Showing papers in "American Journal of Clinical Pathology in 1986"
TL;DR: It appears that secondary amyloidosis is emerging as a significant, although rare, complication of cystic fibrosis as greater numbers of these patients survive into adulthood.
Abstract: The authors report the pathologic features of three cases of amyloidosis associated with cystic fibrosis. Renal biopsy led to the diagnosis (case 1) or suspicion (case 2) of amyloidosis in patients who were 23 and 21 years old, respectively. The third patient died at age 22 years, and amyloidosis was not discovered until autopsy. Immunohistochemical staining and potassium-permanganate pretreatment of histologic sections in all three cases provided evidence that the amyloid seen in these patients is of the secondary (AA) type. Congo red staining in each case and electron microscopy in case 1 confirmed the initial diagnosis of amyloidosis. A markedly elevated serum amyloid A protein (160 micrograms/mL; normal less than 1 microgram/mL) in case 1 indicated the presence of large quantities of the precursor protein from which the AA fibrils of secondary amyloid are derived. The kidneys, spleen, and liver contained amyloid deposits in autopsy material from all three cases. Involvement of other organs by amyloid was variable. Review of autopsy material in Boston from 23 additional cystic fibrosis patients with long-term survival did not reveal any evidence of amyloidosis. It appears that secondary amyloidosis is emerging as a significant, although rare, complication of cystic fibrosis as greater numbers of these patients survive into adulthood.
1,219 citations
TL;DR: BAL is a valuable first procedure for diagnosing invasive pulmonary aspergillosis in the compromised host and has a diagnostic sensitivity and specificity of 58% and a specificity of 92%.
Abstract: Cultures and histochemical stains for fungi were performed on concentrated, cytocentrifuged bronchoalveolar lavage (BAL) samples from 82 immunocompromised patients undergoing bronchoscopic evaluation of new pulmonary infiltrates. Aspergillus hyphae were identified in 9 of 17 BAL samples from patients with invasive pulmonary aspergillosis and from 3 of the remaining 65 study patients without this diagnosis. Thus, the presence of Aspergillus hyphae in BAL samples had a 53% sensitivity, 97% specificity, and 75% positive predictive value for the diagnosis of invasive pulmonary aspergillosis. BAL fungal cultures were positive in only 4 of 17 cases (23% sensitivity). A combination of fungal stains and cultures yielded a diagnostic sensitivity of 58% and a specificity of 92%. Results of routine fiberoptic bronchoscopy procedures in the 17 patients with aspergillosis who had BAL and in a retrospectively identified group of 10 patients with invasive aspergillosis who had only routine bronchoscopy were tabulated. Routine bronchoscopy procedures yielded a diagnosis in 5 of 27 cases (22% overall yield), with washings diagnostic in 4 of 27 cases (15%), and transbronchial biopsies positive histologically in 2 of 11 cases (18%). BAL is a valuable first procedure for diagnosing invasive pulmonary aspergillosis in the compromised host.
184 citations
TL;DR: Two cases of thyroid-carcinoma characterized by tall columnar epithelium with marked nuclear stratification with local lymph node metastasis and distant metastasis are presented, and both patients died of tumor within two years of initial thyroid surgery.
Abstract: Two cases of thyroid carcinoma characterized by tall columnar epithelium with marked nuclear stratification are presented. There were small foci exhibiting solid spindle-cell growth in both cases and a component demonstrating a microfollicular pattern in one. Both tumors were unencapsulated and invasive. Regional lymph node metastasis occurred in one case and distant metastasis in both, and both patients died of tumor within two years of initial thyroid surgery.
182 citations
TL;DR: The association between Campylobacter-like organisms (CLOs) and lesions of the gastric mucosa was studied in 59 consecutive biopsies using Hematoxylin and eosin and Warthin-Starry silver stains and high-resolution light microscopy.
Abstract: The association between Campylobacter-like organisms (CLOs) and lesions of the gastric mucosa was studied in 59 consecutive biopsies. Hematoxylin and eosin and Warthin-Starry silver stains, as well as high-resolution light microscopy (HRLM) and transmission electron microscopy (TEM), were used. The organisms were found in intimate contact with foveolar cells showing abundant phagolysosomes and alterations of the intercellular complexes. CLOs also were seen in close proximity of parietal cells in resting phase, some of which showed degenerative changes. The findings are discussed in light of recent reports linking CLOs to the cause of gastritis.
176 citations
TL;DR: The results of the present study indicate that S-100 may be more widespread in human tissues than previously thought, and that its value as a marker of the histogenetic origin of human tumors should be reappraised.
Abstract: In a previous paper from this laboratory, the production of monoclonal antibodies recognizing antigenic determinants common to the alpha and beta chains of bovine brain S-100 protein was reported. In the present study, the immunohistochemical labeling patterns of these monoclonal antibodies against a wide range of normal and pathologic human tissues are described, and these results are compared with those obtained using polyclonal anti-S-100 antiserum. Although many of the reactions of the monoclonal antibodies were very similar to those of the polyclonal antiserum (and the previously reported sites of S-100 immunoreactivity) several additional cell types (e.g., thyroid follicular cells, biliary epithelium, pancreatic cells, renal tubules) were labeled by one or both of the monoclonal antibodies. Blocking experiments prove that immunohistochemical differences obtained with monoclonal and polyclonal antibodies are at least partly caused by differences in the repertoire of antigenic determinants on S-100 protein that are recognized by the two species (i.e., mouse and rabbit, respectively). These results indicate that S-100 may be more widespread in human tissues than previously thought, and that its value as a marker of the histogenetic origin of human tumors should be reappraised. It is suggested that the marked variability observed in the reactivity of different tissues in the present study may indicate that S-100 is a heterogeneous group of molecules, and its expression may be related to the functional activity of cells.
174 citations
TL;DR: Findings indicate that nodular lymphocyte-predominant Hodgkin's disease differs from the other subtypes of Hodgkin’s disease and that the neoplastic cells are of B-lymphoid origin.
Abstract: To throw light on the question of whether B-cell-derived forms of Hodgkin's disease exist, more than 100 cases of Hodgkin's disease (including all four major histologic categories) were investigated for the presence of J chain and were also immunostained for epithelial membrane antigen and the granulocyte-associated antigen X hapten. Reed-Sternberg and Hodgkin cells (RS & H) expressed J chain in 22 cases, 8 of which also expressed epithelial membrane antigen (EMA). X hapten was found in 62 cases, but all of these were J chain negative. J chain-positive RS & H cells were restricted to cases of lymphocyte-predominant disease, while X hapten-positive tumor cells were found frequently in nodular sclerosis, mixed cellularity, and lymphocyte-depletion Hodgkin's disease, but only occasionally in cases of lymphocyte-predominant disease. These findings indicate that nodular lymphocyte-predominant Hodgkin's disease differs from the other subtypes of Hodgkin's disease and that the neoplastic cells are of B-lymphoid origin.
168 citations
TL;DR: The finding of acute microangiitis in a lung biopsy from a patient with pulmonary hemorrhage should suggest the diagnosis of SLE, and it may be a more reliable diagnostic feature than the demonstration of immune complexes.
Abstract: The authors describe four patients with systemic lupus erythematosus (SLE) and massive pulmonary hemorrhage in whom open-lung biopsies showed a distinctive small-vessel vasculitis. This lesion is characterized by acute inflammation and necrosis involving capillaries, arterioles, and small muscular arteries and is termed microangiitis to reflect the small size of the affected vessels. The involvement of capillaries is manifested by an infiltrate of necrotic neutrophils within alveolar septa often associated with destruction of the alveolar wall. This capillaritis was present in all cases, while involvement of arterioles and small arteries was seen in three. Immunofluorescence and electron microscopy demonstrated immune complexes in only two. The finding of acute microangiitis in a lung biopsy from a patient with pulmonary hemorrhage should suggest the diagnosis of SLE, and it may be a more reliable diagnostic feature than the demonstration of immune complexes.
161 citations
TL;DR: Atypical polypoid adenomyomas of the uterus should be distinguished from endometrial carcinomas and other malignant uterine neoplasms with which they are often confused, particularly in curettage specimens.
Abstract: Twenty-seven atypical polypoid adenomyomas of the uterus were reviewed. The tumors occurred in women ages 21-53 (average 39.7) years old, who presented with abnormal uterine bleeding in most cases. Two of the patients had Turner's syndrome. The adenomyomas most frequently involved the lower uterine segment, measured up to 6 (average 1.9) cm in greatest dimension, and were characteristically polypoid and well circumscribed. Microscopic examination disclosed endometrial glands with varying degrees of hyperplasia and atypicality up to the appearance of carcinoma in situ within neoplastic smooth muscle. Squamous differentiation was common within the glands; the smooth muscle occasionally was atypical. Follow-up data suggested that the lesion is benign, although it persisted in two patients treated by curettage alone. Atypical polypoid adenomyomas should be distinguished from endometrial carcinomas and other malignant uterine neoplasms with which they are often confused, particularly in curettage specimens.
141 citations
TL;DR: A fourth lesion in this article was a paratesticular mass composed of endometrial glands and stroma and bundles of smooth muscle that arose in an 82-year-old man who had been treated with estrogens for prostatic adenocarcinoma.
Abstract: Three new and eleven previously reported testicular or paratesticular tumors that resembled ovarian tumors of common epithelial type are discussed. The 14 tumors occurred in patients ages 11-68 (average 47) years of age. The exact location for 12 of the tumors is known; 5 involved primarily the testicular parenchyma, 3, the tunica vaginalis, and 4, paratesticular tissue. Five tumors were serous, four of which were in the borderline category. Four tumors were Brenner tumors, admixed in one case with an adenomatoid tumor. Single examples of mucinous cystadenoma, mucinous cystadenocarcinoma, endometrioid adenoacanthoma, clear cell adenocarcinoma, and a benign tumor of mixed cell types complete the list. Follow-up of from 3 months to 14 years is available in eight cases; only one tumor, the clear cell adenocarcinoma, is known to have been clinically malignant. A fourth lesion in this article was a paratesticular mass composed of endometrial glands and stroma and bundles of smooth muscle. It arose in an 82-year-old man who had been treated with estrogens for prostatic adenocarcinoma.
130 citations
TL;DR: It is concluded that platelet aggregation can be studied conveniently with the impedance method in the more physiologic medium of WB, and an increased sensitivity of the WB system to some aggregating and anti-platelet agents is shown.
Abstract: Platelet aggregation studies generally are performed in platelet-rich plasma (PRP) by the turbidometric method. The authors compared this technic with the recently introduced impedance aggregometry in PRP and whole blood (WB). In healthy controls there was a good correlation between the two technics when aggregation was induced by ADP or collagen. As compared with PRP, platelets in WB were more sensitive to the aggregating effect of thrombin, ristocetin, and arachidonic acid. Platelet sensitivity to prostacyclin was increased in WB. The anti-platelet effect of a single oral dose of aspirin could be detected for a longer period in WB than in PRP. Platelet aggregation tests in WB from patients with platelet dysfunctions showed the same response pattern to different aggregating agents as in PRP. In contrast to turbidometry, the impedance method in PRP and WB enabled registration of platelet aggregation in a dose-de-pendent fashion in a sample from a patient with severe hyper-lipoproteinemia. It is concluded that platelet aggregation can be studied conveniently with the impedance method in the more physiologic medium of WB. Providing the same information as the well-established turbidometry, the time-sparing impedance method needs less citrated blood. Moreover, our results show an increased sensitivity of the WB system to some aggregating and anti-platelet agents.
123 citations
TL;DR: All tumors behaved in a benign fashion after local resection or snare polypectomy; long-term follow-up showed no recurrence in any case.
Abstract: The clinicopathologic features of 11 cases (8 in men) of duodenal gangliocytic paraganglioma are presented. The patients averaged 56 years of age; none showed evidence of phakomatosis. Ten tumors occurred in the second portion of the duodenum, and one arose in the third portion. All tumors were polypoid, and half presented with gastrointestinal bleeding. The neoplasms were composed of paraganglioma and carcinoid-like elements, neurons, and Schwann as well as sustentacular cells. All tumors behaved in a benign fashion after local resection or snare polypectomy; long-term follow-up (1-25 years; mean, 8.3 years) showed no recurrence in any case. Immunocytochemical examination demonstrated the presence of somatostatin, serotonin, and human pancreatic polypeptide within endocrine cells and neurons.
TL;DR: A wide range of mouse monoclonal antibodies of varying specificities and isotypes were used to stain both frozen and paraffin-embedded sections of various normal and neoplastic tissues, allowing a large quantity of sections to be stained simultaneously with a minimal amount of technical time involved.
Abstract: We describe a method of biotin/avidin-peroxidase detection using second and third stage reagents in Coplin jars. This method allows a large quantity of sections to be stained simultaneously with a minimal amount of technical time involved. A wide range of mouse monoclonal antibodies of varying specificities and isotypes were used to stain both frozen and paraffin-embedded sections of various normal and neoplastic tissues. Three different biotinylated anti-mouse antibodies were tested, including F(ab')2 antibody fragments of one, followed by horseradish peroxidase conjugated avidin. All monoclonal antibodies employed gave good staining, using incubation times of 30-50 minutes. The staining was done during a mean period of 25 to 27 days with an average staining load of 500 sections per Coplin jar.
TL;DR: Autopsy findings indicate that the greater virulence of C. tropicalis is related to increased invasiveness in the gastrointestinal tract in susceptible hosts.
Abstract: The pathologic features of Candida albicans and Candida tropicalis in 23 consecutive autopsied patients with culture-proven disseminated candidiasis were studied in order to determine the pathologic basis for the greater virulence of C tropicalis Disseminated C tropicalis infection with gastrointestinal invasion occurred only in eight neutropenic patients; whereas, C albicans infection occurred in nine neutropenic and six nonneutropenic patients C tropicalis involved the entire alimentary tract in four of eight patients versus one of fifteen patients with C albicans C tropicalis penetrated to the deep submucosa in six of eight patients with C tropicalis and four of fifteen patients with C albicans Nine of ten patients with submucosal invasion were neutropenic Invasion of submucosal blood vessels occurred in six of eight patients with C tropicalis and only two of fifteen patients with C albicans All patients with submucosal blood-vessel invasion were neutropenic A band of tissue necrosis at the advancing mycelial margin was present with C tropicalis but not with C albicans These autopsy findings indicate that the greater virulence of C tropicalis is related to increased invasiveness in the gastrointestinal tract in susceptible hosts
TL;DR: It is proposed that NAE represents intravascular malignant lymphomatosis (IML), which appears to be a primary manifestation and/or a major secondary form of disseminatedmalignant lymphoma.
Abstract: Neoplastic angioendotheliomatosis (NAE) is a rare entity characterized by multifocal, intravascular proliferation of large pleomorphic cells within small vessels of most organs, with a particular affinity for the central nervous system. Clinically, patients with NAE present with focal neurologic signs and a progressive decline in mental status, followed by death in a few months. The histogenesis of NAE is controversial but has been previously thought to represent a malignant proliferation of endothelial cells. Three autopsy cases with clinical and histologic features of NAE were investigated by electron microscopic, standard histochemical, and immunohistochemical technics that included the use of three panleukocyte monoclonal antibodies (PLA), the endothelial-cell-specific reagents, FVIII-RAG anti-sera and Ulex europaeus agglutinin (UEA), and muramidase. The NAE cells in all three cases were stained positively by the PLA, whereas the adjacent endothelial cells and not the NAE cells were stained by FVIII-RAG and UEA. Muramidase by immunoperoxidase technic and nonspecific esterase (chloracetate) were not present in NAE cells. These results indicate that NAE is a leukocyte-derived neoplasm and not a malignant endothelial cell neoplasm. Based on these findings and on a review of the literature, it is proposed that NAE represents intravascular malignant lymphomatosis (IML). IML appears to be a primary manifestation and/or a major secondary form of disseminated malignant lymphoma. This would explain the spectrum of findings in previously reported cases.
TL;DR: Keratin proteins were clearly superior to epithelial membrane antigen as a tumor cell marker in 29 cases and represented a better marker in eight cases, mainly for small-cell anaplastic carcinomas and some renal cell and pulmonary adenocarcinomas.
Abstract: Epithelial membrane antigen and keratin proteins represent markers of epithelial differentiation that may be detected in routine formalin-fixed, paraffin-embedded tissues. Eighty-seven neoplasms, including 48 adenocarcinomas of various types, squamous and transitional cell carcinomas, small-cell anaplastic carcinomas, carcinoid tumors, mesotheliomas, hepatomas, melanomas (metastatic), adrenal cortical carcinomas, germ cell tumors, and extramammary Paget’s disease, were assessed to determine the relative effectiveness of these antigens as tumor markers. Immunoperoxidase studies were performed using monoclonal antibodies to epithelial membrane antigen and monoclonal (combined AE1 and AE3) and polyclonal (bovine muzzle keratins) antibodies to keratin proteins. In more than half the cases (50/87, 58%), both markers yielded comparable results. However, in 29 cases (33%), keratin proteins were clearly superior to epithelial membrane antigen as a tumor cell marker. Particular discrepancies were apparent for some gastrointestinal adenocarcinomas, squamous cell carcinomas, hepatomas (hepatocellular type), spindle cell components of mesotheliomas, and carcinoid tumors. Epithelial membrane antigen represented a better marker in eight cases (9%), mainly for small-cell anaplastic carcinomas and some renal cell and pulmonary adenocarcinomas. Adrenal cortical carcinomas, melanomas, and seminomas were nonimmunoreactive for both antigens. Epithelial membrane antigen and keratin proteins represent useful complementary markers in diagnostic surgical pathology.
TL;DR: Cases reported here are distinct from those reported in some children and patients with the acquired immunodeficiency syndrome who have massive histiocytic infiltrates with innumerable intracellular AFB.
Abstract: The pathology of disseminated Mycobacterium avium-intracellulare (MAI) was studied in 20 specimens from 11 patients. The patients ranged from 28 to 65 years and included 8 immunosuppressed and 3 immunocompetent hosts. Specimens of lymph node (five), spleen (one), liver (four), bone (three), pulmonary tissue (three), skin (three), and an aortic aneurysm were included. All cultured specimens grew MAI, but only two-thirds of these showed acid-fast bacilli (AFB) on staining. Some tissues (liver, spleen) showed granulomas similar to those seen in tuberculosis. Other tissues (skin, bone, bronchus) showed necrotizing acute and chronic inflammation with histiocytes but no definite granulomas. Lymph nodes showed a variety of nonnecrotizing and necrotizing granulomatous lesions. In skin, bone, and some lymph nodes, MAI infection appears to be histopathologically distinguishable from tuberculosis. The cases reported here are distinct from those reported in some children and patients with the acquired immunodeficiency syndrome who have massive histiocytic infiltrates with innumerable intracellular AFB. This difference may be due to a specific defect in host response involving T-cell macrophage interaction.
TL;DR: The light-microscopic, immunohistochemical, and ultrastructural features of two examples of a pseudosarcomatous fibromyxoid tumor of the urinary bladder are reported, illustrating that clinicopathologic correlation is essential to define certain pseudosurgery lesions.
Abstract: The light-microscopic, immunohistochemical, and ultrastructural features of two examples of a pseudosarcomatous fibromyxoid tumor of the urinary bladder are reported. Both patients were women, 56 and 52 years old. Gross hematuria was the chief complaint and occurred for two days and two weeks, respectively, before presentation. Cystoscopy revealed a 2 X 1 X 1 cm mass located at the dome in case 1 and a 4 X 3 X 3 cm mass at the left posterior lateral wall in case 2. Microscopically, the lesions were composed of spindle, plump, or stellated fibroblast-like cells embedded in myxoid stroma with little collagen; mitotic figures were about 2 per 10 high-power fields, and both cases showed encroachment of the superficial muscle bundles. Because of bizarre spindle cell proliferation, occasional mitoses, and invasion to the underlying muscle, these lesions were initially diagnosed as embryonal rhabdomyosarcoma. However, follow-up examination disclosed the benign nature of these lesions. There was no previous instrumentation or surgery on the genitourinary tract. Immunohistochemical and ultrastructural studies revealed the fibroblastic-myofibroblastic nature of these lesions. These cases illustrate that clinicopathologic correlation is essential to define certain pseudosarcomatous lesions.
TL;DR: A patient with hemorrhagic colitis and TTP secondary to a verotoxin-producing serotype of E. coli is reported, which is now recognized as an important identifiable cause of bloody diarrhea in patients in whom more common gut pathogens cannot be detected.
Abstract: Sporadic cases and occasional outbreaks of hemorrhagic colitis recently have been associated with the rare Escherichia coli serotype 0157:H7, which is now recognized as an important identifiable cause of bloody diarrhea in patients in whom more common gut pathogens cannot be detected. The authors report such a case in a 49-year-old woman who developed thrombotic thrombocytopenic purpura (TTP) and hemorrhagic transverse and descending colitis with a lesion having many of the features of pseudomembranous colitis. While pseudomembrane formation has been described in the hemolytic uremic syndrome (HUS), these features have not, to the authors’ knowledge, been described in a patient with hemorrhagic colitis and TTP secondary to a verotoxin-producing serotype of E. coli .
TL;DR: Compared to enzyme immunoassay, latex agglutination assay is less sensitive, but this latex procedure provides a rapid and less elaborate test for elevated levels of cross-linked fibrin degradation products in patients with thrombosis.
Abstract: Conformational and structural changes on conversion of fibrinogen to fibrin and its cross-linking by Factor XIIIa lead to the development of new antigenic determinants that permit differentiation between their plasminolytic cleavage products. A monoclonal antibody (DD-3B6/22) that is specific for cross-linked fibrin derivatives containing the D dimer configuration has been used in developing a latex agglutination procedure that can detect fibrin degradation products in either plasma or serum. Fibrinogen or its degradation products do not cross-react with this antibody. Results were calibrated with an enzyme immunoassay, which used a purified D dimer standard. Plasmas from 40 normal subjects, all having D dimer levels below 250 ng/mL measured by enzyme immunoassay, were all negative by latex assay. In contrast, positive latex agglutination titers were obtained with 87 of 88 patients with demonstrated deep venous thrombosis, pulmonary embolism, or disseminated intravascular coagulation. Compared to enzyme immunoassay, latex agglutination assay is less sensitive, but this latex procedure provides a rapid and less elaborate test for elevated levels of cross-linked fibrin degradation products in patients with thrombosis. Plasma assays for fibrin degradation products are preferable to those using serum.
TL;DR: Mean nuclear areas (MNA) were calculated morphometrically in 10 cases of well-differentiated adenocarcinoma, ten cases of atypical alveolar cuboidal cell hyperplasia (AAH), and five cases of alveolars cuboidalcell hyperplasticity (AH) and were compared with each other.
Abstract: Mean nuclear areas (MNA) were calculated morphometrically in ten cases of well-differentiated adenocarcinoma, ten cases of atypical alveolar cuboidal cell hyperplasia (AAH), and five cases of alveolar cuboidal cell hyperplasia (AH) and were compared with each other. In cases of adenocarcinoma, the MNA were significantly larger than those of AAH and AH, and the standard deviation (SD) of nuclear area was greater in adenocarcinoma than that in AAH and AH, thus implying greater "scatter" of the nuclear areas in the former than the latter two. The MNA and the SD of nuclear area in AH were smallest in these three groups. In one case each of AAH and adenocarcinoma, there were two different populations of nuclear size in the same lesions, that is, histograms showed both adenocarcinoma and AAH in the same tumor. Through the use of the morphometric method, many cases of AAH were easily distinguishable from adenocarcinoma cases, and there were two cases in which foci of adenocarcinoma and AAH coexisted.
TL;DR: Using polarized light is a simple, fast, sensitive, and specific method for localizing intracellular pigmented malaria parasites in wet preparations of blood.
Abstract: The diagnosis of malaria is still sometimes difficult because of the insensitivity of microscopic screening at low levels of parasitemia. The malarial pigment, hemozoin, is a crystalline product of the digestion of hemoglobin by the parasites. Under polarized light at 500X magnification, brilliantly birefringent granules of the pigment were detected in Wright's stained smears, and the parasites easily localized, in 18 cases of malarial infection. Fresh, wet, coverslipped preparations of cultures of Plasmodium falciparum also were examined under polarized light. Serial dilutions of the cultures showed that, even at the very low level of 0.01% parasitemia, intracellular birefringent granules were detected in an average of 45 +/- 16 (SE) seconds at 500X magnification. Using polarized light is a simple, fast, sensitive, and specific method for localizing intracellular pigmented malaria parasites in wet preparations of blood.
TL;DR: The authors identified 24 patients given the diagnosis of Ph1-negative CGL after evaluation by the Hematology Department of the Mayo Clinic between January 1976 and August 1984, and found that median survival for the 22 patients was 17 months.
Abstract: Clinical, hematologic, and prognostic differences between Philadelphia chromosome (Ph1)-positive and Ph1-negative chronic granulocytic leukemia (CGL) have been described. However, Ph1-negative disease may be a mixture of other entities. The authors identified 24 patients given the diagnosis of Ph1-negative CGL after evaluation by the Hematology Department of the Mayo Clinic between January 1976 and August 1984. Each patient was Ph1-negative, and a bone marrow examination was interpreted as CGL. Initial peripheral blood and bone marrow samples were available for review in 22 patients. Their disorders were reclassified as chronic myelomonocytic leukemia (13 patients), chronic myelomonocytic leukemia in transformation (1 patient), preleukemic syndrome (3 patients), and undifferentiated chronic myeloproliferative disease (5 patients). Median survival for the 22 patients was 17 months.
TL;DR: It is concluded that the human reactive lymph node, like the spleen, contains MZL, which apparently belong to a dynamic B-cell compartment, the morphologic expression of which may vary from scattered singular cells hidden in the lymphocytic corona to a clearly recognizable peripheral rim of medium-sized lymphoid cells.
Abstract: The presence and localization of the marginal zone (MZ) in the human lymph node is controversial. The authors analyzed the distribution of sIgM+sIgD- MZ lymphocytes (MZL) expressing alkaline phosphatase (ALP) activity in a series of reactive lymph nodes and spleens with the use of immuno- and enzymehistochemistry, and a combination of both technics. MZL were found scattered in lymphocytic coronas composed of densely packed, small, round lymphocytes. In the lymphocytic coronas showing prominent zonal layering into an inner, densely packed rim and outer, loosely arranged rim, the latter area proved to be composed of sIgM+sIgD-ALP+ MZL, in contrast to the inner rim, which was composed of sIgM+sIgD+ALP- small, round lymphocytes. It is concluded that the human reactive lymph node, like the spleen, contains MZL. These MZL apparently belong to a dynamic B-cell compartment, the morphologic expression of which may vary from scattered singular cells hidden in the lymphocytic corona to a clearly recognizable peripheral rim of medium-sized lymphoid cells.
TL;DR: If the light microscopic morphologic features of herpes simplex hepatitis are recognized in a biopsy, the diagnosis of herpetic hepatitis can be made and anti-viral therapy may be instituted.
Abstract: A study of eight cases of herpes simplex hepatitis in apparently immunocompetent adults is presented. The clinical features were nonspecific and were usually those of a severe systemic infection, mimicking septic shock. However, the histologic features were distinctive, with randomly distributed patchy areas of coagulative necrosis surrounded by hepatocytes containing viral inclusions. Viral particles could be identified by electron microscopy and Herpes simplex antigens by immunohistochemistry, but these were not necessary for diagnosis. The light microscopic morphologic features are so distinctive that if these are recognized in a biopsy, the diagnosis of herpetic hepatitis can be made and anti-viral therapy may be instituted.
TL;DR: The authors found that target cells, erythrocytosis, and the ratios alone or in combination with the RDW were not specific in separating heterozygous thalassemia from iron deficiency, and conclude that a sequential evaluation of cases of microcyTosis is still needed.
Abstract: The red blood cell distribution width (RDW) has been proposed as an additional variable that would improve the initial classification of anemia. Microcytic anemias with an elevated RDW (greater heterogeneity) were used to distinguish iron deficiency from heterozygous thalassemia, which was said to have a normal RDW (more homogeneous). The authors attempted to classify their population of microcytic cases using the RDW as a major variable, but found only limited utility. While most of the iron-deficient cases had an increased RDW, almost one-half of the thalassemia cases also were classified as microcytic heterogeneous (increased RDW). The authors also found that target cells, erythrocytosis, and the ratios alone or in combination with the RDW were not specific in separating heterozygous thalassemia from iron deficiency. They conclude that a sequential evaluation (to include iron and hemoglobin studies) of cases of microcytosis is still needed.
TL;DR: The continuous range of changes in histopathologic features suggested that FGP arise through progressive formation and unfolding of secondary glandular buds, to result in cystic dilatation.
Abstract: To assess the histopathologic features of fundic gland polyps (FGP) of the stomach, 83 specimens from 25 patients were examined. In nine patients, FGP were associated with an inherited adenomatous polyposis syndrome; the other 16 patients had nonsyndromic FGP. FGP were microscopically characterized by the presence of fundic glands with variably disordered architecture, a feature not previously emphasized. Disordered architecture, found in 80 of 83 specimens (96%), comprised a spectrum of abnormalities, ranging from prominent glandular and cellular budding, found in 51 biopsies (61%), to irregular tortuous glands, noted in 61 biopsies (75%), to microcysts lined by fundic epithelium, seen in 72 biopsies (87%). The continuous range of these changes suggested that FGP arise through progressive formation and unfolding of secondary glandular buds, to result in cystic dilatation. No differences were found between syndromic and nonsyndromic FGP with respect to histologic features or mucin histochemistry, including presence of O-acylated sialomucins.
TL;DR: The findings indicate that, in addition to endothelial and lymphoid cells, Ia antigens are expressed in endometrial glandular and surface epithelial cells, and this expression may be influenced by lymphoids cells inendometrium and by hormones.
Abstract: Recent studies suggest that la antigens may be expressed in epithelial cells and that their expression may be under hormonal control. Therefore, the distribution of these antigens was studied in frozen sections of 37 human endometria with two monoclonal antibodies (Mab) to monomorphic determinants of la antigens using an avidin–biotin–complex (ABC) method. Five early proliferative, 9 midproliferative, 3 late proliferative, and 12 secretory endometria were examined. Two gestational endometria and six endometria with chronic endometritis were also used. Four consecutive sections from each case were stained for 1a, OKT8, Leu-3a, and B1 antigens. Throughout the cycle, the endothelial cells, many lymphocytes, and various monocytic-macrophagic cells in endometrial stroma were la positive. Furthermore, la antigens were localized to the normal endometrial epithelium. The intensity and the pattern of la expression, however, varied in different phases of the cycle. la antigens were stained weakly in endometrial glands and surface epithelium in early proliferative phase, and strongly in surface epithelium and glandular cells of the basalis and to a lesser extent of the functionalis in midproliferative and late proliferative phases. The expression of la antigens in epithelium was absent or focal during the secretory phase and in gestational endometria. Throughout the cycle and in gestational endometria, glandular cells in intimate association with lymphocytic aggregates were la positive. In chronic endometritis, the increased number of la positive stromal lymphoid cells was associated with a strong display of la antigens in epithelium. The findings indicate that, in addition to endothelial and lymphoid cells, la antigens are expressed in endometrial glandular and surface epithelial cells. This expression may be influenced by lymphoid cells in endometrium and by hormones.
TL;DR: Five cases of benign lymphoepithelial cysts of the parotid gland are reported, and the histologic, aspiration cytologic, and ultrastructural findings are described in detail.
Abstract: Five cases of benign lymphoepithelial cysts (BLCs) of the parotid gland are reported, and the histologic, aspiration cytologic, and ultrastructural findings are described in detail. These uncommon parotid lesions contain epithelium-lined cystic spaces encased by abundant lymphoid tissue with germinal centers. The epithelium was "mucoepidermoid" in three of our cases and squamous in two. Familiarity with the morphologic features of BLCs should make it possible to distinguish them from similar-appearing cystic lesions, especially low-grade cystic mucoepidermoid carcinoma and cystic types of benign lymphoepithelial lesion (so-called Mikulicz's disease). These distinctions, however, are difficult on aspiration cytology specimens.
TL;DR: The anatomic distribution of the tumor, its ultrastructural features, immunologic phenotype, and enzymatic profile are all consistent with a derivation from lymph node interdigitating reticulum cell.
Abstract: A 67-year-old man presented with a malignant tumor involving abdominal lymph nodes, spleen, liver, and lungs, with associated protracted fever and night sweats. The tumor consisted of large pleomorphic cells, often surrounding microabscesses. Intracytoplasmic S1000 protein, surface T6, Leu-3a (T4), and HLA-DR antigens were demonstrated. The malignant cells also possessed ATPase activity. Ultrastructurally, the cells exhibited numerous interdigitating cell processes but no Birbeck granules. The anatomic distribution of the tumor, its ultrastructural features, immunologic phenotype, and enzymatic profile are all consistent with a derivation from lymph node interdigitating reticulum cell. The tumor was unresponsive to the chemotherapeutic agents administered, and the patient soon died.
TL;DR: A satisfactory response characterized by correction of hypoalbuminemia, clearance of proteinuria, and an increase of endogenous creatinine clearance occurred with corticosteroid therapy, which resembles lipoid nephrosis in its responsiveness to steroid.
Abstract: The authors studied eight cases of IgA nephropathy presenting with nephrotic syndrome. Renal biopsy revealed only mild mesangial proliferation or minor glomerular changes on light microscopic examination but typical features of IgA nephropathy on immunofluorescent and electron microscopic examination. A satisfactory response characterized by correction of hypoalbuminemia, clearance of proteinuria, and an increase of endogenous creatinine clearance occurred with corticosteroid therapy. These cases represent a variant of IgA nephropathy associated with a nephrotic syndrome that resembles lipoid nephrosis in its responsiveness to steroid.