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S H Paplanus

Publications and source records attributed to S H Paplanus.

At least 19 recordsLinked to original sources
PubMed1990

A diagnostic expert system for colonic lesions.

The diagnostic expert system for colonic lesions (DESCL) was designed to discriminate colonic adenoma and adenocarcinoma from normal colonic tissue. Although it was originally developed for use in conjunction with a machine vision analytic system, the DESCL has evolved into a teaching tool and a model for conceptual machine learning. The expert system is table driven and consists of a shell and a knowledge base. The latter comprises a series of architectural and cytologic observations and a quantitative estimate of diagnostic importance relating these observations to diagnostic outcome. In a validation study of 100 colonic lesions, the expert system achieved a success rate of 98%. It has the flexibility to allow individual pathologists to "customize" the knowledge base to suit their diagnostic criteria.

Adenocarcinoma↗
PubMed1989

Ultrastructural morphometry distinguishes Burkitt's-like lymphomas from neuroendocrine neoplasms: useful criteria applied to the evaluation of a poorly differentiated neuroendocrine neoplasm of the nasal cavity masquerading as Burkitt's-like lymphoma.

The present study describes the potential usefulness of ultrastructural morphometry in diagnosis. Ultrastructural morphometric criteria were applied to the evaluation of a poorly differentiated neuroendocrine neoplasm of the nasal cavity that was initially thought to be a Burkitt's-like lymphoma (BLL). Although the nasal lesion in question failed to stain with over 50 cell lineage-relevant antibodies, it did stain for vimentin (an intermediate filament protein) and Ki-67 (a nuclear antigen associated with cell proliferation). Routine electron microscopy revealed a primitive neoplasm with abundant cytoplasmic lipid droplets and sparse dense granules with no intercellular junctions. Treatment options, which included extensive facial surgery, prompted more study. Tissue processed for the uranaffin reaction revealed sparse uranaffin-positive granules indicating the presence of true neurosecretory granules. An ultrastructural morphometric analysis of the neoplastic nuclei of this patient placed the tumor outside the morphometric domains for BLLs (18 cases) and neuroblastomas (11 cases) and within the morphometric domain of neuroendocrine carcinomas (9 cases). A greater mean standard deviation (P less than 0.05) and mean coefficient of variation (P less than 0.02) of nuclear perimeter in the neuroendocrine (NE) group related to the BLL group indicated greater nuclear pleomorphism within the NE group as illustrated in bivariate graphic displays. The possible origin of the neoplasm within the nasal mucosa is discussed.

Burkitt Lymphoma↗
PubMed1988

Colonic lesion expert system. Performance evaluation.

A computer-based expert system for diagnosing colonic sections as normal, adenoma or adenocarcinoma is described, along with an evaluation of its performance. On the basis of its knowledge base, consisting of the values of diagnostic clues and their associated certainty factors for the possible diagnoses, the system will suggest the diagnosis for new cases presented to it. Using the data provided for 16 diagnostic clues, the system arrived at correct diagnoses for all cases of normal colon, for 49 of 50 cases of adenoma and for 48 of 49 cases of adenocarcinoma. Sample outputs from the expert system are presented and discussed, and the effects of possible alterations in the data base are considered.

Adenocarcinoma↗
PubMed1988

Micromorphometry of colonic lesions.

In the formulation of a quantitative component for the knowledge base of a diagnostic expert system, we developed a mathematical model to describe nuclear placement patterns in colon. Glands from normal colon, tubular adenomas, and adenocarcinomas were studied, and a ratio developed of percentage internally displaced nuclei to percentage displacement area. This displacement area represented an inner epithelial zone bounded centrally by the lumen and peripherally by the apical limit of basal nuclei. The mean percentage internally displaced nuclei to percentage displacement area ratio was 0.15 +/- 0.13 for normal glands, 0.75 +/- 0.09 for adenomas, and 1.04 +/- 0.13 for carcinomas. When the percentage internally displaced nuclei to percentage displacement area ratio was plotted against total number of nuclei, there was statistically significant separation of the diagnostic categories at alpha less than or equal to 0.05. Relative nuclear area and its variance were also studied for normal colonic glands, adenomas, and adenocarcinomas. Mean relative nuclear area for cells from normal glands was 284.2, from adenomas 342.4, and from adenocarcinomas 416.4, these being statistically significantly different at alpha less than or equal to 0.05. Variance of relative nuclear area, compared for the three diagnostic categories, was statistically significantly increased only in adenocarcinoma. Quantitation of nuclear placement patterns appears to provide a useful diagnostic clue for the knowledge base of a diagnostic expert system in the discrimination among normal colonic glands, adenomas, and adenocarcinomas.

Adenocarcinoma↗
PubMed1987

Detection of diagnostic clues in statistical histometry.

Examples are given of the detection of diagnostic clues in quantitative cytology and histopathology by statistical testing, such as may be applied in image analytical procedures. Schematic and other examples are presented of the visual images analyzed by each procedure, whose limits are also discussed. The situations analyzed include increased cellularity, differences in nuclear placement patterns, uniformity of displacement, variance in nuclear diameters and chaincode variance of nuclear placement. A specific model is presented for describing or generating a series of dependent observations representing nuclear placement, based on the Box-Jenkins (ARIMA) models for decomposing a spatial or temporal series into several components. This model describes the statistical observations that are random samples from the series. Finally, one graphic example is given in which visual inspection more readily ascertains an alteration than does statistical analysis of a modest-sized sample.

Analysis of Variance↗
PubMed1987

Morphometry in surgical pathology.

The potential role of morphometry in surgical pathology is discussed. Specific areas in which morphometry could be helpful are in (1) identifying malignant cells in lesions that are largely composed of benign-appearing cells (e.g., follicular thyroid neoplasms), (2) defining reference points in apparent continua (e.g., in the progression from normal colon to adenoma to adenocarcinoma), (3) distinguishing between benign and malignant lesions with similar appearances (e.g., fibromatosis and fibrosarcoma of the soft tissue) and (4) distinguishing between similar-appearing types of malignant neoplasms (e.g., between small-cell carcinoma of the lung and small-cell lymphoma). Morphometric techniques are already being used in DNA ploidy determinations, which frequently bear prognostic information. The measurement of other nuclear and cellular parameters has been used for both diagnostic and prognostic ends; one example is the relation of nuclear roundness to metastatic potential in prostatic carcinomas. Morphometry is now being increasingly applied to histologic sections, as in the prognostic study of lesion thickness in malignant melanoma and the diagnostic study of glandular architecture in colonic adenoma. The use of morphometry can enhance the observation and interpretation of morphologic features, which, combined with the clinical data and the experience of the pathologist, can lead to greater accuracy and precision in surgical pathology diagnoses.

Cytodiagnosis↗
PubMed1986

Fibrolamellar carcinoma of liver: a primary malignant oncocytic carcinoid?

Immunohistochemical and ultrastructural findings in two cases of fibrolamellar carcinoma of the liver and two cases of hepatocellular carcinoma of the common histologic type are described. Ultrastructural examination of both cases of fibrolamellar carcinoma revealed the presence of neurosecretory (NS) granules which were sparse in some cells and abundant in others. Many of the tumor cells had a distinct oncocytic appearance with abundant mitochondria. A portion of the glutaraldehyde-fixed neoplasm was processed for the uranaffin reaction (an ultrastructural cytochemical stain specific for the NS granules of neuroendocrine tissue). Abundant uranaffin-positive granules were found in the neoplastic cells of both cases of fibrolamellar carcinoma, whereas no uranaffin-positive granules were found in hepatocellular carcinoma of the common histologic type. There was no statistical difference in the mean diameter of the uranaffin-positive granules measured from both cases. Immunohistochemistry revealed the presence of neuron-specific enolase (NSE) and serotonin in one of the two cases of fibrolamellar carcinoma and no NSE staining in two cases of hepatocellular carcinoma of the common histologic type. These findings suggest that some liver tumors presenting histologically as fibrolamellar carcinoma may be neuroendocrine in nature.

Adult↗
PubMed1986

Pseudosarcomatous changes in inflammatory pseudopolyps of the colon.

The occurrence of pseudomalignant changes in biopsy specimens from two patients with ulcerative colitis and pseudopolyposis is described. One lesion was characterized by the proliferation of large ganglion cell-like cells, similar to those observed in proliferative fasciitis. Ultrastructural and immunohistochemical findings supported a fibroblastic origin. Biopsy specimens of an inflammatory pseudopolyp from the second patient showed proliferation of oval to spindle cells that were initially interpreted as a possible neoplasm. The site of origin and reactive nature of this lesion became apparent on a subsequent polypectomy specimen. Attention is called to the occurrence of pseudosarcomatous changes in inflammatory pseudopolyps of the gastrointestinal tract that may lead to an erroneous diagnosis of malignancy.

Adolescent↗
PubMed1985

Fluorescence of damaged myocardium in endomyocardial biopsy specimens for the evaluation of cardiac transplantation.

Sections stained with hematoxylin-eosin from 138 endomyocardial biopsy specimens were examined in a Zeiss epifluorescent ultraviolet microscope for fluorescence indicative of myocardial injury. The biopsy specimens had been obtained from cardiac transplant recipients for routine follow-up evaluation or due to clinically suspected episodes of rejection. Yellow fluorescence and/or granularity of necrotic myofibers (with normal myocardium appearing olive green to yellow-brown), as reported in autopsy series, was observed in 22 of our specimens, for which the results of staining with hematoxylin-eosin and/or trichrome were found to contain areas of fiber fluorescence that were not recognized by staining with hematoxylin-eosin or trichrome. In some areas in an additional 13 specimens, the fiber damage seen on ultraviolet examination was greater than that suspected on the basis of the light microscopic morphologic changes. In seven cases routine light microscopy revealed fiber necrosis that could not be confirmed by ultraviolet illumination study. Fluorescence of damaged myofibers under ultraviolet illumination may contribute to the detection of early or mild myocardial injury in endomyocardial biopsy specimens from cardiac transplant recipients.

Biopsy↗
PubMed1985

Statistical histometry in the diagnostic assessment of tissue sections.

A statistical histometric model to distinguish adenoma of the colon from normal colon is described. The model, based on the number and location of glandular nuclei, with a dependency scheme based upon displacement, was tested and shown to be significant and capable of simulating the architecture of an adenoma.

Adenoma↗
PubMed1984

Association of carcinoid with neurofibromatosis.

Patients with neurofibromatosis have a predilection for other types of tumors. We have described a case of carcinoid tumor of the ampulla of Vater in a patient with extensive cutaneous neurofibromatosis and visceral involvement limited to the heart. A review of the literature as to the types of tumors associated with neurofibromatosis and of several similar cases suggests that carcinoid tumors should be prominently featured among those found in conjunction with the disease.

Aged↗
PubMed1983

Nerve invasion by benign proliferating ductules in vasitis nodosa.

Vasitis nodosa is a benign reactive condition characterized by nodular thickening of the vas deferens which usually develops following vasectomy. In addition to chronic inflammation, fibrosis and sperm granulomas, an exuberant proliferation of ductules resembling invasive adenocarcinoma is seen. A review of vasa deferentia from 210 patients submitted to the surgical pathology service at Arizona Health Sciences Center yielded ten cases of vasitis nodosa. In two of these cases ductular epithelium was found within the endoneurium of small nerve fascicles. Two additional cases were referred to us, one of these showing ductular epithelium around a small peripheral nerve. The aggressive and infiltrative nature of the proliferating ductules in this relatively common benign lesion is important to recognize. Since nerve involvement has also been reported in fibrocystic disease of the breast, normal and hyperplastic prostate, and normal pancreas, it cannot be used as evidence for malignancy in these situations.

Adult↗
PubMed1983

Congenital blood cysts of the heart valves.

Congenital blood cysts of the heart valves are found most commonly on the tricuspid and mitral valves of fetuses and infants. Hearts available following 38 random autopsies of fetuses and infants 2 years of age or younger were examined. Blood cysts were found in 18 cases (47 per cent) in which ages ranged from 26 weeks of gestation to 11 months. The cysts varied in diameter, from microscopic to 3 mm. Affected valves had from one to 20 cysts. Light microscopic examination of serially sectioned paraffin-embedded tissue and plastic-embedded tissue and scanning electron microscopic examination revealed connections between the cyst lumens and ventricles via small endothelium-lined channels. The cyst structure suggested formation from ventricular endothelial infoldings in the valve leaflet base, which bulged into the atrium because of the pressure gradient present during valve closure. Blood cysts are a common finding in neonates dying of various causes and probably have no clinical significance. There is no association with asphyxia as previously described. Blood cysts may persist and enlarge to form giant cysts of the heart valves.

Aortic Valve↗
PubMed1982

Utility of thyroid aspiration biopsy.

The utility of fine-needle aspiration biopsy to detect carcinoma in thyroid nodules was evaluated by a decision-analysis approach in 102 patients. The procedure caused no morbidity. Cytologic diagnoses were categorized as unsatisfactory (4), no abnormality detected (61), atypical (13), suspicious for malignancy (14), malignancy (2), and inflammation (8). The duration of follow-up averaged 13 months. Of 21 thyroidectomy patients, 10 (48%) had carcinoma. Half of the ten patients operated upon for suspicious cytologic findings were found to have malignancy. Assuming criterion I, that atypical, suspicious, or malignancy results indicated cancer, sensitivity was 90%, specificity 77%, false positive fraction 23%, positive predictive value 31%, negative predictive value 99%, and accuracy 79%. Assuming criterion II, that only suspicious or malignancy cytologic findings represented carcinoma, sensitivity was 70%, specificity 90%, false positive fraction 10%, positive predictive value 44%, negative predictive value 96%, and accuracy 88%. We conclude that sensitivity and specificity of fine-needle aspiration biopsy vary depending upon the use of criterion I or II. Accuracy is highest if atypical results are not considered to represent carcinoma. Positive predictive values remain low and negative predictive values are high in either case. The utility of fine-needle aspiration biopsy when interpreted in relation to clinical criteria is supported by these results.

Adolescent↗
PubMed1980

Leiomyosarcoma of the stomach: results of surgery and chemotherapy in an eleven-year-old girl with liver metastases.

This report describes an 11-7/12-year-old girl with leiomyosarcoma of the stomach metastatic to liver who was treated with surgical resection and combination chemotherapy, which included adriamycin. She remains well 52 months after diagnosis and 27 months after cessation of chemotherapy. The favorable course of this patient suggests that aggressive adjuvant chemotherapy should be considered for patients with leiomyosarcoma who have poor prognostic features.

Antineoplastic Agents↗
PubMed1980

Testicular fibrosis and cardiomegaly in Shwachman's syndrome.

Shwachman's syndrome is an uncommon disorder; its principal manifestations are pancreatic and hematopoietic insufficiency. We report here a case of Shwachman's syndrome with autopsy findings of cardiomegaly (anticipated from clinical observations) and unexpected testicular fibrosis, both examined by electron microscopy.

Agranulocytosis↗