Daniel Seckinger

Varied anatomical types of ovarian adenofibroma

Ovarian adenofibroma is redefined to indicate a compound benign tumor composed of epithelial and fibromatous elements. The varied anatomical forms and geographic sites afford a classification herein enclosed. Gross identification of adenofibroma is not difficult. Solid types generally show small cysts (smooth or papillary) which contain clear fluid. Conversely, cystic forms, unlike serous cystadenoma, retain bands or islands of fibrous tissue. A double primary “cystoma and fibroma” are identified by the “apartheid” of the epithelial and stromatogenous components which in adenofibromata are intermingled. Cancerous changes are rare in adenofibroma and generally confined to the solid zones. Malignancy is focal and requires numerous blocks for its detection. The prognosis of fibroadenocarcinoma or cystadenofibrocarcinoma appears relatively favorable because of circumscription by the fibrogenous benign component of the compound tumor.

A Review of DNA Flow Cytometric Preparatory and Analytical Methods

The detection of cell surface antigens is the most familiar application of flow cytometry in clinical immunology. Rapid advances in immunocytochemical applications of monoclonal antibodies, which may now be regarded as “true” reagents in the clinical laboratory, have made possible the immunological characterization of various tumors (1–3) and the classification of cells of the immune system (4–6). This extensive immunological characterization was virtually unattainable a few years earlier.

Prospective observational evaluation of the particle immunofiltration anti-platelet factor 4 rapid assay in MICU patients with thrombocytopenia

IntroductionHeparin-induced thrombocytopenia (HIT) results from antibodies to PF4/heparin complexes and clinical diagnosis is difficult. We evaluated the particle immunofiltration anti-platelet factor 4 (PIFA) rapid assay, in conjunction with a clinical risk score, in the diagnosis of HIT.MethodsWe performed a prospective observational study in all patients admitted to the medical intensive care unit (MICU) in a large academic medical center. Patients were screened daily for thrombocytopenia defined as either a platelet count that decreased by at least 33% or an absolute platelet count less than 150,000/μL. Patients with suspected HIT underwent PIFA and ELISA testing for anti-PF4/heparin antibodies. Available residual frozen sera were sent to a reference laboratory for serotonin release assay (SRA) testing.ResultsDuring the study period, 340 patients were admitted to the MICU, of which 143 patients met criteria for thrombocytopenia. Forty-three patients had no evidence of recent heparin exposure. PIFA and ELISA testing were performed on 100 patients, of which 92 had samples available for SRA analysis. PIFA results were negative in 62, positive in 28 and inconclusive in 2 patients. The 4Ts score showed low to intermediate risk in 57 of the PIFA negative patients. The ELISA results were negative in 86 and positive in 6 patients. SRA testing identified 3 patients with a positive SRA test and 89 patients with a negative result. All patients with a negative PIFA result also had a negative SRA result. In the one patient deemed to have clinical HIT, the pretest probability was high (4Ts score of 6) and the anti-PF4/heparin antibody testing revealed a positive SRA, inconclusive PIFA and a negative ELISA result.ConclusionsWhile thrombocytopenia in our population is common, the prevalence of HIT is low. The combination of a low to intermediate pretest probability with a negative PIFA test can rapidly exclude the presence of platelet activating anti-PF4/heparin antibodies and, therefore, HIT as the cause of the thrombocytopenia. Since a positive PIFA result has a low positive predictive value, a positive PIFA is not diagnostic of HIT and additional evaluation is warranted.

Colposcopy plus cytology

Cytology and colposcopy are not competitive but rather supplement each other in the diagnosis of cervical cancer. The diagnostic overlap of the two methods is such that few carcinomas will escape detection with their routine use simultaneously. Neither method alone is better than the other in the diagnosis of cervical cancer but colposcopy is far superior for the detection of cervical dysplasia. In a series of 1,100 private patients, 521 of whom were biopsied, simultaneously colposcopy and cytology revealed 19 cases of carcinoma in situ and 8 invasive carcinomas. Cytology missed 3 cases of carcinoma in situ and colposcopy missed 2. Cytology missed 2 invasive carcinomas and colposcopy missed one. Of 141 dysplasias found in these 1,100 patients by colposcopy-oriented biopsy, 131 were cytologically Papanicolaou Class I or II; only 10 were Papanicolaou Class III or atypical.

Characteristics of Monoclonal Antibody Measurements in Human Peripheral Blood

Three areas of monoclonal antibody measurements using flow cytometry have been presented. These include a description of a dual immunofluorescent method for measuring two antibodies simultaneously, the effects of blood storage on enumeration of helper (H) and suppressor (S) cells, and the relationship between absolute lymphocyte count and H/S ratio in both control and AIDS patients. These studies reveal that a dual immunofluorescent labeling method is useful for enumerating lymphocytes from peripheral blood which bear the helper, suppressor and/or thymus-derived (T) cell receptors. Fluorescein (FL)-conjugated Leu-3a + 3b antibodies were used to enumerate helper T-lymphocytes, while the B-phycoerythrin (B-PE)-conjugated Leu-2a antibodies were utilized for enumerating suppressor T-lymphocytes. Dual immunofluorescently stained lymphocytes, prepared from whole blood, were analyzed by flow cytometry. Two light scatter parameters, (forward and 90 degree scatter) were used to define the lysed erythrocyte, lymphocyte, monocyte, and granulocyte populations. Only the lymphocytes were analyzed for dual immunofluorescence activity. The helper and suppressor distributions from 167 control patients were as follows: The average percentage +/- SD of the helper and suppressor cells were 42.8 +/- 7.5 and 21.6 +/- 6.4, respectively. The H/S ratio was 2.17 +/- .75. These studies show that the H/S ratio can be determined in a single preparative sample and analyzed by dual immunofluorescence in a single flow cytometric analysis even though the H/S ratio may vary from normal during a disease condition. The dual immunofluorescent assay enables one to correlate the activities of two antibodies against cell surface receptors and allows the measurement of a large number of samples in a minimal time. This study also compared the effects of anticoagulant, storage time, and temperature on the phenotypic determination of the percentages of helper and suppressor T-lymphocytes in human peripheral blood. Blood was drawn in ACD, heparin, and EDTA and stored for up to 4 days at room temperature or 4 degrees C. Phenotypic determination of helper/suppressor lymphocytes was most stable for ACD or heparinized blood at room temperature. Marked changes were observed in the percentages of helper cells at 4 degrees C, whereas the percentages of suppressor cells did not change appreciably regardless of the anticoagulant storage time or temperature. Finally, the relationship between ALC and the H/S ratio in control and AIDS patients was determined. The ALC varied considerably in both control and patient populations as a function of time. Conversely, the H/S ratio remained constant.(ABSTRACT TRUNCATED AT 400 WORDS)