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PubMed1996

Multibacillary nerve histology in clinically diagnosed borderline tuberculoid leprosy patients.

The classification of leprosy into multibacillary (MB) and paucibacillary (PB) patients in almost all clinics is entirely dependent on clinical examination. In a study of 21 patients clinically classified as borderline tuberculoid (BT) and, therefore, belonging to the PB group, skin smears and skin and nerve biopsies were examined. Four patients did not have any histopathological evidence of leprosy. Skin smears showed that 1 patient was positive for acid-fast bacilli (AFB), 2 skin biopsies belonged to the borderline lepromatous (BL) category and showed AFB in their lesions, and AFB were present in 10 nerve biopsies classified as BL. It is possible that reported relapses among PB patients may be in those patients with demonstrable AFB in the lesions, including nerves. A careful follow-up study of this particular group of patients after PB multidrug therapy is suggested to resolve this question.

Biopsy↗
PubMed1996

Autistic barriers in the psychoanalysis of borderline adults.

The authors discuss Frances Tustin's work on childhood autism in order to clarify the nature and protective function of autistic barriers in adult patients who present challenging resistances in treatment. Tustin's thesis is that childhood autism constitutes a massive formation of avoidance reactions that develop in infancy to ward off traumatic awareness of bodily separateness. She describes two forms of childhood pathology that may develop: the encapsulated child who defends against all 'not me' experience by means of self-generated bodily sensations that augment the illusion of complete bodily continuity with the mother; and the entangled child who generates a protective illusion of being enfolded inside the body of the mother to minimise the experience of separateness. The transference resistances of borderline adults can be categorised according to Tustin's typology of encapsulation and entanglement. Clinical material is presented from the analyses of two borderline patients, one encapsulated and the other entangled. Despite seemingly different transference manifestations, both belong to the category of autistic barriers inasmuch as they ward off awareness of separation-induced injury to the primal self. The countertransference difficulties that the analyst encounters with patients who employ autistic barriers are discussed and treatment issues are reviewed.

Autistic Disorder↗
PubMed1997

[Success and failure in the treatment of patients with borderline personality disorder].

This paper reviews the main treatment options for patients with borderline personality disorder. Pharmacological interventions are of marginal value, and hospitalization has not been shown to prevent suicide in this population. Psychodynamic psychotherapy has not been proven to be effective, but dialectical behavior therapy yields symptomatic improvement. Borderline patients present many special difficulties in therapy, particularly their chronic suicidality. Future developments in treatment could involve improved drug treatment combined with cognitive therapy.

Borderline Personality Disorder↗
PubMed1997

[Dialectic behavioral psychotherapy for patients with borderline personality disorder].

Any therapist working with borderline patients knows that this is a crisis prone population that can be as burdening for the professional clinician as for the individual who experiences these intense relational episodes. Within this context, it is quite surprising that leaders of the behavioral approach waited until the beginning of the nineties before applying their technology to the treatment of patients diagnosed with borderline personality disorder. Linehan put numerous efforts to empirically demonstrate the efficiency of her newly developed dialectical behavior therapy, which makes it a noteworthy model. This article presents some historical and philosophical underpinnings of her approach, followed by the diagnostic criteria, the main clinical tools she advocates, the various dialectal dilemma, the treatment modes as well as an overview of the basic therapeutic strategies used in this approach.

Behavior Therapy↗
PubMed1997

[Masteron's approach to the borderline disorder of the self].

Borderline pathology challenges the mental health field with its dynamic complexity and management difficulties. James F. Masterson, M.D., is a leading authority and pioneer in the diagnosis and treatment of the Borderline Disorder of the Self. His work is based on 30 years of intensive clinical experience and research, integrated with a synthesis of the major psychodynamic concepts, including developmental theory, object relations, and concepts of the Self. Masterson's specific theory and applied technique has proved uniquely effective in understanding and treating this controversial syndrome that has become central to psychotherapeutic concern.

Borderline Personality Disorder↗
PubMed1997

Reversal reaction in borderline leprosy is associated with a polarized shift to type 1-like Mycobacterium leprae T cell reactivity in lesional skin: a follow-up study.

Borderline leprosy patients often undergo acute changes in immune reactivity that manifest as reversal reaction (RR) in the course of the disease. RR is associated with an exacerbated local delayed-type cellular immune response to Mycobacterium leprae and is responsible for severe tissue damage. We investigated whether RR episodes are associated with a change in T cell subsets in the lesional skin with regard to their cytokine secretion profiles. M. leprae-responsive T cell lines and thereafter T cell clones (TCC) were generated from the lesional skin of seven untreated borderline leprosy patients (with or without RR) and again from three of these patients experiencing RR during treatment. The phenotypes of the M. leprae-responsive TCC were either CD4+, CD8+, CD4-/CD8+/TCR gammadelta+, or CD4-/CD8-/TCR gammadelta+, although most of them were CD4+. Regardless of the clinical status of the untreated patients, a major subset of the M. leprae-responsive TCC was type 0-like and produced both IFN-gamma and IL-4. Interestingly, in all three patients who experienced a (re)occurrence of RR during treatment after the first analysis, a clear shift to polarized IFN-gamma production by the M. leprae-responsive TCC (type 1-like) was observed. This shift in T cell subsets was also reflected in the observed decrease in serum IgG and IgM levels of the same patients during RR. These finding indicate that CD4+ M. leprae-responsive T cells with a polarized type 1-like phenotype might be responsible for the immune-mediated tissue damage occurring during RR.

Cytokines↗
PubMed1997

[The problems in dealing with the incest experiences of borderline patients].

Sexual and/or physical abuse can be found in large numbers in the history of severely disturbed borderline patients. The treatment of experiences of incest can induce new symptoms as well as reinforce still existing symptoms. Thus the free-floating anxiety, which is connected with the anxiety of impending doom in early childhood, can be reduced. During in-patient treatment the extent of free-floating anxiety of borderline patients can be reduced by the holding function of the therapeutic team. Reduction of the other symptoms can take place only subsequent to this. A therapy geared to the reduction of singular symptoms might be less successful.

Adult↗
PubMed1998

On borderline phenomena.

The author describes his struggle to resolve some theoretical and technical problems posed by borderline patients. For this he has made use of an ancient Indian myth of King Trishanku taken from Bhagwat Puran--the Hindu Book of Genesis. He has tried to demonstrate, step by step, how fruitfully this myth has helped him to understand such patients. Special emphasis has been laid on the language used by borderline patients. The contrary and apparently meaningless nature of this language is likened to the formulation of King Trishanku's unique desire, 'to go to heaven without actually dying'. The author then proceeds to show that this language is not quite as meaningless as it appears to be--that it is the result of a complicated system of projective identification devised by these patients to manipulate their objects in order to achieve their own omnipotent ends. Detailed clinical examples are given to describe the handling of the problems of appropriation, manipulation and consequent suspended state of such patients. Taken from three different stages of various analyses these examples show how a very slow and gradual change was brought about in the mental structures of the patients treated by the author.

Adult↗
PubMedDate not supplied

[Suicide by a borderline patient at the end of fatal self-destructive behavior].

The presence of a borderline personality disorder must also be considered in forensic medicine appraisements, beside the various motivations for a self injurious behaviour and apart from other psychiatric illnesses. This personality disorder is frequently characterized by cuts and scratches made by the patients using sharp objects to inflict themselves when in situations causing great psychological distress. A case of a young female student is presented who exhibited a clear auto-destructive behaviour. Due to a tragic psychodynamic development, she committed suicide by means of carbamazepine intoxikation. In addition to the impressive morphological and traumatological injury pattern, the psychiatric case history of the female patient also showed that she had suffered from a typical borderline personality disorder.

Adult↗
PubMed1997

Tandem duplication of 11p12-p13 in a child with borderline development delay and eye abnormalities: dose effect of the PAX6 gene product?

We report on a girl with a duplication of chromosome band 11p12-->13, which includes the Wilms tumor gene (WT1) and the aniridia gene (PAX6). The girl had borderline developmental delay, mild facial anomalies, and eye abnormalities. Eye findings were also present in most of the 11 other published cases with partial trisomy 11p, including 11p12-->13. Recently, it was shown that introduction of additional copies of the PAX6 gene into mice caused very variable eye abnormalities. Therefore, a PAX6 gene dosage effect is likely to be present in mice and humans. The central nervous system may be less sensitive to an altered PAX6 gene dosage, which is consistent with the borderline developmental delay in the present patient. Urogenital abnormalities were absent in this patient and in most of the other patients with partial trisomy of 11p. Therefore, the effect of a WT1 gene duplication on the embryological development of the urogenital tract remains uncertain.

Chromosome Aberrations↗
PubMed1997

TP53 protein accumulation and gene mutation in relation to overexpression of MDM2 protein in ovarian borderline tumours and stage I carcinomas.

Three hundred and seventy-four early-stage ovarian tumours, including 27 borderline tumours and 347 stage I carcinomas, were investigated immunohistochemically for overexpression of the TP53 and MDM2 proteins. TP53 (p53) and MDM2 alterations were detected in 15 and 4 per cent of borderline tumours, and in 50 and 13 per cent of stage I carcinomas, respectively. Mutations in the TP53 gene (exons 5-8) were demonstrated in 29 of the 50 stage I carcinomas studied, using denaturing gel electrophoresis followed by direct sequencing. TP53 overexpression was seen less often in tumours of mucinous and endometrioid type than in tumours of other histological types and more often in moderately and poorly differentiated than in well differentiated tumours. MDM2 protein overexpression was seen more often in clear cell carcinoma than in tumours of other histological types. These results indicate that TP53 abnormalities play a crucial role, and MDM2 abnormalities a minor role, in the development of early-stage ovarian carcinoma. There was no significant association between TP53 or MDM2 alterations and survival in multivariate analysis.

Adolescent↗
PubMed1997

Trends in the incidence of ovarian cancer and borderline tumours in Norway, 1954-1993.

Histology-specific long-term trends in the incidence of ovarian cancer and borderline tumours in Norway were examined, based on data from the population-based Cancer Registry of Norway. A total of 14,352 cases of ovarian cancer were diagnosed between 1954-1993, of which 94% of the histologically verified ovarian cancers were epithelial tumours. The age-adjusted incidence rate rose from 10 per 100,000 person-years in 1954-1958 to a peak of 14 per 100,000 person-years in 1984-1988. In women older than 50 years, there was an increasing trend in incidence rates during the entire study period. From the cohort perspective, the largest increase was observed among women born between 1870-1899. A total of 2,343 borderline tumours was diagnosed between 1970-1993. The age-adjusted incidence rate has increased since 1970, reaching 4.8 per 100,000 person-years in 1989-1993.

Age Factors↗
PubMed1997

Phenotypic analysis of ovarian carcinoma: polypeptide expression in benign, borderline and malignant tumors.

Studies of multiple markers in tumors are required for adequate biological characterization. We have characterized the expression of multiple proteins in human ovarian tumors using the technique of 2-dimensional gel electrophoresis (2-DE/PDQUEST). Tumor cells were prepared from the tissue of 22 ovarian tumors. Large variations were observed between tumors in the expression of various polypeptides, indicating heterogeneity in gene expression. An increase in the spot density of 2 cell-cycle-related proteins, PCNA and OP18/stathmin, was observed in carcinomas. Borderline tumors expressed low levels of these proteins. Significant increases in the levels of nm23, GST-pi, elongation factor 2 and triose phosphate isomerase were recorded in ovarian carcinomas. Furthermore, decreases in the levels of tropomyosin-2 and lamin C were observed in malignant as compared with benign tumors. The pattern of expression of 9 protein markers was examined in individual tumors. All malignant tumors showed simultaneous alterations in the expression of 5 or more of these proteins, whereas no benign tumor showed alterations in the expression of more than 3 polypeptides. Borderline tumors showed alterations in 0 to 6 markers. We conclude that the simultaneous analysis of multiple polypeptides, which can be achieved by 2-DE, is useful for characterization of gene expression and diagnostic studies in ovarian tumors.

Adult↗
PubMed1999

Cytologic score and DNA-image analysis in the classification of borderline breast lesions: a prospective study on 47 fine-needle aspirates.

We prospectively evaluated the accuracy of the cytologic score system developed by Masood et al. combined with DNA-image analysis in the subclassification of 47 fine-needle aspiration samples with cytologic features of borderline breast lesions. Cytologic scores ranged between 12-18. All cases underwent surgical excision of the lesion, and histology revealed 24 cases of florid hyperplasia, 8 of atypical hyperplasia, and 11 noninvasive and 4 invasive ductal carcinomas. DNA-image analysis demonstrated 33 diploid and 14 aneuploid cases. Diploid samples were divided into slowly proliferating (S + G2/M < or = 13%) and rapidly proliferating (S + G2/M > 13%) cases. By considering florid hyperplasia a "low-risk" lesion and by amalgamating atypical hyperplasia, and in situ and invasive ductal carcinoma in the category of "high-risk" lesions, the positive predictive value of a score value > 16 was 100%. In cases scoring < or = 16, the slowly proliferating pattern had a negative predictive value of 95%, while the aneuploid and rapidly proliferating patterns had a positive predictive value of 100% and 63%, respectively. We conclude that a combination of cytologic score evaluation and DNA-image analysis is very useful in differentiating "low-risk" from "high-risk" cases in the field of breast borderline lesions, thus improving the impact of fine-needle aspiration diagnosis on patient management.

Biopsy, Needle↗
PubMed1991

Enhancement of tumor-associated glycoprotein-72 antigen expression in hormone-related ovarian serous borderline tumors.

The immunoreactivity of monoclonal antibody (MoAb) B72.3 with ovarian serous tumors of borderline malignancy from 44 women who were pregnant, were on hormone medication containing a progestin, or were known to be in the secretory phase of the menstrual cycle, was compared with that of similar tumors of 32 patients who were not known to be in any of these three categories. All 76 borderline tumors expressed the tumor-associated glycoprotein (TAG-72) recognized by MoAb B72.3. Striking staining differences (P less than 0.0001) were observed between the hormone-related and the nonhormone-related tumors. Differences were also noticed between the staining of tumors from pregnant patients and that of previous, persistent, or recurrent tumors of the ipsilateral or contralateral ovaries when the same patients were not pregnant. Tumor MoAb B72.3 reactivity increased with progressive gestational age and fell to lower levels at term and during the postpartum period. Although it has been suggested by cell culture studies, enhanced TAG-72 expression in human tumors under hormonal stimulation has not been described before.

Antibodies, Monoclonal↗
PubMed1992

Differential diagnosis of borderline and invasive serous cystadenocarcinomas of the ovary by computerized interactive morphometric analysis of nuclear features.

Whether borderline serous tumors of the ovary can be differentiated from invasive serous cystadenocarcinomas by morphometric analysis of nuclear features of the neoplastic epithelium was examined. Multiple descriptors extracted from nuclear tracings and intranuclear gray-level analysis of argyrophilic nucleolar organizer regions were evaluated in 11 borderline and 18 invasive tumors using computerized interactive morphometric analysis. These descriptors included: nuclear area and perimeter; number, area, and perimeter of argyrophilic nucleolar organizer regions; standard deviations of these findings; and a size distribution of nuclear areas in discrete classes. Multivariate statistical analysis showed the internal consistency of the two groups in terms of physical descriptors and the discriminating value of the parameters of nuclear size and pleomorphism (independently of nucleolar organizer region parameters). The results indicated that interactive morphometric analysis of nuclear features, combined with appropriate statistical methods, could be used to distinguish between these tumors.

Cell Nucleus↗
PubMed1994

Mucinous borderline and malignant tumors of the ovary. A clinicopathologic and DNA ploidy study of 92 cases.

BACKGROUND: The morphologic spectrum of ovarian mucinous tumors is well known, but the features that predict aggressive behavior are still controversial. METHODS: Ninety-two cases of primary ovarian mucinous tumors with atypical epithelial proliferation and/or stromal invasion were analyzed histologically and by DNA flow cytometry, and the results were correlated with clinical findings. RESULTS: The authors reviewed 57 intestinal mucinous borderline tumors (IMBT), 3 endocervical-like mucinous borderline tumors (EMBT), 21 noninvasive mucinous carcinomas (NIMC), and 11 invasive mucinous carcinomas (IMC). The 5-year survival rate for Stage I tumors was: IMBT 100%, EMBT 100%, NIMC 94% and IMC 60%. The 5-year survival of Stage II-IV tumors was: IMBT 50%, NIMC 33% and IMC 0%. Forty-four IMBTs were diploid, and 4 were aneuploid. All six high stage IMBTs were diploid. Two EMBTs were diploid, and one was aneuploid. There were seven diploid, four polyploid, and six aneuploid NIMCs. Two of the three lethal NIMCs were aneuploid. Four IMCs were diploid, and four were aneuploid. Of these, only the diploid Stage I IMCs were nonlethal. All NIMCs that recurred or presented with metastases had been sampled inadequately. High stage tumors with pseudomyxoma peritonei (PP)-type lesions often were associated with pseudomyxoma ovarii of the cellular type. CONCLUSIONS: Mucinous tumors with stromal invasion or presenting with PP had a definite malignant behavior. All other atypical mucinous tumors, when confined to the ovary and optimally sampled, had an excellent prognosis. DNA ploidy analysis may prove useful in determining the risk of progression, especially in Stage I IMCs.

Adenocarcinoma, Mucinous↗
PubMed2002

Incidence patterns of invasive and borderline ovarian tumors among white women and black women in the United States. Results from the SEER Program, 1978-1998.

BACKGROUND: Malignant tumors of the ovary are the leading cause of death from gynecologic malignancies in the United States. Population-based incidence data for these neoplasms by histopathologic type and race are limited. Variation in rates may provide clues for future etiologic studies. METHODS: The authors performed a detailed, population-based analysis of U.S. incidence rates by histologic type, race, and age for invasive ovarian tumors that were diagnosed during 1978-1998 and for borderline ovarian tumors that were diagnosed during 1992-1998 using data from the U.S. Surveillance, Epidemiology, and End Results (SEER) Program. RESULTS: White women had significantly higher rates compared with black women of all types of epithelial tumors, with the white:black rate ratios ranging from 1.23 to 2.56. Black women had higher rates of gonadal stromal tumors. Among both white women and black women, total carcinoma rates did not change greatly from 1978-1982 to 1995-1998. Among white women, the reported incidence rates for invasive serous, endometrioid, and clear cell tumors increased during 1978-1998, whereas the rates of mucinous; papillary, not otherwise specified (NOS); and other epithelial tumors declined. Among black women, the reported rates of papillary, NOS tumors decreased significantly, whereas the rates of other tumor types fluctuated. Incidence rates of borderline ovarian tumors were higher among white women compared with black women and did not change significantly during 1992-1998. Serous and mucinous tumors were the predominant tumors reported for women age < 45 years, whereas serous; papillary, NOS; and other epithelial tumors predominated among older women. CONCLUSIONS: Incidence rates for malignant ovarian tumors have remained relatively stable, with higher rates for white women compared with black women. The reported rates for some specific histopathologic tumor types have changed over time, in part reflecting more specific pathologic classification. The possible effect of shifting exposure prevalence on incidence patterns warrants further study.

Adolescent↗