Comparison of fine-needle aspiration cytology and core biopsy for diagnosis of breast cancer.

Both fine-needle aspiration (FNA) cytology and core biopsy are useful in the diagnosis of breast cancer. In order to compare the sensitivities of these procedures, we reviewed 209 patients with breast cancer who had either FNA, core biopsy, or both, and also either mastectomy or lumpectomy. Sensitivities for FNA and core biopsies for diagnosing breast cancer were calculated and compared. Sensitivity for FNA or core biopsies interpreted as either atypical or malignant was 93.8% for FNA and 90.1% for core biopsy (P > 0.05). Sensitivity for FNA or core biopsies interpreted as malignant was 65.4% for FNA and 88.7% for core biopsy (P < 0.0001). Sensitivities of FNA interpreted as either atypical or malignant were 92.4% for FNA performed by pathologists and 100% for FNA by nonpathologists (P > 0.05). Sensitivities of FNA interpreted as malignant were 75.8% for FNA by pathologists and 20.0% for FNA by nonpathologists (P < 0.00001). Both FNA and core biopsies are sensitive procedures for the detection of breast cancer. There was no significant difference between sensitivity of FNA and core biopsies interpreted as either atypia or malignancy, although the sensitivity of core biopsies interpreted as unequivocal malignancy was greater than that of FNA. FNAs performed by pathologists were more sensitive than FNAs performed by nonpathologists in making an unequivocal diagnosis of breast cancer.

Severe murine lung immunopathology elicited by the pathogenic equine herpesvirus 1 strain RacL11 correlates with early production of macrophage inflammatory proteins 1alpha, 1beta, and 2 and tumor necrosis factor alpha.

The CBA mouse model was used to investigate the immunopathology induced in the lung by the pathogenic equine herpesvirus 1 (EHV-1) strain RacL11 in comparison to infection with the attenuated vaccine candidate strain KyA. Intranasal infection with KyA resulted in almost no inflammatory infiltration in the lung. In contrast, infection with the pathogenic RacL11 strain induced a severe alveolar and interstitial inflammation, consisting primarily of lymphocytes, macrophages, and neutrophils. Infection with either EHV-1 strain resulted in the accumulation of similar numbers and ratios of CD4 and CD8 T lymphocytes in the lung and bronchoalveolar lavage (BAL) fluid. Further analysis of these T-cell populations revealed identical EHV-1-specific cytotoxic T-lymphocyte responses. RNase protection analysis of RNA isolated from the BAL fluid of RacL11-infected mice on day 3 postinfection revealed much higher levels of RNA specific for macrophage inflammatory protein 1alpha (MIP-1alpha), MIP-1beta, and MIP-2 than were observed for KyA-infected mice. Furthermore, significantly higher levels of transcripts specific for tumor necrosis factor alpha were induced on day 3 postinfection with RacL11 compared with KyA. These findings suggest that the early production of proinflammatory beta chemokines plays a major role in the severe, most often lethal, respiratory inflammatory response induced by the pathogenic EHV-1 strain RacL11.

Cytohistologic correlation between AGUS and biopsy-detected lesions in postmenopausal women.

OBJECTIVE: To evaluate histologic findings in patients aged 50 and older whose cervical smears revealed atypical glandular cells of undetermined significance (AGUS). STUDY DESIGN: Computerized records spanning a four-year period were retrospectively analyzed. Thirty patients over age 50 had cervical smears interpreted as AGUS and had follow-up biopsies within 12 months following the abnormal smear. The most important histologic diagnosis from the biopsy specimens was correlated with the subcategory of the cervical smear. RESULTS: Five smears interpreted as AGUS, favor reactive, revealed abnormal histology in four cases: three endometrial polyps and one squamous carcinoma. Two smears interpreted as AGUS, favor dysplasia, revealed squamous intraepithelial lesions on biopsy in both cases. Seventeen smears interpreted as AGUS, favor endometrial cells, revealed abnormal histology in 13 cases: 1 endocervical polyp, 6 endometrial polyps, 3 endometrial hyperplasias and 3 adenomyosis. Six patients with smears interpreted as AGUS, unclassifiable, revealed abnormal histology in five cases: two endocervical polyps, one endometrial polyp, one endometrial carcinoma and one ovarian carcinoma. CONCLUSION: The presence of AGUS in cervical smears from women over 50 was highly predictive of abnormal lesions detected by histologic examination. Although three cancers were detected on histologic follow-up, the most common lesions detected were endometrial polyps.

Equine herpesvirus-1 strain KyA, a candidate vaccine strain, reduces viral titers in mice challenged with a pathogenic strain, RacL.

The equine herpesvirus type-1 (EHV-1) strain Kentucky A (KyA) has a long history of repeated passage either in vivo in the Syrian hamster or in vitro in mouse L-M fibroblast tissue culture. This repeated passage in cells other than those of the natural host has caused genomic alterations of the KyA chromosome resulting in deletion of several genes or portions of open reading frames (ORFs). This report presents in vivo data from a mouse model of EHV-1 infection demonstrating the attenuated nature of EHV-1 strain KyA and that intranasal infection with KyA protects animals from subsequent challenge with a pathogenic strain, RacL, by reducing RacL viral titers in the lungs of the challenged animals. Mice infected with KyA exhibit no clinical manifestations of EHV-1 disease and do not experience the wasting that occurs with RacL infection. KyA-infected mice clear virus from the lung by day 5 post-infection (p.i.), whereas RacL infected mice have substantial virus titers (5 x 10(5) pfu/lung) at this time point. Intranasal infection with KyA followed by a challenge with RacL 4 weeks post-KyA infection resulted in a significant (P = 0.0079) reduction in the lung titers of the RacL virus. RacL was identified as the virus present in the lungs of the challenged mice by a PCR assay employing primers to amplify the EUS4 gene which differs in size by 1.2 kilobase pairs (kbp) in the two strains. Importantly, the protection afforded by KyA is long lasting in that challenge with RacL 15 months after KyA infection, results in reduced virus titers and viral clearance by day 5 post-challenge. These results support the further consideration of EHV-1 KyA as a live virus vaccine.

Regressing malignant melanoma.

Malignant melanoma may undergo spontaneous regression. This phenomenon may cause difficulty in clinical or pathologic diagnosis. The cases reported in the literature as complete spontaneous regression of primary malignant melanomas have been diagnosed only in retrospect, after the patient presented with metastatic malignant melanoma. Two cases of malignant melanoma with partial regression are reported. In these cases the areas of complete regression cannot be recognized as malignant melanoma. The definitive diagnosis of malignant melanoma can be made only in the areas with at least two of three characteristic features of melanoma, (1) melanocytic cells with atypical nuclei and prominent nucleoli, (2) mitoses in melanocytic cells, and (3) invasion of the epidermis by atypical melanocytic cells. Clinical features suggesting regressing malignant melanoma include changes in color, especially areas of depigmentation, variations in color in different areas of a pigmented mole, and decrease in size of a mole. Histopathologic features of regression include loss of melanin pigment from the epidermis, melanophages in the dermis, telangiectasia of capillaries in the dermis, and lymphocytic infiltration in the dermis in a band-like or perivascular pattern. These histologic findings may also be found in inflammatory lesions such as lichen planus and in regressing benign melanocytic nevi.

Tubal ectopic pregnancy: a histologic, morphometric, and statistical study.

Pathologists are occasionally asked for medicolegal reasons to estimate the gestational age of an ectopic pregnancy based on morphologic findings. We evaluated the correlation between the gestational age and the maximal diameter of the resected fallopian tube, the average diameter of chorionic villi, the number of chorionic villi per square millimeter of the microscopic section, the number of degenerated villi per square millimeter, the number of syncytial knots per square millimeter, and the average number of layers of cytotrophoblastic cells covering the villi. There was a significant correlation between the diameter of the fallopian tube and the gestational age, with a correlation coefficient of 0.41 and a P value of .05. There was no significant correlation of the gestational age with any of the microscopic parameters measured. The findings indicate that an approximate estimation of the gestational age of tubal ectopic pregnancies may be made using the diameter of the resected fallopian tube.

Acute suppurative cholangitis associated with choledochal sludge.

Three patients with acute cholangitis who lacked cholangiographic evidence of common bile duct stones are reported. One presented 7 yr after cholecystectomy, and the other two had gallbladder sludge but no gallstones. The clinical features were mild, consisting of biliary pain, low grade fever without chills, and with modest leukocytosis. In each case, free cannulation of the bile duct was not possible, necessitating needle-knife papillotomy. After endoscopic sphincterotomy, balloon retrieval yielded purulent bile and sludge, but no stones. Prompt clinical improvement resulted in all three patients. Cultures of bile obtained at endoscopic retrograde cholangiopancreatography grew Escherichia coli in two patients and Enterobacter aeruginosa in the other. These observations suggest a link between intermittent obstruction due to biliary sludge in the common bile duct and bacterial cholangitis. We hypothesize that recurrent passage of biliary sludge may precipitate obstructive inflammation and fibrosis of the ampulla of Vater. Acute cholangitis should be added to the differential of potential complications of biliary sludge.

Retroperitoneal necrotizing fasciitis.

We present a case of retroperitoneal necrotizing fasciitis treated by urgent abdomino-perineal resection of the rectum with permanent colostomy. We can find no prior case in the English literature treated in this manner. Retroperitoneal occurrence of this disease is unusual. The process originated from perianal sepsis following chemotherapy for head and neck cancer.

Use of psychoactive substances by medical students: a survey.

The use and abuse of alcohol and other psychoactive substances is of concern to the medical profession and to medical educators. Sixty-eight members of the sophomore class at LSU Medical Center in Shreveport participated in a substance use survey. Ten students (14.7%) described themselves as abstainers from alcohol consumption. Although none described themselves as heavy or abusive drinkers, 9 (13.2%) drank 6-10 alcoholic beverages on a weekend if there was no examination scheduled for Monday or Tuesday, and 3 (4.4%) consumed more than 10 alcoholic beverages on such a weekend. At a large school social event, 9 students (13.2%) drank 6-10 alcoholic beverages and 3 (4.4%) drank more than 10 alcoholic beverages during the event. Nine students (13.2%) used marijuana at least 1-3 times per year. Tobacco was used by 17.6% of the students sampled. Only 4 students (5.9%) avoided caffeine completely. Twelve students (17.6%) drank 5-10 caffeinated beverages daily. The use of cocaine (2.9%), amphetamines (4.5%), and unprescribed sedatives (6%) was small in this student sample. More education concerning effects of psychoactive substances is encouraged.

Kaposi's sarcoma involvement of the bone marrow.

Kaposi's sarcoma (KS) is a predominantly cutaneous malignancy with several clinical variants. Extracutaneous sites of involvement are uncommon in all disease variants except epidemic KS (human immunodeficiency virus related) and the African lymphadenopathic variant. Extracutaneous KS usually involves the lymph nodes, gastrointestinal tract, and respiratory tract. The authors report the first description of a patient with classic KS to have bone marrow involvement. Two additional patients with KS variants and bone marrow involvement have been described. Bone marrow tumor invasion should be considered in patients with KS and hematologic abnormalities.

Pulmonary fibrosis as the initial manifestation of scleroderma.

We report a patient who developed pulmonary fibrosis before the appearance of cutaneous scleroderma. This unusual clinical presentation has been infrequently reported in the English literature. Recognition that pulmonary disease may occur before extensive skin changes in scleroderma is important to ensure proper management.

Valvular xenografts in the inferior vena cava.

The unsolved problem of valvular incompetence is a common denominator to chronic venous insufficiency. Cardiac experience with tissue valves suggests the potential for their use in more peripheral locations. The current initial work evaluated 22 valvular xenografts placed in the inferior vena cavas of 22 dogs. Patency extended to 28 months in 12 valves. There was a plausible explanation for failure in 8 of the 10 unsuccessful units. Patent valves functioned with minimal pressure gradients at moderate flow with no evidence of pulmonary emboli. Retrograde valvulograms showed acceptable functional competence in six of eight units examined despite autopsy evidence of leaflet fibrosis and anatomic incompetence. The study establishes the feasibility of long-term patency of valvular xenografts in the inferior vena cava, but also raises questions concerning design requirements for prosthetic venous valves.

Tungiasis: report of one case and review of the 14 reported cases in the United States.

Tungiasis is a cutaneous parasitic infestation by the fertilized female sand flea Tunga penetrans. It is prevalent in tropical Africa and in Central and South America. Despite increasing air travel to and from these countries, surprisingly the disease is rarely reported in the United States. This report describes another case of tungiasis and reviews the 14 previously reported cases in the United States. Clinical features, differential diagnosis, treatment, and prophylaxis of tungiasis are discussed.

An evaluation of uterine scar integrity after cesarean section in rabbits.

Cesarean sections were performed on 30 rabbits at term pregnancy. Two incisions were made in each of the two uterine horns, and each incision was closed according to a predetermined method (continuous, everted; continuous, inverted; interrupted, everted; or interrupted, inverted). Tissue from the uterine scar region was sampled at three different time periods (5-8 days, 12-15 days, or 28-30 days) post-surgery to evaluate the degree of uterine healing by a variety of histologic criteria. The initial healing response in the scarred region occurred around 28-30 days post-surgery. The different uterine closure techniques did not appreciably influence the healing response in this study. We evaluated tensile strength in 36 uterine muscle specimens containing the scar obtained from nine animals in the 28-32-days post-surgery group. Of these 36 specimens, 86.1% tore through the muscle instead of through the scar when tension was applied to the muscle.

Diagnosing breast cancer using frozen sections from Tru-cut needle biopsies. Six-year experience with 162 biopsies, with emphasis on outpatient diagnosis of breast carcinoma.

Experience in a 6-year period with 162 frozen sections from needle biopsies of the breast is reported. The technique was used mainly to diagnose breast cancer in outpatients. The results of frozen section on needle biopsies are compared with frozen sections of excisional biopsies. The sensitivity of detection in breasts containing carcinoma using frozen section of breast needle biopsies was 77%. The sensitivity of detection of carcinoma in needle biopsies subsequently shown to contain carcinoma by paraffin section was 92.8%. The specificity of frozen sections of breast needle biopsies was 86.4% and was devoid of false-positive results. Interpretation of frozen sections of needle biopsies of breast lesions is reliable when performed by experienced surgeons and handled and interpreted by experienced pathologists.

Tissue morphology of Histoplasma capsulatum in acute histoplasmosis.

Reports of histopathology in acute histoplasmosis are rare. A case of fulminating acute histoplasmosis with hematogenous dissemination is described in which Histoplasma capsulatum was identified in transbronchial biopsy. This report represents the first morphologic description of H. capsulatum within human pulmonary tissue in the early phase of acute histoplasmosis. The yeast forms observed were of typical size, but they were present within the alveoli and were budding. No tissue granulomata were noted. This unusual morphology is in sharp contrast to the classic description of the organism in tissues and presented diagnostic difficulties, which are discussed in this report. Hematogenous dissemination is considered to be an important part of the pathogenesis of the disease, but it is rarely documented during the symptomatic phase of acute histoplasmosis. Cultural documentation of hematogenous dissemination was obtained in this patient. These observations stress the importance of obtaining culture material from extrapulmonary sites early in the course of acute histoplasmosis when a specific diagnosis is necessary.