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PubMed1977

Angiographic and pathologic correlations of hepatic focal nodular hyperplasia.

Focal nodular hyperplasia of the liver has a distinctive gross appearance which includes a central fibrous zone containing vessels with a variety of abnormalities. When focal nodular hyperplasia is visualized arteriographically, an artery enters the lesion, branches, and supplies the mass centrifugally. It is likely that the central fibrous zone is the area from which the these branches originate. Nodular hyperplasia is not a life-threatening lesion, except in women taking oral contraceptives who may have massive hemorrhage. If an asymptomatic lesion of the liver has the distinctive arteriographic centrifugal filling pattern of nodular hyperplasia, resection is not recommended as long as oral contraceptives are not used.

Adolescent↗
PubMed1991

Immunocytochemical analysis of estrogen and progesterone receptors in benign stromal lesions of the breast. Evidence for hormonal etiology in pseudoangiomatous hyperplasia of mammary stroma.

Five cases of pseudoangiomatous hyperplasia of mammary stroma, together with seven examples of mammary hamartoma, were probed with monoclonal antibodies H222 and KD68 to investigate the possible role of estrogen and progesterone receptor expression in the pathogenesis of these benign stromal proliferations. All five cases of pseudoangiomatous hyperplasia showed patchy, intense labelling of the stromal cells with progesterone receptor antibodies, a pattern contrasting markedly with the absence of immunoreactivity in normal (nongestational) mammary stroma or the stromal component of common juvenile mammary hyperplasia. The stroma of the hamartoma group labeled inconsistently, with the notable exception of three myoid hamartomas. Stromal immunoreactivity was diffuse and intense in two of these, and patchy and distinct in the remaining case. These findings (a) support the contention that pseudoangiomatous hyperplasia represents a localized form of stromal overgrowth with a hormonal (primarily progestagenic) etiology and (b) further highlight the heterogeneity of so-called mammary hamartomas by demonstrating dramatically different progesterone receptor immunoreactivity patterns in myoid lesions as compared with other hamartoma variants.

Adult↗
PubMed1991

Symptomatic C-cell hyperplasia associated with chronic lymphocytic thyroiditis.

A 58-year-old euthyroid man with episodic flushing and a 2-year history of progressive wheezing was found to have a hypoechoic lesion in one lobe of his thyroid and hypercalcitoninemia in response to pentagastrin stimulation. Thyroidectomy revealed bilateral C-cell hyperplasia unexpectedly associated with chronic lymphocytic thyroiditis. The C-cells exhibited positive immunohistochemical staining for calcitonin and polyclonal carcinoembryonic antigen (CEA). Postoperatively, the wheezing and flushing subsided and the serum calcitonin level was not elevated with pentagastrin stimulation. The substance or substances responsible for the wheezing and flushing were not specifically identified. Nine other specimens of chronic lymphocytic thyroiditis were examined for C-cell hyperplasia and two had small hyperplastic foci, but of a lesser degree than the index case. These patients did not exhibit wheezing and flushing. The development of C-cell hyperplasia in chronic lymphocytic thyroiditis is uncommon and the mechanism for its occurrence is unexplained. This patient appears to be the first reported case of symptomatic C-cell hyperplasia associated with chronic lymphocytic thyroiditis. The substance or substances responsible for the clinical symptoms remain to be identified.

Acute Disease↗
PubMed1992

Atypical duct hyperplasia of the breast in young females.

Atypical duct hyperplasia of the breast is an unusual finding in the adolescent or young adult female. We report nine young women, ages 18-26 years (mean 21) with atypical duct hyperplasia. Clinical presentation was either breast hypertrophy treated by reduction mammoplasty (five patients) or a thickening or mass that was examined via biopsy (four patients). No focal abnormalities were present on gross examination other than two fibroadenomas in one patient. Microscopically, isolated hyperplastic ducts were scattered in a background of prominent stromal collagenization. Each case showed a continuum of ductal changes, from partial to complete involvement by micropapillary and laciform epithelial hyperplasia, which was sometimes markedly atypical. In four, lobules were poorly developed or not present in the available sections. During a follow-up of 5-68 months (mean 39), none developed breast carcinoma. Much longer follow-up is needed to determine if young women with atypical duct hyperplasia are at increased risk for subsequent development of breast carcinoma. Presently, no surgical or medical intervention is recommended, but such patients should perform breast self-examination and be monitored regularly by a physician.

Adenofibroma↗
PubMed1993

Florid hyperplasia of mesonephric remnants involving prostate and periprostatic tissue. Possible confusion with adenocarcinoma.

Two cases of florid hyperplasia of mesonephric remnants occurring in the prostate are described. One case was originally interpreted as invasive adenocarcinoma on transurethral resection (TUR), resulting in radical prostatectomy. In the second case, a TUR specimen was diagnostic for adenocarcinoma, which was confirmed in the radical prostatectomy specimen. Florid mesonephric hyperplasia in the second case was an incidental finding. The TUR specimen in the first case and sections of the prostatectomy specimens in both cases contained a proliferation of tubules, which ranged from aggregates of microacini to dilated structures containing a characteristic colloid-like material. The location of these lesions in the base of the prostate gland and periprostatic soft tissue suggests that these may be mesonephric remnants that have become hyperplastic. This type of lesion shares many features with mesonephric hyperplasia occurring in the female genital tract, including the presence of eosinophilic intratubular material and a lobular arrangement of microacini lined by a single layer of epithelium with prominent nucleoli. However, the latter feature, along with the apparent permeation of the prostatic fibromuscular stroma, periprostatic soft tissue, and even neural spaces, closely mimicked prostatic adenocarcinoma. In both cases, the proliferating tubules reacted with keratin 903 and were negative for prostate-specific antigen and prostate acid phosphatase, thereby excluding the diagnosis of prostatic adenocarcinoma. We concluded that lobular hyperplasia of mesonephric remnants is a distinct histologic entity that may occur in the prostate and periprostatic soft tissues and closely mimic prostatic adenocarcinoma.

Adenocarcinoma↗
PubMed1994

Pseudocarcinomatous hyperplasia of the fallopian tube associated with salpingitis. A report of 14 cases.

We describe 14 cases of pseudocarcinomatous changes in the fallopian tube characterized by florid epithelial hyperplasia and in half the cases mesothelial hyperplasia and associated with chronic salpingitis. The patients' ages ranged from 17 to 40 years. Seven had clinical evidence of pelvic inflammatory disease. Tubal enlargement or thickening were observed in 12 cases and pyosalpinx, tubo-ovarian abscesses, or hydrosalpinx, in six cases. All cases showed no gross evidence of tumor. The reactive atypical hyperplasia mimicked carcinoma microscopically because of a cribriform pattern, penetration of the tubal wall by hyperplastic epithelium, florid mesothelial hyperplasia, or a combination of these findings; epithelial papillae were present in the lymphatics in two cases. In five cases, an erroneous microscopic diagnosis of carcinoma had been made or seriously entertained initially, and one patient underwent a radical hysterectomy as a result. The typically young age of the patients, absence of a gross tumor, presence of severe chronic inflammation, lack of solid epithelial proliferation, mildness of nuclear atypia, and paucity of mitotic figures facilitated the differential diagnosis. Nine patients for whom follow-up information was available had no recurrence of tubal disease.

Adolescent↗
PubMed1997

Nodular histiocytic/mesothelial hyperplasia: a lesion potentially mistaken for a neoplasm in transbronchial biopsy.

This report describes two examples of nodular histiocytic/ mesothelial hyperplasia as seen in transbronchial biopsy that initially led to serious consideration of neuroendocrine neoplasm or meningioma. The biopsies showed nodular collections of cohesive polygonal or round cells with ovoid or deeply grooved nuclei and a moderate amount of finely granular cytoplasm. Nuclear pleomorphism was mild. Immunohistochemical studies showed few cells staining for cytokeratin and the mesothelial marker HBME-1, whereas most cells were decorated by the histiocytic marker PG-M1 (CD68). This lesion appears to be identical to nodular mesothelial hyperplasia as described in hernia sacs and mesothelial/monocytic incidental cardiac excrescences, and we propose modifying the designation to "nodular histiocytic/mesothelial hyperplasia" to take into account the marked predominance of histiocytes over mesothelial cells. The clues to recognition of the true nature of the lesion are clinicopathologic correlation and identification of strips of low cuboidal (mesothelial) cells in the vicinity, and the diagnosis can be further confirmed by immunohistochemical staining. Nodular histiocytic/mesothelial hyperplasia probably results from irritation to the mesothelial lining by various causes leading to focal aggregation of histiocytes within retraction pockets or crevices of the serosal cavity.

Biopsy↗
PubMed1999

Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms.

Atypical histologic variants of focal nodular hyperplasia have been reported and are sometimes difficult to recognize. To characterize the morphologic spectrum of focal nodular hyperplasia, we studied 305 lesions surgically resected from 168 patients. Clinicomorphologic correlations were established by statistical analyses. The patients included 150 women and 18 men (sex ratio, 8:1; median age, 38 years). One hundred twenty-eight (76.2%) patients had solitary lesions, and 40 (23.8%) had 2 to 30 lesions. All 305 lesions measured 1 mm to 19 cm in diameter. Only 49% of these lesions had one to three macroscopic scars. Histologically, 245 (80.3%) lesions were of classical form, and 60 (19.7%) lesions were nonclassical. The latter were classified as focal nodular hyperplasia of telangiectatic form (47 lesions), of mixed hyperplastic and adenomatous form (five lesions), and with atypia of large cell type (eight lesions). Several benign or malignant tumors were found in association with these lesions. This large retrospective series of focal nodular hyperplasia shows the relative incidence of its classical and nonclassical forms. The absence of a central scar could explain the difficult preoperative diagnosis of some of the cases. The morphologic diagnostic criteria in this study require further prospective evaluation.

Adolescent↗
PubMed1974

Hypoglycemia and insular hyperplasia: review of 148 cases.

On the bases of personal experience and the series of 148 cases from an international inquiry and a review of the literature, the relation between insular hyperplasia and hypoglycemia was examined. The fundamental points in this investigation included: age, diagnostic investigations, histological findings and postoperative results. The data on the patients with insular hyperplasia indicates that 83% were of adult age. Insular hyperplasia was the only abnormal factor determined to be present. Through treatment a high percentage of cases (71%) was cured. From a practical surgical point of view, differentiation between occult insulomas and insular hyperplasia is not critical. Consequently, good results can be achieved in botlh diseases by practicing a progressive blind resection guided by examination of the operated specimen and by intra-operative blood sugar levels.

Adenoma, Islet Cell↗
PubMed1975

Ectopic apudocarcinomas and associated endocrine hyperplasias of the foregut.

Foregut endocrine polypeptide-secreting APUD cells (Amine-Precursor-Uptake and Decarboxylation), in their embryologic migration from neural crest to foregut may become "arrested" in the mesoderm or in other ectopic locations. They may become hyperplastic, adenomatous or malignant. Eight illustrative patients are reported. One patient had "pancreatic hyperparathyroidism" with hypercalcemic crises, pancreatic apudocarcinoma, normal parathyroids, biologically active parathormone, but inert immunochemically to the usual parathyroid antisera. Two had gastrin-secreting malignancies in the mesoderm. Remission after excision, but eventual recurrence of the syndrome due to islet cell hyperplasia required total gastrectomy. One patient had a gastric corpus apudocarcinoma found prospectively with hypergastrinemia which required excision of the tumor. One patient had acromegaly with hypergastrinemia and antral gastrinosis treated by pituitary irradiation, One patient had the antral or intermediary type of the Zollinger-Ellison syndrome with moderate hypergastrinemia, duodenal ulcer and antral gastrinosis, treated by vagotomy and antrectomy. One patient had hyperparathyroidism with antral gastrinosis, treated by parathyroidectomy. One patient had malignant Zollinger-Ellison syndrome and developed associated thyroid parafollicular cell hyperplasia and parathyroid chief cell hyperplasia, treated by total gastrectomy and multiple endocrine excisions. These investigative observations demonstrate ectopic loci and associated hyperplasias which support the concept of migration and bizarre potentiality of polypeptide-secreting cells of the foregut.

Adenoma↗
PubMed1980

Aspirin and dipyridamole decrease intimal hyperplasia in experimental vein grafts.

Release from platelets of a factor mitogenic for smooth muscle cells is a postulated mechanism for the pathogenesis of vascular intimal hyperplasia. In this study the effect of antiplatelet therapy was evaluated. Aspirin (165 mg twice daily) and dipyridamole (25 mg twice daily) were administered to six rhesus monkeys and six were given placebo only. Bilateral vein bypass grafts were placed in the iliac arteries. In addition, to evaluate the relative contribution of adventitial dissection and intimal injury, on one side the carotid artery and femoral vein were stripped of adventitia and on the other side the intima of these vessels were injured by the single passage of an inflated balloon tipped catheter. Animals were killed after 16 weeks. In grafts relative luminal area was determined by a photographic gravimetric method at three standard locations. Femoral veins and carotid arteries were classified as histologically normal or as exhibiting hyperplasia. All vessels with adventitial stripping were normal. All vessels with intimal injury in the placebo group except one exhibited intimal hyperplasia compared to the drug treated group in which over half were normal. Relative intimal area was significantly less in grafts from drug treated animals at all three locations and luminal area greater in two. These data suggest that vascular intimal hyperplasia can be reduced by treatment with antiplatelet agents.

Animals↗
PubMed1980

Long-term evaluation of patients with primary parathyroid hyperplasia managed by total parathyroidectomy and heterotopic autotransplantation.

Since 1973, we have performed total parathyroidectomy and forearm parathyroid autotransplantation in 36 patients with generalized (four gland) primary parathyroid hyperplasia. Twenty (56%) patients had nonfamilial parathyroid hyperplasia (NFPH) and 16 (44%) patients had familial parathyroid hyperplasia (FPH). Twenty-one patients (Group A) were undergoing operation for the first time and 15 (Group B) were having either second, third or fourth re-explorations for persistent hyperparathyroidism. All patients in Group A and nine patients in Group B had parathyroid resection and immediate autotransplantation as a single procedure. Six Group B patients had hyperfunctioning parathyroid tissue resected, cryopreserved, and subsequently grafted when it was evident that they had been rendered aparathyroid. A sustained differential elevation (13.7 fold +/- 2.7) of parathyroid hormone was detected in the antecubital vein of the grafted compared to the nongrafted arm in 35 (97%) patients. Two (5.6%) of the 36 patients (both with FPH; one Group A and one Group B) required permanent oral calcium and vitamin D replacement therapy and one (3%) patient (NFPH: Group A) had persistent hypercalcemia postoperatively, presumably due to a supernumerary gland. The remaining 33 (92%) patients became normocalcemia after surgery and 23 (70%) of them remained so. Ten (30%) of the 33 patients developed recurrent graft dependent hyperparathyroidism. Eight patients were from the group with FPH (8/14, 57%) and two were from the group with NFPH (2/19, 11%)(FPH vs. NFPH, p < 0.005). Because of symptoms of hypercalcemia or a serum calcium concentration exceeding 11 mg/dl, partial graft resection was performed in five patients and four became normocalcemic. Patients with generalized primary parathyroid hyperplasia may be difficult to cure, especially if the disease is familial. The technique of total parathyroidectomy and heterotopic autotransplantation of fresh or cryopreserved parathyroid tissue offers distinct advantages over alternative techniques.

Humans↗
PubMed1982

Surgical management of hyperparathyroidism due to primary hyperplasia.

A series of 104 consecutive patients treated at the Massachusetts General Hospital between 1933 and 1978 for primary hyperplasia was reviewed. Early in this period (1933-1958) nine patients were treated by what was the considered subtotal resection (five with clear cell and four with chief cell hyperplasia). Hypercalcemia persisted in four cases; three from inadequate resection and one (case 170) associated with a fifth gland in the mediastinum that was removed at a second stage operation. Later (1959-1978), adequate subtotal resection, leaving 30 to 50 mg of viable hyperplastic tissue, was performed in 28 patients (7 with clear cell and 21 with chief cell hyperplasia). The operation was successful in 27 patients (96%). In one patient (case 442) subtotal resection failed, and hypercalcemia recurred, requiring a second operation. Sixty-seven patients in this series had excision of one, two, or three (but not more than three) glands. Of these 21 (31%) had persistent hypercalcemia after operation and required further surgery. Transient hypocalcemia occurred in 40 patients, permanent hypocalcemia in two. This study shows that subtotal resection, leaving 30 to 50 mg of viable tissue, is the surgical treatment of choice for primary parathyroid hyperplasia. It is effective in the great majority of patients. We have not found total parathyroidectomy with autotransplantation necessary and believe that it should be reserved only for selected cases.

Adult↗
PubMed1991

Chronic ACE inhibition reduces intimal hyperplasia in experimental vein grafts.

Intimal hyperplasia is an important factor in the pathophysiology of vein graft failure. Local renin-angiotensin systems recently have been shown to modulate the development of intimal hyperplasia in arteries after intimal injury. The effect of chronic angiotensin-converting enzyme (ACE) inhibition on the development of intimal hyperplasia in experimental vein grafts was examined in this study. Ten New Zealand White rabbits received 10 mg/kg of captopril daily in their drinking water. One week later the right carotid artery was divided and bypassed with the reversed right external jugular vein in these rabbits and in 10 matched controls. Captopril was continued for 28 days after operation, when all the grafts were harvested. Five grafts from each group were perfusion fixed, and the intimal thickness in the proximal, middle, and distal segments was determined. Rings from the remaining grafts (n = 20 in each group) were studied in vitro under isometric tension, and their responses to norepinephrine (NE), histamine (HIST), serotonin (5-HT), angiotensin I (AI), and angiotensin II (AII) was measured. The intimal thickness of the proximal, middle, and distal segments of the captopril-treated grafts were significantly less than controls, being reduced in all segments by approximately 40% (p less than 0.0001). With regard to vasoreactivity, the captopril-treated grafts were hypersensitive to 5-HT (control ED50 5.5 +/- 0.5 X 10(-7) mol/L vs. captopril-treated 1.1 +/- 0.2 X 10(-6) mol/L; p less than 0.005) although the maximal response was significantly reduced (control 1.6 +/- 0.3 g vs. captopril-treated 0.8 +/- 0.1 g; p less than 0.05). There were no differences in sensitivity between control and captopril-treated rings with respect to NE, HIST, AI, or AII. Four of the ten captopril-treated segments, however, failed to respond to AI, and the maximal active tension of the responders was significantly reduced (control 0.47 +/- 0.06 g vs. 0.20 +/- 0.05 g; p less than 0.02). These results suggest that ACE is involved in the modulation of vein graft intimal hyperplasia, and that ACE inhibitors may have therapeutic applications in patients undergoing vein bypass procedures.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

Association of breast cancer with the finding of atypical ductal hyperplasia at core breast biopsy.

OBJECTIVE: The purpose of the study is to evaluate the prevalence of occult breast carcinoma in surgical breast biopsies performed on nonpalpable breast lesions diagnosed initially as atypical ductal hyperplasia (ADH) by core needle biopsy. BACKGROUND: Atypical ductal hyperplasia is a lesion with significant malignant potential. Some authors note that ADH and ductal carcinoma in situ (DCIS) frequently coexist in the same lesion. The criterion for the diagnosis of DCIS requires involvement of at least two ducts; otherwise, a lesion that is qualitatively consistent with DCIS but quantitatively insufficient is described as atypical ductal hyperplasia. Thus, the finding of ADH in a core needle breast biopsy specimen actually may represent a sample of a true in situ carcinoma. METHODS: Between May 3, 1994, and June 12, 1996, image-guided core biopsies of 510 mammographically identified lesions were performed using a 14-gauge automated device with an average of 7.5 cores obtained per lesion. Atypical ductal hyperplasia was found in 23 (4.5%) of 510 lesions, and surgical excision subsequently was performed in 21 of these cases. In these 21 cases, histopathologic results from core needle and surgical biopsies were reviewed and correlated. RESULTS: Histopathologic study of the 21 surgically excised lesions having ADH in their core needle specimens showed seven (33.3%) with DCIS. CONCLUSIONS: In the authors' patient population, one third of patients with ADH at core biopsy have an occult carcinoma. A core needle breast biopsy finding of ADH for nonpalpable lesions therefore warrants a recommendation for excisional biopsy.

Biopsy, Needle↗
PubMed1983

Predicting the outcome of endometrial hyperplasia by quantitative analysis of nuclear features using a linear discriminant function.

Nuclear parameters from 24 cases of atypical endometrial hyperplasia were determined by means of graphic tablet and microcomputer. Eight of the 24 hyperplasias progressed to carcinoma, but the remaining 16 did not progress during a mean follow-up period of 11.8 years. A linear discriminant function selected the mean and standard deviation of maximal nuclear diameter as useful predictors of clinical outcome. The linear discriminant function predicted the correct outcome in 83% of the cases. This study suggests that measurement of nuclear parameters in atypical endometrial hyperplasia may provide a more objective means of predicting the behavior of the various forms of hyperplasia.

Cell Nucleus↗
PubMed1993

Florid mesothelial hyperplasia associated with ovarian tumors: a potential source of error in tumor diagnosis and staging.

Five ovarian tumors were associated with florid mesothelial hyperplasia that in four cases created initial problems in histologic classification and staging of the tumors. In two cases, small nests, cords, and gland-like arrangements of atypical mesothelial cells within the cyst wall of a serous or mullerian mucinous tumor of borderline malignancy were initially considered to possibly represent, or were misdiagnosed as, foci of stromal invasion, lymphatic invasion, or both. In the three other cases--an endometrioid adenocarcinoma, a struma ovarii, and a yolk sac tumor--papillary and sheet-like proliferations of mesothelial cells involved the extraovarian pelvic peritoneum; in one of the cases, necrosis of the mesothelial cells was prominent. These foci of extra-ovarian mesothelial hyperplasia were interpreted as metastatic tumor intraoperatively (three cases) and on initial microscopic examination (two cases). Factors that may have predisposed to the mesothelial hyperplasia included large size of the primary tumor (two cases), the presence of metastatic tumor elsewhere in the pelvis (three cases), ascites (two cases), and coexistent endometriosis (two cases). Distinction of mesothelial proliferation from invasive or metastatic ovarian tumor is obviously important in correct classification, staging, and management of the tumor. Awareness of the occasional occurrence of florid mesothelial hyperplasia in patients with ovarian neoplasms and attention to the histologic, histochemical, and immunohistochemical features of the mesothelial proliferation should facilitate the correct diagnosis.

Adult↗
PubMed1991

Effect of nimodipine on subintimal hyperplasia of autologous vein bypass grafts in rats: a placebo-controlled study.

Autologous vein grafts are commonly used conduits for coronary bypass grafts. However, as many as 20% of the grafts may occlude in the first year to a subintimal hyperplasia. Although the initiating mechanism remains unclear, it has been demonstrated that subintimal hyperplasia is dependent upon smooth muscle cell proliferation and migration from the medial to the intimal layer. The present study focused on the prevention of smooth muscle cell proliferation using a calcium antagonist. A vein bypass graft from the jugular vein on the abdominal aorta was performed in 40 rats, divided into two groups of 20. Animals in the treated group received nimodipine (15 mg/kg of body weight), and those of the control group received a placebo. Nine months after grafting, the results showed that the group receiving nimodipine presented no or only slight subintimal hyperplasia as compared with the placebo group (p less than 0.001). The data presented in this study show that nimodipine can reduce subintimal hyperplasia in rats and strongly suggest that a calcium antagonist could be employed in the prevention of venous graft disease.

Animals↗