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Biomedical subjects

R U Levine

Publications and source records attributed to R U Levine.

At least 19 recordsLinked to original sources
PubMed1997

Bilateral serous cystadenofibromas clinically simulating hyperreactio luteinalis following controlled ovarian hyperstimulation and in vitro fertilization.

We report a case of bilateral serous cystadenofibromas clinically simulating hyperreactio luteinalis during a normal pregnancy resulting from controlled ovarian stimulation and in vitro fertilization. Incomplete regression at 2-year follow-up prompted surgical intervention. This case demonstrates that the clinical and sonographic features that have been associated with hyperreactio luteinalis are not specific for this condition and emphasizes the need for close clinical follow-up in all presumptive cases for which a histologic diagnosis has not been established.

Adenofibroma↗
PubMed1997

Ovarian steroid cell tumors: sonographic characteristics.

The goal of the gynecologist is to detect ovarian tumors in their earliest stages. Small virilizing tumors, which barely affect the size of the ovaries, are such lesions. Since the introduction of transvaginal sonography it is technically possible to detect small intraovarian neoplasms. Three cases of virilizing steroid cell tumors in postmenopausal women with ovarian volumes just exceeding the normal sizes for age are presented. High-frequency transvaginal ultrasound and color Doppler studies to measure flow parameters were used. These small tumors had different echogenicity from the surrounding ovarian tissue and two had low impedance-to-flow values. Gray-scale transvaginal sonography combined with color Doppler studies can make the diagnosis of small steroid cell tumors easier and, at times, better than other, more costly imaging modalities.

Aged↗
PubMed1996

Transvaginal sonographic detection of adducted thumbs, hydrocephalus, and agenesis of the corpus callosum at 22 postmenstrual weeks: the masa spectrum or L1 spectrum. A case report and review of the literature.

Prenatal diagnosis of non-chromosomal syndromes relies, among others, on the detection of specific morphological findings. In rare syndromes the index case may not be prenatally diagnosed but subsequent pregnancies may benefit from early diagnosis. In this article we discuss the clinical spectrum of an X-linked hereditary disease which contains hydrocephalus, congenital agenesis of the corpus callosum, adducted thumbs, shuffling gait, aphasia, mental retardation, and at times other associated findings. The purpose of this case report is to describe the prenatal sonographic findings of a fetus affected with adducted thumbs, hydrocephaly, and agenesis of te corpus callosum. The patient was referred at 22 1/2 weeks' gestation for prenatal diagnosis. Ultrasound revealed a male fetus with dilatation of the lateral ventricles and partial agenesis of the corpus callosum. The fetal hands showed the thumbs to be fixed in a flexed-adducted position. These findings were consistent with the MASA spectrum (mental retardation-aphasia-shuffling gait-adducted thumbs) present in the older brother. The patient elected to terminate the pregnancy and autopsy confirmed the sonographic findings. In conclusion, prenatal sonography, especially the presence of adducted thumbs, allowed prenatal diagnosis of the second affected child with the MASA spectrum in this family. This morphology-based approach becomes feasible between postmenstrual weeks 15 and 20. Prior to this gestational age, the diagnosis should rely on molecular biology tests.

Agenesis of Corpus Callosum↗
PubMed1993

Conservative management and pregnancy outcome in diethylstilbestrol-exposed women with and without gross genital tract abnormalities.

OBJECTIVES: Our goal was to determine the effect of conservative management on pregnancy outcome in diethylstilbestrol-exposed women with and without gross structural lesions of the genital tract. STUDY DESIGN: The study included a case series of women prospectively enrolled over a 10-year period. RESULTS: Pregnancy outcome and both antepartum and intrapartum events occurring in a case series of 120 conservatively managed pregnancies in 50 diethylstilbestrol-exposed women were reviewed. Group A (n = 34, 89 pregnancies) consisted of women with gross upper or lower genital tract lesions associated with diethylstilbestrol exposure, whereas group B (n = 16, 31 pregnancies) consisted of women whose lesions were limited to colposcopic findings. Cerclage was limited to women with a history of cervical incompetence (n = 1, two pregnancies) or acute cervical change in the second trimester (one pregnancy). Women with cervical change occurring after 25 weeks' gestation were managed with bed rest. Group A experienced more spontaneous first-trimester losses than group B (25.8% vs 12.9%, p < 0.01), whereas group B had a greater gestational age at delivery (39.8 +/- 1.5 vs 37.3 +/- 3.8 weeks, p < 0.01) than group A. Overall, pregnancies surviving the first trimester (n = 94) resulted in delivery of a viable infant discharged home 92.2% of the time; 77.9% of pregnancies reached term. The perinatal loss rate was 1.3%. Preterm labor (6.5%) and preterm rupture of membranes (3.8%) resulted in an overall rate of preterm birth of 9.2%. There were no significant differences in length of any labor stage between groups, nor were there any differences in the use of oxytocin augmentation or cesarean section rates between groups. Postpartum hemorrhage and retained placenta were infrequent complications. CONCLUSIONS: The majority of pregnancy loss in diethylstilbestrol-exposed patients occurs in the first trimester. Cervical incompetence is an infrequent cause of pregnancy loss even in patients with gross structural abnormalities of the genital tract. Patients who had conservative management had good pregnancy outcomes. Prophylactic cerclage for all diethylstilbestrol-exposed patients should not be recommended.

Abnormalities, Drug-Induced↗
PubMed1989

Correlation of histology and human papillomavirus DNA detection in condyloma acuminatum and condyloma-like vulvar lesions.

The diagnosis of a vulvar condyloma is made when perinuclear halos are seen with nuclear atypia and binucleate forms (koilocytotic atypia). These changes are most prominent in the granular layer and are associated with the presence of human papillomavirus (HPV). However, these changes may be absent or minimal in patients with papillary vulvar lesions; this situation can thus present diagnostic difficulties. We analyzed the histologic features of 53 biopsies from 48 patients who had vulvar lesions suggestive of condylomata. Of the 26 biopsy specimens with koilocytotic atypia, 20 (77%) had sequences homologous to HPV DNA as detected by Southern blot hybridization analysis using a probe of HPV s 6/11, 16, 18, 31, 35, and 51. In cases where the histologic features were suggestive but not diagnostic of condylomata, because unequivocal koilocytotic atypia was not noted, five of 27 (19%) had detectable HPV DNA. In this latter group, we found no histologic feature to distinguish the cases that had detectable HPV DNA from those that did not. Analysis for HPV DNA by in situ hybridization in the cases that were histologically equivocal for condyloma was uniformly negative. We conclude that there is a marked decrease in the detection rate of the HPV types associated with genital tract neoplasms in vulvar lesions that lack koilocytotic atypia. Southern blot hybridization analysis was the only reliable way to distinguish the "equivocal for condyloma" cases that had HPV from those where HPV DNA was not detected.

Adult↗
PubMed1989

Endometrial polyps in postmenopausal patients receiving tamoxifen.

The histologic features of an endometrial polyp include irregular, often dilated glands, thick-walled blood vessels, and a fibrotic stroma. Such polyps may be responsive to some chemotherapeutic drugs that can exert hormonal effects. We report on endometrial polyps detected in three postmenopausal patients who were receiving tamoxifen for treatment of metastatic breast carcinoma. The clinical presentation in all cases was vaginal bleeding and all had documented uterine enlargement suggestive of an intrauterine malignancy. The polyps were large, measuring up to 9 cm in largest diameter. On histologic examination each polyp had extensive cystic glandular hyperplasia. In one case foci of atypical epithelial proliferation and predecidualization were noted. The atypical proliferation suggested a borderline neoplastic process and was strongly positive for carcinoembryonic antigen. These findings underscore the marked proliferative changes that can be induced in endometrial polyps in postmenopausal women receiving hormonally active chemotherapeutic agents.

Aged↗
PubMed1988

Isolation of a novel human papillomavirus (type 51) from a cervical condyloma.

We cloned the DNA from a novel human papillomavirus (HPV) present in a cervical condyloma. When DNA from this isolate was hybridized at high stringency with HPV types 1 through 50 (HPV-1 through HPV-50), it showed weak homology with HPV-6 and -16 and stronger homology with HPV-26. A detailed restriction endonuclease map was prepared which showed marked differences from the maps for other HPVs that have been isolated from the female genital tract. Reassociation kinetic analysis revealed that HPV-26 and this new isolate were less than 10% homologous; hence, the new isolate is a novel strain of HPV. The approximate positions of the open reading frames of the new strain were surmised by hybridization with probes derived from individual open reading frames of HPV-16. In an analysis of 175 genital biopsies from patients with abnormal Papanicolaou smears, sequences hybridizing under highly stringent conditions to probes from this novel HPV type were found in 4.2, 6.1, and 2.4% of biopsies containing normal squamous epithelium, condylomata, and intraepithelial neoplasia, respectively. In addition, sequences homologous to probes from this novel isolate were detected in one of five cervical carcinomas examined.

Adult↗
PubMed1987

Colposcopic correlates of cervical papillomavirus infection.

We compared the colposcopic and histologic features of 39 papillomavirus-related cervical lesions with their associated human papillomavirus type. Two thirds of the lesions contained human papillomavirus type 16-related deoxyribonucleic acid, and 69% of them were classified as cervical intraepithelial neoplasia I or II, in contrast to 92% of lesions containing human papillomavirus 6/11 deoxyribonucleic acid. On histologic examination, low-grade cervical intraepithelial neoplastic lesions tended to be sharply demarcated and have an uneven or granular surface contour. In contrast, high-grade lesions often had diffuse borders and were usually smooth in appearance. Both low- and high-grade lesions displayed variable degrees of whiteness, thickness, and papillomatous configurations. Patterns of coarse punctuation were more common in higher grade cervical intraepithelial neoplastic lesions and in those containing human papillomavirus 16. Predictably, the colposcopic features of lesions containing human papillomavirus 6/11 deoxyribonucleic acid sequences compared closely with those of low-grade cervical intraepithelial neoplasia. In contrast, human papillomavirus 16-associated cervical intraepithelial neoplasia exhibited a greater spectrum of colposcopic patterns, including those associated with condyloma and low- and high-grade cervical intraepithelial neoplastic lesions. We conclude that, although a portion of low- and high-grade cervical intraepithelial neoplastic lesions can be distinguished colposcopically, a significant number of lesions containing features of low-grade cervical intraepithelial neoplasia or condyloma contain human papillomavirus 16 deoxyribonucleic acid and cannot be distinguished from presumably innocuous human papillomavirus infections.

Adult↗
PubMed1986

In situ hybridization analysis of HPV 16 DNA sequences in early cervical neoplasia.

The authors examined 18 cervical intraepithelial neoplasms (CIN) for the presence of human papillomavirus (HPV) DNA sequences by Southern blot hybridization and DNA-DNA in situ hybridizations for HPV DNA sequences and compared the epithelial distribution of HPV 16 DNA sequences with HPV 6/11 sequences in selected condylomas. Fifteen of the 18 CIN lesions contained HPV 16 DNA as determined by Southern blot hybridization. With the use of biotinylated HPV 16 DNA probes, 10 of the 18 were positive by in situ hybridization, 9 of which were also positive by Southern blot hybridization. In situ hybridization to HPV 16 probes was found primarily in areas of CIN which contained either maturation or koilocytotic atypia, although in two cases hybridizing sequences were detected in superficial cells from epithelium with no discernible maturation. Staining in both condylomas and CIN lesions varied in distribution and intensity. However, in some CIN lesions staining from cell to cell varied considerably. This greater variability in staining appeared to correlate with greater morphologic variations which characterize CIN, and which may influence greater variation in HPV DNA replication. Thus, some differences in patterns of hybridization for HPV DNA between CIN and condylomas may be explained by morphologic differences in the two classes of lesions. Differences in viral gene expression between condylomas and CIN and their relationship to morphologic findings remain to be clarified.

Base Sequence↗
PubMed1986

Human papillomavirus type 16 infection: a morphological spectrum with evidence for late gene expression.

Human papillomavirus (HPV) type 16 is a unique strain found almost exclusively in squamous precancerous lesions and invasive carcinomas of the genital tract. A histological and immunohistochemical analysis of 34 cervical biopsies from which HPV 16 was isolated was performed to determine: the morphological spectrum of HPV 16 "infection" and if HPV late genes were expressed in lesions containing this virus. Twenty-eight of thirty-four (82%) biopsy specimens contained areas fulfilling the histological criteria for cervical intraepithelial neoplasia (CIN) (defined as the presence of abnormal mitoses and/or diffuse nuclear atypia in a portion of the biopsy). However, 19 of 28 (68%) CIN lesions also contained focal areas of epithelium indistinguishable from condylomata. Three biopsy specimens each contained condyloma only and normal-appearing squamous epithelium. Three of thirty-one lesions (10%) showed evidence of HPV capsid antigens. The presence of areas of condyloma, as well as capsid antigens, indicates that lesions containing HPV 16 share certain similarities with conventional warts associated with other HPVs. Furthermore, the wide range of morphology in lesions containing HPV 16 suggests that histological or cytological recognition of HPV 16-associated CIN lesions may not always be possible.

Carcinoma in Situ↗
PubMed1985

Cervical papillomaviruses segregate within morphologically distinct precancerous lesions.

We combined molecular hybridization and histological analysis of 58 biopsy samples from the uterine cervix to correlate the presence of certain strains of human papillomaviruses (HPVs) with specific pathological changes. HPV sequences were frequently detected (85%) in biopsies that contained a broad spectrum of precancerous changes. The presence of HPV 16 correlated strongly with precancers that exhibited morphological aberrations commonly found in invasive carcinomas and precancers that have a high risk of progression. This association underscores the potential importance of HPV type 16 in the genesis of genital cancers and emphasizes the value of histological analysis for detecting potentially oncogenic HPVs.

Base Sequence↗
PubMed1985

Outpatient management of cervical intraepithelial neoplasia. A summary of 279 cases.

Two hundred seventy-nine patients with cervical condylomas or cervical intraepithelial neoplasia (CIN) were treated as outpatients with cryotherapy. Every patient followed received a Papanicolaou smear, colposcopic evaluation, cervical biopsy and endocervical curettage four months following treatment. The treatment failure rates for CIN 1/condyloma, CIN 2 and CIN 3 were 2.9%, 5.7% and 4.3%, respectively. The percentage of patients eventually requiring conization was 0.7, 1.6 and 2.7, respectively. No patient who had a negative clinical and histologic examination at four months subsequently had a recurrence. The mean follow-up was 23.1, 26.0 and 35.0 months for CIN 1/condyloma, CIN 2 and CIN 3, respectively. Proper triage is important with CIN 3, and a complete colposcopic examination at the initial follow-up visit is valuable for predicting outcome.

Ambulatory Surgical Procedures↗
PubMed1984

Human papillomavirus infection and cervical neoplasia: new perspectives.

This review addresses several problems associated with human papillomavirus (HPV) infection of the cervix and lower female genital tract. These include the definition of HPV infection and its distinction from HPV-associated neoplasia, the distinction of HPV infection from reactive epithelial changes induced by other infections, and the transmission of HPV infection via the male partner. The available evidence indicates that there are two distinct intraepithelial processes in the cervix associated with HPV. One is the classical condyloma and its counterpart in immature epithelium, atypical immature metaplasia. The other is intraepithelial neoplasia, which, like classical infection, may be mature [cervical intraepithelial neoplasia (CIN) with koilocytosis] or immature (high grade CIN or carcinoma in situ). Molecular hybridization studies indicate that HPVs 6 and 11 are most commonly detected in the former, whereas HPVs 16 and 18 DNA are most common in the latter and in invasive cancer. From the clinical standpoint the most important distinction is between HPV-related disease (condyloma or CIN) and reactive changes associated with other pathogens, such as Chlamydia. The former should be removed from the cervix, whereas the latter should be treated medically or followed. It is stressed that therapy should not hinge upon the histological distinction of HPV infection from neoplasia and that all lesions should be removed, by conservative means if possible. This is underscored by the fact that a high proportion of CIN lesions contain areas identical to condyloma and that lesions with deep endocervical canal involvement, including those with features suggesting condyloma, should be treated by cone biopsy to exclude the presence of invasive cancer. Histological classifications for nonneoplastic, HPV-infected, and neoplastic epithelium are proposed. The management of the male partner is still unsettled. However, a large proportion of male partners of these patients have penile lesions and should be included in diagnostic and therapeutic protocols of women with genital HPV infections or neoplasms.

Animals↗
PubMed1984

Cervical papillomavirus infection and intraepithelial neoplasia: a study of male sexual partners.

The male sexual partners of 34 women with cervical condyloma or cervical intraepithelial neoplasia (CIN) were examined for penile condylomata and/or urinary tract lesions. External lesions were detected in 18 (53%) of the male consorts of women with cervical lesions including 14 of 22 whose consorts had cervical condyloma or low grade CIN, one of six whose consorts had CIN 2, and three of six whose consorts had CIN 3. The majority of lesions were present either on the glands or the penile shaft, and one patient had a lesion in the urethral meatus. The urinary cytology specimens from the men with and without penile lesions contained nonspecific abnormalities consisting of squamous metaplasia with mild degrees of cytologic atypia. Koilocytotic atypia characteristic of condyloma was not found except in cases with documented distal urethral condylomata. Hence, at present the diagnosis of human papillomavirus infection in the man is best made by careful clinical examination. Whether or not papillomavirus resides deep in the urinary tract of these patients remains to be determined.

Animals↗
PubMed1983

Atypical immature metaplasia (AIM). A subset of human papilloma virus infection of the cervix.

Atypical immature squamous metaplasia (AIM) is a poorly understood lesion with uncertain biological and clinical significance. This report reviews 170 cases of cervical condylomata and 60 cases of high-grade cervical intraepithelial neoplasia (CIN II/III); AIM was found in association with 34% of condylomata and 16% of high-grade CIN. Thirty-seven cases of AIM alone were reviewed and nearly all presented with a cytologic diagnosis of CIN I or condyloma and a colposcopic appearance of white epithelium with or without punctation and mosaic structure. The mean ages of patients with condylomata, AIM, CIN II, and CIN III were 27, 27, 32, and 37 years, respectively. By immunoperoxidase techniques 75% of condylomata, 16% of AIM, and 0% of CIN lesions were positive. The histologic criteria for the diagnosis of AIM and it's morphologic distinction from CIN and relationship to condylomata, are outlined. AIM is a distinct histologic entity that shares similar epidemiologic, morphologic and biologic characteristics with condyloma. When AIM is found alone in biopsy material, careful correlation of cytology, and biopsy results should be performed and therapy should be based on the size and distribution of the lesion.

Adult↗
PubMed1983

Human papilloma virus infection (condyloma) of the cervix and cervical intraepithelial neoplasia: a histopathologic and statistical analysis.

Two hundred fifty consecutive cases previously diagnosed as advanced intraepithelial neoplasia (CIN 2 and CIN III) were reviewed and examined for the presence of coexisting condyloma. When the mean ages and age distributions were analyzed, there was a consistent shift of the age distribution to a younger age among women with CIN and condyloma as opposed to CIN alone. Furthermore, when the relationship between age and case accumulation was normalized from a curvilinear to a linear relationship, there were significant differences in the slope of the accumulation rate between cohorts of CIN III with and without condyloma. These differences suggest that the concordant observation of both lesions in a given patient is not a random process resulting from two independent events but rather indicates an underlying dependence between the two (i.e., condyloma and CIN). It cannot, however, be determined statistically whether the associated condyloma is directly responsible for the CIN lesion or hastens its transit time.

Adult↗
PubMed1983

Cervical papillomavirus infection in diethylstilbestrol-exposed progeny.

Histologic sections from cervical and vaginal biopsies showing dysplasia in 37 women exposed to diethylstilbestrol (DES) in utero were stained for human papillomavirus structural antigens using an immunoperoxidase technique. Forty-three percent of the lesions had detectable papillomavirus antigens. These findings indicate that a significant proportion of cervical dysplasia observed in DES-exposed progeny is associated with papillomavirus infection.

Animals↗