Methoxychlor may cause ovarian follicular atresia and proliferation of the ovarian epithelium in the mouse.

Methoxychlor (MXC) is currently used to protect agricultural products from insects. Previous studies show that MXC adversely affects the ovary, but the target cells were not revealed by those studies. Therefore, the purpose of this study was to test the hypothesis that MXC induces ovarian changes by adversely affecting the antral follicles and the ovarian surface epithelium in the mouse. To test this hypothesis, cycling female CD-1 mice (39 days) were dosed with MXC (8, 16, or 32 mg/kg/day), kepone (KPN, 8 mg/kg/day, positive control), or sesame oil (vehicle control) via intraperitoneal injection for 10 or 20 days. Estrous cyclicity was evaluated daily via vaginal lavage. After dosing, ovaries were collected for histological evaluation of follicle numbers, atresia, and surface epithelial height. The results indicate that at the 20-day time point, MXC (32 mg/kg) and KPN (8 mg/kg) increased the percentage of atretic antral follicles (n= 4-9,p

Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients.

BACKGROUND: Thoracic aortic injury (TAI) is a devastating condition in which prompt recognition can obviate morbidity and mortality. It is a long-held belief that TAI is more likely when there is a "major mechanism of injury." The purposes of this prospective study were to determine mechanism characteristics that are predictive of TAI and to evaluate chest computed tomography (CT) as a screening tool for TAI. METHODS: Over a 5 1/2 year period, blunt chest trauma patients at two Level I trauma centers were evaluated for potential TAI. Patients were assigned mechanism and radiograph scores from 1 (low suspicion for TAI) to 5 (very high suspicion for TAI). Immediate aortography was obtained when suspicion for TAI was very high. The remaining patients were evaluated with contrast-enhanced chest CT. Confirmatory aortography was obtained on all positive chest CT scans and on all patients with mechanism scores of 4 or 5 even if the CT was negative. Mechanism and radiographic data were correlated with the results of aortic imaging. RESULTS: Of the 1,561 patients evaluated for TAI, 30 aortic injuries were found. The assessment of mechanism was imperfect with a reliance on often incomplete and subjective data. The subjective mechanism score proved to be the most useful predictor of TAI. Radiographic scores were useful but insensitive for intimal injuries. Computed tomography was found to have 100% and 100% NPV for TAI. CONCLUSION: Considering the inherent difficulties in identifying patients at risk for TAI and the effectiveness of chest CT as a screening tool for aortic injury, we recommend liberal use of chest CT in blunt chest trauma. Guidelines for determining the need for aortic imaging are outlined.

Can chest CT be used to exclude aortic injury?

PURPOSE: To determine whether chest computed tomography (CT) can be used to exclude aortic injury. MATERIALS AND METHODS: Patients in whom there was very high suspicion of traumatic aortic injury were examined with aortography only. Other patients were examined with contrast material-enhanced CT. Follow-up aortography was performed in all patients with moderate to high suspicion of traumatic aortic injury and in all patients with CT scans that were positive for traumatic aortic injury. CT scans were regarded as positive when they showed mediastinal hematoma or direct findings of aortic injury. During a 4 1/2-year period, 1,009 patients (263 female, 746 male; age range, 3-90 years) were evaluated for possible traumatic aortic injury. RESULTS: Of the 207 patients who underwent aortography directly without CT, 10 had traumatic aortic injury. Of the 802 patients who were examined with CT, 382 underwent follow-up aortography. In this group, there were 10 true-positive and no false-negative CT scans. CT had 100% sensitivity and a 100% negative predictive value for the detection of traumatic aortic injury.

AGUS in cervical endometriosis.

OBJECTIVE: To evaluate cervical endometriosis as a source of abnormal glandular cells in cervicovaginal smears. STUDY DESIGN: Histologically documented cases of cervical endometriosis with concurrent cervicovaginal smears were reviewed. The cytologic specimens were evaluated for the presence of glandular abnormalities. RESULTS: There were eight cases of superficial endometriosis (five of which had concurrent tuboendometrioid glandular metaplasia) and two cases of deep endometriosis in this series. Five of the eight cases of superficial endometriosis had abnormal glandular cells in the smears; neither of two cases of deep endometriosis had glandular abnormalities. Four of the eight cases of superficial endometriosis had previously undergone conization for cervical intraepithelial neoplasia (CIN) (squamous intraepithelial lesion [SIL]) and were being monitored for recurrence. Of the five cases of atypical glandular cells of unknown significance (AGUS), one case had concurrent high grade CIN (SIL). Another case was originally misinterpreted as recurrent glandular dysplasia. CONCLUSION: Physicians monitoring patients after treatment for CIN need to be aware that endometriosis and tuboendometrioid metaplasia may be the source of atypical glandular cells and on occasion may be subject to misinterpretation.

Calcifying amyloidoma of the breast.

In this case, a distinctive amyloid tumor of the breast clinically simulated carcinoma, although the patient related onset to trauma. Hepatosplenomegaly, elevated globulins, and anemia led to identification of large amounts of monoclonal IgG-kappa production. The patient died of renal failure within several months despite chemotherapy. The matrix of the breast tumor was tinctorially characteristic of amyloid light chain (AL) protein. The mass contained islands of plasma cells that morphologically suggested local production of amyloid matrix. Moreover, plasma cell and matrix immunohistochemically displayed reactivity of IgG-kappa protein, indicating a clonal plasma cell infiltrate. Pseudo-acinar arrangement of plasma cells may be misinterpreted as epithelial cells in needle biopsy specimens. The notion that some amyloidomas may represent in situ production of protein by clonal immunocytes ("secretory immunocytomas") should be further studied.

Calcium pyrophosphate arthropathy of the spine: case report and review of the literature.

Calcium pyrophosphate deposition disease is a relatively uncommon arthropathy characterized by the clinical features of pseudogout, the radiographic manifestations of chondrocalcinosis, and the pathological deposition of calcium pyrophosphate crystals in both hyaline and fibrocartilage. Symptomatic involvement of the spine by calcium pyrophosphate deposition disease is rare except by nodular deposition in the ligamentum flavum and atlanto-occipital ligament. We report a 50-year-old woman who presented with an acute herniated disc syndrome secondary to an intraspinal inflammatory calcium pyrophosphate deposition disease mass at the level of the L4-L5 interspace. The magnetic resonance image and histopathological features of the case are also discussed.

Posterior fossa venous angiomas with drainage through the brain stem.

PURPOSE: To describe 11 cases of posterior fossa venous angiomas with drainage through the brain stem. METHODS: Eleven cases of posterior fossa venous angioma with drainage through the brain stem were evaluated using MR. Correlation with known routes of venous drainage for the cerebellum and brain stem is made. RESULTS: Six of the 11 venous angiomas were found in the cerebellum, four in the brain stem; one involved both the cerebellum and brain stem. The cerebellar venous angiomas drained to subependymal veins about the fourth ventricle and dorsal pons. These then connected with an enlarged transmesencephalic or transpontine vein, to drain anteriorly to the anterior pontine veins. The brain stem angiomas had variable drainage depending on location. Evidence of hemorrhage was seen in five cases. CONCLUSION: Cerebellar and brain stem venous angiomas have several potential routes of drainage, including an enlarged vein traversing the pons, midbrain, or medulla. A knowledge of the normal venous anatomy of this region helps to understand the occurrence of these uncommon routes of venous drainage.

Gas in the cavernous sinus.

PURPOSE: To evaluate the significance of cavernous sinus gas identified on head CT scans. METHODS: Head CT scans were viewed prospectively for a period of 3 years. The charts of patients who demonstrated cavernous sinus gas were reviewed. RESULTS: Seventeen patients without head trauma and 10 patients with head trauma demonstrated gas in the cavernous sinus. None of the patients had symptoms or developed symptoms originating in the cavernous sinus. All of the patients without trauma had an intravenous line in place. Sphenoid fractures or basilar skull fractures were not a constant finding in trauma patients with cavernous sinus gas. CONCLUSIONS: In patients without symptoms referable to the cavernous sinus, gas in the cavernous sinus does not appear to be a significant finding. The gas is most likely the result of venous air emboli from intravenous lines or penetrating trauma.

Analysis for steroid production of a Sertoli-Leydig cell tumor.

Sex cord stromal tumors of the ovary can be characterized by the production of virilizing steroid hormones. The authors present a case of a poorly differentiated Sertoli-Leydig cell tumor in which ascitic fluid was found to have a high concentration of androgenic hormones and precursors from the delta steroid pathway (17-OH progesterone, testosterone, and androstenedione). These values correlated with samples taken from the right ovarian vein, draining the ovarian neoplasm, but not with those taken from the left ovarian vein or the peripheral blood sample. Selective peritoneal fluid sampling may aid in the diagnosis of hormonally active tumors.

Pathologic correlation in mammographically directed breast biopsies.

In a series of 1137 diagnostic breast biopsy specimens in a 2-year period, nearly half (n = 534) underwent specimen mammography. Calcifications were found in 48% of the specimen mammograms. In a quarter of the cases, calcification was a marker either for carcinoma or a significant precursor lesion. Moreover, in the majority of these malignancies, calcifications were markers of preinvasive carcinoma. In another quarter of cases, some form of proliferative ductal hyperplasia accounted for calcifications, and in the remainder, cysts and miscellaneous other conditions accounted for calcifications. The yield of malignancy was much lower in noncalcified specimens (12%). A nodular or asymmetric density proved to be a fibroadenoma in 30% of cases. However, the majority of cases had less well-defined changes, probably representing some form of lobular fibrosis. We found submission of a duplicate specimen mammogram with the breast biopsy specimen to pathology to be a significant adjunct to correlation. The abnormal area is marked on the mammogram by the radiologist for the pathologist. This is particularly helpful for localizing noncalcified stromal abnormalities. Calcifications are most easily and reliably isolated by serial slicing and performing another radiograph of the slices.

Prognostic value of pathologic features and DNA analysis in endometrial carcinoma.

In a series of 38 nonmetastasizing and 29 metastasizing endometrial cancers, histologic subtype, aneuploidy, nuclear grade, and depth of myometrial invasion were the features most distinctly separating these two groups of patients. The most important factor was histologic type: papillary, papillary serous, adenosquamous, clear cell, and diffusely infiltrating carcinomas were strongly correlated with metastasis using chi square analysis. Nuclear grade 3 and deep myometrial invasion were similar to each other in sensitivity and predictive value, and both were also strongly correlated with metastatic risk. Aneuploidy, also correlated with metastasis, was similar to nuclear grade 3 and deep myometrial invasion in predictive value but was more sensitive. DNA analysis appeared to be most useful when histologic studies were inconclusive in assigning a high degree of risk. Twice as many aneuploid carcinomas having nuclear grade 2 (intermediate risk) morphology proved to be metastatic. A similar relationship was found with deep myometrial invasion. A quantitative correlation between the DNA index and the risk of metastasis was found; a DNA index above 1.5 was a strong attribute of the metastatic group.

Use of the von Kossa stain in identifying occult calcifications in breast biopsies.

In a two-year series of more than 300 mammographic-directed biopsies with radiographic calcifications, calcium deposits could not be identified in approximately 10% with the use of routine hematoxylin and eosin (H and E) stains. In most of these cases, calcifications, sometimes in surprising amounts, could be identified by use of the von Kossa stain. These included calcium deposits in acinar secretions (nine), cyst fluid (four), ductal ectasia (six), and papillomatosis (five). It would appear that the von Kossa stain is more sensitive for calcium than hematoxylin and is a useful technique when combined with specimen radiography in providing satisfactory radiologic-pathologic correlation.

Feulgen cytometry in simultaneous endometrial and ovarian carcinoma.

The modal DNA value was measured in six patients with simultaneous endometrial and ovarian carcinoma by Feulgen static cytometry. One patient with low-grade endometrial and ovarian carcinoma manifested diploid indices at both sites. Another patient demonstrated aneuploid ovarian carcinoma and diploid endometrial carcinoma, indicating that these were separate neoplasms. The remaining four patients with Stage III disease had aneuploid endometrial and ovarian carcinomas with identical DNA indices. These data support a single neoplastic process with metastasis in the latter four patients. There was good correlation with the clinicopathologic impression on the likelihood of synchronous primaries versus metastatic neoplasms. It was concluded that DNA analysis is a useful adjunct in assessing the probability that spatially separate neoplasms represent metastasis.

Adenocarcinoma arising in Barrett's esophagus with Zollinger-Ellison syndrome.

A 61-year-old man with a 20-year history of recurrent gastric peptic ulcerations had an adenocarcinoma of the esophagus resected. The carcinoma was associated with columnar cell-lined (Barrett's) esophagus with carcinoma in situ. The patient had hypergastrinemia (gastrin level, 1,000 pg/dl), and at autopsy two months after the operation, a 3-mm pancreatic adenoma was discovered. In addition to the rarity of this clinical constellation, the case is of interest in suggesting that hypergastrinemia does not protect against peptic esophagitis and its sequelae.

Polyamine metabolism in liver of young rats.

Rat liver undergoes a phase of rapid growth during weaning. We followed the changes in polyamine metabolism occurring during this period of natural growth, and compared them with changes in DNA and RNA accumulation. There was a 2.5-fold increase in the number of cells per liver between suckling (18--19 days old) and weaning (30--32 days old) rats. Ornithine decarboxylase activity increased from the low value in 18-day-old rat pups and remained significantly higher (approx. 5--10-fold) than that in adult rats from day 21 to day 34. Putrescine-dependent S-adenosylmethionine decarboxylase activity was slightly but significantly increased during most of this period. Spermidine and RNA concentrations fluctuated in concert, whereas spermine content per cell doubled during the period from day 23 to day 30.

Analysis of spermidine and spermine in rat liver. Effect of hypophysectomy on polyamine concentrations.

A simple, rapid, reproducible assay for tissue polyamines using a standard unmodified amino-acid analyzer is described. This technique will allow accurate measurement of the polyamines from as little as 10 mg of liver in less than 1 h. We have used this method to establish the optimum conditions for the extraction of polyamines from liver and to study the effects of hypophysectomy on polyamine content of rat liver. Hypophysectomy caused a fall in RNA, protein, putresine, and spermidine content prevented the normal increase in spermine in rat liver seen with increasing age.

The glycosaminoglycans of the human colon in inflammatory and neoplastic conditions.

The glycosaminoglycans from normal colonic mucosa and colons with a variety of inflammatory diseases, as well as benign and malignant neoplasms were analyzed. Normal colonic mucosa contains predominantly chondroitin sulfates and dermatan sulfate. Increases in the levels of hyaluronic acid and heparan sulfate, as well as substantial increases in the amount of total glycosaminoglycans were characteristic of invasive colonic adenocarcinoma. Lesser elevations in the amount of total glycosaminoglycans and hyaluronic acid and heparan sulfate were present in neonatal colonic mucosa, villous adenoma, ulcerative colitis, and mucosa adjacent to carcinoma. The degree of elevation was proportional to the dysplastic potential. Since dysplastic lesions have scant connective tissue, the epithelial component of colonic neoplasms may contribute to these neoplasm-related alterations in glycosaminoglycan composition.

Mucinous carcinoma of the colon and rectum.

The clinicopathologic significance of mucus production by adenocarcinoma of the colon and rectum was analyzed in retrospective study with stage matched non-mucus producing control carcinomas. Mucinous carcinoma of the colon and rectum comprised 132 (15%) of 893 cases of colorectal carcinoma. The rectum was the most common site (33% of cases). While 120 mucinous cancers had a poorer five-year survival than non-mucinous tumors (34% vs. 53%, p less than .005), these had a particularly bad prognosis in the rectum (18% 5 year survival vs. 49% for the non-mucinous tumor controls, p less than .00k). The theoretical basis for this location-dependent behavior is considered. From this study, distinctive clinico-pathologic features emerge. There were seven documented cases of ulcerative colitis and 8 additional patients gave a history of "colitis". An additional five patients had received prior pelvic irradiation. Of particular note was the fact that 31% of mucinous carcinomas were associated with villous adenomas, implying a histogenetic relationship. Moreover, this finding again emphasizes the neoplastic potential of the villous adenoma, especially in the rectum where the development of mucinous carcinoma is particularly ominous.