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Biomedical subjects

G L Ellis

Publications and source records attributed to G L Ellis.

At least 19 recordsLinked to original sources
PubMed1992

Mucoepidermoid carcinoma of intraoral salivary glands. Evaluation and application of grading criteria in 143 cases.

The histopathologic criteria most useful for grading of mucoepidermoid carcinomas are controversial. To identify those histologic features most important in the grading of intraoral mucoepidermoid carcinomas, 143 cases of this disease with clinicopathologic correlations were studied. Twelve histopathologic features of each tumor and their clinical presentation were correlated with patient outcome. Seven patients died of disease, 5 had regional metastases only, 10 had recurrences only, and 121 had no additional problems. Clinical features suggesting aggressive behavior were short duration, presence of clinical symptoms, and location of tumor in the tongue and floor of the mouth. The histopathologic features that indicated high-grade behavior were an intracystic component of less than 20%, four or more mitotic figures per ten high-power fields, neural invasion, necrosis, and cellular anaplasia. The simultaneous assessment of these features showed improved prognostic correlation over individual parameters. A quantitative grading system was devised using these features. Tumors with a point score of 0 to 4 were considered low grade, and none of 122 patients with scores in this range died of their tumor, although 9 had recurrences only and 3 had regional metastases. Point scores of 7 or above indicated highly aggressive behavior. Six of ten patients with these high scores died of tumor. Most of these six patients had recurrences and regional metastases, and all had distant metastases. Two other patients had regional metastases only. Scores of 5 to 6 were considered intermediate between low-grade and high-grade scores because only 1 of 13 patients with these scores died of disease. Three of the five patients with regional metastasis had low-grade tumors, indicating the inability of the grading system to identify them. Nonetheless, with an average follow-up on these patients of 10 years after treatment of the metastasis, no patient had additional problems. The relative objectivity of our proposed grading system for intraoral mucoepidermoid carcinomas may help achieve more accurate and consistent grading of these rare tumors.

Adolescent↗
PubMed1992

Metastasizing mixed tumor of salivary glands. A clinicopathologic and flow cytometric analysis.

Among salivary gland neoplasms are a group of rare tumors that are histologically identical to benign mixed tumors that inexplicably metastasize; they have been called metastasizing mixed tumor (MZMT) of salivary glands. We report the clinicopathologic features and flow cytometric findings for 11 cases of MZMT. At the time of discovery of metastatic disease, the patients, six women and five men, ranged in age from 20 to 83 years. Primary sites of involvement included the parotid gland (eight cases), submandibular gland (two cases), and the nasal septum (one case). With one exception, all the patients had at least a single recurrences of their primary mixed tumor, but two or more recurrences were the norm before development of metastatic foci. The metastases were discovered from six to 52 years following the occurrence of the primary tumor. Metastatic deposits were identified in bone, lung, regional lymph nodes, skin, kidney, retroperitoneum, oral cavity, pharynx, calvarium, and central nervous system. The metastases either occurred simultaneously with an episode of recurrent mixed tumor (n = 5) or from 5 to 29 years after a recurrence (n = 6). The treatment of the primary, recurrent, and metastatic neoplasms was surgical excision. Follow-up, ranging from 8 months to 16 years following the diagnosis of MZMT, revealed seven patients to be alive without disease (64%) and two dead of causes unrelated to metastatic disease (18%). Two patients (18%) died as a direct result of metastatic tumor at 3 and 2 years after metastasis of their mixed tumors. Flow cytometric analysis revealed a diploid DNA cell population in the primary and/or metastatic tumors in nine cases. Aneuploid DNA cell content was identified in two of the cases. DNA ploidy levels and cell proliferation rates were compared with those of conventional benign mixed tumors and also with malignant mixed tumors. Retrospective analysis of histologic parameters (mitotic rate, cellular pleomorphism, infiltrative growth, vascular or lymphatic invasion) and flow cytometric analysis failed to identify criteria to predict the development of metastasis in these neoplasms.

Actins↗
PubMed1992

Inflammatory pseudotumors of the major salivary glands. Clinicopathologic and immunohistochemical analysis of six cases.

Inflammatory pseudotumor is a pathologic term used to describe reactive, pseudoneoplastic phenomena, which reportedly occur in many parts of the body. Clinicopathologic and immunohistochemical findings in six cases of inflammatory pseudotumor of the major salivary glands are described. All six lesions involved the parotid gland. There were three men and three women affected, with a median age of 72.5 years. All patients presented with a swelling of several months' duration in the parotid region. Five patients were alive and free of tumor at an average of 3.2 years after surgical removal, and one patient was lost to follow-up. The lesions were firm, discrete nodules, grossly described as homogenous yellow-gray tissue. Histologically, all lesions contained a diversified admixture of four histological elements: (a) myofibroblasts, (b) histiocytes, (c) plasma cells, and (d) lymphocytes. Results of immunohistochemical studies showed a biphasic spindle cell population of myofibroblasts and histiocytes with variable staining characteristics for KP-1(CD-3), smooth muscle actin, muscle-specific actin, and vimentin. These findings are in agreement with the concept that inflammatory pseudotumor is a fibroinflammatory lesion with an abundant component of myofibroblastic/fibrohistiocytic elements.

Actins↗
PubMed1992

Radiologic evaluation of foreign bodies.

The correct selection of a radiologic imaging modality along with knowledge of indirect radiologic findings can help determine the presence and location of a foreign body. Plain radiographs should be the initial screening modality for a suspected foreign body. Whereas most metal and glass foreign bodies are detectable on radiographs, many foreign bodies, including wood, are not. We do not advocate using xeroradiography for the detection of foreign bodies. When a suspected superficial foreign body is not delineated on radiographs, ultrasonography should be the next modality of choice. CT should be reserved for deep foreign bodies or when foreign bodies are not seen on radiographs or ultrasonography but are suspected.

Diagnostic Imaging↗
PubMed1991

Usefulness of antikeratin immunoreactivity in osteosarcomas of the jaw.

The immunohistochemical typing of cytoplasmic intermediate filaments has proved helpful to the pathologist in classifying poorly differentiated malignant neoplasms. In general, identification of keratin-type intermediate filaments has been associated with epithelial histodifferentiation, but several exceptions to this generalization have been reported in the literature. A recent report identified false-positive immunostaining for keratin in osteosarcomas of the jaws that was attributed to cross-reactivity induced by enzyme digestion of the tissue specimens before immunostaining. Because the jaws are unique in the skeletal system because of their relatively high incidence of intraosseous epithelial neoplasms, false-positive immunoreactions for keratin could complicate differentiating sarcomatoid epithelial neoplasms from poorly differentiated osteosarcomas. To evaluate this possible pitfall in our laboratory, eight osteosarcomas of the jaws were evaluated for keratin immunostaining with polyclonal and monoclonal antibodies on tissue sections that had been enzymatically treated with protease. No immunostaining was demonstrated in these tumors. Repudiation of the usefulness of antikeratin immunohistochemistry for intraosseous jaw tumors was not confirmed with the procedures used in our laboratory.

Adult↗
PubMed1991

Calcifying odontogenic cyst. A review of ninety-two cases with reevaluation of their nature as cysts or neoplasms, the nature of ghost cells, and subclassification.

Ninety-two cases of calcifying odontogenic cyst (COC) were reviewed with special consideration of their nature as cysts or neoplasms, the nature of ghost cells, and classification on the basis of clinicopathologic features. The cases were divided into 79 (85.9%) cysts and 13 (14.1%) neoplasms. The cysts occurred as four variants: (1) nonproliferative COC (35 cases), characterized by a simple unicystic structure; (2) proliferative COC (17 cases), characterized by a cystic structure with multiple daughter cysts, extensive ghost cell formations, and marked tendency for calcification; (3) ameloblastomatous COC (11 cases), characterized by ameloblastoma-like, cyst-lining epithelium with ghost cells and calcifications; and (4) COC associated with odontoma (16 cases), which combined features of COC and odontoma. The neoplasms occurred as three variants: (1) ameloblastoma ex COC (two cases), which showed unifocal and multifocal intraluminal and intramural ameloblastoma proliferating from the COC-lining epithelium; (2) peripheral epithelial odontogenic ghost cell tumor (eight cases), which occurred in the gingiva and resembled peripheral ameloblastoma except for clustered ghost cells in the central portion of epithelial islands and the presence of juxtaepithelial dentinoid; and (3) central epithelial odontogenic ghost cell tumor (three cases). The latter showed ameloblastomatous or adenomatoid odontogenic tumor-like epithelial clusters with ghost cell formation and juxtaepithelial dentinoid. The clinical features of cystic and neoplastic variants were tabulated and described. On the basis of histopathologic features and their immunohistochemical reaction to polyclonal antikeratin antibody, it is suggested that ghost cells might be the result of coagulative necrosis.

Adolescent↗
PubMed1991

Imaging of the atlas (C1) and axis (C2).

In imaging the atlantoaxial region in injured patients, the initial modality is plain radiography. The lateral C-spine as well as the open-mouth view are essential in this regard. On these views, it is not only important to examine the bony contour but also to look for indirect signs of injury such as prevertebral soft-tissue swelling, air in the prevertebral space, an increased width of the anterior atlantodental interval, and overriding of the C1-C2 joint on one side (the so-called wink sign of atlantoaxial rotatory subluxation). In patients in whom there is a high index of suspicion for occult trauma, but without fractures suggested or adequately visualized on routine films, or in those with severe cranial trauma, further studies should be pursued. CT scan is the modality of choice in optimally imaging the bony contours of the axis and atlas. It has limitations in visualizing transversely oriented fractures such as high dens fractures, transverse fractures of the facet joints (although widening of the facet joint is an indirect indication of facet fracture), or transverse arch fractures. Plain tomography may better demonstrate such transverse fractures but has several disadvantages. Plain tomography is often not as readily available as CT; it requires that the patient be placed in lateral decubitus position to obtain lateral tomograms, which may be contraindicated in such clinical circumstances; and it is not as easy to appreciate three-dimensional relationships on plain tomography as it is on CT. CT clearly defines the location of displaced bone fragments in relationship to the spinal canal as well as often demonstrating disc injuries. Ligamentous injury, though potentially visualized directly on MR imaging, is more commonly addressed with flexion-extension films. Flexion-extension studies should, obviously, be performed only in awake, oriented patients who are without neurologic deficit, and the studies should be done with close physician supervision and stopped at the first onset of pain. MR imaging may be helpful in demonstrating soft-tissue injuries such as hemorrhage, disc herniation, nerve root impingement, and direct spinal cord damage.

Adult↗
PubMed1990

Basal cell adenocarcinomas of the major salivary glands.

Basal cell adenoma of salivary gland has become an established variant of monomorphic adenoma since its segregation from pleomorphic adenoma in 1967. Although there have been many comprehensive reports about benign basal cell adenomas, only rare case reports of malignant basal cell type neoplasms have appeared in the literature. Described in this report are the clinicopathologic features of 29 cases labeled basal cell adenocarcinomas that had morphologic characteristics of basal cell adenomas but infiltrative, perineural, and intravascular growth features that indicated a malignant potential. With limited follow-up, seven tumors are known to have recurred, and three of these metastasized to lymph nodes and lung. One patient died with extensive local spread of the tumor. All patients were adults. The peak incidence was in the sixth decade of life, and there was no gender predilection. The parotid gland was the predominant site. A solid type growth configuration was most frequent; membranous, trabecular, and tubular types were less frequent, in that order. Three patients also had dermal cylindromas, perhaps indicative of a salivary gland-skin adnexal diathesis that has been previously reported.

Adenocarcinoma↗
PubMed1990

Pacemaker twiddler's syndrome: a case report.

A patient with a dual-chamber pacemaker presented with rhythmic contractions of her right hemidiaphragm. The atrial lead of her pacemaker had retracted into the right subclavian vein, causing pacing of the right phrenic nerve. The cause of the lead displacement is unknown, but may have resulted from unintentional manipulation of the pacemaker generator pouch by the patient, the so-called Pacemaker Twiddler's Syndrome.

Aged↗
PubMed1990

Viral infections during pregnancy: a guide for the emergency physician.

Emergency physicians are frequently called on to treat or advise pregnant patients. When faced with a pregnant patient who has clinical evidence of or exposure to a viral illness, the emergency physician must be aware of the potential maternal and fetal risks posed by various viral agents. This review provides current, accurate information and guidance for the pregnant patient.

Emergency Medicine↗
PubMed1990

Detection of soft-tissue foreign bodies by plain radiography, xerography, computed tomography, and ultrasonography.

Detection of a soft-tissue foreign body is common yet often difficult, particularly when the foreign material is not radiopaque. Various imaging modalities have been advocated for detecting foreign bodies that are not revealed by plain radiography. The abilities of plain radiography, xerography, computed tomography, and ultrasonography to detect glass, wooden, and plastic foreign bodies in an in vitro preparation are compared. While all of these imaging techniques demonstrated a glass foreign body, only ultrasonography clearly identified wooden and plastic foreign bodies.

Evaluation Studies as Topic↗
PubMed1990

Subdural hematoma in the elderly.

The presentation of subdural hematoma is often more subtle in the elderly than in younger patients, due in part to cerebral atrophy and in part to the interaction with other medical conditions to which the elderly are prone. With the advent of computed tomography, the diagnosis of subdural hematoma has become easier and noninvasive. This improvement in diagnostic capability has enhanced the understanding of the epidemiology and presentation of subdural hematomas in the elderly. The role of magnetic resonance imaging is also discussed, as is the pathophysiology, management, and prognosis in the elderly patient.

Aged↗
PubMed1988

A clinical and histomorphologic comparison of the central giant cell granuloma and the giant cell tumor.

The clinical, histologic, and histomorphometric features of 42 giant cell tumors (GCT) of long bones and 49 central giant cell granulomas (CGCG) of the jaws were compared. These findings were also correlated with the clinical behavior of 25 cases of CGCG for which follow-up information was available. There was a female predilection for both lesions. The mean ages of patients with CGCG and GCT were 21 and 25 years, respectively. In contrast to CGCG, GCT rarely occurred in persons below the age of 10 years. The only statistically significant quantitative difference between the lesions at the histologic level was the greater number of nuclei in the giant cells of the GCT. There were four significant histologic differences between the two lesions, but 26% of the GCTs were histologically similar to most of the CGCGs and 10% of the CGCGs were histologically similar to most of the GCTs. Five of the 25 patients with CGCG for whom follow-up information was available had recurrences. The average age of those five patients was 11 years, compared to 29 years for those patients without recurrence. All five patients with recurrence were under 17 years of age, and they constituted 45% of the patients in this age group with follow-up. There were no quantitative or histologic differences between the recurrent and nonrecurrent CGCGs that were useful in predicting the likelihood of recurrence. Our findings suggest that the GCT and the CGCG represent a spectrum of a single disease process modified by the age of the patient and the site of occurrence.

Adolescent↗
PubMed1988

"Clear cell" oncocytoma of salivary gland.

For the most part, clear cell neoplasms of the salivary glands are adenocarcinomas of at least low-grade malignant potential. However, a rare benign clear cell tumor of major salivary glands can be distinguished as a histologic variant of oncocytoma and oncocytosis. Ten such cases have been identified in the files of the Armed Forces Institute of Pathology (Washington, DC). Eight patients were women, and nine of the lesions involved the parotid gland. All of the patients were middle-aged or older adults. The light-microscopic morphology and the phosphotungstic acid-hematoxylin (PTAH), PAS, and mucicarmine staining patterns were consistent with oncocytoma and oncocytosis. Transitions from typical eosinophilic oncocytes to clear cells were evident. Electron microscopy and histochemistry demonstrated that the clear cytoplasm seen by light microscopy was primarily due to artifact and intracytoplasmic glycogen. Mitochondria were the preponderant cytoplasmic organelles. Two patients were known to have experienced recurrent lesions.

Adenocarcinoma↗
PubMed1987

Salivary gland tumors of the tongue. Analysis of 55 new cases and review of the literature.

Fifty-five cases of primary salivary gland tumors of the tongue from the files of the Armed Forces Institute of Pathology are reported and analyzed and the results compared with the information in the literature. Five tumors were benign and 50 were malignant. The average age at presentation was 47 years for the benign tumors and 54.3 years for the malignant ones. Although the overall benign/malignant ratio was 1:10, women were more likely to have a malignant tumor than were men. The site of 80% of the benign tumors was the middle to anterior portion of the tongue, whereas over 85% of malignant tumors involved the base. Clinical signs and/or symptoms related to the site aroused suspicion in some cases but often were of short duration and in over 60% of cases did not occur. The most common benign tumor type was the myoepithelial variant of the benign mixed tumor. The most common malignant tumor type was the low-grade mucoepidermoid carcinoma (38%) followed by adenocarcinoma (20%), high-grade mucoepidermoid carcinoma (14%), adenoid cystic carcinoma (10%), and clear cell carcinoma (8%), with occasional basaloid, papillary cystadenocarcinoma, acinic cell and mucus-producing adenocarcinoma. Treatment was similar to that of other accessory salivary gland neoplasms of similar histologic type and clinical stage. Prognosis worsened with high histologic grade, old age, and advanced clinical disease at presentation.

Adenocarcinoma↗
PubMed1987

Central granular cell odontogenic fibroma.

First described in 1962, the so-called granular cell ameloblastic fibroma has been a rarely reported benign odontogenic tumor. On reviewing the literature, we have identified eight previously reported cases. All cases involved well-circumscribed radiolucencies in women who ranged in age from 53 to 65 years. Seven lesions occurred in the posterior body of the mandible, and one occurred in the premolar region of the maxilla. All lesions were treated with surgical excision, and no recurrences were identified during follow-up periods of 6 to 144 months. Two additional cases also appear to represent instances of this neoplasm, which bring the total number identified to ten. We describe the clinical, radiographic, and histopathologic features of two additional cases and suggest reasons the tumor should be referred to as central odontogenic fibroma, granular cell variant.

Adult↗