Signalment and clinical complaints initiating hospital admission, methods of diagnosis, and pathological findings associated with bovine lymphosarcoma (112 cases).

BACKGROUND: Lymphosarcoma in adult cattle has multiple manifestations. OBJECTIVE: To describe the signalment, clinical complaints, and tumor location, and to evaluate utility of diagnostic tests in cattle with lymphosarcoma. ANIMALS: Adult cattle admitted to Cornell University between January 1980 and December 2008 with a definitive diagnosis of lymphosarcoma. METHODS: Retrospective case study was conducted with a search of all medical records at Cornell University for cattle diagnosed with lymphosarcoma. Categorical data were analyzed with a Wilcoxon rank-sum tests. Sensitivities of diagnostic tests were calculated. RESULTS: There were 106 cows and 6 bulls (median age 5 years) examined for anorexia (34%), weight loss (16%), and fever (14%). The sensitivities of antemortem diagnostic tests performed were peripheral lymph node (PLN) wedge biopsy, 100%; surgical exploration and biopsy, 100%; pleurocentesis, 80%; pericardiocentesis, 67%; PLN fine-needle aspirate, 41%; abdominocentesis, 33%; and cerebral spinal fluid tap, 19%. Median peripheral blood lymphocyte count was 4,900 cells/muL, 10% of cattle were leukemic and 25% had lymphocytosis according to the Bendixen Key. The most frequently identified tumor locations (% of cattle) were the heart (66%), abomasum (61%), uterus (38%), kidney (32%), and epidural space (26%). CONCLUSIONS AND CLINICAL IMPORTANCE: Predilection sites were similar to previously reports but we found a higher incidence of renal tumors and lower incidence of retrobulbar tumors. Knowledge of common clinical presentations, organ involvement, and sensitivities of diagnostic tests will aid informed decisions on the most appropriate tests and interpretation of their results in clinical cases of bovine lymphosarcoma.

Oestrogen and progesterone receptor status of individual foci in multifocal invasive ductal breast cancer.

Widespread acceptance of breast conserving surgery for early breast cancer has led to renewed interest in multifocality, which is seen in 13-63% of breast cancers. According to current guidelines, oestrogen/progesterone receptor status is assessed on the sample obtained at initial core biopsy or the main tumour focus in multifocal breast cancer (more than one distinct tumour focus in a quadrant). We assessed receptor status of individual foci in multifocal breast cancer. Mastectomy specimens for 18 cases of multifocal breast cancer were identified. Immunohistochemical staining for oestrogen and progesterone receptors was performed on all tumour foci. On histological examination 11 patients demonstrated two independent tumour foci, three demonstrated three foci and four demonstrated four foci. Minor differences in oestrogen receptor score were seen between foci (attributed to the subjective nature of the scoring system), which did not affect the overall positive/negative classification. Sixteen patients (88%) were oestrogen receptor-positive. Progesterone receptor staining showed more variability between foci in two patients but, since the tumours were oestrogen receptor-positive this would not have affected clinical decision-making. No major differences in oestrogen receptor status between multiple tumour foci in the same quadrant were found in this pilot study.

Recurrence rates after DCE-MRI image guided planning for breast-conserving surgery following neoadjuvant chemotherapy for locally advanced breast cancer patients.

BACKGROUND: Neoadjuvant therapy results in a significant increase in breast-conserving surgery. However, traditional imaging methods are unable to accurately predict the extent of viable residual disease leading to uncertainty in surgical planning and some previous studies have shown a disproportionately high incidence of locoregional recurrence. Dynamic contrast enhanced-MRI (DCE-MRI) has been shown to provide a potentially more accurate prediction of residual disease. RESULTS: Patients undergoing neoadjuvant chemotherapy for breast cancer in our unit are staged with the DCE-MRI of the breast performed at 1.5 T before, during and after treatment and the final result was used to plan surgery. Two hundred and four patients with breast cancer were treated with neoadjuvant chemotherapy between 1996 and April 2005. Eighteen of these patients had distant metastases at the time of initial diagnosis and so were excluded from the present study. Following neoadjuvant chemotherapy, 186 patients underwent surgical treatment. Of these, 68 patients had breast-conserving surgery. At a median follow up of 30 months (range: 5.6-72 months) 21 patients in this group developed subsequent recurrence (21/68 - 30%) of whom 9 (9/68 - 13%) had locoregional recurrence, 7 had local recurrence (7/68 - 10%), and 17 (17/68 - 25%) had distant recurrence. Logistic regression analysis revealed only vascular invasion (p=0.006) of the tumour to be significantly associated with overall recurrence. None of the pathological factors (ER, PR status, vascular invasion, lymph node metastases, pathological complete response to neoadjuvant chemotherapy) showed a significant association with locoregional recurrence. CONCLUSION: Breast-conserving surgery with DCE-MRI planning after neoadjuvant chemotherapy provides an acceptable level of local recurrence without the need for mastectomy.

Superficial spreading melanoma and blue naevus within naevus spilus--ultrastructural assessment of giant pigment granules.

BACKGROUND: Abnormal melanosomes occur in naevus spilus (NS). OBJECTIVE: To determine whether melanoma arising in NS contains abnormal melanosomes. METHODS: Light and electron microscopy of melanoma within NS and congenital naevus (Case 1), and of blue naevus within NS (Case 2). Light microscopy of additional naevi and melanomas. RESULTS: The melanoma and NS (Case 1) both had large numbers of giant pigment granules (GPGs), demonstrated ultrastructurally to be melanosome macrocomplexes. These were not observed in a congenital naevus (Case 1), or in the blue naevus within NS (Case 2). Small numbers of GPGs were observed in 0/2 NS, 8/16 benign naevi and 11/16 malignant melanomas (MMs). CONCLUSION: NS may be associated with other melanocytic tumours including MM and blue naevi; abnormal melanosomes in NS may also be present in the associated tumour. The prognostic importance of these is unknown, but occasional GPGs in melanocytic lesions are a frequent finding.

The incidence and significance of vaginal metaplasia of the bladder trigone in adult women.

One hundred and six bladders were removed at autopsy from adult women dying of diseases unrelated to the urinary tract. A fixative solution had been introduced into the bladder as soon as possible after death. The naked-eye appearances were recorded before and after application of Lugol's iodine solution and the trigones then submitted to histological examination. Vaginal metaplasia of the trigone was present in the majority (72%) of bladders, a similar incidence being found in both pre-menopausal and post-menopausal age groups. Histological evidence of chronic inflammation was found significantly more frequently in bladders showing vaginal metaplasia and it is suggested that vaginal metaplasia is not a consequence of chronic inflammation but that its surface characteristics may predispose to chronic infection. Its purported hormonal aetiology does not explain all observed features. Prominent venous channels within the tunica propria around the urethral orifice were a constant feature in all bladders studied. Two of the 76 bladders showing vaginal metaplasia also displayed atypical hyperplasia of this squamous epithelium, a previously unrecorded observation. The possible implications of such atypical hyperplasia are briefly discussed.