Vijaya B. Reddy

Cell proliferation markers in predicting metastases in malignant melanoma

It is often difficult to predict the outcome of melanoma in patients with Clark level III‐IV disease. We sought to identify markers of cell proliferation which may be useful in predicting prognosis. Patients with Clarks level III‐IV malignant melanoma who had no local recurrences or metastases were matched with patients of comparable level and thickness who did experience recurrences or metastases. Cell proliferation markers p53, proliferating cell nuclear antigen (PCNA), and Ki‐67 were assessed by immunohistochemistry. DNA ploidy was determined by flow cytometry. There was no difference in the expression of p53, PCNA, and Ki‐67 between patients with metastases and patients without metastases. However, patients with metastases were more likely to have an aneuploid tumor cell population than were patients without metastases (p<0.03). Expression of cell proliferation markers do not appear to help predict prognosis in advanced level melanoma; however, aneuploidy may be associated with a greater probability of metastasis.

Plasma cell granuloma of the heart.

A case of plasma cell granuloma arising in the free ventricular wall and involving the coronary arteries of a 10‐month‐old female infant is presented. Morphologic characteristics were comparable with those of plasma cell granulomas arising elsewhere. The histologic, immunohistochemical, and ultrastructural observations, and in particular the quiescent clinical course of the disease and its control with anti‐inflammatory medication, favor a nonneoplastic nature of the lesion. This report documents the presence of an intracardiac plasma cell granuloma for the second time in the medical literature.

Posttransplant lymphoproliferative disorders: a fine-needle aspiration biopsy study.

Fine‐needle aspiration biopsy (FNAB) has been used with high sensitivity and specificity in the diagnosis of both Hodgkins and non‐Hodgkins lymphoma. However, studies of FNAB of posttransplant lymphoproliferative disorders (PTLDs) are rare. The clinical course of 593 allograft recipients (cardiac, 288; renal, 250; lung, 50; and heart/lung, 5) was reviewed. Twenty‐six patients developed PTLD with an overall incidence of 4.4%. Of these patients, 12 underwent FNAB. Their age ranged from 33–67 yr (mean, 55 yr). The interval between transplantation and FNAB ranged between 2–14 mo (average, 8.4 mo). The lungs were the most common site aspirated (7 cases), followed by lymph nodes (3 cases) and other extranodal sites (2 cases, liver and paraspinal mass). The cytologic features of these aspirates could be classified into two categories: a polymorphous smear composed of a spectrum of mature and immature lymphocytes with scattered plasma cells and histiocytes; and a monotonous population of large lymphoid cells consistent with malignant lymphoma, large‐cell type. Surgical biopsies were available in 10 (83.3%) cases and confirmed the FNAB diagnosis. In summary, FNAB appears to be a highly sensitive and specific diagnostic tool in patients with PTLD. Diagn. Cytopathol. 16:392–395, 1997.

Proliferation markers and prognosis in Merkel cell carcinoma

Merkel cell carcinotna (MCC) is a frequently aggressive primary cutaneous neuroendocrine malignancy. We investigated 3 cell proliferation markers which may be useful in predicting the aggressiveness of MCC: 1) p53, a tumor suppressor protein, 2) Ki‐67, a marker of cell cycling, and 3) proliferating cell nuclear antigen (PCNA). Twenty patients with MCC were studied. The 3 cell proliferation markers were studied by immunoperoxidase. Clinical and immunoperoxidase results were tabulated according to recurrence or death from disease. Of the 20 patients, 10 experienced recurrence, and 10 did not. Seven tumors were positive for p53. We found correlations between recurrence and death in MCC patients, between p53 positivity and recurrence/death, and between p53 positivity and head/neck primary sites. We found no correlation with recurrence by gender or primary site. PCNA was positive in only 1 patient, while Ki‐67 was positive in all patients, making these 2 markers unsuitable for predicting recurrence. Further clinical studies will be helpful to confirm and refine the application of this test. Prognostic information from such studies may be useful in planning observation and treatment for patients in the future.

Sebaceous gland hyperplasia of the penis.

A 22-year-old circumcised white man presented with asymptomatic 1 mm. papular lesions on the penis 11 days in duration. The lesions were arranged around the dorsal surface of the distal penile shaft. Biopsy was performed. Paraffin embedded sections were stained with hematoxylin and eosin. On microscopy benign hyperplastic sebaceous glands were composed of multiple mature lobules that coalesced centrally (see figure). Cases of sebaceous gland hyperplasia from an 8-year period were reviewed for comparison. This review revealed 206 previous patients with sebaceous gland hyperplasia, mostly facial involvement, of whom the majority (198) were elderly (mean age 61.2 years).

Prognostic Factors for Carcinoma of the Male Breast

Male mammary carcinoma (MMC) affects approximately 1000 men in the United States each year. Aside from the impact of estrogen-receptor positivity on the clinical course of this tumor, relatively little information exists in published form on the ability of special pathologic studies to predict its biologic behavior. The authors analyzed 26 cases of invasive ductal MMC, comparing overall survival with tumor size, histologic grade (Page and Anderson), immunohistologic estrogen receptor protein status, DNA ploidy, expression of S 100 and gross cystic disease fluid proteins, and immunohisto chemically-detected amplification of the c-erbB-2 (HER-2/neu) oncoprotein. Tumor size and amplification of c-erbB-2 oncoprotein emerged as the statistically significant predictors in this group; MMCs of <2 cm had a more favorable prognosis than large tumors. Estrogen receptor protein was seen in 80% of cases; c-erbB-2 amplification was present in 35%; 80% were DNA-aneuploid; and S 100 and gross cystic disease fluid were observed in 38% and 62% of cases, respectively. The latter data are virtually identical to those on histologically similar tumors in women, but all except c-erbB-2 failed to achieve statistical prognostic value in this study. Substrata of histologic grades among MMCs were numerically too small to subject to statistical assessment. These findings suggest that no substantive differences exist between the pathologic features of male and female breast cancers. They also indicate that adjunctive laboratory studies are currently unhelpful in the prognostication of MMC. Int J Surg Pathol 2(3):199-206, 1995

Amphicrine carcinoma of the lung. Diagnosis by fine needle aspiration cytology.

A case of pulmonary carcinoma with dual (glandular and endocrine) differentiation diagnosed by fine needle aspiration cytology is reported. By light microscopy, the neoplastic cells showed mucicarmine, periodic‐acid Schiff, and Grimelius silver positivity. On immunostaining, neuron specific enolase, chromogranin, calcitonin and serotonin were demonstrated. Electron microscopy revealed two different types of distinctive cytoplasmic inclusions in the same cell, namely: carcinoid type of neurosecretory granules and mucin droplets. Diagnostic criteria and possible histogenesis of this rare tumour entity are discussed.

Lectin Histochemistry of Sex Cord-Stromal Tumors and Small Cell Carcinoma of the Ovaries

Binding sites of peanut agglutinin (PNA), Ulex europaeus (UEA-1), concanavalin A (Con A), and wheat germ agglutinin (WGA) were localized in 10 granulosa cell tumors, 10 Sertoli-Leydig cell tumors, 4 theca cell tumors, and 5 small cell carcinomas. Con A and WGA reacted positively with the majority of the studied neoplasms. PNA and UEA-1 were persistently negative in the sex cord-stromal tumors (SCST) but showed focal positivity in small cell carcinomas. Negative reactions of SCST with PNA and UEA-1 may serve for differentiation between them and common epithelial tumors that are usually PNA and UEA-1 positive.

Differential diagnosis in cytopathology

Preface Acknowledgments 1. The pap smear Lourdes R. Ylagan 2. Exfoliative pulmonary cytology Claire W. Michael 3. Body cavity fluids Mohammad M. Yousef and Claire W. Michael 4. Gastrointestinal tract cytology Reda S. Saad, Telma C. Pereira and Jan F. Silverman 5. Urine cytology Guliz A. Barkan, Umesh Kapur and Eva M. Wojcik 6. Cerebrospinal fluid and intraocular cytology Rosa M. Davila 7. Cytopathology of the central nervous system Walid E. Khalbuss, Anil V. Parwani and Syed Z. Ali 8. Fine needle aspiration of the thyroid gland Richard L. Cantley, Ritu Nayar and Ajit Paintal 9. Parathyroid gland, head and neck cytopathology Aylin Simsir and Joan Cangiarella 10. Cytopathology of the salivary glands Pascale Levine and Joan Cangiarella 11. Cytopathology of the breast Shahla Masood and Marilin Rosa 12. Fine needle aspiration of lymph nodes Marilin Rosa and Shahla Masood 13. FNA of lung, pleura, and mediastinum Jing Zhai 14. Fine needle aspiration of the liver Amy A. Lo, Julianna M. Ubago, Ritu Nayar and Xiaoqi Lin 15. Fine needle aspiration of the pancreas Natasha Berg, Ajit Paitnal and Ritu Nayar 16. Fine needle aspiration of soft tissue and bone Lester J. Layfield 17. Fine needle aspiration of the kidney and adrenal gland Blythe K. Gorman, Luan D. Truong and Rose Anton 18. Cytology of the gonads Guliz A. Barkan and Eva M. Wojcik 19. Fine needle aspiration cytology of tumors of unknown origin Tarik M. Elsheikh Index.