PubMed Health⌕ Search

Biomedical subjects

A C Coogan

Publications and source records attributed to A C Coogan.

15 recordsLinked to original sources
PubMed1999

Pulmonary vascular morphological changes in cirrhotic patients undergoing liver transplantation.

Cirrhosis and portal hypertension may be associated with pulmonary hypertension and pulmonary dysfunction. However, morphological pulmonary vascular lesions in patients with cirrhosis have not been well characterized morphometrically. We morphometrically evaluated pulmonary vessels in liver transplant recipients with pretransplantation cirrhosis and correlated our findings with pretransplantation cardiopulmonary function, postoperative course, and postmortem cardiopulmonary findings. Autopsy lung slides from 23 transplant recipients with pretransplantation cirrhosis were examined. External vessel diameter, intimal thickness, and arterial medial thickness were measured with a micrometer after pentachrome staining. The percent of total diameter comprised by intima or media was calculated for each vessel. Medical records were reviewed for smoking history, pretransplantation cardiopulmonary function testing, and postoperative course. Autopsy cases without liver or significant cardiopulmonary diseases, matched for age, sex, and smoking history, served as controls. Transplant recipients had significantly more pulmonary venous intimal thickening than matched controls (P <.0001). Sixty-five percent (15 of 23) of these patients had some degree of pretransplantation pulmonary dysfunction, defined by abnormalities in pulmonary function tests, oxygen saturation, and/or increased pulmonary artery pressures. However, the severity of venous intimal thickening did not correlate with the severity of pretransplantation pulmonary dysfunction. Arterial intimal and medial thickness were not statistically significantly different from controls. Pulmonary venous intimal thickening and resultant luminal impingement are morphological findings not previously described in this population. The arterial lesion, when present, is similar to that seen in pulmonary hypertension from other causes. These pulmonary vascular lesions may be implicated in pulmonary dysfunction in patients with cirrhosis and may be associated with increased posttransplantation cardiopulmonary morbidity and mortality.

Adult↗
PubMed1999

Diagnostic accuracy in fine-needle aspiration of soft tissue and bone lesions. Influence of clinical history and experience.

Interpretation of soft tissue and bone lesions with fine-needle aspiration (FNA) is difficult. We determined whether clinical history or experience improves diagnostic accuracy of FNA interpretation of these lesions. Four cytopathologists with varying degrees of experience retrospectively reviewed 89 soft tissue and bone lesions, initially without knowledge of clinical history and subsequently with knowledge of clinical history. Each time, the pathologist rendered a precise diagnosis (histogenetic classification, e.g., angiosarcoma, lipoma) for each case and classified the lesion into one of 4 categories: benign, probably benign, probably malignant, or malignant. The proportion of correct precise diagnoses was calculated. Also, the numbers of correct and incorrect classifications of malignancy were used in standard relative operating characteristic (ROC) curve analysis. The area under the ROC curve was estimated to give an indicator of diagnostic accuracy. Knowledge of clinical history increased the proportion of correct diagnoses and the accuracy of the classification for all observers. Experienced observers more accurately classified lesions, and knowledge of clinical history particularly improved the diagnostic accuracy of less experienced observers.

Biopsy, Needle↗
PubMed1997

Hyaline matrix material in high-grade endometrial stromal sarcoma diagnosed by fine-needle aspiration: case report.

We present a case of a high-grade endometrial stromal sarcoma metastatic to the abdomen with an unusual extracellular hyaline matrix material seen on fine needle aspiration biopsy. The patient was initially diagnosed with a stage IIIA high-grade endometrial stromal sarcoma and had received four cycles of chemotherapy over the past year. She subsequently developed an abdominal mass that consisted of discohesive small cells with scanty cytoplasm on fine needle aspiration. On the Diff-Quik-stained smears, metachromatic, extracellular hyaline material was identified. This appeared on the Papanicolaou-stained smear as cyanophilic material and did not react with reticulin stain. This case emphasizes the importance to the cytopathologist of including endometrial stromal sarcoma in the differential diagnosis of hyaline matrix material.

Abdominal Neoplasms↗
PubMed1997

Cytologic features of pulmonary metastasis from a granulosa cell tumor diagnosed by fine-needle aspiration: a case report.

We report on a case of a granulosa cell tumor of the ovary metastatic to the lung and diagnosed by fine-needle aspiration. The patient was a 70-yr-old woman who was diagnosed with a granulosa cell tumor of the ovary 17 yr previously. She subsequently developed abdominal metastases and received several cycles of chemotherapy. A 0.5-cm right upper lobe pulmonary nodule was found on a routine chest radiograph and subsequent computerized tomography scan. Aspiration cytology of this pulmonary nodule demonstrated small, relatively uniform neoplastic cells with nuclear grooves and indentations consistent with a granulosa cell tumor. The differential diagnosis of granulosa cell tumors from other metastatic and pulmonary lesions is reviewed.

Aged↗
PubMed1997

Cervical intraepithelial neoplasia in HIV-infected women in a southeastern US population.

The objectives of our study were to determine the prevalence of cervical intraepithelial neoplasia (CIN) in a southeastern human immunodeficiency virus (HIV)-positive population relative to an HIV-negative control group and to compare these findings with published reports from other geographic regions. Demographic, medical, and cytopathologic data were collected on 89 HIV-positive women receiving care at the Duke Adult Infectious Disease Clinic. Comparisons were made with 100 HIV-negative obstetric patients who delivered at Duke and with published reports from other regions of the United States and abroad. Cervical intraepithelial neoplasia was present in 43 (49%) of 87 HIV-positive women compared with 23% of the 100 HIV-negative patients. Two of the HIV-positive patients had invasive cancer. Comparison of these patients with patients from other geographic regions revealed similar odds ratios for the presence of CIN in HIV-positive patients compared with HIV-negative patients. These results suggest a significantly increased risk for cervical dysplasia in HIV-positive women in this southeastern population.

Adult↗
PubMed1996

Fine-needle aspiration of low grade adenosquamous carcinoma of the breast.

Low-grade adenosquamous carcinoma is an unusual variant of mammary carcinoma. This malignancy generally presents as a palpable mass without mammographic microcalcifications, and fine-needle aspiration may be the initial technique selected for diagnosis. To our knowledge, the cytologic findings associated with this neoplasm have not been reported. We report a case of low-grade adenosquamous carcinoma of the breast in a 57-yr-old woman, initially studied by fine-needle aspiration cytology and confirmed by excisional biopsy. The aspiration biopsy smears were characterized by low cellularity and small disoriented clusters containing uniform cells of small to medium size. Bipolar cells were not seen in the background. The diagnostic features and differential diagnosis of this unusual neoplasm are reviewed.

Biopsy, Needle↗
PubMed1996

Prospective correlation of cervicovaginal cytologic and histologic specimens.

An effective, prospective, computer-guided method of correlation is reported. The mechanism for identification of cases, comparison of diagnoses, and reconciliation of discrepancies are explained. The results are similar to prior, retrospective, correlation studies. The benefits specific to this unique prospective approach include optimal capture of cases for correlation, minimization of errors before diagnoses are released to clinicians and patients, and internal standardization of diagnostic criteria. Three thousand four hundred and four consecutive paired cervicovaginal cytologies and biopsies were accessioned at the Pathology Department of Duke University Medical Center over a 43-month period. Of these, 481 paired cases (14%) had discordant diagnoses, defined as differing more than one degree of dysplasia or as dysplasia or carcinoma identified by only one modality. Additional evaluation reconciled the diagnostic differences in 35 cases. Eighteen initial diagnostic differences arose from cytologic screening errors, 16 from interpretive errors by staff pathologists, and one from superficial initial histologic sections. The remaining 446 discordances were attributed to sampling differences. The cytologic smear contained the diagnostic lesion in 40% of the cases and the biopsy the remainder, emphasizing the utility of pairing these sampling techniques in patients at risk for dysplasia.

Biopsy↗
PubMed1996

The complementary roles of fast spin-echo MR imaging and double-phase 99m Tc-sestamibi scintigraphy for localization of hyperfunctioning parathyroid glands.

OBJECTIVE: Our purpose was to evaluate and compare prospectively fast spin-echo MR imaging and double-phase technetium-99m-sestamibi scintigraphy for preoperative localization of hyperfunctioning parathyroid glands in high-risk surgical patients. SUBJECTS AND METHODS: Twenty-five patients, including 17 with a history of neck surgery, underwent preoperative MR imaging and technetium-99m-sestamibi scintigraphy. Initial interpretation of each study was made independently by two radiologists and then done in combination. At surgery, the location, weight, and dimensions, as well as detailed histopathologic evaluations, of all excised glands were recorded. RESULTS: All but two patients became normocalcemic after surgery. MR and sestamibi imaging revealed 31 of 37 (84%) and 29 of 37 (79%) of all abnormal glands, respectively. Sensitivities of MR and sestamibi imaging were higher for adenomas (17 of 18 [94%] and 16 of 18 [89%], respectively) than for hyperplastic glands (14 of 19 [74%] and 13 of 19 [68%], respectively). The specificity of sestamibi imaging (94%) exceeded that of MR imaging (75%). All ectopic glands (n = 8) were correctly localized by both techniques. Glands with atypical MR imaging characteristics (isointense or hyperintense to normal thyroid on T1-weighted spin-echo and fast spin-echo images) were more likely to have increased fat, chronic hemorrhage, or sclerosis and fibrosis (p < .05). When MR imaging and sestamibi studies were interpreted together, their sensitivities for adenomas and for hyperplastic glands were 94% (17 of 18) and 84% (16 of 19), respectively. Overall sensitivity of MR imaging and sestamibi studies interpreted together was 89%; overall specificity was 95%. CONCLUSION: The greater specificity and anatomic coverage of sestamibi scintigraphy coupled with the greater anatomic detail provided by MR imaging and its improved sensitivity over sestamibi imaging in specific patients may justify using both techniques in high-risk surgical patients who have hyperparathyroidism, particularly patients undergoing repeat surgery.

Adenoma↗
PubMed1995

Hyperparathyroidism in high-risk surgical patients: evaluation with double-phase technetium-99m sestamibi imaging.

PURPOSE: To evaluate the accuracy of technetium-99m sestamibi as a single agent in the detection and localization of hyperfunctioning parathyroid tissue in patients who underwent prior neck exploration or who otherwise are high surgical risks. MATERIALS AND METHODS: Thirty-nine patients with hyperparathyroidism underwent 40 double-phase Tc-99m sestamibi studies. Histopathologic correlation was obtained for all studies. RESULTS: Thirty patients had solitary adenomas, and nine had hyperplastic glands. One developed recurrent hypercalcemia after five-gland resection and underwent repeat imaging and operation. Double-phase sestamibi imaging prospectively enabled localization of 46 (77%) of 60 abnormal glands. Twenty-eight (93%) of 30 adenomas were correctly localized, whereas 18 (60%) of 30 hyperplastic glands were localized. The overall specificity of the study was 98% with one false-positive study. Gland weight and vascularity were statistically significant predictors of uptake of sestamibi. CONCLUSION: Double-phase Tc-99m sestamibi imaging is a promising technique for localization of parathyroid adenomas in high-risk surgical patients. Localization of multiple hyperplastic glands remains a challenge.

Adenoma↗
PubMed1995

Gout as a source of sesamoid pain.

Isolated gout of a great toe sesamoid has not been described previously. We present a case of gout of the medial sesamoid in a young athlete. Because a diagnosis is often elusive in patients with sesamoid pain, it is possible that other cases of gout of a hallucal sesamoid have gone unrecognized. Consideration of this diagnosis might lead to curative medical therapy precluding the need for surgical intervention.

Adolescent↗
PubMed1995

Simultaneous endometrial malignant mixed mesodermal tumor and ovarian serous adenocarcinoma.

Although simultaneous endometrial and ovarian tumors are observed occasionally, rarely are the two neoplasms histologically disparate. We report a case of simultaneous endometrial malignant mixed mesodermal tumor and ovarian serous adenocarcinoma with a single right external iliac lymph node metastasis. Using immunohistochemical profiles, we demonstrated that the two tumors are separate primary neoplasms and identified the origin of the metastatic deposit as the mixed malignant mesodermal tumor.

Cystadenocarcinoma, Serous↗
PubMedDate not supplied

Clinical significance of an inconclusive cytopathologic diagnosis: a five-year experience at Duke University Medical Center. II. Analysis and follow-up of specimens from the respiratory tract.

OBJECTIVE: As a follow-up of our initial report, we critically examined a selected number of cases from the respiratory tract with an original diagnosis of "atypical cells present suspicious for malignancy" in order to ascertain if any particular features of the specimen or the atypical cells were predictors of malignancy. STUDY DESIGN: From a total of 563 such cases, 31 were identified with subsequent histologic findings of a nonneoplastic pathologic process. An additional 45 cytologic cases were randomly selected to represent those with subsequent histologic findings confirming the suspicion of malignancy. All the cytologic specimens were examined without knowledge of the histologic follow-up results. RESULTS: Analysis of the cellular composition of the specimens identified no discernible difference between specimens from benign and malignant processes. Quantitative analysis of the atypical cells and qualitative assessment of the nuclear abnormalities revealed that marked nuclear hyperchromasia and a very high nuclear/cytoplasmic ratio were more likely to represent a malignant process. However, none of the parameters examined could consistently predict the presence or absence of malignancy. CONCLUSION: When a single cytologic specimen is inconclusive as to the presence or absence of malignancy, standard cytologic criteria cannot reliably predict a malignant process.

Cytodiagnosis↗
PubMedDate not supplied

Clinical significance of an inconclusive cytopathologic diagnosis. I. Positive predictive value.

We retrospectively analyzed the pathology database of 1,057 patients at Duke University Medical Center who received an inconclusive cytopathologic diagnosis during the five-year period 1984-1989 in an attempt to answer the question, what is the significance of a cytopathologic diagnosis of "atypical cells are present that are suspicious for, but not diagnostic of, malignancy?" We identified 1,110 cytologic specimens from all body sites receiving this diagnosis, and of them, 805 (73%) had a follow-up specimen from the same anatomic site that was definitive as to the presence or absence of malignancy; 305 (27%) had no follow-up specimen. Of the follow-up specimens, 596 (74%) were histopathologic specimens, and 209 (26%) were cytopathologic. Specimens from the respiratory tract accounted for 51% (563) of the cases, and the positive predictive value (PPV) of an inconclusive diagnosis at this site was 85%. Of the remaining specimens, those from the urinary (10%) and genital (8%) tracts were the most common, and the PPVs of an inconclusive diagnosis at these sites were 83% and 61%, respectively. The overall PPV of an inconclusive cytologic diagnosis from all body sites was 80% and ranged between 57% and 93%, depending on the anatomic site.

Biopsy↗