Marylee M. Kott

Endocrine carcinoma intermediate cell type of the uterine cervix

Nine cases of endocrine carcinoma, intermediate‐cell type of the uterine cervix, were found in a study of 404 cases listed in the files of the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston as adenocarcinoma of the cervix. Based on light microscopic patterns, these cases were divided into pure endocrine carcinoma (six cases), and endocrine carcinoma mixed with adenocarcinoma (three cases). All tumors were 3 cm or larger in at least one dimension. On light microscopic examination, the predominant pattern was trabecular; however, insular, glandular, and spindle patterns were also identified. Argyrophilic granules were demonstrated in all cases by Grimelius stain, and Fontana‐Masson (argentaffin) stain was negative. Electron microscopic examination of three cases showed membrane‐bound, dense‐core granules of the neurosecretory type. Although no endocrine symptoms were found, immunoperoxidase studies demonstrated 5‐hydroxytryptamine in seven cases, substance P in three, vasointestinal polypeptide in two, pancreatic polypeptide in one, and somatostatin in one. Clinical behavior of these tumors was extremely agressive. Although five cases were Stage IB at presentation, two Stage IIB, one Stage IIIB, and one Stage IV, 87.5% of these patients died of their neoplasms within 3 years. This study emphasizes the importance of correctly diagnosing endocrine carcinoma, intermediate‐cell type in the uterine cervix, because of the poor prognosis of this tumor when compared with adenocarcinoma of the cervix.

Cytokines disrupt intracellular patterns of Parkinson's disease-associated proteins alpha-synuclein, tau and ubiquitin in cultured glial cells

The purpose of this study was to determine the effects of specific proinflammatory cytokines interleukin-6 (Il-6), interleukin-1beta (Il-1beta), interferon-gamma (IFN), and tumor necrosis factor-alpha (TNFalpha), on content and distribution of alpha-synuclein (alpha-synuclein), tau and ubiquitin in human derived cultured glial cells. Exposure paradigms mimicked acute (2 h), intermediate (18 h) and prolonged time frames (96 h); consisting of single or repeated low doses (10 ng/ml) or high doses (50 ng/ml), consistent with either mild or serious systemic infectious/inflammatory responses. Images of intracellular protein content and distribution were reconstructed from emission patterns generated by fluorescence deconvolution microscopy. Minor alterations were seen in protein content with IFN; Il-1beta decreased alpha-synuclein and tau at 18 and 96 h; TNFalpha inversely reduced alpha-synuclein and increased ubiquitin content. Combinations of Il-1beta and IFN produced a robust increase of alpha-synuclein and tau at 2 h. Consecutive low doses of Il-6 produced only minor increases in alpha-synuclein and ubiquitin after 4 h, whereas a single high dose resulted in major increases for all three proteins over the first 18 h. Protein localization patterns were distinctly different and were altered dependent upon cytokine treatment. A high dose exposure (2 x 50 ng/ml) with Il-6 and IFN demonstrated that protein increases and dispersals could be sustained and that the normal perinuclear tau and peripheral alpha-synuclein patterns were disrupted. These results support the postulate that specific cytokines affect temporal protein changes with concomitant pattern disruptions, possibly reflecting a mechanism of cell dysfunction in Parkinsons degeneration.

Adenoid Cystic Carcinoma of the Thymus Gland: A Rare Tumor

Thymic carcinomas are rare malignant neoplasms. We present a case of adenoid cystic carcinoma of thymus in a 65-year-old woman that was initially misdiagnosed and was treated as non-small cell carcinoma of the lung. We describe the clinical and pathologic features of this extremely rare thymic epithelial tumor, with survival at 2 years and 6 months of follow-up.

Massive postpartum corpus luteum cyst: A case report

A young woman presented with an asymptomatic unilateral adnexal mass at six weeks postpartum. Her abdomen and pelvis had been considered unremarkable upon examination at parturition, at which time no adnexal masses were palpated. At laparotomy a 20 cm. right ovarian cyst was found, which was shown microscopically to be of corpus luteum origin. Each of the features--size, rapid development, and presentation in the postpartum state--is most unusual.

Cryptococcosis associated with crescentic glomerulonephritis

Crescentic glomerulonephritis (CGN) is an uncommon form of renal injury in childhood. Whereas many infectious processes are known to be linked to CGN, fungal infections typically are not. This report describes an 11-year-old girl who presented with CGN, cutaneous anergy, and cryptococcal mediastinitis. Whereas cryptococcal disease in children is usually associated with immunodeficiency (inherited or acquired), extensive immunologic evaluation of the patient was notable only for relative CD4 lymphopenia with normal CD4/CD8 ratios. Testing for human immunodeficiency virus was negative. Clinical and diagnostic studies are presented, along with a review of the literature regarding glomerular disease and cryptococcal infections.

Strongyloides Hyperinfection as a Mimic of Inflammatory Bowel Disease

With respect to hepatitis B virus (HBV) vaccine, not only IBD patients, but other patients with impaired immune function tend to have lower peak anti-hepatitis B (HBs) levels than immunocompetent indivi duals ( 3 ). In the case of IBD patients, the response rate is low, even among those not receiving immunosuppressants or biologic therapy, suggesting that IBD per se could be responsible for the suboptimal serologic response to HBV vaccine ( 3 – 4 ). Adult patients undergoing dialysis and other immunocompromised patients should receive high doses of HBV vaccine to achieve response. For IBD patients in particular, the European Crohn ’ s and Colitis Organization Consensus recommends higher doses of this vaccine for a favorable outcome ( 2 ). A recent study by our group showed an advantage of a doubledose vaccination protocol over the standard dose both in patients with and without immunosuppressive treatment ( 5 ). Th erefore, the double-dose protocol seems to be a suitable option in patients with IBD. Finally, anti-HBs titers can decline to undetectable levels allowing clinically signifi cant HBV infections in immunocompromised responders who do not maintain anti-HBs concentrations > 10 IU / l ( 3 ). It has been recently found that a relevant proportion of patients with protective anti-HBs titers aft er vaccination lose them over time (18 % of patients per year of follow-up), a fi gure that is higher than that reported in the healthy population ( 6 ). Furthermore, the risk of losing protective anti-HBs titers was threefold higher among patients on anti-tumor necrosis factor therapy ( 6 ). In conclusion, given the fact that IBD patients have been shown to have an impaired response to the majority of vaccines and that the response seems to be further diminished with the use of immunosuppressants, vaccines should be administered upon diagnosis of IBD. Furthermore, strategies to increase the effi cacy of vaccines in this population should be investigated.

Accuracy of Intraoperative Frozen Section Diagnosis of Borderline Ovarian Tumors by Hospital Type

STUDY OBJECTIVE To compare the accuracy of frozen section diagnosis of borderline ovarian tumors among 3 distinct types of hospital-academic hospital with gynecologic pathologists, academic hospital with nongynecologic pathologists, and community hospital with nongynecologic pathologists-and to determine if surgical staging alters patient care or outcomes for women with a frozen section diagnosis of borderline ovarian tumor. DESIGN Retrospective study (Canadian Task Force classification II-1). SETTING Tertiary care, academic, and community hospitals. PATIENTS Women with an intraoperative frozen section diagnosis of borderline ovarian tumor at 1 of 3 types of hospital from April 1998 through June 2016. INTERVENTIONS Comparison of final pathology with intraoperative frozen section diagnosis. MEASUREMENTS AND MAIN RESULTS Two hundred twelve women met the inclusion criteria. The frozen section diagnosis of borderline ovarian tumor correlated with the final pathologic diagnosis in 192 of 212 cases (90.6%), and the rate of correlation did not differ among the 3 hospital types (p = .82). Seven tumors (3.3%) were downgraded to benign on final pathologic analysis and 13 (6.1%) upgraded to invasive carcinoma. The 3 hospital types did not differ with respect to the proportion of tumors upgraded to invasive carcinoma (p = .62). Mucinous (odds ratio, 7.1; 95% confidence interval, 2.1-23.7; p = .002) and endometrioid borderline ovarian tumors (odds ratio, 32.4; 95% confidence interval, 1.8-595.5; p = .02) were more likely than serous ovarian tumors to be upgraded to carcinoma. Only 88 patients (41.5%) underwent lymphadenectomy, and only 1 (1.1%) had invasive carcinoma in a lymph node. CONCLUSIONS A frozen section diagnosis of borderline ovarian tumor correlates with the final pathologic diagnosis in a variety of hospital types.