Biomedical subjects
A Y Dixon
Publications and source records attributed to A Y Dixon.
Fatal peliosis of the liver and spleen in a patient with agnogenic myeloid metaplasia treated with danazol.
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Histologic features predictive of basal cell carcinoma recurrence: results of a multivariate analysis.
Previous univariate analysis of 30 recurrent and 74 non-recurrent basal cell carcinomas identified 6 histologic parameters predictive of recurrence: distance to the closest resection margin, growth pattern, shape of cell groups, contour of invading edge, degree of peripheral palisading, and nuclear pleomorphism. Re-analysis of the data by multivariate analysis to select the few most important independent prognostic variables identified two parameters in each of two final models: resection margin distance and growth pattern (Model 1), and resection margin distance and shape of cell groups (Model 2). Based on these variables, a logistic regression equation could be derived for each model to calculate the predicted probability of recurrence or non-recurrence.
Pulmonary mucinous cystic tumor. Case report with review of the literature.
Mucinous cystic tumors of the lung are exceedingly rare. We describe the case of a 59-year-old white man with a left upper lobe mass documented on chest radiographs 11 years before thoracotomy. Grossly, the lobectomy specimen contained a 4.5 x 4.5 x 4.0 cm cystic gelatinous mass with complete occlusion of the anterior segmental bronchus by mucinous material. Although microscopically this pulmonary mucinous cystic tumor contained a focus of marked glandular atypia consistent with adenocarcinoma, the patient has remained free of recurrence or metastasis during 5 years of close postoperative follow-up. Pulmonary mucinous cystic tumors appear to have a remarkably favorable prognosis and should be distinguished from other common lung neoplasms.
Histologic evolution of basal cell carcinoma recurrence.
The biological behavior and appropriate therapy of recurrent basal cell carcinoma (BCCA) is controversial, with some studies suggesting that this tumor becomes more aggressive with each recurrence, and other studies indicating that the majority are aggressive from the onset. The authors studied the histologic evolution of BCCA by comparing 29 original tumors with their subsequent recurrences to determine if there were any predictable histologic changes. There were borderline statistically significant changes only in degree of fibrosis, prominence of nucleoli, and mitotic frequency. There were no statistically significant changes in any of the other parameters, including those that were shown previously to be predictive of recurrence or aggressive behavior. The results of this study clearly indicate that the majority of recurrent BCCAs are aggressive from the onset, and that in many cases this can be predicted from the histomorphology of the original tumor.
Metastatic basal cell carcinoma: report of a case presenting with respiratory failure.
Metastasis from basal cell carcinoma (BCC) of skin is rare. A case of a 58-year-old male presenting with increasing shortness of breath and right pleural effusion is described. Open right pleural biopsy demonstrated metastatic carcinoma consistent with BCC. Review of medical records from another hospital revealed that four years previously a recurrent BCC had been excised from the left back. One and three years prior to this excision, a skin lesion at this same site had been treated with electrocautery. Review of the skin excision slides demonstrated infiltrating BCC histologically very similar to the metastatic pleural neoplasm. The patient died two months after the pleural biopsy. At autopsy, the cutaneous BCC had not recurred and metastatic BCC extensively infiltrated the pleura bilaterally, with focal involvement of underlying lung parenchyma, subcarinal lymph nodes, diaphragm, and pericardium.
Subdural hematoma associated with metastatic neoplasms.
Two cases of subdural hematoma, one acute and the other chronic, associated with cancer metastatic to the dura are reported. Various mechanisms of the association of hematomas with cancer are reviewed.
Project L.I.N.C. (Ladders In Nursing Careers): an innovative model of educational mobility.
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Factors predictive of recurrence of basal cell carcinoma.
Thirty recurrent basal cell carcinomas were compared with 74 nonrecurrent basal cell carcinomas to identify clinical and histologic features predictive of recurrence. Three clinical parameters were evaluated: age, duration, and location; only location proved to be of prognostic significance. Among the histologic parameters, statistically significant differences between the recurrent and nonrecurrent groups were found in: measured distance to the resection margins, shape of cell groups, growth pattern, contour of invading edge, and degree of peripheral palisading and nuclear pleomorphism. Degree of fibrosis, cystic change, and atypical squamous change were of possible prognostic significance. There were no statistically significant differences between the two groups regarding: measured depth of invasion and diameter, degree of inflammation, actinic change, tumor necrosis, nuclear hyperchromasia, nucleoli, mitoses, amount of melanin or amyloid, and size of cell groups. Based on histologic findings, the pathologist may in many cases be able to suggest to the surgeon which tumors are more likely to recur and therefore require more aggressive therapy.
Saccharomyces cerevisiae pneumonia in a patient with acquired immune deficiency syndrome.
The clinical course of a patient with a polymicrobial pneumonia that included Saccharomyces cerevisiae infection is described. S. cerevisiae was recovered from autopsy cultures of the lungs, spleen, oral mucosa, and small intestine, and organisms morphologically consistent with S. cerevisiae were visualized in histologic sections of the lung. The role of this organism as a human pathogen is reviewed.
Effect of corticosteroid treatment on cell recovery by lung lavage in acute radiation-induced lung injury.
The purpose of this study was to quantitate cell populations recovered by lung lavage up to 6 weeks following thoracic irradiation (24 Gy) as an index of the acute inflammatory response within lung structures. Additionally, rats were treated five times weekly with intraperitoneal saline (0.3 cc) or methylprednisolone (7.5 mg/kg/week). Lung lavage of irradiated rats recovered increased numbers of total cells compared to controls beginning 3 weeks after irradiation (P less than 0.05). The initial increase in number of cells recovered was attributable to an influx of neutrophils (P less than 0.05), and further increases at 4 and 6 weeks were associated with increased numbers of recovered macrophages (P less than 0.05). Lung lavage of steroid-treated rats at 6 weeks after irradiation recovered increased numbers of all cell populations compared to controls (P less than 0.05); however, numbers of recovered total cells, macrophages, neutrophils, and lymphocytes were all significantly decreased compared to saline-treated rats (P less than 0.05). The number of inflammatory cells recovered by lung lavage during acute radiation-induced lung injury is significantly diminished by corticosteroid treatment. Changes in cells recovered by lung lavage can also be correlated with alteration in body weight and respiration rate subsequent to treatment with thoracic irradiation and/or corticosteroids.
Environments of care for the patient with Alzheimer's disease.
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Project L.I.N.C. (ladders in nursing careers). An innovative model of educational mobility.
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Adenocarcinoma of the lung: a comparative diagnostic study using light and electron microscopy.
Several techniques for diagnosing adenocarcinoma of the lung are commonly available, but the frequency of their use and diagnostic sensitivity may vary. Twenty cases of primary lung adenocarcinoma obtained at surgery were studied by the following four routine techniques: light microscopy (LM) using hematoxylin-eosin (H&E) stain, mucicarmine stain, and PAS-diastase stain, and electron microscopy (EM). Three observers independently determined the positivity (0 [none], +/- [equivocal], 1 + [slight], 2 + [moderate], 3 + [marked]) of each of these cases for lumen formation in H&E-stained sections (LM lumens), intracytoplasmic (cytoplasmic mucicarmine) or intraluminal (luminal mucicarmine) mucicarmine, intracytoplasmic (cytoplasmic PAS) or intraluminal (luminal PAS) PAS-diastase, and lumen formation (EM lumens) or microvilli (EM microvilli) on electron microscopy. Comparative matching of these seven microscopic determinants (using Wilcoxon signed-rank test) demonstrated significant (P less than .01) sensitivity of EM microvilli over EM lumens, EM microvilli over luminal mucicarmine, cytoplasmic PAS over luminal mucicarmine, EM microvilli over cytoplasmic mucicarmine, cytoplasmic PAS over cytoplasmic mucicarmine, and EM microvilli over LM lumens, and a significant (P less than .05) sensitivity of cytoplasmic PAS over LM lumens, EM microvilli over luminal PAS, luminal PAS over luminal mucicarmine, and cytoplasmic PAS over EM lumens. Friedman's nonparametric test (P less than .05) indicated a significant difference among the microscopic determinants. The most sensitive was EM microvilli (mean rank score, 5.17) followed by cytoplasmic PAS (4.77), luminal PAS (4.02), cytoplasmic mucicarmine (3.62), LM lumens (3.52), EM lumens (3.47), and luminal mucicarmine (3.40). However, each of the diagnostic techniques had case examples positive for one, but not for the others, indicating that maximum yield of adenocarcinoma diagnoses will be obtained by performing all four techniques (H&E, mucicarmine, PAS-diastase, and electron microscopy.
Dual carcinoid tumors of Meckel's diverticulum presenting as metastasis in an inguinal hernia sac: case report with literature review.
Neoplasms arising in Meckel's diverticulum or involving hernia sacs are rare. The authors present a unique case of two asymptomatic carcinoid tumors arising in a Meckel's diverticulum, which were discovered because of microscopic metastasis in a grossly unremarkable inguinal hernia sac. This article describes the clinical and morphologic features of this unusual case, reviews the topic of neoplasms involving hernia sacs and Meckel's diverticula, and includes a brief review of immunocytochemical findings in carcinoid tumors.
Chronic relapsing pancreatitis with pseudocyst erosion into the portal vein and disseminated fat necrosis.
A 63-year-old man with the triad of chronic relapsing pancreatitis, disseminated fat necrosis with subcutaneous nodular panniculitis, and polyarthritis was found to have a pseudocyst which had eroded into the portal vein. These lesions were associated with markedly elevated serum pancreatic enzymes. Although recent immunological studies by others suggest a possible contribution of immune-mediated tissue injury, clinical and pathological evidence in the present case including direct tissue immunofluorescent findings do not support an immune pathogenesis of this association. The present study further substantiates the concept of physiochemical tissue injury by circulating pancreatic enzymes as the primary pathogenetic mechanism.
Legionnaires' disease associated with rash and renal failure.
Legionnaires' disease is recognized as a multisystemic illness. Afflicted patients may have pulmonary, gastrointestinal tract, and central nervous system complications. However, dermal involvement is not well documented and renal insufficiency is uncommon and usually of mild severity. We report two consecutive cases of proven Legionella infection that were unusual in that a macular rash and profound renal failure requiring hemodialysis were noted. Skin biopsy specimens of the rash and autopsy findings suggest that these atypical features may have been mediated by the Legionella infection. Although it is not entirely clear from these two cases, we suggest that the skin and renal involvement may have been mediated by either a "toxin" elaborated by the organism, an immunologic response of the host to the organism, or some other unidentified mechanism.
Primary omental leiomyosarcoma masquerading as hemorrhagic ascites.
An 85-year-old man with unexplained hemorrhagic pseudoascites of four years' duration was discovered to have a primary omental leiomyosarcoma. Neoplasms arising in the greater omentum are rare. To date, only three primary omental leiomyosarcomas have been described. Clinical and pathologic findings of this case are presented and the topic of primary omental neoplasms is reviewed.