Ira S. Schwartz

Interobserver variation in the identification of breast carcinoma in intramammary lymphatics

Nine surgical pathologists participated in a microscopic review of 35 cases of pT1-2 N0 M0 breast carcinoma. The pathologists outlined strict criteria for the identification of intramammary lymphatics and blood vessels and for the identification of cancerous emboli in these vascular channels. Each mastectomy case was studied by three different pathologists. All three concurred on the presence or absence of intralymphatic cancer in 12 of the 35 cases. Observers agreed on the absence of blood vessel invasion in 30 of the 35 cases. There was no consistent bias on the part of a single reviewer, either alone or with another pathologist, in identifying the emboli. We conclude that the identification of intralymphatic cancerous emboli in mastectomy specimens is not a reliably reproducible prognostic finding on which recommendation of systemic chemotherapy in stage I breast carcinoma patients can be based.

Diffuse multinodular oncocytoma (“oncocytosis”) of the parotid gland

A multinodular parotid tumor in a 63‐year‐old man occupied almost the entire gland and was found to represent diffuse oncocytic growth. The literature on salivary gland oncocytoma is reviewed. This case appears to be a unique example of diffuse proliferation of oxyphilic granular cells (oncocytes) virtually replacing the normal parotid acinar structure. There was no evidence of local or distant spread.

Subdiaphragmatic bronchogenic cyst with communication to the stomach: A case report

A case of an infradiaphragmatic bronchogenic cyst in an adult patient presenting with nausea, vomiting, and epigastric discomfort is reported. An upper gastrointestinal series showed a multiloculated cyst communicating with the stomach via a patent fistulous tract. At laparotomy the cyst was found to be connected to and communicating with the posterolateral portion of the stomach. The cyst was completely below the diaphragm and received its blood supply from a branch of the abdominal aorta. Histologically, the cyst was composed of smooth muscle, respiratory epithelium, cartilage, and submucous glands. A review of the literature reveals that this case of bronchogenic cyst was unique in that it was located entirely beneath the diaphragm, was not associated with a diaphragmatic hernia or other congenital anomaly, and maintained a patent communication with a portion of the gastrointestinal tract, ie, the stomach, reminiscent of its embryological development.

Bilateral nasal bone osteophytosis associated with short-term oral isotretinoin therapy for cystic acne vulgaris.

Bilateral 2.5 and 3.0 mm nasal bone osteophytes developed five weeks following the initiation of oral isotretinoin therapy (50 mg daily) for severe cystic acne vulgaris in a healthy 30-year-old white woman who had undergone uneventful rhinoplasty 12 years earlier. Histologically mature bone fragments were removed at surgery. Vitamin A and its analogs have been reported to cause hyperostosis of the vertebrae and long bones, but no known reports link them to nasal bone changes. Clinically significant nasal bone osteophytosis may be another adverse reaction to oral isotretinoin therapy.

Fatal hemorrhage from a gastric cirsoid aneurysm

Gastric cirsoid aneurysm has been reported as a cause of massive bleeding from the stomach in less than 50 cases. It is an abnormally wide and tortuous submucosal gastric artery that is manifested clinically only subsequent to erosion and hemorrhage. A patient is described in whom the source of hemorrhage was unrecognized despite angiographic and gastroscopic examinations. Medical management was unsuccessful, and the source of fatal hemorrhage was not determined until postmortem examination.

Computed tomography of soft-tissue lesions of the extremities, pelvic and shoulder girdles: Sonographic and pathological correlations

Sixty-five patients with various soft-tissue tumours were examined by computed tomography (CT) and ultrasonography. Results were correlated with pathological findings. Although an accurate histological prediction could not be made in most cases, certain patterns appeared to be characteristic of specific types of tumours. A lipoma of uniformly low density may be differentiated from the heterogeneously denser liposarcoma. Multiple irregular linear densities with calcification are characteristic of haemangioma. An echo-free mass on the sonogram with soft-tissue density on CT suggests lymphoma or certain sarcomas. Small isodense subcutaneous lipomas or intramuscular lymphomatous masses may be clearly delineated on sonogram but not seen on CT. Our study indicates that the combined use of CT and ultrasound gives a very detailed basis for planning the surgical approach to the tumour.

Pulmonary embolism in the nursing home population: high frequency at autopsy in female residents

Pathological and clinical findings of all consecutive autopsies performed at The Jewish Home and Hospital for Aged from 4/1/85 to 12/31/86 were reviewed to determine the frequency and clinical significance of pulmonary embolism as a cause of death in the nursing home. The autopsies were performed by a single pathologist and a diagnosis of pulmonary embolism (PE) was based on microscopic confirmation of macroscopic findings. All charts during this time period were reviewed for classic signs and symptoms of PE, presence of risk factors associated with PE, ambulatory status and rapidity of death. The autopsy rate during this period was 25.6%. Of 41 autopsies reviewed (31 females and 10 males) 14 cases of pulmonary embolism were found representing a prevalence of 34.1%. All occurred in females. Pulmonary infarction was present in four cases. Massive PE (interrupting blood flow to both lungs) and major PE (interrupting flow to one entire lung) made up 11 of the cases (26.8% of all autopsies). Classic symptoms were not more frequent premortem in those with PE than those without PE. The presence of risk factors, or rapid death, or bedbound state did not predict the presence of PE. In none of the cases was the diagnosis established premortem. Elderly female residents of chronic care facilities appear to be at special risk of death from pulmonary embolism. Clinical findings are not of a diagnostic nature.

Suppurative keloidosis in a black woman

The development of suppuration and sinus tract formation within previously well developed keloidal scars is a rare event, predominantly occurring in the beard, neck, and presternal areas of black men. Keloidal entrapment of epithelial cystic elements, such as pilosebaceous units, has been suggested as one possible mechanism for the occurrence of suppurative keloids. We report the extremely rare development of a large, submental, submaxillary suppurative keloid in a black woman, with resulting sinus tract formation and intraoral drainage. The important clinical characteristics and treatment of suppurative keloidosis are discussed. The gross pathologic picture of keloidal epithelial-cystic entrapment and inflammation is also demonstrated.

The Sweet Contraceptive

To the Editor.— The lighthearted editorial by Dr. Henry T. Ricketts (231:392, 1975) concerning the potential of 5-thio-glucose as a male contraceptive prompted a verse in the same spirit: Five-thio in mice competes with D-Perhaps it can work for you and me. Within the testis it gums the works So spermatogenesis no longer works. No more hormones, IUDs, and the rest of that biz? Then hail 5-thio-glucose How sweet it is!