The chain saw: an uncommon means of committing suicide.

A suicide committed with a power saw is an uncommonly reported incident: and the use of a chain saw in particular has been extremely rare. We report two cases of suicide that were committed by using chain saws. In each case the victim had a history of depression or of a prior suicide attempt, and applied the chain saw to his neck to kill himself. We summarize the findings of the two death investigations and the world literature pertaining to suicide committed with power saws.

Pulmonary arterial fibromuscular dysplasia: a rare cause of fulminant lung hemorrhage.

Arterial fibromuscular dysplasia (FMD) represents a collection of noninflammatory and nonatherosclerotic vascular diseases with a poorly understood etiology. Classically occurring in renal and cerebral arteries, this entity has also been reported in coronary, carotid, and other medium and small arteries. One case occurring in the pulmonary vasculature has been reported. Fatal hemothorax and lung hemorrhage have multiple causes, including other vascular malformations and connective tissue disorders; however, cases of pulmonary FMD are exceedingly rare. We report what appears to be the second such association, occurring in a 69-year-old man. The patient presented with a 3-week history of increasing dyspnea, fatigue, and productive cough; 3 days of increasing back and chest pain; and syncope. Chest radiograph showed a "white-out" of the left lung. The patient died shortly after admission from a fulminant respiratory disease of undetermined etiology. At autopsy he was found to have a massive left hemothorax resulting from an unsuspected pulmonary arterial fibromuscular dysplasia.

Adenosquamous carcinoma arising in a mucinous cystadenoma of the pancreas.

BACKGROUND: Approximately 500 cystic neoplasms of the pancreas have been reported, and among these the mucinous pancreatic cystadenomas are known to have malignant potential. We report a rare case of a mucinous cystadenoma containing adenosquamous carcinoma. METHODS: We studied the histochemical and immunohistochemical staining characteristics of the tumor by staining with hematoxylin/eosin, Alcian Blue/Periodic Acid Schiff, and with immunoperoxidase-labelled antibodies against carcinoembryonic antigen, epithelial membrane antigen, low and high molecular weight cytokeratins, the proliferation antigen Ki-67, and the tumor suppressor antigen p-53. The K-ras oncogene was analyzed by direct sequencing. RESULTS: This case illustrates the usual presentation and features of this unusual tumor-a middle aged woman with abdominal pain and no history of alcohol abuse or abdominal trauma. The mucinous cystic tumor of her pancreas was composed predominantly of benign epithelium with areas of a malignant component that were identified by thorough sampling. CONCLUSION: We discuss the nomenclature of these neoplasms and suggest that continuing efforts to subclassify mucinous cystic pancreatic tumors histologically may not be necessary, since the tumors are all histologically similar and are malignant or have malignant potential, and for all, treatment should include resection.

Fine-needle aspiration cytology of sarcoma: retrospective review of diagnostic utility and specificity.

Fine-needle aspiration cytology (FNA) is useful because of its low cost, quick turn around time, and low incidence of complications. This study investigates the role FNA plays in the evaluation of sarcoma. We reviewed all the pathologic material from patients with sarcoma or a FNA diagnosis suggestive of sarcoma at the University of California-Davis Medical Center (1985-1994). Fifty-two of 196 patients identified (26.5%) were evaluated with FNA exhibiting 46 soft tissue and 6 bone lesions located in the extremities (19), trunk (19), head and neck (8), retroperitoneum (3), and abdominal cavity (3). Among 196 patients identified, those evaluated by FNA had soft tissue rather than bone lesions (P < .001) and primary sites other than in the extremities (P < .001). The primary neoplasms for the 52 FNA patients included 47 sarcomas (10 malignant fibrous histiocytomas and 16 other types), 1 intramuscular myxoma, 2 lymphomas, and 2 spindle cell (sarcomatoid) carcinomas. In 43 patients (22% of total), FNA was used first, before a primary diagnosis. The FNA report showed the correct specific neoplasm in only 20.9%. However, the FNA reports reflected an effective positive diagnosis leading to appropriate diagnostic biopsy in 88.4%, while only 7.0% were misleading (benign or inflammatory) and 4.6% inadequate. Review of FNA slides for 32 of 43 patients in which FNA was used first, in a blinded fashion, exhibited 21.9% specificity for the specific neoplasm, and 88.4% effective positive diagnoses. In 9 patients, FNA was utilized to investigate recurrence. Five out of 5 instances of recurrent sarcoma were identified by FNA. However, FNA misidentified recurrence in 3/4 instances, exhibiting suspicious cells from regenerating skeletal muscle (2) and a traumatic neuroma (1). The specific diagnosis for sarcomas is challenging even with surgical material. FNA usually does not provide a specific diagnosis (only in 20.9% of cases) and review of routinely prepared slides showed the same specificity as reflected by the original FNA report, at times formulated with the benefit of immunohistochemistry or electron microscopy. FNA effectively evaluated lesions in 45 of 52 patients (86.5%), confirming the useful screening role for this technique in sarcomas.

Basaloid squamous carcinoma of the head and neck. Report of a case occurring in the anterior floor of the mouth.

Basaloid squamous carcinoma was initially characterized in 1986, and it has been an uncommon entity, with 86 reported cases occurring in the head and neck. Although histologically associated with squamous cell carcinoma and squamous atypia, basaloid squamous carcinoma has distinctive clinical features. It is frequently diagnosed at an advanced stage, often with distant metastases, and it may be associated with second primary tumors. This tumor most commonly occurs in the base of the tongue, hypopharynx, and larynx. We report a case of basaloid squamous carcinoma that occurred in the anterior floor of the mouth--a distinctly unusual location.