Flow cytometry (FC), estrogen receptor (ER), and progesterone receptor (PR) analyses were performed on 226 breast cancers. The presence of steroid receptors was inversely proportional to proliferative index and percent aneuploidy. Within the two ER (+ and -) groups, the presence of PR did not add significantly to the comparison. The mean proliferative index for the diploid tumors was 17.5 +/- 6.8 compared to 27.8 +/- 9.8 for aneuploid tumors (p less than .001). The degree of aneuploidy, or DNA index, was not related to cell cycle kinetics or steroid receptor status. In 163 tissues analyzed for percent tumor present, a correlation between the relative number of aneuploid cells and percent tumor in the histologic review was observed. A study of the diploid tumors indicated greater than 75% had at least 10% tumor cells by histologic review. Since with FC one can observe at least 10% aneuploid cells in a tumor sample, it is our opinion that the percent aneuploidy in this study is not artifactually low due to sampling error. There was no significant relationship between nodal status or number of positive nodes and proliferative index, aneuploidy, or steroid receptor status. Metastatic tumors had a higher mean proliferative index, but this was not statistically significant. There was a relationship between age and proliferative index but not between age and ploidy status. In a small group of patients there was a trend for proliferative index and percent aneuploidy to be higher in the poorly differentiated and larger tumors when compared to the well differentiated and smaller tumors.
Pulmonary alveolar proteinosis (PAP) is an uncommon disease in which alveoli are progressively filled with surfactant-related material. Although a definitive diagnosis is usually made by an open lung biopsy, bronchoalveolar lavage (BAL) cytology may play a decisive role in the clinical work-up of these patients, and, in some cases, may spare a patient a more invasive diagnostic procedure. The authors present three patients in whom BAL cytology specimens contained the characteristic (although not specific) globules of amorphous proteinaceous PAS-positive material accompanied by only rare background macrophages and inflammatory cells. The patients include a 40-year-old man with an 8-year history of fever of unknown origin, a 30-year-old man with a chronic nonproductive cough, and a 6-year-old boy diagnosed at 5Pulmonary alveolar proteinosis (PAP) is an uncommon disease of uncertain and possibly multiple etiologies in which the pulmonary alveoli are progressively filled with amorphous, periodic acid-Schiff (PAS) positive-diastase resistant, lipoproteinaceous, surfactant-related material.1 An appreciable inflammatory cellular infiltrate is absent and there is preservation of the normal, delicate, alveolar septal architecture. The onset of PAP is usually insidious and the presenting symptoms are nonspecific, often causing a significant delay in the diagnosis. Patients with PAP may progress rapidly into severe respiratory distress; therefore, a prompt diagnosis with initiation of appropriate therapy with pulmonary lavage has clinical merit.' Although a definitive diagnosis of PAP may be made by an open lung biopsy, a thorough cytologic and ultrastructural evaluation of bronchoalveolar lavage (BAL) fluid may play a decisive role in the clinical work- up of these patients. We present three patients in whom BAL cytology specimens revealed the characteristic light microscopic and/or ultrastructural findings associated with PAP (Table 1). CASE 1A 40-year-old man being followed for fever of unknown origin (FUO) had experienced persistent recurrent fevers, generalized malaise, occasional night sweats, headaches, myalgias, and episodes of weight loss during the previous 8 years. Extensive clinical work-ups including a complete physical exam as well as biochemical, hematologic, and serologic laboratory studies were noncontributory in revealing a possible etiology for his symptoms.After 4 years of FUO the patient was hospitalized for progression of his symptoms. At that time new symptomatology included a nonproductive cough and wheezing. A chest radiograph revealed a diffuse, reticulonodular pattern suspicious for an infectious process. Multiple sputum cultures for fungi and bacteria including acidfast bacilli (AFB) were negative as were serological studies for human immunodeficiency virus (HIV), EpsteinBarr virus (EBV), Legionella, Toxoplasma, and Brucella. He was treated empirically with doxycycline and his symptoms improved without further therapeutic intervention.
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