Implementing health promotion activities using community-engaged approaches in Asian American faith-based organizations in New York City and New Jersey

Faith-based organizations (FBOs) (e.g., churches, mosques, and gurdwaras) can play a vital role in health promotion. The Racial and Ethnic Approaches to Community Health for Asian Americans (REACH FAR) Project is implementing a multi-level and evidence-based health promotion and hypertension (HTN) control program in faith-based organizations serving Asian American (AA) communities (Bangladeshi, Filipino, Korean, Asian Indian) across multiple denominations (Christian, Muslim, and Sikh) in New York/New Jersey (NY/NJ). This paper presents baseline results and describes the cultural adaptation and implementation process of the REACH FAR program across diverse FBOs and religious denominations serving AA subgroups. Working with 12 FBOs, informed by implementation research and guided by a cultural adaptation framework and community-engaged approaches, REACH FAR strategies included (1) implementing healthy food policies for communal meals and (2) delivering a culturally-linguistically adapted HTN management coaching program. Using the Ecological Validity Model (EVM), the program was culturally adapted across congregation and faith settings. Baseline measures include (i) Congregant surveys assessing social norms and diet (n = 946), (ii) HTN participant program surveys (n = 725), (iii) FBO environmental strategy checklists (n = 13), and (iv) community partner in-depth interviews assessing project feasibility (n = 5). We describe the adaptation process and baseline assessments of FBOs. In year 1, we reached 3790 (nutritional strategies) and 725 (HTN program) via AA FBO sites. Most AA FBOs lack nutrition policies and present prime opportunities for evidence-based multi-level interventions. REACH FAR presents a promising health promotion implementation program that may result in significant community reach.

Abstract P4-13-13: The correlation between mastectomy specimen weight and volume- a guide to the choice of implant size in breast reconstruction

Introduction: The concept of “conservative” mastectomy with breast reconstruction has led to a huge positive impact on the quality of life of breast cancer survivors. In 2015, 106,338 breast reconstructions were performed with implant-based reconstruction (IBR) constituting 86,013 (80.9%) of those procedures. Technically speaking, there is still no consensus on the most accurate method of assessing the size of implant used to achieve the desirable aesthetic results and symmetry. Some surgeons use the volume of the mastectomy specimen, believing that the volume of the implant replacing the volume of breast tissue removed is a logical way of thinking. Others prefer to depend on the weight of the specimen owing to the presumption that a mixture of fat and fibroglandular tissue will give an approximate overall density of 1.0g/cm3. To the authors' knowledge, the correlation between the mastectomy specimen volume and weight has been scarcely reported in the literature.

Materials and Methods: Patients undergoing nipple or skin-sparing mastectomy with immediate IBR at the London Breast Institute between January 2014 and December 2016 were included in this study. They were under the care of two senior Oncoplastic breast surgeons. Data on breast weight and volume as well as the size of implants used were prospectively collected. The volume of the breast tissue was assessed by volume displacement method while the weight was measured on a scale in grams. The exclusion criteria included patients with mastectomy specimen weighing more than 2000 grams. Further subgroups were divided into patients younger and those older than 50 years old. The presence or absence of cancer was also reviewed to assess whether the tumor tissue would have heavier weight when compared with volume.

Results: Between January 2014 and December 2016, a total of 236 mastectomies were performed, of which 144 were accompanied with IBR. The mean age of the patients was 45 years (range= 25-74). There were 79 right and 65 left breast specimens. Among these cases, 36 were bilateral. Tissue volume and weight had a strong direct correlation (N=144, R=0.99, P<0.00). Mastectomy volume had a marginally stronger correlation with implant volume/size (N=144, R=0.82, P=<0.00) than weight (N=144, R=0.79, P=<0.00). Further subgroup analysis showed that neither the presence of cancer nor the variation in breast density with age or menopausal status seemed to affect the correlation between the weight and volume of the breast tissue. 75% of reconstructions had implant size within 100 mls or grams of the mastectomy specimen.

Conclusions: Our study has shown that mastectomy specimen weight and volume have close enough correlation. The volume measurement was best estimated to the nearest 25 to 50 mls. On the other hand, the weight assessment was more accurate, objective, easier, and more reproducible with minimal inter-observer error. Hence, we believe that the breast weight can be reliably used to estimate the size of the implant. However, there are many other factors that should be taken into consideration when choosing an implant. For instance, the woman's wish for smaller or larger size, the width and height of the breast base, and the availability of a wide range of implants.

Citation Format: Wazir U, El Hage Chehade H, Choy C, Kasem A, Mokbel K. The correlation between mastectomy specimen weight and volume- a guide to the choice of implant size in breast reconstruction [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-13.

Abstract P2-13-04: Clinical outcome and patient satisfaction with the use of bovine-derived acellular dermal matrix (SurgiMendTM) in implant-based immediate reconstruction following skin sparing mastectomy: A prospective observational study

The advent of acellular dermal matrix devices (ADMs) has facilitated immediate breast reconstruction (IBR) with mammary implants following skin sparing mastectomy (SSM) for breast cancer treatment or risk reduction.

This is a prospective observational single institution study of 118 consecutive patients undergoing a total of 164 SSM and IBR procedures using an implant and bovine-derived ADM (SurgiMend) for breast cancer or risk reduction purposes during 2012-2014. The primary endpoint was the explantation rate and secondary endpoints included patient quality of life, patient satisfaction, objective assessment of aesthetic outcome, surgical complications, recurrence and mortality.

The mean age of the patients was 50.1 years (median age of 48, range of 27-78). Median follow up time was 21 months (mean of 21.4 months, range of 2-40 months). 46 patients had a bilateral SSM and IBR, 5 of whom had bilateral breast cancer and 3 for risk reduction due to a significant genetic mutation. The remaining 37 patients had unilateral breast cancer and a contralateral risk reducing mastectomy. 27 (37.5%) of the 72 patients who had unilateral SSM underwent contralateral adjustment procedures to optimise symmetry, including 9 augmentation mammoplasty, 12 mastopexy and 4 reduction mammaplasty procedures and 2 combined augmentation-mastopexies. 61 patients (51.7%) received chemotherapy, 5 of whom had primary systemic therapy prior to surgery. 32 (27.1%) patients received radiotherapy (10 patients had prior radiotherapy and 22 patients had post mastectomy radiation: PMR). Those with ER positive disease received hormonal therapy. Those with Her2 positivity received Herceptin +/- Pertuzumab.

Over the study period, 2 implants had to be removed resulting in an explantation rate of 1.2%. Overall, wound complications were observed in 6 (3.7%) cases. There were 2 cases of local recurrence (1.7%), one distant recurrence (0.8%) and one patient died of metastatic breast cancer (0.8%). Overall survival was 99.2% and locoregional disease free survival (LRFS) was 98.3%. One patient (0.8%) developed a mild inflammatory reaction secondary to the underlying mesh. Wound complications were observed in 3 other patients (2 haematomas and wound dehiscence/persistent seroma requiring implant replacement).

Patient satisfaction with the procedure was very high. The mean Breast Q Score was 85 and mean overall patient satisfaction was 9 out of a possible 10. The mean objective assessment score was 8.9 out of a possible 10 and the mean subjective capsular contracture severity score was 2.9 out of 10.

In patients undergoing reoperations, the incorporation rate of the mesh was found to be very high almost approaching 95%.

SurgiMendTM is an effective adjunct to IBR using implants following SSM for breast cancer or risk reduction, with a very low rate of implant loss and a high level of patient satisfaction. Furthermore, this ADM seems to incorporate readily and is associated with a very low incidence of inflammatory reactions. Neither prior radiotherapy nor PMR radiation represents a contraindication to its use.

Citation Format: Wazir U, Kasem A, Headon H, Choy C, Manson A, Heeney J, Mead O, Mokbel K. Clinical outcome and patient satisfaction with the use of bovine-derived acellular dermal matrix (SurgiMendTM) in implant-based immediate reconstruction following skin sparing mastectomy: A prospective observational study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-13-04.

Clinicopathologic features and treatment outcome of mature T-cell and natural killer-cell lymphomas diagnosed according to the World Health Organization classification scheme: a single center experience of 10 years

BACKGROUND

Data on mature T-cell and natural killer (NK)-cell lymphomas diagnosed with the World Health Organization (WHO) classification scheme are scarce. They are regarded to be more common in Asian populations.

METHODS

Consecutive T-cell and NK-cell lymphomas classified according to the WHO scheme within 10 years in a Chinese population were reviewed.

RESULTS

There were 148 cases, constituting 16.6% (T-cell, n=90, 10.1%, NK-cell, n=58, 6.5%) of all non-Hodgkin lymphomas in this period. There was a male predominance (male:female = 2.5), young age at diagnosis (median age 50 years, range 8-86) and frequent extranodal presentation. Commonest T-cell lymphomas included anaplastic large cell lymphoma (ALCL, n=25, median age 35 years, nodal 60%, stage I/II 60%), peripheral T-cell lymphoma, unspecified (PTCL, n=24, median age 54 years, nodal 42%, stage I/II 42%), and angioimmunoblastic T-cell lymphoma (AILT, n=19, median age 67 years, nodal 95%, stage I/II 26%). Overall frequencies of T-cell lymphomas were comparable to Western patients. AILT, PTCL and ALCL were aggressive with a poor outcome. NK-cell lymphomas were predominantly extranodal (96%) and aggressive, with a frequency much higher than Western patients.

CONCLUSIONS

The apparent high prevalence of T-cell and NK-cell lymphomas in the Chinese was due to more frequent NK-cell but not T-cell lymphomas.

Primary anaplastic large cell lymphoma of the pancreas

Most solid pancreatic tumors are exocrine adenocarcinomas. We presented a patient with primary ALCL of the pancreas masquerading as a carcinoma of the head of pancreas. She was scheduled for a Whipple's operation and the intra-operative frozen section showed anaplastic carcinoma. The proper diagnosis was only derived later with CD30 immunohistochemical study. This carries important implications on the management, as radical surgery is indicated in resectable carcinoma but not for a chemosensitive lymphoma.

Characterization of Salmonella enterica subspecies I genovars by use of microarrays

Subspecies 1 of Salmonella enterica is responsible for almost all Salmonella infections of warm-blooded animals. Within subspecies 1 there are over 2,300 known serovars that differ in their prevalence and the diseases that they cause in different hosts. Only a few of these serovars are responsible for most Salmonella infections in humans and domestic animals. The gene contents of 79 strains from the most prevalent serovars were profiled by microarray analysis. Strains within the same serovar often differed by the presence and absence of hundreds of genes. Gene contents sometimes differed more within a serovar than between serovars. Groups of strains that share a distinct profile of gene content can be referred to as "genovars" to distinguish them from serovars. Several misassignments within the Salmonella reference B collection were detected by genovar typing and were subsequently confirmed serologically. Just as serology has proved useful for understanding the host range and pathogenic manifestations of Salmonella, genovars are likely to further define previously unrecognized specific features of Salmonella infections.

Totally extraperitoneal repair of obturator hernia

BACKGROUND

One distinct advantage of the 1aparoscopic inguinal hernia repair is the opportunity for clear visualization of the direct, indirect, femoral, and obturator spaces. The surgeon should routinely inspect all of them. Obturator hernia accounts for as few as 0.073% of all hernias, but the mortality rate when it is acutely incarcerated can be as high as 70%. There is only one previous report of a totally extraperitoneal repair for obturator hernia. Five such procedures are described.

METHODS

A retrospective review was undertaken to evaluate one surgeon's experience with the totally extraperitoneal repair of obturator hernia over a 4-year period. Four of five cases were completed, and the remaining case was converted to an open procedure.

RESULTS

Three hernias were on the right side, and two on the left. One patient presented with an acutely incarcerated obturator hernia and underwent a small bowel resection for strangulated bowel within the obturator space. The other four hernias were found during totally extraperitoneal repair, and the patients were discharged home several hours later. There was one complication, a midline wound infection in the patient with strangulated bowel. It was treated with dressing changes. There were no other complications, and during a follow-up period of 3 to 48 months, there was no recurrence.

CONCLUSIONS

The laparoscopic totally extraperitoneal approach allows inspection and repair of direct, indirect, femoral, and obturator hernias. This study found this procedure to be feasible, safe, and highly effective for the diagnosis and repair of obturator hernias.

Hodgkin’s lymphoma in Chinese migrants to British Columbia:a 25-year survey

BACKGROUND

Compared with the West, Hodgkin's lymphoma in Oriental countries is characterized by a lower incidence rate and a higher proportion of mixed cellularity histology. Both environmental and genetic factors may be involved.

PATIENTS AND METHODS

The incidence and pattern of pathology of Hodgkin's lymphoma in the migrant Chinese population (0.4 million) in British Columbia (population 3.2 million) were studied. From a computerized database, all Hodgkin's lymphoma cases diagnosed in British Columbia from 1970 to 1997 were identified. Chinese descent was determined using patient surname by standard methodology and verified from the treatment record or by patient interview. The corresponding figures from the Chinese population in Hong Kong were used for comparison. For incidence rates, the age-specific incidence of Hodgkin's lymphoma in Hong Kong was obtained from the government cancer registry. For comparison of histology subtypes, 200 Hodgkin's lymphoma records from a Hong Kong regional referral center for the same time period were reviewed. Crude and age-standardized incidence rates were calculated by 5-year intervals in terms of age and calendar year, and relative rates were compared between the three populations.

RESULTS

From 1970 to 1997, Hodgkin's lymphoma was diagnosed in 34 Chinese patients in BC, with 24 cases diagnosed from 1970 to 1994. Thus, the crude and age-adjusted incidence rates from 1970 to 1994 were 0.91 and 1.14 per 100,000 per year in the British Columbia Chinese migrant population. Within the same period, 1862 cases of Hodgkin's lymphoma were diagnosed in British Columbia, giving a provincial background crude and age-adjusted incidence rates of 5.2 and 4.87 per 100,000 per year. The number of cases in the Hong Kong Chinese population (1970-1994) was 404, giving crude and age-adjusted incidence rates of 0.32 and 0.31 per 100,000 per year, respectively. Corrected for age and calendar year trends, the observed 25-year incidence of Hodgkin's lymphoma in British Columbia Chinese was significantly lower than expected from the British Columbia background population [24 observed versus 71 expected cases; standardized incidence ratio (SIR) = 0.34; 90% confidence interval (CI) 0.24-0.48; P <0.0001]. On the other hand, it is higher than that expected by extrapolating from the Hong Kong Chinese population (24 observed versus 8.5 expected cases; SIR = 2.81; 90% CI 1.94-3.95; P <0.0001). The difference is mainly accounted for by young patients with nodular sclerosis type disease in the migrant population.

CONCLUSIONS

Although any conclusion about the impact of migration on Hodgkin's lymphoma incidence and types in the Chinese population must be considered tentative due to the small number of observed cases and confounding variables such as age, changing diagnostic standards and secular trends in Hodgkin's lymphoma rates, our data demonstrate a tendency for the Chinese population of British Columbia to take on a Western pattern of Hodgkin's lymphoma. This observation provides additional evidence that both genetic and environmental influences play a role in the pathogenesis of this lymphoma, and that environmental factors can exert their influence over a relatively short period of time.

Investigating a possible cause of mesh migration during totally extraperitoneal (TEP) repair

BACKGROUND

In experienced hands, laparoscopic inguinal hernia repair has a low rate of recurrence, but it still can recur, and a number of reasons for this have been identified. In published studies, the majority of such cases seem to result from inadequate dissection leading to missed hernias or suboptimal mesh placement. But even with adequate dissection and proper placement of a sufficiently large mesh, recurrence sometimes happens. A number of investigators have cited mesh migration or dislocation as a possible cause, and this study examined how hip flexion affects the position of newly placed meshes and staples in totally extraperitoneal (TEP) repair of inguinal hernia.

METHODS

After completion of the dissection and reduction of discovered hernias, a 15 x 15-cm polypropylene mesh was placed either unilaterally or bilaterally, as indicated. The preperitoneal space then was desufflated. The operating table, in an extended -20 degrees position during surgery, was placed in a 90 degrees position for approximately 15 s. After reinsufflation, the possibility of mesh migration and folding was investigated. Finally, the mesh was stapled, the table again extended and flexed, and the possibility of mesh migration and staple dislodgement investigated once more.

RESULTS

The mesh did not migrate or become displaced from any potential hernia area, nor did any of the staples become dislodged.

CONCLUSIONS

Concern about mesh migration attributable to patients sitting up immediately after surgery appears to be unfounded, at least according to the findings for the current, small, simulated study group.

Treatment of postrenal transplantation lymphoproliferative disease manifesting as plasmacytoma with nonmyeloablative hematopoietic stem cell transplantation from the same kidney donor

Posttransplantation lymphoproliferative disease (PTLD) presenting as an Epstein-Barr-virus (EBV)-related nasal plasmacytoma developed in a renal-allograft recipient 13 years after transplantation. Systemic dissemination occurred despite immunosuppression withdrawal, surgery, irradiation, and chemotherapy. A nonmyeloablative hematopoietic-stem-cell-transplantation (HSCT) with peripheral blood HSC from the kidney donor was performed. With the onset of graft-versus-host disease, resolution of the systemic disease was demonstrated clinically and molecularly by serial quantification of plasma EBV-DNA. Isolated relapse occurred in the central nervous system (CNS), a known tumour sanctuary site, ultimately leading to death. Nonmyeloablative HSCT might be considered a cellular therapy for PTLD, but possible CNS relapse must be effectively tackled.

Primary B-cell lymphoma and lymphoma-like lesions of the uterine cervix

We present three patients with atypical lymphoid cells on cervical smear screening, with diffuse large-cell B-cell lymphoma diagnosed by morphology on cervical biopsy. One patient with extensive pelvic disease was treated with chemotherapy and radiotherapy and remained in remission 8 years later. Two patients with presumed stage 1E lesions showed spontaneous regression on repeat cervical biopsy, despite light chain restriction and clonal immunoglobulin gene rearrangement. They are without recurrent malignancy 1 and 5 years after their initial diagnosis. The presence of malignant looking lymphoid cells on cervical smear should be investigated by repeated colposcopic biopsies. The reason for the highly skewed atypical B-cell lymphoproliferation in lymphoma-like lesions of the cervix is unknown. With early stage, nonbulky cervical lymphoma in an otherwise healthy patient, a cone biopsy is advised. A number of these lesions may regress even when clonal populations are detected.

Chronic T-cell lymphoproliferative disease expressing natural killer cell receptors: clinicopathological and molecular features

The frequency and clinicopathological significance of the expression of natural killer cell receptors (NKRs) in T-cell malignancies remain undefined. A 71-year-old man presented with leukocytosis, generalized lymphoadenopathy, and hepatosplenomegaly. Bone marrow and lymph node biopsies showed a T-cell lymphoproliferative disease expressing NKRs (CD2(+), CD3(+), CD4(+), CD5(+), CD7(+), CD8(-), CD56(-), CD94(+), CD158a(+), CD158b(+), CD161(-), p70(-), TCRalphabeta(1), TCRgammadelta(2), TIA-1(-)). An abnormal clone, 46,Y,add(X)(p14),der(1)t(1;6)(p33;p21),t(7;12)(p10;q10), was found on conventional karyotyping. Comparative genomic hybridization confirmed these findings, and showed a deletion of 12p that was not apparent on karyotyping. Clinically, the disease remained indolent and responded transiently to purine analogs but not to intensive chemotherapy. Peripheral T-cell lymphoproliferative disease of CD4(+)alphabeta(1)NKR(+) phenotype is hitherto undescribed. The issues of whether this case was derived from transformation of a rare T-cell subtype or represented aberrant T-cell expression of NK-cell antigens, and the clinicopathologic significance of these T-cell neoplasms warrant further studies.

Is MRI more accurate than CT in estimating the real size of adrenal tumours?

BACKGROUND

The size of adrenal tumour plays an important role in the indications for surgical excision of non-functioning adrenal tumours and in selecting the best surgical approach. Computed tomography (CT) has been reported to underestimate the real size of adrenal lesions. The accuracy of magnetic resonance imaging (MRI) in predicting the true tumour size has not been previously investigated. The present retrospective study investigates the accuracy of MRI and CT in the pre-operative determination of true adrenal tumour size.

METHODS

The medical records of 65 patients who underwent adrenalectomy for an adrenal mass were reviewed. The size of adrenal tumours as determined by pre-operative MRI and/or CT was compared with the "true" histopathological size. The impact of histological diagnosis on size estimation was also investigated.

RESULTS

The median age at diagnosis was 42 years (range 1-82 years) and more patients were female (60%). Five patients had bilateral adrenalectomy, thus giving rise to 70 adrenal specimens. The histopathological size of adrenal tumours ranged from 0.9 to 26 cm with a mean of 5.96 cm and a median of 4.70 cm. For tumours larger than 3 cm, MRI significantly underestimated the real tumour size by 20% (P<0.001). CT also underestimated the size of such tumours by 18.1% (P<0.003). Adrenal phaeochromocytomas were consistently underestimated by both modalities.

CONCLUSIONS

MRI and CT significantly underestimated the true size of adrenal tumours larger than 3 cm by 20% and 18%, respectively. Surgeons and endocrinologists should interpret the pre-operative size of adrenal lesions with caution.

Primary CD56 positive lymphomas of the gastrointestinal tract

BACKGROUND

Primary CD56 positive lymphoma of the gastrointestinal (GI) tract is rare. Genotypically, these tumors can be classified into natural killer (NK)-like T-cell lymphoma or NK cell lymphoma by the presence or absence of T-cell receptor (TCR) gene rearrangement. However, they have a considerable degree of morphologic and immunophenotypic overlap, making a definitive diagnosis difficult.

METHODS

The clinicopathologic features of three patients with primary CD56 positive lymphoma of the small and large bowel are presented. This is followed by a review of the English literature from 1966 to the present.

RESULTS

All patients had CD56 positive/CD3epsilon positive disease on paraffin section. Two patients were positive for Epstein-Barr virus-encoded early nuclear RNAs (EBER) according to in situ histochemistry results and were negative for TCR gene rearrangement, consistent with primary NK lymphoma of the GI tract. The other patient was EBER negative with rearranged TCR, consistent with NK-like T-cell lymphoma. There was no clinical or histologic evidence of enteropathy in any of the patients. The major presenting symptoms included fever, weight loss, and intestinal perforation. All patients died between 1 week and 6 months after diagnosis despite undergoing surgery and intensive chemotherapy.

CONCLUSIONS

These results, together with a literature review, suggest that primary NK cell lymphoma of the GI tract may be considered a distinct clinicopathologic entity. Both primary NK and NK-like T-cell lymphoma pursue an aggressive clinical course. EBER and TCR gene rearrangement are useful in distinguishing NK cell lymphoma from NK-like T-cell lymphoma, particularly when frozen tissue is not available for immunophenotyping.

Predictors of positive margins after local excision of ductal carcinoma in situ

BACKGROUND

This study aimed to examine the association between clinicopathologic parameters and positive margins in women with ductal carcinoma in situ (DCIS) treated by breast-conserving surgery (BCS).

METHODS

We retrospectively reviewed the clinical, radiologic, and pathologic data of 100 women who had undergone BCS for DCIS in our center.

RESULTS

Sixty-seven percent of patients presented via breast screening and 55% of all cases were diagnosed preoperatively on fine needle aspiration cytology ([FNAC] ie, C5). Overall, 45% of patients had clear margins after initial local excision. Positive margins showed a nonsignificant trend of association with distribution of microcalcifications (MCC), nonconsultant operating surgeon, inconclusive preoperative FNAC, presence of necrosis, and low specimen weight. There was a highly significant association between low grade DCIS (P = 0.003) and incomplete excision. There was no significant association with age, associated invasive focus, morphology of MCC, or with mode of presentation.

CONCLUSION

Positive margins after local excision of DCIS are significantly associated with low nuclear grade, and preoperative determination of nuclear grade by core biopsy may have surgical implications.

Primary hepatic lymphoma

We report the histologic and CT imaging findings of a patient with primary Burkitt's lymphoma of the liver. She presented with a massive, painless abdominal mass. The tumor responded to chemotherapy but the patient died of neutropenic sepsis.

Aggressive subcutaneous panniculitis-like T-cell lymphoma: complete remission with fludarabine, mitoxantrone and dexamethasone

Subcutaneous panniculitis-like T-cell lymphoma (SCPTCL) is a rare cutaneous T-cell lymphoma. The optimal treatment of this disease is undefined. A 36-year-old woman presented with swinging pyrexia, weight loss and disseminated SCPTCL involving her limbs and trunk. Typical histological features of panniculitic infiltration with rimming of fat cells and sparing of the dermis and epidermis were seen. Immunophenotyping confirmed a CD8+ cytotoxic T-cell phenotype. The patient was successfully treated with a combination of fludarabine, mitoxantrone and dexamethasone (FND), and has remained in remission 15 months after cessation of treatment. FND may be an effective regimen for aggressive SCPTCL.

Hodgkin's disease with primary manifestation in the liver

We describe a patient with HD presenting with hepatomegaly and impaired liver function and discuss the differential diagnosis and histologic diagnosis of HD in the liver.

Cytogenetic characterization of childhood hepatoblastoma

We describe the cytogenetic abnormalities in two cases of childhood hepatoblastoma. The first case was of fetal histology with squamous metaplasia, and cytogenetic study showed an add(5)(q31). Although an association between hepatoblastoma and familial adenomatous polyposis is recognized, the breakpoint in this case is distal to 5q21 and most probably does not involve the APC gene at that location. The second case was of macrotrabecular histology, and cytogenetic study showed an unbalanced translocation in the form of der(4)t(1;4)(q12;q34) in a hyperdiploid clone. Including our case, der(4)t(1;4)(q12;q34) has been recognized in four cases of hepatoblastoma, and it may be the first recurrent translocation in this tumor. Understanding the molecular mechanism and clinical significance of this translocation awaits analysis of more cases.

Is dissection of the internerve tissue during axillary lymphadenectomy for breast cancer necessary?

AIMS

The study evaluates the necessity of dissecting the tissue between the long thoracic and thoracodorsal nerves (internerve tissue) during axillary dissection in breast cancer surgery. By reviewing the lymph node yield and the metastatic rate in the internerve tissue, we examine whether the internerve tissue could be left in situ to minimize the risk of nerve injury.

METHODS

A prospective study was conducted on 30 consecutive women undergoing axillary lymphadenectomy for breast cancer. The internerve tissue remaining was excised separately after a routine axillary dissection and was examined by the same pathologist.

RESULTS

Twenty (67%) of 30 internerve specimens contained lymph nodes; the internerve nodes were positive for carcinoma in three cases (10%). In one case the lymph node in the internerve tissue was the only metastatic node in the axilla.

CONCLUSIONS

There is a significant incidence of lymph nodes (67%) and axillary node metastases (10%) in the tissue lying between the long thoracic and thoracodorsal nerves. Therefore excision of this internerve tissue is strongly recommended in order to optimize decision making regarding adjuvant treatment and oucome in women with operable breast cancer.

Clinical significance of telomerase activity in the non-cancerous epithelial region of oesophageal squamous cell carcinoma

Treatment of gallbladder cancer by radical resection

A. A. Riaz, A. M. Isla, Department of General Surgery, Imperial College of Medicine, Hammersmith Hospital Campus, London W12 0TS, UK

Authors' reply : T. Todoroki, Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, Tennodai, Tsukuba-shi 305-8575, Japan

Clinical significance of telomerase activity in the non-cancerous epithelial region of oesophageal squamous cell carcinoma

K. Mokbel, C. Choy, A. Engledow. Department of Surgical Oncology, St Bartholomew's Hospital, London EC1A 7BE, UK

Authors' reply : K. Koyanagi, S. Ozawa, N. Ando, H. Takeuchi, M. Ueda, M. Kitajima, Department of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, USA

Colonic motility is abnormal before surgery for rectal prolapse

A. Macdonald, Department of Surgery, Monklands Hospital, Airdrie ML6 0JS, UK

Authors' reply : A. J. Brown, A. F. Horgan, J.H. Anderson, R. F. McKee, I.G. Finlay, Department of Coloproctology, Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, UK

Isolated uterine relapse of nasal T/Nk cell lymphoma

A case of isolated uterine relapse of nasal T/NK cell lymphoma is reported. A 47-year old lady developed menstrual symptoms a year after attaining complete remission from her nasal T/NK cell lymphoma. Endometrial tissue showed characteristic zonal necrosis, angiocentricity and infiltration by lymphoma cells that were positive for both the characteristic immunopheotypic profile of T/NK cell (CD2+, surface CD3-, cytoplasmic CD3 [CD3epsilon]+ and CD56+) and EBER.

Fine needle aspiration cytology of epithelial-myoepithelial carcinoma of salivary glands. A report of three cases

BACKGROUND

Epithelial-myoepithelial carcinoma is a rare, low grade malignant tumor of the salivary glands. Histologically, it has a biphasic cellular composition and exhibits a high degree of differentiation. The fine needle aspiration cytology of this rare tumor is rarely described in the literature.

CASES

We report the fine needle aspiration cytology of three epithelial-myoepithelial carcinomas, arising in the right parotid, left parotid and minor salivary gland of the hard palate. Cytology showed a biphasic population consisting of cells of ductal epithelial and myoepithelial origin arranged in small clusters and sheets. The myoepithelial cells had small, uniform nuclei; ample, clear cytoplasm and distinct cell borders, while the ductal epithelial cells had larger, mildly pleomorphic nuclei and scanty cytoplasm. These ductal cells tended to form tubules among background sheets of clear myoepithelial cells. This feature, if present, was an important diagnostic clue. Hyaline material surrounding cell clusters and focal adenoid cystic carcinoma-like areas with orangeophilic globules were also not uncommon.

CONCLUSION

While the cytologic appearance of epithelial-myoepithelial carcinoma may closely mimic that of other salivary gland tumors, such as adenoid cystic carcinoma, pleomorphic adenoma and basal cell adenoma, certain peculiar cytologic features may allow a distinction to be made on fine needle aspiration biopsy.

Primary anaplastic large cell lymphoma of skeletal muscle presenting with compartment syndrome

We describe a patient with primary anaplastic large cell lymphoma of the forearm presenting with compartment syndrome. Urgent decompression fasciotomy and combination chemotherapy resulted in durable remission status. This is followed by a review of primary skeletal muscle lymphoma in the English literature.

Desmoplastic malignant melanoma on the buttock of an 18-year-old girl: differentiation from desmoplastic nevus

Melanocytic proliferation in young people may sometimes pose a diagnostic dilemma. This is particularly so when a desmoplastic component is present. Because the two main differential diagnoses, desmoplastic malignant melanoma and desmoplastic Spitz nevus, share some morphologic features, the diagnosis of desmoplastic malignant melanoma may be overlooked. Distinction between the two is important because they show completely different biological behavior. The age of patient, site of lesion, histologic findings of melanocytic atypia, neurotropism, mitosis, and maturation help to distinguish the two entities. We report a case of desmoplastic malignant melanoma occurring in the buttock of an 18-year-old Chinese girl. Histologically, it had typical features of desmoplastic malignant melanoma with junctional melanocytic atypia and prominent neurotropism. Clinical and histologic differences between desmoplastic malignant melanoma and desmoplastic Spitz nevus are reviewed. We conclude that although desmoplastic Spitz nevus occurs much more commonly in adolescents, desmoplastic malignant melanoma can occur in this age group and even in non-sunexposed skin. Microscopic findings remain the mainstay that guides the final diagnosis.

Neutrophils in chronic active hepatitis type B

Liver biopsy specimens from 95 patients with chronic active hepatitis type B were studied to define the incidence of portal tract and/or septal neutrophilic infiltration and its relationship with other morphohistologic factors and with liver function tests. Neutrophils were identified in the portal tracts and fibrous septa in 59 cases (62%), among which 19 cases (20%) showed four or more neutrophils per high-power field. Significant neutrophilic infiltration (greater than 6 per high-power field) was observed in only seven (7.4%) of 95 cases. Multiple-regression analysis revealed that neutrophilic infiltration was significantly associated with marginal duct proliferation, bile duct proliferation, and an elevated alanine aminotransferase level. Applying a partial correlation coefficient, it was shown that neutrophilic infiltration was not related to piecemeal necrosis after controlling for marginal duct proliferation or bile duct proliferation. The findings suggest that in chronic active hepatitis B, while piecemeal necrosis interferes with bile flow at the limiting plate region, marginal duct and bile duct proliferations follow and lead to the accumulation of neutrophils.

Pathology of motor neurons in accelerated hereditary canine spinal muscular atrophy

Hereditary canine spinal muscular atrophy is a dominantly inherited lower motor neuron disease with three phenotypic variants: accelerated, intermediate, and chronic. Pups with the accelerated disease develop weakness by 1.5 months and are quadriparetic by 3 months. The motor neurons of selected brainstem nuclei and ventral horn of the spinal cord are characterized by chromatolysis and by neurofibrillary abnormalities in perikarya, dendrites, and, most strikingly, proximal axons. Dendrites and axons are segmentally enlarged by accumulations of maloriented fascicles of neurofilaments; the axonal swelling usually involve internodes and are delimited by the initial segment or nodes of Ranvier. The disorganized neurofilaments appear to entrap mitochondria and other particular organelles. We have hypothesized that the neurofibrillary changes in this genetic disorder in dogs is associated with an abnormality of the cytoskeletal constituents of motor neurons. Hereditary canine spinal muscular atrophy shows features in common with human motor neuron disease.

Diffuse cystitis glandularis. Associated with adenocarcinomatous change

Although cystitis glandularis has been considered a premalignant lesion, the instance of cystitis glandularis progression to adenocarcinoma or cystitis glandularis associated with adenocarcinomatous change is rare. This article includes 4 cases of neurogenic bladder with urinary diversion for different periods of time. In the first case with ureterocutaneostomy for twenty-five years diffuse cystitis glandularis with multifocal adneocarcinomatous change developed. The second case with suprapubic cystostomy for twenty-two years had diffuse cystitis glandularis of gastrointestinal type without evidence of malignancy. The other 2 cases with suprapubic cystostomy for merely ten years showed only mild to moderate cystitis glandularis and chronic cystitis with squamous metaplasia, respectively. The extent of cystitis glandularis appeared to correlate with the duration of urinary stasis. Ureterocutaneostomy rendered constant infection of the urinary bladder of the first case because of inadequate drainage. Thus, we assume that the intensity of the infection with a toxic product and virulence of organism may be responsible for the development of adenocarcinoma in this patient. Cystitis glandularis, especially diffuse type, can undergo malignant degeneration under constant irritation, but it is a long-term process.