Four cases of thyroidectomy for suspected thyroid carcinoma after previous irradiation for Hodgkin's or non-Hodgkin's lymphoma are reviewed. The patients ranged in age from 18 to 33 years at the time of thyroid surgery with an average latency period of 12 years (range, 8-20 years) from radiation therapy to thyroidectomy. All patients had a clinically palpable thyroid nodule, and pathologically showed a pattern of multiple adenomatous nodules with cytologic atypia. The microscopic changes were sufficiently striking to cause the primary pathologist to request consultation to rule out thyroid carcinoma in each case. Fine-needle aspiration was performed in one case and suggested a thyroid neoplasm. The pathologic findings are reviewed and distinction of this lesion from thyroid carcinoma is discussed.
A 66-year-old man with a history of smoking was seen for increasing shortness of breath. A chest radiograph demonstrated a right lower lobe mass. Chest computed tomography confirmed the presence of a 2.7-cm lung lesion suggestive of neoplasm. Preoperative cardiac clearance included echocardiography. Transthoracic echocardiography demonstrated a 1-cm mass in the apex of the left ventricle. No other cardiac pathology was noted. Removal of the mass was accomplished through a left ventriculotomy with cardiopulmonary bypass by means of an Embol-X aortic cannula (Embol-X, Inc, Mountain View, Calif). The intraoperative finding was that of a friable tumor embedded within the apical endocardium and myocardium (Figure 1). Pathologic findings included a 1-cm friable tumor with histologic features consistent with papillary fibroelastoma. The heparin-coated mesh filter of the Embol-X cannula captured a 1-mm tumor fragment. The patient had an uneventful recovery and was discharged at 6 postoperative days.Papillary fibroelastomas account for 8% of all cardiac tumors, with 85% involving the cardiac valves. An apical left ventricular location is a rare finding. The main indication for removal is the risk of embolic complications, particularly stroke. [1][2][3] Removal is surgical.
False aneuploidy was detected on flow cytometric DNA analysis of paraffin embedded axillary lymph nodes negative for tumor. It was hypothesized that "clearing" of axillary fat in Carnoy's solution to facilitate lymph node dissection might be responsible for false aneuploidy. Various tissues fixed overnight in Carnoy's were compared to formalin fixed paraffin embedded controls. Under these conditions no false aneuploid peaks were detected, but Carnoy's fixation did shift the GO/G1 histogram peak to the left, increase the GO/Gl CV and increase the S phase fraction relative to formalin fixed controls. It was then hypothesized that partial fixation of nodes in Carnoy's followed by formalin fixation might result in false aneuploid peaks. Twenty-two lymph nodes were partially fixed in Carnoy's for periods ranging from 5 to 60 min followed by complete fixation in formalin. Seven of these nodes did show false aneuploid peaks. By contrast, no aneuploidy was detected in formalin fixed controls. It was concluded that tissues in contact with Carnoy's solution may be a source of false aneuploidy andlor false elevation of S phase fraction. This reinforces the need for matched negative tissue controls for DNA analysis of paraffin embedded specimens whenever possible. (1,7). This report documents an additional cause of both false aneuploidy and false elevation of S phase fraction (SPF) in paraffin embedded normal tissues. These abnormalities were observed in tissues in contact with Carnoy's solution.Carnoy's solution is a rapidly penetrating fixative composed of absolute ethanol, chloroform and glacial acetic acid (6). In our laboratory, Carnoy's is used to "clear" or render translucent fat from node dissections to optimize lymph node yield. The fat is placed whole in a large volume of Carnoy's for several hours prior to node dissection. The dissected nodes are then placed in cassettes and completely fixed in 10% neutral buffered formalin prior to embedding in paraffin.The first phase of this study documents the presence of false aneuploid peaks on flow cytometric DNA analysis of normal lymph nodes processed in the manner described above. The second phase studies the effect of complete fixation of various tissues in Carnoy's solution compared to formalin fixed controls. The third phase of the study examines the effects of partial fixation in Carnoy's compared to formalin fixed controls. This last phase demonstrates the occurrence of false aneuploidy related to partial fixation in Carnoy's. The second phase suggests a mechanism whereby this occurs.Fixation has previously been reported as a factor affecting flow cytometric DNA analysis of paraffin embedded tissues (2,3,5). False aneuploidy as it relates to partial fixation or exposure to more than one fixative has not previously been emphasized. The implications for flow cytometric DNA analysis of paraffin embedded tissues are discussed. 'This project was conducted through The John S. Sharpe Research Foundation at The Bryn Mawr Hospital.
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