Polyoma virus infection after renal transplantation. Use of immunostaining as a guide to diagnosis.

BACKGROUND: Polyoma virus infection is characterized by lymphocytic interstitial infiltrate in the kidney, and it mimics acute rejection. The purpose of this study is to estimate renal allograft outcome with this infection and characterize the lymphocytic infiltrates in polyoma virus-infected renal allografts. METHODS: Patients who had polyoma virus inclusions in renal allograft biopsies were identified. Other viral inclusions were excluded by immunohistochemistry. The lymphocytic infiltrates of six cases of polyoma virus infection were compared with six cases of definite acute rejection by immunostaining for T and B cells. RESULTS: There were 10 cases of polyoma virus infections in renal transplant recipients. Immunosuppressants consisted of mycophenolate mofetil with tacrolimus in eight cases and mycophenolate mofetil with cyclosporine in two. The median time of diagnosis of polyoma virus infection after transplantation was 9.5 months, and the time to graft failure after the diagnosis was 4 months. Reduced allograft survival was seen in patients who had polyoma virus infection. Immunostaining for T and B cells revealed marked increase in the B cells (CD20) in renal allografts with polyoma virus infection of 21% (range, 5-40%) compared with 6% (range, 0-10%) in those with acute rejection (P=0.039). Reduced cytotoxic T cells (TIA-1: median, 7%; range, 2-15%) were seen in polyoma virus-infected allografts compared with 24% (range, 15-30%) in those patients who had acute rejection (P=0.0159). CONCLUSION: Irreversible graft failure is more prevalent with polyoma virus infection. Enhanced immunosuppressants with mycophenolate mofetil with tacrolimus may play a role in the development of this infection. An increase in CD20 and a decrease in cytotoxic T cells in allografts is characteristic of polyoma virus infection.

Axillary sentinel lymph node examination in breast carcinoma.

OBJECTIVE: To evaluate whether the type of pathologic examination of breast sentinel nodes (frozen section, step sections, and immunoperoxidase staining) results in different percentages of nodes positive for metastatic disease. DESIGN: Twenty-eight consecutive patients with breast sentinel node biopsies were evaluated by step-sectioning the sentinel node(s) along with performing immunoperoxidase stains for low-molecular-weight cytokeratin and epithelial membrane antigen. SETTING AND PARTICIPANTS: The patients were from a university hospital and large private hospital. MAIN OUTCOME MEASURES: The results of the step sections and immunoperoxidase stains were compared with routine examination, that is, intraoperative frozen section along with a single hematoxylin-eosin slide. RESULTS: Nine cases were positive by routine evaluation, 10 by step sections, and 11 by immunoperoxidase staining. CONCLUSIONS: The large, multi-institutional studies of sentinel node utility must take into account the surgical pathology methods used to evaluate these specimens so that uniform techniques, which reliably predict the status of the axillary nodes, can be instituted at all institutions that use this procedure.

Cervical cytology and immunohistochemical features in endometrial adenocarcinoma simulating microglandular hyperplasia. A case report.

BACKGROUND: The histology of a few cases of adenocarcinoma simulating cervical microglandular hyperplasia (MGH-AdCa) has been reported. However, the cytologic features of MGH-AdCa in cervical smears and the immunohistochemical profile have not been described. CASE: A 73-year-old female presented with vaginal bleeding. The cervical Pap smear was initially interpreted by the cytotechnologist as "reactive endocervical cells" and was referred for cytopathologist review. The final interpretation was atypical glandular cells of undetermined significance (AGUS), probably neoplastic. Endometrial biopsy and total abdominal hysterectomy with bilateral salpingo-oophorectomy showed International Federation of Gynecologists and Obstetricians grade 1 endometrial carcinoma. The superficial component of the tumor resembled cervical microglandular hyperplasia (MGH); the deeper component had an endometrioid pattern. The Pap smear predominantly showed a glandular component with features of MGH. However, the presence of scattered single cells with hyperchromatic nuclei, one to three nucleoli, easily detectable mitotic figures, randomly scattered apoptotic bodies and focal, watery diathesis suggested a neoplastic process. Immunohistochemistry was studied on paraffin sections. In addition to other markers, the tumor cells were immunoreactive for carcinoembryonic antigen (CEA). CONCLUSION: Although the cervical Pap smear in this case had an MGH-like pattern, some features were atypical enough to suggest a diagnosis of AGUS, probably neoplastic. CEA immunoreactivity of MGH-AdCa could also help to differentiate it from MGH.

Localization of somatostatin-, bombesin-, and serotonin-like immunoreactivity in the lung of the fetal rhesus monkey.

Immunoreactivity of regulatory peptides has been demonstrated in the fetal lung of Macaca mulatta by the peroxidase anti-peroxidase method. Serotonin-immunoreactive neuroepithelial bodies are distributed in the airways from the bronchi to the alveolar ducts. Many neuroepithelial bodies also show bombesin-like immunoreactivity; a very few are immunoreactive to somatostatin antiserum. Four populations of neuroepithelial bodies were identified which contain immunoreactivity for 1) serotonin alone, 2) serotonin and bombesin, 3) serotonin and somatostatin, and 4) serotonin, bombesin, and somatostatin. Since bombesin and somatostatin have been demonstrated to have opposite effects on the release of other peptide hormones, it seems likely that the presence of these same peptides in neuroepithelial bodies may have a similar regulatory role in the lung.

Chronic recording from the His bundle of the awake dog.

The conventional catheter method for measuring specialized A-V nodal and His-ventricular conduction times in the intact dog heart precludes an unanesthetized control. This control is necessary for meaningful studies of the effect of drugs or drug-drug interactions on A-V conduction times. At right thoracotomy (halothane anesthesia), mongrel dogs had bipolar electrodes sutured to the epicardial surface of both atrial appendages, junctions of the sulcus terminalis with both vena cavae, and right ventricle. A unipolar needle electrode, referenced to a unipolar electrode on the ascending aorta, was inserted into the interatrial septum from the aortic root for recording the His bundle electrogram. After one to three weeks for stabilization, weekly measurements were made of A-V nodal conduction time (AVN) and His-ventricular conduction time (H-V) for up to 52 weeks (4 to 52 weeks). Mean values (13 dogs) for spontaneous cycle length, AVN and H-V conduction times were 477 +/- 25, 82 +/- 3, and 30 +/- 1 msec, respectively. Simultaneous recordings from catheter and implanted His bundle electrodes were made during changes in atrial paced rate (five dogs, pentobarbital anesthesia). Values for AVN and H-V conduction times from catheter or implanted electrodes were the same. AVN conduction time increased, H-V conduction time remained constant during increases in atrial rate. Atropine shortened and propranolol prolonged AVN conduction time in six unanesthetized, unsedated dogs; neither affected H-V conduction time. Histologic examination of electrode sites in two dogs at 43 and 52 weeks showed no evidence of damage to underlying myocardial recording sites. This preparation provides reproducible awake values for AVN and H-V conduction times, and hence a more meaningful control for pharmacologic investigations.

An immunocytochemical method for quantification of lung tissue fibronectin.

A technique to quantify tissue fibronectin was developed, using peroxidase-antiperoxidase immunocytochemistry and automated scanning light microscopy. This technique was developed using isolated perfused rat lungs, some of which were subjected to acute oxidant lung injury. Both injured and control lungs were perfused with solutions containing heterologous fibronectin. The technique clearly demonstrated differences in the amount of tissue fibronectin in injured and noninjured lung as well as differences between lungs exposed to fibronectin and those not exposed. The described technique offers a reliable method for quantifying tissue fibronectin and is sensitive enough to detect differences in tissue fibronectin under experimental conditions of acute lung injury.

Primary squamous cell carcinoma of the breast: sensitivity to cisplatinum-based chemotherapy.

Primary squamous cell carcinoma (SCC) of the breast is a rare malignancy whose optimal treatment and prognosis are unknown. A patient with SCC whose tumor responded dramatically to chemotherapy as part of multimodal treatment is presented. A 61-year-old woman had a palpable 5.5-cm tender left breast mass with overlying skin edema and erythema and irregular margins by mammography. Fine needle aspiration revealed malignant squamous cells with keratinization; incisional biopsy confirmed SCC. Extensive evaluation for an extramammary primary site of disease was negative. Neoadjuvant cisplatinum and 5-fluorouracil (5-FU) led to tumor shrinkage and complete resolution of pain and erythema. Modified radical mastectomy with post-operative chest wall radiation were performed. Neither residual invasive carcinoma nor metastatic nodal disease was found, though intraductal carcinoma with marked squamous features was identified. The patient remains disease-free 2.5 years after diagnosis. Cisplatinum-based chemotherapy should be considered in the treatment regimen of this disease.

Increased numbers of neuroepithelial bodies (NEB) in lungs of fetal rhesus monkeys following maternal dexamethasone treatment.

Numbers of neuroepithelial bodies in the lungs of fetal Rhesus monkeys increase in a dose-dependent manner when mothers are treated antenatally with dexamethasone. Maternal doses of 15 mg/kg result in numbers of neuroepithelial bodies in lungs of fetuses of 135-day gestational age not different from those of the mature control group at 162 days. Controls at 135 days are significantly different from those at 162 days. Serotonin immunoreactive neuroepithelial bodies were localized by immunocytochemistry.