Biomedical subjects

P D Unger

Publications and source records attributed to P D Unger.

At least 19 recordsLinked to original sources

PubMed2001

Immunohistochemical analysis of prostate specific antigen in breast cancer.

The presence of immunoreactive prostate-specific antigen (IR-PSA) has been reported in breast cancers and has been suggested to confer a positive prognosis. However, recent large, well-controlled studies have found no significant prognostic value when IR-PSA positivity is examined as an independent variable, even when ultrasensitive immunofluorometric techniques are utilized. The present study, using indirect immunohistochemistry on 75 formalin-fixed, paraffin-embedded breast cancers shows PSA immunoreactivity in only seven of 75 cases (9%), suggesting that PSA positivity in breast carcinoma is not useful as a prognostic or tumor marker with hospital-based methods.

Adult↗

PubMed2001

Primary epithelioid angiosarcoma of the adrenal gland.

Primary angiosarcomas of the adrenal gland are exceptionally rare vascular tumors. We report a case of a 63-year-old man with an epithelioid angiosarcoma of the left adrenal gland. Visualized on computed tomography as a nonhomogeneous round mass, the tumor measured 3 cm in diameter. Histology showed a vascular tumor composed of epithelioid cells with vesicular nuclei and prominent nucleoli that lined irregular vascular spaces and also formed solid areas and showed pleomorphism and rare mitotic activity. Immunohistochemical stain confirmed the diagnosis of epithelioid angiosarcoma. We report our findings and review previously described literature cases of this rare entity.

Adenoma↗

PubMed2001

Renal cell carcinoma with intravascular lymphomatosis: a case report of unusual collision tumors with review of the literature.

We report the case of a 77-year-old white woman who presented with a left breast mass, lethargy, and weight loss. Pelvic computed tomographic scan revealed a 9.5-cm mass in the right kidney. Surgical pathology demonstrated a diffuse large B-cell lymphoma of the subcutaneous tissue of the breast and renal cell carcinoma with concurrent extensive intravascular lymphomatosis. Systemic dissemination of malignant lymphoma to a concurrent visceral primary neoplasm is rare. To the best of our knowledge, this is the first case illustrating a renal cell carcinoma collision with intravascular lymphomatosis.

Aged↗

PubMed1997

Localized amyloidosis of the seminal vesicle. Possible association with hormonally treated prostatic adenocarcinoma.

OBJECTIVE: Localized seminal vesicle amyloidosis is an unusual finding in surgical pathology material. Previous studies have demonstrated that the amyloid is directly produced by the seminal vesicle epithelial cells. We investigated the possible association of seminal vesicle amyloid in patients hormonally treated for prostate carcinoma. METHODS: Cases were collected from over 200 prostate needle biopsies, seminal vesicle biopsies, and prostatectomy specimens from the surgical pathology files at The Mount Sinai Hospital, New York, NY. None of the patients with seminal vesicle amyloidosis had a chronic inflammatory disorder, serum or urine protein abnormalities, or other identifiable masses. RESULTS: Six cases of localized seminal vesicle amyloidosis were found in the surgical pathology material examined. Five of the six cases had prostatic carcinoma, and one case was seen in a biopsy for benign prostatic hyperplasia. Four of the five carcinoma cases had prior hormonal treatment (luteinizing hormone-releasing hormone agonist with an antiandrogen agent, and one patient, in addition, had received radiotherapy). The amyloid deposits were limited to the seminal vesicle lamina propria without involvement of vascular walls. The amyloid reacted with Congo red staining that was sensitive to potassium permanganate. Immunohistochemically, all cases were negative for AA amyloid, beta 2-microglobulin, and kappa and lambda light chains. CONCLUSION: We raise the possibility that in some instances, prior hormonal therapy may act as a seminal vesicle epithelial stimulant for the elaboration of this protein.

Adenocarcinoma↗

PubMed1996

Prostate specific antigen findings and biopsy results following interactive ultrasound guided transperineal brachytherapy for early stage prostate carcinoma.

BACKGROUND: Interactive, transrectal, ultrasound-guided transperineal implantation is a new technique for performing permanent brachytherapy implants of the prostate. Prostate specific antigen (PSA) findings, biopsy results, and morbidity are examined to demonstrate its efficacy and safety in treating early stage prostate carcinoma. METHODS: Ninety-seven patients underwent permanent implants for classifications T1 to T2 adenocarcinoma of the prostate gland with a median follow-up of 18 months (range: 6-51 months). Seventy-nine patients had negative laparoscopic pelvic lymph node dissections prior to implantation. Patients with positive lymph nodes were not implanted. The radioactive isotope used was I-125 in 71 patients and Pd-103 in 26 patients. RESULTS: PSA failure was defined as two consecutive increases in PSA above the nadir level. The actuarial freedom from PSA failure (FFPF) at 2 years was 76% for the entire group. Stage significantly affected FFPF. Patients classified as T1b to T2a (35) had a FFPF of 91% at 2 years compared with 68.5% for patients classified as T2b to T2c (62) (P = 0.04). The pre-treatment PSA also significantly affected FFPF. Patients with PSA values of < or = 10 ng/mL (44) had a FFPF of 83% at 2 years. A similar rate of 82% was found in patients with PSA values of 10.1 to 20 ng/mL (29). Patients with PSA values > 20 ng/mL (24) had a significantly poorer FFPF at 2 years of 58% (P = 0.02). The PSA values of patients free from a PSA failure (82) ranged from 0.1 to 12.9 ng/mL with a median of 0.8 ng/mL. Transrectal prostate biopsies were performed 18 to 36 months posttreatment in 39 patients. Negative biopsies were found in 74% (29/39) of cases. The procedure was associated with an actuarial preservation of erectile function rate and sexual potency at 2 years of 96% and 79%, respectively. There were no cases of urinary incontinence or radiation cystitis. Associated morbidity included urinary retention requiring catheterization in 4% of the patients, outlet obstruction requiring a transurethral resection of the prostate in 2% and Grade 2 rectal complications in 1%. CONCLUSIONS: Interactive, ultrasound-guided transperineal brachytherapy results in a low PSA failure rate, high negative biopsy rate, and is associated with low morbidity and preservation of erectile function.

Adenocarcinoma↗

PubMed1995

Ex vivo activated memory T-lymphocytes as adoptive cellular therapy of human renal cell tumour targets with potentiation by cis-diamminedichloroplatinum(II).

OBJECTIVE: To determine if cis-diamminedichloroplatinum(II) (CDDP) enhances, by immunomodulation, ex vivo anti-tumour cytotoxicity of autolymphocyte therapy (ALT) against a chemotherapy-resistant tumour, and if lysis is mediated through T-cells, NK-cells, or both. MATERIALS AND METHODS: Human renal cell carcinoma (RCC) target cells were derived from surgical specimens and incubated in complete medium (CM) with CDDP, or in CM alone (control group). ALT-cells were prepared from autologous whole peripheral blood mononuclear cells (PBMC) or NK-cell (CD56)-depleted PBMC obtained before surgery. Tumour cells from each group were labelled with chromium-51(51Cr) and used as targets for ALT-cells and PBMC in a standard (4 h) and delayed (18 h) 51Cr-release assay at varying effector/target ratios (E:T). RESULTS: Tumour cells incubated in CDDP showed enhanced lysis, as measured by the 51Cr-release assay, at all E:T tested. This lysis was significantly greater during the 18 h assay and when ALT-cells were used as the effector cells rather than PBMC. Depletion of CD45RO+ (memory) T-cells from the ALT cell population precluded both the 4 and 18 h tumour cell lysis. Depletion of NK-cells (CD56+) diminished the ex vivo lysis of autologous targets during the 4 but not the 18 h assay. ALT-cells derived from two patients demonstrated ex vivo tumour-specificity against autologous and allogeneic RCC. CONCLUSIONS: These data suggest that: (i) ex vivo activated memory T-cells are the principal component demonstrating significant tumour-specific cytotoxicity of ALT-cells against RCC tumour targets; (ii) CDDP may alter the physical properties of tumour cells rendering them susceptible to immune-mediated attack; (iii) the combination of ALT and CDDP may lead to increased therapeutic efficacy in patients with metastatic RCC.

Carcinoma, Renal Cell↗

PubMed1995

Computerized interactive morphometry in the differential diagnosis of irradiated prostates.

Radiation therapy is becoming a treatment of choice for many patients with prostatic carcinoma. Distinguishing radiation change in prostate glands from carcinoma may be difficult. In this study we objectively assessed, by morphometric methods, the nuclear characteristics of benign and malignant prostates with a history of radiation treatment (125I implant with or without prior external beam radiation). This is part of our continuing efforts to achieve difficult differential diagnoses by analyzing perimeter, diameter and nuclear profile area of cells or interest and applying methods of statistical classification. Biopsies were performed 18-36 months following implant therapy. Eleven cases with residual prostate tumor constituted the malignant group. These were compared to 20 benign cases (benign glands in the 11 carcinoma cases plus 9 other cases with no residual carcinoma). Immunohistochemical staining with keratin 903 was performed on all cases. Differences in the nuclear parameters were most evident in the average nuclear profile areas (32.5 microns 2 for the malignant groups vs. 39.6 for the benign) and in the mean maximal cord length (diameter) (7.4 microns for the malignant group vs. 9.0 for the benign). Classification, however, is based on the size distribution plots of nuclear profile areas, which, in the malignant cases, had a sharper peak at lower value, while the benign cases had higher value and a broader peak with a trailing off into the larger values. This study emphasized the marked nuclear alterations that occur in irradiated prostates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed1994

Nuclear diffuseness as a measure of texture: definition and application to the computer-assisted diagnosis of parathyroid adenoma and carcinoma.

A measure of texture, the nuclear diffuseness, was formulated for use in biological classification, and specifically to characterize quantitatively chromatin texture. Nuclear diffuseness corresponds to the amount of local intensity variation in the digitized image of a nuclear profile. As a setting in which to test the efficacy of nuclear diffuseness as a diagnostic tool, the identification of parathyroid adenoma and carcinoma was considered. Digitized images of sections of parathyroid chief cell nuclei were obtained from 16 biopsies, and the nuclear diffuseness, as well as other morphometric descriptors, were computed. With just the average nuclear diffuseness and average nuclear profile area, jackknife (leave-one-out) classification using an artificial neural network was able to diagnose correctly and unambiguously the condition (normal, parathyroid adenoma, or parathyroid carcinoma) in 15 of 16 cases. In one case, the neural network assigned a higher weight to the correct diagnosis, but was unable to distinguish between normal and adenoma conclusively.

Adenoma↗

PubMed1994

Intra-abdominal pulmonary sequestration exhibiting congenital cystic adenomatoid malformation. Report of a case and review of the literature.

We describe the fifth case, to our knowledge, of an intra-abdominal pulmonary sequestration that histologically displayed the features of congenital cystic adenomatoid malformation (CCAM) type 2. This mass was found during routine prenatal ultrasound in an infant with no other congenital malformations. A literature search found 13 previously reported cases of CCAM in extralobar pulmonary sequestration (EPS), nine of which were thoracic and only four were intra-abdominal. An analysis of our case and the 13 previously reported cases shows that the clinical features of EPS containing CCAM type 2 do not differ significantly from those of EPS occurring alone. The presence of CCAM type 2 in our patient is consistent with previously reported cases. Extralobar pulmonary sequestrations located in the abdomen are rarely diagnosed prior to excision, and the presence of CCAM type 2 in this situation may further compound diagnostic difficulties. The morphologic features separating CCAM into three distinct types and the exclusive association of CCAM type 2 occurring in EPS are also discussed.

Bronchopulmonary Sequestration↗

PubMed1994

HMB-45 reactivity in renal angiomyolipoma and lymphangioleiomyomatosis.

Recent reports have elucidated the variety of tissue types that can react with HMB-45. Consistent positivity has been demonstrated in angiomyolipomas, but only in the smooth-muscle cells. In this report, we examine five renal angiomyolipomas and 20 mesenchymal lesions with similar morphological features and with a possibly similar histogenesis. These include one retroperitoneal lymphangioleiomyomatosis, five epithelioid leiomyomas, nine leiomyosarcomas with epithelioid features, and five alveolar soft part sarcomas. HMB-45 demonstrated a strong diffuse cytoplasmic positive reaction with the smooth-muscle component in all cases of renal angiomyolipoma and in the one case of lymphangioleiomyomatosis. All alveolar soft part sarcomas, leiomyomas, and leiomyosarcomas were uniformly negatively stained by this antibody. We discuss the widening spectrum of lesions that are reactive with HMB-45 and the relationship of angiomyolipoma and lymphangioleiomyomatosis.

Adult↗

PubMed1993

Morphometric analysis of neoplastic renal aspirates and benign renal tissue.

This study was designed to develop a practical morphometric procedure for the diagnosis of carcinoma in renal aspirates. We studied aspirates from renal cell carcinomas (grades 1-2) and normal kidneys. Video images of nuclei were traced on a high-resolution, touch-sensitive screen connected to an image analysis system. From each tracing the computer calculated nuclear perimeter length, nuclear profile area, maximal chord length, and the means and standard deviation for all measurements. Size distribution of nuclear profile areas and perimeter length in discrete bins ranged, respectively, from 30 to 80 at 10 microns2 intervals for areas and from 1 to 12 microns at 1-micron intervals for the maximum chords. The size distribution plots for the maximal chord of individual nuclei demonstrated an early narrow peak at low values for normal renal aspirates (peak located in the class ranging from 7 to 8 microns), while a broader, flatter peak with a shift to the right and a malignant tail was seen in renal cell carcinoma aspirates (peak located at 9-10 microns). These data were used for multivariate analysis to form two categories to establish a data base against which unknown cases could be tested. Multivariate analysis using a total of 14 variables yielded a value of 169.1 for the euclidean distances between the center of clusters of the neoplastic and normal renal aspirates and confirmed the classification with posterior probabilities of 1.0. From these data, automated classificatory analysis of 10 unknown cases was performed by means of the k-nearest neighbor procedure, with correct classification established in each case.

Biopsy, Needle↗

PubMed1992

Paneth cell-like metaplasia of the prostate gland.

We report two cases of Paneth cell-like metaplasia of the prostate gland, one in poorly differentiated carcinoma and the second in benign hyperplasia. By light microscopy, the Paneth-like cells were indistinguishable from Paneth cells found in the normal small intestine and ultrastructurally showed electron-dense granules typical of Paneth cells. Immunohistochemical stains were positive for prostate-specific antigen and prostatic acid phosphatase and negative for lysozyme and alpha 1-antitrypsin. The clinical significance of Paneth cell-like metaplasia is unknown and may represent an example of the multipotential metaplastic capability of actively dividing cells.

Adenocarcinoma↗

PubMed1992

HMB-45 reactivity in adrenal pheochromocytomas.

Melanoma-specific antibody (HMB-45) is highly specific for junctional nevi, malignant melanomas, and related lesions. Rarely have other benign or neoplastic tissues demonstrated positivity with the monoclonal antibody following purification. In the present study, four of 12 pheochromocytomas contained chief cells that reacted with HMB-45. We discuss the clinical and pathologic implications of this finding.

Adolescent↗

PubMed1991

DNA flow cytometric evaluation of serous and mucinous cystic neoplasms of the pancreas.

There have been few reports of flow cytometric studies of pancreatic neoplasms, whether endocrine or exocrine. In this report, the DNA content of three mucinous and seven serous cystic tumors of the pancreas was evaluated by flow cytometry on formaldehyde solution-fixed, paraffin-embedded tissue. Two serous cystadenomas were aneuploid, with the remaining five serous and all three mucinous being diploid. All cases had a low S phase (ranging from 0.1% to 3.1%), indicating neoplasms with a low turnover. From these results, it appeared that DNA flow cytometry as an independent factor did not discriminate between the benign pancreatic serous cystadenomas and the more aggressive mucinous cystic neoplasms.

Adult↗

PubMed1990

Disseminated Pneumocystis carinii infection causing extrapulmonary organ failure: clinical, pathologic, and immunohistochemical analysis.

Pneumocystis carinii pneumonia is an important infection in the immunocompromised host, and the rate of symptomatic infections has risen dramatically with the advent of immunosuppressive therapies and infections with the human immunodeficiency virus (HIV). However, dissemination of P. carinii is thought to be an unusual event, and it is rarely suspected of causing extrapulmonary symptomatology. We have recently examined the cases of patients with acquired immunodeficiency syndrome (AIDS) who demonstrated at autopsy extrapulmonary infection with P. carinii. Three of these patients had widespread pneumocystosis, and in one patient dysfunction in several organs could be directly attributed to effects of P. carinii, which contributed to his death. The possible factors leading to dissemination of P. carinii are discussed. We also describe the use of a newly developed monoclonal antibody to P. carinii in detecting extrapulmonary infections.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Lipid degeneration in a pheochromocytoma histologically mimicking an adrenal cortical tumor.

A recurrent adrenal pheochromocytoma is reported in an 18-year-old woman with a family history of multiple endocrine neoplasia type IIA. The tumor was noteworthy for the presence of numerous fine intracytoplasmic lipid droplets confirmed by fat stain. Immunohistochemical studies revealed cytoplasmic positivity for chromogranin and neuron-specific enolase typical of pheochromocytoma. Electron microscopy demonstrated dense-core neurosecretory granules, in addition to the cytoplasmic lipid vacuoles. The presence of lipid within an adrenal pheochromocytoma is rare and, to our knowledge, has been documented in only one previous case report in the literature.

Adolescent↗

PubMed1990

Primary renal carcinoid.

A case of primary renal carcinoid in a 34-year-old man is reported. The lesion was morphologically identical to carcinoid tumors arising in the gastrointestinal or respiratory tracts. The renal carcinoid was focally argyrophilic and contained chromogranin and neuron-specific enolase disclosed by immunohistochemical studies. The diagnosis was further confirmed by membrane-bound cytoplasmic neurosecretory granules visualized by electron microscopy. The possible histogenesis of this unusual tumor and a review of the literature are discussed.

Adult↗

PubMed1988

Disseminated Pneumocystis carinii infection in a patient with acquired immunodeficiency syndrome.

A case of disseminated pneumocystosis occurring in a patient with the acquired immunodeficiency syndrome is described. Postmortem examination of this patient, who had three episodes of Pneumocystis carinii pneumonia during his 3-year clinical course, revealed clinically unsuspected infiltration of lymph nodes, spleen, adrenal glands, and bone marrow, in addition to persistent pulmonary infection by the organism.

Acquired Immunodeficiency Syndrome↗