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Biomedical subjects

A S Patchefsky

Publications and source records attributed to A S Patchefsky.

At least 37 records · Page 2Linked to original sources
PubMed1984

Chest radiograph in lymphomatoid granulomatosis: comparison with Wegener granulomatosis.

A form of angiitis and granulomatosis principally involving the lung was identified as a variant form of Wegener granulomatosis only 15 years ago. Recent experience indicates that the most common form of pulmonary angiitis and granulomatosis is lymphomatoid granulomatosis. Chest radiographs of 16 patients with this condition were reviewed and the findings compared with those of Wegener granulomatosis. The frequency and distribution of nodular masses, cavitation, and migratory lesions were similar in the two disorders, but reticulonodular infiltrates occurred only in lymphomatoid granulomatosis. The study suggests that lymphomatoid granulomatosis and Wegener granulomatosis occasionally can be distinguished by radiographic criteria. Although radiologic patterns will suggest the diagnosis of pulmonary angiitis and granulomatosis, the specific diagnosis of lymphomatoid granulomatosis must rely on clinical, immunologic, and pathologic evidence. Accurate differentiation is essential since treatment of Wegener granulomatosis with cyclophosphamide is highly effective while treatment of lymphomatoid granulomatosis is infrequently successful.

Aged↗
PubMed1983

Ultrasound mammography for the augmented breast.

Ultrasound examinations were performed on 25 women with augmented breasts using whole-breast water-path scanning. In these patients, ultrasound imaged carcinoma, benign lesions, and fibrous capsule formation; these were confirmed by surgery. In addition, it was noted that certain prostheses appeared to be displaced posteriorly onto the chest wall and some prostheses had internal echoes. To evaluate these findings, in vitro B-scanning was performed on three different commonly used mammary prostheses: the silicone gel, the saline inflatable, and the double-membrane gel-inflatable type. Ultrasound study of the augmented breast allowed evaluation of breast abnormalities in the parenchyma overlying the prostheses and also permitted evaluation of the complications unique to the implantation procedure: abscess formation, displacement of the implants, fibrous capsule formation, and wrinkles or cracks within the implant.

Adult↗
PubMed1982

Interobserver variation in the identification of breast carcinoma in intramammary lymphatics.

Nine surgical pathologists participated in a microscopic review of 35 cases of pT1-2 N0 M0 breast carcinoma. The pathologists outlined strict criteria for the identification of intramammary lymphatics and blood vessels and for the identification of cancerous emboli in these vascular channels. Each mastectomy case was studied by three different pathologists. All three concurred on the presence or absence of intralymphatic cancer in 12 of the 35 cases. Observers agreed on the absence of blood vessel invasion in 30 of the 35 cases. There was no consistent bias on the part of a single reviewer, either alone or with another pathologist, in identifying the emboli. We conclude that the identification of intralymphatic cancerous emboli in mastectomy specimens is not a reliably reproducible prognostic finding on which recommendation of systemic chemotherapy in stage I breast carcinoma patients can be based.

Breast Neoplasms↗
PubMed1982

Clinical experience with a prototype real-time dedicated breast scanner.

The evaluation of 1,003 sonomammographic examinations on a predominantly symptomatic population using a prototype real-time dedicated breast scanner is presented. Interpretations were initially made by one of four experienced radiologists without knowledge of clinical data (i.e., symptoms, age, physical findings, or other imaging modality interpretations). A second interpretation was subsequently made with this information. Pathologic confirmation was available on 262 lesions, including 71 carcinomas and 191 benign biopsies. Of the carcinomas, 19 were smaller than 2.0 cm in diameter. The sensitivity of sonographic detection of breast cancer on initial readings was 0.76 and on second readings with clinical data was 0.85. The specificity for a benign reading on sonography was 0.80 on initial interpretation and 0.81 on the second interpretation.

Adolescent↗
PubMed1982

Ultrasound mammography for male breast enlargement.

Fourteen men referred for ultrasound evaluation of breast enlargement had ultrasound mammography using water path techniques. Gynecomastia, both the localized type and the diffuse type, could be differentiated from the normal soft tissues of the chest wall on the B-scans. Among nine cases of men who underwent excision, there were six cases of gynecomastia, two lipomas, and one biopsy revealed normal subcutaneous tissue. The ultrasound B-scan images are correlated with the histologic findings in these nine cases. Ultrasound mammography using water path techniques is a useful imaging examination for male breast enlargement.

Adult↗
PubMed1981

Ultrasound mammography: a comparison with radiographic mammography.

The results of 1,029 ultrasound B-scan examinations of the breast using two automated water-path scanners were correlated with histopathology data in 278 patients who had undergone biopsy. Of the 1,029 patients, a subgroup of 709 patients had both ultrasound mammograms (USM) and radiographic mammograms (XRM) obtained. A sensitivity for breast cancer of 69% was found for USM and 74% for XRM on initial independent readings when there was no knowledge of clinical data. These are not statistically different using the McNemar test for paired comparisons. When the USM were reinterpreted with the knowledge of the patient's age, history, physical examination, and, when available, the XRM interpretation, the USM sensitivity for breast cancer was 79%.

Adolescent↗
PubMed1981

Synovial sarcoma: a clinical, pathological, and ultrastructural study of 26 cases supporting the recognition of a monophasic variant.

Twenty-six cases of synovial sarcoma (14 biphasic, 12 monophasic) were subjected to a clinicopathological study that included electron-microscopic examination of six tumors. Monophasic tumors were composed predominantly of uniform, densely packed, small spindle cells with scant cytoplasm identical to those of the "stromal" elements of typical biphasic tumors. The arrangement of these cells into narrow interlacing fascicles, forming tight whorls and showing little collagenization, was distinctive for this tumor. Major clinical differences between the two types of synovial sarcoma were the tendency for monophasic tumors to arise in distal extremity locations (seven of 10), and the poorer prognosis of monophasic tumors, 30% surviving 5 years compared to 58% for biphasic tumors. At the ultrastructural level, monophasic tumors and the spindle-cell components of biphasic tumors were identical. Both were composed of spindle or polygonal cells attached by numerous desmosomes. Prominent Golgi, abundant RER, perinuclear microfilaments, and glycogen aggregates were characteristic. Intercellular spaces containing elongated cytoplasmic filopodia were observed consistently, as were fragments of basement membrane-like material. The EM findings concur with those described previously in normal and pathologic synovium, and support a synovioblastic origin for the monophasic variant of synovial sarcoma.

Adolescent↗
PubMed1981

Intravascular fasciitis: a report of 17 cases.

Seventeen cases of intravascular fasciitis were reported from the files of the AFIP (14 cases) and the Pathology Department, Thomas Jefferson University Hospital (three cases). It is characterized by the histologic features of nodular fasciitis but with intraluminal, intramural, and extramural involvement of small to medium-sized veins and arteries and multinodular or serpentine growth along the course of affected blood vessels. A painless, slowly growing mass was most common. Fourteen patients (82%) were under age 30 (range 1/2-57 years); the sex ratio was about equal. Seven cases were located in the upper extremity (three hand, two wrist or forearm, two shoulder), three on the ankle or lower leg, five on the head and neck, and two in the chest wall and breast. Most cases were small with a mean diameter of 1.5 cm, but two were elongated masses measuring 4-5 cm in length. At surgery, four cases showed intimate association with large veins or arteries. This type of fasciitis is rare and has been found in only one of 14 consecutive cases of modular fasciitis operated at this university hospital between 1969 and 1978. Six of 15 consultation cases were originally confused with sarcoma. Intravascular fasciitis is benign. Seven patients were free of disease from 2.5 to 20 years (mean 9.5 years); two patients had local recurrences.

Adolescent↗
PubMed1980

Immunohistologic study of blood group substances in polyps of the distal colon. Expression of a fetal antigen.

Forty-four polyps and 14 adenocarcinomas of the left colon from 28 patients were studied for the presence of blood group substances of the A, B system, using the method of specific erythrocytic adherence. Forty-one percent of all polyps and 57% of all cancers were found to have reactivity for blood group substances. Fifty-four percent of villous adenomas (seven of 13), 39% of tubular adenomas (five of 13), 14% of mixed tubulovillous adenomas (one of seven), and no hyperplastic polyps (zero of four) showed reactivity for blood group substances. Lesional blood group substance reactivity, when present, was the same as that for the patient's own blood group type, with the exception of two patients of B blood group type, whose lesions had A-blood group substance reactivity. Cytologic atypia showed no correlation with the presence of blood group substances. Polyps with blood group substance reactivity were seen more frequently in patients with cancer. Twelve patients had both a cancer and a polyp studied, with both polyp and cancer showing similar blood group substance reactivity for nine of these patients. A, B, H-blood group substances in the left colon are normally absent in the adult and present only in the fetus. The reappearance of these fetal antigens in both polyps and cancers adds immunologic evidence to the theory that colonic adenocarcinoma evolves through a polyp-cancer sequence.

ABO Blood-Group System↗
PubMed1980

Clinically occult breast cancer. Multicentricity and implications for treatment.

Two hundred thirty-two biopsies have been performed for nonpalpable mammary lesions, detectable by mammography, but not clinically apparent. Sixty-two malignancies were demonstrated within this group, including thirty invasive ductal cancers, seven minimally invasive ductal cancers, 20 noninvasive ductal cancers, and five lobular carcinomas-in situ. When mastectomy specimens were examined for evidence of multifocal cancer in quadrants other than that in which the primary was located, 39.6% of the breasts examined demonstrated evidence of multifocal cancer ductal or lobular, invasive or non-invasive. These findings suggest that any therapeutic procedure for invasive or noninvasive ductal cancer which does not include total mastectomy may leave behind foci of cancer which may be a threat to the patient.

Adult↗
PubMed1979

Thyroid carcinoma: a clinical and pathologic study of 125 cases.

Retrospective clinicopathological study of 125 thyroid carcinoma cases followed for 9 to 19 years was performed. Case selection for unfavorable histologic type and advanced disease was observed for referred cases. All medullary and anaplastic tumors were in patients over age 40; younger patients all had papillary and follicular carcinoma. Actuarial survival rates showed favorable outcome from papillary carcinoma followed by follicular and medullary or anaplastic tumors. Within the papillary carcinoma group, older age and male sex adversely affected survival; the former appeared related to clinical stage at presentation. Clinically palpable papillary carcinomas that were poorly circumscribed or showed vascular invasion were associated with poorer survival than tumors without these features. For papillary carcinomas under 1.5 cm, soft tissue invasion, vascular invasion, and occult lymph node metastases did not effect disease free survival. Two deaths from thyroid cancer were observed in this group, however, in patients who presented initially and with distant metastases. The biology of these small lesions is briefly discussed.

Adenocarcinoma↗
PubMed1979

Adenomatous and carcinomatous changes within hyperplastic colonic epithelium.

Hyperplastic colonic polyps are benign, nonneoplastic proliferations; unlike tubular and villous adenomas, they do not predispose the patient to colonic cancer. Theoretically, these hyperplastic polyps, like normal colonic epithelium, should be able to undergo adenomatous transformation and possibly develop into cancer. In this report, we discuss an unusual case of a patient with numerous hyperplastic polyps, in which adenomatous changes occurred and cancer developed. We also discuss the significance of these changes as they relate to the polyp-cancer sequence.

Adenoma↗
PubMed1979

Low-grade mucoepidermoid carcinoma of the breast.

Two cases of primary breast carcinoma morphologically identical to low-grade mucoepidermoid carcinoma of salivary gland origin occurred. To our knowledge, this article represents the first description of this tumor type in the breast. Both lesions were well circumscribed, wholly or partially cystic, and composed of intimately associated, well-differentiated, squamous and mucinous glandular epithelium. It is suggested that these may represent an indolent tumor type in the breast analogous to their behavior in the salivary gland.

Aged↗
PubMed1978

Clinicopathologic correlations and significance of clinically occult mammary lesions.

Experience with 189 clinically occult, i.e., nonpalpable breast lesions is presented. The described technique of localization and excision all but guarantees removal of even the smallest radiographically suspicious findings with an inconspicuous incision and minimal breast deformity. The incidence of carcinoma encountered in these 189 biopsies is 27.5%. Axillary node metastases were present in less than 25% of the invasive nonpalpable cancers, approximately half of what might have been expected if the lesions had been discovered in the usual manner. There were no patients with axillary node metastases among those with in situ ductal or microinvasive ductal carcinomas. This implies a better prognosis and lower death rate from breast cancer in these patients. Screening programs employing mammography, designed to detect breast cancers in this pre-palpable stage, are encountered as a means of uncovering a higher proportion of such cancers at an earlier stage in their natural histories.

Adolescent↗
PubMed1978

Tubular carcinoma of the breast.

Retrospective pathologic review of 636 breast carcinomas from 611 patients revealed twelve tumors which were pure low grade tubular carcinoma (TC) and nineteen tumors with features combining both low grade tubular carcinoma and invasive duct carcinoma (T&D). A control group of 23 cases consisted of invasive duct carcinoma with at least a third of the tumor surface area showing tubular formation, but without the low grade features of tubular carcinoma. Life table analysis at 15 years showed a 100%, 72%, and 33% survival for TC, T&D, and controls, respectively. Eight percent of TC and 21% of T&D had axillary metastases compared to 67% for controls. Axillary metastases had no detrimental effect on TC or T&D survival. There were no recurrences in the TC group. Patients with T&D with tumor diameter 1.0 cm or less with 50% or greater low grade tubular carcinoma component are alive and well. The mean age of T&D was 7 years greater than TC. The combined TC and T&D group showed a significant incidence of multiple cancers in the ipsilateral breast and a significant trend toward bilateral cancers when compared to controls. Tubular carcinoma has an inherently low malignant potential with a histological and biological spectrum.

Adenocarcinoma↗
PubMed1978

Tubular carcinoma of the breast. Mammographic appearance and pathological correlation.

Xeromammographic and pathological findings in 17 cases of tubular carcinoma of the breast are presented. No patients had axillary lymph node involvement. The mean lesion size was 0.95 cm. Thirteen lesions (76%) were clinically occult. Because of the characteristic histological pattern of infiltrative growth and marked desmoplasia, 81% (13/16) were seen on xeromammography as scirrhous masses, 19% (3/16) only as microcalcifications. None appeared as a well-circumscribed mass or poorly defined density.

Aged↗
PubMed1977

Epithelioid sarcoma: ultrastructural similarity to nodular synovitis.

The ultrastructure of nodular synovitis of the knee and epithelioid sarcoma of the hand are compared. Both lesions show a similar pattern of light and dark cells having filopodia and microvilli, an outer coat of finely granular matrix without well defined basal laminae, maculae adherentes and attachment sites, pinocytotic vesicles, cytoplasmic filaments and complex nuclear invaginations. These similarities suggest a common histogenesis and support the concept that the epithelioid sarcoma is derived from synovioblastic mesenchyme.

Cell Membrane↗