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Biomedical subjects

B S Ducatman

Publications and source records attributed to B S Ducatman.

At least 37 records · Page 2Linked to original sources
PubMed1989

Nonpalpable breast lesions: evaluation by means of fine-needle aspiration cytology.

A prospective study was undertaken to assess the utility of fine-needle aspiration (FNA) cytology in women with nonpalpable suspicious microcalcifications or masses detected at mammography. Ninety-six breast lesions were aspirated during wire localization with standard mammographic technique. Cytologic results were compared with surgical pathology results. Sixty-one of the 96 aspirates were adequate for diagnosis. Nine were positive for malignant cells; seven, suspicious; 12, atypical; and 33, negative. All lesions demonstrating positive or suspicious cytologic findings were found to be malignant at biopsy; five of the 12 with atypical cytologic findings were malignant. Of 33 lesions deemed negative by means of cytology, two were biopsy-proved carcinomas. Cytologic examination permitted accurate diagnosis of 21 of the 23 (91%) carcinomas in which an adequate sample was obtained. Insufficient cellular material was obtained from 35 lesions, 16 of which showed marked fibrosis at histologic examination. The authors conclude that FNA cytology can aid in establishing a diagnosis in many cases in which nonpalpable breast lesions are detected at mammography.

Adult↗
PubMed1988

Lithium battery hazard: old-fashioned planning implications of new technology.

Lithium battery technology has important military applications and will increasingly enter the civilian marketplace. In order to prevent explosive fragmentation under some circumstances of malfunction or misuse, lithium batteries are designed to vent externally in the event of malfunction. Depending on the chemistry and size of a venting lithium battery, the release of toxic gases such as sulfur dioxide or thionyl chloride may pose risks to exposed individuals, particularly in enclosed spaces. Chemical and thermal burns, laryngeal edema, pulmonary edema, and bronchiolitis obliterans are potential outcomes. A case report is presented which illustrates the hazards. The hazards are not from unpredictable outcomes, but from failure to plan for predictable outcomes.

Accidents, Occupational↗
PubMed1987

Differential staining techniques in amniotic fluid cytology diagnosis of neural tube defects: a prospective study of 129 pregnancies.

In order to assess the utility of amniotic fluid cytology in the diagnosis of neural tube defects (NTDs), we performed a prospective study of 129 pregnancies selected for maternal age or history of prior congenital defects or multiple stillbirths. Amniotic fluid obtained between the 16th and 22nd weeks of gestation was cytocentrifuged and stained with hematoxylineosin (H&E), Papanicolaou, and Diff-Quik. Chromosomal analysis, amniotic fluid alpha fetoprotein (AFP) level, and eventual pregnancy outcome were recorded for each case. The AFP levels were normal in 128 cases, including two closed NTDs (meningomyelocele and encephalocele). Three patients had abnormal chromosomal studies: two with 47,XXX and one with trisomy 21. Of these 128 cases, 16 had inadequate cytologic preparations; the remainder, including the five aforementioned patients, showed predominantly squamous cells, amnion cells, and minicells. Other cell types, including genito-urinary cells, umbilical cord cells, respiratory cells, and macrophages, were also present in smaller numbers. One case exhibited a large population of small, darkly staining neural cells and large macrophages. The AFP in this case was markedly elevated, and the fetus was noted to be anencephalic. We found the H&E to be the preferred stain for both cytologic detail and minicell preservation; however papanicolaou was better for bloody specimens. Amniotic fluid cytology may provide a rapid and inexpensive method of confirming the diagnosis of open NTDs.

Amniotic Fluid↗
PubMed1987

Extradural spinal meningioma presenting as a neck mass. Diagnosis by aspiration cytology.

A case of a 36-year-old woman with an extradural spinal meningioma presenting as a neck mass is documented. Fine-needle aspiration biopsy was used as an initial diagnostic procedure and provided the diagnosis. Fine-needle aspiration biopsies are an excellent, cost-effective, diagnostic approach with low morbidity. Although these are underused, we recommend their use in the management of patients with neck masses. The entity of extradural spinal meningioma is briefly discussed.

Adult↗
PubMed1986

Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases.

A review was done of 120 cases of malignant peripheral nerve sheath tumor (MPNST) seen during a 71-year period. Of the 120 patients, 52 were males and 68 were females with a mean age at diagnosis of 35.3 years; 12 patients were younger than 20 years. The series included 62 (52%) patients with neurofibromatosis, 13 (11%) with postradiation sarcomas, and 19 (16%) with metaplastic foci. The incidence of MPNST arising in neurofibromatosis was 4.6% in the current series and 0.001% in the general clinic population. Tumors greater than 5 cm and the presence of neurofibromatosis adversely affected the prognosis (P less than 0.05). When both features were present, survival was greatly decreased. Patients with tumor in the extremities did better than those with head or neck lesions. Metaplastic foci or previous radiation at the tumor site did not alter the prognosis. Each tumor was graded 1 to 4 on the basis of cellularity, pleomorphism, mitotic index, and necrosis. No significant correlation was noted between survival and either grade or mitotic rate. Survival was improved when total rather than subtotal resection was done. This was most marked in patients with a small lesion, which may reflect the difficulty in adequately excising large tumors. Adjuvant radiation or chemotherapy did not appear to affect survival. The MPNST is an aggressive uncommon neoplasm, and large tumor size, the presence of neurofibromatosis, and total resection are the most important prognostic indicators.

Adolescent↗
PubMed1986

Functioning parathyroid lipoadenoma. Report of a case diagnosed by intraoperative touch preparations.

Lipoadenoma of the parathyroid gland is an unusual cause of primary hyperparathyroidism. Inasmuch as they may grossly resemble lipoma more than parathyroid adenoma, these tumors may be missed by surgeons and surgical pathologists alike. In this case, the diagnosis was made during surgery utilizing touch preparations because frozen sections were technically difficult to perform due to the fat content of the tumor. Examination of multiple sections disclosed a neoplastic proliferation of parathyroid cells, thus supporting the premise that this entity represented an adenoma rather than a hamartoma.

Adenoma↗
PubMed1985

Catheter-induced lesions of the right side of the heart. A one-year prospective study of 141 autopsies.

We examined prospectively for one year the hearts from 141 consecutive autopsy cases in which a central catheter was present at the time of death. Three deaths were attributable to catheter use, two to perforation. Furthermore, mural thrombi were present in 33 (33%) of 99 patients with pulmonary arterial catheters and in 12 (29%) of 42 patients with central venous catheters. The incidence of pulmonary emboli or bacteremia was no greater in patients with thrombi than in those without. The use of central catheters may thus be complicated by perforation or the development of mural thrombi. Although the thrombi may embolize or may become infected, the incidence and clinical significance appear to be low. The incidence of catheter-related deaths in our autopsy population does not necessarily reflect the incidence in a population of living patients.

Adolescent↗
PubMed1985

Platelet transfusion therapy in acute leukemia: lack of effect of splenomegaly on transfusion requirements and risk of hemorrhage.

Platelet transfusions are an important supportive measure during treatment for acute nonlymphocytic leukemia (ANLL). The presence of splenomegaly may produce decreased posttransfusion platelet increments leading some to recommend an increased dose of platelets per transfusion in this situation. Forty-nine newly diagnosed patients with ANLL were evaluated during 1980 and 1981, and 24% had palpable splenomegaly. Although treated with usual doses of platelets per transfusion, there was no detectable statistical increase in transfusion requirement or incidence of hemorrhage in patients with splenomegaly. Experimental evidence indicates that the splenic platelet pool enlarges with splenomegaly, but the life span of circulating platelets is not significantly changed. Furthermore, the splenic platelet pool is in dynamic equilibrium with the circulating platelet pool thus allowing these platelets to participate in hemostasis. Although posttransfusion increment in platelet count may be less, it appears that platelet transfusion therapy need not be altered solely because of splenomegaly.

Acute Disease↗
PubMed1984

Malignant peripheral nerve sheath tumors with divergent differentiation.

Malignant peripheral nerve sheath tumors are uncommon sarcomas of Schwann cell or fibroblastic derivation which occasionally show histologic evidence of focal divergent differentiation to rhabdomyosarcoma, osteosarcoma, chondrosarcoma, angiosarcoma, epithelial elements, or a combination thereof. The finding of these heterotopic elements in nerve sheath sarcomas is believed to illustrate the differentiating capacity of neuroectodermal tissue. The authors present the clinicopathologic features of 17 such tumors, which represent 14.7% of the malignant peripheral nerve sheath tumors in the authors' institutional experience. Most of the lesions were associated with von Recklinghausen's disease. These tumors do not seem to differ from ordinary malignant peripheral nerve sheath tumors in presentation, operative, gross, and microscopic features, response to therapy, or prognosis.

Adolescent↗
PubMed1984

Malignant peripheral nerve sheath tumors in childhood.

Malignant peripheral nerve sheath tumor (MPNST) is an uncommon sarcoma in the pediatric population; however, its presence should be considered in a child with an enlarging or painful soft-tissue mass. Diagnosis of this neoplasm depends on either the demonstration of its origin within a peripheral nerve or the association with a contiguous neurofibroma. We have identified 16 cases of MPNST involving children 16 years of age or less, which represent 12.8% of the total cases seen at the Mayo Clinic. Most of the lesions arose in children with von Recklinghausen's disease and were associated with a contiguous neurofibromatous component. The mean survival of patients who were known to have died of tumor was only 1.8 years. This sarcoma requires prompt aggressive therapy utilizing wide surgical excision. Because of the association of MPNST with von Recklinghausen's neurofibromatosis, a careful workup and family history should be obtained for the potential prognostic value and for the purpose of genetic counseling.

Adolescent↗
PubMed1984

Malignant histiocytosis: a clinical, histologic, and immunohistochemical study of 20 cases.

To better characterize the diagnostic criteria and clinical behavior of malignant histiocytosis, 20 patients treated at the Mayo Clinic during a 25-year period were studied. A wide spectrum of cytologic differentiation was observed, with cells ranging from bland to highly anaplastic; hemophagocytosis was prominent only in conjunction with a bland histologic appearance. In surgical specimens, the diagnosis of malignant histiocytosis necessitated the use of immunoperoxidase methods for lysozyme, immunoglobulin light chain, and alpha-antitrypsin content, as well as cytochemical stains for acid phosphatase and nonspecific esterase. All autopsies showed that organ involvement had varied somewhat from that reported earlier. The correct diagnosis of malignant histiocytosis was made prior to death in only ten of the 20 cases. The mean survival in the 17 fatal cases was 7.6 months; three of the seven patients treated by aggressive chemotherapy achieved complete remission. Relatively longer survival was correlated with initial confinement to the skin and the absence of cytopenia or liver function abnormalities. Three patients with pulmonary involvement from malignant histiocytosis had apparent inappropriate antidiuretic hormone secretion in the absence of central nervous system disease. The accelerated clinical progression of malignant histiocytosis and its response to current chemotherapeutic regimens make rapid diagnosis and familiarity with the pathologic variations seen in this disorder imperative. Routine utilization of special light-microscopic and immunohistochemical stains is mandatory.

Adult↗
PubMed1983

Postirradiation neurofibrosarcoma.

A known risk of radiation therapy is the induction of secondary neoplasms, most commonly osteosarcoma and fibrosarcoma. A recent addition to the list of postirradiation neoplasms is neurofibrosarcoma, a Schwann cell or fibroblastic malignancy arising in peripheral nerves, often associated with von Recklinghausen's disease. In a clinicopathologic review of 109 patients with neurofibrosarcoma seen at the Mayo Clinic from 1912 to 1981, the tumors in 12 cases were found to originate in areas that had previously been irradiated for benign or malignant disease. Seven of the 12 patients demonstrated stigmata of von Recklinghausen's disease. The mean latency period between irradiation and clinical presentation of the sarcoma was 15.6 years (range, 5-26 years). Eight patients experienced at least one recurrence; metastases were present in two, and nine patients died of their disease. The mean interval between initial diagnosis and death was 3.4 years. In summary, neurofibrosarcoma may arise secondary to radiation; animal studies on the effects of radiation on peripheral nerves support this concept. It is the authors' opinion that patients with von Recklinghausen's disease should not be unnecessarily irradiated, and that those who do receive radiation therapy should be carefully observed for the development of secondary neurofibrosarcoma.

Adult↗
PubMed1983

Fatal rectus sheath hematoma.

Rectus sheath hematoma is an uncommon, often misdiagnosed, and usually self-limited condition. In a recent review of autopsy cases at the Mayo Clinic, Rochester, Minn, we found two patients in whom hemorrhages into the rectus sheaths were considered the immediate cause of death and one in whom the hemorrhage was considered a contributing cause of death. Rectus sheath hematoma should be included in the differential diagnosis of an abdominal mass of sudden onset, especially in patients who have been given anticoagulants. The condition may be fatal if the volume of the hemorrhage is large and if treatment is delayed.

Abdominal Muscles↗
PubMed1983

Malignant bone tumors associated with neurofibromatosis.

Neurofibromatosis (von Recklinghausen's disease), a phakomatosis inherited as an autosomal-dominant trait, predisposes to multiorgan neoplasia as well as to skeletal abnormalities. In an attempt to define more clearly the nature of osseous malignant lesions associated with von Recklinghausen's disease, we reviewed three cases of coexistent neurofibromatosis and malignant tumors of bone. None of the tumors was considered neurogenic. One patient had a fibrosarcoma, and two patients had malignant fibrous histiocytomas. No gross relationship to nerves was demonstrated, and special studies for axons were negative. Primary neurogenic sarcomas of bone are extremely rare; the diagnosis should be considered only when the tumor originates from an intraosseous nerve or contiguous neurofibroma. The occurrence of primary bone sarcomas in patients with neurofibromatosis seems to be a sporadic event.

Adult↗
PubMedDate not supplied

Fine needle aspiration of the breast. A probabilistic approach to diagnosis of carcinoma.

OBJECTIVE: To develop a classification scheme for reporting the results of fine needle aspiration (FNA) cytology of a breast lesion according to its likelihood of being a carcinoma. STUDY DESIGN: To verify the validity of this scheme, we studied a total of 267 FNAs that were prospectively classified according to predefined criteria as positive (76), suspicious (41), proliferative with atypia (66), proliferative without atypia (48) and unremarkable (36), and compared these results with the final histology. RESULTS: The percentages of patients who had carcinoma on histology were 100% (76), 93% (38), 35% (23), 6% (3) and 31% (11) of cases diagnosed as positive, suspicious, atypical proliferative, proliferative without atypia and unremarkable on cytology, respectively. However, if only invasive carcinoma is considered, then the percentage of carcinoma was 99% (75), 93% (38), 23% (15), 2% (1) and 11% (4), respectively. The only invasive carcinoma in the proliferative-without-atypia category was a tubular carcinoma and represented a false negative diagnosis. All four invasive carcinomas with an unremarkable cytologic diagnosis were due to sampling errors. Definitive surgery after FNA was common in cases with positive (65%) and suspicious (42%) cytologic diagnosis, whereas all but one patient with atypical, proliferative and unremarkable diagnoses had a biopsy initially. CONCLUSION: This scheme of reporting breast FNA results with defined criteria according to the probability of identifying carcinoma provides a rational basis for guidelines for the management of breast lesions.

Biopsy, Needle↗