Biomedical subjects

R H Young

Publications and source records attributed to R H Young.

At least 91 records · Page 5Linked to original sources

PubMed1997

Granulocytic sarcoma of the female genital tract: a clinicopathologic study of 11 cases.

Eleven patients, 13 to 76 (mean, 40) years of age, had granulocytic sarcoma of the female genital tract (FGT) (ovary, seven cases; vagina, three cases; cervix, one case). In nine cases, the FGT involvement was the initial clinical presentation of the disease, and in the other two cases, the FGT involvement was discovered during a relapse of acute myeloid leukemia. The tumors ranged from 0.5 to 14 (mean, 7.5) cm in greatest dimension. Two ovarian tumors were bilateral, and three were green. Microscopic examination revealed a predominantly diffuse pattern of growth, but cords and pseudoacinar spaces were also present focally in several cases. Sclerosis was seen in five tumors and was prominent in one. Prominent myeloid differentiation was readily recognizable on routinely stained sections in three cases, whereas the neoplastic cells in the other cases were primitive with only rare eosinophilic myelocytes. All 11 tumors were positive for chloroacetate esterase, nine of nine were strongly and diffusely positive for lysozyme, eight of eight for myeloperoxidase, seven of seven for CD68, and six of six for CD43. Examination of bone marrow or peripheral blood performed after the diagnosis of FGT involvement revealed acute myeloid leukemia in three of five cases. Two of these patients died of disease, 1 and 16 months after the initial diagnosis, and the third, who received chemotherapy, is alive and free of disease 8 months after the initial diagnosis. One of the two patients with negative bone marrow had recurrent granulocytic sarcoma 30 months after diagnosis and died of sepsis 1 month later; no residual disease was noted at autopsy. The other patient is alive and free of disease 18 months after the diagnosis. One of the four remaining patients with primary FGT involvement who did not have a bone marrow biopsy died of leukemia 24 months later; no follow-up information is available for the other three patients. One of the two patients with a prior diagnosis of acute myeloid leukemia was alive with disease 26 months later; follow-up is not available for the second patient. The diagnosis was often difficult in these cases, the most common problem being distinction from malignant lymphoma, but carcinoma, granulosa cell tumor, and, rarely, other tumors were considered. Immunohistochemical and enzyme histochemical staining were useful in establishing the diagnosis, although suspicion of the diagnosis on examination of routinely stained sections was of paramount importance.

Adolescent↗

PubMed1997

Infantile hemangioendothelioma of the ovary: a monodermal teratoma or a neoplasm of ovarian somatic cells?

Vascular tumors of the female genital tract are uncommon, and only a few cases have been reported in the ovary. We describe herein, an unusual tumor of the ovary: infantile hemangioendothelioma (cellular hemangioma of infancy) in a newborn. The tumor consisted of well-formed blood vessels and proliferating endothelial cells that were arranged in solid cordlike structures. The tumor permeated the ovarian stroma and entrapped normal ovarian follicles. By immunohistochemistry the neoplastic cells expressed factor VIII, CD34, and alpha smooth-muscle actin, and ultrastructurally they had the features of endothelial cells that were focally associated with pericytes. We examined simple sequence repeat (SSR) polymorphic markers in the tumor tissue, as well as in the patient's and parents' blood. The informative SSR markers were found to be identical in the tumor and in the patient's somatic cells. We suggest that the tumor described herein is a congenital infantile hemangioendothelioma arising from ovarian parenchymal cells rather than a teratoma originating from germ cells. A similar morphologic lesion has been described recently in the ovary and interpreted as monodermal teratoma composed of vascular tissue.

Actins↗

PubMed1997

Large cell calcifying Sertoli cell tumor of the testis: contrasting features of six malignant and six benign tumors and a review of the literature.

We report six malignant and six benign large cell calcifying Sertoli cell tumors of the testis and compare the features of malignant and benign cases based on these cases and those in the literature. All the tumors in this report consisted of sheets, nests, solid tubules, and cords of eosinophilic cells, with focal calcifications, as well as a substantial neutrophilic infiltrate in 11 of them. Analysis of our cases and those in the literature showed that the malignant tumors were unilateral and solitary and occurred at a mean age of 39 years (range 28-51 years), whereas the benign neoplasms were bilateral and multifocal in 28% of cases and occurred at a mean age of 17 years (range 2-38 years). Only one malignant tumor occurred in a patient with evidence of a genetic syndrome (Carney syndrome), whereas 36% of benign tumors had various genetic syndromes or endocrine abnormalities. Most of the tumors in the latter cases were bilateral and multifocal. There were strong associations of malignant behavior with size >4 cm, extratesticular growth, gross or microscopic necrosis, high-grade cytologic atypia, vascular space invasion, and mitotic rate greater than three mitoses per 10 high-power fields. All malignant cases exhibited at least two of these features, whereas all benign cases lacked any of them. The presence of any one of these features in a solitary large cell calcifying Sertoli cell tumor, especially in a patient >25 years of age, should be viewed as suspicious for malignant behavior, whereas the presence of two or more of these features indicates a strong probability of a malignant course. "Low" percentages (< or =35%) of tumor cells staining for proliferating cell nuclear antigen (PCNA) also may correlate with benign behavior, but some benign tumors have high PCNA values. Ki-67 values (MIB-1 antibody) did not correlate with biologic behavior, nor did immunostains for p53 protein.

Adolescent↗

PubMed1997

Adenocarcinoma of the epididymis: a report of four cases and review of the literature.

Primary epididymal carcinoma is extremely rare and has been the subject of only sporadic case reports; the validity of some of the reported tumors is questionable. We report our experience with four examples, which arose in men 27, 66, 77, and 81 years of age. All of them presented with scrotal masses; three of them had small hydroceles. None had a history of von Hippel-Lindau disease. Grossly, all of the tumors were centered in the epididymis and two were confined to it. One tumor invaded the periepididymal soft tissue and spermatic cord and the fourth invaded the adjacent testis. They were 2.0-7.0 cm in greatest diameter; three had foci of hemorrhage and necrosis. Microscopically, all of the tumors were adenocarcinomas. Two of them were composed of approximately equal numbers of simple tubules and more complex tubulopapillary formations lined by cuboidal or columnar predominantly clear cells that infiltrated the epididymal smooth muscle wall, periepididymal soft tissue, or both. The other two had large cysts into which grew complex papillary or confluent, back-to-back glands lined by columnar cells with clear, lightly amphophilic or eosinophilic cytoplasm. Necrosis was present in three cases. An undifferentiated, sheetlike growth of anaplastic tumor cells was present focally in one case. Cilia were absent. Small amounts of cytoplasmic glycogen were present in the two cases in which periodic acid-Schiff staining was performed. Immunohistochemical staining, performed in one case, demonstrated strong positivity for cytokeratins (AE1/3, Cam 5.2) and epithelial membrane antigen (luminal only). Results of staining for carcinoembryonic antigen, Leu M1, B72.3, and Ber-EP4 were negative. Ultrastructural analysis, performed in one case, showed well-developed desmosomal junctions, cytoplasmic multivesicular bodies, glycogen particles, and well-developed cilia. Two of three patients with follow-up data died of disease 8 months and 2.5 years after diagnosis; the third was disease free 30 years after the diagnosis despite having paraaortic lymph node metastases at the time of presentation. After reviewing the literature and analyzing our cases, we conclude that bona fide examples of epididymal adenocarcinoma are usually tubular, tubulocystic, or tubulopapillary adenocarcinomas, often with an appreciable content of clear cells, which can usually be readily separated from other paratesticular malignant tumors, such as malignant mesothelioma and carcinomas of the müllerian type. Distinction from metastasis may be difficult and may depend largely on careful clinical evaluation.

Adenocarcinoma↗

PubMed1997

Clear cell hyperplasia of the fallopian tube epithelium associated with ectopic pregnancy: report of a case.

A case of clear cell hyperplasia of the fallopian tube epithelium associated with ectopic pregnancy is described. The lesion was encountered in a 31-year-old woman who presented with abdominal pain and had a positive pregnancy test. Ultrasound examination disclosed an enlarged right fallopian tube. The patient underwent laparotomy, at which time the right fallopian tube was excised. On gross examination, a firm, 1.2 x 1 x 1-cm nodule almost obliterating the lumen of the tube and an abundant blood clot were present. On histologic examination, chorionic villi were found in the blood clot. The nodule was composed of epithelial cells that formed solid and glandular structures. The cells had clear cytoplasm and nuclei without atypia. The differential diagnosis included clear cell adenocarcinoma, but clear cell hyperplasia associated with pregnancy was diagnosed because of the absence of cytologic atypia and mitotic figures. The patient has had an uneventful postoperative follow-up period of 1 year.

Adenocarcinoma, Clear Cell↗

PubMed1997

Atypical oxyphilic metaplasia of the endocervical epithelium: a report of six cases.

We report six examples of a hitherto undescribed atypical metaplastic change of endocervical glandular epithelium that we have designated atypical oxyphilic metaplasia of the endocervical epithelium. The patients ranged in age from 41 to 62 (mean 47.8) years; one was postmenopausal. Gravidity ranged from one to five (mean 2.8) and parity from one to four (mean 2.7). At the time of diagnosis one patient was taking combined oral contraceptives and one was taking tamoxifen for breast cancer. All of the lesions were incidental findings and were unassociated with a gross abnormality. Microscopically, affected endocervical glands were lined by large cuboidal or polygonal epithelial cells with dense, eosinophilic, focally vacuolated cytoplasm and varying degrees of nuclear atypia. Nuclei were enlarged, hyperchromatic, and frequently multilobated or multinucleated. Rare apical snouts were present in two cases. Stratification and mitotic activity were absent. Rare, focal periodic acid-Schiff positivity with and without diastase predigestion was present in three of three cases. Mucin staining was negative in two of three cases and focally stained luminal secretions in one of three cases. Three of three cases were negative for GCDFP-15 and carcinoembryonic antigen. Meaningful follow-up in four patients ranged from 1 to 15 (mean 5.5) years and was uneventful in all of them. Atypical oxyphilic metaplasia of endocervical epithelium represents yet another benign endocervical glandular atypia that must be distinguished from more serious lesions.

Adult↗

PubMed1997

Nodular fasciitis of the vulva: a study of six cases and literature review.

We report six cases of histologically typical nodular fasciitis that each presented as a vulvar soft tissue mass. The diagnosis of nodular fasciitis had not been considered by the referring pathologist in any of the five consultation cases. The patient's ages ranged from 7 to 51 years (mean 34). The lesion was confined to the labia in the four cases in which a specific site was noted. The masses ranged from 1.5 to 3.5 cm (mean 2.2) in maximal dimension. All of them were locally excised, and the resection margins were involved in each case. In addition to the typical features of nodular fasciitis, a noteworthy finding in two of the six cases was the presence of cleftlike spaces lined by plump synovial-like cells. Follow-up ranged from 3 months to 7 years (mean 24 months). A local recurrence developed in one patient at 4 months and was reexcised; there have been no recurrences in any other case. The literature contains only five additional examples of vulvar nodular fasciitis. Although all were pathologically typical, the diagnosis was often not considered, evidently because of the unusual location. Awareness that nodular fasciitis may occur in the vulva and the features that allow its distinction from other mesenchymal "tumors" occurring at this site will facilitate its correct diagnosis.

Actins↗

PubMed1997

Epidermolytic hyperkeratosis in the lower female genital tract: an uncommon simulant of mucocutaneous papillomavirus infection--a report of two cases.

Two examples of epidermolytic hyperkeratosis (EH) involving the female genital tract are described. The first case, an isolated epidermolytic acanthoma, involved the vulva of a 75-year-old woman. The second case involved the vaginal wall of a 40-year-old woman who had similar lesions of the oral mucosa. EH is characterized by epidermal acanthosis, compact papillomatous hyperkeratosis, and dissolution of the suprabasilar epithelium, resulting in perinuclear clear zones. Granular keratohyalin clumping, hypergranulosis, and dyskeratosis resulting in intracellular eosinophilic globules ("cells within a cell" appearance) are additional distinctive findings. Because of the rarity of the lesion in the female genital tract, it may be confused with other lesions that more commonly affect this region. Correct recognition of EH may have significant clinical implications.

Adult↗

PubMed1997

Tumors of the fimbriated end of the fallopian tube: a clinicopathologic analysis of 20 cases, including nine carcinomas.

Twenty tumors that were primary in the tubal fimbriae are reported. They were found in patients aged 17 to 83 (average 57) years. All were of mullerian type. Nine tumors were benign (eight adenofibromas, one cystadenoma), of which seven were serous and two, endometrioid. Two tumors were borderline, a serous papillary cystic tumor of borderline malignancy and an endometrioid adenofibroma of borderline malignancy. Nine tumors were carcinomas, of which four were serous, three endometrioid, and two undifferentiated. Follow-up information was available for six patients with carcinoma. One with serous carcinoma was well at 1 year; a second had ascites with malignant cytologic features nine years postoperatively and is currently on chemotherapy. One patient with endometrioid carcinoma was alive without disease after 8 years, and the other died of tumor at 6.5 years. One patient with undifferentiated carcinoma was alive without disease at 5 years and the other died of disease at eight months. The occurrence of fallopian tube tumors that arise in the fimbriae has received scanty attention in the literature. A fimbrial origin for the tumors is often overlooked initially. Carcinomas confined to the fimbriae cannot be adequately staged according to the current staging system of the International Federation of Gynecology and Obstetrics. It is proposed that they be placed in a new category, Stage I(F), because the tumor cells are exposed directly to the peritoneal cavity even though they do not invade the tubal wall. Although experience is limited it appears that they may have a worse prognosis than Stage I tubal tumors that are nonfimbrial.

Adenofibroma↗

PubMed1997

Cervical squamous cell carcinoma in situ with intraepithelial extension to the upper genital tract and invasion of tubes and ovaries: report of a case with human papilloma virus analysis.

A 55-year-old woman, who was found to have malignant squamous cells on a routine cervical smear, underwent a conization biopsy, followed by hysterectomy with bilateral salpingo-oophorectomy. No gross tumor was present in the uterus, but both ovaries, which were of normal size, contained multiple cysts filled with light brown, soft material. Microscopic examination showed squamous cell carcinoma in situ of the cervix with contiguous spread to the endometrium, fallopian tubes, and ovaries; squamous cell carcinoma extensively replaced the endometrial and tubal epithelium, focally invaded the wall of the fallopian tubes, and involved the parenchyma of both ovaries. Although an invasive cervical carcinoma occasionally spreads to the ovary, this case illustrates that exceptionally an in situ tumor spreads along the epithelium of the upper genital tract and the ovarian surface and invades the ovary and tubes. The detection of human papillomavirus DNA in the cervical, endometrial, tubal, and ovarian tumors by the polymerase chain reaction suggests a role for human papilloma virus infection in this case.

Carcinoma in Situ↗

PubMed1997

Primary angiosarcoma of the ovary: a report of seven cases and review of the literature.

Seven primary ovarian angiosarcomas were diagnosed in 7 patients 20 to 32 (mean 26) years of age. The most common clinical presentation was abdominal pain and distention. Three tumors were in the right ovary and 3 in the left; one was bilateral. Four tumors were Stage I and 3 Stage III. The tumors were brown and hemorrhagic, ranging in maximum dimension from 6 to 13 (average 10) cm. Microscopically, 5 tumors were pure angiosarcomas and 2 were associated with a dermoid cyst. Follow-up information ranging from 2 months to 9 (average 3.6) years was available for 5 patients. Three patients, all with Stage III disease, died of tumor (1 with a pure angiosarcoma, 2 with tumors arising in a dermoid cyst) 2, 15, and 30 months postoperatively. Two patients with Stage I disease and follow-up data were alive and healthy 5.5 and 9 years postoperatively. The differential diagnosis of these tumors is discussed and the literature reviewed.

Adult↗

PubMed1997

Fibromatosis of soft tissue type involving the female genital tract: a report of two cases.

Two cases of soft tissue-type fibromatosis of the female genital tract are described. One involved the vulva of a 19-year-old woman, and was approximately 6.0 cm in greatest dimension and had a rubbery consistency with a gray-white, whorled cut surface. Microscopically, it had infiltrating borders and extended to the ischio-rectal region. All gross tumor was resected. There was no evidence of recurrent disease 6 years later. The other tumor involved primarily the ovary of a 20-year-old woman. It was 24 cm in greatest dimension and infiltrated the mesentery, psoas muscle, and iliac vessels. The tumor was resected along with the sigmoid colon and the patient was free of disease 3 months later. Fibromatosis of the female genital tract, histologically identical to the soft tissue lesion and distinct from so-called "ovarian fibromatosis," should be included in the differential diagnosis of low-grade spindle cell lesions of this region.

Adult↗

PubMed1997

Smooth-muscle hamartoma of the tunica dartos of the scrotum: report of a case.

Hamartomatous proliferations of genital smooth muscle are uncommon and may be easily overlooked if the normal microscopic appearance of the scrotal dartos is unfamiliar to the pathologist. We describe a hamartomatous proliferation of the scrotum in a 60-year-old patient in which incomplete knowledge of the regional histology caused initial problems in diagnosis. On histologic examination, the lesion consisted of an expansile, unencapsulated, relatively circumscribed proliferation of smooth muscle accompanied by muscular arterioles and prominent nerve branches embedded in a densely collagenized stroma. These features are dissimilar both clinically and histologically from all previous reported lesions at this site. We highlight the histologic differences between our case and genital leiomyomas, and the spectrum of hamartomatous smooth-muscle proliferations associated with a Becker nevus, and congenital and acquired smooth muscle hamartomas.

Genital Neoplasms, Male↗

PubMed1997

A mutation in the follicle-stimulating hormone receptor occurs frequently in human ovarian sex cord tumors.

A subset of ovarian tumors, referred to as sex cord-stromal tumors, produce endocrine manifestations due to the secretion of estrogens or androgens. Because gonadotropins induce the growth, differentiation, and function of the steroid-producing cells of the ovary, we hypothesized that mutations in the FSH receptor (FSH-R) might occur in this group of tumors. Ovarian sex cord tumors (n = 13), small cell carcinomas of the ovary (n = 3), and control DNA specimens (n = 116) were screened for mutations in the transmembrane domains of the FSH-R. A heterozygous T-->C mutation was found at nucleotide 1777 that converts codon 591 from phenylalanine to serine (F591S). This sixth transmembrane domain mutation was found in 9 of 13 (69%) sex cord tumors and 2 of 3 ovarian small cell carcinomas, but it was not present in control specimens, including 5 normal ovaries, 5 nonsex cord ovarian tumors, 16 thyroid tumors, or 90 specimens of peripheral blood leukocyte DNA, suggesting that this nucleotide change is not a polymorphism. The functional effects of identified mutations were assessed by expression of the wild-type or the F591S mutant FSH-R in COS-7 cells. The F591S mutation eliminated FSH-stimulated cAMP production, and a similar effect was observed when this mutation was introduced into the homologous location of the LH receptor. The high prevalence of the F591S mutation in the FSH-R suggests that it plays a role in the development of ovarian sex cord tumors.

Adolescent↗

PubMed1997

Granulocytic sarcoma of the testis: a report of two cases of a neoplasm prone to misinterpretation.

We report the cases of two men, aged 48 and 71 years, with granulocytic sarcoma of the testis. Both presented with left testicular swelling and underwent orchiectomy, which revealed cream-colored to yellow-tan, rubbery-to-firm, testicular tumors with extensive paratesticular spread. The tumor in the younger patient was composed of a uniform population of primitive cells with scant cytoplasm and was initially misinterpreted as malignant lymphoma. Staging revealed no extrascrotal spread. The patient was treated with radiation and chemotherapy and remained free of disease for 12 years, at which time he died of unrelated causes. The older patient had a history of a myelodysplastic syndrome. His tumor contained cells with bright eosinophilic, occasionally granular cytoplasm, consistent with myeloid lineage. Because of a prominent component of myelocytes, with round, eccentric nuclei and moderately abundant cytoplasm, and because of an associated chronic inflammatory cell infiltrate that contained mature plasma cells, the tumor was initially misinterpreted as a plasmacytoma, although it was reinterpreted as a granulocytic sarcoma before initiation of therapy. Tumor cells in both cases were positive with a chloroacetate esterase stain. Immunohistochemical staining revealed expression of myeloperoxidase, lysozyme, leukocyte common antigen, and CD43, but not of B-cell-specific or T-cell-specific antigens in both cases. Granulocytic sarcomas are apt to be misinterpreted as other hematolymphoid tumors, which may result in a significant error in management. The diagnosis should at least be thought of any time the diagnosis of malignant lymphoma or plasmacytoma of the testis is being considered.

Aged↗

PubMed1997

Intraepithelial lesions of the urinary bladder with a discussion of the histogenesis of urothelial neoplasia.

Bladder neoplasia of the transitional cell type progresses by two distinct, but occasionally interrelated, pathways characterized morphologically by a papillary or nonpapillary configuration. In this review, the authors discuss intraepithelial lesions of the urinary bladder, le, those lesions confined within the basement membrane of the urothelium. The emphasis is on histogenesis of bladder neoplasia, its putative precursor lesions, and its noninvasive forms. Areas of controversies are highlighted, and the pertinent clinical features, histological findings, and biological potential of these lesions examined.

Carcinoma in Situ↗

PubMed1997

Carcinoma of the urinary bladder: a review of its diverse morphology.

The microscopic appearances of carcinomas of the urinary bladder are reviewed, with emphasis on patterns that have been highlighted only recently or account for major problems in differential diagnosis. Approximately 80% of bladder cancers are of urothelial (transitional cell) type. The major new information pertaining to that category is the appreciation of the extent to which they may have unusual patterns that, on occasion, lead to their misinterpretation as benign. The homology between some of these variants and benign epithelial abnormalities is emphasized and helps in understanding them: nested carcinomas and von Brunn's nests, small tubules and nephrogenic adenoma, carcinomatous glands and cystitis glandularis, cystic carcinomas and cystitis cystica. Other peculiar patterns seen in urothelial carcinoma include silt-like spaces, clefts, and angulated nests with spikes. Differences in opinion have been apparent in recent contributions concerning carcinomas of the bladder with a prominent component of spindle cells (sarcomatoid carcinomas) and whether they represent a category distinct from carcinosarcoma. Irrespective of this academic distinction, the potential for some epithelial-derived tumors of the bladder to be dominated by or even have an exclusive component of spindle cells is important. Three other major categories of primary bladder cancer are squamous cell carcinoma, adenocarcinoma, and undifferentiated carcinoma. The differences in the frequency of subtypes of adenocarcinoma originating in the bladder mucosa and urachus has recently been emphasized, as has the spectrum of undifferentiated carcinomas. In some bladder cancers, the stroma has unusual features. These are carcinomas with pseudosarcomatous stroma, osseous or cartilaginous metaplasia, or osteoclast-type giant cells. The diversity of appearances of bladder cancer has important implications in differential diagnosis.

Adenocarcinoma↗

PubMed1997

Pseudoneoplastic lesions of the urinary bladder and urethra: a selective review with emphasis on recent information.

Selected tumor-like lesions of the urinary bladder and urethra, particularly those that have been the subject of recent attention in the literature, are reviewed. Within the category of epithelial abnormalities, it has recently been appreciated that cystitis glandularis of the intestinal type is occasionally associated with prominent mucin extravasation into the stroma, a finding that should not lead to the misdiagnosis of adenocarcinoma. Additionally, the problems that nephrogenic adenoma may cause have been the subject of recent study, and a detailed microscopic analysis of this lesion has shed light on the relative frequency of its common, and uncommon, features. Within the category of tumor-like lesions of the bladder, the inflammatory pseudotumor has been the subject of much interest as have müllerian lesions. It has recently been appreciated that endosalpingiosis is rarely seen at this site, usually in association with endocervicosis or endometriosis, leading to the suggested usage of the designation "müllerianosis." Selected other tumor-like lesions of the urinary bladder and urethra are also reviewed, including the problems nephrogenic adenoma may cause when it involves the prostatic urethra in men or a urethral diverticulum in females as well as the peculiar stromal cells that have recently been described within some urethral caruncles.

Diagnosis, Differential↗