Lung cancer treated on the basis of cytologic findings: an analysis of 112 patients.

The authors studied 112 patients who received definitive radiotherapy/chemotherapy solely on the basis of positive cytologic findings in the appropriate clinical context. Eighty patients (71.4%) were treated on the basis of one or more positive sputum studies, while the remainder had at least one positive bronchial cytologic preparation. Eighty-six patients (76.3%) received radiotherapy alone; 19 received both radiotherapy and chemotherapy; only 7 were exclusively given chemotherapy. The utilization of stringent verification criteria revealed that none of our patients was falsely positive for malignancy. For those patients categorized as having malignant disease by verification criteria I-IV, there were no significant disparities between histologic and cytologic diagnoses. This study demonstrated, in a systematic fashion, that patients can be reliably and definitively treated for lung cancer on the basis of positive respiratory cytology findings without tissue corroboration.

Electrohydraulic shock wave induced renal injury.

The pathological effects of focused electrohydraulic shock waves on renal parenchyma were studied using a porcine model. Testing was carried out using the Northgate SD-3 and Dornier HM-3 shock wave lithotripters. Pigs received 3,000, 5,000 or 6,000 shocks at energy levels equivalent to 18 to 20 KV on the Dornier HM-3. The animals were sacrificed one or four weeks post treatment and evaluated for renal injury. Kidneys were serially sectioned and injury volume calculations carried out. The predominant injury pattern was interstitial and perivascular fibrosis with chronic lymphoid infiltration. Dense areas of fibrosis ranged from less than 0.01% to 0.13% and from less than 0.01% to 1.04% of renal volume in those kidneys treated on the SD-3 and HM-3 respectively. Surrounding areas of perivascular and interstitial fibrosis intercalated with areas of normal appearing parenchyma were noted and were more extensive than the central scar. While the calculated volumes of parenchymal scarring are probably insignificant with respect to renal function, the surrounding areas of partial injury may be related to the development of hypertension.

The diagnosis of pulmonary small-cell anaplastic carcinoma by cytologic means: a 13-year experience.

This article reports on a series of 432 patients with positive respiratory (sputum and bronchial) cytology and proven malignant respiratory tract disease as corroborated by detailed verification criteria; 54 of these patients were diagnosed as having small-cell anaplastic carcinoma (SCAC). None of the 31 patients with autopsy-and/or biopsy-proven disease had false-positive results for SCAC. Typing accuracy for SCAC versus non-SCAC was 97.7% in the 263 patients with histologic confirmation of their respiratory tract disease. Twenty-three of the 54 patients (42.6%) were treated for SCAC solely on the basis of positive cytology in the context of compatible clinical data. This finding underscores the great importance of proper specimen preparation, quality control procedures, and diligent clinical follow-up in an era of heightened cost-containment awareness when many patients with pulmonary SCAC will be treated on the basis of positive cytology not immediately confirmed by histologic methods.

Craniopharyngioma and "reactive" subependymoma of the third ventricle--a case report.

A 42-year-old woman with an 18-year history of suprasellar tumor, treated by repeated radiation therapy and surgery, was found to have both a craniopharyngioma and subependymoma of the third ventricle. The case is unique in that well documented subependymomas have not been reported in this location. Furthermore, only a few cases of subependymoma have been reported to be accompanied by a primary tumor of the central nervous system other than an ependymoma. Potential causative factors for this seemingly reactive subependymoma are briefly discussed.

Wound healing of true vocal cord squamous epithelium after CO2 laser ablation and cup forceps stripping.

A study was conducted on the effect of deepithelization of the true vocal cords; microcup forceps were used, as opposed to CO2 laser ablation. A CO2 laser, coupled to an operating microscope, was used to ablate the surface epithelium of the right true vocal cords in eight canines, while conventional microlaryngeal stripping was performed on the left true cords in the same animals. Photographs were taken immediately after injury and again before the animals were killed. Histologically, the series of true vocal cords ablated by the CO2 laser revealed granulation formation at day 5, whereas those treated with conventional stripping developed granulation at day 3, thus indicating delayed healing. Charred carbonaceous debris of CO2 laser ablation was found to cause a giant cell reaction that persisted after reepithelization. Despite the precise control offered by the laser, many of the laser-injured true vocal cords revealed vocalis muscle edema and muscle destruction. After healing occurred, dense fibrosis was found in the vocal muscle injured during CO2 laser ablation of the overlying squamous epithelium.

Argyrophilic, 'carcinoid-like' prostatic carcinoma. An immunocytochemical study.

Four cases of argyrophilic or carcinoid-like prostatic carcinoma were studied immunocytochemically, using immunoperoxidase stains for prostatic-specific antigen, neuron-specific enolase, hydroxytryptamine (serotonin), somatostatin, and adrenocorticotropic hormone. All four showed strong positive reaction to prostatic-specific antigen and uniformly negative results with neuron-specific enolase, hydroxytryptamine, somatostatin, and adrenocorticotropic hormone. These findings lend further support to the concept that this particular prostatic tumor is truly a carcinoma that somehow manifests a carcinoid-like histomorphology, but does not possess evidence of true neuroendocrine or carcinoidal nature.

Clostridial septicemia complicating the course of leukemia.

The authors report an analysis of 47 leukemia patients (including 9 from our own medical center) whose courses were complicated by 48 episodes of clostridial septicemia. There were 36 adults and 11 children; acute myelogenous leukemia and acute lymphoblastic leukemia accounted for 61.7% and 14.9% of cases, respectively. All patients for whom remission status was known were in leukemic relapse. Fever was a presenting complaint in at least 36 patients whereas neutropenia, thrombocytopenia, and gastrointestinal lesions were noted in 100%, 90.9%, and 87.9%, respectively, of the patients for whom information on these parameters was available. Overall mortality from clostridial septicemia was 78%; none of the children and none of the patients with intravascular hemolysis survived. Overall, antibiotic therapy resulted in a 40% survival rate. However, among patients receiving beta lactam and/or chloramphenicol therapy, 57% survived their episode of clostridial septicemia. Prompt initiation of appropriate antimicrobial therapy offers the best chance of survival in leukemia patients with clostridial septicemia.

The clinicopathologic significance of vitreous fluid cytology examinations in a series of 38 patients.

The authors systematically analyze a series of 38 patients having a total of 40 vitreous fluid cytology determinations. Nine of the 38 patients (23.7%) have cytologic results diagnostic for, or at least highly suggestive of, a specific disease process. These include two cases of bacterial endophthalmitis; two cases of fungal endophthalmitis; one case of vitreal amyloidosis; and four cases called positive for intraocular lymphoma. There are no vitreous fluid cytology determinations falsely positive or falsely negative for malignancy in this series. Intraocular lymphoma and the increasingly important role of vitreous fluid cytology examination in its diagnosis are discussed. The authors conclude that a strong commitment to quality control concepts, including detailed clinical follow-up, is essential in order to develop clinician trust and help achieve optimal patient care benefit from this valuable diagnostic modality.

Atypical ovarian hyperthecosis in a virilized postmenopausal woman.

Ovarian venous concentrations of testosterone (18.7 ng/mL and 8.2 ng/mL) were three to six times higher than the peripheral concentrations (2.8 ng/mL) in a hirsute postmenopausal woman. She had cystic hyperplasia of the endometrium and atypical hyperthecosis of the ovary. Postoperatively, the testosterone levels returned to normal. From the results of the immunoperoxidase reaction, the luteinized stromal cells of the ovaries were the site of increased production of the testosterone and estradiol. By the same technic, these cells were negative for LH but strongly positive for FSH. From these data, the authors conclude that the luteinized cells were the primary source of the excessive testosterone, that the same cells were the direct and indirect (by peripheral testosterone conversion) source of estradiol, that LH was very likely not involved in the process of steroid hormone production, and that FSH may be the trophic stimulus responsible for the functional activity of the luteinized stromal cells in this virilized postmenopausal woman.

Transthoracic fine-needle aspiration cytology. Analysis of 82 patients with detailed verification criteria and evaluation of false-negative cases.

The authors herein report a series of transthoracic fine-needle aspiration cytology studies performed over a ten-year period at a medical center. The verification criteria they utilized for "positive" and " nonpositive " results are unique to the TFNA literature, as is the authors' detailed analysis of false-negative cases. The authors' statistical findings included specificity, 100%; sensitivity, 79.0%; and overall accuracy, 83.0%. Eleven of 13 false-negative studies (84.6%) were consequent to sampling error; the remaining two cases (both "suspects") were the result of cytopathologist judgment error. In those patients with tissue corroboration of their lung disease, the authors obtained a 93.8% concordance rate between cytology and histology results. They conclude that uniform verification criteria, as well as careful analysis of "suspects" and false negatives, can lead to better patient care through improved quality control.

Psammoma bodies in malignant carcinoid tumor metastases.

A clinically and histopathologically well-documented case of malignant carcinoid tumor (with carcinoid syndrome) is described. The presence of numerous psammoma bodies in metastatic carcinoid tumor deposits, confirmed by histochemical and ultrastructural analyses, represents a heretofore unreported finding.

Hodgkin's disease followed by mycosis fungoides in the same patient. Case report and literature review.

Hodgkin's disease and mycosis fungoides are only rarely reported to occur in the same individual. The authors report a patient who initially presented with Hodgkin's disease but later died with massive visceral mycosis fungoides. This sequence of events is unique in the world's reported lymphoma experience.

Budd-Chiari syndrome complicating metastatic ocular melanoma in a patient not receiving chemotherapy.

The authors report a case of malignant melanoma associated with Budd-Chiari syndrome, that is unique for two reasons; the malignant melanoma metastases arose from an ocular primary site and the patient had not been treated with antimetabolite therapy. A review of neoplasms associated with Budd-Chiari syndrome accompanies the case report.

Immunoperoxidase localization of estrogen receptors in human brest carcinoma.

Monoclonal antibodies to the estrogen receptor protein were used to evaluate the specificity of the peroxidase antiperoxidase (PAP) method for localization of estrogen receptors (ER) in human breast carcinoma. Twenty-five cases of breast carcinoma were selected, and they were roughly classified as ER-rich and ER-poor tumors based on ER levels as determined by dextran-coated charcoal (DCC) assay. ER-rich tumors showed strongly positive cytoplasmic and, to a lesser degree, nuclear staining. Both the cytoplasmic and nuclear staining were less intense in ER-poor tumors, and the staining intensity varied from one to another cell population in the same tumor. Completely negative cells were also observed. The results of the PAP and DCC methods correlated fairly well in ER-rich tumors but not in ER-poor tumors. The PAP method provided visual localization of ER combined with excellent tissue morphology. Application of both methods (DCC and PAP) may provide better assessment of the estrogen receptor levels in breast carcinomas.

Late lesions in aorta-coronary artery vein grafts.

Aorta-coronary artery vein grafts, obtained from 2 patients 37 and 59 months after an aorta-coronary bypass operation, showed extensive mural changes characterized by degenerative tissue lesions, loss of normal morphological features of the intima, and extracellular accumulation of lipids. Both patients had increased plasma triglyceride levels.