Comparative immunohistochemical investigation of markers for malignant histiocytes.

The presence of lysozyme, alpha 1-antitrypsin (AT), alpha 1-antichymotrypsin (ACT), and cytoplasmic receptors for peanut and soy bean agglutinin and for concanavalin A (PNA, SBA, and ConA, respectively) was investigated in formalin-fixed, paraffin-embedded material from 16 cases of malignant histiocytosis. The tumors in these cases did not show phenotypic characteristics of T or B cells. Lysozyme and AT especially were found less frequently in tumor cells from malignant histiocytosis than in normal histiocytes, whereas ACT and binding sites for the lectins were maintained during malignancy. Specimens from 44 per cent of the cases were positive for lysozyme, 56 per cent for AT, 82 per cent for ACT, 88 per cent for PNA receptors, 94 per cent for SBA receptors, and 100 per cent for ConA receptors. Tumor cells from B- and T-cell lymphomas were negative for these markers. Plasma cells, granulocytes, and fibroblasts sometimes bound ConA, but not PNA or SBA. The cases of malignant histiocytosis were subdivided into three groups on the basis of grade of differentiation. The tumor cells from the cases in group 1 showed the highest degree of differentiation, those from group 2 an intermediate degree, and those from group 3 the lowest degree. Mitotic activity was present mainly in groups 1 and 2. Lysozyme was present most frequently in groups 1 and 3 and in cases with the least mitotic activity. Expression of AT was decreased in groups 2 and 3. The presence of phagocytosis, which is not obligatory for the diagnosis, was always correlated with ACT staining. The presence of binding sites for these lectins can be considered a useful marker for malignant histiocytes.

Lymphoscintigraphy and ultrasound-guided fine needle aspiration cytology of sentinel lymph nodes in head and neck cancer patients.

Accurate staging of the regional lymph nodes is crucial for the appropriate management of patients with squamous cell carcinoma of the head and neck (HNSCC). However, the current diagnostic modalities have low accuracy for N0 neck, and even the most optimal procedure, ultrasound-guided fine needle aspiration cytology (USgFNAC), still has a sensitivity of only 42%-73%. In this study we evaluated whether the identification of the sentinel node might improve the selection of lymph nodes for USgFNAC. Twelve HNSCC patients received 3-4 peritumoral injections of 10-30 MBq 99mTc-labeled colloidal albumin, and the sentinel node was identified by dynamic scintigraphy and marked on the skin using a handheld probe, and/or by scintillation counting of the aspirates. After sentinel node identification USgFNAC was performed. Correct aspiration of the identified sentinel node(s) was confirmed by scintillation counting. In 11 out of 12 cases the sentinel node(s) could be visualized by dynamic planar imaging. In one case the sentinel node(s) were identified by scintillation counting only. In a number of patients different or supplementary lymph nodes were aspirated on the basis of sentinel node identification. These initial data strongly suggest that sentinel node identification might improve the staging of the neck by USgFNAC.

[Effective intraoperative identification of parathyroid adenomas by means of a gamma probe after injection of technetium 99m-sestamibi in 5 patients]. / Effectieve intraoperatieve detectie van een bijschildklieradenoom met een gammaprobe na injectie van technetium-99m-sestamibi bij 5 patiënten.

Primary hyperparathyroidism is caused by a single adenoma in the majority of patients. In five patients (2 men aged 74 and 78 and 3 women aged 78, 58 an 73 years) a recently introduced approach for intraoperative identification of pathological parathyroid glands was applied using intravenously injected technetium-99m(99mTc)-sestamibi and a gamma probe. For two patients this was a reoperation in this region. All patients had one adenoma removed and became normocalcaemic postoperatively. The time between the start of the operation until the extirpation of the adenoma was 13-25 min, a lot shorter than bilateral cervical exploration takes, even in the two reoperations. These results confirm the literature that this approach minimizes operative intervention, thereby shortening operative time and reducing potential surgical complications.

[Less axillary dissection necessary due to sentinel node biopsy in patients with breast carcinoma]. / Minder okselklierdissectie nodig door schildwachtklierbiopsie bij patiënten met mammacarcinoom.

OBJECTIVE: To determine whether the sentinel node concept is appropriate in patients with breast cancer, notably whether the sentinel node can be identified after peritumoral injection of colloidal 99mTc albumin using lymphoscintigraphy or a handheld gamma probe in the axillary drainage area. DESIGN: Descriptive. SETTING: Academic Hospital Free University, Amsterdam, the Netherlands. METHOD: In 30 consecutive patients with T1 and T2 breast cancer lymphoscintigraphy was performed 2 and 18 hours after peritumoral injection of 40 MBq of colloidal 99mTc albumin injection. Focal accumulations in the axilla were registered and localized in vivo using a handheld gamma probe. All patients underwent axillary lymph node dissection. From each surgical specimen the sentinel node was isolated and examined histopathologically. RESULTS: In 28 of the 30 patients lymphoscintigraphy revealed at least one distinct focal accumulation in the axillary region after 2 and 18 h. In nine women more than one sentinel node was registered: two in six and three in three women. In all 28 patients the node was identified in the surgical specimen by gamma probe. In 19 of the 28 (67%) both the sentinel node and the axillary lymph nodes were without metastasis. Three patients had metastases both in the sentinel and in the other axillary nodes, and in 6 patients (21%) the sentinel node was the only node with metastasis. CONCLUSION: In the majority of breast cancer patients a sentinel node was identified after peritumoral injection of colloidal 99mTc albumin, and with a handheld gamma probe the node could be found in the surgical specimen. In none of the women metastasis was found in other lymph nodes if the sentinel node was unaffected.

[Summary of the guideline 'Sentinel node biopsy in breast cancer.' Dutch Work Group 'Sentinel Node Biopsy for Breast Cancer']. / Samenvatting van de richtlijn 'Schildwachtklierbiopsie bij mammacarcinoom'.

The team Sentinel Node Biopsy Breast Cancer issued guidelines for the performance of the sentinel node procedure. The team took into account the problems resulting from the introduction of the technique. The eligible group consists mainly of women with demonstrated breast cancer with a diameter of < or = 2 cm without palpable axillary nodes. Contraindications include presence of more than one tumour, pathological nodes in the ipsilateral axilla and previous treatment of breast or axilla. After injection of a radioactive substance, the sentinel node is detected during the operation using a gamma probe. The tracer is injected 2 to 24 hours before the operation in or near the tumour. Shortly before the incision, patent blue is injected as well, improving the detectability of the sentinel node. One or several sentinel nodes are examined histologically. The pathology report meets minimal requirements. In the planning and introduction of the technique in a hospital a locally responsible radiation expert should be involved. The procedure should be performed a number of times and evaluated with reference to a histopathological result before it is decided to draw clinical conclusions from the procedure. For the necessary evaluations of the procedure central registration is an absolute condition.

Lymphatic mapping after previous breast surgery.

BACKGROUND: To assess the feasibility of lymphatic mapping and determine the lymphatic drainage pathways in patients previously treated with breast conserving therapy (BCT). METHODS: We included patients without current breast cancer that previously received BCT with sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND) for primary breast cancer. The study population consisted of 44 patients and was divided into two groups according to previous surgical treatment of the axilla: 22 patients after previous SNB and 22 patients after previous ALND. Standard lymphatic mapping was performed and the lymphatic drainage pattern was registered. Drainage located outside the ipsilateral axilla was recorded as aberrant. RESULTS: Lymphoscintigraphy revealed a drainage pattern in 17 of 44 patients (39%). The identification rate in the SNB-group was 41% and 36% in the ALND-group (P=0.760). 8 patients (18%) showed aberrant drainage, which tended to be more frequent in the ALND-group than in the SNB-group (27% versus 9%, P=0.122). Lymphatic drainage to the contralateral axilla was observed in 2 patients, both previously treated with ALND. CONCLUSIONS: Lymphatic mapping seems feasible after previous BCT with axillary treatment, in spite of a relatively low identification rate. Aberrant drainage tends to be more frequent after previous treatment with ALND.

Human papillomavirus, lichen sclerosus, and squamous cell carcinoma of the vulva: detection and prognostic significance.

Detection of HPV-DNA in squamous vulvar carcinoma, its prognostic significance, and investigation of the presence of lichen sclerosus near HPV-DNA-positive vulvar carcinomas were the objectives of this study. In 60 samples of squamous vulvar cancer, we looked for HPV-DNA by means of PCR. The same samples were examined for the presence of lichen sclerosus. The possible prognostic significance of the presence of HPV-DNA and lichen sclerosus was studied. Nineteen (32%) of the samples were HPV-DNA positive using PCR. Patients with an HPV-positive tumor had a better prognosis than those with an HPV-negative tumor (P = 0.03). Lichen sclerosus was found in 19 tumor samples, of which 7 had detectable HPV-DNA. Only a minority of vulvar cancers contain HPV-DNA. In contrast to previous statements, near some of these HPV-positive cancers, lichen sclerosus can be found.