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B M Wenig

Publications and source records attributed to B M Wenig.

At least 55 records · Page 3Linked to original sources
PubMed1995

Inflammatory myofibroblastic tumor of the larynx. A clinicopathologic study of eight cases simulating a malignant spindle cell neoplasm.

BACKGROUND: Inflammatory myofibroblastic tumors of the larynx are uncommon lesions that easily may be misinterpreted as malignant epithelial or mesenchymal spindle cell neoplasms. METHODS: Eight cases of laryngeal inflammatory myofibroblastic tumors were identified from the files of the Otolaryngic Tumor Registry--Armed Forces Institute of Pathology. Clinical records and follow-up were available in all cases. The light microscopic features (hematoxylin and eosin and special histochemical stains) were evaluated in all cases; immunohistochemical analysis was performed in the seven cases with available paraffin blocks; in four cases ultrastructural analysis was done. RESULTS: The patients included five males and three females ranging in age from 19-69 years (median, 59 years). Presenting symptoms included hoarseness, dysphonia, or rapidly progressive stridor with the duration of symptoms ranging from 10 days to 4 months. The most common site of involvement was the true vocal cord. The lesions appeared as polypoid or pedunculated masses. Histologically, the cellularity of the lesions varied, consisting of spindle-shaped to stellate cells with no consistently discernible growth pattern, in a fibromyxoid stroma that included a mixed inflammatory cell infiltrate. Features suggesting a malignant cellular infiltrate were not present. The spindle-shaped cells had consistent immunoreactivity with vimentin, muscle specific actin, and smooth muscle actin. Ultrastructurally, intracytoplasmic microfilaments were identified. In seven of the patients, conservative but complete excision of the lesion was curative; these patients have been free of disease over periods ranging from 12 to 36 months. In one patient, the lesion recurred twice over a 2-year period and ultimately required a total laryngectomy. This patient died of unrelated causes. CONCLUSIONS: Inflammatory myofibroblastic tumors of the larynx are unusual benign proliferative lesions. Conservative surgical management is advocated and is curative. Recurrence is rare, but metastases disease or death attributable to these lesions is not.

Actin Cytoskeleton↗
PubMed1995

Aggressive psammomatoid ossifying fibromas of the sinonasal region: a clinicopathologic study of a distinct group of fibro-osseous lesions.

BACKGROUND: Psammomatoid ossifying fibromas represent a unique subset of fibro-osseous lesions of the sinonasal tract. They have distinctive histomorphologic features and a tendency toward locally aggressive behavior, including invasion and destruction of adjacent anatomic structures. METHODS: Seven cases of psammomatoid ossifying fibromas of the sinonasal tract were identified in the files of the Otolaryngic Tumor Registry at the Armed Forces Institute of Pathology. Medical records, including the clinical history, location of the lesions, radiographs, treatment, and follow-up were reviewed in each case. Follow-up information was available in all of the cases. RESULTS: Four of the patients were male and three were female. The patient's ages ranged from 5 to 54 years (median age, 33 years). Symptoms included facial swelling, nasal obstruction, pain, sinusitis, headache, and proptosis. Radiographic studies confirmed the presence of an osseous and/or soft tissue mass varying in appearance from well demarcated without invasion or erosion to invasive with bone erosion and intracranial extension. Sites of involvement included the nasal cavity and all paranasal sinuses, particularly the ethmoid and maxillary sinuses. Often, more than one sinus was involved and extension of disease included involvement of the orbit, nasopharynx, palate, and anterior cranial fossa. The histologic appearance was characterized by the presence of small mineralized (psammomatoid) bodies admixed with a cellular stroma with a variable amount of myxomatous material and scattered giant cells. Confusion with other osseous and soft tissue tumors may occur resulting in too limited or too aggressive management. En bloc surgical excision is the treatment of choice and may prove curative. Aggressive behavior with recurrence(s) or invasion into adjacent structures occurred. At the time of this writing, the patients are alive over follow-up periods ranging from 6 months to 7 years. CONCLUSIONS: Gnathic and midfacial fibro-osseous proliferations are a diverse group of lesions. A subset of these fibro-osseous lesions with predilection for the sinonasal tract were identified. These lesions are characterized by their distinctive histology, including psammomatoid ossicles and their locally aggressive growth. Complete surgical removal is the treatment of choice.

Adult↗
PubMed1995

Laryngeal mucosal malignant melanoma. A clinicopathologic, immunohistochemical, and ultrastructural study of four patients and a review of the literature.

BACKGROUND: Primary laryngeal mucosal malignant melanomas are uncommon tumors that morphologically are readily confused with more common types of laryngeal cancer. METHODS: Four cases of primary laryngeal mucosal malignant melanoma were identified from the files of the Otolaryngic Tumor Registry-Armed Forces Institute of Pathology. Clinical records were available for all four cases. Paraffin blocks or unstained slides were available for three of the four cases. The light microscopic features were evaluated in all cases. Immunohistochemistry was performed in three cases; electron microscopic analysis was performed in two cases. Follow-up data was available in three of the four cases. RESULTS: The patients were all males and ranged in age from 35 to 84 years. The clinical presentations included hoarseness, hemoptysis, dysphagia, and airway obstruction, with complaints ranging from 1 to 8 months. The sites of involvement included the supraglottic larynx and the right true vocal cord. A history of cutaneous melanoma or of a melanoma of another site was not reported for any of the patients. Histologically, the tumors were invasive and composed of a pleomorphic epithelioid cell population of malignant cells. Malignant spindle-shaped cell could also be identified. The presence of melanin was identifiable by light microscopy in two cases; Fontana stains confirmed the presence of melanin in the other two. The immunohistochemical findings showed diffuse immunoreactivity with S-100 protein and HMB-45. There was no immunoreactivity with cytokeratin. The specimen of one patient demonstrated focal immunoreactivity with chromogranin. Electron microscopic features included the presence of premalonosomes or melanosomes. Total laryngectomy was the treatment of choice supplemented with radiotherapy. Follow-up information was available for three patients and all three died of metastatic disease within 36 months of diagnosis. Metastasis occurred to the brain, lungs, spine, and regional lymph nodes. The fourth patient was lost to follow-up. CONCLUSIONS: Laryngeal mucosal malignant melanoma is an uncommon neoplasm that clinically and pathologically simulates more conventional types of laryngeal cancers. The light microscopic, immunohistochemical, and electron microscopic findings confirm the diagnosis. Aggressive management is indicated, as these tumors disseminate widely and are rapidly fatal.

Adult↗
PubMed1995

Non-Hodgkin's lymphoma of the sinonasal tract. A clinicopathologic and immunophenotypic study of 120 cases.

BACKGROUND: Non-Hodgkin's lymphomas (NHLs) of the sinonasal tract are uncommon neoplasms that can be morphologically difficult to distinguish from destructive nonneoplastic processes or other malignant neoplasms in this site. METHODS: From the files of the Otolaryngic Tumor Registry-Armed Forces Institute of Pathology from 1965 to 1992, 120 cases of NHL involving the sinonasal tract were selected for which clinical records and paraffin-embedded tissue blocks were available. The histologic features and immunophenotypic findings of each patient were examined, and follow-up data were obtained for 66 (55%). RESULTS: The ratio of males to females was 1.35:1, and the ages ranged from 3 to 94 years (median, 59 years). Sixty percent of the cases of NHL occurred in the patients' sixth to eighth decades of life. Clinical presentations varied according to histologic type. The low grade lymphomas presented with a nasal cavity or paranasal sinus mass associated with obstructive symptoms. The high grade lymphomas were more likely to present with aggressive signs and symptoms including nonhealing ulcer, cranial nerve manifestations, facial swelling, epistaxis, or pain. Of note, the high grade B-cell lymphomas tended to present with soft tissue or osseous destruction, particularly of the orbit with associated proptosis, whereas the T-cell lymphomas were associated with nasal septal perforation and/or destruction. Sites of disease included the nasal cavity, one or more paranasal sinuses, or multiple regions within the sinonasal tract. Of patients who received adequate follow-up, nodal and extranodal dissemination were identified in a limited number (n = 11). Nodal dissemination occurred in cervical and axillary lymph nodes. Extranodal sites of involvement included the larynx, skin, liver, uvula, kidney, breast, lacrimal gland, testis, and prostate gland. There was a wide spectrum of morphologic types of lymphoma, classified according to the Working Formulation. Immunophenotypic analysis on paraffin embedded tissue sections of all patients demonstrated a B-cell to T-cell ratio of 1.18:1. Treatment primarily included radiotherapy and chemotherapy. Follow-up information was available for 66 (55%) patients ranging from 1 to 16 years (median, 3 years). Of these 66 patients, 24 (36.4%) died of disease, 17 (25.7%) are alive without disease, 13 (19.7%) are alive with disease, and 12 (18.2%) are dead of unrelated or unknown causes. CONCLUSIONS: Non-Hodgkin's lymphomas of the sinonasal tract are heterogeneous diseases that can be clinically aggressive. The frequency of these lymphomas in the United States cannot be estimated accurately because all of our cases were of histologic slides submitted for consultations. There appears, however, to be a slight B-cell predominance in this population that previously has been observed, unlike in South America and Asia where the majority of cases have a T-cell phenotype.

Adolescent↗
PubMed1995

Primary mucoepidermoid carcinoma of the thyroid gland: a report of six cases and a review of the literature of a follicular epithelial-derived tumor.

Primary mucoepidermoid carcinomas of the thyroid gland are uncommon tumors of low-grade malignant potential. We report six cases of thyroid mucoepidermoid carcinoma, four occurred in women and two in men with an age range of 29 to 57 (median, 46 years). The clinical presentation was that of a painless mass. Radiographic studies showed a single, solid, "cold" nodule in either the right or left lobe, or isolated to the isthmus. There was no history of a mucoepidermoid carcinoma developing in more typical locations (eg, salivary gland) in any of the patients. Histologically, the tumors were characterized by an intimate admixture of squamoid/epidermoid cells and mucocytes. The tumors were delineated but not encapsulated with prominent cyst formation and a variable amount of associated fibrosis. The squamoid component showed horny pearl formation, individual cell keratinization and/or the presence of intercellular bridges. Intracytoplasmic and luminal epithelial mucin was observed in all cases. In three of the cases a prominent eosinophilic cellular infiltrate was intimately identified within the neoplastic proliferation. One other case was noteworthy for the presence of ciliated epithelium. In all of the cases the uninvolved thyroid tissue showed the presence of lymphocytic thyroiditis. Rare foci of squamous metaplasia were observed in two of the cases. A microscopic focus of thyroid papillary carcinoma was observed adjacent to the mucoepidermoid carcinoma in one case. Immunohistochemical evaluation of the mucoepidermoid carcinoma showed the following antigenic profile: cytokeratin (five of five), CAM 5.2 (four of four), thyroglobulin (five of six), calcitonin (none of six), chromogranin (none of six), polyclonal carcinoembryonic antigen (four of four), and monoclonal carcinoembryonic antigen (none of five). Surgical excision was the treatment of choice. All of the patients reported are alive without disease (recurrence or metastasis) over periods ranging from 1 to 15 years. Based on our findings, we believe that these tumors are of low-grade malignant potential and originate from thyroid follicular epithelial cells rather than from solid cell nests of the ultimobranchial body.

Adult↗
PubMed1995

Lipomas of the larynx and hypopharynx: a review of the literature with the addition of three new cases.

Lipomas of the larynx and hypopharynx are uncommon mesenchymal neoplasms. This report discusses the clinical and pathological features of three cases of laryngeal and hypopharyngeal lipomas. Two of the cases occurred in females and one in a male. The ages of the patients were 28, 51 and 51 years respectively. Two of the cases involved the supraglottic larynx (left arytenoid and left vestibular fold); the third involved the pyriform sinus. Symptoms included airway obstruction, dysphagia, throat discomfort, a sensation of excessive secretions in the throat and an increase in snoring. The complaints occurred over periods ranging from several months to one year in duration. Clinically, a polypoid lesion described as yellow in appearance was seen. Histologically, the tumours were composed of mature adipocytes without evidence of pleomorphism, lipoblasts or infiltrative growth. Surgery was the treatment of choice and included simple but complete excision in two of the cases. In these two cases, surgery proved curative with follow-up periods of 11 and seven years, respectively. In one case, the initial tumour was removed in pieces. This lesion recurred 15 years after the initial resection and was totally excised at that time. This patient has been free of tumour for more than five years.

Adult↗
PubMed1995

Necrotizing sialometaplasia of the larynx. A report of two cases and a review of the literature.

Two cases of necrotizing sialometaplasia of the larynx are reported. One of the cases occurred in the subglottic larynx of a 37-year-old woman and the other occurred in the right false vocal cord of a 59-year-old man. In both of the cases, the sialometaplasia was identified in association with another pathologic process. The female patient presented with dysphagia. Excisional biopsy was performed twice in the span of an 8-day period. Both biopsy specimens showed fibrosis. The subglottic stenosis was felt to be of undetermined origin. There was evidence of necrotizing sialometaplasia in only the second biopsy material. Subsequently, the patient was diagnosed as having relapsing polychondritis, the probable cause of the subglottic stenosis. The male patient presented with increasing hoarseness and was found to have a mass of the right false vocal cord. Biopsy of the mass was diagnostic for a poorly differentiated squamous cell carcinoma with separate foci of necrotizing sialometaplasia. In both cases, it appears that the sialometaplasia occurred secondary to the other pathologic processes with the likely pathogenesis the result of vascular compromise to the affected area.

Adult↗
PubMed1995

Amyloid goiter. A clinicopathologic study of 14 cases and review of the literature.

The authors report the clinicopathologic features of 14 cases of amyloid goiter (AG). Eleven patients were males and three females with ages ranging from 23 to 75 years (median, 54 years). Eight patients had secondary amyloidosis and six had primary amyloidosis. Nine cases were identified at autopsy. In symptomatic patients (n = 5), the clinical presentation included a nontender, rapidly enlarging neck mass with associated dysphagia, dyspnea or hoarseness. Clinical or laboratory evaluation failed to detect evidence of thyroid dysfunction. The histologic appearance of the thyroid predominantly consisted of diffuse amyloid deposition surrounding thyroid follicles. In two cases, a nodular pattern of amyloid deposition was seen resulting in compression and distortion of the follicular architecture. Areas of mature adipose tissue and focal lymphocytic thyroiditis with or without foreign-body type-giant cells were seen in approximately one third of the cases. Confirmation of amyloid was made by the presence of congophilia and apple-green birefringence under polarized-light microscopy. Immunohistochemical evaluation demonstrated the presence of amyloid A immunoreactivity. No Immunoreactivity was seen with calcitonin or thyroglobulin. Fine-needle aspiration may facilitate the diagnosis, as occurred in one the patients. In symptomatic patients, thyroidectomy is warranted to alleviate pressure symptoms.

Adult↗
PubMed1995

Primary basaloid squamous cell carcinoma of the trachea.

Basaloid squamous cell carcinoma (BSCC) is an unusual but well-established entity, primarily in the upper aerodigestive tract, composed of basaloid cells associated with dysplastic to neoplastic squamous cells, and characterized by an aggressive and rapidly fatal course. To date, BSCC originating in the trachea has not been reported. In this article, the authors describe the clinical, gross, and microscopic pathologic, histochemical, and immunohistochemical features of two cases of BSCC arising in the trachea. Features distinguishing this entity from other, more common tumors of the trachea, including metastases and direct extension from other sites of origin, are also discussed.

Aged↗
PubMed1995

The columnar cell variant of thyroid papillary carcinoma. Case report and discussion of an unusually aggressive thyroid papillary carcinoma.

The columnar cell variant of thyroid papillary carcinoma is an aggressive tumor associated with widespread dissemination and a fatal outcome. We report a case of a 29-year-old white woman who presented with a large thyroid mass extending into the mediastinum with local and distant metastases. The histologic features included focal papillary growth with columnar cells and nuclear stratification. However, the histologic picture was dominated by cells with a clear to vacuolated-appearing cytoplasm similar to that seen in association with secretory-type endometrium. In addition, areas of solid growth and organoid or glandular features were also identified. This tumor followed an aggressive course with widespread metastatic disease unresponsive to all therapeutic intervention. The patient died 7 months after diagnosis. We believe this tumor represents the columnar cell variant of thyroid papillary carcinoma. This is only the second reported case of columnar cell carcinoma to occur in a female. Other than the unusual occurrence in a woman, the clinical and pathologic features of this case are similar to those previously reported, including an aggressive behavior followed rapidly by the death of the patient.

Adult↗
PubMed1995

Pancreatoblastoma. A clinicopathologic study and review of the literature.

Pancreatoblastoma is a rare pancreatic tumor with a distinctive histologic appearance that generally affects infants and young children. We have studied 14 cases of pancreatoblastoma and reviewed 41 previously reported examples. Nine of our cases occurred in children (from newborn to 4 years old; mean, 2.4), and five affected adults (from 19 to 56 years old; mean, 40). There were 8 male cases and 6 female cases. Most patients presented with incidental abdominal masses, although pain, weight loss, and obstructive jaundice were present, but rarely. The tumors were very cellular microscopically, with cytologically uniform epithelial cells arranged in sheets and nests. Well-formed acinar structures were a consistent feature, and several cases contained ectatic ductular formations, rarely exhibiting intracellular mucin. Consistently present were squamoid corpuscles: circumscribed, whorled nests of plump spindle cells with a squamous appearance and occasional keratinization. The stroma was moderate to abundant and frequently quite cellular (especially in the pediatric cases). By immunohistochemistry, the tumors exhibited acinar, endocrine, and ductal differentiation, with positivity for pancreatic enzymes (100%), endocrine markers (82%), and carcinoembryonic antigen (85%). Ultrastructural examination most commonly revealed acinar differentiation, although mucigen granules and neurosecretory granules were also occasionally found. The behavior was variable: 36% of patients developed metastases, especially to the liver. The adult patients did poorly: three of five died of tumor (mean survival, 18 months), and two were alive at 5 and 15 months, respectively. In contrast, five of the six evaluable pediatric patients were alive from 22 months to 22 years after diagnosis, and only one died of tumor after 16 months. Good responses to chemotherapy were noted in the pediatric group.

Adult↗
PubMed1995

Laryngeal paraganglioma versus atypical carcinoid tumor.

Paraganglioma and atypical carcinoid tumor of the larynx are two neuroendocrine neoplasms that have often been confused in the past, and even in the present, in the literature. The clinicopathological profile of the two lesions is presented and the differential diagnosis is discussed. A correct diagnosis is of paramount importance, since treatment and prognosis depend on diagnostic accuracy and differ for the two lesions. Paraganglioma of the larynx is usually benign, whereas atypical carcinoid tumor is malignant and has an aggressive clinical course.

Adolescent↗
PubMed1995

Respiratory epithelial adenomatoid hamartomas of the sinonasal tract and nasopharynx: a clinicopathologic study of 31 cases.

We report the clinicopathologic features of 31 cases of respiratory epithelial adenomatoid hamartomas occurring in the nasal cavity, paranasal sinuses, and nasopharynx. The patients included 27 men and 4 women ranging in age from 27 to 81 years (median, 58 years). Symptoms included nasal obstruction, nasal stuffiness, deviated septum, epistaxis, and chronic (recurrent) rhinosinusitis. The symptoms occurred over various time periods from as short as a few months to up to 8 years in duration. Physical examination identified the presence of a polypoid mass lesion(s), most often identified in one or both nasal cavities (n = 22). Within the nasal cavity the most common site of occurrence was the nasal septum, particularly along its posterior aspect. Other areas within the nasal cavity were also involved, as were the ethmoid sinus, frontal sinus, and nasopharynx. The gross appearance of the mass lesions suggested a diagnosis of an inflammatory polyp, but because of subtle differences, including frequent occurrence along the nasal septum and a more indurated quality, these polyps were considered unusual for the typical inflammatory polyps. Histologically, these lesions were characterized by a prominent glandular proliferation lined by ciliated respiratory epithelium originating from the surface epithelium. The differential diagnosis of these adenomatoid hamartomas includes schneiderian papillomas of the inverted type and adenocarcinomas. Diagnostic misinterpretations may result in untoward surgical intervention. Limited but complete surgical resection was the treatment of choice, following which there were no instances of recurrent disease.

Adult↗
PubMed1995

Atypical stromal cells in inflammatory nasal polyps: immunohistochemical and ultrastructural analysis in defining histogenesis.

The authors investigated 29 cases of sinonasal polyps with atypical stromal cells (ASC). The clinicopathologic features of these lesions were of benign inflammatory polyps except for the presence of ASC. Misinterpretation of these cells resulted in contributor diagnosis of sarcoma (rhabdomyosarcoma). Immunohistochemical study of the ASC demonstrated the presence of actin (smooth muscle and muscle specific), KP-1, and vimentin; no reactivity was seen with desmin, myoglobin, S-100 protein, or glial fibrillary acidic protein (GFAP). Unexpectedly, cytokeratin reactivity was identified in more than 75% of the cases analyzed. Ultrastructural analysis revealed that the ASC shared morphologic features in common with fibroblasts and smooth muscle cells. Based on the light microscopic, immunohistochemical, and ultrastructural findings, it was concluded that the ASC represent reactive myofibroblasts and not a neoplastic proliferation. Follow-up data supported this contention indicating the absence of an aggressive biological course. Misinterpretation as a malignant neoplasm might result in unwarranted and unnecessary therapeutic intervention.

Actins↗
PubMed1995

Liposarcomas of the larynx and hypopharynx: a clinicopathologic study of eight new cases and a review of the literature.

Laryngeal and hypopharyngeal liposarcomas were studied in seven men and one woman. Patient age ranged from 25 to 81 years, with a median of 64 years. Symptoms included dysphagia, airway obstruction, and the sensation of a foreign body in the back of the throat. Histologically, seven of the tumors were of the biologically favorable types, either representing well-differentiated (lipoma-like) liposarcomas or myxoid liposarcomas. One tumor was a pleomorphic liposarcoma. Six of the eight patients had one or more episodes of recurrent tumor. Surgery is the treatment of choice and can include conservative (organ-sparing) procedures. However, to eradicate the tumor completely and thereby prevent recurrent disease, open surgical approaches (i.e., lateral pharyngotomy), rather than endoscopic techniques should be employed. The morbidity rate for laryngeal and hypopharyngeal liposarcomas is high because these tumors tend to recur over extended periods of time. In this study, however, there were no instances of metastatic disease, and no deaths were attributed to liposarcoma. Prospectively, laryngeal and hypopharyngeal well-differentiated (lipoma-like) liposarcoma is a difficult clinical and histopathologic diagnosis to establish. Often, this diagnosis is made only after one or more episodes of recurrent disease.

Adult↗
PubMed1994

Identification, classification, treatment, and prognosis of laryngeal paraganglioma. Review of the literature and eight new cases.

This study details the clinicopathologic features of 62 cases of laryngeal paraganglioma (LP), including 54 acceptable cases identified in the literature (although clinical information is lacking on 7 of these) and 8 previously unpublished cases identified from the Registry of Otolaryngic-Endocrine Pathology at the Armed Forces Institute of Pathology. Demographic findings show that the overwhelming majority of cases affect women (41:14), mainly in the fourth to sixth decades of life (age range, 14 to 83 years; median, 44 years), with a prevalence in the supraglottic larynx. These neoplasms are treated by surgical resection and are benign. Despite the characteristic pathologic features associated with LP, it is sometimes confused with other neoplasms, particularly neuroendocrine carcinomas of the larynx, and this confusion leads to unfortunate designations such as malignant paraganglioma and metastasizing paraganglioma of the larynx. Judging from the cases reported in this study and those identified in the literature, we conclude that malignant biologic behavior associated with LP is extraordinarily rare (< 2%). Because of the misdiagnoses of LP, the prognosis associated with this entity has been skewed to suggest that LP may behave aggressively. This has led to the inappropriate classification of LP among the malignant categories of laryngeal neuroendocrine neoplasms. The goal of this study is to detail the features diagnostic of LP and to discuss the appropriate treatment, prognosis, and classification of these neoplasms.

Female↗
PubMed1994

Tracheal reconstruction using an epithelial equivalent.

The application of a rapidly vascularized epithelial equivalent that inhibits wound contraction would have great potential in the prevention and repair of tracheal stenosis. An animal model was developed to simulate the effects of circumferential tracheal injury and an autologous epithelial equivalent was created from a fibroblast-collagen matrix and subsequently implanted in the traumatized site in an attempt to prevent stenosis. Postinjury physiologic and histologic evaluation revealed near-normal mucosal flow analysis in the treated sites and an area of less than 20% stenosis versus 95+% in controls. This study's findings indicate that tracheal stenosis can be limited by the use of an epithelial equivalent.

Animals↗