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PubMed1983

[Left ventricular basal fibrous myocardial aneurysm in a 3-week-old girl].

A congenital bulging of the myocardial wall is a rare finding; little is known about its etiology and clinical course. The case of a 3-week-old girl in whom rapidly progressive cardiac insufficiency occurred after a completely normal postnatal development is described. Selective ventricular angiography revealed ventricular malfunction and an akinetic area occupying 57% of the basal free left ventricular wall. The child died in acute cardiac failure. Autopsy disclosed a basal fibrous aneurysm which extended to 34% of the free ventricular wall. There was no indication of a coronary or inflammatory etiology, so a focal disorder of myocardial architecture was presumed. Congenital bulging of the ventricular wall can be divided into broad-based aneurysms and diverticula, the latter being connected with the ventricle by a small orificium. A further distinction can be made on the basis of localization and histology. A reclassification of the congenital bulging of the left ventricular wall presented in the literature showed that apical muscular diverticula are the most frequent, whereas only four cases of fibrous aneurysms were reported. Differences were found, with regard to the distribution of age and race, the clinical course, and the possible etiology.

Diagnosis, Differential↗
PubMed1984

[Histological classification and biological behavior of germ cell tumors of the testis. Studies based on surgery and autopsy data 1958-1979].

Report about 155 cases of germ cell tumors observed at the department of pathology of the district hospital Schwerin, GDR, from 1958 to 1979 in orchiectomy specimens (146 cases) and in autopsies (9 cases; primary diagnosis at autopsy). The reclassification of the tumors according to WHO-Classification resulted in orchiectomy specimens 54 seminomas (37%), 18 embryonal carcinomas (12%), 44 teratocarcinomas (30%), 10 choriocarcinomas with another histological type (7%), 6 teratocarcinomas with seminoma and 5 embryonal carcinomas with seminoma. Yolk sac tumors were found four times, immature teratomas four times, a mature teratoma once. The 9 germ cell tumors in autopsies were seminomas (2), embryonal carcinomas (3), choriocarcinomas (2) and Choriocarcinomas with embryonal carcinoma (2). The average age of patients with seminomas is about 38 years, the average age of the patients with other germ cell tumors is about 28 years. 11 times a maldescended testis was found (10 times of the involved testis, once of the opposite one). Five years after diagnosis two thirds of patients with seminomas and only one third of patients with the other germ cell tumors are alive. Beside the histological type the extension of the tumor at beginning of the therapy is an essential factor of prognosis.

Adult↗
PubMed1984

[Potentials and limits of conventional differential diagnosis of the endometrium].

The reproducible identification of various histological types of the endometrium is of special interest for many reasons. The controversy in endometrial classification and terminology led us to study the algorithm of conventional endometrial diagnosing. This study is to examine the significance of historical morphologic parameters for differential diagnosis by semiquantitative or binary recording and computer-assisted evaluation. The results are based on cross-tables and cluster-analysis. The statistical test showed that most of the historical parameters were neither adequate for reclassification nor exclusion of historical typing of the endometrium. An objective and reproducible classification of endometrial changes by using binary parameters can only be achieved for specific histological types of normal endometrium and several types of hyperplastic endometrium. The dedifferentiated carcinoma is a diagnosis "per exclusionem ", since nearly all of the binary parameters cannot be analysed. The individual borderline lesions cannot be differentiated from each other by descriptive parameters. They cannot even be distinguished from the highly differentiated endometrial carcinomas. This kind of differential diagnosis is obviously not based on conventional formalistic criteria but on nonquantifiable empirical data. This might be a reason for the above mentioned controversy in endometrial diagnosis and terminology.

Diagnosis, Differential↗
PubMed1983

[Morphologic studies on the occurrence of HBs antigen in liver cirrhoses, epicirrhotic and pure cancers in a large autopsy sample].

1063 hepatic cirrhoses, 138 epicirrhotic carcinomas, and 138 carcinomas without cirrhosis from the autopsy material of the Dresden region obtained from 1970 to 1979 were examined for the occurrence of HBsAg by means of reclassification and after-staining of the documented section material with orcein staining according to Shikata. The portion of the post-B-hepatic cirrhoses of the liver was 95 (8.9 per cent of the total material). In epicirrhotic carcinomas a HBsAg-containing cirrhotic portion was identified in 14 cases (10.1 per cent), whereas hepatic tissue of carcinomas without cirrhosis never showed HBsAg. A relation between the activity degree of the hepatic cirrhosis and the quantity and distribution of HBsAg could not be established. The found out numbers (about equally frequent occurrence of HBsAg in hepatic cirrhosis and epicirrhotic carcinomas, no identification in the hepatic tissue of carcinomas without cirrhosis) reveal that the thesis of a hepatocarcinogenic effect of the hepatitis B virus cannot be supported by the histologic identification of HBsAg in our investigational material. The possibility of confusion of ground-glass hepatocytes with liver oncocytes in the HE-stained section material of the autopsy material is pointed out.

Aged↗
PubMed1978

[Bioptic and autoptic findings in lymphogranulomatosis].

A reclassification of bioptical and autoptical findings in the lymphogranulomatosis according to the criteria of Lukes and co-workers resulted in an unambiguous prevailing of the mixed cellularity in bioptical preparations and of the form poor in lymphocytes in autoptical preparations. The comparison of bioptical and autoptical findings revealed the expected changing from the type rich in lymphocytes to the type poor in lymphocytes. The causes for this changing of the histological form might to be found in the deteriorating immunological defensive condition of the patient as well as in the influence on the histological picture by our modern therapy.

Autopsy↗
PubMed1983

[Radiodiagnosis of pathologic processes of the stomach using EDP as a diagnostic aid].

The use of EDP makes it possible to increase the accuracy of the radiodiagnostics of the stomach. The retrospective study is based on 540 X-ray examinations of benign and malignant processes of the stomach which had been diagnosed histologically. It can be proved by means of examination findings that the use of the multivariate discriminatory analysis allows a reliable analysis of the manifold interrelations between the various classes of diagnosis on the one hand and diagnostically usable sign patterns on the other hand so that, in the majority of the classes of diagnosis, the degree to which the diagnostic information issued will increase in comparison to the empirically established radiodiagnoses. The reclassification resulted in the following correct assignments to the various classes: ulcus ventriculi, benign 87 per cent; ulcus ventriculi, malignant - 78 per cent; exulcerated carcinoma - 82 per cent; polyp, benign - 85 per cent; polyp, malignant - 75 per cent; polypoid carcinoma - 91 per cent; stenosis, benign - 85 per cent; stenosis, malignant - 79 per cent; infiltrating carcinoma - 63 per cent. Preconditions for the practical application of EDP in the radiodiagnostics of the stomach are an examination technique and method which exhaust all the available technical possibilities, and an exact interpretation of the radiographic signs.

Diagnosis, Differential↗
PubMed1982

[Contribution of visual evoked potentials to the diagnosis of isolated progressive paraparesis in the adult].

Pattern reversal VEPs were recorded in 30 adult patients with progressive spastic paraparesis. Abnormal responses were observed in 17 patients (57 per cent) without any clinical evidence of visual impairment. Abnormal VEPs helped to the diagnostic reclassification of these patients by demonstrating the multifocality of the lesions. When the number of lymphocytes and/or the lgG level were abnormal in the cerebrospinal fluid (CSF) abnormal VEPs conforted the diagnosis of multiples sclerosis (MS) in 12 cases out of 20. In five patients out of the ten whose CSF was normal MS was considered as highly probable because of VEPs abnormalities.

Adult↗
PubMed1981

[Papilloma of urinary bladder according to the WHO-classification. A critical contribution to morphological diagnostics (author's transl)].

Reclassification of 1905 bladder tumors out of a total of 2845 bladder biopsies revealed that only 47, i.e. 2.5% could be classified as papillomas according to the WHO-classification. The reasons for former uncertain classification of low grade papillary bladder tumors and the advantage of clear morphological classifications are discussed on the basis of 283 tumors which were temporarily classified as border line cases and finally as G1-pTA-tumors according to the WHO- and UICC-definition.

Biopsy↗
PubMed1981

Management of carcinoma of anal canal.

The application of various treatment modalities in the management of carcinoma of the anal canal remains controversial. Forty-nine patients were reviewed from the affiliated hospitals of the Medical College of Wisconsin. Exclusions for postoperative deaths, associated vulvar carcinoma, and lack of follow-up left 35 patients for determinate study. The overall 5-year survival rate was 28.6% (10 of 35). When reviewed by stage of disease, a direct relationship between advanced stage and decreased survival (i.e., 60% five-year survival rate with stage I, 25% with stage II, and 14.3% with stage III) was noted. Further reclassification of stage III, nodal involvement, showed the same survival for perirectal nodal involvement as for synchronous inguinal node involvement. Seven of ten 5-year survivors received a combined surgery-radiotherapy approach. In addition, in those patients receiving tumoricidal radiation pre- or postoperatively, no local recurrence was demonstrated. A treatment protocol of abdominal perineal resection, with combined radiation therapy for locally advanced lesions, is proposed.

Adult↗
PubMed1981

[Pathological re-evaluation of cases of chronic lymphoid leukemia].

Lymph nodes of 46 autopsy cases regarded clinically on the basis of bone marrow and blood film findings as chronic lymphoid leukaemia were reinvestigated. Considering the new reclassification of malignant lymphomas only 38 per cent of the cases have shown histologic pattern of chronic lymphoid leukaemia. 28 per cent out of the remaining 62 proved to be lymphoplasmocytic immunocytoma, 10 per cent centroblastic-centrolytic ML and 8 per cent centrocytic ML.

Bone Marrow↗
PubMed1995

False positive cervical smears: a cytometric and histological study.

The evidence of exfoliative cytology of the cervix uteri depends on various factors. The rate of false positive cervical smears is on average 8.8%. We have reviewed 170 false positive routinely Papanicolaou-stained cervical smears and the corresponding histological specimens. The aim was to look for non-neoplasic changes explaining the cytological over-interpretation. In addition, nuclear Feulgen-DNA measurements of the smears were made to look for changes in DNA pattern. In 50% of all cases, a cause was found for the false positive cytological diagnosis by means of histological reexamination: non-neoplastic nuclear and cellular polymorphia, severe purulent-erosive inflammation, a higher reclassification or a positive presurgical biopsy. In 51.9% of these cases, there were signs of an infection with human papilloma virus (HPV). In cases without histological explanation of the cytological findings, DNA measurements were made on the suspicious cells. By means of single cell algorithm (5c/9c exceeding events), a general rate of 62.7% of aneuploid specimens was detected. The number of aneuploid single cells ranged between 5 and 63 per slide. Of these cases, 23.1% showed signs of HPV infection. As a result of the study, the number of real 'false positive' cytological diagnoses decreased from 170 to 97 as a result of histological reexamination and DNA measurement. In doubtful cases, DNA measurement of suspicious smears should be made.

Carcinoma↗
PubMed1995

Pancreatoblastoma in an older adult.

We present a case of pancreatoblastoma in a 61-year-old man. To our knowledge, this is the oldest patient with this tumor to be reported. Originally regarded as a microadenocarcinoma, the tumor was composed of small cells, sometimes in acinar groups with clusters of squamoid cells. It also showed acinar and neuroendocrine features by immunohistochemistry. Staining for trypsin and several neuroendocrine markers was widespread and intense in the smaller, majority-type cells. There was faint staining for some neuroendocrine markers in the larger squamoid cells. By electron microscopy both exocrine secretory and neurosecretory dense core granules were found. Modern methods of immunohistochemistry and greater understanding of rare tumor types allowed reclassification of this tumor.

DNA, Neoplasm↗
PubMed1995

Myeloperoxidase mRNA detection for lineage determination of leukemic blasts: retrospective analysis.

Myeloperoxidase (MPO) mRNA is an early myeloid marker; its detection in the morphologically and immunophenotypically primitive blasts of acute undifferentiated leukemia (AUL) establishes myeloid lineage and allows reclassification as acute myelogenous leukemia with minimal differentiation (AML-MO). We have previously reported a procedure for MPO mRNA detection by RT-PCR (reverse transcription-polymerase chain reaction) and an adaptation for use of routine hematology smears. This variant procedure allows retrospective analysis of mRNA and is used in the present study to evaluate the lineage of leukemic blasts in seven cases with morphology and cytochemistry consistent with AUL. All hematology smears used in this study were air-dried, unstained or Wright-stained and stored at room temperature for periods varying between 3 days and 2 years. MPO mRNA was detected in six cases, establishing the myeloid lineage of the blasts and the diagnosis of AML-MO. In the remaining case, the blasts were MPO mRNA negative, confirming the diagnosis of AUL. The RT-PCR procedure for retrospective mRNA analysis is useful in the clinical setting, due to its high specificity and sensitivity, speed (less than 24 h), safety (no radioactivity) and convenient use of routine hematology smears; it is particularly attractive in clinical situations when fresh or frozen specimens are no longer available at the time when the need for molecular diagnostics becomes apparent.

Acute Disease↗
PubMed1995

Hypermetaphase fluorescence in situ hybridization for quantitative monitoring of Philadelphia chromosome-positive cells in patients with chronic myelogenous leukemia during treatment.

Using Philadelphia chromosome-positive (Ph+) chronic myelogenous leukemia (CML) as a model, our aim has been to develop a molecular cytogenetic method of high resolution analysis for monitoring the frequency of cells with nonrandom chromosome rearrangements in the bone marrow of patients receiving treatment for hematologic malignancies. Long-term exposure (24 hours) of bone marrow cultures to colcemid (0.1 microgram/mL) maximized a high frequency of metaphase collection. Such preparations were subjected to fluorescence in situ hybridization (FISH) using a 5 Mb probe that overlapped the region of the translocation at chromosome 9q34. This detected the Ph translocation in the resultant large number of overly contracted chromosome spreads. The procedure was validated and verified by studying 70 double-blind marrow samples from patients in different stages of Ph+ CML and from patients with Ph- hematologic malignancies (controls). This hypermetaphase FISH (HMF) method clearly identified Ph+ metaphases and allowed the analysis of 500 hypermetaphases per sample in less than 1 hour after FISH. HMF (1) identified statistically significant differences between the frequencies of Ph+ cells in samples that differed by less than 4%; (2) resolved such differences among patient samples that were all judged 100% Ph+ by standard G-band cytogenetics (CG); (3) resulted in the reclassification of response status in 23% of the patients initially classified by CG; (4) recognized Ph+ cells in 16% of patients characterized as having a complete cytogenetic response and in one patient with an original diagnosis of Ph- CML; and in one patient with an original diagnosis of Ph- CML; and (5) was informative where insufficient metaphases were obtainable for analysis by CG. HMF appears to be uniquely suitable for monitoring the status of patients with CML receiving treatment. It should also be applicable for patients with any hematologic diseases where chromosomal alterations are known and appropriate FISH probes are available.

Azure Stains↗
PubMed1993

Treatment of stage A1 prostate cancer: the case for observation.

Stage A1 prostate cancer implies indolence. If only well-differentiated low-volume tumors are considered, the rate of cancer growth, clinical progression, and prostate cancer death is exceedingly low. All but a very few of these patients will need observation alone. Younger patients (those less than 60 years of age) and those with more moderately differentiated tumors or with serological or ultrasound evidence of residual cancer need further evaluation. It is likely that patients within this group are those who have in past studies experienced a higher degree of progression and cancer mortality. A stepped-up effort to detect nonpalpable prostate cancer has included PSA and transrectal ultrasound with random biopsies. Prostate cancer screening using a serum test and/or ultrasound has allowed increased detection of otherwise clinically silent cancer (stage A). Occult prostate cancer identified by needle biopsy or detected through elevated PSA levels most often is peripheral zone cancer and more aggressive than that arising in the transitional zone. A reclassification of stage A is therefore needed and a new scheme for TNM staging was recently introduced (Table 4). Because of its more aggressive potential, the new stage T1c will likely require different treatment recommendations than those for traditional stage A1 (T1a). More time and evaluation will be needed to estimate the prognosis of those diagnosed with minimal stage T1c prostate cancer.

Aged↗
PubMed1995

Medullary carcinoma of the breast: interobserver variability in histopathologic diagnosis.

To assess the interobserver reproducibility for the diagnosis of medullary carcinoma of the breast (MC), 53 previously diagnosed MCs were independently assessed by six observers for growth pattern, nuclear grade (NG), inflammation, tumor margin, intraductal component, and glandular features. Tumors were reclassified as MC, atypical MC, or infiltrating ductal carcinoma according to the histopathologic criteria of Ridolfi et al. (Cancer 40:1365, 1977), Wargotz and Silverberg (Hum Pathol 19:1340, 1988), and Pedersen et al. (Br J Cancer 63:591, 1991). NG was the most reproducible parameter, and tumor margin was the least, with consensus agreement by four of six observers for 49 (92%) and 26 (49%) of cases, respectively. Utilizing the histopathologic criteria proposed by Ridolfi et al., Wargotz and Silverberg, and Pedersen et al., consensus diagnoses were achieved in 37 cases (70%), 46 cases (87%), and 51 cases (96%), respectively. A consensus diagnosis of MC in all three systems was unassociated with tumor size, axillary lymph node status or overall survival (median follow-up: 89 mo). The consensus (or better) reclassification of 44/53 (83%), 35/53 (66%), and 27/53 (51%) previously diagnosed MC as atypical MC or infiltrating ductal carcinoma by the criteria of Ridolfi et al., Wargotz and Silverberg, and Pedersen et al., respectively, suggests that MC was previously over-diagnosed. While the scheme of Pedersen et al. is the most reproducible, additional follow-up information is necessary to determine the biological significance of this classification system. To minimize these difficulties in practice, pathologists should carefully adhere to published criteria and indicate the classification system utilized.

Adult↗
PubMed1976

Recent advances in neurosurgical techniques - historical considerations.

1. The basic principles of neurosurgery have changed but not as radically as we might believe. 2. The most radical changes include a full facility of power tools, the aid of magnification techniques with excellent illumination, and the great value of shrinking agents, with less damage to the assaulted brain. 3. The surgeon has been aided by a reclassification of tumors and thus can estimate his surgical attack and prognosis more accurately. History has not proven the malignant gliomas amenable to long-term surgical results, and out hopes must lie in chemotherapy. 4. The ancillary disciplines of neuroradiology and neuroanesthesia have aided the surgeon immeasurably in the planning of his operation, but the final results still depend basically on the surgeon's ability and judgment in that difficult decision "should I go for broke or stop?"

Anesthesia, General↗
PubMed1994

Nuclear morphometry of soft tissue tumors of fibrous origin.

In this study we investigated the diagnostic significance of a set of different morphometric nuclear parameters in the differential diagnosis of soft tissue tumors. Nuclear area, the standard deviation of the nuclear area, the shape factor and other parameters such as Feret's Diameter and Martin's Radii were assessed using a computer assisted image analyzer system. A statistically significant difference (p < 0.01) between benign and malignant tumors and tumor-like lesions could be confirmed for the nuclear area and the standard deviation of the nuclear area, with the significance level being lower (p = 0.5) for the latter parameter. The shape factor also discriminated between the examined groups. Reclassification of the assessed histological diagnosis was performed by linear discriminant analysis using all possible combinations of the different nuclear parameters. This procedure disclosed an increasing rate of correctly reclassified cases with rising number of parameters applied. We conclude that the assessment of nuclear parameters may be helpful in the correct diagnosis and differential diagnosis of soft tissue tumors and tumor-like lesions of fibrous origin.

Cell Nucleus↗