An examination of the effects of distress intolerance and rating of perceived exertion on changes in mood and anxiety following aerobic exercise among treatment-seeking smokers

Aerobic exercise is frequently used as an intervention for depression and smoking cessation because of its antidepressant and anxiolytic effects. Distress intolerance (DI) is a proposed individual difference factor that, coupled with a higher rating of perceived exertion during exercise, may significantly impact the acute mood and anxiolytic effects of exercise. The current study examined the interactive effect of maximum rating of perceived exertion (RPE) and DI on change in mood and anxiety. Treatment-seeking smokers (Mage = 45.32; 72% female) with elevated depressive symptoms completed a 1-mile treadmill walk at their preferred intensity and self-reported their RPE during the test. Analyses were conducted to examine whether there was an interactive effect of maximum RPE and DI on change in self-reported mood and anxiety from before to after the walk test. Findings indicate a significant moderating effect of RPE at lower ratings. Individuals reporting a low maximum RPE and higher DI exhibit a greater change in mood over the course of an exercise session, whereas individuals reporting a low maximum RPE and a lower DI exhibit smaller changes in mood. These results indicate that the subjective effects of exercise within a population of cigarette smokers could be improved by tailoring exercise intensity to individual characteristics. Mild to moderate-intensity exercise, as compared to high-intensity exercise, may result in greater changes in mood for individuals endorsing difficulty tolerating affective and physical distress.

Trial-level bias score versus mean bias score: Comparison of the reliability and external validity using dot-probe task among daily smokers

INTRODUCTION

Attentional bias (AB) is an individual difference risk factor that represents the extent to which cigarette cues capture one's attention. AB is typically indexed by mean bias score (MBS), theoretically assuming that AB is static. However, poor reliability of MBS has threatened valid interpretation of the results on AB. Based on observed trial-by-trial temporal fluctuation and variability of attentional allocation, trial-level bias score (TLBS) has been introduced as an alternative index with evidence of better psychometric properties in various populations, as compared to MBS. However, such evidence is limited among daily smokers. The current study aimed to replicate and extend extant findings in a sample of daily smokers by hypothesizing that TLBS, as compared to MBS, would demonstrate superior reliability and external validity.

METHODS

Forty-eight daily smokers completed self-reports, ad-libitum smoking, and a dot-probe task three times, which was comprised of 36 pairs of pictorial stimuli of cigarette and neutral cues, yielding 144 total trials.

RESULTS

The TLBS demonstrated superior internal (range intra class correlation [ICC] = 0.79-0.95) and test-retest reliability (range ICC = 0.64-0.88) compared to MBS (range ICC = 0.31-0.40 and 0.06-0.16, respectively). However, few significant relations between either the MBS or TLBS and measures of biobehavioral and self-report indices of smoking reinforcement were observed.

CONCLUSIONS

The current findings demonstrate that TLBS, as compared to MBS, is a more reliable measure of AB among daily smokers, while evidence of its external validity is limited.

Examining the Role of Emotion Regulation in the Bidirectional Relation between Physiological and Subjective Stress Response among Daily Cigarette Smokers

Cigarette smoking is associated with autonomic dysregulation and altered stress responsivity. There exists a reciprocal relation between subjective and physiological stress reactivity and recovery in smokers. Emotion regulation may impact the extent to which these domains influence each other. The current study examined the moderating role of lack of emotional awareness, lack of emotional clarity, and nonacceptance of emotions, in the relation between heart rate reactivity to, and subjective recovery from, stress, and vice versa. To determine specificity of cross-domain findings, these relations were also examined within domain. Fifty-six daily smokers (46.4% female; M _age = 29.33, SD = 11.92) participated in a biological challenge. Heart rate and subjective distress were assessed continuously before, during, and after the challenge. Individual growth curve models revealed that deficits in emotional clarity significantly moderated the effect of heart rate reactivity on subjective recovery. Lack of emotional awareness also moderated the association between subjective reactivity and heart rate recovery. Emotion regulation processes did not affect relations within the same domain, but altered the relation across domains.

Distress intolerance and withdrawal severity among daily smokers: The role of smoking abstinence expectancies

BACKGROUND

Distress intolerance (DI), the perceived inability to withstand distress, is implicated in cigarette smoking maintenance. Greater DI may contribute to anticipation of negative outcomes from smoking abstinence, which in turn could contribute to withdrawal symptom severity. The current study aimed to evaluate (1) the association between DI and acute abstinence expectancies and (2) the potential mediating role of abstinence expectancies in the relationship between DI and withdrawal symptom severity.

METHOD

Participants (n = 444) were daily smokers who reported at least one prior quit attempt, participating in a larger online study on distress and smoking. DI, subjective nicotine withdrawal, and smoking abstinence expectancies were assessed using the Distress Tolerance Scale (DTS), Minnesota Nicotine Withdrawal Scale (MNWS), and Smoking Abstinence Expectancies Questionnaire (SAEQ).

RESULTS

DTS was significantly negatively associated with SAEQ, specifically Negative Mood (r = -0.37, p < .001), Somatic Symptoms (r = -0.47, p < .001), and Harmful Consequences (r = -0.59, p < .001) subscales, but was not associated with Positive Expectancies subscale (r = 0.05, p = .31). Results indicated a significant effect of DTS on withdrawal symptom severity via SAEQ. Follow-up analyses indicated that the indirect effects were driven specifically by SAEQ Negative Mood and Harmful Consequences subscales.

DISCUSSION

DI is related to more negative abstinence expectancies, particularly affective aspects of abstinence, which may contribute to the severity of nicotine withdrawal symptoms. This study provides initial evidence of a specific cognitive process that may explain why DI contributes to heightened subjective experience of nicotine withdrawal symptoms.

Negative urgency and ad-libitum smoking topography

BACKGROUND

Negative urgency (NU), the tendency to act rashly in response to distress, is associated with negative reinforcement smoking expectancies. The study examined whether NU was associated with behavioral smoking reinforcement in the context of self-reported distress.

METHOD

Non-treatment seeking daily smokers (n = 124) completed an ad-libitum smoking trial. Puff topography, including puff volume, duration, velocity, and inter-puff interval, was averaged across the cigarette and evaluated at the puff level.

RESULTS

Multilevel models revealed a significant interaction of NU and distress as reported on the Subjective Units of Distress scale over the course of smoking in relation to puff duration and inter-puff interval. There was a significant effect of quadratic time x NU x distress on duration (b=-0.00004, p = 0.04). Smokers lower in NU reporting lower baseline distress evidenced a puff duration that decreased at a faster rate over the course of a cigarette following a quadratic function. Persistently elevated puff durations over the course of a cigarette were observed among smokers with elevated NU, regardless of basal distress. There was also a linear time x NU x distress interaction on inter-puff interval (b=-0.01, p = 0.04). Lower NU smokers, regardless of acute distress, exhibited increasing inter-puff intervals that stabilized over the course of a cigarette. Smokers with elevated NU in the context of low distress also demonstrated linearly increasing inter-puff intervals, while they demonstrated increasing intervals followed by decreasing intervals in the context of higher distress.

DISCUSSION

Trait NU in the context of acute distress may contribute to differences in puff topography.

Positive alcohol use expectancies moderate the association between anxiety sensitivity and alcohol use across adolescence

Anxiety sensitivity (AS), or the fear of anxious symptoms and the belief that these symptoms may have negative physical, social, and cognitive consequences, is one personality trait that emerges in early adolescence and may be linked to alcohol use. However, findings are equivocal as to whether elevated AS during adolescence directly predicts alcohol use. Adolescents do report increases in positive alcohol use expectancies during this developmental period, and these expectancies have been found to be significantly associated with alcohol use. The current study examined whether positive alcohol use expectancies and AS in early adolescence predicted changes in alcohol use throughout adolescence. This aim was examined via secondary data analyses from a longitudinal study examining the development of risk behaviors in adolescents. Results of univariate latent growth curve modeling suggest that AS alone was not a significant predictor of baseline alcohol use or change in use over time after controlling for gender, age, and self-reported anxiety. However, AS in early adolescence was found to be a significant predictor of increases in alcohol use across adolescence for youth who reported greater positive alcohol use expectancies. These results indicate that beliefs regarding the positive effects of alcohol use are an important moderator in the relation between AS and change in alcohol use during adolescence.

Primary Melanoma of the Ovary in a 25 Year Old Primigravida - A Case Report

A 25 year old primigravida with edema of the left foot and fetal distress during 36 weeks gestational period underwent an emergency lower segment cesarian section (LSCS). During surgery ascites and a left ovarian tumor with omental seedlings were observed. Cytopathology of the ascitic fluid, histopathology of the ovarian tumor and the omental seedlings showed features of a malignant melanoma, further confirmed at electron microscopy. Considering the age of the patient and the intra-abdominal restriction of metastasis of the neoplasms this tumor appeared to be a primary melanoma of the ovary. This case is reported since there is no reference to a pure melanoma of the ovary occurring in a young primigravida in the literature.

Negative affect mediates the relation between trait urgency and behavioral distress tolerance

Distress tolerance is associated with a range of psychopathology and risk-taking behavior. Current research suggests that the behavioral ability to persist at goal-directed behavior when distressed may be malleable. However, little is known about the contributing factors that underlie individual differences in distress tolerance. Trait urgency, or the tendency to act impulsively in the context of acute changes in affect, may predict distress tolerance because the prepotent response to avoid or remove an aversive state may undermine persistence. To date, most research has examined the role of negative urgency, a valenced subfactor of urgency, in relation to distress tolerance. However, the broad trait of urgency may be associated with a greater change in affect that precedes the inability to tolerate distress. The current study examined whether greater changes in negative affect was indeed a mediator in the relationship between trait urgency and behavioral distress tolerance. The effects of both positive and negative urgency on affect change were examined to investigate the potential contribution of the broader urgency trait. The results suggest that a greater change in negative affect over the course of a stressor mediated the association between both subfactors of urgency and distress tolerance. These findings suggest that trait urgency, regardless of valence, may be associated with experiencing greater changes in affect that ultimately undermine the ability to tolerate distress. These findings also highlight important components of distress tolerance that could inform behavioral interventions. (PsycINFO Database Record

Risk-Taking Propensity in Older Adolescents: Internalizing Symptoms, Gender, and Negative Reinforcement

OBJECTIVE

Engagement in risk behaviors, including substance use, risky sex, and violence, tends to increase throughout adolescence into young adulthood. One motivational process that may underlie risk behaviors during adolescence is negative reinforcement. Moreover, gender and internalizing symptoms (e.g., depression and anxiety) may both convey risk for negative reinforcement-based risk taking. Along these lines, the aims of the current study were to (a) examine gender differences in negative reinforcement-based risk-taking propensity and (b) examine internalizing symptoms as a moderator of the relationship between gender and negative reinforcement-based risk-taking propensity.

METHOD

Participants included 103 youth between the ages of 18 and 21 (50.49% female, age M(SD) = 19.41(1.06)) who were recruited from a large Mid-Atlantic university between September 2013 and November 2014. Participants completed self-report assessments of internalizing symptomatology and a computerized behavioral analog assessment of negative reinforcement-based risk-taking propensity.

RESULTS

Results indicated that, overall, female older adolescents were riskier under conditions of negative reinforcement than male older adolescents. In addition, internalizing symptoms significantly moderated the relationship between gender and negative reinforcement-based risk-taking propensity such that the relationship between gender and negative reinforcement-based risk-taking propensity was nonsignificant at high levels of internalizing symptoms, and female gender was significantly positively predictive of heightened negative reinforcement-based risk-taking propensity at low levels of internalizing symptoms.

CONCLUSIONS

Thus, although female youth overall were riskier, the predictive utility of gender for negative reinforcement-based risk taking may be most relevant at low levels of internalizing symptoms. Results are discussed in terms of implications for future prevention and intervention.

Delay discounting in opioid use disorder: Differences between heroin and prescription opioid users

BACKGROUND

Among those with opioid use disorder, heroin use is associated with poorer prognosis relative to use of prescription opioids alone. However, relatively little is known about distinguishing features between those who use heroin relative to those who use prescription opioids. In the present study we evaluated differences in delay discounting in those with opioid use disorder based on primary opioid of use. Delay discounting is associated with a range of negative outcomes and is an important therapeutic target in this population.

METHODS

Treatment-seeking adults with opioid dependence completed self-report measures including past-month opioid use and the Monetary Choice Questionnaire (Kirby and Marakovic, 1996; Kirby et al., 1999), a measure of delay discounting. Participants were divided into two groups based on whether they used any heroin in the past 30days or only prescription opioids, and delay discounting scores were compared between the groups. Group differences in sociodemographic or clinical variables were included in the analysis as covariates.

RESULTS

Results from a forward stepwise linear regression indicated that heroin use was associated with significantly higher delay discounting (B=-0.99, SE_B=0.34, t=-2.88, p=0.005), even when considering covariates.

CONCLUSIONS

Adults with opioid dependence who exclusively used prescription opioids had lower delay discounting relative to those who used heroin. This finding contributes further to the literature suggesting that heroin use is associated with greater clinical severity among those with opioid use disorder.

An alternative approach to calculating Area-Under-the-Curve (AUC) in delay discounting research

Applied to delay discounting data, Area-Under-the-Curve (AUC) provides an atheoretical index of the rate of delay discounting. The conventional method of calculating AUC, by summing the areas of the trapezoids formed by successive delay-indifference point pairings, does not account for the fact that most delay discounting tasks scale delay pseudoexponentially, that is, time intervals between delays typically get larger as delays get longer. This results in a disproportionate contribution of indifference points at long delays to the total AUC, with minimal contribution from indifference points at short delays. We propose two modifications that correct for this imbalance via a base-10 logarithmic transformation and an ordinal scaling transformation of delays. These newly proposed indices of discounting, AUClog d and AUCor d, address the limitation of AUC while preserving a primary strength (remaining atheoretical). Re-examination of previously published data provides empirical support for both AUClog d and AUCor d . Thus, we believe theoretical and empirical arguments favor these methods as the preferred atheoretical indices of delay discounting.

An investigation of negative affect, reactivity, and distress tolerance as predictors of disordered eating attitudes across adolescence

The current study examined internalizing symptoms, affect reactivity, and distress intolerance as prospective predictors of increases in eating disorder (ED)-attitudes during adolescence. Adolescents (n = 206) took part in a six-year longitudinal study examining the development of psychopathology. Latent growth curve analysis was used to examine associations between predictors and later ED-attitudes. Distress intolerance and internalizing symptoms were associated with ED-attitudes at baseline, but did not predict increases over time. Affect reactivity, however, was significantly associated with increases in ED-attitudes over time. Baseline affect reactivity did not interact with baseline distress intolerance to predict increases in ED-attitudes; however higher baseline internalizing symptoms interacted with distress intolerance to predict increases in ED-attitudes across adolescence. These results are among the first to document that affect reactivity alone and the combined effect of high internalizing symptoms and high distress intolerance early in adolescence are risk factors for the later development of ED-attitudes.

Papillary thyroid carcinoma with exuberant nodular fasciitis-like stroma: treatment outcome and prognosis

Papillary thyroid carcinoma with nodular fasciitis-like stroma (PTC-NFS) is one of the extremely rare variants of papillary thyroid carcinoma. To date, the majority of reported cases have been published in the surgical pathology and cytopathology literature, addressing the diagnostic difficulties posed by the condition's extensive, reactive stromal proliferation. Because of the rarity of PTC-NFS among papillary thyroid carcinoma variants, it has been unexplored from a clinical viewpoint. A MEDLINE search on the clinical course, role of radioiodine, treatment outcome and long term follow up of this disease yielded no result.

We report the clinicoradiologic and histopathologic profile, together with post-treatment long term follow up, in a 35-year-old woman harbouring this rare entity. To the best of our knowledge, this is the first report of a five-year follow up of this rare variant of PTC following total thyroidectomy and radioiodine treatment. Our follow-up findings reiterate the disease's favourable clinical course when managed in the same manner as a classical, differentiated papillary carcinoma of the thyroid, akin to that predicted by the pathologists, and emphasize the importance of differentiating PTC-NFS as a separate entity from the papillary carcinoma variants with aggressive histology. Given the rarity of this condition, the experience gained from the present case is a useful addition to the current knowledge on disease prognostication and management.

A systematic review of the existing literature on PTC-NFS, including the case reported in the present paper, is also carried out, aiming to explore the patient characteristics and clinical behaviour pattern of this rare entity and to make appropriate recommendations on management strategy. The age of presentation ranges from 20 to 82 years, with a mean of 44.5 years. Female preponderance was observed, with a female to male ratio of 3[ratio ]1. No racial predilection was observed. Tumour size varied from 2 to 9 cm along its greatest diameter (mean = 4.3 cm). Metastasis to lymph nodes at presentation occurred in 25 per cent of cases. Metastasis to surrounding structures (e.g. parathyroid and skeletal muscle) was observed in 12.5 per cent. There have been no reports of pulmonary or skeletal metastasis at presentation.

Genital lesions associated with visceral leishmaniasis and shedding of Leishmania sp. in the semen of naturally infected dogs

Although visceral leishmaniasis is primarily transmitted by a biological invertebrate vector, transmission in the absence of the vector has been reported, including venereal transmission in humans. Considering the possibility of venereal transmission, we studied genital lesions in dogs naturally infected with visceral leishmaniasis and shedding of Leishmania sp. in the semen. Approximately 200 dogs were serologically tested for anti-Leishmania antibodies and divided into three groups: 1) serologically negative dogs (n = 20), 2) asymptomatic serologically positive dogs (n = 20), and 3) symptomatic serologically positive dogs (n = 20). Samples from both testes, all segments of both epididymes, prostate gland, glans penis, and prepuce were histologically evaluated and processed for immunodetection of Leishmania sp. Semen samples were obtained from 22 symptomatic serologically positive dogs and processed for detecting Leishmania DNA by polymerase chain reaction. A significantly higher frequency of inflammation was observed in the epididymes, glans penis, and prepuce of dogs with visceral leishmaniasis, which was associated with a high frequency of immunohistochemically positive tissues (up to 95% of tissues from symptomatic dogs were positive by immunohistochemistry). Leishmania DNA was detected in eight of 22 semen samples from symptomatic dogs. Together these findings indicate that genital lesions and shedding of Leishmania sp. (donovani complex) in the semen are associated with visceral leishmaniasis. Additional studies should address the possibility of venereal transmission of the disease in the dog.

Squamous cell carcinoma of esophagus masquerading as solitary thyroid nodule

Secondary neoplasm of the thyroid mimicking a primary thyroid lesion is a rare finding, especially in an individual without a past history of malignancy. A case of squamous cell carcinoma metastatic to the thyroid (presenting as a solitary thyroid nodule), who had an unsuspected primary in the esophagus is described. Usually, multiple areas of the gland are involved in the secondary involvement of the thyroid. The clinical presentation of an apparently asymptomatic mass with neck lymphadenopathy, normal thyroid functions, and a cold nodule on 99mTcO4- thyroid scan can often lead to a misdiagnosis as primary thyroid neoplasm. The present case underscores the fact that due importance to the subtle signs and symptoms and a high degree of suspicion, whenever the histology is unusual for a thyroid primary, is needed and the workup should include ruling out other primary malignancies.

Chest wall metastases from unknown primary hepatocellular carcinoma

Metastases of hepatocellular carcinoma (HCC) to the bones are common but bone metastases of hepatocellular carcinoma in the presence of a normal liver are an uncommon entity. A 50-year-old male patient presented with a rapidly growing tumour on the sternum. Biopsy of the lesion showed metastatic sternal tumour from a primary hepatocellular carcinoma. Radiological evaluation however, failed to detect a primary lesion in the liver. Bone metastases of hepatocellular carcinoma localized to the chest wall in the presence of a normal liver are scarcely reported as anecdotal case reports in the literature.

Angiogenesis is redundant for tumour growth in lymph node metastases

AIMS

Angiogenesis is essential for the growth of solid tumours. As the role of angiogenesis is unclear in the pathogenesis of primary lymph node (LN) tumours, we wondered whether neoangiogenesis was important in supporting and promoting the growth of tumours in LNs.

METHODS AND RESULTS

We investigated 16 cases of squamous carcinoma involving oral cavity (n=9) and larynx/pyriform fossa (n=7), all of whom had lymph node metastases. Sections of the primary tumour, uninvolved mucosa, metastatic LN and nonmetastatic LN were double-immunostained with factor VIII-related antigen and MIB-1. Proliferating blood vessels, i.e. neoangiogenesis, was identified by coexpression of factor VIII-related antigen-stained blood vessels and MIB-1 staining of the endothelial cell nuclei. Counts were performed in an area of 4 mm2. Primary tumours (127-188.7), uninvolved mucosa (54-84.5) and metastatic LNs (123.5-167) had significantly lower vessel counts than nonmetastatic LNs (194-253.9) (P=0.003; P < 0.001; P < 0.001, respectively). With regard to neoangiogenesis, primary tumours (1.7-5) had significantly higher counts than uninvolved mucosa (0-0.4), nonmetastatic LNs (0-0.4) and metastatic LNs (0.9-2.4) (P < 0.001; P < 0.001; P=0.047, respectively).

CONCLUSIONS

Our data suggest that because of the rich native vascularity of lymph nodes, neoangiogenesis is redundant for the growth of metastatic tumour.

Intermediate histological effect markers for breast cancer

The evidence that ductal carcinoma of the breast (DCIS) is an obligate precursor of invasive breast cancer and thus qualifies as an intermediate effect marker in chemoprevention research is reviewed. Much of the evidence on the natural history of DCIS has been derived from the era before the introduction of mammographic screening. Thus it may not be applicable in the present situation when women are likely to be under mammographic surveillance in chemoprevention trials. Further, the data that are becoming available from breast screening trials suggest that at least over follow-up periods now exceeding a decade, detection and treatment of DCIS has no impact on subsequent incidence of breast cancer. Although there are some indications that other biomarkers of malignancy are expressed similarly in DCIS and invasive cancer of similar grade, this evidence may not be sufficient to allow exclusive reliance on DCIS as an intermediate-effect marker in chemoprevention research.

Primary extranodal mucosa associated lymphoid tissue (MALT) lymphoma of the prostate

Low-grade B-cell mucosa associated lymphoid tissue (MALT) lymphoma can rarely present primarily in extranodal sites other than stomach, which is the most common site for it. Until now only four cases of primary prostatic MALTomas have been described in the literature and we report the fifth. We describe a case of primary prostatic MALToma in a 67-year-old man and the diagnosis was made on the trans-urethral resection specimen of the prostate. As the disease was limited to prostate (stage IEA), the patient was treated with external beam radiation therapy to a total dose of 4400cGy in 22 fractions. The patient achieved completed remission and has remained free of disease in the following 36 months.

Hodgkin's disease involving Waldeyer's ring: a study of four cases

We report four cases of Hodgkin's disease who presented with involvement of Waldeyer's ring. Their clinical, morphological and immunohistochemical features are discussed. The patients were immuno-competent, were between 17 and 65 years of age and presented with symptoms related to swelling in the nasopharynx or oropharynx and cervical lymphadenopathy. The nasopharyngeal biopsy and the cervical lymph node in all four cases showed features of classical Hodgkin's disease. The Reed Sternberg cells expressed CD15 and CD30, and in three cases, CD20 and Epstein-Barr virus--latent membrane protein -1 (EBV-LMP-1). Extranodal involvement by Hodgkin's disease which is not in continuity with nodal disease is rare in immunocompetent patients. Morphologically, such extranodal lesions, especially in locations like the oropharynx and nasopharynx, should be differentiated from EBV-associated lymphoproliferations.

Apoptosis index is a predictor of metastatic phenotype in patients with early stage squamous carcinoma of the tongue: a hypothesis to support this paradoxical association

BACKGROUND

Patients with squamous carcinoma of the oral tongue in clinical stages TIN0M0 and T2N0M0 with a tumor thickness < or = 3 mm usually do not have lymph node (LN) metastasis. However, factors that are useful in predicting LN metastasis in thicker tumors (> 3 mm thick) need to be identified. The authors investigated the clinical relevance of the apoptotic index (AI), the proliferation index, and tumor grade in relation to LN metastasis in patients with early stage squamous carcinoma of the oral tongue.

METHODS

Twenty-three patients with squamous carcinoma of the anterior two-thirds of the tongue measuring < 2 cm in height and > 3 mm in thickness were evaluated for tumor grade, AI (by using the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling technique), and proliferation index (by proliferating cell nuclear antigen [PCNA] expression).

RESULTS

The mean AI value was significantly higher in LN positive patients compared with LN negative patients (P = 0.012). The LN positive and LN negative subgroups did not differ in the mean PCNA index, and there was no significant difference in the distributions of tumor grade between LN positive and LN negative subsets. Four of 12 tumors with an AI < or = 5% and 10 of 11 tumors with an AI > 5% had LN metastasis (P = 0.009; risk ratio, 20). The AI maintained its significance with respect to LN metastasis in the multivariate analysis (P = 0.003). The 4-year recurrence free survival was significantly better in patients with tumors that had an AI value < or = 5% compared with patients with tumors that had an AI > 5% (92% vs. 32%) (P = 0.033). However, the AI lost its impact on recurrence free survival within a Cox proportional hazards model (P = 0.068).

CONCLUSIONS

A higher AI value is a predictor of LN metastasis and may serve as a prognostic factor in patients with early stage squamous carcinoma of the oral tongue. The authors present a hypothesis to explain this rather surprising finding.

Cytokeratin expression in human fetal tongue and buccal mucosa

Expression of cytokeratins (CK), a subset of intermediate filament (IF) proteins in epithelia, is developmentally regulated. CK expression may also change after malignant transformation. Our earlier studies on CK expression in human oral tumours and pre-cancerous lesions have shown specific changes in CK expression. We analysed CK expression in human tongue and buccal mucosa (BM) in fetuses in the embryonic age group of 16 to 27 weeks using biochemical and immunohistochemical techniques to find out whether there is any similarity in CK expression in human oral squamous cell carcinomas (SCC) and fetal oral tissues. CK 1, 8 and 18 were detected in a majority of samples using both techniques. Our earlier studies had shown aberrant expression of CK 1 and 18 in many of the oral SCC and leukoplakias. Studies by immunohistochemistry showed that these different CK antigens were expressed in different cell layers. CK 1(2) were present in the stratified epithelial layers whereas CK 8 and 18 were restricted to glandular epithelium. Till 27 weeks of gestation, both tongue and BM expressed CK 1, 8 and 18 along with CK 6 and 16. Thus, fetal tissues showed some similarities in CK pattern with their respective SCC.

Scrape cell-block technique for fine needle aspiration cytology smears

An inconclusive diagnosis on fine needle aspiration cytology (FNAC) may be due to poor spreading and presence of thick tissue fragments despite aspiration of adequate material. Repeat aspiration may not be possible especially when aspirates of deep seated organs have been obtained by image guided techniques. We have resorted to a 'scrape cell-block' (SCB) technique in such cases. In this technique the cellular material on the slides which had already been fixed and stained, was carefully removed by scraping following destaining and then processed as a cell block. SCB interpretation was then compared with the smear diagnosis and histological diagnosis, wherever available. A total of 27 cases were studied. In 12 cases SCB slides added information to the FNAC smears. In 14 cases SCB did not offer any additional information. SCB was inconclusive in one case. Final histological correlation was available in eight cases and the SCB diagnosis was confirmed in six cases, whereas in two cases SCB failed to identify the tumour. Immunocytochemistry (ICC) was done in one case. SCB is a useful technique to make the best use of the available material when reaspiration is difficult.

MALT lymphoma of nasal mucosa treated with antibiotics

Mucosa associated lymphoid tissue (MALT) lymphomas occur in sites other than the gastrointestinal tract and in the early stages respond to treatment with antibiotics. We report a rare case of nasal mucosal MALT lymphoma which responded to treatment with antibiotics and has since then remained in remission.

Long-term carcinogenicity of pan masala in Swiss mice

Carcinogenicity of pan masala, a dry powdered chewing mixture of areca nut, catechu, lime, spices and flavoring agents was evaluated by means of the long-term animal bio-assay 6- to 7-week old male and female S/RVCri mice were divided randomly into intermediate and lifetime exposure groups and fed normal diet without pan masala-(zero dose) or diet containing 2.5% and 5% pan masala. Animals in the intermediate-exposure group (n = 10/gender/dose group) were killed after 6, 12 or 18 months of treatment, while those in the lifetime-exposure group (n = 54/gender/dose group) were killed when moribund or at the termination of the experiment at 24 months. Several tissues were processed for histopathological examination. The body weight and survival rate of mice fed pan masala were lower than that of the controls. Histopathological observations of tissues from control animals did not reveal any neoplastic alterations. However, lifetime feeding of pan masala induced adenoma of the liver, stomach, prostate and sebaceous glands, also forestomach papilloma, liver hamartoma, hepatoma and hemangioma, carcinoma of the forestomach, adenocarcinoma of the lung and liver, and testicular lymphoma. Neoplastic lesions appeared mainly in the liver (n = 13), stomach (n = 3) and lung (n = 8). Lung adenocarcinoma, the most frequent malignant tumor type, was observed in 2/120 mice in the intermediate-exposure group and in 8/216 animals in the lifetime-exposure group. Statistical analysis of tumor-induction data revealed a significant dose-related increase in lung adenocarcinomas but not in liver and stomach neoplasms indicating that lung is the major target tissue for the carcinogenic action of pan masala.

p53 inactivation in chewing tobacco-induced oral cancers and leukoplakias from India

The inactivation of p53 tumour suppressor gene vis-á-vis point mutation, overexpression and degradation due to Human Papilloma virus (HPV) 16/18 infection, was examined in chewing tobacco-associated oral cancers and oral leukoplakias from India. The analysis of mutations was assessed by polymerase chain reaction (PCR) with single strand conformation polymorphism (PCR-SSCP) of exons 5-9 on DNA from 83 oral cancer cases, and the mutations confirmed by direct nucleotide sequencing of the PCR products. p53 protein expression was evaluated by immunohistochemical analysis on paraffin-embedded sections of 62 representative oral cancer biopsies and 22 leukoplakias, using p53-specific monoclonal antibody DO-7. The presence of HPV16/18 was detected in the 83 oral cancer cases by PCR analysis using HPV L1 consensus sequences, followed by Southern hybridization with type-specific oligonucleotide probes. Forty-six per cent (38/83) of oral cancer tumours showed p53 alterations, with 17% (14/83) showing point mutations, 37% (23/62) with overexpression and 25% (21/83) with presence of HPV16 wherein the E6 HPV16 protein degrades p53. HPV18 was not detected in any of the samples. Ninety-two per cent concordance was observed between missense point mutations and overexpression of p53 protein. A significant correlation was not observed between p53 alterations in oral cancer and clinico-pathological profile of the patients. Twenty-seven per cent (6/22) of oral leukoplakias showed p53 overexpression. The overall p53 alterations in oral cancer tissues and oral lesions are comparable to data from the oral cancers reported in the Western countries with smoking and alcohol-associated oral cancers, and suggest a critical role for p53 gene in a significant proportion of oral cancers from India. The overexpression of p53 protein in leukoplakias may serve as a valuable biomarker for identifying individuals at high risk of transformation to malignant phenotype.

Primary primitive neuroectodermal tumour of the parotid gland

AIMS

Primitive neuroectodermal tumour (PNET) is a malignant small round cell tumour that exhibits neuroepithelial differentiation. Isolated cases of PNET have been reported in visceral sites such as the kidney, uterus, ovary, testis, urinary bladder and pancreas. We present two cases of PNET of the parotid gland.

METHODS AND RESULTS

The first case was a 60-year-old woman, who presented with a parotid swelling of 10 months duration. The second case was a 45-year-old man, who presented with a recurrent temporofacial swelling of 6 months duration. Histological evaluation, in conjunction with immunohistochemistry, confirmed the diagnosis of PNET.

CONCLUSIONS

This is the first documentation of PNET of the salivary gland. The probable origin is from the facial nerve.

Pseudolymphomatous phase of Kikuchi-Fujimoto disease

Kikuchi-Fujimoto lymphadenitis is a distinctive entity which is easily recognised in its classical histology. However, cases which are biopsied in the early stage of the disease, before entering the necrotic phase may be misdiagnosed as non-Hodgkin's lymphoma. Ten cases of Kikuchi-Fujimoto disease which mimicked non-Hodgkin's lymphoma and in which less than 10% of the lymph node was occupied by necrosis were chosen for this study. The patients included 4 males and 6 females with an age range of 15-40 years. Eight patients presented with cervical lymphadenopathy. The pathologic areas ranged from 70% to 95% of the total nodal area. The features that helped distinguish this lesion from non-Hodgkin's lymphoma were: 1) a sprinkling of karyorrhectic debris throughout the node 2) plasmacytoid monocytes as well as "histiocytes" in the company of transformed lymphocytes (immunoblasts) 3) enlarged mottled T-zone areas, and 4) presence of residual lymphoid follicles. Follow up on six patients revealed no evidence of disease.

Cytokeratin expression in precancerous lesions of the human oral cavity

Cytokeratin (CK) expression was studied in buccal mucosa (BM) from 20 leucoplakia and 7 submucous fibrosis patients using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), immunoblotting and two-dimensional gel electrophoresis with iso-electric focussing (IEF) as the first dimension. Normal BM expresses CK 4, 5, 13, 14 and perhaps 19. Of 20 leucoplakia samples analysed, CK 5 was not detected in 17 samples, while CK 14 was not found in 13 samples. CK 1 and CK 8 were aberrantly expressed in six and seven samples, respectively. CK expression in contralaterally collected uninvolved tissues from 3 patients showed a normal pattern in two samples. Non-expression of CK 5 was observed in five of seven submucous fibrosis samples, while CK 14 was not detected in only two samples. CK 8 was aberrantly expressed in three samples. All the leucoplakia patients were chronic tobacco chewers. Thus, non-expression of CK 5 may be an early event occurring in tobacco-associated pathological changes in the BM.

Teratocarcinosarcoma of the paranasal sinuses: a clinicopathologic and immunohistochemical study

We report four cases of sinonasal teratocarcinosarcoma (SNTCS), a rare malignant tumor that displays combined features of an immature or malignant teratoma and a carcinosarcoma. The patients, three men and one woman, were all adults ranging in age from 21 to 69 years who presented with nasal obstruction and epistaxis. The tumors were typically composed of round cells and short spindle cells with neuroectodermal/rosette-like structures. Also seen were foci of fetal-like squamous epithelium, glandular epithelium, immature mesenchyme, immature cartilage, and neuronal differentiation. Immunohistochemistry performed in three cases showed expression of vimentin, CD99 (MIC2), and neuron-specific enolase in most cells, and focal expression of cytokeratin, epithelial membrane antigen, alpha fetoprotein, glial fibrillary acidic protein, chromogranin, and synaptophysin. The tumors were consistently negative for beta human chorionic gonadotrophin, neurofilament protein, and leukocyte common antigen. The entities considered in the differential diagnosis were poorly differentiated carcinomas, sarcomas, and olfactory neuroblastoma. We suggest that these neoplasms arise from a primitive cell capable of organized divergent differentiation.

Uteruslike masses of the ovary associated with breast cancer and raised serum CA 125

We describe three cases of a uteruslike mass of the ovary, a condition in which the ovary is replaced by a mass that grossly and microscopically resembles the uterus. The patients were 38, 43, and 39 years of age, and only the first was nulliparous. Two of them also had breast carcinomas. Two patients also had elevated CA 125 levels that gave rise to a clinical suspicion of ovarian malignancy. There were no anatomic abnormalities in any of the patients. The presence of residual ovarian stroma in two of the patients (both of whom had breast cancer) suggests that metaplasia rather than a congenital anomaly is the cause. Elevated CA 125 levels are consistent with the endomyometriosis nature of the lesion.

Evaluation of carcinogenic/co-carcinogenic activity of a common chewing product, pan masala, in mouse skin, stomach and esophagus

Pan masala, a dry powdered mixture of areca nut, catechu, lime, unspecified spices and flavoring agents, has gained widespread popularity as a chewing substitute in India. In this study, the carcinogenic and tumor-promoting potential of an ethanolic pan masala extract (EPME) was determined using skin of S/RVCri-ba mice and forestomach and esophagus of ICRC mice as the target tissues. Carcinogenic activity of pan masala was tested by painting the mouse skin for 40 weeks with EPME or by gavage feeding for 6 months. Following initiation with 9,10-dimethylbenz(a)anthracene (DMBA), carcinogenesis of mouse skin was promoted with different doses of EPME, while gastric- and esophageal-tumor-promoting activity was determined by administering EPME by gavage to animals initiated with diethylnitrosamine (DEN). The ability of EPME to effect progression of skin papilloma to carcinoma and cutaneous alterations after a single or multiple EPME treatment were also evaluated. EPME at 25 mg per dose promoted skin-papilloma formation between 30 and 40 weeks of treatment and enhanced the rate of conversion of papilloma to carcinoma. Induction of mild epidermal hyperplasia, dermal edema, increase in epidermal mitotic activity and the rate of epidermal and dermal DNA synthesis by EPME correlated well with its skin-tumor-promoting potential. In ICRC mice, EPME was inactive as a complete carcinogen, but effectively promoted the development of forestomach and esophageal papilloma and carcinoma in a concentration-dependent manner. The tumor incidence at 25 mg EPME per dose was comparable with that obtained in the 12-O-tetradecanoylphorbol-13 acetate(TPA)-treated group. The findings indicate that habitual pan-masala use may exert carcinogenic and co-carcinogenic influence.

Histologic trends in thyroid cancer 1969-1993: a clinico-pathologic analysis of the relative proportion of anaplastic carcinoma of the thyroid

BACKGROUND

It was observed that new presentations of anaplastic carcinoma of the thyroid had become infrequent in the last two decades.

METHODS

All cases of thyroid cancer seen at our centre between 1969-1993 (n = 2921) were classified as papillary 49%, follicular 34%, medullary 7.5%, anaplastic 4.7%, and other 4.8%. The total number of thyroid cancers show a 3.5-fold rise.

RESULTS

The differentiated thyroid cancers show a significant rising trend as against the relative proportion of anaplastic carcinoma, which shows a significant decline (P = 0.002). Clinicopathologic data on 124 patients of anaplastic carcinoma revealed 50% patients had either long-standing goitres, previous thyroid abnormalities, or associated differentiated thyroid carcinoma on histology.

CONCLUSIONS

The decline in the relative proportion of anaplastic carcinoma may in part be explained by the clinicopathologic findings or it may be attributed to histological reclassification.

Rhabdoid phenotype in squamous carcinoma. A report of two cases

We report two cases of squamous carcinoma in which a prominent rhabdoid phenotype was seen. The tumors which occurred in the buccal mucosa of a 70 year old man and the skin of a 85 year old man were positive for cytokeratin and epithelial membrane antigen indicating their epithelial nature. Co-expression of vimentin was also noted. The aggressive nature of the rhabdoid component is confirmed by the fact that the cervical lymph node metastasis in case I was also rhabdoid.

Cytokeratin expression in squamous cell carcinomas of the tongue and alveolar mucosa

Cytokeratins (CK), the intermediate filament markers for epithelial cells were analysed in 23 squamous cell carcinomas (SCC) of the tongue and 11 SCC of the alveolar mucosa (AM) by SDS-PAGE, immunoblotting and two dimensional gel electrophoresis. Normal human adult ventral tongue expresses CK nos 4, 5, 6, 13, 14, 16 (17) while the dorsal tongue expresses CK nos 1, 5, 6, 10, 14, 16 (17). CK 5 and CK 14 were not detected in a majority of samples and CK 18, a marker of simple epithelia, was aberrantly expressed in 18 samples. Normal human adult AM expresses CK nos 4, 5, 6, 13, 14, 16 (17). Among 11 SCC of AM, CK 4 and CK 5 were detected in only two samples each. CK 1 and CK 10 were aberrantly expressed in nine and one samples, respectively. The basic CKs such as CK 4, 5 and 14 were not expressed in SCC at both these sites while others like CK 1 and 18 were aberrantly expressed. Thus, non-expression of basic keratin, CK 5, of the oral lining epithelia and aberrant expression of simple epithelial keratins seem to be the major events in malignant transformation in the oral epithelia.

Risk factors and prevalence of antibodies against hepatitis A virus (HAV) in children from day-care centers, in Goiania, Brazil

A seroepidemiologic survey about hepatitis A virus (HAV) infection was carried out in a group comprising 310 children, ranging in age from 3 months to 9 years, from day-care centers, in Goiania, a middle sized city in the central region of Brazil. The biomarkers employed in the investigation of previous infection include total IgG and IgM anti-HAV antibodies, and for the detection of more recent infection, IgM anti-HAV antibodies were analyzed. The study was performed in 1991 and 1992. According to the results, 69.7% of the children presented total IgG/IgM anti-HAV antibodies, with 60% of the group in the age range of 1 to 3 years. Among 10 day-care centers analyzed, the prevalence of the biomarker IgM anti-HAV was 3.2%, with an uniform distribution of the cases in the group of children ranging in age from 1 to 4 years. Multivariate analysis was performed to investigate the sociodemographic factors that could influence the results. It was verified that the risk for the infection increased with the length of the attendance in the day-care centers, i.e., the risk for children with attendance of one year or more was 4.7 times higher, when compared with children with one month attendance (CI 95% 2.3-9.9). According to the results, hepatitis A is an endemic infection in day-care centers in the study area. The length of attendance in the day-care settings was demonstrated to be a risk factor for the HAV infection. Such findings suggest that if hepatitis A vaccination becomes available as a routine policy in our region, the target group should be children under one year. Moreover, those children should receive the vaccine before they start to attend the day-care centers.

[Seroepidemiology of hepatitis A virus infection in street children of Goiânia-Goiás]

A cross-sectional study was performed to determine the age-prevalence of hepatitis A virus (HAV) among street youth from Goiania city--Central Brazil, and to determine if any risk factors could be identified. The surveys were conducted between 1991/1992. The street youth were 397 individuals aged 7 to 21 years old living in institutions and teenagers working at streets. Then, 313 adolescents working at streets and with family links, and 84 institutionalized ones without family were screened for antibodies against HAV. Prevalences ranged from 80.0% to 92.2% to total anti-HAV and there was not a statistically significant trend of positivity with age in this group. Univariate analysis for risk factors associated with HAV infection was performed with no statistically significant difference for adolescents working at streets and living with parents, and street youth with family links. Economic variables were not statistically associated with seropositivity, probable due to homogeneous characteristics of the group. This study disclosed that street youth have a high rate of HAV infection. These findings do not suggest differences between subgroups of populations in acquiring immunity to HVA. The public health implication and the need of screening other subgroups of population of the same city were suggested in order to discuss vaccine strategy in underdeveloped countries.

Solid and papillary epithelial neoplasm of the pancreas. Diagnosis by fine needle aspiration cytology in four cases

The cytologic features of four cases of solid and papillary epithelial neoplasm of the pancreas that were diagnosed on fine needle aspiration cytology are described. Papillary structures with delicate vascular cores covered with several layers of bland tumor cells were a distinctive feature. The papillae in two of the cases showed mucoid material in their cores. The cytologic features of solid and papillary epithelial neoplasm of the pancreas are distinct from those of other cystic pancreatic tumors.

Ovarian myxoma in a premenarchal girl

A case of ovarian myxoma in a 12-year-old premenarchal girl is reported. This paper details the clinical presentation, gross and microscopic pathology, Immunocytochemical profile, and behavior of this rare tumor. The differential diagnosis and possible histogenesis is briefly discussed.