Mycobacterium xenopi and pulmonary disease.

Mycobacterium xenopi was cultured from a portion of surgically resected lung of an asymptomatic patient who had a renal transplant. The patient was receiving azathioprine and prednisone for the prevention of transplant rejection, as well as treatment for previously diagnosed pulmonary tuberculosis. M. xenopi infection was recognized as a second mycobacterial infection. The role of M. xenopi as an opportunistic pathogen in the compromised host is emphasized.

Spontaneous regression of pulmonary metastases from renal cell carcinoma.

One year after nephrectomy for renal cell carcinoma in a seventy-year-old man pulmonary nodules developed which proved to be metastases by needle biopsy. Chest radiographs thirteen and eighteen months later revealed complete spontaneous regression of the nodules without therapy.

Vitrectomy retinotomy aspiration biopsy of choroidal tumors.

We used an investigational technique for the biopsy of intraocular tumors to aid in the diagnosis of three choroidal tumors. A three-port trans-pars plana vitrectomy was performed in conjunction with retinotomy, tumor biopsy, endophotocoagulation, and air-fluid exchange. Vitrectomy was used to decrease the amount of traction secondary to retained vitreous after intraocular surgery. Retinotomy sites were chosen under microscopic control to avoid large caliber retinal vessels. Then a modified tumor-aspiration technique, together with endophotocoagulation and aspiration of intraoperative vitreous hemorrhages, provided an opportunity to sample tumor tissue continually at varied depths. We have added standard vitreous surgery concepts, techniques, and instrumentation to produce vitrectomy retinotomy aspiration biopsy of choroidal tumors.

Diagnostic pathology in the acquired immunodeficiency syndrome. Surgical pathology and cytology experience with 67 patients.

We report the pathologic findings in specimens submitted for histologic and cytologic evaluation from 67 patients with the acquired immunodeficiency syndrome. A wide variety of opportunistic pathogens were identified in 41 patients. Mycobacterium avium-intracellulare evoked only a mild host response: granulomas, if present, were poorly formed. Biopsy specimens showing cytomegalovirus gastroenteritis required sections at multiple levels to demonstrate inclusions. Combined histologic and cytologic evaluation can increase the diagnostic yield in pulmonary and esophageal infections. Kaposi's sarcoma was found in biopsy specimens from 29 patients. Early lesions were often extremely subtle, yet distinct from, benign vascular proliferations in involuted lymph nodes. Malignant lymphoma was diagnosed in ten homosexual men who were suspected of having the acquired immunodeficiency syndrome. The lymphomas were characterized by B-cell origin, a diffuse pattern, frequent extranodal presentations, and an aggressive clinical course with prominent central nervous system involvement.

Similes and metaphors I: A nature walk through benign gynecologic cytology.

Similes and metaphors useful in benign gynecologic cytology are presented. Included are those pertaining to normal cellular elements, organisms, contaminants, and benign changes.

Nipplelike protrusions in endocervical and other cells: further observations.

OBJECTIVE: To explore the possibility that artifact, such as externally applied mechanical stress, may contribute to the formation of nipplelike nuclear protrusions in certain predisposed cells. STUDY DESIGN: The following specimens were examined for the presence and morphology of nipplelike protrusions: 100 endocervical smears, 40 bronchial specimens (brushings, washings and bronchoalveolar lavage) and fine needle aspirates of seven lactating adenomas and 10 fibroadenomas of the breast. RESULTS: Nipplelike nuclear protrusions in endocervical cells were present in the majority of gynecologic endocervical smears showing abundant endocervical cells virtually regardless of menstrual status. They were observed frequently in bronchial specimens and fine needle aspirates of lactating adenoma of the breast. CONCLUSION: It appears that nippling in cytologic preparations is a common phenomenon, particularly in benign endocervical and bronchial columnar cells, and may be found in other tissues and some neoplasms as well. The apparent nonspecificity of nippling, together with the association with other phenomena, such as nuclear "holes", stripped nuclei, nuclear distortion and cellular degeneration, strongly suggests that nippling may be largely the result of mechanical stress during smearing, brushing or other phases of specimen procurement or preparation. Nucleoli may serve as a nidus for nipple formation. Other qualities of a cell, including fragility and cytoplasmic features, may predispose it to the formation of nippling.

Cytologic features of colonic adenocarcinoma. Differences between primary and metastatic neoplasms.

OBJECTIVE: To evaluate cytologic differences between primary and metastatic specimens of colonic adenocarcinoma. STUDY DESIGN: Fifty colonic brushings of primary adenocarcinoma of the colon and 50 specimens of metastatic colonic adenocarcinoma were examined. The latter included fine needle aspirates of lung, liver and other sites and bronchial brushings. RESULTS: In contrast to primary colonic adenocarcinomas, which typically showed large, hyperchromatic nuclei, many cases of metastatic colonic adenocarcinoma showed nuclei with fine, delicate chromatin and distinct nuclear membranes. Often occurring in conjunction with those two features were prominent nucleoli and thin internuclear pseudochannels separating adjacent nuclei. Other features noted in occasional metastatic cases but only rarely in primary specimens were small tumor cell size, uniformity and cohesiveness. CONCLUSION: The features delicate chromatin, distinct nuclear membranes and prominent nucleolus, with the occasional presence of thin internuclear pseudochannels, may be viewed as constituting a secondary cytologic pattern of colonic adenocarcinoma to complement the basic classic pattern of elongated cell shape; hyperchromatic, cigar-shaped nuclei; nucleoli; molding of nuclei; palisaded or glandular arrangement; and necrosis. Varying states of preservation and degeneration may explain many of these differences.

CT-guided transthoracic needle biopsy of small solitary pulmonary nodules.

The use of CT guidance in performing transthoracic needle biopsy is well established. We evaluated its accuracy in the diagnosis of small solitary nodules and found it to be highly accurate regardless of size or location. While specific benign diagnoses were uncommon, additional confidence in a benign diagnosis can be gained by careful analysis of needle tip location using strict CT criteria.

Retroperitoneal neuroblastoma metastatic to brain. Report of a case and review of the literature.

Brain metastases from extracranial neuroblastoma are rare. They are generally produced by direct extension from metastatic lesions of skull or dura. Very few cases with primary cerebral metastases have been described. We reviewed all autopsy cases of extracranial neuroblastoma at Children's Memorial Hospital in the 12-year period from 1976 to 1978. Of 27 cases in which the brain was examined, 14 had intracranial involvement but only one presented parenchymal metastases in the absence of skull or dural involvement. This case is reported in detail and the literature is reviewed.

Fine needle aspiration of the abnormal prostate: a cytohistological correlation.

Cytological diagnosis by fine needle aspiration of the prostate was compared to histological diagnosis by either perineal needle biopsy or transurethral prostatic resection in 110 patients suspected to have prostatic cancer by rectal examination. Of the 94 prostatic aspirations that could be given a definite cytological diagnosis there was histological correlation in 85 (90.4 per cent). The false negative rate was 2.7 per cent for fine needle aspiration and 5.3 per cent for perineal needle biopsy. Inadequate cytological samples occurred mainly at the beginning of the study. There was a 69 per cent correlation in 36 cases in which cytological grading was compared to histological grading. Our results indicate that fine needle aspiration is an easily performed, diagnostically reliable outpatient procedure with minimal complications that also can be used for grading purposes.