Application of synoptic reports.
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Clinical Protocols↗
Biomedical subjects
L E Nochomovitz
Publications and source records attributed to L E Nochomovitz.
Recommendations for the reporting of resected neoplasms of the kidney. Association of Directors of Anatomical and Surgical Pathology.
The Association of Directors of Anatomic and Surgical Pathology has developed recommendations for the surgical pathology reporting of common malignant tumors. The recommendations for renal cell neoplasms are reported here.
Carcinoma, Renal Cell↗
Lymphocytic hypophysitis: occurrence in two men.
Two men undergoing transsphenoidal exploration for pituitary adenoma were found to have lymphocytic hypophysitis. Both presented with frontal headaches, lethargy, and diminished libido. Laboratory investigations showed markedly depressed serum testosterone, and magnetic resonance imaging demonstrated pituitary enlargement, with optic chiasm involvement. Intraoperatively, the dura was adherent to the pituitary in each case. The resected glands were effaced by a dense lymphoplasmacytic infiltrate and fibrosis, without granulomas. Nonspecific peripheral enhancement on imaging suggested a diagnosis other than adenoma, but more experience with peripheral enhancement in lymphocytic hypophysitis is needed. The diagnosis was histological and required surgical intervention. Long-term pituitary replacement therapy is usually required.
Adenoma↗
Detection of carcinoembryonic antigen in colonic effluent by specific anti-CEA monoclonal antibodies.
To characterize the CEA in colonic effluent, anti-CEA monoclonal antibody COL-4 was used in a qualitative radioimmunoassay in both fractionated and unfractionated colonic effluent. Both effluent samples and tissue extracts, were subjected to Western blotting and tissue sections to immunohistochemistry. Quantitative levels of colonic effluent CEA were determined by a kit (Abbott-EIA). Higher mean values of COL-4 binding activity were seen only in patients with a past history of polyps (P < 0.01). Quantitated CEA correlated with the presence of colorectal cancer (CRC) as compared to normal subjects, (1133 +/- 875 vs. 459 ng/ml +/- 602, P < 0.05) but not when standardized for protein content. COL-4 reacted with an 180,000 M(r) CEA in the effluent and activity was associated with membrane fraction of the effluent, but bore no relation to the immunohistological staining. We conclude that CEA is detectable in colonic effluent and is membrane associated, but the overlapping values in effluent samples do not make this a useful test in the diagnosis of CRC.
Antibodies, Monoclonal↗
Placebo-controlled trial of ulcerative colitis with oral 4-aminosalicylic acid.
Forty patients with active ulcerative colitis were randomly assigned to receive either 4 g of oral enterically coated 4-aminosalicylic acid (para-aminosalicylic acid) or placebo. The duration of treatment was 12 weeks. Disease activity was assessed by grading clinical symptoms of blood, mucus, urgency, sigmoidoscopic findings, and degree of histological inflammation in rectal biopsy specimens. At 12 weeks, 11 of 20 patients (55%) who received 4-aminosalicylic acid showed improvement in clinical and sigmoidoscopic variables. In contrast, only 1 of 20 patients (5%) who had received placebo showed improvement (P less than 0.005). Eighteen of the 19 patients in the placebo group who showed no improvement were treated subsequently with open-label 4-aminosalicylic acid. Of the 18, 11 showed clinical and sigmoidoscopic improvement. Patients allergic or intolerant to sulfasalazine with extensive disease were more likely to respond to 4-aminosalicylic acid.
Administration, Oral↗
Scrotal carcinoid. Presenting manifestation of multiple lesions in the small intestine.
A middle-aged man presented with a paratesticular carcinoid tumor, his first manifestation of multiple carcinoid tumors of the small bowel. Of the nine carcinoids reported in the English-language literature as metastatic to the scrotum, five simulated a primary lesion. Although the bulk of scrotal carcinoids arise in the testis, the differential diagnosis always should include metastasis from an extrascrotal source.
Carcinoid Tumor↗
Gastroduodenal polyps in familial polyposis coli.
This endoscopic evaluation of 25 patients with familial polyposis coli (FPC) further establishes gastro-duodenal polyps as a significant extracolonic manifestation of the condition. Ten patients had polyps, distributed as follows: stomach (2), duodenum (4), stomach and duodenum (4). Altogether, there were six gastric and seven duodenal lesions. Half of the gastric tumors were hyperplastic and half were adenomatous. All the duodenal tumors were adenomatous, four being ampullary. The one symptomatic patient had intra-polypoid adenocarcinoma. There were no significant correlations between the endoscopic findings and patient age, sex, presence of colon cancer, or other extracolonic abnormalities. The authors affirm that gastroduodenal polyps are an important component of FPC and recommend that all patients with this condition undergo initial and follow-up gastroduodenoscopy. Multiple small lesions may be carefully monitored, but larger ones, particularly those in the region of the ampulla, must be excised.
Adenomatous Polyposis Coli↗
Dysplasia and cancer surveillance in inflammatory bowel disease.
There are no absolutely reliable methods of detecting precancerous change in the colons of patients with ulcerative colitis. Periodic surveillance colonoscopy and biopsy are the mainstay of follow-up of patients with extensive, longstanding disease.
Colitis, Ulcerative↗
Photodynamic therapy: response of normal canine urethra using a cylindrical fiber.
Normal urethral response to photodynamic therapy (PDT) utilizing a cylindrical fiber was assessed in ten study and two control NIH fox-hounds. The canine urethras were treated 48 hours after intravenous injection of 3 mg/kg dihematoporphyrin ether (Photofrin II). A 1-mm fused silica optical fiber, with the distal 2-3 cm modified for cylindrical light distribution (660-microns diameter), was placed in the pendulous urethra. An argon-pumped dye laser delivered 100 mW of 630-nm light for 7 minutes (42 J) to the treatment area. Urethroscopy using either a 2.5-mm or a 2.8-mm flexible pediatric bronchoscope with video recording capability was performed immediately after PDT (12 animals) and 6 weeks later (nine animals); intravenous urography was performed 3 days and 6 weeks after PDT. There was no evidence of either urethral damage or stricture formation in any animal. Histopathology of the first three study specimens, obtained at 6 weeks, confirmed the absence of any pathology. Flexible instrumentation facilitates post-treatment assessment. This study demonstrates for the first time that, when a cylindrical fiber is used, photodynamic therapy may be applied to the urethra without damage to the normal urethral mucosa. This result has implications for potential treatment of initial or recurrent carcinoma in situ of the urethra using PDT.
Animals↗
Response of normal canine ureter to photodynamic therapy using a cylindrical fiber.
Photodynamic therapy (PDT) was performed utilizing a cylindrical optical fiber to determine feasibility of distal ureteral treatment on 10 study and two control NIH foxhounds. The study animals were administered three mg./kg. dihematoporphyrin ether (Photofrin II) intravenously followed 48 hours later by open cystotomy. One ureter was irradiated with 42 joules of 630 nm. light delivered by a 660 micron diameter optical fiber modified for cylindrical light distribution. Intravenous urography was performed both at three days and six weeks post PDT. Hydroureteronephrosis was revealed in one treated ureter and one untreated ureter. Mild dilatation of the ureter was noted by urography in another treated ureter and in one ureter that did not undergo light irradiation; no distal obstruction was revealed in either case by proximal infusion of saline or by histopathology. Nine of the 10 treated ureters were found to have either no abnormal pathology or only minimal lymphocytic infiltration. In this study, the normal ureter was shown to tolerate photodynamic therapy at energy densities equivalent to those used to effect tumor regression and the feasibility of using a cylindrical optical fiber for treatment of ureteral malignancies was confirmed.
Animals↗
Treatment of left-sided ulcerative colitis with 4-aminosalicylic acid enemas. A double-blind, placebo-controlled trial.
Twenty-five patients with active left-sided ulcerative colitis were randomly assigned to receive either 2 g of 4-aminosalicylic acid (para-aminosalicylic acid) or placebo in a 60-mL volume as a nightly retention enema. The duration of treatment was 8 weeks. Disease activity was assessed by grading clinical symptoms of blood, mucus, urgency, sigmoidoscopic findings, and degree of histologic inflammation in rectal biopsies. At 8 weeks, 10 of 12 patients (83%; 95% confidence interval [CI], 55% to 97%) who received 4-aminosalicylic acid showed improvement in clinical, sigmoidoscopic, and histologic variables. In contrast, only 2 of 13 patients (15%, 95% CI, 4% to 38%) who had received placebo showed clinical improvement (P less than 0.005). The 11 patients in the placebo group who showed no improvement were treated subsequently with open-label 4-aminosalicylic acid enemas. Of the 11, 9 showed clinical, sigmoidoscopic, and histologic improvement. No adverse effects were seen. 4-Aminosalicylic acid enemas are a safe and effective means of treating left-sided ulcerative colitis.
Adult↗
Active specific immunotherapy with an autologous tumor cell vaccine in patients with resected non-small cell lung cancer.
Eighteen postoperative patients with non-small cell lung cancer were actively immunized with a vaccine that included autologous cryopreserved irradiated tumor cells admixed with bacillus Calmette-Guerin. Patients received three weekly intradermal immunizations beginning 1-3 months after surgery (15 patients) or after completion of postoperative radiotherapy (3 patients). There was marked heterogeneity in the relative proportion of tumor cells versus host infiltrating cells within individual vaccines (range of percent tumor cells 7-75%). Five patients exhibited positive delayed cutaneous skin test reactivity (DCR) to autologous irradiated tumor cells prior to immunization, whereas 8 of 13 converted from skin test negative to positive. There were no correlations between DCR reactivity and in vitro lymphoproliferative responses to autologous tumor cells or to clinical outcomes, i.e., freedom from relapse. Possible explanations for the heterogeneity of the lung cancer vaccine and approaches for improving its immunogenicity are discussed.
BCG Vaccine↗
Immunocytochemical localization of lingual lipase in serous cells of the developing rat tongue.
The ontogeny of the rat lingual serous and mucous glands was explored by light and electron immune microscopy using the peroxidase-antiperoxidase and streptavidin-gold techniques. Tissues from fetal and neonatal rats from day 18 of gestation through 4 wk after birth were fixed and embedded in paraffin or Epon for light and transmission electron microscopy, respectively. Electron microscopy revealed that the only cells containing lingual lipase were the developing serous cells; secretory granules containing lingual lipase of varying degrees of maturity were seen. Mucous cells did not show immunospecific staining in rats of any age. The neonatal "mixed" lingual glands secrete lingual lipase from serous components immediately after birth to aid in fat digestion.
Animals↗
Cerulein induces hyperplasia of the pancreas in a rat model of chronic pancreatic insufficiency.
Chronic pancreatic insufficiency (CPI) was induced in male Wistar rats by the injection of a zein-oleic acid-linoleic acid solution into their pancreaticobiliary ducts. Animals injected developed severe pancreatic atrophy with fibrosis and greater than 90% loss of pancreatic enzyme content. The animals also developed malabsorption of fat and bentiromide. Three weeks after the CPI lesion was induced, animals were randomized to receive cerulein 2 micrograms/kg twice daily subcutaneously or saline twice daily subcutaneously for 2 weeks. Cerulein significantly increased pancreatic trypsinogen (p less than 0.03), amylase (p less than 0.01), lipase (p less than 0.02), DNA (p less than 0.02), and RNA (p less than 0.01) content and improved fat and bentiromide malabsorption as compared to saline (p less than 0.05). We conclude that cerulein therapy can cause significant hyperplasia of pancreatic acinar parenchyma in an animal model of CPI and that this therapy can partially reverse malabsorption.
Animals↗
Primary cardiac non-Hodgkin's lymphoma.
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Brain Neoplasms↗
The diagnostic challenge of metastatic linitis plastica. Two cases and a consideration of the problem.
Linitis plastica of the stomach is usually difficult to diagnose preoperatively and can extend locally and metastasize widely before recognition. This insidious manner of spread may cause unusual presentations in organs distant from the stomach. The authors recently treated two patients who were initially found to have radiologic abnormalities of the colon and bladder, respectively. One patient was surgically explored with a view towards the resection of a primary colonic tumor, the other to determine the nature of a bladder tumor. Intraoperative histologic interpretation of frozen tissue samples from the gastric wall in each case radically altered the surgical approach and the prognosis. The clinical presentations illustrate that it may be difficult to obtain preoperative diagnostic tissue samples in such cases and that it is important for the surgeon to inspect and palpate the stomach wall during all abdominal explorations for cancer.
Adenocarcinoma, Scirrhous↗
Inflammatory pseudotumor of the urinary bladder--possible relationship to nodular fasciitis. Two case reports, cytologic observations, and ultrastructural observations.
An inflammatory pseudotumor of the urinary bladder might cause a large, pedunculated intraluminal mass that clinically and radiologically simulates a malignant tumor. This benign lesion can easily be mistaken for a sarcoma because by light microscopy it consists of clon-gated strap cells that resemble rhabdomyoblasts. The loose texture, the myxoid background, the relative paucity of mitoses, and the absence of nuclear hyperchromasia are important histologic determinants of benignity. Smears and imprints yield voluminous tapering cells in an inflammatory background. There are no cytoplasmic cross-striations or Z-bands and the tumor cells have the ultrastructural characteristics of myofibroblasts. It is important to recognize this lesion as benign to avoid the potentially serious consequences of misdiagnosis.
Adult↗
Benign duodenal villous adenoma obstructing the ampulla of Vater: a surgical dilemma.
The discovery of an elevated serum alkaline phosphatase level during routine blood screening in a 53-year-old man led to tests that showed a large benign villous adenoma obstructing the ampulla of Vater in the second part of the duodenum. Although the preferred treatment of such a lesion is local excision, the tumor was extensive and necessitated a pancreatoduodenectomy. Histologically benign duodenal villous adenomas that also obstruct the common bile duct are uncommon and may be missed during surgical exploration; therefore, whenever there are no stones to account for symptoms or signs of extrahepatic obstruction, the surgeon should carefully palpate the ampullary region of the duodenum.
Adenoma↗