Treating carcinomatous pleural effusion by intrapleural injection of OK-432 in patients with non-small-cell lung cancer

The effect of intrapleural injection of OK-432, a streptococcal preparation, for management of carcinomatous pleural effusion was investigated in patients with non-small cell lung cancer (NSCLC). Ten patients, including 5 men and 5 women with performance status 2-3(ECOG) and average age of 66.4 years, received OK-432 for different times after the tumor burden in effusion was relieved with adequate drainage. The response rate was 100% in terms of decreased reaccumulation of pleural fluid, improvement of general status, and disappearance of tumor cells in the fluid. The adverse effects of this treatment were mild-including fever, chills, chest pain and nausea-and all were tolerable to patients. Median survival time was 4.5 months after treatment. This preliminary report indicates that intrapleural injection of OK-432 is an effective alternate method for management of carcinomatous pleural effusion to improve the quality of life for terminally ill cancer patients.

Fine-needle aspiration of histiocytic necrotizing lymphadenitis (Kikuchi's disease)

Fine-needle aspiration (FNA) of the lymph node was done in five patients with histiocytic necrotizing lymphadenitis (Kikuchi's disease). In four patients, the aspirates were found to have many small and large atypical lymphocytes, some reactive, phagocytic histiocytes, and intense extracellular debris. Neutrophils, plasma cells, or multinucleated giant cells were not seen. These cytologic findings were considered diagnostic for Kikuchi's disease. In one patient, the aspirate did not show significant histiocytosis or tissue necrosis and was considered nondiagnostic. In patients with both typical clinical features and characteristic cytologic findings in the lymph node aspirates, FNA of the lymph node alone will suffice for diagnosis. In those patients with typical clinical features but nondiagnostic findings in the FNA aspirates, the diagnosis of Kikuchi's disease may have to be established either on repeated nodal FNA or on lymph node biopsy.

Prediction of chemotherapy response in human leukemia using in vitro chemosensitivity test

We performed the dye exclusion assay (DEA) and the MTT dye reduction assay to determine the drug sensitivity of acute leukemia using short-term microplate cultures. The in vitro results were compared with the clinical response of 31 patients with acute leukemia treated by combination chemotherapy. The true-positive rates of the DEA and MTT assays were 86.7 and 91.3%, respectively; the true-negative rates were 33.3 and 77.8%, respectively; and the predictive accuracy was 62.5 and 87.5%, respectively. The DEA and MTT assays gave comparable results in drug sensitivity testing of leukemic blast cells. Our data suggest that MTT assay is the more suitable for assessing chemosensitivity in acute leukemia.

Intrathoracic extraskeletal Ewing's sarcoma: a case report and review of literature

Extraskeletal Ewing's sarcoma (EES) is a rare tumor of soft tissue. As an uncommon clinical entity with histologic features similar to those of other small round-cell tumors, EES occasionally produces difficulty in diagnosis. Hence, diagnosis should be confirmed by histochemical, immunohistochemical and clinical findings. Here, we describe a man aged 29 years who had intrathoracic mass was diagnosed as EES after incisional biopsy of the tumor. The presence of glycogen in the tumor cells was demonstrated by periodic acid-Schiff (PAS) stain but immunoreactivity for cytokeratin, epithelial membrane antigen, leukocyte common antigen, desmin, actin and neuron-specific enolase were absent; vimentin was present. The patient was successfully treated with VIP regimen (etoposide, ifosfamide and cisplatin) followed by local irradiation. He remained alive without recurrence after one year. A review of the literature and recent advances in the treatment of EES are reported.

Absence of varicella zoster DNA in varicella embryopathy tissue utilizing the polymerase chain reaction

We have previously examined a case of varicella embryopathy (VE) occurring in a 41-week gestational age infant, showing some of the most severe lesions reported to be associated with the syndrome to date. A previous survey of the postmortem tissue with two anti-varicella zoster antibodies was negative. It was hypothesized that if varicella-zoster virus (VZV) was associated with VE, a latent viral infection might be expected, similar to that occurring in adults infected with VZV. Subsequently, an attempt was made to identify DNA encoding three separate and specific VZV genes using the highly sensitive polymerase chain reaction from formalin-fixed tissues of the central nervous system including cerebral cortex, cerebellum, and brainstem, in addition to frozen tissue of liver, adrenal, and thymus. Although amplifications utilizing primers for a normal human DNA sequence (ME491) demonstrated the ability of the samples to serve as a target for the PCR, none of the samples contained amplifiable VZV DNA. Substitution of biotin 11-dUTP in the PCR and subsequent detection of the biotinylated amplimers resulted in a large increase of the sensitivity of the PCR amplimer detection, but still failed to detect the presence of VZV DNA in the samples. The most likely explanation for these findings suggests a complete destruction of fetal tissue tropic for VZV with a subsequent inability for a latent VZV infection to be established.

A new variant of lethal neonatal short-limbed platyspondylic dwarfism

This article describes an unusual skeletal dysplasia in a male fetus diagnosed by ultrasound at 18 weeks of gestation. The clinical and radiologic findings resemble thanatophoric dysplasia. Histologic examination revealed abnormalities in the resting cartilage, physeal growth plate, and bone. The resting cartilage contained peculiar large chondrocytes with huge lacunae. The growth plate revealed absence of column formation and hypertrophic vacuolated chondrocytes extending far into the metaphyseal bone trabeculae. The bone was hypercellular with absence of lamellar bone. The cortical bone was scanty and woven. The histopathologic features are, therefore, unique and differ from all other well-recognized varieties of short-limbed platyspondylic dwarfism.

Captopril-induced agranulocytosis: a case report

Captopril 12.5 mg twice daily was initially administered given to a woman with chronic renal failure and hypertension. Three weeks later, she developed chills, high fever and sore throat. Hemogram showed severe neutropenia; the white cell count showed 600/cu mm; bone marrow aspirate and biopsy revealed a paucity of myeloid series. Antineutrophil antibody was not detected in the serum. The neutrophil counts returned to normal after captopril was discontinued two weeks later. We recommend that the peripheral white blood cell count in patients whom captopril is prescribed must be carefully monitored in the first three months, particularly in those with impaired renal function.

Ultrastructural changes of articular cartilage chondrocytes associated with freeze-thawing

In an attempt to justify the use of cryopreserved versus fresh articular cartilage (AC) allografts, we used transmission electron microscopy (TEM) to study the ultrastructure of fresh versus frozen-thawed AC with or without a dimethyl sulfoxide (DMSO) treatment. AC explants were cut aseptically from the femoral condyles of healthy, mature rabbits when they were killed. Half of all explants were incubated in Ham's F-12 medium, supplemented with antibiotics and with or without 7.5% DMSO, frozen to -80 degrees C, stored for 24 h, and thawed rapidly. These, and the control explants, were fixed with glutaraldehyde, paraformaldehyde, and acrolein in cacodylate buffer. Sections were stained for acid phosphatase (APase), postfixed with osmium, embedded, and examined under TEM. The typical organization of the matrix and the cells was noted in control sections. The chondrocytes contained intact nuclei, organelles, and discrete plasma membrane. Although some endoplasmic reticula and nuclear membrane appeared intact, distinct ultrastructural changes were observed in frozen-thawed samples treated with DMSO. These changes included condensation of chromatin, large lipid droplets, partly disrupted plasma membrane, and pericellular precipitation of APase-positive crystalites. In sections not treated with DMSO, the cytoplasm was extensively vacuolated and no distinct organelles could be detected in the chondrocytes. Little difference was noted between the matrix organization of fresh or frozen-thawed samples. Our results suggest that distinct ultrastructural changes occur in the chondrocytes following freeze-thawing of intact AC and that DMSO pretreatment may contribute to improvement in the cryopreservation of AC.

Giant cell fibroblastoma in childhood immunohistochemical and ultrastructural study

Two cases of giant cell fibroblastoma in children are presented. Histologic features included a dense fibrous tissue stroma with multinucleated giant cells lining sinusoid-like spaces. Immunohistochemical stains and electron microscopy provide evidence of a fibroblastic origin of the tumor cells. Ultrastructure of the multinucleated cells revealed segmentation of the nuclei with multiple centrioles, suggesting that an abnormality in the division of the tumor cells may be the mechanism for the formation of the giant cells.

Localization and therapy of human cervical tumor xenografts with radiolabeled monoclonal antibody 1H10

Murine IgG3 monoclonal antibody (Mab) 1H10, which recognizes a tumor-associated antigen expressed on the surface of more than 40% of human cervical carcinoma tissues, was used for in vivo localization and therapy of cervical tumor xenografts. A human cervical carcinoma cell line, CaSki, was used as our experimental tumor system. Mab 1H10 antigen expression on the surface of CaSki cells was found to be cell-cycle independent. The ability of Mab 1H10 F(ab')2 to bind to CaSki tumor xenografts was verified by direct immunohistochemical staining of thin tumor sections with a Mab 1H10-peroxidase conjugate. Radioimmunoscintigraphy of nude mice bearing CaSki tumors after iv administration of [131I]1H10 F(ab')2 showed clear tumor images 48 hr after Mab injection. Radiolabeled Mab 1H10 F(ab')2 was found to specifically localize in solid CaSki tumors 96 hr after antibody injection. Radioactivity in tumor tissue was 4 times higher than that in kidney tissue and over 6 times higher than that in liver tissue. Mab 1H10 F(ab')2 binding to xenografted CaSki tumors was 17 times greater than a control IgG3 F(ab')2 after 96 hr. Therapy of athymic mice bearing established CaSki tumors with three iv injections of 100 microCi [131I]1H10 F(ab')2 resulted in extensive tumor necrosis and significant suppression (p < 0.05) of tumor growth compared to that in control mice. These results indicate that Mab 1H10 F(ab')2 may be clinically useful for detection or treatment of cervical cancer.

Primary colorectal lymphoma in Taiwan

BACKGROUND

Sixteen patients with primary lymphoma of the colon and rectum were studied.

METHODS

The median age of these patients was 34 years, and 13 were men. These patients often experienced abdominal pain, diarrhea, a palpable abdominal mass, weight loss, bloody stools, and tumor of the cecum. Intermediate or high-grade lymphomas occurred in 14 patients, and 5 patients had T-cell lesions. The diagnoses were established by using laparotomy in 14 patients and colonoscopic biopsy in 2 patients. Fourteen patients had surgical resections followed by chemotherapy: cyclophosphamide, doxorubicin, vincristine, and prednisolone in 10; cyclophosphamide, vincristine, and prednisolone (COP) in 2; and cyclophosphamide, vincristine, methotrexate, and prednisolone in 1 patient. Two patients underwent biopsy alone followed by chemotherapy with COP in one and chemotherapy with prednisolone in the other.

RESULTS

The median follow-up time was 38 months (range, 2-82 months). Eight patients are alive with no evidence of disease (range, 10-82+ months). Six patients died of disease from 2 to 44 months after diagnosis. One patient who had no evidence of lymphoma died of esophageal carcinoma at 61 months. The median survival time was 59 months.

CONCLUSIONS

The authors' experience with colorectal lymphoma in Taiwan is different from that reported from Japan and other countries. The patients of this study were significantly younger and many had T-cell lesions. Despite the frequently poor histologic types, surgical resection and adjuvant chemotherapy can result in long-term, disease-free survival in many patients with primary colorectal lymphoma.

Collagen fibril structure of normal, aging, and osteoarthritic cartilage

The collagen architecture in normal, aging, and osteoarthritic articular cartilage was studied optically using a new silver staining technique based on specimens from 50 autopsy cases, four amputated limbs, and six osteoarthritic knees. In the normal articular cartilage, the collagen fibrils in the superficial zone were compactly arranged into layers of decussating flat ribbons mostly parallel to the artificial split lines. The fibrils showed a tendency to condense into vertical arcade columns undergirded by tangential bundles in the intermediate zone. In the deep zone, the fibrils formed a random meshwork with a slight preponderance of vertical fibrils in the perilacunar region. Three types of early degradative lesions involving the collagen network were identified. Type I lesions consisted of focal superficial disruptions related to age and friction. Type II lesions consisted of focal disruptions of tangential fibrils in the intermediate zone leading to cyst formation, probably representing a form of local stress failure. Type III lesions were found in the patella and consisted of marked swelling of the superficial zone, the cause of which was unknown. Lesions of varying severity were seen within each of the three types; the morphological changes of the more severe lesions overlapped with those of clinically overt osteoarthritis.

Primary cecal lymphoma. Report of a case with preoperative diagnosis by fine needle aspiration and immunocytochemistry

Fine needle aspiration of a cecal mass was performed on a patient with a cecal tumor and iron-deficiency anemia. Cytologic studies of the air-dried smears showed large cell lymphoma. The diagnosis of large cell lymphoma of the B-cell type was affirmed by immunocytochemical studies and at laparotomy and resection of the tumor. Even under unusual circumstances, the diagnosis of such a rare abdominal lesion as primary cecal lymphoma can be made with certainty by cytologic and immunologic studies of fine needle aspirates.

[Evaluation of marrow neutrophilic reserve in normal subjects and aplastic anemia patients]

The widespread use of potent marrow suppressing drugs in malignant diseases has gained increasing importance in the functional assessment of neutrophil system. A peripheral neutrophil count of 500 cells/cumm is considered to be a good indicator of risk of bacterial infection. However, despite extreme neutropenia, infection is rare in chronic benign neutropenia patients. It may be presumed that adequate marrow reserve delivers mature neutrophil during bacterial infection in these patients. Currently available methods such as determination of blood neutrophil concentration, differential counts, estimation of bone marrow cellularity provide a relatively crude estimates of the functional capacity of the neutrophil system. The use of endotoxin, etiocholanolone and steroids have been introduced to determine the marrow neutrophil reserve with greater accuracy. In this study, intravenous hydrocortisone 100 mg was used to evaluate marrow neutrophilic reserve in normal and aplastic anemia subjects. The results showed significant statistical differences (P less than 0.001) between controls and aplastic subjects in 2, 3, 4 and 5th hour groups after steroid injection. The sensitivity and specificity occurring 3 and 4 hours after steroid injection were 78.6% and 100%, respectively. The normal marrow neutrophilic reserve showed more than 1198/cumm of increment neutrophilic counts 4 hours after steroid injection. No complication was found. The present finding suggests that steroid may be useful as an accurate evaluator of marrow neutrophilic reserve.

Varicella embryopathy

Varicella embryopathy is a rare entity afflicting infants born to mothers who have contracted varicella during the first 20 weeks of pregnancy. The teratogenicity of varicella has not been established from epidemiologic studies, but isolated case reports describe characteristic malformations following early maternal infection. We describe a male neonate delivered at 40 weeks' gestation to a 26-year-old grava 2, para 2 mother who developed varicella during the first trimester. The infant lived 7 days and died of bronchopneumonia. At postmortem examination there was growth retardation, multiple cicatricial skin lesions, flexion contractures of all major joints, hypoplastic right diaphragm, bilateral hydroureters and mucosal fibrosis of the trachea, as well as intestinal fibrosis and colonic stricture. The brain contained areas of cystic necrosis involving the frontal, parietal, temporal, and occipital lobes, with generalized ventriculomegaly. The midbrain, pons, and medulla were hypoplastic. There was denervation atrophy of muscles of the lower limbs and loss of dorsal root ganglia as well as of neurons of the anterior horn of the spinal cord. The cerebral white matter was degenerated, with proliferation of reactive astrocytes. Chorioretinitis was not observed. Immunocytochemical stains using two commercially available antivaricella antibodies were negative in all tissues examined. The sporadic nature and pathogenesis of the varicella embryopathy, which may have been caused by focal defects in the fetal T-cell immune response, are discussed.

Myeloblastic leukemoid reaction in paroxysmal nocturnal hemoglobinuria associated with myelodysplasia

Paroxysmal nocturnal hemoglobinuria (PNH) has been observed to evolve into myelofibrosis and acute myeloid leukemia. Myeloblastic leukemoid reaction has not been described in PNH. We described a patient with PNH with myelodysplasia and septicemia. The marrow aspirates showed a picture of myeloblastosis which subsided when sepsis was controlled. The myeloblastic leukemoid reaction in our patient related to overwhelming sepsis, splenectomy and overt hemolysis.

Signet-ring chondrosarcoma: a new morphologic entity

A 65-year-old, otherwise healthy white man presenting with an asymptomatic anterior chest wall mass diagnosed from a routine preoperative chest x-ray is reported. A fine needle aspirate of the mass was initially interpreted as a metastatic adenocarcinoma with prominent "signet-ring" features, but ultrastructural study of the cell block later suggested a chondrosarcoma. The resected surgical specimen confirmed the diagnosis of a grade 2 chondrosarcoma, with most of the tumor cells containing a large, clear, single vacuole shown to be lipid. The positive immunostaining for vimentin and S-100 as well as the ultrastructural appearance confirmed the diagnosis of a chondrosarcoma. Flow cytometric DNA analysis of the tumor on two separate occasions documented a very large aneuploid cell population (50% to 60%) which, when interpreted with the histologic appearance, suggested an aggressive tumor. This case illustrates the first published example of a "signet-ring" chondrosarcoma.

Perfusion scan in pulmonary tumor microembolism: report of a case

A 76-year-old male patient was admitted to our hospital with the chief complaint of dyspnea. A chest CT scan showed pericardial effusion, mediastinal lymphadenopathy and a tumor in the right ventricle with invasion to the main trunk of the pulmonary artery. A 99mTc MAA perfusion lung scan revealed multiple small subsegmental peripheral defects and a "fissure sign", while the 133Xe ventilation scan was normal. After the chest CT scan and scans of both lungs, tumor microembolism was highly suspected. Open chest surgery was performed. A huge tumor in the right ventricle involving the main trunk of the pulmonary artery was found. In addition, multiple tumor thrombi in the pulmonary arteries and veins were also noted. The pathology was metastatic squamous cell carcinoma. Thereafter, the primary lesion was found by bronchoscopy. The final diagnosis was squamous cell carcinoma of the right lower lobe bronchus with metastases to the right ventricle and pulmonary vessels, and in association with pulmonary tumor microembolism. We present this uncommon case and describe the pulmonary perfusion pattern of the tumor microembolism.

Structure, secretion, and bacterial specificity of an endogenous lectin from cystic fibrosis lung

Endogenous heparin-binding lectin purified from postmortem lung samples of two cystic fibrosis (CF) patients was compared to lectin derived from normal tissue with respect to structure, carbohydrate specificity, interaction with alginate derived from CF isolates of Pseudomonas aeruginosa, and secretion within the lung. Lectin was purified from extracts of lung tissue by gel filtration on Sepharose CL-2B followed by affinity chromatography on heparin-Sepharose. Lectin purified from either CF lung or control tissue ran as two peptides of approximately 16,000 and 13,000 molecular weight on electrophoresis in sodium dodecyl sulfate. The lectins displayed similar carbohydrate specificity and interacted in much the same way with bacterial alginate. An increase in lectin secretion was seen in CF lungs affecting the bronchial epithelial cells and the mucosal glands. The data suggest that the major changes seen in endogenous heparin-binding lectin in CF are related to the quantity and distribution of lectin secretion.

[Non-Hodgkin's lymphoma in adults: a clinico-pathologic study of 169 cases]

From 1983 to 1988, non-Hodgkin's lymphoma was diagnosed in 169 patients ranging from 19 to 89 years of age (mean 49). They were investigated using both unifactorial and multivariate regression (Cox model) analyses to determine the relationship of survival rate and prognostic factors including age, sex, histology, B symptom and clinical stage. All cases were histologically classified according to the criteria of the working formulation and were staged according to the Ann Arbor classification. Non-Hodgkin's lymphoma occurred roughly 9 times as frequently as Hodgkin's disease. The lymph nodes of the neck and inguinal regions were noted to be the most common sites of involvement. However, extranodal lymphomas originated most frequently from the stomach. For the patients with non-Hodgkin's lymphoma, the proportions of low grade, intermediate grade, and high grade were 10.7%, 59.1% and 20.7%, respectively. The remaining 9.5% of cases were unclassified (7.7%) and true histiocytic (1.8%). The most common subtype was diffuse large cell (33.7%). Lymphoblastic lymphoma was found to have a predilection for young male adults. Follicular lymphomas occurred mainly in mid-adult life. The patients with high grade lymphoma almost always presented the advanced stage. The median survival time (MST) of our series was 20 months, the 3-year survival rate was 43.3% and the 5-year survival rate was 30.40%. Statistical studies of both unifactorial (p less than 0.01) and multivariate regression (p less than 0.05) analyses showed that patients with an age greater than 60 years old, having B symptom, clinically advanced stage, or both histologically intermediate and high grade experienced a much poorer prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastrointestinal function and structure in HIV-positive patients

We examined 19 patients (17 men) with human immunodeficiency virus (HIV) infection and gastrointestinal symptoms to determine whether those symptoms were due to either a gastrointestinal tract infection or a defect in mucosal absorption because of an enteropathy. The erythrocyte folate and serum vitamin B12 levels were within normal limits in all of the patients. The serum ferritin level was elevated in 12. The xylose absorption test results were abnormal in 8 of the 13 patients able to complete the study. None of the duodenal aspirates yielded a pathogen. Light microscopy revealed nonspecific lymphocytic inflammation without infection in the stomach (in seven patients), the esophagus (in five), the duodenum (in two) and the rectum (in two). However, biopsy specimens were positive for Candida albicans in the esophagus (four patients), cytomegalovirus in the esophagus (one) and the rectum (two), Helicobacter pylori in the antrum (two), Treponema infection in the rectum (two) and Mycobacterium avium-intracellulare in the small intestine (one). Only three patients had a normal series of biopsy specimens. All of the patients had similar ultrastructural changes at the epithelial-stromal junction of the antral glands and in the intestinal crypts. We conclude that abnormal biochemical and endoscopic findings are common in HIV-positive patients with gastrointestinal symptoms. Defects in carbohydrate absorption and ultrastructural changes may be responsible for some aspects of HIV enteropathy.

Silver staining of collagen fibrils in cartilage

Direct visualization of individual collagen fibrils by light microscopy in human cartilage was achieved by applying a periodic acid-silver methenamine stain on plastic sections. Collagen fibrils, 100 nm in diameter or thicker, were delineated individually by light microscopy and were easily traced for a length beyond 100 microns. Thinner fibrils not readily visible optically were identified if arranged in compact bundles as occurring in the superficial zone of articular cartilage.

The growing teratoma syndrome. A case of primary mediastinal nonseminomatous germ cell tumor treated with chemotherapy and radiotherapy

A 21-year-old man presenting with a mediastinal mass was diagnosed as having primary mediastinal mixed nonseminomatous GCT by incisional biopsy and elevated serum concentrations of AFP and beta-HCG. After four courses of PVB chemotherapy followed by 4,000 rads of radiotherapy, the AFP level declined markedly, but the mediastinal mass further enlarged and underwent cystic change. Pathologic examination of the resected tumor only showed immature teratoma. The serum AFP level returned to normal and remained so three months after the operation. This experience suggests that in patients with nonseminomatous GCT treated with combination chemotherapy, measurements of tumor volume alone do not provide information regarding the tumor's response. Early recognition of the "growing teratoma syndrome" will allow for surgical salvage.

The differential diagnosis of benign and malignant bony lesions in bone scanning. Using the ratio of radiouptake at different times

For the evaluation of bony metastases in cancer patients, bone scanning has become an important tool, but some limitations exist. One of these is the differential diagnosis of benign and malignant bony lesions, in which bone scanning shows one or more lesions in the spine. To help solve this, bone scintigraphy was performed 4 and 24 hours after intravenous injection of Tc-99m MDP; the ratio of radiouptake in the lesion and normal spine was measured as 24-hr/4-hr (T/F) ratio. Fifty-four patients with an average age of 56 years were studied and divided into two groups. Group A included 34 patients (17 women and 17 men) with bony metastases. Group B included 20 patients (8 women and 12 men) with radiographically proven benign bony lesions and no evidence of cancer. An LFOV Elscint Apex 400 digital gamma camera and an Informatek Simis 5 nuclear minicomputer were used. The results showed that the T/F ratio of Group A was 1.3 +/- 0.15 (mean +/- SD) and that of Group B was 1.0 +/- 0.12 (mean +/- SD). The P value was less than 0.001. We conclude that the ratio of radiouptake of lesions and normal spine at 24 and 4 hours may be a reliable method of differentiating benign bony lesions from malignant lesions.

A system of interlacunar network and thick fibrils in human hyaline cartilage

A system consisting of an interlacunar network and thick fibrils was demonstrated in the matrix of human fetal and neonatal hyaline cartilage, using an osmium-ferrocyanide mixture as a second fixative. The network appeared as irregular strands consisting of hyaluronidase-sensitive, amorphous and fine fibrillar material. The thick fibrils measured 75-125 microns in diameter, each appearing to consist of several collagen fibrils twisted into a cable and cemented by dense amorphous material. Strands of the network were seen to cross and focally distort the thick fibrils, suggesting that the strands exert some tensile forces on the thick fibrils. During the first year of life the network rapidly became undemonstrable, but the thick fibrils persisted into adulthood. This system of interlacunar network and thick fibrils appears to form an integral functional unit which may play an organizational role in the formation of cartilagenous matrix during development. Furthermore, it may contribute to the mechanical strength of the collagen framework in hyaline cartilage.

Endogenous heparin-binding lectin activity in human placenta: purification and developmental expression

Human placental extracts contain a herapin-inhibitable lectin activity. The lectin, which closely resembles those from chicken and rat tissues, was purified by heparin-affinity chromatography. It shares many properties with the previously reported lectins, including hapten specificity, molecular weight of monomers, and immunological cross-reactivity. Sections from different stages of placental development, stained by immunohistochemistry procedures using lectin-specific antibody, showed that the lectin was initially present only in cytotrophoblasts of early first trimester villi. Later in the first trimester, both cytotrophoblasts and syncytiotrophoblasts were stained positively for lectin. From second trimester to term, the lectin was seen only in syncytiotrophoblasts.

Reconstruction of superior vena cava in invasive thymoma

Aggressive en-bloc resection of the superior vena cava was performed in a 50-year-old man who had superior vena caval syndrome caused by invasive thymoma. After the superior vena cava was resected, a Gore-Tex vascular graft was used to reconstruct the lower end of the right innominate vein and lower end of the superior vena cava. The patient was treated with postoperative radiotherapy to the mediastinum and has been asymptomatic for 14 months following surgery.

Natural history of in situ breast cancer in a defined population

The entire experience of in situ breast cancer in Alberta from 1953 to 1984 was examined. Of 243 patients coded, 226 were available for review by a panel of three pathologists. In 149 cases the diagnosis of in situ disease was confirmed. One hundred and eight patients had 109 ductal carcinomas in situ, 38 patients had lobular carcinomas in situ, with 3 patients having both. A multitude of treatments was used, ranging from local excision to radical mastectomy. Survival at a mean of 6 years follow-up was equal in all groups, with only two patients with a confirmed diagnosis of ductal carcinoma in situ dying from clinically suspected systemic disease. In patients treated by local excision, ipsilateral cancers were seen in 12% of ductal carcinoma in situ patients who had local excision and 13% of patients with lobular carcinoma in situ. Contralateral metachronous invasive cancers were seen in 6% of ductal carcinoma in situ patients and 3% of lobular carcinoma in situ patients. No lymph node involvement was seen in any of these patients, either with prophylactic dissection or in follow-up. The conclusion reached was that both in situ lesions are similar in their clinical course. Lymph node dissection is not necessary. Pathologic review is critical for accurate studies, with a change in diagnosis of 36% of diagnoses. Treatment does not appear to affect prognosis. The most appropriate treatment needs to be determined in prospective randomized trials.

Occult prostate adenocarcinoma with pulmonary metastasis: diagnosis by fine needle aspiration biopsy of the lung and immunohistochemistry

Metastatic pulmonary nodules were found in a 70-year-old man, who also had osteoblastic bone lesions and symptoms of prostatism. Extensive searching, including a transurethral resection of the prostate, failed to establish the primary site of the malignancy. One of the pulmonary nodules was biopsied using a fine needle aspiration technique, and revealed adenocarcinoma. The tumor cells in this lesion stained positive for prostate specific antigen. The patient was treated with estrogen for prostatic carcinoma and improved.

Collagenous colitis and microscopic colitis: the watery diarrhea-colitis syndrome

Nine patients (seven females, two males) with chronic watery diarrhea and nonspecific colonic mucosal inflammation followed for 1-5 yr are presented. Eight were diagnosed as having collagenous colitis on the basis of marked thickening of the subepithelial collagen layer in at least one set of biopsies. The thickness of the collagen table varied with time in all eight cases. When thickening was minimal, morphological features were indistinguishable from microscopic colitis, signifying that, in most cases, collagenous colitis and microscopic colitis are part of the same spectrum of colonic mucosal response. One of the eight patients had documented collagenous colitis and gluten-associated enteropathy for 12 yr. The colitis and duodenal histology improved synchronously when a gluten-free diet and corticosteroids were administered. The ninth patient had microscopic colitis and enteropathy which did not respond to gluten withdrawal. This patient never exhibited thickening of subepithelial collagen in repeated biopsies over 5 yr, suggesting that an entity of microscopic colitis may exist independent of collagenous colitis. Duodenal mucosal biopsies showed normal histology in four other patients with collagenous colitis. The histological variability of collagenization and inflammation during the course of collagenous colitis and microscopic colitis and the clinical feature of watery diarrhea suggest that these two entities be grouped together as the watery diarrhea-colitis syndrome.

Idiopathic retractile (sclerosing) mesenteritis and its differential diagnosis

We report a case of retractile mesenteritis presenting as an abdominal mass with incomplete small-bowel obstruction. Histological features included fat necrosis, fibrosis, elastosis, dystrophic calcification, and chronic inflammation. Lymphatic obstruction resulted in the accumulation of lipid-laden macrophages in the ileal mucosa. Ultrastructurally, myofibroblasts were the principal cells present. The differential diagnosis of retractile mesenteritis is discussed with particular attention to myofibroblastic disorders such as inflammatory pseudotumors, desmoids, retroperitoneal fibrosis, and other uncommon conditions that appear to be morphologically or clinically distinguishable although the etiology and pathogenesis are obscure.

Direct comparisons of peripheral T-cell lymphoma with diffuse B-cell lymphoma of comparable histological grades--should peripheral T-cell lymphoma be considered separately?

Peripheral T-cell lymphoma (PTCL) forms a morphologically heterogeneous group of non-Hodgkin's lymphomas (NHL) with distinct immunophenotypes of mature T cells. Progress has been slow in defining specific clinicopathological entities to this particular group of NHL. In order to elucidate the specific characteristics of PTCL, a direct comparison of PTCL with a group of diffuse B-cell lymphomas (DBCL) was performed. Between June 1983 and December 1987, we studied 114 adults with NHL, using a battery of immunophenotyping markers. Adult T-cell leukemia/lymphoma, lymphoblastic lymphoma, mycosis fungoides/Sézary syndrome, follicular lymphoma, well-differentiated lymphocytic lymphoma, and true histiocytic lymphoma were excluded from this study since these are distinct clinicopathologic entities with well-recognized immunophenotypes. Of the remaining 75 patients, 70 who had adequate clinical information were analyzed, and of these, 34 were PTCL and 36 were DBCL. Classified according to the National Cancer Institute (NCI) Working Formulation (WF), 68% of PTCL and 31% of DBCL were high-grade lymphomas. Clinical and laboratory features were similar, except PTCL had a characteristic skin involvement and tended to present in more advanced stages with more constitutional symptoms. Induction chemotherapy was homogeneous in both groups, and complete remission rates were 62% for PTCL and 67% for DBCL. Patients with DBCL had a better overall survival than patients with PTCL, but the survival benefit disappeared after patients were stratified according to intermediate- or high-grade lymphoma. A subgroup of PTCL patients who had received less intensive induction chemotherapy was found to have a very unfavorable outcome. We conclude that (1) PTCL follows the general grading concept proposed in WF classification; (2) within a given intermediate or high grade, PTCL and DBCL respond comparably to treatment; (3) the intensity of induction chemotherapy has a crucial impact on the outcome of PTCL patients; and (4) with a few exceptions, the clinical and laboratory features of PTCL and DBCL are comparable.

A novel enteropathy with partial villous atrophy, microscopic colitis, and pemphigoid change

Microscopic colitis associated with gluten-resistant partial villous atrophy was documented in a 21-year-old woman with chronic nonbloody diarrhea. Electron microscopic examination of the colonic and duodenal biopsies showed focal separations of basal lamina from cryptal epithelial cells forming subepithelial blebs in which were mast cells and fibroblasts. These morphologic features have not been previously described in any inflammatory bowel disease and are reminiscent of bullous pemphigoid of the skin. The findings suggest that not all cases of microscopic colitis lie within the spectrum of collagenous colitis.

Cyclosporine toxicity on cultured rat microvascular endothelial cells

The present study was undertaken to study the mechanism of cyclosporine-induced nephrotoxicity and hypertension. Cultured rat microvascular endothelial cells were exposed to cyclosporine for up to six days at one of the following concentrations: 10, 50, 250, and 1000 ng/ml of culture medium. Cyclosporine inhibited endothelial cell replication in a dose-dependent manner; at higher concentrations (250 and 1000 ng/ml), cell replication decreased by as much as 70 to 90% of controls at four and six days post-treatment, with no evidence of increased cell death. Drug-treated endothelial cells revealed abnormal morphological changes such as formation of cytoplasmic vesicles and nucleolar changes. Prostacyclin release by endothelial cells was increased by about threefold with the addition of cyclosporine (P less than 0.01). Indomethacin significantly decreased prostacyclin release by endothelial cells in the presence or absence of cyclosporine (P less than 0.01). Our data suggest that cyclosporine-induced nephrotoxicity may be mediated, at least partly, by the inhibitory influence of cyclosporine on the regenerative response of microvascular endothelial cells to injury, and the resultant alterations in prostacyclin production by these cells.

The histopathology of the upper airway in the neonate following mechanical ventilation

Laryngotracheobronchial lesions were carefully documented in 26 neonatal autopsies and were classified into two main types. Type I lesions were focal desquamative or ulcerative, asynchronous, and variable in severity involving areas exposed to contact with endotracheal tube or suction catheter. These lesions are most likely due to trauma of artificial ventilation. Type II lesions were diffuse, necrotizing, more synchronous and uniform in severity involving tissues distal to the endotracheal tube and extending to second or third generation bronchi. The early or mild type II lesions consisted of coagulative necrosis of epithelial cells and mucosal oedema. The late or severe type II lesions showed features similar to those of necrotizing tracheobronchitis described by Metley et al. All the cases with type II lesions had been ventilated with 100 per cent oxygen continuously for at least 3 h during life. The use of pure oxygen may be an important factor leading to necrotizing tracheobronchitis.

Primary rhabdomyosarcoma of the prostate. Diagnosis by needle biopsy and immunocytochemistry

Needle aspiration biopsy of the prostate in a patient who initially presented with multiple metastatic lesions in the lungs and a pleural effusion showed the presence of many malignant cells. These cells appeared either as noncohesive round and oval cells or as clusters. The cytologic impression that these were sarcoma cells was confirmed by subsequent histologic and immunochemical studies. By correlating the cytologic, histologic and immunochemical findings with the clinical findings, it was possible to determine that the primary site of the tumor in this patient was the prostate. Our experience in this case suggests that air-dried smears stained with Romanowsky stains are suitable and useful for cytodiagnosis.

Alteration of pulmonary structure by Pseudomonas aeruginosa exoenzyme S

Intratracheal administration of purified Pseudomonas aeruginosa exoenzyme S elicited extensive, grossly observable damage in the rat lung within 2 h. Light and electronmicroscopy revealed injury and necrosis of bronchial epithelium, type I pneumocytes and capillary endothelial cells after 1 h; associated haemorrhage, fibrinous exudation and released type II cell lamellar bodies in alveolar lumina after 1-12 h; progressively increasing accumulations of polymorphonuclear leucocytes in the bronchi and alveoli and in alveolar septae (interstitial pneumonia) after 1-12 h; collapse of alveolar septal connective tissue and damage to pulmonary arterioles and venules. Treatment of monolayer cultures of bronchial fibroblasts with purified exoenzyme S elicited vacuolation of the cells with apparent membrane damage as revealed by light and electronmicroscopy. In-vivo production and activity of P. aeruginosa exoenzyme S may be an important pathogenicity determinant in the necrotising lung injury characteristic of P. aeruginosa pneumonia.

Vitamin A hepatotoxicity in multiple family members

Three of five family members experienced symptoms and biochemical evidence of hepatitis that could not be explained on the basis of infectious, metabolic or immunologic disorders of the liver. A history of prolonged ingestion of moderate amounts of vitamin A (20,000 to 45,000 IU per day for 7 to 10 years) was obtained in each of the three family members and was absent in the remaining two unaffected individuals. A liver biopsy performed in one family member confirmed the diagnosis of vitamin A toxicity. This report emphasizes the finding that even moderate amounts of vitamin A, when ingested over a prolonged period of time, can cause significant hepatocellular injury.

Fine-needle aspiration of an apocrine breast carcinoma with multivacuolated, lipid-rich, giant cells

The frequency of mammary apocrine carcinoma varies considerably and reflects the definitional differences of various researchers. Lipid synthesis by malignant mammary cells is not uncommon, and occasionally it is so extensive that the designation lipid-rich carcinoma is warranted. Many subtypes of lipid-rich carcinoma are described. Although focal apocrine change is observed in one type, a tumor composed predominantly of an apocrine carcinoma with an intimate admixture of lipid-rich malignant cells is previously undescribed. The fine-needle aspiration, histologic, and ultrastructural features of such a tumor is delineated for which the descriptive title lipid-rich apocrine carcinoma is coined.

Invasiveness of Yersinia enterocolitica lacking the virulence plasmid: an in-vivo study

Rabbits were given, by the intra-gastric route, two isogenic strains of Yersinia enterocolitica that differed only in the presence or absence of the virulence plasmid. Clinical illness and characteristic morphological lesions of Y. enterocolitica infection were seen only in rabbits infected with the plasmid-bearing strain (MCH700S). Although rabbits infected with a strain lacking the plasmid (MCH700L) remained healthy, mild histological changes in the small intestine, consisting of epithelial-cell damage, dilatation of lymphatics and a slight increase in neutrophil polymorphonuclear leukocytes in lamina propria, were seen in the first 12 h after inoculation. Bacteria, which were identified as Y. enterocolitica by indirect fluorescent antibody staining, were seen in dilated lymphatics. These early lesions tended to abate quickly and were no longer detectable at 24 h. Strain MCH700L was recovered from the mesenteric lymph nodes in increasing numbers until 24 h after inoculation; the number then began to decrease rapidly. In contrast, the early lesions in rabbits given strain MCH700S progressed to micro-abscesses, focal destruction of villi, and ulcerations beginning 24 h after inoculation; the number of bacteria recovered from the lymph nodes continued to increase beyond 24 h after inoculation. Bacteria were also recovered from the liver and spleen. These results suggest that both plasmid-bearing and non-bearing strains of Y. enterocolitica are capable of penetrating the intestinal mucosa. However, the virulence plasmid is required for invading bacteria to proliferate in the host tissue and to establish infection.

Fibrous hamartoma of infancy

Fibrous hamartoma of infancy is an uncommon fibroproliferative lesion that occurs only in infancy and childhood. The present case is unusual for the presence of two separate lesions, infiltration into the superficial muscle, infiltration and entrapment of nerves, and rapid recurrence after initial surgery. Despite these unusual and suspicious features, follow-up evaluations over the 15 months subsequent to the last resection showed no evidence of recurrence.

Plasmid-mediated resistance to phagocytosis in Yersinia enterocolitica

Results of our previous studies have shown that the chemiluminescence response of human neutrophils (polymorphonuclear leukocytes [PMNs]) is inhibited by plasmid-mediated cell surface components from Yersinia enterocolitica. In this study we examined the susceptibility to phagocytosis of Y. enterocolitica cells with or without plasmid-mediated surface structure and the effect of isolated outer membrane fragments on phagocytosis of Escherichia coli by PMNs in vitro. Y. enterocolitica cells with expressed plasmid-mediated surface structure were much less sensitive to ingestion by PMNs than those without it, and the resistance to phagocytosis was readily eliminated in a dose-dependent fashion by pronase treatment of whole cells, which was shown to remove plasmid-encoded outer membrane proteins. Ingestion and intracellular killing of E. coli were inhibited significantly in the presence of isolated outer membrane fragments derived from plasmid-bearing Y. enterocolitica cells. To assess the interaction of Y. enterocolitica with phagocytic cells in vivo, two isogenic strains of Y. enterocolitica, differing only in the presence or absence of the virulence plasmid, were inoculated intradermally into the backs of rabbits; and tissue sections obtained at 12 h postinoculation were examined by light and electron microscopy. The plasmidless strain was found almost entirely in PMNs or mononuclear cells. In contrast, the plasmid-bearing strain was found to be surrounded by, or interspersed with, PMNs and mononuclear cells; but most bacteria were extracellular, with little evidence of phagocytosis. These results suggest that plasmid-mediated cell surface components of Y. enterocolitica act as antiphagocytic factors, thus facilitating the survival and proliferation of the organism in the host tissue.

Metastatic renal carcinoma to larynx

The larynx is a most unusual site for metastatic cancer. A case of metastatic renal cell carcinoma of the larynx is presented to illustrate the following features: its exceptional indolent course; the difficulty in arriving at a correct diagnosis, and the good result following local excision.

Fat embolization and pulmonary infiltrates after bone marrow transplantation

Pulmonary interstitial infiltrates developed in a 22-year-old female after bone marrow transplantation (BMT) for acute lymphoblastic leukemia (ALL) in second remission. She was receiving prednisone for graft versus host disease (GvH). There was some evidence of cardiac failure, but the primary diagnosis was that of cytomegalovirus (CMV) pneumonia, which resolved. Recurrent infiltrates were associated with the appearance of fat emboli in the pulmonary capillaries. There was little histological evidence of CMV pneumonitis, although other tests confirmed persistent infection. The patient recovered after further treatment directed at CMV infection and cardiac failure with a modest reduction in steroid dose. Most previous descriptions of pulmonary fat embolization (PFE) in immunocompromised patients have been derived from autopsy studies, and the majority of patients have received steroid therapy. The present case illustrates that PFE may complicate or contribute to the picture of interstitial pneumonitis (IPN) in the BMT recipient and that this syndrome may be reversible.

Collagenous colitis: a disease of pericryptal fibroblast sheath?

Mucosal biopsies from four women with collagenous colitis and ten controls were studied. By light microscopy the cells of the pericryptal fibroblast sheath appeared diminished in number but increased in size in collagenous colitis. Electron optically in the controls the pericryptal fibroblasts were in intimate contact with the epithelial basal lamina in the crypts. On the free surface the fibroblasts maintained contact with the epithelial cells by attenuated cell processes. In collagenous colitis, in the middle and upper thirds of the crypts the fibroblasts sheath was separated from the epithelium and the fibroblasts assumed the characteristics of myofibroblasts. The separation was accentuated towards the mouths of the crypts. Beneath the surface epithelium the attenuated fibroblast cell processes seen in normal colon were grossly deficient. The basal lamina was also deficient focally and the surface epithelial cells were resting directly on a thickened collagen table. In collagenous colitis the excess collagen appeared to be secreted by the activated myofibroblasts of the pericryptal sheath.

A comparative study on the binding characteristics of the tight serum biliverdin-protein complexes in two fishes: Anguilla japonica and Clinocottus analis

The binding characteristics of biliverdin to its carrier protein in the blue-green blood of Clinocottus analis (woolly sculpin) and Anguilla japonica (freshwater eel) were operationally defined by various chemical probing methods and spectra analysis. The biliverdin in C. analis is a rotatable coiled molecule enveloped in a hydrophobic pocket of its carrier protein. The biliverdin in A. japonica is an open form molecule with external hydrogen bond or weak ester bond interacting with the carrier protein. This, for the first time, shows that the novel firm binding biliprotein complexes in the blood of different species are biochemically different. Their comparative and evolutionary significance is discussed.