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Biomedical subjects

F J Paradinas

Publications and source records attributed to F J Paradinas.

At least 55 records · Page 3Linked to original sources

Changes induced by local injection of human lymphoid cell lymphokine into dermal metastases of breast carcinoma: a light and electron microscopical study.

Lymphokines (LCL-LK) prepared from the human lymphoid cell line RPMI 1788 were injected into dermal nodular metastases of three patients with advanced breast carcinoma anergic to recall antigen (tuberculin). Three different injection schedules were employed. Ten such nodules were examined by excision biopsy and their histological appearances were compared with biopsies of four further nodules not injected with the lymphokine. Intranodular injection of LCL-LK resulted in clinical regression of tumour and histological evidence of tumour-cell necrosis with pleomorphic leucocytic infiltration by polymorphs, macrophages and lymphocytes. Electron microscopy of two such nodules failed to show close cell contact between leucocytes and tumour cells prior to tumour-cell necrosis. This study extends evidence that injection of inflammatory lymphokines into accessible tumour can result in local tumour regression and it suggests that such tumour-cell destruction may be the result of a variety of factors operating during local inflammatory response.

Breast Neoplasms↗

Placental site trophoblastic tumour (trophoblastic pseudotumour): a study of four cases requiring hysterectomy including one fatal case.

The clinico-pathological features of four patients with placental-site trophoblastic tumour (trophoblastic pseudotumour) are presented. One patient had the nephrotic syndrome associated with evidence of disseminated intravascular coagulation, with complete resolution after hysterectomy. In two patients the tumour extended beyond the uterus, and one of them died with many metastases in spite of intensive post-operative chemotherapy and 'second look' laparotomy. In three patients the tumour behaved as an actively infiltrative neoplasm resistant to chemotherapeutic regimes usually effective for choriocarcinoma. Serum HCG levels were relatively low compared with those of choriocarcinoma. Histologically the tumours were predominantly composed of mononuclear cells supported by a variable amount of vascular stroma and lacked the bilaminar structure characteristic of choriocarcinoma. Scattered cells stained positively with anti-beta HCG and anti-alpha HCG antisera. Prior curettage was diagnostic in two of three cases. We did not find a clear correlation between mitotic activity and subsequent behaviour. Inflammatory cell infiltration and evidence of organisation around the tumour may be favourable prognostic indicators. We agree with a recent publication stressing the variable behaviour of this tumour, and emphasize the importance of serum HCG monitoring. Total surgical excision is usually feasible and in aggressive cases offers the best chance of eradication. We support the recent suggestion that 'trophoblastic pseudotumour' is an unsuitable name for a potentially lethal disease.

Adult↗

Comparison of the Trucut and Surecut liver biopsy needles.

The Trucut and Surecut liver biopsy needles have been compared in a prospective randomised study. Although the Surecut specimens were longer and heavier they tended to fragment during processing. Trucut specimens were subject to less artefact and were rated more highly by the histopathologist. However, the majority of biopsies obtained by both needles were satisfactory for diagnostic purposes.

Biopsy↗

Natural history of liver disease in chronic hepatitis B surface antigen carriers. Survey of 100 patients from Great Britain.

100 consecutive British chronic carriers of hepatitis B surface antigen seen in a London teaching hospital are described. 77 were male homosexuals and only 19 had either symptoms or signs of chronic liver disease. 27 had normal liver function tests and 69 of the remaining patients had minimal changes, chronic persistent hepatitis, chronic active hepatitis, cirrhosis, or hepatocellular carcinoma diagnosed on liver biopsy. The 4 remaining patients did not have a biopsy but did have abnormal liver function tests. Chronic hepatitis B virus infection was an important cause of these conditions. Most patients showed no clinical, biochemical, or histological change during a mean follow-up period of 44 months, and only 9.7% spontaneously seroconverted from hepatitis B antigen positivity to become anti-hepatitis B e antibody carriers. Although the prognosis is good in the medium term, 7 patients died from hepatocellular carcinoma.

Adolescent↗

The HBe antigen-antibody system and its relationship to clinical and laboratory findings in 100 chronic HBsAg carriers in Great Britain.

HBeAg or anti HBe were detected using radioimmunoassay in 93 out of 100 British patients who were chronic HBsAg carriers. HBeAg was found more commonly than anti HBe in younger patients and those with higher titres of HbsAg and abnormal liver function tests. HBeAg was present particularly in patients with chronic active hepatitis (26 out of 29) and chronic persistent hepatitis (16 out of 21). Anti HBe was found particularly in healthy carriers (19 out of 27), and patients with cirrhosis (4 out of 8) and hepatocellular carcinoma (7 out of 8). However, the system was of little help in predicting the liver biopsy appearances in the individual patient. During a mean follow-up period of 44 months, 6 of the 62 (9.7%) HBeAg positive carriers converted to anti HBe, a spontaneous seroconversion rate of 2.68% per year.

Adolescent↗

Histopathology and localization of viral antigens in the liver of HBsAg positive homosexuals.

In a survey of the prevalence of chronic hepatitis B in a male homosexual population, liver biopsies were done in 28 asymptomatic patients who had persistently raised aminotransferases. Four patients had active cirrhosis (AC), 13 had chronic active hepatitis (CAH) of various degrees of severity and 11 had either chronic persistent hepatitis (CPH) or minor changes of the type seen in hepatitis B virus carriers. Core associated antigens and surface antigen, were demonstrated by the PAP immunoperoxidase method in 20 cases. Core and surface antigens tended to be present in the same areas of the biopsy and quantitation showed higher core to surface antigen ratios in CAH than in CPH, the difference being statistically significant. In seven cases no core-associated antigens were demonstrated in the presence of surface antigen: most of these patients had either inactive disease or active cirrhosis. In one carrier neither antigen was demonstrated. Ten patients had two or more biopsies. Four of these had no treatment and the amounts of core and surface positive cells in the liver did not increase. Six were treated with immunosuppressants. This did not alter the degree of either inflammation or fibrosis. but the number of surface and core antigen positive cells in the liver was higher after treatment in almost every case.

Azathioprine↗

Cholangiocarcinoma coexisting with developmental liver cysts: a distinct entity different from liver cystadenocarcinoma.

We report one liver cystadenocarcinoma and two cholangiocarcinomas coexisting with developmental liver cysts. The cystadenocarcinoma was a solitary multilocular cyst with histological features similar to those seen in ovarian mucinous cystadenocarcinoma. In contrast, the other two tumours were a mixture of solid adenocarcinoma and multiple non-neoplastic cysts containing serous fluid and lined mainly by atrophic epithelium. In both these cases renal cysts were also present and in one case there was focal malignant change of the epithelium lining the cysts from which the solid adenocarcinoma could have originated. Our observations support the view that cholangiocarcinoma associated with developmental liver cysts is an entity different from liver cystadenocarcinoma.

Adenoma, Bile Duct↗

The pathology of the liver in porphyria cutanea tarda.

We report the findings in 53 biopsies from 45 patients with porphyria cutanea tarda (PCT). Red autofluorescence and birefringent acicular cytoplasmic inclusions were constant findings in all untreated cases. Autofluorescence occurs in other hepatic porphyrias, but acicular inclusions appear to be specific for PCT; we have seen them in subclinical porphyria and before development of cutaneous symptoms. They are probably uroporphyrins and they trend to disappear during rinsing by water during most staining procedures. We recommend unstained paraffin sections for their demonstration. Liver damage in PCT has features distinct from other liver diseases, including alcoholic liver disease. These include constant but mild periportal siderosis, focal lipofuscin deposition, focal lobular hepatocyte necrosis associated with groups of pigment-laden macrophages, focal steatosis, marked hepatocyte hyperplasia and the presence of periductal lymphocyte aggregates. The latter have not been previously described in PCT and were present in 43% of our cases. There is a direct relationship between increasing age and progressive distortion of liver architecture, with fibrosis present at a mean age of 48 years, cirrhosis at 57 and hepatocellular carcinoma at 66. The characteristic liver histology and the natural history of PCT are against this being the result of any non-specific liver damage and favour instead a specific liver disease whose pathogenesis may be mainly the result of the metabolic defect of PCT.

Adult↗

An androgen-associated hepatic adenoma in a trans-sexual.

A case is reported of an hepatic adenoma developing in a patient who had been taking testosterone for 3 years. There appears to be an association between various steroid preparations and hepatic neoplasia. Reports of such cases with all relevant data will allow a balanced assessment of the problem to be made.

Adenoma↗

Vitamin B12 binding protein as a tumour marker for hepatocellular carcinoma.

Grossly raised levels of tumour related vitamin B12 binding protein, reflected by rises in serum vitamin B12 and unsaturated vitamin B12 binding capacity (UBBC), were found in three of 44 patients with hepatocellular carcinoma. All three were HBsAg negative and had normal serum alpha fetoprotein levels. The patients did not have underlying cirrhosis and the tumours contained characteristic intracellular inclusions. In the first patient the UBBC level fell during a partial remission induced by adriamycin therapy and in the second patient UBBC levels rose with progression of her disease. In the third patient serum B12 binding protein levels fell after tumour resection. Assay and subsequent monitoring of serum vitamin B12 and UBCC may prove valuable in the assessment and follow-up of some patients with hepatocellular carcinoma whose alpha fetoprotein levels are normal.

Adolescent↗

Liver damage from long-term methyltestosterone.

Of 60 patients (42 female transsexuals and 18 impotent males) receiving long-term therapy with methyltestosterone 50 mg three times a day, 19 had abnormal liver-function tests and 33 out of 52 had abnormal liver scans, particularly those who had been treated for more than a year. Liver biopsy specimens showed accumulation of hepatocytes in the liver cords and within the walls of centrilobular veins, and early peliosis hepatis. One patient had a hepatic adenoma. Of the androgens, only 17alpha-alkylated steroids seem to be implicated in the development of cholestatic jaundice, peliosis hepatis, and liver tumours.

Adenoma↗

Hyperplasia and prolapse of hepatocytes into hepatic veins during longterm methyltestosterone therapy: possible relationships of these changes to the developement of peliosis hepatis and liver tumours.

We report the pathological changes in liver biopsies from 10 patients (four female transexuals and six impotent males) after treatment with 150 mg methyltestosterone daily for periods of up to 3 years, and in a hemihepatectomy specimen from a female transexual who developed a liver adenoma after 37 months of this treatment. Hepatocyte hyperplasia and mild focal sinusoidal dilatation was found in most cases. In some cases there were microcysts and dissociation of hepatocytes. In nine patients there was accumulation of hepatocytes between the endothelium and the supporting collagen of hepatic veins which often resulted in either partial occlusion of their lumina or disruption of their walls. These vascular changes do not appear to have been reported before. It is postulated that a single pathological process-hyperplasia, perhaps related to the anabolic effect of methyltestosterone--could be partly responsible both for the formation of cysts through mechanical obstruction of hepatic veins and for the formation of nodules and tumours.

Adult↗

Hypophosphataemic osteomalacia associated with a malignant tumour of the tibia: report of a case.

A case of vitamin D resistant hypophosphataemic osteomalacia with glycosuria and aminoaciduria is reported. The course of the disease was dramatically altered by the removal of a bone sarcoma which probably had been growing slowly since the onset of the patient's symptoms five years previously. The histology and electron microscopy of the tumour are described. Three years after the operation the patient remains free of symptoms.

Adult↗

Portal hypertension in a patient with chronic myeloid leukaemia.

A patient with chronic myeloid leukaemia treated with busulphan for 4-5 years, developed signs of busulphan toxicity and portal hypertension with ascites, oesophageal varices and jaundice. At post-mortem there was minimal leukaemic infiltration but there were alterations in the liver architecture sufficient to explain the portal hypertension. The pathogenesis of the liver changes and their possible relationship to splenomegaly and busulphan toxicity are considered.

Busulfan↗