Donald E. Bauermeister

Angioimmunoblastic lymphadenopathy: Clinical spectrum of disease

The clinical features of 13 patients with angioimmunoblastic lymphadenopathy were analyzed to determine prognostic factors and response to therapy. Eleven patients presented with sudden onset of fever, weight loss, generalized lymphadenopathy, and hepatosplenomegaly. Laboratory features included autoimmune hemolytic anemia and polyclonal hypergammaglobulinemia. Pulmonary involvement was seen in six cases and skin rash in four. Two patients had localized lymphadenopathy without systemic symptoms. Both are alive at 5.5 and 2.5 years, respectively, after diagnosis, although the latter patient has required intermittent prednisone for recurrent lymphadenopathy. An additional patient is alive on treatment four months following diagnosis. The remaining ten have died, nine of sepsis and one of cerebral hemorrhage. The immunosuppression and myelosuppression of combination chemotherapy may have hastened their deaths. An individualized, conservative treatment approach is recommended.

The role and limitations of frozen section and needle aspiration biopsy in breast cancer diagnosis

Frozen section of breast biopsy specimens, and cytologic smears of breast mass aspirates, are both acceptable methods in the initial evaluation of palpable breast masses. The latter method is an outpatient procedure without significant morbidity. Interpretation may be made immediately; however, the diagnostic information obtained is limited to “malignant” or “negative.” Frozen section may be applied to open biopsy or needle core biopsy specimens. In either case, the false‐negative rate is less than that experienced with needle aspiration, and additional information is obtained regarding the histologic characteristic of the neoplasm. Although open biopsy is an operating room procedure, needle core biopsy may be performed in the office; however, local anesthetic is required and the patients do experience more pain than with fine‐needle aspiration. The selection of the proper procedure must be individualized, depending on the clinical situation and the amount of diagnostic information required. It is essential to remember that although a positive result may be considered diagnostic, a negative report is always tenuous and should not lead to definitive therapy.

Langerhans Cells and Serum Precipitating Antibodies against Fungal Antigens in Bronchioloalveolar Cell Carcinoma: Possible Association with Pulmonary Eosinophilic Granuloma

In an ultrastructural study of 37 cases of bronchioloalveolar cell carcinoma (BAC), we identified seven cases (19%) in which Langerhans cells (LC) were closely associated with tumor cells. Serum precipitating antibodies against Aspergillus species and/or thermophilic actinomyces were present in five BAC patients whose tumors contained LC and in six patients whose tumors lacked LC. In a simultaneous study we identified marked atypical bronchiolar and alveolar lining cell hypertrophy and hyperplasma in pulmonary eosinophilic granuloma (PEG). Our data plus current information suggesting that PEG is a form of hypersensitivity pneumonitis support our hypothesis that those cases of BAC in which LC are present may rise in localized or diffuse pulmonary scars caused by PEG.

Pilot study of the relationship between histologic progression and hepatic iron concentration in chronic hepatitis C.

Hepatic iron deposition is common in patients with chronic hepatitis C (HCV) and may play a role in progression of liver disease. This pilot study examines the relationship between hepatic iron concentration (HIC) and histologic progression over time in patients with HCV. HIC was retrospectively measured in 14 patients with HCV who had 2 serial liver biopsies prior to the era of interferon therapy. The mean interval between biopsies was 56 ± 46 months. Mean Knodell score worsened between first and second biopsies (10.0 ± 2.8 versus 12.4 ± 3.3; P = 0.007). There was increased portal inflammation (3.2 ± 0.4 versus 3.6 ± 0.5; P = 0.028) and fibrosis (1.8 ± 1.3 versus 2.7 ± 1.2; P = 0.002), but no significant change in piecemeal necrosis or lobular degeneration. There was no significant change in HIC between first and second biopsy (P = 0.66). However, HIC was noted to increase significantly among patients with cirrhosis on initial biopsy or those who progressed to cirrhosis (P = 0.009). In this pilot study, histologic progression in patients with precirrhotic HCV was not associated with an increase in HIC, whereas hepatic iron accumulation was observed in 3 patients once cirrhosis was present. The interaction between progression of hepatitis C and iron deposition warrants further study.

Breast imaging : a correlative atlas

I Approach to Mammographic Analysis II Ultrasound Technique and Cross Correlation Case Examples: Pattern Approach to Mammography III Circumscribed Masses IV Irregular Masses V Calcifications VI Increased Density VII Architectural Distortions VIII Male Breast XI Post Surgical Findings X Masses Poorly Indentified Mammographically Pattern Approach to Breast Sonography I Fluid Collections II Solid Masses III Normal Structures IV Architectural Distortion VI Calcifications VII Post-Surgical (Including Implants) VIII Male Breast IX Masses Poorly Identified Sonographically