Sphingobacteriumsoli sp. nov., isolated from soil

A Gram-stain-negative, strictly aerobic, rod-shaped, non-motile, non-spore-forming bacterial strain, designated YIM X0211T, was isolated from a soil sample of Shiling County, Yunnan Province, south-west China. The new isolate was characterized taxonomically by using a polyphasic approach. The strain grew optimally at 30 °C, at pH 7.0 and with 0-3 % (w/v) NaCl. It was positive for catalase and oxidase but negative for H2S production. Comparative 16S rRNA gene sequence analysis showed that strain YIM X0211T fell within the cluster comprising Sphingobacterium species and clustered with Sphingobacterium mizutaii DSM 11724T (97.93 % similarity). The G+C content of the genomic DNA was 41.2 mol%. The predominant respiratory quinone was menaquinone MK-7. The major fatty acids were iso-C15 : 0 2-OH, iso-C17 : 0 3-OH and summed feature 3 (C16 : 1ω7c/C16 : 1ω6c). The polar lipids consisted of phosphatidylethanolamine, sphingolipid, and several unknown phospholipids or lipids. The DNA-DNA hybridization value between strain YIM X0211T and S. mizutaii DSM 11724T was 42.3±0.4 %, which is below the 70 % limit for species delineation. These chemotaxonomic data supported the affiliation of strain YIM X0211T to the genus Sphingobacterium. Based on the recorded phenotypic and genotypic characteristics, it is determined that the isolate represents a novel species of the genus Sphingobacterium, for which the name Sphingobacterium soli sp. nov. is proposed. The type strain is YIM X0211T (=KCTC 42696T=CGMCC 1.15966T).

[Surveillance on the epidemiological and etiological characteristics of hand-foot-mouth disease during the outbreaks in three cities of Jiangsu province, 2012-2015]

Objective: To analyze the epidemiological and etiological characteristics through monitoring the outbreaks of hand-foot-mouth disease (HFMD), in three cities of Jiangsu province from 2012 to 2015 and to provide evidence for prevention and control of the disease. Methods: Data related to cases of HFMD during the outbreaks was collected through active surveillance programs in three cities of Jiangsu province, under the guidelines of clusters and outbreaks of HFMD (2012 edition HFMD). Features related to clusters and outbreaks of the disease were identified according to the real-time RT-PCR detection. Descriptive analysis was conducted to understand the type/subtype of HFMD virus and time, area, place and extent of the outbreaks. Logistic regression was used to explore the influencing factors. Results: From 2012 to 2015, a total of 1 425 HFMD epidemics, including 1 314 clusters and 111 outbreaks were reported. Two incidence peaks were observed each year, between March and June, as well as between September and December, accounting for 58.18% (829/1 425), 33.68% (480/1 425), respectively. Most HFMD clusters and outbreaks were reported in Wuxi city, accounting for 59.30% (845/1 425) of the total. Most HFMD clusters and outbreaks happened in kindergartens, accounting for 68.63% (978/1 425) of the total. A total of 931 HFMD clusters and outbreaks were confirmed under laboratory findings. The main pathogens were Entervirus type 71 (EV71) in 2013 and Coxsackie A16 (Cox A16) in 2015, respectively, while both EV71 and Cox A16 were predominant in 2012 and 2014. With multivariate backward conditional regression, surrounding environment was identified as important risk factor associated with the attack rate. Health condition of the environment was quite good, with low attack rates (middle vs. bad: OR=0.150, 95% CI: 0.034-0.667; good vs. bad: OR=0.072, 95%CI: 0.016-0.317). Time between the onset of index patient and the reporting of HFMD clusters or outbreaks was important in the control program of HFMD epidemics (4-7 d vs. 1-3 d: OR=3.452, 95%CI: 2.293-5.198; 8 d vs. 1-3 d: OR=12.108, 95%CI: 7.767-18.763). Conclusions: The clusters and outbreaks of HFMD happened in Jiangsu province showed an obvious feature of seasonality. The predominant types or subtypes of the virus varied in different years. Kindergartens were the hard-hit places of HFMD clusters and outbreaks. Timely report of the disease appeared the key point regarding the control of HFMD clusters and outbreaks.

The integrated spintronic functionalities of an individual high-spin state spin-crossover molecule between graphene nanoribbon electrodes

The spin-polarized transport properties of a high-spin-state spin-crossover molecular junction with zigzag-edge graphene nanoribbon electrodes have been studied using density functional theory combined with the nonequilibrium Green's-function formalism. The molecular junction presents integrated spintronic functionalities such as negative differential resistance behavior, spin filter and the spin rectifying effect, associated with the giant magnetoresistance effect by tuning the external magnetic field. Furthermore, the transport properties are almost unaffected by the electrode temperature. The microscopic mechanism of these functionalities is discussed. These results represent a step toward multifunctional molecular spintronic devices on the level of the individual spin-crossover molecule.

MICA*002:04: a new allele identified by sequence-based typing in a Chinese individual

The novel MICA*002:04 allele differs from MICA*002:01 by a single mutation at position 486 (C>A) in codon 20 (GCC>GCA) in exon 3.

FIGO stage III and IV uterine papillary serous carcinoma: impact of residual disease on survival

The objective of this study was to assess the impact of surgical cytoreduction on the survival of patients with uterine papillary serous carcinoma (UPSC). Patients added to the institutional tumor registries between January 1980 and September 2001 with the diagnosis of UPSC were reviewed. The records of 43 patients who underwent surgical cytoreduction for FIGO stage III and IV disease were reviewed. The median survival of UPSC patients with microscopic residual disease was significantly improved compared to those with macroscopic residual disease following primary surgical cytoreduction. We conclude that primary surgical cytoreduction resulting in microscopic residual disease is associated with an improvement in recurrence-free survival and overall survival in women with UPSC.

E2 and not P4 increases NO release from NANC nerves of the gastrointestinal tract: implications in pregnancy

In women, during pregnancy, there is decreased motility of the gastrointestinal tract leading to a delay in gastric emptying and an increase in colonic transit time. Whether the rise in estradiol (E2) or progesterone (P4) is responsible for this effect is controversial. As the nitrergic component of the nonadrenergic, noncholinergic (NANC) nerves is responsible for modulating gastrointestinal motility in vivo, the purpose of this study was to evaluate whether the increased release of nitric oxide (NO) from the nitrergic component of the NANC nerves innervating the gastric fundus and colon that occurs during late pregnancy in rats is mediated by E2 or P4. Ovariectomized rats treated with E2 or P4 alone or in combination were used for our studies. We also wanted to assess the cellular and molecular mechanisms involved. The NANC activity was studied by assessing changes in tone after application of electric field stimulation (EFS). The role of NO was determined by observing the effects of EFS in the presence and absence of the NO synthase (NOS) inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME) and the reversibility of the effects of L-NAME by L-arginine. Our studies indicated that there was increased magnitude of relaxation of isolated strips of rat gastric fundus and rat colon after application of EFS to tissues obtained from animals treated with E2 alone or a combination of E2 + P4 but not from those treated with P4 alone. L-NAME attenuated relaxation responses in E2- and E2 + P4-treated animals. To elucidate whether the increased NO release may be due to an increase in neuronal NOS (nNOS) protein, we used both Western blot analysis and immunohistochemistry. We also used RT-PCR to determine whether there was an increase in nNOS mRNA after treatment with sex steroids. In nonpregnant animals, nNOS was detected by Western blot in the fundus and the colon and was barely detectable in the ileum. In pregnancy, there was an increase in nNOS in both the gastric fundus and the colon. The nNOS protein was also increased in ovariectomized animals treated with either E2 alone or E2 + P4 but not P4 alone when compared with ovariectomized animals receiving vehicle. Our results indicated that there was an increase in nNOS protein that was localized to the neurons of the myenteric plexus in the gastric fundus and colon in E2- and E2 + P4-treated animals, but this increase was not observed in animals treated with P4 alone. This increase in nNOS protein was accompanied by an increase in nNOS mRNA. These results suggest the possibility that E2, rather than P4, may be responsible for the delay in gastric emptying and increase in colonic transit time observed in pregnancy.

Morphological study of cultured cardiac ganglionic neurons from different postnatal stages of rats

This study sought to establish a culture model of cardiac ganglia (CG) neurons of the Sprague-Dawley (SD) rat which could by used to study the distinct characteristics of CG neurons. After culturing, the morphology and immunocytochemistry of CG neurons obtained on different days after birth were compared. Samples of CG neurons were taken from the posterior atrial wall of rats aged 7, 14, 21 and 40 postnatal days (designated as P7, P14, P21 and P40, respectively). During 3-6 days of culture, the morphological changes of the cultured neurons were monitored using a light microscope. Immunocytochemical staining of the neurofilaments (NF-L, -M and -H) was performed to identify the CG neurons and the changes in morphology. The differences in size of the CG soma of each culture were compared by morphometry. Frozen sections of CG neurons were used as the in vivo control of the above experiments. The results showed that the rate of growth in size of the CG soma was highest in the P7 group, and was slower after weaning (21 days after birth). Cultured neurons were categorized into unipolar-like (Type I), multipolar-like (Type II), and bipolar-like (Type III) based on their morphological characteristics. In NF immuocytochemical staining, there were strong responses to NF-H and NF-M in all cultures, but not to NF-L. More specifically, responses to NF-H were mainly observed in perikaryons and neurites, whereas the responses to NF-M were mainly in perikaryons. The present study has established a culture system for cardiac ganglia neurons of SD rats. Our results show that the intracardiac neurons were still developing in their somata and the processes and that various responses to different antibodies of NF for CG neurons occurred in different postnatal stages in rats.

Hemangiopericytoma of the head and neck

PURPOSE

To report a series of patients with hemangiopericytoma (HP) of the head and neck, to review pathological features of these tumors, and to discuss management options.

MATERIALS AND METHODS

A retrospective review of the medical records at the University of California, Los Angeles (UCLA) Medical Center in Los Angeles, CA, was done in order to identify those patients with primary HP of the head and neck, including soft tissue and mucosal sites.

RESULTS

Ten patients with HP of the head and neck were identified. There was an equal sex distribution and an average age of 36 (range 10-65). Seven of the tumors arose from soft tissue sites in the head and neck, and the remaining 3 arose from the mucosa. All patients underwent wide excision of the primary lesion with a local recurrence rate of 40%. Thirty percent of patients developed metastatic lung disease 0 to 8 years after initial diagnosis. Each patient who developed metastatic disease had abundant mitoses on pathological review compared with rare or absent mitoses in the lesions that took a more benign course.

CONCLUSIONS

Pathological appearance of resected HP is predictive of later metastatic potential. Long-term follow-up is necessary in patients even after radical resection because recurrence or metastasis may be delayed by many years.

Treatment results of unresected or partially resected desmoid tumors

The authors compare the progression-free survival of patients with unresected or partially resected desmoid tumors treated with radiotherapy with those not given radiotherapy. A retrospective analysis and pathologic review was performed on 14 patients treated at the University of California Los Angeles School of Medicine from 1965 through 1992. Median follow-up was 6 years. The 6-year progression-free survival for irradiated patients was 100%, compared with 50% for those not irradiated (p = 0.04). Of the seven patients irradiated, only two had a complete response and one had a partial response. There was no difference in disease-specific survival between patients irradiated and those not irradiated, because only 1 of 14 patients died of desmoid tumor progression, which caused airway obstruction. This data suggest that radiotherapy may improve the progression-free survival of patients with unresected or partially resected desmoid tumor; however, the number of patients in this series is small. Most patients did not have a complete response to radiotherapy. For patients with tumor adjacent to the airway in the neck or upper thorax, the authors recommend radiotherapy because of the potential for mortality. Otherwise, because tumor progression rarely causes death, one must consider whether the morbidity of treatment would outweigh the morbidity of disease progression.

Transvaginal sonographic evaluation of multiple peripherally distributed echogenic foci of the ovary: prevalence and histologic correlation

OBJECTIVE

Our aim was to determine the prevalence, histopathologic correlation, and clinical significance of multiple peripherally distributed echogenic foci seen within ovaries on transvaginal sonography.

SUBJECTS AND METHODS

Transvaginal sonograms of 264 ovaries in 135 patients were prospectively analyzed for the presence of peripheral echogenic foci that were then characterized as linear, punctate, or globular. Previous examinations, when available, were reviewed for this sonographic feature, and the time interval between studies was recorded as a measure of stability. Sonograms were correlated with available surgical specimens in six patients, five of whom underwent hysterectomy and bilateral oophorectomy and the remaining patient who underwent laparoscopic ovarian wedge biopsy.

RESULTS

Multiple peripheral echogenic foci were common and were found in 66 patients (49%) and 97 ovaries (37%). The punctate pattern was seen in 63 (95%) of 66 patients. The linear and globular patterns were present in only three and four patients, respectively. These echogenic foci were found on previous examinations in 18 patients. No suspicious sonographic features were seen in the ovaries of any of these patients. Histologic evaluation revealed multiple superficial epithelial inclusion cysts and associated psammomatous calcifications in all five patients who underwent bilateral oophorectomy. An additional finding in one of these patients was extensive endosalpingiosis.

CONCLUSION

Multiple peripheral echogenic foci involving the ovaries is a common incidental finding on routine transvaginal sonography of the pelvis. Our data suggest that this sonographic finding represents psammomatous calcifications associated with superficial epithelial inclusion cysts.

The role of adjuvant radiotherapy in the treatment of resectable desmoid tumors

PURPOSE

Desmoid tumors have a high propensity for local recurrence with surgical resection. There are many reports describing good responses of desmoid tumors to irradiation, but none have clearly established the indications for adjuvant radiotherapy in treating resectable desmoid tumors.

METHODS AND MATERIALS

A retrospective analysis was performed on 61 patients with resectable desmoid tumor(s) who were treated at our institution from 1965 to February of 1992. Five patients had multifocal disease and are analyzed separately. Fifty-six patients had unifocal disease, of which 34 had positive surgical margins. Forty-five of the 56 patients with unifocal disease were treated with surgery alone, while 11 were treated with surgery plus adjuvant radiotherapy. Median follow-up was 6 years. Local control was measured from the last day of treatment, and all cases were reviewed by our Department of Pathology.

RESULTS

Multivariate analysis of the 56 patients with unifocal disease revealed that positive margins independently predicted for local recurrence (p < or = 0.01). Only 3 of 22 patients with clear margins experienced a local recurrence, with a 6-year actuarial local control of 85%. Multivariate analysis of the 34 patients with positive margins revealed that adjuvant radiotherapy independently predicted for improved local control (p = 0.01), and patients with recurrent disease had a slightly higher risk of local recurrence (p = 0.08). The 6-year actuarial local control determined by Kaplan-Meier for patients with unifocal disease and positive margins was 32% (+/-12%) with surgery alone, and 78% (+/-14%) with surgery plus adjuvant radiotherapy (p = 0.02). Subgroup analysis of the patients with positive margins and recurrent disease revealed that those treated with surgery alone had a 6-year actuarial local control of 0% vs. 80% for those treated with surgery plus radiotherapy (p < or = 0.01). Patients with positive margins and primary disease had a trend towards improved local control with adjuvant radiotherapy, but this was not statistically significant. None of the patients treated with radiotherapy developed serious complications or a secondary malignancy.

CONCLUSIONS

Margin status is the most important predictor of local recurrence for patients with resectable, unifocal desmoid tumor. Adjuvant radiotherapy is indicated in the treatment of patients with positive margins following wide excision of recurrent disease. The role of adjuvant radiotherapy in patients with positive margins following resection of primary disease is controversial, and should be based on a balanced discussion of the potential morbidity from radiotherapy compared to the potential morbidity of another local recurrence. Adjuvant radiotherapy is less likely to benefit those with clear margins due to the excellent results for these patients treated with surgery alone. The local control of desmoid tumor in the adjuvant setting is excellent with total doses ranging from 50-60 Gy, with acceptable morbidity. Field sizes should be generous to prevent marginal recurrences, and large volume MRIs of patients with extremity lesions should be used to identify those patients with multifocal disease.

Subglottic paraganglioma

Paragangliomas are uncommon neuroendocrine tumors. In the head and neck region they are most commonly associated with the carotid body, vagus nerve, jugulotympanic paraganglia, and occasionally the superior and inferior laryngeal paraganglia. Laryngeal paragangliomas and subglottic paragangliomas are rare. There have been nine reported cases in the English literature of subglottic paragangliomas. We present a case of this unusual lesion and discuss histologic characteristics and surgical treatment.

Angiolymphoid hyperplasia with eosinophilia and vascular tumors of the head and neck

PURPOSE

The clinicopathologic distinctions between angiolymphoid hyperplasia with eosinophilia (AHE) and vascular tumors are controversial. Some investigators believe that AHE is a variant of hemangioma, whereas others state that it is an inflammatory phenomenon. To better delineate the clinicopathologic entity of AHE and investigate the efficacy of various treatment regimens, we undertook a retrospective analysis of AHE and compared it with other angiomatous lesions treated at a tertiary referral center.

MATERIALS AND METHODS

We reviewed the histopathologic features of hemangioma, AHE, and angiosarcoma of the head and neck seen in 46 cases at University of California Los Angeles (UCLA) Medical Center between 1950 and 1992. Lesions were evaluated for presence of lymphoid and eosinophilic infiltration, type of endothelial cell, and pattern of vascular proliferation. Patient charts were also reviewed for clinical history and outcome.

RESULTS

The typical findings of AHE were present in 13 cases of conventional hemangioma and angiosarcoma. The clinical data of 8 AHE patients were also reviewed and a benign outcome was observed.

CONCLUSION

We propose that AHE represents an angiomatous neoplasm similar to the hemangioma but characterized by a marked reactive appearance. AHE may comprise part of a spectrum of vascular tumors with differences between lesions depending in part on host-mediated inflammatory and immune responses.

Angiosarcoma. A report of 67 patients and a review of the literature

BACKGROUND

Angiosarcomas (AS) are rare, aggressive tumors. Optimal treatment has not been well defined. The authors undertook a retrospective review of patients seen at their institution with the intent of identifying prognostic factors and optimal treatment strategies.

METHODS

Between 1955 and 1990, 67 patients with AS were seen at the University of California, at Los Angeles Medical Center. Follow-up ranged from 1 to 173 months with a median of 30 months.

RESULTS

The overall prognosis was poor. The actuarial 2- and 5-year disease free survivals (DFS) were 44% and 24%, respectively. Of 52 recurrences after primary treatment, 81% (42 of 52) had a component of local failure. Twenty-eight patients had developed distant metastases at last follow-up. Of patients who received surgery (S) and radiation therapy (RT), with or without chemotherapy (CT), 5-year actuarial DFS was 43%, compared with 17% for patients who underwent S +/- CT as initial treatment (P = 0.03). Only 9% of patients (1 of 11) treated with RT +/- CT were rendered free of disease.

CONCLUSIONS

Patients with AS usually present with high grade histology, and with multifocal disease. There is a propensity for both local recurrence and distant metastases. Our results and a review of the literature, suggest that S plus RT offers the best chance for long term control of this aggressive tumor. The role of CT remains undefined.

Loop electrosurgical excision in the peritoneal cavity. Preliminary experience with the rat model

OBJECTIVE

To evaluate a monopolar electrosurgical loop electrode designed for use at laparoscopy.

STUDY DESIGN

A pilot, observational study of cutting effectiveness followed by a nonrandomized comparative study of thermal injury associated with the loop electrode and CO2 vaporization in the rat model. The observer evaluating thermal injury was blind to the energy source used.

RESULTS

The loops cut most effectively with a continuous, sinusoidal, radiofrequency output at 40 W. The depth of coagulative necrosis was similar in the laser vaporization and loop excision groups of lesions when using outputs and power densities commonly attainable at laparoscopy. There was more necrotic debris in the lasered lesions.

CONCLUSION

While a randomized comparison will be necessary to clarify these results, electrosurgical loop electrodes seem to have a role in a number of gynecologic laparoscopic procedures.

Extranodal Rosai-Dorfman disease of the head and neck

Rosai-Dorfman disease is a rare, idiopathic, benign histiocytic proliferation usually seen in younger patients. Massive lymphadenopathy most commonly involves the cervical lymph nodes, with a predominant infiltration of sinusoidal histiocytes. Nearly half of the patients will have extranodal involvement, 75% occurring in sites in the head and neck. Three cases of extranodal Rosai-Dorfman disease of the head and neck involving the nose, paranasal sinuses, and parotid gland are presented. The clinical presentation, histologic characteristics, radiographic findings, and treatment of the disease are discussed. Because of the scarcity of cases, the clinical and histopathologic features of this disease may be overlooked. Familiarity with its relatively frequent clinical manifestations in the head and neck, as well as with the diagnostic histopathology, should preclude confusion with other disease entities.

Postirradiation sarcoma of the gynecologic tract. A report of 13 cases and a discussion of the risk of radiation-induced gynecologic malignancies

With improvement in survival after cancer treatment, it is becoming increasingly important to examine treatment-related morbidity and mortality. Sarcomas can develop within the irradiated field after radiation therapy (RT) for gynecologic malignancies. We undertook a study to assess the outcome after treatment of postirradiation sarcoma (PIS) of the gynecologic tract. In reviewing our data and the literature, we compare the absolute risk of PIS and other radiation-associated second malignant neoplasms (SMNs) with the mortality risk of surgery and general anesthesia. Between 1955 and 1987, 114 patients with uterine sarcomas were seen at the University of California, Los Angeles (UCLA), Medical Center. Thirteen had a prior history of RT. Conditions for which these patients received RT included choriocarcinoma (one), menorraghia (four), cervical cancer (six), and ovarian cancer (two). RT doses were known in six cases and ranged from 4,000 to 8,000 cGy. Latency time from RT to the development of PIS ranged from 3 to 30 years, with a median of 17 years. Twelve patients were treated with surgery or additional RT. Two patients remain alive 5 months and 57 months, respectively, following salvage therapy. Five-year disease-specific survival for all patients is 17%. From our data and a review of the literature, we estimate that the absolute risk of PIS with long-term follow-up ranges from 0.03 to 0.8%. Postirradiation sarcoma of the gynecologic tract is a relatively rate event associated with a poor prognosis. Mortality risks of radiation-associated SMN are similar to mortality risks of surgery and general anesthesia. Given the large number of patients with gynecologic malignancies who can be cured or palliated with RT, concern regarding radiation sarcomagenesis should not be a major factor influencing treatment decisions.

Extrinsic inhibitory innervation to rubral neurons in rat brain-stem slices

Synaptic connections between the neurons in the red nucleus (RN) and its extrinsic neurons were studied using rat brain-stem slices. Intracellular records were obtained from the RN neurons. Ipsilateral stimuli to areas in the dorsolateral mesencephalic reticular formation (DLMRF) or substantia nigra (SN) elicited monosynaptic hyperpolarizing postsynaptic potentials (PSPs) in about 95% of RN neurons recorded. The hyperpolarizing PSPs could be reversibly blocked by bicuculline, indicating that they were GABAA receptor-mediated-Cl(-)-inhibitory PSPs. The sites of most inhibitory synapses arising from DLMRF and SN are possibly located on the proximal half of the soma-dendritic membrane of RN neurons, according to the analysis of the IPSPs with Rall's model. In addition, tracing dyes were employed to examine the morphological pathways. After rhodamine B, a retrograde tracer, was applied to the RN in brain slices, the cell bodies of a number of neurons in DLMRF and SN were labeled. These labeled neurons were also immunopositive for glutamic acid decarboxylase (GAD) as revealed from double labeling with an anti-GAD antiserum. The anterograde tracer, tetramethylrhodamine dextran, was applied to the DLMRF or SN and taken up by many neurons in the areas. A portion of these cells extended their processes toward and terminated within the RN. Moreover, electron microscopic examination confirmed that the tetramethylrhodamine dextran-decorated synaptic terminals were present in the RN. The results indicate that the rubral neurons receive direct GABAA receptor-mediated inhibitory inputs from neurons in the DLMRF and SN, which may participate in modulation of rubral outputs.

Preoperative therapy for soft tissue sarcoma

Soft tissue sarcomas appear to be an ideal tumor type for delivering preoperative therapy. The rationale for preoperative therapy is that it is delivered to undisturbed tissue planes with well-oxygenated tissue. This is of great benefit for radiation therapy, because with new computed tomography scan treatment planning it is possible to completely delineate the tumor without surgical clips or postoperative hematoma (or both) obscuring the tumor margin.

Laryngeal dysplasia: epidemiology and treatment outcome

A retrospective analysis was undertaken of 65 patients with long-term follow-up for laryngeal squamous dysplasia. Based on the degree of dysplasia demonstrated on initial biopsy, 0 of 6 patients showing hyperkeratosis without dysplasia, 3 of 26 patients (12%) showing mild dysplasia, 5 of 15 patients (33%) showing moderate dysplasia, 4 of 9 patients (44%) showing severe dysplasia, and 1 of 9 patients (11%) showing carcinoma in situ eventually progressed to invasive carcinoma. An analysis was made of the impact of various treatment modalities in 33 patients demonstrating moderate dysplasia, severe dysplasia, or carcinoma in situ. Invasive carcinoma developed in 10 of 21 patients (48%) treated endoscopically and 0 of 12 patients treated by more aggressive therapy, including external beam radiotherapy, partial laryngectomy, or total laryngectomy. Of the patients in the endoscopic therapy group who developed invasive carcinoma, all were salvaged successfully. The overall rate of laryngeal preservation was 15 of 21 patients (71%) in the endoscopic treatment group and 11 of 12 patients (92%) in the aggressive treatment group. This difference is not statistically significant. We conclude that there is a moderately high rate of progression to invasive carcinoma in patients undergoing repeated endoscopic therapy for intraepithelial neoplasms of the larynx. However, with close, long-term follow-up, patients undergoing endoscopic therapy have an overall outcome similar to that in patients treated with partial laryngectomy or radiotherapy prior to developing invasive disease.

Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck

Although computed tomography and magnetic resonance imaging have contributed to the ability to identify metastatic disease in head and neck cancer, inadequacies in evaluating lymphadenopathy still exist. This study was undertaken to estimate the accuracy of radiological criteria used to detect cervical lymph node metastases. The morphological characteristics of 957 lymph nodes from 36 neck dissections from patients with squamous cell cancer were examined microscopically. A large number of malignant nodes were found to have diameters of less than 10 mm. Extranodal spread also occurred in a substantial percentage of smaller nodes. Because the present radiological criteria for assessing cervical lymph node status are based largely on size, findings indicate major limitations in the capabilities of detecting metastatic disease. New modalities to improve the staging of head and neck cancer are discussed.

Clinical and pathologic distinction between primary and metastatic mucosal melanoma of the head and neck

Metastatic mucosal melanoma is extremely rare. Only 0.6% to 9.3% of patients with cutaneous malignant melanoma will have metastases to the mucosa of the upper aerodigestive tract. The records of all patients with mucosal melanoma of the head and neck at the University of California, Los Angeles Medical Center during the past 30 years were reviewed. Patients with primary tumors were separated form those with metastatic involvement from a cutaneous primary site. These two groups were compared for differences in clinical symptoms, histopathologic findings, treatment, and survival characteristics. Frequent sites of metastatic involvement included the base of tongue and nasal cavity. These arose from a variety of cutaneous sites including the trunk and extremities and, in most instances, did not arise until 2 to 7 years after the initial cutaneous lesion. Most of those with metastases to the head and neck mucosa had disseminated disease. The histopathologic distinction between the two groups is described with photomicrographs. Junctional activity in the overlying or adjacent mucosa distinguishes primary mucosal melanoma from metastatic disease, in which the overlying mucosa is usually intact. This difference is useful in determining workup and treatment options. Aggressive surgical resection is suggested in treatment of primary melanomas, whereas surgery is at best palliative in those with metastatic disease.

Clinical and Pathologic Distinction between Primary and Metastatic Mucosal Melanoma of the Head and Neck

Metastatic mucosal melanoma is extremely rare. Only 0.6% to 9.3% of patients with cutaneous malignant melanoma will have metastases to the mucosa of the upper aerodigestive tract. The records of all patients with mucosal melanoma of the head and neck at the University of California, Los Angeles Medical Center during the past 30 years were reviewed. Patients with primary tumors were separated from those with metastatic involvement from a cutaneous primary site. These two groups were compared for differences in clinical symptoms, histopathologic findings, treatment, and survival characteristics. Frequent sites of metastatic involvement included the base of tongue and nasal cavity. These arose from a variety of cutaneous sites including the trunk and extremities and, in most instances, did not arise until 2 to 7 years after the initial cutaneous lesion. Most of those with metastases to the head and neck mucosa had disseminated disease. The histopathologic distinction between the two groups is described with photomicrographs. Junctional activity in the overlying or adjacent mucosa distinguishes primary mucosal melanoma from metastatic disease, in which the overlying mucosa is usually intact. This difference is useful in determining workup and treatment options. Aggressive surgical resection is suggested in treatment of primary melanomas, whereas surgery is at best palliative in those with metastatic disease.

Loop electrosurgical excision with a laparoscopic electrode and carbon dioxide laser vaporization: comparison of thermal injury characteristics in the rat uterine horn

OBJECTIVE

Our purpose was to compare the thermal intraperitoneal injury in lesions resulting from a monopolar electrosurgical loop electrode designed for laparoscopic surgery with similar lesions fashioned by carbon dioxide laser vaporization.

STUDY DESIGN

A randomized, observer-blinded comparison was made of histopathologically measured thermal injury in rat uterine horns. The primary outcome measure was the depth of necrotic debris and coagulative necrosis in the lesions created by the two methods.

RESULTS

The depth of coagulative necrosis was similar in the laser vaporization (0.118 +/- 0.028 mm) and the loop excision groups (0.165 +/- 0.167 mm). However, the average amount of necrotic debris was greater in the lasered lesions (0.053 +/- 0.019 mm) compared with those made with the loop electrode (0.013 +/- 0.011 mm).

CONCLUSIONS

The depth of coagulative necrosis in rat uterine lesions fashioned with a loop electrode is similar to that of lesions created by carbon dioxide vaporization at power densities comparable with those usually achieved at laparoscopic surgery. There is a greater amount of necrotic debris in the lasered lesions. This suggests that electrosurgical loops designed for laparoscopic surgery may have promise for the cost-effective excision of intraperitoneal tissue.

The importance of communication between the pathologist and the clinician in caring for patients receiving gynecologic treatment

These cases clearly illustrate the importance of communication between the pathologist and gynecologist or gynecologic oncologist to deliver optimal patient care. It is not only important for the pathologist and gynecologist to review the pathologic diagnosis before implementing treatment plans, it is also imperative that the gynecologist provide the pathologist with a thorough history. As part of this communication process, the pathologist conveys abnormalities of histology as well as uncertainties, such as that which occurred in the mucinous cystadenocarcinoma case. By maintaining open communication, the patient receiving gynecologic treatment will receive the best possible care.

Laryngeal dysplasia. A clinicopathologic study

BACKGROUND

Histologic changes that may predict irreversible neoplastic transformation remain poorly defined for lesions of the larynx. To date, more than 20 schemes for the classification of laryngeal dysplasia have been proposed, yet no one system has gained wide acceptance. This has led to considerable confusion in defining the pathogenesis of this process and controversy in selecting the optimal management strategy of patients with premalignant changes of the larynx.

METHODS

A detailed and systematic review was made of 125 laryngeal biopsies from 62 patients with laryngeal squamous cell dysplasia who received long term follow-up (mean, 74 months). Various histopathologic parameters were assessed in an attempt to define the prognostic importance of each parameter for progression from atypia to invasive carcinoma.

RESULTS

Five parameters were found to be significantly different when comparing lesions that progressed to carcinoma with those that remained stable or resolved: abnormal mitotic figures, mitotic activity, stromal inflammation, maturation level, and nuclear pleomorphism. Surface morphology, nucleolar prominence, and koilocytosis were not significantly different when comparing the two groups. Surface keratin formation did not suggest improved prognosis for patients with lesions with other features of dysplasia.

CONCLUSIONS

These findings suggest that within the laryngeal glottis, severe keratinizing dysplasia occurs more frequently than does classic carcinoma in situ, and both entities likely represent intraepithelial neoplastic transformation.

Papillary squamous neoplasms of the head and neck

Papillary squamous neoplasms of the upper respiratory tract are rare variants of squamous cell carcinoma and are related temporally to proliferative verrucous leukoplakia. Fifty-two cases of papillary squamous neoplasms were selected from 2366 cases of squamous cell carcinoma. This is the first study to characterize the biological behavior of papillary squamous neoplasms. Papillary squamous neoplasms exhibit two distinct, yet sometimes overlapping, histologic patterns including an exophytic papillary and an inverting verrucous morphologic appearance. A high rate of synchronous or metachronous lesions were found, especially with the inverting-type of papillary squamous neoplasm. Stage T3 and T4 lesions had a high rate of neck metastasis. Early surgical intervention and close long-term follow-up is mandatory.

Mammographically detected recurrent nonpalpable carcinoma developing in a transverse rectus abdominus myocutaneous flap. A case report

BACKGROUND

Breast reconstruction is performed with increasing frequency and has become important in the treatment of mastectomy patients.

METHODS

The development of recurrent carcinoma after a mastectomy and transverse rectus abdominus myocutaneous (TRAM) flap procedure is described.

RESULTS

The lesion was nonpalpable and was detected by mammography.

CONCLUSION

This case raises questions about the practice of not performing postreconstruction mammography for detection of local recurrence after mastectomy.

Assessment of less than monthly progestin therapy in postmenopausal women given estrogen replacement

OBJECTIVE

To study progestin administration at less than monthly intervals in postmenopausal women given continuous estrogen replacement.

METHODS

Eighty postmenopausal women received 0.625 mg/day of conjugated equine estrogens for 48 weeks. Using a double-masked design, the subjects were randomized to medroxyprogesterone acetate 10 mg/day for 14 days every 28 or 84 days, or the same dosage for 28 of 84 days. Bleeding patterns, endometrial histology, and serum lipids were assessed.

RESULTS

The total days of bleeding during the 48-week study were significantly reduced (P < .05) in the women given the progestin for 14 days every 3 months (mean +/- standard deviation 29 +/- 16 days) than with the other two regimens. In all groups, secretory endometrium was reported in 17-39%. At 24 but not 48 weeks, simple hyperplasia was observed in one subject in each of the less than monthly progestin groups. Significant increases (P < .05) of high-density lipoprotein cholesterol were observed before but not after medroxyprogesterone acetate in the women receiving it less than monthly. No change was seen with monthly progestin.

CONCLUSIONS

In this direct comparison, medroxyprogesterone acetate given for 14 days every 3 months elicited less vaginal bleeding than standard monthly administration. Only a single woman had simple hyperplasia with each regimen of progestin given every 84 days. Medroxyprogesterone acetate given for 14 days every 3 months represents a possible alternative to standard monthly therapy if coupled with regular assessment of the endometrium.

Morphometry of the prostate: I. Distribution of tissue components in hyperplastic glands

OBJECTIVES

Morphometry, or quantitative image analysis, offers great promise in characterizing the various histologic types of benign prostatic hyperplasia (BPH), but to date, a systematic study of the tissue components is lacking. Thus we employed morphometry to examine the distribution of primary BPH tissues throughout whole human prostates.

METHODS

The prostate glands of 20 men with BPH were removed for low-volume carcinoma and subjected to a uniform, comprehensive, systematic quantification of the primary BPH tissue components using the technique of digitization and point-count morphometry.

RESULTS

We found the following average volumes among the 20 glands: epithelium, 19.9% (S.D. 5.1%, range 11.7% to 30.8%); fibromuscular stroma, 50.4% (S.D. 9.4%, range 32.2% to 74.4%); glandular lumina, 29.7% (S.D. 8.9%, range 11.9% to 47.5%). Within the individual prostates, we found symmetry in primary BPH tissue distribution, except that the outer prostate was on average 25% richer in epithelium than the inner prostate (p < 0.05). When tissue composition was determined in simulated biopsy specimens, corrected for radial (ie, inner vs outer gland) orientation, the correlation with whole-organ composition was statistically significant for "percentage epithelium" (r = 0.72, p < 0.01) and for "stromal/epithelial ratio" (r = 0.63, p < 0.01).

CONCLUSIONS

Major differences in primary tissue composition may separate different hyperplastic prostates. Primary BPH tissues are rather symmetrically distributed within individual prostates. Quantitative histologic differences between prostates, potentially important in clinical decision-making may be accurately diagnosed by morphometry of radially oriented biopsy specimens.

Postirradiation sarcomas. A single-institution study and review of the literature

BACKGROUND

With improvement in survival after cancer treatment, it is becoming increasingly important to examine treatment-related morbidity and mortality. Sarcomas can develop in the irradiated field after radiation therapy (RT). The authors undertook a study to estimate the risk, and compared the risk of postirradiation sarcoma (PIS) with other treatment modalities used against cancer.

METHODS

Since 1987 the authors have reviewed the records of 1089 patients with head and neck, gynecologic, gastrointestinal, and extremity sarcomas. Of these 1089 patients, 37 had a prior history of RT.

RESULTS

Conditions for which these patients received RT included: Hodgkin's disease (2 patients), retinoblastoma (3), non-Hodgkin's lymphoma (2), acne (1), astrocytoma (1), multiple recurrent mixed parotid tumor (1), laryngeal cancer (1), papillary adenocarcinoma of the thyroid (1), bony fibrous dysplasia (1), lymphangioma (1), squamous cell carcinoma of the nasopharynx (1), Ewing's sarcoma (1), choriocarcinoma (1), menorrhagia (4), cervical cancer (6), ovarian cancer (2), breast cancer (7), and hypoplasia (1). RT doses ranged from 3000 to 12,440 cGy. Latency time from RT to the development of PIS averaged 12 years. More than 15,000 patients have received RT for various conditions at our institution since 1955.

CONCLUSIONS

From our data and a review of the literature, we estimate the risk of PIS with long-term follow-up to be 0.03-0.8%. From a review of the literature that compared mortality risks of chemotherapy, general surgery, and anesthesia, the risk of PIS appears no worse. Thus, given the large number of patients who can be cured or receive palliative treatment with RT, concern regarding PIS should not be a major factor influencing treatment decisions in patients with cancer.

Synovial sarcoma. Uniform response of metastases to high dose ifosfamide

BACKGROUND

This report describes the unusually high response rate of metastatic synovial sarcoma to high dose ifosfamide (14-18 g/m2) when that drug was used to treat 13 consecutive patients with recurrent metastatic synovial sarcoma before surgery (or thoracotomies) to provide optimal salvage therapy for these patients.

PATIENTS AND METHODS

Thirteen patients with recurrent or pulmonary metastatic synovial sarcoma seen at the Cedars-Sinai Comprehensive Cancer Center (Los Angeles, CA) from April, 1989 through January, 1993 were treated with high dose ifosfamide (14-18 g/m2). Ifosfamide was infused at the dose of 2 g/m2 over a 4-hour bolus infusion, followed by 2-g/m2 24-hour continuous infusions of ifosfamide, for a total of 14 or 18 g/m2 (6-8 days). Mesna (Mesnex, Bristol-Myers Oncology, Princeton, NJ) was infused with the ifosfamide at equimolar doses. Supplemental sodium bicarbonate (180 mEq) was given daily to prevent severe acidosis. Nine of the thirteen patients were treated with prior chemotherapy for their primary tumors. Prior chemotherapy consisted of doxorubicin (Adriamycin, Adria Labs, Dublin, OH) in all patients and doxorubicin combined with cisplatin in eight of them.

RESULTS

All 13 patients had objective responses to high dose ifosfamide chemotherapy. There were nine partial responses and four complete responses. Five of the patients died of disease at 20-40 months (median, 27 months) from initial therapy. Eight patients have survived from 2 to 43 months (median, 20 months) from initial therapy, and three of these patients are disease free. Those patients surviving disease free had successful surgical removal of their residual metastatic disease after chemotherapy.

CONCLUSION

Metastatic synovial sarcoma appears to be particularly sensitive to high dose ifosfamide chemotherapy. This experience suggests that there is a role for high dose ifosfamide chemotherapy in preoperative and postoperative adjuvant chemotherapy for primary synovial sarcoma, which is usually always a high grade malignant lesion with a poor prognosis after surgery alone.

The postnatal development of the GABAA/benzodiazepine receptor in the rat red nucleus

The development of the GABAA/Benzodiazepine receptor (GABAAR) in the red nucleus was studied using 3H-flunitrazepam (FNZ) as the probe. Saturation binding assay showed that the Bmax of the ligand to the membranes of the nucleus increased from 0.50 +/- 0.04 nmol/mg protein at postnatal day 4, to 0.71 +/- 0.1 and 0.78 +/- 0.08 at day 7 and day 10. At day 20 the Bmax decreased to a level near day 4 and persisted until day 40. However, the affinity of 3H-FNZ to the receptor remained quite constant. At least 4 proteins of 51kD, 53kD, 59kD and 62kD in the nucleus were labeled by 3H-FNZ, as revealed from photoaffinity binding and SDS-PAGE. The labeling of 53kD, 59kD and 62kD was high at earlier ages than day 10, whereas the 51kD was predominent from day 10 to day 40. Receptor binding autoradiography of the nucleus also showed that the most dense labeling was seen around day 10. The early transient increase in the GABAAR of the red nucleus may indicate the plasticity of the nucleus in response to environmental changes after birth.

Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma

OBJECTIVE

To determine the incidence of uterine sarcoma in patients operated on for symptomatic uterine leiomyomas or "rapidly growing" leiomyomas.

METHODS

We reviewed the medical records of 1332 women admitted to either of two community hospitals between 1988-1992 for hysterectomy or myomectomy for uterine leiomyomas. The incidence of leiomyosarcoma, endometrial stromal sarcoma, and mixed mesodermal tumor was calculated. Patient ages, admitting symptoms, and operative and pathologic findings were analyzed. The study included 371 women (28%) operated on for rapidly growing leiomyomas. All patients operated on during the same interval and found to have a uterine sarcoma were reviewed.

RESULTS

One of the 1332 patients operated on for presumed leiomyoma was found to have a leiomyosarcoma. This women was the only patient found to have a sarcoma among 371 women operated on for rapid growth of the uterus. None of 198 patients who met a published definition of rapid growth had a uterine sarcoma. Two women (0.15%) had endometrial stromal sarcoma, but none had a mixed mesodermal tumor. During the same interval, nine additional patients were found to have uterine sarcomas, and for these women, the preoperative diagnosis was sarcoma in four, endometrial cancer in three, ovarian cancer in one, and prolapsed uterus in one.

CONCLUSIONS

The total incidence of uterine sarcoma (leiomyosarcoma, endometrial stromal sarcoma, and mixed mesodermal tumor) among patients operated on for uterine leiomyoma is extremely low (0.23%). The incidence of sarcoma among patients having surgery for "rapidly growing" leiomyoma (0.27%) or among those who met published criteria for rapid growth (0%) does not substantiate the concept of increased risk of sarcoma in these women.

Case report 826: Physiological resorption of allograft simulating recurrent giant cell tumor

A case of focal resorption in a limb salvage/bone allograft is presented, illustrating that roentgenological differentiation from other causes for graft resorption may be very difficult. The possibilities of infection and tumor recurrence, as well as "physiologic" graft resorption, must be considered in the differential diagnosis of a lytic process in an allograft for limb salvage. To date, early biopsy remains mandatory for accurate diagnosis.

Angiosarcoma of the head and neck. The UCLA experience 1955 through 1990

Between 1955 and 1990, 28 patients with angiosarcoma of the head and neck were seen at UCLA Medical Center, Los Angeles, Calif. Half the lesions arose on the scalp; the remainder occurred in the soft tissues of the face and neck. Nine patients presented with multifocal disease. Follow-up ranged from 3 to 159 months, with a median of 32 months. The overall prognosis was poor, with a 5-year disease-free survival of 26% (7/27 patients). Of 21 patients having recurrences after primary treatment, 90% (19/21 patients) had a component of local failure. Distant metastasis had developed in nine patients at last follow-up. Of patients treated initially with surgery alone, 8% (1/12 patients) remain disease free vs 67% (4/6 patients) who received postoperative radiation therapy, with or without chemotherapy. Only one (14%) of seven patients treated primarily with radiation therapy with or without chemotherapy was rendered disease free. Angiosarcoma usually presents with high-grade histologic features and frequently with multifocal disease. There is propensity for both local recurrence and distant metastasis. Our results and a review of the literature suggest that combined modality therapy offers the best chance for long-term control in patients with angiosarcoma of the head and neck.

Primary lymphoma of female urethra: long-term control by radiation therapy

We report a case of primary urethral lymphoma successfully managed by external beam radiation therapy. Long-term freedom from recurrence in this case suggests irradiation is a viable treatment option for this rare malignancy.

Postirradiation sarcoma of the head and neck

BACKGROUND

With improvement in survival after cancer treatment, it is becoming increasingly important to study treatment-related morbidity and mortality. Sarcoma can develop in the irradiated field after radiation therapy. The authors performed a study to estimate the risk, and compared the risk of sarcoma after radiation therapy with that of other treatment modalities used against cancer.

METHODS

Between 1955 and 1988, 229 patients with sarcoma of the head and neck were seen at the University of California, Los Angeles (UCLA), Medical Center. Of these, 13 (6%) had a previous history of radiation therapy to the head and neck.

RESULTS

Radiation doses were known in 10 of 13 patients and ranged from 30 to 124.4 Gy. The latency time from radiation therapy to the development of postirradiation sarcoma (PIS) ranged from 3 months to 50 years, with a median of 12 years. More than 2000 patients have received radiation therapy to the head and neck for various conditions at the UCLA Medical Center since 1955.

CONCLUSIONS

The authors conclude that most head and neck sarcomas are not radiation related and that the risk of PIS after head and neck irradiation for other diseases is low. From a review of the literature comparing mortality risks of chemotherapy, general surgery, and anesthesia, the risk of PIS appears no worse. Given the large number of patients who can be cured or receive palliation with radiation therapy, concern about PIS should not be a major factor influencing treatment decisions in patients with cancer.

Postirradiation sarcoma of the head and neck

BACKGROUND

With improvement in survival after cancer treatment, it is becoming increasingly important to study treatment-related morbidity and mortality. Sarcoma can develop in the irradiated field after radiation therapy. The authors performed a study to estimate the risk, and compared the risk of sarcoma after radiation therapy with that of other treatment modalities used against cancer.

METHODS

Between 1955 and 1988, 229 patients with sarcoma of the head and neck were seen at the University of California, Los Angeles (UCLA), Medical Center. Of these, 13 (6%) had a previous history of radiation therapy to the head and neck.

RESULTS

Radiation doses were known in 10 of 13 patients and ranged from 30 to 124.4 Gy. The latency time from radiation therapy to the development of postirradiation sarcoma (PIS) ranged from 3 months to 50 years, with a median of 12 years. More than 2000 patients have received radiation therapy to the head and neck for various conditions at the UCLA Medical Center since 1955.

CONCLUSIONS

The authors conclude that most head and neck sarcomas are not radiation related and that the risk of PIS after head and neck irradiation for other diseases is low. From a review of the literature comparing mortality risks of chemotherapy, general surgery, and anesthesia, the risk of PIS appears no worse. Given the large number of patients who can be cured or receive palliation with radiation therapy, concern about PIS should not be a major factor influencing treatment decisions in patients with cancer.

Dermatofibrosarcoma protuberans of the head and neck. A report of 16 cases

Dermatofibrosarcoma protuberans of the head and neck is a rare neoplasm. Overall, sarcomas account for less than 1% of all head and neck malignancies. Of 229 patients with sarcomas of the head and neck seen at our institution between 1955 and 1988, 14 (7%) were assigned the diagnosis of dermatofibrosarcoma protuberans after pathologic review. Two additional cases have been seen since 1988, bringing the total to 16. All cases were low-grade lesions. Follow-up ranged from 36 to 198 months, with a median of 114 months. Fifteen patients were managed with surgery alone, and nine (60%) developed local recurrence. Eight were salvaged with further surgery. There were no regional lymph node recurrences or distant metastases. One patient was judged to be a poor surgical candidate and received primary radiation therapy. He died disease free 3 years after treatment. At last follow-up, 15 (94%) of 16 patients were ultimately disease free after salvage treatment. The overall 5-year survival rate was 93% (13/14). We conclude from this series, and from a review of the literature, that wide surgical resection achieving good margins offers excellent probability of cure, and that radiation therapy is a reasonable alternative in patients who have unresectable lesions or who are medically inoperable.

Endocervical glandular atypia and adenocarcinoma: a correlation of cytology and histology

Of the 34,384 cervical smears sampled by cervical scraping and Cytobrush, reactive glandular atypia was found in 1.7%, low-grade glandular atypia in 0.08%, and high-grade glandular atypia/adenocarcinoma in 0.05%. Cells of reactive glandular atypia and low-grade atypia could be distinguished from those of high-grade atypia/adenocarcinoma by the architecture of the cellular aggregates, nuclear morphology, and nuclear-cytoplasmic ratios. Further histologic studies found that most reactive and low-grade atypias were associated with condyloma, squamous dysplasia, carcinoma in situ, and cervicitis. Eighty-two percent of women with cellular evidence of high-grade atypia/adenocarcinoma were confirmed to have in situ or invasive adenocarcinoma of the cervix. Although Cytobrush samples seem to improve the detection of early-stage glandular neoplasms, many minor atypias unrelated to cervical carcinogenesis are also detected.

Use of monoclonal antibodies MSN-1 and B72.3 in the prediction of the natural history of endometrial hyperplasia

Forty patients, originally diagnosed as endometrial hyperplasia, were reviewed histopathologically and evaluated for immunohistochemical staining with antibodies directed against TAG-72 and MSN-1 antigens. All patients had follow-up endometrial biospies or hysterectomies from 1 to 13 years later. The extent of regression to normal of nonhyperplastic endometrium, persistence as any type of endometrial hyperplasia, or progression to endometrial adenocarcinoma was correlated with the histologic hyperplastic subtype and immunohistochemical staining. As expected, cases of complex or atypical hyperplasia more often progressed to carcinoma than cases of simple or no hyperplasia. Interestingly, MSN-1 positivity was more prevalent in cases of higher grades than lower grades of hyperplasia and was associated with the tendency to show persistent hyperplasia or progression to carcinoma. B72.3 positivity was uncommon in the hyperplastic endometrium and was not correlated with clinical regression or progression. Although the tendency for progression of endometrial hyperplasia to endometrial carcinoma is best judged histologically, MSN-1 may add prognostic information in subgroups of hyperplasia.

Subglottic plasmacytoma: the use of jet ventilation and contact Nd:YAG laser for tissue diagnosis

Extramedullary plasmacytomas (EMP) constitute only 1% of all head and neck malignancies, with the vast majority occurring in the upper respiratory tract. The diagnosis of laryngeal EMP can be difficult since the symptoms are non-specific and the tumor usually mucosally covered. This paper discusses the successful combination of jet Venturi ventilation technique with suspension microlaryngoscopy and contact Nd:YAG laser for tissue diagnosis in a patient presenting with a large subglottic mass. Previous attempts using standard endotracheal intubation and forceps technique for biopsy failed to reach the diagnosis and resulted in significant bleeding from the biopsy site. A review of the disease and technique is presented.

Chondrosarcoma of the head and neck. The UCLA experience, 1955-1988

Chondrosarcoma of the head and neck is a rare tumor. In an attempt to clarify optimal treatment of these lesions, we reviewed the records and pathologic material of 18 consecutive cases of head and neck chondrosarcoma seen at our institution between 1955 and 1988. Follow-up ranged from 3 to 168 months with a median of 72. Absolute 5-year survival was 68% (11/16), with 9/16 (56%) patients surviving disease-free. Grade was the most important prognostic factor. Only one of 7 (14%) patients known to have high grade histology was rendered disease-free, as opposed to 9/10 (90%) with low-grade lesions. Tumor size and completeness of surgical resection were also important prognostic factors. Four of 10 patients managed initially with surgery alone achieved local control with greater than 5-year survival. All four had low-grade lesions. Five patients received surgery and radiation as primary treatment, and three are disease-free with greater than 5-year follow-up. Two of these were irradiated because of positive margins. One patient received radiation alone and has persistent disease. Two patients received combined chemotherapy and surgery because of high-grade lesions, and one is free of disease with greater than 5-year follow-up. Patients with incomplete resections should receive further surgery or postoperative radiation therapy. High-grade lesions should be treated aggressively.