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Biomedical subjects

W M Murphy

Publications and source records attributed to W M Murphy.

At least 37 records · Page 2Linked to original sources
PubMed1997

Urogenital involvement by desmoplastic small round-cell tumor.

PURPOSE: We strove to characterize the clinicopathologic features of a rare malignant tumor involving the urogenital system. MATERIALS AND METHODS: Of 109 reported cases of desmoplastic small round-cell tumor, 25 have involved organs ordinarily evaluated and treated by urologists. Experience based on these cases plus 2 from our files forms the basis of this review. RESULTS: The term desmoplastic small round-cell tumor has been applied to a rare, highly malignant neoplasm that occurs most often in the abdominal cavity and is described in the nonurological literature. This cancer has distinctive histological, immunohistochemical and ultrastructural features. Several reports suggest a characteristic genetic abnormality. All reported patients who have tumors involving the genitourinary structures have been treated with chemotherapy, but prognosis has been poor. CONCLUSIONS: The literature on desmoplastic small round-cell tumor indicates that a significant percentage of these rare malignancies involve genitourinary organs. In most cases, tumors have been unresectable surgically and treatment has been multidrug chemotherapy. Response to treatment has been poor, with only 3 of 25 determinate cases free of disease when reported.

Adolescent↗
PubMed1997

Conventional bladder wash cytology performed by four experts versus quantitative image analysis.

Bladder wash cytology provides superior results for the detection of bladder malignancies than does voided urine analysis. Image analysis systems have been developed for quantification of cytologic features. In this study, routine bladder wash cytology is compared with an automated image analysis system (QUANTICYT). We studied a random set of 100 bladder wash samples from a population of 1614 patients in follow-up after bladder cancer. Four experienced pathologists interpreted the same 100 Papanicolaou-stained slides. Cytologic and image analysis results were compared for prediction of a cystoscopic lesion, histologic abnormalities, and tumor recurrence. After application of receiver operating characteristic curves, prediction of a cystoscopic lesion by cytology and image analysis was comparable. Both the image analysis system and the cytologic examination detected all of the high-grade lesions. Image analysis was superior to cytologic analysis for the prediction of tumor recurrence after normal findings at cystoscopic examination.

Cell Nucleus↗
PubMed1996

The histogenesis of clear cell adenocarcinoma of the lower urinary tract. Case series and review of the literature.

Clear cell adenocarcinoma of the lower urinary tract is a rare neoplasm whose histogenesis has not been thoroughly investigated. We have examined six specimens of clear cell adenocarcinomas collected from three institutions using histological, histochemical, and immunohistochemical techniques. Results indicate that almost all clear cell adenocarcinomas of this region express morphological and antigenic features, suggesting müllerian differentiation, and that müllerian differentiation is not a feature of either nonclear cell adenocarcinomas or normal female paraurethral glands. Including the authors' six specimens, 46 specimens have been reported in the available English literature. The accumulated experience confirms the initial impression that these tumors develop predominantly in the urethras of women and occur over a wide age range. Despite high stage at diagnosis, most patients have been alive with no evidence of disease when reported, a prognosis that seems to apply regardless of length of follow-up.

Acid Phosphatase↗
PubMed1996

Primary primitive neuroectodermal tumor of the kidney. Case report and review of the literature.

Small cell tumors are a heterogeneous group of neoplasms with similar morphologic features. They include lymphomas, carcinomas with variable degrees of neuroendocrine differentiation, rhabdomyosarcomas, and neuroblastomas. The authors describe a rare case of primitive neuroectodermal tumor (PNET) located in the kidney that was thoroughly studied with modern diagnostic techniques, including expression of protein P 30/32 MIC2 with the antibody 013 with subsequent demonstration of a genetic translocation consistent with t(11;22). The literature on small cell tumors of the kidney, with special emphasis on PNET, is reviewed.

Adult↗
PubMed1996

Prostate cancer. The problem of prognostic factors.

The assessment of factors that might predict the future behavior of a neoplasm is one of the principal responsibilities of pathologists. This activity is of pivotal importance and should be critically evaluated. The value of information describing the features of cancer to the care of any particular patient cannot be assumed. It must be understood in light of the nature of prostatic carcinoma and the actual direct benefit to the patient of the information. Prognostic factors represent dynamic information that may change over time. Mechanisms for ongoing evaluation of the value of these data should be instituted by each practice setting, lest the accumulation of unnecessary information create adverse financial conditions for the practice.

Humans↗
PubMed1996

The nested variant of transitional cell carcinoma: an aggressive neoplasm with innocuous histology.

The nested variant of transitional cell carcinoma (TCC-NV) is a rare neoplasm; only eight cases have been described. This report reviews the clinicopathologic features of 16 additional examples. The cases were collected from consultations received during a 13-year period. In most instances, a consultation was sought because the histologic features suggested an atypical proliferation of Brunn's nests or a lesion similar to the previously published examples of TCC-NV. Clinical data were gathered and tissues were studied to exclude prostatic cancer and adenocarcinoma. TCC-NV is characterized by the presence of irregular nests and/or tubules of transitional cells infiltrating the lamina propria without surface involvement. Neoplastic cells tend to have innocuous features but at least a few cells in every case are cytologically anaplastic. There is a marked male predominance. Synchronous or metachronous TCCs of more usual histologic make-up may occur. After a follow-up averaging 16.6 months, only three patients are known to be alive with no evidence of disease. Clinicopathologic information from our 16 cases combined with the 8 previously reported examples confirms that TCC-NV is a persistent and aggressive neoplasm notable for its innocuous appearance in histologic preparations.

Acid Phosphatase↗
PubMed1995

Pathology of androgen deprivation therapy in prostate carcinoma. A comparative study of 173 patients.

BACKGROUND: Leuprolide, an agonist of luteinizing hormone-releasing hormone (LH-RH), and flutamide, an antiandrogen, increasingly are being used in the treatment of clinically localized prostate cancer. Only two small series (of 23 and 12 patients) have been published on the distinctive pathologic changes induced in the prostate by androgen deprivation therapy with discrepancies on the presence of squamous metaplasia, necrosis, and possible tumor destruction by combined androgen deprivation therapy. METHODS: One hundred and thirteen radical prostatectomy specimens obtained after at least 3 months of leuprolide-flutamide androgen inhibition therapy and 60 nonhormonally treated prostates in randomly selected clinical Stage T2 prostate adenocarcinoma patients were entirely sectioned. Distinctive histologic findings were tabulated and their statistical value determined. RESULTS: Resection margins of excision were involved by tumor in 43% of untreated and in 19% of androgen-deprived patients. Characteristic changes in androgen-inhibited nontumor glands included atrophy, basal cell prominence, vacuolated luminal cell layer, and squamous and transitional cell metaplasia. Prostatic intraepithelial neoplasia (PIN) was observed in 35% of treated patients. The presence of small tumor glands separated by stroma was the most frequently noted effect of androgen deprivation on prostate adenocarcinoma; pyknosis and branching empty spaces were less frequent. Large clear tumor cells within an inflammatory response was a third histologic pattern. Apparently unaltered tumor areas were observed in 43% of prostates exposed to androgen deprivation therapy. CONCLUSIONS: Androgen deprivation therapy results in histologically distinctive changes that can be recognized in both nonneoplastic and neoplastic prostate tissue. Residual tumor was present in all 113 treated radical prostatectomy specimens. In addition to glandular shrinkage, therapy was associated with statistically significant reductions in the frequency of high grade PIN and extension of cancer to prostate specimen margins of excisions.

Androgen Antagonists↗
PubMed1995

Clinical and experimental bone changes after intraosseous implantation.

Long-term prosthodontic rehabilitation has been extensively documented with the use of osseointegrated biocompatible materials in the mandible and maxilla with resultant improvements in quality of life for patients. In addition, clinical evidence is accumulating to show that mandibular atrophy may slow and even be reversed after implantation. Increased bone height and density have been reported: a finding not unexpected in the light of Wolff's law, which is a universal response of bone to increased functional loads.

Animals↗
PubMed1995

Stress in bone adjacent to dental implants.

Finite element analysis (FEA) was employed to assess patterns of stress in bone adjacent to an implant after application of loads through an attached distal extension cantilever. Under all loading conditions, the highest stresses occurred at the distal cervical bone margin adjacent to the cantilever. In clinical studies, this is not consistently the site of the greatest bone changes seen radiographically. This suggests that extrapolation of FEA studies to clinical implantology should be approached with caution until further data become available on both mechanical properties of bone and patterns of bone remodelling induced by defined functional stresses in mandible and maxillae.

Bone Remodeling↗
PubMed1994

Carcinoma in situ of the urinary bladder. Clues to host involvement in human carcinogenesis.

BACKGROUND: Carcinoma in situ (CIS) of the urinary bladder is a neoplasm of uncertain biologic behavior. It rarely occurs as the primary disease and exists most often in association with high grade, invasive tumors. The unfavorable prognosis ascribed to CIS may not be due to tumor-related factors but to low host resistance or to host-tumor relationships established for previous or co-incident invasive cancers. The scant available evidence indicates that a large proportion of patients with primary CIS have a low frequency of muscle invasion and death from disease. METHODS: Of 2000 patients with bladder neoplasms in our pathology files and tumor registry, 102 had CIS confirmed on histologic review. There were 29 cases of primary CIS and 73 cases of secondary CIS. These cases were compared, with an emphasis on patient outcome. RESULTS: The data indicate that primary and secondary CIS are histologically identical lesions whose effect on patients is related mainly to the presence of multifocal disease, often associated with previous or coincident invasive cancers. Progression or death from disease is unusual among patients presenting with primary CIS but common among individuals with CIS associated with other bladder cancers. CONCLUSION: The authors suggest that the appearance of urothelial CIS identifies patients with at least localized resistance to the development of invasive bladder cancer. The degree of patient resistance to carcinogenic events leading to bladder carcinoma is manifested by the type, grade, and stage of their initial neoplasms.

Adult↗
PubMed1994

Histologic changes in prostate carcinomas treated with leuprolide (luteinizing hormone-releasing hormone effect). Distinction from poor tumor differentiation.

BACKGROUND: Treatment of patients with prostate carcinoma using drugs with antiandrogenic effects is increasingly common. One of the most popular agents is leuprolide (with or without flutamide), an agonist of luteinizing hormone-releasing hormone (LH-RH). Prostates exposed to antiandrogenic agents develop distinctive pathologic changes. The ability of a group of 18 pathologists to recognize these LH-RH effects on prostate cancers and to distinguish them from poor tumor differentiation was tested using a Delphi technique. METHODS: The Delphi method maximizes the opportunity for individual contributions by eliminating opportunities for group dynamics and confrontational interaction. In this study, participants were provided with a set of duplicate transparencies and a list of written definitions of both poor tumor differentiation and LH-RH effect. They were instructed to examine the cases privately using the definitions provided and to distinguish poor tumor differentiation from LH-RH effect. Responses of the participants were shared anonymously, and each was asked to reexamine the cases in light of this knowledge. RESULTS: After a learning experience accomplished by one round of examination and feedback, LH-RH effect could be correctly distinguished from poor tumor differentiation in greater than 90% of cases by 83% of the participants. A small percentage of cases confounded complete consensus, although every case was correctly identified by most participants. CONCLUSIONS: The pathologic effects associated with androgen deprivation with leuprolide (plus flutamide) are sufficiently distinctive to be recognized by knowledgeable pathologists. In most cases, the tissue shrinkage representing a favorable response to the drug can be distinguished from solid or infiltrating patterns of poorly differentiated carcinoma.

Cell Differentiation↗
PubMed1994

Androgen deprivation prior to radical prostatectomy for T2b and T3 prostate cancer.

OBJECTIVE: In an effort to improve on the results of radical prostatectomy for clinical stages T2b and T3 prostate cancer, a selected group of patients received androgen deprivation for three to sixteen months prior to surgery. METHODS: Fifteen men with clinical T2b and 22 with small T3 tumors received a luteinizing hormone-releasing hormone analog (n = 34) or a bilateral orchiectomy (n = 3) three to sixteen months prior to radical retropubic prostatectomy. The prostate was evaluated with particular attention to tumor grade, presence of extracapsular extension, tumor at the inked margin, seminal vesicle invasion, and tumor in the lymph nodes. RESULTS: No patient had clinical or chemical (prostate-specific antigen [PSA]) progression during androgen deprivation. The PSA level declined a mean 90 percent and remained above 4 ng/mL in only two patients. The prostate volume decreased an estimated 30-50 percent. Prostate cancer at the inked margin was found in 15 (41%) and seminal vesicle involvement in 11 (30%) patients. Five (14%) had tumor in regional lymph nodes. There was no difference in regard to positive margins or lymph node metastases between those clinically staged as T2b and those preoperatively staged as T3. Fourteen patients have received adjuvant therapy (13 androgen deprivation, one radiation therapy). None has progressed (mean follow-up, 38.4 months). Of 23 who did not receive immediate additional therapy, six (26%) had progression, as was evident from an increase in PSA and have since been treated. Only one continued to progress. Thirty-five of the 37 patients are alive. Seventeen (46%) are tumor free (PSA < 0.4 ng/mL) without further androgen deprivation. CONCLUSIONS: Only a prospective randomized trial can determine whether androgen deprivation prior to radical prostatectomy has a role. The results from this trial are encouraging for several reasons. The prostate is much smaller as a result of androgen deprivation and this may facilitate surgery. Although the great majority of these patients were expected to be margin positive, 60 percent had negative margins and only 14 percent had positive lymph nodes.

Combined Modality Therapy↗