Signet-ring cell variant of invasive lobular carcinoma of the breast. A clinicopathologic study of 11 cases.

In signet-ring cell carcinoma of the breast, which was recognized in 1976 as a distinct clinicopathologic variant of lobular carcinoma, more than 20% of the malignant cells appear as signet rings formed by mucin-positive intracytoplasmic vacuoles. Several recent studies have demonstrated that the neoplasm behaves aggressively and is associated with a poor prognosis. However, the literature lacks information concerning steroid hormone receptor assays and DNA ploidy profiles, especially regarding how these tests affect a patient's prognosis. During a 5-year period (1985 to 1990), 11 (8.7%) of 126 cases of invasive lobular carcinoma met the criteria for signet-ring cell carcinoma. Ten of 11 cases were positive for estrogen and progesterone receptors; six cases showed type I and five showed type III DNA histograms. The high incidence of positive hormone receptors is significant: patients with receptor positive tumors, even those with type III DNA histograms, who were treated with tamoxifen citrate therapy after surgery had a significant increase in disease-free survival (30 months). Both the pathologist and the clinician should be aware of the prognostic influence of hormone receptor studies in the management of signet-ring cell carcinoma of the breast.

An evaluation of red blood cell heterogeneity (increased red blood cell distribution width) in iron deficiency of pregnancy.

A new classification of anemias, which is based on mean corpuscular volume and quantitative anisocytosis (red blood cell distribution width), was evaluated in 331 pregnant women on initial presentation for prenatal care. Seventy-four of them had severe iron depletion (serum ferritin level less than or equal to 10 ng/dl). Contrary to the above classification, early iron deficiency without anemia was infrequently identified by an increase in distribution width (4 of 25 patients). The distribution width was not consistently increased in the 49 anemic, iron-deficient patients; 34 were normal and would have been considered to have thalassemia minor or anemia of chronic disease according to the new classification. The distribution width was no more sensitive than the mean corpuscular volume in suggesting iron deficiency. This study does not confirm the usefulness of the new classification in the diagnosis of iron deficiency in this patient population.

Absence of myelin basic protein in granular cell tumors.

Thirty-one granular cell tumors were studied for the presence of myelin basic protein (MBP) using a monoclonal antibody with a characterized specificity and an immunoperoxidase technique. The tumors studied were from all areas of the body, from both sexes, and from nine decades of age. All the tumors stained negatively for MBP. One brief report using a monoclonal antibody had noted positive staining for MBP in granular cell tumors. A more recent study using polyclonal antibodies found negative staining for MBP in Schwann cell neoplasms including granular cell tumors. This study, using an immunohistochemical technique, demonstrated the absence of an MBP marker in granular cell tumors of diverse location despite the fact that granular cell tumors are widely held to be of Schwann cell origin.

Selective screening of hospitalized patients for the presence of asymptomatic hepatitis B virus carriage: predictability based on census tract data.

Review of all hepatitis B surface antigen-positive patients reported to the county health department over the past 3 years showed that 60% of patients had been diagnosed at our hospital, which serves an inner city, predominantly black, indigent population. Sera from 524 adult patients admitted to the hospital were prospectively collected and tested for hepatitis B surface antigen, eight (1.5%) of which were antigen-positive. Census tract data allowed us to perform selective screening of sera from 95 other patients who were subsequently hospitalized and deemed "high risk" for hepatitis B infection. Nine of 95 (9.5%) selectively screened samples were positive for hepatitis B surface antigen, which represented a significantly higher rate of antigen carriage (P less than 0.0001) in hospitalized patients from "high risk" areas than that found in the general population screen. The methodology presented herein may be useful in providing a means of identifying hepatitis B surface antigen-positive patients from adult, urban, indigent care populations.

Paget's disease of the anal mucosa in association with carcinoma demonstrating mucoepidermoid features.

A case of Paget's disease of the anal mucosa with an underlying carcinoma demonstrating mucoepidermoid features is reported. The histopathologic characteristics of both extramammary Paget's disease and mucoepidermoid carcinoma are noted. Special histochemical staining procedures were consistent with the diagnosis. The actual histogenesis of extramammary Paget's disease and mucoepidermoid carcinomas are controversial topics that are briefly discussed in this paper.

Example of a thimerosal-dependent antibody without apparent blood group specificity.

A third example of a thimerosal-dependent hemagglutinin is reported. The IgG antibody reacted by antiglobulin or ficin techniques with all cells incubated in the presence of thimerosal, including iadult cells and two examples of the Rhnull phenotype. Agglutination was inhibited by excess thimerosal (5 g/dl).