Prognostic significance of the intra-vessel tumor characteristics of invasive ductal carcinoma of the breast: a prospective study.

Hasebe T., Sasaki S., Imoto S. and Ochiai A.

Invasive ductal carcinomas (IDCs) of the breast are composed of stroma-invasive tumors and tumors in vessels. The purpose of this study was to prospectively investigate whether the histological characteristics of the tumors in vessels were more significantly associated with the outcome of 393 IDC patients than well-known histological parameters. Multivariate analyses showed greater than six apoptotic figures in tumor cells in lymph vessels to be significantly associated with increased hazard rates (HRs) of tumor recurrence and death in IDC patients without nodal metastasis (P<0.05). Among IDC patients with nodal metastasis whose tumors were positive for estrogen receptors (ERs) or progesterone receptors (PRs) or both, greater than six apoptotic figures in tumor cells in lymph vessels and greater than four mitotic figures in tumor cells in lymph vessels significantly increased the HR of tumor recurrence and the HR of death, respectively (P<0.05). Among IDC patients with nodal metastases whose tumors were negative for ERs and PRs, multivariate analyses showed that greater than two apoptotic figures in the blood vessel tumor emboli significantly increased the HRs of tumor recurrence and death (P<0.005). Authors conclude that apoptotic figures and mitotic figures in tumor cells in vessels are very important prognostic indicators for patients with IDC of the breast

Virchows Arch. 18 Nov. 2003

 

Bone marrow core biopsy specimens in AL (primary) amyloidosis.

A morphologic and immunohistochemical study of 100 cases.

Swan N., Skinner M. and O'Hara C. J.

AL (primary) amyloidosis is the common form of systemic amyloidosis. and is due to an underlying plasma cell dyscrasia that produces an amyloidogenic light chain, which deposits as amyloid fibrils within tissues. The prognosis of AL amyloidosis is poor, with a median survival of 1 to 2 years but, recently, improved survival has been seen with more aggressive therapy using high-dose melphalan and autologous stem cell transplantation. Once the initial histologic diagnosis of amyloid deposition is made, subsequent typing for AL amyloidosis is dependent on the identification of monoclonal light chains by serum and/or urine immunofixation electrophoresis (IFE). Bone marrow core biopsy is performed to identify the underlying plasma cell dyscrasia present and to exclude plasma cell myeloma. Morphologic features of the bone marrow core biopsy specimen in patients with AL amyloidosis are subtle, and often the diagnosis may be missed when examining routine histochemical stains. The identification of a monoclonal population of plasma cells by using immunohistochemical techniques on bone marrow core biopsy specimens sometimes is difficult because of the low number of plasma cells present. The aim of this study was to assess the morphologic and immunohistochemical bone marrow features in a large group of cases of AL amyloidosis. In addition, authors describe how bone marrow core biopsy supplements other diagnostic tests that are used in the initial evaluation of patients for AL amyloidosis.

Swan, Skinner and OHara retrospectively reviewed 100 bone marrow core biopsy specimens from patients with AL (primary) amyloidosis. The morphologic and immunohistochemical features were assessed by standard histochemical stains (H&E, periodic acid-Schiff, Congo red) and immunohistochemical stains for light chain immunoglobulins. Bone marrow core biopsy revealed a plasma cell dyscrasia in 83% (lambda, 65; kappa, 18) of cases. Amyloid deposits were observed in 60% of the bone marrow core biopsy specimens and, when present, were detected most often in blood vessel walls only (39/60). However, if present, interstitial amyloid deposition was significantly more associated with patients with a monoclonal kappa light chain gammopathy (P = .04). Through the careful analysis of standard histochemical and immunohistochemical stains, bone marrow core biopsy provides essential diagnostic information in cases of AL amyloidosis.

Am J Clin Pathol. 120(4): 610-6, 2003.

 

 

Serous effusions: diagnosis of malignancy beyond cytomorphology.

An analytic review.

Mohanty, S. K. and Dey, P.

Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

In this brief review, the role of various ancillary techniques to detect malignancy in effusion fluid are evaluated and discussed. The data were collected from a large number of research articles published in various medical journals. The role of these techniques to increase the diagnostic accuracy in serous effusions is emphasised. The cytological diagnoses of serous effusions are usually made by routine cytomorphology with certainty, allowing treatment decisions. Various studies have shown a sensitivity of 57.3% and specificity of 89% by conventional cytology for the detection of malignant cells in effusion samples. Studies have shown that positive and negative predictive values for detection of malignancy by cytomorphology are 89.3% and 69.4% respectively. However, a grey zone always exists, where the cytopathologist encounters problems in determining the nature of the cells whether reactive, atypical, or beyond doubt malignant. Therefore various ancillary techniques should be used to increase the diagnostic accuracy of malignancy in serous effusions. The various ancillary techniques and markers are:

• Immunocytochemistry.
• Electron microscopy.
• Argyrophilic nucleolar organiser region.
• Flow cytometry.
• Image morphometry.
• Cell proliferation indices.
• Tumour markers.
• Marker of metastasis.
• Immunofluorescence.
• Telomerase activity.
• Polymerase chain reaction.
• Fluorescent in situ hybridisation.
• Growth factors.
• Blood group antigens.
• HLA antigens.
• p53 oncogene product.

Postgrad Med J 2003; 79:569574

 

Cholera biofilm dynamics:

The O139 O-antigen and Ca²⁺ are essential for Vibrio cholerae biofilm development

Kierek, Katharine and Watnick, Paula

Bacterial biofilm is a structured community of bacterial cells enclosed in a self-produced polymeric matrix and adherent to an inert or living surface, which constitutes a protected mode of growth that allows survival in hostile environment. The biofilm-forming microorganisms have been shown to elicit specific mechanisms for initial attachment to a surface, formation of microcolony leading to development of three-dimensional structure of mature biofilm. They differ from their free-living counterparts in their growth rate, composition and increased resistance to biocides, antibiotics and antibodies by virtue of up regulation and/or down regulation of approximately 40 per cent of their genes. This makes them highly difficult to eradicate with therapeutic doses of antimicrobial agents. A greater understanding of mechanism of their formation and survival under sessile environments may help in devising control strategies.

V. cholerae has the ability to form biofilms on biotic and abiotic surfaces, a property relevant to environmental survival, but the molecular mechanisms that control the biofilm formation are not known. Katharine Kierek and Paula Watnick show that the V. cholerae O139 O-antigen polysaccharide is essential for Ca²⁺-dependent biofilm development in seawater.

Kierek and Watnick examined different biofilm-altered V. cholerae mutants cultured in model and true seawater. They observed that the ΔwbfF mutant displayed increased surface adhesion, indicating that the V. cholerae O139 capsule antigen was involved in biofilm formation. In addition, the authors observed that V. cholerae biofilms exhibiting O-antigen polysaccharide dependence disintegrated when Ca2⁺ was removed from the mediumsuggesting Ca2⁺ interacts directly with the O-antigen polysaccharide.

The laboratory-based experiments described here suggest readily testable hypotheses regarding the impact of estuarine ion flux on the microbial ecology of the estuary. Environmental studies to evaluate these hypotheses are necessary, conclude the authors.

Proceedings of National Academy of Sciences 100:14357-14362, 2003.

 

 

Confirmation of Escherichia coli and its distinction from Klebsiella species by gas and indole formation at 44 and 44.5C

Maarit Niemi, R., Mentu J., Siitonen, A. and Niemel, S.I.

Aims: In the enumeration of coliform bacteria, confirmation of Escherichia coli has been based upon gas and indole production at the elevated incubation temperature. The test for gas production has recently been questioned. The aim of this study was to investigate the impact of gas production test on the reliability of confirmation of E. coli.

Methods and Results: The impact of several media on growth, gas and/ indole formation was tested at 44 and445C using 547 environmental isolates. These were mainly E. coli, Klebsiella pneumoniae, K. oxytoca and Enterobacter cloacae strains. Another set of 250 faecal and environmental klebsiellae were tested for their maximum temperature for growth (Tmax) and for gas formation. Escherichia coli and even K. pneumoniae grew well in all the media, but gas production was more dependent on the medium used. Growth of the mainly gas negative Ent. cloacae and K. oxytoca strains was still more sensitive to the medium and incubation conditions.

Tryptophan salt broth was the most productive medium for the indole test, followed by lauryl tryptose mannitole and tryptone mannitol ricinoleate broth (TRM). Tmax of K. oxytoca was clearly lower than Tmax of K. pneumoniae but a rather high fraction of its isolates produced indole at 445C.

Conclusions: False-positive E. coli confirmation is possible if gas production is not tested for and the confirmation is based on indole test only.

Significance and Impact of the Study: Erroneous positive results on routine analysis for E. coli can occur

Journal of Applied Microbiology 95: 1242 December 2003