Interobserver variability in the diagnosis of high-grade prostatic intraepithelial neoplasia and adenocarcinoma.

High-grade prostatic intraepithelial neoplasia (PIN) is a strong predictor of carcinoma when identified in small-needle biopsy specimens. However, the diagnostic variability of PIN is unknown. Eight pathologists reviewed 321 prostatic biopsy specimens to assess the variability of the diagnosis of high-grade PIN and carcinoma. All of the specimens were classified as negative, high-grade PIN, suspicious for high-grade PIN, carcinoma, or suspicious for carcinoma, more than one diagnosis was permitted, except for negative. We compared diagnoses made by two observers by pairing them for negative versus high-grade PIN, negative versus carcinoma, high-grade PIN versus carcinoma, and all diagnostic categories together. Mean kappa coefficient values for 28 interobserver combinations were 0.451, 0.845, 0.669, and 0.482, respectively, for each of the four comparison combinations considered. Our results indicate a high level of agreement, "almost perfect" (kappa = 0.81-1.0) for carcinoma, "moderate" (kappa = 0.41-0.60) for high-grade PIN, and "substantial" (kappa = 0.61-0.81) for high-grade PIN versus carcinoma. We found that variability was related to the level of interest in prostatic pathology, the conditions of the study, the subjective application of diagnostic criteria, and the influence of peers and clinical colleagues.

Warthin's tumor-associated neoplasms: report of two cases and review of the literature.

The association of Warthin's tumor with another neoplasm of a different histological type in the same salivary gland is extremely rare. The literature includes 42 such cases to date. A case of malignant lymphoma developing within Warthin's tumor and another case of oncocytoma synchronous with Warthin's tumor in the same parotid gland are reported. The relation of Warthin's tumor to other neoplasms is discussed.

Glycogen storage disease type I: laboratory data and diagnosis.

A study of 20 cases of glycogen storage disease type I has shown differences from the classical picture. Hyperuricemia was observed in fewer than half of the cases. All patients had increased triglycerides in serum, but fewer than two thirds had increased concentrations of total cholesterol. There was a consistent increase of aminotransferases in serum. Many textbooks discuss hyperuricemia, lactic acidemia, and lipidemia in this disease without mentioning aminotransferases, and above-normal values for these enzymes ought to be given consideration, to avoid misdiagnosis. Glycogen storage disease type IB was detected by comparing glucose-6-phosphatase (EC 3.1.3.9) activity in frozen and unfrozen portions of the same liver biopsy. Latent activity, which appeared after freezing, increased the total activity to within the normal range (4.7-9.1 mumol/min per gram of tissue, wet weight) in type IB, but not in type IA.

Extradural spinal angiolipoma.

Two cases of extradural spinal angiolipomas are reported. The literature is reviewed and the entity of extradural spinal angiolipoma proposed. A tumor of adulthood, unassociated with bony changes, it occurs mainly in the mid-dorsal spine. Paraparesis progresses over a period of 1-2 years and may wax and wane with pregnancy or body weight changes. Characteristically, the tumor lies over the dorsal aspect of the dura, from which it may be peeled off easily. Its port-wine color contrasts strikingly with the contiguous epidural fat. A benign condition, it responds favorably to surgical excision.

Anaplastic transformation of thyroid cancer: report of two cases and review of the literature.

Transformation of well-differentiated thyroid adenocarcinoma to anaplastic cancer has been occasionally reported. Two new cases of such transformation are now described. The time interval from diagnosis to the development of anaplastic cancer was 15 years in the first patient and 10 years in the second. Both patients ultimately developed extensive bilateral pulmonary metastases and died within 6 months from the diagnosis of the transformation. Hypotheses concerning the pathogenesis of the transformation and the literature were reviewed. We believe that histopathological confirmation of recurrent and rapidly progressive thyroid tumors is necessary prior to initiation of therapy.

Experience of the blood bank at the American University Hospital during the war in Lebanon.

The difficulties of switching from a community hospital blood bank type of practice to a field hospital blood bank operation with all the associated problems, are presented. Whole blood consumption markedly increased during the war while components use dropped and the voluntary benevolent donorship became the only source of blood supply. Guidelines of blood bank practice are derived from this experience.

The prevalence of hepatitis B surface antigen (HBsAg) among students and blood donors at the American University of Beirut (AUB).

HBsAg testing by CEP was performed on 2359 students and 6153 blood donors at the American University of Beirut. No significant difference existed in the prevalanece rates among the various socioeconmic groups of the Arab Asians tested. There was, however, a definite difference among the various geographic groups. The findings suggest that socioecomic factors do not satisfactorily explain the differences in the prevalence rates among various nationals.