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Biomedical subjects

J D Cotelingam

Publications and source records attributed to J D Cotelingam.

At least 55 records · Page 3Linked to original sources

The development of small cell lung cancer in the contralateral lung of a patient surviving 8 years after the original diagnosis of small cell lung cancer.

The development of non-small cell lung cancer in patients successfully treated for small cell lung cancer has been previously described. Many of these non-small cell tumors appear to be second primary lung tumors. However, the development of second primary small cell lung cancers has not been clearly delineated. In this report, a patient with limited stage small cell lung cancer who had a complete response to chemotherapy plus chest radiotherapy and remained cancer-free for 8 years is described. Small cell lung cancer developed in this patient's contralateral lung with no evidence of recurrence at the original primary site. Clinical evidence suggests that a second primary small cell lung cancer developed in this patient.

Antineoplastic Combined Chemotherapy Protocols↗

Low-grade astrocytomas: treatment results and prognostic variables.

Low-grade astrocytomas in adults are uncommon malignant neoplasms of the central nervous system which are fatal in the great majority of patients despite a lack of aggressive histologic features. Several series of such patients have been previously reported, but prognostic factors have not been fully identified. Between 1960 and 1986, 50 patients with low-grade astrocytomas have been treated with megavoltage radiation at the Naval Hospital, Bethesda, MD, following surgical biopsy or excision. Overall actuarial survival at 10 years for the entire treated group was 32%, similar to other series. The most significant prognostic factor was patient age, with decreasing survival for each age decade and a highly significant difference in survival between patients less than age 40 compared to older patients (p = .0017). The era of treatment (before or after 1978) was also an important prognostic indicator (p = .057), largely due to an effect of dose, although better tumor localization in the CT era may also have played a role. There was a trend toward increasing survival with increasing dose of radiation, although not reaching statistical significance at the p = .05 level on multivariate analysis. Patient sex, extent of surgical resection, use of whole brain irradiation, and tumor grade did not significantly affect survival. In comparison, in a separate group of 10 patients who received surgery without radiation during the same period, all patients who were completely resected were long-term survivors, whereas none of those with incomplete resections survived longer than 6 years.

Adolescent↗

Neuroendocrine differentiation in endocrine and nonendocrine lung carcinomas.

Bronchial carcinoids and small cell lung cancer (SCLC) are currently recognized as neuroendocrine (NE) neoplasms. However, non-SCLC (NSCLC) may also express NE properties. Paraffin-embedded sections of a comprehensive panel of 113 lung carcinomas were analyzed for the expression of three general markers common to all NE cells, namely, chromogranin A, Leu-7 and neuron-specific enolase (NSE), five specific NE secretory products, and four other tumor markers by immunohistochemistry using the sensitive avidin-biotinylated peroxidase technique. The authors were able to demonstrate the following: (1) most, but not all carcinoids and SCLCs expressed multiple NE markers in a high percentage of tumor cells; (2) up to a half of NSCLC cases contained small subpopulations of cells expressing NE in a high percentage of tumor cells; (2) up to half of NSCLC cases contained small subpopulations of cells expressing NE markers; and (3) occasional NSCLCs showed staining patterns indistinguishable from SCLC. Specifically, 7 of 77 NSCLCs expressed four or more NE markers. NE markers in NSCLCs were more commonly expressed in adenocarcinomas and large cell carcinomas and rarely in squamous cell carcinomas. For comparison, the mean number of NE markers expressed by all cases of NSCLC was 1.5, carcinoids 6.0, and SCLCs 3.8. Individual "marker counts" were not useful in categorizing lung tumors as carcinoids and SCLC versus NSCLC. Instead, 95% of the tumors were correctly classified, applying a statistical model created from staining indices of the three general NE markers (chromogranin A, Leu-7, NSE) and three other tumor markers (carcinoembryonic antigen, keratin, vimentin). Because NSCLCs with NE features might have different clinical characteristics than other NSCLCs, immunohistochemistry provides an effective manner to identify this biologically interesting subset of NSCLCs in routine paraffin sections.

Adenocarcinoma↗

Chromogranin A expression in normal and malignant human tissues.

We used a recombinant cDNA probe for human chromogranin A to measure the expression of mRNA encoded by this gene in a variety of normal human tissues and tumor specimens using Northern blot and in situ hybridization analysis. With few exceptions, the expression of chromogranin A mRNA appears to be restricted to normal tissues and tumors of neuroendocrine lineage. However, we have detected mRNA expression of this gene in 1 of 14 cell lines and 2 of 13 tumor specimens of colon adenocarcinoma. The finding of chromogranin A expression in some colon carcinomas suggests that a previously unrecognized subgroup of these tumors has neuroendocrine features. The detection of this subgroup demonstrates the potential for improving tumor classification through the use of techniques and reagents developed by recombinant DNA technology.

Adrenal Glands↗

Barrett's esophagus. A prevalent, occult complication of gastroesophageal reflux disease.

A prospective study of patients with symptoms of gastroesophageal reflux was undertaken to determine the prevalence of Barrett's esophagus and reevaluate the diagnostic approach necessary to detect this complication. Endoscopy with mucosal biopsy was performed in 97 subjects. Twelve (12.4%) were found to have Barrett's esophagus. The sensitivity and specificity of the endoscopic and radiologic examinations for Barrett's esophagus were prospectively evaluated. Endoscopy (92%) was significantly more sensitive than radiology (24%) in detecting Barrett's esophagus (p less than 0.001). The frequency and severity of reflux symptoms among patients determined to have Barrett's esophagus, reflux esophagitis, or normal esophageal biopsies were quantitatively similar in all three groups, except for significantly greater daytime heartburn in those with reflux esophagitis (p less than 0.01). These data indicate that Barrett's esophagus complicates gastroesophageal reflux more often than previously believed.

Barrett Esophagus↗

Unusual metastasis to the cauda equina: case report.

A case of intradural metastasis from endometrial carcinoma to the cauda equina is presented. The clinical presentation and radiographic findings were misleading and suggested a herniated nucleus pulposus. Findings at operation were most suggestive of an ependymoma, but final pathological diagnosis revealed endometrial carcinoma. This has never been reported. Once again it demonstrates that surgeons managing lumbar disc disease must be prepared for possible intradural exploration with an appropriate team.

Adenocarcinoma↗

Malignant lymphoma in patients with the Wiskott-Aldrich syndrome.

The type and incidence of malignant lymphoma developing in patients with the Wiskott-Aldrich syndrome being followed at the National Cancer Institute (NCI) between the years 1966 and 1982 was evaluated. Histologic material from lymphoid tissue was available for review on 24 of the 50 Wiskott-Aldrich patients followed by the Metabolism Branch of the NCI. In 17 patients, specimens were obtained by biopsy performed for diagnosis of lymphoid mass lesions, and in 16 patients autopsy specimens were reviewed. In 9 of the 24 patients a diagnosis of malignant lymphoma was made. A distinct preponderance of non-Hodgkin's lymphoma (NHL) over Hodgkin's disease (HD) with a ratio 8:1 was observed, and the overall incidence of malignant lymphoma in all 50 patients was 18%. The most common histologic subtype of NHL was large cell immunoblastic. In all but one patient the diagnosis of lymphoma was made antemortem, most often presenting in extranodal sites or the brain. Involvement of peripheral lymph nodes was conspicuous by its absence. Immunoperoxidase staining for kappa and lambda chain immunoglobulin and lysozyme was negative in the four cases studied, failing to provide supportive evidence for a B-cell or true histiocytic origin for the tumor cells. Histologic subtypes of lymphoma commonly observed in childhood, such as Burkitt's lymphoma and lymphoblastic lymphoma, were not observed. Despite treatment with combination chemotherapy in some patients, there were no long-term remissions and median survival was less than one year following the diagnosis of lymphoma.

Adolescent↗

Myeloma cells in the urine.

We report two unusual manifestations of multiple myeloma in a 71-year-old man. Late in the course of his disease, myeloma cells were observed in the patient's urinary sediment. At post mortem, the source of the cells was found to be a plasmacytoma of the urinary bladder. To our knowledge, this appears to be the first report of a clearly demonstrable anatomic source for myeloma cells in the urine.

Aged↗

Erythroleukemia in a child: value of immunocytochemistry and transmission electron microscopy in its diagnosis.

A 4 1/2-year-old girl presented with erythroleukemia (EL) that mimicked acute lymphocytic leukemia (ALL). The diagnosis was established with transmission electron microscopy (TEM) and immunocytochemical staining for hemoglobin. Erythroleukemia may present in childhood and may require TEM and immunocytochemistry to make the diagnosis. The correct diagnosis is extremely important since EL has a much poorer prognosis and requires entirely different therapy. Therefore, it is most important to consider EL in those cases of ALL in which the data are not clear-cut and in which the patient fails to respond.

Bone Marrow↗

Inflammatory pseudotumor of the spleen.

Two examples of an unusual splenic inflammatory pseudotumor are reported. Splenectomy followed detection of a mass lesion by CT scan in one case, and in the other, the pseudotumor was an unexpected and incidental pathologic finding. Despite the alarming gross appearance of these lesions, microscopic features were unequivocally inflammatory and benign. To our knowledge, this entity has not been described previously in the spleen.

Aged↗

Parotid heterotopia with pleomorphic adenoma.

We observed an unusual and clinically unsuspected pleomorphic adenoma developing in the anterior midcervical region of a young man. The tumor developed within an ectopic parotid-type salivary gland. Surgical extirpation seems to have been curative. Embryologic concepts explaining the histogenesis of ectopic salivary glands (ESGs) are explored, and the problem of their concurrence with neoplasms is addressed. An additional feature was the presence of well-developed lymph nodes within the glandular complex, a morphologic component of ESGs that has not been previously emphasized.

Adenoma, Pleomorphic↗

Bowenoid papulosis of the penis.

Bowenoid papulosis of the penis is a recently emerged entity that clinically resembles benign dermatosis but it is histologically identical to pre-invasive carcinoma. Its lesions are multiple, painless and wart-like in appearance, and occur in young, circumcised men between 21 and 38 years old. Therapy consists of excision, electrodissection or topical 5-fluorouracil. We report 2 cases of bowenoid papulosis of the penis and compare this entity to Bowen's disease, erythroplasia of Queyrat and invasive carcinoma.

Adult↗

Hepatolienal fusion: case report of an unusual lesion.

A unique fusion of liver and spleen was observed at autopsy between a tongue of hepatic parenchyma and the superolateral aspect of the spleen in an adult Caucasian male. No instance of hepatolineal fusion was found in the literature, prompting this report. An embryologic explanation is offered.

Humans↗

Selective calcification of pancreatic islets of Langerhans. An unusual association with hypercalcemia and diabetes mellitus.

An unusual and extensive calcification of islets of Langerhans was found at autopsy in a man, 58 years old, who developed myeloma and, subsequently, hypercalcemia and diabetes. Although the islet cell calcification appears to be related to the hypercalcemia, the pathogenesis of the calcification is not clear, as primary metastatic calcification of pancreatic islets due to hypercalcemia does not occur. In support of this, a retrospective study of pancreatic tissue from 52 hypercalcemic patients with parathyroid adenoma and 34 patients with multiple myeloma, who frequently have hypercalcemia, did not reveal islet calcification. The islet calcification is ascribed to primary islet cell degeneration and necrosis, with hypercalcemia playing an augmenting but crucial role. It is considered that the combination of islet degeneration and calcification resulted in the diabetic state.

Calcinosis↗