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PubMed2001

Clinical evaluation of borderline nuclear changes in cervical smears at colposcopy and biopsy.

The aim of this study was to determine the incidence of cervical intraepithelial neoplasia at colposcopy and biopsy in woman with smears showing borderline nuclear changes to assess the predictive rate of colposcopy in identifying CIN and to verify the importance of follow-up. A retrospective study of 134 cases referred for colposcopic assessment with borderline nuclear changes in smears was carried out. Of the 134 patients studied, 44.8% had cervical intraepithelial neoplasia and 30% had benign changes of the cervix; 25.5% of cases were normal, 14% of the study population had HPV infection confirmed by biopsy. Of all cases of CIN, 38% were diagnosed to have low grade abnormalities, 6.8% had high-grade abnormalities. The predictive rate of colposcopy in identifying low-grade abnormalities was approximately 60% and 80.7% had a normal smear after 6 months, follow-up. As cervical intraepithelial neoplasia was found in a significant number of patients, borderline changes in cervical smears need subsequent evaluation. Even though more than two-thirds of women had negative smears at 6-month follow-up, the study recommends annual follow-up smears for several years as the long-term risk is not definitely known.

Journal Article↗
PubMed1988

Difference in response of vascular resistance to orthostasis in patients with borderline and sustained essential hypertension.

Changes in hemodynamic parameters following 50-degree head up tilt were studied in a population of 78 males, including 30 patients with sustained essential hypertension, 30 patients with borderline hypertension, and 18 normotensive controls of the same age. The increase in vascular resistance following tilt was significantly higher in hypertensive subjects. In patients with sustained hypertension, baseline vascular resistance was significantly higher than in normotensive controls, and it was strongly correlated with its change following orthostasis. In patients with borderline hypertension, baseline vascular resistance was similar to that of normotensive controls and did not correlate with its change following orthostasis. The latter result suggests an abnormality in the autonomic nervous control in patients with borderline hypertension, possibly mediated by cardiopulmonary mechanoreceptors in the low pressure system.

Adult↗
PubMed1988

Renal and systemic hemodynamics in borderline hypertension.

Cardiac output (CO), renal blood flow (RBF), and glomerular filtration rate were measured in 29 young patients with borderline hypertension, in comparison with 26 normotensive controls of the same age and sex. In patients with borderline hypertension, both CO and RBF were significantly increased, whereas the RBF/CO ratio remained within the normal range. No significant changes in glomerular filtration rate and renal filtration fraction were observed. The study clearly demonstrated that renal ischemia was absent in young patients with borderline hypertension.

Adolescent↗
PubMed1989

Microalbuminuria and casual and ambulatory blood pressure monitoring in normotensives and in patients with borderline and mild essential hypertension.

Several reports suggest that urinary albumin excretion may be elevated in patients with essential hypertension and that this index may be a good predictor for cardiovascular complications. The aim of this study was to compare 24-hour urinary albumin excretion in a group of normotensives, borderline, and untreated mild hypertertensives and to assess, in a subgroup of them, the possible relations between microalbuminuria and arterial blood pressure. Fifteen normotensives, 16 borderline, and 19 mild hypertensive patients were studied. Slightly but significantly higher values of microalbuminuria were observed in the mild hypertensives compared to the other two groups. In 21 borderline and mild hypertensive patients 24-hour microalbuminuria was related to casual blood pressure and noninvasive ambulatory blood pressure monitoring. A significant correlation was found between microalbuminuria and average day-time diastolic blood pressure. Our data suggest that albumin excretion is slightly increased in mild arterial essential hypertension; the direct association between microalbuminuria and arterial diastolic blood pressure during daily activities seems to confirm a pathophysiological link between transcapillary protein escape and arterial blood pressure that warrants further studies.

Adult↗
PubMed1993

Responsiveness to alpha- and beta-adrenergic receptor agonists. Effects of race in borderline hypertensive compared to normotensive men.

The responsiveness of alpha- and beta-adrenergic receptors was assessed in 13 black and 13 white borderline hypertensive and normotensive men, matched for age and body mass. White borderline hypertensives showed significantly decreased responsiveness of cardiac beta-adrenergic receptors and vascular beta 2-adrenergic receptors to intravenous isoproterenol. In contrast, black borderline hypertensives showed no evidence of decreased beta-adrenergic receptor responsiveness. Vascular alpha 1-adrenergic receptor responsiveness, assessed by pressor response to phenylephrine, was unrelated to blood pressure, but was significantly greater in black than in white men. These preliminary observations suggest that there may be racial differences in adrenergic receptor mechanisms involved in the pathogenesis of hypertension.

Adolescent↗
PubMed1979

Assessing vulnerability to schizophrenia or manic-depression in borderline states.

In a discussion of the article on genetic determinants of borderline conditions by Siever and Gunderson, a phenotypic continuum between pure schizotypal and pure affective conditions is postulated. Many "borderline" cases are seen as attenuated forms of schizophrenia, schizoaffective psychosis, or manic-depression. A Venn diagram illustrates differences among syndromes described by Gunderson, Kernberg, Spitzer, and Klein ("hysteroid dysphoria"). Evidence is presented suggesting that Gunderson's borderline syndrome contains more schizotypal individuals than Kernberg's, whereas hysteroid dysphoria is nearer the affective pole of the continuum. A second diagram illustrates how the strength and nature of the genetic factors vary according to the syndrome.

Bipolar Disorder↗
PubMed1979

The relatedness of borderline and schizophrenic disorders.

This article is an editor's introduction to the theme of a special issue of the Schizophrenia Bulletin devoted to borderline conditions. The editor reviews various approaches to defining borderline patients and concludes that these descriptive efforts are now showing considerable consensus. Questions remain, however, about whether borderline patients constitute a diagnostic category that is unrelated to schizophrenia or some other established diagnostic group. The historical origins of these questions are briefly reviewed, and then the multiple interpretations given to the current research efforts to answer them are described.

Diagnosis, Differential↗
PubMed1979

Diagnosis of borderlines: a discussion.

In a discussion of two reviews of the literature on borderline conditions by Liebowitz (1979) and Rieder (1979), the author briefly describes his own research on clinical aspects of the borderline syndrome. Each of the investigators involved in the study of borderline conditions seems to have his own theoretical position and diagnostic evaluation procedures. There seems to be a consensus, however, that the syndrome represents a basic developmental defect with relatively "stable instability" within four subcategories.

Affect↗
PubMedDate not supplied

Changes in blood pressure in the lying and sitting positions in normotensive, borderline and hypertensive subjects.

Blood pressure of hypertensive subjects reacts differently from that of borderline or normal subjects at rest in either sitting or lying positions. In the hypertensive group the diastolic pressure tends to rise more on consecutive measurements and the systolic blood pressure tends to fall less than in the two other groups. Similarly, on going from the lying to the sitting position, diastolic blood pressure of hypertensives rises less than that of normotensive or borderline hypertensive individuals. Thus, people with 'casual' hypertension differ in their reaction to rest and changes in body position in their reaction to rest and changes in body position with respect to normotensives or borderline hypertensives. This behavior could lead to labelling of subjects as 'normal' or 'hypertensive' depending on position and timing of the blood pressure measurement.

Blood Pressure↗
PubMed1984

Evidence for altered vascular reactivity in sodium-sensitive young subjects with borderline hypertension.

To assess mechanisms associated with the pressor effects of a high sodium diet in susceptible individuals, the hemodynamic and hormonal effects of sodium depletion and repletion were studied in 33 normal subjects and 30 subjects with borderline hypertension. The hypertensive group had significantly higher mean arterial pressure, weight, hematocrit, and upright plasma renin activity. Forearm hemodynamics were measured during periods of ad lib diet, 10 mEq, and 200 mEq sodium diet. The fall in forearm resistance during reactive hyperemia was inversely related to mean arterial pressure at rest (R = .400, p less than .005) and rose significantly in hypertensive subjects during salt depletion, 39 +/- 3.6 to 61 +/- 6.1 mmHg/ml/min/100 g (p less than .05). Sodium sensitivity in either normotensive or borderline hypertensive subjects was defined as an increase in mean blood pressure of more than 5% when sodium repleted. The individuals who were sodium sensitive had a higher forearm vascular resistance during sodium depletion than those who were sodium resistant, 67 +/- 10.5 versus 45 +/- 4.1 mm/ml/min/100 g (p less than .03). We conclude that young individuals with borderline hypertension already have alterations in vascular reactivity. This trait is shared by normotensive individuals whose blood pressure rises in response to sodium.

Adult↗
PubMed1985

Atypical and borderline endometrioid adenofibromas of the ovary. A report of 27 cases.

The significance of varying degrees of epithelial atypicality was investigated in 27 endometrioid adenofibromas and cystadenofibromas of the ovary. The tumors were classified as atypical or borderline on the basis of the degree of atypicality of the epithelial element. All tumors were confined to the ovary at the initial operation and most of them were treated by a hysterectomy and bilateral salpingo-oophorectomy. Seven tumors with mild to severe cytologic and architectural atypicality similar to that encountered in atypical endometrial hyperplasia were classified as atypical adenofibromas. No recurrences or deaths from tumor occurred in patients with this type of tumor during 1-18.5 years of follow-up. Twenty tumors that contained closely packed glands or epithelial islands with a cribriform pattern composed of cells with low-grade malignant nuclear characteristics embedded in an abundant fibromatous stroma without evidence of invasion were classified as borderline. Nineteen patients with tumors of this type had no evidence of disease 1-13 years after initial therapy. One of these tumors was discovered at autopsy. These data, although based on a relatively small series of cases, suggest that atypical endometrioid adenofibromas and those of borderline malignancy have an excellent prognosis.

Adenofibroma↗
PubMed1996

Subclassification of serous borderline tumors of the ovary into benign and malignant types. A clinicopathologic study of 65 advanced stage cases.

Poor outcome in serous borderline tumors (SBT) of the ovary is limited to patients with advanced stage disease. This study was designed to determine whether there are histologic features among advanced-stage SBTs (International Federation of Gynecology and Obstetrics [FIGO] stages II and III) that predict behavior. The 65 cases in the study were divided into three groups: typical SBTs, with noninvasive implants (51 cases), SBTs with invasive implants (three cases), and a recently described tumor, designated micropapillary serous carcinoma (MPSC) (11 cases), a proliferative serous ovarian neoplasm that often lacks destructive infiltrative growth but appears to behave as a low-grade invasive carcinoma. When the tumor lacks infiltrative growth, as it did in the 11 cases in this series, it qualifies as a borderline tumor. After censoring nontumor deaths, the 5- and 10-year actuarial survival rates were 98% for SBTs with noninvasive implants, 33% for SBTs with invasive implants, and 81% at 5 years and 71% at 10 years for MPSCs. The mean follow-up was 100 months. Two (4%) of 51 patients with SBTs with noninvasive implants subsequently developed invasive carcinoma, and one (2%) died of carcinoma. In contrast, two (67%) of three women with SBTs accompanied by invasive implants developed invasive carcinoma, and both died of disease. Finally, of the 11 patients with MPSC, seven (64%), all of whom had invasive implants, developed recurrences of invasive carcinoma and/or died of tumor. MPSCs had significantly higher rates of mortality (p < 0.001) and recurrence as invasive carcinoma (p < .002) than SBTs with noninvasive implants. The recognition that SBTs can be divided into benign and malignant subtypes provides the basis for replacing the borderline category. The benign subgroup is composed of typical SBTs, including those with noninvasive implants for which the term atypical proliferative serous tumor is appropriate. In contrast, tumors displaying a micropapillary growth pattern (MPSC) and SBTs with invasive implants should be classified as carcinomas and treated accordingly.

Adolescent↗
PubMed2000

Some mullerian inclusion cysts in lymph nodes may sometimes be metastases from serous borderline tumors of the ovary.

Glandular inclusions that appear morphologically benign are occasionally found in lymph nodes as well as in peritoneal and omental biopsies. In patients with gynecologic malignancies, the nature and significance of these mullerian inclusion cysts (MIC) present a diagnostic challenge with regard to whether they are benign and incidental or are related to the coincident tumor for which surgery is being performed. Sixty-two cases of MIC were prospectively identified during a 6-year period. The frequencies were calculated and stratified by lymph node chain distribution, primary tumor site, and primary tumor type. MIC appeared as small cysts lined by a serous (mullerian)-type, cytologically bland, cuboidal to columnar epithelium with a simple architecture. Among 62 women, MIC was found in lymph nodes (27 cases), pelvic peritoneum (19 cases), omentum (16 cases), bowel serosa (9 cases), uterine serosa (8 cases), and parametrial connective tissues (4 cases). Among a set of 417 consecutive cases in which lymphadenectomy was performed, 46 (11%) women had MIC. The MIC involved multiple sites (26 cases in the peritoneum/omentum and 27 in lymph nodes). The primary tumor was in the ovary in 32 of the 46 women with MIC (70%) and of these, 17 were borderline serous (53%). Sixty-two of 6,154 lymph nodes examined contained MIC (1.0%). 3.2% of nodes contained MIC in which the primary tumor arose in the ovary, but only 0.1% with either endometrial or cervical tumors (chi2, p <0.00001). The lymph nodes most often involved by MIC were from para-aortic sites (40%), which reflect the primary drainage route from the ovary. Not uncommonly, neighboring areas in the same lymph node group with MIC disclosed separate foci of obvious metastatic borderline tumor (4 of 10; 40%). In summary, the increased frequency of MIC in lymph nodes sampled for primary ovarian malignancies suggests that MIC in some cases, rather than being benign, incidental inclusions, are more likely bland-appearing forms of metastatic tumor. The preponderance of inclusions occurs with serous ovarian tumors of borderline malignancy, and the inclusions are overrepresented in the lymph nodes that primarily receive drainage from the ovary.

Cysts↗
PubMed2002

A comparative analysis of 57 serous borderline tumors with and without a noninvasive micropapillary component.

The literature concerning serous borderline tumors with a noninvasive micropapillary component suggests an association with invasive implants. We compared the clinicopathologic features of micropapillary serous borderline tumors (MSBTs) with typical SBTs to determine the following: 1) the importance of focal micropapillary architecture in an otherwise typical SBT, 2) the behavior of low-stage MSBTs, 3) whether high-stage MSBTs are inherently more aggressive than high-stage SBTs, and 4) whether invasive implants are prevalent in an MSBT cohort without referral selection bias. The 57 borderline tumors studied were diagnosed at a university hospital between 1981 and 1998; they included 14 MSBTs, 35 SBTs, and 8 SBTs with focal micropapillary features. None of the specimens were referrals for expert pathologic consultation, thus distinguishing our study group from most of those previously reported. Neither MSBTs nor SBTs were associated with invasive implants at diagnosis (0 of 14 and 0 of 43, respectively). They also did not differ with respect to overall stage at diagnosis, but MSBTs were more frequently bilateral than SBTs (71% versus 23%, p = 0.001). There was an increased risk of recurrence in MSBT versus SBT (3 of 14 versus 1 of 43, p = 0.035), but this was stage related; there was no difference between groups when evaluating recurrence in stage I disease (0 of 8 versus 0 of 27). There was no difference in recurrence or stage at diagnosis between SBTs with focal micropapillary features and other SBTs. There was 100% survival in all groups. We conclude that high-stage MSBTs with noninvasive implants should be considered a subtype of SBTs with an increased risk of recurrence. Stage I MSBTs demonstrate clinical features that are similar to low-stage SBTs. Focal micropapillary architecture (<5 mm) has no bearing on outcome. MSBTs in the general population are not strongly associated with invasive implants.

Aged↗
PubMed1994

Immunohistochemical detection of p53 protein in borderline and malignant serous ovarian tumors.

The p53 suppressor gene protein expression was studied with immunoperoxidase staining in 61 serous tumors of the ovary. Twenty four (53%) of the 45 histologically malignant tumors were positive for p53, whereas neither the six benign nor the 10 tumors of borderline malignancy showed positive staining, except for one borderline tumor with atypia and increased mitotic activity. Therefore, p53 immunostaining may have diagnostic value in discriminating between borderline and malignant serous ovarian tumors. Malignant ovarian tumors with negative staining for p53 were associated with a 67% 3-year crude survival rate as compared with only an 18% 3-year survival rate if p53 staining was positive (p = 0.002). In a multivariate analysis, the p53 staining was the most important prognostic factor, with a relative risk of 4.2 (95% confidence interval, 1.8-9.9) followed by the FIGO stage (2.1, 1.3-3.5). We conclude that immunohistochemical p53 suppressor gene protein expression analysis has both diagnostic and prognostic value.

Adult↗
PubMed1995

Borderline and malignant serous tumor arising in pelvic lymph nodes: evidence of origin in benign glandular inclusions.

This report describes two cases of malignant serous cancers with areas of borderline malignancy, which appear to have arisen within benign glandular inclusions of coelomic origin in pelvic or para-aortic lymph nodes. The patients were 44 and 62 years of age. In both cases the nodes contained benign glandular inclusions lined by a single layer of epithelium which resembled that of tubal epithelium. The location of the glandular epithelium varied from within the fat near the node to intracapsular, subcapsular, or interfollicular positions. The number of glands ranged from few to extensive. In both cases the glandular inclusions disclosed epithelial proliferations, ranging from minor degrees of stratification with formation of small papillae of atypical cells (borderline serous tumor) to almost solid tumor typical of serous cancer. In both cases, the borderline and cancerous tumors exhibited areas of transition which appeared to arise from benign glands. Although benign glandular inclusions of coelomic origin are well documented to occur in pelvic or para-aortic lymph nodes of 5-20% of women and have been considered to be of significance only because of the possibility of the misdiagnosis of cancer, it should now be recognized that the glandular inclusion cysts themselves can become neoplastic.

Adult↗
PubMed1988

Altered platelet alpha 2-adrenoceptors and adrenaline response in adolescents with borderline hypertension who have a family history of essential hypertension.

We studied the relationship between a family history of essential hypertension and the characteristics of platelet alpha 2-adrenoceptors in male university students. Platelet membranes were prepared by the method of U'Prichard. Tritium-rauwolscine was used for the alpha 2-adrenoceptor binding assay. The maximum number of binding sites (Bmax) of platelet alpha 2-adrenoceptors was higher in borderline hypertensives with a family history of hypertension than in normotensives without it. However, no significant difference in the Bmax was found between the normotensives without and those with a family history. Dissociation constants (Kd) were not significantly different among the three groups. The plasma concentration of adrenaline after 30 min of standing was higher in the borderline hypertensives with a family history than in the normotensives, either with or without a family history. These results suggest that alterations in the alpha 2-adrenoceptor density or affinity for antagonists of platelets may not be linked to a positive family history of essential hypertension. However, an increased alpha 2-adrenoceptor density in platelets and an enhanced adrenaline response may be involved in blood pressure elevation in borderline hypertensives with a family history of hypertension.

Adult↗
PubMed1989

Increased beta-adrenergic tone enhances arterial compliance in hyperkinetic borderline hypertension.

Arterial compliance, assessed by the stroke volume-pulse pressure relationship, was measured in 32 patients with a high cardiac output together with borderline hypertension and 26 control subjects with normokinetic borderline hypertension. Measurements were obtained in the supine position both before and after 0.2 mg/kg intravenous propranolol. Baseline arterial compliance was significantly greater in the hyperkinetic group (P less than 0.01). The inter-group difference was no longer significant after the administration of propranolol, since compliance tended to increase in the normokinetic group and decrease in the hyperkinetic group. Therefore, disparities in vascular beta-adrenergic tone between hyperkinetic and normokinetic borderline hypertensive patients probably contribute to group differences in arterial compliance.

Arteries↗