Evaluation of lymph nodes in squamous cell carcinoma of the cervix: touch imprint cytology versus frozen section histology.

Metastatic involvement of pelvic lymph nodes (LNs) is the most important negative predictor of survival in early stage cervical cancer. Because the presence of nodal metastases precludes the continuance of any radical surgical procedure, an extraperitoneal LN dissection is performed and LNs are sent for frozen section (FS). As the time for routine FS is about 15 minutes per LN, the use of a faster method, cytology by touch imprint (TI), was investigated. A prospective study was performed to determine the feasibility of TI technique vs. FS. Three hundred eighteen pelvic and para-aortic LNs from 32 patients with cervical cancer of stage I-IV were bisected and submitted for FS after TI had been prepared. Twenty-nine nodes (9.1%) revealed metastatic squamous cell carcinoma (SCC) by frozen section histology. Twenty-six of these were diagnosed by TI and confirmed histologically. Reasons for the 3 false negatives included inadequate preparation or misinterpretation of the TI. Permanent histology always agreed with the frozen section result. Cytologic evaluation of pelvic LNs for SCC at the time of intraoperative consultation had a sensitivity and specificity of 90% and 100%, respectively. Touch imprints may provide a sensitive, specific, and time-efficient method to diagnose nodal metastases in cervical SCC.

Congenital parvovirus infection.

Congenital parvovirus infection was diagnosed in two liveborn premature infants born at 24 and 35 weeks of gestational age. The illnesses were associated with placentomegaly, petechial rash, edema, hepatomegaly, anemia and thrombocytopenia, respiratory insufficiency, and death at 5 and 6 days of age. The syndromes exhibited by these cases shared common but nonspecific features with other life-threatening congenital infections. Serological studies in one case supported the diagnosis of parvoviral infection. Postmortem examination of both revealed nuclear inclusions in erythroid precursor cells characteristic of parvovirus infection. Use of the polymerase chain reaction confirmed the presence of parvovirus DNA in one of the cases. Intrauterine parvovirus B19 infection is most commonly associated with hydrops fetalis, "transient" hydrops, or a favorable outcome in infants found to be viremic after birth. These and previously reported examples of congenital B19 disease exemplify an exceptional form of human parvovirus infection.

p53 and MDM2 immunostaining in pulmonary blastomas and bronchogenic carcinomas.

Pulmonary blastomas (PBs) are rare primary malignancies that include adult types: biphasic pulmonary blastoma (BPB) and well-differentiated fetal adenocarcinoma (WDFA); and childhood type: pleuropulmonary blastoma (PPB). Their pathogenesis and relationship to bronchogenic carcinoma (BCA) are controversial. To determine whether or not PB share molecular pathological features with BCA, the authors immunostained three BPB, three WDFA, three PPB, and 80 standard BCA for p53 protein and MDM2 protein, gene products believed to be significant in the pathogenesis of BCA. Paraffin-embedded tissue sections were immunostained with monoclonal antibody to p53 and MDM2 proteins. Strong intranuclear staining in greater than 10% of cells was considered positive. Three (50%) BPB and WDFA stained for p53 and five (83%) for MDM2. None of the PPB stained for p53, and one PPB did not stain for either p53 or MDM2. Five of six adult type PB occurred in smokers, whereas none of the PPB was associated with smoking. Seventy-five (94%) of the BCA stained for MDM2 and 46 (61%) for p53. Immunostaining patterns for p53 and MDM2 in adult types of PB, and not PPB, appear similar to those for BCA. This may suggest that adult type PB, but not childhood PB, have a similar pathogenesis to BCA.

p53 immunostaining in the differentiation of inflammatory pseudotumor from sarcoma involving the lung.

Inflammatory pseudotumor (IPT) of the lung is a non-neoplastic process that consists of proliferating spindle cells (fibroblasts and myoblasts), with variable numbers of mitoses, and inflammatory cells, particularly plasma cells. These lesions clinically, radiographically, and grossly mimic malignant neoplasms but are usually easily distinguished from malignancy on routine histopathology. However, in occasional cases the proliferating spindle cells may histopathologically mimic sarcoma, particularly on small biopsies and needle aspirates. Strong intranuclear immunopositivity for p53 protein is presumed to be indirect evidence of mutation of the p53 tumor suppressor gene and can be detected in many malignancies. In order to determine the utility of p53 immunostaining in differentiating IPT occurring in the lung from sarcoma involving the lung, we immunostained eight solitary IPTs, one IPT that recurred repeatedly over a 10-year period, six sarcomas (two malignant fibrous histiocytomas, two metastatic high-grade sarcomas, one metastatic alveolar soft part sarcoma, and one fibrosarcoma) involving the lung, and one IPT from which a sarcoma arose 10 years after radiation therapy. Immunohistochemistry was performed on 5-microns formalin-fixed sections using a commercially available antibody to the p53 protein (Biogenex, monoclonal 1:200) and a standard antigen retrieval technique. Weak intranuclear staining occurring in less than 10% of proliferating cells was not considered a true immunopositive. All eight of the solitary IPTs were immunonegative for p53 protein by our criteria. The IPT that recurred a number of times and the IPT from which a sarcoma later developed were also immunonegative for p53 protein. Four of the six sarcomas were immunopositive, as was the postradiation sarcoma arising from a p53-immunonegative IPT.(ABSTRACT TRUNCATED AT 250 WORDS)