Biomedical subjects
Publications and source records attributed to J M Bruner.
Besides advancing our knowledge of histogenesis, immuno-cytochemical studies of salivary gland tumors have added an important objective component to the diagnosis and classification of the tumors. Cellular localization of S-100 protein now allows identification of myoepithelial cells and tumors composed of these cells. The four tumors presented in this report illustrate the diagnostic advantages afforded by S-100 protein immunocytochemistry.
Previous studies using immunohistochemical methods to determine the presence of glial fibrillary acidic protein (GFAP) and Factor VIII-related antigen (FVIIIR:Ag) in stromal cells of capillary hemangioblastomas have yielded conflicting results with respect to the possible astrocytic and endothelial origins of these cells. This study included Ulex europaeus I lectin (UEAI), a more sensitive marker of endothelial cells. Antibodies were also used as markers of pericytes and a variety of markers were employed to identify different populations of histiocytes. Results of this investigation indicate that FVIIIR:Ag and UEAI are limited only to endothelial cells, and that GFAP is present in entrapped astrocytes only. Positivity of stromal cells was found with some of the histiocytic markers, but the authors were unable to conclude that these cells have a histiocytic origin. It was concluded that currently there is no evidence that stromal cells are derived from endothelial, pericytic, or astrocytic cells-their origin remains uncertain.
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Five cases of pathologically proven organized intracerebral hematoma with recent hemorrhage are reported. The hemorrhages were spontaneous, were located in deep structures of the brain, and presented without a clinical history of hypertension or trauma. No underlying causes of the hematomas were identified histologically. Various computed tomographic (CT) patterns of recurrent hemorrhage in an organized hematoma were observed. A hyperdense, well demarcated mass with minimal contrast enhancement but no surrounding edema was observed when rehemorrhage was confined within a late-organizing hematoma. A "target" sign of a ring-enhancing mass was observed when the new hemorrhage developed within an early-organizing hematoma. When a new hemorrhage occurred outside a solid-enhancing organized hematoma, the CT appearance suggested a possible tumoral hemorrhage. Close clinical and CT follow-up is desirable for initial management of a suspicious rehemorrhaging organized hematoma situated in the deep-seated or superficial sensitive structures if the symptomatology has stabilized or improved. Tissue diagnosis and surgical evacuation are indicated when the clinical course fluctuates or progresses and CT demonstrates an interval increase of lesion.
CT findings of 15 patients with histologically proven primary central nervous system (CNS) lymphoma were reviewed with pathologic correlation in order to evaluate variable CT patterns. There were a total of 32 lesions. Of the 15 patients studied, seven had acquired immunodeficiency syndrome (AIDS), all diagnosed within the past 3 years. The CT observations of eight non-AIDS patients were consistent with findings reported previously. Most of the lymphomatous lesions were either hyper- or isodense, round or oval masses with homogeneous contrast enhancement and variable surrounding edema. Pathologic examination showed tightly packed preserved lymphoma cells without necrosis. In AIDS patients, rim or ring enhancement of lymphoma, indistinguishable from brain abscess, was frequently seen. Histologic examination consistently showed extensive tumor necrosis with preservation of viable tumor cells at the periphery. A third and infrequent CT pattern was multiple infiltrative nonnodular solid enhancement with extensive edema. Pathologic correlation showed infiltrating viable tumor cells without necrosis. The rim- or ring-enhancing brain lesion seen in AIDS patients can either be an abscess or a primary lymphoma; proper tissue collection is essential for correct diagnosis and appropriate treatment.
Fifty formalin-fixed, paraffin-embedded meningiomas were studied with a panel of ten antibodies directed against epithelial antigens, intermediate filaments, and neuroectodermal antigens. Twenty-five (50%) of these were stained with monoclonal antibodies (MoAb) to epithelial membrane antigen (EMA), 12 (24%) with keratin antibodies, 9 (18%) for vimentin, and 4 (8%) for S100 protein. Monoclonal antibodies to Leu-7, desmin, neurofilament 200 kDa, and glial fibrillary acidic protein (GFAP) all failed to stain any of the 50 neoplasms. Overall, 34 (68%) meningiomas stained with one or more antibodies. Sixteen (32%) failed to stain at all. The dual epithelial and mesenchymal nature of meningiomas is supported in this study. Applications to diagnostic surgical pathology and histogenetic implications are discussed.
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Intrathoracic intercostal nerve block is a well-described procedure used to provide postoperative pain relief following thoracotomy. The two cases described present possible complications secondary to such blocks and suggest that the routine use of intrathoracic intercostal nerve blocks should be discouraged.
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