Is the routine microscopic examination of proximal and distal resection margins in colorectal cancer surgery justified?

Microscopic examination of the proximal and distal resection margins is part of the routine pathologic evaluation of colorectal surgical specimens removed for adenocarcinoma. Anastomotic donuts are frequently received and microscopically examined. We examined 594 specimens received over a period of 10 years and found only 3 cases of definitive direct involvement of a longitudinal margin by carcinoma. All 3 cases also showed tumor at the margin grossly. One case of margin involvement by adenocarcinoma was found in which the tumor was grossly 1.7 cm away; however, this finding was likely a tumor deposit, as the patient had diffuse metastatic disease. All 242 anastomotic donuts examined were free of carcinoma. Our study suggests that the proximal and distal margins of colorectal cancer specimens need not be examined microscopically in order to accurately assess margin status in cases where the tumor is at least 2 cm away from the margin of resection. Also, in cases in which anastomotic donuts are included with the case, these should be considered the true margins of resection and may be microscopically examined in place of the bowel specimen margins when margin examination is needed. Anastomotic donuts need not be examined if the tumor is more than 2 cm away from the margin. An exception to this rule would be cases of rectal adenocarcinoma where neoadjuvant therapy is given prior to surgery. In these cases, mucosal evidence of malignancy may be absent and microscopic examination of the margins is the only way to assure complete excision.

Cutaneous drug eruptions: a 5-year experience.

BACKGROUND: The diversity of cutaneous drug eruptions encompasses many clinicopathologic entities. METHODS: Cases with a pathologic diagnosis of drug eruption from 2000 to 2005 were retrieved from our institution. The histologic slides were reviewed, the patterns of inflammatory changes were recorded, and a chart review was performed. RESULTS: The majority of the cases (94%) were "morbilliform"-type rashes. Eighty-two percent of cases exhibited an inflammatory infiltrate confined to the superficial dermis. Eighty percent exhibited a perivascular and interstitial pattern of dermal infiltrate. The infiltrate was composed of lymphocytes and eosinophils in approximately 29% of cases, lymphocytes and neutrophils in approximately 10% of cases, and lymphocytes, eosinophils, and neutrophils in approximately 21% of cases. Eosinophils were present in only 50% of cases. Approximately half (53%) of the cases exhibited epidermal-dermal interface changes. LIMITATIONS: The cases were limited to those with a pathologic diagnosis of cutaneous drug reaction, thereby excluding any cases with drug-induced disease not specifically diagnosed (histologically) as such. CONCLUSIONS: While the histologic features of most drug eruptions are not entirely specific, the finding of superficial infiltrates composed variably of lymphocytes, neutrophils, and eosinophils, either with or without interface changes, should suggest the possibility of a morbilliform drug eruption. Clinical correlation is very helpful to confirm the diagnosis. To our knowledge, this study is the most extensive documenting the histologic findings in morbilliform drug eruptions.

An immunohistochemical evaluation of c-kit (CD-117) expression in malignant melanoma, and results of imatinib mesylate (Gleevec) therapy in three patients.

In order to determine whether imatinib mesylate (Gleevec), a tyrosine kinase inhibitor that binds the CD-117 (c-kit) receptor, may be of value in the treatment of malignant melanoma, an immunohistochemical analysis of 40 cases of primary and metastatic melanoma was undertaken. Thirty-five of the 40 cases showed 1+ or stronger labelling for CD-117 (up to a maximum of 4+). Three patients with neoplasms showing 4+ staining were selected for imatinib therapy. None responded. c-kit (CD-117) expression in melanoma appears to be common; however, the value of imatinib therapy remains to be proven.

Kaposiform hemangioendothelioma associated with nonimmune fetal hydrops.

We describe the case of a 31-week fetus who died in utero with an invasive retroperitoneal kaposiform hemangioendothelioma. This rare vascular neoplasm usually presents as a localized violaceous skin lesion in infants and behaves in a benign fashion; however, kaposiform hemangioendothelioma may present as an invasive neoplasm of the chest or abdominal cavity, where it can lead to the Kasabach-Merritt syndrome, which consists of thrombocytopenia, consumptive coagulopathy, and microangiopathic anemia in association with a vascular anomaly. The case we describe is unique in that the tumor presented in utero and led to intrauterine nonimmune fetal hydrops. Kaposiform hemangioendothelioma has been described in utero; however, to our knowledge, intrauterine fetal death as a direct consequence has not been reported previously in the literature.