David M. Menke

Bio: David M. Menke is an academic researcher from Mayo Clinic. The author has contributed to research in topics: Lymphoma & Diffuse large B-cell lymphoma. The author has an hindex of 26, co-authored 95 publications receiving 2544 citations.

Diagnostic value of immunostaining for tryptase in patients with mastocytosis.

Abstract: The term "mastocytosis" is used to describe a heterogeneous group of disorders characterized by abnormal growth and accumulation of mast cells (MCs). Cutaneous and systemic variants exist. Systemic mastocytosis may show an indolent or malignant clinical course. In malignant mastocytosis (MM), the diagnosis often is missed because the MCs are morphologically abnormal and lack metachromatic granules or the underlying histologic picture is complex. The cytoplasmic serine protease tryptase is produced by MCs and is thought to be expressed at all stages of MC maturation. To assess the diagnostic value of tryptase staining in mastocytosis, tissue sections from 93 patients with mastocytosis, including MM (n = 37), systemic indolent mastocytosis (n = 47), urticaria pigmentosa (n = 5), MC leukemia (n = 2), and solitary skin mastocytoma (n = 2) were stained with the antitryptase antibody G3. The results were compared with those of Giemsa and chloroacetate esterase (CAE) staining. Using antitryptase antibody G3, MC infiltrates were identified in all patients examined, including those with MM (37 of 37), and virtually all the neoplastic MCs (> 95%) appeared to react with G3. In MM, significantly fewer MCs were positive in Giemsa (54.5%; p 10% of neoplastic cells positive) was considerably lower with Giemsa (48.6%; p < 0.05) and CAE (75.7%; p < 0.05) staining. By contrast, tryptase, Giemsa, and CAE produced diagnostic staining of MCs in virtually all cases of systemic indolent mastocytosis, urticaria pigmentosa, and solitary skin mastocytoma. In systemic mastocytosis, survival was significantly reduced in cases with Giemsa-/tryptase+ or CAE-/tryptase+ tumor cells compared to those cases with Giemsa+ or CAE+ MC infiltrates (p < 0.001).

Schwannoma: radiologic-pathologic correlation.

Abstract: History A 52-year-old man presented to his primary care physician complaining of a painless mass in the left elbow that had slowly enlarged over a 2-year period. When pressure was applied to the mass, the patient experienced “electrical shocks” that radiated to the left hand. Physical examination demonstrated a soft, mobile mass in the anteromedial aspect of the left antecubital fossa. The patient’s strength, motion, sensation, and two-point discrimination were normal. A Tinel test was positive, evoking pain and numbness within the left forearm and hand. Nerve conduction velocity studies were normal. Imaging Findings Radiography of the left elbow revealed soft-tissue prominence in the antecubital fossa (Fig 1). No osseous erosion was present. Magnetic resonance (MR) imaging of the left elbow verified a round, sharply marginated intermuscular mass measuring 5.4 cm in diameter. The mass was in the antecubital fossa, on the ulnar side of the elbow joint line. On spin-echo T1-weighted MR images, the lesion was homogeneous and isointense relative to skeletal muscle (Fig 2). The median nerve was identified as a distinct structure at the proximal and distal aspects of the mass; however, it could

The clinical spectrum of Castleman's disease.

Abstract: Castleman's disease (CD) is a rare, poorly understood lymphoproliferative disease The spectrum of symptoms and course of disease are broad, but there is no large study describing the natural history of this disease Basic clinic and laboratory data from the records of 113 patients with CD evaluated at the Mayo Clinic and University of Nebraska were abstracted The impact of these variables on overall survival (OS) from time of diagnosis was evaluated Sixty patients had multicentric disease Of the patients with multicentric CD, 32% had criteria sufficient for a diagnosis of POEMS syndrome For all patients, 2, 5, and 10-year OS was 92%, 76%, 59%, respectively Most of the factors identified as risk factors for death on univariate analysis cosegregated with diagnostic criteria for POEMS syndrome, which supported the concept of four categories of CD, which are (along with their 5-year OS): (1) unicentric CD (91%); (2) multicentric CD associated with the osteosclerotic variant of POEMS syndrome (90%); (3); multicentric CD without POEMS syndrome (65%); and (4) multicentric CD with POEMS syndrome without osteosclerotic lesions (27%) We have demonstrated that CD represents a spectrum of disease that can be differentiated by simple prognostic factors that provide a framework for further study

The spectrum of localized amyloidosis: a case series of 20 patients and review of the literature.

Abstract: Localized deposition of amyloid may occur in individual organs, in the absence of systemic involvement. The reason for localized deposition is unknown, but it is hypothesized that deposits result from local synthesis of amyloid protein, rather than the deposition of light chains produced elsewhere. We identified 20 cases of localized amyloidosis at our institution between 1993 and 2003. There were 11 males and nine females in the group. The mean age at the time of diagnosis was 65.5 years. Organs involved included skin, soft tissues, oropharynx, larynx, lung, bladder, colon, conjunctiva, and lymph node. In six of nine patients typed, the amyloid light chain was lambda. In those patients where follow-up was available (mean 7.6 years), none developed systemic disease. Localized amyloidosis occurs in a variety of organ systems. Evolution into systemic amyloidosis was not seen in our series of patients, supporting the hypothesis of local production of amyloid protein in these cases.

Guidelines for the management of rheumatoid arthritis: 2002 update - American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines

Abstract: Rheumatoid arthritis (RA) is a progressive polyarthritis that is responsible for over nine million office visits annually. It is likely that most nurse practitioners will care for one or more patients with RA because approximately 1% of the adult population is affected by this disabling disorder. The guideline reviewed in this month’s column describes the recommended care of patients who have been previously diagnosed with RA. Author Grace Newsome, EdD, APRN-BC, FNP, is an Associate Professor of Nursing, North Georgia College & State University, Dahlonega, GA.

Guidelines for the Management of Rheumatoid Arthritis 2002 Update

Abstract: Rheumatoid arthritis (RA) is a progressive polyarthritis that is responsible for over nine million office visits annually. It is likely that most nurse practitioners will care for one or more patients with RA because approximately 1% of the adult population is affected by this disabling disorder. The guideline reviewed in this month's column describes the recommended care of patients who have been previously diagnosed with RA.