[Gastrointestinal stromal tumors. Observations on the basis of 29 cases]

42 gastrointestinal mesenchymal tumors are analyzed by the authors with characterization of immunohistochemistry and DNA study. Out of 42 tumors, 29 GIST 3 leiomyoma, 4 leiomyosarcoma, 3 benign schwannoma, 1 soliter fibrous tumor, 1 inflammatory myofibroblastic tumor and 1 benign haemangiopericytoma were found. All 29 GIST but two could be characterized by c-kit (CD-117) and CD-34 positivity independently weather they displayed focal neurogenic and/or myogenic immunomarkers. In GIST group, 10 cases were benign, 6 borderline and 13 malignant. All benign cases were euploid by DNA study, the malignant tumours were highly aneuploid. Concerning the borderline GIST group by morphology, the aneuploid DNA content may speak for malignant biological behavior, and the diploid DNA content in low grade malignant GIST by morphology may speak for better outcome in the malignant group. There is a discussion about the nomenclature of this morphological group, about the role of the c-kit gene and the necessity of the immunohistochemistry and DNA content determination.

[Dual fluorescence in situ hybridization analysis of synovial sarcoma]

Synovial sarcoma have (about in 95% of the cases) the specific and characteristic reciprocal chromosomal translocation t(X; 18) (p11.2; q 11.2). Application of dual-colour fluorescence in situ hybridization (FISH) on interphase nuclei to identify the specific translocation has a diagnostic importance for daily pathological practice. For visualisation of the translocated chromosomal fragments of synovial sarcoma cells on imprint smears, chromosome X painting probes and chromosome 18 centromeric probes were used. Our present study indicates that the precise preoperative diagnosis of synovial sarcoma using dual-colour FISH is possible on smears and this possibility (to identify specific chromosomal translocations in soft tissue tumours) is a landmark in the preoperative diagnosis of soft tissue sarcomas.

[Morphological parameters of breast cancers detected by mammography with and without organized screening; a comparative study]

Some pathological findings and prognostic indices recorded in breast cancer cases, detected, on one hand, by a provider-initiated mammography screening program (Group 1), and, opportunistically, in self-referred symptomatic women (Group 2) on the other, are compared. In 8877 symptom-free women, aged 50-65 years, individually invited to attend the screening offered for the residents of the III., XII. and XIII. districts of Budapest, 67 cancer cases were detected (7.5 in 1000 screenees), in accordance with the cancer detection rate of the first, "prevalence" round of organised screening programmes. In the other group of 1593 symptomatic, self-referred women of the same age, 113 cancer cases were diagnosed by mammography. As far as the pathological parameters are concerned, the number of cases with invasive cancer less than 15 mm in diameter, and those with axillary nodes present was found to be significantly higher in the screened group as compared to the self-referred one (p < 0.01). In "small" cancers (i.e. less than 15 mm in diameter), no significant difference was found in the proportion of histologic grade III tumours among the two groups. In screen-detected cancers both the morphometric prognostic index (as calculated by Baak et al.) and the Nottingham Prognostic Index (NPI) proved to be more favourable, as compared to those in the self-referred group. The p-value as determined by Mann-Whithey test was 0.000003 in the screened group, and 0.000015 in the other one. These findings provide convincing evidence in support of the public health importance of provider-initiated, organised mammography screening for breast cancer, therefore, the introduction on service basis of organised breast screening into the health care system in Hungary is strongly recommended by the authors.

[Occurrence of Helicobacter pylori in patients with gastroesophageal tumors]

Authors examined the occurrence of H. p. retrospectively in bioptic material for three years. Fifty-one oesophageal and gastric tumorous patients were examined and as a control fourty-seven non tumorous patients with chronic gastritis chosen at random. The demonstration of H. p. was performed by modified Giemsa stain. Different types of chronic gastritis, forms and localisation of the tumours as well as their relation with sex and age were investigated. The occurrence of H. p. was higher in chronic gastritis than in tumorous processes. Seventy-one % H. p. positivity was found in the control group against 17.6% in the tumorous patients.

[Cancer screening in Hungary: World Bank supported model programs]

Since 1995, a model cancer screening program has been in operation in Hungary, the overall purpose of which is to promote the establishment of effective and efficient screening programs by means of adapting the internationally agreed principles of organized screening to the needs and opportunities in Hungary. The establishment and operation of a national population-based cancer registration system is an other aim of the Program. The model program--financed partly from a loan from the World Bank, partly from local funds provided by the Government of Hungary--is to develop standard procedure for cervical, breast and colorectal screening and to end up with tested recommendations for introduction of organized screening of proved effectiveness, integrated into the health care system, on country-wide service bases in Hungary.

[Aspiration cytology in gastroenterologic endoscopy]

The aspiration cytology is a long since well proved method in the diagnosis of near to the body surface alterations in the gastrointestinal tract. The endoscopic fine needle aspiration is a less wide-spread method. Fine needle aspiration cytology has been described as 70-94% accurate for diagnostic upper gastrointestinal tract malignant lesions, and more than 90-99% accurate when used in conjunction with traditional endoscopic forceps biopsy. This technique was performed on 97 consecutive patients parallel with conventional endoscopic biopsy. Sensitivity of the method 86.8%, specificity 98.3%, predictive value in positive cases 96.6%, and in negative cases was 91%. Authors would like to prove with illustrative cases how this technique can be used for the diagnosis of gastrointestinal lesions, primarily in submucosal processes.

[Simultaneous occurrence and treatment of right atrial myxoma and extensive colonic polyposis causing recurrent intestinal hemorrhages]

The authors describe the case history of 68 year old man. Right atrial myxoma had been diagnosed two years prior to this present observation, however surgical intervention has been contraindicated due to high operative risk. Later the patient was referred to a cardiological evaluation because of chronic atrial fibrillation before a cataract surgery in a symptom free condition. The right atrial myxoma caused inflow obstruction and tricuspid regurgitation was removed before the eye surgery. In addition, tricuspid valve replacement and revascularization of three coronary arteries has been performed. The patient receiving chronic anticoagulant therapy experienced severe gastrointestinal bleeding the source of which turned out to be a partially malignant colon polyposis. The polyps were successfully removed by coloscopy and intra operative coloscopy. No gastrointestinal bleeding has been observed afterwards in spite of the continued anticoagulation. After review of the literature the authors observed that according to their knowledge the common occurrence of the right atrial myxoma and the colon polyposis had not been described before.

Diagnostic value of AgNOR method in thyroid cytopathology: correlation with morphometric measurements

A silver staining technique was applied to 51 thyroid smears. The numbers of silver-stained nucleolar organizer regions (AgNORs) were counted, and the mean AgNOR and nuclear area per cell were determined with an image analyzer. The mean AgNOR count per cell was significantly higher in malignant than in benign lesions, but there was a considerable overlap. The mean AgNOR area and the mean SD of the AgNOR area per cell were significantly higher in carcinomas than in benign lesions (P = 10-9 and P = 5 x 10-10, respectively) and there were only two and one benign cases, respectively, of overlap. A strong correlation was observed between the mean AgNOR area and the mean nuclear area (r = 0.88), the former being a better discriminator between benign and malignant lesions. The AgNOR technique may contribute to routine thyroid cytopathology.

Simultaneous response of brain electrical activity (EEG) and cerebral circulation (REG) to microwave exposure in rats

The correlations between physiological modalities in microwave field-activated systemic or localized regulatory mechanisms with changes in the central nervous system (CNS) seem not to be identical. These problems are important because of the increased number of radiating appliances, e.g. portable radios and mobile telephones. In two series of experiments on anaesthetized rats (N = 40) (i) before and after 10 min, whole body exposures to 2.45 GHz CW microwaves, and (ii) during 30 min exposures to 4 GHz amplitude modulated (AM, 16 Hz) microwaves, the effects on the CNS were observed simultaneously with those on the cardiovascular system by quantitative polygraphic measurement. In acute experiments on rats, electroencephalograms (EEG), rheoencephalograms (REG) as an index of cerebral blood flow (CBF), brain tissue DC impedance and temperature and ECG were recorded simultaneously. The total power of EEG spectra increased after whole body 30 mW/cm2 2.45 GHz CW exposure for 10 min. No changes occurred at 10 mW/cm2. The CBF increased after 10 mW/cm2 exposure. The power of EEG delta (0.5-4 Hz) waves was increased by thermal level of brain localized 4 GHz CW exposure at 42 mW/g specific absorption rate (SAR) simultaneously with the REG amplitude as an index of cerebral blood flow. Amplitude modulation at 16 Hz and 8.4 mW/g SAR was associated with increased power of EEG beta (14.5-30 Hz) waves but changes in the CBF were not observed. CW radiation at 8.4 mW/g increased the cerebral blood flow, but did not change EEG spectra.

Occult breast cancer presenting with axillary metastasis

The literature of occult breast cancer is reviewed and the management of our 43 patients is discussed. In 20 patients mastectomy and axillary block dissection, in nine upper-outer quadrant resection of the breast with axillary block dissection, and in two axillary biopsy were carried out. The primary tumour was found only in 11 patients during the first operation, either by macroscopic or microscopic examination. In 12 patients the primary breast tumour became detectable only later. Out of the 20 mastectomy specimens two primary tumours could not be identified even with the most thorough examination. In four patients of the breast conservation group the primary tumour remained occult until recently, and in the axillary block dissection group (12 patients) the site of the primary cancer could be identified only in two patients. The difficulties of the diagnosis and the dilemmas of the surgical indications and treatment are dealt with.

[Occult breast cancer causing axillary metastasis]

Authors review 43 cases of occult breast cancer selected from 6396 patients operated on for breast cancer in the National Institute of Oncology, Budapest over a 20-year period (1972-1991). In 20 patients mastectomy and axillary block dissection, in 9 upper-outer quadrant resection of the breast with axillary block dissection, in 12 only axillary block dissection, and in 2 axillary biopsy were carried out. The primary tumor was localized only in 11 patients during the first operation either by macroscopic or by microscopic examination. In 12 patients' breast the primary tumor became detectable only later. Out of the 20 mastectomy specimens, 2 primary tumors could not be identified even with the most thoroughful examination. Out of the breast conservation group in 4 patients, the primary tumor remained occult until recently, and in the axillary block dissection group (12 patients) the site of the primary cancer could be identified only in 2 patients. The authors deal with diagnostic difficulties and the dilemmas of the surgical indications and treatment.

[The use of multivariate mathematical methods in medical diagnostic systems--a model for the evaluation of cytological smears]

The methods of the multivariate mathematics have been applied in several studies to increase the diagnostic reliability of medical decision support system. In the recent years some new algorithms for decision support (fuzzy logic) and for pattern recognition (neural nets), both specified by nonlinearity, were developed. This paper provides results for the application of this methods in the area of quantitative cytology and the comparison with the traditional classifiers. 21 normal, 15 dysplastic, 23 malignant, Feulgen stained gastric imprint smears were analysed on a Leitz Miamed DNA equipment. The determination of mean DNA content, the 2c deviation index (2cDI), 5c Exceeding rate (RcER), G1,S,G2 phase fraction ratios, cell nucleus area, form factor was performed. The discriminant analysis classified correctly the 95.6% of malignant cases, 86.7% of dysplasias, and 80.7% normal cases. Our diagnostic system using fuzzy logic made the diagnostic borders fine tuneable, and reliable. The back propagation neural net could classify all three diagnostic groups above 95% correctly. The application of nonlinear computational methods made the diagnostic system more reliable. The application of these algorithms are encouraged.

[Doege-Potter syndrome. Fibrous mesothelioma of multicentric localization, causing hypoglycemia]

The authors present a case of a 73 year old female patient. She had a left side pleural mesothelioma and had been operated thrice. At the third operation an abdominal propagation joined to the thoracic mesothelioma. Starting from this third surgery severe hypoglycemic episodes illustrated the clinical pictures. The electronmicroscopy of the resected tumor mass documented the presence of neurosecretory granules. This strongly suggests that tumor mass produced a substance which could have been responsible for the hypoglycemic episodes. Due to the fact the insulin levels measured during severe hypoglycemias were always on a low level, we suppose that an insulin like material (IGF--II) was responsible for the above mentioned symptoms. The authors briefly review the literature.

Malignant fibrous histiocytoma of the esophagus. Report of a case with cytologic, immunohistologic and ultrastructural studies

A 65-year-old man presented with an esophageal polyp that proved to be malignant pleomorphic fibrous histiocytoma, extremely rare at that location. Diagnosis of the abrasion cytology specimen was confirmed by immunohistochemical and electron microscopic methods. Differential diagnostic problems of pleomorphic soft tissue tumors and epithelial tumors mimicking them are discussed.

[Quantitative morpho- and densitometric parameters in the evaluation of aspiration cytology smears of the breast]

Quantitative morpho- and densitometric analysis of Feulgen stained breast aspiration smears were performed by absorption cytophotometer and a TV image analyser. The DNA Index, and the ratio of G1-S-G2 phase fraction ratio yielded by the quantitative DNA analysis, showed significant differences between benign and malignant alterations. Based on the 13 morphometric and 5 densitometric parameters the TV-image analyser could classify the examined smears 80% correctly by cluster analysis. Groups of the cytological Grade I.-III. were also differentiable by this method. The application of TV image analyser system in the diagnosis of aspiration cytological smears could be suggested. The complex quantitative morpho- and densitometric analysis could contribute to the correct classification of diploid tumours.

[Carcinoid tumor of the breast]

Two cases of carcinoid breast tumour are presented by the authors. Discussing the diagnostic and therapeutic possibilities, it is emphasized that this type of tumour represent a bad prognosis, in spite of the relative benign behaviour of the carcinoid tumour of other organs. In case of carcinoid tumour of the breast, radical operation and careful follow-up is recommended.

Determination of G1-S-G2 phase fraction ratios of tumour subpopulations from DNA histograms

Authors describe a new mathematical approach based on mixture decomposition and maximum likelihood method for the determination of subpopulations and G1-S-G2 phase fraction ratios in aneuploid, multiploid DNA histograms. A special computer routine was developed for this purpose (DAHSY). The present study relates to DNA histograms obtained by a Leitz Miamed DNA TV image analyser system. Altogether 23 normal, 14 dysplastic and 28 tumours Feulgen stained gastric imprint smears were measured. In addition to determination of subpopulations and G1-S-G2 phase fraction ratios, the authors also performed a morphometric analysis of Feulgen stained nuclei and determined the values of 5c exceeding rate (5cER) and the 2c deviation index (2cDI). More than one subpopulation were found only in tumours. The usual G1-S-G2 phase fraction rates in normal gastric smears were 85.5%, 9.04%, 4.9%, in dysplastic cases 74%, 15.4%, 10.2% and in tumours 53.8%, 22.9%, 18.8%. Significance of the differences were calculated by the T-test. The G1 phase fraction ratio clearly discriminates the malignant lesions from all others. The S+G2 phase fraction ratio, however, distinguishes the normal cases from the dysplastic ones. The 2cDi and 5cEr could support a multivariate diagnostic system. The cell nucleus area was found also to be of diagnostic value.

[New classification in cervical cytology: the Bethesda system]

A new, contemporary classification of cervical cytopathology was developed in Bethesda (USA) in 1988. The introduction of the Bethesda-system is discussed by the authors. Recommendations and opinions are expected from the Hungarian gynecologists, pathologists, cytopathologists for promotion of the new classification.

Fine needle aspiration cytology of biphasic synovial sarcoma of soft tissue. Report of a case with ultrastructural, immunohistologic and cytophotometric studies

A case of biphasic synovial sarcoma initially diagnosed by fine needle aspiration cytology is described. The diagnosis was confirmed by electron microscopic studies on a repeat aspirate and histologic and immunohistochemical studies on the surgical specimen. The cellular DNA content was also measured. The differential diagnosis and histogenesis of this neoplasm are discussed.

DNA cytometry of soft tissue tumours with TV image-analysis system

We examined 69 soft tissue tumours for DNA content. Altogether 42 aspiration cytology and 27 imprint Feulgen-stained smears, each verified by histology, were analysed and the results evaluated with Böckings's algorithm. Except one false negative case (extramedullary ependymoma) 43 malignant and 25 benign soft tissue tumours could clearly be separated on the basis of their DNA content. The sensitivity of the positive cases (suspicious and malignant) came up to 97.7% with a false negative ratio of 2.2% while the sensitivity of the negative cases (benign) proved to be 75% with a 0% false positivity ratio. Cytometry is a useful aid in aspiration cytology diagnostics of soft tissue tumours particularly when their benign or malignant character is to be determined because the primary surgical therapy and consequently the further fate of patient, too, depend on the precise cytological diagnosis.

Branchiogenic carcinoma (malignant branchioma)

The authors describe the characteristics of branchiogenic carcinoma as that of a pathological entity on the occasion of reporting four cases. The clinical course of the disease and the cytological and histological features are discussed on the basis of our observations and literature data. The authors stress the importance of careful and repeated clinical examinations, which exclude the possibility of a primary tumor of other localization, in establishing the diagnosis of branchiogenic carcinoma.

[Angioimmunoblastic lymphadenopathy]

Cytological, histological and ultrastructural characteristics of a cose of an extranodal and nodal angioimmunoblastic lymphadenopathy persisting during several years are given. Angiomatous proliferation in the case reported seemed to be identical both in the lymph node and in the cutaneous infiltration. Types of cells seen in the angioimmunablastic lymphadenopathy did not differ from those of other immunoreactive processes. In the extranodal infiltrates in addition to other phenomena thickening of the immunological techniques decrease of the natural cytotoxicity and the number of T-lymphocytes could be observed.