142 results on '"Ordonez NG"'
Search Results
2. HISTOLOGIC CHARACTERISTICS OF RESIDUAL RENAL-CELL CARCINOMA FOLLOWING INTERFERON-ALPHA-BASED THERAPY - CORRELATION WITH CLINICAL-PARAMETERS
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SHIN, HJC, primary, RO, JY, additional, SELLA, A, additional, AMIN, M, additional, ORDONEZ, NG, additional, and AYALA, AG, additional
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- 1995
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3. Critical airway obstruction due to pseudomembranous Aspergillus tracheitis.
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Grosu HB, Bashoura L, Ost D, Ordonez NG, and Faiz SA
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- Acute Disease, Adult, Airway Obstruction microbiology, Airway Obstruction therapy, Anti-Infective Agents therapeutic use, Antifungal Agents therapeutic use, Antineoplastic Agents therapeutic use, Aspergillus isolation & purification, Bronchoscopy, Cryotherapy, Dyspnea complications, Dyspnea etiology, Female, Humans, Immunocompromised Host, Leukemia drug therapy, Necrosis microbiology, Necrosis therapy, Neutropenia drug therapy, Neutropenia etiology, Radiography, Thoracic, Steroids adverse effects, Steroids therapeutic use, Tracheitis drug therapy, Tracheitis microbiology, Airway Obstruction etiology, Leukemia complications, Tracheitis complications, Voriconazole therapeutic use
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- 2014
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4. Bronchial chloroma.
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Faiz SA, Ordonez NG, Morice RC, Bashoura L, and Jimenez CA
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- Humans, Male, Middle Aged, Bronchial Neoplasms diagnosis, Sarcoma, Myeloid diagnosis
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- 2014
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5. Oral extragonadal yolk sac tumor in a patient with Aicardi syndrome: putative origin and differential diagnosis.
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Burch-Smith R, Ordonez NG, Ginsberg LE, Ater JL, and El Naggar AK
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- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Child, Preschool, Diagnosis, Differential, Endodermal Sinus Tumor drug therapy, Female, Humans, Mouth Neoplasms drug therapy, Aicardi Syndrome complications, Endodermal Sinus Tumor complications, Endodermal Sinus Tumor pathology, Mouth Neoplasms complications, Mouth Neoplasms pathology
- Abstract
We report, for the first time, a primary oral presentation of a germ cell yolk sac tumor in a 4-year-old girl with Aicardi syndrome. The diagnosis, differential diagnosis, and histogenesis are discussed., (Copyright © 2012 Elsevier Inc. All rights reserved.)
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- 2012
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6. Primary schwannoma in a cervical lymph node.
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Black JO, Zhai QJ, Varona OB, Ordonez NG, and Luna MA
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- Aged, Female, Head and Neck Neoplasms etiology, Head and Neck Neoplasms therapy, Humans, Neurilemmoma etiology, Neurilemmoma therapy, Head and Neck Neoplasms pathology, Lymph Nodes, Neurilemmoma pathology
- Abstract
Background: Spindle cell neoplasms within lymph nodes are rare and include benign and malignant tumors and primary and metastatic tumors such as palisaded myofibroblastoma, leiomyoma, leiomyosarcoma, reticular cell neoplasms, and vascular sarcomas. Ancillary studies may help distinguish these neoplasms., Methods: A 77-year-old white woman was seen with a painless, slowly growing mass of the left neck. Her clinical history was noncontributory. An excisional biopsy was performed without complication. There has been no recurrence, to date, of the lesion., Results: Gross examination, microscopic examination, immunohistochemistry, and ultrastructural studies were consistent with the diagnosis of schwannoma arising within a lymph node., Conclusions: We report the first case of intranodal schwannoma arising in a cervical lymph node. The recognition of intranodal schwannoma is important because it is cured with excision, whereas some of the other diagnostic considerations for a spindle cell lesion within a lymph node may require radiation or chemotherapy., ((c) 2009 Wiley Periodicals, Inc.)
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- 2010
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7. Uroplakin is not a reliable immunohistochemical marker for malignant mesothelioma of the pleura.
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Butnor KJ and Ordonez NG
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- Humans, Immunohistochemistry, Membrane Glycoproteins chemistry, Mesothelioma diagnosis, Mesothelioma pathology, Pleural Neoplasms diagnosis, Pleural Neoplasms pathology, Uroplakin III, Biomarkers, Tumor chemistry, Membrane Glycoproteins metabolism, Mesothelioma metabolism, Pleural Neoplasms metabolism
- Abstract
Aim: To analyze the immunohistochemical expression of uroplakin (URO) in pleural malignant mesothelioma (PMM)., Methods and Results: We analyzed URO expression in PMM using similar immunohistochemical techniques at 2 separate institutions. At an antibody dilution of 1:10, 0/5 PMMs were immunoreactive for URO. At 1:8, diffuse weak cytoplasmic staining was seen in all 38 PMMs tested, but no membrane staining was observed. Adjacent nontumor tissue and positive control tissue showed cytoplasmic staining of equivalent intensity. Similar staining results were observed in 27 PMMs at a 1:5 dilution., Conclusions: At an antibody dilution for which positive and negative control tissues stain appropriately, PMM does not stain for URO. At higher antibody concentrations, PMM exhibits nonspecific cytoplasmic staining. We assert that URO is not a useful immunohistochemical marker for the detection of PMM. Further studies addressing whether URO is overexpressed at the mRNA level in PMM are warranted.
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- 2008
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8. Concurrent epithelioid malignant peripheral nerve sheath tumor and papillary thyroid carcinoma in the treated field of Hodgkin's disease.
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Yildirim G, Gillenwater AM, Ordonez NG, Garden AS, and El-Naggar AK
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- Adult, Carcinoma, Papillary surgery, Epithelioid Cells pathology, Female, Hodgkin Disease radiotherapy, Humans, Neoplasms, Radiation-Induced pathology, Neoplasms, Radiation-Induced surgery, Neoplasms, Second Primary surgery, Nerve Sheath Neoplasms surgery, Peripheral Nervous System Neoplasms surgery, Thyroid Neoplasms surgery, Thyroidectomy, Carcinoma, Papillary pathology, Neoplasms, Second Primary pathology, Nerve Sheath Neoplasms pathology, Peripheral Nervous System Neoplasms pathology, Thyroid Neoplasms pathology
- Abstract
Background: Simultaneous malignancies in the field of radiation for Hodgkin's disease is an extremely rare event. A unique case of concurrent thyroid and neck mass in the postirradiation field of a young patient with Hodgkin's disease is presented., Methods and Results: Thyroidectomy and excision biopsy of the neck mass were performed. A 1.5-cm papillary thyroid carcinoma was identified in thyroidectomy and an initial diagnosis of undifferentiated malignant neoplasm was rendered on the neck mass biopsy. Subsequent surgical excision of the neck mass and immunohistochemical analysis revealed malignant peripheral nerve sheath tumor., Conclusion: Concurrent malignancies in the field of treatment of Hodgkin's disease may occur. Rare malignancies including malignant peripheral nerve sheath tumor may be encountered along with the more common papillary thyroid carcinoma.
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- 2008
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9. Epithelioid hemangioendothelioma of the head and neck: role of podoplanin in the differential diagnosis.
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Naqvi J, Ordonez NG, Luna MA, Williams MD, Weber RS, and El-Naggar AK
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- Adolescent, Aged, Biomarkers, Tumor metabolism, Child, Preschool, Combined Modality Therapy, Diagnosis, Differential, Female, Head and Neck Neoplasms therapy, Hemangioendothelioma, Epithelioid therapy, Humans, Male, Middle Aged, Treatment Outcome, Head and Neck Neoplasms diagnosis, Hemangioendothelioma, Epithelioid diagnosis, Membrane Glycoproteins metabolism
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Epithelioid hemangioendothelioma is an uncommon vascular tumor of soft tissue and bone that may rarely occur in the liver, lung and the head and neck. We present five new cases of epithelioid hemangioendothelioma of the head and neck region diagnosed and managed in one institution in order to define the phenotypic characteristics, podoplanin immunohistochemical staining and the biological outcome. Podoplanin is a transmembrane mucoprotein selectively expressed in lymphatic endothelium and recently in some vascular neoplasms. The patients were comprised of two male and three female patients ranging in age from 4 to 71 years. The lesions were found in the gingiva, submandibular region soft tissue, nasal cavity and tongue, and ranged in size from 0.7 to 2.5 cm. All tumors manifested infiltrative cords and nests of epithelioid cells with occasional spindle morphology in a myxoid stroma. Immunohistochemical analysis of vascular and epithelial markers showed strong and uniform cytoplasmic reactivity for podoplanin and variable intensity and staining of CD31 and lack of cytokeratin staining in tumor cells. Surgical treatment included simple and wide local excisions. Of the three patients with follow-up, one developed lymph node metastasis and one had no evidence of disease 10 months after surgery. The patient with multiple recurrences and LN metastases was additionally treated with chemotherapy and is under consideration for radiation therapy. Hemangioendothelioma of the head and neck is: (1) a low-grade malignancy with a tendency for local recurrence and regional lymph node metastasis, (2) complete excision with negative margins is the treatment of choice for localized disease and (3) podoplanin may be useful in differentiating epithelioid hemangioendothelioma from non-vascular tumors.
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- 2008
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10. Thyroid transcription factor-1 expression in endometrial and endocervical adenocarcinomas.
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Siami K, McCluggage WG, Ordonez NG, Euscher ED, Malpica A, Sneige N, Silva EG, and Deavers MT
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- Adenocarcinoma pathology, Carcinoma, Endometrioid pathology, Cell Differentiation, Cell Nucleus chemistry, Cystadenocarcinoma, Serous pathology, Endometrial Neoplasms pathology, Female, Humans, Neoplasm Staging, Northern Ireland, Texas, Thyroid Nuclear Factor 1, Uterine Cervical Neoplasms pathology, Uterine Neoplasms pathology, Adenocarcinoma chemistry, Biomarkers, Tumor analysis, Carcinoma, Endometrioid chemistry, Cystadenocarcinoma, Serous chemistry, Endometrial Neoplasms chemistry, Nuclear Proteins analysis, Transcription Factors analysis, Uterine Cervical Neoplasms chemistry, Uterine Neoplasms chemistry
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Thyroid transcription factor-1 (TTF-1) is widely used in the diagnosis of lung and thyroid carcinomas. Although there have been reports of TTF-1 immunoreactivity in tumors other than those originating in the lung or thyroid, endocervical and endometrial adenocarcinomas have not been studied in large numbers. Our study provides data regarding the incidence and distribution of TTF-1 expression in these tumors. Twenty-eight endocervical (9 well, 12 moderately, and 7 poorly differentiated), 32 endometrioid endometrial adenocarcinomas (11 grade I, 8 grade II, and 13 grade III), and 13 uterine serous carcinomas were retrieved and stained with TTF-1. None of the tumors had a neuroendocrine component. The hematoxylin and eosin and anti-TTF-1 antibody stained sections were reviewed, and the presence and distribution of TTF-1 nuclear positivity was recorded. A semiquantitative grading system used to evaluate the distribution of TTF-1 staining (0 = negative, 1+ = <5%, 2+ = 5% to 25%, 3+ = 26% to 50%, 4+ = 51% to 75%, and 5+ = >75%). TTF-1 expression was seen in 1 of 28 (4%) of the endocervical adenocarcinomas and this was 4+ in distribution. The positive endocervical carcinoma was poorly differentiated. TTF-1 expression was present in 6 of 32 (19%) of the endometrioid adenocarcinomas (1 grade I, 2 grade II, and 3 grade III) and varied from 1+ to 4+ in distribution. Only 2 of 32 (6%) of the endometrioid adenocarcinomas stained diffusely (4+). There was no apparent correlation between the degree of differentiation and TTF-1 positivity in the adenocarcinomas. Three of 13 (23%) serous carcinomas were also positive (1 case 5+ and 2 cases 1+). Although TTF-1 is generally considered to be a relatively specific marker for lung and thyroid neoplasms, the occasional expression of endometrial and endocervical carcinomas should be kept in mind when evaluating neoplasms of uncertain origin. It should also be taken into consideration in the evaluation of adenocarcinomas involving the lung in patients with a history of a gynecologic malignancy.
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- 2007
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11. Recommendations for the reporting of pleural mesothelioma.
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Butnor KJ, Sporn TA, and Ordonez NG
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- Humans, Societies, Medical, United States, Medical Records standards, Mesothelioma pathology, Pathology, Clinical standards, Pleural Neoplasms pathology
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It has been evident for decades that pathology reports are very variable even within a single institution. Standardization of reporting is the optimal way to ensure that information necessary for patient management, prognostic and predictive factor assessment, grading, staging, analysis of outcomes, and tumor registries is included in pathology reports. In recent years, 2 societies (first the Association of Directors of Anatomic and Surgical Pathology [ADASP] and then the College of American Pathologists [CAP]) have undertaken to publish guidelines for the reporting of common cancers. The CAP assigned multidisciplinary groups of pathologists, surgeons, radiation, and medical oncologists to develop the protocols. Other pathologists and clinicians then reviewed them. After those reviews the protocols were reviewed by multiple CAP committees and finally approved by the Board of Governors. The ADASP, in contrast, chose a pathologist expert in each filed to assemble a group from within the pathology community (with clinician input if desired) to write specific cancer protocols. These were then approved by the ADASP council and subsequently by the membership. Although both societies began the process at approximately the same time, the streamlined approach adopted by the ADASP enabled them to publish years earlier in pathology journals frequented by anatomic pathologists. Although the formats are somewhat different, the contents are essentially the same. The American College of Surgery Commission on Cancer (COC) accredits cancer centers in the United States. Recently, the COC decided to require elements, deemed as essential by the CAP, to be described in all pathology reports in their accredited cancer centers as of January 2004. Importantly, they do not require that the specific CAP protocols or synoptic reports be used. The ADASP has updated all of its protocols to comply with the COC requirements in the form of 37 uniform checklists. The checklists use the staging criteria sited in the American Joint Committee on Cancer 2002 Staging Manual (sixth edition) but include a variety of other references listed in each of the checklists. Moreover, the checklists are formatted for ease of use. They may be used as templates for uniform reporting and are designed to be compatible with voice-activated transcription. The different elements in these revised ADASP diagnostic checklists have been divided into required and optional. The term required in this context only signifies compliance with the COC guidelines. The ADASP realizes that specimens and practices vary, and it will not be possible to report these elements in every case. However, the ADASP hopes that pathologists will find these checklists to be useful in daily clinical practice, while facilitating compliance with the new COC requirements.
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- 2007
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12. Sarcomatoid carcinoma of the lung: a predictor of poor prognosis.
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Martin LW, Correa AM, Ordonez NG, Roth JA, Swisher SG, Vaporciyan AA, Walsh GL, and Rice DC
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- Adult, Aged, Carcinoma, Non-Small-Cell Lung mortality, Carcinoma, Non-Small-Cell Lung pathology, Female, Humans, Lung Neoplasms mortality, Lung Neoplasms pathology, Male, Middle Aged, Neoplasm Recurrence, Local, Prognosis, Retrospective Studies, Survival Rate, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms surgery
- Abstract
Background: Sarcomatoid cancer (SARC) of the lung is a rare histologic type of non-small cell lung cancer (NSCLC). Although believed to be associated with poor prognosis, its effect on survival and recurrence has not been well defined. Our goal was to determine the prognostic significance of SARC histology in patients undergoing pulmonary resection., Methods: We retrospectively evaluated all patients who underwent pulmonary resection for NSCLC during a 20-year period at the University of Texas MD Anderson Cancer Center and compared recurrence and survival rates of patients with SARC with a cohort of patients with typical NSCLC. To account for known prognostic factors such as smoking status, age, gender, pathologic stage, and adjuvant therapy, we used one-to-one matching based on propensity scores., Results: The study included 63 SARC patients and 1133 NSCLC patients with complete data. Propensity score matching identified 63 NSCLC patients that were similar to the 63 SARC patients from known clinical factors. The 5-year survival for SARC patients was 24.5% compared with 46.3% for NSCLC patients (p = 0.01); median time to recurrence was 11.3 months and 61.4 months, respectively (p = 0.001)., Conclusions: Compared with other histologic subtypes, SARC behaves in an aggressive fashion. These tumors are frequently symptomatic, are locally advanced, and have higher rates of recurrence. Future investigation of novel treatment approaches is warranted. Nonsurgical treatment modalities may be appropriate for patients with clinically advanced disease.
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- 2007
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13. Inhibition of c-Src expression and activation in malignant pleural mesothelioma tissues leads to apoptosis, cell cycle arrest, and decreased migration and invasion.
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Tsao AS, He D, Saigal B, Liu S, Lee JJ, Bakkannagari S, Ordonez NG, Hong WK, Wistuba I, and Johnson FM
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- Cell Line, Tumor, Dasatinib, Enzyme Activation drug effects, Exons genetics, Female, Gene Expression Regulation, Neoplastic drug effects, Humans, Inhibitory Concentration 50, Male, Mesothelioma enzymology, Mutation genetics, Neoplasm Invasiveness prevention & control, Neoplasm Metastasis, Neoplasm Staging, Pleural Neoplasms enzymology, Protein Kinase Inhibitors pharmacology, Proto-Oncogene Proteins pp60(c-src) genetics, Proto-Oncogene Proteins pp60(c-src) metabolism, Signal Transduction drug effects, Apoptosis drug effects, Cell Cycle drug effects, Cell Movement drug effects, Mesothelioma pathology, Pleural Neoplasms pathology, Proto-Oncogene Proteins pp60(c-src) antagonists & inhibitors, Pyrimidines pharmacology, Thiazoles pharmacology
- Abstract
Malignant pleural mesothelioma (MPM) is a deadly disease with few systemic treatment options. One potential therapeutic target, the non-receptor tyrosine kinase c-Src, causes changes in proliferation, motility, invasion, survival, and angiogenesis in cancer cells and may be a valid therapeutic target in MPM. To test this hypothesis, we determined the effects of c-Src inhibition in MPM cell lines and examined c-Src expression and activation in tissue samples. We analyzed four MPM cell lines and found that all expressed total and activated c-Src. Three of the four cell lines were sensitive by in vitro cytotoxicity assays to the c-Src inhibitor dasatinib, which led to cell cycle arrest and increased apoptosis. Dasatinib also inhibited migration and invasion independent of the cytotoxic effects, and led to the rapid and durable inhibition of c-Src and its downstream pathways. We used immunohistochemical analysis to determine the levels of c-Src expression and activation in 46 archived MPM tumor specimens. The Src protein was highly expressed in tumor cells, but expression did not correlate with survival. However, expression of activated Src (p-Src Y419) on the tumor cell membrane was higher in patients with advanced-stage disease; the presence of metastasis correlated with higher membrane (P = 0.03) and cytoplasmic (P = 0.04) expression of p-Src Y419. Lower levels of membrane expression of inactive c-Src (p-Src Y530) correlated with advanced N stage (P = 0.02). Activated c-Src may play a role in survival, metastasis, and invasion of MPM, and targeting c-Src may be an important therapeutic strategy.
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- 2007
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14. Mucinous tubular and spindle cell carcinoma of kidney is probably a variant of papillary renal cell carcinoma with spindle cell features.
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Shen SS, Ro JY, Tamboli P, Truong LD, Zhai Q, Jung SJ, Tibbs RG, Ordonez NG, and Ayala AG
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- Adenocarcinoma metabolism, Adenocarcinoma, Mucinous metabolism, Adult, Aged, Antigens, Neoplasm metabolism, Biomarkers, Tumor metabolism, Cadherins metabolism, Carcinoma metabolism, Carcinoma, Papillary metabolism, Carcinoma, Renal Cell metabolism, Female, Humans, Keratin-7 metabolism, Kidney Neoplasms metabolism, Lewis X Antigen metabolism, Male, Middle Aged, Mitogen-Activated Protein Kinases metabolism, Necrosis pathology, Neprilysin metabolism, Racemases and Epimerases metabolism, Adenocarcinoma pathology, Adenocarcinoma, Mucinous pathology, Carcinoma pathology, Carcinoma, Papillary pathology, Carcinoma, Renal Cell pathology, Kidney Neoplasms pathology
- Abstract
Mucinous tubular and spindle cell carcinoma is a rare and newly described type of renal cell carcinoma (RCC) with a relatively indolent behavior. However, its histogenetic origin or line of differentiation remains unclear. Twelve cases of mucinous tubular and spindle cell carcinoma were identified and retrieved from the files of 3 institutions. Detailed morphological features, as well as their immunohistochemical profile established with markers of proximal renal tubules (RCC marker antigen, CD15, and alpha-methylacyl-CoA racemase) and of distal renal tubules (kidney-specific cadherin and cytokeratin 7), were studied. The age range of the patients was 35 to 73 years with a median of 56 years. The male to female ratio was 1:3. All of the patients were alive with follow-up between 4 and 38 months. All the tumors were confined to the kidney with a mean tumor size of 6.9 cm (range, 1.8-17 cm). The tumors were composed of variable proportions of tubular and spindle cell areas with focal to prominent mucinous or myxoid stroma. Foamy macrophages were seen in 10 cases and were prominent in 4 cases. A focal compressed tubulopapillary growth pattern was seen in 10 cases. The tumor cells were uniformly cuboidal with ovoid to round nuclei and inconspicuous nucleoli (Furhman nuclear grade 3 in 6 cases). Focal necrosis was seen in 3 cases. Immunostains showed that tumors were positive for RCC marker antigen (11/12), alpha-methylacyl-CoA racemase (11/12), CD15 (8/12), CD10 (2/12), kidney-specific cadherin (1/12), and cytokeratin 7 (11/12). Its morphological features as well as a strong preferential expression of proximal tubule markers suggest that this tumor is a type of RCC with proximal tubular differentiation, which appears closely related to or represents a morphological variant of papillary RCC.
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- 2007
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15. Extended surgical staging for potentially resectable malignant pleural mesothelioma.
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Rice DC, Erasmus JJ, Stevens CW, Vaporciyan AA, Wu JS, Tsao AS, Walsh GL, Swisher SG, Hofstetter WL, Ordonez NG, and Smythe WR
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- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pneumonectomy methods, Mesothelioma pathology, Mesothelioma surgery, Neoplasm Staging methods, Pleural Neoplasms pathology, Pleural Neoplasms surgery
- Abstract
Background: Extrapleural pneumonectomy for malignant pleural mesothelioma (MPM) is a high-risk procedure, and patients require careful preoperative staging to exclude advanced disease. Computed tomography, magnetic resonance imaging, and positron emission tomography are useful staging modalities, but do not reliably identify contralateral mediastinal involvement or transdiaphragmatic invasion. We evaluated the role of extended surgical staging procedures, which generally includes a combination of laparoscopy, peritoneal lavage, and mediastinoscopy, to more precisely stage patients with MPM., Methods: One hundred eighteen patients with MPM, deemed clinically and radiologically resectable, underwent extended surgical staging. Mediastinoscopy was performed in 111 patients, laparoscopy in 109 patients, and peritoneal lavage in 78 patients., Results: Ten (9.2%) patients had gross evidence of transdiaphragmatic or peritoneal involvement. Peritoneal lavage was positive for metastatic MPM in 2 (2.6%) patients, neither of whom had obvious transdiaphragmatic invasion. Ipsilateral mediastinal nodes contained metastatic tumor in 10 of 62 (16.1%) patients. Contralateral nodes were positive in 4 of 111 (3.6%) patients. Of the patients who underwent biopsy of both ipsilateral and contralateral mediastinal nodes, and who had complete pathologic staging after extrapleural pneumonectomy (n = 46), 14 (30.4%) had N2-positive nodes. Only 5 of these patients were correctly identified by mediastinoscopy (sensitivity 36%, accuracy 80%). Extended surgical staging identified 16 (13.6%) patients who had contralateral nodal involvement, transdiaphragmatic invasion, or positive peritoneal cytology., Conclusions: Extended surgical staging defines an important subset of patients with unresectable MPM not identified by imaging. Because of the potential morbidity associated with extrapleural pneumonectomy, we advocate that extended surgical staging be performed in all patients with MPM before resection.
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- 2005
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16. Fine needle aspiration cytology of a low grade myxoid renal epithelial neoplasm: a case report.
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Sun W, McGregor DK, Ordonez NG, Ayala AG, and Caraway NP
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- Biopsy, Fine-Needle, Carcinoma classification, Carcinoma diagnostic imaging, Cell Nucleus pathology, Cell Nucleus ultrastructure, Epithelial Cells ultrastructure, Female, Humans, Keratins metabolism, Kidney diagnostic imaging, Kidney Neoplasms classification, Kidney Neoplasms diagnostic imaging, Lewis X Antigen metabolism, Microscopy, Electron, Transmission, Microvilli pathology, Microvilli ultrastructure, Middle Aged, Nephrectomy, Prognosis, Tomography, X-Ray Computed, Vimentin metabolism, Carcinoma pathology, Epithelial Cells pathology, Kidney pathology, Kidney Neoplasms pathology
- Abstract
Background: Recently, several case reports have described a rare but distinct subtype of renal tumor, referred to as a "low grade renal epithelial neoplasm," that appears to have a better prognosis than conventional renal cell carcinoma does. This report describes the cytologic features of this tumor as determined by fine needle aspiration (FNA) biopsy., Case: A 53-year-old woman with a history of lymphoma had a renal mass incidentally discovered on an abdominal computed tomographic scan performed for lymphoma restaging. Results of an FNA biopsy showed relatively uniform, medium-sized tumor cells with moderate amounts of finely vacuolated or wispy cytoplasm and indistinct cell borders. The nuclei were primarily round with coarse chromatin and had prominent nucleoli. In the cell block preparation, the tumor cells showed a tubular architecture and an abundant myxoid matrix. The patient underwent a partial nephrectomy. The tumor was classified as a low grade myxoid renal epithelial tumor., Conclusion: This unusual kidney tumor appears to have distinctive cytomorphologic features, including a uniform population of epithelial cells with round nuclei, an abundant myxoid matrix and tubular architecture.
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- 2005
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17. Localized malignant mesothelioma.
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Allen TC, Cagle PT, Churg AM, Colby TV, Gibbs AR, Hammar SP, Corson JM, Grimes MM, Ordonez NG, Roggli V, Travis WD, and Wick MR
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- Adult, Aged, Female, Humans, Male, Mesothelioma metabolism, Mesothelioma surgery, Middle Aged, Neoplasm Invasiveness pathology, Peritoneal Neoplasms metabolism, Peritoneal Neoplasms surgery, Pleural Neoplasms metabolism, Pleural Neoplasms surgery, Prognosis, Treatment Outcome, Mesothelioma pathology, Peritoneal Neoplasms pathology, Pleural Neoplasms pathology
- Abstract
Localized malignant mesotheliomas are uncommon sharply circumscribed tumors of the serosal membranes with the microscopic appearance of diffuse malignant mesothelioma but without any evidence of diffuse spread. Little is known about their behavior. We report 23 new cases. The mean age at presentation was 63 years, and the sex ratio was approximately 2:1 (male/female). Twenty-one tumors were pleural and 2 were peritoneal. Sixteen tumors reproduced microscopic patterns of diffuse epithelial mesotheliomas, 6 had mixed epithelial and sarcomatous patterns, and 1 was purely sarcomatous. After surgical excision of the tumor, 10 of 21 patients with follow-up data were alive without evidence of disease from 18 months to 11 years after diagnosis. Patients who died had developed local recurrences and metastases, but none had diffuse pleural spread. Localized malignant mesotheliomas should be separated from diffuse malignant mesotheliomas because of their localized presentation, quite different biologic behavior, and far better prognosis.
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- 2005
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18. The Wt1+/R394W mouse displays glomerulosclerosis and early-onset renal failure characteristic of human Denys-Drash syndrome.
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Gao F, Maiti S, Sun G, Ordonez NG, Udtha M, Deng JM, Behringer RR, and Huff V
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- Adaptor Proteins, Signal Transducing, Animals, Base Sequence, Cell Division, Cytoskeletal Proteins, DNA genetics, Denys-Drash Syndrome pathology, Disease Models, Animal, Female, Gene Expression, Glomerulosclerosis, Focal Segmental genetics, Glomerulosclerosis, Focal Segmental pathology, Humans, Intracellular Signaling Peptides and Proteins, Male, Membrane Proteins genetics, Mice, Mice, Inbred C57BL, Mice, Mutant Strains, Microscopy, Electron, Phenotype, Point Mutation, Proteins genetics, Renal Insufficiency genetics, Renal Insufficiency pathology, Species Specificity, Denys-Drash Syndrome genetics, Genes, Wilms Tumor
- Abstract
Renal failure is a frequent and costly complication of many chronic diseases, including diabetes and hypertension. One common feature of renal failure is glomerulosclerosis, the pathobiology of which is unclear. To help elucidate this, we generated a mouse strain carrying the missense mutation Wt1 R394W, which predisposes humans to glomerulosclerosis and early-onset renal failure (Denys-Drash syndrome [DDS]). Kidney development was normal in Wt1(+/R394W) heterozygotes. However, by 4 months of age 100% of male heterozygotes displayed proteinuria and glomerulosclerosis characteristic of DDS patients. This phenotype was observed in an MF1 background but not in a mixed B6/129 background, suggestive of the action of a strain-specific modifying gene(s). WT1 encodes a nuclear transcription factor, and the R394W mutation is known to impair this function. Therefore, to investigate the mechanism of Wt1 R394W-induced renal failure, the expression of genes whose deletion leads to glomerulosclerosis (NPHS1, NPHS2, and CD2AP) was quantitated. In mutant kidneys, NPHS1 and NPHS2 were only moderately downregulated (25 to 30%) at birth but not at 2 or 4 months. Expression of CD2AP was not changed at birth but was significantly upregulated at 2 and 4 months. Podocalyxin was downregulated by 20% in newborn kidneys but not in kidneys at later ages. Two other genes implicated in glomerulosclerosis, TGFB1 and IGF1, were upregulated at 2 months and at 2 and 4 months, respectively. It is not clear whether the significant alterations in gene expression are a cause or a consequence of the disease process. However, the data do suggest that Wt1 R394W-induced glomerulosclerosis may be independent of downregulation of the genes for NPHS1, NPHS2, CD2AP, and podocalyxin and may involve other genes yet to be implicated in renal failure. The Wt1(R394W) mouse recapitulates the pathology and disease progression observed in patients carrying the same mutation, and the mutation is completely penetrant in male animals. Thus, it will be a powerful and biologically relevant model for investigating the pathobiology of the earliest events in glomerulosclerosis.
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- 2004
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19. Trastuzumab in combination with cisplatin and gemcitabine in patients with Her2-overexpressing, untreated, advanced non-small cell lung cancer: report of a phase II trial and findings regarding optimal identification of patients with Her2-overexpressing disease.
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Zinner RG, Glisson BS, Fossella FV, Pisters KM, Kies MS, Lee PM, Massarelli E, Sabloff B, Fritsche HA Jr, Ro JY, Ordonez NG, Tran HT, Yang Y, Smith TL, Mass RD, and Herbst RS
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- Aged, Aged, 80 and over, Antibodies, Monoclonal administration & dosage, Antibodies, Monoclonal pharmacokinetics, Antibodies, Monoclonal, Humanized, Antineoplastic Combined Chemotherapy Protocols adverse effects, Carcinoma, Non-Small-Cell Lung pathology, Cisplatin administration & dosage, Cisplatin pharmacokinetics, Deoxycytidine administration & dosage, Deoxycytidine pharmacokinetics, Female, Humans, Lung Neoplasms pathology, Male, Middle Aged, Survival Analysis, Trastuzumab, Up-Regulation, Gemcitabine, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung genetics, Deoxycytidine analogs & derivatives, Lung Neoplasms drug therapy, Lung Neoplasms genetics, Receptor, ErbB-2 biosynthesis
- Abstract
The purpose of this study was to evaluate the feasibility, efficacy, safety, and pharmacokinetics of trastuzumab plus cisplatin and gemcitabine in patients with Her2-overexpressing stages IIIB or IV non-small cell lung cancer (NSCLC) and to study the relationship between results from the two methods for determining levels of Her2 overexpression. Chemonaive patients were eligible if they had stages IIIB or IV NSCLC with either a Her2 score of at least 1+ by immunohistochemical (IHC) analysis or a serum Her2 shed antigen level of at least 15 ng/ml by enzyme-linked immunosorbent assay (ELISA). Treatment consisted of cisplatin 75 mg/m(2) day one plus gemcitabine 1250 mg/m(2) days one and eight plus trastuzumab 4 mg/kg day one and 2 mg/kg weekly thereafter on a 21-day cycle for six cycles followed by weekly maintenance trastuzumab therapy. Of the 21 patients enrolled, 8 (38%) patients had a partial response. The 1-year survival rate was 62% (13/21). Median time to progression was 36 weeks. Pharmacokinetic studies revealed no interaction between trastuzumab and gemcitabine plus cisplatin. In patients screened for this study, Her2 expression was zero in 283/360 (79%); 1+ in 32/360 (9%); 2+ in 27/360 (8%); and 3+ in 18/360 patients (5%). Serum Her2 shed antigen was >15 ng/ml in 27/ 288 (9%) patients. Of patients who had both Her2 assays, 24% (4/17) with ELISA scores >15 ng/ml had IHC scores of 3+, compared with only 2% (3/145) of the patients <15 ng/ml and 4% (7/162) of all patients. The addition of trastuzumab to cisplatin and gemcitabine was well tolerated, but further study will be required to determine whether this combination is superior to chemotherapy alone. This may be demonstrated if only those patients with Her2, having a score of IHC 3+ were eligible. Since IHC 3+ is rare in NSCLC, performing IHC in only those patients with serum Her2 shed antigen >15 ng/ml would greatly increase the efficiency of IHC screening though at the cost of excluding nearly half the patients with Her2 scores of 3+ on IHC analysis. Thus, if sequential screening consisting of serum ELISA followed by IHC analysis is implemented, it may make a trastuzumab trial feasible but should ultimately be supplanted by another screening system if trastuzumab is shown to be beneficial to some patients with IHC Her2 scores of 3+.
- Published
- 2004
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20. Ovarian steroid cell tumors: an immunohistochemical study including a comparison of calretinin with inhibin.
- Author
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Deavers MT, Malpica A, Ordonez NG, and Silva EG
- Subjects
- Calbindin 2, Diagnosis, Differential, Female, Humans, Immunohistochemistry, Inhibins biosynthesis, Melanoma metabolism, Melanoma pathology, Ovarian Neoplasms pathology, Retrospective Studies, S100 Calcium Binding Protein G biosynthesis, Sensitivity and Specificity, Sex Cord-Gonadal Stromal Tumors pathology, Biomarkers, Tumor analysis, Ovarian Neoplasms metabolism, Sex Cord-Gonadal Stromal Tumors metabolism
- Abstract
Ovarian steroid cell tumors, not otherwise specified (SCTs, NOS) are uncommon sex cord-stromal tumors that may be difficult to distinguish from other oxyphilic or clear-cell neoplasms. Immunohistochemical staining for inhibin, although generally useful in the diagnosis of SCTs, NOS, is not positive in every case and not all laboratories have this marker available. Recently, it has been reported that calretinin is expressed by sex cord-stromal tumors. We studied six SCTs, NOS for both calretinin and inhibin expression to evaluate the sensitivity of calretinin in comparison to inhibin. We also tested for CD99, Melan-A (A103), and S-100, other markers reported to be positive in these tumors. HMB-45 and MART-1 (Ab3) completed our panel of markers. All six tumors were positive for both calretinin and inhibin. Calretinin positivity was present in 60% to >90% of tumor cells, whereas inhibin reactivity ranged from <5% to >90% of tumor cells. Membranous staining for CD99 was present in one tumor. S-100-positive cells were seen in two tumors, whereas four tumors were immunoreactive for HMB-45. All six tumors were positive for Melan-A (A103), but in general the staining was less diffuse than with calretinin. All of the tumors were essentially negative for MART-1 (Ab3). The consistent diffuse staining of the tumors in this study for calretinin, in comparison to inhibin and Melan-A (A103), suggests that it is a sensitive marker for SCTs, NOS. MART-1 (Ab3) immunostaining may be useful for cases in which melanoma is considered in the differential diagnosis.
- Published
- 2003
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21. Adenocarcinomas of the gastrointestinal tract with prominent rhabdoid features.
- Author
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Amrikachi M, Ro JY, Ordonez NG, and Ayala AG
- Subjects
- Adenocarcinoma metabolism, Adenocarcinoma ultrastructure, Aged, Diagnosis, Differential, Female, Gastrointestinal Neoplasms metabolism, Gastrointestinal Neoplasms ultrastructure, Humans, Immunohistochemistry, Male, Melanoma pathology, Microscopy, Electron, Middle Aged, Retrospective Studies, Rhabdoid Tumor pathology, Sarcoma pathology, Treatment Outcome, Adenocarcinoma pathology, Gastrointestinal Neoplasms pathology
- Abstract
Rhabdoid tumor, first described in kidneys of infants and children, is an aggressive tumor that has been reported in several extrarenal locations. Gastrointestinal tumors with rhabdoid features are extremely rare. The effect of the rhabdoid phenotype on the aggressiveness of gastrointestinal tumors remains unclear. We present four cases of rhabdoid tumors of the gastrointestinal tract involving the esophagus, stomach, and small intestine and discuss the clinicopathologic, immunohistochemical, and ultrastructural features. In the four cases reported herein, the patients' ages ranged from 52 to 73 years, and tumor size ranged from 3.8 to 13 cm in greatest dimension. The noncohesive rhabdoid cells exhibited an eccentric nucleus with a paranuclear inclusion, which was shown by electron microscopic examination to be composed of intermediate filaments. On immunohistochemical staining, the tumor cells were positive for vimentin and cytokeratin. Three patients developed distant metastasis shortly after diagnosis and died of disease within 2 to 10 months after initial presentation. A retrospective review of outcomes of the current cases and previously published literature showed that 12 (75%) of the 16 patients died within 6 months of presentation. Recognition of the rhabdoid phenotype in gastrointestinal tract neoplasms is important because this feature is associated with poor prognosis and unresponsiveness to conventional therapy., (Copyright 2002, Elsevier Science (USA). All rights reserved.)
- Published
- 2002
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22. A detailed evaluation of cardiac toxicity: a phase II study of doxorubicin and one- or three-hour-infusion paclitaxel in patients with metastatic breast cancer.
- Author
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Giordano SH, Booser DJ, Murray JL, Ibrahim NK, Rahman ZU, Valero V, Theriault RL, Rosales MF, Rivera E, Frye D, Ewer M, Ordonez NG, Buzdar AU, and Hortobagyi GN
- Subjects
- Adult, Aged, Antineoplastic Agents adverse effects, Antineoplastic Agents, Phytogenic adverse effects, Breast Neoplasms mortality, Dose-Response Relationship, Drug, Doxorubicin adverse effects, Female, Humans, Middle Aged, Neoplasm Metastasis, Paclitaxel adverse effects, Time Factors, Treatment Outcome, Antineoplastic Agents therapeutic use, Antineoplastic Agents, Phytogenic therapeutic use, Breast Neoplasms drug therapy, Breast Neoplasms pathology, Doxorubicin therapeutic use, Heart drug effects, Paclitaxel therapeutic use
- Abstract
Purpose: This Phase II study was designed to determine the efficacy and toxicity of combination doxorubicin and paclitaxel as front-line treatment for metastatic breast cancer., Experimental Design: Eligible patients had no prior anthracycline or taxane therapy and normal cardiac function. They were treated with bolus doxorubicin 60 mg/m2, followed by paclitaxel 200 mg/m2, as either 1- or 3-h infusions for six to seven cycles. Single-agent paclitaxel was continued thereafter. Serial multiple gated acquisition scans were performed, and endomyocardial biopsies were performed for consenting patients., Results: Eighty-two patients were enrolled with a median age of 53 years (range, 32-78 years). Of 79 evaluable patients, 58.2% had an objective response (3.8% complete response + 54.4% partial response), 34.2% had stable disease, and 7.6% had progressive disease. With median follow-up of 37.5 months, median time to progression was 7 months; median survival was 31 months. Multiple gated acquisition scans were performed in 82 of 82 patients at baseline, 75 of 82 patients at a total doxorubicin dose of 60-180 mg/m2, 62 of 68 patients at 200-300 mg/m2, 18 of 52 patients at 310-360 mg/m2, and 4 of 8 patients at 420 mg/m2. Median ejection fractions were 62.5, 60, 57.5, 52.5, and 32%, respectively. Fifteen of 82 (18.3%) patients had a decrease in ejection fraction > or = 15% to an absolute ejection fraction < or = 50%. Eight of these 15 patients (53%) developed clinical congestive heart failure: 4 of 8 (50%) who received a total doxorubicin dose of 420 mg/m2 versus 4 of 74 (5.4%) who received a dose < or = 360 mg/m2 (P = 0.002)., Conclusions: When the doxorubicin dose exceeds 360 mg/m2, the combination of bolus doxorubicin and paclitaxel presents unacceptable cardiac risk.
- Published
- 2002
23. Extranodal follicular dendritic cell sarcoma of the head and neck region: three new cases, with a review of the literature.
- Author
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Biddle DA, Ro JY, Yoon GS, Yong YW, Ayala AG, Ordonez NG, and Ro J
- Subjects
- Adult, Biomarkers, Tumor analysis, Carrier Proteins analysis, Dendritic Cells, Follicular chemistry, Female, Giant Cells, Humans, Immunoenzyme Techniques, Male, Microfilament Proteins analysis, Middle Aged, Pharyngeal Neoplasms chemistry, Pharyngeal Neoplasms surgery, Receptors, Complement 3b analysis, Receptors, Complement 3d analysis, Sarcoma chemistry, Sarcoma surgery, Tonsillar Neoplasms chemistry, Tonsillar Neoplasms surgery, Treatment Outcome, Dendritic Cells, Follicular pathology, Pharyngeal Neoplasms pathology, Sarcoma pathology, Tonsillar Neoplasms pathology
- Abstract
Extranodal follicular dendritic cell (FDC) sarcoma of the head and neck region is uncommon, with 16 well-documented cases previously reported (four in the tonsil, four in the pharynx, two in the palate, five in the soft tissue, and one in the thyroid). We here report an additional three cases of extranodal FDC sarcoma in the tonsil (two cases) and pharynx (one case). In these new cases, the neoplastic cells were arranged in diffuse, fascicular, and vaguely whorled growth patterns. A background lymphocytic infiltrate was sprinkled throughout the neoplasms, with focal prominent perivascular cuffing. Scattered multinucleated giant cells were present. Immunohistochemically, tumor cells were strongly and diffusely positive for follicular dendritic cell markers CD21 and CD35. Tumor cells were diffusely positive for fascin and negative for leukocyte common antigen, S-100 protein, cytokeratin, and Epstein-Barr virus (EBV) latent membrane protein-1 (EBV-LMP). EBV was also not detected in the tumor cells by in situ hybridization for EBV-encoded RNAs. FDC sarcomas are probably an underrecognized neoplasm, especially when they occur in extranodal sites in the head and neck region. Two of the three new cases we report were initially misdiagnosed, and five cases of extranodal FDC sarcoma in the head and neck region reported in the recent literature were initially misdiagnosed. Our aim is to complement the current understanding of this neoplasm and alert pathologists to this rare entity in this region to avoid misdiagnosis. Recognition of extranodal FDC sarcoma requires a high index of suspicion, but this tumor has numerous distinctive histological features that should bring the neoplasm into the differential diagnosis. Confirmatory immunohistochemical staining with follicular dendritic cell markers such as CD21 and/or CD35 is essential for the diagnosis. Correct characterization of this neoplasm is imperative given its potential for recurrence and metastasis.
- Published
- 2002
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24. Ciliated epithelia in the urethra: case report and literature review.
- Author
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Che M, Ro JY, Ordonez NG, Miller RW, and Ayala AG
- Subjects
- Adult, Biopsy, Humans, Male, Microscopy, Electron, Cilia ultrastructure, Endothelium ultrastructure, Urethra ultrastructure
- Abstract
The presence of ciliated epithelial cells in the urethra has not been well recognized. Only two reports in the literature, both of which used scanning microscopy studies, have described this phenomenon. In this report, we illustrate the presence of scattered, ciliated epithelial cells in penile urethral biopsy specimens from a 38-year-old man with a history of bladder calculi and hematuria, by both light and transmission electron microscopy studies. The cilia in the urethra showed typical light microscopic and ultrastructural features of those seen in other organs. These ciliated cells are present in association with urothelial papilloma, condyloma acuminatum and acute inflammation of the urethra. These findings suggest that ciliated cells in the penile 0 urethra might be a consequence of metaplastic change of the urothelium, secondary to local stimulation or irritation.
- Published
- 2001
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25. Reticulum cell sarcoma of lymph node with mixed dendritic and fibroblastic features.
- Author
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Jones D, Amin M, Ordonez NG, Glassman AB, Hayes KJ, and Medeiros LJ
- Subjects
- Adult, CD40 Antigens analysis, Chromosome Aberrations, Dendritic Cells, Follicular pathology, Fibroblasts pathology, Humans, Immunohistochemistry, Karyotyping, Lymphoma, Non-Hodgkin genetics, Lymphoma, Non-Hodgkin metabolism, Male, Tumor Cells, Cultured metabolism, Tumor Cells, Cultured pathology, Tumor Cells, Cultured ultrastructure, Vascular Cell Adhesion Molecule-1 analysis, Lymph Nodes pathology, Lymphoma, Non-Hodgkin pathology
- Abstract
We report a case of clinically aggressive reticulum cell sarcoma with mixed follicular dendritic cell (FDC) and fibroblastic reticular cell (FRC) features. Histologically, the tumor was confined to lymph nodes occurring as a multifocal epithelioid and spindle cell proliferation with appreciable mitotic rate and numerous admixed non-neoplastic B-cells. Ultrastructural examination revealed elongated cells with prominent nucleoli, interdigitating cell processes and frequent desmosomes. These features are typical of FDC sarcoma. However, immunohistochemical stains showed no expression of antigens characteristic of FDCs, including CD21, CD23 and CD35. Cytogenetic characterization of this tumor, by conventional G-banding and multicolor spectral karyotyping, revealed multiple clonal chromosomal aberrations, including del(X)(p11.4) and add (21)(p11.2). Gene expression analysis by cDNA microarray of RNA obtained from short-term tumor cultures revealed high-level expression of a set of genes (including PDGF receptor-alpha and -beta, certain metalloproteinases, and CD105) that were also highly expressed in cultures of nodal FRC cultured from non-neoplastic lymph nodes. We propose that this tumor represents a nodal sarcoma with intermediate differentiation between FDCs and FRCs. This case adds to the diversity of tumors that may arise from lymph node stroma and supports a possible relationship between the FDC and FRC lineages.
- Published
- 2001
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26. Pulmonary granuloma caused by Pseudomonas andersonii sp nov.
- Author
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Han XY, Pham AS, Nguyen KU, Smythe WR, Ordonez NG, Jacobson KL, and Tarrand JJ
- Subjects
- Adult, Anti-Bacterial Agents pharmacology, DNA Primers chemistry, DNA, Bacterial analysis, DNA, Ribosomal analysis, Female, Granuloma pathology, Granuloma surgery, Humans, Lung Diseases pathology, Lung Diseases surgery, Microbial Sensitivity Tests, Polymerase Chain Reaction, Pseudomonas classification, Pseudomonas growth & development, Pseudomonas ultrastructure, Pseudomonas Infections pathology, Pseudomonas Infections surgery, Tomography, X-Ray Computed, Granuloma microbiology, Lung Diseases microbiology, Pseudomonas isolation & purification, Pseudomonas Infections complications
- Abstract
Pulmonary granuloma is a common lesion for which gram-negative bacteria are rarely implicated as a cause. Hence, most physicians are unaware of this etiology. We isolated a gram-negative bacterium from a surgically resected pulmonary granuloma in a 42-year-old, nonimmunocompromised woman. Within the necrotizing granuloma, numerous organisms also were demonstrated by Gram stain, suggesting a cause-disease relationship. Characterization of the bacterium by sequence analysis of the 16S ribosomal gene, cellular fatty acid profiling, and microbiologic studies revealed a novel bacterium with a close relationship to Pseudomonas. We propose a new species for the bacterium, Pseudomonas andersonii. These results suggest that the differential diagnosis of a lung granuloma also should include this gram-negative bacterium as a potential causative agent, in addition to the more common infections caused by acid-fast bacilli and fungi. This bacterium was shown to be susceptible to most antibiotics that are active against gram-negative bacteria.
- Published
- 2001
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27. Low-grade (fibromatosis-like) spindle cell carcinoma of the breast.
- Author
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Sneige N, Yaziji H, Mandavilli SR, Perez ER, Ordonez NG, Gown AM, and Ayala A
- Subjects
- Actins analysis, Adult, Aged, Aged, 80 and over, Biomarkers, Tumor analysis, Breast Neoplasms chemistry, Breast Neoplasms surgery, Carcinoma, Squamous Cell chemistry, Carcinoma, Squamous Cell surgery, Female, Fibroma chemistry, Fibroma surgery, Humans, Immunoenzyme Techniques, Keratins analysis, Lung Neoplasms secondary, Middle Aged, Neoplasm Recurrence, Local, Breast Neoplasms pathology, Carcinoma, Squamous Cell pathology, Fibroma pathology
- Abstract
Spindle cell carcinoma of the breast, a variant of metaplastic carcinoma, includes a wide spectrum of lesions with histomorphologic and nuclear features ranging from overtly malignant to mildly atypical. Spindle cell carcinomas with mildly atypical features may resemble fasciitis, fibromatosis, or myofibroblastic tumors and therefore are often misinterpreted as such. A recent study has suggested that spindle cell carcinomas with a dominant fibromatosis-like phenotype, unlike spindle cell carcinomas in general, have no propensity for distant metastasis and should be termed "tumors" rather than "carcinomas." To investigate the question of fibromatosis-like spindle cell breast carcinoma (FLSpCCs) metastatic potential, we studied cases of FLSpCC seen at the University of Texas M.D. Anderson Cancer Center between 1987 and 2000. Clinical, pathologic, and immunophenotypic features were reviewed, with emphasis on biologic behavior and predictors of clinical outcome. Our series included 24 women who ranged in age from 55 to 85 years (mean 66 years). Tumor size ranged from 1.0 to 5 cm (mean 2.8 cm). Most tumors were grossly well defined but had microscopic infiltrative borders. Tumors showed a dominant fibromatosis-like or myofibroblastic-like growth pattern with prominent collagenization. Inflammatory infiltrate was noted in the majority of tumors. Cytokeratin-positive cells were seen in all cases and usually appeared as cords or sheets of polygonal cells; isolated cytokeratin-positive cells were rare. In most tumors immunoreactivity for smooth muscle actin (SMA) was confined to the cytokeratin-negative cells. In five cases intense co-expression of cytokeratin and SMA was noted. None of the tumors showed immunoreactivity for smooth muscle heavy chain myosin, estrogen receptors, progesterone receptors, or HER-2/neu. Ki-67 expression was noted in fewer than 5% of tumor cells. Treatment consisted of local excision (seven cases) or modified radical mastectomy (13 cases). Treatment was unknown in four cases. In patients who underwent axillary nodal dissection, no lymph node metastases were found. Two of the six patients who underwent local excision developed local recurrence. Two patients who underwent modified radical mastectomy developed lung metastases within 2 years after the initial diagnosis. The metastatic tumors were histologically similar to the primary tumors. Our findings indicate that FLSpCCs have the potential for local recurrence and distant metastasis and should be treated accordingly. Because FLSpCCs may be underdiagnosed as benign, the use of immunohistochemical studies, especially for cytokeratins and SMA, is essential in the evaluation of any spindle cell proliferations of the breast.
- Published
- 2001
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28. Lymph node micrometastases in non small-cell lung cancer: clinical applications.
- Author
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Perez-Cardona JH, Ordonez NG, and Fossella FV
- Abstract
A large number of patients are diagnosed every year with non small-cell lung cancer, and their prognosis and response to treatment are inversely correlated to tumor stage at initial diagnosis. Despite the surgical removal of all apparent malignancy from patients with early disease, many will relapse, presumably as a result of disease that was undetected at initial evaluation. In an effort to identify those patients who have early lymph node involvement by metastatic disease, several groups of investigators have searched for the presence of micrometastases in hematoxylin-eosin-negative lymph nodes using immunohistochemical or molecular methods. Four of six groups of investigators using immunohistochemistry have found a significant incidence of lymph node micrometastases and a direct correlation between the absence of micrometastases and disease-free survival; these are encouraging results that require confirmatory studies. Molecular methods may potentially offer increased sensitivity; however, their high cost and the requirement to process large numbers of samples limits their use to research settings at present.
- Published
- 2000
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29. Primary vulvar and vaginal extraosseous Ewing's sarcoma/peripheral neuroectodermal tumor: diagnostic confirmation with CD99 immunostaining and reverse transcriptase-polymerase chain reaction.
- Author
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Vang R, Taubenberger JK, Mannion CM, Bijwaard K, Malpica A, Ordonez NG, Tavassoli FA, and Silver SA
- Subjects
- 12E7 Antigen, Adult, Antineoplastic Agents therapeutic use, Chromosomes, Human, Pair 11, Chromosomes, Human, Pair 22, Female, Humans, Immunohistochemistry, Neuroectodermal Tumors genetics, Neuroectodermal Tumors therapy, Radiotherapy, Sarcoma, Ewing genetics, Sarcoma, Ewing therapy, Surgical Procedures, Operative, Translocation, Genetic, Vaginal Neoplasms genetics, Vaginal Neoplasms therapy, Vulvar Neoplasms genetics, Vulvar Neoplasms therapy, Antigens, CD analysis, Cell Adhesion Molecules analysis, Neuroectodermal Tumors diagnosis, Reverse Transcriptase Polymerase Chain Reaction, Sarcoma, Ewing diagnosis, Vaginal Neoplasms diagnosis, Vulvar Neoplasms diagnosis
- Abstract
Two cases of extraosseous Ewing's sarcoma/peripheral neuroectodermal tumor arising in unusual, superficial sites are reported. One tumor involved the vaginal wall of a 35-year-old woman, and the other neoplasm arose in the dermis of the vulva in a 28-year-old woman. The tumors showed characteristic microscopic features of Ewing's sarcoma/peripheral neuroectodermal tumor with nodular monotonous proliferations of undifferentiated, small, round, hyperchromatic cells with a low mitotic index. Rare rosette-like formations were apparent only in the vulvar neoplasm. The tumors displayed intense immunoreactivity in a membranous pattern for CD99, the cell surface glycoprotein encoded by the MIC2 gene. Genetically, the tumors expressed the EWS/FLI-1 chimeric transcript, derived from the t(11;22)(q24;q12) chromosomal translocation. Both patients had localized disease treated with wide local excision; one received postoperative chemotherapy, and the other received chemotherapy and radiotherapy. To date, 18 and 19 months after diagnosis, neither patient has had clinical evidence of local recurrence or metastasis. To our knowledge, these are the first reported cases of vaginal and vulvar Ewing's sarcoma/peripheral neuroectodermal tumor, confirmed with molecular genetic analysis, in the English literature.
- Published
- 2000
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30. Extrapleural solitary fibrous tumor: a clinicopathologic study of 24 cases.
- Author
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Brunnemann RB, Ro JY, Ordonez NG, Mooney J, El-Naggar AK, and Ayala AG
- Subjects
- Adult, Aged, Aged, 80 and over, DNA, Neoplasm genetics, Flow Cytometry, Humans, Immunohistochemistry, Microscopy, Electron, Middle Aged, Neoplasms, Fibrous Tissue chemistry, Retrospective Studies, Neoplasms, Fibrous Tissue pathology
- Abstract
Solitary fibrous tumors (SFTs), rare in extrapleural sites, can present difficulties in diagnosis at these locations. From the files of the M. D. Anderson Cancer Center, we accessed 24 cases of extrapleural SFT (14 females, 10 males, ages 19 to 85 yr) obtained for clinical, histologic, immunohistochemical, and follow-up findings. Tumor locations included the head and neck (n = 12), the abdomen (n = 10), and the extremities (n = 2). Tumors were 2 to 25 cm in greatest dimension (mean, 8.2 cm) and were well circumscribed or encapsulated. Histologic features were typical of their pleural counterparts, e.g., bland spindle cells with some hypercellular areas and myxoid to hyalinized backgrounds. A hemangiopericytic vascular pattern was present in 19 cases and prominent in 11. Mitotic activity ranged from 0 to 4 counts per 10 high-power fields. Necrosis was seen in two cases. Focally increased cellularity was seen in seven cases and margins were positive in another seven cases. Spindle cells were positive for vimentin (19 of 19) and CD34 (18 of 20), and negative for cytokeratin (0 of 19). Fibroblastic differentiation was present in the three cases studied by electron microscopy. Flow cytometry in three cases revealed diploid cell populations. Follow-up for 19 cases (9 to 99 mo) revealed no evidence of metastasis, although one patient had residual tumor after an incomplete excision, and one patient died of unrelated causes. Histologic findings such as mitotic counts, necrosis, cellularity, and marginal status were not associated with outcome. We conclude that extrapleural SFTs are clinically and histologically similar to their pleural counterparts. Although the length of clinical follow-up was short (mean follow-up, 41.4 mo), recognizing these lesions is important because they typically follow an indolent clinical course if completely excised. Although CD34 is nonspecific, it is usually positive in SFTs and may aid in their diagnosis.
- Published
- 1999
31. Cytogenetic analysis of a primary salivary gland myoepithelioma.
- Author
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el-Naggar AK, Lovell M, Callender DL, Ordonez NG, and Killary AM
- Subjects
- Actins analysis, Chromosomes, Human, Pair 1, Chromosomes, Human, Pair 12, Chromosomes, Human, Pair 13, Chromosomes, Human, Pair 9, Desmin analysis, Flow Cytometry, Humans, Immunohistochemistry, Karyotyping, Keratins analysis, Male, Middle Aged, Myoepithelioma pathology, Salivary Gland Neoplasms pathology, Myoepithelioma genetics, Salivary Gland Neoplasms genetics, Translocation, Genetic
- Abstract
Myoepithelioma, a rare benign salivary gland neoplasm, is a tumor composed entirely of myoepithelial cells. Unlike pleomorphic adenoma, these tumors lack any ductal epithelial differentiation, and manifest a minor stromal element. Previous cytogenetic and molecular genetic studies have mainly investigated pleomorphic adenomas and reported recurring specific chromosomal alterations at 8q12 and 12q13-q15 regions. The cell origin of these alterations, however, remains speculative. We report the cytogenetic analysis of a parotid myoepithelioma and discuss the putative origin for the cells with cytogenetic alterations. Our analysis shows 12q12 involved in a translocation with a previously unreported partner (1q), and nonrandom del(9)(q22.1q22.3) and del(13)(q12q22). Our results indicate that the myoepithelial cell is the source of those cells with chromosomal alterations, and that myoepithelioma shares 12q alterations reported in a subset of pleomorphic adenomas.
- Published
- 1999
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32. Metastatic renal cell carcinoma to the bladder: a clinicopathologic and immunohistochemical study.
- Author
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Sim SJ, Ro JY, Ordonez NG, Park YW, Kee KH, and Ayala AG
- Subjects
- Adult, Aged, Antigens, Neoplasm, Carcinoembryonic Antigen analysis, Carcinoma, Renal Cell metabolism, Carcinoma, Transitional Cell metabolism, Carcinoma, Transitional Cell pathology, Chromogranins analysis, Diagnosis, Differential, Female, Humans, Immunohistochemistry, Intermediate Filament Proteins analysis, Keratin-20, Keratin-7, Keratins analysis, Kidney Neoplasms metabolism, Lewis X Antigen analysis, Male, Melanoma metabolism, Melanoma pathology, Melanoma-Specific Antigens, Middle Aged, Neoplasm Proteins analysis, Paraganglioma metabolism, Paraganglioma pathology, S100 Proteins analysis, Urinary Bladder Neoplasms metabolism, Vimentin analysis, Carcinoma, Renal Cell secondary, Kidney Neoplasms pathology, Urinary Bladder Neoplasms secondary
- Abstract
Although rare, renal cell carcinoma (RCC) can metastasize to the bladder. When this occurs, it might complicate diagnosis. Morphologically, RCC can be confused with transitional cell carcinomas (TCCs), especially those exhibiting clear cell features, and also with other bladder tumors, such as paragangliomas and metastatic melanomas. We report seven cases of RCC metastatic to the bladder that occurred in 6 men and 1 woman who were 35 to 69 years old. The most common presenting symptom was the reappearance of hematuria, which developed from 2 to 131 months (mean, 41.3 mo) after the removal of the primary RCC. In all of the patients, the metastatic RCC involved multiple organs; no case had an isolated metastasis to the bladder. The prognosis was poor, and five patients died of disease between 4 and 24 months (mean, 12.8 mo) after diagnosis of the metastasis to the bladder. The remaining two patients were lost to follow-up. All of the tumors were conventional clear or "granular" cell RCCs, with nuclear grades of 2 or 3. In five patients, metastases were confined to the lamina propria, but in two patients, tumors involved the muscularis propria as well. A comparative immunohistochemical study showed that metastatic RCCs were positive for CAM5.2, vimentin, and Leu-M1, and negative for cytokeratin 20, cytokeratin 7, 34betaE12, carcinoembryonic antigen, S-100 protein, HMB45, and chromogranin. Classic and clear cell TCCs were positive for all of the cytokeratins and carcinoembryonic antigen and negative for vimentin. Paragangliomas were positive for chromogranin and showed scattered positivity for the S-100 protein in the sustentacular cells. Metastatic melanomas were positive for S-100 protein and HMB45. The histologic appearance of RCC, particularly the delicate fibrovascular stroma with abundant sinusoidal vessels, is a feature that can be used to recognize the tumor. When there is difficulty diagnosing metastatic RCC, TCC, or other tumors in the bladder, the immunohistochemical findings can assist in the differential diagnosis.
- Published
- 1999
33. Concurrent cytogenetic, interphase fluorescence in situ hybridization and DNA flow cytometric analyses of a carcinoma ex-pleomorphic adenoma of parotid gland.
- Author
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el-Naggar AK, Lovell M, Callender DL, Ordonez NG, and Killary AM
- Subjects
- Adenocarcinoma pathology, Adenoma, Pleomorphic pathology, Flow Cytometry, Humans, Immunohistochemistry, In Situ Hybridization, Fluorescence, Karyotyping, Male, Middle Aged, Parotid Neoplasms pathology, Adenocarcinoma genetics, Adenoma, Pleomorphic genetics, Parotid Neoplasms genetics
- Abstract
We report the cytogenetic, fluorescence in situ hybridization (FISH), and DNA ploidy analyses of a high grade carcinoma ex-pleomorphic adenoma of the submandibular gland. Our overall combined analyses showed a marked DNA aneuploidy and numerical abnormalities involving all chromosomes. Cytogenetic analysis revealed a near tetraploid modal chromosomal number with tetraploid loss of chromosomes Y, 1, 6, 9, 11, 14, 15, 17, and 19-21 and hypertetraploid gain of chromosomes 7, 8, and 22. The structural abnormalities included der(1;14)(q10;q10), del(6)(q15q34), +del(6)(q15q34), +der(8) t(1;8)(q12;q12.2),der(9;19)(q10;q10),add(14)(p11.2),i(20)(q10),der(21) t(8;21)(q11.2;q22.3),+der(21)t(8;21) (q11.2;q22.3). Interphase FISH of the primary and short-term cultured cells using directly labeled pericentromeric probes for chromosomes 6-12, 17, 18, and Y resulted in alterations corresponding to the cytogenetic findings. DNA ploidy analysis of both the primary and cultured tumor cells showed a hyperdiploid stemline with DNA indices of 2.6. The results indicate that: (1) marked numerical, structural chromosomal, and DNA content abnormalities are present in this tumor; and (2) alteration at 8q and 6q regions, together with previous results, suggest an association between these events and the development and/or progression of this tumor.
- Published
- 1998
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34. Histologically pure seminoma with elevated alpha-fetoprotein: a clinicopathologic study of ten cases.
- Author
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Nazeer T, Ro JY, Amato RJ, Park YW, Ordonez NG, and Ayala AG
- Subjects
- Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Biomarkers, Tumor blood, Cisplatin, Combined Modality Therapy, Cyclophosphamide, Doxorubicin, Etoposide administration & dosage, Humans, Male, Medical Records, Middle Aged, Mitotic Index, Neoplasm Metastasis, Neoplasm Staging, Orchiectomy, Radioimmunoassay, Retrospective Studies, Seminoma pathology, Testicular Neoplasms pathology, Testicular Neoplasms therapy, Vinblastine administration & dosage, Seminoma blood, Testicular Neoplasms blood, alpha-Fetoproteins analysis
- Abstract
Seminomas account for 50% of testicular germ-cell tumors, and more than 90% of these are classic seminomas. When patients with a histologically pure testicular seminoma show an elevated level of serum á-fetoprotein (AFP), it is generally assumed that an undetected focus of yolk sac tumor (YST) is present and the patient is managed with a treatment regimen for non-seminomatous tumor. We studied 10 cases of histologically pure seminoma with elevated levels of serum AFP in an attempt to identify any distinctive clinical, histopathologic, or immunohistochemical features. The patients ranged in age from 27 to 48 years (mean, 31 years). Eight patients had primary tumors of the testis, and two presented with supraclavicular and ileal tumors. The clinical stage at presentation varied: four tumors were stage I, four were stage II, and two were stage III. Serum levels of AFP were elevated in all patients at ranges of 10.4 to 16 ng/ml (mean, 12.0 ng/ml). In all patients, the primary tumors and metastases when present exhibited classic seminoma histology without other germ-cell components. The tumor cells expressed keratin in seven cases. The pattern of keratin immunoreactivity ranged from focal staining in five cases to moderate staining in two cases. All cases were negative for AFP, and the nine cases in which staining for CD30 (Ki-1) was performed were also negative. All four patients with stage I tumors underwent the conventional therapy for pure seminoma, i.e., orchiectomy and subsequent radiation therapy. Five patients received treatment for non-seminomatous tumors, i.e., chemotherapy after orchiectomy. Extensive work-up failed to detect the primary tumor in one patient, and he was treated for a non-seminomatous tumor, undergoing chemotherapy and irradiation. All patients are alive and well, and none has developed evidence of YST at a mean follow-up of 6 years (range, 6 months to 10 years). However, one patient who presented with an ileal metastasis recently developed a second primary extragonadal mediastinal mixed germ-cell tumor with YST and embryonal carcinoma components and an elevated serum level of AFP (27,000 ng/ml) after a 10-year disease-free follow-up. This study strongly suggests that minor elevations (= 16 ng/ml) of AFP in patients with an otherwise pure seminoma may not indicate that there is a hidden focus of YST and that such patients should be treated with standard therapy for seminoma. Because this study includes very few patients, further studies are required to better understand the significance of borderline elevations of AFP in cases of histologically pure seminoma.
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- 1998
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35. Male adnexal tumour of probable Wolffian origin occurring in a seminal vesicle.
- Author
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Middleton LP, Merino MJ, Popok SM, Ordonez NG, Ayala AG, and Ro JY
- Subjects
- Adult, Biomarkers, Tumor analysis, Female, Genital Neoplasms, Male chemistry, Genital Neoplasms, Male ultrastructure, Humans, Immunoenzyme Techniques, Male, Mesonephros chemistry, Mesonephros ultrastructure, Microscopy, Electron, Neoplasm Recurrence, Local pathology, Seminal Vesicles chemistry, Seminal Vesicles ultrastructure, Urinary Bladder Neoplasms chemistry, Urinary Bladder Neoplasms secondary, Adnexal Diseases pathology, Genital Neoplasms, Male pathology, Mesonephros pathology, Seminal Vesicles pathology
- Abstract
Aims: Adnexal tumours of probable Wolffian origin are rare low-grade malignant neoplasms that have been previously described in the broad ligament, ovaries and retroperitoneum of females. All are characterized by small, bland epithelial cells growing in a diffuse, trabecular, or tubular pattern. The majority of the cases reported have pursued a benign clinical course. However, recurrences and distant metastases have been described. We present a case of a male adnexal tumour of probable Wolffian origin occurring in the left seminal vesicle of a 29-year-old man with 23 years of follow-up., Results: The diagnosis is supported by immunohistochemical and electron microscopic findings: The tumour cells were immunoreactive for cytokeratin and vimentin while smooth muscle antigen and S100 protein were uniformly negative. By electron microscopy cells were arranged in an acinar pattern and surrounded flocculent, electron-dense material. Individual cells contained numerous dense bodies and free ribrosomes. The patient had recurrences at 14 and 23 years after initial diagnosis., Conclusion: This is the first report of this entity in a male. The literature on this unusual tumour is reviewed and the clinicopathological, immunohistochemical and ultrastructural features are described. The differential diagnosis of this seemingly indolent tumour is discussed with genitourinary tumours having a more aggressive clinical course.
- Published
- 1998
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36. The prognostic significance of the biomarkers p21WAF1/CIP1, p53, and bcl-2 in laryngeal squamous cell carcinoma.
- Author
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Jin YT, Kayser S, Kemp BL, Ordonez NG, Tucker SL, Clayman GL, Goepfert H, Luna MA, Batsakis JG, and El-Naggar AK
- Subjects
- Adult, Aged, Carcinoma, Squamous Cell pathology, Cyclin-Dependent Kinase Inhibitor p21, Female, Humans, Immunohistochemistry, Laryngeal Neoplasms pathology, Lymphatic Metastasis, Male, Middle Aged, Multivariate Analysis, Prognosis, Carcinoma, Squamous Cell chemistry, Cyclins analysis, Laryngeal Neoplasms chemistry, Proto-Oncogene Proteins c-bcl-2 analysis, Tumor Suppressor Protein p53 analysis
- Abstract
Background: The clinical course of laryngeal squamous cell carcinoma (LSCC) varies considerably among patients. New biologic markers are needed to facilitate the stratification of individual patients within the conventional clinicopathologic stages of LSCC., Methods: Eighty-three LSCCs from an equal number of patients who received at least 10 years of follow-up were investigated for p53, p21WAF1/CIP1, and bcl-2 protein expression by immunohistochemical techniques. The results were correlated with various clinicopathologic parameters, DNA content, and patient outcome by univariate and multivariate statistical analyses., Results: Stage IV disease, large tumor size (>3 cm), positive lymph node status, extranodal extension, and p53 overexpression (in > 75% of cells) correlated significantly with prognosis in univariate analysis. There was no correlation between patient outcome and age, gender, race, histologic differentiation, or expression of bcl-2 or p21WAF1/CIP1. In multivariate analysis, lymph node status and p53 overexpression were the only factors significantly associated with survival., Conclusions: High p53 expression and positive lymph node status were independent predictors of the outcomes of patients with LSCC. These factors may assist in prognostication and better classification of patients for treatment.
- Published
- 1998
37. Prognostic biomarker study in pathologically staged N1 non-small cell lung cancer.
- Author
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Komaki R, Milas L, Ro JY, Fujii T, Perkins P, Allen P, Sikes CR, Mountain CF, and Ordonez NG
- Subjects
- Adenocarcinoma genetics, Adenocarcinoma immunology, Adenocarcinoma mortality, Adenocarcinoma secondary, Analysis of Variance, Apoptosis, Biomarkers, Carcinoma, Non-Small-Cell Lung genetics, Carcinoma, Non-Small-Cell Lung immunology, Carcinoma, Non-Small-Cell Lung mortality, Carcinoma, Non-Small-Cell Lung secondary, Carcinoma, Squamous Cell genetics, Carcinoma, Squamous Cell immunology, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell secondary, DNA, Neoplasm analysis, Female, Follow-Up Studies, Genetic Markers, Humans, Ki-67 Antigen analysis, Lung Neoplasms genetics, Lung Neoplasms immunology, Lung Neoplasms mortality, Male, Middle Aged, Mitotic Index, Neoplasm Staging, Prognosis, Retrospective Studies, Adenocarcinoma pathology, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Squamous Cell pathology, Lung Neoplasms pathology
- Abstract
Purpose: The prognostic influence of 6 biomarkers correlated to histologic subtypes of non-small cell lung cancer (NSCLC) on loco-regional control, overall survival, disease-free survival (DFS), and distant disease control (DDC) rates, all measured at 5 years, were examined., Materials & Methods: Cell blocks from the primary tumors of 137 patients with pathologically staged N1 NSCLC at MDACC were analyzed by 6-biomarker status correlated to histological subtypes and their outcomes., Results: The ranges of biomarker values were as follows: apoptotic index, 0.2-2.8%; mitotic index, 0-1.8%; the proportion of cells in S+G2M, 3-36%; p53 status, 0-100%; Ki-67, 0-9.3%; DNA index, 1.0-2.74. Subtypes of 137 cases from the postoperative pathology specimen showed that 74 patients had squamous carcinoma and 63 patients had adenocarcinoma. Mean and median lengths of follow-up were 4.21 years and 2.43 years, respectively. Patients with squamous cell carcinoma (SCC) had a better 5-year survival (p = 0.006), DFS (p = 0.002), and distant metastasis control (p = 0.002) than patients with adenocarcinoma (AC). Among patients with AC, the DNA index was a significant predictor of 5-year DFS (p = 0.02), DDC rate (p = 0.04), and local-regional control (p < 0.05). Higher apoptosis (p = 0.03) and mitosis indices (p = 0.03) were also univariate predictors of increased distant disease among patients with AC. Multivariate analysis of patients with AC revealed that the DNA index and Ki-67 were the only significant independent predictors of distant metastasis (p < 0.04 and p < 0.02, respectively) and DFS (p < 0.04 for both). Among patients with SCC, univariate analysis showed that S+G2M proportion (p < 0.05) and Ki-67 levels (p < 0.02) were significant predictors for local-regional control; for SC, multivariate analysis showed that only mitosis was a significant predictor in this case for overall survival (p < 0.04)., Conclusion: Spontaneous apoptotic index and Ki-67 were significantly higher in SC than in AC. Patients with SC had less distant metastasis better DFS and overall survival than those with AC. Multivariate analysis revealed that DNA index and Ki-67 status were significant predictors for DDC and DFS in patients with AC, but only mitotic index was a significant predictor of overall survival for patients with SCC.
- Published
- 1998
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38. Multiple unrelated translocations in a metastatic epimyoepithelial carcinoma of the parotid gland.
- Author
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el-Naggar AK, Lovell M, Ordonez NG, and Killary AM
- Subjects
- Adult, Carcinoma pathology, Chromosome Banding, Humans, Karyotyping, Male, Parotid Neoplasms pathology, Carcinoma genetics, Lymphatic Metastasis, Parotid Neoplasms genetics, Translocation, Genetic
- Abstract
We report the cytogenetic, fluorescence in-situ hybridization (FISH) and DNA flow cytometric analysis of a rare metastatic epimyoepithelial carcinoma of the parotid gland to the lung with a clinical course of 29 years. DNA content and FISH analyses of tumor and short-term culture cells showed diploid DNA content and lack of numerical chromosomal abnormalities. Immunohistochemical analysis of the short-term culture cells showed predominantly keratin positive and sparse desmin staining supporting an epithelial rather than myoepithelial origin. Cytogenetic analysis showed 46,XY karyotype with clonal translocations of t(3;22)(q13.2;q13.1), t(1;7)(q21;q22), t(8;9)(p10;p10), and t(5;6) (q35;q21). Our findings indicate that these alterations developed in a diploid stemline during tumor progression and in the epithelial component of this tumor.
- Published
- 1998
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39. Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: report of two patients, one with distant metastasis, and review of the literature.
- Author
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Sim SJ, Ro JY, Ordonez NG, Cleary KR, and Ayala AG
- Subjects
- Aged, Carcinoma, Mucoepidermoid chemistry, Carcinoma, Mucoepidermoid secondary, Carcinoma, Squamous Cell pathology, Diagnosis, Differential, Female, Humans, Immunohistochemistry, Keratins analysis, Lung Neoplasms secondary, Thyroid Neoplasms chemistry, Thyroiditis, Autoimmune pathology, Carcinoma, Mucoepidermoid pathology, Eosinophilia pathology, Sclerosis pathology, Thyroid Neoplasms pathology
- Abstract
Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) is a recently recognized malignant neoplasm of the thyroid gland. Two additional cases of this condition which occurred in a 70-year-old woman and a 69-year-old woman are presented. The case of the 70-year-old woman (patient 1) is the first report of distant metastasis, besides lymph node metastasis, for this type of tumor. The patient initially presented with a thyroid mass, and the thyroid gland with surrounding cervical lymph nodes was removed. Because of focal keratin "pearl" formation, the tumor was misinterpreted as a metastatic squamous cell carcinoma to the thyroid. Approximately 4 years later, the patient developed a left supraclavicular mass and lung densities. A pathological fracture of the right humeral head followed, and the left supraclavicular mass recurred along with newly developed subcutaneous nodules on the chest wall and arm. Open lung and bone biopsies revealed metastatic SMECE, which was morphologically identical to that of the thyroid mass. The 69-year-old woman (patient 2) had, in 1983, undergone thyroidectomy with left radical neck dissection; this had been diagnosed as follicular carcinoma of the thyroid with lymph node involvement. After multiple isolated lymph nodes metastases, the patient developed locally extensive, recurrent tumor that showed microscopic features of SMECE. Review of the previous thyroid tumor and lymph nodes revealed the same type of histology. To our knowledge, only a single report containing eight cases of this distinctive carcinoma of the thyroid has been published. Herein we describe characteristic morphological features of two additional cases of this rare malignancy, one with distant metastasis, and we review the related literature.
- Published
- 1997
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40. The induction of benign epithelial neoplasms of the ovaries of guinea pigs by testosterone stimulation: a potential animal model.
- Author
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Silva EG, Tornos C, Fritsche HA Jr, el-Naggar A, Gray K, Ordonez NG, Luna M, and Gershenson D
- Subjects
- Animals, Chorionic Gonadotropin pharmacology, Cystadenoma chemically induced, Cystadenoma chemistry, Cystadenoma pathology, Disease Models, Animal, Epithelium chemistry, Epithelium drug effects, Epithelium pathology, Estrone pharmacology, Female, Guinea Pigs, Megestrol pharmacology, Ovarian Cysts chemically induced, Ovarian Cysts chemistry, Ovarian Cysts pathology, Ovarian Neoplasms chemistry, Ovarian Neoplasms pathology, Papilloma chemically induced, Papilloma chemistry, Papilloma pathology, Radioimmunoassay, Testosterone administration & dosage, Testosterone analysis, Uterus chemistry, Ovarian Neoplasms chemically induced, Testosterone pharmacology
- Abstract
We studied the effects of different hormones on the epithelial cells of the ovaries of 11 guinea pigs. Three received testosterone, two received estrone, three megestrol, and three chorionic gonadotropin. Three control guinea pigs received sterile water. Benign epithelial cysts larger than 1.5 mm were found in six guinea pigs, three who received testosterone, one who received megestrol, and two who received chorionic gonadotropin. In one of the three guinea pigs who received testosterone, 2.5-cm bilateral cysts were grossly identified. Papillary excrescences were found on the ovarian surface in four guinea pigs, three who received testosterone and one who received megestrol. The proliferating epithelial cells also formed benign glands in the ovarian stroma in two guinea pigs who received testosterone, the most exuberant epithelial proliferations, including large bilateral cystadenomas, papillary excrescence that formed a small papillary neoplasm, and glands in the ovarian stroma that formed adenomatous areas, were seen in the guinea pig who received an intermediate dose of testosterone for the longest time. By radioimmunoassay, the serum level of testosterone was 22 ng/dL in one of the controls and 10,000, 12,000, and 15,000 ng/dL in the three guinea pigs who received testosterone. In the guinea pig with the most exuberant epithelial proliferation, the level of testosterone in the uterus was similar to that in the serum (13,860 ng/mg), but in the wall of the ovarian epithelial cyst, it was three times higher than it was in the serum (44,000 ng/mg). Our study shows that testosterone stimulates the growth of epithelial cells in the ovaries of guinea pigs, resulting in benign cysts, small adenomas in the ovarian parenchyma, and papillomas on the ovarian surface. The study also shows that guinea pigs can be used as an animal model for epithelial tumors of the human ovary.
- Published
- 1997
41. Vascular adrenal cysts: a clinicopathologic and immunohistochemical study of six cases and a review of the literature.
- Author
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Torres C, Ro JY, Batt MA, Park YW, Ordonez NG, and Ayala AG
- Subjects
- Adrenal Gland Neoplasms blood supply, Adult, Aged, Diagnosis, Differential, Female, Humans, Immunohistochemistry, Male, Middle Aged, Adrenal Gland Diseases pathology, Adrenal Gland Neoplasms pathology, Cysts pathology
- Abstract
The clinical, histologic, and immunohistochemical features of six cases of hemorrhagic adrenal pseudocysts are reported together, with a review of the English literature on this topic since 1950. The mean age at presentation was 57 years (range, 30-72 yr). There were four men and 2 women. The average cyst size was 9.2 cm (range, 6-16 cm). In four patients, the hemorrhagic adrenal pseudocysts were incidental findings. The remaining two patients presented with an abdominal mass and hypertension, respectively. The hemorrhagic pseudocysts were unilocular cystic masses surrounded by a fibrous capsule and containing abundant amorphous material, blood, and fibrin. Numerous dilated, thin-walled, vascular channels that stained strongly for Factor VIII-related antigen, collagen IV, laminin, Ulex europaeus agglutinin I lectin, and CD34 were present within the fibrous capsule, cyst contents, and surrounding residual adrenal gland. These findings support a vascular origin for these lesions, and they are thought, therefore, to be related to endothelial adrenal cysts. The literature review of 111 vascular adrenal cysts (85 hemorrhagic pseudocystic type and 26 endothelial type) showed similar clinical features. The mean age at presentation was 44.5 years (range, 5 d-95 yr), with a female predominance (62%). The most common clinical presentation was abdominal pain (35%), followed by incidental findings (32%). There were no significant clinical differences between hemorrhagic and endothelial type cysts. In some cases, the presence of intracystic islands of cortical cells can cause diagnostic confusion with adrenal cortical tumors. The presence, however, of a rich intracystic and capsular vascular network, normal-appearing islands of cortical cells, and abundant thrombotic fibrinous material, rather than necrotic tumor cells, should rule out the possibility of a degenerating adrenal cortical neoplasm.
- Published
- 1997
42. Intraluminal crystalloids in breast carcinoma. Immunohistochemical, ultrastructural, and energy-dispersive x-ray element analysis in four cases.
- Author
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Ro JY, Ngadiman S, Sahin A, Sneige N, Ordonez NG, Cartwright J Jr, and Ayala AG
- Subjects
- Adult, Aged, Breast Neoplasms diagnostic imaging, Breast Neoplasms surgery, Breast Neoplasms ultrastructure, Carcinoma, Intraductal, Noninfiltrating diagnostic imaging, Carcinoma, Intraductal, Noninfiltrating surgery, Carcinoma, Intraductal, Noninfiltrating ultrastructure, Crystalloid Solutions, Electron Probe Microanalysis, Female, Humans, Hyperplasia pathology, Immunohistochemistry, Isotonic Solutions, Microscopy, Electron, Middle Aged, Mucin-1 analysis, Radiography, Sulfur analysis, Breast Neoplasms pathology, Carcinoma, Intraductal, Noninfiltrating pathology, Plasma Substitutes analysis
- Abstract
Objective: Intraluminal crystalloids have been described in the prostate, salivary gland, and ovary, but have not yet been reported in the breast. We report four cases of breast carcinoma in which these crystalloids were found in ducts with intraductal carcinoma or atypical hyperplasia. The presence of intraluminal crystalloids may be a useful adjunct in making a diagnosis of carcinoma or may be a feature to look for as a marker for the presence of carcinoma., Design: Four cases of breast carcinoma containing intraluminal crystalloids were identified among 6900 surgical breast specimens between January 1990 and June 1995 at M. D. Anderson Cancer Center, Houston, Tex. Those sections with crystalloids identified by hematoxylin-eosin stain were stained with periodic acid-Schiff, Alcian blue, and mucicarmine stains. Immunohistochemical and ultrastructural studies and energy-dispersive x-ray analysis were also performed on these sections., Results: The intraluminal crystalloids were eosinophilic, varied in shape and size, and did not exhibit birefringence under polarized light. Immunohistochemically, the crystalloids were negative for keratin, muscle-specific actin, and kappa and lambda light chains, but the surfaces stained positively for epithelial membrane antigen. By electron microscopy, the crystalloids had no limiting membrane and were composed of an electron-dense material with no discernible periodicity. By energy-dispersive x-ray element analysis, the crystalloids had no mineral content; however, sulfur was found, indicating a protein content., Conclusions: The pathogenesis and constituents of these intraluminal crystalloids remain to be determined. Inasmuch as intraluminal crystalloids have not been found in normal ducts or acini, or in ductal hyperplasia without atypia, their presence may serve as a marker for breast carcinoma.
- Published
- 1997
43. Endocrine carcinoma of the kidney.
- Author
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Gurley SD, Luna MA, Ordonez NG, and Mackay B
- Subjects
- Adult, Biopsy, Needle, Carcinoid Tumor pathology, Carcinoid Tumor surgery, Chromogranins analysis, Female, Humans, Immunoenzyme Techniques, Keratins analysis, Kidney Neoplasms pathology, Kidney Neoplasms surgery, Microscopy, Electron, Tomography, X-Ray Computed, Carcinoid Tumor diagnosis, Kidney Neoplasms diagnosis
- Abstract
A 4-cm mass in the right kidney of a 43-year-old female had an endocrine appearance by light microscopy and electron microscopy confirmed this impression, demonstrating the presence of numerous cytoplasmic granules of endocrine caliber. Unusual features were patchy immunoreactivity for chromogranin, and polarity of the granules within the neoplastic cells. Extrarenal extension and liver metastasis were documented.
- Published
- 1997
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44. Reduplicated basal lamina in clear-cell carcinoma of the ovary: an immunohistochemical and electron microscopic study.
- Author
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Kwon TJ, Ro JY, Tornos C, and Ordonez NG
- Subjects
- Adenocarcinoma, Clear Cell immunology, Adolescent, Adult, Aged, Basement Membrane chemistry, Basement Membrane immunology, Basement Membrane ultrastructure, Child, Female, Humans, Immunohistochemistry, Middle Aged, Ovarian Neoplasms immunology, Regeneration, Uterine Cervical Neoplasms chemistry, Uterine Cervical Neoplasms immunology, Uterine Cervical Neoplasms ultrastructure, Vaginal Neoplasms chemistry, Vaginal Neoplasms immunology, Vaginal Neoplasms ultrastructure, Adenocarcinoma, Clear Cell chemistry, Adenocarcinoma, Clear Cell ultrastructure, Ovarian Neoplasms chemistry, Ovarian Neoplasms ultrastructure
- Abstract
Clear-cell carcinomas of the female genital tract are uncommon tumors that usually arise in the ovary, cervix, or vagina. The objectives of the present study were to examine the immunohistochemical and ultrastructural characteristics of 18 of these tumors and to determine whether any distinctive features were present at the different locations. The fine structure of the neoplastic cells was similar at the several sites but there was a striking difference in the appearance of the basal lamina. Prominent reduplication of the basal lamina was seen in all 7 ovarian carcinomas, whereas it was mild in 3 and absent in 7 of the cervico-vaginal tumors. The distribution of eosinophilic hyaline material in hematoxylin/eosin sections and of immunohistochemical staining for type IV collagen and larminin correlated with the ultrastructural observations. Reduplication of the basal lamina has been observed in a number of epithelial neoplasms and viewed as a criterion of differentiation, but there is currently no evidence that its presence influences the prognosis of clear-cell carcinomas of the ovary.
- Published
- 1996
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45. Endocervical type glands in urinary bladder: a clinicopathologic study of six cases.
- Author
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Nazeer T, Ro JY, Tornos C, Ordonez NG, and Ayala AG
- Subjects
- Adult, Aged, Diagnosis, Differential, Female, Humans, Urinary Bladder Diseases diagnosis, Cervix Uteri pathology, Urinary Bladder pathology, Urinary Bladder Diseases pathology
- Abstract
The authors report six cases of glandular lesions made up of endocervical type glands in the urinary bladders of women aged 34 to 65 years (mean, 39 years). Two patients presented with dysuria, one with painless hematuria, one with complaints of pelvic discomfort and hematuria, and one with vaginal discharge. The sixth patient was asymptomatic, but on a routine gynecologic examination, a pelvic mass was found. On physical examination, three women had masses between the bladder and uterus. Four lesions were located in the posterior wall of the urinary bladder, one in the dome, and one in the trigone. Four patients underwent biopsy of the bladder lesion. One of these patients had undergone a hysterectomy 10 years earlier. One woman with a pelvic mass between the bladder and uterus underwent a hysterectomy, bilateral salpingo-oophorectomy, and partial cystectomy. The sixth patient had a transurethral resection of the bladder tumor and left oophorectomy. Histologically, all cases showed intermediate to large-sized irregularly shaped endocervical type glands in the muscularis propria of the urinary bladder. Some glands exhibited cystic dilatation and contained mucinous secretions. The glands elicited no desmoplastic tissue reaction. The intraluminal mucin frequently contained polymorphonuclear leukocytes. In all cases, the glands were lined by mucinous, tall, columnar cells and less commonly by flattened to cuboidal cells. Rare admixed ciliated cells were also observed. The lining epithelium was bland in five cases, but moderate nuclear atypia was seen in one case. Mitoses were not observed in any case. Associated lesions included endometrial type glands surrounded by elastotic stroma in one case, exuberant cystitis glandularis in one case, and a pseudodiverticulum of the bladder in one case. Review of the slides from the patient who had had a hysterectomy 10 years previously revealed endocervical adenocarcinoma in situ. Follow-up (mean = 30 months; range = 6 to 60 months) shows that all patients are alive and well, suggesting that the lesion is benign.
- Published
- 1996
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46. Prognostic significance of biomarkers (c-erbB-2, p53, proliferating cell nuclear antigen, and DNA content) in salivary duct carcinoma.
- Author
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Felix A, El-Naggar AK, Press MF, Ordonez NG, Fonseca I, Tucker SL, Luna MA, and Batsakis JG
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma genetics, Female, Flow Cytometry, Humans, Immunohistochemistry, Male, Middle Aged, Prognosis, Proliferating Cell Nuclear Antigen analysis, Receptor, ErbB-2 analysis, Salivary Gland Neoplasms genetics, Staining and Labeling, Tumor Suppressor Protein p53 analysis, Biomarkers, Tumor analysis, Carcinoma chemistry, Carcinoma pathology, DNA, Neoplasm analysis, Salivary Gland Neoplasms chemistry, Salivary Gland Neoplasms pathology
- Abstract
Salivary duct carcinoma (SDC), a rare neoplasm of the major salivary glands, is a high-grade carcinoma with a predilection for elderly men. The authors investigated the prognostic role of p53, c-erbB2, proliferating cell nuclear antigen (PCNA), and DNA flow cytometry in a pathobiological evaluation of a cohort of 30 patients with these neoplasms. The patient group comprised 24 men and 6 women, with ages ranging from 22 to 87 years (mean = 61 years). Twenty-eight tumors were located in the parotid gland and two in the submandibular gland. Tumor size ranged from 1.0 to 8.0 cm (mean = 3.48 cm). Regional metastases were found in 73.3% (22 patients), systemic metastases in 43.3% (13 patients), and recurrences in 8 (26.6%) patients. DNA aneuploidy was found in 18 tumors (58.0%) and DNA diploidy in 12 (42%), with proliferative fractions ranging from 8.60% to 15.5 (mean = 10.6%). p53 protein nuclear immunostaining was positive in 56.6% and c-erbB2 overexpression was observed in 63% of the tumors. PCNA positivity ranged from 16.5% to 91.0%, with a mean of 49.5%. p53 immunopositivity, DNA aneuploidy, high growth, and proliferative fractions by PCNA and flow cytometry did not correlate with patient outcome. These results indicate that tumor size (P = .05), distant metastasis (P = .006), and C-erbB2 amplification (P = .04) are independent prognostic parameters in patients with salivary duct carcinoma.
- Published
- 1996
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47. Application of genetic screening information to the management of medullary thyroid carcinoma and multiple endocrine neoplasia type 2.
- Author
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Wohllk N, Cote GJ, Evans DB, Goepfert H, Ordonez NG, and Gagel RF
- Subjects
- Base Sequence, Carcinoma, Medullary diagnosis, Carcinoma, Medullary therapy, Humans, Molecular Sequence Data, Multiple Endocrine Neoplasia Type 2a diagnosis, Multiple Endocrine Neoplasia Type 2a therapy, Mutation, Pedigree, Proto-Oncogene Mas, Proto-Oncogenes, Thyroid Neoplasms diagnosis, Thyroid Neoplasms therapy, Carcinoma, Medullary genetics, Genetic Testing, Multiple Endocrine Neoplasia Type 2a genetics, Thyroid Neoplasms genetics
- Abstract
Application of RET proto-oncogene mutation analysis to the clinical management of MEN 2 and FMTC has simplified and enhanced the power of earlier used screening and treatment efforts for hereditary MTC. The approaches outlined herein are cost-effective, have improved diagnostic accuracy, and hold the promise of improved cure rates for this neoplasm. Further studies to elucidate the mechanism by which these activating mutations cause transformation may lead to other strategies for prevention or treatment of this neoplasm.
- Published
- 1996
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48. Endometrioid carcinoma of the ovary with a prominent spindle-cell component, a source of diagnostic confusion. A report of 14 cases.
- Author
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Tornos C, Silva EG, Ordonez NG, Gershenson DM, Young RH, and Scully RE
- Subjects
- Adult, Aged, Aged, 80 and over, Antigens, Neoplasm analysis, Diagnosis, Differential, Diagnostic Errors, Female, Humans, Immunoenzyme Techniques, Keratins analysis, Middle Aged, Mucin-1 analysis, Carcinoma pathology, Endometrial Neoplasms pathology, Ovarian Neoplasms pathology
- Abstract
Fourteen endometrioid carcinomas of the ovary with a prominent component of spindle-shaped epithelial cells are reported. Eleven were initially misdiagnosed as sexcord stromal tumors, malignant mesodermal mixed tumors, tumors of probable wolffian origin, or metastatic carcinomas. All of the tumors, however, had one or more features establishing them as endometrioid carcinomas, including (a) glands typical of endometrioid adenocarcinoma, (b) foci of squamous differentiation, and (c) an adenofibromatous component. Six cases were examined immunohistochemically, and the epithelial nature of the spindle cells was supported by immunostaining for keratin and epithelial membrane antigen. The patients ranged in age from 42 to 89 years (mean, 61). Four cases were stage I, five stage II, and three stage III. Follow-up information was available in seven cases. Five patients were free of disease at 8, 11, 32, 56, and 103 months, and two patients were alive with disease at 10 and 20 months. The age of the patients, clinical presentation, tumor stage, and gross appearance were similar to those of typical endometrioid carcinomas. It is important that this tumor be distinguished from other ovarian neoplasms with a spindle-cell component because of differences in treatment and prognosis.
- Published
- 1995
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49. Diagnosis of mantle cell lymphoma on tissue acquired by fine needle aspiration in conjunction with immunocytochemistry and cytokinetic studies. Possibilities and limitations.
- Author
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Wojcik EM, Katz RL, Fanning TV, el-Naggar A, Ordonez NG, and Johnston D
- Subjects
- Adult, Aged, Antibodies, Monoclonal, Biopsy, Needle, CD5 Antigens metabolism, Cell Division, Female, Flow Cytometry, Humans, Immunochemistry, Ki-67 Antigen, Lymphoma, Non-Hodgkin pathology, Male, Middle Aged, Neoplasm Proteins metabolism, Neoplasm Staging, Nuclear Proteins metabolism, Proliferating Cell Nuclear Antigen metabolism, Lymphoma, Non-Hodgkin diagnosis
- Abstract
Objective: To investigate the cytokinetic features of mantle cell lymphoma (MCL) and determine if there are measurable differences between mantle zone (MCL-MZ) and diffuse (MCL-D) types of MCL., Study Design: Forty-five fine needle aspirates (FNAs) from 36 patients with MCL were reviewed. Immunohistochemistry, using a panel of kappa, lambda, CD5 and CD3, was applied in all cases. Ki-67 positivity using digital image analysis was measured in 29 cases. Flow cytometric analysis was performed on 40 specimens with DNA and RNA indices, and S + G2M phase was assessed., Results: The great majority of cases (42 cases, 94%) were positive for CD5. There was a predominance of lambda-positive cases (lambda:kappa 2:1). MCL-D had higher mean Ki-67 values as compared to MCL-MZ (14.4% vs. 6.5%), but the differences were not statistically significant (P = .07). The majority of cases were diploid (35, 87%). MCL-D had significantly higher mean values for RNA index (P = .005). There was no significant difference in percentage of S + G2M between MCL-MZ and MCL-D; however, the diffuse type had higher mean values as compared to the mantle zone type (5.4 vs. 3.7)., Conclusion: Tissue obtained by FNA is adequate for a diagnosis of MCL. However, while certain proliferation and RNA markers did show a trend toward being lower in MCL-MZ, differentiation between MCL-MZ and MCL-D cannot be made based on these alone; histologic architecture is necessary.
- Published
- 1995
50. Epithelial-myoepithelial carcinoma of salivary glands. A clinicopathologic, DNA flow cytometric, and immunohistochemical study of Ki-67 and HER-2/neu oncogene.
- Author
-
Cho KJ, el-Naggar AK, Ordonez NG, Luna MA, Austin J, and Batsakis JG
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Carcinoma genetics, Carcinoma immunology, Child, DNA, Neoplasm analysis, Flow Cytometry, Genes, erbB-2, Humans, Immunohistochemistry, Ki-67 Antigen, Middle Aged, Neoplasm Proteins analysis, Nuclear Proteins analysis, Salivary Gland Neoplasms genetics, Salivary Gland Neoplasms immunology, Carcinoma pathology, Salivary Gland Neoplasms pathology
- Abstract
Thirty-one salivary gland epithelial-myoepithelial carcinomas from 26 patients were studied by DNA flow cytometry, and immunostaining for Ki-67 and HER-2/neu oncogene product. The results were correlated with clinicopathologic factors and patient outcome. The tumor most commonly involved the parotid gland, and mainly affected patients in their 6th to 8th decades. The clinical course was characterized by a high incidence of local recurrence (50%) and not infrequent distant metastasis (25%). None of the patients in this cohort died of disease. DNA content analysis revealed 21 neoplasms with DNA diploidy and 5 tumors with DNA aneuploidy; all aneuploid cases were near-diploid (hyperdiploidy) and showed low proliferative activity. All aneuploid and 60% of the diploid neoplasms developed recurrences and/or metastases. Immunohistochemical analysis of Ki-67 proliferation markers also showed low overall growth fractions. Interestingly, Ki-67 immunoreactivity was largely restricted to myoepithelial cells, suggesting a central role for this cell in the development of these tumors. HER-2/neu oncogene analysis failed to demonstrate overexpression in any of the tumors examined. This study indicates that epithelial-myoepithelial carcinoma is a low grade malignant neoplasm with a high propensity for recurrence. HER-2/neu oncogene and Ki-67 offer no additional advantages over current factors in the biologic evaluation of these neoplasms. DNA aneuploidy may allow for the identification of a subset of tumors that is more prone to recurrence and metastasis, but further studies with extended follow-up are needed.
- Published
- 1995
- Full Text
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