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J M Meis

Publications and source records attributed to J M Meis.

At least 19 recordsLinked to original sources
PubMed1992

Juxta-articular myxoma: a clinical and pathologic study of 65 cases.

We describe 65 cases of juxta-articular myxoma (JAM) that occurred in the vicinity of large joints, possessed histologic features of a myxoma, and were frequently associated with cystic changes that resembled a ganglion cyst. The vast majority of cases (57, 88%) occurred in the region of the knee; a minority involved the shoulder (three cases), elbow (three), ankle (one), and hip (one) regions. Patients' ages ranged from 16 to 83 years (median, 43 years; mean, 44 years) and nearly three fourths of the patients (72%) were male. Thirty-seven lesions presented as a swelling or mass, 21 were associated with pain or tenderness, and sizes ranged from 0.6 to 12 cm (median, 3.5 cm; mean, 3.8 cm). Duration of symptoms was highly variable, spanning from 1 week to 18 years. Fourteen JAMs were intimately associated with the meniscus and five of these had a concomitant tear; in five other cases JAM was an incidental finding at the time of total knee or hip arthroplasty for severe osteoarthritis. Of 29 cases with follow-up, 10 (34%) recurred: five recurred once, two recurred twice, two recurred three times, and one recurred four times. While the majority of JAMs were correctly diagnosed as benign, a sarcoma was seriously considered or diagnosed in 15 (23%) cases.

Adolescent↗
PubMed1992

Rosai-Dorfman disease of soft tissue.

Whereas Rosai-Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy is well described in lymph nodes and other organs, it is frequently not recognized in soft tissue. We studied the clinical and histologic features of 23 previously unreported soft tissue lesions from 17 patients (13 females, 4 males) who were 24 to 66 years of age (mean, 46 years). These lesions involved the extremities (12, 52%), trunk (6, 26%), head and neck (3, 13%), and the retroperitoneum (2, 9%). Associated lymph node involvement was present in four cases; most patients were asymptomatic. RDD of soft tissue had more subtle histologic features than its lymph node counterpart. Emperipolesis was less conspicuous and proliferating histiocytes were frequently spindled, associated with collagen deposition, and arranged in a vague storiform pattern with scattered lymphoplasmacytic aggregates. These features led to a variety of diagnoses, including benign inflammatory and fibrohistiocytic lesions (13 cases) as well as lymphoma and malignant fibrous histiocytoma (three cases). RDD was correctly diagnosed in only one case. Diagnosis was confirmed in 16 of 18 lesions by detection of S-100 protein and histiocytic markers KP1 (12 of 13) and lysozyme (eight of 11) in the characteristic histiocytes. Recognition that RDD of soft tissue occurs in an older patient population than does nodal RDD and that it mimics fibrous and inflammatory lesions of soft tissue is important.

Adipose Tissue↗
PubMed1992

Proliferative fasciitis and myositis of childhood.

Eleven cases of proliferative fasciitis and myositis in children, ages 2.5 months to 13 years, are presented. Eight lesions averaging 2.3 cm in size occurred in the extremities, two in the head and neck region and one on the chest wall. Like proliferative fasciitis and myositis in adults, these lesions consisted of admixtures of large polygonal to spindled, ganglion-cell-like fibroblasts with vesicular nuclei and prominent inclusion-like nucleoli. Seven of 11 lesions were initially diagnosed as sarcomas, most commonly rhabdomyosarcoma. Four patients were treated by wide excision (three with regional lymphadenectomy), three received chemotherapy, and one was given radiation therapy. There were some histologic differences from adult-type proliferative fasciitis and myositis. The childhood lesions were generally well circumscribed, lobulated, extremely cellular with less collagen production, and often associated with acute inflammation and microscopic foci of necrosis. Immunohistochemical comparison with adult proliferative fasciitis and myositis showed similar immuneprofiles; the ganglion-like cells stained for vimentin and actin and focally with KP1, suggesting myofibroblastic and histiocytic features. None of the lesions stained for keratin, desmin, or S-100 protein. Ultrastructural examination of two cases revealed cells with a constellation of fibroblastic, myofibroblastic, and histiocytic features. Follow-up of seven patients, averaging 58 months from diagnosis, confirmed that all are alive and well. Recognition of this cellular variant of proliferative fasciitis and myositis is important to prevent misdiagnosis as a sarcoma and unnecessary, excessive therapy.

Actins↗
PubMed1992

Malignant peripheral nerve sheath tumors (malignant schwannomas) in children.

We studied the clinical and pathologic features of 78 malignant peripheral nerve sheath tumors in children less than or equal to 15 years of age. There were 42 boys and 36 girls, with a median age of 10 years. The majority of the tumors (42, or 54%) were central or axial in location; the rest were peripheral. Sixteen patients (21%) had a history of von Recklinghausen's disease. Fourteen (18%) had a malignant peripheral nerve sheath tumor arising in a nerve trunk or a neurofibroma and were unassociated with von Recklinghausen's disease. Patients typically presented with a painful mass of variable duration. Tumors ranged from 2 to 33 cm (median, 7.5 cm) and demonstrated a wide histologic spectrum that included spindled, epithelioid, and primitive neuroepithelial-like cells as well as heterologous elements (11). Immunohistochemical staining revealed S-100 protein in 28 of 50 cases (56%) as well as vimentin (13 of 21 cases, or 62%), Leu 7 (22 of 49 cases, or 45%), actin (eight of 20 cases, or 40%), and keratin (seven of 27 cases, or 26%). Survival status was known for 57 patients (73%). Kaplan-Meier estimates revealed a median survival of 45 months. Half of the patients had local recurrences at 12 months, and half had metastases at 24 months, most commonly to lungs, followed by lymph nodes, liver, bone, soft tissue, and brain. Age greater than or equal to 7 years, male sex, presence of von Recklinghausen's disease, central location, larger tumor size, and tumors with greater than or equal to 25% necrosis were found to be potentially significant adverse prognostic indicators by univariate analysis. Multivariate analysis revealed that larger tumor size, age greater than or equal to 7 years, tumor necrosis greater than or equal to 25%, and von Recklinghausen's disease to be independent adverse prognostic factors.

Adolescent↗
PubMed1992

Elastofibroma: MR and CT appearance with radiologic-pathologic correlation.

OBJECTIVE: The purpose of our study was to determine the MR and CT appearances of elastofibroma and correlate the imaging features with the underlying pathologic findings. MATERIALS AND METHODS: We reviewed retrospectively the MR and CT findings in five cases of elastofibroma. All patients had a soft-tissue mass; one patient also complained of pain. The mean age of the patients was 71 years (range, 63-79 years). Four lesions occurred in the subscapular region, and one occurred in the thigh. In addition, we reviewed and compared the demographic data of 72 histologically proved cases for which we had archival data. RESULTS: Three of four lesions evaluated with spin-echo MR imaging were approximately isointense with skeletal muscle and contained areas with a signal intensity similar to that of fat; these corresponded to areas of dense collagen and interspersed fat, respectively. In the fourth case, the MR appearance was nonspecific. In one case, MR imaging with gadopentetate dimeglumine showed areas with and without enhancement. Three of four lesions evaluated with CT had variable margins, with tissue attenuation similar to that of the adjacent soft tissue as well as scattered areas of decreased attenuation, suggesting fat within the lesion. In one case, the lesion was well defined and relatively homogeneous with an attenuation less than that of skeletal muscle. CONCLUSION: The MR and CT features of elastofibroma are different from those of most other soft-tissue tumors, reflecting entrapped fat within a predominantly fibrous mass. Although these features are not pathognomonic, their presence in a subscapular lesion in an older patient suggests a presumptive diagnosis of elastofibroma.

Adult↗
PubMed1992

Atypical decubital fibroplasia. A distinctive fibroblastic pseudotumor occurring in debilitated patients.

We report 28 cases of atypical decubital fibroplasia, a distinctive pseudosarcomatous fibroblastic proliferation occurring primarily but not exclusively in physically debilitated or immobilized patients. The subjects included 16 women and 12 men ranging in age from 15 to 95 years. Peak incidence was in the 8th and 9th decades of life. Anatomic locations included the soft tissues overlying the shoulder (eight cases), posterior chest wall (five cases), sacrum (five cases), greater trochanter (four cases), buttock (two cases), thigh (two cases), and arm (two cases). Symptoms were due to a painless mass of 3 weeks' to 6 months' duration. Most lesions were ill-defined, focally myxoid masses that ranged from 1 to 8 cm. Histologically, they were situated in the deep subcutis and secondarily involved adjacent skeletal muscle (11 cases) and tendon (three cases). Extensive epidermal ulceration was typically absent. Microscopically, the lesions had a lobular configuration. They were characterized by zones of fibrinoid necrosis and a prominent myxoid stroma rimmed by ingrowing, ectatic, thin-walled vascular channels. All cases contained atypical, enlarged, degenerated fibroblasts with abundant basophilic cytoplasm, large hyperchromatic, smudged nuclei, and prominent nucleoli; these features resulted in a superficial resemblance to proliferative fasciitis. The enlarged, atypical fibroblasts stained diffusely and strongly for vimentin (15 of 15 cases) and focally for muscle-specific actin (10 of 15 cases), keratin (one of 15 cases), CD68 (10 of 15 cases), and CD34 (five of nine cases) antigens; none of the cases stained for desmin. A malignant diagnosis was considered in 43% of cases. Follow-up in 21 patients ranged from 2 to 78 months (median, 12 months). Two lesions recurred once, one recurred twice, and none metastasized; no deaths were attributable to the lesions. The clinical, histologic, and immunohistochemical features of atypical decubital fibroplasia indicate it is a unique type of pressure sore displaying degenerative and regenerative features distinct from decubitus ulcer. Its recognition by pathologists and clinicians in elderly and debilitated patients is important to avoid misdiagnosis as a sarcoma and to prevent or minimize the occurrence of decubital fibroplasia in progressively aging patient populations.

Adolescent↗
PubMed1991

Mixed glioblastoma multiforme and sarcoma. A clinicopathologic study of 26 radiation therapy oncology group cases.

Twenty-six cases are reported of gliosarcoma (GS) retrieved from a series of 1479 glioblastomas (GBM) that were part of five consecutive, randomized Phase II or III malignant glioma protocols initiated by the Radiation Therapy Oncology Group between 1974 and 1983. The clinicopathologic features of these 26 cases, including actuarial survival times, were compared with the remaining 1453 GBM. The minimal qualitative and quantitative histologic criteria required to diagnose GS are presented. In most cases the sarcomatous component was a malignant fibrous histiocytoma; a minority were fibrosarcoma. No significant differences between GS and GBM were found with regard to age, sex, pretreatment Karnofsky performance status, tumor location, size, median survival (8.3 and 9.6 months, respectively), and actuarial survival. None of the treatment regimens, which included various combinations of radiation therapy and chemotherapy, improved the survival of GS over GBM. Selective involvement of the temporal lobe by GS was not found, and the frequency of GS was determined to be only 1.8% of all GBM.

Adult↗
PubMed1991

Myolipoma of soft tissue.

Nine cases of a previously undescribed benign soft tissue tumor are reported. They were composed of variable amounts of benign smooth muscle and mature adipose tissue. Patient ages ranged from 28 to 73 years. One was located in the subcutaneous adipose tissue, one in the rectus sheath of the anterior abdominal wall, two within the abdominal cavity and attached to the abdominal wall, two in the inguinal region, and three in the retroperitoneum. Sizes varied between 3.5 and 26 cm and averaged 16 cm in greatest dimension. Two of the retroperitoneal tumors were incidental findings during other operative procedures. The remaining seven cases were clinically palpable masses. Eight of the nine lesions were originally diagnosed as benign, and another (retroperitoneal) was diagnosed as well-differentiated liposarcoma. Five of the tumors were at least partially encapsulated. In three of the cases, a nonlipomatous component was grossly recognized. Although the benign nature of this lesion is usually recognized in superficial locations, deeply situated tumors are more likely to be confused with a well-differentiated liposarcoma.

Adipose Tissue↗
PubMed1991

Inflammatory fibrosarcoma of the mesentery and retroperitoneum. A tumor closely simulating inflammatory pseudotumor.

We report 38 cases of inflammatory fibrosarcoma occurring in 23 females and 15 males, 2 months to 74 years of age (median, 8.5 years; mean, 15 years) with symptoms of abdominal pain (17 cases), anemia (21 cases), fever (14 cases), mass (16 cases), and gastrointestinal obstruction (7 cases). Primary tumor sites included mesentery and retroperitoneum (31 cases), omentum (two cases), mediastinum (two cases), liver (one case), diaphragm (one case), and abdominal wall (one case). Sizes ranged from 2.4 cm to 20 cm (mean, 9.6 cm). Follow-up data in 27 cases revealed local recurrences in 10 patients, with multiple local recurrences in three and histologically proven distant metastases to lung (two cases) and brain (one case). Five patients died from their disease (median, 20 months). All tumors, including metastases, consisted of fibroblasts, myofibroblasts, and plasma cells, with variable degrees of fibrosis and calcification. Immunostains indicate myofibroblastic differentiation; 18 of 20 (90%) stained for actin, 15 of 18 (83%) for vimentin, and 10 of 13 (77%) for keratin (primarily in a submesothelial location). Ultrastructural studies also disclosed myofibroblastic features. The locally aggressive, recurrent nature of these neoplasms, as well as the occurrence of metastases and tumor deaths, indicate that they are potentially malignant neoplasms that we believe are better classified as inflammatory fibrosarcomas, not as cellular inflammatory pseudotumors.

Adolescent↗
PubMed1991

Fat-containing soft-tissue masses of the extremities.

The authors review the radiologic spectrum of fat-containing soft-tissue masses of the extremities, with emphasis on computed tomography, magnetic resonance imaging, and pathologic correlation. These masses include both common and uncommon, benign and malignant lesions, such as lipoma, intramuscular and intermuscular lipoma, neural fibrolipoma, lipoblastoma, lipomatosis, hibernoma, hemangioma, elastofibroma, and liposarcoma, as well as lesions that may mimic fat-containing soft-tissue masses. Imaging studies of fat-containing lesions will often allow a specific presumptive diagnosis. When a specific diagnosis is not possible, however, knowledge of the spectrum of fat-containing lesions will allow a suitably ordered differential diagnosis.

Adolescent↗
PubMed1991

A histomorphologic and immunohistochemical study of chordoma in twenty ferrets (Mustela putorius furo).

The histomorphologic and immunohistochemical features of chordoma in 20 ferrets were evaluated. The mean age was 3.4 years, and, in the cases for which sex was known, females (n = 10) outnumbered males (n = 5) two to one. All 20 tumors occurred on the tip of the tail. Nineteen of 20 tumors (95%) were composed of three tissue components, often arranged concentrically with lobules of physaliferous cells at the periphery, trabecular bone in the center, and cartilage in between. The bone often contained marrow and hematopoietic cells. One tumor lacked chondromatous or osseous tissue. Immunohistochemical results were consistent with previous studies of chordoma. All 20 tumors (100%) were positive for keratin and vimentin intermediate filaments; 15 (75%) were positive for S-100 protein; and 17 (85%) were positive for neuron specific enolase. This neoplasm shares morphologic and immunohistochemical features with "classic," as well as chondroid chordoma, of human beings, making it a potential animal model.

Animals↗
PubMed1991

Myositis ossificans: MR appearance with radiologic-pathologic correlation.

We reviewed retrospectively the MR images of eight histologically proved cases of myositis ossificans and correlated the MR appearance with the histologic findings, as well as with other radiologic studies. Patients with available MR images were chosen from a group of 326 cases in our radiologic archives of histologically proved and radiologically correlated myositis ossificans. In addition to MR images, all patients had plain radiographs, six had CT scans, and two had arteriograms. On T2-weighted spin-echo MR, the lesions were relatively well defined and inhomogeneous and had intermediate to high signal intensity. The latter corresponded to a central proliferating core of fibroblasts and myofibroblasts with a myxoid stroma resembling nodular fasciitis, rimmed by osteoblasts with bone production. Edema surrounded lesions less than a few months old. T1-weighted images of early lesions were normal or showed evidence of a mass by displacement of fat planes. Hemorrhage and fluid-fluid levels were seen in one lesion of intermediate duration. Mature lesions tended to be well defined with inhomogeneous signal intensity, similar to that of fat, representing areas of fat situated between bone trabeculae within the lesion. We present the MR appearance of myositis ossificans and correlate it with other radiologic studies and the histologic findings. The varying appearance of myositis ossificans relates to the histologic changes that occur as the disorder progresses. Knowledge of the MR appearance of myositis ossificans is important in that the lesion has many of the MR imaging characteristics frequently associated with malignancy.

Adolescent↗
PubMed1991

Nodular fasciitis. Its morphologic spectrum and immunohistochemical profile.

Although nodular fasciitis (NF) is a well recognized pseudosarcomatous proliferation, it continues to cause diagnostic problems. We reviewed the clinical, histologic and immunohistochemical features of 53 lesions from 30 male and 23 female patients, ages 8-76 years, that involved the upper and lower extremities, trunk, and head and neck. Sizes ranged from 0.6 to 6.5 cm. The morphologic spectrum was broad, including the classic pattern of delicate fibroblasts suspended in a myxoid matrix, granulation tissue-like areas, solid and whorled myofibroblastic proliferations with multinucleated cells, mucoid cysts, and so-called "ancient" forms with dense, refractile strands of keloid-like collagen. Nodular fasciitis was correctly diagnosed in 23 cases (43%); a sarcoma was diagnosed in 11 (21%). A characteristic immunohistochemical profile emerged wherein 49 of 53 cases stained for smooth-muscle and muscle-specific actins, vimentin, and KP1 (a histiocyte marker), indicating dual myofibroblastic and histiocytic differentiation. None of the lesions expressed keratin, S-100 protein, or desmin. Knowledge of the immunohistochemical profile of nodular fasciitis and its overlap with certain sarcomas can decrease the likelihood of misdiagnosis.

Actins↗
PubMed1990

Juxta-articular large cell lymphoma.

Three patients with juxta-articular large cell lymphoma presented as suffering from monarthropathies. A spectrum of radiographic changes was observed that included subchondral sclerosis, regional osteopenia, effusion, and mottled lytic changes in the juxta-articular region of the affected joint. MRI was performed in two patients. In one, it revealed a high signal mass on T2-weighted sequences. In the second, a mass bridging the joint was demonstrated which was difficult to appreciate on CT and was not visible radiographically. In all cases, biopsies revealed large cell non-Hodgkin's lymphoma of bone. We present these studies to emphasize this unusual pattern of non-Hodgkin's lymphoma as well as to demonstrate the contribution of MRI to the diagnosis.

Acromioclavicular Joint↗
PubMed1990

The immunohistochemical profile of malignant mixed müllerian tumor. Overlap with endometrial adenocarcinoma.

The distinction between malignant mixed müllerian tumor (MMMT) of the female genital tract and poorly differentiated endometrial adenocarcinoma (EA) is sometimes difficult and arbitrary. Although several studies have described the immunohistochemical profile of MMMT and EA, the results have varied, and controversy regarding the histogenetic relationship between them remains. The authors examined the histologic characteristics and immunohistochemistry of 31 formalin-fixed paraffin-embedded MMMTs from a variety of female genital tract sites with a panel of monoclonal and polyclonal antibodies using the avidin-biotin-peroxidase complex (ABC) method. Eighteen neoplasms were homologous and 13 were heterologous; the average patient age was 67 years. In all cases the epithelial component stained for keratin (K), whereas the stromal component stained in 48%; vimentin (V) was detected in the epithelial component in 35% and the stromal component in 81%. Myoglobin (M) detected rhabdomyoblasts in three of five cases tested; desmin (D) was found in five of six and actin (A) in all six cases with skeletal muscle. Overall, A stained the stromal components in 45% of cases, whereas none of the epithelial components stained. The coexpression of K and V in the epithelial component of 35% of cases and in the stromal component of 48% of cases led the authors to conclude that the immunoprofile of MMMT broadly overlaps with that of EA and, independent of morphologic findings, it is often not reliable or useful in distinguishing between the two. Furthermore, the variable immunoprofile suggests that MMMT may be a histogenetically heterogeneous group of neoplasms, including both carcinomas (metaplastic, sarcomatoid) as well as true carcinosarcomas. Although A detected rhabdomyoblasts in all cases, it also stained neoplastic mesenchymal elements in eight more cases, suggesting the presence of smooth muscle or myofibroblasts in the stroma of some MMMTs.

Adenocarcinoma↗
PubMed1990

Gliosarcoma: a histologic and immunohistochemical reaffirmation.

Seven cases of mixed glioblastoma multiforme (GBM) and sarcoma, or gliosarcoma (GS) and six cases of GBM with a prominent pilocytic or spindle cell component were studied with a panel of ten antibodies using the ABC method. All 13 cases were originally diagnosed as GS based on hematoxylin and eosin- (H&E) and reticulin-stained sections. In all GS, the glial component stained strongly for glial fibrillary acidic protein (GFAP), and most stained for S-100 protein, while the sarcomatous areas of GS did not stain for either of these antigens. This resulted in a characteristic, bimorphic marmorate staining pattern. In contrast, spindled GBM stained diffusely for GFAP and S-100 protein. Vimentin was detected in neoplastic glia of both GBM and GS and in the sarcomatous foci of GS. A spectrum of cytokeratins, Factor VIII, desmin and neurofilament were not detected in either GS or GBM. Actin, Leu 7 and alpha-1-antichymotrypsin were focally and inconsistently found in both GS and GBM. Perithelial spindle cell proliferations and intramural spindle cells within thick-walled vessels stained for GFAP, S-100 protein and/or vimentin. These studies confirm that GS is a true biphasic neoplasm that frequently cannot be distinguished from pilocytic or spindled GBM on routine histologic examination. Invasion of the dura, leptomeninges, and hyperplastic or hypertrophied blood vessels by malignant glial cells particularly confounds interpretation of H&E and reticulin stains. Immunohistochemical staining for GFAP complements the reticulin stain in confirming the presence of two cell populations in GS.

Adult↗