The effect of external beam irradiation timing on skin graft survival.

BACKGROUND: The purpose of this study was to evaluate skin graft integrity after external beam irradiation in a rat model. METHODS: Forty-eight male Wistar rats were randomly assigned to 8 groups (A, B, C, D, A(c), B(c), C(c) and D(c)). A rectangular full-thickness skin graft was raised and reapplied to its original bed on the dorsum of each rat. Groups A(c), B(c), C(c) and D(c) were the control groups and were not given postoperative irradiation. After grafting, 25 Gy unfractioned cobalt(60) irradiation was administered to groups A, B, C and D on postoperative days 10, 20, 30 and 40, respectively. Histological samples were obtained 8 weeks after grafting. Dermal and epidermal thickness were measured by the KS-400 image analysis program. RESULTS: The difference in the epidermal and/or dermal thickness between the irradiated groups was not found to be significant. Furthermore, when histological features and the image analysis of the irradiated groups were compared with each other, there were no significant differences between the groups. CONCLUSIONS: Although we are aware that experimental results may not directly translate to the clinical setting, the present study indicates that external radiotherapy can be performed to skin-grafted areas as early as 10 days postoperatively.

Evaluation of posttransplantation malignancies compared with de novo tumors.

It is uncertain whether tumors arising in transplant patients resemble ones that develop de novo in pathogenesis, morphology, and behavior. This study sought to investigate some clinical, morphological, and immunohistochemical features of several posttransplantation malignancies compared with similar de novo tumors. The study group consisted of 40 malignant tumors encountered in 1350 transplant patients (1229 kidneys, 113 livers, 8 hearts) between 1986 and 2006. Tumors with 3 or more examples were compared with randomly selected controls. These included Kaposi's sarcoma (n=14); extranodal lymphoma (n=9); squamous cell carcinoma (n=6); and nodal lymphoma (n=3). The variables that were analyzed were the localization, predisposing lesions, degree of differentiation, and host response. For lymphomas, we also determined histological subtype, origin, and Ki-67 proliferation index. Most tumors (36/40, 90%) occurred in patients with renal transplants. However, the relative frequency was higher among liver transplant cases (3.53% vs 2.92% for kidney transplants). No malignancy was seen in heart transplant cases. Squamous cell carcinomas were better differentiated (P<.05) compared with controls and they were more frequently associated with precursor lesions (P<.05). Kaposi's sarcomas involved internal organs more frequently in posttransplant patients, and the Ki-67 proliferation index was higher in posttransplantation nodal lymphomas. However, these factors were not significantly different (P>.05). Our findings suggested that certain posttransplantation malignancies display unique characteristics compared with their de novo counterparts.

Ki-67 proliferation index in Kaposi's sarcoma after renal transplantation: findings in skin-only cases versus cases with internal-organ involvement.

Kaposi's sarcoma (KS) is an angioproliferative condition that accounts for 6% of all malignancies in organ transplant patients. When we review the literature, the results of the studies comparing the different stages and the proliferative activity of the tumor are challenging. However, we found no previous study on Ki-67 protein expression in KS that correlates skin and organ lesions. In the current study, we investigated whether there is a correlation on the proliferative activity between skin and internal organ lesions in KS. Proliferative activity of 13 biopsy specimens of KS was assessed immunohistochemically using the monoclonal antibody MIB-1 (Ki-67). Mann-Whitney U test is used for statistical analysis and a P value < .05 was considered significant. Seven of 13 cases were skin and six were internal organ KS. For skin lesions, the mean MIB-1 proliferation index was 14.5%, and it was 13% for organ lesions. There was no significant association between skin and internal organ KS in regard to MIB-1 PI (P > .05). The findings suggested that the proliferative activity in KS does not differ in skin and organ lesions. On the other hand, it should be considered that the number of cases in our study was limited and further studies with a larger series are needed.

Intra-hospital use of a telepathology system.

Utilization of telepathology systems to cover distant geographical areas has increased recently. However, the potential usefulness of similar systems for closer distances does not seem to be widely appreciated. In this study, we present data on the use of a simple telepathology system connecting the pathology department and the intra-operative consultation room within the operating theaters of the hospital. Ninety-eight frozen section cases from a past period have been re-evaluated using a real-time setup. Forty-eight of the cases have been re-evaluated in the customary fashion; allowing both ends to communicate and cooperate freely. Fifty of the cases, however, were evaluated by the consultant while the operating room end behaved like a robot; moving the stage of the microscope, changing and focusing the objectives. The deferral rate was lower than the original frozen section evaluations. Overall, the sensitivity was 100%, specificity 98%, negative predictive value 96, 5% and positive predictive value 100%. No significant difference was found for the diagnostic performances between the cooperative and robotic simulation methods.Our results strengthen the belief that telepathology is a valuable tool in offering pathology services to remote areas. The far side of a hospital building can also be a remote area and a low cost system can be helpful for intraoperative consultations. Educational value of such a system is also commendable.

Odontogenic myxoma. Report of a periodontally-located case.

In this article, a case of odontogenic myxoma with deceptively bland radiographic findings and a clinical impression of periodontal abscess is presented.

Gingival Langerhans' cells in type I diabetes mellitus.

Langerhans' cells (LCs) are intraepithelial immunocompetent cells. Changes in the number of LCs occur in inflammatory and autoimmune diseases. In this study, the number of gingival LCs in patients with type I diabetes mellitus was compared with those of normal individuals using immunohistochemical methods. Gingival biopsies were obtained from 20 type I diabetics and 10 healthy individuals. Anti-CD1 positive LCs formed an intraepithelial network and showed a marked increase in type I diabetics. This increase was not related to diabetic age. The number of LCs was proportional to the density of subepithelial inflammatory cells. Our findings suggest that LCs may play a role in the development of diabetic gingivitis.

Mast cells in granulomatous liver disease.

Mast cells are known to be present in normal liver tissue but the data on their association with diseases of the liver are limited. In this study we used a long toluidine blue technique to investigate the mast cell numbers in 20 normal and 45 diseased liver biopsies containing granulomas (20 tuberculosis, 14 sarcoidosis, 4 schistosomiasis, 4 neoplasia-associated, 3 drug idiosyncrasy). Our results show that the mast cells are regular constituents of normal portal tracts and the amount of mast cells in the diseased samples corresponds to the area occupied by non-parenchymal tissues. As compared to normal controls, significantly less mast cells were present in biopsies from tuberculosis patients (p less than 0.025). Highest numbers were found in the schistosomiasis group. No link between the mast cell numbers and the cause of the granulomas could be demonstrated.

DNA ploidy and nuclear morphometry in adult intracranial ependymomas.

The identification of prognostic parameters in ependymomas remains an important but controversial issue in particular to the significance of histopathological features. Intracranial location is a rare presentation for adult ependymomas. DNA ploidy status and nuclear morphometric features of ependymomas are not well-established. We retrospectively studied the clinicopathologic features of 12 adult intracranial ependymomas and performed image cytometric DNA analysis with nuclear morphometry. The overall survival rate was 75%. Two cases were anaplastic ependymomas. Statistically, histology failed to demonstrate a correlation with clinical outcome or overall survival. DNA ploidy (p = 0.033), DNA index (p = 0.016) and 5c exceeding rate (p = 0.017) were statistically correlated with clinical outcome, but not correlated with overall survival. Nuclear morphometric features measured using 3 different data selection methods were not correlated with clinical outcome or overall survival. It is difficult to identify prognostic factors in a series of cases with limited number. The problem is complicated by the fact that the common criteria used for recognizing malignancy in gliomas are not completely reliable in ependymomas. Nuclear morphometric findings support the general impression that ependymomas are morphologically highly variable tumors. In spite of the small sample size of our series and other factors influencing survival such as the extent of resection and malignant histology, aneuploidy can be suggested as a promising factor, which may reflect potential aggressiveness of the tumor in adult intracranial ependymomas.

Epidermolysis bullosa associated with pyloric, esophageal, and anal atresia: a case report.

The association of epidermolysis bullosa (EB) and pyloric atresia (PA) in newborns is rare but has been well described. It has been reported that in patients with EB, the esophageal, gastric, intestinal, and colonic mucosae are affected. The authors report a case of EB and PA associated with esophageal and anal atresia in a newborn. To our knowledge, these associations had not been reported in the English-language literature.

Primary non-Hodgkin's lymphoma of the liver (case report).

Primary non-Hodgkin's lymphoma of the liver is very uncommon, and fewer than 100 cases have been reported in the literature. Most reports describe either solitary or multiple mass lesions in the liver. A diffuse lesion without nodule formation is a relatively rare form of the disease. The histologic feature of the disease is a predominantly large cell lymphoma of B-cell lineage. We report a case of primary B-cell non-Hodgkin's lymphoma which had diffusely infiltrated the liver without nodule formation.

Presence of endocervical cells and number of slides in cervicovaginal smears: differences in performance between gynecologists.

OBJECTIVE: To study the association of precancerous cervical lesions with the presence of endocervical cells on Pap smears; and to evaluate gynecologists' approaches to the information on smear reports regarding endocervical cell status. STUDY DESIGN: Pap smear reports on 1,637 samples sent by 12 gynecologists were analyzed. The presence of endocervical cells, number of glass slides used per patient, and frequency and distribution of "atypia" and of pathogenetic microorganisms were recorded. Gynecologists' performances were compared, and their reactions to the reported lack of endocervical cells in their smears were evaluated. RESULTS: Atypia was detected significantly more frequently in samples with endocervical cells (1 in 664 versus 31 in 973, P < .01). Likelihood of detecting a pathogenetic microorganism, however, was not affected by the presence or absence of endocervical cells. In samples from certain gynecologists, endocervical cells were present most of the time, and in others they were generally lacking. This pattern did not change over time; specifically, the performance of the latter group of gynecologists did not improve in spite of their receiving information on the absence of endocervical cells in their samples. CONCLUSION: The performance of the "smear taker" is an important component of Pap smear screening practice. Efforts to increase the quality of service should cover not only laboratories but also gynecologists and others who take smears. Screening can only be successful as a system in the presence of good samples.

Cementifying fibroma diagnosed by fine needle aspiration cytology. A case report.

A case of cementifying fibroma in the right lateral mandible was diagnosed by fine needle aspiration (FNA) cytology. The aspirate was a cellular specimen composed of clusters of oval and spindle-shaped fibroblasts with no atypical features. These cells were admixed with spherical, calcified structures. A diagnosis of "consistent with benign fibroosseous lesion, suggestive of cementoossifying fibroma" was made, and subsequent histologic examination confirmed this cytologic diagnosis. The clinical, cytologic and histologic findings in the case are presented, and the value of FNA cytology in the diagnosis of jaw lesions is discussed.

Fine needle aspiration cytology of malignant lymphoepithelial lesion of the salivary gland. A report of two cases.

Fine needle aspiration cytologic findings in two cases of malignant lymphoepithelial lesion (MLEL) of the parotid glands are presented. Aspirates of both cases showed individual or cohesive clusters of tumor cells intermingling with mature lymphocytes. Cervical lymph node aspirates in both cases were similar to those seen in the parotids. Our findings suggest that neither cytology nor histology of the cervical lymph nodes is conclusive in establishing the primary site of a metastatic lymphoepitheliomalike carcinoma. MLEL of the salivary glands must be included in the differential diagnosis.

Fine needle aspiration cytology of oral cavity and jaw bone lesions. A report of 102 cases.

Fine needle aspiration cytology of oral cavity and jaw bone lesions was performed on 102 patients. The cytologic diagnoses were compared with the results of histologic examination. Thirteen of the 15 histologically malignant lesions and 71 of the 87 histologically benign lesions were cytologically diagnosed accurately. In 12 (92%) of the malignant and 69 (97%) of the benign lesions, specific cytologic diagnoses were given that proved the same or very similar to the final histologic diagnoses. This study showed that the overall accuracy of fine needle aspiration cytology in the oral cavity and jaw bones is high and is not significantly different from that obtained in other body regions.

Fine needle aspiration cytologic findings in a benign lymphoepithelial lesion with microcalcifications. A case report.

Aspiration cytologic findings in a case of benign lymphoepithelial lesion (BLL) of the parotid gland are presented. The aspirate contained a polymorphous lymphoid population, histiocytes, myoepithelial and ductal epithelial cells and numerous bluish, calcified bodies. A cytologic diagnosis of benign nonneoplastic lesion, consistent with chronic sialadenitis and microlithiasis, was made. The clinical impression of neoplasia was inconsistent with the cytologic findings. Subsequent histologic examination showed classic BLL with microcalcifications as an unexpected feature. The value and limitations of fine needle aspiration cytology in the diagnosis of nonneoplastic salivary gland lesions and the differential diagnosis of BLL are discussed.

Isolate abdominal bronchogenic cyst: a case report.

Isolated abdominal bronchogenic cysts are rare abnormalities. They are usually asymptomatic unless secondarily infected or large enough to cause compression of other vital structures. The authors report on a 20-month-old girl who had an abdominal bronchogenic cyst and presented with a history of recurrent urinary tract infections. The evaluation and treatment of this patient is presented as well as a review of the ten previously reported cases. A literature review showed only four cases in the pediatric age group. Excision is recommended to establish diagnosis and alleviate any symptoms. Abdominal bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal masses.

Estrogen and progesterone receptors in the peripheral giant cell granulomas of the oral cavity.

Peripheral giant cell granulomas are common proliferative lesions of the oral cavity with a predilection for females. In this study, the presence of estrogen and progesterone receptors in 26 peripheral giant cell granuloma cases were studied utilizing the immunoperoxidase technique. In fourteen cases, estrogen receptor positivity was found in stromal cells. In ten of these, osteoclast-type giant cells also exhibited estrogen receptor immunostaining. Progesterone receptor expression was not detected. It was concluded that the cells forming peripheral giant cell granuloma are potential targets for estrogens and that these lesions might be conditioned by sex hormones.

Solitary fibrous tumour arising from sublingual gland: report of a case.

A solitary fibrous tumour is a pleural tumour which may rarely be detected at non-pleural sites. In this report, the case of a solitary fibrous tumour arising from the sublingual salivary gland is described.

Ameloblastic fibro-odontoma. Case report.

Ameloblastic fibro-odontoma is a relatively rare odontogenic tumour which is composed of ameloblastic fibroma and a complex or compound odontoma. In this article, a case of a two-year-old boy with this tumour is presented.

Examination of periodontal tissues by a cutting-grinding technique.

The decalcification process removes the mineralized part of the dental hard tissues, making the histologic examination of enamel-associated tissues less than optimal. The cutting-grinding technique allows preparation of histologic slides with well preserved dental hard tissues together with their surrounding soft tissue components. In this paper, the histologic appearances of undecalcified teeth and their associated periodontal tissues prepared using the cutting-grinding technique are described.