Investigation of an outbreak of bloody diarrhea: association with endoscopic cleaning solution and demonstration of lesions in an animal model.

UNLABELLED: OUTBREAK INVESTIGATION: An outbreak of diarrhea, bloody diarrhea, and abdominal cramps occurred among persons undergoing flexible sigmoidoscopy at a branch clinic of a local health center. Illness was associated with use of sigmoidoscopes cleaned by one clinic assistant and appeared to be caused by 2% glutaraldehyde disinfectant solution left in the instruments after cleaning. ANIMAL STUDIES: In subsequent animal studies, colonic instillation of 2% glutaraldehyde solutions caused bloody diarrhea and a distinctive pattern of mucosal damage; similar changes were seen in a review of pathologic samples from other human cases of glutaraldehyde disinfectant-associated diarrhea. CONCLUSION: Our data indicate that improper endoscopic reprocessing can result in serious illness and underscore the importance of adequate training and quality control in this area.

Composite glandular-carcinoid tumors of the colon and rectum. Report of two cases.

Composite glandular-carcinoid tumors of the large bowel are rare. We describe two cases that appeared to be at a relatively early stage in their development. Each of these cases was a composite colorectal adenoma-carcinoid--an entity that has not previously been described. There was no evidence of inflammatory bowel disease (IBD) in either of these cases; and a review of the literature on composite adenocarcinoma-carcinoid neoplasms of the colon and rectum revealed only two cases that arose in a background of IBD. Thus, despite the association of IBD, especially long-standing ulcerative colitis, with epithelial dysplasia and mucosal endocrine cell hyperplasia, respectively, we believe that other factors more significant than IBD may be operative in the genesis of composite glandular-carcinoid tumors of the large bowel. Further documentation of these tumors is needed in order to better appreciate their clinicopathologic manifestations and associations.

Pathological features and mucin histochemistry of primary gastric stump carcinoma associated with gastritis cystica polyposa. A study of six cases.

Six unusual cases of primary gastric stump carcinoma associated with gastritis cystica polyposa and arising in old gastrojejunostomy stomas are presented. The clinical data, the gross and microscopic pathological features, and the histochemical mucin profile of these two lesions are described in detail. A review is undertaken of the most relevant and previously published reports concerning, separately, either primary gastric stump carcinoma or gastritis cystica polyposa. The findings available in these reports are compared with those observed in our six cases. Some aspects of gastritis cystica polyposa are not unlike those seen in the solitary ulcer syndrome of the rectum and Ménétrier's disease. The histological type and mucin profile of primary gastric stump carcinoma parallel those recorded in gastric cancer arising in the unoperated stomach. However, the role of intestinal metaplasia and its histochemical typing appear somewhat different in primary gastric stump carcinoma.

An immunohistochemical study of pleomorphic adenomas of the salivary gland: glial fibrillary acidic protein-like immunoreactivity identifies a major myoepithelial component.

An immunohistochemical study of 34 pleomorphic adenomas of the major salivary glands demonstrated phenotypic differences among the various morphologic regions in these tumors. The phenotypes expressed were comparable to those of normal salivary gland cells. In the normal glands, myoepithelial cells were immunoreactive for glial fibrillary acidic protein (GFAP), S-100 protein, and keratin; acinic cells exhibited strong, predominantly nuclear S-100 staining and weaker keratin staining; intercalated ducts had both cytoplasmic and nuclear S-100 positivity; and several epithelial antigens were observed throughout the ductal system. In the tumors, the presence of classic epithelial markers (including carcinoembryonic antigen, epithelial membrane antigen, secretory component, and keratin) in the luminal cells of ducts and the intense immunoreactivity with GFAP (with weaker keratin and S-100 staining) in periductal and stromal cells indicated distinct epithelial and myoepithelial differentiation. Solid epithelioid areas consisted phenotypically of intercalated duct/acinic cells and/or myoepithelial cells, the former exhibiting predominant nuclear S-100 positivity. The presence of GFAP-like immunoreactivity in normal myoepithelial cells strongly supports the extensive involvement of this cell in pleomorphic adenomas. The spectrum of phenotypes expressed adds weight to existing evidence for pleomorphism rather than a mixed origin of this tumor. The combination of keratin, S-100, and GFAP immunostaining is particularly useful in identifying the component cells in pleomorphic adenomas of the salivary glands.

In-situ and microinvasive adenocarcinoma of the uterine cervix. A clinical, cytologic and histologic study of 14 cases.

In-situ and microinvasive adenocarcinoma of the uterine cervix. A clinical, cytologic and histologic study of 14 cases. Am J Clin Pathol 64: 155-70, 1975. The clinicopathologic features of 14 cases of in-situ and microinvasive adenocarcinoma of the cervix, encountered during the period 1961-1974, form the basis of this report. Seven cases represent examples of in-situ and seven, microinvasive adenocarcinoma. Severe dysplasia and carcinoma in-situ of the squamous epithelium were coincidental finds in 12 patiients. Papanicolaou smears were abnormal in all 14 patients. In nine, malignant glandular cells were identified. Five smears contained both malignant squamous and glandular cells. The mean age of the 14 patients was 38.4 years. Thirteen patients had borne one to six children. Two were pregnant at the time of diagnosis, and four were on birth control medication. Thirteen of the patients underwent conization biopsy. Hysterectomy in one form or another was curative in all. The relatively infrequent occurrence of in-situ adenocarcinoma is probably due to the low incidence of cervical adenocarcinoma and to the fact that the lesion is focal and easily overlooked. Five of the cases in the present series were a chance finding in a review of 200 consecutive cone biopsies of the cervix. The resemblance of the in-situ lesions to carcinoma and the presence of morphologically similar glandular tissue adjacent to foci of microinvasion suggests that the in-situ lesion is the precursor of invasive adenocarcinoma of the cerivs.

Cystosarcoma phyllodes with liposarcomatous stroma.

A case of cystosarcoma phyllodes with liposarcomatous stroma is presented. Electron-microscopic study revealed lipid-containing tumor cells admixed with other mesenchymal cells devoid of fat, correlating well with the light-microscopic findings. The literature is briefly reviewed.

Carcinoma in situ of the male breast.

Two cases of carcinoma in situ of the male breast are described: in one patient it arose as a complication of gynecomastia; in the other, it occurred 'de novo' and proceeded to infiltration with widespread metastases. We reviewed 233 cases diagnosed clinically and histopathologically as gynecomastia to see if we could discover other instances of malignant transformation but none was found. Thirty-two cases of infiltrating male breast cancer were also examined. In 11 there was associated intraduct change. In only one of the 32 cases was there evidence of associated microscopic gynecomastia.

The pathology of Q fever as seen on liver biopsy.

Granulomatous inflammation was seen in liver biopsy specimens from five patients with Q fever. All patients had a fever of unknown origin with mild abnormalities of liver function. The granulomatous process in the liver was very distinctive, with fibrinoid ring formation seen in four of the five cases. A diagnosis of Q fever was suggested in the five cases on the basis of the characteristic granulomatous inflammation. Results of subsequent complement fixation tests were positive in all five patients.

Goblet cell carcinoid tumor of the appendix. Report of five cases and review of the literature.

Five cases of goblet cell carcinoid tumor of the appendix showed characteristic histologic features that justified classification of these lesions as mucinous variants of carcinoid tumor. The tumor has low-grade malignancy, and metastases are uncommon. Resemblance to mucinous adenocarcinoma of the appendix is striking, and the features that help to differentiate the two lesions are delineated.

Intussusception of the appendix. A report of four cases and review of the literature.

The clinical and pathologic features of four cases of intussusception of the appendix are reported and the literature is reviewed. All patients had vague abdominal symptoms. The diagnosis of intussusception of the appendix was not made preoperatively in any of these cases. All four patients were females who ranged from 37 to 70 years of age (mean age, 46 years). Examination of the surgical specimens showed tow appendixes that had completely inverted, one with a polyp attached at the base of the appendix forming the intussusceptum and the other with inversion of the appendiceal tip. Three cases were associated with endometriosis and one with a tubulovillous adenoma. Radiologically and endoscopically, the intussuscepted appendix may mimic a neoplastic lesion. Since intussusception may be caused by both benign and malignant conditions, appropriate management will depend on the associated cause.

Hepatic adenomata in type Ia glycogen storage disease.

Liver adenomata are common in young adults and adults with type Ia glycogen storage disease. Complications that may arise in these patients include acute hemorrhage and malignant transformation. With appropriate dietary therapy, they may partially or completely regress. We describe a young woman with type Ia glycogenosis who developed liver adenomata. Because of its persistence and the significant potential of malignant transformation, liver transplantation was performed. This case is discussed in light of a review of the literature on the subject.

Adenoid cystic carcinoma of the breast. Light and electron microscopy and a brief review of the literature.

The case of two patients with adenoid cystic carcinoma of the breast are reported. In case 1, the predominant pattern was that of a solid, basaloid, cylindromatous tumor, whereas case 2 showed the typical adenoid cystic appearance. Results of electron microscopical study confirmed that many of the cystic spaces seen by light microscopy were extracellular compartments enclosed by tumor cells. Many of the tumor cells contained densely packed fibrils, which support the myoepithelial origin of these tumors. Approximately 92 well-documented reports of this lesion are briefly reviewed.

Chordoma: cytologic and immunocytochemical study of four cases.

We present the cytologic features and the immunocytochemical profile of four cases of chordoma on fine-needle aspiration biopsies. The physaliferous cells in signet-ring, pearl-like formations and the trabecular arrangement with rounded contours are distinctive. Other cell types and cellular arrangements are also described. The negative immunoreactivity of carcinoembryonic antigen (CEA) and the positive staining pattern for neuron-specific enolase (NSE), S-100 protein, epithelial membrane antigen (EMA), and keratin provide a profile that, in the appropriate clinical setting, can be useful in the differential diagnosis of chordoma from similar-appearing neoplasms in small biopsies and fine-needle aspirates.

Aspiration biopsy cytology of lymph nodes in malignant lymphoma.

The cytologic findings of needle aspiration biopsy of lymph nodes in malignant lymphoma are presented. In 42 of 49 cases, a correct cytologic diagnosis was rendered. There was one false-positive diagnosis. The diagnostic accuracy of needle aspiration cytology is high. It helps to select patients for further investigation and treatment, thereby avoiding unnecessary surgery in patients who present with lymphadenopathy. The technique is also useful in the staging work-up of patients with lymphoma and the diagnosis of recurrent disease during the follow-up period.

Ewing's sarcoma. Cytologic features in fine needle aspirates in two cases.

The cytologic findings of two cases of Ewing's sarcoma in fine needle aspiration biopsies are presented in relation to the subsequent histologic findings. The malignant cells were arranged in monocellular layers, pseudorosettes and in perivascular palisades in a fibrillar background. The nuclei were monomorphous with small nucleoli and finely granular chromatin. These features may be helpful in distinguishing this tumor from other small-cell neoplasms; the differential diagnosis between Ewing's sarcoma and such tumors is discussed.

Basal-cell adenoma of parotid. Difficulty of differentiation from adenoid cystic carcinoma on aspiration biopsy.

Two cases of basal-cell adenoma (basaloid monomorphic adenoma, dermal analogue tumor) seen in a one-year period were subjected to fine needle aspiration biopsy and subsequent histologic confirmation. Two cases of adenoid cystic carcinoma occurring in the parotid region were selected for comparison; a great similarity between the two types of tumors was noted. On aspiration smear both lesions consisted of clusters and sheets of uniform, small, regular cells with scant basophilic cytoplasm and regular round or oval bland nuclei. The smears contained varying amounts of homogeneous, pale, eosinophilic stromal substance within and around the cell clusters. Individual cell differences between the two lesions were minimal, with the adenoid cystic carcinomas tending to exhibit more nuclear hyperchromatism and irregularity; the architectural arrangements of the cell clusters and the stromal substance permitted differentiation between the two lesions.

Endoscopic brush cytology and biopsy in the diagnosis of cancer of the upper gastrointestinal tract.

Brush cytology and biopsy under direct vision was performed on 250 patients. Of the 44 proven cases with cancers of the upper gastrointestinal tract, brush cytology yielded positive results in 88.6%, and multiple mucosal biopsies yielded positive results in 93.2%. With the combined technique the results increased to 95.4%. False-negative results were due to large tumors with necrotic surfaces or to infiltrative tumors at the cardioesophageal junction. There was one false positive with brush cytology and none with biopsy. Four cases of early gastric cancer were diagnosed with the combined technique.

Characterization of human malignant melanoma cell lines. IV. Cytologic and histochemical characteristics.

The cytologic and histochemical characteristics of seven established human melanoma cell lines were studied using monolayer culture and cytocentrifuge perparations. The morphology of the cells is different in the two preparations. There is a strong resemblance between the Cytocentrifuge preparations and the histological tissue sections and cytologic smears that are used in routine diagnostic work.

Fine needle aspiration biopsy cytology of major salivary glands.

Fine needle aspiration biopsy of the major salivary glands was performed on 160 patients. In 146 patients with satisfactory samples, the cytologic diagnosis was correlated with clinical follow-up and histologic findings. There were 122 benign lesions, including 47 tumors. There were 24 malignant lesions, 10 of which were primary and 14 metastatic. The overall accuracy was 98%. The sensitivity of the technique was 87.5%. There was no false-positive diagnosis. There were three false-negative diagnoses due to sampling errors and inexperience during the initial period of the study. This study documents that needle aspiration biopsy cytology of the salivary glands is accurate, simple, rapid, inexpensive, well tolerated and harmless to the patient.

Fine needle aspiration biopsy cytology of paragangliomas. Cytologic, light microscopic and ultrastructural studies of three cases.

Paragangliomas are uncommon tumors arising in paraganglion tissue, which is especially well represented in the head and neck. In our hospital three head and neck masses recently proved to be paragangliomas on aspiratory biopsy cytology, with subsequent histologic confirmation. One was an apparently benign carotid body tumor, while the others were metastatic nasopharyngeal paragangliomas. The latter two tumors were clearly malignant, with roentgenographically proven pulmonary metastases in one and widespread lymph node involvement in the other. Histologically all were vascular tumors composed of large cells with abundant cytoplasm and pleomorphic, sometimes bizarre nuclei. These characteristic chief cells were clearly evident on cytology, with pleomorphic nuclei, prominent nucleoli, clumped chromatin and generally eosinophilic, finely granular or reticular cytoplasm. However, the distinction between benign and malignant tumors depended on the presence of mitoses or a tumor diathesis. Cytology seems to be able to provide a diagnosis of paraganglioma and, in these cases at least, an estimation of the biologic behavior.