Prognostic factors in carcinoma of the vulva: a clinicopathologic and DNA flow cytometric study.

The clinical staging of carcinoma of the vulva is a predictor of patient survival; however, the significance of other prognostic factors remains somewhat controversial. Length of survival after diagnosis of invasive squamous cell carcinoma was determined for 39 clinically staged and surgically treated patients who were followed at our institution. Clinical stage, tumor type, use of radiotherapy (RT), histopathologic features (invasive pattern, depth of invasion, lymph node status, nuclear grade, adjacent dysplasia, desmoplasia, inflammation) and DNA ploidy (determined by flow cytometry from paraffin-embedded tissue) were evaluated as predictors of survival. Kaplan-Meier survival curves were generated for strata defined by each of the various predictors and compared using the log-rank test. Advanced stage (p = 0.0002), RT use (p = 0.0004), "spray" invasive pattern (p = 0.005), positive lymph node status (p = 0.001), increased positive lymph node number (p = 0.016), and greater depth of invasion (p = 0.039) were associated univariantly with decreased survival time. Spray invasive pattern (p = 0.018), positive lymph node status (p = 0.030), positive lymph node number (p = 0.040), and RT use (p = 0.045) continued to be associated with decreased survival time after controlling for stage. Of the significant factors, invasive pattern stands out as a qualitative feature that may have potential benefit in predicting survival independent of clinical stage in patients with vulvar carcinoma.

A comparison of the healing properties of rabbit Achilles tendon injuries at different levels.

Rabbit Achilles tendons were transsected at the muscle-tendon junction (Group 1), midtendon (Group 2), or at the calcaneus insertion (Group 3). Treatment consisted of immobilization in a long leg cast without surgical repair. The contralateral leg served as a control. Tensile testing was performed at four weeks. Groups 1 and 2 failed most often in the proximal muscle rather than at the healing site. In contrast, Group 3 failed more often at the healing site than in the muscle and was statistically superior to Groups 1 and 2 with respect to strength and stiffness. Statistically, control specimens showed failure at the musculotendinous junction at greater loads and were stiff compared to the experimental groups.

Multicentric papillary-cystic neoplasm of the pancreas.

Two distinct papillary-cystic neoplasms were found in the pancreas of a young black woman. She presented to the hospital in her first trimester of pregnancy with the chief complaint of sharp right upper quadrant abdominal pain that radiated to the right shoulder. This was associated with jaundice, vomiting, and pruritus. On examination, a large, nontender, midepigastric abdominal mass was palpated. Serum liver enzyme levels were moderately to markedly elevated. An abdominal computed tomographic scan revealed a 9-cm solid and cystic mass located within the head of the pancreas with associated marked bile duct dilatation. A total pancreatectomy was performed. Gross examination of the specimen revealed two separate well-circumscribed tumors of unequal size. The larger one was found within the head of the pancreas and contained multiple hemorrhagic, cystic cavities. The smaller one, located within the tail, consisted primarily of solid tissue. Microscopic examination of both lesions revealed papillary-cystic neoplasms. To our knowledge, this is the first report of two synchronous papillary-cystic tumors of the pancreas and the first reported demonstration of the potential of this tumor for multicentricity.

Clear-cell change in follicular adenoma mimicking Hürthle-cell tumor on thyroid aspiration biopsy cytology.

We present a case of follicular adenoma with clear-cell change, which on fine-needle aspiration biopsy mimicked a Hürthle-cell tumor. Papanicolaou-stained smears revealed a monomorphic pattern of loosely cohesive groups of cells with abundant cytoplasm and centrally placed round nuclei with single prominent nucleoli. The cytoplasm was granular or finely vacuolated with occasional intracytoplasmic brown pigment. Subsequent surgical histology of the partial thyroidectomy specimen revealed a follicular adenoma composed of macro- and microfollicles. The microfollicular areas showed clear-cell change: these cells appeared identical to those seen on cytology. No Hürthle-cell change was present in the surgical specimen. Follicular cells with clear-cell change of the granular type must be added to the list of differential diagnoses when cells with Hürthle-like features are seen on aspiration biopsy of the thyroid.

The biomechanical and morphological changes in the medial collateral ligament of the rabbit after immobilization and remobilization.

The effects of immobilization and remobilization on the biomechanical and morphological properties of the femur-medial collateral ligament-tibia complex and each of its components were investigated in the rabbit. Specimens that had been obtained after periods of unilateral immobilization of the knee and remobilization were evaluated for structural properties. In addition, the mechanical properties of the substance of the medial collateral ligament and the histological characteristics of both the substance of the ligament and its sites of insertion were evaluated. After immobilization, there were significant reductions in the ultimate load and energy-absorbing capabilities of the bone-ligament complex, and an increased number of failures occurred by tibial avulsion. The tissue of the medial collateral ligament also became less stiff as a result of immobilization. Histologically, the femoral and tibial insertion sites showed increased osteoclastic activity, resorption of bone, and disruption of the normal attachment of the bone to the ligament. With remobilization, the ultimate load and energy-absorbing capabilities of the bone-ligament complex improved but did not return to normal. Failure by tibial avulsion became less frequent, and the stress-strain characteristics of the medial collateral ligament returned to normal. Histologically, the sites of insertion of the ligament also showed evidence of recovery.

Effects of postmortem storage by freezing on ligament tensile behavior.

The purpose of this study is to examine the effect of prolonged postmortem freezing storage (between 1 1/2 and 3 months at -20 degrees C) on the structural properties of the medial collateral ligament (MCL)-bone complex as well as the mechanical properties of the MCL substance from the rabbit knee. Tensile testing of the femur-MCL-tibia specimen was performed and no statistically significant changes were noted between the fresh and stored samples in terms of the cyclic stress relaxation, the load-deformation characteristics, as well as the load, deformation and energy absorbing capability at failure. The area of hysteresis of the stored samples was significantly reduced in the first few cycles, however. The mechanical properties of the MCL substance, as represented by the stress-strain curves, tensile strength and ultimate strain also did not change following storage. We conclude, therefore, proper and careful storage by freezing would have little or no effect on the biomechanical properties of the ligaments.

Tensile properties of the medial collateral ligament as a function of age.

The biomechanical properties of the rabbit medial collateral ligament (MCL) as a function of maturation and age were investigated. Femur-MCL-tibia (F-M-T) preparations were obtained from rabbits of different age groups (open or closed epiphysis). Parallel increases in the animal body weight and ligament cross-sectional area were recorded with age. Cyclic and tensile failure tests were performed to obtain the structural properties of the F-M-T complex and the mechanical properties of the MCL substance. There were significant increases in the load at failure, energy-absorbing capability of the bone-ligament junction, and in the tensile strength of the ligament substance as a result of maturation and subsequent aging. Increases in the area of hysteresis obtained during cyclic loading-unloading were also documented. At the closing of the epiphysis, the mode of failure of the F-M-T structure progressed from tibial avulsion to failure in the midsubstance of the ligament. An asynchronous rate of maturation was observed between the structural properties of the bone-ligament complex and the mechanical properties of the ligament substance.