Primary fallopian tube adenocarcinoma: preoperative diagnosis, treatment and follow-up.

Preoperative diagnosis of fallopian tube carcinoma is difficult due to the rarity and silent course of this neoplasm. We present herein the case of a 58-year-old woman with primary fallopian tube carcinoma that was diagnosed preoperatively on the basis of a positive for adenocarcinoma Papanicolaou vaginal smear, repeated episodes of vaginal bleeding, negative endocervical and endometrial curettage, characteristic features on ultrasonography and elevated CA-125 levels. The patient was treated by total abdominal hysterectomy, bilateral salpigno-oophorectomy and omentectomy. Pathologic confirmation of primary serous papillary adenocarcinoma of the left fallopian tube was made. Peritoneal washings were positive for malignancy. FIGO stage was considered as IIIb and the patient received six courses of combined carboplatin-taxol chemotherapy. At two years from onset of therapy the patient underwent a modified radical mastectomy and lymphadenectomy because of primary carcinoma of the right breast. The patient was started on tamoxifen therapy, which she is still taking. At 60 months after initial surgery, the patient is alive and well. In conclusion, our study suggests an association between fallopian tube carcinoma and breast cancer and a good response of the patient to platinum-based chemotherapy.

Contribution of exfoliative cytology to the diagnosis of laryngeal lesions.

OBJECTIVE: To estimate the diagnostic accuracy and reliability of exfoliative laryngeal cytology. STUDY DESIGN: Over three years (1996-1999) cytologic smears were obtained from clinically suspicious laryngeal lesions during laryngoscopy in a total of 31 selected patients (28 males and 3 females with an age range from 28-90 years). The cytologic diagnoses were analyzed and correlated with the histologic and final clinical diagnoses in 17 and 14 cases, respectively. Cytologic identification of the exact histologic type of the lesion was evaluated in 17 patients from whom both cytologic smears and biopsy material were obtained. RESULTS: The overall specificity was 100%, with no false positive diagnoses. The overall sensitivity was 93.3%, with one false negative cytologic diagnosis, in a case of non-Hodgkin's lymphoma. Cytohistologic correlation showed complete agreement between cytologic and histologic diagnoses in five of six benign lesions, in four cases of dysplasia and in six cases of squamous cell carcinoma. The overall diagnostic accuracy of cytology was 96.7% CONCLUSION: Exfoliative cytology by the smear technique is a reliable and accurate method in clinically suspected laryngeal lesions. Moreover, exfoliative cytology may be applied as the only alternative diagnostic method, especially in elderly patients with coexistent cardiorespiratory problems, when biopsy is not advisable or indicated.

Analysis of chromosomal aberrations in breast cancer by comparative genomic hybridization (CGH). Correlation with histoprognostic variables and c-erbB-2 immunoexpression.

The establishment of additional powerful prognostic markers in breast cancer patients is of unquestionable importance given that breast cancer is characterized by morphologic, biologic and genetic heterogeneity. In the present study we analyzed 8 primary invasive breast carcinomas by comparative genomic hybridization (CGH) in order to find and map the DNA copy number changes occurring in these tumors. Furthermore, in order to evaluate the potential prognostic significance, we compared these genetic changes with other histo- and immunopathologic prognostic variables, such as tumor type, tumor grade, lymph node status, estrogen receptors content and c-erbB-2 oncoprotein expression. All the studied cases showed a wide variety of gains and losses of chromosomal regions or arms distributed among 16 chromosomes with an average number of 6.12 aberrations per case. Although several genetic changes appeared to be common, none was unique or consistent in all the studied cases. The most consistent regions of gain were on 1q, 20q and 8q while the most common regions of loss on 3p and 6q. Accumulation of chromosomal changes were more frequently found in high grade ductal breast carcinomas with overexpression of c-erbB-2 oncoprotein in both lymph node-negative and lymph node-positive patients, whose tumors were positive for estrogen receptors. If any of these genetic changes identified by CGH in breast cancer patients carry prognostic information, regardless of stage or other factors predictive of biologic behavior, further investigation is needed.

Clonal analysis by PCR and RFLP in breast cancer and precancerous lesions. Preliminary data.

In order to investigate the clonality in various benign, precancerous and malignant breast lesions, we analyzed small DNA samples from paraffin sections of various breast lesions by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) of the X-chromosome-linked phosphoglycerokinase (PGK) gene. DNA from the lesion as well as from the adjacent normal tissue were analyzed in each case. Two restriction endonucleases. Hpa-II, a methylation sensitive restriction enzyme and Bst XI, a restriction endonuclease, which recognizes this polymorphic site on the PGK gene, were used. Of 19 cases, one case of in situ ductal Ca (DCIS), two cases of invasive ductal Ca and one case of multifocal ductal Ca were shown to be monoclonal. Two cases of intraductal papillomas were found to be polyclonal. One case of atypical ductal hyperplasia showed no conclusive findings. Additionally DNA was not yielded from 3 cases and other 7 cases were not informative, derived from females homozygotes. Further study of a larger number of cases is in progress.

Diagnostic accuracy of pericardial fluid cytology: an analysis of 53 specimens from 44 consecutive patients.

Over a 7-yr period, a total of 53 pericardial fluid specimens from 44 patients was examined. A correlation between cytological and histological diagnosis was made in 19 of these cases. In the remaining 25 cases, where a biopsy was not performed, the cytological diagnosis was correlated with the final clinical diagnosis and the patients' clinical outcome. Finally, in 9 out of 14 cases of malignancy where both cytological and a histological diagnosis was made, the cytologic prediction of the histologic type of cancer was evaluated. The overall sensitivity was 100%, the overall specificity was 93.3%, and the overall cytological accuracy was 95.4%. The predictive value of the correct histologic type of cancer by cytology was 77.7%. Our findings show that the careful cytomorphological examination of pericardial fluid aspirates is a valuable, reliable, and diagnostically highly accurate method, which could be performed on a routine basis in a busy cytopathology department. Judiciously chosen ancillary procedures, as well as clinicopathological correlation, are of great value for an accurate diagnosis in problematic cases.

Giant hemangioma in infant. A case presentation and literature review.

Giant hemangioma of infancy is a rare and extensive variant of the hemangiomas, that occurs in newborns and infants and is often complicated by life-threatening events. We describe herein an unusual case of a giant hemangioma in a female infant. At the age of 45 days she was admitted to the hospital because of increasing respiratory distress and distented abdomen. The response to supportive therapy was poor and the infant died from cardiac arrest on its 75th day of life. Autopsy revealed a giant tumor occupying extensive areas of the thoracic and abdominal cavity. The histologic diagnosis was compatible with a giant capillary hemangioma. A review of the literature was also attempted.

Neglected cases of papillary and follicular thyroid carcinoma. Occurrence of subcutaneous scalp metastases.

Three cases, two follicular and one of papillary thyroid carcinoma are reported. All three patients presented with subcutaneous cystic scalp metastases; they had a long-standing history of thyroid cancer, although two had never sought medical attention. We discuss this unusual clinical manifestation in patients with untreated well differentiated thyroid carcinoma.

High incidence of malignant pleural mesothelioma in neighbouring villages of Northwestern Greece.

Between 1981 and 1985 seven patients from three villages of the Metsovo area in Northwestern Greece (population 5000) developed malignant pleural mesothelioma (MPM). The diagnosis was made with pleural biopsy and pleural fluid cytology. Six of these patients have died 18-24 months after the first symptoms (usually dyspnea on exertion) and 1 is still alive after 24 months. Seven MPMs in 5,000 in five years is about 280 times the expected incidence of 1/1,000,000/year. In the same area, endemic pleural calcifications linked to nonoccupational asbestos exposure have recently been reported, but none of our patients with MPM had pleural calcifications. The combination of MPM and pleural plaques in such a high frequency in the same area strongly suggests asbestos fiber as a common etiologic agent. On the other hand, the fact that the combination of MPM and pleural plaques did not occur in the same individuals, suggests a different response to this common offending agent.

The gastrointestinal involvement in primary Sjögren's syndrome.

Gastrointestinal manifestations in patients with primary Sjögren's syndrome (SS), which is an autoimmune exocrinopathy, include dysphagia, nausea, epigastric pain, dyspepsia and nutritional deficiencies. In this report, we are presenting the nature and incidence of esophageal, pancreatic and liver involvement in our primary SS patients. Esophageal motility was studied in 27 patients with primary SS and 25 normal age and sex matched volunteers. Esophageal dysfunction was detected in 11 of the 27 patients (40.71%). Individual analysis of the esophageal motility studies showed different patterns of esophageal dysfunction. These esophageal abnormalities did not correlate with the parotid flow rate, the degree of inflammatory infiltrate of the minor salivary glands, the extraglandular manifestations or the presence of autoantibodies. Sera from 25 patients with primary SS were studied for the total serum alpha-amylase activity and isoamylases. Sera from 81 normal age and sex matched volunteers were used as controls. None of these patients had abdominal pain or gastrointestinal symptoms at the time of blood collection. The presence of hyperamylasemia of P-type and S-type in 6/25 patients (24%) probably reflects a slow, subclinical, inflammatory process of the exocrine glands. Clinical and biochemical evaluation of the liver function was studied in 22 primary SS patients. One of them had abnormal liver function tests and another hepatomegaly and splenomegaly. Percutaneous liver biopsies in both revealed chronic active hepatitis.

Comparative immunostaining of T-associated plasma cells and other lymph-node cells in paraffin sections.

The immunoperoxidase technique after trypsinization was used on paraffin sections of 24 lymph nodes with reactive lymphadenitis and abundant nests of T-associated plasma cells. These cells were negative for all the markers investigated, which were: intracytoplasmic immunoglobulins (CIg), a1-antichymotrypsin(a1-ACT), a1-antitrypsin(a1-AT), lysozyme(Lz) and fibronectin. Other categories of cells were positive or negative depending on their type. The best markers for polymorphs proved to be a1-AT and Lz, and for monocytes and histiocytes a1-ACT and Lz. Sinus histiocytes in particular were much more constantly and strongly positive for a1-ACT than for Lz. Endothelial cells appeared almost always positive for a1-ACT and were also occasionally positive for a1-AT. Fibronectin was consistently positive in mast cells and sometimes positive in other cells, especially those of monohistiocytic origin. Our present findings are against a B-cell or monohistiocytic origin for T-associated plasma cells.