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The American Journal of Gastroenterology 08/1996; 91(7):1456-7. · 7.28 Impact Factor
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ABSTRACT: Immunoreactivity for a panel of 15 monoclonal antibodies (MAbs), which are known to react with different gastrointestinal tumor antigens, was assessed in formalin-fixed paraffin-embedded sections that were prepared from cholecystectomy specimens obtained from Mexican patients. Each case was classified histologically into one of the following groups: (1) invasive adenocarcinoma (N = 21), (2) high-grade dysplasia (carcinoma in situ) (N = 2), (3) low-grade dysplasia (N = 4), hyperplasia (4) (N = 15), and (5) chronic cholecystitis (N = 10). Significant differences (P < 0.05) were identified among the five histopathologic groups in the proportion of epithelial cells demonstrating immunoreactivity with MAbs to Lewisb; Lewis(a); sialylated Lewis(a); sialylated Lewis(a) and Lewis(a); Y antigen; H antigen; X antigen; X-like antigen; 200-kDa protein of CEA; 180-, 160-, 50-, 40-kDa proteins of CEA; 30- to 37-kDa protein; and an undefined antigen identified by MAb 99-57, with invasive carcinoma more frequently being positive as compared to nonneoplastic (hyperplasia, chronic cholecystitis) epithelium. Significant differences were also observed among the five histopathologic groups (P < or = 0.0005) in the proportion of epithelial cells demonstrating immunoreactivity with MAbs to Y antigen and the 20- to 50-kDa glycoprotein. However, with these two antibodies immunoreactivity was more frequently found in nonneoplastic epithelium rather than in invasive carcinomas. No significant differences in immunoreactivity were detected among the different histologic groups with MAb to blood group B antigen, types 1 and 2. This study demonstrates that cellular antigens are both developed and lost during the process of neoplastic transformation in the gallbladder.(ABSTRACT TRUNCATED AT 250 WORDS)
Digestive Diseases and Sciences 01/1993; 38(1):155-60. · 2.12 Impact Factor
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ABSTRACT: A 54-yr-old man with a 22-yr history of Crohn's disease was found to have a microscopic focus of immunoblastic lymphoma within a segment of small bowel resected to relieve intestinal obstruction. There was no other clinically evident disease. Thirty months later, he developed axillary adenopathy with recurrent lymphoma of the same immunophenotype (IgA lambda) and was given combination chemotherapy, with complete clinical response. Lymphoma recurred 6 months later in the axilla and progressed rapidly over the next 3 months, despite chemotherapy. He developed extensive mediastinal, mesenteric, and retroperitoneal disease with malignant ascites and died 39 months after diagnosis of the incidentally discovered bowel mucosal primary tumor.
The American Journal of Gastroenterology 08/1992; 87(7):894-8. · 7.28 Impact Factor
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ABSTRACT: To study the potential utility of magnetic resonance (MR) imaging in staging colorectal tumors, 15 resected colonic segments containing 17 elevated lesions were examined on a 1.5- or 1.9-T superconductive MR system. The whole intestinal wall was apparent as three or five layers on images obtained with a short repetition time (TR) and short echo time (TE) and as six or eight distinct layers, including the intestinal wall proper as well as an adherent mucus layer and an outer layer of pericolonic fat, on the long TR/TE images. In cases of colonic carcinoma, MR images correlated well with the pathologic findings, including the macroscopic growth pattern, depth of mural invasion, and the presence of foci of calcific tumor necrosis and pools of extracellular mucin (colloid). These features suggest that MR imaging may be valuable in the clinical evaluation of colorectal tumors.
Radiology 01/1991; 177(3):695-701. · 5.73 Impact Factor
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ABSTRACT: The authors present a simplified radiographic classification of non-Hodgkin lymphoma involving the small intestine. The classification system is based on radiographic findings in 22 pathologically proved cases of lymphoma involving the small bowel and consists of three major forms: primary, lymphoma complicating celiac disease, and mesenteric nodal. In this series, small bowel lymphoma was evenly distributed in the jejunum and ileum. The most common radiographic patterns were circumferential lesion (seven cases), cavitary lesion (four cases), and mesenteric nodal disease invading the small bowel (seven cases). Obstructive symptoms were usually encountered with the mesenteric nodal form. Lymphoma complicating celiac disease was typified by multiple, thickened, nodular folds involving a segment of proximal small intestine.
Radiographics 12/1990; 10(6):985-98. · 2.85 Impact Factor
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ABSTRACT: At radiography, hyperplastic polyps classically appear as smooth, sessile elevations less than 5 mm in diameter. However, a retrospective review of double-contrast barium enema studies in 22 patients with 31 pathologically proved hyperplastic polyps revealed an average polyp size of 7.3 mm, with a range of 3-21 mm. Fifteen polyps (48%) were 2-5 mm, 12 (39%) were 6-10 mm, and four (13%) were greater than 10 mm in diameter. Twenty-nine polyps (94%) were sessile, and two polyps (6%) were pedunculated. Twenty-three polyps (74%) had a smooth contour, and eight polyps (26%) were lobulated. Twenty-six of the hyperplastic polyps (84%) were located in the rectosigmoid colon. If the radiologic criteria for an atypical hyperplastic polyp at double-contrast barium enema examination include size greater than 5 mm, lobulation, and/or pedunculation, 16 of the 31 hyperplastic polyps (52%) could be classified as atypical. Thus, radiologists should be aware that many hyperplastic polyps seen at double-contrast barium enema examination do not fit the classic description of a smooth, sessile elevation less than 5 mm in size but instead appear as larger, more lobulated lesions that are indistinguishable from adenomatous polyps.
Radiology 07/1990; 175(3):691-4. · 5.73 Impact Factor
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Archives of Internal Medicine 06/1990; 150(5):1132, 1134. · 11.46 Impact Factor
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ABSTRACT: To differentiate neuroendocrine (NE) neoplasms arising at different levels of the gut and pancreas, the authors studied the expression of neurofilament (NF) proteins and chromogranin (CR) in normal and neoplastic NE cells of the human gastrointestinal tract (GIT) (14 ileal/jejunal carcinoids, six appendiceal carcinoids, 11 rectal carcinoids) and pancreas (23 islet cell tumors). Among pancreatic islet cell tumors, those with middle molecular weight (NF-M)-positive cells were more abundant than those with high molecular weight (NF-H)-positive cells; nearly all of these tumors expressed CR. Although NF-M was abundantly expressed in greater than 50% of tumor cells in a subset of these tumors, only one of these tumors exhibited diffuse immunoreactivity with NF-H. Among rectal carcinoid tumors, NF-M and NF-H-positive cells were present in approximately the same number of tumors, yet only diffuse immunoreactivity to NF-H could be detected. Chromogranin immunoreactivity in greater than 50% of tumor cells was present in 74% of islet cell tumors, 93% of ileojejunal carcinoids, and 83% of appendiceal carcinoids, but only in a minority of rectal carcinoids (36%). Although ileojejunal carcinoid tumors rarely expressed NF-M and did not express NF-H, diffuse immunoreactivity with CR was present in nearly all of these tumors. None of the appendiceal carcinoid tumors expressed NF-M or NF-H, yet all of these tumors demonstrated immunoreactivity with CR. Neurofilament immunoreactivity was not detected in normal GIT and pancreatic NE cells, whereas CR immunoreactivity was always present. These results suggest that for NE neoplasms of the GIT and pancreas the differential expression of NF subtypes appears to be related to tumor site; and CR is a marker of most GIT and pancreatic NE neoplasms although NF may discriminate subtypes of GIT and pancreatic NE tumors. Neurofilament subtyping may be useful in the evaluation of the origin of NE tumors presenting as metastatic lesions.
Cancer 04/1990; 65(5):1219-27. · 4.77 Impact Factor
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ABSTRACT: Classic radiographic findings described in adult celiac disease--lumen dilatation, flocculation of barium, hypersecretion, thickening of folds--are nonspecific or are secretion related artifacts. The small bowel enema technique and CT make it possible to demonstrate specific diagnostic features of the disease and its complications. This substantially modified approach to the diagnosis of adult celiac disease is presented together with correlative pathology. Examples of the complications of celiac disease--ulcerative jejunoileitis, lymphoma, hyposplenism, carcinoma, and the cavitary lymph node syndrome--are illustrated.
Radiographics 12/1989; 9(6):1045-66. · 2.85 Impact Factor
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ABSTRACT: To investigate the association between human papillomavirus (HPV) infection and anal carcinoma, we applied a sensitive in situ hybridization technique to detect HPV messenger RNA (HPV m-RNA) in formalin-fixed, paraffin-embedded sections from 18 patients. Using tritium-labeled probes, HPV m-RNA was detected in 12/18 (67%) patients. HPV 6 was detected in four patients, coexisting with HPV 18 in two cases, and HPV 16 was found in eight patients. In six patients, hybridization failed to demonstrate the presence of HPV. With respect to histology, HPV 6 was detected in 1/4 cases of well differentiated invasive squamous cell carcinoma. Ten of thirteen moderately or poorly differentiated invasive squamous cell carcinomas demonstrated HPV m-RNA (HPV 16, eight cases; HPV 6, one case; HPV 6 and 18, one case). HPV 31 was not detected in any specimens. These results suggest that HPV infection may play an important role in the pathogenesis of anal carcinoma.
Modern Pathology 10/1989; 2(5):439-43. · 4.79 Impact Factor
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ABSTRACT: The nature of gastric infiltrates consisting primarily of benign-appearing small lymphocytes is at present a controversial issue. Earlier reports of gastric lymphoma developing in gastric pseudolymphoma and more recent immunohistochemical studies demonstrating monoclonal B-cell populations in pseudolymphoma suggest that at least some cases represent low-grade lymphomas or clonal precursor lesions that may develop into lymphoma. Observations of a small lymphocytic infiltrate arising in the region of a gastric ulcer that lacked definitive morphologic evidence of malignancy (lymphoma) but was clearly a monoclonal B-cell proliferation by immunohistochemical and gene rearrangement studies support the notion that some gastric lymphoproliferative lesions that histologically have been called pseudolymphomas may include one or more clonal lymphoid expansions. A histopathologic/molecular model suggesting a potential pathway for the development of morphologically recognizable lymphoma from benign-appearing small lymphocytic infiltrates is presented, and the concept that for a variety of lymphoid proliferations clonality and malignancy may not be synonymous is discussed.
Gastroenterology 08/1989; 97(1):195-201. · 11.68 Impact Factor
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ABSTRACT: A patient with celiac sprue was found to have an asymptomatic pneumoperitoneum. Prompt recognition that the pneumoperitoneum was due to pneumatosis cystoides intestinalis prevented unnecessary surgical intervention. Severe mucosal disease of the small intestine can be associated with an asymptomatic pneumoperitoneum.
Journal of Clinical Gastroenterology 03/1989; 11(1):70-2. · 3.16 Impact Factor
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Transactions of the American Clinical and Climatological Association 02/1989; 100:177-84.
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ABSTRACT: During a 10-year period between 1978 and 1987, there were 25 confirmed cases of herpes esophagitis with positive esophageal brushings, biopsies, and/or cultures for the herpes simplex virus. Eighteen of those patients had double-contrast esophagrams, but two were excluded from our study because they had combined fungal and viral esophagitis. All of the remaining 16 patients were symptomatic, and 14 were immunocompromised. Herpes esophagitis was diagnosed on the original radiographic reports in nine (56%) of those 16 patients. In all nine, double-contrast radiographs revealed discrete, superficial ulcers on a relatively normal background mucosa without significant plaque formation. In the remaining seven patients, double-contrast esophagrams revealed plaquelike lesions that were indistinguishable from those of Candida esophagitis (four cases), thickened folds (two cases), and a giant esophageal ulcer (one case). During the same period, herpes esophagitis was diagnosed on seven other double-contrast esophagrams in which histologic, cytologic, and virologic studies were negative for the herpes simplex virus. However, the endoscopic findings were also suspicious for herpes esophagitis in six of those cases, suggesting that they may represent true-positive cases in which there was inadequate tissue sampling. Thus, our experience indicates that radiographic abnormalities can almost always be detected on double-contrast esophagrams in patients with herpes esophagitis, and in more than 50% of cases, a specific radiographic diagnosis can be made because of discrete ulcers without significant plaque formation.
American Journal of Roentgenology 08/1988; 151(1):57-62. · 2.78 Impact Factor
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ABSTRACT: Results from ultrasonography, computed tomography (CT), scintigraphy, hepatic angiography, and magnetic resonance (MR) imaging were analyzed for five patients with surgically proved fibrolamellar hepatocellular carcinoma (FL-HCC)--a variant of hepatocellular carcinoma (HCC) that usually occurs in younger patients and has an improved prognosis and chance for curative resection. The radiologic findings were generally inconclusive for a differential diagnosis because the appearance of the lesions on the various imaging studies closely simulated that of either focal nodular hyperplasia, HCC, or metastases. CT and technetium-99m sulfur colloid scintigraphy were the most effective techniques for the workup of these lesions, but because they do not allow a definitive diagnosis, open biopsy is recommended for most lesions simulating focal nodular hyperplasia and HCC in younger patients. Although the current specificity of MR imaging in diagnosing liver lesions is low, further experience may permit more specific characterization of these lesions.
Radiology 05/1988; 167(1):25-30. · 5.73 Impact Factor
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ABSTRACT: The effect of a pectin-supplemented enteral diet on experimental colitis was compared with parenteral nutrition and with a pectin-free enteral diet. Forty-five rats had feeding catheters placed into either the stomach (IG, n = 31) or the superior vena cava (IV, n = 14) and then received acetic acid (colitis) or saline (control) enemas. After the enema, all rats received the same diet, either IG or IV, for 6 d except for 15 rats (IGP, 9 colitis and 6 controls), which had 1% pectin added to the diet. At the end of the feeding period the IGP group had significantly less colonic inflammation and/or necrosis than either IV (p less than 0.03) or IG (p less than 0.04) groups. Nitrogen balance, serum albumin, total iron-binding capacity and body weight did not differ significantly among dietary regimens. Thus, the degree of bowel injury in experimental colitis was decreased when animals were fed a pectin-supplemented enteral diet and this effect was independent of nutritional status.
American Journal of Clinical Nutrition 05/1988; 47(4):715-21. · 6.67 Impact Factor
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ABSTRACT: A blinded, retrospective study was performed to determine the role of double-contrast esophagography in diagnosing Barrett's esophagus. The study group consisted of 200 patients who had double-contrast esophagrams and endoscopy because of severe reflux symptoms. The radiographs were reviewed by two gastrointestinal radiologists who had no knowledge of the endoscopic findings. Patients were classified as being at high risk for Barrett's esophagus if the radiographs revealed a high stricture or ulcer or a reticular mucosal pattern; at moderate risk if the radiographs revealed a distal peptic stricture and/or reflux esophagitis; and at low risk if none of the aforementioned findings were present. When these radiologic criteria were used, 10 patients (5%) were thought to be at high risk, 73 (37%) at moderate risk, and 117 (58%) at low risk for Barrett's esophagus. Endoscopic correlation revealed biopsy-proved Barrett's mucosa in nine (90%) of 10 patients at high risk, in 12 (16%) of 73 at moderate risk, and in only one (1%) of 117 at low risk for Barrett's esophagus. Thus, endoscopy is clearly indicated for patients in the high-risk group. Because of the lower prevalence of Barrett's esophagus in the moderate-risk group, clinical judgment should be used in deciding when to perform endoscopy in these patients. However, most patients were in the low-risk group, and the prevalence of Barrett's esophagus was so low in this group that endoscopy does not appear to be warranted. Thus, the major value of double-contrast esophagography is its ability to separate patients into high-, moderate-, and low-risk groups for Barrett's esophagus to determine the relative need for endoscopy and biopsy.
American Journal of Roentgenology 02/1988; 150(1):97-102. · 2.78 Impact Factor
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ABSTRACT: A case of fibrolamellar hepatocellular carcinoma (FL-HCC) associated with adjacent focal nodular hyperplasia (FNH) is described. These two regions were adjacent but distinct, both on gross and microscopic examination. Currently, it is unclear whether FL-HCC rarely arises in preexisting FNH, or whether FNH is a typical response to this vascular variant of hepatocellular carcinoma (HCC). The FNH region, which is peripheral, may be biopsied to exclude the underlying carcinoma, and thus lead to inadequate therapy. Previous reports of this association are reviewed.
Cancer 01/1988; 60(12):3049-55. · 4.77 Impact Factor
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S H Saul
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ABSTRACT: The clinicopathologic features of nine patients with inflammatory polyps of the anorectal transition zone (inflammatory cloacogenic polyp, ICP) were reviewed. All polyps were characterized histologically by crypt hyperplasia and a thickened muscularis mucosa arising beneath a surface epithelium consisting of variable proportions of squamous, columnar, and often transitional epithelium. Tubulovillous architecture was characteristic. Sialomucin predominated over sulfomucin in eight of nine cases. One polyp displayed focal dysplasia and condylomatous features, while two others had associated hemorrhoids. Three cases had been previously diagnosed as adenomas. Seven patients were women, and two were men; their median age was 54 years (range, 17 to 85). Clinical presentation was most commonly intermittent rectal bleeding, and the clinical diagnosis was anal polyp or hemorrhoids in all cases. Six patients had the solitary rectal ulcer syndrome (SRUS) and/or evidence of mucosal prolapse. Papillomavirus was demonstrated by histochemical and immunohistochemical methods in one case in which multiple foci of dysplasia were also noted. Two patients had Crohn's disease, and the remaining patient had a coexistent adenocarcinoma located several centimeters proximal to his ICP. The pathologist and clinician must be aware that although ICP is often associated with SRUS/mucosal prolapse, it may occur in other clinical settings.
Human Pathlogy 12/1987; 18(11):1120-5. · 2.88 Impact Factor
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ABSTRACT: A patient with pustular psoriasis developed jaundice, peripheral blood eosinophilia, and biochemical evidence of hepatocanalicular dysfunction four weeks after the initiation of etretinate therapy. A liver biopsy specimen showed bile duct damage, a periportal inflammatory infiltrate composed of neutrophils, eosinophils and lymphocytes, canalicular cholestasis, and focal hepatocyte necrosis. Clinical exclusion of other possible etiologic factors coupled with near resolution of the biochemical abnormalities within six weeks after complete discontinuation of the drug indicates that etretinate may induce an idiosyncratic hypersensitivity reaction. This is the first report to document etretinate associated bile duct injury.
Digestive Diseases and Sciences 11/1987; 32(10):1207-11. · 2.12 Impact Factor
