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Can you count on the mitotic index?

The mitotic index (MI) is the most commonly use quantitative measure in anatomic pathology but has been widely criticized for supposed "irreproducibility." In this article, the authors show that mitotic figure (MF) counts may be described by a Poisson distribution, give confidence intervals for the MI, and show that the supposed irreproducibility is largely a consequence of the counting techniques. They also show how to obtain the MI to a predetermined level of precision and present an analysis of why mitotic figure counting works, when properly used, despite the inherently low precision of the estimates that are usually obtained.

Breast Neoplasms↗

Complex translocation [7;22] identified in an epithelioid hemangioendothelioma.

We describe a malignant epithelioid hemangioendothelioma arising in the back of a 45-year-old man with pulmonary and bone marrow metastases. Light microscopic and immunohistochemical features of this tumor are presented. Karyotyping revealed several clonal abnormalities: a complex unbalanced translocation [7;22] involving multiple breakpoints (confirmed by fluorescence in situ hybridization), a Robertsonian t(14;14), and loss of the Y chromosome. Monosomy for chromosome 11 was noted in a subset of the tumor cells. To our knowledge a karyotype has not been previously reported for this unusual vascular tumor.

Bone Neoplasms↗

Cytogenetic studies in malignant fibrous histiocytoma.

Among soft tissue sarcomas, malignant fibrous histiocytoma is considered to be the most commonly encountered tumor-type of late adult life. Cytogenetic data are, however, sparse and contradictory, without any specific anomalies. We are describing the results of cytogenetic studies in 20 malignant fibrous histiocytomas of various subtypes and gradings. Although we saw two single and therefore possibly primary rearrangements, t(13;14) and t(5;7), most tumors had complex rearrangements without sharing any characteristic aberrations. In our opinion, the heterogeneity of these findings supports the concept that malignant fibrous histiocytoma is not a distinctive entity but merely a name for a group of as yet poorly defined sarcomas.

Aged↗

[Resection of bronchogenic carcinoma invading the diaphragm].

The prognosis for survival when small cell non-anaplastic bronchogenic carcinoma (SCN-ABC) invades the diaphragm has not been clearly established because the diagnosis is rare. We report a series of eight patients who underwent full resection of SCN-ABC with diaphragm invasion. One died during the postoperative period. Mean survival was eight months for the remaining seven and no patient lived five years. All died as a result of remote metastasis. Given these results, we question whether surgery is the most appropriate treatment for these patients.

Aged↗

Granular cell tumor of the tongue.

The granular cell tumor has been and still is a debatable lesion in several aspects. The etiology and pathogenesis are still unknown. Granular cell tumors may occur everywhere in the body, but the oral cavity is a favorite location. The majority of the oral lesions are found in the dorsum and the borders of the anterior two-thirds of the tongue. Seven patients with a granular cell tumor of the tongue are described. The clinical and microscopic findings have been discussed. In all cases an excisional biopsy had been aimed at. In spite of incomplete excision in six out of the seven cases, local recurrences were noticed in only one patient. In one patient "metastatic" occurrence of granular cell tumors was noticed.

Adult↗

Musculoskeletal system neoplasia.

Tumors of the musculoskeletal system are rare in horses; however, they must be taken seriously. Diagnosis requires observation of clinical signs, radiographic findings, and histological examination. Veterinarians must realize prognosis is not favorable for most tumors; however, some of these tumors can be treated or at least ameliorated. Tumors discussed in this article include: osteoma and osteosarcoma; osteoblastoma; chondrosarcoma; fibroma and fibrosarcoma; plasma cell myeloma; synovioma; rhabdomyosarcoma and tumors metastatic to the musculoskeletal system.

Animals↗

[18-FDG positon emission tomography and distal metastasis from lung cancer].

"Whole body" FDG-PET usually covers the body from the base of the skull to the upper third of the thighs, arms in abduction. Thus, the upper part of the head and the lower limbs are not included in the acquisition field. We report the cases of three patients with non-small-cell lung cancer who developed secondary distal localizations beyond the acquisition field of "whole body" FDG-PET. Lung cancer is known to favor hematogenic dissemination, raising the possibility of early distal metastasis. A pretherapeutic PET scan which includes the extremities can be useful to search for distal extension. These true whole body scans are time consuming and can thus limit machine availability. Furthermore, the diagnostic yield of this type of examination may be low since it can be estimated that about 1% of patients will develop isolated distal metastases (3 out of 293 patients in our series initially treated for non-metastatic non-small-cell lung cancer). In the current context of technical availability, systematic inclusion of the lower limbs in the PET scan acquisition field would not appear warranted for the initial work-up of patients with non-small-cell lung cancer. However, clinicians must be aware that distal metastases (brain, lower limbs) may not be detected.

Adenocarcinoma↗

Oral commissure reconstruction with split masseter muscle transposition and cheek skin flap.

Satisfactory reconstruction of the cheek involving the oral commissure is always challenging. A 64-year-old male patient underwent full-thickness repair of a cheek defect involving the oral commissure following excision of squamous cell carcinoma. Reconstruction was performed with a cheek skin flap combined with split masseter muscle transposition. This method was found to be useful for reconstructing the oral commissure with good functional and aesthetic results.

Carcinoma, Squamous Cell↗

[Inflammatory myofibroblastic tumour (so-called pseudotumour) of the hepatobiliary system].

The purpose of this report is to describe the ultrasonographic features of hepatic inflammatory myofibroblastic tumour (IMT). This tumour presented as an area of periportal soft-tissue infiltration. Because periportal infiltration is a common feature in both IMT and other malignant tumours of the hepatic portal, histological examination should be considered before final diagnosis and treatment.

Gallbladder Neoplasms↗

Granular cell myoblastoma in the tongue of a dog: a case report.

A granular cell myoblastoma was found in the dorsal side of the tongue of a 9-year-old female mongrel Pinscher. Macroscopically the tumour was white, well circumscribed, and 1 1/2 cm in diameter. Microscopically the tumour cells were arranged in small compact nests or cords with delicate, poorly vascularized collagen bundles in between. Acinar structures were found, also a few mitotic figures were present. Cytoplasmic granules showed a positive periodic acid Schiff reaction. Ultrastructural features included indented nuclei and small-sized vesicular cytoplasmic granules. The histogenesis of the neoplasm remains uncertain.

Animals↗