Survival of patients with subglottic squamous cell carcinoma

Objective

Subglottic squamous cell carcinoma is a rare subsite of laryngeal cancer that behaves more aggressively and portends a worse prognosis. Using a population-based cancer registry, our objective was to report overall survival (os) and laryngectomy-free survival (lfs) in patients diagnosed with subglottic squamous cell carcinoma, and to determine whether primary laryngectomy results in improved survival.

Methods

This retrospective population-based study considered patients with a new diagnosis of squamous cell carcinoma in the province of Ontario over a 15-year period (1995-2009). The Ontario Cancer Registry was examined for patients with the diagnosis of interest during the period of interest. Linked population-based databases were used to obtain patient demographics, comorbidity measures, staging, survival, and primary treatment with laryngectomy.

Results

Of 4927 patients identified to have laryngeal carcinoma, 89 were defined as having primary subglottic carcinoma (1.8%). In the subglottic cohort, 68 patients were men (76.4%), and mean age at diagnosis was 68 years (interquartile range: 60-77 years). The 5-year os was 47.2%, and the 5-year lfs was 31.5%. In 13 patients (15%), the primary treatment was laryngectomy, which, compared with primary radiation, did not predict for improved os. No differences in os or lfs were observed during the 15-year study period (os p = 0.42, lfs p = 0.83).

Conclusions

The survival of patients with subglottic carcinoma is poor and has remained stable over time (1995-2009). Compared with primary radiation, primary treatment with laryngectomy does not appear to improve os.

Seasonal variation in hospital encounters with hypoglycaemia and hyperglycaemia

AIM

To assess whether rates of hospital encounters with hypoglycaemia and hyperglycaemia display seasonal variation.

METHODS

Time series analyses of the monthly rates of hospital encounters (emergency room visits or inpatient admissions) with hypoglycaemia and hyperglycaemia from 2003 to 2012 using linked healthcare databases in Ontario, Canada.

RESULTS

Over the study period, there were 129 887 hypoglycaemia and 79 773 hyperglycaemia encounters. The characteristics of people at the time of their encounters were similar across the seasons in 2008 (median age 68 years for hypoglycaemia encounters and 53 years for hyperglycaemia encounters; 50% female; 90% with diabetes). We observed moderate seasonality in both types of encounters (R² autoregression coefficient 0.58 for hypoglycaemia; 0.59 for hyperglycaemia). The rate of hypoglycaemia encounters appeared to peak between April and June, when on average, there was an additional 49 encounters per month (0.36 encounters per 100 000 persons per month) compared with the other calendar months (5% increase). The rate of hyperglycaemia encounters appeared to peak in January, when on average, there was an additional 69 encounters per month (0.50 encounters per 100 000 persons per month) compared with the other calendar months (11% increase).

CONCLUSIONS

In our region, there is seasonal variation in the rate of hospital encounters with hypoglycaemia and hyperglycaemia. Our findings may help to highlight periods of vulnerability for people, may inform future epidemiological studies and may aid in the appropriate planning of healthcare resources.

Secular trends in antihyperglycaemic medication prescriptions in older adults with diabetes and chronic kidney disease: 2004-2013

AIM

To examine how antihyperglycaemic medications were prescribed to older adults with diabetes and chronic kidney disease over the last decade.

METHODS

We conducted a population-based study of 144 252 older adults with diabetes and chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m(2) or receiving chronic dialysis) in Ontario, Canada. In each study quarter (3-month intervals from 1 April 2004 until 31 March 2013) we studied the proportion of treated and newly treated patients prescribed insulin, sulphonylureas, α-glucosidase inhibitors, metformin, thiazolidinediones, meglitinides and dipeptidyl peptidase-4 (DPP-4) inhibitors. We further examined prescription trends by stage of chronic kidney disease.

RESULTS

The mean age of patients increased slightly (from 76 to 78 years) over the study period and the percentage with comorbidities declined. Metformin was the predominant therapy prescribed (prescribed to a mean of 56.1% of treated patients). Glyburide (glibenclamide) and thiazolidinedione prescriptions decreased (glyburide prescriptions declined from 45.5 to 9.5%, rosiglitazone from 3.6 to 0.2% and pioglitazone from 1.9 to 1.7%), while gliclazide and DPP-4 inhibitor prescriptions increased (gliclazide prescriptions increased from 0.6 to 26.4%, sitagliptin from 0 to 15.3% and saxagliptin from 0 to 2.0%). Up to 48.6% of patients with stage 3a-5 chronic kidney disease or receiving chronic dialysis were prescribed glyburide, and up to 27.6% of patients with stage 4-5 disease or receiving chronic dialysis were prescribed metformin.

CONCLUSIONS

In patients with chronic kidney disease, there were trends towards safer antihyperglycaemic medication prescribing. A considerable number of patients, however, continue to receive medications that should be avoided.

Neutral heel lateral push test: The first clinical examination of spring ligament integrity

INTRODUCTION

The spring (calcaneonavicular) ligament is an intricate multiligament complex whose primary role is to stabilise the medial longitudinal arch and head of talus. Clinical suspicion of a spring ligament injury in isolation is roused when persistent medial midfoot pain is present with associated pes planus following trauma.

METHOD

We undertook a cadaveric study on 21 specimens to assess the use of a neutral heel lateral push test to examine the spring ligament in a standardised procedure, measuring lateral translation with graduated antegrade and retrograde defunctioning of surrounding structures and the spring ligament.

RESULTS

In all specimens, a significant displacement occurred on incision of the spring ligament regardless of order of dissection. The degree of displacement increased by an insignificant amount as surrounding structures were incised at each incremental force applied.

DISCUSSION

The neutral heel push test is the first clinical examination to be described to determine integrity of the spring ligament complex. Our study objectively demonstrates that lateral displacement in relation to the mid and hind-foot is influenced most significantly by the integrity of the spring ligament and to a lesser extent by tibialis posterior and flexor digitorum longus.

Multiplex PCR in determination of Opiinae parasitoids of fruit flies, Bactrocera sp., infesting star fruit and guava

Malaysia is a tropical country that produces commercial fruits, including star fruits, Averrhoa carambola L. (Oxalidales: Oxalidaceae), and guavas, Psidium guajava L. (Myrtales: Myrtaceae). There is a high demand for these fruits, and they are planted for both local consumption and export purposes. Unfortunately, there has been a gradual reduction of these fruits, which has been shown to be related to fruit fly infestation, especially from the Bactrocera species. Most parasitic wasps (Hymenoptera: Braconidae: Opiinae) are known as parasitoids of fruit fly larvae. In this study, star fruits and guavas infested by fruit fry larvae were collected from the Malaysian Agricultural Research and Development Institute. The parasitized larvae were reared under laboratory conditions until the emergence of adult parasitoids. Multiplex PCR was performed to determine the braconid species using two mitochondrial DNA markers, namely cytochrome oxidase subunit I and cytochrome b. Two benefits of using multiplex PCR are the targeted bands can be amplified simultaneously using the same reaction and the identification process of the braconid species can be done accurately and rapidly. The species of fruit flies were confirmed using the COI marker. The results obtained from our study show that Diachasmimorpha longicaudata (Ashmead) (Hymenoptera: Braconidae), Fopius arisanus (Sonan), and Pysttalia incisi (Silvestri) were parasitoids associated with Bactrocera carambolae (Drew and Hancock) (Diptera: Tephritidae) infested star fruits. Fopius arisanus was also the parasitoid associated with Bactrocera papayae (Drew and Hancock) infested guavas. Maximum parsimony was been constructed in Opiinae species to compare tree resolution between these two genes in differentiating among closely related species. The confirmation of the relationship between braconids and fruit fly species is very important, recognized as preliminary data, and highly necessary in biological control programs.

Kidney disease in Bahrain: a biopsy-based epidemiological study

The aim of this study was to establish the incidence of renal diseases in Bahrain during January 2003 through October 2006, based on biopsy results. This study continued a previous biopsy-based survey covering 13 years from January 1990 through December 2002. Comparisons were made with the previous study to ascertain whether the disease pattern continued in the same trend. The current study included 145 biopsies on 130 patients, of whom glomerular diseases constituted 64.8%; transplant biopsies, 23.4%; chronic glomerulosclerosis, 8.9%; and other etiologies, 4.1%. There were comparable numbers of primary and secondary glomerular diseases in the present series. The incidence of renal biopsies per 100,000 population per year did not significantly change over the last 15 years: 5.4/100,000 per year in the present series versus 5.8/100,000 per year in the previous study. The pattern of primary glomerular diseases showed the minimal change disease--focal segmental glomerulosclerosis (MCD-FSGS) complex--remained the most common of all primary glomerular diseases, although decreased in absolute numbers compared with the previous study. A significant increase in the number of patients with immunoglobulin A nephropathy was observed over the years. Secondary glomerular diseases showed an increased incidence with lupus nephritis the number one diagnosis. Also we observed a steady increase in the number of allograft biopsies.

Internal fixation for osteomyelitis of cervical spine: the issue of persistence of culture positive infection around the implants

BACKGROUND

We describe the management of osteomyelitis of the cervical spine, utilizing internal fixation with subsequent removal and culture of the implants. Four out of five patients had evidence of bacterial colonisation in close proximity to the internal fixation device.

METHODS

Five consecutive patients (all female, ranging in age from 50 to 74 yrs) presenting with unstable cervical osteomyelitis were treated by surgical decompression, primary internal fixation followed by three months of intravenous antibiotics. The internal fixation was removed in 4 out of 5 cases within a year of stopping the intravenous regime. The remaining patient was deemed medically unfit for further operation. Multiple specimens from the screw sites were taken at the time of metal removal. A final course of oral antibiotics was prescribed based on the results of these specimens.

FINDINGS

Four patients, who had removal of the implants, had positive cultures growing different bacteria from the primary infection, at the time of removal of the implant. None of the patients developed instability after removal of the implant.

INTERPRETATION

Asymptomatic bacterial colonisation of a metallic implant has profound management implications. We recommend long-term oral antibiotic regimes after insertion of internal fixation devices in the face of infection and eventual removal of these implants and microbiological re-sampling.

Olfactory neuroblastoma metastatic to the breast

Olfactory neuroblastoma (Esthesioneuroblastoma) is a rare malignant tumour arising from olfactory epithelium. It has a predilection for cervical lymph node metastasis and also has potential for distant metastasis to unusual sites like scalp, face, aorta, spleen, liver, adrenal gland and ovary. We report here a rare case of olfactory neuroblastoma in an adolescent girl with metastatic deposits in the breast. A poor prognosis due to rapidly progressive disseminated disease was observed. The relevant literature regarding metastatic olfactory neuroblastoma and metastasis in the breast from non-mammary malignant neoplasms is reviewed.

Mature teratoma of the nasal vestibule: a case report

Teratomas are rare congenital neoplasms that arise from pluripotent cells. They consist of tissue from all three embryonic germ layers. According to most studies, teratomas of the head and neck account for only 2 to 9% of all cases. In this article, we report the first case of a teratoma of the nasal vestibule in a newborn. We also discuss methods of diagnosis and treatment of upper airway teratomas, and we include a brief review of the literature.

Human ocular dirofilariasis in Kerala Southern India

A twenty-six year old female presented to the Ophthalmology OPD with swelling of the upper eyelid. On excision, two long, thin, dead worms were removed. Microscopic and HPE showed the worms to belong to the Dirofilaria species.

Cytodiagnosis of primary neuritic leprosy

The diagnosis of primary neuritic leprosy (PNL) and its differentiation from other causes of peripheral neuropathy is difficult since acid-fast bacilli (AFB) smears and skin biopsy are negative from anesthetic areas. A biopsy of the involved nerve is the only conclusive method of diagnosis. Such a biopsy may not necessarily be free of complications when a large nerve is involved. However, fine needle aspiration has in this study proved to be a simple technique to demonstrate inflammation granulomas and AFB from these involved nerves in 18 of the 27 cases suspected to have PNL. The validity of the cytological classification into morphological subtypes may have to be supplemented by a large series of studies.

Hepatitis C infection and B-cell non-Hodgkin's lymphoma in British Columbia: a cross-sectional analysis

OBJECTIVES

To determine the prevalence of hepatitis C virus (HCV) infection in patients with B-cell non-Hodgkin's lymphoma (NHL) in British Columbia.

DESIGN

A cross-sectional analysis.

SETTING

The British Columbia Cancer Agency (BCCA), a Canadian provincial tertiary oncology referral center.

SUBJECTS

Consecutive patients with B-cell NHL registered onto the BCCA lymphoma database in 1996 and part of 1997 and a control group of patients with T-cell NHL registered on the database from 1995 through 1997. Patients with HIV infection were excluded from the analysis. A second control group (n = 1085) consisted of health-care workers tested for HCV infection following a needle-stick injury.

INTERVENTIONS

Stored sera from patients with B-cell NHL (n = 88) and T-cell NHL (n = 37), identified from the database, were tested for the presence of HCV infection with commercially available serologic tests.

MAIN OUTCOME MEASURES

HCV seropositivity in the B-cell lymphoma group compared to the control groups (T-cell NHL and health-care workers).

RESULTS

2.3% of the B-cell NHL group, none of the T-cell NHL group and 1% of the health-care worker control group were positive for HCV infection. These results were not statistically significantly different.

CONCLUSION

Patients in British Columbia with B-cell NHL do not have an increased prevalence of HCV infection. These data suggest that the lymphotrophism of HCV may differ by regional, racial and genotypic variations around the world.

Diagnostic value of qualitative and quantitative variables in thyroid lesions

Two hundred and thirty-three thyroid lesions were studied by fine needle aspiration (FNA) cytology using standard cytologic criteria available in the literature. These included 114 cases of nodular colloid goitre (NCG), 47 cases of Hashimoto's thyroiditis (HT), 12 follicular adenomas (FAd), five cases of subacute thyroiditis and three cases of thyrotoxicosis among the benign lesions. The malignant lesions seen were 30 cases of papillary carcinoma (PCa), 16 follicular carcinomas (FCa), three cases with double lesions, e.g. papillary carcinoma with coexisting NCG, and three of papillary carcinoma with HT. Emphasis was given to eight qualitative and quantitative (morphometric) variables in these various thyroid lesions. Cell measurements were done using a Visopan Lux projection microscope. The three qualitative variables included type of nuclear membrane (regular/irregular), type of nuclear chromatin and the presence or absence of conspicuous nucleoli. The quantitative variables studied were nuclear diameter, nuclear area, cytoplasmic diameter, cytoplasmic area & N/C ratio. Statistical analysis was performed in order to know whether the standard cytologic criteria used at FNA cytology in the literature (increased cellularity, microfollicles, increased N/C ratio, absence of significant haemosiderin-laden macrophages and scanty colloid) could differentiate a follicular adenoma from a follicular carcinoma. A statistical analysis was also performed to establish the utility of the qualitative and quantitative variables. The results showed that none of the standard cytologic criteria applied could differentiate follicular adenoma from a follicular carcinoma. With regard to qualitative variables, irregularity of nuclear membrane and presence of conspicuous nucleoli were most significant in papillary carcinoma, followed by follicular carcinoma, then by follicular adenoma; these features being hardly evident in nodular colloid goitre and Hashimoto's thyroiditis. A coarse nuclear chromatin was most significant in follicular carcinomas followed by follicular adenomas. It was less obvious in the benign conditions, but more prominent in Hashimoto's thyroiditis compared with a goitre. It was also not obvious in a papillary carcinoma. Of the quantitative variables, all measurements were greatest in PCa > FCa > FAd > NCG = HT. When differentiating follicular adenoma from follicular carcinoma the qualitative variables of significance were the presence or absence of nucleoli, the chromatin pattern and regularity/irregularity of nuclear membrane; the nuclear area was the most important feature among quantitative variables.

Cytodiagnosis of Kimura's disease

Kimura's Disease, a rare chronic inflammatory disorder with a benign course affecting the lymphoid tissue is reported hare in an 18 year old South Indian male who presented with bilateral solitary swelling over the mastoid region. Its fine needle aspiration cytology characterised by the Warthin-Finkeldey type giant cells against a background of a bimodal population of lymphocytes and eosinophils prompted the diagnosis of Kimura's disease at cytology itself. This was confirmed at histology. This is the third cytological report of its kind being reported in English literature. Literature with regard to the cytological appearances of Kimura's disease has been reviewed and the various differential diagnoses discussed.

Aspiration cytology of echinococcus oligarthrus. A case report

BACKGROUND

Fine needle aspiration cytology is a useful technique in the diagnosis of several parasitic infections. The present case highlights the aspiration cytology findings in a case of Echinococcus oligarthrus infection, a rare variant of the Echinococcus species affecting humans. To the best of our knowledge, this is the first case report on the cytology of E oligarthrus in English.

CASE

A submandibular swelling developed in a 14-year-old male. A mistaken diagnosis of Cysticercus cellulosae was made on the first aspirate and of a hydatid cyst (Echinococcus granulosus) on the second aspirate. A diagnosis of E oligarthrus was made on subsequent histopathologic examination of the excised lesion.

CONCLUSION

This seems to be the first case report in English of the cytomorphology of E oligarthrus on fine needle aspiration cytology with histopathologic confirmation.

AgNORs and their relationship to cell size, histological grade, lymph node involvement, metastases, and survival pattern in carcinoma of the breast: a study from south India

An AgNOR count using the Smith and Crocker [Histopathology 12:113-125, 1988] method of staining was performed on 200 cases of carcinoma of the breast. A count of coarse AgNORs per nucleus was made on 50 random cells and the mean of their number per nucleus calculated. The relationship of a single variable "AgNOR count" to other variables such as cell size, histological grade, number of positive ipsilateral axillary lymph nodes, and presence of metastasis in regions other than the ipsilateral axillary lymph nodes was found using a univariate method of analysis. Also, the effect of different independent variables, e.g., number of AgNORs, cell size, histological grade, number of positive axillary lymph nodes, and metastasis on a single variable, i.e., 4-year period of survival, was also assessed by a univariate method of statistical analysis. It was found that the AgNOR count was significantly related to the cell size, histological grade, and presence of metastasis. Large cells, grade III tumors, and neoplasms with evidence of metastasis showed larger numbers of AgNORs in their nuclei. It was observed that the number of AgNORs significantly affected the 4-year survival of patients. The higher the AgNOR counts, the poorer were the chances of surviving for 4 years. The other factors that influenced survival in the present study were the number of positive axillary lymph nodes and metastasis to sites other than axillary lymph nodes.

Laryngeal carcinoma ex-papilloma in a non-irradiated, non-smoking patient: a clinical record and review of the literature

Malignant transformation of respiratory papillomata is not uncommon in the presence of precipitating factors such as tobacco smoking and therapeutic irradiation. Respiratory papilloma changing to carcinoma in the absence of smoking and irradiation is seldom seen, with only about 20 documented cases presented in the literature. Here we report one such case in a 30-year-old male patient.

Evidence for a lactate-anion exchanger in the rat jejunal basolateral membrane

BACKGROUND/AIMS

The mechanism by which lactate, absorbed from the intestinal lumen or generated within the epithelium, crosses the basolateral membrane of the enterocyte and enters the bloodstream has not previously been characterized in detail.

METHODS

L-lactate uptake into and efflux from isolated jejunal basolateral membrane vesicles was investigated at room temperature using rapid filtration techniques.

RESULTS

Furosemide sensitive uptake of L-lactate was unaffected by cis sodium or proton gradients but could be stimulated by a trans gradient of bicarbonate and chloride. Kinetic analysis showed uptake to consist of a saturable component with a Michaelis constant (Km) of 3.2 mmol/L and a maximum velocity (Vmax) of 67 pmol.mg protein-1 x s-1 and a nonsaturable alpha-4-hydroxy-cinnamic acid insensitive component. Pyruvate, butyrate, acetate, valerate, and propionate competitively inhibited lactate uptake into the vesicles. Efflux of lactate from preloaded vesicles was furosemide sensitive and accelerated by a trans bicarbonate gradient as well as by 10 mmol/L acetate, butyrate, and pyruvate.

CONCLUSIONS

It is concluded that there is a short chain-fatty acid carrier system in the intestinal basolateral membrane, which operates as an anion exchanger.

Primary carcinoma of the ureter--a 24-year-study from south India

This study from India has envisaged a characterization of primary carcinomas of the ureter using a review of all available Indian literature over a period of 32 years. The character of the tumor in the Indian patients was clinically; pain, abdominal lump and haematuria with most neoplasms being single, situated in the ureteric pelvis and such neoplasms being squamous cell in type. The others were transitional cell carcinomas. Similar ureteric neoplasms reported from Western literature showed that the reporting authors gave the predominant complaint as haematuria alone, the neoplasm being usually multicentric and histologically mainly transitional cell carcinoma. Although a significant follow up could not be achieved among the 101 Indian patients, Western authors found that muscle invasion was the single most important histologically related point to endanger a good progress. The possible pathogenesis that could be thought of appears to be related to stasis.

An experience with ultrasonically guided liver aspirates from south India

Fine needle aspiration (FNA) was performed on 102 hepatic lesions under ultrasound control. Eighty-eight lesions were solid and 14 were cystic. Ninety aspirates provided adequate material for cytodiagnosis. Aspirates from the solid lesions were assessed for the presence or absence of 20 cytological features. It was found that on a univariate statistical analysis, 11 of the features were significantly associated with hepatocellular carcinomas. Five of these 11 were considered diagnostic of the lesion on a step-wise multiple linear regression analysis. Two other features (not included among the 11) were found to be significantly associated with metastatic neoplasms. Cystic lesions were diagnosed as being either abscesses, hydatid cysts or congenital cysts. The physical appearance of the cyst fluid proved to be of diagnostic value in many cases.

Ultrasonically guided fine needle aspiration of the parathyroid. A report of two cases

Two cases of parathyroid adenoma were diagnosed with ultrasound-guided fine needle aspiration. Both patients were clinically suspected of having features of primary hyperparathyroidism. On aspiration, one had an associated cystic change with golden brown fluid and the other a markedly cellular aspirate. The cells aspirated were differentiated from thyroid epithelial cells.

A study from south India on the association between the papilloma virus and carcinoma of the penis

Specimens from 39 cases of squamous cell carcinoma of the penis were treated for the papilloma virus using the bovine papilloma virus antibody and the peroxidase-antiperoxidase technique. All 39 cases showed a viral antigen situated intranuclearly, intracytoplasmically or both intranuclearly and intracytoplasmically. No correlation could be seen between the presence of viral antigen and age of patient, duration of lesion, cell morphology and histological grade. The adjacent mucosa and skin were used as controls and showed no viral antigen. The inflammatory infiltrate was dense and predominantly "T" lymphocyte in type.

Primary pleural mesotheliomas in south India: a 25-year study

In this report from South India, 15 patients with primary pleural mesothelioma have been diagnosed in the 25-year period 1, April 1966 through 31, March 1991, representing 0.02% of 76,239 biopsies received. The patients were mainly male with a mean age of 46.5 years. All except two had lived in urban Bangalore. None had been exposed to asbestos. The presentation clinically was peculiar, being continuous pricking pain, breathlessness, and cough with sputum. Physical and roentgenogram examination showed massive pleural effusion with irregular pleural thickening. Thoracotomy findings showed a distinct sessile nodularity with many slit-like spaces. Histologically, 14 were epithelial type mesotheliomas and 1 was a sarcomatous type. While the epithelial type neoplasms showed patchy squamoid differentiation, all showed mucin production. The CEA was always observed in areas of moderate differentiation. Spread occurred centrifugally to local structures on the same side as the lesion.

Cutaneous eruptions in Indian tick typhus

Although frequently unrecognized, rickettsial infections may be an important cause for fever and exanthem in persons presenting to physicians in South India. Most often these patients are referred to dermatology departments with a diagnosis of "drug eruption." In the current study the authors analyzed 12 cases of rickettsial fever that were seen in the dermatology department of St. John's Medical College Hospital, Bangalore, between 1985 and 1989. The distinctive cutaneous eruption was found to be an important clue to an early clinical diagnosis. Specific serodiagnosis enabled us to confirm that Indian tick typhus, a member of the spotted fever group, was the most frequent cause for rickettsial fever presenting at our hospital.

Fine needle aspiration cytodiagnosis of clinically suspected tuberculosis in tissue enlargements

A retrospective study of the use of fine needle aspiration (FNA) cytology to confirm a clinical suspicion of tuberculosis in tissue enlargements was performed, using 70 cases. The criteria required to make an FNA cytodiagnosis of tuberculosis were reassessed, and the sensitivity and predictive value of cytology for diagnosing such aspirates was determined. All but 2 of the 70 aspirates contained adequate cellularity. The adequate samples were diagnosed as 40 cases of caseating tuberculosis, 11 cases of noncaseating tuberculosis and 17 cases of acute necrotizing granulomatous inflammation suspicious for tuberculosis. Subsequent histologic study verified the cytologic diagnosis in 27 of 27 biopsied caseating lesions, 4 of 7 biopsied noncaseating cases and 5 of 8 necrotizing cases. The six cases with a false-positive cytodiagnosis of tuberculosis were histologically diagnosed as one Lennert's lymphoma, two reactive lymph nodes and three necrotizing metastatic carcinomas. The sensitivity of FNA cytology for the diagnosis of tuberculosis was 100%, with the predictive value of a positive result being 88%. The findings in this study emphasize that all criteria for the diagnosis of tuberculosis in FNA samples must be utilized and that particular caution should be exercised in making a diagnosis of acute necrotizing tuberculosis.

Mixed mesodermal tumours of the ureter

This report is of a 78 year-old male with a mixed mesodermal tumour of the left ureter. A comparison of all reported patients with such neoplasms has been made in the discussion, in an attempt at characterization of this neoplasm.

Herpetic cervicitis--a histo-morphologic study

The purpose of this paper has been to find out the prevalence of herpetic cervicitis among routine surgical cervical biopsies, categorize the morphological changes and study their evolution. In a 51-month-period, 879 human uterine cervices were examined histologically, 19 percent (168) conforming to predetermined criteria for herpetic cervicitis. These criteria were typed as A through D starting with nuclear homogenization and passing through vesicle formation, bulla formation and finally ulceration. The type D lesion showed an agglomeration of Type A-C morphological changes occurring together, in addition to which focal submucosal haemorrhages were seen with severe congestion. The presence of the Herpes virus was confirmed with the Peroxidase-Antiperoxidase stain and the evolution of the bullae studied by means of the Alcian Blue-Periodic Acid Schiff stain (AB-PAS), Methyl Green-Pyronine (MG-P) stain and the Reticulum stain.

Primary pulmonary rhabdomyosarcoma in a child, with a review of literature

A cyst in the left lower lobe of the lung was removed from a 15-month-old girl and showed evidence suggesting a preexistent congenital cystic adenomatoid malformation; in addition a rhabdomyosarcoma was identified. Primitive mesenchyme and mesenchymal elements also were seen. The origin of the rhabdomyosarcoma is discussed. The findings in the present case are compared with those of all childhood pulmonary rhabdomyosarcomas reported in the literature. This report of a child with a coexistent congenital adenomatoid malformation and a rhabdomyosarcoma is the third of its kind in the literature.