Biomedical subjects

L Angervall

Publications and source records attributed to L Angervall.

At least 37 records · Page 2Linked to original sources

PubMed1990

Surgery for soft tissue sarcoma in the extremities. A multivariate analysis of the 6-26-year prognosis in 137 patients.

In 137 patients with soft tissue sarcomas in the extremities, the influence of patient and tumor characteristics and surgical procedures on prognosis was studied using a multivariate statistical analysis. The minimum follow-up time was 6 years, and no patient was lost to follow-up. Eighty-nine patients were referred with the tumor intact (primary series), while 48 were referred after biopsy or with local recurrence after previous surgery (secondary series). The frequency of amputation was 15 percent in the primary series and 48 percent in the secondary series. A local, function-preserving operation with a wide margin was performed in 37 patients without biopsy (clinical diagnosis alone). Local control of the disease was obtained in all but one of these patients without any adjunctive treatment. Independent, unfavorable factors concerning local recurrence were advancing age, open biopsy, and marginal surgery. Independent, unfavorable factors concerning survival were advancing age, increasing histologic malignancy grade, and ablative surgery. A tumor-related death was observed in 0, 29, 47, and 67 percent of the patients with tumors of malignancy grades I, II, III, and IV, respectively.

Adolescent↗

PubMed1989

Intermediate and fine filaments of vascular leiomyomas (angiomyoma), leiomyoma and leiomyosarcomas of large veins.

The expression of fine and intermediate filaments in 10 cases of leiomyosarcoma originating from a large vein, 9 cases of vascular leiomyoma (angiomyoma) and one case of a leiomyoma originating from the wall of the saphena magna vein was studied immunohistochemically by using 6 different anti-desmin antibodies, one anti-vimentin antibody and 2 antibodies to muscle-specific isoforms of actin. All the benign tumors and all the leiomyosarcomas of a large vein as well as the vein of origin were positively stained for desmin. The staining results obtained using the different anti-desmin antibodies varied considerably, however, and formaldehyde-fixed tissues were apparently inappropriate for some of them. No single anti-desmin antibody produced a positivity in all cases, and the extent and distribution of the positivity varied by being irregular and patchy in the leiomyosarcomas and in the muscle walls of the veins, while the benign tumors generally revealed a more uniform and strong positivity. Antibodies to muscle-specific and smooth muscle-specific actin produced a positive staining in all the benign tumors, as well as all the leiomyosarcomas and the veins from which they originated. A strong and uniform positivity was observed in the benign tumors and muscle walls of the veins, while the positivity in the leiomyosarcomas was more irregular, as it was for desmin. Vimentin was constantly expressed in the benign tumors and in the veins of origin, but only in 5/10 of the leiomyosarcomas. It is concluded from this study that the immunohistochemical demonstration of desmin, utilizing a monoclonal antibody appropriate to the type of fixation used, and muscle specific isoforms of actin, provide strong support to the light-microscopic diagnosis of leiomyosarcoma of venous origin.

Actins↗

PubMed1989

Rhabdomyosarcoma in middle-aged and elderly individuals.

In a review of a national series of malignant tumors in middle-aged and elderly individuals (over 40 years of age), in all 107 cases primarily diagnosed and reported to the Swedish Cancer Registry as rhabdomyosarcomas during the period 1972-1981, 4 cases were accepted as botryoid, embryonal or alveolar rhabdomyosarcoma, using light-microscopic criteria for the diagnosis. An electron-microscopic and immunohistochemical analysis was performed on the 4 cases along with 7 cases of botryoid, embryonal and alveolar rhabdomyosarcoma in patients of over 40 years of age obtained from our own files. Rhabdomyoblastic differentiation was established ultrastructurally by the presence of myofilaments and Z-like densities in 10 of these 11 cases. There were tumor cells in the formaldehyde-fixed, paraffin-embedded material which were positively stained for desmin in all cases, for myoglobin in 7/11 cases, for vimentin in 5/11 cases and for actin in all cases, using monoclonal antibodies. The demonstration of desmin by the monoclonal antibody which was used on the formaldehyde-fixed, paraffin-embedded material is of particular value in the diagnosis of rhabdomyosarcoma. Another tumor, located in the minor pelvis, lacked the light-microscopic features of botryoid, embryonal or alveolar rhabdomyosarcoma, but presented ultrastructural and immunohistochemical evidence of a rhabdomyoblastic differentiation. This tumor was epithelioid in appearance and shared features with alveolar soft part sarcoma. The label epithelioid rhabdomyosarcoma is proposed for this tumor. Nine pleomorphic sarcomas were selected from the national series as possible pleomorphic rhabdomyosarcomas because of the presence of ribbon-shaped tumor cells with an eosiniphilic cytoplasm. There was no electron-microscopic or immunohistochemical evidence of a myogenic differentiation in any of these 9 tumors. The present investigation indicates that a pleomorphic type of rhabdomyosarcoma, indistinguishable from embryonal, botryoid and alveolar rhabdomyosarcoma, is extremely rare or non-existent.

Adult↗

PubMed1988

Cytology of embryonal rhabdomyosarcoma: a cytologic, light microscopic, electron microscopic, and immunohistochemical study of seven cases.

A correlated cytologic and histologic study of seven cases of embryonal rhabdomyosarcoma is presented. The diagnosis of rhabdomyosarcoma was established by light and electron microscopy and immunohistochemistry of the operative specimens. The cytologic appearance of the smears corresponded well with the histopathologic findings. Cytologically, two main cell types were distinguished: a predominant primitive, small round cell with scant cytoplasm and a large cell with an abundant cytoplasm, sometimes tadpole- or ribbon-shaped. The tumor cells were often enclosed in a background of mucosubstances. The lack of cytologic features proving rhabdomyoblastic differentiation, such as cross-striation, necessitates the use of additional methods in the cytologic diagnosis of embryonal rhabdomyosarcoma. The value of the embedding technique for ultrastructural analysis and immunohistochemistry in the demonstration of desmin in aspirates is emphasized in the diagnosis of embryonal rhabdomyosarcoma.

Adolescent↗

PubMed1988

Alveolar soft part sarcoma. An immunohistochemical, cytologic and electron-microscopic study and a quantitative DNA analysis.

The type, differentiation and histogenesis of the tumor cells of alveolar soft part sarcoma (ASPS) have been analyzed in a series of ten cases by a light-microscopic, ultrastructural, immunohistochemical and cytologic investigation and quantitative DNA analysis. Four tumors deviated from ordinary ASPS: three were wholly or partly of the so-called pleomorphic variant of ASPS and a fourth tumor showed calcifications of the psammoma body type. The ultrastructural findings and immunohistochemical demonstration of desmin supported the hypothesis of a rhabdomyomatous differentiation and gave no support to epithelial (negative immunoreactions for cytokeratins, epithelial membrane antigen, HMFG-1 and -2, tissue polypeptide antigen (TPA] or neuroectodermal (negative for S-100 protein, glial fibrillary acidic protein, neurofilaments) differentiation. The negative immunoreactions for vimentin and myoglobin and the positive reaction for neuron specific enolase (NSE) do not exclude a rhabdomyomatous differentiation since in rhabdomyosarcomas the undifferentiated rhabdomyoblasts generally contain vimentin and the differentiated tumor cells contain myoglobin and rhabdomyosarcoma has previously been reported as being positive for NSE. The production of external lamina material peripherally in the tumor cell nests and around vessels in the vascular septa was demonstrated both ultrastructurally and by immunohistochemistry using antibodies against collagen IV and laminin. The cytologic appearance in smears obtained by fine-needle aspiration from a case of the pleomorphic variant showed some resemblance to that of a carcinoma. The seven tumors with an ordinary cell appearance were found to show a diploid DNA-distribution at a quantitative analysis performed on paraffin sections, while the three tumors wholly or partly of the pleomorphic type showed an additional tetraploid peak.

Adolescent↗

PubMed1988

Epithelioid sarcoma. An electron-microscopic and immunohistochemical study.

The present report is a light- and electron-microscopic and immunohistochemical study of 7 cases of epithelioid sarcoma. Formalin-fixed and paraffin-embedded material and in one case ethanol-fixed material from the tumors as well as control tissues were used for the immunohistochemical analysis. A positive reaction for cytokeratins was observed in all 7 tumors when using 3 different polyclonal antibodies and 1 of 3 monoclonal antibodies. All tumors were positively stained with monoclonal antibodies against the epithelial membrane antigen (EMA) and all except one with monoclonal antibodies against the human milk fat globule (HMFG 1 and 2). In all tumors there was a positive reaction for actin and vimentin, using monoclonal antibodies. Ultrastructurally the tumor cells were characterized by pinocytic vesicles, cytoplasmic projections surrounding lumen-like slits, desmosome-like cell junctions and abundant thin and intermediate filaments, sometimes forming condensed bundles and tonofilament-like structures. In one case there were numerous dense cytoplasmic bodies, up to 800 nm in diameter, apparently formed by condensed intermediated filaments. The tumor cells of epithelioid sarcoma share morphologic features and immunohistochemical properties with epithelial cells, which however does not exclude the possibility of a mesenchymal origin.

Actins↗

PubMed1988

Alveolar and poorly differentiated rhabdomyosarcoma. A clinicopathologic, light-microscopic, ultrastructural and immunohistochemical analysis.

Eighteen poorly differentiated, small and dark cell malignancies afflicting young individuals without light-microscopic evidence of a rhabdomyoblastic differentiation or a growth pattern characteristic of rhabdomyosarcoma were analyzed and compared with a series of 30 alveolar rhabdomyosarcomas of varying differentiation, where the diagnosis could be established light-microscopically. The study comprised clinical data, light and electron microscopy and immunohistochemistry, using a battery of mono- and polyclonal antibodies against intermediate filaments, myoglobin, epithelial membrane antigen, neuron-specific enolase, S-100 and leucocyte common antigen. All 30 alveolar rhabdomyosarcomas were positive for desmin, while a minority were positive for myoglobin, using monoclonal antibodies. In 8 of the 18 small and dark cell malignancies, support for a rhabdomyoblastic differentiation was obtained by a positive staining for desmin. In only 3 of these 8 cases was there ultrastructural evidence of rhabdomyosarcoma. The results of the investigation indicate that immunohistochemistry is a more useful tool than electron microscopy in the diagnosis of poorly differentiated rhabdomyosarcoma and that the criteria for the diagnosis of poorly differentiated rhabdomyosarcoma may need to be reformulated.

Antibodies, Monoclonal↗

PubMed1987

Primary leiomyosarcoma of bone. A clinical, radiographic, pathologic-anatomic, and prognostic study of 16 cases.

Sixteen cases of primary leiomyosarcoma of bone are described. The patients, 11 males and 5 females, ranged in age from 9 to 74 years. The annual incidence of this tumor in Sweden was calculated to be 0.09 cases per million. This figure was obtained by reviewing a Swedish series of spindle cell sarcomas of bone of which one quarter (11/44) were diagnosed by us as primary leiomyosarcoma. The diagnosis was based on light- and electron-microscopic examinations using the same criteria as for leiomyosarcoma of soft tissues. Thirteen tumors were located in a long bone of an extremity (nine close to the knee joint) and three in the central skeleton. Radiographically, all the tumors presented as a purely osteolytic lesion, and three patients had sustained a pathologic fracture. In four of six cases angiography suggested malignancy by revealing hypervascularity, irregular tortuous vessels, and diffuse contrast opacification. Contrast-enhanced computed tomography, performed in two cases, showed hypervascular areas within the tumors. Scintigraphy showed a marked increase in radionuclide uptake in all five cases studied. The clinical behavior indicates that primary leiomyosarcoma of bone is highly malignant. Eight patients had died of the tumor and, of the eight patients who were alive at follow-up, two had metastases, and one had been operated on three times for a cutaneous metastasis, which had recurred locally twice. The remaining five patients had been continuously free of disease for 6.5 to 12.3 years.

Adolescent↗

PubMed1987

Myoglobin, desmin and vimentin in ultrastructurally proven rhabdomyomas and rhabdomyosarcomas. An immunohistochemical study utilizing a series of monoclonal and polyclonal antibodies.

The present study is an immunohistochemical analysis utilizing a series of mono- and polyclonal antibodies to myoglobin, desmin and vimentin in smooth and striated control muscle tissues, 7 alveolar and 7 embryonal rhabdomyosarcomas and 1 adult and 1 fetal rhabdomyoma with ultrastructurally proven rhabdomyoblastic differentiation in all the tumors. Formaldehyde-fixed and paraffin-embedded tissue was used for the immunohistochemical analysis of all the tumors, while ethanol fixation was also used for the analysis of the control tissues. The staining for myoglobin with the poly- and monoclonal antibody used was positive in both formaldehyde- and ethanol-fixed skeletal and cardiac control muscle. Trypsin treatment abolished the positive staining when the monoclonal antibody was used. Both the striated and smooth control muscle tissues were positively stained by the antidesmin antibodies. The influence of the fixative that was used and the trypsin treatment depended on the antibody used and the type and origin of the muscle tissue. All the tumors were positively stained with the polyclonal antimyoglobin and 8/14 rhabdomyosarcomas and the 2 rhabdomyomas were positively stained with the monoclonal antimyoglobin. All the tumors were positively stained with the polyclonal and 3 of the 5 monoclonal antidesmin antibodies used. Well-differentiated tumor cells were usually positively stained for both myoglobin and desmin. There were small, poorly differentiated tumor cells in the rhabdomyosarcomas and the fetal rhabdomyoma which were positively stained for desmin, whereas very few or no such cells were positively stained for myoglobin. A varying number of mostly small, poorly differentiated tumor cells were positively stained for vimentin in 12 of 14 rhabdomyosarcomas and in the fetal rhabdomyoma. The study showed that one of the monoclonal antidesmin antibodies produced the most consistent result with a positive staining in all cases. The monoclonal antimyoglobin antibody, which is a specific marker of rhabdomyoblastic differentiation, is also considered to be of value, although it did not produce positivity in all cases. It remains to be shown whether desmin can help in the diagnosis of poorly or undifferentiated rhabdomyosarcomas without light- or electron-microscopic evidence of rhabdomyoblastic differentiation.

Adolescent↗

PubMed1986

Epithelioid malignant schwannoma. A study of 14 cases.

We report a light and electron microscopic, immunohistochemical, clinical and prognostic study of 14 patients with epithelioid malignant schwannoma. In 8 patients the tumour involved a major nerve. The tumours were rather small in most instances, the largest diameter being less than 5 cm in 7 cases. Light microscopically, they showed highly cellular areas of epithelioid, polygonal or rounded cells characteristically forming cords and rows and arranged in nodules of varying size. Spindle cell sarcoma areas as in classical malignant schwannoma were seen in 9 cases, and neurofibromatous areas in one case. Four cases were entirely epithelioid in appearance. Electron microscopically the epithelioid tumour cells showed nuclei with mostly even contours containing one or two trabecular or reticular nucleoli, cytoplasmic projections, intra-cytoplasmic myelin-like figures, intercellular junctions and discontinuous, sometimes multilayered external lamina material. The ultrastructural findings indicate that epithelioid malignant schwannoma is a tumour of neural crest derivation having features of Schwann cell differentiation. Immunohistochemically, S-100 protein was demonstrated in 7 tumours and neuron specific enolase in 3. There was a female predominance, 9/14, and a median age of 38.5 years (range 17-74). The extremities, including the hip and shoulder regions, were the most common sites, 12/14. The tumour proved highly malignant; 9 of 14 patients were dead at the time of follow-up and a high incidence of metastasis (7 of 14) was observed.

Adolescent↗

PubMed1986

The diagnosis and prognosis of soft tissue tumors.

In this review, we present our experience on the clinical, radiographic, and morphologic diagnosis of soft tissue tumors gathered over a quarter of a century. Included is a brief presentation of our principles for surgical therapy and the results of multivariate statistical analysis performed to assess which clinical and morphologic variables determine prognosis.

Humans↗

PubMed1986

Ewing's sarcoma of bone. A correlative cytological and histological study of 14 cases.

A correlative cytological and histological study of 14 cases of Ewing's sarcoma is presented. All smears from the fine needle aspirates were performed during the diagnostic investigation before treatment of the patients. The smears were very cellular with relatively small, round to oval tumour cells which appeared rather uniform. Two cell types could be distinguished, however. There was a predominance of relatively light, so-called principal or chief cells, but smaller and darker cells, so-called dark cells, were also observed. We found that Ewing's sarcoma has a characteristic appearance in smears and that fine needle aspiration cytology can be used in its primary diagnosis. A conclusive diagnosis may be made when the clinical and radiographic findings are also consistent.

Adolescent↗

PubMed1985

Atypical hemangioendothelioma of venous origin. A clinicopathologic, angiographic, immunohistochemical, and ultrastructural study of two endothelial tumors within the concept of histiocytoid hemangioma.

Two patients, a 62-year-old man and a 50-year-old woman, both with deep-seated atypical endothelial tumors within the wide concept of histiocytoid hemangioma, are reported. In case 1, the tumor involved the brachial vein, and, in case 2, a medium-sized vein of the anterior neck. In both cases the involved vein was occluded. Angiography in case 1 suggested a tumor that was enclosed by the same fibrous sheath, the conjunctiva vasorum, that enclosed the occluded vein and its concomitant artery. Both tumors were solid, without conspicuous vascular differentiation by light microscopy. Such differentiation, however, was evident from the electron-microscopic examination, which showed tumor cells with endothelial features forming primitive vascular structures. Positive lectin histochemistry (Ulex Europeus I) and positive immunohistochemistry for factor-VIII-related antigen, actin, and vimentin also gave strong support for the endothelial differentiation of the tumor cells. Immunohistochemical studies of markers for histiocytic (alpha 1-antitrypsin, ferritin, lysozyme), epithelial (cytokeratin, epithelial membrane antigen), and neuroectodermal (S-100 protein) and skeletal muscle (myoglobin) differentiation were negative. At follow-up, after 7 years and 2 years, respectively, there were no signs of local recurrence or metastasis.

Angiography↗

PubMed1984

Leiomyosarcomas of venous origin in the extremities. A correlated clinical, roentgenologic, and morphologic study with diagnostic and surgical implications.

This article presents a correlated clinical, roentgenologic, and morphologic study of six cases of leiomyosarcoma of large veins in the extremities. Growth of the tumor within the lumen of the affected vein was demonstrated by phlebography in one case and by angiography and computed tomography in one case. In all six cases, such growth was demonstrated by dissection of the surgical specimen. In four cases, arteriography showed both neovascularity at the site of the lesion and compression of the artery accompanying the affected vein. The compression apparently was caused by entrapment of the artery within the same preformed fibrous sheath (conjunctiva vasorum) that enclosed the tumor and the vein from which it had arisen. The histologic diagnosis was based on the light microscopic appearance in all cases and was supported by electron microscopic findings in three cases by the demonstration of ultrastructural features of leiomyoblasts. All six tumors were light microscopically of high-grade malignancy. Five of the patients died of metastatic tumor disease and one is alive with lung metastases. The information obtained by a careful physical examination combined with phlebography, arteriography, and computed tomography may be helpful in the clinical diagnosis and the planning of adequate surgical treatment.

Adult↗

PubMed1984

Dermal nerve sheath myxoma. A light and electron microscopic, histochemical and immunohistochemical study.

Two cases of dermal nerve sheath myxoma have been examined by light and electron microscopy, and by immunohistochemical and histochemical methods. The nomenclature of this tumor has been debated, and the histogenesis unsettled. Light microscopically, the lobulated myxoid tumors were generally composed of spindle-shaped and stellate tumor cells in an abundant matrix of mucosubstances. Ultrastructural features indicated an origin from the peripheral nerve sheath; among the pertinent findings were a single or duplicated external lamina investing the cells, desmosome-like junctions, cytoplasmic microfilaments and myelin figures, and interdigitating cytoplasmic processes. S-100 protein was demonstrated by means of the immunoperoxidase technique within both tumors, further supporting this origin. The histochemical analysis of the mucosubstance showed the presence of sulphated glucosaminoglycans. The name dermal nerve sheath myxoma, suggested by Harkin and Reed, is recommended.

Aged↗

PubMed1984

Primary leiomyosarcoma of the vagina: a study of five cases.

The clinical and light and electron microscopic features of five cases of primary vaginal leiomyosarcoma, representing 2.9% of all vaginal malignancies registered at the Swedish Cancer Registry, are presented. The ages of the patients ranged from 31 to 69 years. The most common clinical presentation was an increasing mass and/or local tenderness. The tumor was located in the anterior wall in three cases and in the lateral wall in two. The size of the tumors ranged from 2 to over 10 cm. Four patients had tumors of high histologic malignancy grade and were all dead within 36 months. One patient had a tumor of low grade and is still alive 10 years after the initial excision. The ultrastructural observations of abundant myofilaments with focal elongated densities in primary paraffin-embedded material conform with the light microscopic diagnoses in all cases and indicate the usefulness and value of such material for electron microscopy in order to arrive at the diagnosis of leiomyosarcoma. The therapeutic and diagnostic aspects are discussed.

Adult↗

PubMed1984

An immunohistochemical analysis of S-100 protein and glial fibrillary acidic protein in nasal glioma.

The authors describe a recurrent nasal glioma of the nasal septum in a new-born boy. Histologically, the nodular tumor tissue resembled normal glial tissue. Immunohistochemical studies with the immunoperoxidase (PAP and ABC) techniques revealed the presence of both S-100 protein and glial fibrillar acidic protein (GFAP), indicating the glial nature of the tumor.

Glial Fibrillary Acidic Protein↗

PubMed1984

Nasal polyps with atypical stroma cells: a pseudosarcomatous lesion. A light and electron-microscopic and immunohistochemical investigation with implications on the type and nature of the mesenchymal cells.

A case of nasal polyposis with stroma cell atypia in a 33-year-old man is reported. The light microscopic appearance made a rhabdomyosarcoma strongly suspected because of the presence of polymorphous, acidophilic, rhabdomyoblast-like cells. The clinical course was that of an ordinary recurring inflammatory nasal polyp. The ultrastructural and immunohistochemical analysis showed the fibroblastic and histiocytic nature of the atypical cells as being of a probably reactive nature. The reported case illustrates the value of electron microscopy and immunohistochemistry in the evaluation of the true type and nature of atypical mesenchymal cells in pseudosarcomatous lesions.

Adult↗