Esophageal carcinoma with prominent spindle cells.

Eight cases of esophageal carcinoma with prominent spindle cells (carcinosarcoma or pseudosarcoma) were studied using the avidin-biotin immunoperoxidase method and monoclonal antibodies to various keratins and vimentin. In all eight cases positive immunoreactivity for keratin was found in carcinomatous areas and for vimentin, in the spindle cells. It is interesting that five cases demonstrated focal immunoreactivity to keratin in the spindle cell component. Trace positivity to vimentin was seen in the carcinomatous areas in one case. These findings are consistent with the hypothesis that esophageal carcinoma with prominent spindle cells is of epithelial origin and may represent a morphologic variant of squamous cell carcinoma.

Suture technique in preventing dehiscence of prosthetic mitral valves.

To evaluate suture techniques for mitral valve replacement, 60 fresh porcine hearts were used to determine suture holding strength. Using four techniques (simple interrupted, figure-of-eight, and horizontal without and with pledgets), the anterior leaflet, the posterior leaflet, and the commissures were sutured. The free ends of the sutures were then attached to a force transducer, and tension was increased until disruption occurred. In the anterior leaflet, horizontal mattress sutures disrupted with significantly less force than the other techniques. Pledgets increased the holding strength of mattress sutures, but figure-of-eight and simple interrupted sutures had greater holding strength than sutures with pledgets, suggesting that the direction of the suture vs that of tissue fibers is critical. Histologic studies confirmed this point. The posterior leaflet exhibited less holding strength than the anterior leaflet for all suture techniques but did not demonstrate a superiority for any specific technique. The posterior leaflet is the problem area for suture disruption from the mitral anulus. We secure mitral prostheses with horizontal mattress sutures with pledgets around the entire anulus, placing them from the atrial side.

Epithelioid leiomyosarcoma originating in a hamartomatous polyp from a patient with Peutz-Jeghers syndrome.

A case of Peutz-Jeghers syndrome with long history and multiple resections is presented. Despite the large number of intestinal polyps in these patients, malignant transformations are rare. In this case, an epithelioid leiomyosarcoma developed within a single polyp. At the time of resection this tumor had already metastasized to the liver. The histology and ultrastructure of this tumor is presented. Reviews of the clinical syndrome and leiomyosarcoma are given, with discussion of the possible interaction of these two processes as presented in this patient.

Cytologic diagnosis of gastric cancer.

Follow-up of cytologic examinations of specimens obtained from 187 patients by gastric lavage with saline solution, without the use of enzymes or abrasive devices, showed a false positive rate of 0.6 per cent and a false negative rate of 17 per cent. To achieve satisfactory results with such examinations, great attention to detail in obtaining, preparing and examining the specimens is essential. Cytologic examination should be done in any case in which gastric cancer is suspected clinically or roentgenographic or gastroscopic findings arouse suspicion.