Fine needle aspiration cytology of foreign bodies presenting as cystic abdominal masses. A report of three cases

BACKGROUND: Foreign body material (gauze sponges) presented as cystic abdominal masses and were confused with malignant tumors. CASES: Two females and one male presented with abdominal masses. They had undergone laparotomy 5-12 years earlier. Clinically the masses were diagnosed as benign or malignant cystic lesions. Fine needle aspiration revealed necrotic material, hemosiderin-laden macrophages, foreign body giant cells, cholesterol crystals and many fragments of birefringent material. The possibility of malignancy was ruled out. Cut sections of the excised cystic lesions revealed gauze sponges surrounded by a thick, fibrotic wall. CONCLUSION: This report underscores the usefulness of fine needle aspiration in ruling out malignancy.     

Molecular weight and restriction mapping of the DNA of cholera phages

Molecular masses of cholera bacteriophages 493, 7226 and Eltor II were defined by electron microscopic technique. DNA of these bacteriophages was digested by the restriction endonucleases PstI, BglI, MluI and SalI. The number and molecular masses of the obtained restricts were identified. The physical map of bacteriophage 493 was constructed using three restriction endonucleases. The obtained data can be used for classification and molecular biology research of cholera bacteriophages.     

Preserved brains in medieval skulls

Fifty-six out of seventy-four skulls dating from the Middle Ages contained intracranial masses with more or less preserved external brain features. The skulls were excavated from a churchyard outside a former Franciscan monastery in Svendborg, Denmark. Histologic, scanning electron microscopic, and biochemical studies have established that the masses consist of brain material preserved in the state of adipocere.     

A peritoneal mesothelioma in a captive aardwolf (Proteles cristatus)

A 10-year-old male aardwolf (Proteles cristatus) was presented abdominal distention and emaciation for 3 months. Physical examination revealed firm abdominal masses with effusions. Cytologic assessment of the effusion showed uniform round tumor cells with a surface brush border. Necropsy showed white velvety masses covering the peritoneal surface of the liver, gall bladder, stomach, omentum, mesentery, spleen, intestine, abdominal wall and diaphragm. Histologic examination demonstrated papillary projections, lined with cuboidal tumor cells supported by fibrous connective tissue cores, arising from the serosa of visceral organs. Cytoplasmic vacuolation and a surface brush border were evident on some cells under light microscopy. Tumor cells stained positive for both cytokeratin (AE1/AE3) and vimentin. Electron microscopy showed prominent surface microvilli, rough endoplasmic reticulum, mitochondria and desmosomes in tumor cells. This may be the first reported case of peritoneal mesothelioma in a captive wild aardwolf.     

Spontaneous anaplastic large cell lymphoma in a chimpanzee: A clinicopathological and immunohistochemical study

Abstract: An anaplastic large cell lymphoma with disseminated abdominal metastases was diagnosed in a 35-year-old male chimpanzee. Clinically, the animal displayed lethargy, weight loss, ascites, and abdominal distention. Imaging studies showed several large abdominal masses. At necropsy, variably sized masses of neoplastic mesenteric lymph nodes that encompassed several intestinal loops were present throughout the abdomen. The largest mass measured 9 × 5 cm and had cauliflower-like protrusions into the jejunal lumen. The entire abdominal cavity was covered by a sheet of neoplastic tissue. Histopathologically, the tumor consisted of solid sheets of proliferating lymphoid cells forming a cohesive growth that filled the lymph node sinuses. The tumor had invaded the intestinal wall. Anaplastic large cell lymphoma was diagnosed from immunohistochemistry findings on the basis of positive reaction to the CD3 and CD30 markers and negative reaction to the CD20 marker. Serologic analysis revealed positive titers for Epstein-Barr, cytomegalo-, and varicella-zoster viruses. Both serologic and virologic studies showed no evidence of detectable retroviral infection. This type of tumor has not been reported before in the chimpanzee.     

Actinomycosis in fine needle aspiration cytology

Four cases of actinomycosis were diagnosed by fine needle aspiration (FNA) cytology and eight more cases were detected during a review of FNA smears reported as inflammatory. the age of these 12 cases ranged from 20 to 61 years with a median of 35 years. the male to female ratio was 3:1. the common regions of involvement were cervicofacial in seven cases (58.3%), thoracic in three (25.0%) and abdominal in two (16.7%). Four of the seven cervicofacial cases presented with intra-oral masses; the thoracic lesions were pulmonary in location, and the abdominal lesions presented as bowel masses. the possibility of actinomycosis was not considered clinically in any case. the main reason for missed cytodiagnosis in two thirds of the cases appeared to be observer error. It is suggested that when the aspiration smear from a mass is found to be an inflammatory exudate rich in neutrophils, special efforts must be made to look for this microorganism.     

5例腹膜后异位嗜铬细胞瘤的CT表现并文献复习

目的：分析腹膜后异位嗜铬细胞瘤的CT影像学结果,探讨其特异性的CT表现。方法：回顾性分析5例经病理证实为腹膜后异位嗜铬细胞瘤患者的临床、手术及CT资料。结果：5例均为单发肿块,位于腹主动脉周围,CT平扫表现为境界清楚的圆形或椭圆形肿块,肿块直径3CM-7CM,平均4．5CM,瘤体密度较均匀,无囊变和坏死,增强后呈明显较均匀强化。结论：腹膜后异住嗜铬细胞瘤常位于腹主动脉旁,CT增强显示腹主动脉旁类圆形富血供软组织肿块,若t临床合并高血压,应高度警惕嗜铬细胞瘤的可能。     

Diagnosis of abdominal masses with percutaneous biopsy guided by ultrasound.

OBJECTIVE--To assess the accuracy and safety of percutaneous biopsy of abdominal masses guided by ultrasound. DESIGN--Prospective study. SETTING--Combined gastroenterology service, Scarborough Hospital. PATIENTS--108 Consecutive patients identified as having a discrete mass on diagnostic ultrasound examination of the abdomen. INTERVENTION--A sample of tissue was obtained with an aseptic technique under local anaesthesia: an 18 steel wire gauge needle (Tru-Cut) was mounted in a spring loaded firing device (Biopty gun) that was advanced under simultaneous ultrasound scanning, permitting precise localisation of the target organ. MAIN OUTCOME MEASURE--Results of histological examination of tissue specimens. RESULTS--Biopsy failed in four patients. Adequate histological specimens were obtained in 104 patients with masses in the liver (31), pancreas (37), kidney (10), and adrenal glands (six) and in 20 undiagnosed abdominal and retroperitoneal masses. Follow up was until death or confirmation of the diagnosis. Three complications but no deaths occurred. Malignancy was suspected in 84 patients before biopsy. This was confirmed in 70 patients, in 26 of whom confirmation of dissemination obviated the need for further investigation. In 10 patients biopsy indicated a previously unsuspected primary tumour, and in 12 it showed only a benign lesion. Among 24 patients considered to have benign disease biopsy showed an unsuspected neoplasm in seven. Use of biopsy thus had a major effect on clinical management in 55 patients. Four false negative but no false positive diagnoses resulted from the procedure. CONCLUSION--Percutaneous biopsy of abdominal and retroperitoneal masses under ultrasound guidance is a safe and accurate method of obtaining a histological diagnosis. The results obtained have a considerable effect on clinical management.     

Plasma androgens and their association with the reproductive cycle of the male fence lizard, Sceloporus undulatus

Seasonal variation in plasma androgen levels was determined for males of the lizard Sceloporus undulatus. Plasma androgens peaked in both spring and in fall prior to brumation, coinciding with periods of maximum testicular enlargement and advanced spermatogenic development. Plasma androgen concentrations were minimal during summer, following testicular regression and breeding in spring. Epididymal masses were positively correlated to plasma androgen levels, while abdominal fat body masses demonstrated a negative correlation.     

Abdominal Lipomatosis with Secondary Self-Strangulation of Masses in an Adult Rhesus Macaque (Macaca mulatta)

An 10-y-old, intact male rhesus macaque (Macaca mulatta) presented for bilateral scrotal swelling and a distended abdomen. A soft mass in the left upper quadrant of the abdomen was palpated. A barium study did not reveal any gastrointestinal abnormalities. Exploratory laparotomy revealed a large (1.25 kg, 15.0 × 13.0 × 9.5 cm), red and tan, soft, circumscribed, spherical mass within the greater omentum and 10 to 20 smaller (diameter, 1 to 4 cm), soft to firm masses in the mesentery and greater omentum. The resected mass was a self-strangulating abdominal lipoma, a pedunculated neoplasm composed of white adipocytes arising from peritoneal adipose tissue undergoing secondary coagulation necrosis after strangulation of the blood supply due to twisting of the mass around the peduncle. The smaller masses were histologically consistent with simple or self-strangulating pedunculated abdominal lipomas. The macaque presented again 9 mo later with a firm, 5.0-cm mass in the midabdomen, with intestinal displacement visible on radiographs. Given this animal''s medical history and questionable prognosis, euthanasia was elected. Necropsy revealed numerous, multifocal to coalescing, 1.0- to 15.0-cm, pale tan to yellow, circumscribed, soft to firm, spherical to ellipsoid, pedunculated masses that were scattered throughout the mesentery, greater omentum, lesser omentum, and serosal surfaces of the gastrointestinal tract. All of the masses were pedunculated abdominal lipomas, and most demonstrated coagulation necrosis due to self-strangulation of the blood supply. To our knowledge, this report is the first to describe abdominal lipomatosis with secondary self-strangulation of masses in a rhesus macaque.Lipomas have been reported frequently in veterinary medicine as benign subcutaneous neoplasms in canines¹⁶ or as pedunculated peritoneal masses with the potential to cause intestinal strangulation in geriatric horses.⁶ Abdominal lipomatosis (multiple abdominal lipomas) in humans and dogs had been reported only rarely and have been accompanied by clinical signs of abdominal distention with or without secondary gastrointestinal complications.¹⁶ Lipomas of the skin of nonhuman primates have affected a patas monkey, an African green monkey, rhesus macaques, and chimpanzees. Lipomas within the peritoneal cavity have been diagnosed rarely in nonhuman primates. Reported cases include an omental lipoma in a mona monkey and an adrenal lipoma in a hamadryas baboon.¹⁴ Here we report the clinical signs, postmortem examination, and histopathologic features of abdominal lipomatosis in a rhesus macaque (Macaca mulatta).     

Fine needle aspiration of pediatric abdominal masses. Cytologic and electron microscopic diagnosis.

Fine needle aspiration (FNA) was performed under ultrasound guidance on 17 abdominal masses in 16 pediatric patients at Baragwanath Hospital. The aspirated cellular material was assessed by conventional cytomorphology and by electron microscopy (EM). A diagnosis of malignancy was rendered for all 15 tumors that were adequately sampled (88.2%); the remaining 2 masses yielded insufficient material for either light microscopy or EM. Cytologic cell typing (including the use of EM) was successful in 12 of the 15 tumors (80%) as compared with the histologic diagnosis. EM was in agreement with the initial cytologic diagnosis in eight tumors, but corrected the initial impression in four tumors. The tumors with adequate aspirates included nine nephroblastomas and single examples of neuroblastoma, hepatoblastoma, non-Hodgkin's lymphoma, rhabdomyosarcoma, renal carcinoma and malignant rhabdoid tumor. The last three were not accurately typed by cytology plus EM. These preliminary results suggest that FNA cytology with adjunctive EM could become a useful technique in the preoperative assessment of pediatric abdominal tumors.     

Fine structure of interphase nuclei

The initiation and replication sites of DNA synthesis in the plasmodial nuclei of Physarum polycephalum were studied with electron microscopic autoradiography. By using both thin sectioning and whole mount techniques, it was shown that the dense chromatin masses in the nucleus consisted of predominantly elementary chromatin-like fibrils, approximately 300 Å in diameter while the electron transparent region in the nucleus consisted of predominantly finer fibrils, less than 100 Å in diameter. With electron microscopic autoradiography it was found that (1) the initiation sites of DNA synthesis were definitely in the boundary regions between the dense chromatin masses and the electron transparent region, (2) the initiation and replication sites of DNA synthesis were definitely not on the nuclear membrane, (3) within a few minutes, replication sites migrated from the initiation sites to the electron transparent region and (4) in this electron transparent region, almost all of the nuclear DNA was synthesized.     

Splenic Subcapsular Hematoma—Ultrasonic Diagnosis

In five patients with varying histories of blunt abdominal trauma, examinations were carried out with ultrasonography and other imaging modalities. In all five patients, large, fluid-filled masses were noted in the left upper quadrant. Two patients had nonpalpable hematomas, but examinations were done because of history and vague clinical symptoms. Three patients had palpable masses. In all five patients there was surgical confirmation of the ultrasonic findings, and all recovered without complications. Ultrasonic tomography offers a convenient noninvasive method for assessing suspected splenic hematoma and can also exclude the possibility in a careful examination.     

Cytodiagnosis and comparison of nondecidualized and decidualized endometriosis of the abdominal wall. A report of two cases.

We describe two cases of endometriosis of the abdominal wall occurring in young, multiparous women in which the diagnosis was made by fine needle aspiration biopsy. One case illustrates the cytologic features of non-decidualized endometriosis: a biphasic population of stromal and glandular cells. In contrast, the other case showed large, plump stromal cells in a distinctive myxoid background, creating a picture of decidualized endometriosis. The differential diagnoses of palpable masses in the abdominal wall and the importance of clinicopathologic correlation are discussed.     

B超引导下乳腺肿块粗针穿刺诊断的分析（附120例报道）

目的：探讨B超引导下粗针穿刺在乳腺肿块诊断中的应用意义。方法：使用B超引导下粗针吸取穿刺对120例乳腺肿块进行穿刺活检,然后进行固定,脱水,染色,镜检,结合临床作出病理学诊断。结果：粗针穿刺诊断包括良性病变48例,非典型性导管上皮增生（ADH）32例,导管内癌12例,浸润性癌28例。与后续手术标本病理诊断比较得出确诊率,其中良性病变的诊断率为95．83％（46／48）,ADH的确诊率为75％（24／32）,导管内癌的确诊率为58．33％（7／12）,浸润性癌诊断率为92．86％（26／28）,其中导管内癌与浸润性导管癌和乳腺良性病变的确诊率有显著性差异,而ADH与浸润性导管癌和乳腺良性病变间的确诊率有差异,但本组数据没有统计学意义。结论：超声引导下粗针穿刺对乳腺浸润性癌和良性病变的诊断率较高,但对ADH和原位癌的确诊率较低,有待进一步改进。     

Analysis of the quaternary structure of secreted repressible acid phosphatase from the yeast Saccharomyces cerevisiae]

The structural organization of extracellular repressible acid phosphatase from S. cerevisiae has been studied. The existence of multiple acid phosphatase forms with isoelectric points at pH 4.1-4.8 has been confirmed by isoelectrofocusing. The molecular masses of three acid phosphatase isoforms (56, 57-59, and 60 kDa) obtained after enzymatic deglycosylation correlate with the data obtained previously during the analysis of translation products in cell-free systems. Electron microscopic studies revealed that the acid phosphatase molecule has a square shape and is made up of four identical subunits with molecular masses of about 125 kDa.     

1例热带念珠菌脓肿误诊分析

报告1例热带念珠菌引起的腹腔脓肿瘘管真菌感染。患者女,78岁,因十二指肠球部穿孔并发腹膜炎,行腹腔镜术,术后伤口反复未完全愈合,有少量分泌物溢出。发现腹壁瘘管及腹腔脓肿入院,两次细菌培养均无菌生长,再次取分泌物直接镜检阳性,真菌培养鉴定为热带念珠菌。手术清理组织,病理示感染性肉芽肿改变,查见大量假菌丝及孢子。经口服伊曲康唑和两性霉素B溶液纱条引流治疗3个月后基本痊愈。     

Cytomorphological spectrum in scar endometriosis: a study of eight cases

OBJECTIVE: Endometriosis due to ectopic endometrial tissue that responds to hormonal stimulation and is extremely rare in a surgical scar appearing in 0.1% of women who have undergone Caesarean section. Fine needle aspiration cytology (FNAC) can be a valuable diagnostic aid in the evaluation of these subcutaneous abdominal masses. METHODS: We present the cytomorphological spectrum in eight cases of abdominal wall endometriosis diagnosed by FNAC over a 6-year period (June 1998-June 2004) in Mubarak Al-Kabeer Hospital (Kuwait). The patients ranged from 27 to 56 years of age. Seven had a prior Caesarean section and one had a hysterectomy for fibroid. They presented 3-8 years later with nodules in/near the abdominal scar. Five cases presented with a painful nodule, fluctuant with the menstrual cycle. RESULTS: Cytological findings comprised epithelial clusters and fusiform stromal cells with numerous haemosiderin-laden macrophages. Mild to moderate epithelial atypia was observed in three cases. A diagnosis of endometriosis was rendered in all the eight cases and tissue was available in four cases. CONCLUSIONS: Endometriotic nodules need to be differentiated from other benign/malignant masses and evaluated for possible malignant transformation. FNAC provides a safe and effective tool for diagnosis thereby obviating the need for other procedures.     

Radiation-induced endometriosis in Macaca mulatta.

Female rhesus monkeys received whole-body doses of ionizing radiation in the form of single-energy protons, mixed-energy protons, X rays, and electrons. Endometriosis developed in 53% of the monkeys during a 17-year period after exposure. Incidence rates for endometriosis related to radiation type were: single-energy protons, 54%; mixed-energy protons, 73%; X rays, 71%; and electrons, 57%. The incidence of endometriosis in nonirradiated control monkeys was 26%. Monkeys exposed to single-energy protons, mixed-energy protons, and X rays developed endometriosis at a significantly higher rate than control monkeys (chi 2, P less than 0.05). Severity of endometriosis was staged as massive, moderate, and minimal. The incidence of these stages were 65, 16, and 19%, respectively. Observations of clinical disease included weight loss in 43% of the monkeys, anorexia in 35%, space-occupying masses detected by abdominal palpation in 55%, abnormal ovarian/uterine anatomy on rectal examination in 89%, and radiographic evidence of abdominal masses in 38%. Pathological lesions were endometrial cyst formation in 69% of the monkeys, adhesions of the colon in 66%, urinary bladder in 50%, ovaries in 86%, and ureters in 44%, focal nodules of endometrial tissue throughout the omentum in 59%, and metastasis in 9%. Clinical management of endometriosis consisted of debulking surgery and bilateral salpingo-oophorectomy combined in some cases with total abdominal hysterectomy. Postoperative survival rates at 1 and 5 years for monkeys recovering from surgery were 48 and 36%, respectively.     

Relationship of Anterior and Posterior Subcutaneous Abdominal Fat to Insulin Sensitivity in Nondiabetic Men

Recent studies from our group reveal that adipose tissue (AT) in the subcutaneous abdominal region is the most important determinant of peripheral and hepatic insulin sensitivity. Because of different anatomic and physiologic characteristics of anterior and posterior subcutaneous abdominal AT, we investigated the relationship of the masses of each compartment, as determined by magnetic resonance imaging, to insulin sensitivity (using euglycemic hyperinsulinemic glucose clamp technique), and other anthropometric variables. Thirty-four healthy men with varying ranges of obesity were recruited for the study. The mass of posterior subcutaneous abdominal AT was ～1.6 times more than that of the anterior compartment, and these masses accounted for 12.9% and 8.2% of the total body fat mass, respectively. All anthropometric variables, including body mass index (BMI), waist-to-hip circumference ratio (WHR), skinfold thicknesses, and intraperitoneal AT mass were more significantly related to the posterior than the anterior subcutaneous abdominal AT mass. Compared to the anterior compartment mass, the posterior compartment mass displayed stronger relationship with insulin-mediated glucose disposal (Rd) (r=-0.44, p=0.009, and r=-0.76, p=0.0001, respectively) as well as with residual hepatic glucose output during the 40 mU.^?2.min-¹ insulin infusion (r=0.39, p=0.02, and r=0.53, p=0.001, respectively). After adjusting for total body fat, the Rd values showed a significant partial correlation with the posterior subcutaneous abdominal AT mass (r=-0.52, p=0.002). To conclude, posterior subcutaneous abdominal AT mass is a more important determinant of peripheral and hepatic insulin sensitivity than the anterior subcutaneous abdominal AT.