[Ultrasonography-guided biopsies of tumors in the anterior mediastinum].
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Adult↗
Biomedical subjects
M Apaja-Sarkkinen
Publications and source records attributed to M Apaja-Sarkkinen.
Ultrasound-guided aspiration cytology of the spleen.
The cytologic results of ultrasound-guided fine-needle biopsies (FNB) of the spleen in 42 patients were analyzed retrospectively. A focal lesion was punctured in 28 of them, splenomegaly in 12, and an enlarged accessory spleen in 2. Sufficient material was aspirated for cytologic analysis in 41 (97.6%) cases. A final diagnosis of malignancy was made in 16 (38%), and a benign condition diagnosed in 26 (62%) patients. The sensitivity, specificity, and accuracy of the method for differentiating malignancy from benign conditions were 68.8%, 100%, and 88.1%, respectively. No complications occurred. We conclude that ultrasound-guided FNB is a safe, highly specific, but relatively insensitive method of defining splenic pathology.
Adolescent↗
Combined CT-guided biopsy and cytology in diagnosis of bony lesions.
The results of 44 trephine (OD 1.4-4 mm) biopsies and 39 fine needle (0.7-0.9 mm) aspirations of skeletal, mainly vertebral, lesions performed under CT-guidance in 54 patients were evaluated. The fine needle sample was aspirated through the trephine as a complementary procedure in 29 patients and a fine needle aspiration only was performed in 10 patients. Trephine biopsy only was performed in 15 patients. Sufficient material for histologic and cytologic analyses was obtained in 93% (41/44) and 97% (38/39) and a correct benign or malignant diagnosis was obtained in 84% (37/44) and 90% (35/39), respectively. Among the combined examinations the fine needle aspiration alone was diagnostic in 2 cases while the trephine specimen alone provided diagnostic material in 2 cases. In 24 cases both the cytologic and histologic samples were adequate for diagnostic purposes. In one case both methods gave false-negative results. The combined use of cytologic and histologic samples in CT-guided bone biopsies increased diagnostic accuracy. The aorta was perforated once with a 1.4-mm needle but without sequelae. CT-guided bone biopsy was found to be a safe, reliable and cost-efficient method.
Adult↗
Ultrasound-guided aspiration biopsy of anterior mediastinal masses.
Five anterior mediastinal tumors were biopsied with a fine needle under ultrasound guidance. All the tumors were solid, hypoechoic, perivascularly situated masses. Their mean diameter was 7.2 cm. Cytologically there were 2 mediastinal metastatic carcinomas, 1 poorly differentiated carcinoma or non-Hodgkin lymphoma, 1 germ-cell tumor (embryonal cell carcinoma), and 1 malignant lymphoma or thymoma. There were no complications. Ultrasound-guided anterior mediastinal aspiration biopsy is a safe and rapid procedure in the evaluation of anterior mediastinal masses. Biopsy of a mediastinal mass enables simultaneous diagnosis and staging. Mediastinoscopy and diagnostic thoracotomy can be avoided.
Adult↗
Distribution of laminin and types IV and III collagen in fetal, infant and adult human spleens.
The immunohistochemical distribution of the basement membrane (BM) proteins, laminin and type IV collagen, and interstitial type III collagen was investigated in 12 fetal spleens at the 15th-38th gestational weeks (g.w.) and in spleens of 8 infants from term to 4 years. The results were compared with the distribution of the same proteins in adult human spleen. BM proteins were found to be abundantly present in the red pulp of all spleens during the whole of development. The content of type III collagen gradually decreased with advancing age and, in adult spleen, there were only occasional positively staining fibers in Billroth's cords. This finding indicates that the composition of reticular fibers in the red pulp of spleen is different from the reticular fibers elsewhere in lymphoreticular tissue. Early signs of ring fiber formation in the walls of venous sinuses were detectable at the 15th-19th g.w., although their more complete development occurred relatively late from the 36th g.w. onwards. Ring fibers contained both laminin and type IV collagen in all the investigated spleens. They never stained for type III collagen. The developing white pulp was positive for BM proteins, but showed no staining for type III collagen at the 15th g.w. At later ages, the white pulp stained similarly for both BM proteins and type III collagen.
Adult↗
[Guided fine-needle biopsy as a diagnostic method].
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Biopsy, Needle↗
Radiologic findings in renal oncocytoma.
The imaging findings of 36 renal oncocytomas in 32 patients were evaluated retrospectively. Twenty-two patients underwent ultrasound (US), 16 CT, 25 angiography, 19 urography, and 6 fine-needle biopsy. At US 8 of the oncocytomas were isoechoic, 7 hyperechoic, and 7 hypoechoic. The structure was homogeneous in 59% and nonhomogeneous in 41%. At plain CT 12 oncocytomas were homogeneously hypodense, 3 isodense, and one hyperdense. Contrast enhancement was homogeneous in 10 and inhomogeneous in 4 cases. A stellate scar was detected in one case, and in one case a contrast study was not performed. At angiography the oncocytomas were hypervascular in 21, hypovascular in 3 cases, and one was not detected. Nineteen of the tumors were well delineated. A spokewheel arterial pattern was detected in 3 tumors. The cytologic diagnosis was benign renal oncocytoma in 4 cases and highly suggestive of oncocytoma in 2 cases. We conclude that the homogeneity of a renal tumor at US and at CT may suggest the possibility of oncocytoma. US-guided fine-needle biopsy is a useful diagnostic tool in patients who need a precise presurgical diagnosis.
Adenoma↗
Accuracy of adrenal biopsy guided by ultrasound and CT.
We reviewed the results of fine needle biopsy of the adrenal glands guided by ultrasonography or CT in 56 patients. The final diagnoses, obtained at operation, autopsy or follow-up were: metastasis (n = 22), adenoma (n = 21), adrenal cyst (n = 6), hematoma (n = 3), lymphoma (n = 1), pheochromocytoma (n = 1), lymph node (n = 1), and amyloid mass (n = 1). Sufficient cytologic material was obtained in 96.4% (54/56). The overall accuracy to differentiate benign from malignant disease was 85.7% (48/56), 2 were false-negative, one was false-positive. The biopsy was inconclusive ("possibly malignant") in 3 patients, 2 of whom had an additional cutting needle biopsy yielding a correct positive finding. No complications occurred. We conclude that in disseminated malignant disease with suspected adrenal metastases diagnostic results can be obtained with guided fine needle biopsy. Biopsy in primary adrenal lesions is helpful, especially if the aspirate of the lesion turns out to be composed of something other than adrenal cells.
Adrenal Gland Neoplasms↗
Ultrasound-guided aspiration cytology of enlarged lymph nodes.
Cytological results of US-guided fine needle aspiration biopsies of enlarged lymph nodes from 179 patients were analyzed retrospectively. The final diagnoses were benign lymphadenopathy in 90 cases, metastasis in 56, and malignant lymphoma in 33 cases. The material was sufficient for cytological analysis in 174 cases (97.2%). Correct diagnosis of malignant (C-IV-V) and benign (C-I-II) lymphadenopathy in the whole material was possible in 80 percent of cases. Correct subtyping of lymphoma was possible in 63.6 percent of the cases. There was one (0.6%) false positive (C IV), 6 (8.5%) false negative (C-I-II), and 24 (13.8%) suspicious (C III) cytological findings. All but one of the false negative cytological findings were from superficial lymph nodes. No complications occurred. US-guided lymph node aspiration biopsy is safe and accurate in the superficial, anterior mediastinal, abdominal, and retroperitoneal lymphonodal areas. Lymph nodes with a C 0 cytological result should undergo rebiopsy and suspicious (C III) or clinically doubtful cases should be referred for a surgical biopsy.
Adolescent↗
Ultrasound-guided aspiration cytology of renal expansions.
Ultrasound-guided fine needle aspirates from 52 malignant renal tumours and 128 benign expansions taken in 1982-1988 were analyzed retrospectively. There were three suspicious aspirates (class III) suggesting a possibility of malignancy among the cases of benign renal expansions and seven false negative aspirates (C I-II) among the malignancies. The accuracy, sensitivity and specificity of the method for differentiating malignant cases from benign ones were 94.1%, 85.1% and 97.5% respectively. Cytology was correct in 86% of the radiologically equivocal cases and in 63.6% of the small renal neoplasms. Aspiration cytology identifies haemorrhagic cysts and infectious conditions, but is not reliable for the detection of malignancy in a multilocular cyst.
Adolescent↗
The effect of contact Nd:YAG laser on arterial wall and atherosclerotic plaques. Considerations for angioplasty. An experimental study.
The predictability and reproducibility of the laser effect in regard to depth of penetration and atheroablation are important considerations for clinical laser angioplasty. This study was designed to investigate those effects experimentally. A continuous wave contact laser system (SLT CL60R with an SLT MTR 1.5 sapphire tip) was used to produce a total of 592 lesions on 14 portions of atherosclerotic human aorta and 46 portions of intact pig aorta. Different power (1 to 40W) and time (0.1 to 10 sec.) were used. These tissue specimens were analyzed by an independent pathologist. Penetration and extent of thermal damage were recorded. The measurements were analyzed statistically. Analysis shows that the effect of the laser is reasonably well predictable horizontally (correlations .755 and .699) but not at all in depth (correlation .006).
Animals↗
An immunohistochemical study of laminin, type-IV collagen and type-III pN-collagen with relation to reticular fibres in Hodgkin's disease.
The distribution of aminoterminal propeptides of type-III procollagen (indicating the presence of type-III pN-collagen, i.e., type-III collagen molecule with a non-cleaved aminoterminal propeptide), laminin and type-IV collagen was studied by immunohistochemical methods. The results were compared with the distribution of reticular fibres using Gomori's reticulin stain. Lymph nodes from 20 cases of Hodgkin's disease (HD) and 3 spleens affected by nodular sclerosis HD were studied. The reticular fibres stained for all the antigens investigated, the strongest reaction being for pN type-III collagen. Thick fibres stained mainly for type-III pN-collagen, the BM proteins being located in a fragmented rim on the surface. The distribution and composition of fibres was similar in both nodal and extranodal infiltrations. The morphological alterations noted in the fibres comprised (1) compression between nodules in the nodular type of lymphocyte-predominant HD, and (2) fragmentation, present in collections of histiocytes in lymphocyte-predominant HD. BM proteins and type-III pN-collagen were present in the walls of the sinuses and vessels. The marginal sinuses were often partially spared in spite of extracapsular invasion. Our results suggest that laminin, type-IV collagen and type-III pN-collagen are important components of reticular fibres in HD and that the composition of the fibres is similar to that seen in the normal lymph node.
Adult↗
Alcoholic bile does not intensify acute pancreatitis in rats.
The toxicity of intraductal injections of normal bile, bile obtained from rats receiving ethanol i.v., and normal bile mixed with ethanol at a concentration of 1.5 g/l to the pancreas were tested using male Wistar rats (n = 60). The animals were killed by exsanguinating the abdominal aorta 24 h after the induction of acute pancreatitis by a retrograde infusion into the pancreatic ducts, the pancreases resected, and histological samples taken from the constant place of the pancreas. The histological specimens were classified according to the degree of severity of pancreatitis. No statistically significant differences in the severity of acute pancreatitis were observed between the groups. In conclusion, ethanol given i.v. or ethanol mixed with normal rat bile do not increase the toxicity of an intraductal bile injection to the pancreas. Thus, the previously observed increased toxicity of alcoholic bile obtained from chronic alcoholic rats must be mediated by a change of some metabolites of bile.
Alcoholism↗
Characterization of extracellular matrix in non-Hodgkin's lymphomas.
Basement membrane proteins laminin, type IV collagen and aminoterminal propeptide of type III collagen (type III pN-collagen) are important components of extracellular matrix of normal lymph nodes; they are present in reticular fibres and in the walls of blood vessels and sinuses. We have studied the distribution of these proteins in 45 cases of non-Hodgkin's lymphomas representing different types of Kiel classification. Light microscopic immunohistochemistry was used on sections from formalin fixed, paraffin embedded biopsy specimens. Reticular cells were identified by using antibodies against S-100 protein, a marker for dendritic and interdigitating reticulum cells, and against cystatin A for the demonstration of follicular dendritic reticulum cells. The findings of the immunohistochemical stainings were generally similar in the different lymphoma types. Thus the method for the demonstration of extracellular matrix proteins could not give obvious aid for lymphoma classification. BM stainings proved to be efficient in the demonstration of sinuses. Marginal and medullary sinuses of the nodal cases were either totally or partly spared and open also in the cases in which there was extracapsular growth. The fibre content was variable, but generally the distribution of all the three extracellular matrix proteins was comparable with each other and mainly corresponded with the pattern seen in conventional Gomori's reticulin stain. This also holds for the tumor tissue infiltrated through the capsule and for extranodal cases. Areas of sclerosis of some cases contained only type III pN-collagen. Reticular fibres were at places seen to be closely associated with cells of spindle or dendritic shape. A few reticulum cells could be found to show cytoplasmic staining for laminin, type IV collagen and type III pN collagen. This finding suggests that the cells are synthetizing these proteins. The amount of cells staining for cystatin A or S-100 protein did not generally correlate with the amount of fibres, and most of the stained cells were not closely associated with fibres. The results show that in non-Hodgkin's lymphomas basement membrane proteins and type III pN-collagen are important components of reticular fibres. Results also indirectly support the main role of fibroblastic reticulum cells in the production of the fibres.
Adolescent↗
Laminin and type IV collagen in different histological stages of Kaposi's sarcoma and other vascular lesions of blood vessel or lymphatic vessel origin.
Immunohistochemical staining was used to demonstrate basement membrane (BM) laminin and type IV collagen in eight cases of Kaposi's sarcoma (KS). These KS were not associated with AIDS and represented different histological stages of the disease: patch (three cases), plaque (one case), and nodule (four cases). Nine cases of benign angiogenic lesions, five of blood vessel origin, and four of lymphatic vessel origin were also studied. An early event in vascular proliferation at the patch stage of KS was an intersection of dermal collagen bundles and the appearance of granular BM material around this space. With the increase of amount and linear arrangement of BM material, well-defined capillaries were formed. Two types of capillary were found in KS lesions. One showed morphological features of blood capillaries, with a round lumen; thick, continuous BM, and occasional pericytes in the wall. The other included irregularly shaped vessels with thin, often disrupted BMs; thus these capillaries morphologically resembled lymphatic capillaries. BM staining also clearly revealed the vascular nature of the nodular lesions of KS, which were composed of a network of slit-like spaces surrounded by BMs. The solid tumor cell areas were sparse; they were composed of spindle-shaped cells surrounded by thin, interrupted basal laminae. By using antibodies against human laminin and human type IV collagen, it was also possible to demonstrate thin, widely disrupted BMs subendothelially in normal dermal lymphatic capillaries. Typically, the BMs in lymphangiomas and lymphangiectasias were continuous and more clearly defined.
Aged↗
Non-operative inactivation of a parathyroid tumour in a patient with hypercalcaemic crisis.
A parathyroid tumour in a patient with hypercalcaemic crisis was inactivated under continuous ultrasonic guidance using percutaneous injection of 96% ethanol.
Aged↗
Microabscesses in gastric biopsies shown by acridine orange staining.
Acridine orange staining of endoscopic biopsies of gastric mucosa was used in 70 patients with various upper gastrointestinal symptoms to identify Campylobacter pylori abscess formations with polymorphonuclear leucocyte infiltration. In comparison with cultures, the staining test proved to be a rapid and reliable test particularly in outpatient clinics as results are available in 6-8 min, thus enabling any necessary treatment to start immediately.
Abscess↗
Experimental acute pancreatitis in rats receiving different diets and ethanol. Correlation between histological findings and mortality.
The correlation between histological findings and mortality was studied in rat experimental acute pancreatitis (AP) modified by different diets and chronic ethanol consumption. Male Wistar rats (n = 192) were divided into eight groups and they were fed either a mixture of water and 15% (v/v) ethanol or tap water combined with standard or special diets for 12 weeks. The animals were followed up for 24 h after induction of AP, and the lowest mortalities were observed in the groups receiving water and standard (S) or carbohydrate-rich (C) diets and the highest in the groups receiving water and protein-(P) or fat-rich (F) diets. In the groups receiving S- or F-diets and ethanol the mortality was significantly increased. The animals were relaparotomized after 24 h of follow-up time. Histological specimens were taken from the surviving rats and evaluated on an arbitrary scale. Histologically, AP was the most severe in the group receiving the C-diet and ethanol, but in this group mortality did not differ significantly from the S-diet and water receiving group. The lack of correlation between the mortality and histological findings suggests nutritional factors to be important for the survival of the animals in experimental AP. It also stresses the assessment of the severity of experimental AP to be based on the all available parameters - not only on the basis of histological findings.
Acute Disease↗