Radiographic and anatomic characterization of the nasal septal swell body.

OBJECTIVE: To analyze the radiographic, anatomic, and histologic characteristics of the nasal septal swell body. DESIGN: Computer-aided analysis of magnetic resonance images (MRIs) and histologic examination of cadaveric nasal septa. SETTING: Tertiary medical center. PATIENTS: Fifty-four head MRI studies were performed on adult live patients; we also used 10 cadaveric nasal septa. MAIN OUTCOME MEASURES: Radiographic dimensions of the swell body and distances to other nasal landmarks were measured. Nasal septa and swell body histologic characteristics were evaluated using light microscopy. Relative proportions of vascular, connective, and glandular tissues within the swell body and the adjacent septum were compared. RESULTS: The swell body was fusiform shaped and located anterior to the middle turbinate, with mean (SD) width of 12.4 (1.9) mm; height, 19.6 (3.2) mm; and length, 28.4 (3.5) mm. The epicenter was 24.8 (2.9) mm from the nasal floor, 43.9 (4.1) mm from the nasal tip, and 39.0 (4.6) mm from the sphenoid face. Histologic analyses revealed that, compared with adjacent septal mucosa, the swell body contained significantly more venous sinusoids (37% vs 16%, P < .001) and fewer glandular elements (28% vs 41%, P < .001). CONCLUSIONS: The swell body is a conserved region of the septum located anterior to the middle turbinate approximately 2.5 cm above the nasal floor. The high proportion of venous sinusoids within the swell body suggests the capacity to alter nasal airflow. Additional study is required before these findings are used in a clinical setting.

Fine needle aspiration biopsy of monophasic spindle synovial sarcoma of lung with fluorescence in situ hybridization identification of t(x;18) translocation: a case report.

BACKGROUND: Primary monophasic spindle synovial sarcoma can occur in areas with no apparent relation to synovial structures. The diagnosis can be challenging because of the ability to mimic other spindle cell neoplasms. Within the lung, these neoplasms are rare and cytologic descriptions are limited. CASE: A 58-year-old woman was diagnosed with colonic adenocarcinoma; chest computed tomography (CT) revealed a 5-cm solitary pulmonary mass, and CT-guided fine needle aspiration was performed. Aspirate smears were cellular, with large, loosely cohesive complex tissue fragments that showed dense spindled cells with numerous single stripped spindle cells. Spindle cells were bland and monomorphic, with minimal cellular variation. There was no anaplasia or specific mesenchymal differentiation. Immunohistochemical stains on the cell block were positive for vimentin and bcl-2. A diagnosis of spindle cell neoplasm was rendered; it was believed to be a second neoplasm unrelated to the colonic adenocarcinoma. The main diagnostic consideration was synovial sarcoma. On resection, the neoplasm demonstrated t(x:1 8) chromosomal translocation by fluorescence in situ hybridization. CONCLUSION: In a spindled cell neoplasm arising as a single peripheral pulmonary nodule, monophacir spindle synorvial sarcoma should be considered in the differential diagnosis; detection of the t(x;18) chromosomal translocation can confirm the diagnosis.

Hemostatic agent microporous polysaccharide hemospheres (MPH) does not affect healing or intact sinus mucosa.

OBJECTIVES/HYPOTHESIS: Absorbable hemostatic agents are used routinely following sinus surgery. Recent studies suggest that current biomaterials, such as FloSeal Matrix Hemostatic Sealant (Fusion Medical Technologies, Mountain View, CA) may interfere with mucosal regeneration. This study was designed to evaluate the effects of Microporous Polysaccharide Hemospheres (MPH, Medafor, Inc., Minneapolis, MN), a novel rapidly-absorbing hemostatic powder, on healing and intact sinus mucosa. STUDY DESIGN: Prospective, controlled study using the rabbit model. METHODS: Both maxillary sinuses of 14 New Zealand white rabbits were surgically opened. The mucosa of 10 rabbits were stripped bilaterally, and the left sinus of each was then treated with either MPH or FloSeal. The mucosa of four additional rabbits were incised but otherwise remained undisturbed. Again, the left sinus of each of the four additional rabbits was treated with either MPH or FloSeal. The right sinus served as an untreated control (stripped or intact) in both arms of the study. Animals were recovered and euthanized 2 weeks later. Specimens were examined by a blinded pathologist using light microscopy. RESULTS: Untreated regenerated mucosa showed expected areas of sparse cilia, mild serous gland reduction, and fibrosis. MPH-treated sinuses showed no significant changes compared to respective controls, and no MPH substance was identified. In contrast, regenerating mucosa treated with FloSeal showed extensive loss of cilia, inflammation, and fibrosis. Residual FloSeal particles were present within the sinus cavity and grossly incorporated within healing mucosa. Unexpectedly, intact mucosa exposed to FloSeal showed similar findings. CONCLUSIONS: Absorbable hemostatic materials have starkly different effects on mucosal healing. Unlike other agents, MPH is rapidly cleared and has no negative effects on healing or intact sinus mucosa.

Squamous metaplasia and chronic rhinosinusitis: a clinicopathological study.

BACKGROUND: The significance of squamous metaplasia (SM) in chronic rhinosinusitis (CRS) is unknown. The objectives of this study were to determine the prevalence of SM in histopathological specimens from patients with CRS and to correlate these histological findings with clinical features. METHODS: We reviewed the clinical records and pathological slides from 87 consecutive patients who underwent endoscopic sinus surgery for CRS. Demographic and clinical data, preoperative Chronic Sinusitis Survey (CSS) scores, and sinus CT stage were evaluated. Pathological slides were graded by a pathologist to characterize the degree of inflammation and SM, when present. CRS patients with and without SM were compared using student's t-test and chi2 test. RESULTS: Evaluation of the pathology slides revealed that 18.4% of specimens had SM present, whereas only 2.2% of pathology reports noted this. Histological grading of chronic inflammation showed significantly greater severity in specimens with SM (n = 16) when compared with the cohort without SM (n = 75; 100.0% versus 77.5%, respectively; p = 0.016). There was no difference in preoperative CT stage or the presence of hyperostosis on imaging, CSS scores, duration of CRS symptoms, or other clinical features between those with SM and those without SM (p > 0.05). Immunodeficiency was the only comorbidity more prevalent in the metaplastic group (12.5% versus 0%, respectively; p = 0.003). CONCLUSION: SM is present in approximately 18% of routine CRS specimens. It has a positive correlation with the severity of inflammation noted histologically in CRS but does not correlate with disease severity or chronicity, clinically.

A report on four new cases of nephrogenic fibrosing dermopathy in chronic hemodialysis patients.

Nephrogenic fibrosing dermopathy (NFD) is a rare clinical entity affecting patients with renal failure, often on chronic dialysis or after transplantation. The patient profile at risk for this debilitating condition is undefined. Lack of awareness of the condition has hampered epidemiologic work in identifying the etiology. We present four chronic hemodialysis (HD) patients who developed this disease. The patients' ages ranged from 26 to 75 years, and they had received HD from between 20 months and 10 years before the diagnosis of NFD. Two patients had a history of renal transplantation. All patients had progressive thickening and woody induration of the skin associated with contractures, leading to difficult ambulation, and permanent disability within weeks of the diagnosis. In one case, the diaphragm, psoas muscle, and pericardium were involved. The latter is likely the first report of pericardial involvement of NFD. In all four patients, the skin findings were restricted to the extremities, sparing the trunk and face. Skin biopsy findings included thickened dermis with particularly thickened collagen bundles, fibroblast proliferation, minimal mucin deposition, and nearly absent inflammation. The pathologic findings were distinct from scleromyxedema and scleroderma. We found no laboratory evidence of autoimmune disease or thyroid dysfunction to account for alternate etiologies. CD34-positive cells were documented in the skin biopsies as well as in the diaphragm, psoas muscle, and pericardial tissue of the concerned case. NFD is a novel fibrosing disorder of progressively debilitating nature which needs further clinical characterization and recognition to guide investigation of its pathogenesis.

Concurrence of histologic features of steatohepatitis with other forms of chronic liver disease.

Steatohepatitis, of either alcoholic or nonalcoholic etiologies, is ultimately diagnosed by clinical-pathologic correlation and is characterized histologically by lesions that differ from the portal-based chronic inflammation and fibrosis of most other forms of chronic liver disease. With the increasing prevalence of steatohepatitis in our society, it is likely that some patients will have coexistent clinical and/or histopathologic findings of steatohepatitis concurrently with another form of liver disease. The aim of this study was to document clinical and histologic findings in biopsies in an academic referral center. Ninety-three non-allograft liver biopsies with lesions of both steatohepatitis and another liver disease were retrospectively identified in 85 patients. The finding of coexisting disease represented 5.5% of all hepatitis C biopsies and 4.0% of other forms of chronic liver disease in the 34 month time period. Clinical chart review of patients with concurrent disease showed the following: Group 1, patients with hepatitis C (n = 54); Group 2, patients with hepatitis C and prior or current history of more than 80 g/d alcohol consumption (n = 20); Group 3, patients with other forms of chronic liver disease (n = 11). Groups 1 and 3 had <10 g/d alcohol use. Obesity (body mass index >30) was noted in 75%, 60%, and 33% respectively, while 94%, 87% and 100% of patients were considered overweight (body mass index > or = 25). Diabetes was reported in 35%, 25%, and 9%. The concurrence of clinical and histologic features of steatohepatitis with another chronic liver disease may be a reflection of the frequency of steatohepatitis in the population at large.

Limited success of HCV antiviral therapy in United States veterans.

OBJECTIVE: The treatment of hepatitis C virus (HCV) infection in United States veterans has become a major task for the Veterans Administration Healthcare System. Although the comprehensive diagnosis and treatment of HCV-infected patients has been mandated, little is known about the performance characteristics of HCV clinics and about the outcomes of antiviral therapy in this unique patient population. METHODS: We retrospectively examined clinic show rates, treatment eligibility, and the response to antiviral therapy in a dedicated HCV outpatient clinic in a large urban Veterans Affairs medical center. RESULTS: Our data demonstrate that few veterans--regardless of their age or ethnic background--pursue evaluation and treatment of their HCV infection by hepatologists. A minority of those patients who undergo a comprehensive clinic evaluation meet the standard eligibility criteria for antiviral therapy. The overall efficacy of antiviral treatment, as measured by the sustained virological response rate, is substantially lower than previously reported in randomized clinical trials. HCV-infected veterans are characterized by a unique combination of risk factors that are predictive of a poor response to antiviral therapy, including a preponderance of male gender, HCV genotype I, age > 40 yr, and histologically advanced degrees of liver disease. CONCLUSIONS: Our study demonstrates the limitations of outpatient HCV treatment initiatives in the United States veteran population, and suggests that the overall impact of current HCV treatment programs may be small.