The histopathologic features of lithium-associated thyroiditis.

The case of a 62-year-old woman with lithium-associated thyroiditis is presented. Lithium can produce goiters associated with hypothyroidism and, less commonly, hyperthyroidism and euthyroidism. The characteristic histopathologic features of the affected thyroid gland included fibrosis, lymphoid follicles with atrophy, and hyperplasia of thyroid follicles. The pathogenetic mechanism appears to be immunologic, with lithium acting as a haptene with a thyroid antigen to induce an "autoimmune" type of thyroiditis.

An immunohistochemical study of pleomorphic adenomas of the salivary gland: glial fibrillary acidic protein-like immunoreactivity identifies a major myoepithelial component.

An immunohistochemical study of 34 pleomorphic adenomas of the major salivary glands demonstrated phenotypic differences among the various morphologic regions in these tumors. The phenotypes expressed were comparable to those of normal salivary gland cells. In the normal glands, myoepithelial cells were immunoreactive for glial fibrillary acidic protein (GFAP), S-100 protein, and keratin; acinic cells exhibited strong, predominantly nuclear S-100 staining and weaker keratin staining; intercalated ducts had both cytoplasmic and nuclear S-100 positivity; and several epithelial antigens were observed throughout the ductal system. In the tumors, the presence of classic epithelial markers (including carcinoembryonic antigen, epithelial membrane antigen, secretory component, and keratin) in the luminal cells of ducts and the intense immunoreactivity with GFAP (with weaker keratin and S-100 staining) in periductal and stromal cells indicated distinct epithelial and myoepithelial differentiation. Solid epithelioid areas consisted phenotypically of intercalated duct/acinic cells and/or myoepithelial cells, the former exhibiting predominant nuclear S-100 positivity. The presence of GFAP-like immunoreactivity in normal myoepithelial cells strongly supports the extensive involvement of this cell in pleomorphic adenomas. The spectrum of phenotypes expressed adds weight to existing evidence for pleomorphism rather than a mixed origin of this tumor. The combination of keratin, S-100, and GFAP immunostaining is particularly useful in identifying the component cells in pleomorphic adenomas of the salivary glands.

The differential effect of pentoxifylline on cytokine production by alveolar macrophages and its clinical implications.

The aim of this study was to investigate the effects of pentoxifylline (PTX) on the production of TNF-alpha, IL-1 beta, IL-6 and GM-CSF by lipopolysaccharide (LPS)-stimulated alveolar macrophages (AM). AM and peripheral blood monocytes (PBM) from 10 patients were cultured for 24 h in the presence of LPS (10 micrograms ml-1) and PTX at concentrations of 2.0 mM, 1.0 mM, 0.5 mM, 0.1 mM and 0.01 mM. TNF-alpha and GM-CSF were measured from the culture supernatants of both the AM and PBM from all 10 patients and IL-1 beta and IL-6 from the culture supernatants of the AM from five patients. The TNF-alpha production by AM was significantly suppressed in the presence of PTX at concentrations of 2.0 and 1.0 mM, while production of IL-1 beta, IL-6 and GM-CSF remained unaffected. In PBM cultures, PTX significantly suppressed the production of TNF-alpha and GM-CSF, at all tested concentrations. The present study provides evidence that PTX selectively suppresses the production of TNF-alpha by LPS-stimulated AM and may have a role in the treatment of lung diseases where TNF-alpha is involved. The mode of administration of PTX should take into account the suppressive effect of this drug on GM-CSF production by PBM.

Urinary bladder paragangliomas. An immunohistochemical study.

The immunohistochemical characteristics of three cases of urinary bladder paragangliomas are presented. These are compared with similar studies on paragangliomas from other anatomic sites and the clinical and pathologic implications are discussed.

Concurrent appearance of multiple myeloma with other B-cell lymphoid neoplasms. A report of two cases.

Two cases of multiple myeloma appeared concurrently with other B-cell neoplasms. These were rare occurrences; only one case of concurrent lymphoma and myeloma and 11 cases of concurrent chronic lymphocytic leukemia and myeloma have been reported in the literature. It was unclear in each case if the B-cell neoplasm arose from a common cell at different phases of development. The rarity of reports in the literature suggests that this combination of the two diseases is accidental.

Hepar lobatum associated with chemotherapy and metastatic breast cancer.

Hepar lobatum is now a rarity in developed countries. In this article, we describe three cases with typical liver morphology associated with carcinoma of the breast metastatic to the liver, treated with combination chemotherapy. The pathogenesis of hepar lobatum in our cases is multifactorial with tumor-related desmoplasia and effects of chemotherapy, with resultant tumor necrosis and fibrosis playing a major role.

Chordoma: cytologic and immunocytochemical study of four cases.

We present the cytologic features and the immunocytochemical profile of four cases of chordoma on fine-needle aspiration biopsies. The physaliferous cells in signet-ring, pearl-like formations and the trabecular arrangement with rounded contours are distinctive. Other cell types and cellular arrangements are also described. The negative immunoreactivity of carcinoembryonic antigen (CEA) and the positive staining pattern for neuron-specific enolase (NSE), S-100 protein, epithelial membrane antigen (EMA), and keratin provide a profile that, in the appropriate clinical setting, can be useful in the differential diagnosis of chordoma from similar-appearing neoplasms in small biopsies and fine-needle aspirates.

Cyto-histological correlates in a colposcopic clinic: a 1-year prospective study.

As part of the Quality Assurance Program, all surgical pathology reports of cervical colposcopic biopsies, cone biopsies, and hysterectomy specimens of 772 consecutive patients were correlated with cytology results for a period of 1 yr. The abnormality in cytology or histology ranged from HPV effect to invasive carcinoma. Cytohistological correlation within one grade of severity was obtained in 662 (86%) cases. On formal review of the remaining 110 (14%) cases, sampling error occurred in 75 cytology smears and in 21 colposcopic biopsies. Screening and interpretation error occurred in 10 smears and four biopsies. In this study the sensitivity of cervical cytology in detecting epithelial abnormalities was 90%, with a positive predictive value of 99.7%. The false-negative rate of cytology was 11% and the false-positive rate 0.26%. The majority (90%) of false negatives were due to sampling error; the rest were due to laboratory error. The sensitivity of colposcopic biopsy was 97% with a positive predictive value of 99.4%. The false-negative rate of biopsy was 2.7% and the false-positive rate 0.5%. Endocervical cells were seen in 48% (370) of smears and absent in 52% (402). However, in both instances the detection rate of squamous abnormality was 90%. Also 43% (33) of smears that showed endocervical cells failed to contain the abnormal cells. Endocervical curettage or cone biopsy in 16 of these 33 cases clearly showed a small CIN-III lesion high in the endocervical canal. We believe that the value of endocervical cells as an indicator of adequacy is questionable.(ABSTRACT TRUNCATED AT 250 WORDS)

The advantages of intraoperative cytology. Analysis of 215 smears and review of the literature.

A two-year experience with intraoperative cytology was evaluated, and the pertinent literature was reviewed. During that period, cytology smears (imprints, scrapings or aspirates, depending on the sample) were prepared from 215 consecutive specimens submitted for diagnosis. A discrepancy between the cytologic, the frozen section and the final diagnoses was noted in only two instances; in both cases, the frozen section interpretation was also difficult. This series and previous studies demonstrate the high accuracy of intraoperative cytology and emphasize its advantages as a rapid and reliable diagnostic method in the frozen section room. The technique may be used to augment or, in some instances, supplant the standard frozen section analysis. In addition to the routine stains used for cytomorphologic evaluation, the smears prepared can be used for special histochemical and immunohistochemical studies.

Ewing's sarcoma. Cytologic features in fine needle aspirates in two cases.

The cytologic findings of two cases of Ewing's sarcoma in fine needle aspiration biopsies are presented in relation to the subsequent histologic findings. The malignant cells were arranged in monocellular layers, pseudorosettes and in perivascular palisades in a fibrillar background. The nuclei were monomorphous with small nucleoli and finely granular chromatin. These features may be helpful in distinguishing this tumor from other small-cell neoplasms; the differential diagnosis between Ewing's sarcoma and such tumors is discussed.

Squamous metaplasia in colonic adenomata: report of two cases.

Two cases of squamous metaplasia in colonic adenomata are reported. Since squamous metaplasia is known to occur rarely in the colon it is surprising that its occurrence in colonic adenomata has not been emphasized; this is more remarkable as its presence may have clinical significance as a precursor of rare forms of carcinoma of the colon.

Fatal retropleural hematoma complicating internal jugular vein catheterization. A case report.

This report describes a case of fatal retropleural hematoma complicating percutaneous insertion of a central vein catheter. The patient was a 55-year-old female undergoing surgery for severe rheumatic mitral valve disease. Factors responsible for this catastrophic incident are the anticoagulation of the patient, the edematous state of the soft tissues, and the multiple punctures of the wall of the jugular vein.

Adenosquamous carcinoma of the colon--an immunocytochemical and ultrastructural study. Report of two cases and review of the literature.

This paper presents two cases of adenosquamous carcinoma of the colon and brings to 39 the total number documented in medical literature. The concurrent glandular and squamous differentiation of the tumor cells was demonstrated by immunocytochemistry and electron microscopy. Evaluation of the biologic characteristics of all the reported cases suggests that malignant squamous elements in colonic carcinomas behave more aggressively than their glandular counterparts. In contradistinction from the pure squamous-cell carcinoma of the colon, adenosquamous carcinoma does not show the same predilection for the right colon.

Familial calcification of aorta and calcific aortic valve disease associated with immunologic abnormalities.

We report three patients of the same family with linear calcification of the ascending aorta, severe calcific mixed aortic valve disease associated with increased levels of globulins, lambda-chain gammopathy, an increased T4/T8 lymphocyte ratio, and other immunologic abnormalities. None of the patients had syphilis, atherosclerosis, abnormalities of calcium or phosphorus metabolism, lymphadenopathy, or other systemic diseases. It is postulated that these cases and some previously reported in the literature as idiopathic represent a distinct pathologic entity, familial or sporadic, in which localized vascular and valvular calcific disease is associated with an underlying immunologic disorder or autoimmune process.

Postembedding immunogold electron microscopy for S100, tubulin, and cytoskeletal proteins in an amelanotic malignant melanoma.

A postembedding Protein A-colloidal gold technique was used for the ultrastructural immunocytochemical investigation of S100, tubulin, and cytoskeletal proteins in a Lowicryl K4M-embedded melanoma with numerous microtubules. S100 protein was localized in the cytoplasm and the nuclei of tumor cells. Melanosomes were not labeled with S100. Perinuclear intermediate filaments and filaments in cytoplasmic processes reacted positively for vimentin. The straight, rod-shaped, parallel intracisternal microtubules failed to react with antisera to tubulin, S100, vimentin, cytokeratin, neurofilaments, desmin, glial fibrillary acidic protein, and immunoglobulin light chains. These results give an improved correlation between the ultrastructural and immunocytochemical characteristics of the tumor, confirm the melanocytic origin of it, and demonstrate the application and usefulness of the postembedding immunogold method in the investigation of the protein composition of subcellular structures.

Immunohistochemical localization of metallothionein in human testicular embryonal carcinoma cells.

The presence of high levels of metallothionein (MT) in developing mammalian cells is well documented. It has been suggested that the developmental profile and gene expression of MT is similar to that of the so-called oncodevelopmental gene products such as a-fetoprotein. In this study tissue sections of nine human embryonal carcinomas of the testis were tested by means of the avidin-biotin peroxidase complex for the presence of MT. The antigen was localized in variable amounts in the cytoplasm and nucleus in tumour cells in all cases. There was evidence that immunoreactivity was related to the histological growth pattern of tumour cells. These findings suggest that MT may be considered an oncodevelopmental product which could be useful as a tumour marker. In addition, the histology of these tumours might predict MT expression; this may prove of value in testing the hypothesis of MT-related emergence of drug-resistant cell lines in the course of treatment of tumours with metal-containing chemotherapeutic agents.

Evaluation of risk factors for stomal recurrence after total laryngectomy.

The development of a stomal recurrence after total laryngectomy is a complication with a dismal prognosis. The risk factors and mechanisms involved are still not well understood. In this review of 352 patients, 21 (6%) developed a stomal recurrence. We studied the group of 74 patients (21%) with subglottic involvement separately. There was no significant difference in the rate of stomal recurrence in those with emergency tracheostomy (23.3%) as compared with those with intra-operative tracheostomy (18.2%). Stomal recurrence was more strongly associated with subglottic involvement itself (20.3%) and T4 stage (15.3%). The findings suggest that submucosal extension and lymph node metastases are probably more important mechanisms of stomal recurrence than cancer cell implantation.

Soluble interleukin-2 receptors and other markers in primary lung cancer.

Serum levels of soluble interleukin-2 receptors (sIL-2R), carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), beta-chorionic gonadotropin (beta-HCG), pregnancy-specific glycoprotein (SP1), and beta 2-microglobulin (beta 2M) were taken in 92 patients with primary lung cancer and 43 controls. The mean value of sIL-2R in the cancer group was twice as high as that of the controls (P less than 0.001) and the highest values were observed in those with small cell carcinoma (SCC) (P less than 0.0001). Of the cancer patients, 51.1% had CEA values higher than the cutoff level of 5 ng/ml. Extended-disease patients had a higher percentage of increased CEA values than those with limited disease. Adenocarcinoma (ADCC) and SCC groups had the highest percentages of increased CEA levels. There was no significant difference between the groups for beta-HCG, AFP, SP1, and beta 2M, and intermarker correlation was not seen. The results suggest that sIL-2R and CEA may be useful in monitoring the extent of disease and possibly indicate the histologic subtype, thus having a bearing on treatment and prognosis.

Nasomaxillary skeletal dimensions complex in patients with osseous nasal septum deformities.

Controversy still exists regarding the precise contribution of the nasal septum to facial growth and development. Several reports indicate that early surgical intervention for the correction of nasal septum abnormalities leads to a high recurrence rate that necessitates revision procedures in adulthood. In this study we compared a group of patients with posterior nasal septum deformities to a control group by using cephalometric radiographs and recording several measurements on composite tracings. Our data, analysed by a computerized statistical programme, demonstrate significant differences between the two groups, supporting the view that the development of the anterior part of the neurocranium influences the development of posterior nasal septum deformities.