Significance of ploidy in laryngeal cancer

We studied 48 patients with laryngeal or hypopharyngeal primary tumors with DNA flow cytometry. Twenty-four of the tumors were glottic, 18 were supraglottic, and 6 were from the pyriform sinus. Patients were followed for a minimum of 12 months, with a mean follow-up of 23 months. Twenty-three of the 48 primary tumors (48 percent) were clearly aneuploid, 22 percent were tetraploid, and 30 percent were diploid. We concluded that patients with aneuploid primary tumors, high DNA levels, or both have a significantly better prognosis than those with diploid tumors, and this remained statistically significant when clinical outcome was adjusted for tumor status, stage, and nodal status.     

Bizarre (pseudomalignant) granulation-tissue reactions following ionizing-radiation exposure. A microscopic, immunohistochemical, and flow-cytometric study

Two patients developed extremely bizarre (pseudomalignant) granulation-tissue reactions in the larynx and facial sinuses, following radiation therapy for carcinoma. Containing pleomorphic spindle cells and numerous (sometimes atypical) mitotic figures, both tumefactive lesions simulated high grade malignancies. While the pleomorphic cells contained vimentin immunoreactivity, they were nonreactive for low or high molecular weight keratin. Flowcytometric study of paraffin-embedded tissues revealed DNA indexes of 0.75 and 1.0. Neither recurred locally nor spread distantly after therapy. Their granulation-tissue growth pattern, and the presence of stromal and endothelial cells showing similar degrees of cytologic atypia were central to their recognition as benign. These findings show that severely atypical, sometimes aneuploid, granulation-tissue reactions can occur following radiation exposure. Care should be taken not to misinterpret these lesions as malignant.     

Nuclear roundness factor: a quantitative approach to grading in prostatic carcinoma, reliability of needle biopsy tissue, and the effect of tumor stage on usefulness

Morphometric analysis and histologic grading were performed on case material from 26 patients. Relative nuclear roundness factor (RNRF) was calculated and correlated with clinical course in 14 patients undergoing prostatectomy for stage A or B prostatic carcinoma. The only patients with progression of disease were two with RNRF of 1.10. RNRF in cases without progression ranged from 0.98 to 1.07. Histologic grading by the methods of Gleason or the M.D. Anderson system failed to discriminate between the progressing and nonprogressing groups. However, when RNRF was measured in tumors initially diagnosed as stage C or D, four of eight were below 1.10, within the range of the nonprogressing low-stage cases. Thus, the usefulness of morphometry and RNRF may be limited to low-stage disease. It was additionally found that RNRF could not be reliably measured in needle biopsy specimens.     

Doxycycline-induced pill esophagitis

Pill-induced esophagitis is a complication seen in patients who use certain medications such as tetracycline and non-steroidal anti-inflammatory drugs. In this short report, we described five cases of doxycycline-induced esophagitis with endoscopic images. All of the patients were young or middle-aged women. Dysphagia or odynophagia with retrosternal pain were the main presenting symptoms in all cases. The observed injuries were at the middle third of esophagus with a normal surrounding mucosa. All patients had a history of swallowing the capsule with a small amount of water or in a recumbent position. Two patients with dysphagia were managed by intravenous fluid support and parenteral acid suppression. The symptoms were improved in 2-7 days after the ceasing of the drug and control endoscopies were completely normal in all cases after 3-4 weeks of admission. The drug-induced esophagitis is not rare with certain drugs and should be suspected in all patients presenting with chest pain and dysphagia. Physicians must warn the patients to take the pills and capsules with enough liquid and in the upright position.     

Granulocytic sarcoma presenting as pulmonary nodules and lymphadenopathy

A patient presented with anterior and posterior cervical lymphadenopathy as well as widespread intrapulmonary nodules. Histologic sections of both lymph node and lung revealed dense infiltration by sheets of cells which were cytochemically positive for chloroacetate esterase and myeloperoxidase, thus suggesting a diagnosis of granulocytic sarcoma. The patient was initially treated with daily hydroxyurea. After 6 weeks, when progression of the disease was apparent, hydroxyurea was discontinued and the patient was placed on mithramycin, an agent reported to induce differentiation of myeloid precursor cells both in vitro and in vivo. On this latter agent, a dramatic response has been noted with a decrease in the pulmonary symptoms, and a marked reduction in the size of the lymph nodes and lung nodules. The authors report this case because it represents a rare presentation of an uncommon disease and because of the striking improvement that followed the initiation of a novel therapeutic modality.     

Progesterone secreting Sertoli cell tumor of the ovary

A 33-year-old woman presenting with secondary amenorrhea and galactorrhea was found to have a Sertoli cell tumor of the ovary. The neoplasm also had a sex cord tumor with annular tubules (SCTAT) component. Further investigations revealed that in many respects the patient was endocrinologically pregnant. She had markedly elevated serum estrogen and progesterone levels and the endometrium demonstrated pronounced decidualization, but there was no evidence of actual pregnancy. Estrogen and progesterone were demonstrated by immunohistochemistry to be present in both the Sertoli cell and SCTAT portions of the tumor.     

Cartilaginous variant of congenital adenomatoid malformation of the lung

We report the occurrence of an unusual variant of congenital adenomatoid malformation (CAM) of the lung in a 16-year-old male. Abundant cartilage in the walls of malformed bronchioles, an extremely rare finding in CAM, distinguishes this lesion from the usual forms. We present the roentgenographic, computed tomographic, and pathologic features of this lesion as well as its embryologic implications. In addition, two similar cases are reviewed, one of which has been briefly discussed in a previous publication. Cartilaginous CAM should be distinguished from another lesion with abundant cartilage, the so-called pulmonary hamartoma.     

Diabetic Fibrous Mastopathy: Case Reports and Radiologic-Pathologic Correlation

Abstract: Diabetic fibrous mastopathy, an unusual finding in patients with early onset, long-standing insulin dependent diabetes, can present as a palpable mass with mammographic and sonographic findings highly suggestive of breast cancer. These suspicious clinical and imaging findings necessitate a biopsy, which demonstrates characteristic findings of dense, keloid scarring and intralobular lymphocytic infiltrates. We present 2 cases of diabetic fibrous mastopathy with characteristic mammographic, sonographic, and pathologic findings diagnosed with ultrasound guided core needle biopsy and confirmed with surgical excision. In the appropriate clinical setting, a patient with long-standing insulin dependent diabetes with a firm, mobile breast mass and characteristic sonographic findings of a hypoechoic mass with lobulation and marked posterior acoustic shadowing should suggest the possibility of diabetic fibrous mastopathy. Awareness of this entity may obviate the need for surgical excision in patients whose clinical, imaging, and pathologic findings are consistent with diabetic fibrous mastopathy.