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Biomedical subjects

T M Ulbright

Publications and source records attributed to T M Ulbright.

At least 109 records · Page 6Linked to original sources
PubMed1984

Juxtaglomerular cell tumor of the kidney.

The authors describe a juxtaglomerular cell tumor (JGCT) which caused severe hypertension in a 58-year-old man. Light microscopy showed a circumscribed tumor composed of interlacing cords and occasional nodules of relatively uniform cells with no mitotic activity. Rhomboid crystals characteristic of "prerenin" were present within the cytoplasm of tumor cells, and there was a close relationship between the tumor and unmyelinated nerve axons. Intracytoplasmic renin was demonstrated by immunofluorescence, and tumor granules were shown to contain zinc by electron-beam microanalysis. Review of 14 prior cases, with additional follow-up of 9, showed that no patient had developed recurrence, metastasis, or another tumor. Four patients, however, are hypertensive but probably because of secondary tumor effects rather than recurrent hyperreninism. The distinction of JGCT from hemangiopericytoma with renal involvement is important because of the high mortality associated with the latter. The authors conclude that JGCT is benign, but patients with JGCT may remain hypertensive postnephrectomy because of hypertensive angiopathy.

Adolescent↗
PubMed1984

Morphologic observations after percutaneous transluminal balloon angioplasty of early and late aortocoronary saphenous vein bypass grafts.

Clinical and morphologic observations from two patients undergoing percutaneous transluminal angioplasty of stenotic aortocoronary saphenous vein bypass grafts early (3 months) and late (56 months) after graft insertion are described. Each patient had one or more clinically successful graft dilations resulting in an angiographic increase in luminal diameter and a decrease in mean trans-stenotic gradient, and each had restenosis of the graft at the site of previous angioplasty within 2 months of dilation. Both operatively excised grafts had diffuse but variable amounts of intimal fibrous thickening and severe narrowing at the previous angioplasty site. The early graft had no evidence of dilation injury, and the intimal thickening consisted solely of fibrocollagenous tissue free of calcific deposits. In contrast, the late graft had a healing intimal dissection at the angioplasty site, and the intimal thickening consisted of atherosclerotic plaque with calcific deposits. Angiographic and morphologic correlations suggest that the mechanism of saphenous vein angioplasty early (less than or equal to 1 year) after insertion is by graft "stretching," while late (greater than 1 year) after insertion it is by atherosclerotic plaque "fracture" similar to that observed in atherosclerotic coronary arteries subjected to angioplasty procedures.

Adult↗
PubMed1984

Astrocytic tumors of the retina. Differentiation of sporadic tumors from phakomatosis-associated tumors.

A single, 1.3-cm, intraocular tumor, composed of interlacing, spindle-shaped astrocytes, involved the retina and optic disc of a 13-month-old girl. Neither the patient nor her family had stigmas of a phakomatosis. We found 42 previous cases of histologically documented astrocytic tumors of the retina. Twenty-four patients (57%) had tuberous sclerosis, six patients (14%) had neurofibromatosis, and 12 patients (29%) were otherwise normal. Patients with tuberous sclerosis usually had multiple, peripheral, retinal tumors containing giant "astrocytes." Patients with neurofibromatosis and otherwise normal patients more frequently had disc-based tumors. However, three patients (50%) with neurofibromatosis had multiple tumors, whereas multiplicity occurred in only one of the patients in the sporadic group. We conclude that if the tumor is single, is disc based, and lacks giant cells, the patient is not at great risk of tuberous sclerosis.

Adolescent↗
PubMed1983

Epithelioid sarcoma of the vulva. Evidence suggesting a more aggressive behavior than extra-genital epithelioid sarcoma.

The authors describe two cases of epithelioid sarcoma of the vulva and summarize the clinical and pathologic experience with this vulvar neoplasm. Findings indicate that epithelioid sarcoma of the vulva usually occurs in the labia majora of young women, but may occur in later life. Clinically it may mimic a Bartholin's duct cyst, thus leading to inadequate treatment. Pathologic findings are characterized by sheets and nests of acidophilic, polygonal cells. Follow-up study suggests that vulvar epithelioid sarcoma behaves more aggressively than extragenital epithelioid sarcoma. Four of five patients died of metastatic sarcoma. The courses of three patients were quite rapid, whereas a fourth patient had multiple recurrences over a long period, which is typical of extragenital epithelioid sarcoma. Complete initial excision is important. All patients with local recurrence died with distant metastases. Vascular invasion also indicates a poor outcome.

Adult↗
PubMed1983

Glassy cell carcinoma of the uterine cervix. A light and electron microscopic study of five cases.

Five cases of glassy cell carcinoma of the uterine cervix were examined by light and electron microscopy. Light microscopic features included areas of large cells with ground glass and granular cytoplasm, distinct borders, prominent stromal inflammation, and lack of apparent squamous or glandular differentiation. Two neoplasms were associated with separate foci of squamous cell carcinoma in situ and one with endocervical adenocarcinoma. Electron microscopy showed a predominant cell type with cytoplasmic filaments, dilated rough endoplasmic reticulum, Golgi complexes, and large nuclei with complex nucleoli. In some cells there were tonofibrils and well developed desmosomes. The neoplasm of one patient showed poorly developed intracellular lumina. These observations were interpreted to indicate that glassy cell carcinoma is associated with and demonstrates both glandular and squamous differentiation. It is, therefore, properly classified as a type of poorly differentiated adenosquamous carcinoma, which likely develops from the subcylindric reserve cell. The results of this experience reaffirms its poor prognosis.

Adenocarcinoma↗
PubMed1983

Papillary serous carcinoma of the retroperitoneum.

We describe a retroperitoneal neoplasm in an 11-year-old girl which had a light microscopic appearance identical to that of papillary serous carcinoma of the ovary. There was no evidence of ovarian involvement. Immunohistochemical staining for amylase was positive within the cytoplasm of tumor cells. Since amylase is a marker for serous ovarian tumors, this finding supports the belief that "ovarian-type" neoplasms that occur at ectopic locations are essentially identical to their ovarian counterparts. We believe they originate from metaplasia of mesothelium. Our findings support the concept that these tumors should exhibit a biologic behavior and therapeutic response which are similar to those of an ovarian tumor of the same grade and comparable stage. The demonstration of intracytoplasmic amylase also may prove useful in differentiating peritoneal serous tumors from non-metaplastic mesothelial proliferations. We are unaware of a prior report of an extra-ovarian serous carcinoma in a child.

Amylases↗
PubMed1982

Bowenoid dysplasia of the vulva.

The histologic findings of five patients with clinically typical Bowenoid dysplasia (BD) allowed the authors to classify the vulvar and perineal biopsies of 18 patients under 40 years as BD and the vulvar biopsies of six patients under 40 years as squamous cell carcinoma in situ (CIS). The two best criteria for BD are cellular uniformity and absence of pilosebaceous involvement. Vesicular chromatin is a less constant feature of BD. Clinically, patients with BD were younger than those with CIS, more frequently had elevated and multiple lesions and other developed BD with pregnancy. Histologic features therefore discriminate between clinical BD and CIS, but the authors emphasize that both clinical and pathologic features are necessary for proper diagnosis. Follow-up of BD has been benign, with one exception. Spontaneous regression occasionally occurred. One patient with CIS developed microinvasive carcinoma. Patients with BD were regarded at lesser risk for invasive carcinoma than patients with CIS; they are therefore amenable to conservative therapy.

Adult↗
PubMed1982

Ovarian strumal carcinoid. An immunocytochemical and ultrastructural study of two cases.

Examination by immunoperoxidase methods showed that two strumal carcinoids contained thyroxine in the follicular epithelium and colloid. Ultrastructure showed features of thyroid epithelia. Granule-containing cells replaced some follicular epithelial cells at the colloid interface. The morphology of the granules of these cells resembled those of C-cells and foregut-hindgut carcinoids. Transition between thyroid and carcinoid occurred by proliferation of interfollicular cells which subtly formed trabecular structures. Immunoperoxidase for calcitonin was positive both in the interfollicular cells of one tumor and in cells near the transition from thyroid to carcinoid pattern of the other. We conclude that thyroid tissue is a proven component of strumal carcinoid but that follicular epithelial cells may be replaced by granule-containing parafollicular cells. We suggest that the transition from thyroid to carcinoid is accomplished through an intermediate stage of calcitonin-positive cell proliferation. We emphasize, however, that these neoplasms are types of teratomas which may show several forms of differentiation. The tumor of one patient had mid-gut carcinoid elements and represents the first described strumal carcinoid with the carcinoid syndrome.

Aged↗
PubMed1982

Clinical, radiographic and pathologic effects of Amipaque on rabbit lung. Comparison with barium and Gastrografin.

The effects of saline and 3 contrast media, Amipaque, Gastrografin and barium, were evaluated for 24 hours following intratracheal instillation in rabbits. Respiratory rates, serial chest films, and pathologic examination of the lungs demonstrated that Amipaque induced significantly less respiratory distress than the other 2 contrast media whereas inflammatory reactions were comparable for all of the media. Significant pulmonary edema occurred with both Amipaque and Gastrografin but was greater with Gastrografin. Both of these media were cleared from the lung within 24 hours, however barium continued to obstruct bronchi and fill alveolar air spaces. It is concluded that in comparison to Gastrografin and barium, Amipaque is relatively innocuous in the lung.

Animals↗
PubMed1981

Intramural papilloma of the vagina: evidence of Müllerian histogenesis.

A papillary tumor occurred in the posterior-superior vaginal wall of a 5-year-old girl who was free of recurrence one year following surgical excision. The light microscopic features included papillae lined by eosinophilic cells with uniform, bland nuclei, solid areas of identical cells, and scattered glandular lumina which contained mucopolysaccharides. Foci of eosinophilic hyaline globules were another distinctive feature. Electron microscopy of the tumor demonstrated features associated with müllerian neoplasms including projecting microvilli, whorls of perinuclear cytoplasmic microfilaments, conspicuous lysosomes, squamous metaplasia, complex cytoplasmic interdigitations, and pseudoinclusions of "cytoplasmic" collagen. Previously described "mesonephric papillomas" of the vagina and cervix are compared with the tumor of the authors' patient. The previously described tumors share some histologic and clinical features, although they were superficial rather than intramural proliferations. The authors conclude that the ultrastructure, location, and documented presence of müllerian structures in the vagina favor a müllerian origin for this vaginal tumor. A number of other vaginal tumors that occur in children and young women show different light microscopic features.

Child, Preschool↗
PubMed1981

C-cell hyperplasia developing in residual thyroid following resection for sporadic medullary carcinoma.

Four days following resection of a medullary carcinoma of the thyroid, a 49-year-old man experienced elevated serum calcitonin levels. There was no evidence of metastasis. A re-exploration of the patient's neck demonstrated a histologically normal thyroid remnant that demonstrated C-cell hyperplasia by immunoperoxidase staining. The lack of a familial history, a normal parathyroid, and the absence of C-cell hyperplasia in non-tumorous thyroid of the original resection support the concept that the patient had a sporadic tumor. Patients who had undergone incomplete thyroidectomies for non-familial disease are at risk for developing C-cell proliferation and possibly medullary carcinoma. We conclude that the C-cell hyperplasia in this thyroid remnant is the source of the elevated calcitonin level; this mechanism may also explain postoperatively elevated calcitonin levels in some patients with medullary carcinoma treated by partial thyroidectomy and high calcitonin levels for a variable period after complete thyroidectomy.

Adult↗
PubMed1981

Kaposi's sarcoma: relationship with hematologic, lymphoid, and thymic neoplasia.

Four cases of Kaposi's sarcoma (KS) are described; one each was associated with Hodgkin's disease, a thymoma, an atypical lymphoid proliferation resembling Castleman's disease, and a cutaneous reticulosis. The association of KS with lymphoproliferative, hematologic, and other neoplasms is thoroughly reviewed, with special attention to tissue diagnosis, relative order of development, and relationship to immunosuppressive treatment. Review of 65 accepted cases, including ours, showed that 85% of patients with KS and a known order of development appeared with KS either simultaneously or after the second neoplasm. There was a disproportionate tendency for hematologic malignancy to develop simultaneously with KS. Of the 22 patients who had KS subsequent to a second neoplasm, 18 (82%) had received some form of interval immunosuppression. This evidence and observations in renal allograft recipients, patients with pemphigus, and patients with other autoimmune disorders point to the frequency of a common background of deranged immune status in patients with KS. Therefore, either naturally occurring or iatrogenic immune deficiency likely predisposes patients to KS. Some possible mechanisms for this phenomenon are reviewed.

Adult↗
PubMed1981

Mucin-like changes in keloids.

Six of 125 keloids of the earlobe demonstrated a peculiar accumulation of mucinous material within their stroma. The six patients had all received prior injections of a corticosteroid compound. The histopathologic picture is characterized by irregularly contoured pools of amorphous eosinophilic material surrounded by a variable granulomatous response of multinucleate giant cells and bubbly histiocytes. Histochemical studies demonstrated that the material is different from the hyaluronic acid-rich substances of the usual forms of cutaneous mucinoses. The lesion is similar to but distinct from that previously described to occur in nasal mucosa injected with corticosteroids. Its recognition and correlation with clinical history should prevent confusion with other entities.

Adolescent↗
PubMed1980

Intravenous pyogenic granuloma: case report with ultrastructural findings.

A nodule, attached to the intimal surface of the external jugular vein of a 12-year-old boy, showed the light microscopic features of a pyogenic granuloma. The small muscular arteries in the adventitia contained numerous tufted intraluminal capillaries, and it is possible that the angiomatous proliferation within the jugular vein originated from the vasa vasorum, with subsequent growth into the venous lumen. This intraluminal growth dispersed the tunica elastica into the pyogenic granuloma. Ultrastructural examination showed, the lesion to be composed of capillaries lined by low and cuboidal endothelial cells, with occasional pericytes surrounded by focally multiple basal luminae. In some locations, the capillary endothelial basal lamina abutted directly on collagen with no intervening pericyte. In the stroma of the tumor there were cells with myofibroblastic features. This benign intravascular growth should be distinguished from other benign but atypical intravascular and vascular proliferations.

Child↗
PubMed1980

Solitary necrotizing granulomas of the lung: differentiating features and etiology.

The clinical and pathologic features of 86 roentgenographically solitary pulmonary granulomas were reviewed to determine etiology and to provide guidelines for histologic evaluation. Fungal or acid-fast organisms were identified within the tissue in 60 cases (70%) and fragments of a helminth were found in one. The organisms were almost always present in the center of necrotic granulomas, and examination of two blocks containing active granulomas was usually sufficient for their identification. Microbiological cultures were less productive than direct examination of the tissue. In 25 cases an infectious etiology could not be identified: two were diagnosed as hyalinizing granuloma, one as Wegener's granulomatosis, and 22 were not further classified. A prominent overlapping spectrum of histologic features was found between infectious granulomas and Wegener's granulomatosis, suggesting that the latter may represent an abnormal immune response to an infectious agent that is no longer identifiable within the tissue. Caution is urged in diagnosing limited Wegener's granulomatosis and other pulmonary angiitides in patients with roentgenographically solitary granulomas.

Adolescent↗