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Biomedical subjects

M N Koss

Publications and source records attributed to M N Koss.

108 records · Page 6Linked to original sources
PubMed1983

Primary non-Hodgkin's lymphoma and pseudolymphoma of lung: a study of 161 patients.

The authors studied 161 cases of primary non-Hodgkin's lymphomas and pseudolymphomas of lung. Small lymphocytic proliferations, which they believe to be lymphomas, constituted 31.6 per cent of cases; plasmacytoid lymphocytic and small cleaved follicular center cell lymphomas (Lukes-Collins system), 22.4 and 11.8 per cent of cases, respectively; and the remaining follicular center cell lymphomas and B-immunoblastic sarcomas, 5.6 per cent of cases. Pseudolymphomas constituted 14 per cent of cases. Most patients were elderly and asymptomatic; in most cases a solitary nodule or infiltrate was observed on a chest radiograph. Radiographic evidence of effusion was found in both lymphomas and pseudolymphomas, but hilar adenopathy was restricted to lymphomas. A few peribronchial reactive germinal centers and intralesional giant cells/granulomas were seen frequently in unequivocal lymphomas, so their presence cannot be used to exclude neoplasia. A generally monomorphic cell population and invasion of bronchial cartilage or visceral pleura are suggestive of malignancy, whereas primitive cytologic appearance and invasion of lymph nodes or parietal pleura are pathognomonic of malignancy. Diffusely admixed mature lymphocytes and plasma cells with numerous reactive follicles suggest pseudolymphomas. Immunologic determination of clonality may be diagnostically definitive. Most localized lesions in lung were treated by surgical resection, whereas in cases of extensive pulmonary disease, biopsies were performed and patients were treated by chemotherapy or irradiation. Both lymphomas and pseudolymphomas recurred, most often within three years. Pseudolymphoma recurred only in lung. When distant spread of lymphoma occurred, it commonly involved extranodal sites. Only 18 of 101 patients with lymphoma died with or of tumor, and no patient with pseudolymphoma died of disease. Neither histologic subtype among the "small cell" lymphoid lymphomas nor the presence of regional node involvement was prognostically significant, but pleural effusion on the initial chest radiograph was a significant predictor of both recurrence and mortality.

Adolescent↗
PubMed1982

Bronchocentric granulomatosis: roentgenographic manifestations.

The roentgenographic manifestations of bronchocentric granulomatosis were reviewed in 15 patients. Nine patients had mass lesions. Four had alveolar infiltrates and 2 presented with reticulonodular infiltrates . Correlation of these radiographic patterns with the pathologic findings helps explain the varied morphologic appearance of this disease on the chest radiographs. Upper lobe involvement and unilateral disease were predominant. Seven of 15 patients (47%) presented with solitary mass lesions. Pleural reaction was occasionally noted. Hilar adenopathy and cavitation were infrequent. There was little correlation between radiographic pattern and clinical presentation.

Adult↗
PubMed1981

Bronchocentric granulomatosis.

The clinical and morphologic features in 15 patients with bronchocentric granulomatosis were reviewed. Patients were divided into two groups on the basis of the morphologic findings. Group I consisted of five patients with necrotizing granulomas containing abundant eosinophils in the areas of necrosis. Three of these patients were asthmatic, two had elevated blood eosinophil counts, and in one there were fungal hyphae within necrotizing granulomas. In another case a sputum culture was positive for Aspergillus. The findings in these cases support the contention that some bronchocentric granulomas associated with tissue eosinophilia may represent a hypersensitivity reaction to inhaled Aspergillus. Group II included 10 patients with bronchocentric granulomas showing many polymorphonuclear cells but few eosinophils. One of these 10 had asthma, and blood eosinophilia was found in only one patient. The etiology and pathogenesis of these bronchocentric granulomas in unclear. The differences in morphology and clinical symptomatology between the two groups suggest that these lesions may arise from more than one etiologic agent and pathogenetic mechanism. Follow-up information was available for 11 individuals. Corticosteroids were given to four patients and lesions were resected from five patients. Neither recurrence of bronchocentric granulomas nor death due to them was reported.

Adolescent↗
PubMed1981

Pulmonary blue bodies.

Pulmonary blue bodies are intra-alveolar laminated basophilic concretions of uncertain etiology. Blue bodies were studied in lung biopsy specimens from 10 patients. The patients ranged in age from 47 to 69 years and were predominantly men. Three had a history of overt exposure to environmental dusts such as sawdust and asbestos, and two showed occasional ferruginous bodies in the lung, raising the possibility of pneumoconiosis. In eight cases there was interstitial pneumonitis, which resembled desquamative interstitial pneumonia by light microscopy but which was often seen to be patchy and asymmetrically distributed in the lung by chest x-ray examination. Of two other patients, one had xanthogranulomatous inflammation and the other, necrotizing granulomatous inflammation. Light and electron microscopic, histochemical, microchemical, and x-ray diffraction studies of blue bodies were also performed. Calcium carbonate is a major component of blue bodies and is responsible for their birefringence in unstained sections and ready solubility in acid solutions. Blue bodies also contain a mucopolysaccharide matrix and iron. We offer the hypothesis that blue bodies (calcium carbonate) are a product of histiocytic catabolism.

Aged↗
PubMed1981

Allergic granulomatosis (Churg-Strauss syndrome): pulmonary and renal morphologic findings.

The pulmonary histopathology of four cases of allergic granulomatosis (Churg-Strauss syndrome) was reviewed. Renal tissue was also studied in one case. The patients were young and most presented with asthmatic symptomatology. They showed marked peripheral blood eosinophilia, and had fluffy nodular pulmonary infiltrates by chest x-ray. Serum IgE was elevated in the one patient in whom it was obtained. The lung tissue in all cases showed necrotizing giant-cell vasculitis, interstitial and perivascular granulomas, and eosinophilic pneumonia-like areas. These microscopic features distinguish allergic granulomatosis from other forms of pulmonary eosinophilia or vasculitis. Renal tissue showed necrotizing granulomatous vasculitis and interstitial eosinophilic nephritis, without evidence of glomerulonephritis. Electron-microscopic study of one lung biopsy and of the renal tissue demonstrated tissue eosinophilia and, in lung, a granuloma. There was no evidence of vascular or glomerular electron-dense deposits. These findings are discussed in the light of possible pathogenetic mechanisms of allergic granulomatosis.

Adolescent↗
PubMed1981

Wegener's granulomatosis. Electron microscopic and immunofluorescent studies.

We report a case of classic Wegener's granulomatosis. Direct immunofluorescent study showed finely granular deposits of IgG and IgM in some of the alveolar walls, and of IgM in the maxillary sinus arteries. Electron-microscopic study of the lung and maxillary sinus showed intravascular fibrin, but failed to demonstrate electron-dense deposits in the blood vessel walls. Our patient also had circulating cryoglobulins, consisting of IgG, IgM, Clq, and C3, and evidence of circulating immune complexes as demonstrated by the Clq-binding test. These findings suggest that circulating immune complexes may play an important role in the pathogenesis of the respiratory lesions of Wegener's granulomatosis.

Complement Activating Enzymes↗
PubMed1976

The nature and incidence of cryoproteins in hepatitis B antigen (HbsAg) positive patients.

Hepatitis B (HbsAg) surface antigen has been detected in the serum of patients with a variety of diseases and immune complexes of this antigen and antibody have been implicated in tissue damage to various organs. Previously we have demonstrated that serum cryoproteins occur in a variety of immune complex disorders and represent pathogenic complexes of antigen and specific antibody. Sera from patients with acute HbsAg positive hepatitis, chronic hepatitis B antigenemia, acute and chronic HbsAg negative hepatitis, as well as a variety HbsAg negative miscellaneous liver diseases and normals were studied for the presence and nature of cryoproteins. Cryoproteins were detected in a large number of patients with acute and chronic HbsAg positive hepatitis and chronic HbsAg carriers. The quantity of these cold insoluble precipitates was highest in acute hepatitis. Cryoproteins were detected with much less frequency in HbsAg negative patients and were not found in normals. The precipitates in HbsAg patients contained either HbsAg, anti-HBsAg or both, along with immunoglobulins and occasionally complement and rheumatoid factor. The cryoproteins in these patients had biological properties attributable to immune complexes and several of the patients had clinical manifestations of acute or chronic serum sickness. Cryoproteins from HbsAg negative patients did not contain HbsAg or antibody to HbsAg and did not have biologic properties of immune complexes. In HbsAg positive patients HbsAg and antibody to HbsAg were concentrated in the cryoprecipitate. The preliminary studies suggest that investigation on cryoproteins in hepatitis may be of clinical and immunopathogenic value.

Antigen-Antibody Complex↗
PubMed1976

Experimental Bence Jones cast nephropathy.

C3H mice received intraperitoneal injections of a single dose of 50 to 200 mg. of purified lambda Bence Jones protein. Control animals received injections of comparable amounts of ovalbumin. The mice which received 200 mg. of lambda Bence Jones protein developed extensive cast formation in the distal renal tubules. By electron microscopy, the casts were found to contain elongated crystalloid structures. In some areas, these crystalloids appeared to penetrate into or be engulfed by tubular epithelial cells. By immunofluorescence, only lambda Bence Jones protein was detectable in the casts during the first 5 days. Thereafter, Tamm-Horsfall protein was also found in increasing amounts. The casts induced an inflammatory response characterized by the sequential appearance of polymorphonuclear leukocytes and mononuclear cells. The secondary tubular cell changes included atrophy, degeneration, and regeneration. Giant cells were present around many casts, but it could not be determined whether these derived from tubular epithelial or mononuclear inflammatory cells. Elevated blood urea nitrogen was found terminally in most animals. Smaller doses of the same protein as well as preliminary studies with two other lambda Bence Jones proteins failed to produce comparable changes. This experimental model of Bence Jones nephropathy closely resembles the morphologic features of so-called "myeloma kidney" in man.

Animals↗
PubMed1975

Nephropathy associated with sickle cell anemia: an autologous immune complex nephritis. I. Studies on nature of glomerular-bound antibody and antigen identification in a patient with sickle cell disease and immune deposit glomerulonephritis.

The nature of the glomerular-bound antibody and the putative antigen was investigated in one of the patients with sickle cell disease and immune deposit membranoproliferative glomerulonephritis by immunohistologic and glomerular antibody elution. Renal proximal tubular epithelial antigen was localized in association with immunoglobulins G (IgG), M (IgM), Clq fraction of the first component of complement (Clq) and the third component of complement (C3) in a granular pattern along the glomerular basement membrane of the patient's kidney. IgG and IgM were eluted from glomeruli. These immunoglobulins fixed to the proximal tubules of normal human kidney by direct immunofluorescence. This localization was abolished by absorption of the eluted immunoglobulins with renal tubular epithelial (RTE) antigen. The IgG eluted from the glomeruli blocked the fixation of rabbit anti-RTE antigen to normal proximal tubular brush border. These studies suggest that the nephritis in this patient was due to deposition of complexes or RTE antigen and specific antibody. An autologous immune complex nephritis may develop in some patients with sickle cell anemia secondary to RTE antigen released possibly after renal ischemia or some other phenomenon causing renal tubular damage.

Adolescent↗
PubMed1975

Cryoglobulins. III. Further studies on the nature, incidence, clinical, diagnostic, prognostic, and immunopathologic significance of cryoproteins in renal disease.

Serial serum samples from a large number of patients with immunologic renal disease, normal healthy controls, acute infections as well as non-immunological renal disease were studied for the presence, nature and properties of cryoproteins, and these correlated with serial renal functional, morphologic, immunohistologic and clinical fingings as well as serologic observations. A high incidence of cryoproteins were found in renal disease thought to be mediated by immune complexes. Cryoprecipitates were not detected in the other patients. The presence of fibrinogen in a serum cryoprecipitate was always associated with rapidly progressive disease and poor prognosis. An association between the detection of cryoproteins and the clinical and morphological activity of disease was observed. Persistence of cryoproteinemia was associated with progression and apparent disappearance with resolution or progression to end stage renal disease. In patients with hematuria or proteinuria of questionable significance cryoprotein detection was always associated with immune complex nephritis. Renal transplantation in the presence of cryoproteinemia was associated with recurrent nephritis in the graft. Cryoproteins were found to have biologic properties attributable to antigen-antibody complexes, to contain immune complexes of antigen and antibody and to have serologic factors concentrated. The detection of serum cryoglobulins was found to be a better index of clinical and morphologic activity of immune complex renal disease than was serum complement. As in our previous studies, these proteins appear to be of diagnostic and prognostic value in renal disease and provide a method of antigen identification in these disorders.

Animals↗
PubMed1975

The human choroid plexus and autoimmune nephritis.

The choroid plexus resembles the glomerular basement membrane (GBM) and may be a site of injury or source of antigen in Goodpasture syndrome. Immunohistologic studies were performed on the choroid plexus of a patient with auto-immune nephritis and pulmonary hemorrhage. The studies showed linear deposition of host IgG, IGM, and beta1c. Antibody eluted from the diseased kidney fixed in a linear pattern to normal choroid plexus and could be absorbed by either choroid plexus or GBM. Antibody to choroid plexus fixed to GBM and the linear staining was no longer observed after absorption with GBM or choroid plexus. Antibody to GBM fixed to normal choroid plexus and was obsorbed by both choroid plexus and glomerular basement membrane. The studies suggest an immunologic relationship between choroid plexus and GBM and a role for the choroid plexus in autoimmune nephritis.

Animals↗