Candida albicans translocation across the gut mucosa following burn injury.

Normal guinea pigs were challenged intragastrically with Candida albicans 1 hr prior to a 30 or 50% flame burn to determine if burn injury increased translocation of the yeasts across gut mucosa. Tissues were harvested between 3 and 24 hr postburn and cultured on Sabouraud dextrose agar. Control animals (no yeast challenge) showed no yeast in intestinal homogenates or in the mesenteric lymph nodes (MLN). At a dose of 1 X 10(9) yeasts, they did not escape from the gut lumen, with either a 30 or 50% burn. At a dose of 2 to 4 X 10(10) organisms, they translocated to the MLN in 92% of the 50%-burned animals (P less than 0.001), 75% of the 30%-burned animals (P less than 0.05), and 12.5% of unburned animals. The ileal mucosa appeared to be the most susceptible site for yeast invasion. To observe the penetration through the gut mucosa and/or translocation to other tissues, yeasts were labeled with biotin before administration, and tissues were stained with avidin-peroxidase diaminobenzidine sequence. With biotinylated yeasts, phagocytized organisms were observed in large numbers in the lamina propria and mesenteric lymph nodes but they were not viable upon culture. Toluidine blue staining of semithin sections revealed that translocated yeasts were located selectively in the lymphoid follicles of the MLN, entrapped by macrophages.

Benign dermal cylindroma of the external auditory canal: a clinicopathological report.

Considerable confusion exists regarding the nature of benign dermal cylindroma of the external auditory canal. In the past, authors have used the term cylindroma to refer to malignant lesions such as adenoid cystic carcinoma. Benign dermal cylindroma is a specific clinical entity consisting of benign tumors arising from the epidermal appendages; however, whether they are apocrine- or eccrine-derived is not conclusively known. Six per cent are reported to be related to the ear. Histologically they are characterized by cords of basophilic cells, hyaline material, and cystic duct-like structures. Rarely, cases of malignant degeneration are reported. However, for the most part, these lesions are benign and should be treated with complete local excision. Radiotherapy may be useful in treating massive lesions not amenable to surgery.

The clinical significance of minimal breast cancer: a pathologist's viewpoint.

We can draw the following conclusions about minimal breast cancer: The concept of minimal breast cancer as a stage of cancer that is 95% curable is a valid one, if minimal breast cancer is defined by strict parameters. Both 0.5 and 1.0 cm have been defined as the upper limit of size for minimal invasive cancer. Some data indicate that 0.5 cm is the preferable dividing line and that 1-cm cancers are no longer minimal. Other data suggest that the most important factor is axillary lymph node status. One-centimeter cancers are probably 95% curable if axillary lymph nodes are negative. Cancers of 0.5 cm and smaller in size are probably not 95% curable if axillary lymph nodes are involved. Carcinoma in situ appears to be highly curable, even if axillary lymph nodes are involved. Minimal breast cancer should include lobular carcinoma in situ (lobular neoplasia) and ductal carcinoma in situ regardless of nodal status, and (tentatively) invasive carcinoma smaller than 1 cm in total diameter, if axillary lymph nodes are not involved. Many cases of minimal breast cancer are asymptomatic. If special screening is not used, less than 10% of women with breast cancer will be at the minimal stage when diagnosed. Screening programs can increase this ratio to as much as one third of patients, perhaps even more. While serious questions about cost effectiveness of mass screening remain, screening programs appear to represent the best way of detecting minimal breast cancer. Screening programs should include careful history and physical examination, of course. The role of mammography is still controversial. It is probable that at least 50% of all minimal cancers would be missed without mammography. After a period of significant worry about the risk of radiation, opinion seems to be changing now and many authors are willing to accept the fact that mammography is of more benefit than risk for younger women. The HIP study would indicate that the risk/benefit ratio becomes favorable at age 50. Many authorities would now comfortably include mammography in the screening of women age 40 or older. Some authors believe that the benefits of mammography outweight the risks for patients of all ages. This question needs to be tested, and several randomized prospective clinical trials now in progress are doing just that. The legitimate worry over the risks of mammography should not obscure a very important fact.(ABSTRACT TRUNCATED AT 400 WORDS)

Bronchoalveolar lavage in acute drug-hypersensitivity pneumonitis probably caused by phenytoin.

We have reported a case of acute hypersensitivity pneumonitis, probably caused by phenytoin, in which the results of bronchoalveolar lavage suggested a predominantly lymphocytic type of alveolitis, comparable to the alveolitis of sarcoidosis or chronic hypersensitivity pneumonitis.

Effect of Dextran 40 and aprotinin on experimental acute pancreatitis.

This study examines and compares the prophylactic role of aprotinin and Dextran 40 in acute pancreatitis. Experimental acute pancreatitis was induced in 70 male Wistar rats using the closed-duodenal-loop technique. The rats were randomly divided into four groups; sham operation, untreated acute pancreatitis, and therapy with aprotinin or Dextran 40. Samples of blood and urine were collected at the beginning and at the end of the 24-hr period for measurement of amylase and creatinine which allowed calculation of the amylase-creatinine clearance ratio (ACCR). Mortality in the aprotinin group was the same as the untreated rats (20%). Dextran 40 therapy was associated with a lower mortality rate (6.7%). Light microscopic examination confirmed that the histologic changes of acute pancreatitis were less severe in both the aprotinin- and Dextran 40-treated rats. The ACCR was elevated after Dextran 40 therapy, which was due mainly to high urinary amylase levels. These results suggest that Dextran 40 may have a prophylactic role in acute experimental pancreatitis but again emphasizes the high false-positive rate of the ACCR determination.

Proliferative myositis in the head and neck.

Benign fibrous lesions in the head and neck include lesions with a wide range of histologic features. Some of these conditions may be mistaken for malignant tumors, leading to unnecessary radical therapy. Proliferative myositis is one such lesion. A 49-year-old man had a one-week history of swelling over the left side of this mandible and upper neck. Most of the mass was removed and the diagnosis of proliferative myositis was confirmed by excisional biopsy. The patient was free of disease one year after surgery.

Erysipeloid.

Erysipelothrix infections have been a well-known clinical entity for over a century. Only a few cases have been studied histologically, and the agent has rarely been cultured from infected patients. We present here a case of erysipeloid of Rosenbach, in which histologic study and electron microscopy document the presence of microorganisms. We also present a complete review of the clinical and pathologic features of Erysipelothrix infections and their treatment. Our observations suggest that Erysipelothrix rhusiopathiae is capable of producing L forms that may revert to a bacterial form and produce sepsis at a later time.

A thoracic benign mesenchymoma in association with hemihypertrophy.

A thoracic benign mesenchymoma was removed from an 18-year old caucasian male who also had hemihypertrophy. The very large benign mesenchymoma which was removed was found to consist of an admixture of cytologically mature vascular spaces, adipose tissue, and smooth muscle. After removal of the tumor, the patient has had no recurrence with one year of follow-up. Patients with hemihypertrophy appear to be at high risk to develop neoplasms. Malignant neoplasms of the adrenal gland, kidney, and liver are most common. It is suggested that patients with hemihypertrophy should be followed periodically for their entire life because of their propensity to develop tumors.

Emphysema-like changes in the lungs of starved rats.

We examined the effects of starvation on lung structure in rats allowed only one fifth of their measured daily food consumption until they lost 40% of their initial body weight, and evaluated volume-pressure relationships in saline-filled lungs, lung morphometric and connective tissue morphologic features and lung ultrastructure by scanning electron microscopy. Compared with rats fed full rations, the volume-pressure curve was shifted upward and to the left and the chord compliance was significantly increased. In the starved rats, enlargement of air spaces and alveolar wall destruction was associated with a significant increase in mean linear intercept and a decrease in internal surface area. Elastic fibers appeared short, irregular, and fewer in number in starved lungs. Scanning electron microscopy showed enlarged air spaces, thin, irregular, and effaced alveolar walls, and an increased number and size of interalveolar pores in the starved group. We concluded that starvation results in mechanical and morphologic changes in the lung similar to those seen in emphysema, and that starved lung may be a useful experimental model for the study of emphysema.

Dermatofibrosarcoma protuberans arising on the hand.

Dermatofibrosarcoma is a relatively common, locally aggressive, soft tissue fibrous histiocytoma. Ignorance of its marked propensity for locally invasive growth can lead to inadequate excision, and patients often suffer multiple recurrences. We present a case of dermatofibrosarcoma arising on the hand, and discuss its natural history and proper surgical therapy.

Proliferative disorders of the breast as risk factors for breast cancer in a self-selected screened population: pathologic markers.

A study was done to quantify the pathologic risk of subsequent breast cancer in women whose biopsies demonstrated proliferative histologic conditions. Out of a total of 10,530 patients, 1,408 had biopsies which were classified as either bland fibrocystic or hyperplastic. The behavior of the disease in these patients was compared to that of the general screened population. It was concluded that women whose biopsies reveal hyperplastic disorder, primarily atypical hyperplasia and fibroadenoma, run the greatest risk of getting cancer. For women with atypical hyperplasia, the risk is 13 times that of the general population, and for those with fibroadenoma it is three times greater.

Metastatic chondroblastoma: report of an unusual case treated with radiotherapy.

Although most chondroblastomas are cured by limited surgical procedures, occasional lesions behave more aggressively and may even metastasize. We report here an unusual case of chondroblastoma, characterized by slow growth, two clinical recurrences following attempts at excision, and pulmonary metastases after a total course of 34 years. This tumor was moderately radiosensitive, as it decreased 50% in size 6 months after a dose of 4000 rads in 4 weeks. Review of the literature suggests that aggressive chondroblastomas may show several types of behavior. Most lesions are unusually aggressive from their inception, displaying local invasion and early recurrence. Other lesions, such as the present case, continue to grow slowly and may eventually metastasize if inadequately resected. This latter type of behavior may exemplify the natural history of untreated chondroblastoma.

Malignant myoepithelioma of the parotid gland.

Myoepithelial cells are a significant component of most types of salivary gland neoplasms. A small but increasing number of case reports have also shown that pure myoepitheliomas form a distinct class of neoplasms with unique histological features. Previously reported cases have been either benign or, at most, locally aggressive. We present here a case of a malignant myoepithelioma of the parotid gland, confirmed by electron microscopy, that was locally aggressive and eventually metastasized. Review of this case and of existing reports indicates that myoepitheliomas exhibit a wide range of biological behavior that seems to correlate with their histological appearance.

Multiple myeloma. Orbital involvement in a youth.

Orbital involvement by multiple myeloma is rare and affects older individuals usually. The youngest reported patient in a recent series that cites a median age of 56 years is 30 years of age. The present case involves a 19-year-old pregnant black female subject who complained initially of diplopia and whose presenting sign was proptosis. An extensive medical work-up and electron microscopic study were necessary to establish the diagnosis.

Nodular fasciitis, a lesion of myofibroblasts: an ultrastructural study.

Eight histologically typical cases of nodular fasciitis were studied by electron microscopy and histochemistry. The findings confirm accepted views of the morphology of this lesion, and also reveal the previously undescribed fact that nodular fasciitis is a lesion of myofibroblasts. Its cells have the basic ultrastructural features of fibroblasts. In addition, all cells contain peripheral, longitudinally oriented bundles of myofilaments and hemidesmosome-like structures with associated basement membrane-like material. Many cells have deeply clefted nuclei, desmosomes, and pinocylotic vesicles. These specialized features are identical to thos of the myofibroblasts that have been described ifibroblasts have been found in inflammatory and trauma-related conditions and not in most studies of fibroblastic neoplasms. However, additional studies of proliferative and neoplastic fibroblastic lesions are needed to clarify the distribution and significance of myofibroblasts.

Small cell undifferentiated carcinoma of salivary gland origin: an ultrastructural study.

A case of small cell carcinoma of salivary gland was studied by light and electron microscopy. Light microscopy showed sheets of small uniform cells with scanty cytoplasm and pyknotic nuclei. Electron microscopy showed two distinct cell types; an electron-lucent epithelial-appearing cell, and a denser cell with processes containing bundles of filaments and other features suggesting myoepithelial differentiation. Neurosecretory granules were absent. These findings support a salivary duct origin, and are evidence against a neurendocrine derivation for this tumor.

Functional and ultrastructural status of platelets prepared by the Celltrifuge.

Function and morphology of platelets collected by the Celltrifuge were investigated. In vitro platelet tests included aggregation by adenosine diplhosphate, collagen, and epinephrine, ability to support clot retraction, uptake and release of labeles serotonin, and morphology at the ultrastructural level. Each of these tests was also performed on platelets obtained from the same donor before the collection procedure was instituted. Data obtained from pre- and post-Celltrifuge platelet samples were compared and analyzed on individual donor basis as wass as on eight donors as a group. The hemostatic effectiveness of Celltrifuge-collected platelets was evaluated by their ability to raise platelet counts and to shorten the template bleeding time in four thrombocytopenic recipients. Our results indicate that platelets prepared by this continuous flow centrifugation equipment retained their functional and ultrastructural integrity, and significantly raised the platelet counts and shortened the bleeding time of all four patients.

Altered in vitro functions of platelets prepared by the Haemonetics blood processor.

The function and ultrastructure of platelets collected by the Haemonetics blood processor were investigated. Aggregability, release ability, and morphology of these platelets were compared with platelets of the same donors before plateletpheresis was instiuted. Data of a group of 15 normal donors were pooled and analyzed. Our results showed that Haemonetics-isolated platelets had the following altered in vitro functions. Adenosine diphosphate-induced aggregation was markedly reduce, and epinephrine-induced aggregation was often absent. Collagen-induced aggregation was characterized by prolongation of the aggregation time and, sometimes, also by reduction of aggregation. Increase of adenosine diphosphate or collagen concentration resulted in improvement of aggregation of Haemonetics-collected platelets; increase of epinephrine concentration had no effect. Exogenous CaCL2, pre-Haemonetics platelet-rich or platelet-poor plasma failed to correct the abnormal aggregation of post-Haemonetics platelets. Release of labeled serotonin induced by spinephrine and collagen was reduced. However, the ultrastructure of post-Haemonetics platelets was normal.