Samuel H. Paplanus

Congenital blood cysts of the heart valves

Congenital blood cysts of the heart valves are found most commonly on the tricuspid and mitral valves of fetuses and infants. Hearts available following 38 random autopsies of fetuses and infants 2 years of age or younger were examined. Blood cysts were found in 18 cases (47 per cent) in which ages ranged from 26 weeks of gestation to 11 months. The cysts varied in diameter, from microscopic to 3 mm. Affected valves had from one to 20 cysts. Light microscopic examination of serially sectioned paraffin-embedded tissue and plastic-embedded tissue and scanning electron microscopic examination revealed connections between the cyst lumens and ventricles via small endothelium-lined channels. The cyst structure suggested formation from ventricular endothelial infoldings in the valve leaflet base, which bulged into the atrium because of the pressure gradient present during valve closure. Blood cysts are a common finding in neonates dying of various causes and probably have no clinical significance. There is no association with asphyxia as previously described. Blood cysts may persist and enlarge to form giant cysts of the heart valves.

Fibrolamellar Carcinoma of Liver: A Primary Malignant Oncocytic Carcinoid?

Immunohistochemical and ultrastructural findings in two cases of fibrolamellar carcinoma of the liver and two cases of hepatocellular carcinoma of the common histologic type are described. Ultrastructural examination of both cases of fibrolamellar carcinoma revealed the presence of neurosecretory (NS) granules which were sparse in some cells and abundant in others. Many of the tumor cells had a distinct oncocytic appearance with abundant mitochondria. A portion of the glutaraldehyde-fixed neoplasm was processed for the uranaffin reaction (an ultrastructural cytochemical stain specific for the NS granules of neuroendocrine tissue). Abundant uranaffin-positive granules were found in the neoplastic cells of both cases of fibrolamellar carcinoma, whereas no uranaffin-positive granules were found in hepatocellular carcinoma of the common histologic type. There was no statistical difference in the mean diameter of the uranaffin-positive granules measured from both cases. Immunohistochemistry revealed the presence of neuron-specific enolase (NSE) and serotonin in one of the two cases of fibrolamellar carcinoma and no NSE staining in two cases of hepatocellular carcinoma of the common histologic type. These findings suggest that some liver tumors presenting histologically as fibrolamellar carcinoma may be neuroendocrine in nature.

Axillary lymphadenopathy 17 years after digital silicone implants: Study with x-ray microanalysis

Axillary lymphadenopathy developed in a patient with rheumatoid arthritis 17 years after the placing of Swanson implants in the hand. Foreign material in the lymph nodes was identified as silicone by energy-dispersive x-ray microanalysis. This emphasizes the long latent period that may be associated with this clinical phenomenon which may mimic other, more serious, diseases.

The significance of pulmonary infiltrates developing in patients receiving granulocyte transfusions

Summary. We reviewed a series of 109 patients given granulocyte transfusions between 1974 and 1978, to determine if pulmonary infiltrates developing during granulocyte transfusion therapy carried any specific prognostic significance. Eighteen patients developed new infiltrates while receiving granulocytes. Six of these patients died during the acute episode, an overall mortality rate no different from patients not developing new infiltrates. However, the subgroup with pulmonary infiltrates who died had some special features including: infiltrates that developed between 7 and 21 d after transfusions were begun; infiltrates that progressed or persisted during the period of transfusion; and infiltrates that were local rather than diffuse. Autopsies on five of the six patients who died revealed disseminated fungal infection in three, pulmonary haemorrhage in one, and alveolar hyaline membranes in association with Pseudomonas sepsis in one. Besides this high‐risk group specific aetiologies could rarely be assigned for other more diffuse or earlier/later developing infiltrates, despite usual diagnostic studies.

Knowledge engineering in quantitative histopathology.

Ongoing research on a system for the automated evaluation of digitized images of histopathologic sections is described. The system comprises an ultrafast laser scanner microscope capable of recording image data at 64 Mhz in each of two wavelength channels, and a multiprocessor computer containing thirty-six Motorola 68000 processing elements. The operating system allows an image-data-driven dynamic reconfiguration of the computer architecture; this reconfiguration is based on prior knowledge of the histopathologic sections to be processed. Knowledge engineering methods are used extensively as development tools in the development of an expert system-controlled scene segmentation, processing task scheduling, in the diagnostic expert system module, and its validation procedures.

Image understanding in expert systems in histopathology

The use of model-based reasoning, combined with locally adaptive selection of segmentation procedures, has already been found productive in expert-system-guided scene segmentation of histopathologic imagery. It applies human understanding of segmentation problems, with suitable remedial procedures, and knowledge of the structure of the tissues to the segmentation. Expert-system-guided scene segmentation thus implements certain aspects of image understanding to attain robustness. For diagnostic expert systems, though, image understanding in a much broader sense is required. A pathologists verbal description of histopathologic patterns must be related to specific information extraction and analytic processes, which are to be executed by the automated system.<<ETX>>

Fluorescence of damaged myocardium in endomyocardial biopsy specimens for the evaluation of cardiac transplantation.

Sections stained with hematoxylin-eosin from 138 endomyocardial biopsy specimens were examined in a Zeiss epifluorescent ultraviolet microscope for fluorescence indicative of myocardial injury. The biopsy specimens had been obtained from cardiac transplant recipients for routine follow-up evaluation or due to clinically suspected episodes of rejection. Yellow fluorescence and/or granularity of necrotic myofibers (with normal myocardium appearing olive green to yellow-brown), as reported in autopsy series, was observed in 22 of our specimens, for which the results of staining with hematoxylin-eosin and/or trichrome were found to contain areas of fiber fluorescence that were not recognized by staining with hematoxylin-eosin or trichrome. In some areas in an additional 13 specimens, the fiber damage seen on ultraviolet examination was greater than that suspected on the basis of the light microscopic morphologic changes. In seven cases routine light microscopy revealed fiber necrosis that could not be confirmed by ultraviolet illumination study. Fluorescence of damaged myofibers under ultraviolet illumination may contribute to the detection of early or mild myocardial injury in endomyocardial biopsy specimens from cardiac transplant recipients.

Bildgewinnung und Bildverarbeitung

Die mikrophotometrische Bewertung histopathologischer Praparate stellt Anforderungen, die weit uber diejenige hinausgehen, die an die analytischen Verfahren in der quantitativen Zytologie gestellt werden. Die pathologischen Veranderungen im Gewebe erstrecken sich uber vergleichsweise sehr viel ausgedehntere Flachen im Praparat. Es mussen also gleichzeitig viel mehr Informationen und damit erhebliche Datenmengen aufgenommen und verarbeitet werden. Die Zerlegung des mikroskopischen Bildes in seine Komponenten bringt zahlreiche logische wie auch technische Schwierigkeiten mit sich. Eine verlasliche, fruhzeitige Erkennung gerade einsetzender pathologischer Veranderungen verlangt Strategien fur die Beschreibung und Klassifizierung der Gesichtsfelder, die weitaus komplizierter sind, als dies in der quantitativen Zytologie erforderlich ist (2, 4).

Expert system-guided scene segmentation

The complexity of histopathologic imagery presents substantial difficulties for scene segmentation preceding diagnostic information extraction. An expert-system-guided segmentation strategy founded on model-based reasoning allows a locally adaptive selection of segmentation procedures and performance control. This introduces increased stability and reliability to the process.<<ETX>>