Extramedullary hematopoiesis occurring in a hemangioma of the skin.
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Hemangioma↗
Biomedical subjects
L K Green
Publications and source records attributed to L K Green.
Primary cardiac rhabdomyosarcoma: definition of a rare entity.
Primary cardiac rhabdomyosarcoma (PCR) is a highly malignant tumor that is rarely recognized prior to surgery or necropsy. We present the pathologic findings of a primary atrial rhabdomyosarcoma in an 82-year-old woman and an update on PCR as a clinicopathologic entity. In addition to pleomorphic tumor cells with cross-striations and a positive immunoperoxidase reaction for myoglobin, some areas of our patient's tumor had features of sarcoma botryoides. Electron optic studies showed primitive cells with fibroblastic and/or myoblastic differentiation. A comprehensive study of 77 cases in the international literature yielded new information and perspectives on PCR. The incidence of PCR is bimodal among males, being highest in infancy and early childhood with a secondary peak in the sixth and seventh decades. Females, however, have a single peak incidence in the fifth decade. Septal origin is 35.2% among infants and children but only 5.2% among adults. The predilection for the pediatric age group in conjunction with common septal origin among these patients suggests a congenital form of PCR that may arise from embryonic cell tests.
Aged↗
Ectopic pregnancy: clinical and pathological review of 150 cases.
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Female↗
Recurrent and metastatic cutaneous neuroendocrine (Merkel cell) carcinoma mimicking angiosarcoma.
An elderly man presented with bright red-to-purple confluent nodules and plaques of the scalp that appeared clinically consistent with angiosarcoma. He had undergone surgical removal of a similar lesion from his left temple seven months before this presentation. Although routine histologic examination was not sufficient for diagnosis, Merkel cell carcinoma was diagnosed by immunohistochemical studies and electron microscopy. In addition, oat cell carcinoma of the lung was excluded with a computed tomographic scan of his chest. With chemotherapy, the recurrent and metastatic lesions of Merkel cell carcinoma completely resolved, rapidly recurred, and resolved a second time with chemotherapy. Eight months following the fourth course of chemotherapy, the patient again developed widespread cutaneous lesions. He committed suicide within one month of this last recurrence. An autopsy revealed no primary tumor other than of the skin.
Aged↗
Pyoderma gangrenosum and chronic persistent hepatitis.
Pyoderma gangrenosum is a diagnosis of exclusion. A 36-year-old woman was clinically diagnosed as having pyoderma gangrenosum and appropriate exclusion tests were performed. Pyoderma gangrenosum may occur in association with underlying diseases such as leukemia, monoclonal gammopathy, inflammatory bowel disease, arthritis, and chronic active hepatitis. However, these diseases were excluded in this patient who did have chronic persistent hepatitis. To our knowledge, this is the first reported case of chronic persistent hepatitis and pyoderma gangrenosum.
Adult↗
Uterine anomalies. Frequency of diagnosis and associated obstetric complications.
Uterine anomalies are associated with an increase in cases of breech presentation, premature labor, abnormal presentation with dystocia, and the necessity for cesarean section. The yearly frequency of diagnosis of an anomaly has varied from 0.06 to 0.48 at this medical center depending on the physician's clinical suspicion. Thus, if the true incidence and the decrease of obstetric complications are to be accomplished, an increased interest in diagnosing uterine anomalies is essential.
Breech Presentation↗
Cancer of the colon during pregnancy. A review of the literature and report of a case associated with ulcerative colitis.
The first case of adenocarcinoma of the transverse colon and splenic flexture during pregnancy associated with ulcerative colitis is reported. The patient presented with perforation and widespread metastatic disease. After 10 years' duration of symptoms of ulcerative colitis, the risk of coexisting cancer of the colon is 3 to 5% each year. As ulcerative colitis frequently coexists with pregnancy, the obstetrician needs to be alert to the potential for malignant changes in these patients. With the addition of this patient, there are now 18 reported cases of cancer of the colon during pregnancy. These 18 cases are reviewed especially as to management, outcome of the pregnancy, and prognosis.
Adenocarcinoma↗
Life-threatening epistaxis associated with pregnancy.
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Adult↗
Needle biopsy for suspicious lesions of the head of the pancreas: pitfalls and implications for therapy.
Controversy continues to exist concerning the optimal diagnostic approach to a pancreatic head lesion suspected of being a neoplasm. The objective of this study was to evaluate the impact of needle biopsy in suspicious pancreatic head neoplasia and its effect on therapy and outcome. Seventy-three patients with symptoms or signs of periampullary neoplasia and a pancreatic head lesion identified on CT scan were reviewed retrospectively. Forty patients with potentially resectable lesions underwent intraoperative transduodenal core needle biopsy of the head of the pancreas. Thirty-three patients underwent CT-guided percutaneous fine-needle aspiration. The sensitivity and specificity of core needle biopsy were 76% and 100%, respectively. One death was directly related to the procedure and therapy was adversely affected in one patient with a false negative result. The sensitivity and specificity of percutaneous fine-needle aspiration were 85% and 92%, respectively, and were not significantly different from the core needle biopsy results (P >0.3). Three false negative fine-needle aspiration biopsies occurred in patients with potentially resectable lesions and a low clinical suspicion for malignancy. In patients with a mass in the head of the pancreas on CT scan, fine-needle aspiration biopsy offers results similar to those of intraoperative transduodenal core needle biopsy. In patients estimated to have resectable disease, a pancreaticoduodenectomy should be performed without a biopsy. For patients with unresectable disease, cytologic examination of fine-needle aspirate should be performed. If this examination is positive, it offers the advantage of facilitating the construction of a rational plan for palliation.
Biopsy, Fine-Needle↗
Gynecomastia: cytologic features and diagnostic pitfalls in fine needle aspirates.
OBJECTIVE: To illustrate some of the uncommon cytologic findings of gynecomastia, such as apocrine metaplasia, cellular atypia and foamy macrophages, that can be misinterpreted as evidence of malignancy. STUDY DESIGN: The clinical data and fine needle aspiration (FNA) cytologic material from 100 men with the diagnosis of gynecomastia were retrospectively reviewed. The excisional biopsy slides were available for 16 cases. For comparison, FNA smears from five men with breast lesions other than gynecomastia were studied. RESULTS: The patients ranged in age from 23 to 91 years. Cytologic findings were as follows: cohesive sheets of cells containing 20-1,000 cells (98%); scattered, single, bipolar cells (78%); spindle cells (68%); ductal epithelial atypia (26%); apocrine metaplasia (8%); and foamy histiocytes (12%). In nine cases the atypia was marked, and in two of them the possibility of malignancy could not be ruled out. Surgical follow-up on 16 patients, including the cases with marked atypia, showed gynecomastia. In one case, gynecomastia was associated with intraductal papilloma. No correlation between the underlying etiology and atypical cytologic features of gynecomastia was identified. CONCLUSION: Apocrine metaplasia and epithelial atypia are common findings in gynecomastia. Attention to the cell patterns, the presence of sheets of ductal cells and absence of atypical single cells will point to the correct diagnosis.
Adult↗
Increased natural killer cells in fluids. A new, sensitive means of detecting carcinoma.
OBJECTIVE: Natural killer (NK) cells are cells of undefined lineage that are capable of lysing certain tumor cell lines in vitro. Determination of NK cell percent (NK%) in effusions by flow cytometry could aid in the detection of malignancies. STUDY DESIGN: Over a six-month period at the Houston Veterans Affairs Medical Center, fresh effusions were routinely processed for cytology, and a portion was submitted for lymphocyte immunophenotyping using the FACScan and a panel including CD16/CD56 for NK cells. Seventy fluids (42 pleural, 28 peritoneal) from 62 men were examined. RESULTS: NK cell percents were markedly increased in 15 cases (29-68%, mean 45.5) and low in 55 (2-20%, mean 8). Fourteen of the 15 cases with increased NK% were positive for carcinoma (93%), while 54/55 cases with low ones were negative for carcinoma (98%). Mesotheliomas, lymphomas and leukemias had low NK%. CONCLUSION: Using the Mann-Whitney U test, an increase in NK% predicts metastatic carcinoma with a P level of < .00001.
Adult↗
p53 gene product in pleural effusions. Practical use in distinguishing benign from malignant cells.
OBJECTIVE: To determine the utility of positive p53 immunostaining as an adjunct in the diagnosis of malignancy in pleural effusions, we reviewed 103 effusions representing the typical range of diagnoses encountered in the evaluation of pleural fluid cytology. STUDY DESIGN: Immunohistochemistry was performed on paraffin-embedded cell blocks using a monoclonal antibody to the p53 suppressor gene product clone BP53-12 and a standard avidin-biotin complex technique with a citrate buffer antigen retrieval solution. RESULTS: Forty-one of 75 effusions with an unequivocal cytologic diagnosis of malignancy were immunopositive for p53 protein (55%). One of nine effusions cytologically interpreted as showing reactive mesothelial cells showed immunopositivity; that case was subsequently diagnosed as a mesothelioma on pleural biopsy. Nineteen cases were interpreted as suspicious for malignancy. Of these, 16 were negative, and 3 were positive for p53 protein. Of the three positive cases, two showed the presence of non-small cell and poorly differentiated large cell carcinoma. CONCLUSION: These findings suggest that p53 protein immunostaining is relatively sensitive and highly specific in differentiating benign mesothelial cells from malignant cells in pleural effusions. While negative p53 protein immunostaining does not exclude malignancy, positive staining in reactive or suspicious cells warrants further diagnostic evaluation of the patient.
Evaluation Studies as Topic↗
Primary diagnosis of disseminated coccidioidomycosis by fine needle aspiration of a neck mass. A case report.
Coccidioidomycosis is a pulmonary fungal infection endemic to the southwestern United States and northern Mexico. Disseminated coccidioidomycosis occurs in 0.1-0.5% of cases and is a life-threatening condition. We report a case of disseminated coccidioidomycosis in an immunocompetent black male with cutaneous lesions, a flocculent neck mass, bilateral hilar adenopathy, persistent fever, night sweats and malaise. The clinical suspicion was lymphoma with cutaneous involvement. Fine needle aspiration (FNA) of the neck mass provided the primary diagnosis of coccidioidomycosis. It was confirmed by culture of FNA-obtained fluid and a subsequent biopsy of a cutaneous lesion. As shown in this case, FNA of soft tissue masses may provide rapid identification of the responsible organism and allow early initiation of therapy for this potentially life-threatening infection.
Adult↗