Esophageal squamous papillomatosis with dysplasia. Is there a role of balloon-based radiofrequency ablation therapy?

Esophageal squamous papillomatosis (ESP) is a rare condition, occurring in an estimated 0.01-0.097% in data from upper gastrointestinal endoscopies and autopsy series. Chronic mucosal irritation and infection with human papilloma virus (HPV) are proposed etiologies. Heavy use of tobacco and alcohol are common associations. The premalignant potential of ESP has long been debated in literature. The clinical course is variable, ranging from spontaneous regression to the development of squamous cell carcinoma. Due to the paucity of reported cases, no generalized therapeutic or surveillance recommendations exist. Photodynamic therapy (PDT) has been successfully used to treat Barrett's esophagus as well as superficial adenocarcinoma. However, its safety and efficacy in treating ESP with dysplasia is lacking. Balloon-based radiofrequency ablation using the HALO90 Ablation System is designed to remove the diseased cells using controlled heat. In recent clinical trials, it has shown great promise in treating Barrett's esophagus with high-grade dysplasia. We report the first ever use of balloon-based radiofrequency ablation to treat ESP with dysplasia. Clinical symptoms resolved after the first therapy session, however, ablation therapy was terminated early because squamous cell carcinoma in-situ was detected on surveillance endoscopy prior to the fourth therapy session. Although we failed to treat type 4 ESP with high-grade dysplasia with balloon-based radiofrequency ablation therapy, we believe that it might play a role in treating other localized types of ESP.

Stromal eosinophilia in colonic epithelial neoplasms.

OBJECTIVE: The purpose of this retrospective study was to determine the frequency and intensity of eosinophilic infiltration (or tissue eosinophilia) in the stroma of colonic adenomas, hyperplastic polyps, and colorectal adenocarcinomas. Eosinophilic infiltration in various malignancies has been reported but has not been evaluated in benign colorectal adenomas and hyperplastic polyps. METHODS: We analyzed 488 colonic neoplasms: 176 tubular adenomas, 55 tubulovillous adenomas, 82 villous adenomas, 15 early carcinomas in polyps, 95 invasive adenocarcinomas, and 65 hyperplastic polyps for the presence of eosinophilic infiltration. The eosinophilic infiltration was graded as negative (< or =5%), mild to moderate (>5-40%), or marked (>40%), depending on the percentage of eosinophils relative to total inflammatory cells in the stroma. RESULTS: Mild to moderate eosinophilia was noted in 75% of all adenomas. The transitional zone in all cases of invasive adenocarcinoma (zone between normal tissue and adenocarcinoma) revealed a high percentage of tissue eosinophilia. There was a striking absence of TE in the stroma of invasive adenocarcinomas. Only 5% of hyperplastic polyps had any eosinophilic infiltration. CONCLUSIONS: These data suggest that, in the spectrum of colonic neoplasms, stromal eosinophilia is most prominent in adenomas and seems to decrease with progression through the adenoma-carcinoma sequence. The ramifications of this study may alter management plans and provide some prognostic information for clinical evaluation.

Improved technique for performing endoscopic ultrasound guided fine needle aspiration of lymph nodes.

BACKGROUND AND STUDY AIMS: Trans-esophageal real-time endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has emerged as an important technique for sampling perigastrointestinal lymph nodes. The purpose of this study was to compare the yield of EUS-guided FNA of mediastinal lymph nodes using different techniques. MATERIALS AND METHODS: A 2 cm mediastinal lymph node was dissected at autopsy. FNA was performed on this lymph node with a 21 gauge needle which is used clinically for EUS-guided FNA (GIP-Mediglobe). FNA of the lymph node was performed for 60 sec, while continuous or intermittent suction was applied with a 10 ml, 20 ml and 30 ml syringe. The pathologist was blinded to the technique used for FNA of the lymph node. The slides were examined and the results recorded independently by two pathologists who were blinded to each other's findings. A similar procedure was repeated in a 2 cm lymph node removed during another autopsy. RESULTS: Pathologic examination revealed metastatic transitional cell bladder carcinoma in the first lymph node, and metastatic non-small cell lung carcinoma in the second lymph node. The cellularity and quality of FNA performed with the 10 ml syringe was better than with the 20 ml or 30 ml syringe. With the 10 ml syringe, continuous suction for one minute provided a better sample than intermittent suction. FNA with a 20 ml or 30 ml syringe was more cumbersome, as it required more physical force. CONCLUSIONS: Our study reveals that continuous rather than intermittent suction with smaller syringes (5-10 ml) provides optimal cellularity in EUS-guided FNA of mediastinal lymph nodes and that use of larger (20-30 ml) syringes does not improve the rate of obtaining a diagnostic specimen.

Hepatobiliary dysfunction as the initial manifestation of disseminated cryptococcosis.

A case of hepatobiliary dysfunction as the initial manifestation of disseminated cryptococcosis is described. The patient was admitted with symptoms of hepatitis with cholestatic jaundice. Antibody tests for hepatitis B and C and human immunodeficiency virus were negative. The patient continued to deteriorate clinically. Eventually, the patient succumbed to hepatic failure. Autopsy disclosed systemic cryptococcosis that caused extensive necrosis of the liver. In review of the literature, only nine cases of cryptococcal infection presenting as hepatitis, cholangitis, and cholecystitis as initial manifestation were reported. Four of these patients had been subjected to exploratory laparotomy for clinical suspicion of acute abdomen. One patient developed cirrhosis as a result of cryptococcal hepatitis. Two patients succumbed to hepatic failure. Cryptococcosis is known to occur commonly in immunocompromised patients, yet only two reported cases presenting as hepatitis were associated with immunocompromised status.

Rapid method for permanent slide preparation of colonies in soft agar cultures.

A method is presented for preparing permanent microscopic slides from colony-bearing agar layers in soft agar cultures. The main advantages of this technique are its simplicity, rapidity and accurate colony preservation. This method could have broad applications in the human tumor clonogenic assay (HTCA), particularly in the quantitative morphological, cytochemical and immunocytochemical assessment of colonies that form in both control and drug-treated cultures. Thus, this method opens up possibilities for using cytopathological criteria as a quantitative endpoint of the HTCA.

Relationship between histopathology and in vitro clonogenicity in breast cancer.

The human tumor clonogenic assay was used to culture 268 primary and metastatic breast cancer samples. Cultures of 181 specimens were prepared in the double-layer agar system and 87 in a modified system utilizing a liquid upper layer. Successful growth (greater than 5 colonies) was 53% for the agar 2-layer method and 68% for the modified system. Three morphologically distinct colony types were observed: Type I--small, dark, compact colonies; Type II--clear colonies; and Type III--mixed colonies of Types I and II. In 73 cases the histologic slides of the original tumor specimens were reviewed, and the histopathological findings correlated with the clonogenicity of the specimens. There was a significant positive relationship between the degree of differentiation and focal microscopic tumor necrosis in the original specimen and its subsequent clonogenicity. However, other histologic parameters did not show any relationship with clonogenicity.