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Biomedical subjects

K H Perzin

Publications and source records attributed to K H Perzin.

At least 19 recordsLinked to original sources
PubMed1996

Lobular neoplasia. Long term risk of breast cancer and relation to other factors.

BACKGROUND: Lobular neoplasia (LN), also known as lobular carcinoma in situ, is an incidental histologic finding in tissue removed at breast surgery. Patients with LN are known to be predisposed to develop invasive or intraductal carcinoma (CA). This study investigates factors that influence the cancer risk in LN patients. METHODS: Analysis of data concerning long term follow-up (median: 18 yrs) of 236 patients with LN identified in a pathologic review of more than 2000 biopsy specimens with benign epithelial proliferative breast disease. RESULTS: The probability of CA developing in either breast in long term survivors after a biopsy that contained LN was approximately 1/3, which is 5.4 times (95% CI: 4.2 - 7.0) the rate in the general population. The relative risk (RR) tended to decrease with increasing age at diagnosis, but was approximately doubled (RR: 1.8; 95% CI: 1.1-3.2) for patients with benign epithelial breast disease preceding their initial diagnosis of LN. CA risk remained markedly elevated for at least 20 years, and increased substantially if there was a second operation showing LN- from 4.9 (95% CI: 3.7-6.4) after a single operation with LN to 16.1 (95% CI: 6.9-31.8) after a second such operation. CONCLUSIONS: LN is a marker of increased CA risk that is further exacerbated by episodes of preexisting benign breast epithelial proliferative changes, and that remains substantially elevated for many years.

Adult↗
PubMed1995

Complex colon duplication mimicking an obstructed, non-functioning kidney in a newborn with imperforate anus and spinal dysraphism.

Gastrointestinal (GI) duplications contain tissue resembling several portions of the GI tract and are associated with vertebral and genitourinary (GU) abnormalities [1-4]. We report a newborn with low, imperforate anus and lumbosacral dysraphism, who presented with a large cystic mass in the left renal fossa and pelvis. The flank mass (felt initially to be a dysplastic kidney and ureter) proved to be a complex GI duplication with histologic evidence of gastric, small bowel, and colonic mucosa, as well as respiratory epithelium and pancreatic tissue.

Abnormalities, Multiple↗
PubMed1993

Prognostic significance of benign proliferative breast disease.

BACKGROUND: Recent studies concerning an association between benign breast diseases and risk of subsequent breast cancer have focused on benign proliferative lesions recognized in biopsy specimens. Some have implicated atypical hyperplasia as being associated with the greatest risk. METHODS: The histologic sections of specified benign breast lesions from 1799 women were reviewed and reclassified, using published criteria for proliferative disease. Prognostic significance was assessed by relating the pathologic findings to the development of breast cancer observed during an average 21 years of follow-up, in which time 157 women developed the disease. RESULTS: Benign proliferative changes were recognized in 85% of the patients, with a corresponding relative risk of subsequent carcinoma equal to 2.2 times population rates (95% confidence limits, 1.9 and 2.6). Increasing levels of hyperplasia and atypia in lobules or ducts were associated with modest increases in risk, ranging from 2.1 to 2.3 to 3.0 for proliferative changes with no atypia, mild atypia, and moderate to severe atypia, respectively. This trend was not statistically significant. The most significant risk indicators in this study were the presence of adenosis (relative risk, 3.7), and moderate or severe atypia in ducts (relative risk, 3.9). CONCLUSIONS: Benign proliferative breast disease recognized in biopsy specimens is associated with an increased risk of future breast cancer, but fine distinctions among levels of hyperplasia and atypia did not significantly distinguish risk among patients in this study.

Adolescent↗
PubMed1993

Reproducibility and validity of pathologic classifications of benign breast disease and implications for clinical applications.

BACKGROUND: Research studies on the relationship between benign breast diseases and cancer risk typically identify certain conditions as risk factors, and others as carrying no prognostic significance. This study addresses several issues concerning the relevance of such research results for advising individual patients in a clinical setting. METHODS: Data were obtained as part of a "blinded" retrospective pathology review of benign breast biopsies. A random sample of cases was reviewed twice, providing information about reliability. Comparisons with diagnoses that used information from the operative reports and gross pathology descriptions as well as microscopic histology were used to assess validity. RESULTS: Among cases that were reviewed twice, excellent agreement was achieved for diagnosing carcinoma and lobular neoplasia, good agreement for adenosis and intraductal papilloma, and relatively poor agreement about levels of hyperplasia and atypia, and whether ducts or lobules were involved. Distinctions among levels of hyperplasia also apparently were influenced by the number of slides available for review. The "blinded" review diagnoses frequently differed from the diagnoses that used all information available at the time of surgery in detecting the presence or absence of gross cystic disease, and in distinguishing solitary from multiple papillomas. CONCLUSIONS: Problems with reliability of precise distinctions among levels and sites of hyperplasia and atypia seem to limit the usefulness of such classifications as guidelines for individual patient care. For conditions with some clinical manifestations, diagnoses based exclusively on histologic review of biopsy specimens often are not accurate.

Breast↗
PubMed1992

The epidemiology of gross cystic disease of the breast confirmed by biopsy or by aspiration of cyst fluid.

This study concerns 3443 patients treated by 1 physician for benign breast conditions, with follow-up on 94% of the patients averaging 19 years. Over three quarters of these patients had gross cystic disease (GCD) of the breast confirmed by aspiration of cyst fluid or by biopsy. Diagnosis of GCD by microscopic pathology review alone is shown to have high error rates when compared with information in the operative report and the gross pathology report. The risk of subsequent breast cancer for GCD patients was more than double the rates in the general population, and about the same as that of patients with no GCD who had biopsy findings of benign proliferative disease. Among patients with aspirations for GCD and no biopsy, there was a trend of increasing risk of subsequent breast cancer with increasing numbers of aspirations, with a sixfold relative risk for patients with ten or more aspirations.

Adult↗
PubMed1991

Hepatobiliary complications of polyarteritis nodosa.

Although polyarteritis nodosa (PAN) may result in thrombosis or aneurysm formation in any organ in the body, hepatobiliary complications are unusual. We reviewed seven cases that demonstrated the diagnostic difficulties and therapeutic options available in the management of hepatobiliary PAN. No consistent sign that indicated the severity of hepatobiliary PAN could be identified. In cases of thrombotic PAN, acalculus cholecystitis usually could be diagnosed preoperatively. Early tissue diagnosis and aggressive intervention are required for appropriate patient treatment. If the diagnosis is unclear, a preoperative muscle or skin biopsy specimen is often helpful in establishing a tissue diagnosis of PAN, even if no obvious pathologic condition is evident. Patients who undergo celiotomy for acalculus cholecystitis or peritoneal signs of an unclear origin should have tissue specimens (gallbladder wall, liver, or omentum) submitted for pathologic study. Angiography may be diagnostic preoperatively or when results of biopsies are equivocal. In addition, early angiography can define the extent of visceral involvement and permit control by embolization of hemorrhage secondary to aneurysm rupture. Awareness of the possibilities of thrombotic, ischemic, or bleeding complications from PAN allows more aggressive and rapid management of abdominal complaints, especially in patients who are receiving immunosuppressant therapy.

Adult↗
PubMed1989

Elastofibroma dorsi: benign chest wall tumor.

Elastofibroma dorsi was diagnosed in seven patients at the Columbia-Presbyterian Medical Center between 1976 and 1986. The ages of the patients ranged from 6 to 79 years (mean 49.3 years). No sex predominance was seen. Five cases of unilateral subscapular tumor and two cases of bilateral masses were identified. Four patients had pain with arm motion, and the remaining patients were free of symptoms. A nonencapsulated soft tissue mass elevating the scapula was identified by computed tomography. Incisional biopsy was performed in all cases, followed by local excision of the tumor. On gross examination, these lesions were firm and rubbery. Histologic evaluation demonstrated a slightly hypercellular fibrous tissue that contained variable numbers of fragmented elastic fibers. All patients with symptomatic tumors had complete relief of their pain after the operation. No recurrences were observed. Clinically, elastofibroma may mimic sarcoma and fibromatosis (extraabdominal desmoid tumors). Whether elastofibroma is a true neoplasm or a reactive fibrous lesion that produces not only collagen, but also abnormal elastic fibers, has been the subject of controversy and remains undetermined.

Adolescent↗
PubMed1986

Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. XIV: Chordomas.

Twenty cases of a rare tumor, chordoma involving the nasal cavity, paranasal sinuses, or nasopharynx, are reported. Patients most often had localized headache, nasal obstruction, decreased hearing, or symptoms related to cranial nerve involvement, especially diplopia. A mass bulging into the nasopharynx, posterior nasal cavity, or pharynx was found on physical examination in 13 of these 20 patients, and in another 6 patients on radiologic examination. Paralysis of one or more cranial nerves was identified in the majority of patients who had tumors involving the upper nasopharynx. On radiologic examination, bone destruction was frequently identified in the clivus and sphenoid areas, and less commonly in the cervical vertebrae. Each patient had biopsy-proven tumor in the nasopharynx or sphenoid areas. Patients usually were treated by combinations of surgery and radiotherapy, in some cases leading to prolonged periods of apparent tumor control. Radiotherapy frequently resulted in regression of symptoms, sometimes lasting many months or years. A few tumors that involved mainly the lower nasopharynx were more amenable to surgical resection, in one case leading to apparent tumor control. In those cases with adequate follow-up information, most patients had either died of their disease or were living with recurrent or persistent inoperable tumor. Some patients lived for many months or years between recurrences or with known tumor, indicating that chordomas often are slowly growing neoplasms. The histologic features of these chordomas are described and illustrated, and the histopathologic differential diagnosis is discussed.

Adolescent↗
PubMed1985

Carcinoid tumorlets of the lung with metastasis to a peribronchial lymph node. Report of a case and review of the literature.

A case of a rare entity, pulmonary tumorlets that metastasized to a peribronchial lymph node, is reported. The patient, a 38-year-old man, underwent a right pneumonectomy for end-stage lung disease caused by bronchiectasis, chronic bronchitis, and pulmonary fibrosis. No tumors were detected on radiologic or on gross examination of the lung. Microscopically, multiple tumorlets were identified in the fibrotic pulmonary parenchyma. Five peribronchial lymph nodes were found and appeared grossly normal. A microscopic focus of metastatic tumor, histologically identical to the pulmonary tumorlets, was discovered in one of these nodes. This metastasis was identified only because a diligent search for peribronchial lymph nodes was undertaken, and because sections of each node were obtained. Pathologists usually do not extensively examine peribronchial lymph nodes in cases of chronic inflammatory disease of the lung, even when small tumorlets are discovered as incidental findings, because it is presumed that the tumorlets have not metastasized. As shown by our case, this presumption is not always correct. Pulmonary tumorlets may metastasize to peribronchial lymph nodes more frequently than has been previously recognized.

Adult↗
PubMed1985

Mucoepidermoid carcinoma arising in an intraparotid lymph node.

A well-differentiated mucoepidermoid carcinoma that was confined to, and apparently arose within, an intraparotid lymph node is reported. Salivary gland ducts and acini often are found within intraparotid lymph nodes, and occasionally within extraparotid nodes. Salivary gland tumors, both benign and malignant, can develop within this ectopic salivary tissue. When a malignant salivary-gland-type neoplasm is found within an intraparotid or periparotid lymph node, the possibility exists that the tumor has arisen within the node and does not necessarily represent a metastasis from some other occult site.

Adult↗
PubMed1984

Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. XIII: Meningiomas.

Twelve cases of meningiomas involving the nasal cavity and paranasal sinuses are reported. Meningiomas only rarely involve the upper respiratory tract; these 12 cases were found among the 566,000 surgical pathology cases that have been studied in this laboratory. In this series, five meningiomas probably arose in the cranial cavity and secondarily extended into the nasal cavity and paranasal sinuses. Because radiographs demonstrated hyperostosis or bone destruction, three other tumors could have involved the cranial cavity, but this was never proven. In two other cases, the meningiomas appeared to involve only extracranial tissues and thus probably were primary extracranial lesions. (The data available in two other cases were insufficient to assess the possibility of intracranial involvement). These patients clinically had nonspecific signs and symptoms similar to those produced by other types of neoplasms growing in the upper respiratory tract. The tumor involved the sphenoid area in seven cases, the nasal cavity in six, the maxilla in five, the ethmoid sinus in four, and the frontal sinus in one. The diagnosis was first established when biopsy material was examined, although in several cases the presence of meningioma was first suggested on radiographic examination. Treatment depended upon the size and location of the tumor. In some cases, surgical resection appeared to control the lesion. These tumors did not appear to respond well to radiotherapy. The histologic differential diagnosis is discussed.

Adult↗
PubMed1984

Intramucosal carcinoma of the small intestine arising in regional enteritis (Crohn's disease). Report of a case studied for carcinoembryonic antigen and review of the literature.

A case of carcinoma of the small intestine arising in a patient with regional enteritis (Crohn's disease) of the ileum is reported. The patient, a 54-year-old woman, had a 21-year history of regional enteritis which was treated intermittently with sulfasalazine and prednisone. Segmental resections of the ileum had been performed on two previous occasions. Because of recurrent low-grade intestinal obstruction, another segment of ileum was resected. The bowel demonstrated the typical gross and histologic appearance of regional enteritis. Histologic examination also disclosed a carcinoma that was confined to the ileal mucosa. This case is the first reported in which a small bowel carcinoma arising in regional enteritis has been found only in the mucosa. Adjacent to the carcinoma, the mucosa showed varying degrees of dysplasia consistent with the "precancerous" changes that have been described in inflammatory bowel disease. Using a peroxidase-antiperoxidase immunoperoxidase technique, carcinoembryonic antigen was identified in normal, hyperplastic, dysplastic, and carcinomatous mucosa, but the most intense staining was seen in hyperplastic and dysplastic cells. Carcinoembryonic staining, however, did not aid in differentiating between hyperplasia, dysplasia, and carcinoma because of an overlap in staining frequency and intensity.

Carcinoembryonic Antigen↗
PubMed1983

Rare synchronous parotid tumors of different histologic types.

A review of the approximately 2000 parotid salivary gland tumors studied at the Columbia-Presbyterian Medical Center in New York from 1918 to 1978 showed that separate, synchronous neoplasms of different histologic types were found in the parotid gland in only 7 patients. In 6 of these patients, there was a clinically solitary mass; in the other patient, two separate nodules were palpated. In each case, subtotal or total parotidectomy was performed. On examination of the resected tissue, two separate nodules were identified grossly in three patients; in one, a benign mixed tumor and a mucoepidermoid carcinoma; in the second, a benign mixed tumor and a Warthin's tumor; and in the third, a mucoepidermoid carcinoma and a Warthin's tumor. In the remaining 4 patients, only one grossly evident tumor was found, including benign mixed tumor in 3 patients and a poorly differentiated adenocarcinoma in 1 patient. In each of these cases, the second tumor, discovered only microscopically, was a Warthin's tumor. Thus, in 6 of the 7 patients, the second neoplasm was a Warthin's tumor.

Adenolymphoma↗
PubMed1982

Adenoid cystic carcinoma involving the external auditory canal. A clinicopathologic study of 16 cases.

Sixteen patients with a rare tumor, adenoid cystic carcinoma (ACC) involving the external auditory canal, have been studied. Clinically, most patients complained of ear pain, often of several years duration. On physical examination, a mass or a nodule usually was identified in the ear canal. In most cases, treatment consisted of a wide surgical resection of the auditory canal and adjacent structures. Histologically, these neoplasms had the same appearance as ACC originating in salivary glands. In eight cases, the tumor was confined to the ear canal wall and unquestionably arose in this area, probably within the ceruminous glands. When incompletely excised, these lesions usually recurred locally. Nine patients had a total of 26 local recurrences. Most recurrences were found within two years of the preceding treatment, but the interval in some cases was long, ranging up to 14 years. Of the 16 patients, seven had no evidence of recurrence following surgical resection, two were living with recurrent, unresectable tumor, five had died of disease, one had died of other causes, and one was lost to follow-up. Some patients died of tumor after a prolonged clinical course with multiple recurrences. Death usually was caused by intracranial extension by the tumor, or by pulmonary metastases. Radiotherapy did not appear to cure the lesion, but probably resulted in palliation. An increased incidence of recurrent, unresectable tumor or of death from the neoplasm correlated with the following histologic features: demonstration of tumor on the lines of surgical excision, involvement of the parotid gland, extension into bone, perineural invasion and local recurrence of tumor.

Adult↗
PubMed1982

Nonepithelial tumors of the nasal cavity, paranasal sinuses and nasopharynx. A clinicopathologic study. XII: Schwann cell tumors (neurilemoma, neurofibroma, malignant schwannoma).

Twelve Schwann cell tumors (two neurilemomas, six neurofibromas, and four malignant schwannomas), arising in the nasal cavity, paranasal sinuses or nasopharynx, are described. Schwann cell neoplasms only rarely develop in this area. Clinically, these tumors lead to nonspecific symptoms including nasal obstruction epistaxis, facial pain and swellling, and proptosis, similar to those produced by other neoplasms that involve this area. On radiologic examination, a mass lesion may be identified. Benign Schwann cell tumors may lead to bone erosion, which thus is not necessarily a sign of malignancy. The correct diagnosis of Schwann cell tumor is usually made only when histologic sections are studied. The histologic differentiation between Schwann cell neoplasms and myxomas, fibroblastic tumors, fibrous histiocytomas and fibro-osseous lesions is discussed. Treatment depends upon the type of tumor. Neurilemomas, which usually are encapsulated neoplasms, can be treated by local excision. Neurofibromas may infiltrate extensively, and thus may require an extensive surgical resection; however, functional and cosmetic considerations should be taken into account because neurofibromas, even if incompletely excised, may recur clinically only after many years. Malignant schwannomas tend to be aggressive neoplasms, but because of the anatomy of the area, radical resections leading to complete removal of the tumor cannot always be carried out.

Adult↗
PubMed1982

Adenomatous and carcinomatous changes in hamartomatous polyps of the small intestine (Peutz-Jeghers syndrome): report of a case and review of the literature.

The authors report the unique case of a patient with the Peutz-Jeghers (P-J) syndrome who had multiple small bowel hamartomatous polyps, some of which also showed adenomatous and carcinomatous changes. Over the course of 30 years, over 100 small bowel and colonic polyps were resected; all histologically demonstrated the typical features seen in hamartomatous polyps. Several jejunoileal polyps excised during the last few months of the patient's life showed not only hamartomatous features but also adenomatous epithelium. As far as the authors can determine, this is the first documented case of adenomatous changes found within a small bowel hamartomatous polyp. In addition, at least one duodenal polyp demonstrated areas of hamartoma, adenoma, and in situ carcinoma. The literature on the occurrence of gastrointestinal adenomas and carcinomas in patients with the P-J syndrome is reviewed, and the relationship of hamartomas, adenomas, and carcinomas of the gastrointestinal tract is discussed.

Adenoma↗
PubMed1982

Extramammary Paget's disease.

Extramammary Paget's disease is an in situ skin and mucosal carcinoma frequently associated with and probably arising in a subjacent or regionally proximate carcinoma. Microscopic spread of tumor cells almost always extends beyond clinically apparent disease. Surgical treatment requires carefully planned, systematic excision under precise histologic control. An ideal treatment method remains to be developed. Inadequate excision usually results in recurrences that can be successfully treated by reexcision. Associated invasive carcinomas occur frequently, and mortality is high in these patients.

Adult↗