Diverticulum arising from mitral valve.

Diverticula arising from the mitral valve are very rare. They are usually detected by echocardiography as masses arising from the cardiac valves. We present a case of an incidental finding of a diverticulum arising from the mitral valve. This was initially detected by transesophageal echocardiography, and later confirmed by pathologic appearance. The case illustrates the unique findings on echocardiography that would help to differentiate diverticula from other valvular masses.     

Hazardous chemicals: psychological dimensions of the health sequelae of a community exposure in Texas.

STUDY OBJECTIVE--A chemical spill from an oil refinery exposed the local community to more than 40,000 lb of highly toxic and corrosive hydrofluoric acid. A community based symptom prevalence study found an association between exposure and physical symptoms: the psychological impact of the disaster and its potential effect on the reporting of physical symptoms is examined here. DESIGN--The study used a population based survey design consisting of two phases: phase I, the exposure phase, and, phase II, the symptom prevalence phase. SUBJECTS--In phase I, information indicative of exposure was collected on 10,811 individuals in a door to door survey of a geographically defined area. In phase II, symptom prevalence information was gathered through in-person interviews with 2509 subjects selected from the phase I census in a sampling scheme that balanced across the exposure categories with regard to age, gender, and predisposition. The refusal rate in both phases was < 5%. MEASUREMENT AND MAIN RESULTS--Stepwise logistic regression analyses were used to assess the relative predictive importance of psychological variables and hydrofluoric acid exposure in explaining the reported physical symptoms two years after the disaster. The findings show a linear relationship between the level of hydrofluoric acid exposure and the degree of psychological stress two years after the accident. High exposure had a long term (more than two years) impact on physical health for some self reported symptoms, even after controlling for the psychological impact. Some physical symptom reports, however, were better explained by psychological status than by exposure to hydrofluoric acid. The physical symptoms for which exposure was the major predictor were those for which the biological plausibility of a relationship with hydrofluoric acid exposure was direct. CONCLUSIONS--Measures of psychological status should be included in symptom studies of health sequelae to man-made disasters so that the physical effects of exposure can be more accurately assessed.     

Potassium permanganate resistant amyloid in fine-needle aspirate of the liver

A case of primary amyloidosis, initially detected by fine-needle aspiration of the liver, is reported here. Amorphous acellular metachromatic material was seen extracellularly in between the hepatocytic cords compressing them. This material showed typical apple-green birefringence under crossed bipolars after alkaline Congo-red staining proved its amyloid nature. It was resistant to potassium permanganate pretreatment, indicating it to be of the AL type. © 1994 Wiley-Liss, Inc.     

A community-based epidemiologic study of health sequelae of exposure to hydrofluoric acid.

An accident at an oil refinery in Texas City, Texas, released around 40,000 lb of hydrogen fluoride, exposing the community to the highly toxic and corrosive substance. A population-based epidemiologic study was conducted to evaluate the impact of the accident on the health of the community. Exposure assessment was done using a multipronged approach through a door-to-door survey of 10,811 individuals. A symptom survey resulting in 1994 completed interviews was conducted with a stratified random sample selected from the exposure study database. The sampling was balanced with respect to age, gender, and predisposition across the three ordinal exposure categories. The results show a strong dose relationship (P < 10(-4)) between the exposure and symptoms reported following the accident and 2 years later, most notably breathing and eye symptoms. However, substantial improvement in health was reported over the 2-year period regardless of the level of exposure. Problems of recall bias and behavioral sensitization are considered and it is recognized that the study may have overestimated the effect. It is also recognized that the study may not have completely unraveled the relative importance of exposure and host response in health outcome, since the two were probably conflated in the exposure measure. Nevertheless, the independence of predisposition and reported level of exposure, the magnitude of effect and its consistency, the unmistakable dose response, the large sample size, and the mutual corroboration of various findings make it difficult to dismiss the interpretation that the hydrofluoric acid exposure indeed caused health problems in the community that continued for at least 2 years after the accident.     

The value of fine-needle aspiration biopsy in the cytodiagnosis of salivary gland lesions

Fine-needle aspiration cytology (FNAC) was performed on 195 cases of salivary gland lesions. The smears were technically adequate in 178 cases. Tissue examination was available for subsequent histocytologic correlation in 57 cases. The cytodiagnosis included inflammatory lesions (59) and benign (68) and malignant (51) tumors (total, 119). The accuracy of cytodiagnosis was 87.7% with a sensitivity of 80.9% and a specificity of 94.3%. Exact histologic typing was possible in 61.9% of the malignant tumors. Mucoepidermoid tumors and cellular-atypical pleomorphic adenoma posed difficulties in cytodiagnosis.     

Ghrelin expression in hyperplastic and neoplastic proliferations of the enterochromaffin-like (ECL) cells

Ghrelin, a recently discovered peptide isolated from the gastric corpus mucosa, is believed to be important in the regulation of growth hormone secretion and has been shown to increase appetite and food intake as well. It may also have other gastrointestinal and cardiac functions. Because a cell of origin for ghrelin has not been convincingly identified in the gastric mucosa thus far, we studied the immunohistochemical expression of ghrelin in proliferative lesions of the enterochromaffin-like (ECL) cells—a cell that is not only exclusively confined to the gastric corpus mucosa but is its dominant endocrine cell type as well. Formalin-fixed, paraffin embedded tissues from three cases of gastric ECL cell hyperplasia and five ECL carcinoids (three with coexisting foci of diffuse, linear, and micronodular hyperplasia) were immunohistochemically stained for ghrelin, using a commercially available antibody. The Sevier-Munger stain for ECL cells and immunohistochemical stains for chromogranin, gastrin, serotonin, somatostatin, and vesicular monoamine transporter-2 (VMAT-2) were performed on parallel sections for correlation with the ghrelin staining results. All ECL cell carcinoids and hyperplastic lesions were positive for both the Sevier-Munger and the immunohistochemical stains for chromogranin and VMAT-2. Immunoreactivity for ghrelin was seen in 4/5 ECL carcinoids, all cases of ECL cell hyperplasia, as well as in all areas with linear and micronodular hyperplasia adjacent to the ECL cell carcinoids. In each instance, such staining was confined to the Sevier-Munger, and VMAT-2 positive cells only. Our findings indicate that the ECL cells are either the ghrelin-producing cells of the gastric mucosa or acquire the capability to synthesize ghrelin during proliferative states encompassing the entire hyperplasia to neoplasia spectrum. In view of the orexigenic and other known actions of ghrelin, the functional and/or biologic significance of ghrelin production in such ECL cell proliferations needs to be investigated further.     

Cytopathology of uncommon malignant renal neoplasms in the pediatric age group

Malignant renal neoplasms are common solid tumors in pediatric oncology practice. These include the common Wilms' tumor/nephroblastoma and the uncommon neoplasms such as clear-cell sarcoma of the kidney (CCSK), rhabdoid tumor, renal-cell carcinoma, and others. The aim of this study was to describe in detail the cytopathological features of the histopathologically proven uncommon pediatric renal tumors. Aspirates from Wilms' tumor, which are mesenchyme predominant, show clusters of spindle cells associated with the matrix material. Evidence of rhabdomyoblastic differentiation may be present. CCSK, classic subtype, is characterized by round to oval cells arranged perivascularly and also in sheets and clusters intimately associated with a metachromatic matrix mucopolysaccharide material better appreciated in May-Grunwald-Giemsa (MGG)-stained smears. The cells also have more abundant cytoplasm and may show nuclear grooves. Spindle-cell pattern of CCSK is difficult to diagnose on aspiration cytology. Renal-cell carcinoma of childhood shows similar cytological features as its adult counterpart. Rhabdoid tumor of the kidney is characterized by a monomorphic population of cells with abundant cytoplasm, eccentric nuclei with prominent nucleoli. Intrarenal yolk sac tumor is a rare neoplasm and shows severely pleomorphic cells on aspiration.Awareness of these entities is important for the practicing cytopathologist. Further, non-Wilms' renal malignant neoplasms must be distinguished from the common Wilms' tumor so that appropriate chemotherapy protocols may be instituted in cases where the tumor is in an advanced stage of malignancy.