Valerie A. Fitzhugh

Significance of a diagnosis of microorganisms on pap smear.

The Pap smear has been in use for more than half a century as the primary screening test for preinvasive and invasive lesions of the uterine cervix. Although not the primary use and an imperfect test, it can be extremely useful in the diagnosis of some microorganisms. This review focuses on the use of the Pap smear in the diagnosis of several microorganisms including Actinomyces, Chlamydia trachomatis, Candida, Trichomonas vaginalis, Leptothrix vaginalis, Herpes Simplex Virus, the causative agents of bacterial vaginosis, and other rarer organisms. The accuracy of diagnosis using the smear varies among the different organisms in question.

Significance of Divergent Expression of Prostaglandin EP4 and EP3 Receptors in Human Prostate Cancer

PGE2 has been implicated in prostate cancer tumorigenesis. We hypothesized that abnormal prostaglandin receptor (EPR) expression may contribute to prostate cancer growth. Twenty-six archived radical prostatectomy specimens were evaluated by immunohistochemistry (IHC) and Western blotting for the expression of EP1, EP2, EP3, and EP4. As a corollary, EPR expression in one normal (PZ-HPV7) and four prostate cancer cell lines (CA-HPV10, LNCaP, PC3, and Du145) were assessed by Western blotting. Prostate cancer and normal cell growth were compared in vitro after EPR blockade, siRNA EPR knockdown, or overexpression. EP1, EP2, EP3, and EP4 receptors were detected by IHC in all areas of benign tissue within the clinical prostate cancer specimens. In areas of prostate cancer, EP4 and EP2 were overexpressed in 85% (22 of 26) and 75% (18 of 24) and EP3 expression was reduced in all (26 of 26, 100%) specimens (P < 0.05 vs. benign tissue). EP1 showed no specific differential expression pattern. Increased EP4 and reduced EP3 was confirmed by Western blotting in fresh clinical specimens and in prostate cancer cell lines (CA-HPV10, LNCaP, PC3, and Du145) compared with the normal prostate cell line (PZ-HPV7). EP2 and EP4 siRNA knockdown resulted in reduced in vitro growth and metastasis-related gene expression (MMP9 and Runx2) of prostate cancer lines, and in vitro migration was inhibited by EP4 antagonists. As a corollary, EP3-overexpressing PC3 cells displayed impaired growth in vitro. Human prostate cancer is associated with EP4 and EP2 overexpression and reduced EP3 expression. These data suggest that targeting specific EPR may represent a novel therapeutic approach for prostate cancer. Mol Cancer Res; 11(4); 427–39. ©2013 AACR.

Adnexal Torsion Leading to Death of an Infant

BACKGROUND Torsion of the uterine adnexa is an uncommon occurrence in infants, but when it does occur, the consequences may be catastrophic. CASE A 4-month-old female presented with sudden cardiac and respiratory arrest. There were no prior signs of illness. The infant was resuscitated and survived for one day after the event. Autopsy revealed a left ovarian cyst with torsion. Necrosis of the transverse colon was also seen. Other organs revealed signs of shock. The cause of death was felt to be related to the torsion. SUMMARY AND CONCLUSION Torsion of the uterine adnexa is rare in infants. In the few reported cases, antecedent symptoms were present. Clinicians should be aware of this possibility and include it in the differential diagnosis of death in infancy.

Mesenchymal lesions of the vulva.

Mesenchymal lesions of the vulva may be either regionally specific to the vulva or soft tissue neoplasms that can occur in multiple locations on the body. They may have overlapping histological and immunohistochemical features and, in routine practice, are not likely to be encountered, adding to the diagnostic difficulty. A review of mesenchymal vulvar lesions is presented.

Massive localized lymphedema of the vulva: report of a case and review of the literature.

Background Massive localized lymphedema (MLL) is a recently described entity associated with obesity, most often on the thighs. It rarely occurs on the vulva, and it may pose diagnostic difficulty for both clinician and pathologist in this setting. Case An obese 55-year-old woman underwent excision of bilateral polypoid vulvar masses. Histology confirmed the diagnosis of MLL. Conclusions Although MLL is not common on the vulva, with the increasing incidence of obesity in the population, more cases can be anticipated, and an awareness of this lesion is important.

Conjunctival Squamous Cell Carcinoma Harboring Leishmania Amastigotes in a Human Immunodeficiency Virus–Positive Patient

tergent. The detergent may enable the toxin to penetrate deeper into the cornea. We believe that these are the first reported cases of Surgilube use on the ocular surface. Because of the common use of Surgilube in the hospital setting and the similar appearance to certain ocular medications, it is unlikely that this is the first actual time its mistaken use has occurred. It is important to correctly identify any medication being used on the ocular surface. It is also important to identify which medications are safe for use in the eye and not to use medications that do not have this designation. Although the patients in our case reports regained good vision, one patient was left with corneal haze and the other with chronic dry eye irritation. Due to the slow reepithelialization of the cornea, infectious keratitis and loss of visual acuity are possible.

Vaginal blue nevus: report of a case and review of the literature.

Objective: Blue nevi are extremely rare in the vaginal canal and are suspicious for melanoma, especially when multiple lesions are present. We describe a woman with multiple blue nevi of the vagina. Design: We describe 1 case of multiple blue nevi of the vagina. Results: A 37-year-old woman, status after therapy for serous carcinoma of the ovary, presented with multiple blue to black macular lesions present throughout the vagina. Two of the lesions were examined by biopsy and demonstrated dendritic melanocytes. The patient has been closely followed, and the lesions remain unchanged. Conclusions: Multiple vaginal blue nevi are an important differential diagnostic consideration for melanoma of the vagina. These lesions, however, are benign and require only clinical follow-up. Excision is unnecessary.

Multiple Giant Cell Tumors of Tendon Sheath Found within a Single Digit of a 9-Year-Old

Giant cell tumor of tendon sheath is one of the most common soft tissue tumors of the hand. These tumors typically occur in the third or fourth decade of life and present as solitary nodules on a single digit. Currently, the greatest reported number of lesions found within a single digit is five. Although uncommon, giant cell tumor of tendon sheath does occur in the pediatric population. Herein we present a report of a rare case of GCTTS in a child in which seven lesions were identified within a single digit—the greatest number of lesions within a single digit reported to date.

Preoperative Fine Needle Aspiration Cytology Diagnosis of Microcystic Adenoma of the Pancreas: Fact or Fiction?

BACKGROUND Microcystic adenoma is an uncommon benign neoplasm involving the pancreas that usually affects older populations. These neoplasms often enlarge to significant sizes, causing symptoms of obstruction and discomfort. CASES We report 2 cases of microcystic adenoma of the pancreas in which an accurate diagnosis could not be rendered on cytology material alone. Bench fine needle aspiration (FNA) biopsy performed on the resection specimen in one of the cases had a higher cellular yield because a different technique was used to prepare the slide. CONCLUSION A preoperative diagnosis can be helpful in guiding the care of the patient, thereby increasing the importance of a diagnosis to distinguish between a benign vs. malignant process. These case reports demonstrate the difficulty of obtaining diagnostic cells in microcystic adenoma, highlight the use of FNA to increase cellular yield and emphasize the importance of correlating radiologic findings with aspiration of abundant watery fluid from cystic pancreatic masses to make a definitive diagnosis.

Glomangiomatosis: a case report

Glomangiomatosis is a benign vascular variant of a glomus tumor. The lesion represents only 5% of glomus tumors with unusual or atypical features and even fewer glomus tumors with typical features. The lesions are most commonly located in the distal extremities and are multiple, deep, extensive, and often pain producing. They develop from small arteriovenous anastamoses and are most often identified in young adults. The lesions may recur. We present a case of a 33-year-old male who presented clinically with multiple slowly enlarging masses of the leg over a 5-year period, of which one caused significant pain. One of the lesions was reported to be present at birth. Imaging studies were performed and were suggestive of neurofibromatosis. Biopsies from multiple lesions led to an eventual diagnosis of multiple glomangiomatosis.