Brinda R. Kamat

Neovascularization and coronary atherosclerotic plaque: cinematographic localization and quantitative histologic analysis.

A new technique was developed for analyzing the neovascularization associated with coronary artery atherosclerosis: cinematography during silicone polymer injection of the coronary arteries of fixed and cleared human hearts, followed by histologic analysis in routine and 1-micron-thick, Epon-embedded sections. Twenty-two hearts obtained at autopsy were studied. On the basis of cinematographic findings, individual regions of the coronary arteries were classified as negative, positive, or abundantly positive for neovascularization. Positive and abundantly positive areas, which invariably occurred in segments exhibiting changes of atherosclerosis, contained numerous small vessels in the adventitia and outer media (4.7 +/- 1.5 and 9.8 +/- 1.3 [SE] vessel profiles/artery cross-section in positive and abundantly positive areas, versus 1.0 +/- 0.6 in negative regions). Abundantly positive areas, which occurred in coronary artery segments demonstrating the most extensive atherosclerotic change, contained numerous small vessels in the inner media or in the plaque itself. Some of these microvessels were in close proximity to mast cells, which represent potentially rich sources of mediators affecting vascular tone and permeability. Vessels were not observed in the inner media or in atherosclerotic plaque in areas designated either positive or negative by cinematography. These findings show how our approach can be used both to define the three-dimensional, in situ configuration of coronary artery neovascularization and to characterize the histology of this process in detail. They also confirm previous work indicating that areas of coronary arteries involved by atherosclerosis frequently exhibit extensive neovascularization.

Metanephric adenoma-like tumors of the kidney: report of 3 malignancies with emphasis on discriminating features.

BACKGROUND Metanephric adenoma is a very rare benign renal tumor; only 80 well-documented cases have been reported to date. We have seen several renal tumors that were originally incorrectly diagnosed as metanephric adenoma. DESIGN We present 3 unusual renal tumors (2 primary and 1 metastatic), each of which illustrates important pathologic features useful in discriminating metanephric adenoma from malignant mimics. RESULTS Case 1 involved a 46-year-old man with multiple small, cortical, solid, papillary (chromophil) renal cell carcinomas in his right kidney; the patient developed multiple, histologically identical, solid, papillary (chromophil) carcinomas in the opposite kidney 17 months later. Case 2 involved a 32-year-old woman with a 14-cm right renal tumor who developed soft tissue and bone metastases over a 17-year period. Case 3 involved a 52-year-old woman who presented with a 1.8-cm corticomedullary renal nodule, which eventually proved to represent a metastasis from a poorly differentiated (insular) carcinoma of the thyroid. All 3 tumors superficially resembled metanephric adenoma and consisted of primitive, dark-staining cells arranged in tubules or sheets. Each tumor, however, also had features inconsistent with the diagnosis of metanephric adenoma, including multifocal lesions with a variable nuclear-cytoplasmic ratio and diffuse cytokeratin 7 and epithelial membrane antigen immunopositivity in case 1, a 14-cm-diameter tumor with occasional mitoses in case 2, and a distinct fibrous capsule with capsular and vascular invasion in case 3. In addition, all 3 tumors lacked the cytologic features of bland overlapping nuclei with imperceptible cytoplasm consistently seen in metanephric adenoma. CONCLUSION Adherence to strict histopathologic criteria will discourage misdiagnosis of a malignant or potentially malignant renal neoplasm as the rare and always benign metanephric adenoma.

Successful Repair of Aortic and Mitral Incompetence Induced by Methylsergide Maleate: Confirmation by Intraoperative Transesophageal Echocardiography

Methylsergide maleate, an effective anti‐migraine medication, has a well‐documented association with left‐sided cardiac valve dysfunction. Prior reports have described cardiac valve dysfunction in patients using methylsergide chronically for a minimum of 6 years, with surgical intervention consisting of valve replacement for patients with intractable congestive heart failure. We report a 51‐year‐old woman who developed severe mitral and aortic valvular dysfunction after taking methylsergide maleate for migraine headaches for a period of 19 months, and who subsequently underwent aortic and mitral valve repair with excellent short‐term results. (ECHOCARDIOGRAPHY, Volume 20, April 2003)

Transesophageal Echocardiography with Pathological Correlation in Severe Valvular Disease Associated with Fenfluramine-Phentermine

We describe the case of severe diffuse multivalvular disease associated with fenfluramine‐phentermine (Fen‐Phen) in a 52‐year‐old patient who presented to the echocardiography laboratory for evaluation of a new heart murmur and ultimately required isolated aortic valve replacement. The patient was known to have a transthoracic echocardiogram 1 year before starting the diet pill combination that showed no significant valvular disease. Pathological evaluation of the excised aortic valve was consistent with that described with Fen‐Phen use. Transesophageal echocardiography played an important role in defining unique features associated with the valvular disease and in intraoperative management of the patient.

Assessing Adequacy of Cervical Core Specimens From Extirpated Uteri: Implications for Laparoscopic Supracervical Hysterectomy With Transcervical Coring

STUDY OBJECTIVE To describe the histopathologic adequacy of cervical specimens after ex vivo excision of the cervical canal with cervical coring. DESIGN Descriptive study (Canadian Task Force classification III). SETTING Community medical center with university affiliation. INTERVENTION Endocervical coring. MEASUREMENTS AND MAIN RESULTS Eleven cervical core samples from hysterectomy specimens were evaluated. Cervical coring was performed using classic intrafascial supracervical hysterectomy instruments: 15 mm for 6 specimens and 20 mm for 5 specimens. Mean patient age was 49 years, and median (range) parity was 2 (0-3). Three patients (27.3%) were postmenopausal. In most patients (72.7%) leiomyomas and abnormal uterine bleeding was the indication for hysterectomy, and 3 patients (23.3%) had uterovaginal prolapse. The most common cervical pathologic diagnosis was chronic cystic cervicitis (72.7%). Histopathologic presence of the entire cervical transformation zone was present in all 11 cervical core samples. Endocervical glands were absent in the radial margins of all samples. Endometrial glands were absent in the radial margins in 7 samples (63.6%). There was no statistically significant difference in age, parity, cervical remnant, and cervical core dimensions between both core sizes (p > .05). CONCLUSION Cervical coring to remove the endocervical canal during hysterectomy resulted in adequate removal of endocervical glands and endometrial glands in most cases, using either the 15-mm or 20-mm classic intrafascial supracervical hysterectomy instrument.