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PubMed2002

Massive pleural endometriosis.

We present a patient who was referred to our thoracic surgical service with a massive, loculated right pleural effusion accompanied by significant ascites. Thoracotomy and decortication were required and pleural biopsy led to a diagnosis of endometriosis. Aggressive medical therapy was subsequently initiated but hysterectomy with bilateral oophorectomy was required due to poor symptom control and the inability to rule out a neoplastic process. There are less than 15 reported cases of endometriosis presenting with both pleural effusion and ascites. Thoracic surgeons presented with such a scenario should be cognizant of this pathological entity.

Adult↗
PubMed1986

The concept of preleukemia: clinical and laboratory studies.

Thirty-five years ago, a handful of astute clinical hematologists began to notice that some of their patients with acute nonlymphocytic leukemia had a history of a preceding ill-defined hemopathy. This "preleukemic" hemopathy was increasingly reported anecdotally and through careful retrospective analyses. In more recent prospective studies, this syndrome has been relatively well defined. Indeed, it is widely accepted that there exists a hematopoietic abnormality not recognizable as classical, overt, acute nonlymphocytic leukemia, which, nonetheless, can represent an early phase of leukemia. In this manuscript, the author reviews the original case reports, the initial retrospective studies, and the prospective studies which have clarified some of the clinical and laboratory features of the preleukemic syndrome. The notion that the preleukemic syndrome represents an established neoplastic process will be reviewed with special attention to assessment of clonal hematopoiesis, cytogenetic studies, and clonal evolution. Studies on induced leukemia and preleukemia in experimental animals and humans will be reviewed as will be the semantic issues which have complicated our ability to compare interinstitutional studies. A simple classification scheme of the myelodysplastic syndromes will be presented as will be a framework agenda for future studies on the pathophysiology of these syndromes.

Animals↗
PubMedDate not supplied

Noncardiac findings on dual-isotope myocardial perfusion SPECT.

BACKGROUND: This study examined the frequency of reporting noncardiac findings (NCFs), such as malignancies from inspection of raw projection images with dual-isotope single photon emission computed tomography (SPECT) perfusion imaging, which could potentially be of greater clinical importance than myocardial perfusion imaging alone. Dual-isotope (ie, rest thallium 201 and stress technetium 99m sestamibi [MIBI] or Tc-99m tetrofosmin [TET]) SPECT myocardial perfusion imaging combines multipotential tracers for noncardiac purposes (Tl-201 for renal or splenic imaging, inflammation, or lymphoma and MIBI or TET for hepatobiliary imaging and detecting increased mitochondrial number or activity in neoplastic processes). These images are optimally interpreted with cinematic inspection of the raw projection data, but this may not be practiced uniformly in every laboratory. METHODS AND RESULTS: We reviewed 12,526 computer-generated text reports of dual-isotope perfusion SPECT studies from a 6-year period for NCFs. NCFs were categorized by organ and by probability of malignancy: high (eg, focal breast or lung uptake of MIBI or TET), intermediate (eg, lymph node uptake or thyroid abnormalities), or low (eg, filling defects in liver, kidney, spleen, or gall bladder; ascites; or pleural effusions). Confirmatory imaging studies or clinical confirmation for each NCF was sought. There were a total of 207 NCFs identified in 180 reports (1.7% of reports, ranging from 0% to 2.8% of reports of individual interpreters). Of these, 107 NCFs were unsuspected before SPECT; 24% were considered at high probability for malignancy, and 24% were considered intermediate in likelihood of malignancy. Follow-up data were available for 178 NCFs, confirming 88% of these findings, including 82% of breast foci, 62% of lung foci, 86% of hepatobiliary/spleen abnormalities, and 94% of renal abnormalities. The probability of malignancy was highest (82%) in breast or lung foci in which uptake of both Tl-201 and the Tc-99m-labeled agent was present. CONCLUSIONS: In patients referred for evaluation of myocardial perfusion, NCFs are unusual and require systematic and careful inspection of projection images for their detection. With Tl-201, TET, MIBI, or dual-isotope imaging, detecting and reporting NCFs may occasionally result in life-saving early cancer identification.

Artifacts↗
PubMed1996

Cause of oral ulcers in HIV-infected patients: a study of 19 cases.

OBJECTIVES: To study the cause and clinical aspects of oral ulcers in HIV-infected patients. STUDY DESIGN: Forty-one consecutive HIV-positive patients with long-standing oral ulcers were examined; 19 were evaluated by biopsy. From these 19 cases, viral, bacterial, and fungal cultures and biopsies were taken in each patient. When indicated, special microbial stains were undertaken to identify bacteria or fungi. Ten cases without granulomatous bacterial fungal or lymphomatous features were available for in situ hybridization to detect viral DNA of herpes simplex virus 1 and 2, cytomegalovirus, varicella-zoster virus, and Epstein-Barr virus. RESULTS: Most of the oral ulcers occurred in patients with severe immunodepression. Median CD4 T-lymphocyte count was 60 cell/mm3 (range, 3 to 335). It was ascertained that nine (47%) patients had nonspecific aphthous-like ulcers, and ulcers caused by herpes group viruses were identified in six (31.5%) patients. One (5%) person was diagnosed with non-Hodgkin's lymphoma; and in one (5%) patient, multiple ulcers were an expression of lues maligna. Two ulcers (10.5%) in the palate harbored mycotic granulomatous foci (cryptococcosis, histoplasmosis). In this population, almost all of these ulcers were found to be large, persistent, and painful. CONCLUSIONS: Nontumefactive oral ulcers in HIV-positive patients may be a source of diagnostic difficulties because of the diverse array of underlying pathologic entities and multiplicity of etiologic agents. Biopsy should always be performed on long-standing ulcers because either infection or a neoplastic process may be extant. In the absence of infection or neoplasm, such lesions are then designated as ulcers not otherwise specified.

AIDS-Related Opportunistic Infections↗
PubMed1999

Subepithelial nerve plexus (with ganglion cells) associated with taste buds.

OBJECTIVE: The purpose of this investigation was to confirm the presence of subepithelial nerve plexuses associated with taste buds in the human tongue and to study the histomorphologic features of each plexus. STUDY DESIGN: Through use of a light microscope, several hundred microslides representing biopsies of the human tongue were reviewed so that the histomorphologic character of subepithelial nerve plexuses could be detected and studied. Tissue sections were stained with hematoxylin-erythrosin, Bodian, and Masson's trichrome, as well as with immunohistochemical stains for neuron-specific enolase and S-100 protein. RESULTS: Twelve examples of the subepithelial nerve plexus, many with mature ganglion cells, were selected for microscopic evaluation. The plexuses were quite small, ranging from 1 to 3 millimeters in diameter. With one exception, each plexus was an incidental finding in a biopsy of a definitive soft tissue lesion, such as fibroma, papilloma, granular cell tumor, lymphoepithelial cyst, lingual tonsil, or foliate papilla. Ganglion cells, 1 to 5 in number and confirmed by neuron-specific enolase and S-100 protein, were observed in 9 of the cases. CONCLUSIONS: The subepithelial (subgemmal) nerve plexus is a tortuous neural proliferation associated with the taste buds of the human tongue, with ganglion cells and intergemmal/intragemmal branches. When hyperplastic, it should be recognized as such and not diagnosed as a neoplastic process--eg, a ganglioneuroma, neurofibroma, syndrome-associated neuroma, or traumatic neuroma.

Adult↗
PubMed2003

Tumour necrosis factor alpha: a potential target for the therapy of solid tumours.

Tumour necrosis factor alpha (TNFalpha), named for its antitumour properties, was isolated almost 30 years ago. It is a vital member of the multifunctional TNF superfamily and has important roles in immunity and cellular remodelling as well as influencing apoptosis and cell survival. Its central role in inflammation has led to the development of TNFalpha antagonists as effective therapies for rheumatoid arthritis and inflammatory bowel disease. In this review, we discuss the evidence which has accumulated during the past decade that implicates TNFalpha in inflammatory pathways that increase tumorigenesis. There is convincing evidence that under specific conditions TNFalpha is a tumour promoter and helps to produce the toxic effects associated with conventional cancer therapy, such as the cytokine release syndrome and cisplatin-induced nephrotoxicity. Several trials have been set up to investigate the role of TNFalpha antagonists in cancer. It is hoped that these agents inhibit the neoplastic process either alone or in combination with other agents, and ameliorate the side effects of cancer therapy.

Animals↗
PubMed2001

Vertebral involvement in hyperphosphatemic tumoral calcinosis.

Hyperphosphatemic tumoral calcinosis (HTC) is an inherited metabolic disorder characterized by calcified soft tissue masses and hyperphosphatemia. Besides these typical features, a number of less common manifestations have been reported, all of them related to pathologic calcification of various tissues. We have investigated the case of a woman with hyperphosphatemia, recurrent episodes of lumbar pain, and a positive familial history of HTC. A bone scan showed markedly increased uptake in the lower lumbar spine. Magnetic resonance imaging showed pathological changes in L5 compatible with an inflammatory reaction and not suggestive of neoplastic process. There was no evidence of infection, trauma, malignancy, or other disease that could cause the lesion. We treated the patient with analgesics and NSAIDs and the pain remitted over a period of 1 week. In a follow-up magnetic resonance imaging 7 months later, the L5 lesion had disappeared completely. A computed tomography scan analysis with a bone window showed a sclerotic area at the L5 vertebral body. We believe that this patient was affected by the syndrome of HTC and that the inflammatory phenomena found in L5 are a manifestation of this disease.

Adult↗
PubMed1998

Papillary endothelial hyperplasia (Masson's tumour) of the maxillary sinus.

In 1923, Masson described a neoplastic process consisting of papillary hyperplasia of the endothelial cells, with a consequent obliteration of the vascular lumen, followed later by degenerative changes. Masson coined the term vegetant intravascular haemangioendothelioma, however, these days it is more commonly known as papillary endothelial hyperplasia (PEH), or by the pseudonym, Masson's tumour. Although relatively rare, there are numerous accounts of PEH in the literature, describing its predilection for the head and neck region. Our case report describes the finding of a PEH within the paranasal sinuses, a site not previously mentioned even in the largest of series found on literature search. We will then discuss the relevant histological features of the lesion, and its natural history.

Aged↗
PubMed1999

The suprahyoid neck: normal and pathological anatomy.

The suprahyoid neck can be divided into fascia-bound spaces. These spaces, which are readily demonstrated on computed tomography (CT) and magnetic resonance imaging (MRI), form the anatomical framework for generating differential diagnosis and assessing disease extent. By correlating the radiological features with clinical information, the diagnostic possibilities of demonstrated lesions could be narrowed down considerably. Multiple space involvement is common in inflammatory and neoplastic processes and the full extent of these lesions should be outlined to facilitate surgical or radiotherapy planning.

Carotid Arteries↗
PubMed1991

Phosphonate-containing inhibitors of tyrosine-specific protein kinases.

Tyrosine-specific protein kinases (TPK) are important signal transducing enzymes involved in normal cellular growth and differentiation and have been implicated in the etiology of a number of human neoplastic processes. Efforts to develop agents which inhibit the function of these enzymes by interfering with the binding of substrate have been limited by the lack of detailed three-dimensional structural data. Many inhibitors of substrate binding share a common styrene nucleus 1 which has been postulated to function as a conformationally constrained analogue of tyrosine. In an effort to develop high-affinity compounds based on this hypothesis, a number of derivatives were synthesized in which either methylphosphonate (4a-c) or (hydroxymethyl)phosphonate (3a-c) were appended to the aromatic 4-position of styrene-containing moieties. The intent of this approach was to prepare hydrolytically stable analogues which expressed additional enzyme recognition features present during the phosphorylation of tyrosine itself. None of the analogues showed inhibitory activity up to the maximum concentration tested (1000 microM) when assayed against autophosphorylation of A-431-derived epidermal growth factor receptor (EGFR) or p56lck (autophosphorylation and transphosphorylation of rabbit muscle enolase). Additionally, a series of naphthalene-based inhibitors including (1-naphthalenylhydroxymethyl)phosphonic acid (14), its known 2-positional isomer 16, and sulfonate (19, 20) and phosphate derivatives (17, 18) were also tested under similar conditions. Only (2-naphthalenyl-hydroxymethyl)phosphonic acid (16) showed activity (IC50 = 250 microM in EGFR, in agreement with the reported literature value). These results suggest that the interaction of styrene-based inhibitors with the substrate binding domain of TPKS may not occur in a manner analogous to the interaction of tyrosine with this domain.

Animals↗
PubMed1998

Neoplastic odontogenic epithelial cells express bone sialoprotein.

Bone sialoprotein (BSP) is synthesized and secreted by bone-, dentine- and cementum-forming cells and has been implicated in de novo bone formation and mineralization. In this study, we used histological sections of odontogenic neoplasms and performed immunohistochemical and in situ hybridization analyses. In ameloblastoma, BSP mRNA signals were seen in the neoplastic epithelial cells forming nests, strips and islands. BSP deposition was also seen in the stellate reticulum of the tumour masses revealed by immunohistochemistry using human BSP antibodies. In calcifying epithelial odontogenic tumour, the calcified masses demonstrated positive immunoreactivity to the human BSP antibodies, and the hybridization signals for BSP were located in the cells near the calcified particles. In the calcifying odontogenic cyst, strong BSP signals were seen in cells surrounding the characteristic nests of ghost cells, which often calcify subsequently. BSP protein was also found in these cells by immunohistochemistry. The active expression of BSP in the epithelial elements of the odontogenic tumours of adult patients suggests the activation of this matrix protein gene in the neoplastic process, and that BSP may play an important role in tumour formation and differentiation with respect to pathological calcification.

Adult↗
PubMedDate not supplied

Analysis of 24,444 surgical specimens accessioned over 55 years in an ophthalmic pathology laboratory.

PURPOSE: To summarize the pathologic diagnoses of a large number of surgically-obtained specimens over an extended time period in a single ophthalmic pathology laboratory. METHODS: We analyzed the records of 24,444 surgically obtained specimens accessioned in the L.F. Montgomery Ophthalmic Pathology Laboratory, Emory University, Atlanta, GA between May 1941 and December 1995. Age, sex, topography, clinical procedure, and histologic diagnosis were entered into a database using the modified SNOMED coding system. The diagnosis of the surgically enucleated eyes were analyzed with respect to years of enucleation. RESULTS: The most common topographic area associated with a histologic diagnosis was the cornea (39.3%), followed by lens (16.0%), vitreous (12.0%), uvea (9.8%), eyelids (8.0%), conjunctiva (7.7%), retina (7.7%), and orbit (2.1%). The relative proportion of vitreous specimens has continuously increased and became the most common surgical specimen in 1995. The most common underlying disease of surgically enucleated eyes is trauma (40.9%), followed by ocular neoplasia (24.2%), 'surgical' diseases of the cornea, lens and retina including glaucoma (17.3%), vascular diseases (6.7%), and inflammatory conditions (6.7%). The relative frequency of trauma and ocular inflammation as a cause of enucleation decreased significantly (p < 0.05) over the time of the study period while the relative proportion of ocular neoplastic processes increased (p < 0.0001). CONCLUSIONS: The availability of new surgical techniques has caused a change in the relative frequencies of different ocular specimens submitted for histologic examination.

Adolescent↗
PubMed2000

Extensive intra-tumor heterogeneity in primary human glial tumors as a result of locus non-specific genomic alterations.

Genomic changes are a hallmark of the neoplastic process. These range from alterations at specific loci and defined karyotypic changes which influence tumor behavior to generalized alterations exemplified by microsatellite instability. Generalized genomic changes within a tumor would be evidence in favor of the mutator hypothesis which postulates a role for such extensive changes during tumorigenesis. In this report, we have used the DNA fingerprinting technique of randomly amplified polymorphic DNA (RAPD) analysis to study genomic alterations within primary human astrocytic tumors (gliomas) in a locus non-specific manner. The RAPD fingerprinting profile of consecutive segments of tumors 2 mm across was studied; 17 astrocytic (high- and low-grade) tumors were sectioned end to end. Tissue from 50 consecutive sections, 40 microm thick (total 2 mm across), was pooled and taken to be a tumor compartment. DNA was subjected to RAPD amplification by 15 random 10-mer primers. A tumor segment was taken to have a DNA fingerprinting pattern different from others in the same specimen when its RAPD profile differed from others by at least one band of one RAPD reaction. All but one of the tumors showed compartments with a unique genetic profile, indicating genomic instability leading to widespread intra-tumor genetic heterogeneity. Eight tumors were also studied for loss of heterozygosity (LOH) of the p53 and D17S379 loci in the different segments as examples of alteration of specific tumor influencing loci. Three showed LOH of p53, which was limited to only one compartment of each tumor. The extensive intra-tumor genetic instability detected in this study is suggestive of the overall high rate of change in the genomes of tumors including those of a lower grade. It is hypothesized that some of these altered clones, which manifest as zones of heterogeneity in a solid tumor, may accumulate changes at loci known to influence tumor behavior, and thus clinical outcome.

Brain Neoplasms↗
PubMed1999

Endometriosis of the urinary bladder.

Although every seventh or eighth case of endometriosis is found to have urinary involvement, this type of endometriosis is still rarely recognized. The symptoms are not specific and are frequently suggestive of a neoplastic process. On the basis of our two cases of histopathologically two types of endometriosis as well as literature review the practical significance of endometriosis in urology is described. In each patient who previously underwent a gynaecological or surgical procedure in the abdominal cavity, endometriosis of the bladder is likely to occur. This possibility should not be ruled out, otherwise it could lead to misdiagnosis and inappropriate treatment.

Adult↗
PubMed1997

Tuberculous pericarditis and AIDS: case reports and review.

Pericarditis is one of the most common cardiac complications in the course of HIV disease. Opportunistic infections and neoplastic processes represent the most common etiology of pericardial disease. Pericardial tuberculosis is an uncommon condition, especially in developed countries. Two cases of tuberculous pericarditis in adult patients with AIDS occurred over a 12-month period at our clinic, which prompted a literature review of the published cases of tuberculous pericarditis in AIDS. Of note is that in the first patient pericardial effusion represented the AIDS-defining illness and was an expression of a disseminated tuberculous disease. The second patient developed a fatal pericarditis due to a multiple-drug resistant Mycobacterium tuberculosis infection.

AIDS-Related Opportunistic Infections↗
PubMed2001

Human monocyte-derived macrophages and dendritic cells as targets for biomaterial cytocompatibility studies using an improved in vitro culture system.

Since macrophage plays a key role in the biocompatibility process, neoplastic macrophage cell lines and human blood monocytes are commonly used as target cells for in vitro biomaterial tolerance evaluation. However, tumor cells profoundly differ from normal tissue cells and monocytes are only precursors of macrophages. It has become possible to generate recently, under adherent-free conditions, fully mature macrophages and dendritic cells from human blood monocytes in the presence of GM-CSF and GM-CSF + IL4 respectively. In the present work, we examined the effects of titanium-alloy on morphology, adhesion, cell phenotype and TNF-alpha release activity of such differentiated cells grown in hydrophobic teflon bags. Scanning electron microscopy showed that macrophages substantially adhered and spread on titanium-alloy surface throughout the culture period, whereas only a few dendritic cells were adherent. The phenotype of both cell types remained unchanged in the presence of the tested material. However, titanium-alloy stimulated the secretion of TNF-alpha by the macrophages of some donors. This model of culture may offer new insights into the biomaterial evaluation and may be useful for studying individual responses induced by biomaterials.

Journal Article↗
PubMed2004

Polymorphism of promotor region of the tumor necrosis factor-alpha gene in patients with viral hepatitis C.

Study of the pathogenesis of viral hepatitis C is of primary importance because of persistence of this virus and high incidence of chronic course of this disease, and as a consequence, development of cirrhotic and neoplastic processes in the liver determining high mortality from this condition. Proinflammatory cytokines, in particular, tumor necrosis factor, play an important role in the development of these pathological processes. The content of tumor necrosis factor in the circulating blood plasma and hepatocytes increases in acute and chronic hepatitis C. It seems that the capacity of cells to produce proinflammatory IL in high or low levels spontaneously or after antigenic stimulation largely determines the outcome of infectious process in contact with the virus.

Alleles↗
PubMed1999

[Severe hemorrhage, lymphocytosis and leukoerythroblastic blood picture--disseminated intravascular coagulation in metastatic prostate carcinoma and chronic lymphatic leukemia].

Hemorrhagic complications in CLL are most often related to thrombocytopenia either due to decreased megakaryopoiesis caused by diffuse lymphocytic bone marrow infiltration or to increased peripheral platelet consumption by platelet autoantibodies (immune thrombocytopenia), both being typical manifestations of the disease. Disseminated intravascular coagulation (DIC) does not belong to the spectrum of CLL-related complications. In the case here reported with DIC and newly diagnosed CLL the leukoerythroblastic blood changes hinted to bone marrow infiltration by another neoplastic process in addition to CLL. Bone marrow biopsy revealed infiltration by metastatic carcinoma of the prostate in addition to that by CLL, the former being responsible for triggering severe DIC leading to fatal intracranial bleeding.

Aged↗