Biomedical subjects
Publications and source records attributed to T D Trainer.
Paragangliomas of the orbit are extremely rare. A case of an orbital paraganglioma, including the first magnetic resonance imaging description of this tumour is described here. The patient underwent surgery with gross total removal of the tumour and relief of his initial chief complaint of visual blurring. The differential diagnosis and therapeutic options for the management of this tumour are discussed.
OBJECTIVE: To characterize the extent and sources of imprecision in histologic dating of the endometrial biopsy. DESIGN: Duplicate endometrial biopsies from 25 women were dated by five evaluators on two separate occasions to evaluate the overall precision of the measure. Using variance component analysis, estimates of intrauterine, intraevaluator, and interevaluator variability were determined. SETTING: Samples were obtained during outpatient fertility testing. Evaluators were colleagues at the same institution. PATIENTS, PARTICIPANTS: Women presenting with infertility undergoing routine evaluation. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Variability in histologic dating of the endometrium. RESULTS: Inconsistencies between evaluators accounted for 65% of the observed variability, whereas 27% was because of inconsistencies in duplicate readings by the same evaluator. Regional differences in the uterus accounted for only 8% of the total variability. CONCLUSIONS: The overall error from these sources have the potential to result in a substantial false-positive rate for diagnosis of luteal phase defect.
A case of invasive adenocarcinoma of the uterine cervix with small intestinal differentiation to include numerous Paneth cells is presented. The light microscopic findings are confirmed by immunohistochemical and electron microscopic study. To our knowledge, this is only the second reported case of small intestinal cervical adenocarcinoma that contained Paneth cells and the first with ultrastructural and immunohistochemical confirmation. A small focus of in situ adenocarcinoma with similar features is seen adjacent to the invasive area.
Subepithelial fibrosis has previously been reported in the small intestine (collagenous sprue) and colon (collagenous colitis). We report a 15-yr-old girl with chronic gastritis and subepithelial fibrosis of the gastric corpus who presented with recurrent abdominal pain and acute upper gastrointestinal bleeding. Nodularity and erythema of the gastric corpus were persistent endoscopic findings. Biopsies revealed patchy chronic active gastritis with a striking focal thick band of collagen immediately beneath the surface epithelial cells that did not extend to deeper portions of the lamina propria. Contrast radiography demonstrated an abnormal mucosa of the gastric corpus with a mosaiclike surface pattern. Numerous studies have failed to elucidate the etiology. Despite treatment with ranitidine, sucralfate, and furazolidone, there has been no clinical or pathologic improvement. The pathogenesis and prognosis of collagenous gastritis, and its relationship to collagenous sprue and collagenous colitis, remain to be defined.
Testicular varicocele, the most common cause of male infertility, frequently presents in early adolescence. To determine whether testicular damage occurs early in the natural history of varicocele, testicular biopsy specimens from 13 patients, 13 to 18 years of age (mean age, 15.5 years), were studied. The biopsies were compared with testicular tissue from six normal control subjects 15 to 28 years of age (mean age, 23.2 years). Nine of the patients with varicoceles (69.2%) demonstrated some degree of tubular sclerosis. Ultrastructural study demonstrated that the tubular sclerosis was due to collagen deposition by fibromyocytes in the peritubular sheath. Premature germ cell sloughing was present in greater than 50% of tubules examined in all but one biopsy. Six patients (46%) demonstrated small vessel sclerosis. Quantitation of the germinal epithelium revealed that the mean germ cell/Sertoli cell ratio and the percentage of germ cells present as late stage forms (secondary spermatocytes, spermatids and spermatozoa) were significantly reduced in the varicocele group. The testes of two patients exhibited severe hypospermatogenesis approaching germ cell aplasia. None of these changes were seen in the control group. The authors conclude that pathologic changes in the testes of patients with varicoceles are found at or soon after puberty. The histopathologic features include peritubular sclerosis, small vessel sclerosis, premature germ cell sloughing, and variable degrees of hypospermatogenesis.
The gross and microscopic features of the normal adult, prepubertal, and aging testis are described. Qualitative and quantitative parameters of spermatogenic activity are presented in practical terms. Emphasis is placed on these findings, which are important to the pathologist in interpretation of diagnostic biopsy specimens other than neoplasms.
Intramucosal carcinoma arising in an otherwise typical juvenile polyp is reported. Adenomatous change and carcinoma in situ have been previously documented in patients with the multiple juvenile polyposis syndrome. The syndrome was not present in this case. Although rare, juvenile polyps (both in solitary and multiple forms) are a potential site of malignant change.
Parathyroid hormone (PTH) analysis was recently added to the College of American Pathologists ligand assay survey. Synthetic whole-molecule PTH was used as the test hormone. This material was found to be stable in lyophilized serum for at least 10.7 days at 35 degrees C and 3.9 days at 45 degrees C. The survey results showed wide ranges of answers yielding within-assay coefficients of variation from 12% to 93%. The median percentage of the spiked hormone that was recovered by the various assay methods ranged from 24% to 390%. Separation of the spiked and endogenous measured PTH concentrations ranged from a twofold separation to an approximate 50% overlap of results. The survey may not be a valid indicator of PTH assay efficacy since whole-molecule human PTH may not be the most clinically important form of circulating PTH; however, the survey shows that there is a large heterogeneity in commercial PTH assays.
Modern day evaluation of thyroid disorders requires a combination of accurate clinical judgement and reliable, sensitive, and specific thyroid functions tests. Principle among the latter are thyroxine (T4) 3, 5, 3'-triiodothyronine (T3), and thyroid-stimulating hormone (TSH). Also playing an important role in special situations are free thyroxine, an assessment of bound and unbound thyroid-binding globulin, TRH stimulation, long-acting thyroid stimulator (LATS), antibodies to thyroid hormone and to thyroid receptors. Basic to interpretation of these tests in the clinical setting is a comprehension of the relationship of the hypothalamus, the pituitary, and the thyroid gland as well as a knowledge of the peripheral metabolism of thyroxine and triiodothyronine. The role of each of these laboratory tests in the evaluation of hyper- and hypometabolic states, their alteration in nonthyroid and other endocrine disorders, and the effects of environmental and physiological factors on these tests are reviewed.
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Two patients with primary amyloidosis, each of whom had received a renal transplant for chronic renal failure, developed amyloid in their allografts. In one patient amyloid was present primarily in glomeruli and to a lesser extent in the interstitial tissue. This patient developed renal failure necessitating retransplantation. In the second patient amyloid was seen in the interstitium and interlobular blood vessels. Minimal amyloid was present in the glomeruli. This patient died of cardiac amyloidosis with good graft function at the time of death. Of the several patients recorded in the literature with amyloid in renal allografts, our first patient is the only one to exhibit glomerular amyloid and failure of the graft. Amyloid in areas other than the glomerulus does not appear to be incompatible with satisfactory graft function.
A peroxidase-antiperoxidase method that demonstrates both free and encysted toxoplasmata in routinely prepared histologic sections is described. This technic and ultrastructural study were employed to confirm the presence of Toxoplasma gondii in the infected tissues of an immunosuppressed patient who had postmortem examination. An immunohistochemical method may be an aid in the diagnosis of toxoplasmosis.
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This is the sixth reported case of metachronous testicular neoplasia in which a seminoma has preceded an embryonal carcinoma. Of particular note is the presence of atypical germ cells in the biopsy specimen of the gonad from which the embryonal carcinoma arose. There has developed recently an increasing awareness of germ cell atypia and carcinoma in situ. Pathologists examining testicular biopsies in the infertile patient should be alerted to this process.
Chondrocalcinosis of the intervertebral discs is a common finding in patients who have had prior surgical procedures involving the same or adjacent disc space. The crystals in the tissues have the characteristic morphologic and spectrophotometric features of calcium pyrophosphate dihydrate. None of the patients described herein had clinical or radiographic evidence of crystal accumulation in sites remote from the surgical procedure. We propose that the surgical trauma may have played a role in the induction of the crystal deposits.
A 13-year-old male who had bilateral cryptorchid testes since birth underwent testicular biopsies and subsequent left orchiectomy following a diagnosis of malignant germ cell tumor. No tumor mass was noted although the malignant cells were seen within the seminiferous tubules and the interstitium. Five recorded cases of in-situ or incipient germ cell neoplasms of the testes are reviewed; three were infertile, another had a cryptorchid testis, and the fifth was both infertile and cryptorchid. Two of these patients have developed frank carcinoma, which would suggest that the process represents an early phase of invasive germ cell neoplasia.
A competitive protein-binding method (CPB) for serum cortisol determination has been compared with a newly developed automated radioimmunoassay (RIA) technic with respect to reproducibility and correlation of patient results. The RIA method uses an immobilized anti-cortisol antibody covalently coupled to the inner surface of a plastic cartridge. A mixture of 3H-labeled and unlabeled cortisol is passed through the cartridge to achieve separation of free and bound cortisol. The bound cortisol is later eluted to regenerate the antibody for the next sample. The RIA procedure had a day-to-day coefficient of variation (CV) of 7% at three cortisol levels. The CPB method had a day-to-day CV of 10% at a concentration of 8 microgram/dl. A comparison of 67 patient samples showed no statistically significant difference between the methods. The regression equation was RIA = 0.96 CPB + 0.14 microgram/dl, with a correlation of 0.92.
To assess the accuracy of pulmonary lavage in diagnosing pneumonia due to Pneumocystis, we used animals as a model and then prospectively studied 33 immunosuppressed adults with diffuse pulmonary infiltrates. In rats treated with cortisone, Pneumocystis organisms could be found in the effluent from lavage as early as in sections of pulmonary tissue, and the effluent from lavage remained diagnostic throughout the ten weeks of observation. Subsegmental lavage in adult patients was performed through the wedged fiberoptic bronchoscope. Pneumocystis organisms were demonstrated in seven patients by lavage, and no false-negative results were recorded. Pneumocystis organisms were readily identified among the sheets of alveolar macrophages seen in smears of the effluent from lavage that were stained with methenamine silver. Subsegmental lavage via the fiberoptic bronchoscope is an accurate and safe technique for establishing the diagnosis of pneumonia due to Pneumocystis in patients whose respiratory embarrassment or thrombocytopenia makes biopsy of the lung hazardous.