Brian S. Kendall

Routine screening for eosinophilic esophagitis in patients presenting with dysphagia.

Background: Eosinophilic esophagitis (EoE) is a clinicopathologic disorder first described in 1978 which has gained significant recognition over the past 10 years. Numerous prevalence studies have been performed around the globe, both in pediatric and adult populations documenting a prevalence between 0.002% and 6.5%. The aim of this study is to assess the utility of routinely screening for EoE in patients with dysphagia. Methods: A prospective, observational study in which adult patients with a complaint of esophageal dysphagia were enrolled. Results: Of the 135 patients enrolled, 122 completed the study; 100 patients had nonobstructive dysphagia, while 22 patients had a luminal finding which could explain their dysphagia. The prevalence of EoE in the nonobstructive dysphagia group was 22% (95% CI: 13.9–30.1%); 32.7% of male patients with nonobstructive dysphagia were found to have EoE compared with 8.9% of females (p = 0.004). The mean age of nonobstructive patients found to have EoE was 37.8 years. White patients with nonobstructive dysphagia were found to have a 25.9% prevalence of EoE, compared with 0% of African Americans, 0% of Asians, and 14.3% of Hispanics. When comparing Whites with non-Whites, the prevalence of EoE was noted to be 25.9% versus 5.3%, respectively (p = 0.050). Conclusions: EoE is a common cause of nonobstructive dysphagia. We believe that the high prevalence of EoE in patients with nonobstructive dysphagia supports the practice of routine biopsies to screen for the presence of abnormally high numbers of eosinophils in this subgroup.

Asian-Pacific Islander race independently predicts poor outcome in patients with endometrial cancer☆

OBJECTIVE The Department of Defense health care system provides access to care without respect to age, race, or socioeconomic status. We sought to determine the effect of race as a predictor of survival in patients with endometrial cancer treated in the Department of Defense medical system. METHODS Information on patients with endometrial carcinoma was extracted from the Department of Defense centralized tumor registry for the period 1988 to 1995. Data included age at diagnosis, military status, race, tumor histology, grade, FIGO surgical stage, adjuvant therapies, and disease-free survival. The chi(2) test was used for analysis of prognostic factors and adjuvant treatments between racial groups. Actuarial survival curves were calculated by using the method of Kaplan and Meier and compared by the log-rank test. Variables found to be significant on univariate analysis (P < 0.05) were entered into a multivariate Cox regression analysis. RESULTS Of 1811 patients meeting criteria for the study, racial distribution was 90% Caucasian, 4.4% African-American, and 5.5% Asian-Pacific Islander. African-Americans had more advanced stages of disease compared to Caucasians (P < 0.001). Both African-Americans and Asian-Pacific Islanders had higher grade tumors and less favorable histologic types than Caucasians (P < 0.05). The extent of adjuvant therapies was similar for racial groups. African-Americans and Asian-Pacific Islanders had significantly worse 5-year disease-free survivals than Caucasians (P = 0.007). Additional poor prognostic factors included age >60 years, grade, unfavorable histology, and stage. On multivariate analysis age >60 years, stage, and Asian-Pacific Islander race remained significant prognostic factors. CONCLUSION African-Americans and Asian-Pacific Islanders had worse survivals than Caucasians. After controlling for imbalances in clinicopathologic factors, Asian-Pacific Islander race was found to be a newly identified poor prognostic factor.

Use of Desmin Immunohistochemistry To Distinguish Between Mesothelial Cells and Carcinoma in Serous Fluid Cell Block Preparations

OBJECTIVE To evaluate the utility of immunohistochemical stains for desmin in discriminating mesothelial cells from adenocarcinoma in serous fluid cell block preparations. STUDY DESIGN Cell block preparations from 22 cases (representing 18 patients) that were positive for carcinoma and 5 cases that were negative for malignancy were immunostained with an antibody to desmin. Positive staining was evaluated and scored semiquantitatively in both tumor cells and background mesothelial cells in the malignant cases and mesothelial cells in the negative controls. Staining was evaluated with a score of 0-3 for intensity and 0-5 for distribution. The sum of the two scores was recorded as the total score (TS). RESULTS Mesothelial cells from all the carcinoma and benign cases stained with desmin (median TS = 5.5, range 4-8), typically strong in intensity and widespread in distribution. Positivity was observed in carcinoma cells in all cases, typically weak and focal (range 2-4). Using a total score of 4 as a cutoff for definitively positive staining, desmin staining was positive in mesothelial cells in 25/25 cases and carcinoma cells in 1/22 cases (P < .0001, Fishers exact test). Additionally, using the Mann-Whitney ranked sum test on the 20 cases with evaluable mesothelial cells, the medians of the total scores for mesothelial cells (5.5) and carcinoma cells (2.5) were significantly different (P < .0001). CONCLUSION A total score of > or = 4 was significantly associated with mesothelial cell staining. Use of desmin immunohistochemical staining in cell block preparations may be helpful in distinguishing between mesothelial cells and carcinoma.

Reflex High-Risk Human Papillomavirus Testing for Women With Atypical Squamous Cells of Undetermined Significance in Cytologic Smears Effects Since Implementation in a Large Clinical Practice

Reflex high-risk human papillomavirus (HPV) testing often is used in the management of women with atypical squamous cells of undetermined significance identified in cervicovaginal screening. Following implementation of reflex testing, our laboratory processed 8,022 specimens during a 20-month period; sufficient material was available for testing in 7,334 specimens. High-risk HPV was detected in 34.10% of these specimens. Detection rates varied with age, with positive rates as high as 58.46% in women 20 years old or younger, decreasing to 14.58% in women older than 35 years. The detection rate, categorized in 5-year age increments, showed a significant decrease until after 35 years, when the rate remained fairly constant (P < .0001). The detection rate decreased over the time of the study. These results demonstrate that high-risk HPV detection might vary according to the age mix of the population tested and the interval after implementation of testing.

Reflex High-Risk Human Papillomavirus Testing for Women With Atypical Squamous Cells of Undetermined Significance in Cytologic Smears

Reflex high-risk human papillomavirus (HPV) testing often is used in the management of women with atypical squamous cells of undetermined significance identified in cervicovaginal screening. Following implementation of reflex testing, our laboratory processed 8,022 specimens during a 20-month period; sufficient material was available for testing in 7,334 specimens. High-risk HPV was detected in 34.10% of these specimens. Detection rates varied with age, with positive rates as high as 58.46% in women 20 years old or younger, decreasing to 14.58% in women older than 35 years. The detection rate, categorized in 5-year age increments, showed a significant decrease until after 35 years, when the rate remained fairly constant ( P < .0001). The detection rate decreased over the time of the study. These results demonstrate that high-risk HPV detection might vary according to the age mix of the population tested and the interval after implementation of testing.

Effect of Light on Vitamin B12 and Folate

Background: Laboratory specimens submitted for assessment of vitamin B12 and folate have traditionally been light-protected, although this practice is based on limited data. Methods: This study compared changes in assayed values for B12 and folate from 25 healthy human volunteers when measured at 1, 2, and 7 days with both light-protection and light-exposure. Results: For B12, there was an average decrease of 7.5% at 7 days when lightprotected and a 7.7% decrease when lightexposed, while folate showed a 1.7% average decrease when light-exposed and a 1.0% decrease when light-protected. Neither of these values differed significantly between lightexposed or light-protected. Conclusions: This study demonstrates there is no need to light-protect specimens prior to vitamin B12 and folate analysis.

High risk human papillomavirus DNA detection in pap tests with both atypical squamous cells of undetermined significance and Candida.

OBJECTIVE We examined the detection rate of high risk human papillomavirus (hr-HPV) DNA in ThinPrep Pap tests with concurrent diagnoses of atypical squamous cells of undetermined significance (ASCUS) and fungal organisms morphologically consistent with Candida species. STUDY DESIGN Gynecologic cytology records were searched to find reports with concurrent diagnoses of both ASCUS and Candida infection. Over a 19-month period, 309 cases with reflex brhHPV tests results were identified. The rate of hr-HPV detection in this group was compared to our laboratorys overall brhHPV rate for women in general and among 5-year age groupings. RESULTS There was a significantly higher overall rate of hr-HPV detection in cases of ASCUS with Candida (44.7%, p < 0.001) compared to the overall ASCUS hr-HPV rate (34.1%). When age was stratified, the ASCUS with Candida < or = and 21-25 age-groups had significantly higher rates of hr-HPVde tection compared to the overall ASCUS rates (65.0% vs. 58.5, p < 0.001 and 61.6% vs. 50. 5, p < 0.04, respectively). CONCLUSION Our study shows that the presence ofCa ndida does not exclude hr-HPV and that atypical cytologic features in the presence of Candida should not be entirely attributed to reactive cellular changes, especially in younger women.

The significance of high‐risk human papillomavirus detection in women aged ≥ 50 years with atypical squamous cells of undetermined significance cytologic preparations

The use of high‐risk human papillomavirus (HRHPV) testing in the triage of women with a cytologic diagnosis of atypical squamous cells of undetermined significance (ASC‐US) has gained widespread acceptance. To date, very little has been reported on the significance of the detection of HRHPV in elderly women.

HLA-G Is Expressed by the Glandular Epithelium of Peritoneal Endometriosis But Not in Eutopic Endometrium

BACKGROUND HLA-G is a major histocompatability antigen with documented immune-regulatory function. Various epithelial cancers and tissue allografts have been noted to express HLA-G, which is postulated to aid in their escape from immunosurveillance. We evaluated peritoneal endometriosis and eutopic endometrium for the expression of HLA-G protein and gene transcript. METHODS Two experiments were performed: (i) archived tissue blocks from peritoneal endometriotic lesions (n = 15) and eutopic endometrium (n = 12) were evaluated for extent of protein immunostaining, and (ii) eutopic endometrial biopsies from women without (n = 17) and with (n = 24) endometriosis, and peritoneal endometriotic lesions (n = 14) were evaluated for presence of RNA transcript by in situ hybridization. RESULTS HLA-G protein localized in the glandular epithelium of 14 of 15 (93.3%) peritoneal endometriotic lesions, but not in stromal cells. HLA-G protein staining was absent in endometrial biopsies (n = 12). HLA-G gene transcript localized to the glandular epithelium in 13 of 14 (92.8%) peritoneal endometriotic lesions. HLA-G transcript was never observed in eutopic endometrium, regardless of cycle stage or whether from women with (n = 24) or without (n = 18) endometriosis. CONCLUSIONS HLA-G is expressed by endometriotic glandular epithelium but not by eutopic endometrium under normal conditions. Differential expression of HLA-G suggests that peritoneal inflammation or cellular stress may up-regulate mechanisms to promote ectopic endometrial survival.