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J W Bolen

Publications and source records attributed to J W Bolen.

At least 19 recordsLinked to original sources
PubMed1997

Reproducibility of the histologic diagnosis of pneumonia among a panel of four pathologists: analysis of a gold standard.

STUDY OBJECTIVE: To establish a histologic diagnosis of pneumonia by consensus of a panel of pathologists, to test the interobserver and intraobserver variation in the histologic diagnosis of pneumonia, to compare the diagnostic accuracy of diagnosing pneumonia with and without preselected histologic criteria, and to establish more specific histologic criteria for the diagnosis of pneumonia. METHODS: The study group consisted of 39 patients who died after a mean of 14 days of mechanical ventilation. A postmortem open lung biopsy was performed on all patients. The tissue was reviewed independently by four pathologists who categorized the slides from each patient as showing or not showing pneumonia. Interobserver variation was calculated using the kappa statistic. Six months following the initial evaluation, the same slides were resubmitted to one of the pathologists for reevaluation to look for intraobserver error. Finally, the slides were reviewed and categorized by the criteria of Johanson et al into no pneumonia, mild, moderate, or severe bronchopneumonia. A comparison was made of the patients selected as demonstrating histologic pneumonia by each of the examinations. RESULTS: The reliability coefficient (kappa) measuring agreement among the four pathologists was good at 0.916. However, the prevalence of pneumonia as determined by each of the four pathologists varied; pathologist A, 15 of 39 (38%); pathologist B, 12 of 39 (31%); pathologist C, 9 of 39 (23%); and pathologist D, 7 of 39 (18%). Resubmitting the same slides to the same pathologist 6 months later resulted in reclassification of 2 of 39 patients. Using the histologic criteria of Johanson and colleagues, 14 patients were selected as having pneumonia compared with only nine patients selected by consensus of three of four pathologists. CONCLUSIONS: Recognition of histologic pneumonia varies among pathologists. The preselected criteria of Johanson and colleagues detected histologic pneumonia in eight of nine patients picked by consensus of pathologists, but six additional patients classified as "no histologic pneumonia" by the consensus of pathologists were judged to have histologic pneumonia by these criteria. The results established the necessity for standardization of histologic criteria for studies using biopsy as the gold standard for bacterial pneumonia. An atlas showing the criteria used in our selection was developed.

Aged↗
PubMed1993

Fulminant herpes hepatitis mimicking hepatic abscesses.

Fulminant hepatitis due to herpes simplex virus (HSV) in adults is a rare and deadly disease. We describe a 23-year-old woman with a 20-year history of Crohn's disease (CD) who was hospitalized with an acute febrile illness and diarrhea. A computed tomography (CT) scan of the abdomen demonstrated an intramural sigmoid colon abscess and multiple abscesses in the liver. Despite high-dose parenteral corticosteroids and broad-spectrum antibiotics, the patient remained acutely ill, with high fever and markedly elevated serum transaminase levels, but no jaundice. Sigmoid resection and wedge liver biopsy were performed at laparotomy. Histologic examination documented HSV-type intranuclear inclusions and inflammation with necrosis in both the sigmoid colon and liver specimens. The patient subsequently died despite parenteral acyclovir treatment. Although rare, fulminant hepatitis due to HSV simplex virus should be considered in the differential diagnosis of all patients with severe hepatitis. Of special note, the necrotizing liver lesions may be mistaken for pyogenic abscesses on CT scan.

Adult↗
PubMed1992

Cutaneous T-cell lymphoma. Evaluation of pretreatment skin biopsy specimens by a panel of pathologists.

BACKGROUND AND DESIGN: Cutaneous T-cell lymphoma (CTCL) frequently presents a difficult diagnostic challenge for the clinician and pathologist. To assess the diagnostic validity of conventional histopathologic findings in CTCL, pretreatment skin biopsy specimens were scored prospectively and independently by a panel of five to seven dermatopathologists and pathologists. Scores were compared with disease outcome. Repeatability of these scores was examined among observers and for the same observer. The study population consisted of 165 subjects, initially referred for suspected mycosis fungoides or Sézary syndrome. Ninety-two patients determined to have CTCL have been followed up for 6.3 +/- 3.5 years (mean +/- SD) and are categorized according to disease outcome: 22 are in complete remission, 35 are in partial remission, three have progressive lymphoma, 15 died of disease, 13 died of other causes, and four were unavailable for follow-up. Seventy-three patients determined not to have CTCL have been followed up for 5.3 +/- 3.2 years without subsequent clinicopathologic evidence of CTCL. These longitudinal data allowed comparisons of the clinical course with the original histologic interpretations. RESULTS: Data showed that the histologic scores rendered by the pathology panel did not correlate with stage of disease and were not an accurate predictor of clinical outcome, because the histologic ratings did not discriminate between patients who eventually had complete remission and those with either progressive lymphoma or who have died of disease. The results also substantiate the low inherent reliability of histopathologic findings in CTCL. Large differences existed among pathologists in scoring the study populations and repeated reading of selected cases by the same panel member resulted in a change of diagnosis 15% of the time. Among the histologic features evaluated, only the presence of mitoses in the infiltrating cells showed a trend toward an unfavorable outcome. CONCLUSION: Pathologic diagnosis in the CTCL disease spectrum should be interpreted with caution and then only in conjunction with the clinical evaluation. As expected, the use of an average value from a panel of readers added a component of stability to the histologic interpretation.

Biopsy↗
PubMed1992

Current management and clinical outcome of hemangiopericytomas.

Hemangiopericytoma is a rare vascular tumor with variable malignant potential. We report perioperative embolization of a hemangiopericytoma and review the Virginia Mason Clinic experience with six patients during the period 1975 to 1990 with respect to demographics, diagnosis, treatment, and outcome. Our experience suggests that hemangiopericytomas have a variable but predictable malignant potential based on histology and clinical behavior. Three of six patients died of their disease. The remainder were alive and well at 1, 3.5, and 12 postoperative years. These tumors can be specifically and completely delineated preoperatively using magnetic resonance imaging and angiography, the diagnostic procedures of choice. Hemangiopericytomas are highly vascular and amenable to preoperative transarterial embolization. Our most recent case was performed without blood transfusion. This differs from literature reports of massive transfusion requirements and two cases of exsanguination following resection. Finally, recent literature has reported these tumors to respond to greater than 4,500 cGy of local postoperative radiotherapy. We conclude that this interval review of hemangiopericytomas is both timely and relevant with respect to recent developments in imaging and catheter technology. We recommend routine angiography and perioperative embolization prior to wide excision and postoperative radiotherapy.

Adolescent↗
PubMed1988

Myofibroblasts in head and neck surgery. An experimental and clinical study.

Myofibroblasts in human granulation tissue have many of the structural and functional characteristics of smooth-muscle cells and appear to be responsible for wound contraction. They have also been identified in contracted scar tissue in nongranulation wounds. In this report, their role in head and neck wound healing will be explored utilizing transmission electron microscopy and immunoperoxidase techniques with antibodies to the intermediate filament vimentin and to muscle-restricted actins. In piglets, high-tension, low-tension, and granulating wounds were created and studied with serial biopsy specimens. Results showed few myofibroblasts in either the high- or low-tension wounds and multiple myofibroblasts in the granulating wounds. In the clinical studies, the immunoperoxidase technique with monoclonal antibody to muscle-specific actins proved most useful in identifying myofibroblasts. Myofibroblasts were present in granulating wounds and hypertrophic scars. They were not widely present in mature keloids.

Animals↗
PubMed1987

Serosal tissue: reactive tissue as a model for understanding mesotheliomas.

Serosal tissues consist of a surface mesothelial layer and subsurface spindled connective tissue cells. Surface cells are decorated with antibodies to both low and high molecular weight cytokeratin whereas subserosal cells only express the intermediate filament vimentin. Serosal injury results in the proliferation of multipotential subserosal cells (MSC) which have the ultrastructural morphology of myofibroblasts and yet co-express low molecular weight cytokeratin and vimentin. These cells appear responsible for the re-establishment of surface mesothelium during which they acquire high molecular weight cytokeratin and loose vimentin. There are many parallels between reactive and neoplastic serosal tissues. Desmoplastic/sarcomatoid mesotheliomas resemble the MSC and co-express low molecular weight cytokeratin and vimentin and epithelial mesotheliomas resemble surface mesothelium and express both low and high molecular weight cytokeratin. The ability of normal serosal tissue to modulate its cell shape and intermediate filament expression helps understand the diversity of serosal tumors.

Antibodies↗
PubMed1987

Tumors of serosal tissue origin.

Primary serosal neoplasms demonstrate a wide spectrum of growth patterns and biologic aggressiveness. The adenomatoid tumor is uniformly benign, whereas the diffuse malignant mesothelioma pursues a downhill clinical course, rapidly leading to fatality. The cystic peritoneal mesothelioma occupies an intermediate position characterized by persistent and/or recurrent disease but without progression to death. The distinction of an epithelial mesothelioma from metastatic adenocarcinoma remains a challenging problem. In the vast majority of cases, this can be accomplished by combining routine histochemistry, immunocytochemistry, and electron microscopy. The absence of epithelial mucins and nonreactivity with antibodies to CEA strongly favor mesothelioma. Ultrastructurally observed long, thin, sinuous surface microvilli without a glycocalix, well-developed desmosomes, and abundant tonofilaments add further support for a primary serosal neoplasm. The sarcomatoid mesothelioma can easily be confused with a chest-wall sarcoma. Despite lacking ultrastructural evidence of "epithelial" differentiation, immunocytochemical studies demonstrate cytokeratin. This distinguishes the sarcomatoid mesothelioma from most soft-tissue sarcomas. There remains a small number of cases, particularly those in the "poorly differentiated" or "transitional" category, in which the distinction between mesothelioma and metastatic carcinoma remains difficult. In this situation, it is imperative that all the clinical information be closely reviewed and a diligent search for a primary site be carried out. There are many parallels between reactive and neoplastic serosal tissue. The desmoplastic/sarcomatoid mesothelioma morphologically and immunocytochemically resembles the reactive multipotential subserosal cell (MSC) of injured serosal tissue, whereas the adenomatoid tumor, cystic peritoneal mesothelioma, and epithelial mesothelioma resemble surface mesothelium. The poorly differentiated mesothelioma resembles a stage of maturation between the two extremes, and thus the term "transitional" mesothelioma is suggested. The localized fibrous tumor of the pleura is unique among all other serosal neoplasms in its failure to express cytokeratin. It more closely resembles the unspecialized connective tissue fibroblast of normal serosal tissue, and thus may be more analogous to a soft-tissue tumor than to the remaining mesothelial-derived neoplasms.

Asbestos↗
PubMed1986

Fast neutron radiotherapy for soft tissue sarcomas. University of Washington experience and review of the world's literature.

Sixteen patients with inoperable soft tissue sarcomas were treated definitively with fast neutrons at the University of Washington between August, 1970 and May, 1982. Eleven of these 16 patients were treated with curative intent and form the basis of this report. Actuarial plots are shown for local tumor control and survival. This work is placed in the context of worldwide experience in using fast neutrons to treat unresectable soft tissue sarcomas.

Fast Neutrons↗
PubMed1986

Reactive and neoplastic serosal tissue. A light-microscopic, ultrastructural, and immunocytochemical study.

Normal and reactive non-neoplastic serosal tissues and a spectrum of serosal neoplasms were studied using light-microscopic, ultrastructural, immunocytochemical, gel electrophoretic, and immunoblot techniques. Normal surface mesothelium expressed both low- and high-molecular-weight cytokeratins, whereas the scattered submesothelial cells were decorated only with antibodies to vimentin. Reactive non-neoplastic subserosal cells, however, coexpressed both low-molecular-weight cytokeratin and vimentin and demonstrated the ability for surface differentiation during which higher-molecular-weight cytokeratins were acquired and vimentin was lost. The authors suggest the term "multipotential subserosal cells," recognizing the unique intermediate filament expression of reactive subserosal cells and the ability for surface differentiation. The intermediate filament expression of the sarcomatoid/desmoplastic mesotheliomas resembled the MSC, whereas epithelial mesotheliomas resembled surface mesothelium. These findings have potential usefulness for diagnostic pathology.

Carcinoma↗
PubMed1986

Colorectal carcinoma evaluation with CT: preoperative staging and detection of postoperative recurrence.

CT was performed prior to surgery in 103 patients with colorectal carcinoma to assess its value in staging the tumor. Preoperative IBD scans had sensitivities and specificities of 72.7% and 98.9% in detection of liver metastases, 25.9% and 96% in detection of lymph node metastases, and 61.2% and 80.6% in detection of local extension. Compared with the Duke's classification, CT correctly staged only 47.5% of patients: 16.6% were upstaged, and 83.3% were downstaged. Recurrent tumors developed in 11 of 67 patients followed for more than 24 months. CT depicted recurrence in six patients scanned prior to 12 months. Routine scans obtained at 12 months depicted unsuspected tumor recurrence in three of four patients with proved recurrent disease (one patient with pulmonary metastases did not undergo CT). This study indicates that because of the poor accuracy of CT in preoperative local staging of colorectal carcinoma, it has virtually no useful clinical role in this regard. However, preoperative CT evaluation of the liver can be useful. Routine postoperative CT, combined with fine-needle aspiration biopsy, is useful for detection of recurrent tumor.

Carcinoembryonic Antigen↗
PubMed1985

Adenomatous tumor of the middle ear. An ultrastructural and immunocytochemical study.

An adenomatous tumor of the middle ear was examined by light microscopy, ultrastructural and immunocytochemical technics. It demonstrated the typical histologic growth pattern and featured ultrastructural evidence of glandular differentiation with two distinct types of secretory granules, apically oriented mucus granules and basally located uniformly condensed neurosecretory granules. In support of its neuroendocrine differentiation was the detection of neuron-specific enolase and positive reaction with monoclonal antibody to chromogranin. These findings are compared with previously reported cases and with middle ear mucosa. It is suggested that this bidirectional differentiation is analogous to that seen in other endodermally derived neuroendocrine tumors.

Adenoma↗
PubMed1985

Coexpression of intermediate filaments in human epithelial neoplasms.

A wide variety of human neoplasms were examined by immunocytochemical and ultrastructural techniques. In most, one intermediate filament (IF) type was expressed reflecting the tissue of origin. However, multiple classes of intermediate filaments were regularly found in a subgroup of these tumors. We chose to subdivide them into those with a complex or mixed growth pattern, and those which showed a more "monomorphic" histologic growth pattern. This latter group is the subject of this paper. Regular coexpression of cytokeratin and vimentin was observed in tumors of endometrial, thyroid, ovarian and renal origin, and coexpression of cytokeratin and neurofilament was observed in a subgroup of neuroendocrine tumors. Immunocytochemical/ultrastructural correlation demonstrated few, if any, observable intermediate filaments in tumors expressing only low molecular weight cytokeratin, whereas vimentin and neural filament characteristically were randomly dispersed or formed whorled bundles of cytoplasmic filaments. The potential diagnostic usefulness of these observations in surgical pathology is discussed.

Carcinoid Tumor↗