Upgrade rate of core biopsy-determined atypical ductal hyperplasia by open excisional biopsy.

BACKGROUND: Core biopsy finding of atypical ductal hyperplasia (ADH) are generally followed by open biopsy to avoid underestimation of malignant disease. METHODS: Retrospective examination of 11 gauge stereotactic-guided vacuum-assisted core biopsies was made with respect to ADH diagnosis, follow-up open biopsy, and upgrade rate. Readily available clinical, mammographic, and pathologic features potentially contributory to an upgrade were studied. RESULTS: This series of 1,313 patients had 43 ADH diagnoses. Thirty-two had open follow-up. There were 4 upgrades. Mammographic indication for biopsy, age, removal of calcifications, and the percentage of ADH in the specimen were not significant in predicting an upgrade with all probabilities over 0.10, odds ratios not different than 1, and 95% bounds all encompassing 1. CONCLUSIONS: These data indicate a high upgrade rate (13%) for ADH-positive core biopsies with no definitive predictive criteria for an upgrade. Our data support follow-up excision of ADH lesions diagnosed by core biopsy.

Papillary renal tumors. Morphologic, cytochemical, and genotypic features.

BACKGROUND: Papillary renal tumors lack alterations of chromosome 3 and show trisomy of chromosomes 7 and 17, genotypic features distinct from nonpapillary carcinomas. METHODS: The authors examined 39 papillary renal neoplasms to identify morphologic features allowing distinction of high grade from low grade tumors. Twenty-nine papillary tumors and 13 nonpapillary tumors were examined for the presence of trisomy of chromosome 7 using fluorescence in situ hybridization. Data recorded included tumor size, stage, grade, architectural pattern, and the presence of glycogen, foam cells, and iron. RESULTS: Nineteen tumors were classified as low grade and 20 as high grade. The high grade tumors more often formed tall papillae with solid and tubular areas and had more intracellular glycogen, whereas the low grade tumors were more often trabecular. There was no significant difference in tumor size or iron deposition. High grade tumors were of higher stage. Foam cells more commonly were noted in low grade tumors. Sixty-seven percent of low grade, 43% of high grade, and none of the nonpapillary tumors showed trisomy of chromosome 7. Metastases developed only in patients with high grade papillary tumors (10/19, 7 within 2 years of diagnosis), all of whom died of disease. CONCLUSIONS: Papillary renal carcinomas with high nuclear grade are more likely to behave in an aggressive fashion, whereas those with low nuclear grade may be associated with longer disease free survival. Furthermore, trisomy of chromosome 7 can be identified by fluorescence in situ hybridization and is useful in differentiating true papillary from nonpapillary renal neoplasms.

Stomatococcus mucilaginosus bacteremias. Typical case presentations, simplified diagnostic criteria, and a literature review.

Even though Stomatococcus mucilaginosus is considered indigenous oral-pharyngeal flora, cited literature and case reports indicate that it can be the cause of infectious conditions. Tested strains were isolated from blood, the oral region, and wound sources. The organism was routinely misidentified or not identified by conventional or commercial systems (Vitek, STAPH-Trac). Four antimicrobial diagnostic disks for example, bacitracin (0.04 units; Taxo A), furazolidone (100 micrograms), novobiocin (5 micrograms), and polymyxin B (300 units), were evaluated as possible addition to previously applied biochemical characteristics that differentiate between S. mucilaginosus, Micrococcus sp., and coagulase-negative staphylococci. Consistent antimicrobial susceptibility patterns among our isolates to the diagnostic disks produced applicable characteristics for discriminating S. mucilaginosus from similar microorganisms. However, therapeutic choices of antimicrobial agents should be guided by individual organism susceptibility test results because of variable, often resistant patterns to beta-lactams, aminoglycosides, macrolides, new fluoroquinolones, and sulfonamides.