Neurologic manifestations of disseminated infection with Mycobacterium abscessus.

Mycobacterium abscessus is a ubiquitous, saprophytic organism with low pathogenic potential. The authors describe the previously unreported clinical features of meningitis and native valve endocarditis caused by this rapidly growing atypical mycobacterium. The fatal outcome of this unusual case coincides with the grim prognosis of this disseminated infection and the significant mortality rate associated with neurologic complications of infective endocarditis.

Proliferative activity in placentas with hydropic change and hydatidiform mole as detected by Ki-67 and proliferating cell nuclear antigen immunostaining.

Complete hydatidiform moles (CHM) and partial hydatidiform moles (PHM) represent different clinicopathologic entities. To obtain prognostic and therapeutic information about both entities, it is important that pathologic classification be as accurate as possible. The distinction of molar pregnancy and an abortus with hydropic changes (AHC) can sometimes be very difficult. The acquisition of 2 antibodies against nuclear antigens expressed in cycling cells, Ki-67 and proliferating cell nuclear antigen (PCNA), allow the study of trophoblastic proliferation in CHM, PHM, and AHC. The purpose of this study is to determine whether immunocytochemical stains can help in the distinction between those entities. All materials were obtained by curettage from 95 patients with hydropic villi evident on microscopic examination. The 95 cases included 33 cases of CHM, 42 cases of PHM, and 20 cases of AHC. In the case of the Ki-67 staining, the mean was much lower in the ACH group (8.7%) than in the PHM group (65.3%) or in the CHM group (84.6%). In the case of PCNA staining, the mean differences among the 3 groups (AHC, 23.1%; PHM, 80%; and CHM, 89.2%) were all statistically significant. On the basis of the means and the Gaussian results, it appears that the Ki-67 distribution gives a better separation among the 3 groups. In conclusion, proliferative activity is an additional useful parameter for evaluation of molar pregnancies and hydropic changes, with Ki-67 staining allowing better separation than PCNA staining does.

Breast conservation after induction chemotherapy for locally advanced breast cancer.

Neoadjuvant chemotherapy (NC) has been shown to reduce primary breast tumor size in 80 to 90 per cent of patients. This study prospectively evaluated a series of women with locally advanced operable breast cancer treated with NC with the purpose of identifying eligibility for breast conservation surgery (BC) and clinical parameters predictive of chemotherapy response. Patients with stage IIB and III primary operable breast cancer were evaluated prospectively between 1/1/91 and 12/31/95. Thirty-two patients received NC consisting of three cycles of 5-fluorouracil, doxirubicin, and cyclophosphamide. Prechemotherapy tumor size was assessed by palpation and mammography. Patients were offered BC depending on clinical response. Initial tumor size averaged 7 cm (range, 4-15 cm). Reduction of > 50 per cent in tumor size occurred in 17 patients (53%). Twenty-one patients (66%) were potential candidates for BC based on a post-NC pathologic tumor size of less than 4 cm. Five patients (16%) had no residual breast tumor. Four patients underwent BC (13%). Partial response was not associated with patients age, menopausal status, tumor steroid receptor or Her-2/NEU positivity, or tumor size. Patients with a clinically negative axilla had a higher likelihood of partial or complete response. NC in patients with locally advanced breast disease has a high response rate (88%) and can significantly reduce tumor size to enable conservation of the breast.

Fine-needle aspiration cytology of juvenile papillomatosis of breast: a case report.

The cytologic findings of juvenile papillomatosis (JP) have been rarely described. The clinical and cytologic findings were suggestive of a fibroadenoma, but due to the presence of 2 cc of clear fluid during the aspiration, fibrocystic change was in the differential diagnosis. Operation and subsequent examination of the mass identified a case of JP (so-called Swiss cheese disease of the breast). Because JP is a marker for breast carcinoma for the patients' families, and the patients may themselves be at increase risk for malignancy, it is important that this entity be considered in the differential diagnosis. The observations in this case indicate that it is difficult to diagnose JP only by cytology, but the combination of clinical findings--a well-circumscribed mass in a young patient with cystic fluid, but with a residual mass after aspiration due to the multicystic nature of JP--with the cytologic findings--sheets of hyperplatic breast epithelium with areas resembling fibroadenoma, macrophages, and apocrine cells--that appear to be sufficiently characteristic to suggest the diagnosis of JP.

Glial fibrillary acid protein immunoreactivity in fine-needle aspiration of salivary gland lesions: a useful adjunct for the differential diagnosis of salivary gland neoplasms.

The value of immunocytochemical staining for glial fibrillary acid protein (GFAP) in salivary gland lesions was investigated in 33 fine-needle aspiration smears. The study utilized cytologic material from ten pleomorphic adenomas, six normal salivary glands, three cases of chronic sialadenitis, three Warthin's tumors, two adenoid cystic carcinomas, three adenocarcinomas, two malignant mixed tumors, one acinic cell carcinoma, and three mucoepidermoid carcinomas. All tested pleomorphic adenomas stained positively. The adenoid cystic carcinomas and the cases of chronic sialadenitis, along with the low-grade mucoepidermoid carcinoma, were negative for GFAP immunoreactivity. These results indicate that immunostaining for GFAP may be a valuable aid in the diagnosis of pleomorphic adenoma; GFAP may be especially helpful in distinguishing those cases for which the differential diagnosis includes the aforementioned salivary gland neoplasms.

Keratin immunoreactivity in fine-needle aspiration of the prostate: an aid in the differentiation of benign epithelium from well-differentiated adenocarcinoma.

The efficacy of utilizing immunocytochemical staining of prostatic basal cells in separating benign from malignant prostatic epithelium was tested by staining fine-needle aspiration smears of prostatic lesions with the monoclonal antibody EAB-903. This antibody has been shown to stain keratin subtypes present in the prostate only in basal cells. The study utilized 12 benign, nine malignant, and four suspicious-for-carcinoma cases. Ten of 12 benign cases showed an intermingled pattern of staining, which was not found in the malignant cases. Our findings indicate that this distinctive pattern of staining may assist in distinguishing benign epithelium from well-differentiated prostatic adenocarcinoma.

Fine-needle aspiration cytology and the diagnosis of neoplasms in the pediatric age group.

Sixty-six aspirates obtained from 63 pediatric patients clinically suspected of having small cell malignancies were studied by a variety of techniques to determine the accuracy and utility of fine-needle aspiration (FNA) in the diagnosis of small round-cell neoplasms (SRCN) of childhood. FNA correctly identified all 47 SRCNs as malignant and gave a correct specific diagnosis in 81% of the cases. No false-positive diagnoses of malignancy occurred in this series. Electron microscopy, immunohistochemistry, and cell culture performed on FNA material were found to be useful aids in the differential diagnosis of these tumors. The cytologic appearances and differential diagnoses of these neoplasms are discussed.

Fine needle aspiration of invasive cribriform carcinoma with benign osteoclast-like giant cells of histiocytic origin. A case report.

We report the fine needle aspiration findings, with histologic confirmation, of a case of invasive cribriform carcinoma of the breast with benign osteoclast-like giant cells. We suggest that this diagnosis be considered when low to moderate grade malignant epithelial cells and numerous benign giant cells are seen in fine needle aspirates of the breast. We also confirmed immunohistochemically the histiocytic origin of the benign giant cells.

Fine needle aspirate smear morphology in metastatic melanoma.

Cytologic smear preparations of fine needle aspirates obtained from 71 patients with biopsy-proven metastatic malignant melanoma were morphologically analyzed. Cell diameter, percentage of cells lying individually, smear cellularity, mitotic rate, percentage of cells with nuclear inclusions and number of giant cells were quantitated. Qualitative estimates of degree of pigmentation, background composition, presence of macrophages, presence of contaminating blood, cell shape, amount and appearance of cytoplasm, prominence of Golgi apparatus, reactivity with the antibody NKI/C-3 and eccentricity of the nuclei were made. While eccentric nuclei, cytoplasmic vacuoles, intranuclear inclusions, high cellularity and cells with abundant cytoplasm were found frequently in smears from malignant melanomas, the presence of reactivity with NKI/C-3, pigment, giant cells, a bloody background and a lack of cell cohesion were the features most commonly associated with smears obtained from patients harboring metastatic melanoma.

Modified technique for fine needle aspiration biopsy that eliminates needle manipulation.

OBJECTIVE: To evaluate a modified technique of fine needle aspiration biopsy that eliminates needle manipulation after aspiration. STUDY DESIGN: Fine needle aspiration biopsy of 112 palpable lesions was performed using both the conventional and modified techniques. Cellularity, cell preservation and diagnostic yield of the new procedure were compared to those of the conventional technique. RESULTS: Cytologic smears prepared from each method were comparable in quality, quantity and diagnostic yield. CONCLUSION: The modified approach eliminates the hazard of needle manipulation without diminishing the diagnostic efficacy of fine needle aspiration biopsy.

Primary inflammatory malignant fibrous histiocytoma of the colon.

A unique case of inflammatory malignant fibrous histiocytoma of the large bowel is presented. This lesion occurred in the colon of an elderly man suffering from weakness, anemia, anorexia, and weight loss. A right hemicolectomy was performed, and six months later, on follow-up, he was found to be well. The literature on visceral involvement by malignant fibrohistiocytic tumors is reviewed.

Colonic bleeding due to rupture of an isolated iliac artery aneurysm into a caecal carcinoma.

We describe a case of a fistula between an atherosclerotic aneurysm of the right common iliac artery and a caecal carcinoma, causing massive colonic bleeding. A fistula between a true aneurysm and a carcinoma of the colon has not to our knowledge been previously reported. Various aspects of this case are discussed from a pathogenetic point of view.

Intraventricular neurocytoma with prominent myelin figures.

A case is reported of intraventricular neurocytoma that had characteristic light microscopic findings of neurocytoma with prominent intracytoplasmic concentric lamellar structures mimicking myelin sheaths. On routine H&E-stained sections, this tumor showed intracytoplasmic vesicular bleb-like structures having eosinophilic cores that were consistent with ultrastructural concentric lamellar structures. Immunohistochemically, this tumor was immunoreactive for synaptophysin and neurofilament, but negative for antibody to glial fibriallary acidic protein. Electron microscopic findings fulfilled the criteria for neurocytoma, with the presence of neurosecretory granules and neurotubules. These findings may suggest dual differentiation of this tumor into neurocytes and oligodendrocytes.

Imaging of gallbladder carcinoma.

Although carcinoma of the gallbladder has a low overall prevalence, it is the most common malignant tumor of the biliary tract. Retrospectively, 59 cases of histologically proved gallbladder carcinoma were reviewed. The series consisted of 42 women and 17 men, ranging in age from 35 to 86 years. Clinical manifestations of gallbladder carcinoma include right upper quadrant pain, anorexia, weight loss, and jaundice. Radiologic findings included focal or diffuse thickening of the gallbladder wall (49%), a mass in the gallbladder fossa (37%), and an intraluminal mass (14%). Associated findings were cholelithiasis (64%), biliary duct dilatation (38%), invasion of the adjacent structures (67%), distant metastases other than those of the liver (3%), and porcelain gallbladder (4%). The histologic diagnoses were adenocarcinoma (90%) and squamous cell carcinoma (10%). Differential diagnoses include all conditions in which the gallbladder wall appears thickened. A general awareness of the radiologic features of gallbladder carcinoma enhances preoperative diagnoses.