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Biomedical subjects

R E Fechner

Publications and source records attributed to R E Fechner.

At least 91 records · Page 5Linked to original sources
PubMed1986

Sinonasal undifferentiated carcinoma. An aggressive neoplasm derived from schneiderian epithelium and distinct from olfactory neuroblastoma.

Eight cases of a highly aggressive undifferentiated carcinoma of the nasal cavity and paranasal sinuses are described. The patients, who ranged in age from 30-77 years, had multiple sinonasal symptoms, and each had involvement of the nasal cavity, maxillary antrum, and ethmoid sinus. Six tumors extended into the orbital bones, and five penetrated the cranial cavity. Five patients died of disease from 1 to 41 months after diagnosis (median: 4 months), and three are alive with tumor less than 1 year following diagnosis. Microscopically, the neoplasms formed nests, trabeculae, and sheets containing medium-sized cells with small to moderate amounts of eosinophilic cytoplasm. A high mitotic rate, tumor necrosis, and prominent vascular permeation were characteristic. Seven neoplasms were immunoreactive for cytokeratin, five for epithelial membrane antigen, and four for neuron-specific enolase. Ultrastructurally, occasional small desmosomes and rare membrane-bound, dense-core granules were observed. Sinonasal undifferentiated carcinoma is a distinctive clinicopathologic entity that must be distinguished from other, less aggressive sinonasal neoplasms.

Adult↗
PubMed1986

Pleomorphic adenoma of the larynx.

A 40-year-old woman was hoarse for five months due to a pleomorphic adenoma in the false vocal cord. The peripheral, ulcerated portion of the tumor had undergone squamous metaplasia, and this was initially misdiagnosed as squamous cell carcinoma. For that reason, the patient received radiation treatment, but the tumor remained unchanged. It was then locally excised, and the patient was still free of disease 14 years later. This case illustrates the hazard of misinterpreting squamous metaplasia in pleomorphic adenoma, the resistance of this tumor to irradiation, and the satisfactory long-range response to local excision.

Adolescent↗
PubMed1985

Bilateral breast cancer. Risk reduction by contralateral biopsy.

Although survival from primary breast cancer has improved with earlier diagnosis and treatment, the management of the opposite breast is still in question. The risk factors for bilaterality are known, and preoperative mammography is occasionally helpful, but identification of early second breast cancer is very limited. Contralateral biopsy may provide a reasonable answer to the problem. During a 5-year period, 62 elective contralateral biopsies were performed in patients having mastectomies for primary breast cancer. This consisted of either a mirror image biopsy or, more commonly, a biopsy of the upper outer quadrant. Thirteen patients had simultaneous contralateral cancers, of whom two had clinically overt bilateral cancers and 11 (18%) had clinically occult malignancy. Seven of these 11 had both radiologically and clinically normal breasts. Thus, 11.3% had radiologically and clinically occult cancer demonstrated by biopsy. Surgical management consisted of total mastectomy with low axillary dissection for noninvasive cancers and modified radical mastectomy for invasive cancers. Pathologic findings of the dominant breast cancer and the contralateral lesion were: bilateral, noninvasive: three patients; invasive, noninvasive: (seven patients), and invasive, invasive: three patients. Although follow-up is short (median of 40 months), 82% of the patients who had clinically occult second-breast cancer remain free of disease. During a previous 8-year period, 37 of 500 primary breast cancer patients (7.4%) developed metachronous (33) or synchronous (4) second-breast primary cancers primarily diagnosed clinically or radiologically. Of these, 35 were invasive and two noninvasive cancers; 41% had nodal metastases. A selected "favorable group," 28 of these patients who were free of disease 3 years after their first cancer, was analyzed. The analysis showed that only 10 (36%) were surviving free of disease at 7 years; 25% were free of disease at 10 years. Although the incidence of clinically-recognized, second-primary breast cancer is relatively low, development of a second invasive cancer severely impairs patient survival. Contralateral biopsy would appear useful to identify patients with early invasive or preinvasive cancer in the second breast, which appears normal after clinical observation or mammography. It provides opportunity to reduce the risk of invasive cancer in that breast, as well as to provide important diagnostic and prognostic information.

Biopsy↗
PubMed1985

Desquamative interstitial pneumonitis complicating inflammatory bowel disease of childhood.

Sulfasalazine has been associated with bronchopulmonary complications of inflammatory bowel disease (IBD) in adults. We describe a 12-year-old boy who developed desquamative interstitial pneumonitis and hepatic cirrhosis several years following the onset of ulcerative colitis. The restrictive lung disease progressed despite cessation of sulfasalazine and initiation of corticosteroid therapy. We discuss a variety of bronchopulmonary complications of IBD and their association with sulfasalazine.

Adolescent↗
PubMed1984

Extraordinary growth of giant cell reparative granuloma during pregnancy.

A 25-year-old woman had a giant cell reparative granuloma (GCRG) in the nasal fossa during the fifth month of pregnancy. This was treated with a partial excision, but the lesion recurred three months later. By this time, there was extension into the anterior fossa. Because of rapidly decreasing visual acuity, headache, and facial pain, a combined craniofacial approach was undertaken. The lesion encroached on the optic chiasm and a piecemeal, but incomplete, removal of the lesion was performed. The patient spontaneously gave birth to a normal child while in the recovery room. She received no additional therapy and her symptoms disappeared. She remains well 11 years later. The course of disease in this patient is compared with eight other patients from the literature who had GCRG during pregnancy.

Adolescent↗
PubMed1984

Salivary duct carcinoma: an analysis of four cases with review of literature.

Salivary duct carcinoma (SDC) is a histologically distinctive neoplasm of the parotid gland. The criteria for the diagnosis of SDC are circumscribed epithelial nests having a papillary, cribriform, and/or solid architecture coupled with central necrosis. The infiltrating cancer can be papillary, resembling the intraductal component or have a nonspecific, undifferentiated pattern. The authors are presenting four cases and compare them with 11 other acceptable cases from the literature. The neoplasm occurs beyond the age of 50 (median 63 years) and has a dismal prognosis with nearly two-thirds of the patients developing distant metastases. All surviving patients have been treated with combined parotidectomy and radiotherapy.

Adenocarcinoma↗
PubMed1984

Oral mucosal presentation of lymphoma: report of case.

We have presented a case of diffuse mixed lymphocytic and histiocytic lymphoma that appeared as persistent oral ulcerations in a pituitary dwarf with combined variable immunodeficiency. The difficulty in diagnosis is emphasized and the differential features of polymorphic reticulosis, Wegener's granulomatosis, malignant lymphoma, and idiopathic midline destructive disease have been reviewed. Awareness of these disease processes and their distinguishing features may expedite accurate diagnosis.

Adult↗
PubMed1984

Middle ear adenoma. A cytologically uniform neoplasm displaying a variety of architectural patterns.

Seven patients with middle ear adenomas (MEA) are presented. MEA are cytologically stereotyped neoplasms with a spectrum of architectural patterns. All tumors were composed of uniform, round, or ovoid cells that resembled normal middle ear epithelium. The histologic patterns varied from tumor to tumor and within a single lesion. Broad sheets of tightly packed cells were commonly present, but glandular and cribriform areas were also frequent. Complex, interdigitating trabeculae, rows of individual cells, and dissociated cells were sometimes seen. Grimelius argyrophil stains were focally positive in three of five stained tumors, but Churukian-Schenk argyrophil preparations demonstrated only rare positive cells in two of these cases. Lysozyme was demonstrable immunohistochemically in each tumor. Lysozyme is present in normal middle ear epithelium and may be a useful marker for MEA, since the tumor is apparently derived from these cells. The clinical features of the seven cases that we report are combined with 44 MEA from the literature. MEA seldom recurs after excision and very rarely invades bone. No patient died of disease. The clinical and histologic distinction of these tumors from plasmacytoma, paraganglioma, ceruminoma, carcinoid tumor, and papillary carcinoma is discussed.

Adenoma↗