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C J Stewart

Publications and source records attributed to C J Stewart.

At least 19 recordsLinked to original sources
PubMed1999

Endometrial apoptosis in patients with dysfunctional uterine bleeding.

AIMS: To assess glandular apoptosis in the zona functionalis of proliferative phase endometrium in normal individuals and in patients with dysfunctional uterine bleeding (DUB). METHODS AND RESULTS: Routinely processed, haematoxylin and eosin-stained endometrial biopsies were assessed in 26 patients with symptomatic menstrual abnormality, mainly menorrhagia, and in 24 controls. All biopsies were in the proliferative phase and had been reported as within normal limits and consistent with the menstrual cycle dates provided. Apoptotic and mitotic figures were counted in a minimum of 100 transversely sectioned endometrial glands in all cases. In 16 biopsies (12 DUB and four controls) apoptosis was further assessed using the in situ terminal deoxynucleotidyl-transferase-mediated 2'-deoxyuridine-5'-triphosphate (dUTP) nick-end labelling (TUNEL) method. Apoptotic figures were identified in most control biopsies averaging 5.6/100 glands, and were significantly increased in biopsies from patients with DUB averaging 13.9/100 glands. There was no difference in mitotic figure counts. Apoptoses tended to be clustered within adjacent glands in both groups and individual glands exhibited both mitotic and apoptotic activity. Application of the TUNEL method gave broad agreement with morphological assessment although approximately 20-25% of typical apoptotic figures were not labelled. CONCLUSIONS: Endometrial glandular apoptosis is present in most normal proliferative phase biopsies and appears increased in some cases of DUB. The significance of this finding is not known but increased apoptosis may serve as a morphological marker of abnormal endometrial development in otherwise normal biopsy specimens.

Adult↗
PubMed1999

Leukocytes infiltrate the myometrium during human parturition: further evidence that labour is an inflammatory process.

Inflammatory mediators in the cervix, placenta and fetal membranes play a crucial role in human parturition. The aim of this study was to determine whether the upper and lower segments of the myometrium are infiltrated by inflammatory cells during pregnancy and parturition. Myometrial biopsies were obtained from non-pregnant women, and pregnant women at term before and after the onset of spontaneous labour. Subpopulations of inflammatory cells were identified using immunocytochemistry. The intercellular adhesion molecules, 1 and 2, platelet endothelial cell adhesion molecule, vascular cell adhesion molecule and E-selectin were immunolocalized to investigate their involvement in leukocyte accumulation. Histological analysis demonstrated that inflammatory cells, predominantly neutrophils and macrophages, infiltrate human myometrium during spontaneous labour at term. The infiltrate is predominant in the lower uterine segment but is also present in the upper segment. Increased expression of E-selectin was found on the vascular endothelium of biopsies obtained during labour, suggesting a role for this molecule in the accumulation of leukocytes. These results suggest that inflammatory cell infiltration is part of the physiological mechanisms that occur in the myometrium during parturition. Further understanding of this process may suggest new strategies aimed at preventing preterm delivery.

Cell Adhesion Molecules↗
PubMed1998

Fine-needle aspiration cytology of extranodal lymphoma.

The assessment of lymphoproliferative disorders using fine-needle aspiration (FNA) cytology may be problematic particularly when organs other than lymph node are involved. In this report we have reviewed 26 consecutive FNA specimens from superficial extranodal sites which were reported as diagnostic or suggestive of malignant lymphoma. The aspirates were obtained from skin or subcutaneous tissue (ten cases), thyroid (five cases), salivary gland (five cases), breast (four cases), neck, and pharynx (one case each). Ancillary studies including immunocytochemistry, in situ hybridisation to detect immunoglobulin light chain mRNA expression, and polymerase chain reaction for analysis of immunoglobulin heavy chain gene rearrangement were performed in 20, 12, and 7 cases, respectively. Clinicopathologic correlation confirmed the diagnosis of lymphoma in 25/26 aspirates. Nine of the 14 patients whose initial presentation was with an extranodal mass were considered to have primary lymphomas of mucosa-associated lymphoid tissue (MALT) type. In contrast, ten of 11 patients with recurrent extranodal disease had primary nodal type lymphomas. There was one false-positive diagnosis, a neck mass misinterpreted cytologically as B-cell lymphoma which was ultimately shown to be a branchial cyst. FNA cytology supported by appropriate ancillary investigations provides accurate diagnosis in most cases of extranodal lymphoma.

Adult↗
PubMed1998

Peritoneal fluid cytology in serous borderline tumours of the ovary.

Peritoneal fluid cytology findings in three patients with serous borderline tumours of the ovary and peritoneal serous implants are presented. The specimens were characterized by papillary groups, acinar clusters and single neoplastic cells exhibiting cytoplasmic vacuolation and nuclear atypia of variable degree. The cytological appearances were initially considered consistent with ovarian adenocarcinoma in all cases. Histological correlation is required to avoid this diagnostic pitfall.

Adenocarcinoma↗
PubMed1998

Focal endometrial stromal hyperplasia.

AIMS: To describe a patient in whom multiple endometrial biopsies revealed stromal proliferative lesions causing diagnostic difficulty. METHODS AND RESULTS: A 39-year-old woman with a history of menorrhagia and dysmenorrhoea underwent two endometrial biopsies and hysterectomy. In each case histopathology revealed apparently multifocal benign stromal proliferative lesions with no evidence of invasive growth pattern. The lesions were characterized by increased cellularity, nuclear enlargement and spindle cell morphology but no mitotic activity or nuclear pleomorphism were seen. The possibility of low grade stromal neoplasm was considered in the biopsy specimens. The hysterectomy revealed no evidence of malignancy but foci of ovarian endometriosis and cervical stromal endometriosis were present. CONCLUSION: We suggest that the lesions represent focal endometrial stromal hyperplasia, a potential mimic of stromal nodule or stromal sarcoma in biopsy samples.

Adult↗
PubMed1998

Fine needle aspiration cytology diagnosis of malignant lymphoma and reactive lymphoid hyperplasia.

AIMS: To assess the diagnostic accuracy of lymph node fine needle aspiration (FNA) cytology to distinguish reactive lymphoid hyperplasia from malignant lymphoma, and to evaluate the contribution of ancillary techniques applied to cytological material. METHODS: Two hundred and seventy seven consecutive lymph node FNA specimens reported to be consistent with reactive lymphoid hyperplasia (n = 213) or suggestive/diagnostic of malignant lymphoma (n = 64) were reviewed. Follow up data were obtained by case record review or by histological correlation. The value of immunocytochemistry, in situ hybridisation for immunoglobulin light chain mRNA, and polymerase chain reaction (PCR) towards the final clinicopathological diagnosis was assessed in 92, 61, and 45 cases, respectively. RESULTS: Sixty one of 67 lymphomas and 207 of 209 reactive lymph nodes were accurately diagnosed by FNA cytology. There were six false negative aspirates including three cases of follicular lymphoma, two cases of Hodgkin's disease, and one chronic lymphocytic leukaemia. Two FNA specimens considered suspicious of lymphoma proved reactive on histology or clinical follow up. One metastatic small cell carcinoma was wrongly diagnosed as lymphoma. Ancillary studies contributed to the correct diagnosis in most cases although occasional misleading results were obtained, particularly with PCR. CONCLUSIONS: FNA cytology accurately distinguished reactive lymphoid hyperplasia from malignant lymphoma in 97% of cases. However, occasional wrong diagnoses occurred owing to sampling error or misinterpretation. Ancillary studies can be applied to cytological samples and contribute to the diagnosis in most cases.

Adult↗
PubMed1997

Diagnostic value of inhibin immunoreactivity in ovarian gonadal stromal tumours and their histological mimics.

AIMS: Inhibin is a heterodimeric protein hormone which appears to be a sensitive serological and immunohistochemical marker of ovarian granulosa cell tumours. The purposes of this study were to examine inhibin immunoreactivity in a wide range of gonadal stromal neoplasms and to assess its value in the differential diagnosis of problematic ovarian tumours. METHODS AND RESULTS: Inhibin immunostaining was identified in eight cases of stromal hyperthecosis, 24 adult-type granulosa cell tumours, two juvenile granulosa cell tumours, nine Sertoli cell or Sertoli-Leydig cell tumours, one gynandroblastoma, three gonadoblastomas, two cases of sex cord tumour with annular tubules, two steroid cell tumours and two sclerosing stromal tumours. Inhibin was also present in 4/6 fibrothecomas and 2/3 unclassified gonadal stromal tumours. There was no staining of neoplastic cells in any of the problematic ovarian tumours, in many of which a diagnosis of gonadal stromal tumour had been initially considered. However, inhibin was detected in reactive stromal cells in many cases. CONCLUSIONS: Inhibin is a sensitive immunohistochemical marker of a wide range of gonadal stromal tumours and is of value in the differential diagnosis of ovarian neoplasia.

Diagnosis, Differential↗
PubMed1997

Analysis of clonality in cytologic material using the polymerase chain reaction (PCR).

Immunoglobulin heavy chain (IgH) gene rearrangement analysis was performed on 27 fine needle aspiration (FNA) specimens (13 reactive hyperplasia, 11 B cell non-Hodgkin's lymphoma (B-NHL), one Hodgkin's disease and two suspicious of non-Hodgkin's lymphoma). Satisfactory amplification was achieved in 23/27 cases. A polyclonal pattern was seen in 14 cases (11 reactive hyperplasia, one B-NHL, one suspicious of lymphoma, one Hodgkin's disease). A monoclonal band was seen in nine cases (eight B-NHL, one reactive hyperplasia). Amplification was unsuccessful in four cases. Clonal analysis by PCR-based IgH gene rearrangement analysis can be successfully applied to FNA material and can be useful in diagnosis, but the results must be interpreted in conjunction with morphology and other ancillary information.

Biopsy, Needle↗
PubMed1996

Immediate assessment of fine needle aspiration cytology of lung.

AIMS: To assess the value of immediate assessment of cytology in percutaneous fine needle aspiration (FNA) cytology of lung. METHODS: FNA specimens from 75 consecutive patients with suspected pulmonary neoplasms were subjected to immediate cytology assessment. Direct smears were prepared in the radiology department and stained using the Diff Quik method. The cellular content was assessed and, if possible, a provisional diagnosis offered. A second FNA was requested if the initial aspirate seemed of doubtful adequacy. The diagnostic accuracy was examined by review of clinical and radiological data in all patients, and by correlation with other histological or cytological material in 25 patients. Complications of the procedure were identified during the clinical review. RESULTS: Two of 75 specimens were inadequate for diagnosis. Satisfactory diagnostic material was obtained in 51 patients on a single aspirate and following a second FNA in 22 patients. Of the 73 satisfactory aspirates, 58 were malignant, one highly suspicious of malignancy and 14 reported as negative for malignancy. All malignant diagnoses were confirmed on clinical or pathological review. FNA accurately distinguished primary small cell and large cell carcinomas in those patients with pathological follow up. There were two false negative reports, one due to sampling error and the other due to misinterpretation of aspirate material. The diagnostic specificity was 100% and sensitivity 96.6%. Complications were recorded in seven (9.3%) patients, five of whom developed pneumothorax; a chest drain was required in one patient. CONCLUSIONS: Percutaneous FNA cytology provides safe and accurate diagnosis in the investigation of pulmonary lesions. Immediate cytology assessment ensures that aspirate material is handled optimally, and those patients requiring further sampling or ancillary investigation identified rapidly. The number of unsatisfactory and false negative lung FNA are therefore reduced. The complication rate is minimised by decreasing the number of pleural punctures.

Adult↗
PubMed1996

Immunoglobulin light chain mRNA detected by in situ hybridisation in diagnostic fine needle aspiration cytology specimens.

AIMS: To demonstrate expression of immunoglobulin light chain mRNA in diagnostic fine needle aspiration (FNA) cytology specimens using an in situ hybridisation (ISH) technique; and to evaluate ISH in a series of reactive lymphoid proliferations and malignant lymphomas. METHODS: Forty diagnostic FNA specimens showing a lymphoid cell population were examined for immunoglobulin light chain mRNA expression using ISH. Aspirates were obtained from lymph node (n = 34), salivary gland (n = 3), subcutaneous tissue, thyroid and breast (n = 1 each). The cases included 20 B cell lymphomas, five cases of Hodgkin's disease and 15 reactive lymphoid proliferations. Comparison with light chain immunoreactivity was made in 36 cases and histological correlation from biopsy material was available in 24. RESULTS: Immunoglobulin light chain restriction was demonstrated in 14 of 20 B cell lymphomas using ISH and in six of 17 B cell lymphomas using immunocytochemistry. A polytypic pattern of light chain expression was observed in four of five cases of Hodgkin's disease with both techniques, and in 12 of 15 and 11 of 14 reactive lymphoid proliferations using ISH and immunocytochemistry, respectively. CONCLUSIONS: The assessment of immunoglobulin light chain expression is a useful adjunct to morphology in the diagnosis of reactive and malignant lymphoid proliferations in FNA specimens. Light chain restriction can be shown using either immunocytochemistry or ISH, but the latter is more sensitive in the diagnosis of B cell lymphoma.

Biomarkers↗
PubMed1995

Discharge planning from home health care and patient status post-discharge.

An exploratory study of 57 elderly patients discharged from home health agencies sought to identify how they and their caregivers were prepared for discharge and how they were managing. Data were collected from the home care records and post-discharge interviews with patients and caregivers. Results indicate little evidence of formal discharge planning. However, home care records appear to underreport what home care staff do. On follow-up, over half of the patients had improvement in their health, two-thirds were independent in activities of daily living, and few patients had need of formal services.

Aged↗