Evaluation of women presenting with postcoital bleeding by cytology and colposcopy

Objective

To evaluate women with postcoital bleeding (PCB) by clinical examination, cytology, colposcopy, and histopathology.

Methods

A cross-sectional study of 123 women with PCB, who were referred to the Colposcopy Clinic of Arash Hospital, Tehran, over a 2-year period.

Results

Clinical examinations revealed cervical polyps in 18 women and ectropion in 14. Cervical cytology identified 13 patients with atypical squamous cells of undetermined significance, 2 with atypical glandular cells, 4 with low-grade squamous intraepithelial lesions, and 3 with high-grade squamous intraepithelial lesions. Colposcopy indicated invasive cancer in 1 patient. Transitional zones appeared normal in 39.8% of the cohort, were atypical grade 1 in 33.3%, and atypical grade 2 in 4.9%. Fourteen abnormalities were detected at histology, including 1 squamous cell carcinoma, 1 low-grade glandular neoplasm, 9 cervical intraepithelial neoplasia (CIN) grade 1, 2 CIN grade 2, and 1 CIN grade 3. The sensitivity and specificity of cytology were 50% and 86.5%, respectively. A total of 21.4% of abnormal pathologies were missed using colposcopy, which had a sensitivity of 79%.

Conclusion

Because of its higher sensitivity, colposcopy can be recommended for the investigation of persistent PCB, even in the presence of normal cytology.     

Surgical resection of locally advanced granular cell tumor of the orbit

We report a case of locally advanced granular cell tumor of the orbit treated by a multidisciplinary surgical approach. A 49-year-old woman with a recently biopsied granular cell tumor of the orbit was referred to our tertiary care cancer center for evaluation of a right-sided globe ptosis and a palpable mass in the right orbit that had been present for approximately two years. Magnetic resonance imaging showed a large orbital mass that extended posteriorly to the orbital apex and anteriorly to the levator and superior rectus muscle complex. A workup including computed tomography of the chest, abdomen, and pelvis did not show any metastatic foci. Surgical resection of the mass was undertaken via a frontozygomatic craniotomy supplemented by an anterior orbitotomy to repair the levator aponeurosis and the superior oblique tendon, which were partially resected with the mass. Histologic evaluation of the mass revealed solid nests of polygonal cells that had centrally located, round nuclei with abundant eosinophilic granular cytoplasm. The cytoplasmic granules were positive on the periodic acid-Schiff reaction and were diastase-resistant. Immunohistochemical staining was positive for S-100 protein. During the most recent follow-up visit six months after surgery, the patient had no clinical evidence of tumor recurrence, had minimal residual ptosis and exposure keratopathy, and had stable visual function.     

Targeting EGFR and sonic hedgehog pathways for locally advanced eyelid and periocular carcinomas

For patients with metastatic or locally advanced eyelid and periocular carcinoma not amenable to surgical excision, targeted therapies have shown efficacy with better tolerability compared to cytotoxic chemotherapy. Overexpression of epithelial growth factor receptor was found in squamous cell carcinomas. Vismodegib targets the mutation in the hedgehog pathway identified in basal cell carcinoma and basal cell nevus syndrome. Targeted therapies provide a novel and potentially effective treatment alternative for patients with eyelid carcinoma not amendable for surgery, including those with metastatic, locally advanced disease, advanced age, and significant comorbidities. High cost, need for long-term treatment, and toxicity are relative limitations.     

Bursting of prefrontal cortex neurons in awake rats is regulated by metabotropic glutamate 5 (mGlu5) receptors: rate-dependent influence and interaction with NMDA receptors

Metabotropic glutamate 5 (mGlu5) receptors have been recently implicated in prefrontal cortex (PFC)-dependent executive functions because inhibition of mGlu5 receptors impairs working memory and worsens cognitive-impairing effects of NMDA receptor antagonists. To better understand the mechanisms by which mGlu5 receptors influence PFC function, we examined the effects of selective mGlu5 receptor antagonist 2-methyl-6-(phenylethynyl)-pyridine (MPEP), given alone or in combination with the NMDA receptor antagonist MK801, on ensemble single unit activity in the medial PFC (mPFC) of behaving rats. MPEP decreased the spontaneous burst activity of the majority of mPFC neurons. This inhibition was selective for the most active cells because greater decreases were observed in neurons with higher baseline firing rates. MPEP augmented the effects of MK801 on burst activity, variability of spike firing and random spike activity. These findings demonstrate that in awake animals mGlu5 receptors regulate the function of PFC neurons by two related mechanisms: (i) rate-dependent excitatory influence on spontaneous burst activity; and (ii) potentiation of NMDA receptor mediated effects on firing rate and burst activity. These mechanisms support the idea that modulation of mGlu5 receptors may provide a pharmacological strategy for fine-tuning the temporal pattern of firing of PFC neurons.     

Outcomes of dacryocystorhinostomy in patients with head and neck tumors

BACKGROUND: The purpose of this study was to evaluate the outcomes of dacryocystorhinostomy (DCR) in patients with head and neck tumors. METHODS: The clinical records of all 31 patients with head and neck tumors who underwent DCR for nasolacrimal duct blockage at The University of Texas M. D. Anderson Cancer Center between 1999 and 2003 were retrospectively reviewed. RESULTS: The tumor diagnoses were squamous cell carcinoma (n = 18), chondrosarcoma (n = 3), sinonasal carcinoma (n = 2), adenoid cystic carcinoma (n = 2), sinonasal papilloma (n = 2), esthesioneuroblastoma (n = 1); hemangiopericytoma (n = 1); ameloblastoma (n = 1), and osteosarcoma (n = 1). Twenty-eight patients had a maxillectomy or other sinus surgeries, 10 had radiotherapy, and 14 had chemotherapy and radiotherapy before DCR. All 31 patients (35 eyes) experienced improvement of epiphora after DCR, but five patients (six eyes) had recurrent nasolacrimal duct blockage develop during the study period. Two patients had mild wound infections; none had osteoradionecrosis. CONCLUSIONS: DCR alleviates nasolacrimal duct blockage in most patients with head and neck tumors and is not associated with unusual complications in this setting.     

Experience with sentinel lymph node biopsy for eyelid and conjunctival malignancies at a cancer center

PURPOSE: To describe one center's experience with sentinel lymph node (SLN) biopsy in patients with eyelid and conjunctival malignancies performed with a smaller volume of technetium than was initially used and a small incision directly overlying the sentinel node(s). METHODS: A noncomparative interventional case series of 13 patients with clinically negative regional lymph nodes who underwent SLN biopsy for eyelid or conjunctival malignancies at The University of Texas M. D. Anderson Cancer Center between May 2002 and July 2003. Preoperative lymphoscintigraphy was performed with an injection of 0.3 mCi of technetium Tc-99m sulfur colloid in a volume of 0.2 mL. Images were taken as soon as the first SLN was detected through the gamma camera. Intraoperative mapping was performed with the same volume and concentration of technetium Tc-99m sulfur colloid along with an injection of isosulfan blue dye. RESULTS: Five patients had conjunctival melanoma, 6 had sebaceous cell carcinoma of the eyelid, and 2 had eyelid melanoma. SLN(s) were identified in all patients. In 12 patients, more than 1 SLN was identified. During surgery, no SLNs were blue. One patient with conjunctival melanoma had an SLN that was positive on histologic examination. There were no ocular or extraocular complications from the procedure except for mild temporary weakness of the marginal mandibular branch of the facial nerve in 2 patients that resolved completely within 4 to 6 weeks and without any further intervention. None of the patients had permanent blue tattooing of the conjunctival surface or eyelid skin. CONCLUSIONS: Our experience suggests that lymphoscintigraphy and SLN biopsy with a small volume of technetium Tc-99m sulfur colloid and small incisions, even without the use of the blue dye, can identify SLNs in patients with conjunctival and eyelid malignancies, and can be performed safely.     

Outcomes in patients with adenoid cystic carcinoma of the lacrimal gland

PURPOSE: To evaluate the outcomes among patients with adenoid cystic carcinoma of the lacrimal gland treated at various stages of their disease at a tertiary care cancer center. METHODS: A retrospective case series of 20 patients with adenoid cystic carcinoma of the lacrimal gland treated at a single institution between 1952 and 2002. Clinical records were available for all 20 patients; histologic sections from 12 of the 20 patients were available for review. Disease-free survival was measured from the completion of treatment; overall survival was measured from the date of initial diagnosis. RESULTS: The study included 6 men and 14 women. The mean age at diagnosis was 39.5 years. The median follow-up time was 34 months (range, 6 to 264 months). The local/regional treatment modalities included exenteration with bone removal and radiation therapy (RT) in 5 patients, exenteration with RT (no bone removal) in 8 patients, exenteration (no RT or bone removal) in 1 patient, exenteration with bone removal (no RT) in 1 patient, local resection with RT in 3 patients, and local resection without RT in 2 patients. Overall, 16 patients had RT as part of their treatment regimen. Seven patients (35%) had local recurrence. Sixteen patients (80%) had distant metastasis during the study period. At the time of this report, 13 (65%) of the patients had died of disease. The median disease-free survival for the entire group was 18 months. Eight patients had a predominantly basaloid histologic pattern. Ten patients had verifiable histologic evidence of perineural invasion. CONCLUSIONS: This study underscores the generally grave prognosis for patients with adenoid cystic carcinoma of the lacrimal gland and the difficulty in making any conclusive recommendations for local therapy for this disease.     

Effect of stress on prefrontal cortex function

Stress is the major epigenetic factor that contributes to the etiology, pathophysiology, and treatment out-come of most psychiatric disorders. Understanding the mechanisms by which stress contributes to these processes can have important implications for improving therapeutic outcome. Considering that a dysfunctional prefrontal cortex has been implicated in many psychiatric disorders, such as schizophrenia and mood disorders, delineating mechanisms by which stress affects prefrontal cortex (PFC) function is critical to our understanding of the role of stress in influencing the disease process. This paper will review recent mechanistic information about the effects of stress on dopamine and glutamate neurotransmission in the PFC.     

The history and future of the fluorescence activated cell sorter and flow cytometry: a view from Stanford

The Fluorescence Activated Cell Sorter (FACS) was invented in the late 1960s by Bonner, Sweet, Hulett, Herzenberg, and others to do flow cytometry and cell sorting of viable cells. Becton Dickinson Immunocytometry Systems introduced the commercial machines in the early 1970s, using the Stanford patent and expertise supplied by the Herzenberg Laboratory and a Becton Dickinson engineering group under Bernie Shoor. Over the years, we have increased the number of measured FACS dimensions (parameters) and the speed of sorting to where we now simultaneously measure 12 fluorescent colors plus 2 scatter parameters. In this history, I illustrate the great utility of this state-of-the-art instrument, which allows us to simultaneously stain, analyze, and then sort cells from small samples of human blood cells from AIDS patients, infants, stem cell transplant patients, and others. I also illustrate analysis and sorting of multiple subpopulations of lymphocytes by use of 8-12 colors. In addition, I review single cell sorting used to clone and analyze hybridomas and discuss other applications of FACS developed over the past 30 years, as well as give our ideas on the future of FACS. These ideas are currently being implemented in new programs using the internet for data storage and analysis as well as developing new fluorochromes, e.g., green fluorescent protein and tandem dyes, with applications in such areas as apoptosis, gene expression, cytokine expression, cell biochemistry, redox regulation, and AIDS. Finally, I describe new FACS methods for measuring activated kinases and phosphatases and redox active enzymes in individual cells simultaneously with cell surface phenotyping. Thus, key functions can be studied in various subsets of cells without the need for prior sorting.