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Biomedical subjects

J Waisman

Publications and source records attributed to J Waisman.

At least 19 recordsLinked to original sources

Stereotaxic localization for fine-needle aspiration breast biopsy. Initial experience with 300 patients.

The efficacy of stereotaxic aspiration biopsy was evaluated in 300 consecutive patients with nonpalpable mammographic lesions. Sixty-eight patients (23%) had suspicious or malignant aspirates; all cases were proved malignant by subsequent examination of operative specimens. Two hundred sixteen patients (72%) had benign aspirates. Of these, 65 were confirmed by operation and 151 had subsequent mammography at 6- and 12-month intervals with no demonstrable mammographic change. In 10 instances (3%), the aspirates were atypical, and in six (2%), nondiagnostic. Biopsy specimens were obtained in all 16 instances, and eight were malignant. The sensitivity of stereotaxic breast aspiration for the diagnosis of cancer was 96%, and the specificity was 100%. Our experience confirms the efficacy of stereotaxic aspiration for the initial evaluation of mammographically detected, nonpalpable lesions.

Adult

Carcinoid tumor of skin: report of a possible primary case.

A case of a possible primary carcinoid tumor of the skin in a 40-year-old man is presented. The neoplasm was diagnosed as consistent with carcinoid tumor on the basis of conventional light microscopy, immunohistochemical studies, and electron microscopy. Workup revealed no evidence of carcinoid tumor elsewhere. Metastases to the skin from internal carcinoid tumors are uncommon, but presumed primary carcinoid tumors that arise in the skin are extremely rare; only three cases have been found in the English-language literature.

Adult

RBC exchange pheresis for priapism in sickle cell disease.

An intermittent-flow blood cell separator was used to perform a sub-total RBC exchange pheresis with prompt relief or priapism secondary to sickle cell disease. The blood cell separator offers an efficient, practical, safe method of performing exchange transfusion in the adult. Surgical procedures in the treatment of priapism have met with limited success and carry a 50% rate of subsequent impotence. We believe that RBC exchange pheresis offers a superior approach in the treatment of complications of sickle cell crisis, including priapism, and should be instituted in the symptomatic patient before more drastic procedures are undertaken.

Adult

Nodular lymphoma with intracellular immunoglobulin.

A case of malignant lymphoma with vacuolated cells is presented and, as with two other recent reports, is of the nodular poorly differentiated lymphocytic type. This form of malignant lymphoma presumably is composed of neoplastic B lymphocytes, which produce intracellular immunoglobulins or fractions thereof, corresponding to various cellular vacuoles and inclusions. The vacuolated appearance of the neoplastic cells simulates mucinous or "signet ring" adenocarcinoma, which may be excluded by clinical, routine microscopic, histochemical, immunologic, and electron microscopic observations.

Adenocarcinoma

Renal carcinoma: computer analysis of 96 patients treated by nephrectomy.

We submitted to computer analysis 109 items of pathologic, clinical and survival data from 96 patients with renal carcinoma treated by nephrectomy with or without adjuvant therapy between 1956 and 1976. The combined 1, 5 and 10-year calculated survival rates for potentially curable non-metastatic renal carcinoma (stages I, II and III, provided the regional lymph nodes were not involved) were 95, 61 and 47 per cent, respectively, compared to 1, 5 and 10-year survival rates of 61, 5 and 0 per cent, respectively, for stage IV tumors. The cytoplasmic appearance (clear or granular) was not a significant microscopic feature relevant to survival of the patient but the grade of the tumor was predictive of the outcome of disease. Other features of renal carcinoma, particularly invasion of the renal vein and, to a lesser degree, perinephric fat, were not as prognostically significant in this series. In this retrospective study we further analyze the clinical, radiologic, pathologic and survival data of this group of patients.

Adenocarcinoma

Giant adrenal myelolipoma and testicular interstitial cell tumor in a man with congenital 21-hydroxylase deficiency.

The occurrence of a giant myelolipoma of the adrenal gland reported in a patient with congenital adrenal hyperplasia (21-hydroxylase deficiency). Associated significant findings include a massive proliferation of adrenocortical cells as an integral part of the myelolipoma and coincidental tumor of the interstitial cells of the testis. The clinical, radiologic, endocrinologic, and pathologic features of this case are correlated with a review of the literature. The additional myelolipomas are also reported here for the first time. Similar lesions have been induced experimentally in rats and provide further evidence suggesting a hyperplastic rather than a neoplastic nature for this complex lesion, at least in its earlier stages.

17-Ketosteroids

"Pseudosarcoma" of the larynx.

Polypoid epidermoid carcinoma of the larynx with a cellular, often atypical stroma has also been classified as pseudosarcoma, carcinosarcoma, pleomorphic carcinoma, or spindle cell sarcoma. The nature of the spindle-shaped stromal cells has clinical significance, but pathologists do not agree about the origin and potential of these cells. This paper describes two laryngeal tumors, one with an abundant osseous component in which light-microscopic, ultrastructural, and clinical features suggest the origin of these fusiform cells from reactive pluripotential mesenchyme. In a second case, atypical fusiform cells within the stroma show ultrastructural epithelial characteristics. These findings suggest a varied histogenesis for pseudosarcoma of the larynx and may explain divergent theories expressed in the literature.

Carcinoma, Squamous Cell

Clear cell sarcoma with melanogenesis.

An example of clear cell sarcoma, from the great toe of a young woman having an otherwise classic history and appearance is described, and a malignant giant cell component is reported for the first time. Histochemical and electron microscopic studies clearly demonstrate melanogenesis. The controversy over tissue of origin of this uncommon neoplasm is discussed and evidence in support of neurectodermal derivation is presented.

Adolescent

Non-metastatic hepatic dysfunction associated with renal carcinoma.

A retrospective computer analysis of 102 patients treated for renal tubular carcinoma revealed 7 patients who presented with non-metastatic hepatic dysfunction. Of these 7 patients 5 also had the triad of fever, weight loss and fatigue. Only 1 patient survived more than 10 years after nephrectomy. A review of the literature on non-metastatic hepatic dysfunction revealed a significant interval between onset of symptoms and detection of the underlying renal malignancy, as well as a poor over-all survival rate if the syndrome persisted after nephrectomy.

Adenocarcinoma

Hepatic injury due to oxacillin administration.

Hepatotoxicity, in association with intravenous oxacillin therapy, is described and documented for the first time by liver biopsy in an illicit drug user suffering from acute staphylococcal endocarditis. Mild gastrointestinal symptomatology, fever, eosinophilia and abnormal liver enzyme abnormalities were noted. Liver biopsy showed features consistent with a drug-induced hepatic injury. Cessation of therpy led to rapid reversal of clinical and biochemical changes and on further observation no evidence of chronic hepatic dysfunction was noted. A brief review of oxacillin hepatic injury is presented.

Adult

Comparison of the classification by microscopic level (stage) of malignant melanoma by three independent groups of pathologists.

The ability of groups of pathologists to classify and stage malignant melanoma varies with their familiarity with the new nomenclature proposed for that process. Primary lesions of malignant melanoma from 79 patients were independently examined and classified by community pathologists, university pathologists, and a referee pathologist all without access to each others diagnoses. The diagnoses of these groups were compared for agreement in variety of melanoma as well as depth of dermal penetration (stage or level). Greatest success (agreement with the referee) of both the community pathologists and the university pathologists was achieved when assessment of level of invasion (+/- 1) of the referee was compared (community pathologists = 94% +/- 12% agreement, university pathologists = 99% +/- 2% agreement). Our survey demonstrates that only a relatively small number of community pathologists (23%) employ the new nomenclature, but they do so with a facility equal to that of the university pathologists. Based upon this study and our continuing experiences, we recommend the review of all primary lesions of malignant melanoma by a pathologist or group experienced in the diagnosis and microscopic staging of the disease.

Diagnostic Errors

Interstitial cystitis in adolescent girls.

Two cases of interstitial cystitis with typical, large bladder ulcerations in adolescent girls are reported. The specific diagnosis was confirmed histologically after full-thickness segmental resection of the bladder wall at the site of the ulceration during subsequent operations. Contrary to other reports based on subjective clinical findings, interstitial cystitis in children is rare when rigid criteria, including careful histological study, are applied. Treatment in children is the same as in adults and should be conservative. A conscientious attempt should be made to exclude infection and tuberculosis as possible contributors to the symptoms of urinary frequency and discomfort, as well as other causes of bladder abnormality. If conservative management fails to relieve symptoms the bladder may be enlarged in some cases by using a segment of intestine.

Adolescent