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Lagios MD. Pathologic features related to local recurrence following lumpectomy and irradiation. SEMINARS IN SURGICAL ONCOLOGY 1992; 8:122-8. [PMID: 1496221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Breast conservation (lumpectomy and irradiation) has grown increasingly popular as a primary therapy for breast cancer. For the majority of patients whose breast cancers are now being detected at T1N0, both the expected cosmetic result and the survival are excellent. For this reason the possibility of local recurrences in the breast has a disproportionally larger impact on treatment planning for these patients. Although the majority of local recurrences occur in the vicinity of the primary tumor site within the initial 5 years of irradiation, local recurrences can be expected to occur well into the second decade as follow-up is continued. The majority of these late recurrences will not be in the immediate vicinity of the prior excision but represent de novo breast cancers developing in a multicentric fashion in other quadrants. Factors which influence recurrence per se include the size, grade, and stage (nodal status) of the tumor. Such factors influence local, locoregional, and distant metastases. A number of pathologic factors appear to affect only local recurrences. These, including positive margins, gross multicentricity, extensive intraductal carcinoma, and invasive lobular carcinoma, all share a common feature of a greater likelihood of local residual tumor burden. The increased risk of local recurrences related to positive surgical margins and extensive intraductal carcinoma can largely be eliminated by increasing the volume of tissue excised or the radiation dose. In summary, there are no absolute contraindications based on pathologic features of the tumor or the state of the resection margins which should preclude consideration of breast conservation for an individual patient.
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van Dongen JA, Holland R, Peterse JL, Fentiman IS, Lagios MD, Millis RR, Recht A. Ductal carcinoma in-situ of the breast; second EORTC consensus meeting. Eur J Cancer 1992; 28:626-9. [PMID: 1317200 DOI: 10.1016/s0959-8049(05)80113-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Duct carcinoma in situ is now being detected with a frequency and at a size unknown prior to mammography. The majority of currently detected lesions are of limited extent and not associated with either occult invasion or axillary metastasis. For such limited duct carcinoma in situ, attempts at adequate local excision appear appropriate. Duct carcinoma in situ represents a number of biologically different processes that exhibit different frequencies of occult invasion and different risks for local recurrence after attempts at excision biopsy. The risks of local recurrence after a breast-conserving procedure without irradiation observing the selection criteria we employ can be estimated on the basis of the histologic subtype of the in situ carcinoma, the extent of disease, and the adequacy of the resection margins. In our prospective series, these risks ranged from 0 to 25 per cent for specific histologic subtypes at a median of 68 months of follow-up, with an overall frequency of recurrence of 12.6 per cent. All recurrences were local in the breast. Half were noninvasive disease, and all of the latter were initially treated by re-excision only. Other investigators report a similar experience. Invasive recurrences have been of minimal size, and all but one was free of nodal metastases. All patients are well at present. Three deaths have occurred secondary to cardiac disease.
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Lagios MD, Margolin FR, Westdahl PR, Rose MR. Mammographically detected duct carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer 1989; 63:618-24. [PMID: 2536582 DOI: 10.1002/1097-0142(19890215)63:4<618::aid-cncr2820630403>3.0.co;2-j] [Citation(s) in RCA: 401] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Seventy-nine patients with mammographically detected foci of duct carcinoma in situ (DCIS) of histologically confirmed extents of 25 mm or less, were treated by tylectomy without irradiation or axillary dissection. Adequacy of excision was confirmed histologically, by radiographic-pathologic correlation and by postoperative mammographic examination. Eight patients (10.1%) have recurred locally in the immediate vicinity of the biopsy site. Four patients developed recurrent in situ disease identified mammographically, and all were initially treated by reexcision. One of these patients subsequently elected to undergo mastectomy; no residual in situ or invasive disease was detected in the breast or in axillary lymph nodes. Four patients developed recurrent invasive disease; 50% of these recurrences were detected mammographically. All patients were treated by mastectomy with node dissection. Three had confirmed minimal invasive carcinomas and were N0, one patient had a 13-mm invasive lobular carcinoma with a single Group I micrometastasis. All patients, including those treated for a recurrence, are presently free of disease but three patients died of heart disease. Nuclear grade would appear to identify subsets of DCIS more likely to produce local failure after tylectomy alone. Duct carcinoma in situ with high-grade nuclear morphology and comedo-type necrosis was associated with a 19% local recurrence rate after an average interval of 26 months; only one of ten patients with intermediate-grade DCIS developed a local recurrence at 87 months; and none of 33 patients with DCIS of micropapillary/nonnecrotic cribriform type and low-grade nuclear morphology developed local recurrence in the follow-up period.
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30
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Webb GA, Lagios MD. Clear cell carcinoma of the endometrium. Int J Gynaecol Obstet 1988. [DOI: 10.1016/0020-7292(88)90302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Margolin FR, Lagios MD. Development of mammography and breast services in a community hospital. Radiol Clin North Am 1987; 25:973-82. [PMID: 3628754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The growth and development of mammography and related breast services in one community hospital are chronicled and described. With mammography providing the initial stimulus, substantial growth, diversification, and sophistication in diagnosis and treatment of breast disease have developed. The achievement of a cooperative and mutually supportive relationship among radiologists, pathologists, and surgeons committed to the goal of early detection of potentially curable breast cancer has succeeded in identifying increasing numbers of such lesions. The more frequent employment of breast-sparing surgical procedures and the encouraging survival rates in patients detected and treated for these early lesions represents an important contribution to the care of these women. Improvement in the detection of early breast cancer can be achieved by community radiologists, whether in private hospitals or office-based practices.
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Abstract
In a clinical-pathologic review of 825 cases of endometrial carcinoma diagnosed between 1955 and 1984, 735 cases were confirmed as endometrial carcinoma. From this group 29 cases of clear cell carcinoma of the endometrium were found representing a 4% frequency. Clear cell carcinoma of the endometrium was found in an older group of women, all postmenopausal. No relationship to the use of estrogen could be demonstrated. The frequency of clear cell carcinoma of the endometrium dropped from 6% in the group diagnosed between 1955 and 1969 to 3% in the group diagnosed between 1970 and 1984, although the numbers of cases of endometrial cancer rose from 194 to 525 in the comparative time span. Clear cell carcinoma of the endometrium has a poorer prognosis, with a 64% 5-year survival rate compared with an 80% 5-year survival rate for adenocarcinoma, not otherwise stated. Three patients died after 5 years of disease. Treatment is still not satisfactory, but the proved therapy remains total abdominal hysterectomy plus salpingo-oophorectomy. The role of adjunctive therapy has not been established.
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Margolin FR, Lagios MD. Mammographic detection of early breast cancer. Ten years' experience in a community hospital. West J Med 1986; 144:46-8. [PMID: 3953069 PMCID: PMC1306505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mammography is currently the most effective method for detecting early breast cancer. In one community hospital during the decade 1974 through 1983, 35% of 415 cases of breast cancer were discovered by xeromammography alone, with a false-positive interpretation rate of 65% and a false-negative rate of 11.1%. Mammography was responsible for detecting an increasing number of smaller cancers with fewer axillary metastases. Such lesions have the most favourable five- and ten-year survival rates. Much lower detection rates of preclinical breast cancer have been reported from other community hospitals.
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Lagios MD, Westdahl PR, Rose MR, Concannon S. Paget's disease of the nipple. Alternative management in cases without or with minimal extent of underlying breast carcinoma. Cancer 1984; 54:545-51. [PMID: 6329506 DOI: 10.1002/1097-0142(19840801)54:3<545::aid-cncr2820540327>3.0.co;2-m] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Six cases of Paget's disease of the nipple without clinical or mammographic evidence of a breast mass are described, two without underlying carcinoma of duct origin, and four with very limited duct carcinoma in situ of the most distal lactiferous ducts. Ultrastructural and immunohistochemical studies on these cases demonstrate that Paget cells arise in situ and invalidate the prevalent "epidermotropic" theory of histogenesis. Paget's disease of the nipple is considered to be an independent in situ carcinoma and part of the general phenomenon of multicentricity in breast cancer. A therapeutic option of conservative surgical intervention and follow-up is described for five of these select patients, all of whom are presently without evidence of disease with an average follow-up of 50 months (range, 30-69 months).
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Abstract
Short-term treatment failures following 43 segmental mastectomies without radiation therapy and 157 total mastectomies for primary operable breast cancer Stages I and II (T1-2, N0-1, M0) are compared. Although not randomized by design, the patients in the two treatment groups were of similar age and had tumors of comparable histologic type, size, grade, and stage. The overall recurrence rates in an average follow-up of 24 months (range, 6-48 months) were 5% for patients treated by standard mastectomy and 19% for those treated by segmental mastectomy. Recurrence rates in patients with the more commonly encountered carcinomas of 11 to 50 mm in size treated by surgery alone were 7.5% for total mastectomy and 28.0% for segmental mastectomy. Nearly all of this difference relates to a higher frequency of local recurrence in the segmental mastectomy group (P = less than 0.005). Recurrent disease in both groups developed at comparable intervals, averaging 17 months for segmental mastectomy and 16 months for total mastectomy. Using a serial subgross technique, which permitted detection of clinically unsuspected involvement of resection margin by microscopic foci of carcinoma, it was noted that such involvement was an important prognostic indicator for local recurrence. Five of eleven breast resections with this feature developed local recurrence, compared with only 3 of 32 without such involvement of the resection margin.
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Lagios MD, Westdahl PR, Margolin FR, Rose MR. Duct carcinoma in situ. Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures. Cancer 1982; 50:1309-14. [PMID: 6286091 DOI: 10.1002/1097-0142(19821001)50:7<1309::aid-cncr2820500716>3.0.co;2-#] [Citation(s) in RCA: 336] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Fifty-three breasts resected for a biopsy diagnosis of duct carcinoma in situ were studied with a serial subgross and correlated radiographic method of examination designed to permit quantitation of the extent of the noninvasive lesion in the breast. Overall frequencies of occult invasion and multicentricity were 21 and 32%, respectively. Among 24 lesions 25 mm or larger in extent (average, 63; median, 56 mm) 11 showed occult foci of invasion, 13 had multicentric foci and six had nipple involvement. Among 29 lesions less than 25 mm in extent (average, 10; median, 8 mm) there were no instances of occult invasion, four were multicentric and two had nipple involvement (P = less than 0.05 for multicentricity and occult invasion). Twenty patients with lesions averaging 8 mm in extent are being followed after excision only in an experimental program. There have been three local recurrences at an average follow-up of 44 months. All recurrences occurred ipsilaterally, two were within the prior biopsy site. All patients with recurrence are free of disease following local resection in two and modified radical mastectomy in one. For lesions with associated microcalcifications, the distribution of the mammographic microcalcifications closely approximates the extent of disease as confirmed histologically. These findings suggest that an important predictive factor for the presence of occult invasion and multicentricity in the resected breast is the extent of the noninvasive lesion.
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Abstract
Cerebral amyloid angiopathy is nonspecific disease entity that has been associated with a number of neuropathologic conditions, the most prominent being dementia and cerebral hemorrhage. It occurs more commonly than is generally appreciated, with implications that may be overlooked. Amyloid deposits are found in the vessels of the leptomeninges and cerebral cortex. There is often a close topographic relation to senile plaques, the histologic abnormality characteristic of Alzheimer's disease and senile dementia. Because of this relation and the well documented presence of amyloid in senile plaques, a similar natural history has been postulated for each. Histochemical studies indicate, however, that there are distinct differences between the amyloid deposits in cerebral vessels and senile plaques. An association between cerebral amyloid angiopathy and other forms of amyloidosis has similarly failed to be established, and a successful form of therapy has yet to be devised.
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Friedman MA, Hoffman PG, Dandolos EM, Lagios MD, Johnston WH, Siiteri PK. Estrogen receptors in male breast cancer: clinical and pathologic correlations. Cancer 1981; 47:134-7. [PMID: 6257370 DOI: 10.1002/1097-0142(19810101)47:1<134::aid-cncr2820470122>3.0.co;2-m] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Breast cancer tissue from 12 male patients was evaluated for the presence of estrogen receptors (ER), and at least 10 of 12 were found to be high in ER (ER+). A combination of previously published cases and our own experience indicates that 80% of patients (37/47) have ER+ tumors. This incidence of ER positivity in men is greater than that in women with breast cancer. Clinical responses to hormonal therapy have been observed in the ER+ patients but not in one ER--patient. Measurement of ER may be clinically important in men with breast cancer.
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39
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Lauder GV, McCosker JE, Lagios MD. The Biology and Physiology of the Living Coelacanth. COPEIA 1980. [DOI: 10.2307/1444498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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40
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Margolin FR, Lagios MD. Polypoid lipomatosis of the small bowel. GASTROINTESTINAL RADIOLOGY 1980; 5:59-60. [PMID: 7358252 DOI: 10.1007/bf01888602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
An unusual case of multiple polypoid, benign lipomatous tumors in the ileum of a 53-year-old female with vague gastrointestinal symptoms is described. The pertinent literature is reviewed, and a technique which could have allowed definitive preoperative diagnosis is suggested.
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Lagios MD, Rose MR, Margolin FR. Tubular carcinoma of the breast: association with multicentricity, bilaterality, and family history of mammary carcinoma. Am J Clin Pathol 1980; 73:25-30. [PMID: 6243440 DOI: 10.1093/ajcp/73.1.25] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Seventeen tubular carcinomas occurred among 211 consecutive mastectomies (7.6%). The relative frequencies of multicentric involvement in the ipsilateral breast (56%), history of bilateral mammary cancer (38%) (P less than .01), and family history of mammary cancer in a first-degree relative (40%) (P less than .05) were all significantly greater in patients with tubular carcinomas than among patients with other carcinomas studied in a review of serial subgross examined mastectomy specimens. Patients with tubular carcinomas also tended to be somewhat younger (56 vs. 59 years) than those with other forms of mammary cancer. These features suggest that tubular carcinoma may be a histologic marker for a subpopulation of patients with mammary carcinomas strongly associated with multicentricity, bilaterality, and familial history of mammary carcinoma.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Female
- Humans
- Lymphatic Metastasis
- Mammography
- Middle Aged
- Neoplasms, Multiple Primary/genetics
- Neoplasms, Multiple Primary/metabolism
- Neoplasms, Multiple Primary/pathology
- Receptors, Estrogen
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Abstract
A case of meningioma appearing to arise from the stellate ganglion and associated with a unilateral Horner syndrome of long standing is presented. Clinical absence of central nervous system involvement and a normal computerized tomographic scan of the brain favor the neoplasm as being a primary extracranial meningioma. Light and electron microscopy showed characteristic structural features. A brief review of the literature is made, and theories concerning the origin of extracranial primary meningioma are presented.
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Migaki G, Lagios MD, Herald ES, Dempster RP. Hepatic trematodiasis in a Ganges River dolphin. J Am Vet Med Assoc 1979; 175:926-8. [PMID: 521375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hepatic trematodiasis caused by Cyclorchis campula was diagnosed in a juvenile Ganges River dolphin that had been in captivity at an aquarium for approximately 1 year. Histopathologic findings were severe chronic suppurative cholangitis, hyperplasia of the bile duct epithelium, and periductal fibrosis associated with fluke infection of the large bile ducts.
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44
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Lagios MD, Gates EA, Westdahl PR, Richards V, Alpert BS. A guide to the frequency of nipple involvement in breast cancer. A study of 149 consecutive mastectomies using a serial subgross and correlated radiographic technique. Am J Surg 1979; 138:135-42. [PMID: 223463 DOI: 10.1016/0002-9610(79)90253-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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45
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Lagios MD, Stasko-Concannon S. Ultrastructure and ATPase activity of the rectal gland of the chondrichthyean fish Hydrolagus colliei (Holocephali). Cell Tissue Res 1979; 198:287-94. [PMID: 157223 DOI: 10.1007/bf00232011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The anatomy, histology, ultrastructure and ATPase activity of the intramural rectal gland of the chondrichthyean Hydrolagus colliei, are described. The cells of the rectal gland of Hydrolagus demonstrate the same well developed lateral and basal cisternae, elongate mitochondria and luminal border as those of their elasmobranch counterparts. ATPase activity within the rectal gland of Hydrolagus is as intense as that in a number of elasmobranchs examined in the course of the study. Despite its primitive intramural location the rectal gland of Hydrolagus represents a homolog of the more specialized and better known elasmobranch gland and appears as well suited for cation excretion.
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46
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Lagios MD, Stasko-Concannon S. Presumptive interrenal tissue (adrenocortical homolog) of the coelacanth Latimeria chalumnae. Gen Comp Endocrinol 1979; 37:404-6. [PMID: 456876 DOI: 10.1016/0016-6480(79)90014-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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47
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48
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Lee WS, Lagios MD, Leonards R. Wound infection by Prototheca wickerhamii, a saprophytic alga pathogenic for man. J Clin Microbiol 1975; 2:62-6. [PMID: 1225929 PMCID: PMC274126 DOI: 10.1128/jcm.2.1.62-66.1975] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Biopsy of a wound infection of the palmar fascia in a young diabetic woman revealed characteristic periodic acid-Schiff-positive Prototheca species cells with a rosette configuration and internal septation. Prototheca wickerhamii was cultured repeatedly from the wound drainage and the biopsy tissue. Several diagnostic features distinguishing Prototheca species, saprophytic algae, from yeasts are: the formation of endospores by mitosis; greater variation in cell size (2 to 15 mum); the presence of cytoplasmic granules, particularly in old cultures; and the absence of budding forms and pseudomycelia. The organism was resistant to 5-fluorocytosine and the minimal inhibitory concentration of amphotericin B was 12.5 mug/ml. With the exception of the tetracycline group, all other 16 antibacterial agents tested appeared completely ineffective in vitro. A synergism between amphotericin B and tetracycline was clearly demonstrated by the use of the checkerboard method. Infection by Prototheca species may be more common than presently realized due to the common expedient of identifying yeast-like isolates as "yeast--not Candida albicans."
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49
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50
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Lagios MD, Friedlander LM, Wallerstein RO, Bohannon RA. Atypical azurophilic crystals in chronic lymphocytic leukemia. A case report and comparison with other crystalline inclusions. Am J Clin Pathol 1974; 62:342-9. [PMID: 4137551 DOI: 10.1093/ajcp/62.3.342] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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