochemical study with differential diagnostic considerations.

Seventy-nine cases of small round cell tumors involving bone were studied in an attempt to learn whether the immunohistochemical features of the lesions might allow distinction of small cell osteosarcoma from other potential differential diagnostic considerations, including Ewing's sarcoma, atypical Ewing's sarcoma, primitive neuroectodermal tumor, mesenchymal chondrosarcoma, lymphoma, and the Askin tumor. The tissues studied were all formalin-fixed, decalcified, paraffin sections from patients between the ages of 16 and 48 years. With one exception (a small cell osteosarcoma), none of the lesions was cytokeratin positive. Moreover, none of the lesions was epithelial membrane antigen, desmin, factor VIII-related antigen, synaptophysin, or Leu-M1 positive. Accordingly, strong positivity for these antibodies in a majority of tumor cells should prompt inclusion of tumor types other than those listed above in the differential diagnosis. Vimentin positivity was seen in a majority of the tumors studied irrespective of histologic type. Scattered tumor cells (< 25%) showed positivity with antibodies to muscle-specific actin and smooth muscle actin in several of the different tumor types studied. No lesions other than lymphoma were leukocyte-common antigen (LCA) positive; all but two lymphomas were LCA positive, while all but one lymphoma were L26 positive. One (lymphoblastic) lymphoma was LCA and L26 negative. S-100, neuron-specific enolase, and Leu-7 did not prove to be specific for "neural-associated" tumors, but rather appeared in some small cell osteosarcomas, Ewing's sarcomas, atypical Ewing's sarcomas, primitive neuroectodermal tumors, mesenchymal chondrosarcomas, lymphomas, and Askin tumors. Antibody to cell surface antigen HBA71 was positive in three Ewing's sarcomas (two typical and one atypical) and negative in small cell osteosarcoma (three cases), mesenchymal chondrosarcoma (two cases), and lymphoma (one case). While some guidance may be derived from analysis of immunohistochemical staining patterns in a given lesion, the results reported in the present study do not suggest that routine immunohistochemistry alone will permit distinction of these small cell tumors of bone from one another. The value of immunohistochemical studies appears to lie particularly in the use of antibodies to LCA and S-100 protein to distinguish lymphoma and mesenchymal chondrosarcoma, and perhaps antibody to HBA71 to distinguish neural family lesions (such as Ewing's sarcoma), from other small cell tumors, such as small cell osteosarcoma.

Adolescent↗
PubMed1993

Proliferative and histologically malignant struma ovarii: a clinicopathologic study of 54 cases.

We reviewed 54 cases of struma ovarii with histologic features diverging from the normal pattern of benign thyroid tissue. These 54 lesions were divided into proliferative struma (41 cases) and malignant struma (13 cases). The patients diagnosed with proliferative struma ovarii ranged in age from 18 to 84 years (average, 44 years). The most common clinical findings among the proliferative struma patients were a mass (58%) and acute abdominal pain (12%). Preoperative evidence of hyperthyroidism was noted in three of the patients with proliferative struma, whereas one additional patient presented with ascites and hydrothorax ("pseudo-Meigs' syndrome"). Proliferative struma differed from the usual struma ovarii in that they comprised areas of densely packed follicles or papillary formations that raised the possibility of malignancy. However, none of the lesions that we have designated as proliferative struma ovarii showed histologic evidence of overlapping "ground glass" nuclei, vascular space invasion, or mitotic activity that would have supported an unequivocal diagnosis of malignancy. None developed metastases or recurrent disease. The 14 malignant struma ovarii manifested the classical features of thyroid carcinoma (including the presence of overlapping "ground glass" nuclei lining papillary formations and vascular space invasion). Patients with malignant struma ovarii ranged in age from 30 to 77 years (average, 50 years). Their clinical presentations included a mass (78%) and acute abdominal pain (22%). One patient had clinical and laboratory evidence of hyperthyroidism. On follow-up, one patient had persistent disease with peritoneal involvement, but distant metastases did not develop in any of these patients. A diagnosis of malignant struma ovarii should be reserved for lesions that exhibit the full range of changes seen in thyroid carcinoma arising in the cervical thyroid. By requiring that these rigid criteria be adhered to, the diagnosis of malignant struma ovarii will probably become less frequent as the more commonly encountered proliferative struma ovarii are recognized.

Abdominal Pain↗
PubMed1993

Hepatic sarcoidosis. Clinicopathologic features in 100 patients.

The patterns of hepatic injury were studied in 100 patients with a diagnosis of sarcoidosis and clinical evidence of liver disease that led to diagnostic liver biopsy. Granulomas were present in all patients; they occupied from < 1% to > 90% of the total volume of tissue examined and were most often located in the portal/periportal region. In none of the 100 cases were infectious organisms identified by special stains, culture, or serology. In 99% of cases, these granulomas were noncaseating; in one of the 100 cases central caseation was noted. In addition to the granulomas present in all biopsies, three broad categories of histologic change were found: cholestatic (58%), necroinflammatory (41%), and vascular (20%). Among those with cholestasis, 19 patients had bile duct lesions similar to primary biliary cirrhosis, whereas another 13 had a pattern of periductal fibrosis reminiscent of primary sclerosing cholangitis. In 37 patients with chronic cholestasis, a decrease in the number of bile ducts (ductopenia) was noted. Twelve patients had an acute cholangitis suggestive of mechanical obstruction--although no clinical evidence of ductal obstruction was found. Necroinflammatory changes included spotty necrosis suggesting hepatitis of diverse etiologies (including viral infection and drug reaction) and chronic portal inflammation suggestive of chronic active hepatitis. Vascular changes consisted of sinusoidal dilatation (14 cases) and nodular regenerative hyperplasia (9 cases). In 6% of the patients, the only changes in the biopsy were those of granulomatous inflammation; each of these patients had a dominant mass ("sarcoidoma"), which had been biopsied to rule out tumor. Fibrosis was seen in 21% of the biopsies--periportal (13%), bridging (2%), or cirrhosis (6%). It is clear that sarcoidosis can cause progressive liver disease with a wide array of histologic features that can mimic those of other primary liver diseases.

Adolescent↗
PubMed1992

Fine-needle aspiration cytology of multicystic mesothelioma.

This report details the cytologic findings from a case of peritoneal multicystic mesothelioma (MCM). Fine-needle aspiration of a 20 cm abdominal mass in a 31-year-old man yielded a specimen which consisted of a monomorphous population of mesothelial cells lacking cytologic atypia which were arranged in three patterns: monolayered sheets, single cells, and two-cell-thick strands of mesothelial cells with little or no intervening stroma. The background was clean, without necrotic debris or abundant inflammatory cells. The mesothelial cells were not arranged in prominent papillary formations; mitotic figures were not found. The mesothelial cells were cytokeratin positive and vimentin positive, and negative for carcinoembryonic antigen (CEA) and factor VIII. The FNA findings from MCM should be distinguished from those of a variety of other abdominal lesions, including cystic lymphangioma, ovarian and primary peritoneal epithelial tumors, necrotic tumors with cystic degeneration, developmental cysts, and infectious cysts.

Abdominal Neoplasms↗
PubMed1992

Postinfantile giant-cell transformation in hepatitis.

Giant-cell hepatitis is a frequent pattern of liver injury in the neonate, but it is rare after infancy. Such cases have been attributed to autoimmune disease, to non-A, non-B hepatitis and, most recently, to paramyxovirus infection. To better define the entity of postinfantile (syncytial) giant-cell hepatitis, we reviewed 24 biopsy specimens from 20 patients with this finding, either alone or in combination with other diagnoses. The number of multinucleated giant cells varied greatly from one specimen to another. Varying degrees of portal inflammation appeared in all but one of the patients, and all had hepatitislike acinar inflammation associated with hepatocellular injury. Fibrosis was a common finding, varying from mild periportal fibrosis to established cirrhosis (33%). The changes were interpreted as acute giant-cell hepatitis in 25%, as CAH in 42% and as active cirrhosis in the remainder. The patients ranged in age from 2 to 80 yr, with a mean of 35 yr and a male/female ratio of approximately 1:1. The signs and symptoms of liver disease were present for more than 1 mo in most patients. A positive antinuclear antibody titer was found in seven of the patients. Three patients had a direct Coombs reaction and anemia. Overall, evidence of autoimmune disease was found in 40% of the patients. One patient had non-Hodgkin's lymphoma involving the liver. Only one patient had a history of blood transfusion or risk factors for hepatitis C. No patient underwent serological study for paramyxovirus antibodies. Liver tissue from one patient was examined ultrastructurally, but no viral particles could be identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Cortical osteofibrous dysplasia of long bone and its relationship to adamantinoma. A clinicopathologic study of 30 cases.

Thirty cases of cortical osteofibrous dysplasia (COFD) were studied in an attempt at defining the relationship of COFD to adamantinoma. The patients ranged in age from newborn to 39 years (mean 13.4 years). The male:female ratio was 1:1. Presenting symptoms were most often pain or a mass. The tibia was involved in all 30 patients; in addition, the ipsilateral fibula was involved in five patients (17%). The histologic appearance of the lesions was dominated by the combination of woven bone trabeculae with prominent osteoblastic rimming and a loose, slightly myxoid stroma (less heavily collagenized in most instances than usually encountered in intramedullary fibrous dysplasia). Results of immunohistochemical study showed isolated cytokeratin-positive cells in the stroma of 28 of the lesions (93%). However, hyperchromatic epithelial islands characteristic of adamantinoma were not found in any of the 30 cases. A control population of 50 fibro-osseous lesions (intramedullary fibrous dysplasia, sclerosing fibroxanthoma, and cranial ossifying fibroma) was studied immunohistochemically; in none of these control cases were cytokeratin-positive cells found. Follow-up data were obtained in 17 cases (57%); the period ranged from 1 to 16 years (mean 6.05 years). Certain overlapping clinical features (including the location of the vast majority of the lesions in the tibia and, less often, the fibula) and the morphologic similarities of many areas of COFD and adamantinoma (particularly the shared presence of cytokeratin-positive cells) suggest a more than coincidental association between COFD and a adamantinoma. However, to date none of the 30 cases of COFD evaluated in this study has developed an adamantinoma.

Adolescent↗
PubMed1992

Extensive dermal metastases from primary signet-ring carcinoma of the urinary bladder.

Dermal metastasis from internal carcinoma occurs infrequently. Bladder carcinoma is a rare source of skin metastasis. This report details the case of a twenty-five-year-old man with a fatal primary signet-ring adenocarcinoma of the bladder who experienced unique, extensive, infiltrative, cutaneous metastases within a few weeks of his initial presentation with an occultly carcinomatous ruptured spleen. The literature on cutaneous metastasis from carcinoma of the bladder is reviewed.

Adenocarcinoma, Mucinous↗
PubMed1991

The surgical pathology of gastrointestinal Hodgkin's disease.

The files of the National Cancer Institute were searched for all surgical specimens from the gastrointestinal (GI) tract with the diagnosis of Hodgkin's disease (HD) that were accessioned during the years 1953-1990; six patients with a histologically reconfirmed diagnosis were identified. Of these patients, four presented with GI HD and two had recurrent HD. Primary HD appeared in the stomach (three patients) and the duodenum (one patient); recurrent HD after diagnosis in a conventional nodal site appeared in the stomach (one patient) and the colon (one patient). One of the cases of primary gastric disease was a composite lymphoma consisting of HD and diffuse large cell lymphoma. In view of the rarity of GI tract involvement by HD, a diagnosis of primary GI HD should be viewed with skepticism; support for such a diagnosis may be provided by both classic histopathologic features of HD and immunostaining, but no single feature can be regarded as pathognomonic.

Adult↗
PubMed1991

Immunohistochemistry as a diagnostic aid in the interpretation of unusual mesenchymal tumors of the uterus.

Sixty-three pure mesenchymal tumors of the uterus were studied to explore the value of immunostaining in the diagnosis of unusual mesenchymal tumors encountered in the uterus, some not reported previously. Each tumor was evaluated using a panel of immunostains including actin, desmin, vimentin, S-100 protein, and cytokeratin. The final classification, which incorporated the immunohistochemical findings, resulted in the identification of 33 relatively common pure mesenchymal tumors (13 benign and malignant endometrial stromal tumors and 20 benign and malignant smooth muscle tumors) and 30 uncommon tumors (five leiomyosarcomas with osteoclastic giant cells, two xanthomatous leiomyosarcomas, one melanotic schwannoma, one pure rhabdomyosarcoma, one neurofibroma, five plexiform tumorlets, and 15 combined smooth muscle-stromal tumors). The normal endometrial stroma, present in 14 cases, invariably showed a negative reaction for all antibodies. With rare exceptions, the pure endometrial stromal tumors displayed a negative immunoreaction for all antibodies utilized, while the pure smooth muscle tumors consistently showed a positive reaction for actin. Only the two tumors of neural origin (a neurofibroma and a melanotic schwannoma) reacted with S-100 protein. Immunostaining influenced most the final classification of neoplasms initially interpreted as uterine tumors with a sex-cord stromal pattern, endometrial stromal tumors that diverged from the classic lesions by having a spindle cell component, and intravascular leiomyomas with areas of compact proliferation of small round cells with prominent vascularity. All tumors in these three groups were reclassified as combined smooth muscle-stromal tumors following immunohistochemical studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Actins↗
PubMed1991

Nonamyloidotic fibrillary glomerulopathy, immunotactoid glomerulopathy, and the differential diagnosis of filamentous glomerulopathies.

Kidney biopsies from 12 patients between the ages of 10 and 63 yr were diagnosed as nonamyloidotic fibrillary glomerulopathy (NAFG) or immunotactoid glomerulopathy (IG) on the basis of the electron microscopic finding of filamentous or tubular material within the glomerular capillaries and mesangium. Six patients were male and six were female. Eleven presented with nephrotic syndrome and one with acute renal failure. Eight were hypertensive, and four of these patients had gross or microscopic hematuria as well. Biopsies from 11 patients were Congo red negative; one was weakly positive. By light microscopy, the predominant glomerular change was thickening of the capillary basement membrane with or without widening of the mesangium; these changes were suggestive of membranous glomerulonephritis. Immunofluorescent studies performed in four of the cases were positive for immunoglobulin G (IgG). Immunoperoxidase staining for beta 2-microglobulin was negative in four patients. Ultrastructurally, filaments or tubules were identified in the glomerular capillary basement membrane and/or mesangium in each patient. The filaments in NAFG, IG, amyloidosis, and other paraprotein deposits can be differentiated by size, arrangement, and location of filamentous material.

Actin Cytoskeleton↗
PubMed1990

Myospherulosis of the mastoid antrum: a case report.

Myospherulosis is a recently discovered iatrogenic disease caused by the implantation during surgery of mineral oil- or petrolatum-based products into various tissues. The condition results from the action of lipid substances on extravasated erythrocytes. The case report presented is the first detailed description of this uncommon, unique inflammatory lesion occurring in the mastoid and is the second otitic case reported in the literature. The lesion mimicked recurrent cholesteatoma 6 years following an intact canal wall mastoidectomy. As in myospherulosis of the paranasal sinuses, the symptoms and findings of otitic myospherulosis are those of the preceding disease.

Bacitracin↗
PubMed1987

Sequestration hypothesis of atherosclerosis.

Atherosclerosis of the human aorta has been studied by morphometric, chemical, and histochemical methods. Results of these separate approaches are converging upon a theory of pathogenesis. This theory begins with the standard view of a two stage process, intimal fibroplasia followed by atheronecrosis in the most thickened and aged places. The first stage, fibroplasia, can be described in terms of a stochastic process wherein smooth muscle cells, scattered in accordance with a Poison distribution, elaborate matrix materials over time, causing the realms of the cells to expand and to aggregate. The fusion of the expanded smooth muscle cell realms seems to mark the advent of necrosis. The second stage, atheronecrosis, can be described such that the probability of a necrotic core emerging at a site in a vessel is governed by the amount and the age of interstitial matrix materials at the site. Further evidence shows that the matrix materials tend to sequester lipids in greater than proportionate amounts as the intimal bulk increases. The sequestered perifibrous lipid is histochemically different from the lipids of the necrotic core, in that only the latter can be fixed with chromic acid. These results suggest that lipids undergo a qualitative change as well as a quantitative increase at the stage of impending necrosis. This qualitative change is governed by age, which raises the possibility that necrotizing toxicity accumulates in the sequestered lipid as it ages.

Adolescent↗
PubMed1985

Characteristics of the plaque under a coronary thrombus.

Young men dying suddenly and autopsied by the coroner sometimes have coronary thrombosis at a relatively early stage of arteriosclerosis. The plaques under such thrombi often have a complex of features, a) rupture, b) hemorrhage, c) medial destruction, d) nodular collections of foam cells, e) calcification, f) cellular infiltrates of the fibrous cap, fibrous base and adventitia, and g) a newly described kind of phagocytic activity at the boundary between the necrotic core and the fibrous base of the plaque. Commonplace innocuous plaques in most middle and old aged subjects without heart disease also often have some of these features. What structural characteristics might distinguish rare thrombogenic from commonplace innocuous plaques? Twenty-one thrombotic plaques from 18 cases of sudden coronary heart disease (CHD) death were histologically compared with 129 nonthrombotic plaques from these same 18 cases, 85 plaques from 23 cases of CHD death due to arteriosclerotic occlusion, and 94 plaques from 22 cases having no CHD. Plaques with thrombosis all had necrotic cores; plaques for comparison with these were therefore chosen all to have necrotic cores. Rupture and hemorrhage were found in 90% of thrombotic plaques, with mixing of plaque gruel and blood in the thrombus. Medial destruction, foam cells and calcification (features c, d, and e) were commonplace in all types of plaques. Small-cell infiltrates and atherophagocytosis (features f or g) were found in 72-94% of the 21 thrombotic plaques, but only in 18-24% of the 94 not CHD plaques. The necrotic core, characterized by crystalline cholesterol, appears to incite cellular responses in some plaques but not others; those responses distinguish thrombogenesis. The findings imply that thrombogenicity and its accompanying plaque cellularity are incited not by cholesterol, but by some trace or minor component of the plaque gruel of the necrotic core. The possibility of testing these hypotheses by practical methods has been shown to be feasible.

Aged↗
PubMed1983

Fibrous intimal thickening and atheronecrosis of the thoracic aorta in coronary heart disease.

A series of 60 cases of coronary heart disease (CHD) deaths and 85 cases of Not-CHD deaths of a comparable age, race, and sex composition was assembled from a medicolegal service. Lateral walls of the thoracic aorta were sectioned, and measurements were made at 20 equally spaced points along the left and right sections, 40 points per case. At points having foci of atheronecrosis, the thickness of the necrotic focus and the fibroproliferative base and cap were measured. In points lacking atheronecrosis, full intimal thickness was measured. The sum of cap plus base is the total fibroproliferative tissue accompanying atheronecrosis. Aortas of CHD-death subjects had more necrotic points and more connective tissue associated with the necrosis. Aortas of CHD-death subjects also had proportionately less connective tissue in the cap rather than the base of necrotic lesions. These three variables contributed independently in a discriminant function, indicating that CHD-death status could in this set of cases best be predicted from the aortic condition by simultaneously considering the number of atheronecrotic foci, the bulk of connective tissue associated with those foci, and the relative thinness of the cap over the necrosis. One possible theory to explain these and other findings describes atherogenesis as the following two-phase process. In phase one, varying amounts of progressively increasing fibrous intimal thickening (preatheroma) are laid down. In phase two some loci develop atheronecrosis, a second set of loci develops accelerated fibroplasia, and a third set develops both features. The two features are each postulated to be increasingly likely to appear as intimal connective tissue increases. In this context the emergence of atheronecrosis, of accelerated fibroplasia, and of both together would be seen as greater in aortas of CHD-death subjects than in aortas of Not-CHD-death subjects.

Adult↗
PubMedDate not supplied

Intra-abdominal desmoplastic small round cell tumor of the peritoneum in a young man.

The desmoplastic small round cell tumor (DSRCT) has a predilection for involvement of the peritoneal surfaces of young adult men. The tumor has an extremely poor prognosis: despite aggressive therapy the patients usually die of disease within the first 2 years following diagnosis. The present report details the pathologic features of a pelvic tumor, which proved to be a DSRCT, arising in a previously healthy 24-year-old man. The light microscopic features were typical of a DSRCT--the tumor cells were small and round, had inconspicuous cytoplasm, and were grouped into distinctive islands and cords that were dispersed in a fibrous stroma. The immunohistochemical features were likewise characteristic of DSRCT in that the tumor cells were positive for cytokeratin, vimentin, epithelial membrane antigen, and desmin. Ultrastructurally, the tumor cells were distinguished by an abundance of intercellular junctions, cytoplasmic lipid droplets, cytoplasmic intermediate filaments, and an absence of surface microvilli. Recognition of this tumor type is important in view of both its clinical features (extremely poor prognosis despite therapy) and its potential to shed some light on the nature of the family of lesions that has traditionally been classified by light microscopists as small round cell tumors.

Adult↗
PubMedDate not supplied

Pediatric renal artery dysplasia: a morphologic study.

Renal arteries from 12 pediatric patients who had stenosis due to renal artery dysplasia (9 surgical resections and 3 autopsy cases) were examined by light microscopy. The patients ranged in age from 15 months to 14 years; the male/female ratio was one. Bilateral renal artery disease was clinically diagnosed in 8 of the 12 patients; 6 of the 8 also had aortic anomalies. All of the lesions were designated as forms of dysplasia, a departure from previous reports in which dysplasia was subclassified as fibroplasia and hyperplasia. The most common lesion was medial fibrous dysplasia (6), followed by perimedial elastic dysplasia (4); intimal fibrous dysplasia (1) and medial muscular dysplasia (1) were the least common. Medial fibrous dysplasia was present as often with bilateral as with unilateral renal artery stenosis, while perimedial elastic dysplasia was seen exclusively in patients with bilateral renal artery disease. Three patients who came to autopsy had extrarenal vascular involvement by a similar dysplastic lesion. The three patients who had neurofibromatosis showed no distinctive histologic type of renal artery dysplasia.

Adolescent↗