Clinicopathologic features of 5 embryonal rhabdomyosarcomas of the biliary tree are reported and compared with 18 examples from the literature. Embryonal rhabdomyosarcoma of the biliary tree is a rare lesion but must be considered in the differential diagnosis of jaundice in childhood. In their gross and histologic characteristics and natural history, these tumors resemble embryonal rhabdomyosarcoma in other locations. Chemotherapy and irradiation may decrease the size of the tumor, but any hope for cure appears to lie with radical surgery.
Background. A Total Quality Improvement review of frozen section diagnoses yielded four sequential false‐negative frozen section diagnoses in lymph nodes in the evaluation of metastases from prostate carcinoma. Because these results appeared to differ from the department's overall frozen section experience, frozen section diagnoses of pelvic lymph nodes in patients with prostate carcinoma were reviewed to benchmark the department's performance.
Methods. All 220 pelvic lymph node frozen section samples from 110 patients with prostate carcinoma from January, 1986 to July, 1993 at Bridgeport Hospital (BH) were reviewed, and the department's frozen section diagnostic efficiency was compared with: (1) all BH frozen section procedures performed during the same period; (2) pelvic lymph node frozen section analysis and (3) imaging techniques for prostate carcinoma from other institutions found in MEDLARS literature searches from 1973 to 1993.
Results. Frozen section diagnostic efficiency for patients with prostate carcinoma from BH was 93.6% (sensitivity 63.2%, specificity 100%) compared with (1) 98% for all BH frozen section analyses (sensitivity 99%, specificity 98%); (2) 90.1% for MEDLARS search pelvic lymph node frozen section prostate carcinoma analyses (sensitivity 66.5%, specificity 100%); and (3) 88% for MEDLARS search magnetic resonance imaging (MRI) pelvic lymph node prostate carcinoma (sensitivity 41%, specificity 97%).
Conclusions. Frozen section diagnosis of pelvic lymph nodes approaches the overall diagnostic efficiency of frozen section analysis and is more sensitive for the diagnosis of prostate carcinoma in pelvic lymph nodes than is MRI because more than half of the metastases are smaller than the 1.0‐cm resolution limit of the MRI. False‐negative frozen section diagnoses (67% sensitivity) occur because of errors in sampling microscopic metastases. Cancer 1995; 76: 661–8.
We apply a unique micro-optoelectromechanical tuned light source & new algorithms to the hyper-spectral microscopic analysis of human colon biopsies. The tuned light prototype (Plain Sight Systems Inc.) transmits any combination of light frequencies, range 440nm 700nm, trans-illuminating H & E stained tissue sections of normal (N), benign adenoma (B) and malignant carcinoma (M) colon biopsies, through a Nikon Biophot microscope. Hyper-spectral photomicrographs, randomly collected 400X magnication, are obtained with a CCD camera (Sensovation) from 59 different patient biopsies (20 N, 19 B, 20 M) mounted as a microarray on a single glass slide. The spectra of each pixel are normalized & analyzed to discriminate among tissue features: gland nuclei, gland cytoplasm & lamina propria/lumens. Spectral features permit the automatic extraction of 3298 nuclei with classification as N, B or M. When nuclei are extracted from each of the 59 biopsies the average classification among N, B and M nuclei is 97.1%; classification of the biopsies, based on the average nuclei classification, is 100%. However, when the nuclei are extracted from a subset of biopsies, and the prediction is made on nuclei in the remaining biopsies, there is a marked decrement in performance to 60% across the 3 classes. Similarly the biopsy classification drops to 54%. In spite of these classification differences, which we believe are due to instrument & biopsy normalization issues, hyper-spectral analysis has the potential to achieve diagnostic efficiency needed for objective microscopic diagnosis.
The later stages of development (16–40 weeks in utero) of the periotic duct and its adjacent areas in the human fetus indicate that the critical stages of development occur in four specific time related stages over a six‐week period (20–26 weeks). First, the petrous apex ossifies to separate the inferior cochlear vein into the canal of Cotugno and forms the medial wall of the cochlear aqueduct (22 weeks); second, the canalicular otic capsule fuses with the cochlear otic capsule to obliterate Hyrtl fissure and forms the lateral wall of the cochlear aqueduct (24 weeks); third, progressive bone deposition to the medial surface of the membranous labyrinth and cochlea at the petrous apex elongates the periotic duct and cochlear aqueduct (32 weeks in utero); and fourth, active arachnoid tissue ingrowth into the periotic duct occurs at 20–24 weeks and 34–40 weeks in utero. The terminal event is widening of the CNS opening of the periotic duct at 32 weeks in utero.
The periotic duct and cochlear aqueduct length increase with gestation from 26 weeks until term. The periotic duct width remains the same throughout the gestation. The cochlear aqueduct width diminishes with gestational age. The periotic duct remains patent throughout 16‐40 weeks in utero.
Renal splenic heterotopia, a very rare benign occurrence of splenic tissue within the renal capsule, mimics organizing capsular hemorrhage, adenomyolipoma and renal cortical adenoma or carcinoma. It is found incidentally as a result of imaging asymptomatic kidneys for other reasons or may cause signs and symptoms due to mass effect and hypersplenism. When occurring in patients who had had splenectomy it has been classified as splenosis. When found in patients with intact spleens it is called splenorenal fusion and considered to be a developmental heterotopia. Renal splenic heterotopia can be diagnosed by 99mTc-sulfur colloid scan and confirmed with fine needle aspiration biopsy cell block preparations. Unnecessary nephrectomy can be avoided if splenic heterotopia is included in the differential diagnosis of renal lesions, particularly in splenectomized patients.
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