Megakaryocytes in fine-needle aspiration biopsy of breast

An unusual case in which megakaryocytes were found in fine needle aspirate of a breast lesion is reported. The megakaryocytes in the smears were initially mistaken to be malignant cells. However, the cell block sections available later showed normal bone marrow particles, indicating that an inadvertent puncture of a rib was the reason for the presence of megakaryocytes in the smears.

Cytology of bronchial benign granular-cell tumor

The cytologic features of a case with multiple bronchial benign granular-cell tumors are reported and compared with those of previously reported cases. Characteristic tumor cells were found in the bronchoscopic brushing smears and in cell block sections (but not smears) prepared from the washing fluid. These findings were confirmed by the bronchial biopsy and histologic study of the resected tumors. A cytologic diagnosis of bronchial granular-cell tumor should not be difficult because the cytologic appearance of the tumor cells is characteristic; however, the possibility of a concomitant tumor, such as adenocarcinoma or small-cell carcinoma, should be considered and excluded.

Manganese superoxide dismutase is induced by IFN-gamma in multiple cell types. Synergistic induction by IFN-gamma and tumor necrosis factor or IL-1

We have previously characterized more than 20 proteins induced by the immunoregulatory lymphokine IFN-gamma in human fibroblasts by their m.w. and isoelectric points determined in two-dimensional gels. Some of these proteins are induced uniquely by IFN-gamma, whereas others are also induced by IFN-alpha, TNF, or IL-1. Recent technologic advances have allowed us to begin to rapidly identify proteins induced by IFN-gamma and other cytokines by sequencing the induced proteins from blots of preparative two-dimensional gels of total cell lysates. In this study, we show that the approximately 21 kDa, isoelectric point greater than 7 protein induced by IFN-gamma is manganese superoxide dismutase (Mn-SOD), a mitochondrial protective enzyme encoded by a nuclear gene. Mn-SOD is induced by IFN-gamma and also by TNF in all four human cell lines examined: HS153 fibroblasts, ACHN renal carcinoma, A549 lung carcinoma, and A375 melanoma. Induction of Mn-SOD mRNA is a primary, rapid, and dose-dependent response to IFN-gamma. In ACHN renal carcinoma cells, Mn-SOD mRNA and protein are induced synergistically by IFN-gamma in combination with either TNF or IL-1, and the induced protein is enzymatically active. IFN-gamma and TNF together induce Mn-SOD mRNA by more than 100-fold relative to its level in untreated ACHN cells. The induction of Mn-SOD by IFN-gamma and its synergistic induction by IFN-gamma in combination with TNF and IL-1 should protect healthy cells from the toxicity of O2- during an immune response, and may provide a mechanism for selective killing of infected cells.

Manganese superoxide dismutase is induced by IFN-gamma in multiple cell types. Synergistic induction by IFN-gamma and tumor necrosis factor or IL-1

We have previously characterized more than 20 proteins induced by the immunoregulatory lymphokine IFN-gamma in human fibroblasts by their m.w. and isoelectric points determined in two-dimensional gels. Some of these proteins are induced uniquely by IFN-gamma, whereas others are also induced by IFN-alpha, TNF, or IL-1. Recent technologic advances have allowed us to begin to rapidly identify proteins induced by IFN-gamma and other cytokines by sequencing the induced proteins from blots of preparative two-dimensional gels of total cell lysates. In this study, we show that the approximately 21 kDa, isoelectric point greater than 7 protein induced by IFN-gamma is manganese superoxide dismutase (Mn-SOD), a mitochondrial protective enzyme encoded by a nuclear gene. Mn-SOD is induced by IFN-gamma and also by TNF in all four human cell lines examined: HS153 fibroblasts, ACHN renal carcinoma, A549 lung carcinoma, and A375 melanoma. Induction of Mn-SOD mRNA is a primary, rapid, and dose-dependent response to IFN-gamma. In ACHN renal carcinoma cells, Mn-SOD mRNA and protein are induced synergistically by IFN-gamma in combination with either TNF or IL-1, and the induced protein is enzymatically active. IFN-gamma and TNF together induce Mn-SOD mRNA by more than 100-fold relative to its level in untreated ACHN cells. The induction of Mn-SOD by IFN-gamma and its synergistic induction by IFN-gamma in combination with TNF and IL-1 should protect healthy cells from the toxicity of O2- during an immune response, and may provide a mechanism for selective killing of infected cells.

Malignant mesothelioma presenting as Sister Joseph's nodule

We report a rare case of malignant peritoneal mesothelioma in which the patient presented with umbilical tumor involvement. This case is also compared with other cases of umbilical neoplasm.

Appendiceal carcinoma masquerading as primary bladder carcinoma

We report 2 cases of appendiceal adenocarcinoma invading the bladder. Both tumors masqueraded as primary bladder carcinomas. Cystoscopic biopsies obtained adenocarcinomatous tissue and the secondary nature of the bladder lesion became apparent at laparotomy in both cases. One patient was treated with surgical resection of the appendix, the adjacent cecal wall and the bladder wall, and postoperative irradiation. She was well 10 years later. The other patient was treated with right colectomy and segmental bladder resection. She died of diffuse peritoneal recurrence 6 years later.

Fine-needle aspiration cytology of papillary Hürthle-cell tumors of thyroid: a report of three cases

Papillary Hürthle-cell tumors of the thyroid are composed of oxyphilic cells with a prominent papillary component. Their biologic behavior appears to be comparable with that of conventional papillary thyroid carcinomas. The literature on the fine-needle aspiration cytology of these tumors is scanty. The cytologic findings of three such cases are reported here. The findings suggest that most papillary Hürthle-cell tumors cannot be differentiated from other types of Hürthle-cell tumors cytologically.

Thymic-renal-anal-lung dysplasia in sibs: a new autosomal recessive error of early morphogenesis

We report on 3 sisters with a syndrome of unilobed or absent thymus, renal and ureter agenesis/dysgenesis, and intrauterine growth retardation (IUGR). Two of the 3 infants had a unilobed lung and imperforate anus. Recurrence was detected prenatally by the presence of progressive oligohydramnios and IUGR, a unilateral echogenic cystic mass in the renal fossa, and low amniotic fluid disaccharidases in association with an imperforate anus. Several genetic mechanisms can be invoked to explain this occurrence including autosomal recessive inheritance and an unrecognized chromosome imbalance.

Urachal signet-ring cell carcinoma

A case of urachal signet-ring cell carcinoma is reported and compared with the 18 previously reported cases. This tumor appears aggressive, with a five-year survival rate of 27 percent. Only 1 patient achieved a five-year disease-free survival.

Fine needle aspiration cytology of squamous cell carcinoma of the breast

A rare case of pure squamous cell carcinoma of the breast is reported in which the diagnosis was initially suggested by fine needle aspiration cytology. Smears and cell blocks of the aspirate showed atypical keratinized cells admixed with inflammatory cells. The diagnosis was confirmed by open biopsy. The excised tumor tissue was positive for both estrogen and progesterone receptors; flow cytometry showed a diploid DNA content and a high S-phase fraction.

Appendiceal adenocarcinoid with ovarian metastasis

The clinicopathologic features of an appendiceal adenocarcinoid that metastasized to the ovary and peritoneum after a 5-year disease-free interval are presented. A review of the literature reveals that appendiceal adenocarcinoid in women has a high frequency (32%) of ovarian metastasis. Among 18 cases with ovarian metastasis, the ovarian metastasis was diagnosed at initial presentation in 13 cases. In the remaining 5 cases the ovarian metastasis developed after disease-free intervals ranging from 6 months to 8 years. In most cases, the ovarian metastasis was the main clinical presentation of the patients. In 5 cases the ovary was the only site of metastasis clinically when metastasis was first diagnosed. There is no known effective treatment for disseminated adenocarcinoid. It is advisable that oophorectomy be included routinely in the initial surgical treatment of appendiceal adenocarcinoid, with the possible exception of the rare pure tubular variant.

Pleomorphic adenoma of the breast

The clinicopathologic features of 2 new and 24 previously reported cases of pleomorphic adenoma of the breast are reviewed. This benign breast tumor resembles its salivary gland counterpart histologically. The circumscription and preferential juxta-areolar location suggest large breast duct origin of the tumors. Inappropriate surgery, i.e., mastectomy, was performed in 42% of the cases. Misdiagnosis and the resulting inappropriate treatment can easily be avoided if the pathologist includes this entity in the differential diagnosis when confronted with unusual differentiated epithelial breast lesions.

Angiomyolipoma of the vagina

An angiomyolipoma arising in the vaginal apex and presenting as a pelvic mass is reported and compared with other reported cases of extrarenal angiomyolipoma. This case appears to be the second case of angiomyolipoma arising in the vaginal wall.

Cartilage cells in cerebrospinal fluid

A rare case in which cartilage cells were observed in cerebrospinal fluid is reported and the literature reviewed. This phenomenon, occurring in 0.2% of the cerebrospinal fluid specimens, is thought to be caused by accidental puncture of the intervertebral disk. It has the potential of being mistaken for a malignant process.

Psammoma bodies in fine-needle aspiration cytology of papillary adenocarcinoma of the lung

The fine-needle aspiration (FNA) cytology of two cases of papillary adenocarcinoma of the lung is reported. Both cases showed psammoma bodies and papillary clusters of tumor cells in FNA specimens. Both tumors were resected and confirmed as primary papillary carcinoma of the lung by histologic examination and by clinicopathologic exclusion of the possibility of metastasis from other organs.

Facial elephantiasis neurofibromatosa--excision and skin graft

A case of left facial elephantiasis neurofibromatosa was treated with near-total excision and skin graft. Results were favorable. Repositioning of canthal ligaments, preserving part of relatively normal masseter muscle and primary nasal reconstruction with forehead flap were performed. The skin graft over the myxomatous muscle was successful. Troublesome bleeding was avoided or controlled by incising the normal skin, subperiosteal dissection, hypotensive anesthesia, and chromic catgut suture ligature.

Gallbladder vasculitis

Five cases of gallbladder vasculitis were encountered during a 10-year period in a community hospital with annual surgical cases of about 12,000. All five patients were clinically diagnosed as having cholelithiasis with or suspected to have cholecystitis. Vasculitis in the form of arteritis identical to that seen in polyarteritis nodosa was present microscopically in the cholecystectomy specimens. One patient presented with systemic symptoms, and the diagnosis of polyarteritis nodosa was established after arteritic lesions were identified in the cholecystectomy, liver biopsy, and appendectomy specimens. In another patient, the diagnosis of polyarteritis nodosa was established after a retrospective identification of one additional site of arteritis in the appendix removed 5 years prior to cholecystectomy. In another, gallbladder vasculitis was associated with scleroderma; the patient was studied thoroughly at autopsy shortly after cholecystectomy, and no evidence of polyarteritis nodosa was found. In the last two, gallbladder vasculitis was not associated with systemic diseases.

Retroperitoneal seminoma and intratubular germ cell neoplasia

A 30-year-old man with a 6-month history of flank pain was found to have a large retroperitoneal seminoma. A subsequent ultrasound examination revealed an inhomogeneous echo pattern in the normal-sized right testicle, which on orchiectomy showed extensive intratubular germ cell neoplasia. Level sectioning of the entire testicle revealed no extratubular extension of the tumor cells. The retroperitoneal and testicular lesions could represent double primaries. However, the possibility exists that an apparently intratubular germ cell neoplasm may not actually be an in situ lesion and that the retroperitoneal tumor in our case represents a metastasis from the intratubular germ cell neoplasia of the testicle.

Angiodysplasia of the gastrointestinal tract: report of 5 cases and review of the literature

With the application of more refined examinations, angiodysplasia is now being recognized as a common cause of bleeding in patients suffering from lower gastrointestinal bleeding. The diagnosis can be made by angiography or occasionally by colonofiberscopy. Angiography allows one to make this diagnosis even after bleeding has ceased. The lesions may not be clinically evident at the time of surgery, and the diagnosis must be made preoperatively to allow for proper treatment. A right hemicolectomy is the treatment of choice since these lesions are frequently multiple and seldom, if ever, occur distal to the proximal transverse colon. The pathophysiology, diagnosis, management and salient features of these lesions are described. The management of 5 patients is discussed.

Pseudoepitheliomatous hyperplasia in Spitz nevi. A possible source of confusion with squamous cell carcinoma

The presence of epithelial hyperplasia in Spitz nevi has been recognized almost from the time of Spitz's first description of the distinctive lesion that bears her name. However, the fact that this hyperplasia can acquire pseudoepitheliomatous features and thus lead to a mistaken diagnosis of squamous cell carcinoma is not widely appreciated. This report describes six examples of this phenomenon.