Epidemiology of minimal breast cancer among women screened in New York City.

A case-control study based on a screened population in New York City examined epidemiologic risk factor differences between minimal breast cancer (in situ and small invasive carcinomas) and all other breast carcinomas, referred to as clinical breast cancer. Histopathologic re-review of the original slides identified 113 minimal and 792 clinical breast cancers among 1,290 eligible cases; 2,173 randomly selected screenees served as controls. Among those who developed cancer, black women were twice as likely to develop minimal, as compared to clinical, breast cancer. Women who were less than 20 years of age at first live birth had more than double the probability of being diagnosed with minimal breast cancer, whereas women with first live birth at age 30 years or greater and nulliparous women were at 1.5 times the risk of clinical breast cancer. The relative proportion of minimal breast cancer increased with increasing number of children breast fed, being twofold among women who nursed 2 children or more. Unlike clinical breast cancer, minimal breast cancer was not associated with either family history of breast cancer or obesity. Meaningful histologic differences were not apparent between the case subgroups. Except possibly for obesity, these results could not be explained by any plausible diagnostic bias.

Pulmonary calcification caused by Pneumocystis carinii pneumonia. A clinicopathological study of 13 cases in acquired immune deficiency syndrome patients.

Pulmonary microcalcifications were identified in 13 patients with Pneumocystis carinii pneumonia (PCP) and acquired immune deficiency syndrome (AIDS). Several patterns of calcification were noted including bubbly, plate-like, elongate, and conchoidal forms. All calcifications contained P. carinii cysts within them as demonstrated by Grocott's methenamine silver stain. In eight of the 13 cases, the typical intra-alveolar exudate of P. carinii was absent. Therefore, the calcifications were the only histopathologic indication of prior P. carinii infection. The above-mentioned calcifications are important because in five cases they occurred without a prior diagnosis of PCP, subsequent therapy, or prophylaxis. This indicates that in some patients there is destruction of P. carinii organisms with subsequent calcification, and this can occur without therapy.

Particulate environmental matter as seen in lung sections.

A study of particulate environmental matter as seen in lung sections is presented. These particles are blackened and are comparable to particles seen in industrial-urban environments. From the study of histologic sections an attempt is made to determine the tissue reaction to them and their ultimate fate.

Bacillary angiomatosis presenting as a soft-tissue tumor without skin involvement.

A patient with human immunodeficiency virus infection presented with a soft-tissue mass which histologically and clinically mimicked an angiosarcoma. Ultrastructural study, however, revealed bacteria identical to those seen in cutaneous bacillary angiomatosis, but the patient had no skin lesions. To our knowledge, this represents the first report of soft tissue involvement by bacillary angiomatosis without the presence of skin lesions.

Fibrous hamartoma of infancy: an ultrastructural study.

The fine structures of three fibrous hamartomas of infancy were studied. All three components of these lesions were examined. The principal cells in the fibrous and myxoid areas were fibroblasts. Cells with stellate cytoplasmic projections were more prominent in myxoid areas. Myofibroblasts were abundant in two cases and not in the other. The adipose tissue component was formed by lipocytes and occasional preadipose fibroblasts. Blood vessels were more numerous in myxoid areas. Larger vessels were accompanied by smaller vessels and by clusters of cells with primitive junctions, suggesting early blood vessel formation. Some small vessels were surrounded by concentric layers of mesenchymal cells, as if attempting to form media. Electron microscopy seems to confirm the hamartomatous nature of fibrous hamartomas of infancy. The lesion appears to recapitulate the formation of blood vessels and fat, as seen in fetal tissues. Cellular myxoid areas showed prominent vasoformative proliferation, which decreased in the adipose tissue and was least prominent in the dense fibrous component. The latter may represent the end stage of the fibrous proliferation.

Ultrastructural demonstration of intracellular bacteria in xanthogranulomatous pyelonephritis.

Xanthogranulomatous pyelonephritis is considered to be an unusual cellular response to bacterial invasion. This assumption is based on circumstantial evidence and experimental studies. In our electron microscopic study of five cases of xanthogranulomatous pyelonephritis demonstrated a stratification of the cellular components, somewhat resembling that described in the experimental lesions. The center of the xanthogranulomas was occupied by purulent exudate. Bacteria were identified mainly in polymorphonuclear leukocytes and extracellularly in four cases in which central area were available for electron microscopic studies. Many bacteria were located in cytoplasmic vacuoles. more peripherally, histiocytes predominated, and their cytoplasm contained numerous lipid droplets with and without limiting membranes and phagolysosomes. The latter contained electron dense, granular, and membranous structures. The outermost layer of the lesion demonstrated macrophages with a decreased number of lipid droplets and larger intralysosomal particles. Lymphocytes, plasma cells, and fibroblasts represented an increasing proportion of the infiltrate in this layer. Our study suggests that xanthogranulomatous pyelonephritis is a bacteria induced process. Its histological appearance may be related to incomplete bacterial degradation and altered host response.

A retrospective analysis of breast cancer based on outcome differences.

We reviewed tumors from two groups of patients with breast cancer, distinguished by differences in outcome. One group (85 cases) survived more than 8.5 years without tumor recurrence; the other 85 cases had recurrent disease within 2 years. Histologic and immunocytochemical studies on all cases were performed without patient identifiers and prior to review of clinical prognostic factors. As expected, lymph node and estrogen receptor status differed substantially between the groups, but menopausal status and family history for breast cancer did not. We noted that 27% of node-negative patients died within 5 years, and nine patients with four or more tumor-containing nodes were symptom-free for over 8.5 years. Histologic grade (degree of tubule formation) and nuclear grade (including mitotic rate) differed significantly between the groups, as did vascular invasion, including both lymphatics and blood vessels. Prognostic value attached to tumor border only when fat was invaded without fibroblastic or inflammatory response (P = .012). Subgrouping cases of infiltrating ductal carcinoma (not otherwise specified) was prognostically informative in the B subgroup, 69% of whom were in the rapidly recurrent tumor group. Immunocytochemical staining for c-erbB-2 was positive in 19.3% of cases, but was equally distributed between the two outcome groups. We conclude that traditional histologic parameters are highly informative, and that c-erbB-2 studies do not increase the value of histologic diagnosis.

Hermansky-Pudlak syndrome: a clinicopathologic study.

The Hermansky-Pudlak syndrome is a rare disease characterized by multisystemic involvement. Seven families with the disorder were identified in the Puerto Rican population of one municipal hospital, suggesting that the incidence in the Puerto Rican community is sufficient to warrant both dissemination of information about the disease and further investigation. The present study was an attempt to achieve both of these goals.

Cystic parotid lesions in patients at risk for the acquired immunodeficiency syndrome.

Twenty-three patients at risk for the acquired immunodeficiency syndrome presented with cystic lesions of the parotid gland. Fourteen patients had unilateral parotid cysts and nine had bilateral enlargement. Ten patients were positive for antibodies to the human immunodeficiency virus (HIV), three were negative for antibodies to the human immunodeficiency virus, and ten refused testing. Fine-needle aspiration cytology and computed tomography were helpful in making the diagnosis of benign lymphoepithelial cyst. Superficial parotidectomy confirmed the diagnosis. Concurrent malignancy (Kaposi's sarcoma) was diagnosed in one patient from a parotid specimen. Follow-up has ranged from four months to five years.

Megestrol and tamoxifen in patients with advanced endometrial cancer: an Eastern Cooperative Oncology Group Study (E4882).

To investigate the effect of adding tamoxifen to megestrol in the hormonal therapy for advanced endometrial cancer, 66 patients were entered in this study. Initially, 41 patients were randomized to either the standard progestin therapy of megestrol or to the combination of megestrol and tamoxifen between October 1982 and October 1984. The megestrol arm was terminated because of poor accrual and 25 patients were directly assigned to the combination arm. Among the 20 eligible cases on the megestrol arm, the response rate of 20% consisted of I complete response and 3 partial responses. The response rate on the megestrol plus tamoxifen arm was 19% with 1 (2%) complete response and 7 (17%) partial responses among 42 eligible cases. The median survival times were 12.0 months and 8.6 months, respectively. Only mild and moderate toxicities were observed on megestrol compared with more toxic complications observed on the combination of megestrol and tamoxifen, including a life-threatening case of pulmonary embolism. Although we could not carry out a comparative evaluation as intended, we conclude that the combination of megestrol and tamoxifen offers no clinical advantage over megestrol alone in the treatment of advanced endometrial carcinoma.

Acquired immunodeficiency syndrome. Clinicopathologic study of 56 autopsies.

We studied 56 patients with acquired immunodeficiency syndrome who underwent autopsy at the New York University Medical Center. We uncovered several entities that were not previously described or emphasized in prior series. These were as follows: (1) three cases of necrotizing arteritis with cytomegalovirus inclusions; (2) dissemination in 95% of cases of Kaposi's sarcoma; (3) unusual clinical and histologic presentations of Kaposi's sarcoma presenting diagnostic difficulties for both clinicians and pathologists; and (4) a very high incidence of serious nonmycobacterial infections. In addition, previous autopsy studies have disagreed over such matters as the incidence of disseminated candidiasis, hemophagocytosis, and severe adrenal necrosis in acquired immunodeficiency syndrome. All of these studies, except one, involved ten to 12 cases each. Our study of 56 cases helps to resolve these disagreements.

Fibroblastic reticulum cells in human lymph nodes. An ultrastructural study.

The ultrastructural characteristics of the fibroblastic reticulum cell (FRC) in human reactive lymph nodes, which were studied electron microscopically, indicate a myofibroblastic cell with unique properties. Its contractile element is probably useful in controlling the volume of the lymph node and possibly in the movement of antigens and antibodies. The FRC may also play a role in other immunologic functions and seems to be preponderant in some lymphomas.

Fine needle aspiration biopsy of cystic benign lymphoepithelial lesion of the parotid gland in patients at risk for the acquired immune deficiency syndrome.

Cystic benign lymphoepithelial lesion (BLL), a previously rare lesion of the parotid gland consisting of marked lymphoid hyperplasia with accompanying squamous-lined cysts, has recently been described in patients with the acquired immune deficiency syndrome (AIDS) or AIDS risk factors. Thirteen fine needle aspiration (FNA) samples of parotid gland masses from patients with AIDS (one case), AIDS risk factors (five cases) or denial of AIDS risk factors (two cases) and a histopathologic diagnosis of BLL were examined. The FNA features that correlated best with the histopathologic findings were (1) a heterogeneous lymphoid population, (2) scattered single and/or clustered foamy macrophages and (3) superficial and/or anucleated squamous cells. Most aspirates showed some combination of these three components. The differential diagnostic considerations, the clinical and radiologic correlations and the relationship of this lesion to HIV infection are discussed. Patients with parotid masses whose aspirates consist of some combination of squamous cells, lymphocytes and foamy macrophages should be questioned for possible AIDS risk factors.

Stromal atypia in anal papillae.

This report describes the occurrence of stromal atypia in anal papillae. The atypia occurred in two of 15 papillae studied and was present in the larger ones. The stromal atypia is similar to that described to occur in vaginal polyps and in entities such as pseudosarcomatous fasciitis, atypical fibroxanthomas of the skin, radiation dermatitis, and giant-cell cystitis. The atypia is considered to be reactive or reparative.

Eosinophilic pustular folliculitis in patients with acquired immunodeficiency syndrome. Report of three cases.

Eosinophilic pustular folliculitis is a rare disease. Highly unusual is its occurrence in three patients with acquired immunodeficiency syndrome (AIDS), described herein. This association may be the result of immunologic aberrations that are described in AIDS and may represent an abnormal reaction to skin saprophytes and dermatophytes.

Isolated granulomatous disease of the stomach. Report of three cases presenting as incidental findings in gastrectomy specimens.

Three cases of isolated granulomatous disease of the stomach are reported. Other granulomatous diseases were ruled out on the basis of clinical and histological studies. These cases differ from those previously described in having only mucosal granulomas which were discovered as incidental findings in stomachs removed for peptic ulcers. Perigastric lymph node involvement by granulomas was present in one of three cases.

Regeneration-induced lengthening of the cut ends of the rat colon.

The transected colon was studied in rats in an attempt to determine whether the regenerating cut ends could be induced to lengthen by delaying or preventing their spontaneous reattachment. When the two cut ends of the defunctionalized colon were separated by a 2-3-cm length of silastic tubing mucosal, luminal and serosal continuity across the gap was restored in 8-10 weeks. Cannulation of one cut end with silastic tubing so placed as to extend 2-3 cm beyond the cut end led to lengthening of the intestine over the exposed end of the tubing by 20 weeks. The area subadjacent to regenerated mucosa filled initially with granulation tissue which was gradually replaced by loose connective tissue containing at times a thin layer of smooth muscle.

The intranodal distribution of lymph-borne particles injected intravenously.

The sequential distribution of lymph-borne, i.v. injected particles of tantalum in hepatic hilar lymph nodes was studied in rats in an attempt to determine which structural compartments of a node are responsible for mechanical filtration. The injected particles reached these nodes via liver lymph but the i.v. route of administration eliminated any possibility of disturbing either lymph flow or pressure. Particles began to enter hepatic hilar nodes only after an interval of 7-8 h. They were subsequently redistributed from marginal, trabecular and medullary sinuses to the paracortex and finally to medullary cords. Particles accumulated predominantly in the paracortex at 12-24 h and thereafter in medullary cords. This sequential pattern of distribution differed significantly from that observed previously in other lymph nodes after either intralymphatic or intratissue injection.

Alterations in spleen growth and sequestering function in animals receiving trypan blue.

Trypan-blue-induced alterations in spleen size and sequestering activity were studied in rats as possible experimental counterparts of the splenic enlargement and dysfunction associated with lymphomas in man. The spleen was examined radiographically and histologically following the i.v. administration of tantalum particles in animals receiving 4-17 s.c. injections of trypan blue at fort-nightly intervals and in control animals. Spleen size and sequestering activity increased in all rats receiving trypan blue. Histological studies demonstrated that an increase in mechanical filtration was responsible for the dysfunction. Tantalum was deposited extracellularly in perifollicular marginal zones in both experimental and control animals but these areas were much more prominent in experimental animals, contained more tantalum and retained the particles for longer periods.