Fine-needle aspiration biopsy of salivary duct carcinoma: report of five cases.

Salivary duct carcinoma is a high grade malignancy which histologically strongly resembles ductal carcinoma of the breast. The findings from five cases of histologically proven salivary duct carcinoma sampled by preoperative fine-needle aspiration (FNA) cytology are presented. Characteristic cytomorphologic features include cohesive clusters and flat sheets of epithelial cells which display a cribriform pattern with eccentrically located, hyperchromatic nuclei, abundant finely granular cytoplasm, and necrosis in the smear background.

Adenoid cystic ovarian carcinoma compared with other adenoid cystic carcinomas of the female genital tract.

Adenoid cystic carcinoma (ACC) of the ovary is an extremely rare neoplasm referred to infrequently in the literature. A new case of a pure, primary, ovarian ACC is reported. The patient was a 45-year-old white woman who had a stage IA, well-circumscribed, unilateral, ovarian mass. Histologically, the tumor was composed of small, uniform, and basaloid cells exhibiting predominantly a tubular pattern, as well as demonstrating cribriform and focal solid areas. There was no necrosis and minimal nuclear pleomorphism; the mitotic rate was fewer than three cells per 10 high-power fields. Immunohistochemical examination showed that the tumor cells were strongly positive for cytokeratins CAM 5.2 and AE1/3 and carcinoembryonic antigen. The cells at the periphery of the epithelial aggregates in the cribriform and tubular areas were positive for muscle-specific actin and, occasionally, for S100 protein. Electron microscopic examination revealed that these cells had convoluted nuclei and filamentous structures associated with dense bodies. These findings support a myoepithelial component. A characteristic feature was the production of periodic acid-Schiff stain-positive basement membrane material, which appeared as reduplicated basal lamina by electron microscopic examination. The patient is currently alive, without evidence of recurrence or persistent tumor 7 years after surgical excision. The tumor demonstrated immunohistochemical and ultrastructural findings similar to those of ACCs of salivary gland origin and to other ACCs of the female genital tract. The histogenesis of most ovarian ACCs is through metaplasia of the celomic epithelium, but pure cases might also be of teratomatous origin.

Fine needle aspiration cytology of a male breast carcinoma exhibiting neuroendocrine differentiation. Report of a case with immunohistochemical, flow cytometric and ultrastructural analysis.

We present the cytologic, immunohistochemical, flow cytometric and ultrastructural findings of a case of invasive ductal carcinoma of the breast with features of neuroendocrine differentiation occurring in an 83-year-old male. Fine needle aspiration (FNA) cytology of the patient's tumor demonstrated a markedly cellular specimen to discohesive tumor cells, present primarily singly, with occasional loose groups. The cells were relatively large, with pleomorphic, eccentrically placed, round to oval nuclei. The cytoplasm was abundant and contained prominent red granules (Papanicolaou stain) that were also argyrophilic. Immunohistochemical studies performed on the aspirate and the subsequently excised malignant breast tissue revealed positive staining for neuron-specific enolase, chromogranin A, synaptophysin and gastrin. Also, the majority of the tumor stained positive with antibodies to both estrogen and progesterone hormone receptors. DNA flow cytometry demonstrated an aneuploid stemline population with a DNA index of 1.73 and an S-phase fraction of 4.5%. Electron microscopy was performed on the FNA material, and numerous variable-sized, membrane-bound, dense-core granules diffusely scattered within the cytoplasm of the neoplastic cells were identified. The specific cytologic features of this tumor, along with the immunocytochemical and ultrastructural features, can aid the pathologist in rendering an accurate FNA diagnosis of this specific subtype of breast carcinoma.

Ultrastructural, histochemical, and morphometric analysis of skeletal muscle in a murine model of type I diabetes.

BACKGROUND: Since peripheral nerves are damaged in diabetes mellitus, morphological changes occur within the diabetic muscle in response to the diabetic neuropathy. The aim of this study was to examine the extensor digitorum longus (EDL) from a 42-day streptozotocin-induced diabetic Swiss Webster mouse (STZ) and compare the muscle morphology and histochemistry to age-matched, nondiabetic controls. METHODS: The EDL was evaluated using electron microscopy in order to investigate the morphological integrity of the myofibers and neuromuscular junctions. Histochemical analysis was completed using the myofibrillar CA(++)-ATPase reaction of Doriguzzi et al. (1983. Histochemistry, 79:289-294) for use in computer-assisted morphometric analysis of fiber size using Bioquant System 4 software. RESULTS: Ultrastructural analysis of the diabetic EDL (N = 5, 225 myofibers/animal) showed a significant number of abnormal myofibers, exhibiting various degrees of degeneration, signs of denervation, and necrosis. The STZ myofibers exhibited excessive lipid accumulations and abnormal mitochondrial arrangements. Histochemical analysis of the STZ EDL revealed a significant shift in fiber type profile (53.6% type 2A and 46.4% type 2B- STZ myofibers; 47.5% type 2A, 52.5% type 2B nondiabetic controls). Morphometric analysis of myofiber size by fiber type (200 myofibers/muscle/fiber type) indicated a significant decrease in myofiber size for both type 2A and type 2B fibers in the STZ diabetic mouse. CONCLUSION: The degeneration and necrosis of myofibers concomitant with the sever atrophy of both the type 2A and 2B myofibers in the STZ muscle could account for the functional alterations seen in diabetic muscle.

Asphyxial deaths due to hanging in children.

A review of the records for five years from the Coroner's Offices of Marion County, Indiana and Franklin County, Ohio, which have a combined population of 2.4 million, yielded 12 cases of hanging deaths in children 13 years of age or younger. The age range was 2 1/2 to 13 years and only two of the 12 victims were female. There were three unequivocal suicides, five accidental deaths and four cases where, despite extensive investigation, the manner of death remained undetermined. The scene and autopsy findings are presented and the cases discussed with regard to determination of manner of death. Additionally, the significance and pathophysiology of petechiae are discussed.

An autopsy case review of 142 nonpenetrating (blunt) injuries of the aorta.

This study retrospectively reviewed 142 fatal cases of aortic laceration. Data were collected from the autopsy reports (including toxicology results) and included the circumstances of the injury. In the case of automobile crashes this included the direction of impact, time of day, and vehicular damage. Seventy percent of the victims were men with a mean age of 37.5 years; 30% were women with a mean age of 46 years. Thirty-five percent of the 142 victims had elevated blood alcohol levels. Fifty-four percent of the lacerations were located at the classic site (the isthmus). The majority of the aortic lacerations (102) were sustained in automobile crashes. Of these, 42% were broadside collisions and 58% were head-on collisions. Seventy-three percent and 67% of the victims in broadside and head-on collisions, respectively, had aortic lacerations at the classic site. The results suggest that the pathogenesis of aortic rupture involves a lateral oblique compression impact to the chest, which causes thoracic mediastinal structures to shift and deflect the aortic arch, resulting in severe shearing and stretching at the isthmus. The use of seat belts and air bags may reduce the number of aortic injuries.

Skeletal muscle in the diabetic mouse: histochemical and morphometric analysis.

Despite the extensive literature concerning the neuropathy associated with diabetes, only limited information describes changes in the associated muscle. The objective of this study was to evaluate the histochemical and morphometric characteristics of diabetic muscle in the C57BL/KsJ db-m strain of mouse. The histochemical analysis of myofiber type for the diabetic mouse revealed that the extensor digitorum longus muscle consisted of 53.1% type 2a, 46.0% type 2b, and 0.9% type 1 myofibers, a significant shift from the percentages found in the nondiabetic litter mates (44.4% type 2a, 55.6% type 2b, no type 1). Computer-assisted morphometric analysis of myofiber size by fiber type indicated a significant difference in myofiber size for the type 2b fibers in muscles from diabetic mice. Similarly, there was a shift in the fiber size distribution to include a greater number of small type 2b myofibers when compared to controls. Skeletal muscle from diabetic mice exhibited a significant change in the percentage of fiber types, with an increase in the number of type 2a fibers, a fiber type grouping that implies possible denervation and reinnervation, and a decrease in myofiber size. These findings may explain why some diabetic patients complain of muscle weakness.

Cytoarchitecture of muscle in a genetic model of murine diabetes.

Although diabetic neuropathy is well documented, diabetic myopathy is not, except for descriptions of diabetic patients with muscular weakness thought to be due to metabolic changes in the muscle. Muscle and nerve are dependent on each other for normal structure and function; since the peripheral nerve is damaged in diabetes, one would expect concomitant changes in the muscle. This study examines the cytoarchitecture of diabetic muscle. The extensor digitorum longus (EDL) muscles from 165-day-old C57BL/KsJ dbm mice were examined using electron microscopy. Morphological analysis of the diabetic EDL revealed that a significant number of the myofibers, examined within the midbelly region of the muscle, exhibited various degrees of degeneration, signs of denervation, and abnormal lipid stores. Both myoneural junctions and muscle spindles showed significant signs of degeneration, denervation, and abnormal structure. Thus the morphologic changes seen could account for the physiologic changes seen in diabetic muscle.