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Biomedical subjects

S Biesterfeld

Publications and source records attributed to S Biesterfeld.

12 recordsLinked to original sources

Subsequently occurring leiomyosarcoma and desmoid tumor of the right thigh.

We present the case of a 44-year-old patient with a primary leiomyosarcoma of the right upper thigh, who developed a second mesenchymal lesion at the same thigh, diagnosed as an extra-abdominal desmoid tumor, some months after surgical treatment of his leiomyosarcoma. Clinically, histomorphologically, DNA cytometrically, immunohistochemically and radiologically the different histogenetic origin of the two lesions could be proven. The patient died 17 months after his first tumor diagnosis of lung metastases of his leiomyosarcoma.

Adult

[Percutaneous CT-controlled cutting-needle biopsy of diffuse interstitial and alveolar lung diseases--the technic and results].

Twenty-three patients underwent CT-guided large-bore biopsy of diffuse lung disease of clinically and radiologically indeterminate etiology. The procedure was preceded by negative transbronchial biopsy in 20 cases. CT-guided biopsies were performed with a 14-gauge Trucut-needle. Obtaining at least 3 specimens of different parts of the diseased area, a correct histologic diagnosis was achieved in all cases. The size of the histologic specimens (mean: 5-6 mm) exceeded that of the specimens obtained by transbronchial biopsy as reported in the literature. Two major complications occurred and included a rapidly developing tension pneumothorax treated by a small-bore catheter and one self-limited hemoptysis. Major advantages of percutaneous CT-guided biopsy are the nonsuperimposed and very sensitive imaging of lung alterations in diffuse lung diseases that allows evidence of adjacent less and more involved areas accessible by one biopsy approach. CT-guided large-bore biopsy with a cutting needle seems to be a very promising, accurate method in the pathomorphologic work-up of diffuse lung diseases rendering open biopsy unnecessary in many cases.

Adult

Prediction of recurrence in giant cell bone tumors by DNA cytometry.

The most interesting therapeutic aspect of giant cell bone tumors is which patients can be cured without a risk of recurrence by intralesional surgery (curettage). To find out the suitability of some DNA cytometric and morphometric parameters for showing differences between this group of patients (n = 9) and those with recurrence (n = 12), the parameters mean ploidy, 2cDI (mean square deviation of the tumor cell DNA content from the normal 2c value), mean nuclear area and its variability were calculated from cytologic specimens prepared by a cell separation technique from formalin-fixed, paraffin-embedded tissues, measuring the values of 100 stromal cells per case by a TV image analysis system. Further measurements were performed on 19 cases of different diseases of the bone and on an additional 17 cases of giant cell tumors without follow-up. The 2cDI allowed us to distinguish the two groups of patients, with and without recurrence, without overlap; even the lowest value for patients with recurrence was higher than the highest value for cured ones. Mean ploidy analysis resulted in a less convincing discrimination of the patients. Mean nuclear area and its variability failed to predict recurrence. Single-cell DNA cytometry provided a parameter, 2cDI, that was able to predict recurrence in patients with giant cell bone tumors with high sensitivity.

Adult

[A hypervascular adrenal adenoma. A differential diagnostic problem in dynamic CT and MRT].

At dynamic CT, Gd-DTPA-enhanced MRI, and digital subtraction angiography, a large adrenal adenoma verified by resection histology presented as a hypervascular tumor. In all imaging modalities, it showed a strong patchy enhancement during the early phases of the passage of contrast media and subsequent intralesional contrast equilibration. This case demonstrates that even high enhancement does not rule out an adrenal adenoma with certainty. In the oncologic patient, therapeutic decisions should not be made on the basis of the contrast behavior of an adrenal lesion alone.

Adenoma

DNA-cytometric detection of euploid polyploidization in oral lichen ruber planus.

The DNA distribution was analyzed in 29 cases of oral lichen ruber planus that were negative for human papillomavirus and not suspected of being precancerous. Monolayer smears prepared from formalin-fixed, paraffin-embedded tissues were automatically Feulgen stained and used for rapid interactive DNA cytometry via a TV-based image analysis system combined with an automated microscope. Nuclei with DNA contents greater than 4c were found in 25 cases (86%). DNA contents greater than 8c were seen in five cases (17%), and small peaks at 8c were found in three cases. These increased DNA values in nonprecancerous lesions must be interpreted as euploid polyploidization and have to be taken into account if DNA measurements are performed for diagnostic purposes in lichen ruber planus lesions that are suspected of having malignant transformation.

DNA

[Adenomyomatosis of the gallbladder in CT].

The computed tomographic findings of adenomyomatosis of the gallbladder are described in nine patients, including all main types of this disease. Diagnosis was confirmed by typical cholecystographic findings in all cases, as well as by histological evaluation in three cases. Only in the fundal type were the intramural diverticula well visualized on CT. Although in the other types the Rokitansky-Aschoff sinuses were not clearly shown by CT, when performed without application of a cholegraphic agent, the computed tomographic findings nevertheless appeared to be characteristic. In the area involved, layering of the thickened gallbladder wall, associated with irregular ill-defined borders of the inner layer, appears to be typical. Visualization of these findings was improved following enhancement by intravenous contrast media.

Adult

Quantitative pathological study of aggressiveness of giant cell tumor of bone.

Clinical behavior of giant cell tumor of bone (GCT) may vary remarkably from latent to very aggressive. Quantitative pathological methods were used to evaluate the aggressiveness of GCT. Fifteen cytometric parameters were measured and computed on routine sections of 40 GCTs which had been treated with curettage. The surgery factor (with or without additional procedures like bone cement packing or freezing after the curettage) was also taken into account and computed. Nineteen of the 40 GCTs were cured and 21 recurred. While no single one from the 15 parameters measured showed significant differences between the cured and recurrent groups according to the Mann-Whitney's U test or Student's t test, a 4-variable function was established with a stepwise discriminant analysis which could correctly identify 70.8% of the predicted cases as cured or recurrent (jackknife procedure). The function also suggested that in addition to the surgery factor, which no doubt had close relation with the prognosis, the most important risk factor in histological parameters was SA40, i.e. the percent of cells with nucleus larger than 40 square microns. Single cells extracted from paraffin-embedded blocks of 38 GCTs were analyzed by DNA-image cytometry. The 2c deviation index (2cDI) showed wide heterogeneity ranging from those consistent with benign tumors to those with apparent malignant ones, which may account for its diversity in clinical behaviour. Sixteen of the 38 cases had been treated with curettage, 8 of them were cured and followed up for at least 3 years and the remaining 8 recurred. The significant difference of 2cDI between the two groups suggested that these DNA parameters are useful in evaluating the aggressiveness of GCT for the selection of an adequate treatment. Quantitative approaches appeared to be more objective and more sensitive in evaluating the aggressiveness and predicting the prognosis of GCT than the subjective grading system used before.

Bone Neoplasms

[Methodological requirements for precise measurements using DNA single cell cytometry].

Methodological aspects on DNA single cell cytometry were investigated. Specimens can be homogeneously Feulgen-stained if a high constancy of temperature is realized in the staining cuvette during acid hydrolysis. For the TV image analysis system under investigation (TAS-plus, Leitz) a linear correlation (r greater than 0.99) between physically defined optical transmission values and resulting electronic signals was found. Shading effects can be controlled by using a narrow mask width (VQ less than 1.5%). As an internal standard blood cells or epithelial cells can be used if a correction factor, that was found to be mainly constant, is calculated.

Cytodiagnosis

Performance of a TV image analysis system as a microdensitometer.

The performance of a TV image analysis system combined with an automated microscope (the Leitz TAS plus) as a microdensitometer and morphometric device was investigated. There was a strict linear correlation (r greater than .99) between the physically defined optical transmission values and the resulting electronic signals from the plumbicon TV camera for the whole area displayed on the monitor. The shading of the optoelectronic system had a coefficient of variation (CV) of 1.42% for measurements in the center of the displayed area, but a CV of 3.55% for measurements over the whole monitor area. Densitometric measurements remained stable 15 minutes after putting the microscope lamp into operation (T less than 0.075%, remeasuring every two minutes). The geometric distortion, measured as different ferret diameters of ideally round latex particles, ranged from +/- 0.5% to +/- 1.0% deviation over the entire displayed area. These results indicate that densitometric and morphometric measurements with this equipment are sufficiently precise and reproducible when performed in the center of the area displayed on the monitor.

Densitometry

Automated Feulgen staining with a temperature-controlled staining machine.

A Shandon Varistain 24-3 staining machine was modified in order to run automated DNA Feulgen staining. Initial studies showed a strict dependence of the staining intensity (integrated optical density [IOD]) on the temperature of the DNA hydrolysis in 4 N HCl: a difference of 0.5 degrees C around the optimum hydrolysis temperature of 27.5 degrees C resulted in IOD differences of up to 7.8% in epithelial cells and up to 12.0% in lymphocytes. A temperature-controlled stainless steel cuvette, covered with a 4 N HCl-resistant material, was developed and integrated into the machine. Temperature measurements were performed at different positions in the cuvette and on glass slides with copper-constantan electrodes fixed on them; no temperature gradient could be detected within the cuvette. The adjusted temperature of 27.5 degrees C remained constant over 24 hours. The coefficient of variation (CV) of the staining intensity in lymphocytes between different areas on the same slide and between different slides of the same staining cycle was less than 0.6%. The CV between different staining cycles was 5.9%. This system for automated Feulgen staining thus gives reproducible and reliable results and may be introduced into routine diagnostic procedures.

Coloring Agents

Diagnosis of bronchial carcinoma on sections of paraffin-embedded sputum. Sensitivity and specificity of an alternative to routine cytology.

The diagnostic accuracy of sputum cytology for the diagnosis of bronchial carcinoma using paraffin-embedded, serially sectioned and hematoxylin and eosin-stained specimens was tested in 4,297 sputum samples from 1,889 patients, 219 of whom had bronchial carcinoma. The diagnostic sensitivity depended mainly on the number of investigated samples and was 85.4% with three sufficient sputa. The sensitivity was not influenced by the histologic types, location or TNM stage of the tumor. The specificity of the method was 99.5%. In three cases localization of sputum cytologically diagnosed bronchial carcinomas was not possible immediately (occult carcinomas, pTx); in two of these cases the bronchial carcinomas were located during follow-up. The third patient died without verification of the cytologic diagnosis. According to our results, sputum cytology on serial sections is a valuable instrument for mass screening of high-risk groups for the early detection of bronchial carcinoma. Lower sensitivities of sputum cytology in mass screening programs for the early diagnosis of lung cancer are discussed critically.

Carcinoma, Bronchogenic

Detection of high risk patients in chronic myelogenous leukemia by DNA-image cytometry.

Peripheral blood smears from the time of diagnosis of 64 patients with chronic myelogenous leukemia (CML) in chronic phase were restained according to Feulgen. Nuclear DNA content of at least 100 myeloblasts and promyelocytes was measured by interactive DNA-cytometry using a TV-image analysis system, combined with an automated microscope. From the resulting DNA values the DNA parameters stemline ploidy, stemline shoulder fraction and "proliferative" fraction, which reflect cytogenetic and cell kinetic characteristics of CML, were derived. Each of these DNA parameters identified subgroups with a significantly different survival time and duration of chronic phase. Indicators for a good prognosis were a near-diploid stemline ploidy (median survival time 49 v. 26 months), a low percentage of nuclei in the stemline shoulder fraction (45 v. 28 months) and a high "proliferative" fraction (45 v. 23 months). Independently of clinical and hematological features, the DNA-cytometric parameters yielded additional prognostic information both in the univariate and multivariate analysis.

Adult