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Biomedical subjects

C E Keen

Publications and source records attributed to C E Keen.

At least 19 recordsLinked to original sources
PubMed2005

Biphasic solitary fibrous tumour: a report of two cases with epithelioid features.

We present two cases of solitary fibrous tumour (SFT) showing biphasic morphology with a spectrum of malignant epithelioid components. Slides prepared from formalin-fixed and paraffin-embedded tissue from both cases were stained with haematoxylin and eosin and by immunohistochemistry. Interphase fluorescent in situ hybridisation studies were performed in both cases using paraffin-embedded tissue to look for the t(X;18) translocation, thereby to exclude synovial sarcoma. Both cases showed biphasic morphology with some areas having typical benign spindled SFT morphology (including CD34 expression) and other areas having a malignant epithelioid appearance. In one of the cases, the epithelioid area, which was well circumscribed and showed packeting of cell groups, demonstrated expression of cytokeratin and epithelial cadherin but not of CD34. In the second case, the immunophenotype of the epithelioid component was similar to that of the benign SFT component. These findings suggest that epithelioid change in SFT shows a range of differentiation at one end, similar to that of a standard SFT, and at the other end, possibly acquiring epithelial characteristics.

Biomarkers, Tumor↗
PubMed1999

CA125 and thyroglobulin staining in papillary carcinomas of thyroid and ovarian origin is not completely specific for site of origin.

AIMS: A 70-year-old woman presented with metastatic psammoma body-rich papillary carcinoma in a supraclavicular lymph node. No primary site was evident. The tumour showed strong staining for CA125 and weak staining for thyroglobulin. Prompted by this case we aimed to assess the reliability of immunostaining for CA125 and thyroglobulin in making the distinction between thyroid and ovarian papillary carcinoma. METHODS AND RESULTS: Nine papillary carcinomas of the thyroid and 17 serous papillary carcinomas of the ovary were stained for CA125 and thyroglobulin, as well as CAM 5.2, LP 34, carcinoembryonic antigen (CEA), S100 and diastase/periodic acid-Schiff. Nine of nine thyroid carcinomas stained for thyroglobulin; in addition CA125 was positive in four of nine. Normal surrounding thyroid also showed some reaction. Seventeen of 17 ovarian serous carcinomas were positive for CA125; in addition one case showed moderately strong staining for thyroglobulin. Mucin stains were positive in 14/17 ovarian serous carcinomas, but negative in all thyroid carcinomas. The other antibodies assessed showed no useful differences in staining frequency. CONCLUSION: Many cases of papillary carcinoma of the thyroid show CA125 staining, and this feature therefore has little positive predictive value for an ovarian origin. Occasional cases of ovarian papillary carcinoma may show staining for thyroglobulin, and this result should therefore be interpreted cautiously.

Aged↗
PubMed1999

Polyester fibre prosthetic anterior cruciate ligament implant rupture: necrosis of ingrown connective tissue.

AIMS: To describe the histopathological and microanalytical features in seven cases of ruptured Apex(R) polyester (Terylene(R)) fibre anterior cruciate ligament prosthesis. METHODS AND RESULTS: Transmitted and polarized light microscopy was performed in all cases; one case was investigated by immunohistochemistry, transmission electron microscopy and scanning electron microscopy, with backscatter and X-ray detectors for elemental microanalysis. For comparison we also studied synovial biopsy material and unused polyester fibres. In the excised ligaments there was much ingrowth of fibrous tissue accompanying a florid giant cell reaction to the individual intact polyester fibres throughout the ligaments. Phagocytosis of particles of prosthesis-derived material was demonstrated and a striking finding was of necrosis of the ingrown connective tissue in the central portions of the ligaments. Hyalinized areas and 'neoligament growth' were less striking. A consistent finding in the polyester fibres was of small particles containing antimony, used as a catalyst in the manufacturing process. CONCLUSIONS: The pattern of reaction to the prosthetic material and the presence of necrosis differ from previous descriptions in animal and human explants of this and other prosthesis types. The mechanical effect of the necrosis is unlikely to be of significance with this ligament, which is load-bearing ab initio.

Adult↗
PubMed1999

Is involvement of the surgical margins of large loop excision of the cervical transformation zone specimens for cervical intraepithelial neoplasia III a risk factor for persistent cervical intraepithelial neoplasia?

We aimed to test the hypothesis that patients with cervical intraepithelial neoplasia (CIN) III treated by large loop excision of the cervical transformation zone (LLETZ) are more likely to suffer recurrence of cervical abnormalities if the CIN reaches the margins of the index specimen. Three hundred and forty-five women treated by LLETZ in 1991, and 1992, and in whom the histological diagnosis was CIN III, were studied. The reports were reviewed and the cases were categorised as completely excised, incompletely excised, or undetermined. Cytological follow-up, or in some cases histological follow-up in the same year and in each of the 5 following years was tabulated. Follow-up data were recorded from the same and also surrounding institutions. The chi-squared test was used to compare the differences in recurrence rates between the three groups at the various points in time. A small advantage was demonstrated for those cases where excision was complete. This was statistically significant in the third following year (P=0.022). The resection margin status of LLETZ specimens for CIN III has only a minor effect on the likelihood of recurrence. Nevertheless, recording the status may be important in case of unexpected invasion. The relative reassurance the information will provide when the lesion has been excised may also be seen as worthwhile.

Journal Article↗
PubMed1999

Pseudoglandular formations in clot sections from fine needle aspirates--an artefact caused by bubble formation during aspiration.

AIMS: To report the occurrence of an uncommon artefact producing pseudoglandular formations in clot sections from haemorrhagic fine needle aspirations. METHODS: All available histological material from 610 fine needle aspirations by pathologists (23 g needle) over a five year period was reviewed. The frequency and associations of the pseudoglandular artefact was assessed. RESULTS: Clot sections were prepared in 41 of the 610 cases (7%). Bubbles were present in the clots in 22 of these cases (54%), and in three cases (7%) these were lined by lymphocytes creating pseudoglandular formations. These were two lymph node aspirates and one thyroid aspirate. In four further cases lesser numbers of cells partly lined some of the bubbles; these were lymphocytes, macrophages, or in one case, thyroid epithelial cells. CONCLUSIONS: When clot sections are prepared in cases of haemorrhagic fine needle aspiration, bubbles are often produced during suction; these can on occasion become lined by lymphocytes or other cells, leading to pseudoglandular formations. Recognition of this artefact will prevent unnecessary further investigation of their nature.

Adult↗
PubMed1996

Combined skin lesions.

Four brief reports of combined skin lesions are presented: (1) combined basal cell epithelioma and histiocytosis X. (2) combined intraepidermal melanocytic neoplasia (melanoma in situ) and leukaemia cutis, (3) combined melanocytic naevus with pseudoepitheliomatous hyperplasia and desmoplastic trichoepithelioma, and (4) combined melanocytic naevus with lichenoid gold reaction. The importance of the occurrence of such lesions is discussed, as are the clinical and pathological diagnostic difficulties they sometimes pose.

Adult↗
PubMed1995

Ultrasound diagnosis of the Pena Shokeir phenotype at 14 weeks of pregnancy.

This report describes the early prenatal diagnosis of the Pena Shokeir phenotype in an at-risk patient at 14 weeks' gestation. The diagnosis was based on an abnormal fetal movement profile, in association with an abnormal position of the fetal limbs. Pena Shokeir phenotype describes an inherited condition characterized by arthrogryposis and dysmorphic features as a result of fetal akinesia. It is a lethal abnormality and early diagnosis allows safer surgical methods of termination.

Abnormalities, Multiple↗
PubMed1995

Intraosseous secondary calcium salt crystal deposition: an artefact of acid decalcification.

We previously observed, in decalcificated bone specimens, intraosseous crystal deposits with morphological and analytical similarity to calcium pyrophosphate dihydrate. We have now been able, by a combination of more detailed morphological studies of these and similar cases, and by infrared spectroscopy in three cases, to show that this is, in fact deposition of the secondary calcium salts brushite and monetite, occurring as an artefact during formic acid decalcification. Our earlier postulate of bone as an additional primary crystallization site for calcium pyrophosphate dihydrate is effectively disproved. This artefact deserves wider recognition.

Artifacts↗
PubMed1995

Calcium oxalate crystal deposition in epithelioid histiocytes of granulomatous lymphadenitis: analysis by light and electronmicroscopy.

In this study of 55 cases of granulomatous lymphadenitis of various aetiologies, both haematoxylin and eosin stained and unstained sections were examined by light and polarizing light microscopy for crystals within epithelioid histiocytes. This investigation was prompted by a case of granulomatous lymphadenitis in which the identification of ovoid birefringent structures within epithelioid histiocytes led to an initial false suggestion of foreign body reaction. Identical single, small, ovoid or biconvex, intensely birefringent crystals, invisible by ordinary light microscopy, were found within the cytoplasm of mononuclear epithelioid histiocytes in 37 cases. There was only minor crystal loss with routine H & E staining. The sections were also examined by scanning electronmicroscopy in secondary and backscattered electron imaging modes and 27 cases were found to contain biconvex crystals which were shown on X-ray energy dispersive spectroscopic microanalysis to be consistent with calcium oxalate. There was a good quantitative correlation between light and scanning electron microscopy. Tissue from the index case was also examined by transmission electronmicroscopy, and electron dense crystals were identified. We confirm the previous findings of ovoid oxalate crystals in a variety of granulomatous conditions including Mycobacterial infection, sarcoidosis and Crohn's disease. Ovoid crystals of calcium oxalate, a common finding in granulomatous lymphadenitis, appear to be endogenously derived, and should be more widely recognized in order to avoid misdiagnosis of foreign body reaction.

Calcium Oxalate↗
PubMed1994

Fat necrosis presenting as obscure abdominal mass: birefringent saponified fatty acid crystalloids as a clue to diagnosis.

AIMS: To describe the birefringent saponified fatty acid crystalloids seen in pancreatic fat necrosis. METHODS: A histological review, including polarising microscopy, of three cases of subacute or subclinical acute pancreatitis was performed. Histochemical analysis using Nile blue sulphate for lipid, Holczinger's copper rubeanate for fatty acids, and Alizarin Red S for calcium was performed in one case. Scanning electron microscopy and x-ray energy dispersive spectroscopic micro-analysis were performed in two cases. Necropsy pancreatic tissue, surgical archival tissue from cases of pancreatitis, and pancreatic and adipose tissue permitted to autolyse together in the laboratory, were also examined. The autolysed tissue was also examined histochemically. Stained and unstained sections were mounted in DPX and Canada balsam. Surgical material showing traumatic fat necrosis was reviewed. RESULTS: In each of the three cases there were subtle clues to subclinical pancreatitis. In neither surgical case was the true nature of the mass apparent to the operator. Histological analysis in all cases showed ghost adipocytes containing numerous polarising crystalloids, as well as some basophilic debris. Microanalysis showed calcium but no other substantial heavy element signals. Histochemical analysis showed a labile, polar, acidic lipid and the crystalloids behaved as calcium salts of free fatty acid. The crystalloids were not seen in archival material mounted in Canada balsam. No crystalloids were seen in traumatic fat necrosis. CONCLUSIONS: Little recognised, strongly birefringent, saponified free fatty acid crystalloids occurring in pancreatic fat necrosis may survive routine processing, and can point to the origin of obscure mesenteric masses related to subclinical pancreatitis.

Acute Disease↗
PubMed1993

Signet ring cell differentiation in adenocarcinoma of the prostate: a study of five cases.

Signet ring cell differentiation in adenocarcinoma of the prostate is uncommon. In a review of 200 cases of prostatic carcinoma, we identified five cases with this change, all in moderately to poorly differentiated prostatic carcinomas. The signet ring cells in prostatic carcinoma contain an intracytoplasmic lumen, shown on electronmicroscopy to be lined by microvilli. Transition stages were seen from solid to acinar to signet ring cells to mucinous variants. We believe that this change is part of the spectrum of appearances of prostatic carcinoma and should not be regarded as a subtype of specific significance.

Adenocarcinoma↗
PubMed1993

Gold in the dermis following chrysotherapy: histopathology and microanalysis.

Paraffin-embedded sections of skin from patients with rheumatoid arthritis treated with gold who had developed skin rashes were examined by light microscopy and scanning electronmicroscopy with microanalysis. Sparse, small, brown or black granules in plump, often elongated cells in the dermis were shown to contain gold by energy dispersive X-ray microanalysis. These cells expressed some macrophage markers. The amount of gold present showed some correlation with the total gold dose. Gold was not confined to lesional skin. In one case where uninvolved skin was examined, more gold was found there than in lesional skin.

Aged↗