Squamous cell carcinoma detected by high-molecular-weight cytokeratin immunostaining mimicking atypical fibroxanthoma.

Atypical fibroxanthoma can mimic other tumors, particularly spindle cell squamous cell carcinoma and spindle cell or desmoplastic melanoma. We describe a patient with chronic lymphocytic leukemia who developed acantholytic squamous cell carcinoma on the face, which recurred and metastasized to a cervical lymph node. This tumor was at first diagnosed as atypical fibroxanthoma because of its histologic and immunostaining similarity. It showed weak or negative keratin cocktail staining and strong vimentin staining. However, a recurrent tumor was immunostained for high-molecular-weight keratin and showed strong positivity. Aggressive behavior of this squamous cell carcinoma may be due to altered immune response secondary to chronic lymphocytic leukemia.

Xanthogranulomatous salpingitis and oophoritis: a case report and review of the literature.

A case of xanthogranulomatous salpingitis and oophoritis in a 47-year-old woman is presented. Xanthogranulomatous inflammation is an uncommon form of chronic inflammation that is destructive to affected organs; it is characterized by the presence of lipid-filled macrophages with admixed lymphocytes, plasma cells, and neutrophils. Only a few cases of xanthogranulomatous salpingitis and oophoritis have been reported to date. The case presented here is associated with Escherichia coli infection, endometriosis, and an intrauterine device.

It takes two transposons to tango: transposable-element-mediated chromosomal rearrangements.

Transposable elements (TEs) promote various chromosomal rearrangements more efficiently, and often more specifically, than other cellular processes(1-3). One explanation of such events is homologous recombination between multiple copies of a TE present in a genome. Although this does occur, strong evidence from a number of TE systems in bacteria, plants and animals suggests that another mechanism - alternative transposition - induces a large proportion of TE-associated chromosomal rearrangements. This paper reviews evidence for alternative transposition from a number of unrelated but structurally similar TEs. The similarities between alternative transposition and V(D)J recombination are also discussed, as is the use of alternative transposition as a genetic tool.

A multimodal approach in the diagnosis of patients with hematopoietic disorders.

Myelodysplastic syndromes (MDS) are a group of relatively ill-defined hematopoietic disorders in which both qualitative and quantitative defects of the hematopoietic cells cause bone marrow dysfunction. With an incidence estimated to be approximately 1 per 100,000 persons per year, MDS mainly affects the elderly. Myelodysplastic syndromes share many features with acute nonlymphocytic leukemia; in fact, a proportion of patients with MDS eventually develop acute myeloid leukemia. To illustrate a multimodal approach in the diagnosis of patients with hematopoietic disorders, we describe a 66-year-old patient with a question of myelodysplastic syndrome, leukemia, and two translocations involving chromosome 10:t(5;10) and t(7;10). These structural rearrangements effectively gave rise to monosomy for part of the long arm of chromosome 5 and for the long arm of chromosome 7. Findings of del(5q) and del(7) in MDS have been reported in the literature. The results of chromosome morphometry, which was conducted to compare the lengths of all relevant chromosome segments, are consistent with the hypothesized chromosomal abnormalities. The investigational technique of fluorescence in situ hybridization (FISH), using both painting and alpha-satellite probes, was used as an adjunct to conventional cytogenetics to further delineate the nature of the chromosome abnormalities observed in the GTG-banded studies. Confirmatory studies utilizing the new technique of spectral karyotyping (SKY) were also carried out. Thus, the multimodal approach of hematopathology, GTG-banding, chromosome morphometry, FISH, and SKY can be very useful for delineating complex cytogenetic cases.

Trisomy 9 in a patient with secondary acute myelogenous leukemia detected by fluorescent in situ hybridization.

Fluorescent in situ hybridization (FISH) is a molecular cytogenetic technique that is playing an increasingly important role for augmenting the findings of conventional cytogenetics. Here we present the case history of a patient with the clinical diagnosis of secondary acute myelogenous leukemia whose bone marrow cells were found to be hyperdiploid with an extra C group chromosome in a less than optimal preparation. By using FISH the extra chromosome was unequivocally determined to be a chromosome 9. The detection of trisomy 9 in this patient underscores the utility of FISH as an adjunct to GTG banding in the routine diagnosis and management of leukemic patients.

Structure and associated mutational effects of the cysteine proteinase (CP1) gene of Drosophila melanogaster.

The complete structure of the cysteine proteinase (CP1) gene reveals two large 5' introns as well as a small third intron. Deletion studies have shown that null mutations for the locus are female sterile with partial male sterility as well as wing and pigmentation effects. Null alleles can be produced by either deletions to the left or deletions to the right of a P element insertion in the long second intron of the gene. A nearby phenylalanyl tRNA synthetase gene (Pts) was also identified.

The accumulation of P-element-induced recombinants in the germline of male Drosophila melanogaster.

P-element-induced recombination in Drosophila melanogaster occurs premeiotically. Recombinants are therefore expected to accumulate in the stem cells of the germline of P-element-carrying males. We show that both the recombination frequency and the incidence of "clustering" increase with the age of males carrying various P-element derivatives. The combination of end-deleted elements can lead to average recombination frequencies >50% with individual instances of 100% recombination. These elements also lowered the fertility of the carriers. We investigated these features by constructing an analytical and a computer simulation model of the course of events in the germline, incorporating the recently proposed hybrid element insertion (HEI) model of P-element activity. The model is able to predict extreme recombination levels, segregation ratio biases and lowered fertility through cell death in a single analysis.

Client satisfaction: traditional care versus cluster care.

The purposes of this study were to describe and compare the level of satisfaction of clients receiving traditional care and those receiving cluster care. None of the studies reviewed described client satisfaction in the traditional and cluster care service delivery models using a reliable and valid instrument. The study sample consisted of 77 Medicaid-eligible elderly clients from three different home care agencies in an urban city. Of the 77 subjects, 37 (48 per cent) received cluster care, and 40 (52 percent) received traditional care. After receiving approval from the home health care agencies, subjects who agreed to participate in the study were asked to sign a consent form and to complete a demographic data sheet and the Gray's Home Care Satisfaction Scale (GHCSS). Internal consistency reliability for the GHCSS is 0.78, with content validity present. An independent student's t test showed a statistically significant difference in the level of satisfaction of clients receiving traditional care and cluster care (t = -5.27, P = .0005). Clients receiving traditional care had higher levels of satisfaction than clients receiving cluster care. Additional findings showed that men in both the traditional and cluster care groups were more satisfied than women (t = -3.19, P = .003 and t = -2.96, P = .007, respectively). Analysis of variance showed that blacks in both the traditional and cluster care groups had lower levels of satisfaction than either whites or Hispanics. Implications of study findings are discussed.

Stage I and stage II infiltrating ductal carcinoma of the breast analyzed for chromosome 8 copy number using fluorescent in situ hybridization.

We previously reported the results of 30 informative samples (from a total of 34 specimens gathered) of archival breast cancer tissue, including infiltrating ductal carcinoma (NOS), ductal carcinoma in situ, lobular carcinoma, papillary carcinoma and benign lesions of the breast. The study was conducted using fluorescent in situ hybridization (FISH) and a chromosome 8 alpha-satellite probe. Subsequently, a total of 34 cases of infiltrating ductal carcinoma of the breast (NOS, 17 cases stage I and 17 cases stage II) were studied, again using interphase cytogenetics. The aim of the present study is to confirm and extend the results of our initial study of stage I and stage II disease. Towards this end, 36 additional specimens of formalin-fixed paraffin-embedded breast cancer tissue have been analyzed cytogenetically under blinded conditions for the frequency of abnormal chromosome 8 copy numbers using FISH and the previously described protocol optimized for our laboratory. Of these, 18 were stage I and 18 were stage II. The frequency of trisomy 8 among stage I tumors was found to be 28% (5 out of 18). The frequency of trisomy 8 among stage II tumors was found to be 61% (11 out of 18). These results, while less striking, are consistent with those reported in our initial study of stage I and stage II disease, where the frequencies of trisomy 8 among stage I and stage II tumors were 24% (4 out of 17) and 82% (14 out of 17). These results not only establish that chromosome 8 trisomy is a recurrent finding in breast cancer, but also confirm that a higher frequency of trisomy 8 was observed with a higher clinical stage (stage II) than with a lower stage (stage I). It will be of interest to extend the findings in stage I and stage II breast cancer to other stages as well.

Translocation 2;19 in a patient with probable relapsed acute myeloid leukemia.

We report the cytogenetic and hematopathologic results from a patient diagnosed with acute myeloid leukemia. Although the initial specimen revealed an apparently normal male karyotype, a translocation, t(2;19)(q21;p13), was detected in the second specimen. It is not clear whether this was a primary or secondary and possibly chemotherapy-induced abnormality. In an extensive search of the recent medical literature database (Medline, 1966 to the present; CancerLit, 1983 to the present, MDX Health Digest, 1988 to the present; HealthSTAR, 1975 to the present, and CINAHL, 1982 to the present), we found no previous report of this specific translocation. This case is of interest not only because of its cytogenetic rarity and its unique clinical features, but also because of the fact that this patient worked in construction management, performing offshore drilling in oil fields for several years, and also worked with plastics and polymer film for about 4 years, although this past history of possible genotoxic exposure may or may not be of relevance. In addition, it is also of interest that one of the translocation breakpoints, 19p13, is apparently identical to that found in the 1;19 translocation associated with pre-B cell acute lymphocytic leukemia.

P-element-induced recombination in Drosophila melanogaster: hybrid element insertion.

It has previously been shown that the combination of two deleted P elements in trans, one containing the left functional end and the second element the right functional end, can lead to high levels of male recombination. This finding strongly suggests that P-element ends from different chromosomes can become associated, followed by "pseudo-excision". We show that two different processes are involved in resolving the pseudo-excision event: (1) the excised P-element ends continue to function as a single unit (Hybrid Element) and insert at a nearby site in the chromosome or into the element itself [Hybrid Element Insertion (HEI)] and (2) free ends that do not contain P elements repair and rejoin [(Hybrid Excision and Repair (HER)]. Both types of resolution can lead to recombination, and this paper concentrates on the HEI class. One type of HEI event predicts the exact reverse complementary duplication of an 8-bp target site, and we have confirmed the existence of such a structure in six independently derived recombinant chromosomes. There is also a high tendency for insertion events to occur within a few bases of the original 8-bp target site, including six apparent cases of insertion into the exact site.

Cluster care: an alternative to traditional care.

Studies of client satisfaction of the Traditional and Cluster Care service delivery models are virtually nonexistent. In an effort to provide healthcare services to Medicaid-eligible elderly home care clients, the New York City Human Resources Administration has implemented a new concept, Cluster Care. Because Cluster Care is probably going to be the wave of the 21st century, nurses need to be creative so that this new model will be more palatable to its recipients.