Small-cell undifferentiated carcinoma of the cervix. A clinicopathologic, ultrastructural, and immunocytochemical study of 15 cases.

The clinicopathologic, immunocytochemical, and ultrastructural features of 15 small-cell undifferentiated carcinomas (SCUC) of the uterine cervix are reported. Patients ranged in age from 25 to 87 (median, 42 years) and presented as stages IB (nine patients), IIA (one patient), IIB (two patients), IIIB (two patients), and IV (one patient). A variety of treatment regimens were employed. Ten patients died of disease (3-71 months; median, 11 months), one patient has a suspicious lung nodule 10 months after diagnosis, one patient is comatose with brain metastases 4 months after diagnosis, and three patients are alive and well 5, 11, and 78 months after diagnosis. Histologically and cytologically, the tumors were identical to pulmonary small-cell undifferentiated carcinoma. Six tumors were associated with other forms of carcinoma, in situ or invasive or both, including epidermoid carcinoma in situ (two cases), adenocarcinoma in situ and epidermoid carcinoma in situ (one case), adenocarcinoma (three cases), and epidermoid carcinoma (three cases). All 13 tumors expressed one or more epithelial markers and at least one neuroendocrine marker. Electron microscopy demonstrated dense-core granules in six of seven tumors, dendrite-like processes in seven tumors, filament bundles in four tumors, and intracytoplasmic lumina in one tumor. Small-cell undifferentiated carcinoma of the cervix is an aggressive tumor with a propensity for rapid metastasis and high mortality. These tumors may demonstrate multidirectional differentiation, including the frequent expression of neuroendocrine features.

Anti-B cell lymphocytotoxic antibodies in kidney transplant recipients.

Serial serum samples from 47 renal allotransplant recipients were screened for antiperipheral blood lymphocyte, anti-B cell, and anti-Daudi cell line antibodies. Various associations of these antibodies were observed in 28 patients. Anti-Daudi did not correlate with graft survival, whereas anti-B, although they were often associated with anti-peripheral blood lymphocyte antibodies, showed the strongest correlation with chronic rejection (P = 0.00002). However anti-B cytotoxicity preceded or was concurrent with the onset of chronic rejection in only 53% of the cases. Antibodies were absent in six of nine patients with irreversible acute rejection, but they usually appeared after transplant nephrectomy. These findings suggest that anti-B cell antibodies may play a role in the rejection process. In 15 of 17 recipients (88%), anti-B cell antibodies occurred during the first trimester after transplantation. These patients showed 20% 1-year graft survival compared with 68% in those without antibodies at that time (P less than 0.005).

Cytoprotective agents in experimental small bowel volvulus.

An accepted experimental model for midgut volvulus was used to produce small bowel strangulation obstruction of 48 hours duration in Sprague-Dawley rats. A 93% perioperative mortality rate resulted after release of the volvulus. Treatment with three cytoprotective agents at the time of volvulus release resulted in the following mortality rates: superoxide dismutase, 89%; ibuprofen, 50%; prostaglandin E1 (PGE1, 11%. The predominant cause of death in all treatment groups was bowel infarction, with a smaller number succumbing to either sepsis or circulatory collapse. Concomitant administration of ephedrine or indomethacin to suppress prostaglandin E1's splanchnic vasodilatory activity did not cause any increase in mortality. A trial of aspirin, to simulate PGE's antiplatelet actions, showed no reduction in mortality when compared with detorsion alone. Prostaglandin E1 and, to a lesser extent, ibuprofen, appear to have cytoprotective effects during reperfusion of bowel compromised by volvulus, independent of their influence on the mesenteric vasculature and thrombogenesis.

Cimetidine and neonatal small bowel adaptation: an experimental study.

Histamine2-blockers are being used more extensively in the pediatric short gut patient as an agent to accelerate small bowel adaptation. Reversal of lipid malabsorption and a direct trophic effect on the intestinal crypt cells have been postulated as the mechanism for the salutary influence of cimetidine. Weanling Sprague-Dawley rats underwent 85% small bowel resection. Controls had repair of a simple ileal transection. Rats received either a fat-defined rat chow only, or chow with high- or low-dose cimetidine, 2% cholestyramine, or cholestyramine/low-dose cimetidine. All animals were killed 2 weeks postresection, and ileal and jejunal sections were examined for changes in villous and crypt morphology. The animals receiving cimetidine showed earlier and more consistent weight gain than resected animals who received no adjunctive treatment. High- and low-dose regimens were equally efficacious. Cimetidine administered alone decreased fecal fat losses, but not when given with cholestyramine. The cimetidine/cholestyramine group showed increased weight gain when referenced to the resection controls despite continuing lipid malabsorption. Villous and crypt lengthening did not correlate with clinical evidence of adaptation. An augmented lymphocytic activity (plasma cell hyperplasia, enlargement Peyer's patches) was present in the hyperplastic ileal segments of the cimetidine-treated rats. Overall immunoreactivity was similar in all study groups. No significant differences in villous morphology or immunologic activity were seen in jejunal segments. The effects of H2-blockers on lipid absorption and intestinal hyperplasia are inadequate to explain the benefits of cimetidine in the short gut patient. Examination of the immunology of the short bowel complex merits further attention in elucidating cimetidine's action in this setting.

Photo- and auger-electron recoil induced dynamics of interatomic Coulombic decay.

At photon energies near the Ne K edge it is shown that for 1s ionization the Auger electron, and for 2s ionization the fast photoelectron, launch vibrational wave packets in a Ne dimer. These wave packets then decay by emission of a slow electron via interatomic Coulombic decay (ICD). The measured and computed ICD electron spectra are shown to be significantly modified by the recoil induced nuclear motion.

Prenatal diagnosis of neural tube defects: origin of midtrimester vertebral ossification centers as determined by sonographic water-bath studies.

A normal vertebral column was removed from a 17-week stillborn fetus and suspended in a water bath. The specimen was sequentially dissected, with spinous processes, transverse processes, and remaining neural arch removed. After dissection, each specimen was imaged by ultrasound in axial, sagittal, and coronal planes. The resultant images clearly demonstrated the origin of the three ossification centers as one at each lamina-pedicle junction and one in the vertebral body. Corollary X-ray studies confirmed the ultrasound findings and, in a case of open spina bifida, demonstrated the superiority of sonography for making this diagnosis.

Mammographic appearance following implant removal.

Potential complications of augmentation mammaplasty with silicone gel breast implants have been the subject of much recent debate in the medical and lay communities. Some women have undergone implant removal, and others may follow. The mammographic appearance following submammary implant removal in four women and the histologic appearance in one case are described. Bilateral symmetric soft-tissue masses posterior to the glandular tissue with accompanying calcifications should suggest the diagnosis. The radiologist should be familiar with the mammographic appearance following implant removal. Such knowledge may prevent unnecessary concern and unwarranted biopsy.

Flow cytometric analysis of breast needle aspirates.

This study investigated two hypotheses: (1) sufficient cells may be obtained by needle aspiration of breast nodules to produce good flow cytometric DNA profiles; and (2) benign breast lesions do not produce aneuploid G0G1 peaks, and therefore a distinct aneuploid peak is sufficient for a diagnosis of malignancy. Breast specimens received in Surgical Pathology between December 1985 and February 1987 were aspirated, and the cells stained with propidium iodide for flow cytometric DNA analysis. A total of 344 specimens were aspirated, of which 204 (59%) were malignant and 140 (41%) benign. One hundred fifty-three malignant and 111 benign specimens contained sufficient cells for analysis. Cytologic smears were available for 177 malignant and 123 benign specimens. DNA histograms were considered diagnostic of malignancy if an aneuploid peak was present which contained at least 20% of the cells in the distribution, and had a DNA index greater than or equal to 1.2. Using these criteria, 73 of 153 (48%) carcinomas could be identified. None of the benign lesions satisfied these criteria. One fibroadenoma with atypical hyperplasia produced a distinct peak which contained less than 5% of the cells in the histogram, and had a DNA index of 1.25. Flow cytometric analysis provides objective data that complement the subjective cytologic interpretation of fine needle aspirates.

The Ivemark syndrome: prenatal diagnosis of an uncommon cystic renal lesion with heterogeneous associations.

Renal dysplasia has been reported in association with a number of anatomical abnormalities, including pancreatic dysgenesis and hepatic anomalies. The combination of renal, hepatic, and pancreatic dysplasia (RHPD), also known as Ivemark syndrome, is rare and uniformly fatal. We report here the gross and histological findings in 4 cases of combined RHPD, 2 of which were detected by prenatal ultrasonography. Evaluation of these 4 and the other 20 reported cases shows that combined RHPD has considerable variability in the histological findings and in organ involvement. In addition, nearly half were associated with anomalies in other organ systems, and 11 of the 24 were familial. In this study, ultrasonographic and histological abnormalities were seen as early as 18.5 weeks gestation in 1 case.