Biomedical subjects
E F McCarthy
Publications and source records attributed to E F McCarthy.
Idiopathic segmental sclerosis of vertebral bodies.
Five cases of idiopathic vertebral sclerosis are presented. The features of this condition are segmental vertebral sclerosis of a single lumbar vertebra in a young adult without disc space narrowing or alteration of vertebral contour. The differential diagnosis is discussed. Lumbar vertebra biopsies of three patients showed reactive nonspecific osteosclerosis.
Chondrosarcoma of bone with dedifferentiation: a study of eighteen cases.
Eighteen patients with chondrosarcomas showing dedifferentiation were reviewed. Thirteen of the 14 patients in whom there was follow-up died of their tumors, with an average survival of six months. The average age was 61, and the most common location was the distal femur. Eight patients presented with pathologic fractures. Radiographically the tumor appeared as a destructive are with an associated heavily calcified lesion. This corresponded to combined histologic patterns of high grade sarcoma, usually with features of a malignant fibrous histiocytoma, and a low grade chondrosarcoma. This lesion must be distinguished from a primary malignant fibrous histiocytoma of bone in view of the different prognostic implications.
Visual loss associated with choroidal nevi.
Twenty-two of 206 patients (11%) with choroidal lesions diagnosed clinically as nevi of the posterior fundus had decreased visual acuity attributable to the lesion. The decreased visual acuity was secondary to serous foveal detachment (50%), presumed photoreceptor degeneration without serous detachment (42%), and subretinal choroidal neovascularization overlying the nevus (8%). Visual loss associated with a small melanotic choroidal tumor does not necessarily imply that the tumor is a choroidal malignant melanoma as 88% of the small melanotic choroidal tumors causing visual impairment did not grow during an average follow-up period of 25 months, and the great majority of these tumors were probably true spindle cell nevi. However, three tumors (12%), initially categorized as "suspicious nevi," enlarged during follow-up and were recategorized as malignant melanomas.
State special education fiscal policy: the quest for equity.
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Juxtapapillary choroidal nevi.
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Aseptic necrosis of bone. An historic perspective.
The history of aseptic bone necrosis includes important contributions by Hunter, Russell, Goodsir, Paget, König, Axhausen, Phemister, and Chandler. Only after Pasteur discovered bacteria in abscesses could a nonbacterial or aseptic necrosis be conceptualized. Techniques and information gained from the study of bone grafts led to important steps in the recognition of aseptic necrosis. The use of the X-ray and careful pathologic correlation enabled a wide group of radiographically distinct lesions to be recognized as bone necroses. Although many identifiable diseases can underlie aseptic necrosis, the cause of most cases is unknown.
Primary synovial chondromatosis. An ultrastructural study.
Three cases of synovial chondromatosis involving the knee were studied using the electron microscope. Cells in the hyaline cartilage nodules demonstrated ultrastructural features of typical mature cartilage. Adjacent to the cartilage nodules were areas of numerous fibroblast-like cells in a matrix containing abundant coarse cartilage. A few areas contained cells that demonstrated intermediate differentiation between chondrocytes and fibroblast--elongated cells with well developed Golgi complexes. These areas most probably represent sites of active metaplasia where previously resting fibrocytes begin to secrete a chondroid matrix.
The frozen-section autopsy.
A protocol for the rapid completion of autopsies using frozen sections was studied. The protocol was tested on 50 autopsy subjects, and the results compared with those from the standard autopsy protocol used on the same 50 cases. Cost, speed with which the reports could be completed, teaching value, and accuracy were compared; autopsy completed by frozen sections was superior in all four areas. There were 47 errors, none of which involved major disease processes. All but nine were errors of sampling and could be remedied by the more liberal sampling of tissues and the occasional supplementation with paraffin sections. The frozen-section autopsy protocol can replace the standard autopsy protocol in most cases. The rapid completion of the autopsy invites participation of the clinician and stimulates cooperation that benefits both the clinician and the pathologist.
Tetracycline-associated fatty liver of pregnancy, including possible pregnancy risk after chronic dermatologic use of tetracycline.
Two cases of tetracycline-associated fatty liver of pregnancy are reported. In one, the history was negative for antibiotic use, yet autopsy revealed typical gross and microscopic bone fluorescence of tetracycline. Tissue extraction and chemical analysis showed qualitative evidence of tetracycline, whereas quantitation revealed 60 microgram/gm of wet bone tissue. Findings in our cases and in those from the literature indicate that the association of tetracycline use and fatty liver of pregnancy is even more common than has been suggested.
Vascular and cartilaginous hamartoma of the ribs in infancy with secondary aneurysmal bone cyst formation.
Three aneurysmal bone cysts of the rib in infants are presented. These tumors were engrafted on vascular and cartilaginous hamartomas and thus showed the unusual feature of hyalin cartilage associated with aneurysmal bone cyst. The entity of vascular and cartilaginous rib hamartoma is discussed with emphasis on the importance of distinguishing this malformation from a benign or malignant neoplasm.
Malignant fibrous histiocytoma of bone: a study of 35 cases.
Thirty-five cases of primary malignant fibrous histiocytoma of bone are reported. Twenty of these cases were collected from a retrospective analysis of other malignant bone tumors. The age range was from 11 to 69 years; the average age was 34 years. The tumor occurred most commonly in the distal femur and proximal tibia. The distinguishing histologic feature was a storiform arrangement of spindle cells. The differential diagnosis included fibrosarcoma, osteogenic sarcoma, malignant giant cell tumor, malignant lymphoma, and metastatic carcinoma. Follow-up of at least three years was available in 21 cases. Of these, nine patients were alive and free of metastases three and one-half to 12 years after treatment. Two were alive with solitary metastases at three years, and 10 patients died between three months and three years after treatment. In four cases the lesions were multicentric at the time of diagnosis and in four cases were associated with bone infarction. This tumor must be recognized as an important complication of bone infarction and should be suspected when a patient with a known history of bone infarction develops a change in symptoms. Because the prognosis of this tumor is significantly better than that in those tumors with which it had been previously grouped, and in view of its association with bone infarction, it deserves to be maintained as a distinct clinicopathologic entity. Amputation is the treatment of choice.
The ultrastructural localization of secretory acid phosphatase in giant cell tumor of bone.
Three cases of giant cell tumor of bone were studied with the light and electron microscopes to determine the histochemical and cytochemical distribution of acid phosphatase isoenzymes. Using beta-glycerophosphate as a nonspecific substrate, acid phosphatase was found in the giant cells as well as the stromal cells. Ultrastructurally, using this substrate, the enzyme was found to be associated with lysosomes in the stromal cells and giant cells and also with the profuse system of tubules and vesicles in the cytoplasm of the giant cells. Using phosphorylcholine and D-ephedrinephosphate, which are substrates for a specific secretory isoenzyme of acid phosphatase, activity was found only in the vesicles of the giant cell cytoplasm. Lysosomes did not show activity with these substrates. Multinucleated cells of giant cell tumor contain a specific secretory type of acid phosphatase which is not present in the stromal cells. This suggests that the giant cells are attempting to form a secretory system similar to osteoclasts and that the vesicles in the cytoplasm which contain this acid phosphates are the morphologic expression of an abortive secretory system.
A solitary functioning osseous metastasis from a malignant pheochromocytoma of the organ of Zuckerkandl.
A case of a malignant phenochromocytoma of the organ of Zuckerkandl is reported. There was a solitary functional metastasis in the left femur, which was treated by hip disarticulation after removal of the primary. The patient is asymptomatic and free of further metastases after 3 years. Other reported cases of solitary metastases from malignant pheochromocytomas are cited. These occurred most frequently in the skeleton system, which is the most common site of distant metastases in malignant pheochromocytoma. The reported case and the review of the literature indicate that solitary or limited metastatic lesions should be treated surgically by partial or, when possible, complete resection.
Autopsy and medical education.
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A primary rib tumor in a newborn.
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Parosteal (nodular) fasciitis of the hand. A case report.
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