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Biomedical subjects

R B Mann

Publications and source records attributed to R B Mann.

At least 73 records · Page 4Linked to original sources
PubMed1986

Kaposi's sarcoma with bone marrow involvement: occurrence in a patient with the acquired immunodeficiency syndrome.

A patient with the acquired immune deficiency syndrome (AIDS) and the lymphadenopathic variant of Kaposi's sarcoma developed skin, gastrointestinal and pulmonary lesions. A cellular specimen was obtained on bone marrow aspiration, but the bone marrow biopsy revealed dense reticulin fibrosis with slit-like spaces and endothelial-lined channels consistent with Kaposi's sarcoma. At postmortem examination, Kaposi's sarcoma was found in the pleura and lungs, throughout the gastrointestinal tract, in the liver and spleen, and in the thoracic and abdominal lymph nodes. Bone marrow architecture appeared grossly normal, but microscopic examination revealed numerous foci of Kaposi's sarcoma. This is the first reported example of bone marrow involvement with Kaposi's sarcoma in AIDS recognized antemortem.

Abdominal Neoplasms↗
PubMed1986

What should be the morphologic criteria for the subdivision of follicular lymphomas?

The members of the Pathology Panel for Lymphoma Clinical Studies undertook a collaborative study with the hope of resolving some of the controversies regarding the criteria and methods for the subclassification of follicular lymphomas (FLs). A group of 105 patients with FL were subclassified by seven hematopathologists according to two methods. In the first method, cases were subclassified according to the Rappaport, Lukes and Collins, and Working Formulation systems. In each of these systems, FLs are subclassified by estimation of the different cell populations, without actual counting of cells. In the second method, precise counts of different cells were made according to the standard and modified Berard methods. With this counting method, diagnoses were independently derived, based on counts provided by the seven pathologists, for large cleaved (LC), small noncleaved (SNC), and large noncleaved (LNC) cells. To ascertain what method and which criteria are most useful in predicting survival, we made clinicopathologic correlations. When the subjective (first method) diagnoses were rendered, and when the consensus diagnoses of the seven pathologists were used, there were no significant differences in survival among patients with the different subtypes. On the other hand, when we used the counting method of Berard (second method) and the cut-off points for the cell counts suggested by him for the subclassification, we were able to divide the patient population into prognostic subgroups. Because the cut-off points proposed by Berard are not derived objectively, we made statistical comparisons of survival curves to determine cut-off points (and thus to establish objective criteria). We found that the patient population could be separated into at least two prognostic groups, for SNC and/or LNC and for SNC + LNC + LC cells. The cut-off points which we derived differed with cell type, however. Until the usefulness of these new cut-off points is established, we recommend that the cut-off points and the counting method of Berard be used for the subclassification of FL. Because the choice of treatment for the different subtypes of FL is totally dependent on the histologic diagnosis, and because of the variability among the diagnoses of pathologists, treatment planning is difficult.

Age Factors↗
PubMed1985

Malignant lymphomas involving the prostate. A study of 13 cases.

The clinical and pathologic findings in 13 cases of malignant lymphoma involving the prostate gland were reviewed. The lymphomas tended to occur in elderly men with a mean age of 60 years (range, 30-86 years) and were clinically manifested by prostatic enlargement with urinary obstruction. In only one of the patients was there clinical suspicion of lymphoma before surgery. Seven patients had primary extranodal lymphoma of the prostate, with a variety of histologic subtypes, including small cell lymphocytic (one patient), diffuse small cleaved cell (two patients), diffuse mixed small and large cell (two patients), diffuse large non-cleaved cell (one patient), and high-grade diffuse small non-cleaved cell (undifferentiated non-Burkitt's) (one patient). At the time of presentation, none of these patients had hepatosplenomegaly, inguinal lymphadenopathy, abnormal complete blood counts, or elevated serum acid phosphatase levels. Six other patients with previously documented malignant lymphoma at other sites had prostatic involvement 2 to 60 months (mean, 14 months) after the primary diagnosis. Histologically, these secondary prostatic lymphomas included diffuse small cleaved cell (two patients), diffuse mixed small and large cell (one patient), diffuse large non-cleaved cell (two patients), and large cell immunoblastic, polymorphous type (T-cell by immunotyping) (one patient). The mean survival was 14 months for all patients (range, 2-44 months), with no apparent difference between primary and secondary involvement. One patient remains alive 44 months after secondary prostatic involvement with diffuse large non-cleaved cell lymphoma. Although malignant lymphomas involving the prostate are rare, they should be included in the differential diagnosis of lower urinary tract obstruction, particularly in patients with a previous history of lymphoma.

Adult↗
PubMed1985

Malignant large cell lymphoma of B-cell type with multilobated nuclei. Report of a case and review of the literature.

Malignant lymphomas with multilobated nuclei are rare, recently recognized neoplasms of the immune system initially thought to be of T-cell type. Reported is a case of large cell lymphoma with multilobated nuclei in which immunologic marker studies demonstrated that the neoplastic cells had characteristics of B-lymphocytes. The neoplastic cells possessed surface and cytoplasmic immunoglobulin of the IgG, lambda type, and stained diffusely with monoclonal antibodies to B1, Leu-10 and OKIaI antigens and focally with anti-B2. The lymphoma cells did not react with monoclonal antibodies directed against T-cells and monocytes/granulocytes. As documented here with multiple monoclonal antibody lymphocyte markers, the multilobated lymphoma can have a B-cell phenotype as well as the cell phenotype described previously. Thus, even the unique finding of multilobated nuclear morphologic features is unreliable in predicting the lymphocyte lineage.

Adult↗
PubMed1985

Morphological subclassification of follicular lymphoma: variability of diagnoses among hematopathologists, a collaborative study between the Repository Center and Pathology Panel for Lymphoma Clinical Studies.

A collaborative study between the Repository Center for Lymphoma Clinical Studies and the members of the lymphoma pathology subcommittee of the major cooperative oncology groups was undertaken in an effort to ascertain the reproducibility and the interobserver agreement for the cytologic diagnosis of follicular lymphomas. A group of 105 patients with follicular lymphomas were subclassified by seven hematopathologists according to two methods. In the first method, cases were subclassified according to the Rappaport, Lukes, and Collins, and Working Formulation systems. In these systems, follicular lymphomas are subclassified by estimation of the different cell populations without the actual counting of cells. With this method, great variability in diagnosis was noted. For example: (1) The consensus diagnosis was that of poorly differentiated lymphocytic lymphoma (PDL) in 39 cases, but among the individual pathologists the number of cases thus diagnosed ranged from 24 to 65; (2) In 40 cases, the consensus diagnosis was follicular lymphoma, mixed-cell type; however, all seven pathologists independently agreed on this subtype in only one case; (3) A major disagreement was noted in 39 cases (37%), in which both diagnostic extremes (small cleaved and large noncleaved) were expressed. In the second method, only precise counts of different cells were made, according to a modification of the method recommended by Berard. With this counting method, diagnoses were independently derived based on the counts provided by the seven pathologists for large cleaved, small noncleaved, and large noncleaved cells. The variability in the results was wide also with this second method. For example, the average number of large cells found by each pathologist was ascertained, and the ranges were determined. The average range was 28 cells, which was considered high. The same determinations were performed only for large noncleaved cells, and the range was found to be 15 cells, which was also considered high. When the diagnoses derived from counts of only large noncleaved cells were compared with the traditional, more subjective diagnoses, fairly close agreement was obtained. In summary, the great variability in diagnoses of follicular lymphomas among pathologists may be attributed to the difficulties inherent in accurate determination of cell size and of the precise percentages of different cells. Until solutions to these problems are developed, one can subclassify follicular lymphomas according to the Berard method or the estimation method.

Cell Count↗
PubMed1985

Transthoracic needle aspiration biopsy of benign and malignant lung lesions.

Transthoracic needle aspiration biopsy (TNAB) of lung lesions is a well established procedure for diagnosing lung lesions. The emphasis in the literature has been on diagnosing malignant lesions with an accuracy rate greater than 90% frequently reported. Experience with 650 patients showed that TNAB can diagnose malignant lesions in 95% of patients with cancer, and more importantly that TNAB can identify benign lesions in 88% of patients with such lesions. In this patient population, 22% of undiagnosed, noncalcified lung lesions were benign. Therefore, TNAB of lung lesions has a potential of limiting diagnostic thoracotomies to fewer than 8% of patients with lung lesions, significantly reducing the number of unnecessary thoracotomies for benign disease. The success of TNAB is affected by equipment, technique, skill, and experience and is enhanced by close cooperation among the various physicians involved.

Aged↗
PubMed1985

m-AMSA in refractory lymphoma. A phase II trial of the Eastern Cooperative Oncology Group.

m-AMSA (4'-[9'-acridinylamino]-methansulfon-m-anisidide) is an acridine derivative which has shown a wide spectrum of activity in preclinical testing. The mechanism of action is thought to be via interference with synthesis and integrity of DNA chains by intercalation between base pairs and external binding. Initial phase I clinical trials revealed granulocytopenia to be the dose limiting toxicity with occasional thrombocytopenia. Phlebitis, liver function abnormalities, and cardiac abnormalities have also been noted. Early reports suggested activity in leukemia and lymphoma. Based on these results ECOG evaluated m-AMSA in a phase II trial of Hodgkin's disease and non-Hodgkin's lymphoma.

Adolescent↗
PubMed1984

Metastatic carcinoma involving the testis. Clinical and pathologic distinction from primary testicular neoplasms.

Metastatic carcinoma to the testis is unusual. There are only seven previously reported cases in which a testicular mass was the first clinical manifestation of an underlying malignancy. The authors review 127 cases in which the testis was involved by metastatic carcinoma, and describe an additional two patients in whom a malignant testicular mass was the presenting sign of an underlying nontesticular carcinoma. The tumors most commonly reported to metastasize to the testis are: prostate (45 cases), lung (25 cases), melanoma (12 cases), colon (11 cases), kidney (10 cases), stomach (6 cases), and pancreas (5 cases). Neuroblastoma, retinoblastoma, carcinoid tumor, and cancers of the bile duct, ureter, bladder, salivary gland, and thyroid have also involved the testis secondarily. Nineteen patients (15%) had bilateral testicular metastases. Patients with secondary testicular neoplasms were older in general than those with germ cell tumors (mean, 55 years; median, 57 years). Histologically, the presence of extensive lymphatic and vascular invasion and an interstitial pattern, in which the seminiferous tubules are spared, is suggestive of a metastasis. In four of the nine cases (44%) in which testicular enlargement was the first manifestation of an underlying carcinoma the correct pathologic diagnosis was initially missed. Serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) are occasionally elevated in patients with nontesticular primary tumors, but markedly elevated levels in young patients suggest a nonseminomatous germ cell tumor, as does positive immunoperoxidase staining for AFP and HCG.

Adolescent↗
PubMed1984

Adenoid cystic carcinoma of the prostate. A case report with immunoperoxidase staining for prostate-specific acid phosphatase and prostate-specific antigen.

Adenoid cystic carcinoma occurs most commonly in the major and minor salivary glands, but also has been recognized in numerous other locations. Adenoid cystic carcinoma of the prostate gland is, however, extremely uncommon with only two other reported cases. The authors have studied a case of adenoid cystic carcinoma of the prostate with immunoperoxidase staining for both prostate-specific acid phosphatase and prostate-specific antigen, which have been shown to be specific for normal prostatic epithelium and prostatic carcinoma. The negative staining for these antigens in this tumor distinguishes adenoid cystic carcinoma from the usual acinic adenocarcinomas of the prostate, and suggests an origin from periurethral glands or metaplastic urethral mucosa.

Acid Phosphatase↗
PubMed1983

Intraocular lymphomas. Natural history based on a clinicopathologic study of eight cases and review of the literature.

Eight patients with intraocular lymphoma were studied; all were middle-aged or elderly, usually presenting with a unilateral visual deficit. All patients also had an extraocular lymphoma with either systemic (2) or isolated central nervous system (CNS) involvement (6). When ocular symptoms preceded CNS symptoms, they presented from 11 months to 10 years earlier. Intraocular lymphoma tended to affect the eye ipsilateral to the CNS tumor either exclusively or initially, and to the greatest degree histologically. Histologic examination of intervening optic pathways revealed extension of intraocular tumor across the optic nerve into orbital leptomeninges in 3 cases. Corresponding CNS tumors showed prominent leptomeningeal involvement. All intraocular and extraocular tumors showed diffuse growth patterns with histiocytic (large cell), poorly differentiated lymphocytic or mixed lymphocytic-histiocytic subtypes. CNS tumors were detected only after onset of neurologic symptoms, and were almost always fatal, although CNS irradiation prolonged survival for years in some cases. Our data suggest that the peculiar link between intraocular and CNS lymphomas may reflect both multicentric and metastatic disease processes. The prompt recognition of intraocular lymphomas as a harbinger of extraocular tumor may prove valuable in earlier recognition and treatment of the disease.

Aged↗
PubMed1982

Angioimmunoblastic lymphadenopathy progressing to immunoblastic lymphoma with prominent gastric involvement.

Two unusual cases of angioimmunoblastic lymphadenopathy with dysproteinemia (AILD), with progression to immunoblastic lymphoma (IL) and prominent gastric involvement are presented, and detailed immunohistologic studies described. In one case, Bence Jones proteinuria of the kappa type was observed during the course of AILD and was identified immunohistochemically in lymph node biopsy specimens and at autopsy. The potential significance of an M component and the importance of recognizing gastric involvement by AILD are discussed.

Bence Jones Protein↗
PubMed1982

Diffuse large cell and undifferentiated lymphomas with prominent mediastinal involvement.

This report describes 11 adults with non-Hodgkin's lymphoma who presented with symptoms caused by large mediastinal masses. Patients with lymphoblastic lymphoma were excluded from this analysis. Most of the patients were young women with localized disease at presentation. Ten tumors were diffuse large cell ("histiocytic") lymphomas and one was a diffuse, undifferentiated lymphoma, non-Burkitt's type. According to the Lukes' and Collins' classification scheme, seven were large cleaved cell type, three were large noncleaved and one was small noncleaved cell type. Sclerosis was present in four cases. Despite aggressive therapy nine patients died within 26 months of diagnosis and only two remain disease-free. Median survival of these patients was 16 months. Patients with symptomatic mediastinal masses and non-Hodgkin's lymphomas composed predominantly of large cell appear to share certain clinico-pathologic features and to present a poor prognosis subset of patients with non-Hodgkin's lymphoma.

Adolescent↗
PubMed1982

Involvement of the heart by malignant lymphoma: a clinicopathologic study.

Although involvement of the heart by malignant lymphoma is relatively common, it is difficult to detect antemortem, and only a small number of studies discuss this subject in the literature. The authors reviewed the 150 patients with malignant lymphoma autopsied at this hospital and studied the 13 (8.7%) who were found to have metastases to the heart or parietal pericardium. Four patients had Hodgkin's disease, and nine non-Hodgkin's lymphoma. Cardiac or pericardial disease apparently resulted from retrograde lymphatic spread, hematogenous spread, and direct extension from other intrathoracic tumor masses. In two cases, lymphomatous involvement of the heart and pericardium was the immediate cause of death; in one of these, myocardial infiltration was detected during life. For the group as a whole, the signs and symptoms of cardiac dysfunction were typically absent or nonspecific, and electrocardiograms and thallium imaging were not effective screening tools for lymphoma metastases. The findings suggest, however, that the most destructive form of cardiac involvement is that associated with direct epicardial spread, and that this form appears with cardiac dysfunction, which should clinically suggest its presence.

Autopsy↗
PubMed1981

Histiocytic sarcoma with a granuloma-like component occurring in a large colony of Sprague-Dawley rats.

Tumors from a large colony of over 2000 Sprague-Dawley rats were reviewed by a panel of pathologists under the auspices of Universities Associated for Research and Education in Pathology, In the course of this study, a distinct malignancy in 105 rats was segregated and given the name "histiocytic sarcoma." This report describes the histologic features and anatomic distribution of the tumor, along with its incidence by age and sex of the rat. The neoplasm is characterized by a spectrum of histologic patterns, one extreme resembling a sarcomatous process and the other a granulomatous process. The exact morphologic composition varied from animal to animal, as well as in tumors from the same animal. The sarcomatous pattern is composed of sheets of uniform cells, occasionally exhibiting phagocytosis. The granulomatous pattern contains epithelioid histiocytes, central areas of tumor necrosis surrounded by palisading cells, and multinucleate giant cells. The liver is the organ most commonly containing histiocytic sarcoma, both in animals with multiple tumors and in those with involvement of only one organ. Hepatic invasion is typified by expansion of the portal areas and infiltration of the sinusoids by tumor cells. The lung is the second most common site. The distribution of pulmonary tumors is bronchiolocentric and angiocentric. Other common sites included the lymph node and spleen, along with large soft tissue tumors of the mediastinum and retroperitoneum. Although occasional previous reports apparently have described a similar or identical neoplasm under varying names, no large group of tumors of this unique type in rats has been studied and characterized previously.

Animals↗
PubMed1980

Relationship of lysozyme (muramidase) to histiocytic differentiation in malignant histocytosis: an immunohistochemical study.

Malignant histiocytosis (MH) is a rare, usually fatal systemic disease considered to be a neoplasm of true histiocytes. Because MH may be difficult to differentiate from non-Hodgkin's lymphomas or carcinoma, we examined surgical and autopsy material from 10 patients with MH using the immunoperoxidase technique to determine if the presence of intracellular lysozyme is helpful in making this distinction. The cases of MH were divided into three groups based on the degree of cytologic atypia and the amount of phagocytic activity of the neoplastic cells: group I--minimal cytologic atypia and rare erythrophagocytosis; group II--minimal cytologic atypia with extensive erythrophagocytosis: group III--moderate to marked cytologic atypia and rare phagocytosis. Moderate to strong staining for lysozyme was observed in the neoplastic cells of group I, weak or absent staining in group II cells, and no staining in group III cells. These findings suggest the loss of detectable enzyme in poorly differentiated or dedifferentiated neoplastic histiocytes. Consideration must be given to these observations in evaluating the use of lysozyme as a possible serum or tissue aid to the diagnosis of MH.

Adolescent↗