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Biomedical subjects

M N Koss

Publications and source records attributed to M N Koss.

At least 91 records · Page 5Linked to original sources
PubMed1992

Mucinous (so-called colloid) carcinomas of lung.

We present 24 cases of primary mucinous (so-called colloid) carcinomas of the lung. The patients were between 33 and 81 yr old (median: 57 yr), including 15 men and nine women. The lesions were discovered incidentally on chest X-ray, where they presented in diverse forms. No predilection for a particular lobe or pulmonary segment was observed. The tumors varied from 0.5 to 10 cm in greatest diameter. Grossly, the tumors were poorly circumscribed, soft, tan-to-gray mucoid lesions. Microscopically, they showed intra-alveolar pools of mucin containing small clusters of atypical cells floating in the mucin, and foci of neoplastic columnar epithelium lining scattered alveoli. Seven cases showed areas of solid, well-differentiated malignant glands adjacent to pools of mucin. In two cases, lymph node metastases were found at surgery. Eleven (57%) of 19 patients were alive over a follow-up period ranging from 2 to 192 mo; one of them had metastases to bone and another had intrapulmonary recurrence. Eight patients died with/of their tumors, two of them with known metastases to bone and/or brain, and one with recurrence after 2 yr of initial diagnosis. No follow-up was obtained in five patients. Although the extent of clinical evaluation varied, no other primary neoplasms (i.e., breast, gastrointestinal tract, or other organs where primary mucinous carcinomas are known to occur) were observed. These tumors probably represent a variant of bronchioloalveolar carcinoma and share the prognosis of that neoplasm. However, because of their often bland cytologic features and paucity of malignant cells, they may be difficult to diagnose as neoplasms.

Adenocarcinoma, Mucinous↗
PubMed1992

The spectrum of histologic growth patterns in benign and malignant fibrous tumors of the pleura.

A review of the histologic growth patterns in 50 cases of benign and malignant fibrous tumors of the pleura (localized or solitary fibrous tumor, fibrous mesothelioma) is presented. Two major histologic growth patterns were observed admixed in various proportions: solid spindle and diffuse sclerosing. The solid spindle growth pattern assumed various configurations, including fascicular areas, storiform and herringbone formations, angiofibroma and hemangiopericytoma-like areas, synovial sarcoma-like areas, and neural-type palisading, thus simulating a variety of soft-tissue neoplasms. The diffuse sclerosing pattern, although rarely assuming a dominant role, was present in varying proportions in virtually all cases. In areas with extensive sclerosis, focal degeneration of collagen simulating tumor necrosis was often present. Other less frequently observed features were the formation of "amianthoid" fibers, multinucleated giant cells, and foci of metaplastic ossification. On ultrastructural and immunohistochemical examination, the tumor cells showed nondistinct features. Due to the extreme variability in morphologic appearances and the lack of distinctive ultrastructural or immunohistochemical characteristics, these tumors can pose a significant diagnostic problem. Familiarity with their histologic appearances and correlation with the gross findings and clinical setting are essential for arriving at the correct diagnosis.

Adolescent↗
PubMed1991

Pulmonary blastomas.

Pulmonary blastoma is a rare lung tumor composed of immature mesenchyme and/or epithelium that morphologically mimics embryonal pulmonary structure. The prognosis of these tumors is poor, and the clinical course is not readily predicted from histologic appearance. In this report, the clinical, gross, microscopic, and immunopathologic features of 52 cases are described, and prognostically important correlates are determined. Twenty-eight patients were women, and 24 were men. There was a unimodal age peak in the fourth decade; only two patients were younger than 10 years old, and both had biphasic blastomas. Forty-one percent of patients were asymptomatic. Chest radiography typically showed a peripheral or midlung mass without predilection for any lobe. Microscopically, tumors could be divided into two classes: those composed solely of malignant glands of embryonal appearance (well-differentiated fetal adenocarcinomas [WDFA], 28 cases) and those with a biphasic appearance (24 cases). The malignant epithelium contained cytokeratin, carcinoembryonic antigen, milk fat globulin, and often chromogranin; vimentin, actin, and less frequently desmin and myoglobin were present in malignant stromal cells. More often WDFA was a smaller tumor (less than 5 cm) than biphasic tumors (P less than or equal to 0.001). It was more likely to be asymptomatic (P less than or equal to 0.001), and it was less likely to show pleural effusion by chest radiography (P less than or equal to 0.01) or giant or bizarre tumor cells (P less than or equal to 0.001) or frequent (greater than or equal to 30 mitoses/10 high-power fields) mitoses in the microscopic sections (P less than or equal to 0.01). Only 14% of patients with WDFA died of their tumor; 52% of patients with biphasic tumors died (mean follow-up, 97 months and 49 months, respectively). For patients with WDFA, the presence of thoracic adenopathy by chest radiography (P less than or equal to 0.001) and metastasis at initial presentation (P less than or equal to 0.001), followed by tumor recurrence (P less than or equal to 0.01), were the factors most highly correlated with poor prognosis. For patients with biphasic tumors, tumor recurrence (P less than or equal to 0.001) was the most significant indicator of poor prognosis, followed by metastasis at initial presentation (P less than or equal to 0.05) and gross size of the tumor (greater than or equal to 5 cm) (P less than or equal to 0.05). These findings support the idea that histologic class and gross and clinical findings can be of prognostic value in pulmonary blastoma.

Actuarial Analysis↗
PubMed1991

Hepatic amyloidosis: morphologic differences between systemic AL and AA types.

The liver is almost universally involved in systemic amyloidosis. Patterns of topographic distribution of amyloid within the liver lobule have been recognized, but the reliability of using these for classification of amyloid type is in question. We examined 286 livers from cases of systemic amyloidosis obtained from autopsies at Los Angeles County-University of Southern California Medical Center, classifying them as AL or AA type by means of the potassium permanganate Congo red-staining method along with a specific anti-AA antiserum. Prior publications have asserted that deposition of secondary (AA) amyloidosis is limited to the vessels in the portal tract, constituting a "vascular" pattern, and that in primary (AL) amyloidosis the deposits exhibit a "sinusoidal" pattern in that they are seen along hepatic sinusoids as well as in portal vessels. We confirmed that AL amyloid involves the portal vessels as frequently as AA amyloid and that deposition occurred significantly more frequently in the portal stroma, the central vein, and the "sinusoidal" areas. However, we also found a "sinusoidal" pattern in 29 of 78 cases of secondary (AA) amyloidosis; in 14 of these, more than half of the sinusoidal spaces were replaced by amyloid deposits. We also noted that in 23 of the 29 AA amyloidosis cases with "sinusoidal" involvement, a "sago" pattern of distribution of amyloid in the spleen was present. No consistent association of a specific chronic inflammatory disease with "sago" spleen and "sinusoidal" deposits could be documented. We conclude that topographic distribution of amyloid within the liver lobule is not a reliable method of distinguishing AA from AL amyloidosis and that specific staining methods must be used if the physician is to be able to attempt modern therapeutic modalities.

Amyloid↗
PubMed1991

Detection of Epstein-Barr virus in lymphoepithelioma-like carcinoma of the lung.

A case of lymphoepithelioma-like carcinoma of the lung is reported in a Chinese patient with serologic evidence of previous Epstein-Barr (EBV) infection. EBV genomes were detected in the tumor using polymerase chain reaction (PCR) and in situ hybridization (ISH) from formalin-fixed, paraffin-embedded tissue blocks. The use of both techniques afforded the exquisite sensitivity of PCR to detect a few copies of EBV DNA with the ability of ISH to precisely localize EBV to the carcinoma, but not to the lymphoid stroma. These findings support a potential oncogenic relationship between EBV and lymphoepithelioma-like carcinoma of the lung.

Aged↗
PubMed1991

An immunohistochemical study of benign clear cell ('sugar') tumor of the lung.

Benign clear cell ("sugar") tumor is a rare and most unusual pulmonary neoplasm. Although several reports in the literature have focused on the ultrastructural features of benign clear cell tumor, only a few cases have been formally studied by immunochemistry. Using a broad panel of polyclonal and monoclonal antibodies, five cases were evaluated. In all five cases, there was diffuse immunoreactivity for cathepsin B. Four cases showed immunoreactivity for HMB-45 and for alpha 1-antitrypsin. By two different sources for antivimentin, there was immunoreactivity in four cases (Biogenex, Dublin, Calif) and in two cases (DAKO, Santa Barbara, Calif), respectively. Additional immunoreactivity was present for S100 protein (three cases), HAM-56 (two cases), factor XIIIA (two cases), and neuron-specific enolase (one case). No case expressed immunoreactivity for keratin (AE 1, AE 3, or CAM 5.2), carcinoembryonic antigen, chromogranin, synaptophysin, glial fibrillary acidic protein, or alpha 1-antichymotrypsin. This immunochemical profile suggests that HMB-45, in combination with a variety of immunostains, may serve to distinguish benign clear cell tumor from other clear cell neoplasms.

Adult↗
PubMed1990

Rapid diagnosis of Pneumocystis carinii infection in AIDS by cytocentrifugation and rapid hematoxylin-eosin staining.

Pneumocystis carinii pneumonia (PCP) is the major pulmonary complication in patients with the acquired immunodeficiency syndrome. While fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBX) is regarded as the procedure of choice to identify PCP, these techniques, particularly TBBX, pose potential risks to the already compromised patient. To reduce the duration of bronchoscopy and, hence, lessen the chance for complications, we describe a rapid technique to identify PCP in BAL fluid by cytocentrifugation and hematoxylin-eosin staining. By this method, PCP can be easily diagnosed within 10 min. The sensitivity of this rapid diagnostic procedure is 95.7%, and the specificity is 100%.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Ethnic distribution of amyloidosis: an autopsy study.

We examined the ethnic heritage of 467 patients with amyloidosis and related it to the type of amyloid (secondary versus other types) found among 52,370 autopsies at Los Angeles County-University of Southern California Medical Center. Classification of amyloidosis by type was accomplished by using the potassium permanganate Congo red staining method and a specific anti-AA antiserum, supplemented by the anatomical distribution of the amyloid in some instances. We discovered a statistically significant increase in amyloidosis among patients with hispanic surnames as compared with other Caucasians. The overall rate for Hispanics in our total autopsy population was 2.3% as compared with 0.6% for other Caucasians (P less than or equal to 0.001). The increase was mostly among those whose amyloid was negative to tests for secondary (AA) amyloidosis and not anatomically compatible with senile cardiac (senile systemic) amyloidosis. Hispanics accounted for 76% of these cases as compared with 18.5% for Caucasians (P less than or equal to 0.001). Our findings, along with previously published reports, suggest that the frequency of amyloidosis may vary significantly in different ethnic groups.

Adult↗
PubMed1989

Pneumocystis carinii infection in the acquired immune deficiency syndrome.

The acquired immune deficiency syndrome (AIDS) pandemic has focused attention on Pneumocystis carinii pneumonia (PCP). Of special significance are the following key issues. (1) PCP in the AIDS patient can be clinically different than in the non-AIDS patient. (2) The morphologic expressions of PCP in both AIDS and non-AIDS patients are considerably more diverse than previously believed. (3) Rapid diagnostic methods that unequivocally demonstrate the PC microorganisms in the tissue and secretions are crucial to patient care. The clinical manifestations of PCP overlap with those of other pulmonary disorders so that its diagnosis requires at least bronchoscopy, if not an open lung biopsy. In biopsy specimens, typical and atypical histologic features allow the recognition of PCP under microscopic examination. The sensitivities of transbronchial biopsies and bronchoalveolar lavage are comparable, and their combination offers the greatest diagnostic yield. This article discusses the clinical and pathologic features of PCP in the AIDS patient, and explores the advantages and pitfalls of the various diagnostic methods for the identification of PC.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Heterotopic liver in an adrenal gland.

We report a case of heterotopic liver located in the right adrenal gland and connected to the liver through a vascular membranous pedicle. Features of chronic active hepatitis with cirrhosis were present in the heterotopic site, mirroring the abnormal histopathology in the liver.

Adrenal Gland Neoplasms↗
PubMed1988

Hepatic hyaline globules associated with passive congestion.

We describe the presence of hyaline globules in liver associated with hepatic congestion. These globules were present in hepatocytes in 15% of 100 adult autopsies. They are periodic acid-Schiff (PAS)-positive and diastase-resistant by light microscopy, and in one case examined by electron microscopy, contained microfibrillar material with occasional rod-shaped inclusions. The majority of them stained positively for fibrinogen and alpha 1-antitrypsin by immunohistochemical methods. Of possible etiologies, the globules appear most probably as phagosomes containing imbibed serum proteins under conditions of increased sinusoidal pressure with passive congestion. They are more common than generally realized, when compared with other reported forms of nonglycogenic hyaline globules in liver. They must be distinguished from alpha 1-antitrypsin-disease globules.

Humans↗
PubMed1987

Lymphoid interstitial pneumonia: clinicopathological and immunopathological findings in 18 cases.

Eighteen patients with lymphoid interstitial pneumonia (LIP) were studied. The diagnosis was established by the microscopic finding of interstitial infiltrates of lymphocytes and plasma cells. Forty-seven% of patients also had germinal centres, while 72% showed interstitial giant cells. Cases studied by the immunoperoxidase technique showed the interstitial plasma cells to be polytypic. The median age of patients was 56 years; most had cough, dyspnea, or chest pain. Chest X-rays showed either patchy interstitial infiltrates (usually bilateral) or poorly defined nodules. Ten patients had hypergammaglobulinemia; one had hypogammaglobulinemia. Two patients had Sjögren's syndrome, two had biopsy-proven chronic active hepatitis, and two had a clinical diagnosis of primary biliary cirrhosis. Follow-up examination of 14 patients showed clearing of symptoms, X-ray infiltrates or stable infiltrates in 4 cases each. Five patients died (mean survival, 41 months), one of whom succumbed to disseminated lymphoma and a second to respiratory failure. Our results support the hypothesis that LIP is a non-neoplastic cellular proliferation in which lymphoma may supervene. The high incidence (22%) of chronic liver disease has not previously been noted.

Adult↗
PubMed1987

The effectiveness of bronchoscopy in the diagnosis of Pneumocystis carinii and cytomegalovirus pulmonary infections in acquired immunodeficiency syndrome.

We evaluated the sensitivity of bronchoscopy for the diagnosis of Pneumocystis carinii and cytomegalovirus pulmonary infections in patients with acquired immunodeficiency syndrome. The antemortem and postmortem diagnoses were compared in 36 patients who underwent fiberoptic bronchoscopy within two weeks of death. In autopsy-proved cases of Pneumocystis carinii pneumonia (PCP), the organism was correctly identified antemortem in 22 (88%) of 25 cases, including 94% of adequate transbronchial bronchoscopic biopsy specimens, 95% and 88% of bronchoalveolar lavage (BAL) cell blocks and smears, respectively, and 79% of brushing. In 11 patients who underwent simultaneous adequate biopsy, BAL, and brushings, the diagnostic sensitivity for PCP was 100%. The negative predictive value of bronchoscopy for PCP was 85%. Bronchoscopy yielded the diagnosis of cytomegalovirus infection in only 55% of autopsy-proved cases. Diagnostic sensitivity was also reduced when an important diagnostic procedure, such as transbronchial biopsy or BAL, was inadequate or not performed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Lymphomatoid granulomatosis: a clinicopathologic study of 42 patients.

We studied the histological and clinicopathological findings in 42 patients who had lymphomatoid granulomatosis (LYG). In addition to small round lymphocytes, small to intermediate lymphocytes with serpentine nuclei, large immature mononuclear lymphoid cells, abundant histiocytes, and vascular invasion by the cell infiltrate were observed in all cases. Fifty percent of lesions had occasional "atypical" cells with multi-lobed nuclei. Three of four follow-up autopsies showed large cell lymphoma, while one other autopsy and the single repeat biopsy showed increased numbers of large immature mononuclear lymphoid cells. Patients were most frequently men 40-60 yr old who had a history of pulmonary symptoms, such as cough or chest pain, and who showed multiple bilateral lung nodules without hilar adenopathy in the chest x-ray. Thirteen patients (38%) died of disease, 11 of them within 12 mth of initial diagnosis. The presence of neurological signs and symptoms, increased mitoses, or increased numbers of atypical multi-nucleated cells in the initial biopsy were not statistically significant predictors of survival.

Adrenal Cortex Hormones↗
PubMed1986

Amyloidosis presenting in the lower respiratory tract. Clinicopathologic, radiologic, immunohistochemical, and histochemical studies on 48 cases.

We studied 48 cases of amyloidosis localized to the lower respiratory tract. Fourteen cases were classified as tracheobronchial amyloidosis. Twenty-eight cases showed solitary or multiple nodules, and six cases had a diffuse interstitial parenchymal pattern. Almost all patients with tracheobronchial and diffuse interstitial amyloidosis had respiratory symptoms (usually dyspnea), whereas most with nodular amyloidosis were asymptomatic. Nodular parenchymal and, less frequently, tracheobronchial amyloidosis had contiguous cellular infiltrates of plasma cells, lymphocytes, and giant cells. Immunohistochemical staining of specimens from 18 cases showed these plasma cells to be polytypic, except for two tracheobronchial lesions that had a disproportionate number of lambda light chain-bearing plasma cells. Permanganate oxidation of specimens from 19 cases showed patterns in keeping with immunoglobulin-derived amyloid in 12. Local deposits of amyloid in lung may arise from deposition of circulating precursor proteins.

Adult↗
PubMed1986

The pathology of pulmonary cryptococcal infections in the acquired immunodeficiency syndrome.

Specimens from premortem pulmonary cytology, transbronchial biopsy, and autopsy were studied in 11 patients with acquired immunodeficiency syndrome who developed pulmonary cryptococcal disease. Nine of 11 patients had culture-proved cryptococcal meningitis. Extremely low T-cell helper/suppressor ratios (mean, 0.12) were observed in seven of 11 patients. In six of eight patients, transbronchial biopsy specimens showed a characteristic interstitial pattern with yeasts in the alveolar septae, minimal cellular inflammation, and no well-formed granulomas. On cytologic examination, organisms were present in seven (100%) of seven cell blocks and five (83%) of six smears prepared from the bronchoalveolar lavage, and in five (63%) of eight bronchial brushings. Small, poorly encapsulated yeast forms were sometimes present, requiring mucicarmine and acid mucopolysaccharide stains for confirmation of the diagnosis of pulmonary cryptococcosis. Overall, bronchoscopy yielded a diagnosis in seven of eight patients. At autopsy, two of five patients demonstrated an interstitial pattern of infection in all lobes of the lung with marked pleural thickening and giant-cell formation; two other patients showed mixed interstitial and intra-alveolar cryptococcal infiltrates. Nodal and disseminated infection were present in four patients. In patients with acquired immunodeficiency syndrome who have cryptococcal meningitis, pulmonary cryptococcal disease is common and must be distinguished from other opportunistic infections.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Necropsy findings in acquired immunodeficiency syndrome: a comparison of premortem diagnoses with postmortem findings.

Necropsies were performed in 12 patients who fulfilled the Centers for Disease Control (CDC) criteria for acquired immunodeficiency syndrome (AIDS), and the postmortem findings were compared with the premortem diagnoses. All of the patients were men with a male sexual preference and histories of multiple episodes of venereal diseases. Four patients were intravenous drug abusers, while two abused amyl nitrate. All 12 of the patients had evidence of cellular immune deficiency at presentation. The causes of death were a variety of opportunistic infections and neoplasms. Pneumocystis carinii pneumonia was diagnosed prior to death in seven patients. Despite current therapy, all seven of those patients had persistent Pneumocystis carinii pneumonia at necropsy, as well as clinically undiagnosed cytomegalovirus infection. In addition, two cases of acid-fast infections, two of visceral candidiasis, one of pneumocystis pneumonia, one of central nervous system lymphoma, one of gram-negative bacterial pyelonephritis, and one of cutaneous aspergillosis were clinically unrecognized and untreated. Nine patients died with two or more infections. Thus, necropsy is a valuable tool for recognizing clinically undiagnosed infections and malignant disorders in AIDS.

Acquired Immunodeficiency Syndrome↗