Biomedical subjects

K Balogh

Publications and source records attributed to K Balogh.

At least 19 recordsLinked to original sources

PubMed1992

Osteolysis after silicone arthroplasty.

A young woman with a silicone lunate prosthesis for avascular necrosis developed painful lytic lesions in the distal ulna and the triquetrum. At reoperation, abundant reactive synovitis was found extending into those bone lesions. Histologic examination of the curetting samples revealed granulation tissue with histiocytes and many multinucleated giant cells containing refractile particles consistent with silicone. The authors report a giant cell lesion of the bone that radiographically and microscopically mimicked a neoplasm.

Adult↗

PubMed1992

Malignant eccrine spiradenoma. A clinicopathologic study.

UNLABELLED: Malignant eccrine spiradenomas (MES) are exceedingly rare and their immunohistochemical and ultrastructural features have not been fully characterized. We studied two cases, one of them immunohistochemically and electron microscopically. Patient 1 had a 25-year history of multiple exophytic tumors involving the scalp, the skin of the face, and the torso. Of the lesions removed, ten were spiradenomas, two with malignant changes, and three were cylindromas. The malignant areas showed loss of tubular and nesting patterns, lack of two cell populations, and contained anaplastic cells with high mitotic rate. The immunohistochemical findings were consistent with eccrine differentiation. Patient 2 had a cystlike mass of long duration in the right groin. Histologically, the mass consisted of nodules of benign eccrine spiradenomas adjacent to a ductal-cystic mass lined by anaplastic cells, but areas of squamous and glandular differentiation were also present. CONCLUSIONS: (a) Case 1 is probably the first reported MES associated with multiple spiradenomas and cylindromas. (b) Cytodifferentiation in MES is variable, sometimes with almost complete loss of eccrine differentiation. (c) Identification of adjacent spiradenomas may be required for definite diagnosis of MES. (d) Clinical history of longstanding lesions with recent fast growth warrants tissue diagnosis.

Adenoma, Sweat Gland↗

PubMed1991

Primary diagnosis of disseminated fungal disease by fine-needle aspiration of soft-tissue lesions.

Two cases of disseminated fungal infections diagnosed by fine-needle aspiration of soft-tissue masses are presented. Both patients were initially treated on an outpatient basis for a presumed musculoskeletal disorder before the diagnostic biopsy was obtained. The first patient apparently contracted Coccidioides immitis infection while residing in Arizona, but the diagnosis was rendered on an aspirate of a buttock mass performed in Boston. The second patient, a non-insulin-dependent diabetic, was diagnosed with a cryptococcal abscess on an aspirate of a shoulder mass performed in the emergency room. The diagnosis of coccidioidomycosis was confirmed by culture and that of Cryptococcus by serology. Fungal infection was clinically unsuspected in both patients and the cytologic diagnosis facilitated rapid implementation of therapy.

Adult↗

PubMed1991

Evaluation of diagnostic methods for Helicobacter pylori gastritis.

The authors evaluated the use of direct Gram-stained smears, 1- and 24-hour urease broth tests, histologic examination, and culture to detect Helicobacter pylori in 100 gastric biopsy specimens from 97 patients with epigastric symptoms. Twenty-six patients had positive cultures and 27 had H. pylori identifiable in hematoxylin and eosin-stained sections. The gastric biopsy specimens from the 29 patients with culture and/or histologic findings positive for H. pylori showed active gastritis in 27 cases (93%), compared with 26 cases (37%) without H. pylori (P less than 0.0001). Chronic gastritis was present in 25 cases (86%) with H. pylori and 40 cases (56%) without H. pylori (P less than 0.01). Twenty patients had positive Gram-stained smears. Fifteen patients had positive 1-hour urease tests, and 3 had delayed positive 24-hour urease tests. There were no false-positive Gram's stain results, three false-positive 24-hour urease tests, two false-negative histologic results, and three false-negative cultures (one inadvertently incubated anaerobically). The sensitivities of the methods were as follows: 62% for the 24-hour urease test, 69% for direct Gram's stain, 90% for culture, and 93% for histologic examination. The authors conclude that the urease test used in this study has low sensitivity and limited specificity; that the direct Gram-stained smear is a useful, highly specific, rapid screening test; and that the lengthier methods of culture and histologic examination have comparably high sensitivity for the definitive diagnosis of H. pylori gastritis.

Bacteriological Techniques↗

PubMed1991

Collagenous spherulosis in chondroid syringomas.

We report a case of collagenous spherulosis (CS) incidentally found in a chondroid syringoma of the facial skin. The lesion was studied by routine light microscopy, special stains, immunohistochemical methods, x-ray spectrophotometry, and electron microscopy. Light microscopy revealed solitary and confluent eosinophilic globules with radiating fibrillary structures within and around the lumina of the tubuloglandular components of chondroid syringoma. The fibrillary structures stained strongly for collagen and reticulin and less intensely for acidic mucopolysaccharides. Immunohistochemically, the globules were focally positive only for collagen type IV. Electron microscopy revealed radiating collagen fibers surrounded by basal lamina-like material. No inorganic crystals were identified by x-ray spectrophotometry. We conclude that (a) CS is not specific to breast but also occurs in chondroid syringomas; (b) the term collagenous spherulosis is appropriate because collagen fibers were demonstrated histochemically and ultrastructurally in the spherules; (c) CS appears to be associated with tubular epithelial structures; (d) there was no immunohistochemical evidence of myoepithelial differentiation. The etiology and significance of CS remain obscure.

Actin Cytoskeleton↗

PubMed1991

Adenocarcinoma in Barrett's esophagus. A clinicopathologic study of 65 cases.

The natural history of Barrett's esophagus, particularly the prevalence and incidence of malignant changes in it, remains controversial. Furthermore the prognosis of surgically treated patients with carcinoma in Barrett's esophagus has not been elucidated fully. To examine these and other issues, the records of 65 patients with carcinoma in Barrett's esophagus presenting at the Lahey Clinic Medical Center from January 1973 to January 1989 were reviewed. During this period, 241 patients with documented Barrett's esophagus were seen, for a prevalence of carcinoma of 27%. Adenocarcinoma in Barrett's esophagus accounted for 30% of the surgically treated carcinomas of the thoracic esophagus during this period. All but four of these patients were men. Symptoms of chronic reflux were present in less than one half of the patients and dysphagia was often the presenting symptom. In eight patients the carcinoma was discovered on routine surveillance endoscopy, and in four patients progression of disease from benign columnar epithelium to dysplasia to carcinoma was documented. Tumors developed in six patients who had undergone previous antireflux surgery, and in four other patients a second carcinoma developed in residual Barrett's epithelium after a previous resection. Of the 65 patients, 61 (94%) were considered to have operable disease, all of whom underwent resection. Two patients (3.3%) died within 30 days of operation. The resected specimens were staged as follows: stage 0, 4; stage I, 10; stage II, 17; stage III, 25; stage IV, 4. Of the resected specimens, 73% showed areas of dysplasia adjacent to the tumor. The overall adjusted actuarial 5-year survival rate was 23.7%. The 3-year survival rate was 100% for patients with stage 0 carcinoma, 85.7% for patients with stage I carcinoma, 53.6% for patients with stage IIA carcinoma, 45% for patients with stage IIB carcinoma, 25.2% for patients with stage III carcinoma, and 0% for patients with stage IV carcinoma. The premalignant nature of Barrett's esophagus requires endoscopic surveillance to detect early carcinoma because symptoms often occur late or are absent. Antireflux surgery does not protect against the development of carcinoma. All of the Barrett's epithelium must be resected because a second carcinoma may develop in residual columnar epithelium. Severe dysplasia should be considered an indication for resection. Although operability and resectability rates are high, long-term survival is not. Early detection is mandatory if long-term survival is to be achieved.

Adenocarcinoma↗

PubMed1991

Pigmented neuroectodermal tumor of infancy. A light microscopic and immunohistochemical study.

We studied two cases of pigmented neuroectodermal tumor of infancy (PNTI) by routine light microscopy and immunohistochemistry on formalin fixed, paraffin embedded tissues using antibodies to HMB-45 "melanoma associated" antigen, S-100 protein, neuron specific enolase (NSE), Leu-7 antigen, chromogranin, epithelial membrane antigen, collagen Type IV, alpha-fetoprotein and muscle-specific actin and to the intermediate filaments cytokeratin (CK), vimentin, desmin and neural filaments. We found that the large epithelioid cells, many of which contained melanin pigment, were strongly positive for CK and HMB-45, and less intensively positive for vimentin and NSE. The small neuroblast-like cells revealed only focal, weak NSE positivity. Both cell types were negative for S-100 protein and for the other antigens examined. Our results suggest that: (1) the large and small cell populations in PNTI have different immunophenotypes; (2) the expression of CK and HMB-45, together with the S-100 negativity, appears unique for the pigmented cells; and (3) this profile may be helpful in the exclusion of melanoma and peripheral neuroblastoma from the differential diagnosis.

Antigens, Neoplasm↗

PubMed1990

Treatment of latent rabbit and human papillomavirus infections with 9-(2-phosphonylmethoxy)ethylguanine (PMEG).

The acyclic nucleotide PMEG was studied for effectiveness against Shope papillomavirus (CRPV) infection of rabbits and human papillomavirus type 11 (HPV-11) infections of human foreskin xenografts in athymic mice. PMEG given in the latent period strongly suppressed the subsequent growth rates of Shope papillomas. PMEG starting in the latent period and continuing for the duration of the experiment, inhibited HPV-11 infections of human skin, including condyloma growth, and synthesis of viral DNA and capsid antigen. Drug toxicity paralleled the therapeutic effects in rabbits but there was much less toxicity in athymic mice.

Animals↗

PubMed1990

Cancerization of eccrine sweat ducts in Bowen's disease as studied by light microscopy, DNA spectrophotometry and immunohistochemistry.

This study assesses the incidence, histogenesis, and significance of eccrine sweat duct involvement in Bowen's disease (BD). In a review of 96 cases of BD, four showed eccrine duct involvement on hematoxylin and eosin-stained histologic sections. One case was analyzed for deoxyribonucleic acid (DNA) ploidy by using computerized image analysis on Feulgen-stained slides. Sections were also stained immunohistochemically, using antibodies to carcinoembryonic antigen (CEA), gross cystic disease fluid protein (GCDFP), and S-100 protein, and for cytokeratins (CAM 5.2, AE 1/3). Our results showed that, in BD, (a) the eccrine sweat ducts can be extensively involved by atypical cells, (b) the atypical eccrine duct cells had an aneuploid DNA pattern, and (c) the atypical eccrine duct cells were negative for CEA, GCDFP, and S-100 protein but were positive for cytokeratins. We conclude that (a) the frequency of eccrine duct involvement in BD is relatively low (approximately 4 to 9%), (b) the aneuploid DNA pattern makes a benign squamous metaplasia unlikely, (c) the immunohistochemical results exclude coincidental Paget's disease or carcinoma of eccrine sweat glands, (d) the involvement of eccrine sweat ducts may represent a direct extension of the neoplastic epidermal keratinocytes, and (e) this process may have practical implications in the recurrence of superficially treated cases of BD.

Bowen's Disease↗

PubMed1989

Bacterial infections in the acquired immune deficiency syndrome. Clinicopathologic correlations in a series of autopsy cases.

In a group of 46 adult patients with acquired immunodeficiency syndrome (AIDS) who came to autopsy in 1983-1987, the authors found that 38 (83%) had bacterial (nonmycobacterial) infections some time during the course of their illness, compared with 34 (74%) who had parasitic infections, 31 (67%) who had viral infections, 28 (61%) who had fungal infections, and 12 (26%) who had mycobacterial infections. Twenty-five of these patients (54%) had Staphylococcus aureus infections, compared with 7 (15%) who had Pseudomonas aeruginosa infections and 6 (13%) who had enterococcal infections. Overall, undiagnosed infections or malignancies were found in 48%, 22 of the 46 autopsies, including 12 cases of undiagnosed bacterial infections, 8 of these due to S. aureus. These results suggest that bacterial infections in general, and S. aureus infections in particular, are important causes of morbidity and mortality in patients with AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1989

Hyaline cells in chondroid syringomas. A light-microscopic, immunohistochemical, and ultrastructural study.

The origin and significance of hyaline cells (HC) in chondroid syringomas (CS) is unclear. In a review of 20 CS, we found HC in eight cases. These were studied immunohistochemically, using antibodies to cytokeratin, vimentin, carcinoembryonic antigen, epithelial membrane antigen, desmin, muscle-specific actin, S-100 protein, myoglobin, alpha-1-antitrypsin, chromogranin, glial fibrillary acidic protein, and neuron-specific enolase. HC gave a positive reaction to cytokeratin, vimentin, S-100 protein, and neuron-specific enolase, but not to the other antibodies. Thioflavin-T stain for amyloid was negative. Ultrastructurally, HC contained intermediate filaments in hap-hazard arrangement without specific structures or densities, and had sparse intracytoplasmic organelles and rare desmosomal attachments. Intermediate forms between epithelial cells and HCs were also identified. Our results suggest that HCs are relatively common in Cs (40%) and are more frequent in CS with solid nests and myxoid stroma (relative frequency 62.5%). Immunohistochemically, HCs of CS have a specific phenotype profile; however, ultrastructurally, HCs of CS are not distinct and are similar to HCs in other organs. These results do not suggest an exclusive myoepithelial origin of HCs; it appears that HCs could derive from any epithelial cell type of sweat glands, probably via a regressive process.

Adenoma, Sweat Gland↗

PubMed1989

Graft-versus-host disease in fully allogeneic small bowel transplantation in the rat.

Small bowel and its mesentery contain considerable amounts of lymphoid tissue that can mediate graft-versus-host disease in small bowel transplant (SBT) recipients. Present studies determined the existence of GVHD in a fully allogeneic SBT model and examined the effect of donor pretreatment with ALS in eliminating GVHD. Adult male Lewis (Lew) rats received orthotopic small bowel transplants from untreated (LewxBN)F1 (LBNF1) donors (group 1) or Brown Norway (BN) donors that were untreated (group 2) or pretreated with ALS (days -2 and -1) (group 3). All recipients were treated with cyclosporine 15 mg/kg/day i.m. on days 0-6 postoperatively. Animals were weighed and examined daily for signs of rejection and GVHD. No animals in groups 1 or 3 showed any physical signs of GVHD, but all of those in group 2 had characteristic weight loss, diarrhea, and dermatitis between 4 and 6 weeks postoperatively, from which they all recovered. Histologic examination of skin and spleen at this time confirmed the presence of GVHD. The relative spleen weight [( spleen weight/body weight] x 100) of group 2 animals was also significantly greater than that of unoperated control Lew animals. Spleen cells obtained from group 2 animals at the time of subclinical GVHD, but not cells from group 1 or 3 animals, caused enlargement of popliteal lymph nodes when they were injected into the footpads of Lew rats. This study shows that GVHD can manifest itself in recipients of a fully allogeneic small bowel transplant even when rejection is prevented by effective immunosuppression with CsA. However, combined use of recipient treatment with CsA and pretreatment of donor animals with ALS eliminates all manifestations of GVHD.

Animals↗

PubMed1988

Esophageal intramural pseudodiverticulosis: a report of two cases with analysis of similar, less extensive changes in "normal" autopsy esophagi.

Esophageal intramural pseudodiverticulosis (EIPD) is an uncommon cause of dysphagia. In this report, we describe two cases we encountered at autopsy. In both cases, the pseudodiverticula represented dilated excretory ducts of submucosal mucous glands. In addition, we retrospectively examined histologic sections of esophagus taken randomly from 100 autopsies, and prospectively studied 20 esophagi in a standardized fashion. Our findings suggest that the early pathologic changes of EIPD are more common than is appreciated in the literature. We found submucosal chronic inflammation surrounding mucous glands in more than 60% of esophagi at autopsy. Excretory duct dilatation and small pseudodiverticula were also commonly found, their prevalence related to the number of sections of esophagus studied. The finding of chronic inflammation associated with the earliest degrees of duct dilatation and pseudodiverticula formation suggests that inflammation may play a role in the etiology of this disorder.

Aged↗

PubMed1988

Immunohistochemical characterization of chondroid syringomas.

This study was initiated because the histogenesis of chondroid syringomas (CSs), especially the role of the myoepithelial cells, is still controversial. Twelve cases of CS were analyzed by immunohistochemical methods with a broad panel of routinely used antibodies. The epithelial elements were classified as tubuloglandular components, stromal cells, and solid nests. The authors' results indicated the following: (1) The inner cell layers of tubuloglandular components have distinct epithelial features with cytokeratin (CK), carcinoembryonic antigen (CEA), and epithelial membrane antigen (EMA) positivity. (2) The outer cell layers had negative results for muscle-specific actin (MSA), desmin, CEA, EMA, and CK (if antibody AE1/3 was used) and had positive results for vimentin, S-100 protein, neuron-specific enolase (NSE), and in three cases for glial fibrillary acidic protein (GFAP). (3) The stromal cells and, to a lesser extent, the solid nests expressed immunophenotypes similar to those of the outer cell layers. These data suggest that the stromal components may derive from the outer cells of the tubuloglandular elements but derive from the outer cells of the tubuloglandular elements but do not confirm their exclusive myoepithelial origin.

Adenoma, Sweat Gland↗

PubMed1988

Simultaneous aspergillus endophthalmitis and cytomegalovirus retinitis after kidney transplantation.

We report a case of disseminated and intraocular Aspergillus and cytomegalovirus (CMV) infection in a renal transplant recipient. Aggressive management included reduction of the immunosuppressive medications, systemic and intraocular administration of antifungal agents, treatment with a systemic antiviral drug, and ophthalmic surgery. The clinical and histopathologic features of intraocular Aspergillus and cytomegalovirus infections are discussed. The literature of intraocular mixed opportunistic infections is reviewed.

Adult↗

PubMed1988

Studies in small bowel transplantation. Prevention of graft-versus-host disease with preservation of allograft function by donor pretreatment with antilymphocyte serum.

Donor pretreatment with antilymphocyte serum (ALS) effectively prevents graft-versus-host disease (GVHD) in a unidirectional (parent-to-F1 hybrid) rat small bowel transplantation model. ALS must be administered prior to or at the time of transplantation, and the intraperitoneal route is more effective than subcutaneous administration. Donor pretreatment with ALS uniformly prevents GVHD without impairing subsequent allograft function as measured by absorption of dietary energy and nitrogen, weight gain, and bowel morphology. These rodent studies suggest that ALS treatment of donors as well as recipients in small bowel transplantation may be a highly effective, simple, and easily applicable method to prevent or ameliorate GVHD in human small bowel transplantation.

Animals↗

PubMed1987

The distribution of immunoreactive chromogranins, S-100 protein, and vasoactive intestinal peptide in compound tumors of the adrenal medulla.

Three adrenal medullary tumors that showed admixtures of pheochromocytomatous elements with ganglioneuroma or ganglioneuroblastoma were studied to determine the distribution of immunoreactive chromogranins, S-100 protein, and vasoactive intestinal peptide (VIP). Two tumors consisted of typical pheochromocytoma cells admixed with mature-appearing ganglioneuroma. The third consisted of pheochromocytoma admixed with ganglioneuroblastoma and contained many immature and cytologically atypical cells. In all cases, chromogranin staining was absent or weak in neuronal perikarya and moderate to intense in varicosities of neuronal processes, a finding consistent with the presumed distribution of secretory granules in neurons. Chromogranin staining was also intense in chromaffin cells. Glial cells that stained for S-100 were randomly scattered among chromaffin cells but accumulated in areas with neuronal processes. Weak staining for VIP was present in neuronal cells in one of the two tumors with ganglioneuromatous features. Intense staining for VIP occurred in the third tumor in both neuronal and apparently nonneuronal cells. We conclude that granule distribution and cell-cell interactions for specific cell types in compound tumors tend to mimic those in normal adrenal medulla and sympathetic ganglia. Although immunoreactive VIP was localized exclusively to neurons in one tumor, as in normal tissues, patterns of staining for VIP across tumors are less predictable.

Adrenal Gland Neoplasms↗

PubMed1987

Perforation of the terminal ileum with cytomegalovirus vasculitis and Kaposi's sarcoma in a patient with acquired immunodeficiency syndrome.

This case report documents a perforation of the terminal ileum in a 40-year-old white male homosexual with the acquired immunodeficiency syndrome. The perforation occurred at a site that had severe cytomegalovirus infection and was in close proximity to multiple nodules of Kaposi's sarcoma. The ileum showed multiple deep ulcers with large numbers of cytomegalovirus inclusions and vasculitis with infected endothelial cells, small-vessel thrombosis, focal disruption, and hemorrhage. We review the evidence that cytomegalovirus infection--and not Kaposi's sarcoma--was responsible for this perforation and, in light of the new medical therapy for such infections, should be regarded as an important cause of gastrointestinal perforation in patients with the acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗