Fine-needle aspiration biopsy of abdominal lesions: diagnostic yield for different needle tip configurations.

Four fine-needle aspiration biopsy needles with different tip configurations were used in 133 patients with abdominal lesions. The 20-gauge needles were used in random sequence by several physicians. The specimen from each of the 522 needle passes was evaluated by two cytopathologists for adequacy to render a diagnosis and for the presence of cell block material. The Franseen needle produced a 16% and 9% better yield for diagnostic material than did the cut biopsy and spinal needles (P less than .05), respectively. The Westcott needle was better than the cut biopsy needle by 13%, and the spinal needle produced an 11% better yield than did the cut biopsy needle. Differences did not exist in liver biopsies but were present in pancreatic biopsies. The spinal needle was the least successful in yielding cell block material. Use of the cut biopsy needle resulted in the largest proportion of inadequate specimens, except its yield in cell blocks in the liver was 25% higher than that of the Westcott needle. The authors conclude that not all unusual designs for 20-gauge needle tips render results superior to those of the simple spinal needle.

CA-549 is not diagnostically useful as an immunohistochemical marker for breast carcinoma.

We evaluated BC4E549, a monoclonal antibody to CA-549, for use as an immunohistochemical marker to determine (1) differences in staining patterns between breast carcinoma and nonmalignant breast tissue specimens, (2) sensitivity and specificity of staining patterns for CA-549 in breast carcinoma vs other carcinomas, and (3) conservation of primary staining patterns in tumor metastases. We studied paraffin-embedded tissue specimens from 382 cases including nonmalignant breast tissue, endometrium, lung, pancreas, and thyroid gland; breast carcinoma; and adenocarcinomas of the colon, endometrium, lung, ovary, pancreas, and thyroid gland. Membranous staining was present in all nonmalignant breast tissue specimens and in most breast carcinoma tissue specimens. Diffuse cytoplasmic staining was more extensive in breast carcinomas than in benign processes. However, similar staining was also seen in normal and neoplastic tissue specimens obtained from a variety of other sites. Sensitivity and specificity of diffuse cytoplasmic staining for CA-549 in breast carcinoma relative to carcinomas from other sites studied were 78.6% and 77.4%, respectively. Staining patterns were not preserved from primary tumor to metastases in 67.4% of cases evaluated. We conclude that BC4E549 antibody to CA-549 is not a sufficiently sensitive or specific immunohistochemical marker in routinely processed tissue specimens to be useful in the clinical-diagnostic laboratory setting.

Diffuse panbronchiolitis in North America. Report of three cases and review of the literature.

Diffuse panbronchiolitis is a disease largely restricted geographically to Japan. It is manifested clinically by an insidious onset of dyspnea, cough, and production of mucopurulent sputum. Histologically it is characterized by a suppurative bronchiolitis involving primarily the respiratory and terminal bronchioles with subsequent progression to bronchiolectasis. Pulmonary function tests show a mixed obstructive-restrictive pattern. This report presents two cases occurring in white patients and one in an Oriental immigrant to Canada.

Prune-belly syndrome with prostatic hypoplasia, bladder wall rupture, and massive ascites in a fetus with trisomy 18.

An association has been noted between trisomy 18 and genitourinary abnormalities, with six previous reports of the prune-belly syndrome occurring in patients with trisomy 18. We have observed a 120-g fetus of 18 weeks' gestational age at autopsy in whom there was severe prune-belly syndrome and trisomy 18. Serial histologic sections and reconstruction of the lower urinary tract demonstrated severe prostatic hypoplasia with a dilated, angulated prostatic urethra. Obstruction appeared to be present at the internal sphincter as a result of loss of prostatic support of the bladder. The bladder was distended and hypertrophic, and had a disruption of its wall near the apex. Massive ascites and intraabdominal urine accumulation had produced abdominal distention and pulmonary hypoplasia. The findings in this case lend support to the concept of prostatic hypoplasia as a cause of prune-belly syndrome and to the unexplained association between trisomy 18 and genitourinary anomalies including the prune-belly syndrome.

Obstructive lesions of the lower urinary tract in the prune belly syndrome.

The prune belly syndrome is a well-recognized entity consisting of deficient abdominal musculature, cryptorchid testes, and urinary tract abnormalities most consistent with an obstructive phenomenon. However, an obstructive lesion has not been consistently identified in previously reported cases. Retrospective review of the autopsy files of The Johns Hopkins Hospital, Baltimore, identified 18 cases of prune belly syndrome occurring since 1945. In 13 cases, obstructive lesions in the lower urinary tract had been described grossly. A single case, in which the lower urinary tract had been preserved intact and subsequently serially sectioned as 8-micron sections taken at every 120 micron, demonstrated an obstruction consisting of two overriding urethral lumens connected only by a narrow channel. Reconstruction of the sections suggested that this represented a "kink" in a short segment of the prostatic urethra just above the membranous urethra, leading to the obstructive changes of bladder hypertrophy and dilatation, hydroureter, hydronephrosis, and renal dysplasia seen higher in the urinary tract. The results suggest that examination of the lower urinary tract in cases of prune belly syndrome by serial histologic sectioning of the intact unopened prostatic and penile urethra may be required to demonstrate the presence or absence of an obstructive lesion.

Generalized venocentric lesions in the virus-associated hemophagocytic syndrome.

Clinical and autopsy findings in a 41/2-year-old boy who had been healthy until the onset of virus-associated hemophagocytic syndrome are presented. In addition to findings previously reported in association with the syndrome, widely disseminated perivenular expansile nodules of bland necrosis were seen. These nodules were suggestive of vessel injury, with extravasation of vascular contents and focal destruction of normal elements. The morphologic similarities of these nodules to early lesions of pulmonary veno-occlusive disease are discussed.