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Biomedical subjects

K R Geisinger

Publications and source records attributed to K R Geisinger.

At least 73 records · Page 4Linked to original sources
PubMed1994

Identification of sperm and non-sperm male cells in cervicovaginal smears using fluorescence in situ hybridization: applications in alleged sexual assault cases.

The identification of spermatozoa or constituents of seminal fluid is critical in the evaluation of alleged sexual assault victims. However, failure to identify sperm and/or elevated levels of acid phosphatase can occur for a variety of reasons. Molecular techniques, such as molecular cytogenetic analysis offers new approaches to improve on the identification of male cells in alleged sexual assault cases. Fluorescence in situ hybridization (FISH) with a Y chromosome specific DNA probe was applied to archival cervicovaginal smears from 41 alleged sexual assault cases to identify Y-bearing (male) cells. FISH identified Y-bearing sperm and non-sperm cells in 78% of the cases previously confirmed to have sperm. FISH also identified Y-bearing non-sperm male cells in 39% of the cases in which cytology did not detect spermatozoa; in one of these instances, it also detected sperm. Cervicovaginal acid phosphatase levels, determined at the time of the cervicovaginal smears, were also compared with the presence or absence of Y-positive cells. Application of this technique can detect non-spermatozoic male cells in routine cervicovaginal smears of sexual assault victims.

Acid Phosphatase↗
PubMed1993

Leukemic infiltration of the esophagus.

BACKGROUND: Leukemic infiltrates of the esophagus have been described occasionally in autopsy series, but there are no reports of antemortem diagnosis. METHODS: Case reports are presented for three patients with acute myeloid leukemia in whom leukemic infiltration of the esophageal mucosa was diagnosed histologically and cytologically by endoscopic examination. Autopsies of patients with leukemia from 1976-1988 were reviewed. RESULTS: The autopsy review of 207 patients with leukemia showed evidence of leukemic infiltration in the esophagus in 7.2% of cases. The only clinical factor identified to be significantly associated with esophageal involvement by leukemic cells was a high initial leukocyte count. Esophageal involvement was associated with leukemic infiltration of other soft tissues and organs. CONCLUSIONS: Although the etiology of dysphagia in patients with acute leukemia is usually related to infection, reflux, chemotherapy toxicity, or benign strictures, the frequency of esophageal leukemic infiltration in this autopsy series suggests that this diagnosis must be considered. Esophageal leukemia is usually associated with widely disseminated soft tissue and visceral infiltrates.

Adult↗
PubMed1993

Unresectable stage IV nephroblastoma: a potential indication for fine-needle aspiration biopsy in children.

In the United States, the initial morphologic diagnosis of nephroblastoma is usually determined on a nephrectomy specimen prior to the initiation of any additional therapy. Such an approach, however, is not appropriate in all children; we believe that fine-needle aspiration biopsies (FNAB) should be the initial diagnostic procedure in a minority of patients with suspected Wilms' tumor. One such group of patients is those who present with stage IV disease, especially when it is considered unresectable. Herein we present two children with advanced Wilms' tumor to support our contention. The initial microscopic diagnosis in each was made by FNAB. Following chemotherapy, predominantly necrotic Wilms' tumors were excised. Both patients are alive with no evidence of residual disease or untoward affects from the aspiration procedure.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Cytomorphology of familial hemophagocytic syndrome.

Familial hemophagocytic syndrome (FHS) is a rare, fatal disorder of childhood demonstrating failure to thrive, fever, hepatosplenomegaly (HSM), recurrent infections, pancytopenia, and histologically, the infiltration of reticuloendothelial organs by benign-appearing histiocytes demonstrating hemophagocytosis. We report two fatal cases of FHS including a 3 year-old female who underwent fine-needle aspiration (FNA) biopsy of the liver in the initial workup of the disease (case 1) and an 8 month-old boy with ascites and HSM having peritoneal fluid cytology submitted as the first specimen for morphologic examination (case 2). In case 1, the FNA cytologic findings included benign hepatocytes and scattered mature and reactive lymphocytes and histiocytes. The histiocytes demonstrated fine to coarse cytoplasmic vacuoles and erythrophagocytosis. The diagnosis was confirmed at autopsy which revealed extensive lymphohistiocytic infiltrates in various organs including the central nervous system. In case 2, the peritoneal fluid cytology specimen contained numerous atypical and degenerating mononuclear lymphoreticular cells which were dispersed as a single cell suspension admixed with infrequent mesothelial elements; hemophagocytosis was not appreciated. Subsequent liver biopsy revealed portal tracts and sinusoids infiltrated by benign but atypical histiocytes with hemophagocytosis. Bone marrow examination and then autopsy confirmed the diagnosis of FHS. A panel of immunocytochemical studies was performed in the first case which was an aid in confirming the diagnosis of FHS and ultrastructural examination of the second case revealed well-developed erythrophagocytosis. Both patients had siblings who died of FHS. Although not diagnostic, cytomorphology may suggest FHS.

Ascitic Fluid↗
PubMed1993

Fine-needle aspiration cytology of extramedullary hematopoiesis (myeloid metaplasia).

Myeloproliferative disease may be associated with extramedullary hematopoiesis (EH). Clinically, however, the differential diagnosis of solid masses in these patients includes not only EH but also inflammatory lesions and malignant neoplasms, including granulocytic sarcoma. We report the fine-needle aspiration (FNA) cytology of extramedullary hematopoiesis in five patients with a history of myeloproliferative disease. All of the masses developed subsequent to the diagnosis of myeloproliferative disease. Two of the patients had chronic myelogenous leukemia, one had essential thrombocythemia, and two had an unspecified chronic myeloproliferative disorder. The patients ranged in age from 50 to 88 years, and all presented with solid masses involving the kidney (two aspirates), liver (one aspirate), and lymph nodes (three aspirates). One of the lymph node aspirates was from a paratracheal lymph node. Cytologically, the lesions were composed of varying numbers of hematopoietic cells from all three hematologic cell lines. The Diff-Quik stain was especially helpful in the recognition of the hematopoietic cells such as granulocytic precursors, eosinophils, and megakaryocytes. In several cases, the megakaryocytic component was particularly prominent. In one case, the Factor VIII immunoperoxidase stain was used to confirm the megakaryocytic lineage of the multinucleated cells. The cytologic differential diagnosis, which includes granulocytic sarcoma, inflammatory disorders, and other lesions containing multinucleated giant cells, is discussed.

Aged↗
PubMed1993

Hemobilia in systemic lupus erythematosus.

Symptoms of acute cholecystitis developed in a 22-year-old woman with active SLE. Abdominal ultrasonography and biliary patency scan showed evidence of acalculous cholecystitis and common bile duct obstruction, respectively. Operation revealed acalculous cholecystitis and hemobilia; a liver biopsy specimen also showed hemobilia. Surgery relieved the patient's symptoms. This case demonstrates a new complication of SLE.

Adult↗
PubMed1992

A comparative cytopathologic and histologic study of atypia, dysplasia, and adenocarcinoma in Barrett's esophagus.

As a potentially premalignant condition, Barrett's esophagus has stimulated controversy over the need for surveillance of glandular dysplasia and early carcinoma. This prompted the authors to review their experience with endoscopic cytologic brushings and biopsies from patients with Barrett's esophagus. The authors reviewed 65 consecutive specimens from 42 patients with Barrett's esophagus in which both the concurrently obtained esophageal cytologic brushings and companion biopsy specimens were available. In addition, esophagogastrectomy specimens from 9 nine these patients were reviewed. Cytologic and histologic specimens were assigned to one of four diagnostic categories, based on specifically defined criteria: simple Barrett's esophagus with or without inflammatory atypia; dysplasia; adenocarcinoma; or suspicious for dysplasia or carcinoma. Simple Barrett's esophagus was diagnosed in 38 cytologic brushings and 44 biopsy specimens, dysplasia in 4 brushings and 7 biopsy specimens, and carcinoma in 14 brushings and 10 biopsy specimens. Nine brushings and three biopsy specimens were suspicious. In 13 cases, brushings revealed a higher grade lesion than did histology; in 5 cases, biopsy specimens showed a higher grade lesion. Agreement between the two occurred in 72% (47/65) of all specimens. Accuracy was confirmed in the histologic examinations of the resection specimens. The authors conclude that specific criteria, when consistently applied, allow accurate cytologic diagnoses of epithelial changes in Barrett's esophagus. The use of esophageal brush cytology and biopsy specimens provides two complementary techniques, which detect a greater number of serious lesions than either technique alone.

Adenocarcinoma↗
PubMed1992

Continuous versus intermittent acid exposure in production of esophagitis in feline model.

Our morphometric feline model of acid-induced esophageal damage histologically resembles human reflux esophagitis. The histologic scoring system includes intensity and linear extent of basal cell hyperplasia, intraepithelial and subepithelial segmented leukocytes, and ulcers. Each of these four categories is scored from 0 to 4, for a potential total score of 16. Some reports have indicated that the long-duration acid exposure episodes during recumbent nighttime reflux are apt to be associated with greater injury than shorter episodes during daytime upright exposure. We tested the hypothesis that longer single exposures to acid would incite greater morphologic damage in the cat than would multiple, shorter acid exposures. To study the influence of continuous versus intermittent hydrochloric acid exposure, groups of six cats each were infused continuously (single infusion) for 15, 20, or 30 min, and compared with cats infused for 2-min acid infusion times. Our studies indicate that total acid exposure and mucosal damage are more likely to be greater after multiple episodes of the same total duration with adequate clearing (ie, awake upright reflux) than after single long episodes of acid exposure that are poorly cleared (ie, sleeping).

Analysis of Variance↗
PubMed1992

Weight loss induced by gastric implant in rats. Effects of capsaicin sensory denervation.

To study the efficacy and mechanism of action of the intragastric bubble, 1- to 5-ml silicone bubbles were surgically implanted into the stomachs of 10- to 12-week-old female rats. To test the hypothesis that the satiety effects of the implant are mediated by visceral sensory nerves, a subgroup was treated as neonates with the sensory neurotoxin capsaicin, 50 mg/kg subcutaneously. In control animals, the implants caused a transient decrease in body weight, compared to sham-implanted animals, most evident at three days and abolished by 18 days after operation. In contrast, capsaicin-treated animals did not lose weight in response to gastric implantation. Substance P was decreased in the vagus nerves of capsaicin-treated animals, confirming sensory denervation. At autopsy, all gastric implanted rats had enlarged stomachs. We conclude that intact sensory innervation is essential for weight loss in response to the gastric bubble.

Animals↗
PubMed1991

Cytologic diagnosis of aspergillosis in cardiac transplantation.

Fine-needle aspiration of the lung is now widely utilized to diagnose pulmonary neoplasms, but often serologic techniques or open-lung biopsy is relied on for the diagnosis of infectious pulmonary processes. We report a series of four patients in whom the fine-needle aspiration technique was used to make the rapid cytologic diagnosis of pulmonary aspergillosis. Culture confirmation was also obtained on the aspirated material. A discussion of the available techniques for the laboratory diagnosis of pulmonary aspergillosis is presented and the advantages of fine-needle aspiration cytology are stressed. Our favorable results support expanded use of fine-needle aspiration cytology in the evaluation of lung nodules appearing in immunosuppressed populations.

Adult↗
PubMed1991

Gastrointestinal cytology.

Since the development of the fiberoptic endoscope, laboratories have received cytologic specimens obtained from all segments of the gastrointestinal tract in increasing numbers to identify infectious agents and neoplasms. Adenocarcinomas generally are easily diagnosed and distinguished from reparative atypia, but their precursor lesions, dysplasia and adenomas, provide greater interpretive challenges. The same is true for such entities as malignant lymphomas. Most mesenchymal tumors remain outside the diagnostic capabilities of most cytologists.

Cytodiagnosis↗
PubMed1990

Piroxicam decreases postirradiation colonic neoplasia in the rat.

This study evaluated the effects of the nonsteroidal antiinflammatory agent piroxicam on chronic radiation proctitis in the rat. Forty female Wistar rats received a 2250-cGy dose of irradiation to the distal 2 cm of the colon. Twenty received piroxicam 8.0 mg/kg orally 30 minutes before exposure and 24 hours after exposure; 20 rats served as irradiated controls. All animals were evaluated by colonoscopy 1 and 3 weeks postexposure and every third week until death or killing at 1 year. At killing, colons were removed for light microscopic examination. One year postirradiation results showed no differences in mortality, vascular changes, acute inflammation, colitis cystica profunda, or rectal stricture between the control and piroxicam-treated groups. However, at 1 year postirradiation the control group demonstrated neoplasia in 15 of 19 animals compared with eight of 20 animals in the piroxicam-treated group. The first endoscopic appearance of colonic neoplasm occurred at 15 weeks postirradiation in one control irradiated rat whereas the first evidence of endoscopic neoplasm in the piroxicam-treated group did not occur until 36 weeks postirradiation. Histologic examination documented a tendency toward a greater presence of adenocarcinomas in the control group compared with the piroxicam-treated group. The authors conclude that piroxicam treatment significantly decreased the incidence of colonic neoplasia in general as well as delayed the endoscopic appearance of colonic neoplasia in rats after pelvic irradiation.

Adenocarcinoma↗
PubMed1990

Malignant papillary cystic tumor of the pancreas.

An example of the rare papillary cystic tumor of the pancreas was diagnosed cytologically by aspiration of the primary neoplasm. Subsequently, it metastasized, proving its low-grade malignant behavior. Diagnostic cytomorphologic features included abundant straight and branched papillary tissue fragments, and uniform, pale nuclei with folds or grooves. Although the primary tumor had a typical histologic appearance, metastases demonstrated increased nuclear pleomorphism and hyperchromasia, bizarre tumor giant cells, and an increased mitotic rate. Vimentin was diffusely positive, whereas neuron-specific enolase and somatostatin were focally and weakly reactive. Neurosecretory and zymogen granules were absent ultrastructurally. By flow cytometric study, the tumor was aneuploid (DNA Index = 1.3).

Abdominal Neoplasms↗