Granular-cell tumor of trachea masquerading as Hurthle-cell neoplasm on fine-needle aspirate: a case report.

We report on a case of extraluminal tracheal granular-cell tumor which was interpreted as a Hurthle-cell neoplasm of the thyroid on fine-needle aspirate. Review of the literature reveals only one other such case. The patient was a 35-yr-old female who presented with an enlarged thyroid. Aspiration cytology revealed a syncytium of cells with abundant granular cytoplasm interpreted as a thyroid follicular neoplasm with Hurthle-cell change. However, histology of the resection specimen with immunohistochemistry confirmed it as a granular-cell tumor. The cytologic differential diagnosis of neoplasms with oncocytoid cytoplasm in and around the thyroid should include granular-cell tumor of the trachea.

Intraoperative determination of intestinal viability by pulse oximetry.

The utility of transserosal photoplethysmographic pulse oximetry (PO) to assess intestinal viability intraoperatively was evaluated using an experimental canine model. Comparisons of PO were made with continuous-wave Doppler ultrasound (CWDU) and fluorescein (FL) using histopathologic examination for control. Clinical examination estimates were included for reference. Four 20 cm portions of small bowel from each of four dogs were made ischemic by mesenteric ligation. Thus 320 individual 1 cm bowel segments were studied by means of PO, CWDU, FL, and control histologic grading for ischemia. Statistical analysis revealed no significant differences, with PO matching CWDU and FL in intraoperative assessment of small bowel viability. PO, which is readily available in most operating rooms, is a simpler method than CWDU or FL for assessing intestinal viability. This technique is operator independent, easy to interpret and repeat, and is well tolerated. PO is the preferred alternative for objective intraoperative assessment of intestinal viability.

Sinonasal Schneiderian papillomas: human papillomavirus typing by polymerase chain reaction.

A series of 35 formalin-fixed, paraffin-embedded Schneiderian papillomas (24 inverted, nine cylindrical cell type, and two fungiform) of the nasal cavity were evaluated for the presence of human papillomavirus (HPV) types 6b/11, 16, and 18 DNA sequences using both a highly sensitive and specific modification of the polymerase chain reaction technique and conventional in situ hybridization. The HPV gene sequences (E6-E7 portions) were not detected in any of the 24 inverted or nine cylindrical cell papillomas. One of the fungiform papillomas was positive for HPV 6b/11. We conclude: (a) the origin of most Schneiderian sinonasal papillomas is not associated with HPV infection of these common types, and (b) fungiform papilloma is a distinctive clinicopathologic subtype of Schneiderian papilloma that may be HPV-related.

Pulmonary reaction to intravenously injected polymer beads.

The purpose of this study was to characterize the foreign body reaction in the mouse lung following embolization of intravenously injected divinylbenzene copolymer beads. In contrast to usual surgical implantation, this model dissociates the local foreign body reaction to the beads (in the lung) from inflammation and repair of tissue injury associated with implantation (peripheral site of injection). Quantitative determinations of pulmonary granuloma area using light microscopic morphometric measurements on tissue sections confirmed that the intensity of pulmonary inflammatory reaction increased rapidly to a maximum at 48 h following injection, with a volume exceeding 10 times that of the bead; at this time, the cellular exudate was 90% polymorphonuclear leukocytes. Thereafter, the inflammatory reaction decreased in intensity, and individual lesions became progressively richer in mononuclear cells (60% at 4 days and greater thereafter). Determination of intra- and interobserver variability indicated that maximal data precision was attained by measurement of the cross-sectional areas of as few as 10 granulomas in each of five animals for each set of specific experimental conditions. Collagen was undetectable in granulomas at 7 weeks and 6 months, suggesting that the usual fibrous capsule forming in response to surgically implanted biomaterials is largely caused by repair of surgical trauma. The volume of inflammatory exudate at 48 h was reduced 68-86% by the nonsteroidal antiinflammatory agents indomethacin, aspirin, and ibuprofen and the antiinflammatory steroid methylprednisolone. Thus, the pulmonary bead granuloma model is a quantitative, reliable, and economical approach to investigating some aspects of biomaterial/time interactions in the absence of super-imposed surgical trauma.