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Biomedical subjects

R E Fechner

Publications and source records attributed to R E Fechner.

At least 19 recordsLinked to original sources
PubMed1992

Pathologic findings in nonpalpable invasive breast cancer.

Previous studies have shown that patients with nonpalpable invasive breast cancer have a favorable prognosis. These studies, however, have not analyzed pathologic features of mammographically detected tumors according to tumor size. We describe the histopathologic features of 77 nonpalpable invasive breast cancers, comparing neoplasms less than or equal to 1 cm with larger clinically occult tumors. Forty-seven lesions (61%) were less than or equal to 1 cm (group A) and 30 (39%) were greater than 1 cm (group B). In group A, there were 30 infiltrating ductal carcinomas (IDC); seven infiltrating lobular carcinomas (ILC); and two cases each of mixed ILC and IDC, mixed tubular carcinoma and ILC, and infiltrating cribriform carcinoma. There was one case each of mucinous carcinoma, apocrine carcinoma, tubular carcinoma, and mixed mucinous and IDC. In group B, there were 23 (77%) IDC, five (17%) ILC, and two mixed IDC and ILC. Tumors in group B were more frequently grade 3 (22% versus 7%), but this was not statistically significant (p = 0.21). There were no important differences in the frequency, subtypes and location of carcinoma in situ, or other histopathologic parameters evaluated in the biopsy specimens. Mastectomy specimens with axillary lymph node dissections were available for review in 64 cases (83%). Group B patients had a higher rate of residual invasive carcinoma (31% versus 13%) and lymph node metastases (31% versus 16%), but these differences were not statistically significant. Residual carcinoma in situ was more frequent in group B (54%) compared with group A (26%) (p = .036). Of seven group B cases with negative biopsy margins, residual invasive carcinoma was present in five (71%). We conclude that small nonpalpable invasive breast cancers differ from larger nonpalpable tumors primarily in size. The finding of negative biopsy margins should not be construed as conclusive evidence for the absence of residual infiltrating disease.

Adenocarcinoma↗
PubMed1992

Intraarticular synovial sarcoma.

A 43-year-old man presented with decreased range of motion in his left knee and a painful medial joint mass that was grossly visible. Arthroscopy demonstrated a mobile, flat mass 3 cm in diameter in the knee joint that seemed to be loosely tethered to the synovium. The mass was excised, and light microscopic examination demonstrated a biphasic synovial sarcoma. There was no transition with the attached normal synovium. Immunohistochemically, the epithelial component was intensely positive for epithelial membrane antigen and cytokeratins (CAM 5.2 and AE 1/AE 3), and the spindle cell component was focally positive for these markers. The patient has no evidence of disease 9 years after only local excision. Although the term synovial sarcoma suggests a relationship to normal synovium, only rarely has truly intraarticular disease been reported.

Adult↗
PubMed1992

Interobserver reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria.

Although the categorization of proliferative breast lesions provides valuable information regarding subsequent risk of breast cancer, the ability of pathologists to classify such lesions in a reproducible fashion has not been adequately evaluated. To assess further interobserver reproducibility in the categorization of proliferative breast lesions, six pathologists each reviewed 24 proliferative ductal lesions and classified them as either usual hyperplasia (H), atypical hyperplasia (AH), or carcinoma in situ (CIS). Before evaluation of the study slides, all the participants were instructed to use the diagnostic criteria of Page and co-workers and were provided with both a written summary of these criteria and a set of teaching slides with representative examples of each type of lesion. Complete agreement among all six pathologists was seen in 14 cases (58%); five or more agreed in 17 cases (71%); and four or more arrived at the same diagnosis in 22 cases (92%). No pathologist consistently rendered more "benign" or "malignant" diagnoses than any other. After assigning numerical values for each diagnostic category (H = 1, AH = 2, CIS = 3), the scores for the group of 24 cases did not differ significantly by pathologist (p = 0.68; average score range, 1.7-2.0). Our results indicate that with the use of standardized criteria, interobserver concordance in the diagnosis of proliferative ductal breast lesions can be obtained in the majority of cases.

Breast↗
PubMed1992

Rectal carcinoma treated by preoperative irradiation: MR imaging and histopathologic correlation.

We evaluated the role of MR imaging in assessing the effect of preoperative irradiation in 11 patients with primary rectal carcinoma. Findings on MR images obtained before radiotherapy and 5-6 weeks afterward were analyzed and correlated with the histopathological findings (nine patients) or the findings at laparotomy (two patients). Before irradiation, the tumor volumes on MR images were between 3.3 and 51.7 cm3 (mean 19.7 cm3). After irradiation, the volumes were from 0.8 to 33.2 cm3 (mean, 10.4 cm3), representing a decrease in volume of 11% to 88% (mean, 55%). On the MR images obtained before irradiation, the tumors were confined to the bowel wall in four cases (stage A-B1), penetrated the perirectal fat in six cases (stage B2), and involved an adjacent organ in one case (stage B3). After irradiation, no apparent changes were seen in the MR appearance of the local tumor stage in nine of the 11 patients. In one patient, progression of stage was suspected on the postirradiation MR images, but this was not confirmed at histologic examination. In one patient, possible downstaging occurred after irradiation, although this could not be proved. Our findings suggest that MR imaging may be useful for determining the effect of preoperative radiotherapy on rectal carcinomas.

Adenocarcinoma↗
PubMed1991

Case report 690. Nodular fasciitis of the elbow.

Nodular fasciitis is an uncommon, benign, reactive process of the soft tissues related to the fascia. It occurs most commonly in the extremities, trunk, face, and neck. The lesion may grow rapidly and mimic a malignant process. It received little attention in the radiological literature. We describe the MRI features of nodular fasciitis in a patient with a lesion in the right elbow.

Adult↗
PubMed1991

Chronic sialadenitis with psammoma bodies mimicking neoplasia in a fine-needle aspiration specimen from the submandibular gland.

A 65-year-old woman with a submandibular gland nodule had a fine-needle aspiration specimen that contained groups of duct-type cells and a psammoma body, suggestive of adenocarcinoma. The resected gland showed chronic sialadenitis with sialolithiasis and psammoma bodies. In a series of 81 resected nonneoplastic submandibular glands from 72 patients, psammoma bodies, nonlaminated microcalcifications, or both were found in 46 (57%). They were located most commonly just outside of striated or intercalated ducts. When examining fine-needle aspiration specimens from the submandibular gland, it is important that one be aware that psammoma bodies may occur in normal, inflamed, irradiated, and neoplastic conditions.

Adolescent↗
PubMed1991

Diagnostic problems in tissues previously sampled by fine-needle aspiration.

Unusual tissue changes in needle tracts after fine-needle aspiration were studied in two specimens. One specimen, a 3.0 x 2.5 cm mesenteric nodule, was found six days after a nondiagnostic transabdominal fine-needle aspiration of a retroperitoneal mass. At frozen-section examination, the nodule had proliferating spindle-shaped cells interspersed with adipocytes that raised the possibility of well-differentiated liposarcoma. On permanent sections, however, there was fat necrosis and reactive spindle-shaped cells that immunohistochemically were consistent with myofibroblasts. In the second case, a needle tract was noted in breast tissue on which a biopsy was performed two days after a cytologic diagnosis of carcinoma. The 0.4-mm-wide tract contained neutrophils, foamy histiocytes, and clumps of intact, atypical epithelial cells without a desmoplastic or elastotic component. Aside from these epithelial cells, nothing in the biopsy specimen suggested invasive carcinoma. The cells were identical to those from a comedocarcinoma present in the biopsy and mastectomy specimens. These two cases provide examples of pitfalls that may arise during the examination of biopsy specimens obtained after fine-needle aspiration.

Adult↗
PubMed1991

Histologic classification of sinonasal intestinal-type adenocarcinoma.

Kleinsasser and Schroeder recently described a histologic classification system for woodworker-associated, intestinal-type adenocarcinomas of the sinonasal region. To determine if their approach is easily applied and prognostically meaningful for both woodworker-associated and sporadic intestinal-type adenocarcinomas in the sinonasal region, we analyzed 15 such cases. The 12 men and three women ranged in age from 37 to 75 years. Only four were woodworkers. All tumors arose in the nasal cavity or paranasal sinuses. The three authors independently classified the tumors with unanimous agreement in 11 (73%) of 15 cases. Disagreements were resolved by group review and consensus. Ten tumors were papillary tubular cylinder cell type; these were subdivided into grades I (four cases) and II (six cases) on the basis of cytologic atypia. Three tumors were alveolar goblet cell type; one tumor was signet-ring type; and one had a mixed pattern. Median survivals were papillary tubular I, 9 years; papillary tubular II, 3 years; and alveolar goblet cell, 7 years. It is concluded that this classification system is easy to apply, reproducible, and appears to identify a group of sinonasal intestinal-type adenocarcinomas (papillary tubular I) with a prolonged survival.

Adenocarcinoma↗
PubMed1990

Renal liposarcoma.

A liposarcoma arose in the kidney of a 52-year-old man. After 13 years, it recurred, was resected, and recurred again. The second recurrence was inoperable.

Cell Nucleus↗
PubMed1990

Carcinoma arising in oncocytic Schneiderian papilloma.

Two men aged 54 and 73 years, respectively, had oncocytic Schneiderian papilloma (OSP) containing synchronous carcinoma at the time of first biopsy. In both cases, invasive carcinoma involved a small proportion of excised tissue and was in continuity with dysplastic surface epithelium. Our cases document that the epithelial component of OSP can undergo malignant transformation. The focal involvement of OSP with carcinoma underscores the need to examine all excised tissue microscopically.

Aged↗
PubMed1990

Preoperative staging of rectal carcinoma with MR imaging: surgical and histopathologic correlation.

Twenty-nine patients with rectal carcinoma were examined with magnetic resonance (MR) imaging at 1.0 T. In most patients a Helmholtz coil was used and a bowel distention obtained with a barium enema balloon tip. The MR findings were graded according to the modified Astler-Coller staging classification and correlated with the surgical or histopathologic results. Correct diagnosis was made in nine of the 12 patients with stage A and B1 tumors. Overestimation occurred in the other three patients, who had previously undergone radiation therapy or surgery. Local stage was correctly assessed in 11 patients with stage B2 carcinoma and in six patients with stage B3 tumors. Enlarged lymph nodes were detected in four of seven patients with nodes containing carcinoma. In two other patients with enlarged nodes, no carcinoma was identified at histologic examination. MR imaging may enable correct staging of local extent of rectal carcinoma, particularly in patients who have not previously undergone radiation therapy or surgery. However, evaluation of lymph nodes is less accurate.

Adenocarcinoma↗
PubMed1990

Thymomas and thymic carcinomas.

This review discusses epithelial proliferations of the thymus, excluding carcinoid tumor and small cell carcinoma. The clinical features of thymoma, possible etiologic mechanisms, and associated autoimmune and paraneoplastic conditions are summarized briefly. Histologic subtypes of thymoma, including lymphocyte predominant, mixed, and spindle cell tumors are described and illustrated. The concept of "medullary" and "cortical" differentiation in thymoma is reviewed. Immunohistochemical and electron microscopic features of this neoplasm are presented. Flow cytometric studies relating to its prognosis also are summarized. Distinctions between encapsulated thymoma, invasive thymoma, and metastatic or "malignant" thymoma are described in detail. Thymic carcinomas are reviewed, as distinguished from cytologically bland thymomas. Variants of thymic carcinoma include squamous cell, spindle cell, lymphoepithelioma-like, mucoepidermoid, adenosquamous, clear cell, basaloid, and adenoid cystic neoplasms.

Carcinoma↗
PubMed1989

Intra-osseous ganglion. Report of four cases and review of the literature.

Intraosseous ganglia are histologically identical to their soft tissue counterparts. Most commonly seen adjacent to the hip, ankles, knee, or wrist, they are often mistaken for other neoplasms occurring in the epiphysis. We discuss the characteristic clinical, radiological, and pathologic features of four cases of intraosseous ganglia. Intraosseous ganglia should be included in the differential diagnosis of well-demarcated lucent epiphyseal lesions of bone.

Adult↗
PubMed1989

Idiopathic punctate necrosis of the phalanges of the feet.

Small areas of discrete radiolucency surrounded by well-defined margins of sclerosis are incidental asymptomatic findings in the proximal phalanges of the feet, usually in young males. Histologic examination of similar lesions discovered in the feet of cadavers shows fat necrosis. Although the etiology of these lesions is as yet unproven, musculoskeletal stress is suggested.

Cadaver↗
PubMed1989

Mediastinal fibrin glue: hemostatic effect and tissue response in calves.

There is continued controversy regarding the effectiveness and potential adverse effects of fibrin glue. Thus, we chose to evaluate it in a model of experimental calf aortic valve replacement that has been previously well established. Concentrated fibrinogen and topical thrombin were sprayed to form a thin layer of fibrin glue over the mediastinal tissues of 20 consecutive calves undergoing aortic valve replacement. Chest tube outputs of these animals were compared with those of the preceding 20 consecutive calves undergoing aortic valve replacement without fibrin glue. All procedures were performed by the same surgeon, and no other technical changes were made between the two series. Total postoperative chest tube output (mean +/- standard error) was 553 +/- 50 mL for the calves treated with fibrin glue and 1,155 +/- 103 mL for the control calves (p less than 0.001). On histological examination of mediastinal tissues from 5 treated calves killed 6 weeks after operation, there was no evidence of inflammation, fibrosis, or residual fibrin. To our knowledge, this is the first controlled laboratory study to show that fibrin glue spray is an effective hemostatic agent and that it produces no long-term tissue reaction.

Animals↗