performs FNAC and CB. RESULTS. The EWBC recommended 462 OSBs resulting in 310 verified carcinomas, 1 The Elizabeth Wende Breast Clinic, Rochester, for a OSB/Ca ratio of 1.5. The physicians in the remainder of the city recommended New York. 2036 OSBs resulting in 513 verified carcinomas, for a OSB/Ca ratio of 4.0. If the Genesee Hospi-tasis rate of 19% for the breast carcinomas diagnosed in clinic patients was identical tal, Rochester, New York. to that of the women with breast carcinoma in the remainder of the city. interventional diagnostic procedures dedicated solely to the diagnosis NY 14620. of breast carcinoma. The only physicians at the EWBC are diagnostic radiologists. Approximately 75% of the patients live in the Rochesterarea and 25% of the patients are referred to the clinic from western tober
Epithelial hyperplasia, a component of proliferative breast disease (PBD), is a known risk factor for the development of breast carcinoma. To determine if criteria established for tissue biopsy could be used to more precisely define cytologic criteria for diagnosis of PBD, 37 breast fine-needle aspirates with biopsy diagnoses of PBD were studied. In cases with adequate cellularity, the following findings were consistently observed: (1) three-dimensional cell clusters with outlying myoepithelial cells, swirling intralumenal masses and peripheral, slit-like, irregular sublumens (65% of cases); (2) convoluted sheets of ductal epithelium with outlying myoepithelial cells and bulbous projections tethered to the ductal lining (29%); and (3) a background of discohesive small frayed groups of ductal cells (32%). Of the 15 cases that did not meet these criteria, most were paucicellular (87%), which suggested sampling error. Other cytologic features that were observed included: moderately increased cellularity (20 cases), moderate-to-marked nuclear overlap (14 cases), minimal nuclear atypia, and few single epithelial cells. Fifteen cases of confirmed ductal carcinoma in situ were studied for comparison. In these cases, cellularity, nuclear overlap, and atypia were increased, but swirling intralumenal masses, prominent myoepithelial cells and slit-like lumens were absent. In conclusion, the features of PBD established for tissue biopsy can be applied to cytologic specimens, and may provide useful clues to the diagnosis of epithelial hyperplasia in breast fine-needle aspiration specimens.
Cardiac involvement is the most important prognostic factor in primary amyloidosis (AL). The clinical presentation of amyloid cardiomyopathy is varied and may manifest as heart failure, brady or tachyarrhythmias, syncope, angina and rarely with features of hypertrophic cardiomyopathy and advanced symptomatic conduction system disease. The management of amyloid cardiomyopathy has always been a dilemma, as most of the drugs used in congestive heart failure are contraindicated. This report describes a 70-year-old woman who presented with syncope, severe diastolic heart failure, features of hypertrophic cardiomyopathy and severe symptomatic conduction system disease requiring a pacemaker. Amyloidosis was diagnosed on endomyocardial biopsy after abdominal fat aspirate was negative for amyloid. The patient eventually expired due to end-stage congestive heart failure.
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