Chest wall lymphomas: Fine needle aspiration cytodiagnosis and review of the literature

OBJECTIVE

Compared to other chest wall malignancies, lymphoma is a common disease. However, published literature on a series of lymphoma cases involving the chest wall is scarce. The aim of the present study, was to describe experience with chest wall swellings diagnosed as lymphoid neoplasms on fine needle aspiration (FNA) cytology.

METHODS

Eleven chest wall swellings were diagnosed as lymphoid neoplasms on FNA over a period of 15 years (January 2000-December 2014). The age of patients ranged from 19 to 73 years (median, 46). The male-to -emale ratio was 7:4. Ten cases had an anterior or lateral chest wall mass, and one swelling was in the scapular region. Six cases had concurrent lymphadenopathy, and one had bone involvement. The FNA smears were reviewed and classified under WHO Classification of Hematopoietic Neoplasms. The histopathological diagnoses were available in eight cases.

RESULTS

The preliminary cytodiagnoses in 11 cases of chest wall lymphoid neoplasms were anaplastic large cell lymphoma (ALCL) in two cases, and ALCL/malignant melanoma, ALCL/T-cell-rich-B-cell lymphoma (TCRBCL)/Hodgkin's lymphoma (HL), plasmacytoma/neuroendocrine carcinoma, Hodgkin's lymphoma, small cell NHL/CLL, NHL, suggestive of NHL, post-transplant peripheral T-cell lymphoma (PTCL), and a malignant plasma cell tumour in one case each. The reviewed cytodiagnoses of lymphoid neoplasms were as follows: ALCL ( five cases), centroblastic lymphoma (two cases), and small cell lymphoma/CLL, post-transplant peripheral T-cell lymphoma, Hodgkin's lymphoma and plasmacytoma (one case each). Histopathological diagnoses available in eight cases confirmed the presence of lymphoid neoplasms.

CONCLUSION

A variety of lymphoid neoplasms involved the chest wall, and among them, ALCL was a common form.

Soft tissue high grade myoepithelial carcinoma with round cell morphology: report of a newly described entity with EWSR1 gene rearrangement

The case of soft tissue malignant myoepithelioma is presented including clinicopathological, immunohistochemical and cytogenetic findings. A 36-year-old Saudi male patient suffered from large mass involving right scapula and right shoulder joint measuring 14x13x11 mm. Core biopsy revealed sheets and lobules of poorly differentiated small malignant cells with marked atypia and frequent mitosis. Initially, immunohistochemistry was reactive for vimentin, pan-cytokeratin, EMA and CD99. The case was negative for desmin, SMA, CD34, S-100 protein and GFAP. FISH analysis exhibited negativity for SS18 (18q11.2) gene rearrangement and positivity for EWSR1 (22q12) gene rearrangement and a diagnosis of Ewing/PNET was considered. Clinical behavior and therapeutic response did not match the diagnosis with re-evaluation. Wedge biopsy demonstrated aggregates of epithelioid cells besides calponin and P63 positivity. Final diagnosis of malignant myoepithelioma with EWSR1 gene rearrangement was issued; a new entity with aggressive course. Myoepithelial carcinoma of soft tissue exhibits a wide spectrum of cytomorphology with overlapping phenotype similar to other soft tissue sarcoma like synovial sarcoma, mesenchymal chondrosarcoma, epithelioid sarcoma as well as Ewing/PNET. Moreover, a new finding of EWSR1 gene rearrangement is recognized in malignant myoepithelioma with different fusion partners. Hence, myoepithelial carcinoma should be kept in mind in diagnosis of soft tissue tumors even with unusual phenotype and gene rearrangement.

Wall or machine suction rectal biopsy for Hirschsprung's disease: a simple modified technique can improve the adequacy of biopsy

Suction rectal biopsy (SRB) may not include sufficient submucosa for histological diagnosis of Hirschsprung's disease (HD) and a repeat biopsy is required. Substitution of the conventional syringe for sustained suction from a machine or wall suction unit could provide a more consistently adequate tissue biopsy. This study was conducted to compare the adequacy of SRB specimens using a conventional method of syringe suction (SSRB) with those taken by wall or machine suction (WSRB). Hospital records of patients who had a SRB between 2002 and 2004 were studied retrospectively. The biopsy was considered inadequate if there was insufficient submucosa and a repeat specimen was requested. SSRB were taken using the conventional SSRB technique. WSRB were taken with the same Noblett forceps but with suction from wall suction or from a portable suction machine. Ninety-five infants had 103 SRB, 24 had WSRB and all (100%) were adequate for histopathological diagnosis or exclusion of HD. Seventy nine conventional SSRB were undertaken in 71 infants of which 64 (81.02%) were adequate. The difference in adequacy between WSRB and SSRB was statistically significant (P = 0.02). There were no instances of haemorrhage or bowel perforation in either subgroup. WSRB with the Noblett biopsy forceps is more likely to produce an adequate specimen and to reduce the incidence of repeat biopsies.

Seasonal variations of aerosol residence time in the lower atmospheric boundary layer

During a one year period, from Jan. 2002 up to Dec. 2002, approximately 130 air samples were analyzed to determine the atmospheric air activity concentrations of short- and long-lived (222Rn) decay products 214Pb and 210Pb. The samples were taken by using a single-filter technique and gamma-spectrometry was applied to determine the activity concentrations. A seasonal fluctuation in the concentration of 214Pb and 210Pb in surface air was observed. The activity concentrations of both radionuclides were observed to be relatively higher during the winter/autumn season than in spring/summer season. The mean activity concentration of 214Pb and 210Pb within the whole year was found to be 1.4+/-0.27 Bq m(-3) and 1.2+/-0.15 mBq m(-3), respectively. Different 210Pb:214Pb activity ratios during the year varied between 1.78 x 10(-4) and 1.6 x 10(-3) with a mean value of 8.9 x 10(-4) +/- 7.6 x 10(-5). From the ratio between the activity concentrations of the radon decay products 214Pb and 210Pb a mean residence time (MRT) of aerosol particles in the atmosphere of about 10.5+/-0.91 d could be estimated. The seasonal variation pattern shows relatively higher values of MRT in spring/summer season than in winter/autumn season. The MRT data together with relative humidity (RH), air temperature (T) and wind speed (WS), were used for a comprehensive regression analysis of its seasonal variation in the atmospheric air.

Small intestinal obstruction due to Bilharzioma: case report

Schistosomiasis in endemic areas affects all age groups and present with various clinical manifestations. Small intestinal obstruction as a complication of Schistosomiasis was not described in the literature. This is a report of a 10 year old child from an endemic area with an unusual presentation of subacute small intestinal obstruction. Description of the pathological changes in the intestines following infestation with Schistosomiasis and brief presentation of the control modality in this endemic area are given.

Circulating filarial antigens for monitoring the efficacy of ivermectin in treatment of filariasis

Seventy-three asymptomatic bancroftian filariasis patients with positive microfilaria in their blood films were included. The patients were randomly divided into 2 groups: ivermectin group (50 cases) given 2 doses each of 100 ug/kg body weight, 3 months apart, and 23 cases had 2 doses of placebo. The study was run blindly for one year. The initial mean microfilaria (MF) count was 111/ml. At 3 months after ivermectin therapy, mean MF became 7.8/ml and 24% of ivermectin treated cases had no detectable MF (P <0.05). At 6, 9 and 12 months, the mean MF count became 4.1, 6.5 and 11/ml with amicrofilaria in 54%, 42% and 40% of treated cases respectively (P <0.05). On the other hand, no statistically significant change in the mean MF count in placebo group was detected. The routine laboratory investigations were unchanged or slightly improved at 3 and 6 months. Side effects after the first dose of ivermectin were mild fever in 16% and weakness in 20%. None was recorded after the second dose. Circulating filarial antigens could be detected in 66% of cases before treatment, as all cases with high microfilaremia had positive antigenemia. The mean antigen level started to decline significantly after 9 months post treatment. At the end of the study (one-year), all negative microfilaremic cases had negative antigen levels, indicating that detection of antigen in-patients sera is a very good indicator of cure and efficacy of the drug.

Prevalence of toxoplasma infection in Qualyobia governorate, Egypt

ELISA for toxoplasmosis was done on 152 randomly selected individuals, 31 full term parturient and 38 aborted or prematurely delivered women. Seropositivity to specific antitoxoplasma IgG antibodies was observed in 57.9%, 58.1% and 44.7% of random, full term and aborted samples respectively. Only 10.5%, 6.5% and 23.7% were found seropositive for specific antitoxoplasma IgM, respectively. The risk of feto-maternal transmission was very high (50%).

Radon progeny in Egyptian underground phosphate mines

In addition to the workers in uranium mines, the staff of other underground mines, such as workers in underground phosphate mines, can be exposed to 222Rn and its progeny. In this study the individual radon progeny concentrations were measured in three Egyptian underground phosphate mines to estimate the occupational exposure of the workers at those sites. A filter method was used to measure individual radon progeny concentrations (218Po, 214Pb and 214Po). The reported mean values of radon progeny concentrations exceed the action levels which are recommended by ICRP 65 (1993). Based on the measured individual radon progeny concentrations (218Po, 214Pb and 214Po) in these mines, the annual effective dose for the workers has been calculated using the lung dose model of ICRP 66 (1994). According to the obtained results, some countermeasures were recommended in this study to minimise these exposure levels.

Toward an animal model of chronic pancreatitis. Pancreatobiliary secretion in hamsters on long-term treatment with chemical inducers of cytochromes P450

There is currently no reproducible model of the painful and lithogenic disease, chronic pancreatitis. Its biphasic evolution, from acinar cell hyperplasia and hyperactivity toward effacement of enzyme as well as bicarbonate secretory parenchyma, would be rationalized if it was linked to induction of cytochrome P450 mono-oxygenases (CYP): the increased oxidant load from long-term CYP induction eventually erodes micronutrient antioxidant defenses to injure cells. This philosophy would also rationalize the reported hepatobiliary aberrations associated with the human disease, including increases in free radical oxidation products in bile. Accordingly, pancreatic and biliary secretions were studied in Syrian golden hamsters that were reared for 6 mo on low or high (16% corn oil) fat diets that were supplemented with a prototype inducer of CYP2 (200 ppm phenobarbitone) or CYP1 (100 ppm beta naphthoflavone) enzyme families, with or without a putative enzyme inhibitor (400 ppm cimetidine). The drugs did not alter the reduction in flow rate or bicarbonate concentration of pancreatic juice caused by the high fat diet alone, but, in contrast, evoked pancreatic protein hypersecretion in a number of animals. beta naphthoflavone, but not phenobarbitone, augmented the output of biliary lipid peroxidation products irrespective of dietary fat content, and cimetidine cotreatment with either inducer did the same. We conclude: (1) that drug modifiers of CYP magnify the deleterious pancreatobiliary effects of corn oil-enriched diets and draw them closer to those found in human chronic pancreatitis; (2) that these functional derangements are accompanied by pancreatic lipoatrophy; and (3) that long-term CYP induction does not, of its own, cause fibrosis or the ductal abnormalities that generally accompany loss of pancreatic acinar cells in the human disease and, also in contrast, the changes that are caused appear to be painless.

Human resistance to reinfection with schistosomes. II. Specific IgA titres before & 3 months after praziquantel treatment

Specific IgA assays by ELISA technique for schistosomal cases of school age children (12-14 years), were performed before and 3 months after praziquantel treatment. Sera of the resistant cases (non-reinfected after chemotherapeutic cure) showed a significant higher titres of anti-soluble egg antigen (anti-SEA) and anti-soluble worm antigen preparation (anti-SWAP) IgA antibodies than that of reinfected schistosomal cases before and 3 months after treatment. Praziquantel therapy insignificantly (P > 0.05) increased anti-SEA and anti-SWAP IgA antibodies in the sera of schistosomal cases and 3 months after treatment. Anti-SEA IgA & IgE anti-SWAP IgA & IgE were correlated positively with each other among schistosomal cases either resistant or reinfected while anti-SEA and anti-SWAP IgA antibody levels of schistosomal cases with eosinophilia were significantly higher than that with normal eosinophilic counts. Anti-SEA IgA antibody titres of schistosomal cases were correlated negatively, before treatment, with intensity of infection but anti-SWAP IgA titres were not, which might indicates that anti-SEA IgA antibodies inhibit schistosomes for egg laying and subsequently pathological complications due to granuloma formation. The higher titres of specific IgA antibody of resistant cases, its positive correlation with IgE and its negative correlation with intensity of infection might support the role of IgA as an essential component of acquired (resistance) immunity to share with IgE in protection of cured schistosomal cases against reinfection.

The efficacy of artemether in the treatment of Plasmodium falciparum malaria in Sudan

The efficacy of artemether (a qinghaosu derivative) administered intramuscularly for the treatment of Plasmodium falciparum malaria was compared to quinine in an open randomized trial including 54 patients in eastern Sudan, where chloroquine resistance is common. The artemether treatment (5 d intramuscular regimen) was effective and the drug was well tolerated. All patients had cleared the parasitaemia and were free of symptoms 48 h after initiation of treatment. The parasite clearance time was comparable in patients receiving artemether and quinine. No side effect was reported by patients receiving artemether. No recrudescence was seen in 21 patients treated with artemether who completed 28 d follow-up. In the quinine group 3 of 18 patients had recrudescences, or possibly reinfections, on days 14, 21 and 28.

Tetrodonic acid-like substance; a possible precursor of tetrodotoxin

A tetrodonic acid-like substance which was hardly distinguishable from authentic tetrodonic acid in thin-layer chromatography, high performance liquid chromatography, etc., was successfully purified from the ribbon worm and flatworm by a method consisting mainly of Bio-Gel P-2 column chromatography. The tetrodonic acid-like substance showed a specific toxicity of approximately 700 mouse units/mg as tetrodotoxin, unlike tetrodonic acid which is a completely non-toxic substance. Instrumental analyses including gas chromatography-mass spectrometry, secondary ion mass spectrometry and thin-layer chromatography/fast atom bombardment mass spectrometry disclosed that the tetrodonic acid-like substance had a structure similar to, but not the same as, that of tetrodotoxin. This, along with its high convertibility into tetrodotoxin during storage and other experimental operations, suggested that the tetrodonic acid-like substance is a precursor of tetrodotoxin.

Pancreatic and biliary secretion in the anesthetized Syrian golden hamster in response to secretin, cholecystokinin-octapeptide, bombesin, and carbachol

The aim of this study was to characterize pancreatic and biliary secretion in the anesthetized Syrian golden hamster. There were spontaneous secretions of both pancreatic juice and bile, which were increased by 400% and 60% by optimal doses of secretin with parallel increases in bicarbonate concentrations to 150 and 80 mM, respectively. CCK-8 and bombesin had little or no effect on pancreatic water and electrolyte secretion, whereas carbachol increased flow rate and bicarbonate concentration. CCK-8, bombesin, and carbachol all increased pancreatic protein secretion but had no effect on biliary secretion. In conclusion, the patterns of pancreatic and biliary secretion in the hamster are different from those in other rodents but are quite similar to those in humans.

Tetrodotoxin and related substances in a ribbon worm Cephalothrix linearis (Nemertean)

A ribbon worm Cephalothrix linearis (Nemertean) showed a high toxicity, of up to 22,000 MU/g proboscis and 13,600 MU/g body, in terms of tetrodotoxin. This organism secreted the toxin from the skin when wiped with gauze. The toxin was partially purified from the secretion as well as the wiped body by ultrafiltration and Bio-Gel P-2 column chromatography. Thin-layer chromatographic, electrophoretic, high performance liquid chromatographic, and gas chromatography-mass spectrometric analyses showed that the secreted toxin was composed almost exclusively of a tetrodonic acidic-like substance, whereas the remaining toxin in the wiped body consisted of the said substance and tetrodotoxin.

Hypercholesterolemic effect of indomethacin in the rat

The effect of indomethacin on serum lipid constituents of the albino rat was investigated. Indomethacin 1 mg/kg, but not 10 mg/kg body weight, orally administered daily for 3 days, significantly raised total serum cholesterol level from a control value of 58.17 +/- 3.40 to 108.50 +/- 15.3 (N = 10; P less than 0.05) and free cholesterol level from 52.96 +/- 2.21 to 101.17 +/- 9.52 (N = 10; P less than 0.05). Indomethacin, 1 mg/kg p.o. daily for 3 days, also raised serum triglycerides from 45.0 +/- 7.33 to 118.30 +/- 9.05 (N = 10; P less than 0.001), while it reduced phospholipid content from 189.57 +/- 58.04 to 98.75 +/- 25.85 (N = 10; P less than 0.05). The higher dose of indomethacin 10 mg/kg p.o. daily for three days resulted in a significant increase in non-esterified fatty acids, triglycerides and total calcium, while it reduced total bilirubin, phosphorous and total lipid content of rat serum. The results indicate that according to the dose administered, indomethacin could lead to serious derangements in lipid profiles.

The influence of oral hypoglycaemic sulfonyl ureas on prostacyclin release by the rat thoracic aorta

The influence of some oral hypoglycaemic sulfonyl ureas on PGI2 release by the rat thoracic aorta in vitro was examined using reversed phase HPLC. The column (Micro Pack MCH-10) (30 cm X 4 mm) was eluted using the solvent mixture:acetonitrile:glacial acetic acid:water (23:0.1:76.9v/v/v). Preincubation of the aortae with the sulfonyl ureas (15 microM) enhanced PGI2 release. The control release (measured as 6-oxo-PGF1 alpha) was 1.15 +/- 0.1 ng/mg wet weight. This was significantly increased to 2.30 +/- 0.20, 2.50 +/- 0.30, 2.90 +/- 0.25, 2.10 +/- 0.20 and 2.40 +/- 0.30 ng/mg by glibenclamide, gliclazide, acetohexamide, glibornuride and chlorpropamide, respectively (P less than 0.01, n = 6). Mepacrine (0.5 mM) abolished both basal and stimulated release. Thus, the enhanced PGI2 release may probably involve activation of the enzyme phospholipase A2. None of the compounds affected ADP-induced rat platelet aggregation even when the platelets were preincubated for 10 min at a concentration of 100-180 microM. The enhanced release of PGI2 may help to delay the development and progression of retinopathy, nephropathy, hypertension and thrombosis in diabetic patients prone to these diseases. Furthermore, the enhanced PGI2 release may partly underly some of the previously observed and poorly explained findings following the administration of some sulfonyl ureas into mammals.

The effect of oxytetracycline on the fat content and fatty acid composition of the egg yolk

The effects of oxytetracycline (OXT) at doses of 0.291, 0.461, 0.922, 1.383 and 1.844 g/l in drinking water on the egg quality and on the fat content and fatty acid composition of egg yolk were studied. OXT had no effect on egg weight, yolk weight or shell thickness. Increasing availability of OXT in water reduced cholesterol and triglyceride in the egg yolk while it had no effect on the phospholipid content. OXT at higher doses favoured unsaturated and polyunsaturated fatty acids relative to saturated fatty acids in the yolk.

Single dose intra-rectal metronidazole as prophylaxis against wound infection following emergency appendicectomy

A prospective placebo controlled randomized trial was carried out in 104 patients with a presumptive diagnosis of acute appendicitis. A single dose of 1 g of metronidazole was given intra-rectally 1 h preoperatively. There were 16 wound infections, 15 (out of 50) in the placebo group, 1 (out of 54) in the metronidazole group. This study supports the already accepted value of metronidazole but suggests that a single intra-rectal dose regimen is adequate for prophylaxis.

Prostaglandin and thromboxane production by fibroblasts and vascular endothelial cells

We have compared the production of prostaglandins in fibroblast-like cells and endothelial cells in culture. Of the fibroblasts studied 10T1/2, SHE, BP6T and KD produce significant amounts of PGI2, PGE2 and PGF2F2 under optimal culture conditions, but only 3T3 and BHK produce TXA2 in addition to PGI2. The adult bovine aortic endothelial cells (ABAE) and fetal bovine heart endothelium (FBHE) synthesise PGI2 but not TXA2, either from endogenous or exogenous substrates. Both cultured endothelial cells and fibroblasts apparently lack 15-hydroxyprostaglandin dehydrogenase pathway and the ability to convert 6-Keto PGF1 alpha into 6-Keto PGE1. PGI2 production by ABAE was 3-5 times that of FBHE, about twice that of SHE cells and 6-8 times that of 10T1/2 or BP6T cells. Supernatants or media obtained from these cells inhibited aggregation of human platelet-rich plasma, a known biological effect of PGI2. This effect was abolished when cell monolayers were preincubated with indomethacin or tranylcypromine. RIA and chromatographic data of 6-Keto PGF1 alpha from these experiments confirmed that the inhibition of platelet aggregation was due to the formation of PGI2. The production of all prostanoids by endothelial cells or fibroflasts was significantly higher during the exponential phase of growth as compared to confluent monolayers. We propose that fibroblasts 10T1/2 or SHE can serve as useful experimental models for the study of metabolism and transport of PGI2 and/or TXA2 in cells of nonendothelial nature.