Biomedical subjects

E B Helwig

Publications and source records attributed to E B Helwig.

At least 19 recordsLinked to original sources

PubMed1992

Balloon cell malignant melanoma of the skin. A clinicopathologic study of 34 cases with histochemical, immunohistochemical, and ultrastructural observations.

Balloon cell malignant melanoma (BCMM) is a rare histologic variant of malignant melanoma (MM). Thirty-four patients with BCMM from the files of the Armed Forces Institute of Pathology (AFIP) were studied by means of clinicopathologic correlation and histochemical, immunohistochemical, and ultrastructural methods to better define this entity. The cytoplasmic features of the balloon cells observed in BCMM resemble those noticed in balloon cell nevus (BCN), but the presence of nuclear pleomorphism, atypia, and mitoses and the absence of intervening stroma help distinguish BCMM. The cells also show many histochemical, immunochemical, and ultrastructural features of conventional melanoma cells. Although it is generally believed that balloon melanoma cells represent a degenerative change, the immunohistochemical and electron microscopic findings suggest that the balloon tumor cells are most likely metabolically active melanocytic cells. Microscopically, BCMM also must be differentiated from other clear cell tumors such as clear cell sarcoma (MM of soft parts), hibernoma, xanthoma, sebaceous neoplasms, metastatic renal cell carcinoma, (malignant) clear cell acrospiroma, (malignant) granular cell tumor, granular (clear) cell basal cell carcinoma, clear cell syringoma, and atypical fibroxanthoma. The prognosis of BCMM usually correlates with the tumor thickness similar to that in other histologic types of cutaneous MM. Nineteen (57.5%) of 33 patients with adequate follow-up information died of disseminated tumors from 2 months to 12 years after the initial treatment. Six (18.2%) patients developed local recurrences: four of these patients died of metastasis and two were alive with metastatic tumor at last contact. Five (15.2%) patients were alive with metastatic tumors, and seven (21.2%) were alive without evidence of disease at last contact. Recognition of BCMM is important because of its malignant biologic behavior.

Adult↗

PubMed1991

Deceptive bizarre stromal cells in polyps and ulcers of the gastrointestinal tract.

The clinical and pathologic features of 33 pseudomalignant lesions of the gastrointestinal tract with bizarre stromal cells are reported. Deceptive histologic changes were identified in ulcers of seven patients and in inflammatory polyps of 26. A misdiagnosis of malignant neoplasm was made in six of the 33 patients (three polyps and three ulcers). A history of gastrointestinal bleeding and/or inflammatory bowel disease was common. The bizarre stromal cells were usually distributed beneath the ulcerated mucosa or within granulation tissue. They stained strongly for vimentin in 20 of 23 cases. Some of the bizarre cells also stained for muscle specific actin (seven of 23 cases). The cells appear to be reactive fibroblasts or myofibroblasts. Follow-up information obtained on 24 of the 33 patients (including four of the six cases initially diagnosed as malignant) revealed 22 patients to be alive without evidence of a malignant neoplasm (average follow-up, 13 months). Two patients died of other causes. Correct recognition of these bizarre stromal cells in gastrointestinal ulcers and inflammatory polyps will prevent a potentially serious diagnostic pitfall.

Adult↗

PubMed1991

Dysplasia of the stomach and Barrett esophagus: a follow-up study.

Seventy-seven patients with biopsy-proven glandular dysplasia of the esophagus (39 patients) or stomach (38 patients) were followed for a mean of 44 mo or until resection. Of 34 patients with low-grade dysplasia at initial biopsy, 29 had no evidence of high-grade dysplasia or carcinoma on follow-up, three died of other causes, and two had severe dysplasia diagnosed on subsequent biopsy. Of 43 patients with high-grade dysplasia, 28 had no evidence of dysplasia on follow-up (four died of unrelated causes and two of postoperative complications). Fifteen were shown to have invasive carcinoma. Thirteen of the 15 diagnoses of invasive carcinoma were made within 12 mo of original endoscopy. Ulcerated high-grade dysplasias were more likely associated with carcinoma than were nonulcerated high-grade dysplasias (P = 0.001). The presence of ulceration and short time interval to the progression of carcinoma suggest that carcinoma may have been present at the time of initial biopsy in many cases. The frequency of adenocarcinoma's arising in severe dysplasia was slightly less in the stomach (29%) than in the esophagus (41%). We conclude that low-grade dysplasia is often indolent and that ulcerated high-grade dysplasia is often a marker for adjacent invasion.

Adult↗

PubMed1990

Somatostatin-producing duodenal carcinoids in patients with von Recklinghausen's neurofibromatosis. A predilection for black patients.

Eight patients with von Recklinghausen's disease (VRD) and duodenal carcinoids are presented. Seven patients were black, and one white. Six of the eight were women. The presenting symptom was either jaundice or abdominal pain. All tumors were located in the second portion of the duodenum, and three were multiple. Associated tumors other than neurofibromas included multiple leiomyomas, meningioma, neurofibrosarcoma, and prostatic sarcoma. Seven tumors had psammoma bodies, and in three they were numerous. Somatostatin-positive cells were demonstrated in all cases. Two tumors had spread to regional lymph nodes at the time of surgery. There appears to be a predilection for black patients among those with VRD and duodenal carcinoids.

Adult↗

PubMed1990

Goblet cell carcinoids and related tumors of the vermiform appendix.

Appendiceal carcinoids with glandular differentiation pose difficulties in classification and prediction of clinical behavior. Sixty-four such cases were divided into three histologic groups on the basis of routine and immunohistochemical stains: (1) Tubular carcinoids were small and confined to the appendix, had small amounts of intraluminal mucin with few or no goblet cells, were nonargentaffin, lacked serotonin, and were diffusely positive for glucagon. All ten with follow-up (mean, 17 months) were without metastasis. (2) Goblet cell carcinoids were confined to the appendix and mesoappendix, circumferentially surrounded the appendiceal lumen, and were often not suspected grossly. Histologically, they were often mixed with small crypt-like glands and were serotonin positive. All 22 with follow-up (mean, 19 months) were without metastasis whether or not right hemicolectomy was performed. (3) Mixed carcinoid-adenocarcinomas showed spread into the cecum or adjacent viscera at the time of diagnosis and had a large carcinomatous pattern with areas of mucinous, signet-ring, or single-file structure, in addition to goblet cell or insular carcinoid. All patients had right hemicolectomies, and all but two with follow-up died of the disease (mean, 16 months). Although a histologic spectrum exists among carcinoid tumors and certain adenocarcinomas of the appendix, it is possible to delineate three biologically distinct groups. Surgical margins should be taken of all appendices because these tumors often do not form discrete masses.

Adenocarcinoma↗

PubMed1990

Carcinoid tumors of the duodenum. A clinicopathologic study of 99 cases.

Ninety-nine carcinoid tumors of the duodenum were studied. Seventy-seven patients were followed up for a mean period of 65 months, 20 tumors were autopsy findings, and two patients were unavailable for follow-up. Sixteen tumors (21%) produced metastases, all discovered initially; 3 patients (4%) died from metastatic disease (mean survival, 37 months postoperatively). Features associated with metastatic risk were involvement of muscularis propria, size greater than 2 cm, and the presence of mitotic figures. For 51 tumors, there was no correlation between immunohistochemical somatostatin and history of diarrhea, cholelithiasis, or diabetes mellitus (somatostatin syndrome). Five tumors were associated with Zollinger-Ellison syndrome and had immunohistochemical gastrin, but in the others there was no correlation between ulcer disease and gastrin positivity. Duodenal carcinoids are indolent, especially when small and localized to the submucosa. Immunohistochemical identification of somatostatin and gastrin has little clinical relevance.

Adult↗

PubMed1990

Intra-abdominal fibromatosis. A pathologic analysis of 130 tumors with comparison of clinical subgroups.

We studied the clinical, gross, and histologic findings of 130 fibromatoses of the mesentery and other peritoneal sites. Seventeen patients had Gardner syndrome, 12 had prior abdominal surgery, and six had apparent estrogen elevation, including five pregnant or postpartum women and an alcoholic male with gynecomastia. The tumors were usually large and grossly circumscribed. Most often, they were located in the mesentery of the small bowel. They were multiple in 18 cases. Typical histologic features included a dense, collagenous stroma; prominent, dilated, thin-walled vessels; muscular hyperplasia of small arteries; keloidal change; myxoid change; and fibrous tissue insinuation into the muscularis propria of the bowel. Although mitoses were noted in many tumors, they were usually few in number. The gross and histologic features were similar in the clinical subgroups; however, keloidal change was seen less often in female patients. Less than half of the cases were initially correctly diagnosed. Most patients without Gardner syndrome were without recurrence at follow-up, even when the lesions had been incompletely excised.

Abdomen↗

PubMed1989

Carcinoids of the duodenum. A histologic and immunohistochemical study of 65 tumors.

The light-microscopic and immunohistochemical characteristics of 65 duodenal carcinoids are presented. Most tumors showed a mixture of cribriform, insular, glandular, solid, and trabecular growth patterns. Eighty-five percent of the tumors were argyrophil and 15% argentaffin. The nonspecific neuroendocrine markers chromogranin, Leu-7, and neuron-specific enolase were positive in 97, 91, and 83% of tumors, respectively. Immunoreactivity for specific hormones/amines were as follows (percent positive tumors): somatostatin, 47%; N-gastrin, 56%; serotonin, 39%; calcitonin, 19%; insulin, 5%; pancreatic polypeptide, 3%; adrenal corticotropic hormone, 0%; glucagon, 0%. Sixty-eight percent had gastrin/cholecystokinin-like reactivity. Ten psammomatous tumors were located near the ampulla; eight were somatostatin positive, including two in patients with neurofibromatosis. One additional tumor in a patient with neurofibromatosis lacked psammoma bodies but elaborated somatostatin. Eight additional tumors in nonneurofibromatosis patients produced solely somatostatin. Duodenal carcinoids often elaborate more than one polypeptide hormone; those in the ampulla often elaborate somatostatin and have psammoma bodies.

Antigens, Differentiation↗

PubMed1987

Morphometry and cytophotometric assessment of DNA in smooth-muscle tumors (leiomyomas and leiomyosarcomas) of the gastrointestinal tract.

The difficulties in predicting the biologic behavior of gastrointestinal (GI) smooth-muscle tumors (leiomyomas and leiomyosarcomas) based on the usual criteria of malignancy are discussed. In order to evaluate the prognostic importance of the nuclear DNA content and nuclear dimensions, measurements were performed on Feulgen-stained sections of GI smooth-muscle tumors from 66 patients. The best discrimination between benign and malignant tumors was obtained by using DNA index and tumor size as descriptors in a linear discriminate analysis. This method separated 79% of the benign and 97% of the malignant smooth-muscle tumors. However, as with conventional criteria for malignancy, there remained a group of tumors close to the discriminating line with an indeterminate malignant potential. In an attempt to reduce the number of such indeterminate tumors, future studies will include the use of several descriptors in a multivariate analysis system and the application of flow cytometric studies to all tumors.

Adolescent↗

PubMed1986

Prostatic acid phosphatase activity in carcinoid tumors.

In a study of 105 gastrointestinal carcinoid tumors, 67% of the rectal carcinoids and 15% of the carcinoids at other gastrointestinal sites were positive, immunohistochemically, for prostatic acid phosphatase activity. These findings are relevant to the differential diagnosis between rectal carcinoids and prostatic carcinoma.

Acid Phosphatase↗

PubMed1979

Malignant neoplasms associated with nevus sebaceus of Jadassohn.

Nine patients with nevus sebaceus of Jadassohn (NSJ) developed associated morphologically aggressive neoplasms. Four of the tumors were apocrine carcinomas, two of which metastasized to regional lymph nodes, and in one of the two generalized metastases developed. Three tumors were adnexal carcinomas with probable pilar differentiation, but none showed progression of the disease after wide surgical excision. One patient has squamous cell carcinoma and died with generalized metastasis, and one patient had a complex adnexal and squamous cell carcinoma with a large area of anaplastic carcinoma that recurred and invaded the skull.

Adenocarcinoma↗

PubMed1979

Intravenous pyogenic granuloma. A study of 18 cases.

A series of 18 intravenous pyogenic granulomas (IVPG) was studied. The lesions were limited to the neck and upper extremity and appeared as nonspecific tumors. Most had a clinical duration of 2 months or less. Treatment was by excision and there were no recurrences. IVPG consists of an intraluminal polyp attached to the wall of the vein by a fibrovascular stalk. The characteristic appearance is of lobules of capillaries separated by a fibromyxoid stroma. The organization and histologic detail are similar to those of pyogenic granulomas that are uncomplicated by the changes of inflammation. Our observations suggest that IVPG develops in or adjacent to the wall of the involved vein. It probably receives its blood supply from a small artery that enters the lesion in the region of the stalk.

Adolescent↗

PubMed1978

Adenocarcinoid, a mucin-producing carcinoid tumor of the appendix: a study of 39 cases.

Adenocarcinoid is a form of appendiceal carcinoid possessing features of both carcinoid and adenocarcinoma. There are two histologic types. Thirty patients had the goblet cell type, characterized by nests of large mucin-distended cells. Nine patients had the tubular type, characterized by small glandular structures lined by uniform cells. Despite abundant mucin and a goblet cell or acinar-like arrangement, a closer relationship to carcinoid than to adenocarcinoma is suggested by a concentration of tumor elements below the crypts of Lieberkuhn, a lack of evidence of neoplastic transformation of the appendiceal mucosa, and the demonstration of argentaffin or argyrophil granules in 88% of the lesions. Six tumors, all of the goblet cell type, metastasized and resulted in the death of the patients. One of the tumours that metastasized had a prominent tubular component. Most adenocarcinoids can be adequately treated by appendectomy, but hemicolectomy is recommended for those tumors showing atypical foci, a high mitotic count, or spread beyond the appendix.

Adenocarcinoma↗

PubMed1978

Radiologic-pathologic correlation from the Armed Forces Institute of Pathology. Inflammatory fibroid polyp.

The inflammatory fibroid polyp of the stomach, sometimes called eosinophilic granuloma, is a relatively uncommon lesion usually presenting a solitary, benign-appearing filling defect. The differential diagnoses include polypoid adenocarcinoma, hyperplastic mucosal polyp, adenoma, leiomyoma, epitheliod leiomyoma and leiomyosarcoma, and aberrant pancreas. Although difficult to distinguish by gross morphologic features, the inflammatory fibroid polyp shows a distinctive inflammatory response of the mucosal stroma in which eosinophils may be prominent. It is unrelated to the eosinophilic granuloma of lung or bone.

Adenocarcinoma↗

PubMed1978

Cutaneous ciliated cysts.

We studied 11 patients with a cutaneous cyst lined by a simple columnar ciliated epithelium. All of the patients were women in the second or third decade of life. Each had only a single lesion, located on the lower extremity. Clinical examination showed a cyst without specific identifying characteristics. The cyst is considered benign, because of the high degree of differentiation and lack of cellular atypia. The origin of the cyst is unknown. We favor the theory of sequestration and migration over that of transplantation or metaplasia.

Adolescent↗

PubMed1978

Apocrine gland adenoma and adenocarcinoma of the axilla.

Apocrine tumors from the axilla of 12 patients were studied clinically and pathologically. Based on histologic features, two tumors were classified as adenomas and ten as adenocarcinomas. All of the neoplasms were characterized by a glandular arrangement of large cells with abundant eosinophillic cytoplasm and evidence of decapitation secretion. The cytoplasm of the tumor cells contained PAS-positive, diastase-resistant granules. Intracytoplasmic particles of iron were demonstrable in three of ten tumors. Follow-up was available for all 12 patients. The two patients with apocrine adenoma are alive and well. Two patients with adenocarcinoma died of unrelated causes shortly after diagnosis. Of the remaining eight patients with adenocarcinoma, three have died of disease, and one is living with skeletal metastasis. A correlation appears to exist between tumor differentiation and prognosis.

Adenocarcinoma↗

PubMed1978

Lichen nitidus. A study of forty-three cases.

Among forty-three cases of lichen nitidus studied, twenty-one patients were Caucasian, twenty-one were Negro, and one was Spanish-American, ranging in age from five to fifty-eight years. The arm, forearm, trunk, and genitalia were sites most commonly involved. Clinically, the eruption usually appeared as tiny papules. Histologically, the papules showed a parakeratotoic "cap," epidermal atrophy, liquefaction degeneration of the basal layer, and a dermal infiltrate of lymphocytes, epithelioid cells, and sometimes giant cells.

Adolescent↗

PubMed1977

Cellular leiomyomas of the stomach in 49 patients.

The cellular leiomyoma of the stomach is composed of tightly packed, generally uniform spindle cells arranged in palisades, whorls, or interdigitations. Although these neoplasms have been variably considered to arise from gastric smooth muscle or Schwann cells, the morphogenesis is incompletely resolved. Perhaps they derive from a multipotential gastric stromal stem cell that is capable of differentiating toward smooth muscle. A cellular gastric tumor composed of fairly uniform, elongated spindle cells is unlikely to be malignant. Of 49 such tumors, only one metastasized. The combination of an increased mitotic rate and large tumor size is possibly indicative of malignant potential.

Adult↗