A survey of United States obstetric anesthesiologists' perceived value of obstetric anesthesiology fellowship.

INTRODUCTION: Subspecialty training in obstetric anesthesiology is associated with improved patient outcomes and reduced anesthesia-related morbidity and mortality. Despite this, the demand for fellowship-trained obstetric anesthesiologists far exceeds the supply. This survey study aimed to evaluate the perceived value of obstetric anesthesiology subspecialty training on career trajectory, job satisfaction, quality of life, and job autonomy. METHODS: After Institutional Review Board approval, we conducted a cross-sectional study of fellowship-trained obstetric anesthesiologists in the United States of America. In March and April 2022, program directors of obstetric anesthesiology fellowships distributed an electronic survey link containing 29 multiple-choice questions to their program alumni. Survey content included respondent demographic characteristics, practice models, career information, and perceived value of an obstetric anesthesiology fellowship. RESULTS: We surveyed 217/502 (43%) fellowship-trained obstetric anesthesiologists with a response rate of 158/217 (73%). Most worked in urban, academic, and level IV perinatal health centers. The majority believed an obstetric anesthesiology fellowship was "extremely beneficial" (77%), enhanced quality of life (84%), improved the quality of patient care (99%), and was influential in helping obtain their first post-training job (86%). The perceived value of the fellowship included an enhanced career trajectory, a sense of purpose, improved job satisfaction, a sense of work community, lower burnout, involvement in maternal health initiatives, increased mentorship, and departmental leadership. CONCLUSION: In this survey study, fellowship-trained obstetric anesthesiologists perceived a positive impact of fellowship training on career trajectory, job protection and autonomy, quality of life, and job satisfaction. This information may be meaningful to trainees considering pursuing a fellowship and a career in obstetric anesthesiology.

Nomogram to predict the presence of EGFR activating mutation in lung adenocarcinoma.

Epidermal growth factor receptor (EGFR) tumour genotyping is crucial to guide treatment decisions regarding the use of EGFR tyrosine kinase inhibitors in nonsmall cell lung cancer (NSCLC). However, some patients may not be able to obtain tumour testing, either because tissue is limited and/or tests are not routinely offered. Here, we aimed to build a model-based nomogram to allow for prediction of the presence of EGFR mutations in NSCLC. We retrospectively collected clinical and pathological data on 3,006 patients with NSCLC who had their tumours genotyped for EGFR mutations at five institutions worldwide. Variables of interest were integrated in a multivariate logistic regression model. In the 2,392 non-Asian patients with lung adenocarcinomas, the most important predictors of harbouring EGFR mutation were: lower tobacco smoking exposure (OR 0.41, 95% CI 0.37-0.46), longer time interval between smoking cessation and diagnosis (OR 2.19, 95% CI 1.71-2.80), advanced stage (OR 1.58, 95% CI 1.18-2.13), and papillary (OR 4.57, 95% CI 3.14-6.66) or bronchioloalveolar (OR 2.84, 95% CI 1.98-4.06) histologically predominant subtype. A nomogram was established and showed excellent discriminating accuracy: the concordance index on an independent validation dataset was 0.84. As clinical practices transition to incorporating genotyping as part of routine care, this nomogram could be highly useful to predict the presence of EGFR mutations in lung adenocarcinoma in non-Asian patients when mutational profiling is not available or possible.

The time is now: addressing the need for training in maternal critical care medicine.

Amongst many high-income countries, indirect medical conditions (e.g. cardiovascular disease, sepsis) now account for the majority of maternal deaths. In response to this concerning rise in indirect causes of maternal deaths, professional societies have developed guidelines that regionalize high-risk obstetric care and prioritize critical care expertise as a requirement for designated 'top' maternity hospitals. Critical care proficiency is mandated by the Accreditation Council for Graduate Medical Education for graduating obstetric anesthesiology fellows. Despite these requirements, no formal obstetric critical care educational curricula or fellowship pathways, combining critical care medicine and obstetric anesthesiology, currently exist. Dual subspecialty training in both obstetric anesthesiology and critical care medicine represents one strategy to improve the care of critically-ill obstetric patients and reduce maternal mortality and morbidity, which is one of the pressing healthcare issues of our time.

Readability, content, quality and accuracy assessment of internet-based patient education materials relating to labor analgesia.

BACKGROUND: With over 90% of parturients searching the internet for health information, the quality of information is important. Web-based patient education materials (PEMs) related to labor analgesia are frequently of low readability. This study compares the readability, content, quality and accuracy of labor analgesia-related PEMs from relevant healthcare society websites and the top internet search results. METHODS: The first ten PEMs from Google searches for "labor epidural" and "labor pain relief" were compared with PEMs from North American and United Kingdom anesthesiology, obstetric and medical society websites. Readability was assessed utilizing five validated readability indices. Quality was assessed using Patient Education Materials Assessment Tool for Print (PEMAT). The PEMs were graded for accuracy by four obstetric anesthesiologists. Readability, quality and accuracy scores were compared using the independent t-test and content using Chi-square analysis. RESULTS: Society PEMs were significantly more readable than non-society PEMs for three of five readability indices, though the mean of both groups was at or above an eighth-grade (average age 13-14 years-old) reading level. The PEMAT understandability and accuracy scores were significantly higher for society websites. The most frequently mentioned topics were benefits, effects of epidural analgesia on labor and delivery, definitions, post-dural puncture headache and alternative analgesics. CONCLUSIONS: Google search results for labor analgesia lead to PEMs of variable quality and readability. For readers to be better informed, web-based PEMs should be improved or women directed to society PEMs. Inaccurate information may lead to incorrect expectations and conflict during labor, with potentially lower maternal satisfaction.

Efficacy of cytotoxic agents against human tumor xenografts is markedly enhanced by coadministration of ZD1839 (Iressa), an inhibitor of EGFR tyrosine kinase.

The blockade of epidermal growth factor receptor (EGFR) function with monoclonal antibodies has major antiproliferative effects against human tumors in vivo. Similar antiproliferative effects against some of these same tumors have also been observed with specific inhibitors of the EGFR-associated tyrosine kinase. One such inhibitor, the p.o. active ZD1839 (Iressa), has pronounced antiproliferative activity against human tumor xenografts. We now show that coadministration of ZD1839, as with anti-EGFR, will enhance the efficacy of cytotoxic agents against human vulvar (A431), lung (A549 and SK-LC-16 NSCL and LX-1), and prostate (PC-3 and TSU-PR1) tumors. Oral ZD1839 (five times daily x 2) and cytotoxic agents (i.p. every 3-4 days x 4) were given for a period of 2 weeks to mice with well-established tumors. On this schedule, the maximum tolerated dose (150 mg/kg) of ZD1839 induced partial regression of A431, a tumor that expresses high levels of EGFR, 70-80% inhibition among tumors with low but highly variable levels of EGFR expression (A549, SKLC-16, TSU-PR1, and PC-3), and 50-55% inhibition against the LX-1 tumor, which expresses very low levels of EGFR. ZD1839 was very effective in potentiating most cytotoxic agents in combination treatment against all of these tumors, irrespective of EGFR status, but dose reduction of ZD1839 below its single-agent maximum tolerated dose was required for optimum tolerance. The pronounced growth inhibitory action of the platinums, cisplatin and carboplatinum, as single agents against A431 vulvar, A549 and LX-1 lung, and TSU-PR1 and PC-3 prostate tumors was increased several-fold when ZD1839 was added, with some regression of A431 and PC-3 tumors. Although the taxanes, paclitaxel or docetaxel, as single agents markedly inhibited the growth of A431, LX-1, SK-LC-16, TSU-PR1, and PC-3, when combined with ZD1839, partial or complete regression was usually seen. Against A549, the growth inhibition of doxorubicin was increased 10-fold (>99%) with ZD1839. The folate analogue, edatrexate, was highly growth inhibitory against A549, LX-1, and TSU-PR1, whereas edatrexate combined with ZD1839 resulted in partial or complete regression in these tumors. Against the A431 tumor, paclitaxel alone either was highly growth inhibitory or induced some regression, but when combined with ZD1839, pronounced regression was obtained. Combination with gemcitabine neither added nor detracted from baseline cytotoxic efficacy, whereas ZD1839 combined with vinorelbine was poorly tolerated. Overall, these results suggest that potentiation of cytotoxic treatment with ZD1839 does not require high levels of EGFR expression in the target tumors. They also suggest significant clinical benefit from ZD1839 in combination with a variety of widely used cytotoxic agents.

Atypical fibroxanthoma. A study of 14 cases emphasizing the presence of Langerhans' histiocytes with implications for differential diagnosis by antibody panels.

Fourteen consecutive cases of atypical fibroxanthoma (AFX) seen during a 4-year period were studied histologically; of these, 12 were further examined for the presence of immunocytochemically detectable cytokeratin (CK), vimentin (VIM), S-100 protein, melanocyte-associated antigen (MAA), muscle-specific actin (MSA), alpha-1-antitrypsin (A1AT), alpha-1-antichymotrypsin (A1ACT), and ferritin (FER). In four cases, electron microscopy was also performed. Tumor cells were nonreactive with antibodies directed against CK and MAA, strongly reactive with anti-VIM, and variably reactive with A1AT, A1ACT, MSA, and FER. Our findings are consistent with the current notion that these tumors are "fibrohistiocytic". However, in 11 of 12 cases studied, a subpopulation of cells with features of Langerhans' histiocytes (LH) was also identified. These were dendritic cells within the substance of the tumor that were strongly reactive with S-100 antibody and uniformally nonreactive with MAA antibody; ultrastructurally, they were seen to contain typical Birbeck granules. LH characteristically comprised no more than 5% of the overall cell population of the tumor; however, in restricted portions of some lesions, they sometimes accounted for up to 80% of tumor cells. The occurrence of LH in AFX, although previously reported, has not generally been emphasized. Awareness of their presence as an expected and sometimes extensive component of AFX can be important when interpreting differential immunocytochemical panels applied to malignant spindle cell tumors of skin.

Cytokeratin immunoreactivity in Ewing's sarcoma: prevalence in 50 cases confirmed by molecular diagnostic studies.

Ewing's sarcoma (ES) and primitive neuroectodermal tumor (PNET) are characterized by the presence of the specific t(11;22)(q24;q12) or variants thereof, producing diagnostic EWS fusion transcripts. Cytokeratin has been reported sporadically to be expressed in some cases of ES/PNET. However, its prevalence has not been assessed systematically in a series of cases with confirmatory molecular or cytogenetic evidence of a diagnostic translocation. We present in detail three index patients in whom strong cytokeratin immunoreactivity was a confounding factor in the diagnosis. To establish further the prevalence of cytokeratin immunoreactivity in a series of well-characterized ES/PNET, we then performed immunohistochemical studies with antibodies CAM5.2 and AE1/AE3 on 50 cases of ES/PNET diagnosed at Memorial Sloan-Kettering Cancer Center in which molecular evidence of a specific ES/PNET-associated translocation were available. Immunoreactivity to cytokeratin was present in 10 cases (20%), in five diffusely and five focally. There was no significant association between cytokeratin expression and the following parameters: patient age, sex, skeletal and extraskeletal primary site, and the type of EWS fusion transcript. Cytokeratin expression, a manifestation of epithelial differentiation, is present in as many as 20% of ES/PNET in either a diffuse or focal pattern.

Pericardial agenesis and focal aplasia cutis in tetrasomy 12p (Pallister-Killian syndrome).

We report a stillborn female infant with multiple internal and external anatomic abnormalities and mosaicism for isochromosome 12p. These abnormalities included webbed neck, low-set ears, lower jaw tooth bud, left simian crease, shield chest, focal aplasia cutis, diaphragmatic hernia, hypoplastic lungs, agenesis of pericardium, and Meckel's diverticulum. Karyotypic analysis on cord blood lymphocytes showed 10% mosaicism of 46,XX/47,XX, + i(12p), and analysis of skin fibroblasts showed 50% mosaicism for the same karyotype. The parental karyotypes were normal. There are many reported cases describing the anomalies seen in isochromosome 12p. None of these cases, however, have displayed pericardial agenesis or aplasia cutis. The clinical and cytogenetic features of Pallister-Killian syndrome are reviewed.

Incidence of local recurrence and second primary tumors in resected stage I lung cancer.

From 1973 to 1985, 598 patients underwent resection for stage I non-small-cell lung cancer. There were 291 T1 lesions and 307 T2 lesions. The male/female ratio was 1.9:1. The histologic type was squamous carcinoma in 233 and nonsquamous carcinoma in 365. Lobectomy was performed in 511 patients (85%), pneumonectomy in 25 (4%), and wedge resection or segmentectomy in 62 (11%). A mediastinal lymph node dissection was carried out in 560 patients (94%) and no lymph node dissection in 38 (6%). Fourteen postoperative deaths occurred (2.3%). Ninety-nine percent of the patients were observed for a minimum of 5 years or until death with an overall median follow-up of 91 months. The overall 5- and 10-year survivals (Kaplan-Meier) were 75% and 67%, respectively. Survival in patients with T1 N0 tumors was 82% at 5 years and 74% at 10 years compared with 68% at 5 years and 60% at 10 years for patients with T2 tumors (p < 0.0004). The overall incidence of recurrence was 27% (local or regional 7%, systemic 20%) and was not influenced by histologic type. Second primary cancers developed in 206 patients (34%). Of these, 70 (34%) were second primary lung cancers. Despite complete resection, 31 of 62 patients (50%) who had wedge resection or segmentectomy had recurrence. Five- and 10-year survivals after wedge resection or segmentectomy were 59% and 35%, respectively, significantly less than survivals of those undergoing lobectomy (5 years, 77%; 10 years, 70%). The 5- and 10-year survivals in the 38 patients who had no lymph node dissection were reduced to 59% and 32%, respectively. Apart from the favorable prognosis observed in this group of patients, three facts emerge as significant: (1) Systematic lymph node dissection is necessary to ensure that the disease is accurately staged; (2) lesser resections (wedge/segment) result in high recurrence rates and reduced survival regardless of histologic type; and (3) second primary lung cancers are prevalent in long-term survivors.

Role of video-assisted thoracic surgery in the treatment of pulmonary metastases: results of a prospective trial.

BACKGROUND: A retrospective review revealed a 42% error rate between computed tomographic scan reports and thoracotomy findings; therefore, a prospective study was designed to compare the value of computed tomographic scans, video-assisted thoracoscopic exploration, and open thoracotomy in the management of pulmonary metastases. METHODS: Eligibility included any patient with only one or two ipsilateral pulmonary metastases identified on computed tomographic scan who was being considered for surgical resection. Initially video-assisted thoracic surgery was performed and all lesions identified were resected. A thoracotomy adequate for complete lung palpation was then carried out and any additional lesions found were removed. RESULTS: Eighteen patients of a planned 50 were treated before closure of the study. Four patients (22%) had no additional lesions found at thoracotomy. The primary sites of tumor were colon (10), breast (3), and one patient each skin (squamous), cervix, kidney, melanoma, and sarcoma. Four patients (22%) did have additional lesions at thoracotomy, which were benign. In the remaining 10 patients (56%) additional malignant lesions were found at thoracotomy after video-assisted thoracoscopic exploration. After 18 patients were entered, analysis of the early results disclosed a 56% failure rate of a computed tomographic scan and video-assisted thoracic surgery to detect all lesions. Being within the 95% confidence interval (32% to 78%), the study was abandoned. CONCLUSIONS: We conclude that video-assisted thoracic surgery should be used only as a diagnostic tool in managing lung metastasis. A thoracotomy is required to achieve complete resection, which is the major survival prognosticator for satisfactory long-term results.

Hot plate versus tail flick: evaluation of acute tolerance to continuous morphine infusion in the rat model.

The development of tolerance to continuous morphine infusion (2, 4 and 6 mg x kg(-1) x hr(-1) was assessed in rats using two different methods for evaluation of nociception, tail flick (TF) and hot plate (HP). The influence of repeated testing on nociception was evaluated using two regimens; series 1 was tested repeatedly 1, 2, 4, 6, and 8 hr after initiating the morphine infusion and series 2 was tested only twice, at maximum morphine effect and at 8 hr. Both, TF and HP showed pain threshold elevation after the morphine administration of 4 or 6 mg x kg(-1) x hr(-1), which reached a maximum at 2 hr after the start of the infusion. HP: reduction of the effect was found in group 4 mg x kg(-1) x hr(-1) in the series subjected to repeated testing; group 6 mg x kg(-1) x hr(-1) showed reduced effect in both sides. TF: the response latencies did not show reduction at 8 hr. Since TF is predominantly a spinal response and HP is predominantly supraspinal, the results suggest that tolerance during the first 8 hr of morphine infusion develops mainly at supraspinal level.

Assessing local anesthetic effect using the mouse tail flick test.

We used the tail flick test to quantify duration of local anesthetic-induced conduction block in the mouse. Using a baseline tail flick latency (TFL) between 1.0 and 2.5 sec, sensory block was considered present if TFL was > or = 4 sec. Two 20-microL local anesthetic injections were made on opposite sides of the tail base. TFL was tested every 10 min, and local block duration was interpreted as the time to return of TFL to < 4 sec. We tested three different concentrations of procaine (1%, 2%, and 4%), tetracaine (0.125%, 0.5%, and 1%), and lidocaine (0.5%, 1%, and 2%) with and without epinephrine. The testing method could discriminate between the duration of the various local anesthetic concentrations used. For the 1% concentrations, the duration of sensory block was 2 +/- 4 min (S.D.) for procaine, 20 +/- 10 min for lidocaine, 40 +/- 10 min for tetracaine, and 66 +/- 15 min for lidocaine with epinephrine. We found this to be a simple and reliable means of assessing local anesthetic conduction block in the mouse.

Wilms' tumor presenting as sudden death due to tumor embolism.

The clinical and pathologic features of two unusual cases of Wilms' tumor are described. Both cases presented as sudden death due to tumor embolus. One patient, a 7-year-old girl, had a massive tumor embolus filling the right main pulmonary artery. The second patient, a 6-year-old boy, had pulmonary artery tumor embolus, widespread metastases to lungs, lymph nodes, mesentery, bowel, brain, and nerves, and tumor emboli in the myocardial and epicardial vessels and carotid artery. The renal vein was invaded in both patients. The histologic characteristics of the two tumors was strikingly similar, both showing a blastemal predominant pattern with minimal epithelial differentiation in the form of tubules. Anaplasia was not a feature. To our knowledge, the initial presentation of Wilms' tumor as sudden and unexpected death has not been previously described.

Endometrial cancer metastasis to brain: report of two cases and a review of the literature.

Two cases of brain metastases from endometrial adenocarcinoma are reported. A 70-year-old female presented with lung metastases 14 months after hysterectomy and adjuvant treatment. At 6 months later, a cerebellar metastasis was resected and followed by radiation therapy. The patient died 5.5 months later. In the second case, a 60-year-old patient developed a lung endometrial metastasis 6 years after initial treatment. At 1 year later she was diagnosed with bilateral hydrocephalus caused by a left temporal and posterior fossa tumor. A ventriculoperitoneal shunt was inserted and she received brain radiation. Two weeks later she gradually became comatose, with right hemiparesis. A metastatic, hemorrhagic temporal tumor was resected but the patient never regained consciousness and died after 7 weeks. The existing literature on brain metastases from endometrial adenocarcinoma is reviewed.

Cytology of pericardial effusions in AIDS patients.

Pericardial effusions in patients with the acquired immunodeficiency syndrome (AIDS) can be due to a variety of causes and are often large enough to be sampled for cytologic examination. Over a period of 46 months, 15 cytologic specimens from 14 patients with AIDS were examined. Thirteen patients were male, one was female; the age range was 26 to 43 years. All male patients were homosexual or intravenous drug abusers, and the female patient was the spouse of an intravenous drug abuser. In general, the cytology specimens were moderately cellular with inflammatory cells seen in all cases. Atypical or reactive mesothelial cells were found in 12 cases (80%), and the atypia in one of these 12 was so marked that carcinoma was suspected; cells suspicious for malignant lymphoma were found in 2 cases (13%); degenerated mesothelial cells were present in one case. No infections were identified in this series. Ten patients (66%) had subsequent pericardial biopsies. Marked cellularity and nuclear pleomorphism in lymphoid cells with an altered nuclear cytoplasmic ratio were the dominant findings in the two suspected lymphoma cases. Both patients had known lymphoma elsewhere; in one, involvement by lymphoma was also found on pericardial biopsy. Mesothelial proliferations showing papillary formations with psammoma bodies were seen in three cases; in one of these, histoplasmosis was later diagnosed by pericardial biopsy. To our knowledge this is the first series to describe cytologically the marked mesothelial atypia seen in pericardial fluid in AIDS patients. We contrast this atypia with that seen in malignant effusions and caution against overinterpretation of pericardial fluids from AIDS patients.

Large-cell neuroendocrine carcinoma of the lung: proposed criteria for cytologic diagnosis.

The category of large-cell neuroendocrine carcinoma (LCNEC) of the lung, proposed to expand the traditional scheme of typical carcinoid, atypical carcinoid (AC), and small-cell carcinoma (SCC), based on histologic features, has not been defined in cytology. We attempt to describe LCNEC cytologically. Cytologic features in 16 histologically confirmed LCNECs in fine-needle aspiration biopsies, cell blocks, bronchial brushes, washes, and sputum specimens stained with Diff-Quik, Papanicolaou, hematoxylin-eosin, chromogranin, and synaptophysin were analyzed. Three poorly differentiated nonsmall-cell carcinomas, 4 SCCs, and 2 atypical carcinoids were studied similarly. Twenty specimens from 16 histologically confirmed cases of LCNEC with original cytologic diagnoses including high-grade neuroendocrine carcinoma, large-cell carcinoma, nonsmall-cell carcinoma, poorly differentiated carcinoma, adenocarcinoma, and SCC, were examined. Features included flattened three-dimensional clusters with peripheral palisading, moderate to large single cells with scant (alcohol-fixed) or moderate (air-dried) cytoplasm; and large, oval, or polygonal nuclei with irregular contours, thickened nuclear membranes, and finely or coarsely granular chromatin, showing some molding and crush artifact. Nucleoli were generally present, and occasionally prominent. Mitosis and necrosis were apparent. Neuroendocrine stains were applied to all specimens, with at least one marker, commonly synaptophysin, positive in 18/20 specimens. LCNEC can be diagnosed in cytologic material, using morphology confirmed by immunocytochemistry. Treatment can be offered on the basis of cytologic examination.

Fine-needle aspiration of anaplastic thyroid carcinoma with varied cytologic and histologic patterns: a case report.

Anaplastic carcinoma of the thyroid (ACT) is a rare subtype of thyroid neoplasm. This tumor represents approximately 5-10% of all thyroid malignancies and its poor prognosis has not changed in 25 years. ACT often arises in a long-standing thyroid nodule and has been documented to be associated with a variety of more well-differentiated thyroid carcinomas. We describe the cytologic features of a case in which the patient had a 10-yr history of a thyroid nodule. The ACT in this case had a cytologic and histologic appearance of several different subtypes of thyroid carcinomas.

Comparative cytologic features of pancreatic acinar cell carcinoma and islet cell tumor.

Acinar cell carcinoma (ACC) and islet cell tumor (ICT), both rare pancreatic neoplasms, can be diagnosed accurately and rapidly with the use of imaging-guided fine-needle aspiration biopsies. The specific cytologic features of these tumors are described in a series of 17 patients, and histologic and immunocytochemical correlations are discussed. Important cytologic findings in ACC are loosely cohesive clusters with cells having uniform nuclei and prominent nucleoli, cytoplasm is finely granular and eosinophilic. Islet cell tumors show many single cells, occasional rosettes, uniform nuclei, sometimes binucleate, dense basophilic cytoplasm. Chromogranin is often positive (80%) in ICT. Trypsin and chymotrypsin were often positive (71%) in ACC. Histology was confirmatory in all cytology cases. The recognition of cytologic features in conjunction with immunocytochemical studies can increase the diagnostic sensitivity for these two rare tumors.

ThinPrep vs. conventional smears in fine-needle aspirations of sarcomas: A morphological and immunocytochemical study.

Very limited data exist describing the characteristics of sarcomas sampled by fine-needle aspiration (FNA) and processed by the ThinPrep (TP) method. We compared the cytopathological and immunocytochemical features of sarcoma aspirates prepared using both the conventional and TP method. We reviewed 70 sarcoma FNAs. Samples were first used to prepare conventional smears and the remainder of the specimen was rinsed in Cytolyt. The average number of slides examined per case was two for the TP method and five for the conventional technique. Immunocytochemistry for different markers was performed in a subset of cases. Sixty-five cases were positive for sarcoma both by conventional and TP methods. Five cases were positive by one method only. Cellularity was higher on conventional slides. In terms of cytoarchitecture, TP slides revealed fewer thick clusters, more single cells that were more evenly distributed, and sometimes distortion of expected cellular arrangements and architectural patterns. Cytomorphological and nuclear details were better preserved on TP slides. The background of TP slides revealed a reduction of blood but also some loss of necrosis and characteristic background tumor features. Immunocytochemical staining revealed superior results on TP slides. TP and conventional slides showed good correlation. TPs were excellent for immunocytochemistry and represent an alternative to conventional smears when expertise in slide preparation is not available. However, TPs may require additional experience in the interpretation of sarcomas, mainly related to the loss of tumor-specific background features. They are useful as an adjuvant to conventional smears in sarcoma diagnoses, particularly when special studies are needed. Diagn. Cytopathol. 1999;21:351-354.

E-cadherin, N-cadherin, and calretinin in pleural effusions: the good, the bad, the worthless.

The distinction between reactive mesothelial cells (RMC), malignant mesothelioma (MM), and metastatic adenocarcinoma (ACA) in pleural effusions may be impossible based on morphology alone. E-cadherin, N-cadherin, and calretinin are newly described immunocytochemical markers which can potentially be utilized for facilitating this distinction. E-cadherin and N-cadherin are calcium-dependent intercellular adhesion molecules expressed in epithelial cells and mesenchymal/mesothelial cells, respectively. The differential expression of E-cadherins in epithelial cells and N-cadherins in mesothelial cells has been utilized to differentiate reactive mesothelial cells, MMs and ACAs. Calretinin is a calcium-binding protein within the family of EF-hand proteins. It is abundantly expressed in peripheral and central nervous tissues, and has been shown to consistently immunoreact with mesothelial cells. We studied cell block sections from 77 pleural effusions (22 RMC, 26 MM, and 29 ACA) to investigate the potential immunocytochemical use of anti-E-cadherin, anti-N-cadherin, and anti-calretinin antibodies for differentiating between RMC, MM, and ACA in pleural effusions. A modified avidin-biotin peroxidase complex (ABC) method was used. E-cadherin immunostaining was observed in 14% of RMC, 46% of MMs, and 97% of ACAs. A distinct membrane staining pattern was seen in ACAs. The pattern of staining was cytoplasmic in all reactive RMC and varied from membrane to cytoplasmic in MMs. Anti-N-cadherin immunoreacted with 77% of RMC, 35% of MMs, and 48% of ACAs. Twenty-seven percent of RMC, 58% of MMs, and 31% of ACAs immunoreacted with anti-calretinin. Based on these results, we conclude that anti-E-cadherin is a potentially useful marker in the distinction of ACA cells from RMC. However, it is not as useful for the distinction of ACA and MM. Anti-N-cadherin and anti-calretinin did not reliably distinguish between reactive mesothelial, MM, and ACA cells in pleural effusions.