Flow cytometry immunophenotyping of vitreous specimens does not contribute to diagnosis of lymphoma without supporting morphologic features.

BACKGROUND: Diagnostic vitrectomy with flow cytometry immunophenotyping (FCI) is being increasingly used as part of screening for diagnostically challenging cases. We aim to evaluate the utility of combined cytopathology and FCI in diagnostic pars plana vitrectomy. We also aim to evaluate cytologic features that could potentially predict FCI outcomes. This study provides clearer indications for use of FCI in diagnostic vitrectomy. METHODS: A case series of diagnostic pars plana vitrectomy specimens from 2010 to 2016 from a single institution was retrospectively evaluated. Associations between cytologic features and FCI were analyzed statistically. RESULTS: Ninety-nine vitrectomy specimens (90 patients) were evaluated. Evaluation was diagnostic in 39 of 99 (39.4%) specimens. FCI was performed in 66 of 73 (90.4%) specimens collected for lymphoma indication, and 9 of those 66 FCIs (13.6%) demonstrated abnormal lymphocytes. FCI was performed in 10 of 26 (38.5%) specimens collected for non-lymphomatous indications; all 10 FCIs failed to demonstrate lymphocyte abnormality. The absence of large lymphocytes frequently demonstrated negative FCI (negative predictive value = 97.7%), and was the sole cytologic feature significantly associated with a negative FCI result [OR, 14.0; 95% CI, 1.65-635.6; P = .034]. CONCLUSIONS: Diagnostic vitrectomy with cytopathology evaluation is valuable, and concomitant FCI is useful to confirm intraocular lymphoma. However, the absence of large lymphocytes on cytologic examination is the single significant predictor of a negative FCI, and this finding should preclude the use of FCI.

Liposuction-Induced Fat Embolism Syndrome: A Brief Review and Postmortem Diagnostic Approach.

Lipoplasty, or liposuction, the surgical process of removing excess fat, is an elective procedure with rising frequency in the United States. Fat embolism syndrome is a clinical diagnosis and is defined as fat in the circulation with an identifiable clinical pattern of signs and symptoms (eg, hypoxemia, respiratory insufficiency, neurologic impairment, and petechial rash) that occur in the appropriate clinical context. Fat embolism syndrome following liposuction is a life-threatening complication, although its incidence is low. Currently, there is no specific therapy for fat embolism syndrome, so prevention, early detection, and supportive therapy are critical. Many cases of fat embolism syndrome are undiagnosed or misdiagnosed; however, postmortem examination can provide the means for appropriate diagnosis. Therefore, a pathologist must keep a keen eye, as microscopic fat emboli are difficult to appreciate with routine tissue processing and staining.

Potential cytochrome P-450 drug-drug interactions in adults with metastatic solid tumors and effect on eligibility for Phase I clinical trials.

PURPOSE: Potential cytochrome P-450 (CYP) drug-drug interactions in adults with metastatic solid tumors and their effect on eligibility for Phase I clinical trials were characterized. METHODS: This study included adult patients with metastatic solid tumors seen by a medical oncologist from January 2008 through July 2011. The medications used by these patients were identified. Each medication's potential for interacting with CYP isozymes was also characterized. Medication changes required to meet Phase I trial eligibility criteria were also reviewed. RESULTS: Data from 1773 patients were analyzed: 1489 were not enrolled in a Phase I trial and 284 were enrolled in a Phase I trial. Polypharmacy was significantly more prevalent in the group enrolled in a Phase I trial compared with those not enrolled (95% versus 80%, p < 0.001). The majority of patients not enrolled in a Phase I trial were taking at least one CYP isozyme inhibitor (87%) and at least one CYP isozyme inducer (45%). In a separate analysis, four Phase I trials were evaluated. Of 295 screened patients, 3.2% could not enroll due to concurrent medications. Charts from 74 enrolled patients revealed 655 concurrent medications­93 medications required further review for eligibility involving 51 (69%) of patients. Of the 93 medications, 38 (41%) were stopped and 41 (44%) were changed for the study. CONCLUSION: Polypharmacy and the use of medications that interact with CYP isoyzmes were common in adult patients with metastatic solid tumors. Patients enrolling in Phase I studies often require medication changes to meet eligibility requirements.