Cellular dyscohesion in fine-needle aspiration of breast carcinoma. Prognostic indicator for axillary lymph node metastases?

The role of fine-needle aspiration (FNA) in the diagnosis of breast carcinoma is established. We evaluated whether the degree of cellular dyscohesion and the nuclear grade in FNA material of breast carcinomas are reliable prognostic predictors for ipsilateral axillary lymph node metastasis. FNA specimens from 98 women with infiltrating ductal and infiltrating lobular carcinomas were evaluated by 2 observers for degree of cellular dyscohesion and nuclear grade. Follow-up specimens from lumpectomy and/or mastectomy with axillary dissection were available for each patient. By univariate analysis, degree of cellular dyscohesion and nuclear grade were not predictive of axillary lymph node metastasis regardless of tumor size. High histologic grade, size greater than 2 cm, and patient age younger than 52 years were significant predictors of metastasis. By multivariate analysis, size greater than 2 cm and age younger than 52 years were statistically significant for lymph node metastasis. In contrast with a published study, the results of the present study fail to show cellular dyscohesion in FNA specimens as predictive of lymph node metastasis; however, the scoring method for determining the degree of cellular dyscohesion is reproducible between 2 independent observers.

Supernumerary breast tissue: historical perspectives and clinical features.

The presence of extra nipples and breasts, polythelia and polymastia respectively, is not uncommon. Such supernumerary breast tissue usually is found within the milk line extending from the axilla to pubic region. It was once thought that this condition was a symbol of increased fertility and femininity. Anne Boleyn was said to have a third breast. Ancient goddesses of fertility had row upon row of breasts on their chests. Polythelia is seen congenitally. Ectopic breast tissue and polymastia may not appear until enhanced by sex hormones during puberty or early pregnancy. The same pathology that can affect normally positioned breasts, including carcinoma, can occur in supernumerary breast tissue. Renal and other organ system anomalies are associated with supernumerary breast tissue. Further research is needed to establish the clinical significance of supernumerary breast tissue in light of its reported associated conditions. Appropriate treatment is yet to be refined.

Utility of fine needle aspiration in HIV-positive patients with corresponding CD4 counts. Four years' experience in a large inner city hospital.

OBJECTIVE: To assess the utility of fine needle aspiration (FNA) in human immunodeficiency virus (HIV)-positive patients with corresponding CD4 count analysis. STUDY DESIGN: The study group consisted of 108 FNA specimens from 80 patients performed from January 1991 to December 1994. RESULTS: FNAs were sub-typed into four categories: lymph nodes (59 specimens), masses (26 specimens), salivary glands (19 specimens) and breast (4 specimens). Thirty-three were diagnosed as reactive lymph nodes, 15% as benign lymphoepithelial lesions and 9% as granulomas; 9% revealed acute inflammation, 5% were positive for malignant lymphoma, and 3% were suspicious for Kaposi's sarcoma. Differences in CD4 counts were statistically significant for specific subsets of HIV-related illnesses. General trends were noted in mean CD4 counts for specific sub-groups of HIV-related illnesses. CONCLUSION: Material adequate for culture can be obtained with the FNA procedure. FNA in skilled hands is a very useful simple and cost-effective procedure for the diagnosis of HIV-related lesions and in the management of these patients. This study suggested that mean CD4 counts are statistically significant in specific subsets of HIV related illnesses.

Myeloperoxidase deficiency and severe sepsis.

We have described a 45-year-old obese white man found to have myeloperoxidase (MPO) deficiency of the granulocytic and monocytic series. Pancreatic necrosis due to bacterial infection developed as a complication of acute pancreatitis. Subsequently, he died of sepsis. MPO staining of terminal antemortem blood smears and postmortem bone marrow aspirates showed absence of MPO in cells of the myelocytic and monocytic series. Family members' neutrophils and monocytes stained positive for MPO. MPO deficiency associated with severe sepsis is rarely reported. This case serves as a review of the association between hereditary and acquired MPO deficiency and severe infection.

Undifferentiated small cell carcinoma of the urinary bladder.

We have reported a case of small cell carcinoma of the urinary bladder in a 65-year-old white man with a smoking history. He had radical cystectomy, but died 6 months after initial diagnosis. The patient terminally had liver metastasis, confirmed by fine needle aspiration and radiographic evidence of intra-abdominal and right adrenal gland metastasis.