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Orr CE, Beneck D, Jessurun J, Qin L, Tyryshkin K, Yantiss RK, Chen YT. High interobserver variability and frequent overdiagnosis of dysplasia in fundic gland polyps can be improved by detecting atypia on the surface epithelium and an abrupt transition to non-neoplastic cells. Histopathology 2021; 80:314-321. [PMID: 34424570 DOI: 10.1111/his.14549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022]
Abstract
AIMS Fundic gland polyps (FGPs) arise sporadically and in combination with familial adenomatous polyposis (FAP). Criteria for distinguishing low-grade dysplasia (LGD) from regenerative atypia in FGPs are not well established. The aims of study were to determine: (i) interobserver variability in diagnosing LGD in FGPs; (ii) bias in diagnosing LGD in FAP patients; and (iii) stringent criteria for LGD in FGPs. METHODS AND RESULTS Five senior pathologists who were blinded to the clinical history reviewed 72 FAP-associated FGPs and 34 sporadic FGPs. Cases were classified as negative (score = 0) or positive (score = 1) for LGD. Each case was assigned a 'combined dysplasia score' (CDS) ranging from 0 to 5 to reflect all five opinions. Fleiss' kappa showed only moderate interobserver agreement (κ = 0.46). Forty-one FGPs were classified as negative for dysplasia by consensus (CDS = 0-1), including 10 (24%) originally diagnosed as LGD. In contrast, all 37 cases classified as LGD by consensus (CDS = 4-5) were originally diagnosed as LGD, indicating that overdiagnosis of dysplasia is more common than underdiagnosis (P = 0.0012). Cytological atypia in the surface epithelium and an abrupt transition between atypical and normal-appearing epithelium were the most sensitive (97% and 100%, respectively) and specific (100% and 98%, respectively) features of dysplasia (P < 0.0001 for both comparisons). Very good agreement was achieved when a diagnosis of dysplasia was based on the presence of both features (κ = 0.85). CONCLUSIONS There is high interobserver variability and a tendency to overdiagnose LGD in FGPs. Strict criteria requiring both surface atypia and abrupt transition for LGD in FGPs result in low interobserver variability.
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Affiliation(s)
- Christine E Orr
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Debra Beneck
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jose Jessurun
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lihui Qin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kathrin Tyryshkin
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Yao-Tseng Chen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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2
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Hissong E, Baek I, Costa V, Beneck D, Saxena A, Solomon JP, Song W. Identification of a Microsatellite Stable, EGFR-Mutant Lung Adenocarcinoma Developing in a Patient With Lynch Syndrome. JCO Precis Oncol 2020; 4:818-822. [PMID: 35050755 DOI: 10.1200/po.20.00074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Erika Hissong
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - Inji Baek
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - Victoria Costa
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - Debra Beneck
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - Ashish Saxena
- Department of Medicine New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - James P Solomon
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - Wei Song
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
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Kovanlikaya A, Beneck D, Rose M, Renjen P, Dunning A, Solomon A, Sockolow R, Brill PW. Quantitative apparent diffusion coefficient (ADC) values as an imaging biomarker for fibrosis in pediatric Crohn's disease: preliminary experience. ACTA ACUST UNITED AC 2016; 40:1068-74. [PMID: 25248794 DOI: 10.1007/s00261-014-0247-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare histopathology with ADC values in strictured bowel segments in pediatric patients with known Crohn's disease and surgical bowel resection. METHODS Magnetic resonance enterography (MRE) images of 14 subjects with Crohn's disease who had surgical bowel resection for strictures were retrospectively reviewed. Five of 14 subjects had DWI (b=0, 500, 1000) sequences included in the MRE study. ADC measurements were made by placing ROI's in the strictured bowel wall and compared to full-thickness histologic analysis of resected specimens. ADC values were also compared to control ADC measurements (in normal and inflamed-nonstenotic bowel segments) as well as the mean ADC values of Crohn's patients published in the literature. RESULTS All five subjects had transmural fibrosis. The mean ADC value with b = 500 was 0.92 ± 0.10 × 10(-3) mm(2)/s and with b = 1000 was 0.8 ± 0.05 × 10(-3) mm(2)/s. There was a significant difference in ADC values between strictures and inflamed-nonstenotic segments (p=0.0143) and between normal and diseased bowel segments (p=0.009-0.0143). CONCLUSIONS Quantitative ADC measures of transmural fibrosis are lower compared to the reported values of inflammation in Crohn's disease. To our knowledge, this is the first pediatric pilot study to investigate the correlation of quantitative DWI with histology of surgical specimens in pediatric patients with Crohn's disease. Our results are comparable to a recently published study in adult Crohn's patients showing a significant correlation between a decrease in ADC values and fibrosis.
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Affiliation(s)
- A Kovanlikaya
- Department of Radiology, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E 68th St., New York, NY, 1006, USA,
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4
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Kovanlikaya A, Watson E, Hayward J, Beneck D, Sockolow R, Solomon A, Christos P, Brill PW. Magnetic resonance enterography and wireless capsule endoscopy in the evaluation of patients with inflammatory bowel disease. Clin Imaging 2012. [PMID: 23206611 DOI: 10.1016/j.clinimag.2012.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Magnetic resonance enterography (MRE) is increasingly used in children due to growing concerns of radiation. OBJECTIVE To determine the performance of MRE, imaging findings were compared to wireless capsule endoscopy (WCE) and histology results in children with/or suspected inflammatory bowel disease (IBD). MATERIALS AND METHODS Pathology and WCE reports were retrospectively reviewed in 23 patients who had MRE. RESULTS The sensitivity of MRE was 75.0% while the sensitivity of WCE was 77.8%. CONCLUSION MRE and WCE are complementary techniques in evaluation of the small bowel in IBD.
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Affiliation(s)
- Arzu Kovanlikaya
- NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY 10065, USA.
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5
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Cheng E, Cohen L, Gasinu S, Sy C, Beneck D, Spigland N. Cecal diverticulitis as a continuing diagnostic and management dilemma: a report of two cases in children. Pediatr Surg Int 2012; 28:99-102. [PMID: 22138978 DOI: 10.1007/s00383-011-3035-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2011] [Indexed: 10/15/2022]
Abstract
Right-sided diverticulitis remains an exceedingly rare condition in the pediatric population. The clinical presentation mimics acute appendicitis, and the correct diagnosis is often difficult to make prior to operative exploration. We report two cases of cecal diverticulitis, and discuss the diagnosis and management of this disease, with a review of the literature.
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Affiliation(s)
- Elaine Cheng
- Department of Surgery, Weill Cornell Medical College, New York, NY 10065, USA
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6
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Gurian MS, Kovanlikaya A, Beneck D, Baron KT, John M, Brill PW. Radiologic–pathologic correlation in acute appendicitis: can we use it as a quality measure to assess interpretive accuracy of radiologists? Clin Imaging 2011; 35:421-3. [DOI: 10.1016/j.clinimag.2011.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 12/26/2010] [Indexed: 10/15/2022]
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7
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Chen YT, Chiu R, Lee P, Beneck D, Jin B, Old LJ. Chromosome X-encoded cancer/testis antigens show distinctive expression patterns in developing gonads and in testicular seminoma. Hum Reprod 2011; 26:3232-43. [DOI: 10.1093/humrep/der330] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Reichman M, Kovanlikaya A, Mathew S, Beneck D, Brill PW. Pulmonary blastoma in a neonate: a lesion distinct from pleuropulmonary blastoma with unique cytogenetic features. Pediatr Radiol 2010; 40:366-70. [PMID: 19902198 DOI: 10.1007/s00247-009-1456-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Revised: 10/01/2009] [Accepted: 10/20/2009] [Indexed: 11/24/2022]
Abstract
Pulmonary blastoma is a rare malignant primary lung neoplasm typically seen in adults that accounts for 0.3-1.3% of lung malignancies. It has been categorized as a subtype of sarcomatoid carcinoma according to the current World Health Organization Classification of Lung Tumours and is distinct from the more common pediatric lung tumor pleuropulmonary blastoma. We report a case of neonatal pulmonary blastoma, illustrating the imaging characteristics of this rare tumor. The subject of pediatric lung masses is confusing because the terms pleuropulmonary blastoma and pulmonary blastoma have been used interchangeably in previously reported cases. We recommend use of the current WHO classification to differentiate these lesions as additional cases are described. Additionally, we discuss distinctive cytogenetic features of this case.
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Affiliation(s)
- Melissa Reichman
- Department of Radiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY 10065, USA
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9
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Patel NR, Ward MJ, Beneck D, Cunningham-Rundles S, Moon A. The Association between Childhood Overweight and Reflux Esophagitis. J Obes 2010; 2010:136909. [PMID: 20700412 PMCID: PMC2911620 DOI: 10.1155/2010/136909] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 02/28/2010] [Accepted: 02/28/2010] [Indexed: 12/14/2022] Open
Abstract
Background. In adults, it has been shown that obesity is associated with gastroesophageal reflux disease (GERD) and GERD-related complications. There are sparse pediatric data demonstrating associations between childhood overweight and GERD. Objective. To investigate the association between childhood overweight and RE. Methods. We performed a retrospective chart review of 230 children (M : F = 114 : 116) who underwent esophagogastroduodenoscopy (EGD) with biopsies between January 2000 and April 2006. Patient demographics, weight, height, clinical indications for the procedure, the prevalence of BMI classification groups, the prevalence of RE and usage of anti-reflux medications were reviewed. For these analyses, the overweight group was defined to include subjects with BMI>/= 85th percentile. The normal weight group was defined to include subjects with BMI 5th to 85th percentile. Results. Among the 230 subjects, 67 (29.1%) had BMI percentiles above the 85th percentile for age and gender. The prevalence of RE in the overweight group did not differ significantly from that in the normal weight group (23.9% versus 24.5%, resp.). Overweight subjects taking anti-reflux medications clearly demonstrated a higher prevalence of biopsy-proven RE compared to overweight subjects not taking anti-reflux medications (34.1% versus 7.7%, P = .009). Conclusions. There was no significant difference in the prevalence of biopsy-proven RE in the overweight group compared to the normal weight group. However, the prevalence of RE was significantly higher in overweight subjects on anti-reflux medications compared to overweight subjects not taking anti-reflux medications. This finding emphasizes the importance of early recognition and treatment of GERD for the overweight pediatric patients with symptoms in conjunction with weight loss program for this population to reduce long-term morbidities associated with GERD.
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Affiliation(s)
- Nirav R. Patel
- Division of Gastroenterology and Nutrition, Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA
| | - Mary J. Ward
- Division of General Pediatrics, Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA
| | - Debra Beneck
- Department of Pathology, New York-Presbyterian Hospital, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA
| | - Susanna Cunningham-Rundles
- Division of Hematology and Oncology, Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA
| | - Aeri Moon
- Division of Gastroenterology and Nutrition, Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA
- Division of Gastroenterology & Nutrition, Massachusetts General Hospital for Children, 175 Cambridge Street, CPZS-558, Boston, MA 02114, USA
- *Aeri Moon:
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10
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Jordan N, Sockolow R, Beneck D, Moon A. Diagnoses of eosinophilic esophagitis in children who underwent foreign body retrieval of coins. Gastroenterol Hepatol (N Y) 2009; 5:833-836. [PMID: 20567527 PMCID: PMC2886382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Nicole Jordan
- Division of Pediatric Gastroenterology and Nutrition, New York Presbyterian Hospital, Weill Cornell Medical Center, New York
| | - Robbyn Sockolow
- Division of Pediatric Gastroenterology and Nutrition, New York Presbyterian Hospital, Weill Cornell Medical Center, New York
| | - Debra Beneck
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York
| | - Aeri Moon
- Division of Pediatric Gastroenterology and Nutrition, New York Presbyterian Hospital, Weill Cornell Medical Center, New York
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Abstract
Expression of CD43 by B cells is often used as a diagnostic criterion in favor of a B-cell lymphoproliferative disorder, including small lymphocytic lymphoma/chronic lymphocytic leukemia, mantle cell lymphoma, Burkitt lymphoma, precursor B-lymphoblastic lymphoma, and a subset of marginal zone B-cell lymphomas. Benign B cells generally do not coexpress CD43. The authors analyzed 20 biopsies of the terminal ileum for nonneoplastic disease for expression of CD43 and compared them with other sites and with CD20, CD138, and CD3 reactivity. The majority of cases (85%) showed strong coexpression of CD43 by benign perifollicular B cells. The presence of CD43 coexpression in B-cell populations of the terminal ileum, including those of Peyer's patches, should not be used as a diagnostic parameter to differentiate extranodal marginal zone B-cell lymphoma of MALT type from reactive processes.
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Affiliation(s)
- Po-Shing Lee
- From Division of Hematopathology, IMPATH Inc, New York, NY 10019, USA
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Hsu CD, Polavarapu S, Rajendran G, Fuks A, Strassberg S, Godi I, Beneck D, Parton L. The role of Fas-670 gene polymorphism in normal and preeclamptic pregnancies. Am J Obstet Gynecol 2004. [DOI: 10.1016/j.ajog.2004.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
The authors describe a 10-week-old girl with infantile hepatic hemangioendothelioma who initially presented with difficulty feeding, hepatomegaly, and multiple hemangiomas of the skin. Six weeks of steroid therapy and 2 weeks of chemotherapy failed to produce clinical improvement. The patient underwent split liver transplantation. A definitive diagnosis of hemangioendothelioma type II was made. Imaging studies cannot differentiate between hemangioendothelioma and angiosarcoma. Treatment modalities for this condition remain unclear. The patient continues to do well.
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Affiliation(s)
- Rowan Walsh
- Department of Pediatrics, Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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Abstract
Renal tubular dysgenesis (RTD) is a rare form of noncystic renal disease characterized by paucity or absence of proximal renal tubules. Always lethal in the perinatal period, it has been associated with Potter sequence and with other congenital malformations. An autosomal recessive inheritance has been suggested. We present a case of renal tubular dysgenesis associated with fetal hydrops and trisomy 21, with a review of relevant literature.
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Affiliation(s)
- Vibha Jain
- Department of Pathology, Room 2F-01, Westchester Medical Center and New York Medical College, Valhalla, NY 10595, USA
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Affiliation(s)
- Humayun K Islam
- Department of Pathology, Westchester Medical Center, Valhalla, NY 10595, USA.
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16
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Zhang X, Beneck D, Bostwick HE, Weisberger J. Primary Burkitt-like lymphoma presenting as a solitary rectal polyp in a child: case report. Pediatr Dev Pathol 2003; 6:182-6. [PMID: 12522693 DOI: 10.1007/s10024-002-0046-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2002] [Accepted: 11/14/2002] [Indexed: 11/29/2022]
Abstract
Primary rectal lymphoma in childhood is rare. We report a case in a 10-year-old boy who presented with rectal bleeding and a single rectal polyp. Histologic examination, immunophenotyping and molecular genetic study of the polyp showed a diffuse B-cell lymphoma, Burkitt-like type. The literature on this topic is reviewed and pathologic examination of childhood rectal polyps is emphasized.
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Affiliation(s)
- Xinmin Zhang
- Department of Pathology, Westchester Medical Center, Room 2F-01, Valhalla, NY 10595, USA
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17
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Fidvi SA, Brudnicki AR, Chowdhury MI, Beneck D. Cavitary Rhodococcus equi pneumonia with endobronchial granulomas: report of an unusual case. Pediatr Radiol 2003; 33:140-2. [PMID: 12557073 DOI: 10.1007/s00247-002-0845-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2002] [Accepted: 10/14/2002] [Indexed: 10/25/2022]
Abstract
An unusual case of cavitary Rhodococcus equi pneumonia with endobronchial granulomas in congenital HIV infection is presented. The clinical features and radiological manifestations of pulmonary R. equi infection are discussed.
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Affiliation(s)
- S A Fidvi
- Department of RadiologyWestchester Medical Center, Valhalla, NY 10595, USA.
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18
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Abstract
BACKGROUND Liver biopsy findings are important in diagnosing extrahepatic biliary atresia. Diffuse ductular proliferation is a characteristic finding. We describe four patients with conjugated hyperbilirubinemia in whom the initial liver biopsy findings showed a lack of ductular proliferation, despite subsequent development of biliary atresia. RESULTS On initial biopsy, paucity of intrahepatic bile ducts was present in three of four patients, with a bile duct to portal space ratio of 0.3 to 0.4 (normal, 0.9-1.8). A normal bile duct to portal space ratio of 1.0 was observed in the fourth patient. Ductular proliferation became apparent in three subjects between 9 and 12 weeks of age, and biliary atresia was noted at the time of a Kasai portoenterostomy. The fourth child had well-developed biliary cirrhosis at liver transplantation. CONCLUSIONS Changes characteristic of biliary atresia may appear even after 9 weeks of age. Bile duct paucity and normal bile duct to portal space ratio do not preclude the subsequent development of biliary atresia. Infants with unexplained conjugated hyperbilirubinemia and acholic stools should undergo sequential liver biopsies until clinical improvement occurs or until biliary atresia can be excluded from the differential diagnosis.
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Affiliation(s)
- Georgia Azar
- Department of Pathology, North Shore University Hospital, New York University School of Medicine, Manhasset, New York 11030, USA
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19
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Abstract
OBJECTIVE To determine the perinatal effects of histologic chorioamnionitis on preterm neonates and the effectiveness of antenatal steroids in the presence of histologic chorioamnionitis. METHODS We studied neonates at our institution who weighed 1750 g or less at birth from January 1990 through December 1997. The population was stratified primarily by presence of histologic chorioamnionitis and secondarily by exposure to antenatal steroids. Subgroups were compared by various perinatal outcomes and confounding variables. Student t test, chi(2), Fisher exact test, and logistic regression were used for analysis. RESULTS Among 1260 neonates entered, the placentas of 527 had evidence of histologic chorioamnionitis and 733 did not. Those with histologic chorioamnionitis had a lower mean gestational age, lower birth weight, and higher rate of major neonatal morbidities than those without it. After adjusting for confounding variables, histologic chorioamnionitis independently associated with lower gestational age, lower birth weight, and neonatal death. Among neonates exposed to antenatal steroids who had histologic chorioamnionitis, there was a significantly lower incidence of low Apgar scores (18% compared with 33.5%, P <.001), respiratory distress syndrome (RDS) (39.6% compared with 55.9%, P <.001), intraventricular hemorrhage and periventricular leukomalacia (21.9% compared with 36.9%, P <.001), major brain lesions (7.7% compared with 18.4%, P <.001), patent ductus arteriosus (14.8% compared with 23.7%, P =.018), and neonatal death (8.3% compared with 16.2%, P =.02), with no increase in rate of proven neonatal sepsis (18.3% compared with 14%, P =.24). CONCLUSION Histologic chorioamnionitis increases major perinatal morbidity through its association with preterm birth and is independently associated with neonatal death. In the presence of histologic chorioamnionitis, antenatal steroids significantly decreased the incidence of RDS, intraventricular hemorrhage and periventricular leukomalacia, major brain lesions, and neonatal mortality, without increasing neonatal sepsis.
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Affiliation(s)
- A Elimian
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, USA
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20
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Abstract
We report the cytogenetic findings in a Wilms tumor from a 4-year-old boy. Karyotypic analysis revealed isochromosomes of 7q and 17q as coexisting clonal aberrations. The finding is notable in view of recent reports of i(7q) as a nonrandom event in Wilms tumor and the emerging evidence for genetic heterogeneity in this tumor.
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Affiliation(s)
- C Sreekantaiah
- Department of Pathology, New York Medical College, Valhalla 10595, USA
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21
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Abstract
Intrascrotal and testicular masses in the pediatric population do not usually present as treatment dilemmas. Herein, we report an unusual case of an enlarging, intrascrotal capillary hemangioendothelioma in a 3-month-old male infant. Conservative management including watchful waiting in the case of purely cutaneous scrotal hemangiomas is the treatment of choice. However, scrotal lesions with a palpable testicular or scrotal mass do not lend themselves to conservative treatment and, as in this case, exploration with intraoperative evaluation and excision is warranted.
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Affiliation(s)
- M E Kolligian
- Division of Urology, Children's Memorial Hospital, Chicago, Illinois, USA
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22
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Abstract
BACKGROUND Prenatally diagnosed neuroblastomas have been reported in increasing numbers over the past several years, and there are now a few reviews based on up to 21 cases. The purpose of this article is to review the clinical and biologic features of prenatally diagnosed neuroblastoma based on a review of 55 cases. METHODS A review was conducted of 3 cases seen at the study institution and 52 other cases reported thus far in the literature. RESULTS Prenatal diagnosis was made usually after 32 weeks of gestation. Approximately 93% of the tumors were adrenal in origin, and 44% of these were cystic. Thirty-seven patients (67%) had Stage I disease, 12 (22%) had Stage IV-S disease, and only 3 (5%) had Stage IV disease. The DNA index was favorable (> 1) in 14 of 16 patients studied. None of these 16 patients studied had amplification of the N-myc oncogene. Catecholamines were elevated in only 33% of the patients. The liver was the most common site of dissemination, which was observed in 25% of patients; bone involvement was not observed in any patient. Ultrasonography failed to detect existing hepatic metastasis in three patients. Primary surgical resection was performed in 47 patients (85%). Chemotherapy was given to five patients and radiotherapy to three. Of the 50 patients for whom follow-up information was available, 45 (90%) were alive at a range of 2-120 months from diagnosis. CONCLUSIONS Prenatally diagnosed neuroblastomas are predominantly adrenal in origin and frequently cystic. The liver is the most common site of dissemination and bone involvement is notably absent. The vast majority of these infants have a favorable stage of disease (I, II, and IV-S) and favorable biologic features, and consequently have an excellent prognosis. Although surgery alone is curative for most patients, a period of observation may avoid surgery in some individuals who may achieve spontaneous regression.
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Affiliation(s)
- S Acharya
- Division of Pediatric Hematology-Oncology, New York Medical College, Valhalla 10595, USA
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23
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Alobeid B, Beneck D, Sreekantaiah C, Abbi RK, Slim MS. Congenital pulmonary myofibroblastic tumor: a case report with cytogenetic analysis and review of the literature. Am J Surg Pathol 1997; 21:610-4. [PMID: 9158688 DOI: 10.1097/00000478-199705000-00016] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report a case of congenital pulmonary myofibroblastic tumor, and review prior reports of this rare neoplasm to demonstrate its clinically benign behavior despite histologic features previously interpreted as sarcoma. The patient, a female neonate, presented with severe respiratory distress after cesarean section delivery. A large radio-opaque mass was detected in the right hemithorax and resected by right bilobectomy. The tumor mass, confined to the lung, was composed of interlacing fascicles of plump spindle cells showing myofibroblastic differentiation and complex cytogenetic abnormalities. Though sarcomatous in appearance, with highly cellular areas and numerous mitoses, there has been neither tumor recurrence nor metastases. The patient remains alive and well 1 year after surgery. Review of the few other reported cases confirms the uniformly benign behavior of this tumor.
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Affiliation(s)
- B Alobeid
- Department of Pathology, Westchester County Medical Center, Valhalla, NY 10595, USA
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Verma U, Tejani N, Klein S, Reale MR, Beneck D, Figueroa R, Visintainer P. Obstetric antecedents of intraventricular hemorrhage and periventricular leukomalacia in the low-birth-weight neonate. Am J Obstet Gynecol 1997; 176:275-81. [PMID: 9065168 DOI: 10.1016/s0002-9378(97)70485-x] [Citation(s) in RCA: 127] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Neonatal intraventricular hemorrhage and periventricular leukomalacia have a strong correlation with eventual neurologic deficit. Our objective was to correlate obstetric factors with the development of these lesions. STUDY DESIGN Seven hundred forty-five consecutive inborn neonates with birth weights from 500 to 1750 gm were divided into three clinical groups: premature rupture of membranes, refractory preterm labor with intact membranes, and delivery initiated by the physician for maternal or fetal indications. Neonatal neurosonography was performed on days 3 and 7 of life and results were described as normal or abnormal. Abnormal scans included intraventricular hemorrhage seen within 3 days and echodense or echolucent periventricular leukomalacia seen within 7 days of life. Major abnormalities included intraventricular hemorrhage grades 3 and 4, intraventricular hemorrhage with periventricular leukomalacia, and echolucent periventricular leukomalacia. Abnormal scans were correlated with groups of origin and clinical and histologic chorioamnionitis. RESULTS Abnormal scans occurred in 33% of cases of premature rupture of membranes and in 38.9% of cases of preterm labor compared with 17.7% of physician-initiated cases (p < 0.000001). Major lesions occurred in 17.6% of cases of premature rupture of membranes, 21.4% of cases of preterm labor, and 1.1% of physician-initiated cases (p < 0.0000001). Clinical chorioamnionitis occurred in 19.7% of cases of premature rupture of membranes, 11.9% of cases of preterm labor, and 1.1% of physician-initiated cases (p < 0.001) and was associated with a significant increase in the incidence (p < or = 0.005) and severity (p < or = 0.007) of these lesions. Histologic chorioamnionitis occurred in 59.9% of cases of premature rupture of membranes, 43.2% of cases of preterm labor, and 8% of physician-initiated cases and did not correlate significantly with the incidence or severity of abnormal scans. These findings were independent of gestational age. CONCLUSIONS The incidence and severity of intraventricular hemorrhage and periventricular leukomalacia were significantly increased in premature rupture of membranes and preterm labor compared with the physician-initiated cases. Clinical chorioamnionitis increased the incidence and severity of these lesions.
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Affiliation(s)
- U Verma
- Department of Obstetrics and Gynecology, New York Medical College, Westchester County Medical Center, Valhalla 10595, USA
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25
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Stringel G, Beneck D, Bostwick HE. Polypoid lesions of the gallbladder in children. JSLS 1997; 1:247-9. [PMID: 9876680 PMCID: PMC3016727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Polypoid lesions of the gallbladder in children are rare. We report a case of a gallbladder polyp in a 14-year-old boy who presented with recurrent right upper quadrant abdominal pain. Ultrasound examination of the abdomen revealed a polypoid lesion of the gallbladder. His symptoms resolved after laparoscopic cholecystectomy. Histological examination of the gallbladder demonstrated a benign adenomatous polyp. Although the experience with polypoid lesions of the gallbladder in children is limited, we currently recommend cholecystectomy because these lesions are associated with acalculous cholecystitis, and because their long-term effects are unknown.
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Affiliation(s)
- G Stringel
- Department of Pathology, New York Medical College, Valhalla, NY, USA
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26
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Sandoval C, Oiseth S, Slim M, Tugal O, Ozkaynak MF, Brudnicki A, Beneck D, Bostwick H, Jayabose S. Gastric ganglioneuroblastoma: a rare finding in an infant with multifocal ganglioneuroblastoma. J Pediatr Hematol Oncol 1996; 18:409-12. [PMID: 8888754 DOI: 10.1097/00043426-199611000-00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE This report describes a female infant with stage 4 multifocal ganglioneuroblastoma with gastric involvement. PATIENT The patient had a right cervical tumor, a left posterior mediastinal tumor, bilateral adrenal tumors, and bony and bone marrow metastases. The tumor cells were diploid and lacked N-myc gene amplification. The gastric involvement, which did not produce clinical symptoms, was only detected by meticulous exploration during laparotomy. RESULTS Our patient achieved only a partial response to alternating cycles of cyclophosphamide, vincristine, and adriamycin; and etoposide and cisplatin. She currently has stable, unresectable disease with elevated catecholamines. CONCLUSIONS Multifocal ganglioneuroblastomas may arise from either neuroblastic rests or aberrant deposits of neuroblasts. The latter mechanism may have accounted for our patient's gastric tumor. Patients with multifocal ganglioneuroblastomas warrant meticulous radiographic and surgical evaluation to completely document the full extent of disease, and to ensure appropriate staging and therapy.
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Affiliation(s)
- C Sandoval
- Department of Pediatrics, Pathology, Pediatric Surgery and Radiology, New York Medical College, Valhalla 10595, USA
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27
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Levendoglu-Tugal O, Noto R, Juster F, Brudnicki A, Slim M, Beneck D, Jayabose S. Langerhans cell histiocytosis associated with partial DiGeorge syndrome in a newborn. J Pediatr Hematol Oncol 1996; 18:401-4. [PMID: 8888752 DOI: 10.1097/00043426-199611000-00014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE We report the unrecognized association of Langerhans cell histiocytosis (LCH) with partial DiGeorge syndrome. PATIENT AND METHODS A 7-week-old infant with endocrine and immunologic characteristics of DiGeorge syndrome displayed multisystem involvement of Letterer-Siwe disease at birth. RESULTS Despite vigorous medical support and chemotherapy, she died at 9 months of age with multisystem failure. CONCLUSIONS This case supports the role of the thymus n the pathogenesis of LCH.
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28
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Berezin S, Schwarz SM, Slim MS, Beneck D, Brudnicki AR, Medow MS. Gastrointestinal problems in a child with dyskeratosis congenita. Am J Gastroenterol 1996; 91:1271-2. [PMID: 8651192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We describe a pediatric patient with dyskeratosis congenita, whose symptoms included abdominal pain, vomiting, dysphagia, and hematochezia. Gastrointestinal symptom are prominent in this rare genetic disorder.
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Affiliation(s)
- S Berezin
- Department of Pediatrics, New York Medical College, Valhalla 10595, USA
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29
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Affiliation(s)
- J V Ganatra
- Department of Pediatrics, New York Medical College, Valhalla 10595, USA
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30
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Figueroa R, Bracero LA, Aguero-Rosenfeld M, Beneck D, Coleman J, Schwartz I. Confirmation of Borrelia burgdorferi spirochetes by polymerase chain reaction in placentas of women with reactive serology for Lyme antibodies. Gynecol Obstet Invest 1996; 41:240-3. [PMID: 8793493 DOI: 10.1159/000292277] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of our study was to determine whether Borrelia burgdorferi spirochetes were present in placentas of asymptomatic women with reactive Lyme serology using a silver stain, and to confirm the identity of the spirochetes by polymerase chain reaction (PCR). Sixty placentas of asymptomatic women with ELISA-positive or-equivocal serology for Lyme antibodies during pregnancy were examined for spirochetes using a silver stain. The results of the ELISA serology were confirmed by Western blot analysis. PCR amplification for B. burgdorferi was performed on placentas identified to have spirochetes and on a group of placentas negative for spirochetes. Spirochetes were identified by silver staining in 3 (5%) of the 60 placentas. PCR confirmed B. burgdorferi nucleotide sequences in 2 of the placentas. The 5 women had equivocal Lyme ELISA and negative syphilis serology. The results of the Western blot analysis were negative in 2 cases and indeterminate in 1 case. Six controls were negative for spirochetes by silver staining and PCR. A normal perinatal outcome was observed in all cases. Spirochetes identified in placental tissue of pregnancies with reactive Lyme serology were confirmed by PCR to be B. burgdorferi. There was no relationship between the presence of placental spirochetes and the results of Lyme serology or the pregnancy outcome.
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Affiliation(s)
- R Figueroa
- Department of Obstetrics and Gynecology, New York Medical College, Westchester County Medical Center, Valhalla, USA
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31
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Abstract
The incidence of pneumothorax in HIV-infected children has not been reported. In adults with AIDS, pneumothorax has been described exclusively in association with Pneumocystis carinii pneumonia (PCP). We report the cases of three children with AIDS, one with lymphoid interstitial pneumonitis (LIP) without evidence of PCP and two with PCP, all of whom developed spontaneous pneumothorax (SP). On presentation, none of the children had any risk factors for the development of pneumothorax, but all had radiographic evidence of subpleural cystic lesions and bilateral pleural adhesions. None of the patients responded to conservative medical management, which included chest tube thoracostomy and chemical pleurodesis. Two patients underwent pleurectomy that resulted in resolution of the pneumothorax. Both patients with PCP who developed pneumothorax died, but the patient with LIP and SP has had no recurrences of any serious respiratory problems 3 years after pleurectomy and excision of the intrathoracic cysts.
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Affiliation(s)
- S A Schroeder
- Department of Pediatrics, New York Medical College, Valhalla, USA
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32
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Affiliation(s)
- L A Bracero
- Department of Obstetrics and Gynecology, Westchester County Medical Center, Valhalla, New York 11219, USA
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33
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Verma U, Tejani N, Klein S, Reale M, Beneck D, Jeanty M. Maternal chorioamnionitis increases risk of major intraventricular hemorrhage (IVH) & periventricular leucomalacia (PVL). Am J Obstet Gynecol 1995. [DOI: 10.1016/0002-9378(95)91094-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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34
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Affiliation(s)
- S Berezin
- Department of Pediatrics, New York Medical College, Valhalla, 10595
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35
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Abstract
A newborn with hypoalbuminemia, hematochezia, and hypertrophic gastropathy is described. These features are similar to those reported in association with prostaglandin therapy in newborns, as well as those described in so-called Ménétrier's disease. Very few cases of hypertrophic gastropathy have been reported in children and fewer still verified histologically; only three other cases have been reported in newborns. The clinical and pathologic features of hypertrophic gastropathy in children, as well as its close association with eosinophilic gastroenteritis and with prostaglandin therapy, are discussed.
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Affiliation(s)
- D Beneck
- New York Medical College, Valhalla 10595
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36
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Abstract
The purpose of this study was to determine the underlying cause of abnormal umbilical artery Doppler velocimetry in pregnancies complicated by insulin-dependent diabetes, by evaluating placental morphology and correlating Doppler results with pregnancy outcome. Our study population consisted of 14 pregnancies with normal Doppler results and 11 pregnancies with abnormal Doppler results. Quantitative placental examinations were performed. Maternal and perinatal characteristics were analyzed. Infants from the abnormal Doppler group had a statistically significantly higher incidence than those from the normal Doppler group of hyperbilirubinemia, Cesarean delivery for fetal distress, and neonatal intensive care stay of 2 or more days. Women with abnormal Doppler results delivered earlier (36 vs. 38 weeks) and had infants of lower birth weight (3079 vs. 3629 g). They were also three times more likely to have poor glycemic control (relative risk = 3.2; p = 0.0067). The placentae of both groups showed no statistically significant differences in placental weight, number of tertiary stem villi, number of small muscular arteries, or mean arterial width. Our findings suggest a functional rather than structural placental process as the cause of the abnormal Doppler results in pregnancies complicated by diabetes. An association between glycemic control and Doppler velocimetry is suggested.
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Affiliation(s)
- L A Bracero
- Department of Obstetrics and Gynecology, New York Medical College, Westchester County Medical Center, Valhalla, New York 10595, USA
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37
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Abstract
A 4-week-old infant presenting with neonatal cholestasis was found to have congenital toxoplasmosis and biliary atresia. This is the first patient in which their coincidence is reported. Because biliary atresia can coexist with either congenital infection or inborn errors of metabolism, evaluation for an obstructive etiology of jaundice in infants with a recognized cause of intrahepatic cholestasis is necessary.
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Affiliation(s)
- M S Glassman
- Department of Pediatrics, New York Medical College, Valhalla 10595
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38
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Smith FB, Beneck D. Localized Aspergillus infestation in primary lung carcinoma. Clinical and pathological contrasts with post-tuberculous intracavitary aspergilloma. Chest 1991; 100:554-6. [PMID: 1864137 DOI: 10.1378/chest.100.2.554] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Saprophytic infestation with Aspergillus was observed in pathologic specimens of primary squamous cell lung carcinoma. In one case, the fungus grew in cystic scarred parenchyma and bronchi distal to an obstructing carcinoma of a segment bronchus. In the other, fungi colonized the inner surface of a peripheral cavitary carcinoma. Neither patient had roentgenographic evidence of aspergilloma and neither experienced severe pulmonary hemorrhage or other complications attributable to the presence of fungus. Although both specimens showed colonizing growth within the abnormal air spaces, in neither had the colonies detached to form a separate intracavitary fungus ball. These patients, and eight patients with similar lesions reported in the literature, demonstrate that Aspergillus colonization of a lung neoplasm frequently lacks one or both of the features characteristic of post-inflammatory intracavitary aspergilloma, a loose fungus ball and antifungal serum antibodies. No patient, to date, has developed massive hemorrhage as a complication of this lesion.
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Affiliation(s)
- F B Smith
- St. Vincent's Hospital and Medical Center of New York, New York City 10011
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39
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Bracero LA, Beneck D, Stalter P. Neonatal ultrasound casebook. Ultrasound detection of cerebellum in occipital encephalocele. J Perinatol 1990; 10:211-3. [PMID: 2193126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- L A Bracero
- Department of Obstetrics and Gynecology, New York Medical College, Westchester County Medical Center, Valhalla 10595
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40
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Jayabose S, Kogan S, Berezin S, Slim M, San Filippo JA, Godine L, Beneck D, Tugal O, Sunkara S. Combined occurrence of chyloperitoneum and chylothorax after surgery and chemotherapy for Wilms' tumor. Cancer 1989; 64:1790-5. [PMID: 2551473 DOI: 10.1002/1097-0142(19891101)64:9<1790::aid-cncr2820640905>3.0.co;2-v] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Chyloperitoneum is an extremely rare complication of abdominal surgery in children and a combined occurrence of chylothorax and chyloperitoneum after abdominal surgery has never been reported in children. Chylous ascites usually occurs as a result of operative trauma to the thoracic duct, cisterna chyli, or its tributaries. About one third of all patients with chylous ascites after retroperitoneal lymph node dissection also develop secondary chylothorax. Diaphragmatic defects have been shown to be responsible for the occurrence of chylothorax secondary to chyloperitoneum. Congenital diaphragmatic weakness may result in evagination of the peritoneum causing diaphragmatic blebs, the rupture of which results in the movement of the peritoneal fluid into the pleural cavity. In the authors' patient, the rent in the diaphragm that occurred during surgery was probably responsible for the chylothorax. The role of chemotherapy, if any, in the pathophysiology of this complication is unknown. Total parenteral nutrition (TPN) is a simple and effective treatment for postoperative chylous effusions. Surgical treatments such as abdominal exploration for the repair of leaking lymphatics and peritoneovenous shunt should be reserved for patients who fail TPN.
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Affiliation(s)
- S Jayabose
- Department of Pediatrics, New York Medical College, Valhalla 10595
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41
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Glassman MS, Schwarz SM, Medow MS, Beneck D, Halata M, Berezin S, Newman LJ. Campylobacter pylori-related gastrointestinal disease in children. Incidence and clinical findings. Dig Dis Sci 1989; 34:1501-4. [PMID: 2791800 DOI: 10.1007/bf01537100] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Over a one-year period, 95 children and adolescents presenting with epigastric pain and/or vomiting, and without associated risk factors for development of peptide disease, underwent endoscopic antral biopsies for pathologic diagnosis and to detect presence of Campylobacter ss. pylori (C. pylori). Additional biopsies of the esophagus, stomach, and duodenum were obtained for histologic evaluation. C. pylori was identified in 16 patients (16.8%), all of whom had evidence of acute and/or chronic gastritis. Significant discriminating factors between C. pylori-positive and -negative subjects included age at presentation (positive vs negative = 14.6 vs 9.9 years, P less than 0.01), biopsy-confirmed gastritis (100% vs 30.4%, P less than 0.001), and diagnosis of duodenitis alone (0% vs 46.8%, P less than 0.001). Risk for bacterial colonization was significantly higher in the presence of endoscopic gastritis (P less than 0.001). Among C. pylori-positive patients, none responded to standard antiulcer therapy (H2-receptor antagonists, antacids). Symptomatic and histologic remission was achieved utilizing combined therapy with bismuth subsalicylate and antibiotics. Seven of 79 C. pylori-negative patients with biopsy-proven gastritis who responded poorly to antisecretory therapy had the organism identified in follow-up antral biopsies; these patients improved clinically following treatment for C. pylori. These data suggest that C. pylori is a significant factor in the etiology of upper gastrointestinal tract inflammatory disease in pediatrics, and presence of the organism should be evaluated, particularly in children with evidence of acute and/or chronic gastritis.
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Affiliation(s)
- M S Glassman
- Department of Pediatrics, New York Medical College, Valhalla 10595
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42
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Abstract
Quantitative placental examinations were performed on 47 women who had Doppler flow velocity studies of the umbilical artery during their pregnancy. The systolic-diastolic ratio of the umbilical artery was used as the measurement parameter to divide the study population into two groups. Group 1 consisted of women with normal systolic-diastolic ratios (systolic-diastolic less than 3), and group 2 consisted of women with an elevated systolic-diastolic ratio (systolic-diastolic greater than or equal to 3). The group with an increase in systolic-diastolic ratio had more perinatal complications as demonstrated by two stillbirths, a higher incidence of cesarean deliveries for fetal distress, and more admissions to the neonatal intensive care unit. Significant differences were found when gestational age at delivery, placental weight, birth weight, and the number of small muscular arteries in the placenta were compared. Since gestational age may have accounted for the difference in placental findings, patients were matched for gestational age. The placental weights were comparable, but there were fewer small muscular arteries in those patients with an increase in systolic-diastolic ratio (p less than 0.001). In addition, when these findings were examined to determine the influence of diminished uterine flow velocity, none was found.
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Affiliation(s)
- L A Bracero
- Department of Obstetrics and Gynecology, Westchester County Medical Center, Valhalla, NY 10595
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43
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Hoffman M, Mittelman A, Dworkin B, Rosenthal W, Beneck D, Gafney E, Arlin Z, Levitt D, Podack E. Severe intrahepatic cholestasis in patients treated with recombinant interleukin-2 and lymphokine-activated killer cells. J Cancer Res Clin Oncol 1989; 115:175-8. [PMID: 2785519 DOI: 10.1007/bf00397920] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Immunotherapy with recombinant interleukin-2 (rIL-2) and lymphokine-activated killer cells (LAK) has become a new form of therapy that has been shown to induce remissions in patients with renal cell carcinoma and melanoma. Despite encouraging results, this form of therapy has been associated with increasing toxicity, often requiring therapy in an intensive-care unit. In this report severe intrahepatic cholestasis occurred in two patients receiving rIL-2 and LAK cells. This form of cholestasis appeared to be directly related to rIL-2 administration at a doses of 2 x 10(6) U/m2 and 3 x 10(6) U/m2 t.i.d. A liver biopsy showed moderate hepatocellular bile stasis, with lobular and portal inflammation. All other studies for potential cause of this cholestasis were negative, including studies for metastatic disease. When therapy was discontinued, evidence for cholestasis and bile stasis resolved. We conclude that rIL-2 is a drug with a potential to induce severe hepatic injury that is reversible upon cessation of therapy with rIL-2. Further care should be exercised when rIL-2 is administered to patients with abnormal liver function.
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Affiliation(s)
- M Hoffman
- Department of Medicine, New York Medical College, Vahalla 10595
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44
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Casamassima AC, Beneck D, Gewitz MH, Horowitz MA, Woolf PK, Pettersen IM, Shapiro LR. Acrocallosal syndrome: additional manifestations. Am J Med Genet 1989; 32:311-7. [PMID: 2658584 DOI: 10.1002/ajmg.1320320306] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The acrocallosal syndrome (ACS) is a probable autosomal recessive condition of macrocephaly, craniofacial and hand and foot abnormalities, absence of the corpus callosum, and mental retardation. This patient had characteristics of the ACS but also had a severe congenital heart defect and other visceral malformations. After comparing the ACS with and contrasting it to other disorders, we concluded that the internal organ abnormalities found in this patient probably represent further manifestations of the ACS.
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Affiliation(s)
- A C Casamassima
- Department of Pediatrics, New York Medical College, Valhalla, New York
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45
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Freeman TB, Abati AD, Topsis J, Snyder JR, Beneck D, Lehman LB. Neonatal craniopharyngioma. N Y State J Med 1988; 88:81-3. [PMID: 3278255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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46
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Abstract
A 4-year-old girl with a presacral benign mesenchymoma is reported. The nature of the tumor was not recognized preoperatively or intraoperatively. There was evidence of pericapsular infiltration of the soft tissues of the pelvis but not signs of malignancy. A follow-up examination after 3 months indicates that the patient has no clinical evidence of recurrence. Review of the English literature shows the rarity of benign mesenchymoma in childhood and the lack of reports of its occurrence in the pelvis.
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Affiliation(s)
- D Beneck
- Department of Pathology, Westchester County Medical Center, Valhalla, New York 10595
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47
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Abstract
A male infant with partial trisomy 6q is described. This patient shares features with 12 previously reported cases including hypertelorism, cleft soft palate, bow shaped mouth, micrognathia, short, laterally webbed neck, clubbing of hands and feet, syndactyly, and growth retardation. In addition, visceral anomalies less frequently reported are described. These observations may extend the phenotypic characterisation of the trisomy 6q syndrome.
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48
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Beneck D, Becker MH, Genieser NB, Greco MA. Congenital bilateral absence of the fifth ray and vaginal atresia. Am J Med Genet Suppl 1987; 3:389-93. [PMID: 3130874 DOI: 10.1002/ajmg.1320280545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We have studied an infant with respiratory distress, absent fifth rays of the hands, and hydrometrocolpos. Congenital absence of the fifth ray of the hand is a rare malformation. In some syndromes the ulnar defects are symmetrical; however, as an isolated anomaly the defects are usually asymmetric. This patient's malformations appear to be unique in that the ulnar ray was affected bilaterally, with an associated genital malformation.
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Affiliation(s)
- D Beneck
- Department of Pathology, Bellevue Hospital, New York, New York
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49
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Abstract
Except for renal transplant recipients, glomerulonephritis has only very rarely been associated with renal cytomegalovirus (CMV) infection. The kidneys of five infants with congenital cytomegalic inclusion disease, including renal infection, were examined at autopsy. Two of the infants had glomerulonephritis. The younger, a 4-month-old female, had diffuse proliferative and necrotizing glomerulonephritis; virus was present in nuclei and cytoplasm of glomerular endothelial cells and, possibly, in leukocytes as well. There were no electron-dense deposits. The other infant, a 5-month-old male, had diffuse mesangial and focal segmental proliferative and sclerosing glomerulonephritis; electron-dense mesangial deposits were seen ultrastructurally. Three additional infants (a newborn male, a 2-day-old male, a 6-week-old female), all with CMV in tubules and one with a single glomerular inclusion, had only rare glomerular abnormalities, i.e., mesangial proliferation in less than 10 per cent of glomeruli (one infant) and segmental sclerosis in less than 1 per cent of glomeruli (all three infants). Thus, congenital renal CMV infection was associated with proliferative glomerulonephritis in the two infants who survived the longest. The three with shorter survival times had only minor glomerular alterations.
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50
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Gallo GR, Feiner HD, Chuba JV, Beneck D, Marion P, Cohen DH. Characterization of tissue amyloid by immunofluorescence microscopy. Clin Immunol Immunopathol 1986; 39:479-90. [PMID: 3084146 DOI: 10.1016/0090-1229(86)90175-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Immunohistochemical classification of amyloid type was possible in 44 of 50 (88%) patients as judged by the concordance of immunofluorescence, clinical, serum, and urine immunoelectrophoresis, and bone marrow data. In frozen tissue sections incubated with a panel of antisera monospecific for immunoglobulin heavy chains, kappa and lambda light chains, and amyloid-A-related protein, the amyloid was classified as AL in 20 and AA in 24. In 6 patients the amyloid could not be classified because of the absence of reactivity in 2 and overlap staining in 4. The findings indicate that routine immunofluorescence examination of diagnostic biopsies is an important adjunct in the classification of amyloid.
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