PubMed Health⌕ Search

Biomedical subjects

G Cserni

Publications and source records attributed to G Cserni.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Helocobacter heilmannii (Gastrospirillum hominis)-associated gastritis: first reported cases in Hungary].

We found a tightly coiled bacterium, Helicobacter heilmannii that is distinct from Helicobacter pylori in the gastric mucosal biopsy of a 55-year-old man and a 30-year-old woman, both of whom had previous history of intermittent epigastric pain. The organisms were distributed in the antral mucosa, which was endoscopically interpreted as demonstrating chronic gastritis in one case, and being normal in the other. Histologically, the affected mucosa presented a mild chronic gastritis without activity and a moderate chronic gastritis with marker activity, respectively. The bacteria seen on haematoxylin eosin stained slides were strongly Giemsa positive, and were also visualized with Warthin-Starry stain. They were negative with the anti-Helicobacter pylori immunohistochemistry, although a few spots of staining could represent some cross reaction. Electron microscopy revealed fragments of bacterium, with its characteristic spiral shape and length of 4-7 mm in the plane of the section. One of the patient was treated medically and the control examination revealed normal antral mucosa without spiral bacteria. Detection of these organisms may provide a new insight into the pathogenesis of human gastritis.

Adult↗
PubMed1999

Reproducibility of a diagnosis of invasive lobular carcinoma.

BACKGROUND AND OBJECTIVES: THE fact that invasive lobular carcinoma (ILC) is often multicentric has led to mastectomies being regularly performed for this disease in some settings. Reproducibility of the histological typing of breast cancer was investigated. METHODS: Fifty slides from breast cancers were assessed individually by 10 pathologists from different institutions, whose findings were compared. RESULTS: The extent of matching of the reported histological types between the various pairs of pathologists ranged between 28 and 88%. Agreement was better for pathologists with special experience in breast pathology. The kappa values for the exact histological type, for pure ILC and for the presence of an ILC component, were 0.23, 0.31, and 0.32, respectively (0.64, 0.43, and 0.46 for pathologists experienced in breast pathology). CONCLUSIONS: The study demonstrates that there are equivocally interpreted tumors and the presence of ILC in the histological report should not serve as the sole determinant for the performance of mastectomy.

Breast Neoplasms↗
PubMed1999

Estimating the overlap between sentinel lymph nodes and axillary node samples in breast cancer.

Management of the axilla in breast cancer patients is a controversial issue. Axillary sampling and sentinel lymphadenectomy are both conservative surgical approaches which aim to stage the disease. These procedures target selective treatment of node-positive patients and seem to allow the omission of axillary clearance in node-negative ones. In this way, they reduce the rate of complications in an otherwise overtreated subset of patients. Forty consecutive patients with palpable T1 and T2 breast carcinoma underwent sentinel lymphadenectomy following mapping with Patent blue dye, with subsequent axillary clearance and excision of the tumor or mastectomy. Then the largest/firmest 3,4,5 and 6 nodes were selected from all the lymph nodes in order to model an axillary sample. It was suggested that these are the nodes that are the most likely to be included in the specimen during sampling, because of their size and consistency. The probability of the sentinel lymph nodes falling into the sample of the 3-6 largest/firmest nodes was calculated. The sentinel nodes predicted the axillary nodal status in 95%, while the samples of the largest 3, 4, 5 and 6 nodes were predictive in 95, 96, 98 and 98%, respectively. The two methods of evaluation displayed a considerable overlap, as the sentinel node would have been included in the 3 6 largest/firmest nodes in 79 92% of the cases, depending on the number of largest nodes evaluated. The overlap was greater after fine needle aspiration of the primary tumor. Although the two alternative staging procedures of 3, 4, 5 or 6 node sampling and sentinel lymphadenectomy with the vital blue dye technique cannot be simultaneously done without one influencing the other, and the first method was only modeled, the results suggest that there is a considerable overlap between the two; axillary sampling may often remove the sentinel lymph nodes.

Axilla↗
PubMed1999

Nodal staging of colorectal carcinomas from quantitative and qualitative aspects. Can lymphatic mapping help staging?

Retrospective data analysis was performed to determine the minimum number of lymph nodes required for the staging of colorectal carcinomas, and a prospective feasibility study was carried out to identify sentinel nodes in order to clarify whether these may predict the nodal status. From among 240 colorectal carcinoma specimens investigated between 1996 and 1998, 224 tumors were analyzed for their nodal status. Lymphatic mapping with vital patent blue dye injection into the peritumoral sub-serosal layer was performed in 25 patients. Blue nodes were identified by the pathologist in the unfixed specimen immediately after the resection of the bowel and were assessed separately. Of the 123 node-positive carcinomas, 40 had more than 3 nodes involved. The nodal positivity increased substantially when more than 6 nodes were assessed. The cumulative percentage analysis demonstrated that ideally 16 and 13 nodes should be obtained for the identification of any nodal involvement or the involvement of more than 3 nodes, respectively. Lymphatic mapping was successful in 24 patients (96%). Blue nodes were predictive of the nodal status in 19 cases (79%), and were the only sites of metastasis in 2 patients (15% of the node-positive cases). Lymphatic mapping with the vital blue dye technique does not seem to facilitate the staging of colorectal cancers, at least in our patient population with relatively large and deeply infiltrating tumors, and unless the technique is improved or other selective features of lymph nodes are found, all lymph nodes should be assessed. A minimum of 6 nodes, and an optimum of 16 nodes or more, are suggested from these series.

Adult↗
PubMed1999

Metastases in axillary sentinel lymph nodes in breast cancer as detected by intensive histopathological work up.

AIM: To assess the value of the intensive histological work up of axillary sentinel lymph nodes (SLN) to demonstrate regional metastatic disease. METHODS: From a series of 58 successful lymphatic mapping procedures, 78 SLN were analysed by serial sections (mean of 49 levels/SLN) and by immunostaining to cytokeratin and epithelial membrane antigen, and the results compared with those obtained by assessing the central cross section. RESULTS: The central cross section would have failed to detect metastases in eight of 26 lymph nodes (31%) in patients with breast cancer metastasising to the SLN only. This would have led to a false negative node status in six of 21 patients (29%). Two micrometastases were detected with the aid of immunostains. CONCLUSIONS: The results suggest the need to examine SLN at multiple levels and to use immunohistochemistry in negative cases. Serial sections are also useful in the case of micrometastases, as some of these may convert to macrometastases at deeper levels. Multiple level investigation of SLN and immunohistochemistry in the event of the negativity of standard stains would result in improved staging and an increase in the proportion of node positive disease detected.

Axilla↗
PubMed1999

The reliability of sampling three to six nodes for staging breast cancer.

AIMS: To test the hypothesis that a correct qualitative assessment of axillary nodal status can be established by examining only a limited number of lymph nodes. METHODS: Slides from 499 pN1 or pN0 axillary dissection specimens relating to symptomatic breast cancer cases operated on at our institution between 1991 and 1996 were reviewed. Nodes were ranked in descending order on the basis of their estimated size and lymphoid or metastatic tissue content. After ranking, all nodes were studied microscopically; 265 axillary clearance specimens were positive. RESULTS: Assessment of the 3-6 largest/firmest nodes can lead to the detection of 93-98% of node positive patients and can give a correct qualitative assessment of axillary node status in 96-99%. CONCLUSIONS: Sampling the 4-6 largest/firmest nodes seems to be a reliable alternative for the staging of symptomatic breast cancer. These results suggest a reconsideration of the generally held view that a minimum of 10 nodes is required for adequate identification of the pN0 category.

Axilla↗
PubMed1998

[Prognosis in breast cancer based on histopathological findings (based on data from 42 pathology departments)].

A model program for breast cancer screening has been initiated in Hungary. This paper evaluates the distribution of tumours on the basis of histopathological parameters in order to describe the baseline situation before the nation-wide introduction of screening. All pathology departments were asked to contribute to the study by sending in the complete anonymous reports of the last 10 breast cancer cases reported in 1997. Reports of different completeness on 419 tumours from 42 institutions (53% participation rate) were analysed. The mean age of the patients was 61.2 years (range 28-89). The mean tumour diameter was 2.64 cm (range 0.3-13). The prognostic profile (histological type, grade, lymph node involvement) of the tumours was generally poor. The information content of the reports is variable. Reports evaluable for the given factor involved prognostic information in the following proportions: tumour size: 87%; histological type: 100%; grade: 59%; skin involvement: 52%; pTNM categories; 40%; oestrogen and progesterone receptors: 37 and 29%, respectively; margins: 53%; (lymph)vascular invasion: 39%; peritumoral lymphocytic reaction: 36%; necrosis; 31%. Investigation of other prognostic markers was rare. Smaller city hospitals tended to document less prognostic factors and mostly from the less costly ones. Short and long reports showed no differences between their information content. Typewritten reports are still very common in Hungary, while computer based reporting systems requiring the filling out of prognostic markers fields are rare. The prognostic information content of these latter is generally higher. The estimated poor prognostic profile demonstrated by this report also urges the introduction of a nation-wide screening program, which should improve the observed parameters. Some degree of standardisation in pathology reporting seems also justified.

Adult↗
PubMed1998

[The role of the histopathological analysis of sentinel lymph nodes in breast cancer. Preliminary findings].

Axillary lymph node status is the single most powerful prognostic marker for breast cancer. Histopathological assessment of lymph nodes has become the gold standard, although conventional histological work-up may miss 10-20% of node-positive cases, potentially resulting in undertreatment and poorer survival of these patients. Identification and detailed histological assessment of sentinel lymph nodes may improve the error rate of conventional methods. We performed the first 30 lymphatic mappings using patent blue vital staining at our department of Surgery in the second semester of 1997. The success rate of identifying 1 or 2 sentinel nodes was 73.3% (22 cases). Axillary dissection and either breast conserving surgery of mastectomy were performed on all patients. Sentinel lymph nodes were serially sectioned and also investigated by immunohistochemistry using primary antibodies to cytokeratin and epithelial membrane antigen. This correctly predicted the qualitative axillary nodal status gained from all the nodes in 21 cases (95.5%). The only false negative sentinel node was associated with a micrometastatis in a non-sentinel lymph node. From the predictive cases 10 (47.6%) had positive nodes, and half of these had metastases only in the sentinel node. To our knowledge, we are the first in Hungary to report preliminary results from a lymphatic mapping study for breast cancer. It seems evident that assessment of sentinel lymph nodes increases the sensitivity of the less reliable conventional histopathological work-up, and this provides a more accurate staging when performed in conjunction with axillary dissection. On the other hand negativity of the sentinel lymph node may question the need for the clearance procedure.

Axilla↗
PubMed1998

Proliferative epithelial changes in ectopic gastric mucosa of Meckel's diverticula.

Twenty-one Meckel's diverticula containing an adequate amount of assessable heterotopic gastric mucosa were investigated for epithelial changes. Marked or moderate foveolar hyperplasia was present in 52% and 29% of the cases, respectively. Four cases displayed an excessive epithelial proliferation indefinite for dysplasia. It is pointed out that reflux type gastritis or gastropathy, which is the most common lesion in the ectopic gastric mucosa of Meckel's diverticulum, can be associated with the same confusing epithelial proliferation as reflux gastritis in the stomach, but these lesions are best regarded as representing atypia of repair. Distinguishing features from dysplasia are maturation towards the surface, lack of hyperchromatism and abscence of atypical mitoses. Negative p53 immunostaining and localization of the Ki-67 positivity to the expanded neck region could be additive clues that can help to classify lesions indefinite for dysplasia as negative for dysplasia. On the basis of the similarities of the ectopic and ortotopic gastric mucosa, it is suggested that these additive clues previously used in other parts of the digestive tract could also apply for the stomach.

Adult↗
PubMed1998

The impact of axillary lymphadenopathy on further treatment in breast cancer? A model for clinical staging.

Clinical assessment is an important part of the breast cancer patients' work-up, but it has low sensitivity and specificity. In a retrospective study, histological slides of axillary clearance specimens were used to model palpability of the axillary lymph nodes. Obvious nodes (enlarged and involving considerable amount of lymphatic and/or metastatic tissue) and nodes equal to or larger than 1 cm or 1.5 cm were counted and the slides were subsequently reviewed. The false positive and negative rates expected on the basis of the model ranged from 24 to 72 % and from 10 to 38 %, respectively. This model (also valid for intraoperative assessment of nodal status by palpation) documents the lack of specificity of clinical staging of the axilla. These results question the practice of excluding patients with palpable axillary lymph node enlargement from less radical staging procedures such as axillary sampling or sentinel node biopsy.

Axilla↗
PubMed1998

How to improve low lymph node recovery rates from axillary clearance specimens of breast cancer. A short-term audit.

AIM: To implement an audit scheme to increase the lymph node yield from axillary clearance specimens. METHODS: Two pathologists cut up each specimen after weighing it. The number of nodes and the dimensions of the largest and smallest nodes were recorded, together with the number of non-lymph node structures recovered. Fifty consecutive audited cases were compared with 50 consecutive cases assessed before the audit process. RESULTS: It proved possible to increase the median number of lymph nodes from 10 to 22. There was an obvious learning period, during which the number of nodes recovered during the second pathologist's cut-up gradually decreased, while the total number remained relatively constant. The increase in lymph node yield resulted from the recovery of smaller nodes. The identification of lymph nodes also improved, and fewer non-lymph node structures were recovered by the end of the study. CONCLUSIONS: Such an audit scheme can be recommended for all institutions where the lymph node yield of axillary clearance specimens seems suboptimal. The relevance of recovering more nodes remains to be determined; from this small series, it seems to have no clinical impact.

Axilla↗
PubMed1997

[Histopathological variations in the vitelline duct in heterotopic gastric mucosa with special reference to inflammatory changes. (Study of resected specimens from 1956-1995)].

Cases of resected vitellointestinal duct remnants (including Meckel's diverticula, fistulae and a cyst) diagnosed at the Histopathology Department of our hospital between 1956 and 1995 were reviewed for the presence of heterotopic gastric mucosa. The review of the files included the whole archives of the Bács-Kiskun County Hospital. The files contained 166 records of vitellointestinal duct remnant; of these 151 were evaluated and 28 were shown to involve ectopic gastric mucosa. Seven of these latter had no assessable surface mucosa, and therefore only 21 specimens were evaluated for "gastric" histopathologic changes. "Gastritis" was seen in all cases, however the pattern that predominated was that of chemical gastritis, which has not yet been documented at this location. It was present in 57% of cases and could also account for some symptoms leading to the removal of appendices with no histopathologic signs of inflammation. Chronic and chronic active gastritis-like inflammation were also demonstrated in some cases. Those with moderate or severe activity were associated with peptic ulceration or macroerosions. No Helicobacter pylori like organisms were detected with the modified Giemsa stain and haematoxylin & eosin stain. No conclusions could be drawn regarding the role nonsteroidal anti-inflammatory drugs played in erosive gastritis-like diverticulitis because of the lack of information on the use of such agents; however erosions were rare (14%). The fact that the proportion of ectopic gastric mucosa found in several studies (including this one) is about half that suggested by textbooks indicates a need for a more detailed work up of resected Meckel's diverticulum and a search for all kinds of gastric pathology if gastric heterotopia is present. The identification of chemical gastritis like inflammation, which is often viewed and documented as normal mucosa is also important in this process.

Adolescent↗
PubMed1997

[Limb-body wall malformation complex: an unusual developmental abnormality of the abdominal wall. Case report, clinicopathological and etiological implications].

Anterior abdominal wall defects are not too rare between developmental abnormalities. A case of abdominal wall defect associated with complex malformations diagnosed prenatally is reported in the paper. In the present case of limb-body wall complex a right sided abdominoschisis was associated with rotational abnormality of the lower limbs, clubfoot, scoliosis, meningomyelocele, lack of developed pelvic organs, consecutive dilatation of the upper urinary tract, anal atresia, lack of external genitalia, lack of diaphragm and hypoplastic lungs. Review of the pertinent literature has revealed over 100 cases that clearly indicate the possible phenotypic variation of the limb-body wall complex. These data add further evidence to support the existence of two different phenotypes and possibly pathogenesis under the heading of limb-body wall complex. The three principal theories on the possible aetiology of the complex are also discussed. Because the limb-body wall complex is incompatible with life, it is important to diagnose the lesions prenatally, and to differentiate them from other anterior abdominal wall defects. Serum alpha-fetoprotein measurement, and ultrasonographic examination are the key to prenatal diagnosis.

Abdominal Muscles↗