Role of intraoperative cytology combined with histology in detecting continuous and skip type intraductal cancer existence for intraductal papillary mucinous carcinoma of the pancreas

BACKGROUND: Intraductal papillary mucinous neoplasm (IPMN) is a recently discovered pancreatic tumor that has continuous or discontinuous (skip) lesions. Recent reports suggest a higher frequency of cancer recurrence in the remnant pancreas after surgical resection of IPMN. It is therefore important to precisely detect intraductal cancer extension and skip lesions when resecting IPMN. METHODS: Both intraoperative histologic examination of the surgical margin and cytologic examination of the pancreatic juice from each pancreatic segment (head, body, or tail) were performed on 43 IPMN patients. In addition to the preoperatively planned resection, 1 or 2 pancreatic segment(s) were additionally resected if the pancreatic juice tested positive in cytology. When a surgical margin was positive but the cytology in the remaining segment was negative, a subsegment (2-cm slice in width) was additionally resected until a negative margin was confirmed. RESULTS: Twenty-five patients (58%) demonstrated negative results in both histology and cytology obtained from the segment(s) that were not initially intended to be removed. In contrast to the preoperative estimation, 5 patients were found to have a positive surgical margin and negative cytology, 5 patients demonstrated a negative surgical margin and positive cytology, and 8 patients demonstrated a positive surgical margin and positive cytology. Investigations of the resected specimens revealed that 8 patients (19%) had skip lesions in addition to the main lesion. Logistic regression analysis revealed that patients with a dilated main pancreatic duct, or those with cancerous lesions in the main tumors, were at high risk for positive histology and/or cytology. CONCLUSIONS: Using intraoperative frozen-section histology and pancreatic juice cytology, 18 out of 43 patients in the current study (42%) required additional resection of the pancreas. A necessary and sufficient range of resection should be determined by intraoperative examination.     

婴幼儿促纤维增生性星形细胞瘤1例报道及文献回顾

目的 总结分析婴幼儿促纤维增生性星形细胞瘤的病理组织学特征及其与其他中枢神经系统肿瘤的鉴别诊断。方法 对1例婴幼儿促纤维增生性星形细胞瘤进行组织形态学，组织化学和免疫组织化学研究，同时结合文献对其临床表现，病理形态特点及鉴别诊断进行探讨。结果 本例婴幼儿促纤维增生性星形细胞瘤的CT检查表现为左颞叶巨大的囊性病变；组织学表现在丰富的纤维间质中，含有灶状或巢状的向星形细胞分化的神经上皮成份；免疫组织化学显示瘤细胞呈GFAP阳性，vimentin阳性NSE阴性；网织纤维染色显示在致密的嗜银纤维区间可见岛屿状的空染区。结论 婴幼儿促纤维增生性星形细胞瘤是一种罕见的发生在婴幼儿的中枢神经肿瘤。根据其组织学特点，结合组织化学和免疫组化染色结果，可以做出明确的病理诊断。     

Evaluation of stereotactic core needle biopsy (SCNB) of the breast at a single institution

Stereotactic core needle biopsy (SCNB) has become a popular method for diagnosis of occult breast abnormalities. There are few large series of SCNB from a single institution. Data on patients undergoing SCNB for mammographic abnormalities were collected prospectively over 43 months at a university hospital. Mammographic findings were categorized as benign, probably benign, indeterminate, suspicious or malignant. For lesions with SCNB pathology that were non-diagnostic, showed atypical hyperplasia or malignancy (in situ or invasive), or were discordant with the pre-biopsy mammogram findings, surgical excision was recommended. Subsequent surgical pathology was reviewed. All remaining lesions were followed mammographically after SCNB. SCNB was performed on 692 lesions in 607 patients. There were 79 malignancies, for a positive SCNB rate of 11.4%. The 349 SCNB performed for benign, probably benign and indeterminate lesions on mammography had a positive SCNB rate of only 4%. Surgery was recommended for 127 (18.3%) lesions, while 565 (81.6%) were followed mammographically after SCNB. A compliance rate of 61% for at least one follow-up mammogram was obtained, with a median follow-up of 17.2 months and with no cancers found. The sensitivity for malignancy with SCNB was 93%. SCNB provides a minimally invasive method to assess mammographic abnormalities. Abnormalities considered radiographically to be other than malignant or suspicious yielded few cancers. In this series a low positive SCNB rate resulted in no false negatives on mammographic follow-up. The optimal positive biopsy rate for SCNB is debatable.     

Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma

BACKGROUND: The current study was performed to clarify whether the presence of residual carcinoma in situ at ductal resection margins differs prognostically from residual invasive ductal lesions in patients undergoing surgical resection for extrahepatic cholangiocarcinoma. METHODS: A retrospective analysis of 84 patients with extrahepatic cholangiocarcinoma who underwent surgical resection was conducted. The ductal resection margin status was classified as negative (n = 64 patients), positive with carcinoma in situ (n = 11 patients), or positive with invasive carcinoma (n = 9 patients). The median follow-up period was 105 months. RESULTS: Ductal margin status was found to be a strong independent prognostic factor by both univariate (P = 0.0002) and multivariate (P = 0.0039) analyses. The outcome after surgical resection was comparable between patients with negative ductal margins (median survival time of 45 months; cumulative 10-year survival rate of 40%) and those with positive ductal margins with carcinoma in situ (median survival time of 99 months; cumulative 10-year survival rate of 23%; P = 0.4742). In patients with positive ductal margins, the outcome was found to be significantly better in patients with residual carcinoma in situ than in those with residual invasive carcinoma (median survival time of 21 months; cumulative 5-year survival rate of 0%; P = 0.0003). Of 11 patients with residual carcinoma in situ, 4 died of tumor recurrence and the initial site of the disease recurrence was local. All 9 patients with residual invasive carcinoma died of disease recurrence (local recurrence with or without distant metastases) within 40 months after surgical resection. CONCLUSIONS: After surgical resection for extrahepatic cholangiocarcinoma, invasive carcinoma at ductal resection margins appears to have a strong adverse effect on patient survival, whereas residual carcinoma in situ does not.     

Sensitivity and specificity of a stool DNA multitarget assay panel for the detection of advanced colorectal neoplasia

Colorectal cancer is the second-leading cause of cancer death. New noninvasive options for screening capable of diagnosing cancer at an early stage are needed to improve compliance and reduce mortality. This study was designed to provide an estimate of the sensitivity and specificity of a multitarget assay panel (MTAP) of stool DNA changes. Eighty patients with advanced colorectal neoplasia and 212 control subjects provided stool samples before colonoscopy. Patients with hereditary colorectal cancer syndromes were excluded. The MTAP included 21 specific mutations in the adenomatous polyposis coli (APC), p53, and K-ras genes, a microsatellite instability marker (BAT-26), and a marker of abnormal apoptosis (DNA Integrity Assay). All samples were analyzed in the clinical laboratory at EXACT Sciences. Multitarget assay panel detected 33 of 52 patients (63.5%, 95% confidence interval [CI], 49.0%-76.4%) with invasive colorectal cancer, including 26 of 36 (72.2%) with node-negative disease (American Joint Committee on Cancer [AJCC] stage I/II) and 7 of 16 (43.7%) with advanced disease (AJCC stage III/IV). Sixteen of 28 patients (57.1%; 95% CI, 37.2%-75.5%) with advanced adenomas (lesions containing high-grade dysplasia, villous adenomas, or tubular adenomas > 1 cm in size) were detected, including 6 of 7 (85.7%) with high-grade dysplasia and 10 of 21 (47.6%) with other advanced adenomas. Specificity was 96.2% (95% CI, 92.7%-98.4%) in patients with either no colorectal lesions or diminutive polyps. Multitarget assay panel has better sensitivity than that reported with use of Hemoccult(R) II in fecal occult blood testing, with similar specificity. Sensitivity appeared to be equally high for patients with node-negative and advanced disease, as well as for advanced adenomas. This study contained a disproportionately high number of distal cancers and, as such, may not be representative of results in proximal lesions. Although a prospective study in an average-risk population is needed to validate these findings, MTAP may offer an important noninvasive option for population-based screening.     

The results of therapy for bilateral multiple primary lung cancers: 30 years experience in a single centre.

AIMS: This study reviews our 30 years experience in the clinical assessment and surgical management of bilateral multiple primary lung cancer (BMPLC). METHODS: Between January 1973 and December 2001, 1906 patients with primary lung cancer underwent surgical resection in Kanazawa University Hospital. Thirty-seven patients (1.9%) who had developed a BMPLC using the criteria of Martini and Antakli. RESULTS: Eighteen patients had synchronous lesions, and 18 patients had metachronous lesions. One patient had synchronous and metachronous lesions. Overall 10-year survival was 56%. The actuarial 5-year survival for bilateral synchronous cancers was 69%, median survival (MST) 90 months (range 8-153 months), and 10-year survival was 47%. The actuarial 5-year survival for second metachronous cancers was 51%, with an MST of 114 months (range 6-192 months). CONCLUSION: Aggressive surgical therapy is effective in patients with a bilateral MPLC if they satisfy the usual criteria of operability. The surgical methods that preserve healthy lung tissue such as sleeve resection and limited resection must be selected in compliance with cancer characters.     

右心肿瘤的外科治疗

目的总结右心系统肿瘤的发生部位、肿瘤性质、诊断及外科治疗方法.方法 1979年1月～2003年5月我们对27例右心系统肿瘤患者行手术治疗,占同期心脏肿瘤患者的14.1%,男16例,女11例.年龄17～70岁,平均(39.9±13.6)岁.其中良性肿瘤25例,恶性肿瘤2例.结果手术死亡1例,死亡率3.7%.余26例术后随访3个月至15年,2例恶性肿瘤分别于术后5个月、9个月死亡,1例黏液瘤于术后10个月复发.结论临床右心肿瘤以黏液瘤多见,彻底切除肿瘤是防止心脏肿瘤复发的关键.心脏恶性肿瘤手术切除近远期效果差.     

Spontaneously regressing adrenocortical carcinoma in a newborn. A case report with DNA ploidy analysis

Adrenal cortical carcinoma is an uncommon neoplasm in children. Only a handful of congenital adrenal cortical carcinoma cases have been described. A newborn who had metastatic adrenal cortical carcinoma (skin metastases and cerebral lesions) is described. This patient underwent surgical resection of the right adrenal primary, but no further treatment was given. Hemihypertrophy developed in this patient by 2 months of age, and at 4 months of age spontaneous regression of all skin nodules and central nervous system (CNS) lesions was observed. Follow-up at 1 year shows the patient to be alive, well, and disease-free. Evaluation of the tumor included DNA ploidy analysis that showed the tumor to be polyploid, a pattern recently associated with nonmetastasizing adrenal cortical neoplasm. The observation of apparent metastatic disease that regressed spontaneously highlights the prognostic value of DNA ploidy analysis and raises the possibility of an adrenal tumor with properties similar to those of Stage IV-S neuroblastoma.     

Percutaneous intraductal sampling for cyto-histologic diagnosis of biliary duct strictures.

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) allows ductal material to be collected for cyto-histologic examination. We evaluated the data from a large series of patients with a PTBD in whom endobiliary cyto-histologic sampling techniques were employed in order to define a strategy for their use in the diagnostic work-up. PATIENTS AND METHODS: Ductal samples for cyto-histologic examination were obtained from 409 consecutive patients with a PTBD for stenosing lesions of the biliary tree. Bile aspirate cytology was performed for all patients and ductal biopsy specimens were obtained, generally after negative cytology, from 49 of them (11.9%), all candidates for a therapeutic procedure. The cyto-histologic results of intraductal sampling were compared with pathologic surgical data in 210 patients and with clinical-radiologic follow-up in 199. RESULTS: Overall, 22 out of the 409 patients had a final diagnosis of benign stenosis and 177 had samples positive for neoplastic disease. The sensitivity of bile cytology was 43.8% while ductal biopsies showed a sensitivity of 60.4%. The combination of the two sampling techniques achieved a sensitivity of 65.1%. For both sampling methods the specificity was 100%. Hilar metastases from neoplastic lesions of the GI tract and primary lesions of the biliary ducts showed the highest sensitivity. CONCLUSION: Cyto-histologic assessment of stenosing lesions of the biliary ducts is mandatory when highly sophisticated interventions (e.g. wide hepatic resection or liver transplantation) or non-surgical treatments are envisaged. The collection of cyto-histologic samples from bile ducts, in patients with a percutaneous bile drainage, is an easy, safe and valuable method to obtain the diagnosis. In view of the absence of false positive results in our series and in others, intraductal biopsy serves no purpose when positive exfoliative cytology is positive for malignancy. In the presence of negative cytology it is felt that an intraductal biopsy should be mandatory when the choice of a therapeutic program depends on the result of the cyto-histologic diagnosis.     

Prolonged survival after complete resection of metastases from intraocular melanoma

BACKGROUND: The median survival time is only 2-6 months after a diagnosis of metastases from intraocular melanoma. Because complete resection of metastatic melanoma from a cutaneous primary tumor can prolong survival, the authors hypothesized that resection also might benefit patients with metastases from an intraocular site. METHODS: From 1971 to 1999, 112 patients with metastatic melanoma from an intraocular site were enrolled in various treatment protocols after informed consent was obtained. Prospectively recorded clinical variables and follow-up information were retrieved from the patient database. Survival curves were estimated using the Kaplan-Meier method. Univariate analysis was performed with the log-rank test. Multivariate analysis was performed using the Cox proportional hazards regression model. Propensity score analysis was used to reduce the imbalance between subgroups and to assess treatment effect. RESULTS: Seventy-eight patients (70%) presented with liver involvement. Twenty-four patients (21%) underwent resection of metastatic lesions. At a median follow-up time of 11 months (range, 1-97 months; > 36 months for survivors), the median survival period was 11 months and the 5-year survival rate was 7%. Univariate analysis showed that surgical resection, site of metastases, number of metastatic lesions, and disease-free interval were correlated significantly with survival (P < 0.001, P < 0.001, P < 0.001, and P = 0.031, respectively). Multivariate analysis showed that surgical resection was significant (P = 0.008) but that the site of metastases was not (P = 0.146). The median survival and the 5-year survival rate were 38 months and 39%, respectively, for surgical patients, versus 9 months and 0%, respectively, for nonsurgical patients. After adjusting for covariate imbalance by propensity score analysis, surgery remained significant (P = 0.021) on multivariate analysis. CONCLUSIONS: Complete resection may prolong survival in certain patients with distant metastases from intraocular primary melanoma. However, the overall unfavorable prognosis indicates an urgent need for more effective nonsurgical interventions.     

Outcomes of Local Excision for Early Rectal Cancer: a 6-year Experience from the Largest University Hospital in Thailand

Background: This study aimed to determine clinical outcomes of local excision for early rectal cancer from aUniversity Hospital in Thailand. Materials and Methods: We performed a retrospective review of 22 consecutivepatients undergoing local excision for early rectal cancer (clinical and radiological T1/T2) from 2005-2010 at theFaculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. Data were collected from patients’ medicalrecords, including demographic and clinical characteristics, pathological report and surgical outcomes. Results:This study included 10 males and 12 females, with average age of 68 years. Nineteen patients (86%) underwenttransanal excision and the others had trans-sacral excision. Median operative time was 45 minutes. Postoperativecomplications occurred in 2 patients (9%); 1 fecal fistula and 1 wound infection following trans-sacral excision.There was no 30-day postoperative mortality. Median hospital stay was 5 days. Pathological reports revealedT1 lesion in 12 cases (55%), T2 lesion in 8 cases (36%) and T3 lesion in 2 cases (9%). Eight patients receivedadditional treatment; one re-do transanal excision, two proctectomies, and five adjuvant chemoradiation. Duringthe median follow-up period of 25 months, local recurrence was detected in 4 patients (18%); two cases of T2lesions with close or positive margins, and two cases of T3 lesions. Three patients with local recurrence underwentsalvage abdominoperineal resection. No local recurrence was found in T1/T2 lesions with free surgical margins.Conclusions: Local excision is a feasible and acceptable alternative to radical resection only in early rectal cancerwith free resection margins and favorable histopathology.     

Practical approach to patients presenting with multiple synchronous suspect lung lesions: a reflection on the current TNM classification based on 54 cases with complete follow-up.

OBJECTIVES: To examine the survival after surgical treatment of patients presenting with two synchronous suspect lung lesions, and to reflect on the recent TNM classification, which has upgraded patients with two malignant lung lesions of the same histology into the T4 (both lesions in the same ipsilateral lobe) or M1 (different lobes or lungs) category. METHODS: Retrieval of all consecutive patients with a diagnosis of two synchronous suspect lung lesions in the prospective database of the Leuven Lung Cancer Group in the interval between 1990 and 1994. Analysis of characteristics and survival of all patients, who underwent surgical resection with intention to cure for both lesions. RESULTS: Forty-eight of 54 patients had surgical resection with curative intent. Thirty-five of these proved to have two malignant lesions, in 13 the second lesion was benign. The 5-year survival rate in the patients with two malignant lesions was 33% (95% CI: 17-49). The median survival time was 28 months. Although the number of patients in the subgroups was small, there were no obvious differences between patients with two lesions in the same or in different lobes, if a complete resection could be achieved. CONCLUSIONS: An aggressive surgical approach in carefully selected patients presenting with two suspect pulmonary lesions can be rewarding. Although some degree of upstaging is appropriate in patients with two malignant lung tumours of the same histology, their current stage IIIB or IV classification probably underestimates their prospects for long-term survival after radical resection.     

Desmoid tumors: a novel approach for local control

BACKGROUND AND OBJECTIVES: After resection, desmoid tumors are associated with a recurrence rate that is typically 25-50%. Although this is an unusual problem, we instituted a prospective cohort study with neoadjuvant chemotherapy and radiation, followed by surgical resection, in an effort to improve local control. METHODS: Between 1985 and 1999, 13 patients with potentially resectable disease were managed with a treatment protocol of preoperative doxorubicin (30 mg continuous infusion daily for 3 days) and radiotherapy (10 x 300 cGy). Resection was performed 4-6 weeks later. All lesions were resected with an intended margin of 1 cm, but clear adventitial margins were accepted in order to preserve critical structures. RESULTS: The median follow-up was 71 months (range, 22-109). Six patients (46%) presented after failure of a previous surgery. Clear microscopic margins were obtained in 11 patients, and 2 patients had positive margins. There were two local recurrences (15% local recurrence). Both recurrences followed resection of large thigh lesions, which appeared at 30 and 49 months of follow-up. In one patient with a chest wall tumor, two new primary desmoid tumors developed outside the treatment area, in the ipsilateral arm and forearm. Eleven patients have been disease free for a median of 71 months (range, 22-109). CONCLUSIONS: For potentially resectable lesions, this protocol provides excellent local control, even in those with recurrent disease. Neoadjuvant treatment with doxorubicin and radiotherapy appears to be a better option than surgery alone, or surgery and adjuvant radiotherapy. These results need to be confirmed in larger, prospective randomized trials.     

Immunohistochemical diagnosis of methylthioadenosine phosphorylase (MTAP) deficiency in non-small cell lung carcinoma

Methylthioadenosine phosphorylase (MTAP) is involved in the metabolism of purines and converts methylthioadenosine (MTA) to adenine. It is abundant in all normal tissues but is deficient in various tumors. Here, we investigated MTAP deficiency in clinical samples of lung cancer using immunohistochemistry (IHC), and compared these results with those obtained by real-time PCR. Seventy-five samples were obtained from patients who underwent operations for non-small cell lung cancer (NSCLC). MTAP genetic analysis, using real-time PCR, and IHC were carried out on the samples. Methylation-specific primers were used to analyze methylation of the MTAP promoter, using DNA treated with sodium bisulfite. Sixty-nine of 75 samples were compared using both IHC and real-time PCR. The IHC results were consistent with those of real-time PCR in 56 samples. Of 62 positive samples tested by real-time PCR, only 49 (79%) were MTAP-positive by IHC. Seven samples were MTAP-negative by real-time PCR and IHC. In 13 samples of PCR (+) and IHC (-), six samples showed that the promoter region of MTAP was methylated. IHC is an accurate and useful diagnostic method for detecting MTAP deficiency in NSCLC, and the frequency of MTAP deficiency was found to be relatively high. The metabolic alterations diagnosed by IHC could be exploited for selective chemotherapy.     

MicroRNA in pancreatic ductal adenocarcinoma and its precursor lesions

Pancreatic ductal adenocarcinoma (PDAC) is the 4^th deadliest cancer in the United States, due to its aggressive nature, late detection, and resistance to chemotherapy. The majority of PDAC develops from 3 precursor lesions, pancreatic intraepithelial lesions (PanIN), intraductual papillary mucinous neoplasm (IPMN), and mucinous cystic neoplasm. Early detection and surgical resection can increase PDAC 5-year survival rate from 6% for Stage IV to 50% for Stage I. To date, there are no reliable biomarkers that can detect PDAC. MicroRNAs (miRNA) are small noncoding RNAs (18-25 nucleotides) that regulate gene expression by affecting translation of messenger RNA (mRNA). A large body of evidence suggests that miRNAs are dysregulated in various types of cancers. MiRNA has been profiled as a potential biomarker in pancreatic tumor tissue, blood, cyst fluid, stool, and saliva. Four miRNA biomarkers (miR-21, miR-155, miR-196, and miR-210) have been consistently dysregulated in PDAC. MiR-21, miR-155, and miR-196 have also been dysregulated in IPMN and PanIN lesions suggesting their use as early biomarkers of this disease. In this review, we explore current knowledge of miRNA sampling, miRNA dysregulation in PDAC and its precursor lesions, and advances that have been made in using miRNA as a biomarker for PDAC and its precursor lesions.     

Pancreatic cancer screening: identifying premalignant disease

Evaluation of: Canto MI, Goggins M, Yeo CJ et al.: Screening for pancreatic neoplasia in high-risk individuals: an EUS-based approach. Clin. Gastroenterol. Hepatol. 2(7), 606-621 (2004). Endoscopic ultrasound was utilized in the screening of individuals at high risk for pancreatic cancer. Patients with abnormal endoscopic ultrasound findings were further evaluated with fine-needle biopsy, endoscopic retrograde cholangipancreatography, and computerized tomography scanning. A total of 38 patients were enrolled in this prospective screening program. A total of seven patients were identified with suspicious neoplastic lesions and underwent pancreatic resection. No significant morbidity or mortality resulted from the screening tests or subsequent intervention including surgery. Surgical pathology revealed two neoplastic masses (invasive carcinoma and intraductal pancreatic mucinous neoplasm), three pancreatic intraepithelial neoplastic lesions, and two benign lesions for a diagnostic yield of 13.1% (five of 38). The patient with invasive carcinoma remains disease free over 5 years following surgery. The results of this study suggest a reasonable approach to detecting early neoplastic lesions in asymptomatic individuals. Such early intervention efforts hold much potential in reducing the mortality of this aggressive disease. Further studies are needed to confirm the suggested clinical benefit of screening and to answer questions related to specific screening protocols.     

Intraductal papillary neoplasm of the bile ducts: the clinical features and surgical outcome of 25 cases

BACKGROUND AND OBJECTIVES: Intraductal papillary neoplasm of the bile ducts (IPN-B) is considered an uncommon tumor. The purpose of this study was to evaluate the clinical, radiological, and histopathological characteristics of IPN-B, and its prognosis. METHODS: From October 1995 to August 2006, a retrospective analysis was made of 25 patients that underwent surgery for IPN-B. Clinical features and radiological, pathological, and operative findings were reviewed, and survival rates were determined. RESULTS: In five patients (20.0%), lesions were incidentally found. Radiologically, 23 of the 25 (92.0%) showed bile duct dilatation, bile duct dilatation with or without an intraductal mass, and cystic changes of bile ducts. Twenty three of the 25 patients underwent hepatic resection with or without extrahepatic bile duct resection. No in hospital mortality occurred. Median survival time of resected patients was 59.8 months and 1-, 2-, and 4-year survival rates were 90.5%, 84.0%, and 84.0%, respectively. All six patients with benign IPN-B remained alive at a mean of 26.2 postoperative months without recurrence. CONCLUSIONS: A diagnosis of IPN-B is usually made in patients with biliary dilatation by radiologic study. The prognosis of IPN-B, especially of the benign category, is excellent. Aggressive surgical resection is the treatment of choice for IPN-B.     

Increased resistance of peroxisome proliferator-induced hepatic lesions to iron overload in rats

Altered areas (AA), neoplastic nodules (NN) and hepatocellular carcinomas (HCC) induced by chronic administration of ciprofibrate and Wy-14,643 were examined for iron accumulation after systemic iron overload. Eighty percent of AA, 90% NN and 100% HCC showed increased resistance to iron accumulation. However, marked heterogeneity was observed in the amount of iron from area to area within the same lesion with some cells containing no iron, while others showing blue reaction to iron. These findings indicate, that putative preneoplastic and neoplastic hepatic lesions induced by peroxisome proliferators exclude iron in a fashion similar to that of hepatic nodules and carcinomas induced by DNA damaging carcinogens.     

FNAC of salivary gland lesions with histopathological correlation

Hypothesis: Analysis of salivary gland lesions by FNAC and correlation with histopathology. To evaluate utility of FNAC in salivary gland lesions.Back ground: Salivary gland lesions form about 2–6.5% of all head and neck neoplasms in adults. They are easily accessible for FNAC (Fine Needle Aspiration Cytology) and risks of fistula formation or tumour implantation are low compared surgical biopsy. Also, cytology can provide a distinction between asalivary and non salivary lesion, benign and malignant lesions so also specific and non specific inflammation. Methods: Seventy patients were studied prospectively over two years. FNAC was done using 10 cc syringes and 20–22 no. needle. Histomorphology was assessed on routine H & E (haemotxylin and eosin) stained paraffin sections. SPAS (periodic acid Schiff) and mucicarmine satins were also done. Results: 80% of the lesions were neoplastic (61% benign, 31% malignant) and 20% were neoplastic. Pleomorphic adenoma was the most frequent benign neoplasm while mucoepidermoid carcinoma was the most frequent malignant lesion. Among the non neoplastic lesions, the maximum number of cases were of chronic sialadentis. In the present study, FNAC has a sensitivity of 94.54% and specificity of 80.95% for neoplastic lesions. Conclusions: FNAC was found to be a useful diagnostic tool in the evaluation of salivary gland lesions because of its simplicity, excellent patient compliance and rapid diagnosis. This cost effective tool is invaluable in planning the surgical management of the patient.