PubMed Health⌕ Search

Biomedical subjects

S E Kilpatrick

Publications and source records attributed to S E Kilpatrick.

At least 37 records · Page 2Linked to original sources
PubMed1997

Malignant peripheral nerve sheath tumor: a fine-needle aspiration biopsy study.

Although the histopathologic features of malignant peripheral nerve sheath tumors (MPNST) have been well-described, the cytologic features are less well-characterized. We retrospectively reviewed 4 aspiration specimens from 3 patients with histologically-proven MPNST. The biopsy specimens were obtained from the primary tumor (1 case), a local recurrence (2 cases), and a pulmonary metastasis (1 case). The patients were women, aged 42, 61, and 70 yr. The primary tumors arose from the left neck and elbow, and from a neurofibroma in the right medial thigh. The latter patient had von Recklinghausen's disease. Cardinal cytomorphologic features included aggregates and single cells with ovoid to elongated, and comma to serpentine shapes, as well as hyperchromatic nuclei surrounded by delicate, tapering cytoplasm. Nuclear pleomorphism ranged from slight to marked. Multinucleated giant cells were seen in 2 cases. In general, the degree of nuclear variability within each individual case exceeded that typically observed with synovial sarcoma or fibrosarcoma. Although the cytomorphologic features may strongly suggest MPNST, clinical correlation is necessary and immunocytochemistry (i.e., S-100 protein) may help to distinguish MPNST from other spindle-cell sarcomas. Origin from a nerve trunk or preexisting neurofibroma, or occurrence in a patient with von Recklinghausen's disease, confirms the diagnosis of MPNST.

Adult↗
PubMed1997

Dedifferentiated chondrosarcoma in patients with multiple osteochondromatosis: report of a case and review of the literature.

Multiple osteochondromatosis (MOS) is a familial disorder of autosomal dominant transmission characterized by the development of multiple exostoses and often derangements of epiphyseal cartilage, sometimes resulting in long bone growth retardation. Patients with the disorder appear to be at increased risk for developing secondary chondrosarcomas. Rarely, dedifferentiated chondrosarcomas may also occur. We report a single case of a 27-year-old man with multiple osteochondromatosis who developed a fatal dedifferentiated chondrosarcoma. Radiographically, the neoplasm arose from the pelvis completely destroying the left pubic ramus. Subsequently, the patient underwent preoperative chemotherapy followed by a left external hemipelvectomy. On pathologic examination, the tumor was characterized by high-grade pleomorphic sarcoma sharply juxtaposed to a low-grade chondrosarcoma. The patient ultimately died of widespread metastatic sarcoma.

Adult↗
PubMed1997

Mixed tumors and myoepitheliomas of soft tissue: a clinicopathologic study of 19 cases with a unifying concept.

We report 19 unusual cases of mixed tumors and myoepitheliomas arising in soft tissues. The neoplasms occurred in 12 males and seven females. The age at diagnosis ranged from 2 to 83 years (mean 35, median 30). Eight tumors arose in the upper limb, six in the lower limb, three in the trunk, and two in the head and neck region. Three cases involved both dermis and subcutis; the remainder arose in subcutaneous (13 cases) or deep subfascial soft tissue (three cases). The most common presenting complaint was a painless swelling, with duration ranging from 2 weeks to 1 year (median 2.5 months). Microscopically, the tumors were predominantly well circumscribed and lobulated. Six cases showed a focally infiltrative margin. Cardinal morphologic features included nests, cords, and ductules of epithelioid cells and/or nests of spindled cells within a hyalinized to chondromyxoid stroma. One tumor was predominantly composed of myoepithelial cells and devoid of epithelial differentiation (i.e., ductules). Cytoplasmic hyaline inclusions were noted in two cases; squamous differentiation was seen in one case. Osteoid production and/or metaplastic bone was observed in three tumors. Chondroid differentiation (usually mature) was seen in four cases. Adipocytic differentiation was seen in two tumors. Mitotic activity was variable but generally scant; atypical mitotic figures were not identified. By immunohistochemistry, 16 of 16 cases expressed pan-keratin; 16 of 17 S-100 protein; six of 14 alpha smooth muscle actin (IA4); two of 10 muscle specific actin (HHF-35); two of 10 desmin; three of 11 glial fibrillary acidic protein; and three of 16 epithelial membrane antigen. Clinical follow-up was available in 10 patients and ranged from 6 months to 20 years (mean 4.25 years, median 2 years). Two patients developed local recurrence; metastasis to lung and lymph nodes were observed in two additional patients. Both of the latter patients died. We believe that these findings expand the concept of cutaneous mixed tumors to include neoplasms composed predominantly of myoepithelial cells and to include tumors arising in deeper subcutaneous and/or subfascial tissues. The clinical behavior of such neoplasms, when arising in soft tissues, may be difficult to predict but is most often benign; however, a minority of lesions metastasize. Until larger studies with longer follow-up are available, treatment and prognostication are probably best based on criteria used in comparable salivary gland tumors.

Adult↗
PubMed1996

Desmoplastic malignant melanoma of the oral mucosa. An underrecognized diagnostic pitfall.

BACKGROUND: Although cutaneous desmoplastic malignant melanoma (DMM) has been well characterized, those arising from the oral mucosa have been less well defined. METHODS: We evaluated the clinical and pathologic features of three patients with biopsy-proven DMM examined at the North Carolina Baptist Hospital. Routine hematoxylin and eosin-stained slides were reviewed in all three cases. Sections from all cases were examined immunohistochemically using the avidin-biotin-peroxidase (ABC) technique and employing commercially available antibodies to the following antigens: S-100 protein, HMB-45, NK1C3, and cytokeratin (AE1/AE3). Appropriate positive and negative controls were utilized throughout these procedures. Clinical data were obtained from the patients' medical records. RESULTS: Age at diagnosis for the three male patients were 42, 64, and 75 years. Anatomically, these neoplasms arose from the left maxillary oral mucosa (two patients) and the vermilion border of the lower lip (one patient). Initial incisional biopsies of all three patients were misinterpreted as desmoid tumor (one patient) and squamous cell carcinoma (two patients), respectively. Histologically, all tumors were poorly circumscribed and composed of fascicles and bundles of spindle-shaped cells with hyperchromatic nuclei and associated with extensive stromal collagenization. Perineural invasion was noted in two tumors. An overlying atypical, intraepidermal melanocytic proliferation was observed in two tumors. Immunohistochemically, all three tumors showed positive immunoreactivity with S-100 protein and vimentin. One tumor also expressed HMB-45. Wide surgical incision was the primary mode of therapy in all patients. One patient also received multiple courses of radiation therapy and chemotherapy. One patient died of widespread metastatic disease. CONCLUSIONS: DMM of the oral mucosa is a rare, often unrecognized, form of malignant melanoma associated with a fibrosarcoma-like morphologic appearance and abundant collagenization. Meticulous attention to histomorphology and judicious use of immunohistochemical stains will help prevent misdiagnosis.

Adult↗
PubMed1996

The clinicopathologic spectrum of myxoid and round cell liposarcoma. A study of 95 cases.

BACKGROUND: The prognosis of patients with myxoid liposarcoma (ML) or round cell liposarcoma (RCL) has never been adequately defined. METHODS: We evaluated the clinical and pathologic features of 95 patients with biopsy proven ML or RCL examined at the Mayo Clinic between 1971 and 1992. Routine hematoxylin and eosin stained slides of all cases were reviewed. Morphologic variable evaluated included percent of round cell differentiation, percent of lipoblastic differentiation, and presence of tumor necrosis. Clinical follow-up was available for 86 patients (range: 6 months-23.4 years; mean: 7.2 years; median: 5.9 years). Flow cytometry for determination of DNA ploidy was performed on paraffin embedded tissue available from 46 cases. Survival analyses for the 86 patients with adequate clinical follow-up were performed by the Kaplan-Meier test using the approximate chi-square statistic for the log rank test. RESULTS: Age at diagnosis ranged from 16 to 81 years (median: 44 years). The extremities were involved in 91 cases, the retroperitoneum in 3 cases, and the perineum in 1 case. The single most common location was the thigh (61 cases). Histologically, round cell differentiation was present in 41 cases (43%) ranging from 5% to 100% of the tumor volume. Only one case of "pure" RCL was used in the study. Spontaneous tumor necrosis was noted in 4 cases. By flow cytometry, 38 tumors were diploid, 6 were aneuploid, and 1 was tetraploid. The data from 1 case was uninterpretable. Thirty patients (35%) developed metastasis; 27 (31%) died from the disease. CONCLUSIONS: With multivariate analysis, age ( > 45 years), percent of round cell differentiation ( > or = 25%), and the presence of spontaneous tumor necrosis are significantly associated with a poor prognosis. No correlation was observed between DNA ploidy (i.e., diploid vs. aneuploid) and percent of round cell differentiation or clinical outcome.

Adipocytes↗
PubMed1996

Fine-needle aspiration biopsy of synovial sarcoma. A cytomorphologic analysis of primary, recurrent, and metastatic tumors.

Thirteen fine-needle aspiration specimens from 10 patients with histologically proven synovial sarcoma are described. The aspiration biopsy specimens were obtained from the primary tumor in five cases, locally recurrent tumors in four cases, pulmonary metastases in three cases, and mediastinal metastasis in one case. Patient's ages ranged from 22 years to 65 years; there were four women and six men. All cases had a confirmation biopsy and/or resection specimen that were reviewed. Histologic subtypes included monophasic fibrous (5 cases), monophasic epithelial (1 case), biphasic (3 cases), and poorly differentiated (1 case). The majority of the aspiration biopsy specimens were similar with moderate to marked smear cellularity dominated by cohesive clusters of spindle-shaped cells with ovoid, hyperchromatic nuclei and scanty tapering cytoplasm. Nucleoli were not prominent. Epithelial tumor cells with ovoid to round, mostly regular, centrally to eccentrically located nuclei, surrounded by scant to abundant cytoplasm predominated in one case (monophasic epithelial) and were admixed with spindle cells in a second (classical biphasic). Multi-nucleated tumor giant cells were not observed in any of the tumors. In biphasic synovial sarcoma, the neoplastic spindle cells are generally more numerous and frequent than the epithelial cells, making distinction from monophasic synovial sarcoma or other spindle cell soft tissue tumors difficult. Although synovial sarcoma may be diagnosed by fine-needle aspiration cytology, clinical correlation, especially in monophasic types, is necessary to minimize errors in sarcoma classification.

Adult↗
PubMed1996

Extra-acral calcifying aponeurotic fibroma: a distinctive case with 23-year follow-up.

Calcifying aponeurotic fibroma (CAF) is an unusual but well-characterized soft tissue neoplasm that typically involves the digits of children and frequently recurs locally. This report describes a case from the subcutis of the lumbosacral region. A 26-year-old man initially presented at age 3 and developed three recurrences over a 23-year period each at approximately 8-year intervals (ages 10, 18, and 26). The microscopic findings in all recurrences showed a lobulated, poorly circumscribed proliferation of dense fibrous tissue containing epithelioid-like fibroblasts, multinucleated cells, and islands of metaplastic chondroid differentiation with focal calcification. Despite origin from an unusual anatomic site, this case reported herein demonstrates the classical morphologic features and clinical history of CAF which showed little in the way of morphologic evolution despite 23 years of persistence. The clinical and histologic features helpful in distinguishing CAF from infantile fibromatosis and soft tissue chondroma are discussed.

Adult↗
PubMed1996

Intraosseous glomus tumor of the spine. Case report and review of the literature.

The authors report a case of glomus tumor originating within the lumbar spine. Glomus tumors of intraosseous origin are rare, with the only case reported in the spine arising in the sacrum. The patient presented with the solitary complaint of radiating back pain that resolved postoperatively. The histopathological and radiographic findings are reviewed. To the authors' knowledge, this represents the first case report of a glomus tumor of the spine originating above the sacrum.

Female↗
PubMed1995

Langerhans' cell histiocytosis (histiocytosis X) of bone. A clinicopathologic analysis of 263 pediatric and adult cases.

BACKGROUND: Langerhans' cell histiocytosis (LCH) of bone is a disorder of histiocytic proliferation with variable and often unpredictable behavior. METHOD: The authors evaluated the clinical and pathologic features of 263 patients (172 children, 91 adults) with biopsy-proven LCH examined during an 80-year period at the Mayo Clinic. Only patients with bone involvement pathologically and/or radiographically were included in the study. Clinical follow-up was available for 245 patients and ranged from 3 months to 50 years (mean, 12 years; median, 10 years). Chi-square tests were used to determine associations between age, gender, extent of osseous involvement, visceral disease, and pathologic features. Survival analyses were performed by univariate and multivariate Cox regression methods. RESULTS: Age at presentation ranged from 2 months to 71 years with a clear predominance in children. The most common presenting complaint was pain, often worse at night. The skull was the most frequent osseous site in children and adults. Diabetes insipidus was documented in 40 patients. Forty-four children developed skeletal recurrence and/or new bone lesions, 19 of whom had diabetes insipidus. Fourteen children and 3 adults died either directly or indirectly from LCH. One adult patient developed systemic amyloidosis. All but two of these pediatric patients were 3 years of age or younger at presentation. All children with hepatosplenomegaly (7 patients) and/or thrombocytopenia (9 patients) died. Nine of the 14 children who died presented initially with three or more bone lesions. CONCLUSIONS: The clinical behavior of LCH of bone is often unpredictable; however, young age at diagnosis, hepatosplenomegaly, thrombocytopenia, and polyostotic (> or = 3 bones involved) disease are associated with a poor prognosis (P < 0.005). Recrudescence in children, but not in adults, strongly correlates with the presence of diabetes insipidus (P < 0.0005).

Adolescent↗
PubMed1995

Atypical and malignant variants of ossifying fibromyxoid tumor. Clinicopathologic analysis of six cases.

Ossifying fibromyxoid tumor (OFMT) of soft parts is a recently defined fibro-osseous neoplasm, the biologic behavior of which is generally regarded as benign. We report six variant cases of OFMT with histologic features of malignancy, two of which behaved aggressively. All these tumors arose in the extremities of adults (aged 36-76 years), and five of the six were subcutaneous. Four patients were men. Macroscopically, all the tumors were well circumscribed and somewhat lobulated. Cardinal morphologic features included lobules of round to spindled cells within a fibromyxoid matrix and randomly distributed, often centrally located osteoid within which were plump neoplastic cells. In contrast to typical OFMT, a hypocellular, cytologically benign, lamellar bony shell was observed only focally; cellularity was increased (four cases), and mitotic activity was frequent, exceeding two mitotic figures per 10 high-power fields (three cases). One case associated with metastases was morphologically bland. Immunohistochemically, positivity for S-100 protein was observed in the primary tumors of three cases and in the pulmonary metastasis of a fourth. Desmin was positive in one case. Ultrastructural features in three cases were very similar to usual OFMT. Clinical follow-up revealed local recurrence in two cases; one patient has developed recurrent pulmonary metastases. We believe these findings support the view that some atypical cases of OFMT exhibit morphologic patterns that might predict more aggressive behavior.

Adult↗
PubMed1995

Fate of liposuctioned and purified autologous fat injections in the canine vocal fold.

Injection of autologous fat obtained by liposuction has been reported as an augmentation technique for vocal fold paralysis. Unfortunately, it is not known whether this technique is associated with long-term graft survival. The purpose of this study, using a canine model, was to determine the volume of viable injected fat grafts when the tissue was harvested and processed by two different methods: 1. by liposuction alone, and 2. by "purification," i.e., excision of adipose tissue, followed by tissue homogenization and centrifugation in a buffering solution. The results of this study confirm that injected fat grafts survive long-term; however, the average volumetric "take" was only about 20%. Surprisingly, significantly more liposuctioned fat survived than grafts prepared by the purification method (P < .05). At 12 weeks, there was relatively little inflammation present in the tissues surrounding the injected fat, suggesting a stable fat graft volume.

Adipose Tissue↗
PubMed1994

Relationship of DNA ploidy to histology and prognosis in rhabdomyosarcoma. Comparison of flow cytometry and image analysis.

BACKGROUND: Although DNA ploidy correlates with prognosis in certain childhood cancers, e.g., neuroblastoma, its significance in rhabdomyosarcoma (RMS) is unclear and controversial. METHODS: Ploidy by flow cytometry (FCM) and image analysis (IA) in 26 of 27 children with RMS (17 embryonal, 3 mixed embryonal/alveolar, 5 alveolar, 1 anaplastic, 1 ectomesenchymoma) and 4 adults with pleomorphic RMS were evaluated. Statistical comparisons were analyzed between DNA content and gender, age, localization, Intergroup Rhabdomyosarcoma Study (IRS) group, and histopathologic subtype. Survival analyses were performed by the Kaplan-Meier test using the approximate chi-square statistic for the log rank test. RESULTS: The concordance rate between FCM and IA was 26 of 30 (87%); FCM was not performed in one tumor. Image analysis was more sensitive than FCM in detecting aneuploidy. Furthermore, DNA content was associated significantly with histologic subtype (P = 0.031); embryonal histology commonly was hyperdiploid (mean, 1.44; median, 1.27), whereas alveolar histology usually was near-tetraploid (mean, 1.83; median, 1.95). All four adult patients with pleomorphic RMS were aneuploid, with one showing multiple DNA peaks. No correlation between DNA content and survival was observed in the children with RMS. However, IRS group (P = 0.011) and patient age (P = 0.036) were independent prognostic indicators significantly related to survival. All adult patients died of their disease. CONCLUSIONS: Although ploidy correlates with histologic subtype, DNA content is not significantly predictive of prognosis in patients with RMS. Age at diagnosis and IRS group are independent predictors of clinical outcome in children with RMS.

Adolescent↗
PubMed1994

Leiomyoma of deep soft tissue. Clinicopathologic analysis of a series.

Leiomyomas of deep soft tissue are extremely rare and, to our knowledge, have never been adequately characterized either histologically or clinically. We report 11 such cases, most often arising in deep subcutis or skeletal muscle. The lesions were equally distributed among males (six cases) and females (five cases); age at presentation ranged from 14 to 62 years (mean, 37 years; median, 35 years). The extremities represented the single most common site (five cases). Characteristic morphologic features included well-defined circumscription with a fibrous pseudocapsule, myxohyaline stromal degeneration, and intersecting fascicles of spindle cells with mostly uniform, round-ended, elongated nuclei and tapering, eosinophilic cytoplasm. Dystrophic calcification was identified in four cases; degenerative nuclear changes, similar to those in ancient schwannoma, were present in three cases. Two neoplasms showed multiple necrobiotic granuloma-like nodules resembling giant rosettes. Mitotic figures were found in only four cases and were scarce, never exceeding one mitotic figure per 50 high-power fields. Immunohistochemically, all cases showed desmin positivity. Clinical follow-up (median, 4.5 years), available for nine cases, revealed no evidence of local recurrence or distant metastasis. As with all smooth-muscle cell neoplasms, meticulous attention to the presence of significant mitotic activity and suppurative tumor necrosis is essential because they suggest potential malignant behavior.

Adolescent↗
PubMed1991

Musculoskeletal abnormalities in a patient with juvenile hypothyroidism.

Abnormalities in growth and development are the most striking clinical features of juvenile acquired hypothyroidism. Therefore, physicians should consider the diagnosis of hypothyroidism in any child with musculoskeletal growth dysfunction. Drs Kilpatrick and Fincher describe a case demonstrating the severe and potentially irreversible effects of prolonged, untreated hypothyroidism.

Adolescent↗
PubMedDate not supplied

Fine-needle aspiration biopsy of sarcomas and related tumors.

BACKGROUND: Largely due to a lack of experience, familiarity, and/or confidence, few centers rely on simple fine-needle aspiration biopsy (FNAB) for the diagnosis of sarcomas and related tumors. METHODS: The authors have reviewed their own experience in more than 200 cases of FNAB of bone and soft-tissue tumors, as well as cases reported in the literature. RESULTS: FNAB has proven to be accurate and useful in 8 consecutive years of clinical experience. No serious complications have occurred. CONCLUSIONS: FNAB is recommended as an integral part of the initial evaluation of amenable orthopaedic tumors, including sarcomas, especially in cases with classic clinical and radiographic findings.

Adolescent↗