Harold A. Oberman

Metaplastic carcinoma of the breast. A clinicopathologic study of 29 patients.

The clinical and pathologic findings in 29 patients whose primary breast neoplasm manifested the microscopic pattern of spindle cell carcinoma or extensive squamous or pseudosarcomatous metaplasia were studied. In several of the tumors, the diagnosis of primary sarcoma or squamous cell carcinoma was excluded only after a prolonged search for evidence of invasive ductal carcinoma. The paucity of axillary lymph node metastases and the circumscription of these neoplasms belied their aggressive clinical behavior. The size of the neoplasm at the time of initial treatment best correlated with prognosis, since the majority of patients whose carcinoma was less than 4 cm in diameter pursued a favorable course. The lack of correlation of the microscopic pattern of these neoplasms with prognosis, as well as the presence of apparent overlapping microscopic findings, supports the concept that they are variants of a single entity.

Prophylactic versus therapeutic platelet transfusion practices in hematology and/or oncology patients

BACKGROUND: Platelet utilization has steadily increased throughout the past three decades. At the same time, there has been very little study of the current transfusion practices. STUDY DESIGN AND METHODS: A survey was conducted of institutional members of the American Association of Blood Banks (hospitals) that were actively involved in the care of pediatric and/or adult hematology and/or oncology patients. Inquiries were made relating to the extent of prophylactic versus therapeutic use of platelets, criteria used for prophylactic transfusion of platelets and type, and dose of platelets used. Data were analyzed according to patient age and type of hospital. RESULTS: Of 786 responding hospitals, 630 (80.2%) provided sufficient data for analysis; 126 of that 630 provided care for pediatric patients. The majority (60.9%) of responding hospitals had a minimum of four hematologists and/or oncologists. Eighty‐four percent of hospitals reported transfusing some apheresis platelets. The dose of platelet concentrates most frequently used for adults ranged from 6 to 10, with pools of 10 more commonly used in community hospitals. More than 70 percent of hospitals reported transfusing platelets primarily for prophylaxis: 60 percent of hospitals set the threshold platelet count for prophylactic platelet transfusion at 20,000 per microL, with approximately 20 percent each transfusing at higher and lower levels. A platelet count of 50,000 per microL was most frequently required for performance of a minor invasive procedure. CONCLUSION: The data from this study show that the majority of institutions use prophylactic platelet transfusion in both pediatric and adult hematology and/or oncology patients. However, there is considerable variation in platelet transfusion practice.

Adenoid cystic carcinoma of the breast: Value of histologic grading and proliferative activity

Adenoid cystic carcinoma of the breast is an uncommon carcinoma with a distinctive histology. Prognosis is favorable, although recurrence and distant metastases have been described. We assessed whether histologic features and proliferative activity can identify aggressive neoplasms. We studied 31 cases of adenoid cystic carcinoma (age range of patients, 33 to 74 years). Three histologic grades were defined: grade I: completely glandular; grade II: < 30% solid areas, and grade III: > or = 30% solid pattern. In 19 of 31 cases, immunohistochemical stains for estrogen receptor were available. Twelve of 31 cases were immunohistochemically stained for Ki-67 antigen using MIB1 antibody. Ten of 20 tumors were subareolar. All tumors were grossly circumscribed; however, 12 of 20 (60%) had focal infiltration peripherally. Five of 19 tumors were estrogen receptor positive. There was no statistical correlation between MIB1 score and histologic grade, nuclear grade, infiltration of the adjacent fat or breast parenchyma, or estrogen receptor status. All patients were alive with no evidence of disease after a median follow-up of 7 years. Neither histologic or nuclear grading nor proliferative activity were useful prognosticators. None of the tumors had lymph node metastases. Therefore, axillary lymph node dissection may not be necessary. Because more than half of adenoid cystic carcinomas are infiltrative focally, the most important therapeutic goal is complete tumor removal with uninvolved margins of excision.

Secretory carcinoma of the breast in adults.

Six examples of a breast neoplasm distinguished by gross and microscopic circumscription and prominent intracellular and intraacinar mucin are presented. These neoplasms are analogous to similar tumors which, although rare, more characteristically occur in the breasts of children. They apparently are slow-growing lesions and none manifested either local recurrence or metastases.

Hypotensive reactions : a previously uncharacterized complication of platelet transfusion ?

Background: In 1993, the American Association of Blood Banks (AABB) received reports of severe hypotensive reactions associated with platelet transfusions. The question arose as to whether these reports were indicative of a previously uncharacterized platelet transfusion reaction.

Microscopic extracapsular extension in the axilla: Is this an indication for axillary radiotherapy?

PURPOSE Although the axilla is often treated with radiotherapy (RT) postoperatively when microscopic extracapsular extension (ECE) of lymph nodal metastases is present, little data are available to assess axillary failure in the absence of such treatment. As it has been the practice at this institution to withhold axillary irradiation in the presence of microscopic extracapsular spread, we retrospectively analyzed our results for axillary recurrence, disease-free survival (DFS), and overall survival (OS). METHODS AND MATERIALS Clinical records were reviewed of 82 women with Stage II node positive breast cancer treated with lumpectomy, axillary dissection, and RT in addition to systemic chemo/hormonal therapy. Axillary surgery consisted of a level I, II, +/- III dissection, with a median of 16.5 nodes removed. Tangential radiotherapy fields were used to treat the breast. All patients were also treated with an abbreviated supraclavicular field with the lateral border medial to the humeral head. Pathological sections were available for review in 72 of the 82 women. RESULTS Twenty-seven of 72 (37.5%) had evidence of ECE; 45 of 72 (62.5%) had metastatic carcinoma confined within the nodal capsule. Clinical characteristics were comparable between the patients with and without ECE with the exception of (a) pathologic subtype, with a greater percentage of infiltrating ductal tumors associated with ECE (p = 0.044), and (b) number of positive lymph nodes, with 93% of patients without ECE having one to three positive nodes vs. only 56% among patients with ECE (p < 0.001). With a median follow-up of 40 months, 1 of 27 patients (4%) with ECE experienced an axillary failure as a component of first failure compared to 0 of 45 patients without ECE (p = 0.4). There were no isolated axillary failures. Five-year disease-free survival (72% without ECE vs. 57% with ECE, p = 0.12) and overall survival (83% vs. 53%, respectively, p = 0.068) suggested a less favorable outcome for patients with ECE. CONCLUSIONS Microscopic ECE appears to be associated with increased axillary involvement and decreased survival rather than subsequent axillary failure. Our data suggest that radiotherapy to a dissected axilla may be omitted for the sole indication of microscopic extracapsular disease.

Chemodectomas (nonchromaffin paragangliomas) of the head and neck. A clinicopathologic study

Forty patients with chemodectomas arising in carotid body, vagal body or glomus jugulare are reported. These tumors pursued a slowly progressive clinical course, resulting in a long interval between onset of symptoms and diagnosis, and an even longer average interval between treatment and onset of recurrent neoplasm. Whereas the sex incidence of carotid body and vagal body tumors was approximately equal, the majority of patients with glomus jugulare tumors were women. The histologic features and anatomic location of these tumors was distinctive; nevertheless, initial biopsy material from one fourth of these patients was misinterpreted. Four of these patients died as a result of their neoplasm; in three patients local extension of chemodectoma proved fatal while metastatic neoplasm resulted in the fourth patients death. It was not possible to correlate the histologic features of these tumors with their clinical course. Although total excision was the most successful treatment for readily accessible neoplasms, biopsy or partial excision followed by radiation therapy proved almost as effective for tumors which could not be completely resected.

Evidence-based recommendations for the use of WBC-reduced cellular blood components

In the United States, approximately 12 million to 14 million units of blood are donated annually.1 These units typically are fractionated into some 20 million blood components, mainly RBCs, platelets, and FFP.2 Alternatively, plasma, RBCs, and platelets may be obtained by apheresis. On average, 3 million to 4 million patients receive Evidence-based recommendations for the use of WBC-reduced cellular blood components

Olfactory neuroblastomas: a clinicopathologic study.

Clinical and pathologic findings in seven patients with olfactory neurbblastomas are reviewed. These neoplasms occurred over a wide age range and, regardless of microscopic pattern, had an unpredictable clinical course. Total extirpation followed by radiation provided optimal therapeutic benefit. The difficulty of pathologic diagnosis of olfactory neuroblastomas is emphasized by the number of neoplasms excluded from this series after critical review of clinical and microscopic findings.

Compatibility of Common Intravenous Solutions with CPD Blood

Blood anticoagulated with CPD was mixed with lactated Ringers solution, S per cent aqueous dextrose, 5 per cent dextrose in 0.225 per cent saline, 5 per cent dextrose in 0.9 per cent saline, and 0.9 per cent saline solution in varying concentrations and incubated at room temperature and 37 C. Clots formed in the blood‐lactated Ringers mixture after five minutes at a citrate:calcium molar ratio of 4:1 or lower. Aqueous dextrose‐blood mixtures showed immediate clumping with gross hemolysis after 30 minutes incubation. Blood mixed with S per cent dextrose and 0.225 per cent saline hemolyzed within ten minutes incubation at 37 C. No hemolysis occurred in blood mixed with 5 per cent dextrose in 0.9 per cent saline or with 0.9 per cent saline. Traces of solutions labeled with Evans blue dye remained in intravenous administration tubing even 30 minutes after a simulated transfusion was begun. Lactated Ringers solution and 5 per cent dextrose in 0.225 per cent saline should not be administered concurrently with blood. Lactated Ringers solution may also be harmful when used to start transfusions as it rapidly produces clots when mixed with CPD blood.