Allen P Burke

University of Maryland, Baltimore, Baltimore, Maryland, United States

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Publications (230)1438.7 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Given its inconspicuous appearance on radiography, computed tomography (CT), and magnetic resonance imaging (MRI) the pulmonary valve (PV) is often overlooked as an important cause of both cardiac and pulmonary disease. In this pictorial essay, we review the normal appearance of the PV as well as various congenital anomalies including pulmonary atresia, pulmonary stenosis, and valvular fusion anomalies. Infectious entities, degenerative conditions, and malignant lesions are also depicted. We discuss surgical techniques used to repair both congenital and acquired pulmonary valvular diseases and describe postoperative appearances of the PV on imaging.
    No preview · Article · Jan 2016 · Journal of Thoracic Imaging
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    ABSTRACT: Background: Overlapping forms of interstitial pneumonia have been recognized, but are likely underappreciated, and their clinical, radiologic, and histologic characteristics are not well-defined. Methods: We identified 38 patients with surgical lung biopsy demonstrating histologic organizing pneumonia (OP) or histologic organizing pneumonia/non-specific interstitial pneumonia overlap (OP/NSIP) who met established multi-disciplinary clinical-radiologic-histologic criteria for OP. For each patient, radiologic and co-histologic findings were assessed, and clinical outcome was characterized as disease resolution (complete or near-complete resolution of radiologic opacities and absence of chronic respiratory symptoms) or unfavorable disease progression (death due to respiratory failure or forced vital capacity < 70% predicted > six months from diagnosis). Results: Seven of 38 patients had clinical-radiologic-histologic focal OP. Focal OP was associated with histologic OP (p = 0.019), and all seven patients demonstrated disease resolution. In the remaining 31 patients with cryptogenic or autoimmune-associated OP, 21 patients had histologic OP/NSIP, and 10 had histologic OP. Histologic OP/NSIP was associated with ground glass opacity (GGO, p = 0.012), reticulation (p = 0.029), traction bronchiectasis (p = 0.029), reactive pneumocytes (p = 0.013), and unfavorable disease progression (p < 0.0001). Histologic OP was associated with consolidation (p = 0.028) and disease resolution (p < 0.0001). Multivariate analysis demonstrated histologic OP/NSIP (p < 0.001) and radiologic GGO (p = 0.041) to be independently associated with unfavorable disease progression. Conclusions: OP/NSIP overlap, either idiopathic or autoimmune-associated and identified by histologic and radiologic findings, was associated with unfavorable disease progression, and should therefore be recognized as a characteristic clinical-radiologic-histologic entity.
    No preview · Article · Oct 2015 · Respiratory medicine

  • No preview · Article · Sep 2015 · Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer
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    Full-text · Article · Jul 2015 · Radiographics
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    ABSTRACT: Cardiac sarcoidosis is a rare but potentially fatal disorder with a nonspecific spectrum of clinical manifestations, including conduction disorders, congestive heart failure, ventricular arrhythmias, and sudden cardiac death. Although early treatment to improve morbidity and mortality is desirable, sensitive and accurate detection of cardiac sarcoidosis remains a challenge. Except for the histopathologic finding of noncaseating granulomas in an endomyocardial biopsy specimen, most diagnostic tests are limited and nonspecific at best. Therefore, the decision to initiate treatment is based largely on the patient's clinical symptoms and the course of the disease, rather than histologic confirmation. Successful recognition of cardiac sarcoidosis ultimately requires rigorous collaboration among a clinician, radiologist, and pathologist. Advanced imaging modalities, such as cardiac magnetic resonance imaging and positron emission tomography with fluorodeoxyglucose, have become increasingly useful in facilitating diagnosis and therapeutic monitoring, although limited prospective studies exist. This article describes the clinical parameters and pathologic findings of cardiac sarcoidosis and the advanced imaging features and differential diagnostic challenges that must be considered for a successful diagnostic approach. In addition, to improve the understanding of abnormalities detected with different imaging modalities, we suggest a unified terminology in describing radiologic findings related to cardiac sarcoidosis. (©)RSNA, 2015.
    No preview · Article · May 2015 · Radiographics
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    ABSTRACT: Objectives This study assessed grayscale intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) detection of a histological fibroatheroma (FA).Background NIRS-detected, lipid-rich plaques (LRPs) and IVUS-detected attenuated plaques are considered to be vulnerable.Methods IVUS-attenuated plaque and NIRS-LRP (yellow or tan block chemogram) were compared with histopathology in 1,943 sections of 103 coronary arteries from 56 autopsied hearts.Results IVUS-superficial attenuation and NIRS-LRP showed a similar high specificity of approximately 95%, whereas IVUS-superficial attenuation alone had a poor sensitivity (vs. NIRS-LRP) in detecting FAs (36% vs. 47%; p = 0.001). Compared with FA sections with superficial attenuation, FA sections without superficial attenuation had a smaller plaque burden (57.1% vs. 67.7%), a larger arc of calcium (79.7° vs. 16.8°), and a lower prevalence of a ≥20% histological necrotic core (28% vs. 50%) or late FA (14% vs. 37%; all p textless 0.05). Compared with FA sections with NIRS-LRP, FA sections without NIRS-LRP showed a smaller plaque burden (58.0% vs. 63.3%) and a lower prevalence of a ≥20% necrotic core (27% vs. 46%). Conversely, non-FAs with NIRS-LRP (vs. non-FAs without LRP) showed a larger plaque burden (55.1% vs. 46.3%), a greater prevalence of a ≥20% histological lipid pool (34% vs. 5%), and mostly pathological intimal thickening (50%) or fibrocalcific plaque (33%). When sections showed either IVUS attenuation or NIRS-LRP, the sensitivity for predicting a FA was significantly higher compared with IVUS attenuation alone (63% vs. 36%; p textless 0.001) or NIRS-LRP alone (63% vs. 47%; p textless 0.001). When sections showed both IVUS attenuation and NIRS-LRP, the positive predictive value improved compared with IVUS attenuation alone (84% vs. 66%; p textless 0.001) or NIRS-LRP alone (84% vs. 65%; p textless 0.001).Conclusions NIRS-LRP was more accurate than IVUS for predicting plaque containing a necrotic core or a large lipid pool, and the combination was more accurate than either alone.
    Full-text · Article · Feb 2015 · JACC Cardiovascular Imaging
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    ABSTRACT: This study assessed grayscale intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) detection of a histological fibroatheroma (FA).
    No preview · Article · Jan 2015
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    ABSTRACT: There are few studies addressing survival of diffuse peritoneal mesotheliomas (DPM).In this study, survival data were obtained retrospectively from 73 patients treated with intended cytoreductive surgery for DPM, with a mean follow-up of 42 months. Mesotheliomas were classified as well differentiated papillary (WDPM, n = 2), multicystic (MCM, n = 4), and epithelioid mesotheliomas were subclassified as tubulopapillary (TPM, n = 27), solid/deciduoid (S/DM, n = 34), and or biphasic mesothelioma (BPM, n = 6). Invasion was characterised as absent (grade 0), into stroma (grade 1), into fat (grade 2), and into adjacent structures (grade 3). Peritoneal cancer index (PCI) and completeness of cytoreduction (CCR) were assessed surgically.There were no deaths in the WDPM, MCM, and epithelioid DPM with ≤ grade 1 invasion. There was a stepwise decrease in overall survival from invasive TPM, S/DM, and BPM (p < 0.0001). By univariate analysis, advanced age (p = 0.01), incomplete CCR (p < 0.001), PCI (p = 0.004), mitotic count (p < 0.001), nuclear grade (p < 0.0001), stromal inflammation (p = 0.013), depth of invasion (p < 0.0001), necrosis (p = 0.002), and sarcomatoid growth (p < 0.0001) were associated with decreased overall survival. By multivariate analysis, only sarcomatoid growth (p = 0.0006), depth of invasion (p = 0.02), elevated CCR (CCR 2-3) (p = 0.02), and presence of inflammatory stroma (p = 0.04) were significant variables associated with decreased overall survival.DPM form a spectrum of indolent to highly aggressive tumours. Solid epithelioid/deciduoid tumours have a prognosis intermediate between biphasic mesotheliomas and invasive TPM. The presence and degree of invasion, sarcomatoid features, and inflammatory stroma are poor prognostic indicators.
    No preview · Article · Dec 2014 · Pathology
  • Jennifer A. Collins · Yang Zhang · Allen P. Burke
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    ABSTRACT: Background There are few studies on the histologic findings in native infective endocarditis, especially regarding mimics of autoimmune valvulitis. Methods We prospectively studied 106 surgical specimens from 95 patients with a clinical diagnosis of infective endocarditis on native valves, and compared gross and histologic findings with culture results, underlying valve disease, risk factors and time interval from symptom onset to surgical intervention. Results There were 41 (39%) aortic, 33 (31%) mitral, 9 (9%) tricuspid, 1(.9%) pulmonic and 11 (10%) multiple valve replacements. Underlying valve disease was present in 26 (27%) patients (non-calcified bicuspid aortic valve, 10 (38%) cases; mitral valve prolapse, 5 (19%) cases; calcified trileaflet aortic valve, 5 (19%) cases; calcified bicuspid aortic valve, 2 (8%) cases; post-rheumatic mitral valve disease, 2 (8%) cases; hypertrophic cardiomyopathy-related mitral valve disease, 1 (4%) case, trileaflet aortic insufficiency 1 (4%) case) and associated with streptococcal infection (p=.001). Absence of underlying valve disease was associated with intravenous drug abuse (p=.01) and dialysis dependent renal disease (p=.006). Intravenous drug abuse was associated with staphylococcal infection (p=.03). Vegetations were present in 80 (75%) of cases, and on the nonflow surface of the valve in 65 (81%) of these. Gram-stain positivity and neutrophilic microabscesses were associated with staphylococcal infection (p=.03). Epithelioid macrophages with palisading features mimicking necrobiotic granulomas were seen in 42 (40%) valves and more frequently associated with streptococcal infection (p=.03). As expected, the presence of valve necrosis and acute inflammation decreased with an increase in time with respect to symptomatic onset. Conclusion Histologic findings mimicking autoimmune inflammation is frequent in infective endocarditis and associated with streptococcal infection. Risk factors for infective endocarditis include calcific valve disease.
    No preview · Article · Dec 2014 · Pathology - Research and Practice
  • Paul Staats · Fabio Tavora · Allen P Burke
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    ABSTRACT: Aortic sarcomas are predominantly endoluminal tumours that are believed derived from the intima. Because of their rarity, relatively little is known about their pathological features. We report a series of 26 aortic and iliofemoral tumours with histopathological and clinical data.Of the 26 cases, there were 16 men (63.6 ± 13 years) and 10 women (58.6 ± 18 years). Tumours occurred in the abdominal aorta (13), descending thoracic aorta (8), iliac or femoral arteries (4) and ascending aorta (1). Presenting tumour manifestations included claudication or peripheral vascular disease (6), pain (5), pulsatile aneurysm (2) abdominal aortic aneurysm (AAA; 2), occluded graft (2), renal artery stenosis (1), pain from bone metastasis (1), aortic rupture (1), fever (1), weight loss (1), vasculitis (1) impotence (1), incidental finding (1) and bowel ischaemia (1). The diagnosis was not suspected clinically in any case. The tumours were sampled by endarterectomy (9), aortic resection (8), repair of aneurysm (5), and in four the diagnosis was made at autopsy. Histologically and immunohistochemically, 13 were categorised as poorly differentiated angiosarcomas, seven as undifferentiated sarcomas, three as osteosarcomas, two as myxofibrosarcomas, and one as myxoid sarcoma, not otherwise specified. The undifferentiated sarcomas and angiosarcomas were histologically similar to one another and were characterised by tumour cells within and overlying thrombus. The angiosarcomas were defined by diffuse CD31 expression with co-expression of pancytokeratin in 10 (77%). Undifferentiated sarcomas were composed of spindled and/or epithelioid cells and 71% expressed smooth muscle actin. Histological material from metastatic tumours was available in two osteosarcomas and two undifferentiated sarcomas, and showed undifferentiated pleomorphic sarcoma in all cases.In this series, half of aortic intimal sarcomas are histologically undifferentiated and express endothelial and epithelial markers (epithelioid angiosarcoma). The second largest group is undifferentiated sarcoma without immunohistochemical evidence of endothelial differentiation and frequent actin positivity. Rare types include myxofibrosarcoma and osteosarcoma.
    No preview · Article · Dec 2014 · Pathology
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    ABSTRACT: Background The histopathologic distinction between typical carcinoid (TC) and atypical carcinoid (AC) of the lung is based largely on mitotic index. Ki-67 may aid in separation of these tumors, as well as the distinction from large cell neuroendocrine carcinoma (LCNEC).Methods We identified 55 surgically resected primary neuroendocrine lung tumors (39 TC, 7 AC, 9 LCNEC) based on mitotic rate and histologic features. Ki-67 proliferative index based on automated image analysis, tumor necrosis, nodal metastases, local or distant recurrence, and survival were compared across groups.ResultsThe mean mitotic count and Ki-67 index for TC, AC, and LCNEC were 0.1 and 2.3%, 3.4 and 16.8%, and 56.1 and 81.3% respectively. The Ki-67 index did not overlap among groups, with ranges of 0¿6.7% for TC, 9.9-25.7% for AC, and 63.2-91.9% for LCNEC. Nodal metastases were identified in 4/39 (10%) TC, 2/7 (22%) AC, and 2/8 (25%) LCNEC. There was no survival difference between TC and AC, but there was a significant survival difference between LCNEC and TC and AC combined (p¿<¿0.001). There was a step-wise increase in disease free survival with tumor grade: no TC recurred, 2/7 AC recurred or progressed (median interval 35.5 months), and all LCNEC recurred or progressed (median interval 10.1 months). No patient with TC or AC died of disease, compared to 7/8 LCNEC with follow-up data.Conclusions We conclude that Ki-67 index is a useful diagnostic marker for neuroendocrine tumors, with 7% a divider between AC and TC, and 50% a divider between LCNEC and AC. LCNEC is biologically different from AC and TC, with a much more aggressive course, and a high Ki-67 index.Virtual SlidesThe virtual slide(s) for this article can be found here:
    Preview · Article · Oct 2014 · Diagnostic Pathology

  • No preview · Article · Oct 2014 · Chest
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    ABSTRACT: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare type of kidney tumor with relatively indolent behavior. Non-classic morphological variants have not been well studied and rarely been reported. We report a challenging case MTSCC with a peculiar morphology in a 42-year-old man, arising in a background of end-stage renal disease (ESRD). Predominant areas with extensive papillary architecture, psammoma bodies and stromal macrophageal aggregates, reminiscent of a papillary renal cell carcinoma (papillary RCC), were intermixed with foci that transitioned into a MTSCC-like morphology exhibiting elongated tubules and a low grade spindle cell component in a background of mucinous stroma. Immunuhostochemistry demonstrated diffuse positivity for P504s/AMACR and vimentin in tumor cells. Focal positivity for RCC, CD10 and CK7 was also noted. Kidney-specific cadherin, cytokeratin 34betaE12 and TFE3 stains were negative in the tumor. The major differential diagnostic considerations were papillary RCC, clear cell papillary RCC, and Xp11.2 translocation carcinoma. Negative FISH studies for trisomy 7 and 17 in both papillary and spindled components supported the diagnosis of MTSCC. The ultrastructrural profile was not entirely indicative of the cellular origin of the tumor. Cytogenetic analysis should be performed in atypical cases of MTSCC for precise diagnosis.
    Full-text · Article · Jul 2014 · Pathology - Research and Practice
  • Joseph J Maleszewski · Fabio Tavora · Allen P Burke

    No preview · Article · Jun 2014 · The American journal of surgical pathology
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    ABSTRACT: Objectives Three intravascular ultrasound (IVUS) signatures have been associated with coronary artery disease instability: echo-attenuation, intraplaque echolucent zone, and spotty calcification. We sought to investigate the substrates responsible for these IVUS signatures in a relatively large series of postmortem human coronary samples. Background The exact mechanisms and pathologic correlates underlying echo-attenuation, an intraplaque echolucent zone, and spotty calcification remain poorly understood. Methods IVUS was compared to near-infrared spectroscopy (NIRS) detection of lipid core plaque (LCP) and histopathology in 2294 vessel segments from 151 coronary specimens from 62 patients at necropsy using the modified American Heart Association classification. Results IVUS detected echo-attenuated plaques in 18.3% segments, echolucent plaques in 10.5% segments, and spotty calcification in 14.4% segments. Histopathologically, 91.4% echo-attenuated plaques corresponded to either a fibroatheroma with a necrotic core or pathologic intimal thickening with a lipid pool; almost all segments with superficial echo-attenuation indicated the presence of a fibroatheroma with an advanced necrotic core. Echolucent plaques indicated the presence of a relatively smaller lipid/necrotic core compared to echo-attenuated plaques (thickness: 0.51 [interquartile range (IQR): 0.35-0.64] vs. 0.70 [IQR: 0.54-0.92] mm, p<0.001; arc: 74.5° [IQR: 59.0°-101.0°] vs. 90° [IQR: 70.0°-112.0°], p<0.001), although 82.8% of superficial echolucent zones indicated a necrotic core-containing fibroatheroma. IVUS spotty calcification, especially superficial in location (72.6%), was often associated with a fibroatheroma with calcium deposits and had smaller arcs of calcium in the setting of fibroatheroma versus fibrocalcific plaques (37.5° [IQR, 23.0°-53.0°] vs. 59.0° [IQR, 46.0°-69.0°], p<0.001). Comparisons between IVUS and NIRS revealed that echo-attenuated plaques contained the highest probability of NIRS-derived LCP followed by echolucent plaques and spotty calcifications. Conclusions This study demonstrated that echo-attenuated plaque, especially superficial echo-attenuation, was the most reliable IVUS signature for identifying a high-risk plaque, ie, a fibroatheroma containing a large necrotic core.
    Full-text · Article · Jun 2014 · Journal of the American College of Cardiology
  • J.A. Collins · A. Iacono · C. Drachenberg · A.P. Burke

    No preview · Article · Apr 2014 · The Journal of Heart and Lung Transplantation
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    ABSTRACT: The mechanisms of interstitial lung disease (ILD) remain incompletely understood, though recent observations have suggested an important contribution by interleukin (IL)-33. Substantial elevation in IL-33 expression was found in the lungs of patients with idiopathic pulmonary fibrosis and scleroderma lung disease as well as in the bleomycin injury mouse model. Most of the observed IL-33 expression was intracellular and intranuclear, suggesting involvement of the full-length (fl) protein but not the proteolytically processed mature IL-33 cytokine. The effects of flIL-33 on mouse lungs were assessed independently and in combination with bleomycin injury using recombinant adenovirus-mediated gene delivery. Bleomycin-induced changes were not affected by gene deficiency of the IL-33 receptor T1/ST2. Combined flIL-33 expression and bleomycin injury had a synergistic effect on pulmonary lymphocyte and collagen accumulation, which could be explained by synergistic regulation of the cytokines TGF-β, IL-6, MCP-1, MIP-1α, and TNF-α. By contrast, there was no increase in the levels of the Th2 cytokines IL-4, IL-5, or IL-13. Also, flIL-33 was found to significantly increase expression of several heat shock proteins, particularly HSP70, which is known to be associated with ILD. Thus, full-length IL-33 is a synergistic proinflammatory and profibrotic regulator that acts by stimulating expression of several non-Th2 cytokines and activates expression of HSP70.
    Full-text · Article · Jul 2013 · American Journal of Respiratory Cell and Molecular Biology
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    ABSTRACT: Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease with no known effective therapy. It is often assumed, but has not been objectively evaluated, that pulmonary inflammation subsides as IPF progresses. The goal of this work was to assess changes in the degree of inflammatory cell infiltration, particularly lymphocytic infiltration, over the duration of illness in IPF. Sixteen patients with confirmed IPF were identified in patients whom surgical lung biopsy (SLB) was performed in early disease, and in patients whom lung transplantation was subsequently performed in end stage disease. A numerical scoring system was used to histologically quantify the amount of fibrosis, honeycomb change, fibroblastic foci, and lymphocyte aggregates in each SLB and lung explant tissue sample. Analyses of quantitative scores were performed by comparing paired, matched samples of SLB to lung explant tissue. Median time [1st, 3rd quartiles] from SLB to lung transplantation was 24 [15, 29] months. Histologic fibrosis and honeycomb change were more pronounced in the explant samples compared with SLB (P < 0.001 and P < 0.01, respectively), and most notably, higher numbers of lymphocyte aggregates were observed in the explant samples compared to SLB (P = 0.013). Immunohistochemical analyses revealed abundant CD3+ (T lymphocyte) and CD20+ (B lymphocyte) cells, but not CD68+ (macrophage) cells, within the aggregates. Contrary to the frequent assumption, lymphocyte aggregates were present in greater numbers in advanced disease (explant tissue) compared to early disease (surgical lung biopsy). This finding suggests that active cellular inflammation continues in IPF even in severe end stage disease.
    Preview · Article · Mar 2013 · Journal of Inflammation Research
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    ABSTRACT: Humans are constantly exposed to hazardous pollutants in the environment—for example, in the air, water, soil, rocks, diet, or workplace. Trace metals are important in environmental pathology because of the wide range of toxic reactions and their potential adverse effects on the physiological function of organ systems. Exposures to toxic trace metals have been the subject of numerous environmental and geochemical investigations, and many studies have been published on the acute and/or chronic effects of high-level exposures to these types of agents; however, much fewer data are available concerning the health effects of low-dose chronic exposure to many trace metals. Chronic low-dose exposures to toxic elements such as cadmium and arsenic have been shown to cause these metals to accumulate in tissues over time, leading to multiple adverse effects in exposed individuals.
    No preview · Chapter · Jan 2013
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    Aletta Ann Frazier · Allen P Burke
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    ABSTRACT: Pulmonary hypertension (PH) is the remarkable hemodynamic consequence of widespread structural and functional changes within the pulmonary circulation. Elevated pulmonary vascular resistance leads to increased mean pulmonary arterial pressure and, ultimately, right ventricular dysfunction. PH carries a poor prognosis and warrants timely and accurate diagnosis for appropriate intervention. The 2008 Dana Point classification system provides the categorical framework currently guiding therapy and surveillance. Radiologic imaging is an essential tool in the detection and diagnostic evaluation of patients with PH. Echocardiography, ventilation-perfusion scintigraphy, multidetector computed tomography, and cardiac magnetic resonance imaging provide insights into vascular morphology, pulmonary parenchymal status, cardiac function, and underlying etiology of the disorder. Emerging techniques of functional pulmonary and cardiac imaging hold great promise for the assessment and monitoring of these patients in the future.
    Preview · Article · Dec 2012

Publication Stats

19k Citations
1,438.70 Total Impact Points


  • 1994-2015
    • University of Maryland, Baltimore
      • • Department of Medicine
      • • Department of Pathology
      Baltimore, Maryland, United States
  • 2007-2014
    • University of Maryland Medical Center
      • Department of Pathology
      Baltimore, Maryland, United States
    • Texas Heart Institute
      Houston, Texas, United States
    • Massachusetts General Hospital
      Boston, Massachusetts, United States
  • 2007-2009
    • CVPath Institute
      GAI, Maryland, United States
  • 1994-2009
    • German Historical Institute, Washington DC
      Washington, Washington, D.C., United States
  • 1988-2009
    • Armed Forces Institute of Pathology
      Ralalpindi, Punjab, Pakistan
  • 2008
    • Shady Grove Adventist Hospital
      Maryland, United States
  • 2006
    • Georgetown University
      Washington, Washington, D.C., United States
  • 2005
    • Mayo Clinic - Rochester
      Rochester, Minnesota, United States
  • 2004
    • Benaroya Research Institute
      Seattle, Washington, United States
    • Drexel University
      Filadelfia, Pennsylvania, United States
  • 2002
    • Washington DC VA Medical Center
      Washington, Washington, D.C., United States
    • American University Washington D.C.
      Washington, Washington, D.C., United States
    • Duke University
      Durham, North Carolina, United States
  • 2001
    • Louisiana State University Health Sciences Center New Orleans
      New Orleans, Louisiana, United States
    • Harvard University
      • Department of Molecular and Cell Biology
      Cambridge, Massachusetts, United States
  • 1996
    • The Ohio State University
      • Department of Biomedical Engineering
      Columbus, Ohio, United States
  • 1989
    • Uniformed Services University of the Health Sciences
      • Department of Radiobiology
      Maryland, United States