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327
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Hruban RH, Beschorner WE, Baumgartner WA, Achuff SC, Traill TA, Marsh BR, Gupta PK, Hutchins GM, Reitz BA. Diagnosis of lung allograft rejection by bronchial intraepithelial Leu-7 positive T lymphocytes. J Thorac Cardiovasc Surg 1988; 96:939-46. [PMID: 3057293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Currently there is no reliable technique for the diagnosis of lung allograft rejection. The presence of intraepithelial lymphocytes expressing the Leu-7 antigen is a specific marker of renal rejection. We examined whether immunoperoxidase techniques that detect Leu-7 positive lymphocytes could be used to diagnose lung rejection in heart-lung transplant recipients. In lungs from two autopsied patients with lung allograft rejection, numerous Leu-7 positive lymphocytes were present in the donor bronchial mucosa (32 and 65 cells/section), submucosa (23 and 80 cells/section), and submucosal glands (7 and 19 cells/section). These Leu-7 positive lymphocytes were associated with proximal airway injury, including squamous metaplasia, destruction of submucosal glands, and ulceration. In one case, there was bronchiectasis. Both cases also had distal airway bronchiolitis obliterans. In contrast, Leu-7 positive lymphocytes were not identified in the epithelium of the native trachea of these two patients; nor were they found in the bronchial epithelium of two sets of transplanted lungs without evidence of rejection. Only rare Leu-7 positive lymphocytes were evident in the epithelium (0 to 2 cells/section) and submucosal glands (0 to 1 cell/section) of 20 lungs from autopsied patients who had not received a transplant. Application of this technique to epithelial biopsy specimens obtained at bronchoscopic examinations demonstrated that it could be applied to the diagnosis of rejection in living heart-lung transplant recipients.
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328
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Colevas AD, Edwards JL, Hruban RH, Mitchell GA, Valle D, Hutchins GM. Glutaric acidemia type II. Comparison of pathologic features in two infants. Arch Pathol Lab Med 1988; 112:1133-9. [PMID: 3178428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Glutaric acidemia type II (GA II) is a metabolic disorder caused by deficiency of electron transport flavoprotein or its oxyreductase. It is characterized by acidosis, hypoglycemia, hyperammonemia, organic aciduria, and "sweat-sock" odor. Neonatal GA II differs from most inborn metabolic errors in that there are prominent congenital malformations. We recently observed two infants at autopsy with GA II whose malformations included: subcortical renal glomerular cysts, renal medullary dysplasia, cerebral pachygyria, pulmonary hypoplasia, and facial dysmorphism. In addition, there was lipid accumulation in liver, heart, and renal tubular epithelium, tissues that use fatty acids as a primary source of energy. Review of previous reports of 12 patients showed that these lesions are typical of neonatal GA II. The pattern of lesions, in particular the striking localization of renal dysplasia to the medulla, suggests that the malformations may be the consequence of an accumulation of toxic metabolites that is not corrected by placental transfer.
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329
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Ren H, Hruban RH, Kuhlman JE, Fishman EK, Wheeler PS, Zerhouni EA, Hutchins GM. Computed tomography of rounded atelectasis. J Comput Assist Tomogr 1988; 12:1031-4. [PMID: 3183106 DOI: 10.1097/00004728-198811000-00022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
High resolution CT of a fixed-inflated air-dried lung was obtained from a patient with rounded atelectasis. The dense periphery of the mass was shown to correspond to an invagination of the pleura, and the central lucency to slightly aerated atelectatic lung parenchyma.
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330
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Kuhlman JE, Hruban RH, Almaraz R, Fishman EK. Case report 505: Malignant fibrous histiocytoma of thigh and liposarcoma in same lower extremity (synchronous lesions). Skeletal Radiol 1988; 17:518-21. [PMID: 2849210 DOI: 10.1007/bf00364049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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331
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Hruban RH, Beschorner WE, Baumgartner WA, Achuff SC, Traill TA, Digennaro KA, Reitz BA, Hutchins GM. Depletion of bronchus-associated lymphoid tissue associated with lung allograft rejection. THE AMERICAN JOURNAL OF PATHOLOGY 1988; 132:6-11. [PMID: 3293464 PMCID: PMC1880619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Pulmonary infections remain one of the major complications of lung transplantation. The bronchus-associated lymphoid tissue (BALT) forms a local immune system that normally protects the lung from infection. The effects of lung transplantation and lung allograft rejection on the BALT were examined using immunoperoxidase techniques. The BALT was evaluated by quantifying the number of immunoglobulin-bearing plasma cells in the lamina propria of sections of trachea and mainstem bronchus. Sections of donor mainstem bronchus from 2 patients with allograft rejection were compared with sections of native trachea from these same patients, and with sections of mainstem bronchus from 2 transplanted lungs without rejection and 20 controls. Lung allografts from the 2 patients with rejection had a marked depletion of submucosal IgA-bearing and IgG-bearing plasma cells. Two sets of transplanted lungs without evidence of rejection showed only a mild reduction of the BALT. The depletion of BALT associated with allograft rejection may contribute to the increased incidence of pulmonary infections seen in these patients.
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332
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Hruban RH, Erozan YS, Zinreich SJ, Kashima HK. Fine-needle aspiration cytology of monomorphic adenomas. Am J Clin Pathol 1988; 90:46-51. [PMID: 3389343 DOI: 10.1093/ajcp/90.1.46] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The diagnostic accuracy of fine-needle aspiration of salivary gland lesions is now widely accepted. The cytologic appearance of two rare monomorphic variants of pleomorphic adenomas is described. The trabecular-tubular adenoma consisted of a trabecular arrangement of uniform small cells with scant basophilic cytoplasm and round nuclei. No mucoid spheres were present. The canalicular adenoma also had a distinctive cytologic appearance consisting of papillae and interconnected canaliculi lined by a layer of columnar epithelium. Monomorphic adenomas have unique morphologic appearances that can be recognized in fine-needle aspiration cytology. Preoperative diagnosis can greatly aid the surgeon in the planning of definitive surgical excision of salivary gland neoplasms.
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333
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Fishman EK, Drebin RA, Hruban RH, Ney DR, Magid D. Three-dimensional reconstruction of the human body. AJR Am J Roentgenol 1988; 150:1419-20. [PMID: 3259389 DOI: 10.2214/ajr.150.6.1419] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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334
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Rijhsinghani AG, Hruban RH, Stetten G. Fetal anomalies associated with an inversion duplication 13 chromosome. Obstet Gynecol 1988; 71:991-4. [PMID: 3287254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report the cytogenetics and pathology of a fetus with holoprosencephaly associated with an inversion duplication 13 chromosome. The pathology is compared with that found in cases of partial duplication (trisomy) and deficiency (monosomy) of chromosome 13 described in the literature. To our knowledge, this is the first time holoprosencephaly has been associated with this particular inversion duplication 13 chromosome. Careful pathology and complete chromosomal studies proved useful in counseling this couple.
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335
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Hruban RH, Beschorner WE, Gupta PK, Baumgartner WA, Achuff SC, Traill TA, Reitz BA, Hutchins GM. Diagnosis of rejection of lung allografts. N Engl J Med 1988; 318:1129. [PMID: 3281018 DOI: 10.1056/nejm198804283181716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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336
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Meziane MA, Hruban RH, Zerhouni EA, Wheeler PS, Khouri NF, Fishman EK, Hutchins GM, Siegelman SS. High resolution CT of the lung parenchyma with pathologic correlation. Radiographics 1988; 8:27-54. [PMID: 3353534 DOI: 10.1148/radiographics.8.1.3353534] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The authors describe a technique for directly correlating high resolution CT scans and gross and histologic sections of the lung. They conclude that HRCT provides anatomic detail comparable to that seen on gross tissue inspection.
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337
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Hruban RH, Zerhouni EA, Dagher AP, Pessar ML, Hutchins GM. Morphologic basis of MR imaging of benign prostatic hyperplasia. J Comput Assist Tomogr 1987; 11:1035-41. [PMID: 2445800 DOI: 10.1097/00004728-198711000-00022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Fifteen prostates were obtained from patients autopsied at The Johns Hopkins Hospital and imaged fresh in vitro by high resolution magnetic resonance (MR) imaging with a surface coil. Following scanning, the specimens were fixed and sectioned in the same plane as the MR images. The prostate sections, corresponding to the MR images, were examined grossly and histologically for prostate pathology. Tissue characteristics were quantified by morphometric techniques and correlated with MR image intensity. Five prostates were normal and showed two distinct anatomic zones, a central periurethral zone and a peripheral zone. These two zones corresponded to two zones identified on MR of the five normal prostates. In contrast, both the MR images and the pathologic and morphometric studies of nine of the 10 prostates with benign prostatic hyperplasia (BPH) showed three distinct zones: a central region of BPH, a surrounding fibrous capsule, and a peripheral zone. This study suggests that there is a morphologic basis for MR intensity in the prostate.
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338
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Hruban RH, Kuhajda FP, Mann RB. Acute myelofibrosis. Immunohistochemical study of four cases and comparison with acute megakaryocytic leukemia. Am J Clin Pathol 1987; 88:578-88. [PMID: 3314470 DOI: 10.1093/ajcp/88.5.578] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Four cases of acute myelofibrosis are contrasted to three cases of acute megakaryocytic leukemia. The cases were clinically indistinguishable. Light microscopic examination of hematoxylin and eosin-stained bone marrow biopsy specimens from the cases of acute myelofibrosis showed a trilinear proliferation of mature and immature hematopoietic cells, increased numbers of mature magakaryocytes, and marked fibrosis. In contrast, the blast cells in the cases of acute megakaryocytic leukemia showed a continuous spectrum of differentiation from small blasts to megakaryoblasts. Immunoperoxidase staining showed the blast cells in all three cases of acute megakaryocytic leukemia to be strongly positive for Factor VIII, a marker of megakaryocytic differentiation. These same blasts did not stain with markers of myelomonocytic (lysozyme), lymphocytic (Hle), and myeloid (Leu-Ml) differentiation. In contrast, the blast cells in all four cases of acute myelofibrosis were Factor VIII, Hle, and Leu-Ml negative but did occasionally stain with anti-lysozyme.
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339
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Hruban RH, Molina JM, Reddy MN, Boitnott JK. A neoplasm with pancreatic and hepatocellular differentiation presenting with subcutaneous fat necrosis. Am J Clin Pathol 1987; 88:639-45. [PMID: 3673946 DOI: 10.1093/ajcp/88.5.639] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A neoplasm demonstrating both pancreatic and hepatic phenotypes is described. The tumor, from a 53-year-old woman with the syndrome of subcutaneous fat necrosis and arthropathy, was studied histologically, immunohistochemically, ultrastructurally, and biochemically. The clinical features of this case can be explained by the production of large amounts of lipase by the tumor. The hepatocellular properties of the tumor included characteristic morphology and the synthesis of catalase. The pancreatic properties of the tumor included the production of pancreatic lipase. This neoplasm would appear to be analogous to animal models in which the transdifferentiation of pancreatic acinar cells and hepatocytes has been demonstrated. Although the bulk of the tumor was present in the liver, the authors believe the tumor arose from the pancreas. The distinction between differentiation and site of origin of tumors is discussed.
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340
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Hruban RH, Meziane MA, Zerhouni EA, Khouri NF, Fishman EK, Wheeler PS, Dumler JS, Hutchins GM. High resolution computed tomography of inflation-fixed lungs. Pathologic-radiologic correlation of centrilobular emphysema. THE AMERICAN REVIEW OF RESPIRATORY DISEASE 1987; 136:935-40. [PMID: 3310774 DOI: 10.1164/ajrccm/136.4.935] [Citation(s) in RCA: 154] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Centrilobular emphysema (CLE) is a disease defined pathologically. Assessment of the accuracy of high resolution computed tomography (CT) in the diagnosis of centrilobular emphysema has been hampered by a lack of pathologic correlation. We applied high resolution computed tomography to 20 postmortem lung specimens fixed by a method that allows for direct one-to-one pathologic-radiologic correlation. The degree of centrilobular emphysema was assessed radiologically on a visual grading system based on nonperipheral low-attenuation areas. The lungs were then sectioned along the plane of the CT image, and the degree of centrilobular emphysema was graded pathologically by scoring against a panel of standards. A significant correlation (r = 0.91, p less than 0.005) was found between the pathologic grade and the in vitro CT score.
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341
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Hruban RH, Meziane MA, Zerhouni EA, Wheeler PS, Dumler JS, Hutchins GM. Radiologic-pathologic correlation of the CT halo sign in invasive pulmonary aspergillosis. J Comput Assist Tomogr 1987; 11:534-6. [PMID: 3571603 DOI: 10.1097/00004728-198705000-00033] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Invasive pulmonary aspergillosis in the immunocompromised host is difficult to diagnose. Early therapy with amphotericin B improves survival. We correlated early pathologic findings with high-resolution CT of a fixed-inflated air-dried lung obtained from an autopsied patient with invasive pulmonary aspergillosis. Two distinct types of lesions were found radiologically. A large zone of air space consolidation was shown to be a confluent bronchopneumonia, and small halo-like lesions were shown to correspond to a central fungal nodule surrounded by a rim of coagulative necrosis. The halo lesion may represent an early specific sign by which invasive pulmonary aspergillosis can be diagnosed.
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342
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McDonnell PJ, Hutchins GM, Hruban RH, Brown CG. Hemorrhage from gastric mucosal tears complicating cardiopulmonary resuscitation. Ann Emerg Med 1984; 13:230-3. [PMID: 6608297 DOI: 10.1016/s0196-0644(84)80468-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We observed at autopsy two patients in whom clinically significant gastrointestinal bleeding occurred from gastric mucosal tears following closed chest cardiac massage. Review of autopsy files showed that, when the Mallory-Weiss syndrome is excluded, linear mucosal tears along the lesser curvature of the stomach occur in about 2% of patients given cardiopulmonary resuscitation; similar lesions have not been observed in patients not subjected to resuscitation. The localization of the tears along the lesser curvature of the stomach is probably the consequence of the catenoidal configuration of that region. The importance of the mucosal tears lies in their propensity to hemorrhage if resuscitation is successful.
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