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Biomedical subjects

C Urmacher

Publications and source records attributed to C Urmacher.

At least 37 records · Page 2Linked to original sources
PubMed1992

Histologic predictors of survival in acquired immunodeficiency syndrome-associated Kaposi's sarcoma.

The relationship between 22 histologic variables and survival was investigated in 93 patients with acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma (KS). All the patients were homosexual men in whom KS was the initial manifestation of AIDS. All patients were followed for at least 12 months or until death. Histologic specimens of the initial KS biopsy were reviewed in a blind manner by two of the authors and were evaluated for the presence of a number of histologic features. In a univariate analysis nodular lesions of KS (upsilon patch or plaque lesions), the absence of hemosiderin, the absence of irregular vascular spaces, and the presence of spindle cell nodules were all significantly associated with increased length of survival. Two variables previously shown to be related to survival (CD4:CD8 cell ratio, initial lesion on lower extremities) were included in a multivariate analysis (Cox model) in addition to the histologic variables. Complete data were available from 85 patients. In the multivariate analysis a higher helper to suppressor T-cell ratio, initial lesion on lower extremities, presence of spindle cell nodules, and nodular histology (upsilon patch or plaque histology) were all significantly associated with increased length of survival. These data suggest that in AIDS-associated KS, as in reticuloendothelial neoplasms, histologic features may be useful in identifying prognostically different subgroups of patients.

Acquired Immunodeficiency Syndrome↗
PubMed1991

A new syndrome: ascites, hyperbilirubinemia, and hypoalbuminemia after biochemical modulation of fluorouracil with N-phosphonacetyl-L-aspartate (PALA)

OBJECTIVE: To report a new syndrome of ascites, hyperbilirubinemia, and hypoalbuminemia after treatment with N-phosphonacetyl-L-aspartate (PALA) and fluorouracil for metastatic colorectal cancer. DESIGN: Retrospective analysis. SETTING: Regional cancer treatment center. PATIENTS: Forty-four previously untreated patients with metastatic colorectal cancer in a phase I-II trial of PALA-fluorouracil. MEASUREMENTS AND MAIN RESULTS: One or more transient hepatic abnormalities frequently occurred in 15 of the 17 responding patients. Within the first 10 weeks of treatment, 5 patients developed ascites, 12 had a decrease in the serum albumin level, 6 developed bilirubin elevations, and 7 had transaminase elevations, all in the presence of a complete or partial tumor response. Prolongations of the prothrombin time and elevations of serum glucose levels were also seen. CONCLUSIONS: An unusual syndrome of ascites, hyperbilirubinemia, and hypoalbuminemia is associated with a PALA-fluorouracil regimen. These abnormalities, which may be related to decreased hepatic protein synthesis, occurred more often in patients whose tumor was responding to chemotherapy. Clinicians must recognize that in patients undergoing chemotherapy with these agents, ascites and elevated liver function tests may be secondary to drug administration and are not necessarily due to disease progression.

Aged↗
PubMed1991

Merkel cell carcinoma. Prognosis and management.

Seventy patients with Merkel cell carcinoma were treated at Memorial Sloan-kettering Cancer Center between 1969 and 1989. The overall estimated 5-year survival rate was 64%. Factors predictive of improved survival included head and neck site and negative lymph nodes at presentation. Local recurrence was seen in 18 patients (26%) and did not correlate with patient-, tumor-, or treatment-related variables. Nine patients with local recurrence (50%) were free of disease following aggressive reoperation. Regional nodes were involved at some point during the course of the disease in forty-six patients (66%). Regional lymph node involvement was apparent within 2 years of diagnosis in 40 (87%) of 46 patients in whom it occurred. Systemic disease was nearly uniformly preceded by the appearance of nodal metastases and was uniformly fatal regardless of subsequent therapy. This suggests an orderly "cascade" pattern of spread for this tumor, in which elective regional lymph node dissection may be justified. Our recommendations for treatment include a wide excision of the primary tumor and either elective or early therapeutic regional node dissection. The role of adjuvant radiotherapy or chemotherapy remains unproven.

Carcinoma, Merkel Cell↗
PubMed1991

Preoperative staging of esophageal cancer: comparison of endoscopic US and dynamic CT.

Fifty patients with esophageal cancer proved by means of biopsy underwent preoperative staging with endoscopic ultrasonography (US); in 42 of the patients, dynamic CT of the chest and abdomen was also performed. All results were compared with the findings at pathologic examination of resected specimens. In staging the depth of tumor growth, endoscopic US was significantly more accurate (46 of 50 tumors [92%]) than CT (25 of 42 tumors [60%]) (P less than .0003). In staging regional lymph nodes, it was more accurate (44 of 50 patients [88%]) than CT (31 of 42 patients [74%]), but this was not statistically significant. In staging distant metastases, however, CT was more accurate (38 of 42 patients [90%]) than endoscopic US (35 of 50 patients [70%]) (P less than .016). The highest concordance with surgical and pathologic findings in overall stage (36 of 42 tumors [86%]) occurred with the combined use of CT and endoscopic US, which was significantly more accurate than use of CT alone (27 of 42 tumors [64%]) (P less than .008).

Adenocarcinoma↗
PubMed1991

Preoperative staging of gastric cancer: comparison of endoscopic US and dynamic CT.

Fifty consecutive patients with gastric adenocarcinoma proved by means of biopsy underwent preoperative staging with endoscopic ultrasonography (US). Dynamic computed tomography (CT) of the chest and abdomen was performed before surgery in 33 of the patients. In all 50 patients, the TNM classification of the American Joint Committee on Cancer was used to compare the imaging findings with pathologic findings in specimens resected at surgery. When the depth of tumor penetration was evaluated, the findings at endoscopic US and those at pathologic examination were concordant in 46 of 50 patients (92%), and the findings at dynamic CT and those at pathologic examination, in 14 of 33 patients (42%) (P less than .00042). Evaluation of regional lymph node metastases showed a concordance of 78% with endoscopic US and 48% with dynamic CT (P less than .038). Overall determination of stage with both dynamic CT and endoscopic US showed a concordance of 73%, compared with a concordance of 45% for dynamic CT alone (P less than .028).

Adenocarcinoma↗
PubMed1990

Phase I evaluation of a combination of monoclonal antibody R24 and interleukin 2 in patients with metastatic melanoma.

A combination of recombinant human interleukin 2 (rhIL-2) and mouse monoclonal antibody R24 (recognizing the ganglioside GD3) was evaluated in patients with metastatic melanoma in a phase I trial. rhIL-2 was given at a constant daily dose of 1 x 10(6) units/m2 i.v. over 6 h on days 1-5 and 8-12. R24 was given on days 8-12 at four dose levels (1, 3, 8, and 12 mg/m2 daily). Twenty patients were evaluable for toxicity and response, five at each dose level. The toxicity of the combination was not overlapping and generally mild. There was a rebound peripheral blood T-lymphocytosis at the end of treatment increasing with the dose of R24. The median lymphocyte count on day 12 of treatment was 3108 +/- 554/ml in patients treated at R24 doses of 8 and 12 mg/m2 versus 2239 +/- 672/ml at doses of 1 and 3 mg/m2. This evidence and other data suggested that R24 enhanced IL-2-mediated T-cell activation in vivo. Two patients demonstrated increases in R24-mediated antibody-dependent cellular cytotoxicity for GD3-expressing cells during treatment. rhIL-2 appeared to accelerate the development of human anti-mouse antibody; three patients developed human anti-mouse antibody by the fifth day of R24 treatment, earlier than observed in prior studies using R24 alone and one patient during the first week of rhIL-2 alone, prior to R24 treatment. One patient had a partial response in soft tissue sites lasting 6 months and two patients had minor responses. This clinical trial extends the previous observation that R24 enhances lymphocyte proliferation in vitro.

Adult↗
PubMed1990

Comparison of the conventional method of lymph node staging with a comprehensive fat-clearing method for gastric adenocarcinoma.

Discrepant results in long-term survival between United States and Japanese patients with resectable gastric adenocarcinoma may result from more accurate staging in the Japanese series. The authors compared a comprehensive fat-clearing method with the conventional pathology method of lymph node sampling in 11 patients undergoing curative gastrectomy and extended lymphadenectomy at their institution. Comprehensive fat-clearing doubled total lymph node counts (P less than 0.01), identified smaller lymph nodes (P less than 0.001), and identified more histologically involved nodes of significantly smaller size (P less than 0.001). Comprehensive fat-clearing pathologically upstaged 29% of the authors' eligible specimens. Accurate pathologic staging is necessary when comparing Japanese and United States survival data for resectable gastric adenocarcinomas.

Adenocarcinoma↗
PubMed1990

Primary sarcoma of the superior pulmonary vein.

A case of a primary sarcoma of the right superior pulmonary vein is described. To the best of the authors' knowledge, this is the first report of successful surgical management of this unusual tumor. The tumor was confined to the superior pulmonary vein and the presentation was that of a hilar mass, assumed to be a bronchogenic carcinoma. Unlike previously reported cases, there was no clinical evidence of left atrial obstruction. The management of the case is discussed, and a review of the pertinent literature is presented.

Brain Neoplasms↗
PubMed1990

Rhabdomyosarcoma of the liver associated with long-term oral contraceptive use. Possible role of estrogens in the genesis of embryologically distinct liver tumors.

We report a case of rhabdomyosarcoma arising in a 34-year-old woman with a 16-year history of oral contraceptive use. This is the first reported case of hepatic rhabdomyosarcoma associated with oral contraception. The tumor did not grossly or microscopically involve biliary structures or gall bladder. It was mostly comprised of undifferentiated spindle cells that were histologically similar to embryonal sarcoma. Foci of cells showing rhabdomyoblastic differentiation blended into poorly formed muscle bundles. No epithelial neoplasm was identified by either morphologic or immunohistochemical analysis. A review of the literature reveals that, although the incidence is low, mesenchymal neoplasms of the liver have been associated with oral contraceptive use. Furthermore, there is now evidence that a multipotential progenitor cell exists that can give rise to both epithelial and mesenchymal neoplasms. Thus, there may be a common precursor cell on which estrogens could act, and which could give rise to epithelial, mesenchymal, or mixed neoplasms. Finally, we suggest that embryonal sarcomas of the liver can undergo further differentiation to more well-defined mesencymal elements.

Actins↗
PubMed1990

Histology of early lesions of AIDS-associated Kaposi's sarcoma.

The original cutaneous biopsy specimens of 93 patients who presented themselves to the Memorial Sloan-Kettering Cancer Center with acquired immunodeficiency syndrome (AIDS)-related Kaposi's sarcoma (KS) were systematically reviewed for 23 histologic variables. KS was the initial manifestation of AIDS in all of the patients. The vast majority of patients presented with plaque histology of KS. Early lesions of KS were characterized by the presence of dilated vascular spaces haphazardly arranged in the biopsy specimen, a sparse inflammatory cell infiltrate composed of lymphocytes (usually without plasma cells), and aggregates of cuboidal cells with the appearance of epithelioid cells. Individually necrotic tumor cells were present in nearly every case. Spindle cells arranged in fascicles or nodules were seen in a minority of cases. These data provide an overview of the different histologic patterns seen in initial lesions of AIDS-associated KS and may lead to better understanding of the pathogenesis of this tumor.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Pancreatic cystadenoma. A clinicopathologic study.

A retrospective study of 19 patients with pancreatic cystadenoma included 15 patients with microcystic and 4 with mucinous cystadenomas. The typical clinical presentation was that of an elderly woman with an upper abdominal mass. An association with diabetes mellitus and extrapancreatic malignant disease was noted. Total tumor resection provided the best chance of cure and removed the risk of compression of adjacent organs and, in mucinous cystadenomas, the risk of malignant transformation.

Aged↗
PubMed1989

Tissue distribution of GD3 ganglioside detected by mouse monoclonal antibody R24.

Mouse monoclonal antibody (MoAb) R24 detects the disialoganglioside GD3, a neuroectodermal antigen expressed by normal melanocytes and melanomas. This antibody has been used to define the immunohistochemical distribution of GD3 antigen in normal and malignant human tissues. The present study shows that staining with MoAb R24 in normal organs and tissues where low concentrations of the antigen can be detected. The highest expression of GD3 was detected on the surface of melanoma cells. Therefore, MoAb R24 can be a useful reagent for studying cells of melanocytic lineage, and for imaging and therapeutic studies of melanomas.

Animals↗
PubMed1987

Subungual melanoma: a 25-year review of cases.

The purpose of this study was to evaluate subungual melanoma as a site-specific entity, to determine the influence of regional nodal involvement, and to ascertain where possible the role of histologic grading of the primary site. Thirty-three patients with subungual melanoma whose median age was 56 yr underwent treatment between 1950 and 1975. There were 11 male and 22 female patients. Forty-eight per cent of lesions were 11 male and 22 female patients. Forty-eight per cent of lesions occurred on the hand. Of 23 clinical stage I patients, seven patients underwent amputation only, while 16 patients underwent amputation and regional nodal dissection. Histologic examination of the primary tumor suggested a trend towards thicker/ulcerated lesions to be associated with metastatic melanoma in regional lymph nodes and/or death due to disease. Early survival patterns favored female patients but there was no significant difference in 10-year survival when analysed by patient sex. Clinical/pathologic stages were the most significant factors affecting long-term survival with 5- and 10-year survivals of 66% and 55% in stage I patients and 22% and 0% in stage II patients.

Adult↗
PubMed1987

Primary malignant melanoma of the esophagus.

Primary malignant melanoma of the esophagus is exceedingly rare. We identified six patients seen at Memorial Hospital for Cancer and Allied Diseases over a period of 35 years. All patients were Caucasian, with an age range of 30 to 74 years (mean: 60 years). There were three men and three women. No association was noted with tobacco or ethanol use, nor was there a personal or family history of malignant melanoma. Symptoms were related to obstruction or hemorrhage. All tumors were polypoid and had attained large size at the time of initial diagnosis. Histologically, the melanomas had epithelioid, spindle-cell, and pleomorphic areas with focal melanin production. An intraepithelial "in situ" component was present in five cases and melanosis of the non-neoplastic esophagus in five. All six neoplasms were immunoreactive for S-100 protein, and none reacted with anticytokeratins. Two cases examined ultrastructurally showed premelanosomes. All patients were treated by esophagogastrectomy. The mean survival for four patients was only 2.1 months. The two remaining patients are alive at 5.5 and 11 months.

Adult↗
PubMed1987

Papillary eccrine adenoma. Light-microscopic, histochemical, and immunohistochemical studies.

In 1977, Rulon and Helwig described 14 cases of a benign sweat gland tumor that they termed papillary eccrine adenoma. These neoplasms have a characteristic morphology, consisting of dilated ducts that contain eosinophilic secretion and are often associated with intraluminal papillations. They also stressed the benign clinical behavior of these neoplasms. Since their original description, occasional single cases have been reported. We describe herein four new cases and their immunohistochemical characteristics, including the presence of cytokeratins, S100 protein, and carcinoembryonic antigen.

Adult↗
PubMed1986

Trabecular (Merkel cell) carcinoma of the skin. Treatment of primary, recurrent, and metastatic disease.

Four new patients with trabecular (Merkel cell) carcinoma of the skin are described, and an additional 76 patients from the literature are reviewed. The mean age of the combined group of patients was 68; 84% were 60 years or older. Primary tumors appeared most frequently on the head and neck (44%), leg (28%), arm (16%), or buttock (9%). No primary tumor appeared on the trunk. The rate of local recurrence was 36%, regional metastatic disease, 53%; distant metastases, 28%; and death due to metastatic tumor (minimally), 25%. It appears that trabecular carcinoma of the skin is more aggressive and lethal than previously thought. The authors recommend that patients with this tumor undergo wide resection of the primary site and, in healthy patients, prophylactic regional node dissection. Both radiation therapy and chemotherapy are effective in palliating unresectable disease.

Adenocarcinoma↗