Tracking: an answer to psychiatry's recruitment problem?

Part of psychiatry's recruitment problem stems from large-scale defections among students who were planning careers in psychiatry when they entered medical school. The authors present data indicating that University of Maryland freshmen who preferred psychiatry were more than four times as likely to enter psychiatric residency training if they participated in the Combined Accelerated Program in Psychiatry, a continuous 4-year medical school track, than if they pursued the regular undergraduate psychiatry program. The authors believe that an enthusiastic psychiatric faculty intimately involved with students over an extended period of time was the crucial factor neutralizing antipsychiatric socialization experiences in medical school.

Clear cell sarcoma of the ileum: the crucial role of cytogenetics for the diagnosis.

We report a case of clear cell sarcoma that arose in the ileum and metastasized to the liver. The tumor cells did not contain melanin or glycogen; expressed S-100 protein, but not HMB45; and contained possible atypical melanosomes when examined by electron microscopy. They carried a clonal chromosomal rearrangement: 50,XY,t(2;7)(q37;q22),+8,+8,+9,+11, t(12;22)(q13;q12). The diagnosis was greatly facilitated by the cytogenetic analysis. The translocation t(12;22)(q13;q12-13) has been reported as specific for clear cell sarcomas.

The plasminogen activator of the arterial wall.

The plasminogen activator in 645 specimens of various human arteries--thoracic, abdominal aorta, carotic, pulmonary, renal, basilar, coronary - was studied using Todd's histochemical method. 92 cadavers were used, 1--18 hours post mortem from subjects aged from 272 days to 83 years. 45 specimens of pulmonary, renal and splenic arteries were obtained during surgery. The greatest fibrinolytic activity was within the adventitia. Intima occasionally showed very little fibrinolytic activity, or none at all. No statistically significant differences in plasminogen activator activity were found between the various arteries examined. A statistically significant increase in fibrinolysis in adventitia of atherosclerotic arteries was established. No correlation was found between the fibrinolytic activity of the arteries and their alkaline phosphatase content. Some properties of the plasminogen activator of the arterial vessel wall were evaluated. Influence of storage, inactivation with epsilonaminocaproic acid and extracted with potassium thiocyanate was studied.

Ossifying fibromyxoid tumor of soft parts: evidence supporting Schwann cell origin.

Immunohistochemical and ultrastructural studies of an ossifying fibromyxoid tumor of soft parts have been performed. Immunoreactivity of neoplastic cells for S-100 protein and glial fibrillary acidic protein, lack of immunoreactivity for type II collagen, and presence of basal lamina indicate that the tumor is of Schwann cell and not cartilaginous origin.

Progression of inflammatory myofibroblastic tumor (inflammatory pseudotumor) of soft tissue into sarcoma after several recurrences.

We report a case of inflammatory myofibroblastic tumor (inflammatory pseudotumor) arising in the soft tissue of the right forearm and progressing into frank spindle cell sarcoma after five recurrences and a total span of 12 years. Myofibroblastic nature of the neoplastic spindle cells was shown by electron microscopy and immunohistochemistry. The patient developed multiple pulmonary metastases and died. Although five cases of metastasizing inflammatory myofibroblastic tumors were reported, association of sarcomatous transformation of this entity with metastatic capability was not previously described.

Immunoreactivity of paraffin-embedded normal tissues and mesenchymal tumors for smooth muscle myosin.

Immunohistochemical study of smooth muscle myosin, a protein distinct from skeletal, cardiac, or nonmyogenous myosins in paraffin-embedded normal tissues and benign and malignant mesenchymal tumors revealed its strong expression in normal smooth muscle, capillary endothelium, and pericytes. All benign smooth muscle tumors with exception of gastric leiomyomas and few other leiomyomas of the gastrointestinal tract displayed strong or moderate immunoreactivity. On the other hand, strong or moderate immunoreactivity was detected in only eight of 28 spindle-cell leiomyosarcomas, as well as in 13 out of 27 malignant fibrous histiocytomas and three out of nine malignant hemangiopericytomas, while epithelioid leiomyosarcomas, fibrosarcomas, malignant schwannomas, and synovial sarcomas were negative or only weakly positive. Our results demonstrate that, while smooth muscle myosin is a very good marker of normal smooth muscle and benign smooth muscle tumors, it is expressed in diagnostically significant amounts in less than a third of spindle-cell leiomyosarcomas and none of the studied epithelioid leiomyosarcomas.

Cytogenetics of tumors of soft tissue and bone. Implication for pathology.

Pathologists should be aware of the existence of diagnostically useful chromosomal rearrangements in several soft tissue and bone tumors. They include rearrangement of 8q12 in lipoblastomas, ring chromosomes in atypical lipomas, ring and giant marker chromosomes in well differentiated liposarcomas, t(12;16)(q13;p11) in myxoid liposarcomas, rearrangement of 7p21-22 in low-grade endometrial stromal sarcomas, t(2;13)(q37;q14) in alveolar rhabdomyosarcomas, t(X;18)(p11.2;q11.2) in synovial sarcomas, t(12;22) (q13;q13) in clear cell sarcomas, t(11;22)(q24;q12) in Ewing's sarcomas and peripheral neuroepitheliomas, and t(9;22)(q21-31;q11-12) in extraskeletal myxoid chondrosarcomas.

Cytogenetics and molecular biology of small round-cell tumors and related neoplasms. Current status.

Recent years have witnessed considerable advances in cytogenetics and molecular biology of small round-cell tumors. These advances are summarized and discussed in this article.

Pigmented choroid plexus carcinoma: a cytogenetic and ultrastructural study.

A pigmented choroid plexus carcinoma was studied. The pigment was Fontana-positive, and the neoplastic cells focally expressed melanosomal marker HMB45 and contained probable aberrant melanosomes. The tumor was composed of two pseudodiploid clones, having the karyotypes 46,XY,inv(4)(q12q35),t(6;15)(q21;q22),inv(7)(p11.2q22),t(19; 22) (q13.4;q11.2)[15]/46,XY,t(4;14)(q31.1; p11.2),t(12;13)(p11.1;q34)[6]. The available data seem to indicate that rearrangements of 7p11-12, 9q11-12, 15q22, and 19q13.4 may play a role in the development of choroid plexus carcinomas.

Sclerosing epithelioid fibrosarcoma: a cytogenetic, immunohistochemical, and ultrastructural study of an unusual histological variant.

A case of sclerosing epithelioid fibrosarcoma was studied. The tumor cells expressed vimentin, focally epithelial membrane antigen and CD34, contained cisternae of rough endoplasmic reticulum, large Golgi apparatus, many pinocytotic vesicles, and were devoid of basal lamina. Their composite karyotype was 45,Y,t(X;6)(q13;q15), t(6;13)(p11.2;q13),-22¿2/46,Y,t(X;6)(q13;q15),add(13)(p12), add(22)(q13)¿3/44 approximately 46,der(X)t(X;6)(q13;q21),-Y, t(13;14)(q10;q10),-22,add(22)(q13)¿7/46,XY¿8.

Clonal rearrangement of 15p11.2, 16p11.2, and 16p13.3 in a case of nodular fasciitis: additional evidence favoring nodular fasciitis as a benign neoplasm and not a reactive tumefaction.

This article describes a case of nodular fasciitis with the karyotype 47,XY,+4/46,XY,add(15)(p11.2), t(16;16)(p13.3;p11.2). The presence of clonal chromosomal abnormalities in this case, as well as in three previously reported cases, indicates that nodular fasciitis is a benign neoplasm and not a reactive lesion.

Translocation (2;15)(p23;q21.2) and interstitial deletion of 7q in a case of low-grade myxofibrosarcoma.

We describe a case of low-grade myxofibrosarcoma with the karyotype 46,XX,t(2;15)(p23;q21.2), del(7)(q?11.2q?22). Only six of these tumors have been previously studied and all were cytogenetically different.

Isochromosome (17)(q10) as the sole structural chromosomal rearrangement in a case of botryoid rhabdomyosarcoma.

We describe a case of botryoid rhabdomyosarcoma with the karyotype 53,XX,+2,+5,+8,+12,+13, i(17)(q10),+19,+20. Only two cytogenetically analyzed cases of this tumor were previously reported and structural chromosomal abnormalities in each tumor were different.

Mesenchymal chondrosarcoma. A cytogenetic, immunohistochemical and ultrastructural study.

A case of mesenchymal chondrosarcoma was studied. The tumor was near-tetraploid and the clonal structural chromosomal abnormalities included add(7)(p13), add(22)(q13), markers, and double minutes. The ultrastructural and immunohistochemical findings were consistent with the diagnosis. Strong immunoreactivity for desmin was an unusual, not previously reported, feature of the neoplasm.

Solitary fibrous tumor of the pleura: a cytogenetic study.

A solitary fibrous tumor of the pleura was studied. Its karyotype was 46,XY,t(6;17) (p11.2;q23),ins(9;12)(q22;q15q24.1),inv(16)(p13.1q24). The rearrangement of 12q13-15 was also described in a subset of hemangiopericytomas of soft tissue and meninges. Because both types of tumors are morphologically and immunophenotypically quite similar, and because some of them share rearrangement of 12q13-15, the possibility of their histogenetical relatedness should be considered.

Translocation (8;13)(q24.2;q33) in a malignant rhabdoid tumor of the liver.

A case of malignant rhabdoid tumor of the liver associated with hypercalcemia of malignancy was studied. The karyotype of the liver primary was 46,XY,t(8;13)(q24.2;q33)[7]/46,XY[13], and of the brain metastasis 46,XY,t(8;13)(q24;q33)[5]/46,XY,t(7;13)(p14;q22) [3]/46,XY,t(1;2;3)(q25;q21;p21) [2]/46,XY[13], respectively. Band 8q24 was previously reported to be rearranged in two malignant rhabdoid tumors, one renal and one hepatic.

Aberrant oncogene expression in uncultured human sarcoma and melanoma.

Protooncogenes have the ability to induce and/or maintain the transformed state when they are overly expressed or altered by mutation or gene rearrangement. To study the possible involvement of these cellular oncogenes in the neoplastic transformation, we have analyzed their expression in 44 fresh samples obtained from primary, recurrent, or metastatic tumors from patients with a variety of sarcomas and a melanoma. Our analysis was carried out by the northern blot technique using poly (A)+ RNA hybridized with human cellular DNA probes. A normal 2.3-kb c-myc transcript was observed almost universally at various levels. A normal c-k-ras transcript of 5.2-kb was detected at a low level in most of the samples. In three samples we detected aberrant c-k-ras transcripts of 7.0 and 8.5-kb, while in two other samples we found an aberrant lower-molecular-weight transcript of 1.4-kb. N-myc was expressed in only three samples, and in all instances, the transcripts were aberrant (more than 10-kb). A normal 3.7-kb c-sis transcript was expressed at a low level in most of the sarcomas and the melanoma but was uniquely overexpressed in giant cell tumors of bone. C-fos (2.2-kb) was expressed at a low level in almost half of the samples; c-myb was never expressed. We conclude that c-k-ras, n-myc, c-sis, and c-myc are aberrantly or overexpressed in sarcoma/melanoma, and their activation may play a role in the transforming events leading to development and/or progression of these tumors.

Metastatic adenocarcinoma of the uterine cervix to the thyroid gland.

Clinically diagnosed metastasis to the thyroid gland is rare. The authors present the first reported case of metastasis to the thyroid gland from a primary adenocarcinoma of the uterine cervix.

Trichlortriethylamine (TS-160 Spofa) in combination chemotherapy of malignant lymphomas.

Thirteen patients with disseminated malignant lymphomas were treated with combination chemotherapy which included trichlortriethyl amine (TS-160), vincristine (Oncovin), procarbazine hydrochloride (Natulan) and prednisone. All patients but two received some form of chemotherapy and/or radiotherapy prior to being started on four-drug regimen. Good response to the combination chemotherapy was recorded in 84% of patients, while complete remission was achieved in 23% of cases. Drug toxicity has not proved to be a major problem in the combination used. Nausea and vomiting were the side effects the most frequently observed.

Influence of heparin and defibrase on transplantability of syngeneic tumors in mice.

It had been previously demonstrated that fibrin clot might have an important role in the growth of malignant tumors and in metastasis formation. For this reason an attempt had been made to find out whether inhibition of fibrin formation by heparin or fibrinolysis induced by defibrase could limit tumor growth. Male mice of inbred strain were challenged with suspension of tumor cells. For anticoagulation and/or fibrinolytic therapy two different schedules were used. The treatment was started either simultaneously with the tumor transplantation, or one week prior to the injection of tumor cells. The size of tumors was bigger in the group of treated animals, when compared with the controls. However, the difference was not statistically significant. On the other hand, frequency of implanted tumors was significantly higher in animals with heparin and defibrase treatment or pretreatment.