We have designed a new direct isolation method, the foot-press method, to survey dissemination of dermatophytes from the infected soles. A total of 56 untreated patients with tinea pedis were examined. The infected soles of 42 patients were pressed onto actidione-chloramphenicol-5-fluorocytosine (5FC)-gentamicin sulphate Sabouraud glucose medium prepared in a large culture dish; the culture media were then incubated at 25 degrees C. Dermatophytes were isolated in 30 out of the 42 patients, while no dermatophytes could be grown from 10 healthy controls. The number of isolated colonies from each patient ranged from 1 to 97 (mean +/- SD, 11 +/- 20). The isolation frequencies were higher in the patients of hyperkeratotic type and in those with tinea unguium, while causative organisms and the extent of the lesions did not affect the results of the footpress method significantly. In order to reveal the morphology of disseminated dermatophytes, 1 x 1 cm pieces of culture media were cut out from culture dishes after pressing infected soles and were examined microscopically. Dermatophyte-like spores or hyphae, most of which were detached from cornified cells, could be seen in 10 out of 14 patients. Subsequently performed slide cultures isolated dermatophytes from approximately 70% of the pieces on which dermatophyte-like fungi were observed.

Adult↗

PubMedDate not supplied

Cytology of Langerhans cell histiocytosis in effusions: a case report.

BACKGROUND: Langerhans cell histiocytosis is a relatively rare disorder of children, characterized by abnormal proliferation of Langerhans cells. There has been no report on the cytologic appearance of Langerhans cells in effusions. CASE: A 20-year-old had a 12-year history of the disease, since he was 8 years old. He had multiple mass lesions in the bones, lung and liver, and Langerhans cells appeared in the pleural fluid and ascites. They had indented, twisted or grooved nuclei, with a finely or coarsely granular chromatin pattern. Some of the nuclei were eccentrically located, and prominent nucleoli were occasionally seen. Immunohistochemically the cells showed positivity for S-100 protein. Electron microscopic examination revealed abortive Birbeck granules. CONCLUSION: The cytologic appearance was somewhat accentuated and different from that reported for other sites. Immunohistochemical staining for S-100 protein and/or electron microscopic examination should be employed.

Adult↗

PubMedDate not supplied

Markedly high signal intensity lesions in the uterine cervix on T2-weighted imaging: differentiation between mucin-producing carcinomas and nabothian cysts.

PURPOSE: Both mucin-producing carcinomas and nabothian cysts in the cervix show very high signal intensity on T2-weighted images (WI). The purpose of this study was to evaluate the potential of MR imaging in differentiating mucin-producing carcinomas from nabothian cysts. MATERIALS AND METHODS: Forty-six patients who underwent hysterectomy and had very high signal intensity lesions in the uterine cervix on T2-WI were included in this study. The pathological diagnoses were mucin-producing carcinoma in 13 patients, non-mucin-producing carcinoma accompanied with nabothian cyst in four patients, and nabothian cyst in 29 patients. T1-WI, T2-WI, and Gd-T1-WI were obtained in all patients. Malignancies were diagnosed on Gd-T1-WI as follows: (1) an enhanced lesion, (2) an irregular margin, (3) iso-intensity on T1-WI. In contrast, high signal intensity on T1-WI was considered benign. RESULTS: Thirteen of 17 malignant lesions and three of 29 benign lesions were enhanced. Irregular margins were observed in 12 of 17 malignant lesions and four of 29 benign lesions. Nineteen benign lesions and seven malignant lesions demonstrated high signal intensity on supplemental T1-WI. Combining the lesion criteria of enhancement, irregular lesion margin, and iso-intensity on T1-WI, the overall accuracy, sensitivity, and specificity rates of diagnosing malignancy were 89%, 88%, and 90%, respectively (p < 0.01). CONCLUSION: MR imaging accurately differentiated mucin-producing carcinomas from nabothian cysts that showed high signal intensity on T2-WI in the cervical stroma. For diagnosing mucin-producing carcinomas and nabothian cysts when signal intensity was remarkably high on T2-WI, Gd-T1-WI findings provided key information for differentiation, and T1-WI was useful for improving specificity.

Adenocarcinoma, Mucinous↗

PubMedDate not supplied

A case of postmenopausal endometriosis unrelated to neoplasm.

A 55-year-old woman was referred to our hospital for evaluation of a lower abdominal mass. Menopause had occurred at age 52 years. Ultrasonography and magnetic resonance imaging showed a partially solid right ovarian tumor, an appearance suggestive of malignancy. A transabdominal simple hysterectomy and bilateral salpingo-oophorectomy were performed. Pathologic examination revealed an endometrial cyst of the right ovary, a uterine leiomyoma, and adenomyosis.

Diagnostic Errors↗

PubMedDate not supplied

Detection of minute pleural fluid in the pleural retracted space associated with peripheral lung cancer: evaluation with MR imaging.

PURPOSE: To evaluate the efficacy of magnetic resonance imaging (MRI) in detecting minute pleural fluid in the pleural retracted space (PRS) associated with peripheral lung cancer. MATERIALS AND METHODS: Our subjects were 20 patients with peripheral lung cancer in whom thin-section CT in the lung window setting demonstrated lesions adjacent to the pleural surface, and who were referred for MR imaging. The imaging findings were retrospectively evaluated and correlated with the histopathologic specimens. Pleural fluid was aspirated for cytology under ultrasound (US) guidance in six patients. RESULTS: STIR MR images revealed water SI areas beneath the chest wall associated with the lung cancer, whereas, on CT images, lung cancer and minute pleural fluid in the PRS showed similar soft-tissue density without enabling easy differentiation. Two of the six patients who underwent aspiration cytology showed malignancy. All histopathologic specimens obtained from 18 patients who underwent surgery showed pleural retraction corresponding to the water SI areas on STIR images. Histopathological study revealed that the fibrotic focus of the tumor tended to occur more intensively when the shape of pleural retraction was thinner and deeper. CONCLUSION: Water SI areas on STIR images were thought to suggest pleural fluid retention in the PRS. MRI was sensitive in detecting minute pleural fluid in the PRS and may help to avoid overdiagnosis of chest wall invasion induced from peripheral lung cancers.

Adult↗

PubMedDate not supplied

Fine needle aspiration cytology of clear cell sarcoma. Report of a case with immunocytochemical, immunohistochemical and ultrastructural studies.

Cytologic findings of clear cell sarcoma obtained by fine needle aspiration (FNA) of a tumor are described. The tumor probably originated in the retroperitoneal tissue, and the diagnosis was confirmed histologically by open biopsy. Percutaneous needle aspirates of the intraabdominal tumor and touch preparations obtained from the open biopsy specimen revealed numerous atypical cells with an extremely hyperchromatic nucleus, prominent nucleoli and clear cytoplasm. The cytoplasm was rich in glycogen. The immunocytochemical technique demonstrated S-100 protein and neuron-specific enolase in the cytoplasm, both of which were exhibited also in the histologic specimen. Clear cell sarcoma is a rare tumor of soft tissue, and to our knowledge, detailed cytologic appearances of this tumor obtained by FNA have not been reported. In addition, the present tumor was unique in location. It is possible to diagnose clear cell sarcoma accurately on an FNA cytologic specimen if the periodic acid-Schiff stain and immunocytochemical technique are utilized in addition to the routine Papanicolaou method.

Biopsy, Needle↗

PubMedDate not supplied

Survival following resection for lung cancer as a second primary cancer.

A second operation was done on 59 patients with lung cancer (7.4% of all those with lung cancer) as a second primary (double primary), during 1974-1991. There were 16 synchronous tumors (interval less than one year) and 43 metachronous tumors (interval over one year). The criteria for diagnosing lung cancer as a second primary from intrapulmonary metastases were any of the following: 1) different histologic type; 2) origin from carcinoma in situ; 3) gross appearance suggestive of primary lung cancer. The initial operation was in the stomach in 14 patients and in the lung in 10. The overall 5-year survival rate in the double primaries was 57.8%, and the prognosis was similar to those in the single primaries of the lung. Nineteen patients died from the second tumor following the second operation, compared with 5 from the initial tumor. The incidence of primary lung cancer increases, and close follow-up after resection for malignant neoplasms detects a new shadow in the chest roentgenogram. It offers a chance of early detection of primary lung cancer and subsequent resection with acceptable results.

Adult↗

PubMedDate not supplied

Thoracoscopy in the management of intrathoracic neurogenic tumors.

Video-assisted thoracoscopic surgery (VATS) has emerged as a minimally invasive therapy of intrathoracic neurogenic tumors, when the diseases occur in the adult and show no intraspinal extension. We have reviewed five cases: three tumors arose from the sympathetic chain with no intraspinal extension, vagus nerve in one, and intercostal nerve in one. For all five patients, hospitalization was brief, recovery was relatively rapid, and long-term results were excellent. We believe that when the indication for the treatment of patients with an intrathoracic neurogenic tumor are met in the adult, the procedure of choice should be the VATS approach.

Adolescent↗