Biomedical subjects

I Sesterhenn

Publications and source records attributed to I Sesterhenn.

15 recordsLinked to original sources

PubMed2001

Prostate biopsy protocols: 3D visualization-based evaluation and clinical correlation.

OBJECTIVES: Systematic needle core biopsy is commonly used for the diagnosis of prostate cancer by urologists worldwide. As accurate and early diagnosis will result in more and better options for treatment, it is critical that the best possible protocols for biopsy be used clinically. In this study, we develop three-dimensional (3D) modeling and simulation technologies to evaluate most of the biopsy protocols in current clinical use, and correlate the results with those from clinical cases. MATERIALS AND METHODS: Using deformable modeling techniques, 3D computerized prostate surface models were reconstructed from step-sectioned, whole-mounted radical prostatectomy specimens with localized prostate cancer. A 3D computer simulation system was developed to accurately depict the anatomy of the prostate and all individual tumor foci. A user-friendly interface was developed in the system so that a physician can easily and interactively use it for prostate needle core biopsy. A total of 281 prostate models were reconstructed, and 18 biopsies were performed by a urologist on each model to determine the detection rates of seven different biopsy protocols. Clinical biopsies from 35 patient cases were also reviewed and correlated with the simulation results. RESULTS: The most commonly used sextant biopsy had only a 71.5% detection rate, while rates for the 10-pattern and 12-pattern protocols were much higher (96.4% and 97.2%, respectively). Even the lateral 4-pattern protocol performed better than the sextant protocol, with a detection rate of 89.3%. The lateral sextant biopsy protocol (using sites similar to, but more lateral than, those in the sextant protocol) achieved a rate of 92.5%. Although the rate of the 14-pattern biopsy was a little higher (97.5%), it used four more biopsies to achieve this increase, which, according to McNemar's test, is not statistically significant when compared to results with the 10-pattern protocol. The 5-region protocol, which uses 12 biopsies, had a detection rate of 89.7%. Transition zone and seminal vesicle biopsies did not result in a significantly increased detection rate when added to the patterns above. The clinical correlation also confirmed that the 10-pattern protocol was significantly superior to the traditional sextant biopsy pattern. CONCLUSIONS: The 10-pattern biopsy protocol was the most optimized among all the protocols evaluated. This protocol supplemented the sextant biopsy protocol with four more lateral biopsies in the mid and apical sites on both sides.

Biopsy, Needle↗

PubMed1999

Prostate biopsy schemes: 3-D visualization-based evaluation.

We have developed a prostate needle biopsy visualization system for the evaluation and optimization of biopsy schemes. Three-dimensional (3-D) prostate surface models have been reconstructed from the digitized whole-mount radical prostetactomy specimens with localized cancers. We have conducted evaluation of five major biopsy schemes with a total of 201 3-D prostate models. These are sextant, 10-pattern, 12-pattern, 14-pattern, and the 5-region schemes. The 10- and 12-pattern biopsy schemes had a 99.0% detection rate, while the rate of traditional sextant biopsy scheme was only 72.6%. The 5-region biopsy scheme had a 90.5% detection rate and the 14-pattern, which includes all the biopsies used in the above schemes, added only one additional positive case (99.5%). Our results suggest that biopsy schemes that use laterally placed biopsies based on the five region anatomical model are superior to the routinely used sextant biopsy scheme. Significant correlation is found between the tumor volume and the positive needle core volume for each of these five schemes. The 10-pattern scheme is the best in cancer detection among these five biopsy schemes.

Biopsy, Needle↗

PubMed1998

The molecular characteristics of bladder cancer in young patients.

PURPOSE: The molecular characteristics of bladder cancer in children and young adults remain largely undefined. We sought to identify common molecular changes in bladder tumors in young patients using standard immunohistochemical and interphase cytogenetic methods. MATERIALS AND METHODS: We retrospectively evaluated 73 bladder tumors removed from patients younger than 30 years for the p53 tumor suppressor gene product using immunohistochemical techniques and numerical aberrations of chromosomes 9, 17, X and Y. RESULTS: Regardless of stage, immunohistochemical evidence of p53 gene product over expression was found in the majority of tumors studied. Numerical aberrations (monosomy) of chromosome 9 were rare. Aneuploidy of chromosome 17 was common, particularly in carcinoma in situ and invasive bladder cancer. CONCLUSIONS: These data suggest that immunohistochemical evidence of p53 gene product over expression is common in bladder cancer in young patients. Further prospective analysis of lesions in this population may help to establish a comprehensive molecular progression model for urothelial neoplasms.

Adolescent↗

PubMed1996

Lymphoid changes of the nasopharyngeal and palatine tonsils that are indicative of human immunodeficiency virus infection. A clinicopathologic study of 12 cases.

We report 12 cases in which the histomorphologic changes of the nasopharyngeal tonsils (adenoids) or palatine tonsils suggest infection with the human immunodeficiency virus (HIV). The patients included 10 men and two women, aged 20 to 42 years (median, 33 years). The clinical presentation included airway obstruction, pharyngitis, fever, and a tonsillar or adenoidal mass lesion. Histologic evaluation of the excised adenoids or tonsils in 10 of the cases demonstrated a spectrum of changes including florid follicular hyperplasia, follicle lysis, attenuated mantle zone, and the presence of multinucleated giant cells (MGC). The latter characteristically localized adjacent to the surface or tonsillar crypt epithelium. Two of the 12 cases showed marked lymphoid depletion with absent germinal centers, plasmacytosis, and stromal vascular proliferation. Immunohistochemical evaluation for HIV p24 core protein showed reactivity in 10 of 12 cases localized to follicular dendritic cell network (FDC), the MGC, scattered interfollicular lymphoid cells, and cells identified within the surface or crypt epithelium. Localization of viral RNA by in situ hybridization paralleled the HIV p24 immunohistochemical findings. Additional significant findings included the presence of both CD-68 and S-100 protein in the MGC and the presence of S-100 protein in dendritic cells. Other than HIV, no microorganisms were identified. At the time of presentation, eight patients were not known to be a risk for HIV infection, nor were they known to be HIV infected or suffering from AIDS. In these patients, HIV infection was suspected on the basis of the histologic changes seen in the resected tonsillar and adenoidal tissue. Serologic evaluation (by enzyme-linked immunosorbent assay), confirmed the presence of HIV infection. Our findings suggest the possibility of HIV dissemination through the upper aero-digestive tract mucosa via target cells, such as intraepithelial dendritic cells, submucosal macrophages, and T-lymphocytes. Subsequent presentation of viral antigens to the tonsillar and adenoidal lymphoid tissues results in enlargement of these structures that clinically may simulate a neoplastic proliferation but causes histomorphologic changes that are highly suspicious for HIV infection even in asymptomatic HIV-positive patients.

Adenoids↗

PubMed1993

The diagnosis of acute pyelonephritis in the piglet using single photon emission computerized tomography dimercaptosuccinic acid scintigraphy: a pathological correlation.

Single photon emission computerized tomography (SPECT) scintigraphy has proved to be an extremely sensitive renal imaging modality in children with genitourinary pathology, including pyelonephritis, particularly when compared to 2-dimensional planar imaging. This study was undertaken to corroborate SPECT dimercaptosuccinic acid (DMSA) scintigraphic findings with specific histopathology in acute pyelonephritis. Unilateral vesicoureteral reflux was produced in 19 Yorkshire piglets 3 to 4 weeks old. The bladders of 12 animals were inoculated with Escherichia coli 2 weeks later, after baseline SPECT DMSA scans had been obtained. The animals were then re-imaged at 3 (4), 7 (4) or 14 (4) days after infection and sacrificed for histological evaluation. Seven purposefully uninfected piglets with unilateral reflux served as controls and were followed for up to 6 weeks before imaging and sacrifice. SPECT proved to be 97% sensitive and 93% specific in providing the diagnosis of acute pyelonephritis. The SPECT findings were manifest by a spectrum of abnormal findings (mottling, striations, inner cortical scalloping and focal cortical defects), which correlated precisely with the extent and severity of cortical involvement in the acute pyelonephritic process. We propose a new classification scheme for SPECT DMSA renal scintigraphic imaging, and believe that this modality is exquisitely sensitive in providing the diagnosis as well as in evaluating the extent of renal parenchymal involvement when acute pyelonephritis is induced in the animal model.

Acute Disease↗

PubMed1993

[Detection of numerical chromosome aberrations in urologic malignancies using in situ hybridization from formarin-fixed paraffin sections].

It has been shown that molecular cytogenetics in interphase nuclei is applicable to paraffin embedded sections from formarin-fixed materials utilizing in situ hybridization (ISH). This allows precise identification of numerical abnormalities of chromosome in tumor cells without disruption of tumor morphology. Thirteen cases of bladder cancer and twenty six cases of prostate adenocarcinoma were evaluated for numerical aberrations of chromosome 1, 7, 10, 11, 17, 18, X and Y utilizing biotinylated probes specific for the alpha satellite region. In two cases from total prostatectomy, one case from total cystectomy and two cases from TUR-P specimen, hybridized chromosomes could not be detected in individual tumor cells. With respect to the appearance of the ISH signal, optical concentration and time for the digestion enzyme has to be established essentially. This technique can now be applied on the detection of biological activity in various types of urological cancer.

Adenocarcinoma↗

PubMed1992

The 'female prostate': location, morphology, immunohistochemical characteristics and significance.

Using immunostaining for prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP), we can demonstrate prostate-analogous periurethral glands (the 'female prostate') in 66.7% of 33 cases. Histomorphologically, these glands resemble strongly the male prostate glands before puberty. They remain immature throughout life from the fetal period up to advanced age obviously because of a lack of an androgenic stimulus. The glands have long ducts leading into the urethra. A proper stroma component is missing. The immunohistochemical behavior of these glands also corresponds widely to that of the male prostate glands before puberty. No indications can be found for a proper biological function.

Acid Phosphatase↗

PubMed1990

Testicular sparing surgery for prepubertal teratoma of the testis: a clinical and pathological study.

We report on 5 patients 14 months to 6 1/2 years old with prepubertal teratoma of the testis treated by testicular sparing tumor enucleation. All 5 patients had no evidence of recurrence at a mean followup of 96 months. Recognizing that this is not accepted therapy for testis tumors, 17 orchiectomy specimens containing teratoma from children were histologically analyzed in cooperation with the Armed Forces Institute of Pathology Tumor Registry. All patients were prepubertal at orchiectomy (3 months to 8 years old) and all are well with a mean followup of 174 months. Histological examination revealed no foci of teratoma separate from the main tumor in any specimens. Immunohistochemical studies with placental alkaline phosphatase, a marker for malignant germ cells, were done to detect carcinoma in situ in the seminiferous tubules of these testes. This test did not reveal any intratubular malignant germ cells (carcinoma in situ). Based on our clinical experience with testicular sparing tumor enucleation, the histological findings on Armed Forces Institute of Pathology review demonstrating no associated carcinoma in situ and the universally benign behavior of prepubertal testicular teratomas, we recommend a testicular sparing operation rather than orchiectomy for testicular teratoma in prepubertal patients.

Child↗

PubMed1990

Unilateral testicular torsion: abnormal histological findings in the contralateral testis--cause or effect?

A histological review of testicular biopsies of the contralateral testis, obtained at the time of surgical intervention for testicular torsion, was performed in 20 post-pubertal men. Contralateral histological abnormalities were found in 12 specimens. The duration of torsion correlated well with the viability of the involved testis but not with the presence of contralateral abnormalities. The high incidence of contralateral histological abnormalities and their nature suggest that they existed prior to the torsion since they would be unlikely to appear at such an early stage. We believe that some patients who suffer testicular torsion probably have congenital anomalies of both testes. These abnormalities involve testicular parenchyma as well as the suspension system.

Adolescent↗

PubMed1989

Role of superoxide dismutase in the pathogenesis of pyelonephritis: immunological localization of superoxide dismutase in human renal tissues.

The enzyme superoxide dismutase affords a protective effect from renal scarring secondary to acute pyelonephritis in primates. To investigate the relationship between renal superoxide dismutase content and age we selected formalin-fixed normal human renal tissue from subjects of varying age, ranging from premature infant to adult, for immunostaining with human anti-superoxide dismutase antibody using the peroxidase-antiperoxidase technique. Sections that demonstrated acute pyelonephritis were immunostained for comparison. Immunostaining for superoxide dismutase was detected consistently in the proximal tubular cell cytoplasm in all specimens regardless of subject age. Superoxide dismutase was not detected in other segments of the nephron. In kidneys that demonstrated acute pyelonephritis we detected enhanced immunostaining in the proximal tubules, as well as increased background staining related to the inflammatory cells present. These results in conjunction with recent demonstrations of proximal tubular cell endocytosis of bacteria suggest that superoxide dismutase has an important role in mediating the initial events of pyelonephritis within the proximal tubular cell.

Adult↗

PubMed1984

Leydig cell hypoplasia causing male pseudohermaphroditism: diagnosis 13 years after prepubertal castration.

An 11-yr-old patient with male pseudohermaphroditism who was castrated at nine days of age and raised thereafter as a female was evaluated to determine the cause of abnormal sexual differentiation. Stimulation with ACTH for 8 h revealed no abnormality in the biosynthesis of cortisol or adrenal androgens. The administration of fluoxymesterone (10 mg, orally, daily) for 5 weeks at age 13 yr led to significant decrements in serum levels of sex steroid-binding globulin and T4-binding globulin to a degree similar to that found in 2 normal men, but no change in the basally elevated levels of FSH and LH. LH bioactivity was normal in the rat Leydig cell bioassay. Skin fibroblasts cultured from a labial skin biopsy revealed normal 5 alpha-reductase activity and normal androgen receptors. Reexamination of the original testis specimens by light microscopy failed to reveal Leydig cells. Furthermore, when immunoperoxidase staining for testosterone was performed on the tissue sections, only 30-35 positive cells/10 high power fields were seen. In contrast, examination of testis sections from 4 male infants who died of other causes revealed 94-836 cells/10 high power fields that stained positively for testosterone. Although hCG stimulation testing to confirm Leydig cell hypoplasia could not be done in this patient because of previous castration, this patient demonstrates that the diagnosis can be made without it by the use of immunohistochemical stains and in vivo and in vitro tests to exclude other disorders of androgen biosynthesis or androgen action.

Adrenocorticotropic Hormone↗

PubMed1983

Localization of alpha-fetoprotein and human chorionic gonadotropin to specific histologic types of nonseminomatous testicular cancer.

We used an indirect immunoperoxidase technique to localize alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) to specific histologic types of testicular germ cell cancers. Among 20 nonseminomatous tumors studied, yolk sac tumor reacted for AFP in 13 of 15 cases, teratoma in 3 of 11 cases, and embryonal carcinoma in 3 of 14 cases. Syncytiotrophoblasts alone reacted for HCG in 14 of 15 cases, and syncytiotrophoblasts associated with choriocarcinoma reacted for HCG in 2 of 2 cases. There was a close correlation between the tissue demonstration of AFP and HCG and elevated serum levels of AFP and HCG, respectively. We conclude that in nonseminomatous testicular cancer yolk sac tumor is the primary site of synthesis of AFP, and syncytiotrophoblasts are the only site of synthesis of HCG.

Adult↗

PubMed1982

[Lymphoepithelial carcinoma of the oropharynx: incidence and differential di].

From 1960--1980, 452 malignant tumors of the oro- and nasopharynx were observed in the Cologne university ENT-clinic. 313 tumors of the oropharynx and 119 of the nasopharynx could be reclassified using the current classifications of upper respiratory tract tumors (WHO and Cologne modification) and of malignant lymphomas (German Kiel and Rappaport classifications). The analysis showed a different distribution of histological diagnoses in the naso- and oropharynx. Whereas the squamous cell carcinoma dominates with 57% in the oropharynx it is seldom seen (only 13%) in the nasopharynx. The non-keratinizing the undifferentiated carcinomas showed an inverse distribution in both regions. Malignant lymphomas and other types of malignant tumors occur equally frequent in the naso- and in the oropharynx. Only patients with non-keratinizing and undifferentiated carcinomas of the nasopharynx showed elevated antibody titers against Epstein-Barr virus. 7 patients with tumors of the same histological type but localization in the oropharynx had no elevated antibody titers against EBV.

Adult↗

PubMed1978

Plenary lecture: lymphocytic infiltration in relationship to urologic tumors.

In summary, it may be said that, to date, among urologic tumors, seminoma is the only one in which lymphocytic and/or plasmacytic infiltration is known to improve the prognosis, and the available information on tumors of bladder, kidney, and prostate do not yet permit any statement relative to prognostic significance of inflammatory cell infiltration. When studying the relationship of lymphocytic and/or plasmacytic infiltration to tumors, it is essential for one to distinguish between cases in which the infiltration is in intimate relationship to the tumor cells and/or where the tumor cells show definite degenerative changes, e.g., seminoma, from those cases in which the inflammation is present at some distance from the tumor, e.g., chronic prostatis, and from those in which the inflammation is preexisting, e.g., schistosomiasis. Claims made about the prognostic significance of such infiltration should have adequate controls.

Adenocarcinoma↗

PubMedDate not supplied

Three-dimensional modeling of biopsy protocols for localized prostate cancer.

Prostate cancer is the most common malignant tumor in American men, yet only a small percentage of men will develop clinically significant disease. Needle core biopsies are used to confirm the presence of cancer prior to surgery. While needle core biopsies have shown some ability to predict tumor volume and grade in prostatectomy specimens, for the individual patient they are neither sensitive nor specific enough to guide therapy. In this paper, we describe a system for simulating needle biopsies on three-dimensional models of cancerous prostates reconstructed from serial sections. First we segment the serial sections, delineating tumors and landmarks. Next, we register the sections using a color-merging scheme, and reconstruct the three-dimensional model using modified-shape-based interpolation. The resulting volume can be rendered, and simulated needle core biopsies can be taken from the reconstructed model. We use our system to simulate two different biopsy protocols on a reconstructed prostate specimen.

Biopsy, Needle↗