RESUMEN

OBJECTIVE: To report the response to progestin therapy in young women with endometrial complex atypical hyperplasia (CAH) or FIGO grade 1 endometrial adenocarcinoma (FIGO 1 EAC) based on clinicopathologic features, including abnormal DNA mismatch repair (MMR) by immunohistochemistry (IHC). DESIGN: Consecutive case series. SETTING: Olive View-UCLA Medical Center in Sylmar, CA, USA, and Cedars-Sinai Medical Center in Los Angeles, CA, USA. POPULATION: Women ≤55 years old with CAH or FIGO 1 EAC. METHODS: Response to progestin therapy in 84 consecutive patients was assessed based on clinicopathologic factors, including age, body mass index (BMI), initial histology, and IHC staining for MMR proteins. MAIN OUTCOME MEASURES: Rates of abnormal MMR protein expression and response to progestin therapy were determined. RESULTS: Six (7%) patients had abnormal IHC staining, of whom five (83%) had FIGO 1 EAC at initial diagnosis. Following progestin treatment, none of the endometrial lesions in patients with abnormal IHC for MMR proteins had resolution of hyperplasia or malignancy, in contrast to 41 (53%) with normal staining (P = 0.028). Age ≤40 years and initial lesion (CAH versus FIGO 1 EAC) were predictors of response to progestin; BMI was not. CONCLUSIONS: In this cohort, 7% of women ≤55 years of age with CAH or FIGO 1 EAC had loss of MMR proteins by IHC. These patients had a higher incidence of invasive cancer and a lower incidence of resolution with progestin therapy. TWEETABLE ABSTRACT: Abnormal MMR protein expression predicts poor response to progestins in young women with CAH or FIGO 1 EAC.

Asunto(s)

Adenocarcinoma/tratamiento farmacológico , Reparación de la Incompatibilidad de ADN , Hiperplasia Endometrial/tratamiento farmacológico , Neoplasias Endometriales/tratamiento farmacológico , Progestinas/uso terapéutico , Adenocarcinoma/genética , Adenocarcinoma/patología , Adulto , Hiperplasia Endometrial/genética , Hiperplasia Endometrial/patología , Neoplasias Endometriales/genética , Neoplasias Endometriales/patología , Femenino , Humanos , Inmunohistoquímica , Persona de Mediana Edad

RESUMEN

Proliferation and fusion of myoblasts is a well-orchestrated process occurring during muscle development and regeneration. Although myoblasts are known to originate from muscle satellite cells, the molecular mechanisms that coordinate their commitment toward differentiation are poorly understood. Here, we present a novel role for the transcription factor Forkhead box protein C2 (Foxc2) in regulating proliferation and preventing premature differentiation of activated muscle satellite cells. We demonstrate that Foxc2 expression is upregulated early in activated mouse muscle satellite cells and then diminishes during myogenesis. In undifferentiated C2C12 myoblasts, downregulation of endogenous Foxc2 expression leads to a decrease in proliferation, whereas forced expression of FOXC2 sustains proliferation and prevents differentiation into myotubes. We also show that FOXC2 induces Wnt signaling by direct interaction with the Wnt4 (wingless-type MMTV integration site family member-4) promoter region. The resulting elevated expression of bone morphogenetic protein-4 (Bmp4) and RhoA-GTP proteins inhibits the proper myoblast alignment and fusion required for myotube formation. Interestingly, continuous forced expression of FOXC2 alters the commitment of C2C12 myoblasts toward osteogenic differentiation, which is consistent with FOXC2 expression observed in patients with myositis ossificans, an abnormal bone growth within muscle tissue. In summary, our results suggest that (a) Foxc2 regulates the proliferation of multipotent muscle satellite cells; (b) downregulation of Foxc2 is critical for myogenesis to progress; and (c) sustained Foxc2 expression in myoblast cells suppresses myogenesis and alters their lineage commitment toward osteogenesis by inducing the Wnt4 and Bmp4 signaling pathways.

Asunto(s)

Proteína Morfogenética Ósea 4/fisiología , Factores de Transcripción Forkhead/fisiología , Músculo Esquelético/fisiología , Osteogénesis/fisiología , Regeneración/fisiología , Proteína Wnt4/fisiología , Animales , Diferenciación Celular/fisiología , Línea Celular , Proliferación Celular , Fibroblastos/citología , Fibroblastos/fisiología , Ratones , Ratones Endogámicos C57BL , Modelos Animales , Músculo Esquelético/citología , Proteína MioD/fisiología , Mioblastos Esqueléticos/citología , Mioblastos Esqueléticos/fisiología , Células 3T3 NIH , Factor de Transcripción PAX7/fisiología , Transducción de Señal/fisiología

RESUMEN

OBJECTIVE: Modified radical hysterectomy has been advocated for the definitive treatment of patients with cervical adenocarcinoma in situ (ACIS) with positive conization margins due to the risk of a co-existing invasive cervical adenocarcinoma (ICA). We sought to identify patients who can be safely managed with an extrafascial hysterectomy based on predictors of invasion in the conization specimen. METHODS: Between 1996 and 2010, we identified 33 patients who had definitive surgical management for cervical ACIS following conization with positive margins and/or positive endocervical curettage (ECC). Demographic and pathologic characteristics were collected by chart review. Statistical analysis was performed using Fisher's exact test. RESULTS: Among 33 patients, 4 (12%) had ICA in the hysterectomy specimen. Predictors of ICA included pathologic suspicion of invasion (PSI) in the conization specimen and positive ECC. In patients with ICA at hysterectomy, PSI and ACIS-positive ECC were found in 75% (p=0.32) and 100% (p=0.09) respectively. When PSI was present and the ECC was positive, the positive predictive value (PPV) for ICA was 33% (2 of 6). When PSI was absent, the negative predictive value (NPV) for ICA was 94% (1 of 16). When both PSI and ECC were negative, the NPV for ICA was 100% (0 of 6). CONCLUSIONS: Women with cervical ACIS have the highest risk for ICA in the setting of positive cone margins, positive ECC, and presence of PSI in the conization specimen. Extrafascial hysterectomy remains a viable option for women with positive cone margins when ECC is negative and PSI is absent.

Asunto(s)

Adenocarcinoma/patología , Conización , Displasia del Cuello del Útero/patología , Displasia del Cuello del Útero/cirugía , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugía , Adulto , Anciano , Electrocirugia , Femenino , Humanos , Histerectomía , Escisión del Ganglio Linfático , Persona de Mediana Edad , Invasividad Neoplásica , Valor Predictivo de las Pruebas , Factores de Riesgo

RESUMEN

A National Cancer Institute (NCI) "Thyroid Fine-Needle Aspiration (FNA) State of the Science Conference" recently proposed standardized nomenclature and "risks of malignancies" associated with various diagnostic categories. We evaluated the evidence levels of the data used by NCI to predict malignancy risks and whether those estimates had clinical validity in our patient population.Eight hundred seventy-nine patients underwent thyroid FNA during 2006. FNA diagnoses were translated into NCI diagnostic categories, and 2-year follow-up retrospective information was obtained. Four percentages of malignancies were calculated for each diagnostic category using follow-up information from FNA, thyroidectomy, both, and all patients as denominators. 95% confidence intervals (CI) were estimated for all proportions, and results were analyzed with chi-square statistics. "Relative risk" calculations were performed using the percentage of malignancies in the entire population under study as a denominator.Most of the studies cited by the NCI provided incomplete and variable level III evidence based mainly on surgical follow-up. Among our patients, the percentages of malignancies calculated with follow-up data from all patients as the denominator were similar to the "risk estimates" proposed by the NCI, but estimates based on surgical follow-up overestimated the probability of thyroid malignancy for patients with FNA diagnosis of "benign" and "follicular lesions of undetermined significance" (FLUS). Relative risk and 95% CI calculations suggested that the NCI classification could be simplified into three categories: "benign," "FLUS + neoplasm," and "suspicious + malignant."

Asunto(s)

Medicina Basada en la Evidencia , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Centros Médicos Académicos , Biopsia con Aguja Fina , Estudios de Seguimiento , Humanos , National Cancer Institute (U.S.) , Probabilidad , Factores de Riesgo , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/patología , Estados Unidos

RESUMEN

There is an increased incidence of anal squamous carcinoma and its precursor lesions (anal intraepithelial neoplasia [AIN]) among persons who engage in anal-receptive sex. Analogous to cervical cancer screening, anal Papanicplaou (Pap) smears currently are used to screen these high-risk populations. Human papilloma virus (HPV) has been implicated in anal carcinoma pathogenesis and this study was performed to assess the potential role of HPV DNA testing as an adjunct to anal cytology. We correlated cytological diagnoses and HPV DNA (Digene Hybrid Capture [HC II] assay) in anal specimens collected in SurePath liquid medium from 118 patients; 54.8% of cases diagnosed as atypical squamous cells of undetermined significance (ASC-US) and 87.8% diagnosed as low-grade squamous intraepithelial lesion (LSIL) or above tested positive for high- risk HPV DNA (B+). High-grade SIL (HSIL) was present in 31 of the 51 patients with follow-up. Although a cytological diagnosis of ASC-US or above was a reliable indicator for AIN, cytology frequently did not accurately predict the grade of SIL in subsequent biopsy. Our findings suggest that reflex HPV DNA testing would be helpful in triaging patients diagnosed with ASC-US. However, patients diagnosed with LSIL or above should go directly to ansocopic biopsy.

Asunto(s)

Canal Anal/virología , Neoplasias del Ano/diagnóstico , Carcinoma in Situ/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Infecciones por Papillomavirus/diagnóstico , Infecciones Tumorales por Virus/diagnóstico , Adulto , Canal Anal/patología , Biomarcadores de Tumor/análisis , ADN Viral/análisis , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Papillomaviridae/aislamiento & purificación

RESUMEN

Pseudallescheria has been identified as one of the "clinically significant emerging mycoses" but has received little attention in the cytology literature. Recognition of this fungus is of particular importance clinically, because unlike most other fungi (including Aspergillus, with which it is most frequently confused), Pseudallescheria is not effectively treated with amphotericin B, the most frequently and often the only antifungal agent administered. Features helpful in the diagnosis of Pseudallescheria in cytologic material are presented.

Asunto(s)

Micetoma/diagnóstico , Pseudallescheria/citología , Adulto , Anfotericina B/uso terapéutico , Aspergilosis/diagnóstico , Aspergillus/citología , Citodiagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Micetoma/tratamiento farmacológico , Pseudallescheria/crecimiento & desarrollo , Pseudallescheria/aislamiento & purificación , Rhizopus/citología

Asunto(s)

Enfermedades del Íleon/diagnóstico , Neoplasias Intestinales/secundario , Intususcepción/diagnóstico , Leiomiosarcoma/secundario , Neoplasias de los Tejidos Blandos/patología , Actinas/análisis , Desmina/análisis , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades del Íleon/etiología , Neoplasias Intestinales/química , Intususcepción/etiología , Leiomiosarcoma/química , Persona de Mediana Edad , Neoplasias de los Tejidos Blandos/química , Vimentina/análisis

RESUMEN

Review of 275 consecutive peritoneal lavages and concurrent histologic material from gynecologic operations suggested that cytologic evaluation was clinically indicated for only 60.7% of the lavages, representing 46% of the patients in the study. More than one concurrent lavage was received from 21.6% of all patients in the study, comprising 50% of patients with malignant lavages, 18.7% of patients with benign lavages, and 5.3% of patients for whom cytologic evaluation of peritoneal lavage was not clinically indicated. Malignant cells were diagnosed in 15% of the 167 lavages for which cytologic examination was clinically indicated. In this series of patients, identification of malignant cells in peritoneal lavages did not increase the tumor stage beyond that obtained solely from examination of the concurrent histologic material. There were no false-positive cytologic diagnoses and no lavages in which neoplastic cells were misinterpreted as benign. A significant number of lavages, including several from patients with histologically confirmed peritoneal tumor, were sparsely cellular and/or excessively bloody. It is suggested that although peritoneal lavages might be collected during all gynecologic operations, only specimens from selected cases should be submitted for cytologic evaluation, and greater attention should be given to specimen collection to ensure that only well-preserved and representative material from the peritoneum is submitted for cytologic evaluation.

Asunto(s)

Neoplasias/diagnóstico , Lavado Peritoneal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Neoplasias/patología , Sensibilidad y Especificidad

RESUMEN

Review of 203 consecutive cerebrospinal fluid (CSF) specimens submitted concurrently to the cytology and hematology laboratories identified several quality improvement (QI) opportunities. Clinician/laboratory, interlaboratory, and intralaboratory issues are addressed. Data are utilized to formulate a multifaceted approach that would decrease patient expenditure, conserve laboratory resources, and improve the clinical value of CSF reports.

Asunto(s)

Líquido Cefalorraquídeo/citología , Manejo de Especímenes/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Laboratorios/normas , Leucemia/líquido cefalorraquídeo , Leucemia/diagnóstico , Linfoma/líquido cefalorraquídeo , Linfoma/diagnóstico , Masculino , Persona de Mediana Edad , Control de Calidad

Asunto(s)

Seropositividad para VIH/complicaciones , Prueba de Papanicolaou , Neoplasias del Cuello Uterino/diagnóstico , Frotis Vaginal/estadística & datos numéricos , Servicios de Salud Comunitaria , Femenino , Infecciones por VIH/complicaciones , Accesibilidad a los Servicios de Salud , Humanos , Neoplasias del Cuello Uterino/complicaciones , Displasia del Cuello del Útero/complicaciones , Displasia del Cuello del Útero/diagnóstico

RESUMEN

Cysticercus cellulosae, the encysted larva of Taenia solium, is reported in a solitary granulomatous lesion excised from the lung of a 61-year-old woman from Thailand. No extrapulmonary signs of cysticercosis were manifest preoperatively, and the diagnosis was not suspected clinically. Pulmonary cysticercus is rarely diagnosed histologically. When unaccompanied by extrapulmonary disease, a single cysticercus lung lesion may be clinically and radiologically indistinguishable from other granulomata and malignancy.

Asunto(s)

Cisticercosis/diagnóstico , Cysticercus/aislamiento & purificación , Enfermedades Pulmonares Parasitarias/diagnóstico , Pulmón/parasitología , Animales , Cisticercosis/parasitología , Cisticercosis/cirugía , Femenino , Granuloma/diagnóstico , Granuloma/parasitología , Granuloma/cirugía , Humanos , Pulmón/patología , Enfermedades Pulmonares Parasitarias/parasitología , Enfermedades Pulmonares Parasitarias/cirugía , Persona de Mediana Edad , Pruebas de Función Respiratoria

RESUMEN

Neural network (NN) technology was applied to digital image analysis data for 112 Papanicolaou-fixed and -stained smears of lymphocyte-rich effusions (LREs). The smears were analyzed with an inexpensive image analysis system assembled in our laboratory. Several models were developed using backpropagation NN development software in an effort to optimize classification of the LREs as reactive lymphocytosis or malignant lymphoma and to analyze the effects of various parameters on classification rates. The greatest specificity and sensitivity of LRE classification were achieved with NN models that consisted of 7 input neurons, including 5 morphometric and 2 densitometric variables, 10 hidden-layer neurons and 1 output neuron. This NN architecture with a sigmoidal transfer function provided a true cross-validation rate of 89.3% of testing data, with a sensitivity of 76.9%, specificity of 93.0% and shrinkage of 10.7%. The same NN architecture with a step transfer function provided a true cross-validation rate of 95.3%, sensitivity of 85.7%, specificity of 97.6% and shrinkage of 0%. The effects of various parameters, such as network size, shrinkage and ratio of sample size to input layer size, on NN accuracy are discussed.

Asunto(s)

Líquido Ascítico/diagnóstico , Procesamiento de Imagen Asistido por Computador/métodos , Linfoma de Células B/diagnóstico , Redes Neurales de la Computación , Derrame Pleural/diagnóstico , Líquido Ascítico/clasificación , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Linfocitosis , Derrame Pleural/clasificación

RESUMEN

p53 protein is a "natural tumor suppressor" that plays an important role in controlling cell proliferation. Alterations resulting in overexpression of this gene product have been described in a wide variety of human malignancies. We utilize two commercially prepared monoclonal antibodies to assess the potential role of immunoreactivity for p53 protein in distinguishing benign mesothelial from adenocarcinoma cells in effusion smears. p53 protein was detected in adenocarcinoma cells in 78% of the malignant fluids studied. Benign mesothelial cells in 14% of these fluids and in 73% of the benign fluids also stained for p53. Differences in staining were observed with the Bp-53-12-1 and the 1801 antibodies. Intensity, intracellular distribution, and frequency of immunoreactivity within each cell population are described. Observations are discussed in relation to sensitivity and specificity of the monoclonal antibodies for different configurational forms of p53 protein, configurational modifications of p53 protein during the cell cycle, and diagnostic evaluation of effusion smears for the presence of malignant cells. Immunoreactivity for p53 does not correlate with site of primary tumor. Although overexpression of p53 is more frequent in adenocarcinoma cells than in reactive mesothelial cells, p53 protein overexpression is not necessarily indicative of malignancy.

Asunto(s)

Adenocarcinoma/química , Epitelio/química , Proteína p53 Supresora de Tumor/análisis , Adenocarcinoma/secundario , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales , Líquidos Corporales/citología , Células Epiteliales , Femenino , Expresión Génica , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad

RESUMEN

Lymphoid-rich effusions frequently present diagnostic problems in clinical cytology. In the authors' previous studies, most lymphoid-rich effusions had been correctly classified as benign lymphocytosis or malignant lymphoma by an experimental computerized interactive morphometry system, in which randomly selected lymphoid nuclear profile images were measured in Papanicolaou fixed and stained cytospin smears. The present study used the CAS 200 System and criteria from the previously described rule-based expert system to classify similar preparations of 134 lymphoid rich pleural, peritoneal, and pericardial effusions (90 benign lymphocytoses, 36 malignant lymphomas, and 8 chronic lymphocytic leukemias). A total of 98.9% of the benign lymphocytoses and 88.9% of the malignant lymphomas were correctly classified (predictive values of correct diagnoses 95.7% and 97.3%, respectively). Chronic lymphocytic leukemias could not be distinguished from benign lymphocytoses by nuclear profile areas. Optical density histograms of benign, lymphomatous, and chronic lymphocytic leukemias effusions are described. Advantages and limitations of image analysis and immunocytochemistry are discussed.

Asunto(s)

Líquido Ascítico/patología , Leucemia Linfocítica Crónica de Células B/diagnóstico , Linfocitosis/diagnóstico , Linfoma/diagnóstico , Derrame Pericárdico/patología , Derrame Pleural/patología , Sistemas Especialistas , Humanos , Leucemia Linfocítica Crónica de Células B/patología , Linfocitosis/patología , Linfoma/patología

RESUMEN

p53 Protein is a 53-kd nuclear phosphoprotein believed to play an important role in controlling proliferation of neoplastic and normal cells. This "natural tumor suppressor" can be rendered ineffective (or oncogenic) by mutations in the p53 gene or by interactions with proteins synthesized by DNA-transforming viruses, including specific subtypes of human papillomavirus (HPV). We describe the localization of p53 protein in association with HPV in paraffin sections of a spectrum of benign, dysplastic, and malignant anogenital squamous epithelia using immunohistochemical and in situ hybridization techniques. p53 Was detected in 81% of the 48 cases studied. Immunoreactivity for p53 was seen in 83% of the benign and low-grade squamous intraepithelial lesions (SILs), in 73% of the high-grade SILs, and in 86% of the infiltrating squamous carcinomas. In high-grade SILs p53 staining was frequently observed in individual nuclei at various levels of the abnormal epithelium and in the basal layer of the adjacent epithelium, while in squamous metaplasia and low-grade SILs immunostaining for p53 was limited to the basal layer of the epithelium. p53 Was detected in a slightly higher percentage of HPV-positive than HPV-negative epithelia as determined by in situ hybridization. No correlation was observed between p53 immunoreactivity and HPV subtypes. p53 Protein and HPV were detected in anal lesions from a small group of human immunodeficiency virus-positive individuals. Antibodies currently available mainly demonstrate mutant forms of p53 protein that are associated with longer half-lives than the wild-type protein, but demonstration of p53 protein overexpression is not necessarily indicative of malignancy.

Asunto(s)

Neoplasias del Ano/química , Neoplasias del Ano/microbiología , Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/microbiología , Papillomaviridae/aislamiento & purificación , Neoplasias del Pene/química , Neoplasias del Pene/microbiología , Proteína p53 Supresora de Tumor/análisis , Neoplasias del Cuello Uterino/química , Neoplasias del Cuello Uterino/microbiología , Neoplasias Vaginales/química , Neoplasias Vaginales/microbiología , Neoplasias de la Vulva/química , Neoplasias de la Vulva/microbiología , Neoplasias del Ano/patología , Carcinoma de Células Escamosas/patología , ADN Viral/análisis , ADN Viral/genética , Femenino , Humanos , Inmunohistoquímica , Hibridación in Situ , Masculino , Papillomaviridae/genética , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/patología , Neoplasias del Pene/patología , Infecciones Tumorales por Virus/diagnóstico , Infecciones Tumorales por Virus/patología , Neoplasias del Cuello Uterino/patología , Neoplasias Vaginales/patología , Neoplasias de la Vulva/patología

RESUMEN

An experimental computerized interactive morphometry system for the classification of lymphoid-rich effusions is presented. The relatively inexpensive microcomputer-based system was assembled in our laboratory with commercially available hardware and software. One hundred twenty-two effusions (86 benign lymphocytoses, 26 lymphomas, and 10 chronic lymphocytic leukemias) were studied. Lymphoid cells were selected randomly by the system from real-time images of Papanicolaou-fixed and stained cytospin smears of pleural, peritoneal, and pericardial effusions. Parameters of nuclear shape, area, and optical density were measured automatically. Multiparameter statistical procedures of discriminant classificatory analysis analyzed the distribution of lymphoid nuclear profile integrated optical density to yield three groups of effusions, each with a predictive value of diagnosis of 100%. Neither these statistical procedures nor a simple rule-based expert system accurately classified chronic lymphocytic leukemia effusions based on the distribution of lymphoid nuclear profile area. When chronic lymphocytic leukemia effusions were excluded, however, the predictive values of a diagnosis of lymphoma by statistical analysis and by rule-based expert system were 92.3% and 88.9%, respectively, whereas the predictive values of a diagnosis of benign lymphocytosis were 97.7% and 91.3%, respectively. Potential applications and limitations of this technology for the diagnosis of lymphoid-rich effusions are discussed.

Asunto(s)

Procesamiento de Imagen Asistido por Computador/normas , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Linfocítica Crónica de Células B/patología , Linfocitosis/diagnóstico , Linfocitosis/patología , Linfoma/diagnóstico , Linfoma/patología , Cavidad Peritoneal/patología , Núcleo Celular/ultraestructura , Diagnóstico por Computador , Estudios de Evaluación como Asunto , Sistemas Especialistas , Humanos , Linfoma/ultraestructura , Valor Predictivo de las Pruebas , Programas Informáticos , Estadística como Asunto

Asunto(s)

Líquido Cefalorraquídeo/citología , Biopsia con Aguja , Enfermedades del Sistema Nervioso Central/líquido cefalorraquídeo , Técnicas Citológicas , Humanos , Valor Predictivo de las Pruebas , Punción Espinal

RESUMEN

Atherosclerotic plaque rupture with superimposed thrombosis is recognized as the lesion causing late, acute, thrombotic saphenous vein coronary artery bypass graft (CABG) occlusion. To determine the severity of atherosclerosis at the site of plaque rupture, 68 saphenous vein CABGs removed at the time of reoperation or at autopsy were studied. The study population consisted of 57 men, 64 +/- 9 years old, and nine women, 70 +/- 10 years old. The duration of graft implantation was 7.9 +/- 2.7 years (mean +/- S.D.). All CABGs were dissected from the hearts, fixed, decalcified, cut at 2 to 3 mm intervals, and processed routinely for histologic examination. A planimeter was used to measure total vessel, plaque, thrombus, and luminal cross-sectional areas at the site of plaque rupture with thrombosis in sections projected at 13.8 power magnification. At the site of atherosclerotic plaque rupture with superimposed thrombosis, the degree of stenosis due to plaque was: 90 +/- 11% for the right coronary artery grafts (n = 19); 94 +/- 7% for the left anterior descending artery grafts (n = 41), and 90 +/- 14% for the left circumflex artery (n = 8) grafts. Thus in saphenous vein CABGs, atherosclerotic plaque rupture with thrombosis usually occurs at sites of severe narrowing (mean = 93%) by preexisting atherosclerotic plaque.

Asunto(s)

Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Trombosis Coronaria/complicaciones , Vena Safena/trasplante , Anciano , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/patología , Trombosis Coronaria/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rotura Espontánea , Vena Safena/patología , Índice de Severidad de la Enfermedad

Asunto(s)

Neoplasias de la Mama/patología , Carcinoma Papilar/patología , Quistes/patología , Aneuploidia , Neoplasias de la Mama/genética , Carcinoma Papilar/genética , Humanos

RESUMEN

We report the diagnosis of Pneumocystis carinii (PC) in a fine-needle aspirate (FNA) from the thyroid of a human immunodeficiency virus infected (HIV+) male receiving aerosolized pentamidine as prophylaxis for Pneumocystis carinii pneumonia (PCP). The clinical diagnosis prior to FNA was multinodular goiter. The patient did not have pulmonary symptoms nor previous diagnosis of PCP at the time of the aspirate diagnosis. Recently, extrapulmonary Pneumocystis carinii (EPC) has been reported with increasing frequency in HIV+ patients receiving prophylactic aerosolized pentamidine. Awareness of extrapulmonary presentations of Pneumocystis carinii infection is a prerequisite for accurate cytologic diagnosis.

Asunto(s)

Biopsia con Aguja , Infecciones por Pneumocystis/diagnóstico , Pneumocystis/aislamiento & purificación , Enfermedades de la Tiroides/microbiología , Adulto , Infecciones por VIH/complicaciones , Humanos , Masculino , Infecciones Oportunistas/complicaciones , Infecciones por Pneumocystis/complicaciones