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At least 1,621 records · Page 90Linked to original sources

Dermatofibrosarcoma protuberans. A clinicopathologic review with emphasis on fibrosarcomatous areas.

We reviewed 75 cases of dermatofibrosarcoma protuberans (DFSP) from the University of Texas M.D. Anderson Cancer Center. All accessions were examined for areas of giant cell fibroblastoma (GCF), but none was found. The 30 cases having a minimum of 5 years follow-up were studied in more detail. The histologic findings were typical of DFSP in 24 cases, whereas in six cases discrete areas with a fascicular or "herringbone" growth pattern, considered to represent fibrosarcomatous change (DFSP-FS), were evident. The mitotic rate was usually but not always higher in fibrosarcomatous areas, and occasional examples of typical DFSP demonstrated relatively numerous mitotic figures (up to 35 per 10 high-power fields). Other histologic findings of interest were the presence of melanin in two cases of DFSP and the focal presence of a distinctive type of multinucleated giant cell similar to those seen in GCF in six cases. Patients with DFSP-FS differed from those with DFSP in that they had a higher median age (56 years vs. 37 years). Tumor location was similar in both groups, with the trunk being the most common site. No significant difference in either the rate of local recurrence or the interval until recurrence between DFSP and DFSP-FS was evident; the only factor strongly related to local recurrence was adequacy of surgical margins. However, the only two patients who died of tumor, including the sole patient with distant metastasis, had DFSP-FS. We conclude that DFSP-FS deserves recognition as a variant of DFSP.

Adult↗

[Case study: a calcified epithelial odontogenic tumor (Pindborg tumor)].

The calcifying epithelial odontogenic tumor is a benign but locally aggressive tumor. Occasionally the term Pindborg tumor is used after the Danish pathologist who first described this tumor as an entity. The clinical feature is most commonly a slow-growing painless swelling. The tumor may show considerable roentgenographic variation. Usually this tumor shows characteristic histological features. Some variants can mimic malignant neoplasms. The invasive nature is not so obvious as that of an ameloblastoma, nevertheless it has to be treated in the same way. A long follow-up period is indicated since recurrence can occur after many years. A patient with a characteristic Pindborg tumor is presented.

Adult↗

[Objective evaluation of nuclear grade in preoperative aspiration materials from breast cancers--special reference to the relationship of coefficiency variant of nuclear area with pathological prognostic features].

The prognostic significance of cytomorphometry was investigated in 84 invasive ductal breast cancer patients. All patients were clinically followed for at least 5 years after radical mastectomy. The value of coefficiency variant of nuclear area (NA.CV) calculated from morphometor had good correlation with nuclear grade determined subjectively by cytologist on optical microscope. NA.CV in patients who had metachronous metastases (39.0 +/- 7.5%) was significantly higher than that in recurrence free cases (26.8 +/- 4.9%). The recurrence free period was also related to the value of NA.CV. In 39 cases (90.7%) out of 43 recurrence free survivors, the value of NA.CV was less than 30%, whereas it was over 40% in 11 (45.8%) out of 24 cases with short time (less than two years post operatively) metastases. NA.CV was the most variable, independent prognostic factor among several pathological prognostic features. The data assessed in this study showed that the value of NA.CV on cytological materials as the objective evaluation of nuclear grade may provide clinically relevant information with respect to the degree of malignancy and prognosis of patients with breast cancer at preoperative period.

Biopsy, Needle↗

[Ocular form of multiple sclerosis].

Examination of 52 patients has made it possible to identify the ocular form of multiple sclerosis associated with isolated recurrent damage to the optic nerves regardless of the possibility of the development of other neurological symptomatology. This has reduced the group of patients with unexplained damage to the optic nerves and expanded our knowledge about variants of multiple sclerosis.

Adolescent↗

Ameloblastoma in Malaysia--a 25-year review.

Four hundred and one cases of ameloblastoma of the jaw diagnosed in the Division of Stomatology, Institute for Medical Research, Kuala Lumpur, between 1967 and 1991 have been analysed. There were 214 males and 187 females. Of these, 50.1% were Malays, 34.7% Chinese, 8.2% Indians and 7.0% other races. Seventy-two percent of patients were in the second, third and fourth decades of life (mean age: 30.8 years). Ninety-three percent of tumours occurred in the mandible and 6.5% in the maxilla. There were 337 cases of conventional ameloblastoma, 49 cases of the unicystic variant and four cases of peripheral ameloblastoma. The predominant histologic patterns were plexiform (34.2%), follicular (16.5%) and mixture of both (17.7%). Majority of the cases were conservatively treated by enucleation. Fifty-nine cases presented with recurrences. Present findings were generally compatible with regional serial studies reported from Thailand, Singapore and Japan.

Adolescent↗

[Thyroid cancer in children and adolescents. Clinical aspects, diagnostic problems and special therapeutics].

Twenty-five children undergoing surgery for thyroid carcinoma, were compared in a retrospective study. Clinical characteristics and disease course were detailed in three groups. In the first of 11 patients, a lobo-isthmusectomy was performed for a thyroid nodule, except two cases of total thyroidectomy (TT). Papillary carcinoma was diagnosed on histologic findings. Preoperative cytology and peroperative frozen section examination were inadequate for diagnosis. All children had a complete remission after treatment. In the second group, 10 children had evident thyroid carcinoma with cervical lymph node metastases, and lung metastases in two. Microscopicaly, there were diffuse sclerosing variant or multifocal papillary carcinoma. A TT with central node dissection was performed in all, with a lateral lymph node dissection in 9. Treatment included radioiodine therapy and thyroxin suppression therapy. Three patients had a postoperative recurrent laryngeal palsy, one hypoparathyroidism. Reoperation was carried out in 4 for cervicomediastinal lymph node recurrence. All patients are alive, with a complete remission, except for the two patients with lung metastases. In this group of aggressive tumors, a complete cure was possible with combination of extended, sometimes repeated, surgery and radioiodine therapy. In the last group, 4 patients had a medullary carcinoma. One presented with a thyroid nodule. The others were asymptomatic with a positive pentagastrin test during biological screening for familial disease. Two patients with lymph node metastases had a persistent pathologic calcitonin test despite a TT with complete central and lateral lymph node dissection. Early genetic screening in family members is the only way to perform a curative thyroidectomy in a prepathologic stage.

Adolescent↗

[Clinico-morphologic reconsideration of anaplastic lymphoma. Retrospective study of 60 patients with aggressive clinical course and multiple recurrences].

PURPOSE: To identify anaplastic large cell lymphoma Ki-1+ (ALCL-Ki-1+) among a group of patients with aggressive Hodgkin's disease (HD) and to know the biological behaviour of the neoplasia (ALCL-Ki-1+). PATIENTS AND METHODS: Biopsies and clinical data of sixty patients with previous morphological diagnosis of HD lymphocytic depletion (LD), syncytial variant of nodular esclerosis (NE-II) and other subtypes of HD with aggressive clinical features were reviewed. A morphological, immunohistochemical (IHQ), proliferative and flow cytometric (FCM) studies were performed in lymph node biopsies. RESULTS: Morphological study and IHQ identify three groups: 15 patients (25%) lymphocytic predominance (LP) HD, 36 (60%) ALCL-Ki-1+ and 9 (15%) of non-Hodgkin's lymphoma (NHL) and unclassifiable cases. Nine cases of LP show anaplastic and variable immunophenotype being the rest of B-cell nature. 75% of LP patients showed long survival and frequent second neoplasias (47%). ALCL-Ki-1+ group had good initial response to therapy (84%) and multiple relapses, 67% showed CD15 positive marker (the so-called ALCL-HD related). CONCLUSIONS: A retrospective study of a selected group of patients previously diagnosed of aggressive HD showed different pathological subtypes: LP, LP with anaplastic areas, ALCL-Ki-1+ Hr (Hodgkin's related) and ALCL-Ki-1+ (classical type), all of them were CD30+, which could represent different stages of the same neoplasia.

Adolescent↗

Development of low entropy coding in a recurrent network.

In this paper we present an unsupervised neural network which exhibits competition between units via inhibitory feedback. The operation is such as to minimize reconstruction error, both for individual patterns, and over the entire training set. A key difference from networks which perform principal components analysis, or one of its variants, is the ability to converge to non-orthogonal weight values. We discuss the network's operation in relation to the twin goals of maximizing information transfer and minimizing code entropy, and show how the assignment of prior probabilities to network outputs can help to reduce entropy. We present results from two binary coding problems, and from experiments with image coding.

Journal Article↗

Chondromyxoid fibroma-like osteosarcoma: a distinct variant of low-grade osteosarcoma.

Chondromyxoid fibroma-like osteosarcoma is a recently described, extremely rare subtype of low-grade osteosarcoma. Two such cases were encountered among 102 cases of osteosarcoma seen in the Prince of Wales Hospital, Hong Kong, between 1984 and 1994. The first patient, a 39-year-old woman, presented with a mass in her right maxilla which was resected and mistaken as a myxoma. The tumour recurred locally four years later and she now has extensive local recurrent disease six years after initial presentation and is amenable to support treatment only. The second patient, a 28-year-old man, had a pelvic tumour which recurred in the form of a polypoid left atrial tumour and pulmonary nodules six years after operation. The left atrial tumour recurred one year after operation, and led to sudden death of the patient seven years after initial presentation. Radiologically, the tumours in both cases appeared as expansile osteolytic lesions with erosion of adjacent bone and infiltration into soft tissue. Histologically, they consisted of lobules of spindle, stellate or polygonal tumour cells showing mitotic activity and with moderate nuclear pleomorphism and hyperchromatism, set in a highly myxoid stroma superficially mimicking chondromyxoid fibroma. The histological hallmark was the direct production of osteoid by tumour cells. Chondromyxoid fibroma-like osteosarcoma merits recognition as a distinct variant of low-grade osteosarcoma for which early appropriate surgery is indicated.

Adult↗

[Comparative characteristics of the methods of surgical treatment of extrasphincteric rectal fistulas].

The number of recurrences ranged from 2.1% to 14.3% depending on the degree of fistula complexity. Fistulectomy with suturing of its stump by dosage sphincterotomy is indicated in case of extrasphincteric fistulas without cicatricial and inflammatory changes in the intestinal wall and pararectal cellular spaces. Fistulectomy with suturing of the sphincter should be accomplished only in patients with non-branching extrasphincteric fistulas without inflammatory changes in pararectal cellular spaces. The technic of ligation may be employed in most complex forms of rectal extrasphincteric fistulas. A variant of surgery when ligature is put during the operative procedure and the wound is partially closed makes it possible to obtain adequate functional results.

Follow-Up Studies↗

Therapeutic and diagnostic applications of minor histocompatibility antigen HA-1 and HA-2 disparities in allogeneic hematopoietic stem cell transplantation: a survey of different populations.

Minor histocompatibility antigens (mHags) HA-1 and HA-2 are encoded by biallelic loci, with immunogenic variants, HA-1H and HA-2V, which induce strong HLA-A2-restricted alloreactive T-cell responses, and nonimmunogenic counterparts, HA-1R and HA-2M, which represent functional null alleles that are poorly presented by HLA class I molecules. HA-1 and HA-2 are potential targets of selective graft-versus-leukemia and graft-versus-tumor reactivity after allogeneic hematopoietic stem cell transplantation (HSCT); however, these applications are restricted to a limited number of patients. Here, we show that a far more frequent application of HA-1 and HA-2 disparity relies on their use as markers for the state of host chimerism after allogeneic HSCT. We have determined allelic frequencies of 29.3% and 70.7% for HA-1H and HA-1R, respectively, and of 83.7% and 16.3% for HA-2V and HA-2M, respectively, in >200 healthy individuals from northern Italy. Similar frequencies were observed in nearly 100 patients affected by hematologic malignancies or solid tumors, thus showing that HA-1 and HA-2 variability are not associated with the presence of cancer. On the basis of these data, we predict that HA-1 and HA-2 can be used in 32.8% and 23.5% of Italian transplant patients, respectively, as markers for the state of host chimerism, whereas exploitation of disparity for these mHags for targeted immunotherapy will be possible in 10.7% and 1.1% of Italian patients, respectively. Retrospective HA-2 typing of bone marrow aspirates obtained from a patient during complete remission or recurrence of acute myeloid leukemia after haploidentical HSCT showed the feasibility of using HA-2 as a surrogate marker for disease monitoring. Because of an apparent north-south gradient for HA-1 allelic frequencies, with higher frequencies for the HA-1H variant reported in white populations from Southern Europe as compared with Northern Europe and North America, the diagnostic applicability of HA-1 disparity will be slightly more frequent in transplant patients from the north. Taken together, our data show that determination of HA-1 and HA-2 variability can be an important parameter for the selection of allogeneic stem cell donors, in particular for patients affected by hematologic malignancies without a tumor-specific molecular marker.

Biomarkers↗

Therapeutic plasma exchange for acute inflammatory demyelinating syndromes of the central nervous system.

Idiopathic inflammatory demyelinating diseases (IIDDs) of the central nervous system, of which multiple sclerosis is the prototype, represent a family of monophasic, recurrent or progressive diseases with overlapping clinical and pathological manifestations. While most patients recover spontaneously or following a brief course of high-dose corticosteroids, occasional patients, particularly those with fulminant severe IIDDs, such as the Marburg variant, do not respond to corticosteroids and have severe, residual neurological deficits. While it is widely believed that IIDDs are mediated by T lymphocytes, as is experimental allergic encephelomyelitis, additional, possibly humoral, factors may be essential to generate the extensive demyelination seen in these conditions. Anecdotal reports over the past two decades have suggested that patients with acute, severe neurological deficits resulting from IIDDs, who fail to improve after high-dose intravenous corticosteroids, may benefit from plasma exchange. A randomized, sham-controlled, crossover study has recently been completed at the Mayo Clinic, which addresses these observations.

Acute Disease↗

[Therapeutic and histological features of basaloid squamous cell carcinoma].

BACKGROUND AND OBJECTIVE: Basaloid squamous cell carcinoma s a rare, highly malignant carcinoma variant typically situated in the tongue base, supraglottis and pyriform sinus. It is usually only diagnosed at a very advanced stage due to its tendency towards submucosal growth, deep infiltration and early local and distant metastases. PATIENTS/METHODS: The case described involves a 39-year-old man with the clinical and histopathological findings typical for this neoplasm. RESULTS: In contrast to simple squamous cell carcinomas, the basaloid variant with its very poor prognosis calls for therapeutic decisions that give particular consideration to quality of life. It should be stressed that highly invasive surgery is justified only in exceptional cases because of the high local recurrence rate and early distant metastases. CONCLUSIONS: The case presented shows that radio- and chemotherapeutic approaches are just as important as surgery.

Adult↗

Hypereosinophilic syndrome: case presentation and update.

Persistent peripheral blood eosinophilia can be associated with a variety of diseases, ranging from parasitic infection to gastrointestinal disease to vasculitis to the hypereosinophilic syndrome (HES). Mucosal ulcerations are a variant presentation of the HES that appear to be markers for a mutation that characterizes a subgroup of patients with HES responsive to treatment with imatinib mesylate. We present a patient with peripheral blood eosinophilia and severe recurrent mucosal ulcers and discuss his presentation in the context of new information about the evaluation, disease progression, and treatment of HES.

Adult↗

Tall cell variant: an aggressive form of papillary thyroid carcinoma.

Twenty-four cases of the tall cell variant (TCV), a subset of papillary thyroid carcinoma, were identified in a group of 624 patients with thyroid cancer. All pathology specimens were reviewed, and each patient's carcinoma was categorized according to characteristics on presentation, local recurrence, distant metastases, follow-up, and tumor-related mortality. The TCV group was compared with a historical control group (Mazzaferri and Jhiang: 1355 patients). The TCV group had a statistically higher percentage of stage 3 and 4 carcinoma, extrathyroidal invasion, and tumor size less than 1.5 cm than the control group. There was no statistical relationship between age greater than 50 years and stage in the TCV group. No relationship could be found between TCV histology and recurrence or mortality. These findings, combined with those of studies that link stage on presentation to poor outcomes, have led to our conclusion that TCV is an aggressive malignancy warranting appropriate treatment and close follow-up.

Adult↗

Pleomorphic lipoma of the parotid gland.

Lipomata are rare tumours of the parotid gland. The pleomorphic lipoma represents an unusual histological variant of the benign lipoma. We report a case of a pleomorphic lipoma arising in the parotid gland. Only one case of a similar nature has previously been recorded. This tumour is benign, was fully excised and recurrence is not expected.

Aged↗