Correlates of placental infection with cytomegalovirus, parvovirus B19 or human herpes virus 7.

Vertical transmission of viruses is an important cause of morbidity in the fetus and neonate. Placental viral infection indicates risk of vertical transmission, but not always transmission to, or disease of the fetus. Specimens from mothers and babies from three groups-two prospective and one retrospective cohort-were tested for pathogens of teratogenic potential using multiplex PCR. Placental infection was present in 13% of the 105 samples collected. Assessment of the prospective cohorts showed cytomegalovirus (CMV) detected in 4% of placentae from unselected women, parvovirus B19 in 1% and Ureaplasma parvum in 1% of placentae. In a retrospective cohort of women at high risk of transmitting congenital infection due to seroconversion during pregnancy, miscarriage or stillbirth, CMV was detected in 64% and human herpes virus type 7 in 9% of placentae. Of 14 PCR-positive placentae, two were associated with the birth of a living symptomatic infant, two with stillbirth, one with miscarriage, and two with elective terminations of pregnancy. Directed laboratory assessment of women at high risk of transmitting congenital infection, on the basis of clinical or laboratory markers, is important for accurate diagnosis of adverse outcomes of pregnancy. However, routine screening for viruses in the placentae from women with a low-risk serological profile for transmitting congenital infection is unlikely to result in significant numbers of additional diagnoses and is confounded by inadequacy of current diagnostic methods. The major pathogen detected in all cases of placental infection associated with fetal death was human CMV.

Malignant perivascular epithelioid cell tumor (PEComa) arising in the broad ligament.

Malignant perivascular epithelioid cell tumor (PEComa) is an extremely rare mesenchymal neoplasm mostly composed of HMB-45-positive epithelioid cells with clear-to-eosinophilic cytoplasm, a propensity for perivascular distribution and a coexpression of smooth muscle markers. The uterus seems to be one of the most prevalent sites of involvement, although only 14 cases of uterine PEComa have been described. We report the case of a 51-year-old woman with a PEComa arising in the broad ligament. She was treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic radiation, and remains without evidence of disease 15 months after diagnosis. This is, to the best of our knowledge, the first report of a malignant PEComa arising in the broad ligament. To correctly diagnose PEComa, an extensive immunohistochemical panel is essential. As PEComas can behave in an aggressive manner, careful follow-up is warranted.

An audit of breast cancer pathology reporting in Australia in 1995.

To measure the quality of pathology reporting of breast cancer and establish a baseline against which future changes can be measured, we audited item completeness in breast cancer reports in Australia in 1995 before the release of specific recommendations from the Australian Cancer Network. Tumour type and size were given in reports of invasive breast cancer for 93% of women, 70% had, in addition, grade and clearance of the margins while only 28% had all recommended information. The most complete items in reports were histological type of breast cancer (99.6% of cases), tumour size (94%, 95% confidence interval (CI) 92-95) and margins of excision (87%, 95% CI 85-89). Histological grade (84%, 95% CI 82-86 of cases) and presence or absence of ductal carcinoma in situ (DCIS) (79%, 95% CI 77-81) were less complete and vessel invasion (61%, 95% CI 58-63) and changes in non-neoplastic breast tissue adjacent to the breast cancer (68%, 95% CI 66-71) the least complete. Less than half the reports of DCIS reported on tumour size (49%, 95% CI 42-57), presence or absence of necrosis (41%, 95% CI 34-49) or nuclear grade (39%, 95% CI 31-46). Around 1500 reports were identified as issued by 147 laboratories and 392 pathologists; 69% of pathologists issued fewer than two reports a month in the audit. We concluded that infrequency of reporting may have contributed to incompleteness of reporting. In addition, we found significant variation across Australian states with some indication that reporting was consistently poor in one state. The audit highlighted areas for improvement for breast cancer reporting in Australia. Research evidence suggests that multifaceted strategies are needed to assist practitioners with implementing more uniform reporting standards.

A fatality due to moclobemide.

A fatality due to ingestion of the antidepressant drug moclobemide is reported. Moclobemide is a selective and reversible inhibitor of monoamine oxidase type A. Previous reports have suggested that it is a safe drug even when taken in large quantities. The few reported fatalities have all been ascribed to serotonin syndrome, due to an interaction between moclobemide and other serotonergic agents. A 48-year-old woman with a history of depression and suicide attempts was found deceased at home. Autopsy revealed no evidence of significant natural disease or injury. Toxicologic analysis was performed and drug levels measured by capillary gas chromatography. The blood concentration of moclobemide was 137 mg/L and the liver concentration was 432 mg/kg. Low levels of diazepam, nordiazepam, and trifluoperazine were also detected. Death was considered to be due to acute poisoning by moclobemide. This case report is the first, to our knowledge, where death has been attributed to the toxic effects of moclobemide alone.

Is there a role for fine-needle aspiration in radial scar/complex sclerosing lesions of the breast?

The fine-needle aspiration cytology (FNA) from 12 mammographically detected, histologically confirmed radial scar/complex sclerosing lesions (RS/CSL) and their corresponding mammography were reviewed. Six aspirates were obtained by palpation, four by ultrasound guidance, and two by stereotactic guidance. Of the eight lesions with sufficient material five (62.5%) were reported as benign, two (25%) as atypical, and one (12.5%) as suspicious. It is proposed that FNA for RS/CSL should not be performed, and lesions require excision for histologic assessment.

Microadenomas of the human pituitary.

Four hundred and thirty-four pituitary glands from an unselected autopsy series were examined to investigate the incidence and immunohistochemical nature of occult pituitary microadenomas. Fourteen tumors (3.2%) were identified. The ages of the affected patients varied from 11 to 86 yrs, with no age predominance. Males and females were similarly affected. Nine of the microadenomas were available for immunoperoxidase staining. Adrenocorticotropic hormone, follicle stimulating hormone, growth hormone, luteinizing hormone, prolactin and thyroid stimulating hormone were examined. Four of the adenomas were reactive for prolactin; one was reactive for growth hormone, with scattered positivity for adrenocorticotropic hormone, follicle stimulating hormone, luteinizing hormone and thyroid stimulating hormone; 4 were nonreactive.