Digital syndactylization for the treatment of interdigital squamous cell carcinoma in situ (Bowen disease).

Bowen disease, or squamous cell carcinoma in situ, has been described as a premalignant intraepidermal lesion of the skin. Although more frequently occurring on limbs, interdigital presentation of squamous cell carcinoma in situ in the foot has been rarely reported, likely because of undetected development. Excision has been recommended as the treatment of choice; however, removal of these lesions from intertriginous skin may present few options for skin closure. Interdigital syndactylization may be an acceptable option for the treatment of interdigital manifestations of Bowen disease. The authors present a case of interdigital squamous cell carcinoma in situ successfully treated with excision and digital syndactylization. At the 2-year follow-up, there was no recurrence and no digital deformities.

Fine-needle aspiration in PreservCyt: a novel and reproducible method for possible ancillary proteomic pattern expression of breast neoplasms by SELDI-TOF.

Proteomic profiles of tumor protein expression by the surface enhanced laser desorption-ionization time of flight (SELDI-TOF) methodology have been shown to have a potential usefulness for protein discovery as well as screening, diagnosis, prognosis and therapeutic considerations of cancer from several organ systems. Fine-needle aspiration (FNA) specimens from tumor samples is an accepted method to diagnose the cells of interest but often can be a limited assessment due to quantity of the sample. The current use of fresh or rapidly frozen specimens for proteomic profiling can be burdensome for clinicians to collect and submit specimens. The current study tests the hypothesis that placement of FNA and other cytological material in PreservCyt may be an acceptable method of sample handling for protein profiling evaluation by this method though it may not be suitable for true protein discovery or characterization. Excised fresh breast tissue for evaluation and/or treatment of a variety of breast lesions were sampled by FNA technique and placed into PreservCyt. These samples were then homogenized under denaturing conditions and evaluated by the SELDI-TOF methodology. Most samples collected showed a satisfactory quantity of protein for analysis by the SELDI-TOF methodology. Protein patterns from a variety of benign and malignant lesions revealed reproducible patterns on triplicate testing. Benign lesions had similar protein patterns across age groups in this limited series that may have potential diagnostic significance. In conclusion, FNA of breast tissue placed in PreservCyt is a potentially acceptable method of sample handling for evaluation by the SELDI-TOF methodology for establishment of reproducible protein patterns. Preliminary results from a spectrum of breast lesions suggest these patterns may have potential for ancillary testing for diagnostic consideration of breast lesions. This collection methodology could simplify sample gathering for further testing of all types of cytological specimens by the SELDI-TOF methodology. Larger studies will be needed to assess this methodology as a diagnostic aid.

Acute hepatic allograft rejection: a comparison of patients with and without centrilobular alterations during first rejection episode.

The histologic diagnosis of acute hepatic allograft rejection is usually based upon the identification of characteristic portal tract features. In addition to these, centrilobular alterations such as central vein endothelialitis, zone 3 inflammation, and hepatocyte necrosis may also be seen during episodes of acute rejection. The purpose of this study was to identify any differences in the subsequent clinical course of patients with and without centrilobular alterations during their first biopsy-proven episode of acute rejection. Acute rejection was diagnosed at least once in 35 liver recipients who had undergone allograft biopsy. Of these, 15 (43%) had centrilobular alterations in their first posttransplant biopsy. These 15 patients developed ductopenia (60% vs. 30%) and subsequent episodes of acute rejection (53% vs. 25%) more often than did the 20 patients who lacked centrilobular alterations in their first posttransplant biopsy. Time to first episode of acute rejection and rates of subsequent recurrent hepatitis and death were similar between the 2 groups. Patients with centrilobular alterations during a first episode of acute rejection are more likely to have subsequent episodes of acute rejection and to develop features of chronic rejection than are patients without these changes. These patients may benefit from more vigilant clinical follow-up and/or higher levels of immunosuppression.

Histologic changes resembling acute rejection in a liver transplant patient treated with terbinafine.

We present a case of histologic changes resembling acute cellular rejection in a liver transplant patient treated with terbinafine. Approximately 5 years after orthotopic liver transplantation, a 51-year-old Hispanic man developed elevated liver enzyme levels. A biopsy sample was interpreted as acute cellular rejection, and the patient was treated with increased immunosuppression. Review of medications showed that the patient had been started on terbinafine approximately 4 weeks earlier for onychomycosis, and it was discontinued. A follow-up visit 2 weeks later revealed progressive jaundice, malaise, and nausea, and evaluation of a second liver biopsy sample revealed marked centrilobular cholestasis and severe bile duct damage, consistent with terbinafine hepatotoxicity. Although these histologic changes have been described in treated patients with both normal and abnormal livers, the potential for confusion with acute rejection in patients with hepatic transplantation has not previously been reported.

Unique collision of hodgkin lymphoma and adenosquamous carcinoma in the uterine cervix: synchronous malignant neoplasms of the cervix.

To document the first reported synchronous occurrence of Hodgkin lymphoma and adenosquamous carcinoma involving the female genital tract. Review of cytologic, histologic, and immunohistochemical studies obtained from a 50-year-old, multiparous, postmenopausal, Hispanic female who had a left inguinal mass, bilateral lower extremity pain and numbness, fatigue, anorexia, a 20- to 30-pound weight loss, and a malodorous vaginal discharge at presentation is presented. Cervical squamous cell carcinoma was diagnosed by routine cytologic and histologic analysis. Hodgkin lymphoma subsequently was diagnosed in the inguinal lymph nodes by fine-needle aspiration biopsy and excisional biopsy before the patient underwent hysterectomy. In addition to invasive and in situ adenosquamous carcinoma of the uterine cervix, the hysterectomy specimen also contained previously unsuspected Hodgkin lymphoma. To our knowledge, this is the first reported case of adenosquamous carcinoma and Hodgkin lymphoma synchronously involving the female reproductive tract.