Histiocytic necrotising lymphadenitis in mediastinum mimicking thymoma or lymphoma - case presentation and literature review of Kikuchi Fujimoto disease.

Kikuchi Fujimoto disease (KFD) as a rare self-limiting lymphadenopathy of short and benign course concerns most frequently the lymph nodes of the neck. The most common symptoms are painfulness of the diseased area, fever and night sweating. The etiology is not well understood, but in the role of pathogenesis viral, autoimmune and genetic factors are taken into account. In the presented case of 37-year-old female it was necessary to exclude diseases such as lymphoma or thymoma because of atypical mediastinal location of Kikuchi Fujimoto disease. After multidisciplinary consultation the lymph node was resected from the mediastinum with videothoracoscopic approach. The diagnosis was difficult for the pathologist because of the large percentage of necrosis of the lymph node but the image was typical for histiocytic necrotizing lymphadenitis. Two cases of patients with KFD limited to the mediastinum have been previously reported in the literature. This article presents the world's first reported case of this disease in the topographic location of the thymus. Furthermore, a review of current literature was made.

Huge alveolar soft part sarcoma of the retroperitoneum - case report.

Alveolar soft part sarcoma (ASPS) is a rare type of neoplasm, typically occurring in adolescents and young adults. Because of the rarity of this disease, there is no standard treatment plan. Chemotherapy and radiotherapy are not effective in this type of malignancy. Surgical excision is considered to be the treatment of choice. We report a case of a young woman with a painless mass in her left lower abdomen. Ultrasonography and CT scan revealed a large (21 cm) hard tumor occupying the left retroperitoneal space, which was surgically excised in our surgery department. The pathological diagnosis was ASPS.

A giant primary thyroid fibrosarcoma in an octogenarian.

We present an 89-year-old patient who was suffering from severe dyspnoea and mild dysphagia due to tracheal and esophagus compression by a giant goitre. The patient was euthyreotic. A total thyroidectomy was successfully performed. The pathology examination revealed fibrosarcoma G1, which is an extremely rare tumor of the thyroid.

Postural and trunk responses to unexpected perturbations depend on the velocity and direction of platform motion.

This study compares postural and trunk responses to translating platform perturbations of varied velocities and directions. A group of 18 young and physically active subjects were exposed to a set of postural perturbations at varied velocities (5, 10, 15, and 20 cm/s) and directions of platform movement (forward, backward, left-lateral, and right-lateral). The center of pressure (CoP) displacement measurement, in addition to the trunk motion (representing the center of mass (CoM) displacement), were both monitored. Results identified that the CoP displacement increased from slow to faster velocities of platform motion more widely in both anterior and posterior directions (50.4 % and 48.4 %) as compared to the CoM displacement (17.8 % and 14.9 %). However a greater increase in the peak CoM velocity (70.3 % and 69.6 %) and the peak CoM acceleration (60.5 % and 53.1 %) was observed. The values in the anterior and posterior direction only differed significantly at the highest velocity of platform motion (i.e. 20 cm/s). A similar tendency was observed in the medio-lateral direction, but there were no significant differences in any parameter in the left-lateral and right-lateral direction. The velocity of the platform motion highly correlated with peak velocity (r=0.92-0.97, P<0.01) and moderately with amplitude of trunk displacement (r=0.56-0.63, P<0.05). These findings indicate that the velocity of perturbation alters peak CoM velocity rather than the magnitude of CoM displacement. The effect of the direction of perturbations on the trunk response emerges only at a high velocity of platform motion, such that the peak CoM velocity and peak CoM acceleration are significantly greater in anterior than posterior direction.

Reliability and methodological issues of power assessment during chest presses on unstable surface with different weights.

AIM: The study compares the reliability of peak power (Ppeak) and mean power in acceleration (Pmean acc) and entire concentric phase (Pmean total) of chest presses on the bench and unstable Swiss ball with different weights. METHODS: A group of 32 fit men performed over 2 testing sessions 3 trials of barbell chest presses on the bench and Swiss ball, without and with countermovement, with weights of 40, 60 and 80% 1RM. RESULTS: High values of correlation coefficients (above .80) and no significant differences between trials signify stability of measurement under both stable and unstable conditions. When chest presses were performed on the bench, ICC and SEM% values were in range .97 to .98 and 7.6 to 7.7%, respectively for Pmean total, .96 to .98 and 9.1 to 9.6%, respectively for Pmean acc, and .94 to .97 and 9.2 to 10.0%, respectively for Ppeak. Their values during chest presses on a Swiss ball ranged from .93 to .96 and 8.4 to 9.1%, respectively for Pmean total, from .87 to .90 and 11.7 to 12.2%, respectively for Pmean acc, and from .79 to .82 and 12.1 to 13.4%, respectively for Ppeak at weights of 40 and 60% 1RM, and from .70 to .76 and 17.6 to 19.8%, respectively at weight of 80% 1RM. CONCLUSION: Measurement of peak and mean power during unstable chest presses provides reliable data comparable to those obtained during bench presses under all conditions tested. However, peak values of power measured during unstable chest presses with weights ≥80% 1RM should be interpreted with caution.

Immunohistochemically stained markers (p53, PCNA, bcl-2) in dysplastic lesions of the larynx.

The percentage of malignant transformation of laryngeal dysplastic lesions is difficult to estimate. There is a need for new histological markers which could enable more objective assessment of the premalignant stages of the larynx and help in estimation of the potential of future neoplastic progression. We performed a retrospective study to determine whether immunohistochemical staining for the proliferating cell nuclear antigen (PCNA), tumour suppressor gene protein p53 and antiapoptotic protein bcl-2 may be prognostic factors in laryngeal epithelial lesions. Staining was performed on 57 paraffin-embedded biopsies from patients with clinically detected precancerous stages of the larynx. Histopathologic examination revealed normal epithelium in six cases, mild dysplasia in 20 cases, moderate dysplasia in 18 cases, severe dysplasia in seven cases, CA in situ in four cases, papilloma in one case and CA invasivum in one case. The p53 count in mild and moderate dysplasia was 26.8 and 38.6%, respectively. This difference was statistically significant. There was significant correlation between PCNA and p53 scores. There was also a relationship between the scores of these markers and bcl-2 expression. In ten out of 45 cases of dysplastic lesions the invasive cancer developed in 4 years of follow-up. The correlation between PCNA score and malignant progression of the dysplastic lesions was on the statistical borderline. There was significant relationship between malignant transformation and age of the patients.

Cervical carcinoma antigen, carcinoembryonic antigen (CEA), and nonspecific cross-reacting antigen (NCA) in appraisal of uterine cervix smears.

The distribution of cervical carcinoma antigens (AgCaCx), CEA, and NCA in different pathologic states of the uterine cervix was studied in cytologic smears by an immunofluorescence method (IF) using specific immune sera against perchloric acid (PCA) extract of cervical squamous cell carcinoma, anti-CEA, and anti-NCA. After excluding cross-reactivity with CEA and NCA, the presence of AgCaCx was demonstrated in the majority of cervical carcinomas, severe dysplasias, and only in one-fourth of squamous metaplasias, especially when accompanied by mild or moderate dysplasias. The intensity and percentage of IF-positive cells varied from case to case. The preparations of uterine cervix without pathologic changes usually were negative. Similar results were obtained with anti-CEA serum. NCA was present in the majority of smears independent of histologic diagnosis. The most intense fluorescence was observed in upper layers of the epithelium. NCA could be a differentiation antigen of stratified squamous cell epithelium.

Epidermal growth factor receptor (EGFR), proliferating cell nuclear antigen (PCNA) and Ki-67 antigen in laryngeal epithelial lesions.

The epidermal growth factor receptor (EGFR), proliferating cell nuclear antigen (PCNA) and Ki-67 immunostaining in paraffin sections from 154 cases of laryngeal squamous cell carcinoma, 25 specimens of normal and hyperplastic laryngeal epithelium, and 21 preneoplastic lesions was examined. The difference of EGFR expression and PCNA score between laryngeal cancer and dysplastic lesions vs normal and hyperplastic epithelium was significant. There was significant difference in Ki-67 score between malignant vs premalignant lesions and normal and hyperplastic epithelium. There was significant correlation between PCNA score and histopathological grading of the tumour. The highest PCNA expression was detected in stage G3. Our findings have shown that PCNA and Ki-67 staining can be used as a marker of cell proliferative activity in laryngeal epithelial lesions. EGFR, PCNA and Ki-67 expression correlate with severity of laryngeal lesions. PCNA immunostaining can aid in estimating the histological grade of malignant lesions.

Cobalt-activated acylase and aminoacylase I in human malignant tumors.

The activities and isoenzyme pattern of cobalt-activated acylase and of aminoacylase I were estimated in carcinomas of bronchi, lung, thorax, stomach, colon and uterus. In all cancer tissues the activity of cobalt-activated acylase was markedly increased as compared with the normal tissue. Alterations of the isoenzyme pattern of cobalt-activated acylase were found in the carcinoma of stomach and of uterus, with the increased expression of the form-1 of the enzyme. No regularity in the aminoacylase I changes in tumor tissues has been observed.

Contribution of flow cytometric immunophenotyping and bone marrow trephine biopsy in the detection of lymphoid bone marrow infiltration in non-Hodgkin's lymphomas.

The bone marrow (BM) is a frequent site of involvement in non-Hodgkins lymphomas (NHL) and evidence of an infiltrated BM may implicate different therapeutical regimens. Flow cytometric immunophenotyping of bone marrow aspirates now is included in the assessment of patients with NHL and used as an adjunct to morphologic evaluation in the staging of lymphoma. The aim of the study was to compare flow cytometric immunophenotyping of BM and paraffin section staining of BM biopsies in the marrow involvement of NHL. Cytometric immunophenotyping of bone marrow and immunohistochemical paraffin section staining of bone marrow biopsies in 53 B- and T-cell lymphoma patients were performed. We used the following fluorochrom conjugated monoclonal antibodies specific for: CD3, CD4, CD5, CD7, CD8, CD10, CD19, CD20, CD22, CD23, CD79B, FMC7 and Ig kappagamma light chain. Unilateral BM trephine biopsies were obtained in all cases, fixed, decalcified and paraffin-embedded. Morphologic marrow involvement by lymphoma was found in 24 cases; flow immunophenotyping identified 26 cases with NHL: morphology-positive/flow-positive (n=21), morphology positive/flow-negative (n=3), morphology-negative/flow-positive (n=4), and morphology-negative/flow-negative (n=23). The concurrence rate of BM trephine biopsy and flow cytometric immunophenotyping in evaluation of NHL bone marrow infiltration was 88.7%. Immunophenotyping of the bone marrow of NHL patients by flow cytometry is helpful for assessment of bone marrow infiltration, especially in B-cell disorders. Both trephine biopsies and flow cytometry are better than single investigation for detection of infiltration in NHL.

Refracture of the forearm in children.

In a retrospective study we reviewed 28 refractures of the forearm in children, which occurred at a mean of 14 weeks after conservative treatment of the primary fracture. The cause for the refracture was incomplete healing of a primary greenstick fracture in 21 cases (84%). Twenty-two recurrent fractures were treated conservatively, but two had a second refracture. Fifteen patients were followed for over two years. Definitive angulation of more than 10 degrees caused a deficit of forearm rotation. To prevent refracture of the forearm in children, complete and circular consolidation of the primary fracture must be guaranteed.

The natural course of cryptorchidism in rats and the efficacy of orchidopexy or orchidectomy in its treatment before and after puberty.

Both clinical and experimental evidence suggest that fertility is impaired in unilateral cryptorchidism. To investigate the effect of the undescended testis on the contralateral descended gonad, a new experimental model based on natural cryptorchidism in rats was designed. Seventy male Buffalo rats with an undescended right testis noted at the age of 30 days were used. Fifty healthy animals served as a controls. The natural course of cryptorchidism was investigated at the ages of 30, 90, and 180 days. The effects of orchiopexy and orchiectomy performed in cryptorchid animals before and after puberty were evaluated at the age of 180 days. Both nonoperated and operated animals were mated at the age of 150 days in order to estimate their fertility. The animals were killed at 30, 90, and 180 days of life and the testes were removed. In each excised testis testicular weight and seminiferous tubular diameters were measured and the maturity of the germinal epithelium was determined using the Johnsen testicular biopsy score. The experiment demonstrated reduced testicular weight and seminiferous tubular diameters in undescended testis already at 30 days and arrest of spermatogenesis at the spermatocytes stage at 90 and 180 days. There was no significant difference between contralateral descended testes and controls at the age of 30 and 90 days, but at 180 days the degenerative changes were identical with those in the cryptorchid testes. Cryptorchid rats were completely infertile. Both orchiopexy and orchiectomy prevented the damage to the contralateral testis. A significant improvement in size and spermatogenesis was recorded in most cases of the surgically descended testes.(ABSTRACT TRUNCATED AT 250 WORDS)

Division of the genitofemoral nerve in unilateral cryptorchid rats.

The long-term effect of dividing the genitofemoral nerve supply to the undescended testis in naturally cryptorchid rats is reported. 20 male Buffalo rats with an undescended right testis, noted at the age of 30 days, were used for the investigation. 20 healthy animals served as controls. The abdominal division of the right genitofemoral nerve was performed in 10 cryptorchid and 10 healthy animals at the age of 40 days. The animals were mated at 150 days of age. Both testes were removed at 180 days of age. In each excised testis the testicular weight and seminiferous tubular diameters were measured, and the maturity of the germinal epithelium was determined using the Johnsen testiscular biopsy score. The experiment showed that in 70% of the nonoperated cryptorchid rats, both testes were affected at the age of 180 days, and 90% of these animals were infertile. In the operated cryptorchid rats, the contralateral descended were not damaged, and 60% of these animals were fertile. The division of the genitofemoral nerve in healthy animals had no effect. The results suggest that neural transmissions might play a role in the damage to the descended testis in unilateral cryptorchidism. This observation requires further investigations.

Tumor-associated antigens in female genital tract cancers.

The immunologic reactivity of glycoprotein antigens extractable from individual, histologically different ovarian and uterine cancers was studied taking into account their relationship with carcinoembryonic antigen (CEA), nonspecific cross-reacting antigen (NCA), alpha-feto-protein (AFP), and alpha-1-antichymotrypsin. All studies were performed using specific immune sera against perchloric acid (PCA) extracts of ovarian mucinous cystadenocarcinoma (anti-PCA-CaOm) and cervical squamous cell carcinoma (anti-PCA-CaCx), and antisera against the reference antigens mentioned above. A considerable antigenic heterogeneity and the existence of several immunologically related antigenic systems were found: 1) CEA-like antigens; 2) NCA-type antigens; 3) an antigen different from CEA and NCA present in ovarian mucinous adenocarcinomas and often cross-reacting, but not identical with respective antigens of uterine body and cervical carcinomas; 4) an antigen reacting with anti-alpha-1-anti-chymotrypsin serum; and 5) an antigen reacting with anti-AFP serum.

Cytologic appearance of esthesioneuroblastoma in a fine needle aspirate.

Esthesioneuroblastoma (olfactory neuroblastoma) is a rare malignant neoplasm derived from the olfactory epithelium. It was diagnosed by cytologic study of fine needle aspiration biopsy smears of a tumor situated in the nasopharynx in a 57-year-old man.

C-erbB-2 immunostaining in laryngeal cancer.

Tumour progression is strongly associated with a series of specific genetic changes in protooncogenes and tumour suppressor genes. One of the potential factors involved in tumorogenesis of squamous cell carcinomas is protooncogene c-erbB-2 (also known as neu or HER2). The authors analysed the expression of c-erbB-2 oncoprotein in 154 cases of laryngeal squamous cell carcinomas and its relationship to the clinical outcome of the patients. The difference in c-erbB-2 oncoprotein expression between the control group and cancer patients was on the statistical borderline (p = 0.0470). There was no significant correlation between c-erbB-2 expression and sex and age of the patients. T stage, lymph node status, site and histopathological grading of the tumour and clinical outcome of the patients. Univariate analysis revealed no correlation between c-erbB-2 expression and survival rates. We conclude that immunohistological examination of c-erbB-2 on paraffin section is not a valuable prognostic factor in laryngeal carcinoma.

Proliferating cell nuclear antigen in laryngeal cancer.

The expression of proliferating cell nuclear antigen in paraffin sections from 154 cases of laryngeal squamous cell carcinoma were examined. There was significant difference in PCNA expression between the control group and cancer patients (p < 0.001). The mean score of PCNA was higher in patients with poor prognosis than in patients with satisfactory outcome after treatment (p < 0.05). There was no significant correlation between the PCNA count and the patient's age and sex, T and N stage and site of the tumour. Univariate analysis revealed that the PCNA score correlated with the patients' survival rates. In multivariate analysis the prognostic value of PCNA was on the statistical borderline (p = 0.049). In our study clinical features like N and T status had a more important influence on survival rate. Nevertheless it appears that the immunohistological examination of PCNA in paraffin section could be a complementary prognostic tool for laryngeal carcinoma. PCNA expression may also be a valuable tool for differentiating malignant from benign laryngeal epithelium.

[Hematological disorder caused by a giant myoma of the uterus]. / Zaburzenia hematologiczne wywolane miesniakiem macicy.

OBJECTIVES: Polycythaemia means an increase in the number of red blood cells and usually a corresponding increase in the haematocrit and in the quantity of haemoglobin. Regarding etiology, primary and secondary forms of polycythaemia can be distinguished. The primary form--polycythaemia vera--is caused by autonomous erythroblastic hyperplasia. Secondary polycythaemia--erythrocythosis--may arise as a consequence of erythropoietin (EP) overproduction due to tissue hypoxia. These changes may stimulate the EP synthesis in the kidneys. EP may also be produced in metaplastic cells. STUDY DESIGN: A 59-year-old woman was admitted to the Clinic of Haematology of the Wroclaw Medical University with a 10-years' history of significant increase in HB, VPRC and RBC. Physical examination showed an obvious plethora and a large intra-abdominal painless tumour. Laboratory data revealed increases in Hb, VPRC, RBC and EP. A bone marrow aspiration was normal. During surgery, a large leiomyoma of the uterus was found and a total hysterectomy was performed. Pathological examination showed the tumour to be fibroleiomyoma. 4 weeks after surgery Hb, VPRC, RBC and EP, all returned to normal levels. RESULTS: Excluding the effect of the renal compression, it can be concluded that erythropoietin secreted by the the tumour caused the secondary haematological changes.

Influence of the emulsion sign in phenytoin bioavailability.

To study the influence of the emulsion sign in phenytoin bioavailability, two emulsions (w/o and o/w) were prepared. Bioavailability studies were carried out with both emulsions in Wistar male rats. The study was of a randomized two-way cross over design. A radiotracer technique was chosen as analytical procedure, due to the small blood sample collected. 14C-phenytoin was synthesized with a high yield and suitable radiochemical purity. It is concluded, from a biopharmaceutic point of view, that the emulsion sign does not seem to affect the amount of phenytoin absorbed, as it is shown through the comparison of the areas under curve up to 24 h. An emulsion with oil as an external phase is responsible of a longer absorption, taking into account the apparent elimination constant rates.

[Hematologic changes in stomach cancer]. / Zmiany hematologiczne w raku zoladka.

Haematologic disturbances in 13 cases of gastric cancer are described. All the patients had anemia of different origin. Increased leukocytosis was observed in half of the cases, leukemic reaction in one third. Hemolysis was present in 50% of cases. Thrombocytopenia coexisted most frequently with disseminated intravascular coagulation in 4 patients. Bone metastases were visualised as osteolytic foci with radiological methods or increased capture of isotopic marker in the bones under scintigraphic examination. Under the microscope neoplastic metastases were found in bone marrow smears of 5 patients. All patients displayed symptoms of gastric ulcer disease acute or chronic phase. In some cases only repeated gastroscopic examination and mucosa biopsy was the only way to confirm cancer. In other cases the diagnosis was made after the histopathologic examination of the resected stomach, in still others by a section.