Showing papers in "American Journal of Clinical Pathology in 1982"
TL;DR: Four major age components of the DT with different biological properties are defined, including "juvenile" DT, a predominantly extra-abdominal desmoid tumor of the female sex; "fertile"DT, a nearly exclusively abdominal DT of fertile females; "menopausal" DT.
Abstract: We have (1) estimated the incidence of desmoid tumor (DT) in the Finnish population, and (2) defined statistically four major age components of the DT with different biological properties. The incidence of the DT, based on admissions to four separate hospitals and on the number of pathological biopsy specimens analyzed at the Central Pathological Laboratory of Helsinki University, is 2.4-4.3 new cases per 10(6) inhabitants per annum. Statistical analysis demonstrated four major age components where the site of the tumor and/or sex of the patient were non-randomly distributed: "juvenile" DT, a predominantly extra-abdominal desmoid tumor of the female sex; "fertile" DT, a nearly exclusively abdominal DT of fertile females; "menopausal" DT, a predominantly abdominal tumor where the sex ratio approaches one:one; and "senescent" DT, where abdominal and extra-abdominal varieties are equally frequently encountered and where the sex ratio of the affected patients is one:one.
494 citations
TL;DR: The WHO Histological Classification of Breast Tumors, published in 1968, has been completely revised and provides a recommended nomenclature, definitions, and code numbers for both tumors and tumor-like lesions.
Abstract: The WHO Histological Classification of Breast Tumors , published in 1968, has been completely revised. This second edition provides a recommended nomenclature, definitions, and code numbers for both tumors and tumor-like lesions. It aims at promoting uniformity in recording and reporting diagnoses in order to facilitate international and other comparisons.
333 citations
TL;DR: It is suggested that a generalized (inherited or mutant) defect in growth regulation of connective tissue is the most important underlying cause for the DT, however, the other factors, including hormonal effects, trauma, and pregnancy contribute to the growth behavior of the tumor.
Abstract: Eighty histologically verified cases of the desmoid tumor (DT) have been analyzed with regard to factors possibly contributing to the etiology and/or growth behavior of this uncommon neoplasm. Considering the four statistical age components, the "fertile" female and "menopausal" varieties of the DT grew distinctly faster (0.1 less than P greater than 0.05 and less than 0.05), and the female "juvenile" variety distinctly slower (0.1 less than P greater than 0.05) than the male DTs. In a visual estimate, the fertile female patients had a significant (P less than 0.01) predisposition to estrogen predominance, while fewer patients than expected displayed progesterone predominance or were at balance (P = NS and less than 0.01, respectively). Thirty-two per cent of the patients with an abdominal DT had been previously operated in the region of subsequent tumor growth. Significantly more pregnancies were observed in patients with abdominal DT than with extra-abdominal DT (P less than 0.05). On only one occasion did sigmoideoscopy reveal colonic polyposis (Gardner's syndrome). The most striking observation was, however, that up to 80% of the affected patients (compared with less than 5% in the normal control population, P less than 0.05) had multiple minor bone anomalies demonstrable by x-ray screening of the mandible, chest, and long bones. We suggest that a generalized (inherited or mutant) defect in growth regulation of connective tissue is the most important underlying cause for the DT. However, the other factors, including hormonal effects, trauma, and pregnancy contribute to the growth behavior of the tumor.
215 citations
TL;DR: Seven measures of iron metabolism evaluated by both chemical and histological methods showed a per cent saturation of transferrin above 62% to be the best simply-measured indicator of the affected genotype: homozygosity is accurately predicted in 92% of the cases.
Abstract: Tight linkage between the hemochromatosis locus and the HLA region permits determination of genotype in members of hemochromatosis pedigrees. To determine if simple laboratory measures of iron metabolism could predict the affected genotype without the need for HLA typing, we studied seven measures of iron metabolism: serum iron concentration, total iron-binding capacity, per cent saturation of transferrin, serum ferritin concentration, deferoxamine-induced urinary iron excretion and hepatic iron concentration evaluated by both chemical and histological methods. Discriminant analysis showed a per cent saturation of transferrin above 62% to be the best simply-measured indicator of the affected genotype: homozygosity is accurately predicted in 92% of the cases. The logarithmic transform of serum ferritin concentration was only 71% accurate. Pedigree analysis estimated the frequency of the hemochromatosis gene at 0.069 +/- 0.020 with a recombination probability of 0.015 +/- 0.015 with the HLA region. This corresponds to a heterozygote frequency of 0.13 and a disease frequency of 0.005.
180 citations
TL;DR: The TAg may be a prognostically useful immunohistochemical tumor marker in bladder cancer, especially for tumors negative for ABH BGAg.
Abstract: Tumor deletion of the ABH blood group antigens (BGAg) heralds an unfavorable prognosis in human bladder cancer. The T antigen (Thomsen-Friedenreich antigen: TAg), a precursor of other BGAg, has previously been found in malignant but not most normal cells, in which the TAg is cryptic but can be unmasked with neuraminidase (NMD). We investigated the prognostic significance of TAg expression in bladder cancer by staining paraffin sections with a T-specific lectin (peanut agglutinin [PNA]) immunoperoxidase technic. Seventy-two cases of low grade, low stage bladder cancer, 21 cases of high grade bladder cancer, and 68 controls were studied. All normals expressed the TAg only after NMD treatment (Cryptic TAg+). The Grade HI cancers, all invasive, either expressed the TAg (TAg+) (67%) or lacked T even after NMD (Cryptic TAg–) (29%), indicating that the T structure was lost rather than masked as in normal tissue. Thirty-nine per cent of 23 Grade I and II cancers which were TAg+ or Cryptic TAg– subsequently became invasive (Stage B), compared with 10% of 49 Cryptic TAg+ cancers. For 32 Grade I and II, ABH BGAg negative cancers, 64% of TAg+ or Cryptic TAg– cancers became invasive, compared with 17% of cancers which had Cryptic TAg+.
Thus, the TAg may be a prognostically useful immunohistochemical tumor marker in bladder cancer, especially for tumors negative for ABH BGAg.
153 citations
TL;DR: The data suggest that compromised fibrinolytic capacity may be a contributing factor in the development of thrombosis in patients with the lupus anticoagulant.
Abstract: The lupus anticoagulant was identified in three patients. Laboratory studies gave evidence of inhibitory activity directed against phospholipid and prekallikrein. Inhibition of prekallikrein has not been reported previously. When exposed to kaolin, all three patients' plasmas failed to develop the level of fibrinolytic activity achieved by similarly treated normal plasma. The data suggest that compromised fibrinolytic capacity may be a contributing factor in the development of thrombosis in patients with the lupus anticoagulant.
141 citations
TL;DR: The overall incidence of pancreatic cancer appears to be higher than previously reported, and the ductular cells appear to be the progenitor cells of a variety of tumor types, including squamous cell cancer and islet cell tumors, as in the authors' experimental model.
Abstract: A thorough histologic examination of the pancreas was performed on autopsy material from 83 military veterans aged 35–88 years. Hyperplastic, preneoplastic and neoplastic alterations were recorded by severity, multiplicity, location, and age. From this material, two patients had clinically known primary, and three had secondary (metastatic), pancreatic cancer. The following occult malignant lesions were found: two early cancers (one adenocarcinoma and one adenosquamous cell carcinoma), one ductal carcinoma in situ and seven ductular carcinomas in situ . Among patients with ductular carcinoma in situ , three had pancreatic cancer and the remaining four had cancers of other sites (ethmoid, ear, colon, prostate). One patient who was clinically diagnosed as having lung cancer with selective metastases to the pancreas was found to have pancreatic adenosquamous cell carcinoma with lung metastases. Hence, the incidence of neoplastic exocrine lesions was around 10%. In addition, hyperplasia of the ductal and ductular epithelium (in 57% and 39% of the patients, respectively), squamous cell metaplasia of the ductules (in 48% of the cases), as well as endocrine tumors (islet cell adenoma, 10%; mixed ductular-insular adenoma, 3%) were found. Most lesions occurred in the pancreatic head, a few in the tail; These data and other reports lead to the conclusion that, first, the overall incidence of pancreatic cancer appears to be higher than previously reported. Malignant lesions seem to remain clinically occult, either because patients die of other diseases or because of the significantly long latency between premalignant lesions and clinically recognizable invasive cancer. Second; the ductular cells appear to be the progenitor cells of a variety of. tumor types, including squamous cell cancer and islet cell tumors, as in the authors’ experimental model.
130 citations
TL;DR: The best combination of specific labeling and adequate morphology was seen with periodate-lysine-paraformaldehyde (PLP) fixation and the 4-layer PAP method, which proved to be the most sensitive technic.
Abstract: A variety of fixatives and four immunohistochemical technics were compared for demonstration of binding of monoclonal antibodies to cell surface antigens in tissue sections. Three recently described monoclonal antibodies, directed against the human leukocyte-common antigen (PHM 1) and antigens present on mononuclear phagocytes (PHM 2, PHM 3), were used. Antigen stability to fixation and heat were first assessed by quantitating the resultant effect on binding of the monoclonal antibodies to a macrophage cell line in vitro, using a radiolabeled second antibody. All fixatives affected their binding, but least effect was seen with formaldehyde-based fixatives and ethanol. Sections of formaldehyde- and ethanol-fixed lymph nodes were then labeled with monoclonal antibodies, and four developing methods were compared: indirect immunofluorescence, indirect immunoperoxidase, 3-layer heterologous peroxidase-antiperoxidase (PAP), and a 4-layer PAP technic. The 4-layer PAP proved to be the most sensitive technic since all three antibodies were localized successfully while both indirect technics only detected PHM 1, and the heterologous PAP method was not successful with any monoclonal antibody. The best combination of specific labeling and adequate morphology was seen with periodate-lysine-paraformaldehyde (PLP) fixation and the 4-layer PAP method.
120 citations
TL;DR: While papillary carcinoma of the endometrium has a somewhat better prognosis than mixed adenosquamous carcinoma or clear cell carcinoma, it appears to be more aggressive with a lower survival rate and higher rate of death from disease than the usual type of endometrial adenocarcinoma or adenoacanthoma.
Abstract: Forty-six patients with papillary carcinoma of the endometrium were studied. Forty-five were followed for at least five years or until death, and 41 were followed for 10 years. The remaining patient was alive at four years. The survival rate was 51.1% at five years and 46.3% at 10 years. At five years one-third had died of their disease. The median age at time of diagnosis was 63 years, and the age at diagnosis was an important determinant of survival. None of the seven black women survived for five years. Tumor grade was an important predictor of the course of disease and nuclear grading was a significantly more accurate indicator than was the histologic grading of the World Health Organization. Papillary carcinoma should be distinguished from the papillary type of clear cell carcinoma of the endometrium. While it has a somewhat better prognosis than mixed adenosquamous carcinoma or clear cell carcinoma, it appears to be more aggressive with a lower survival rate and higher rate of death from disease than the usual type of endometrial adenocarcinoma or adenoacanthoma.
101 citations
TL;DR: Two methods using commercial kits for high density lipoprotein (HDL) cholesterol quantitation were compared with the Lipid Research Clinics procedures, and results were consistent with underestimation by the enzymic assay of cholesterol in the supernates, offset by a positive interference of Mn2+ in the dextran sulfate-producedsupernates.
Abstract: Two methods using commercial kits for high density lipoprotein (HDL) cholesterol quantitation were compared with the Lipid Research Clinics (LRC) procedures. HDL cholesterol quantitations on 50 patient specimens by the Lancer HDL cholesterol Rapid Stat Kit (Lancer) with phosphotungstate-Mg2+ precipitation and enzymic cholesterol assay averaged 424 mg/L, and by a method with dextran sulfate-Mn2+-polyethylene glycol (dextran sulfate) precipitation and enzymic cholesterol assay averaged 474 mg/L. By comparison, the LRC method (heparin-Mn2+ precipitation combined with a Liebermann-Burchard reagent cholesterol assay) averaged 478 mg/L. Supernates obtained by the three precipitation methods had similar cholesterol values when analyzed by the LRC assay, suggesting that the observed differences were primarily due to differences between the cholesterol assays. Results were consistent with underestimation by the enzymic assay of cholesterol in the supernates, offset by a positive interference of Mn2+ in the dextran sulfate-produced supernates. Among-day CVs of 4-5% were observed for the Lancer method, and 6-7% for the dextran sulfate method. Sedimentation of precipitates in hypertriglyceridemic specimens was excellent by both methods.
92 citations
TL;DR: Results for individual factors confirmed that only patients with lymphatic invasion were at higher risk of recurrence, and vascular invasion, grade of malignancy, cellularity, presence or absence of circumscription, cellular infiltrate, fibroblastic response, neural invasion, and necrosis were not significant predictors of Recurrence.
Abstract: A group of 122 consecutively treated pathologic Stage 1 (TINOMO) patients with cancer of the breast were studied to define histopathologic predictors of recurrence. Lymphatic invasion was the most significant predictor of recurrence; recurrence was present in 32% (8/25) of patients who had lymphatic invasion and in 10.3% (10/97) of patients who did not (P = 0.006). Histologic type was also predictive of recurrent disease. Eighteen per cent (18/101) of patients with invasive ductal or lobular carcinoma developed recurrent disease, while none of the group of 21 patients with medullary carcinoma, tubular carcinoma, colloid carcinoma, Paget's disease, and intraductal carcinoma with minimal invasion suffered a recurrence (P = 0.036). Vascular invasion, grade of malignancy, cellularity, presence or absence of circumscription, cellular infiltrate, fibroblastic response, neural invasion, and necrosis were not significant predictors of recurrence. Multiple logistic regression analysis of patients with invasive ductal or lobular carcinoma confirmed the results for individual factors, that only patients with lymphatic invasion were at higher risk of recurrence.
TL;DR: Observations suggest that a distinctive immunopathologic lesion is associated with mercury-associated membraneous glomerulonephritis, that the role of the metal itself may only be coincidental, and that the involved antigen remains unknown.
Abstract: The nephrotoxicity associated with mercury may be manifested as either acute tubular necrosis or an immune complex glomerulonephritis, depending upon the conditions under which the patient is exposed to the metal. Two patients with industrial exposure to mercury developed the nephrotic syndrome due to membranous glomerulonephritis. A multidisciplinary approach was used to define more precisely the pathogenetic mechanisms involved in the production of the glomerular lesion. Although glomeruli were normal by light microscopy, immunohistochemical studies demonstrated confluent finely granular epimembranous deposits of IgG and C3. This distribution was confirmed at the ultrastructural level with immunoelectron microscopy. High resolution elemental analysis of electron dense inclusions in tubular epithelial phagolysosomes demonstrated energy dispersion spectra characteristic of coexisting mercury and selenium. Eluates from the biopsy material were not immunoreactive against normal rat or human kidney. There was no immunoreactivity of epimembranous deposits with antibodies having renal tubular epithelial antigen or urinary uromucoid specificity. These observations suggest that a distinctive immunopathologic lesion is associated with mercury-associated membraneous glomerulonephritis, that the role of the metal itself may only be coincidental, and that the involved antigen remains unknown. Prednisone therapy had no documented persistent beneficial influence upon the level of proteinuria in one patient who has been lost to follow-up. In one patient not treated with steroid therapy, withdrawal of exposure to the metal resulted in disappearance of mercury from body fluids and clinical remission.
TL;DR: This histopathologic subclassification correctly predicted immunologic phenotype in only 61% of cases, suggesting that in diffuse non-Hodgkin's lymphomas, histologic appearance alone may not be a reliable indicator of immunologic surface markers.
Abstract: Diffuse aggressive non-Hodgkin's lymphomas are immunologically and morphologically heterogeneous. Morphologic subclassifications have been proposed with a presumptive relationship to immunologic phenotype. Six histologic types were studied, four of presumed follicular origin (large cleaved, large non-cleaved, mixed follicular center cell, and blastic) and two of presumed nonfollicular origin (pleomorphic pyroninophilic and pleomorphic convoluted). Two of these follicular subtypes were found to be associated with the frequent presence of B-cell markers; large non-cleaved, six of seven; and blastic, four of six. However, four of nine T-cell lymphomas were misclassified as lesions of follicular center cell type, indicating the difficulty of distinguishing some convoluted cells of T-cell lymphoma from irregularly cleaved cells of follicular lymphoma. Pleomorphic pyroninophilic or B-immunoblastic morphology was associated with B-cell markers in only two of six cases; two additional cases had T-cell markers, one had histiocytic markers and in one case, no markers were demonstrable. Thus, this morphology may reflect a common pathway of transformed lymphoid cells. Some cases of T-cell origin could be recognized by the striking pleomorphic convoluted histology (three of five cases) but morphologic overlap with pleomorphic B-cell tumors, particularly transformed nodular lymphomas, posed a problem. This histopathologic subclassification correctly predicted immunologic phenotype in only 61% of cases, suggesting that in diffuse non-Hodgkin's lymphomas, histologic appearance alone may not be a reliable indicator of immunologic surface markers.
TL;DR: A flow cytometric analysis of biopsies from 19 patients with thyroid lesions indicates a rather limited clinical value of FCM measurements of DNA in the individual case of thyroid disease.
Abstract: A flow cytometric (FCM) analysis of biopsies from 19 patients with thyroid lesions (Hashimoto's thyroiditis, hyperplastic goiter, colloid and adenomatous nodular goiter, follicular adenoma, follicular carcinoma, anaplastic carcinoma) was performed to evaluate the relevance of such results for the individual diagnosis and prognosis and prognosis of such diseases. All cases of Hashimoto's thyroiditis, the colloid nodular goiters, and the hyperplastic goiter had a unimodal diploid pattern, while the anaplastic carcinomas were aneuploid. These lesions are, however, easily diagnosed on morphological grounds and their FCM classification would only be redundant. Follicular adenomas and follicular carcinomas may be either unimodal diploid or aneuploid, and our single case of adenomatous colloid goiter showed a bimodal DNA distribution. This means that a diploid modal DNA content in a follicular tumor does not rule out malignancy, while aneuploidy is not an unequivocal sign on malignancy. The evaluation of the percentage of cells in S-phase did not seem to contribute valuable information for the individual diagnosis of malignancy within the group of thyroid lesions studied. Our study indicates a rather limited clinical value of FCM measurements of DNA in the individual case of thyroid disease.
TL;DR: Patients with chronic lymphocytic leukemia, atherosclerotic heart disease, diabetes mellitus, and chronic undifferentiated schizophrenia had normal platelet volume mean and heterogeneity, while patients with chronic myelogenous leukemia had abnormally large platelets with increased heterogeneity.
Abstract: In normal subjects, mean platelet volume (MPV) has an inverse, nonlinear relation with platelet count, while platelet volume heterogeneity has a direct, nonlinear relation with MPV. Compared with the reference range established for normal subjects, patients with chronic lymphocytic leukemia, atherosclerotic heart disease, diabetes mellitus, and chronic undifferentiated schizophrenia had normal platelet volume mean and heterogeneity. Patients treated with cytotoxic chemotherapy for acute nonlymphocytic leukemia, patients with megaloblastic anemia, and patients with aplastic anemia had abnormally small platelets with increased heterogeneity. Patients with chronic myelogenous leukemia had abnormally large platelets with increased heterogeneity.
TL;DR: All red blood cell typing for Rh-Hr antigens was accomplished using slide/rapid tube reagents making unnecessary the use of saline reactive or chemically modified antisera, and Kidd antigen typing is also possible after ZZAP treatment of IgG sensitized RBC.
Abstract: A reagent (ZZAP) containing a mixture of 0.1 M dithiothreitol (DTT) plus 0.1% cysteine-activated papain was found to dissociate IgG immunoglobulin from red blood cells (RBC) of patients having a positive direct antiglobulin test (DAT) although this could not be achieved with either chemical alone. In all 67 patients tested, ZZAP treatment of IgG sensitized RBC reduced the strength of the DAT, and in all 52 instances tested, this allowed for accurate Rh phenotyping using slide/rapid tube typing reagents. This included five examples in which spontaneous agglutination that occurred in saline or 6% albumin was eliminated by ZZAP. Thus, all red blood cell typing for Rh-Hr antigens was accomplished using slide/rapid tube reagents making unnecessary the use of saline reactive or chemically modified antisera. Kidd antigen typing is also possible after ZZAP treatment of IgG sensitized RBC. In regard to warm autoabsorption tests, ZZAP treatment of 14 RC samples having a positive DAT proved preferable to heat elution technics since equal or greater amounts of IgG were removed by ZZAP and little or no hemolysis resulted. ZZAP has no effect on ABH, Rh or Kidd antigens but denatures Duffy, MNSs and all Kell antigens tested (K:1-K:7, K:11-K:14, K:18, K:19). This should prove valuable in certain investigations of multiple alloantibodies and, moreover, may allow for better characterization of Kell antigens.
TL;DR: Four cases of meconium peritonitis are described and the literature on the pathology, evolution and diagnostic features of the disease, with emphasis on the healed stage, presenting as a tumor mass in the inguinal canal or tunica vaginalis is reviewed.
Abstract: The diagnosis of meconium peritonitis has received little attention in the pathology literature. Morphologic features of meconium peritonitis can be confusing to the pathologist unfamiliar with this specific entity, especially in case of extraperitoneal lesions presenting clinically as tumor nodules in the tunica vaginalis. Unfamiliarity with this entity can lead to unnecessary removal of the testis. This paper describes four cases of meconium peritonitis and reviews the literature on the pathology, evolution and diagnostic features of the disease, with emphasis on the healed stage, presenting as a tumor mass in the inguinal canal or tunica vaginalis.
TL;DR: In this article, 145 well-differentiated tubular carcinomas were divided into two groups: pure tubular and mixtures, each containing a component of infiltrating duct carcinoma occupying less than half the tumor.
Abstract: In this study, 145 well-differentiated (tubular) carcinomas were divided into-two groups: 90 pure tubular carcinomas and 55 which were mixtures in that they contained a component of infiltrating duct carcinoma occupying less than half the tumor. Axillary lymph node metastases developed in 29% of women in the mixed group, but occurred in only 6% of the pure group. The prognosis was good in both groups, with five-year actuarial survival rates in the pure and mixed groups of 100% and 93%, respectively. Residual carcinoma was present in the mastectomy specimen in 28% of the pure group, and in 40% of the mixed carcinomas. In addition, there was a recurrence rate of 50% in patients with pure tubular carcinoma treated by excisional biopsy. These features indicate simple excision of tubular carcinoma is likely to be inadequate therapy and that a mastectomy is warranted. Axillary node dissections should be done when there is a component of infiltrating duct carcinoma because of the increased risk of axillary lymph node metastasis.
TL;DR: In three of four cases, biopsies of the DT demonstrated low yet significant amounts of estrogen but not progesterone receptors in the tumor cytosol, compatible with the suggestion that the basic underlying cause for DT is an inherited defect in growth regulation of the connective tissue.
Abstract: We have carefully examined four patients with desmoid tumor (DT) and their 31 relatives. In three of four cases, biopsies of the DT demonstrated low yet significant amounts of estrogen but not progesterone receptors in the tumor cytosol. In the fourth case, where the receptors were not demonstrable, the affected patient was a menopausal woman and the receptors may have been blocked by endogenous estrogen. Fourteen of their 31 relatives demonstrated multiple minor bone malformations in x-ray screening of the skeleton. The inheritance of these malformations was compatible with an autosomal dominant trait with variable penetrance. These findings are compatible with our suggestion that the basic underlying cause for DT is an inherited defect in growth regulation of the connective tissue. When a trauma is superimposed on such an individual, a DT may result. The growth of the tumor is, however, controlled primarily by sex hormones, estrogen predominance over progesterone being inducive to tumor growth.
TL;DR: It is shown that immunoperoxidase localization of Factor VIII is used to identify megakaryocytes and immaturemegakaryocytic precursors in a case of megakarianocytic leukemia.
Abstract: Coagulation Factor VIII is produced by endothelial cells and megakaryocytes. Antibody directed against Factor VIII or its associated antigens has been shown to be a sensitive marker for both normal and neoplastic endothelial cells. Its use to identify neoplastic megakaryocytes has not been described. We used immunoperoxidase localization of Factor VIII to identify megakaryocytes and immature megakaryocytic precursors in a case of megakaryocytic leukemia.
TL;DR: It is apparent that classical "tuberculosis-like" granulomatous reaction is the most common histologic pattern but should not be expected in all patients with NTM infections.
Abstract: The diagnosis of pulmonary nontuberculous mycobacterial (NTM) infection may be difficult to establish unless open-lung biopsy is performed. Mycobacteria were present in resected lung tissues from forty patients at the Mount Sinai Hospital during the period 1969-1980. M. avium-intracellulare was cultured in 24 patients, M. tuberculosis in six, M. gordonae in three, and M. fortuitum in two. In five instances, mycobacteria were seen in smears of lung tissues but failed to grow in culture. Three distinct clinicopathologic groups of patients with NTM were recognized. (1) Eighteen patients had solitary pulmonary nodules resected with the clinical diagnosis of lung cancer. Histologically, they exhibited granulomas with varying degrees of necrosis. Mediastinal lymph nodes had no granulomas, except in one case. (2) Seven patients presented with roentgenologic evidence of bilateral, diffuse interstitial infiltration. M. avium-intracellulare or M. gordonae were isolated from lung tissue which histologically showed interstitial fibrosis and organizing pneumonia. In only one instance a few non-caseating epitheloid cell granulomas were found. Three of these patients had underlying malignancies treated with chemotherapy and one other had arthritis. The other three had no underlying diseases. (3) Three patients had multiple discrete infiltrates on chest roentgenograms. M. avium-intracellulare was isolated from their lung tissues. One of these patients exhibited necrotizing granulomatous vasculitis indistinguishable from Wegener's granulomatosis. It is apparent that classical "tuberculosis-like" granulomatous reaction is the most common histologic pattern but should not be expected in all patients with NTM infections.
TL;DR: Data from lipid histochemistry and analysis of lipid extracts from the livers and foodstuffs by thinlayer chromatography and gas-liquid chromatography indicate that LG in NFL most likely represent a reaction to absorbed saturated hydrocarbons, like mineral oil, used widely in the food industry.
Abstract: Forty-four cases of lipogranulomas (LG) in non-fatty livers (NFL), consisting of 38 biopsies and six autopsy livers, were studied. LG in NFL have a distinct morphologic characteristic and virtually all are attached to or closely associated with the walls of hepatic venules. The reason for this peculiar location remains unexplained. Our data from lipid histochemistry and analysis of lipid extracts from the livers and foodstuffs by thin-layer chromatography and gas-liquid chromatography indicate that LG in NFL most likely represent a reaction to absorbed saturated hydrocarbons, like mineral oil, used widely in the food industry. The incidence of LG is increasing, as evidenced by a 1.7% incidence in 1952–53 compared with 4.6% in 1978–80. LG seldom present a diagnostic problem provided serial sections are examined. An awareness of the characteristic morphology will prevent an extensive granuloma work-up. They appear to be an incidental finding in liver biopsies, and of no clinical significance at present; however, their long-term implication, if any, must await future observations.
TL;DR: Examination of 19 serum biochemical and hematologic parameters in a group of white male runners demonstrated a significant increase in mean values of K+, BUN, creatinine, CK, LDH, AST (SGOT), alkaline phosphatase, bilirubin, uric acid and leukocyte counts.
Abstract: Examination of 19 serum biochemical and hematologic parameters in a group of white male runners, ranging in age from 23 to 47 years, just prior to and immediately after a 13-mile "mini-marathon," demonstrated a significant increase, by paired Student t-test, in mean values of: K+, BUN, creatinine, CK, LDH, AST (SGOT), alkaline phosphatase, bilirubin, uric acid and leukocyte counts. Prevailing environmental conditions were such as to produce no significant hemoconcentration. Using this group's statistics and this hospital laboratory's upper limits of normal, the percentage of values above two SDs are, for the resting state: K+ 7%, BUN 7%, creatinine 0%, CK 21%, LDH 21%, AST 0%, alkaline phosphatase 0%, bilirubin 7%, uric acid 7%, and leukocyte count 0%. Post-exertional values above normal limits are: K+ 7%, BUN 21%, creatinine 21%, CK 93%, LDH 86%, AST 0%, alkaline phosphatase 0%, bilirubin 14%, uric acid 36%, and leukocyte 71%. Consequently, abnormally high values for K+, BUN, creatinine, CK, LDH, bilirubin, uric acid, and leukocyte counts can often be expected in some patients who exercise heavily. The degree of the abnormality will depend on the level and length of exercise as well as the elapsed time between exercise and testing.
TL;DR: A 70-year-old woman with primary thrombocythemia for three years received no specific therapy, but developed acute leukemia, which is rare and has not been well-documented in the absence of preceding therapy.
Abstract: A 70-year-old woman had primary thrombocythemia for three years. She received no specific therapy, but developed acute leukemia. The progression of primary thrombocythemia to leukemia is rare and has not been well-documented in the absence of preceding therapy.
TL;DR: This study undertook this study of four synovial sarcomas arising in the retroperitoneum, whose ages ranged from 17-57 years (mean, 36 years), and indicated that both died as a direct result of peritoneal sarcomatosis.
Abstract: Synovial sarcoma most commonly affects the extremities, especially the lower thigh and knee region;, other primary sites, in contrast, have been only infrequently reported; Therefore, we undertook this study of four synovial sarcomas arising in the retroperitoneum. This group, whose ages ranged from 17–57 years (mean, 36 years), comprised three males and one female. The nonspecific clinical presentations consisted of pain and/or a mass; diverse preoperative radiographic procedures merely served to reinforce the impression of a retroperitoneal mass. Histologically, all four examples revealed a typical biphasic pattern. Two cases showed a predominant spindle cell component; two others disclosed a more even distribution of the spindle-cell and epithelioid-cell elements, one of these containing, in addition, broad areas of stromal calcification. Follow-up data, obtained for two patients, indicated that both died as a direct result of peritoneal sarcomatosis. The differential diagnosis of selected spindle-cell and biphasic neoplasms known to arise in the retroperitoneum will be discussed.
TL;DR: The mean estimates of this study provide the most practical current consensus estimates of the “true” values for these analytes in these preparations, and can be used to provide an accuracy base to unify interlaboratory results.
Abstract: Under the auspices of the Ad Hoc Committee on Reference Preparations for Serum Proteins of the Standards Committee of the College of American Pathologists (CAP), and the Centers for Disease Control, Public Health Service, U. S. Department of Health and Human Services, 24 collaborators, including many experts from commercial firms that furnish the reagents and working curve calibrators actually used by most clinical laboratories in the United States, have cooperated to assign reliable values of mass and international units to 12 analytes in two freeze-dried reference preparations: The U. S. National Reference Preparation for Human Serum Proteins and the CAP Reference Preparation for Serum Proteins. The analytes estimated were: albumin, a-1-acid glycoprotein, α -1-antitrypsin, α -2-macroglobulin, ceruloplasmin, C3, C4, IgG, IgA, IgM. haptoglobin, and transferrin. Individual collaborators used single radial immunodiffusion, electroimmunodiffusion (rocket assay) rate nephelometry, end-point nephelometry, immunofluorometric assay, and enzyme immunoassay. No method-associated bias was observed in this study, but different collaborators who used the same “local” calibrator with different methods obtained results that were in closer agreement. Overall, the average among collaborator coefficient of variation of the estimated analyte concentrations was 15.9% for concentrations derived from “local” calibrators and 8.9% for concentrations that related to use of a common calibrator. The mean estimates (mass and international units) of this study provide the most practical current consensus estimates of the “true” values for these analytes in these preparations. Consequently, these mean estimates were assigned to these two generally available preparations which now can be used to provide an accuracy base to unify interlaboratory results.
TL;DR: PNA binding- appeared at least as sensitive and specific as muramidase, as a marker for histiocytes, and offers the advantage that it does not bind to cells of the granulocytic series.
Abstract: The histiocyte (macrophage) is a unique cellular constituent of the immune system which is involved in immune and non-immune cellular reactions, as well as in the genesis of a variety of benign and malignant neoplasms. The ability to distinguish histiocytes from similar appearing cells morphologically, is often difficult, yet may be of considerable practical and theoretical importance. The present study describes a new marker for histiocytes, applicable to routinely processed tissues. An immunoperoxidase procedure to detect binding of peanut agglutinin (PNA) was applied to 58 specimens consisting of lymph nodes, extranodal lymphoid tissues, neoplasms and reactive histiocytic lesions. Results were compared with a currently accepted histiocytic marker--cytoplasmic muramidase. Of the 58 tissues, 51 showed PNA binding to morphologically recognizable histiocytes, whereas muramidase was detected in only 44. PNA binding- appeared at least as sensitive and specific as muramidase, as a marker for histiocytes, and offers the advantage that it does not bind to cells of the granulocytic series.
TL;DR: Stained smears from 309 serous effusions from 246 patients for the Epithelial Membrane Antigen revealed three effusions in which malignant cells were not identified in conventionally stained smears and in which a small number of EMA positive cells were identified.
Abstract: The cytological distinction between reactive mesothelial and malignant cells frequently causes problems for the diagnostic cytologist. In order to determine whether an immunocytochemical method might help resolve these difficult cases, we have stained smears from 309 serous effusions from 246 patients for the Epithelial Membrane Antigen (EMA). The EMA staining was classified as strong, weak or negative. Carcinoma cells (as diagnosed by conventional cytology) stained strongly for EMA in 63 of the 116 positive smears (54%). Five out of 15 (33%) of cytologically suspicious smears from patients with known carcinomas gave a strong EMA stain. Of particular interest were three effusions in which malignant cells were not identified in conventionally stained smears and in which a small number of EMA positive cells were identified. The EMA positive cells were subsequently restained by the Papanicolaou method and identified as malignant on retrospective morphological examination.
TL;DR: A patient who developed several unusual complications of an aortofemoral vascular graft were thrombosis, pseudoaneurysm, and infection, which represented a localized, invasive form of aspergillosis.
Abstract: This is a case report of a patient who developed several unusual complications of an aortofemoral vascular graft. These were thrombosis, pseudoaneurysm, and infection. There was an Aspergillus terreus infection of the pseudoaneurysm of the vascular prosthesis. A contiguous vertebral osteomyelitis due to A. terreus subsequently developed. This represented a localized, invasive form of aspergillosis.