Macrophages interact with enriched populations of distinct T lymphocyte subsets for the induction of severe destructive Lyme arthritis.

Severe destructive Lyme arthritis was detected in the hind paws of hamsters infused with enriched populations of either CD4+ or CD4- T lymphocytes along with macrophages exposed in vitro to formalin-inactivated Borrelia burgdorferi and then infected with the Lyme spirochete. Swelling was detected 4 days after infection, increased rapidly, peaked on day 8 of infection, and gradually decreased. Similarly, severe destructive arthritis was induced in hamsters infused with enriched populations of unfractionated T lymphocytes and macrophages exposed to spirochetes after infection with B. burgdorferi. Histopathological examination affirmed that hamsters infused with CD4+, CD4-, or unfractionated T lymphocytes and macrophages exposed to B. burgdorferi-induced arthritis. In addition, macrophages exposed in vitro to B. burgdorferi demonstrated both conventional and coiling phagocytosis, suggesting a mechanism by which CD4+ and CD4- T lymphocytes induce arthritis, respectively. These findings demonstrate that both CD4+ and CD4- subpopulations of T lymphocytes are capable of interacting with macrophages for the induction of severe destructive Lyme arthritis.

Clinical characteristics of anaerobic bactibilia.

During a two-year period, 1,892 patients underwent biliary tract surgery at the Mayo Clinic. Both aerobic and anaerobic bile cultures were performed in 371 patients and 253 of these were positive. Anaerobes were isolated from 100 patients, although only twice in pure culture. Only aerobes grew from cultures from 153 patients. One hundred cases of biliary tract infections involving anaerobes and an equal number involving aerobes only were reviewed in order to determine their clinical characteristics. Prominent features of anaerobic bactibilia included (1) a history of complex, multiple, biliary tract surgeries often involving biliary-intestinal anastomoses and common bile duct manipulation, (2) severe symptoms, (3) high incidence of postoperative infectious complications, especially wound infections. Further analysis of anaerobic biliary infections suggested that Bacteroides fragilis was more often associated with serious pathologic conditions of the biliary tract than was Clostridium.

Sequences of the genes encoding the A, B and C subunits of the Haemophilus influenzae dimethylsulfoxide reductase complex.

The genes (dms) encoding the dimethylsulfoxide reductase protein complex have been cloned and sequenced from Haemophilus influenzae (Hi) type b (Hib) strain Eagan. The Hib dms genes are arranged as an operon whose genomic organization is similar to that of the Escherichia coli (Ec) dmsABC operon. The deduced Hib DmsA, and DmsB and DmsC amino-acid sequences are highly homologous to their Ec counterparts and nearly identical to the recently published sequences of the Hi type-d strain Rd Dms proteins. Hi dimethylsulfoxide reductase appears to be a new member of the superfamily of oxidoreductase enzymes.

Solitary pulmonary nodule due to Cryptococcus neoformans and Mycobacterium tuberculosis.

This report describes a rare combined infection of Cryptococcus neoformans and Mycobacterium tuberculosis that manifested as a solitary pulmonary nodule in a nonimmunocompromised patient. Transthoracic needle aspiration biopsy was initially nondiagnostic, and histopathologic and culture confirmation of the diagnosis was eventually attained after wedge resection of the nodule. An extensive review of the English literature failed to reveal any reported cases of such a combined infection with a similar clinical presentation. The variable morphologic features of C. neoformans in tissue sections and the protean histologic features of pulmonary cryptococcosis can lead to diagnostic difficulties, as illustrated by this case.

Primary pulmonary sporotrichosis. Report of eight cases with clinicopathologic review.

Pulmonary sporotrichosis in the absence of lymphocutaneous disease is unusual; however, its incidence may be greater than previously recognized. This report describes the AFIP experience in eight cases of primary pulmonary sporotrichosis and reviews an additional 23 cases. The disease is often a bilateral, apical, chronic and cavitary, progressive, destructive, and debilitating infection, most often seen in middle-aged men with a history of alcoholism and chronic obstructive pulmonary disease. In this clinical setting, pulmonary sporotrichosis closely mimics tuberculosis or histoplasmosis. However, this clinical charade can be unmasked by serologic tests, cultures, and identification of the causative agent, Sporothrix schenckii, in sections of paraffin-embedded lung containing necrotizing granulomas and stained with periodic acid-Schiff and Gomori methenamine-silver nitrate. Previously not recognized is the presentation of primary pulmonary sporotrichosis as a solitary, peripheral, necrotizing pulmonary nodule, observed in two patients. Chronic cavitary pulmonary sporotrichosis is usually refractory to drug therapy; however, when combined with surgical resection, cure can be attained.

Truly benign "bronchial adenoma". Report of 10 cases of mucous gland adenoma with immunohistochemical and ultrastructural findings.

Mucous gland adenoma of the bronchus (MGAB) is a rare, solitary, benign, well-circumscribed, multicystic, predominately exophytic bronchial tumor. Mucous gland adenoma arises from the submucosal seromucous glands and ducts of proximal airways; since the location, signs and symptoms, and bronchoscopic findings are similar to those of other tumors arising in the bronchus, diagnosis depends on tissue biopsy. We herein report 10 patients with MGAB. Patients ranged in age from 25 to 67 years old (mean, 52). In two thirds of patients, the tumor was located in the middle or lower lobes. Tumors ranged in size from 0.8 to 6.8 cm (mean, 1.8). Cut surface was shiny, mucoid, cystic, and usually firm. Mucous gland adenomas are protean in their histologic patterns. They may appear glandular and tubulocystic or papillocystic, and they often show a mixture of these features. The tumors are rich in mucins and are immunopositive for epithelial markers. Mucous gland adenoma needs to be distinguished from low-grade malignant tumors of the bronchus--most notably, low-grade mucoepidermoid carcinoma. Complete removal of the tumor is curative.

Adiaspiromycosis: an unusual fungal infection of the lung. Report of 11 cases.

Adiaspiromycosis (ad"i-ah-spi"ro-mi-kósis) is a worldwide, noninfectious, nonarthropod transmitted fungal infection of lower vertebrates, most commonly rodents. Humans become an accidental host by inhaling dust-borne spores (conidia) of the saprophytic soil fungus, Emmonsia crescens (recently renamed Chrysosporium parvum variety crescens). We report 11 cases of this unusual deep mycosis from South America, Europe, and the United States. The severity of the disease depends on the number of spores inhaled. In limited inoculum, the disease remains localized (two cases), whereas in heavy inocula the fungus involves both lungs (nine cases) and presents as a diffuse reticulonodular infiltrate. In this disseminated form, patients usually complain of cough, dyspnea on exertion, and low-grade fever mimicking other systemic fungal infections and tuberculosis. It is difficult to unmask the fungus because it is not easily cultured nor is there a reliable serologic test. Therefore, a biopsy is required and the pathologist must recognize the large (ranging in size from 50 to 500 microns), round, Gomori methenamine-silver nitrate and periodic acid-Schiff reagent-positive spherules with a trilaminar wall. The spherules can be surrounded by either suppuration, epithelioid granulomas with or without necrosis, or concentric, hyalinized fibrosis. In the latter chronic stage, the organism may collapse, forming a variety of sizes and shapes thereby resembling other fungi, helminths, mineral particles, or inhaled pollen grains. Clinically, the infection most commonly regresses spontaneously, but may persist, or rarely progress, requiring surgical intervention with limited resection to attain cure.

Localized benign and malignant fibrous tumors of the pleura. A clinicopathologic review of 223 cases.

We reviewed 223 localized fibrous tumors of the pleura and divided them histologically into 141 benign and 82 malignant neoplasms. The criteria used for a judgement of malignancy were high cellularity and mitotic activity (more than four mitotic figures per 10 high-power fields), pleomorphism, hemorrhage, and necrosis. The tumors occurred equally in both sexes, most commonly in the sixth to seventh decades of life. Presenting symptoms included chest pain, dyspnea, and cough; they were observed in three-fourths of patients with a malignant tumor. One in every four of these patients had hypoglycemia, clubbed digits, or pleural effusion. Two-thirds of the tumors were attached to visceral pleura, often by a pedicle. The rest arose from the parietal pleura of the chest wall, diaphragm, or mediastinum. Neoplasms in these atypical sites, together with fissural lesions and tumors "inverted" into peripheral lung, were more often malignant. Most neoplasms measured 5-10 cm and weighed 100-400 g. Microscopically, the "patternless pattern," or hemangiopericytic type, was seen in the majority of cases, and mixed patterns were seen in nearly 40% of tumors. Of the 169 tumors where follow-up was available, all of the benign and 45% of the malignant tumors were cured by simple excision. Patients surgically cured of a malignant neoplasm had pedunculated or well-circumscribed lesions. However, 55% of patients with malignant tumors succumbed to their disease secondary to invasion, recurrence, or metastasis. Resectability is the single most important indicator of clinical outcome. No tumor expressed epithelial differentiation, either immunohistochemically or ultrastructurally; therefore, we favor the term "localized fibrous tumor" of pleura instead of "localized mesothelioma."

A, B, and H substances in syringomas. An immunohistochemical analysis of 15 cases.

This study examines the distribution of A, B, and H substances in 15 syringomas and 11 control axillary skins. Monoclonal antibodies (MCABs) against A, B, and H substances with the avidin-biotin-peroxidase complex (ABC) method were used. Additionally, the H antigen was localized with Ulex europaeus Agglutinin-I (UEA-I) by use of the peroxidase-antiperoxidase method. The MCABs provided specific and reproducible staining of all 15 syringomas as well as the secretory coli and duct of normal eccrine glands. Contrariwise, apocrine and sebaceous glands were uniformly nonreactive. The staining by the UEA-I technique showed a similar pattern to that of the anti-H MCAB but with increased background (nonspecific) staining. These results, using state-of-the-art immunohistochemistry, confirm the eccrine origin of syringoma. Blood group substances may be useful in distinguishing other tumors of eccrine origin from those of apocrine origin.

The role of bronchoalveolar lavage in the diagnosis of invasive pulmonary aspergillosis.

Cultures and histochemical stains for fungi were performed on concentrated, cytocentrifuged bronchoalveolar lavage (BAL) samples from 82 immunocompromised patients undergoing bronchoscopic evaluation of new pulmonary infiltrates. Aspergillus hyphae were identified in 9 of 17 BAL samples from patients with invasive pulmonary aspergillosis and from 3 of the remaining 65 study patients without this diagnosis. Thus, the presence of Aspergillus hyphae in BAL samples had a 53% sensitivity, 97% specificity, and 75% positive predictive value for the diagnosis of invasive pulmonary aspergillosis. BAL fungal cultures were positive in only 4 of 17 cases (23% sensitivity). A combination of fungal stains and cultures yielded a diagnostic sensitivity of 58% and a specificity of 92%. Results of routine fiberoptic bronchoscopy procedures in the 17 patients with aspergillosis who had BAL and in a retrospectively identified group of 10 patients with invasive aspergillosis who had only routine bronchoscopy were tabulated. Routine bronchoscopy procedures yielded a diagnosis in 5 of 27 cases (22% overall yield), with washings diagnostic in 4 of 27 cases (15%), and transbronchial biopsies positive histologically in 2 of 11 cases (18%). BAL is a valuable first procedure for diagnosing invasive pulmonary aspergillosis in the compromised host.

Signet ring cell carcinoma of prostate. Immunohistochemical and ultrastructural study of a case.

Signet ring cell adenocarcinoma (SRCA) is an extremely rare tumor of the prostate. We document with histochemistry, immunohistochemistry, and electron microscopy an incidental "signet ring" cell adenocarcinoma of the prostate in a fifty-seven-year-old white male with chronic lymphocytic leukemia who died of an intracerebral hemorrhage. The signet ring cells stained weakly for neutral mucin and were strongly positive for both prostate-specific antigen and prostate acid phosphatase. In addition, electron microscopy demonstrated intracellular lumina with microvilli and cytoplasmic vacuoles of mucin. This case conclusively supports the existence of SRCA of the prostate.

Sporothrix infection of the lung without cutaneous disease. Primary pulmonary sporotrichosis.

The clinical spectrum of sporotrichosis is expanding and now includes pulmonary infection in absence of skin lesions. Lung involvement, albeit unusual, is a granulomatous pneumonitis which may progress to bilateral, apical, fibrotic, and contracted infiltrates or cavities, thereby mimicking tuberculosis or histoplasmosis. The patients are most often middle-aged men with alcoholism and chronic obstructive pulmonary disease. Our case report is yet another variant of primary pulmonary sporotrichosis that presented as diffuse, bilateral granulomatous pneumonitis without cavitation or predilection for upper lobes.

Isoantigens A, B, H in normal skin and tumors of the epidermal appendages.

Isoantigens A, B, H(O) in biopsy specimens of 26 normal skin and in 35 adnexal tumors were studied by the red cell adherence (RCA) test of Davidsohn. Isoantigens were detected in the stratum corneum, stratum granulosum, stratum spinosum, acrosyringium, keratogenous zone of hair follicle, eccrine duct, and eccrine gland. The apocrine gland and duct consistently had negative test results for isoantigens. Seventy percent of all tumors tested contained isoantigens and included syringoma, hidrocystoma, syringocystadenoma papilliferum, spiradenoma, eccrine poroma, dermal duct tumor, clear cell hidradenoma, and cylindroma. We interpreted the presence of isoantigens in adnexal tumors as being evidence of immunologic maturity with differentiation toward eccrine structures. The RCA test is a new, sensitive, immunologic technique that can complement enzyme histochemical stains and electron microscopy in the study of the histogenesis of adnexal skin tumors.

Miliary nodules, Hodgkin's disease, and eosinophilic granuloma.

We describe a patient with Hodgkin's disease (HD) who subsequently developed miliary lung nodules proven to be eosinophilic granuloma (EG). The differential diagnosis and a brief review of the pertinent literature is presented.

Interstitial emphysema in adults: recognition and prognostic implications.

Interstitial pulmonary emphysema (IPE) is the initial manifestation of ventilator-induced barotrauma and, if unrecognized, may eventuate in life-threatening complications. It can be diagnosed by certain radiographic criteria that reflect the pathophysiology. These include parenchymal stippling, lucent mottling and streaking, perivascular halos, subpleural cysts, lucent bands, and parenchymal cysts or bullae. In the presence of continuing airway pressure elevation and/or significant underlying lung pathology, certain complications of IPE can be anticipated. These include air leak, air block, secondary infection, and extensive pulmonary fibrosis. In the patient who is already in a state of respiratory compromise, pneumothorax or alteration in cardiovascular dynamics can constitute a terminal event. We believe, therefore, that the earliest possible recognition of the radiographic changes of IPE is critical in the management of the patient who requires ventilatory assistance.

The American lung fluke, Paragonimus kellicotti, in a cat model.

Twenty-four specific-pathogen-free domestic cats were infected orally with from 2 to 30 Paragonimus kellicotti metacercariae and followed for 2-61 wk. Following infection by metacercarial cysts dissected from crayfish, the lungs of the cats undergo changes of intense eosinophilic pneumonia, granulomatous pneumonitis, squamous epithelial-lined cyst formation of bronchogenic origin, and finally (late in infection) partial resolution of the host response. Bronchograms and mechanical probing illustrate the patency of cyst communication with bronchi. The modulation of the host response and adaptive changes in the host lung tissue are seen late in infection and have previously been unreported or underemphasized. These adaptive responses may account for the number of asymptomatic cases accidentally found in veterinary patients and the difficulty in prompt and proper diagnosis in human cases.

Malignant jugulotympanic paraganglioma in a dog.

An invasive malignant epithelial neoplasm was diagnosed as a paraganglioma by light and electron microscopy and immunohistochemically by a positive reaction with anti-neuron-specific enolase. Due to the extensive involvement of the middle ear, a primary origin in the jugulotympanic or jugular paraganglia is suggested.