Search

Small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) may be histologically difficult to differentiate from reactive lymphoid hyperplasia (RLH) in the spleen. Because routine hematoxylin and eosin (HE) staining delineates splenic microanatomy poorly, we have developed a method that simultaneously stains reticulin fibers and B-lymphocytes. B3 or formalin-fixed, paraffin-embedded archival splenic tissue with diagnoses of SLL/CLL (11 cases), RLH (10 cases), and trauma (seven cases) were studied using a novel silver nitrate immunoperoxidase (SNIP) double-staining technique. Gordon and Sweet's reticulin stain was followed by immunoperoxidase staining for B-lineage marker CD20 (Dakopatts, Carpinteria, CA) using the avidin-biotin method. This allowed us to clearly localize B cells to Malpighian bodies, periarteriolar lymphoid sheaths, sinuses, or cords. Features identified by SNIP found only in SLL/CLL, but not in RLH or traumatized spleens, were trabecular infiltration (eight of 11 cases), subendothelial infiltration (seven of 11 cases), and prominent sinus involvement (seven of 11 cases). One or more of these features were seen in 10 of 11 cases of SLL/CLL. Other distinguishing features were the percentage area occupied by B-lymphocytes in each section (SLL/CLL = 74%; RLH = 46%; traumatized spleens = 36%); and mean spleen weight (SLL/CLL = 1,603 g; RLH = 287 g; traumatized spleens = 126 g). We have found the SNIP technique to be superior to traditional HE staining in identifying B cells in the context of splenic microanatomy.

Objective To evaluate for human papillomavirus (HPV) infection in the cervix of fetuses from mothers with documented squamous intraepithelial lesions. Methods Fetal cervical epithelium was obtained from the Human Fetal Tissue Repository as per Institutional Review Board protocol. Fetal cervical epithelium was dissected, fixed in formalin, and embedded in paraffin. Sections were tested by in situ hybridization using a wide-spectrum HPV DNA probe. Cases were specimens from mothers with low- and high-grade squamous intraepithelial lesions, and controls were specimens from women with no documented squamous intraepithelial lesions. Results A total of 14 controls and 10 cases were evaluated for HPV DNA. No reactivity was detected in the controls. Two cases showed focal intracellular reactivity with the HPV DNA probe. Conclusion To our knowledge, this is the first study demonstrate fetal cervical HPV infection due to intrauterine exposure. These findings have important implications in understanding the pathogenesis of cervical neoplasia and its management.

PURPOSE: In some organs (eg, the lung), endocrine tumors are classified on the basis of mitotic rate and necrosis. The purpose of this study was to evaluate prognostic factors in pancreatic endocrine neoplasms recently treated at a single institution. PATIENTS AND METHODS: In 136 patients undergoing surgery from 1979 to 1998, the influence on disease-free survival (DFS) and disease-specific survival (DSS) of tumor size, mitotic rate, vascular invasion, necrosis, metastases, and nuclear grade was determined. Cases were further grouped according to an existing proposed classification system and then regrouped on the basis of mitotic rate (< 2 mitoses per 50 high-power fields v higher) and necrosis (present or absent) into low- and intermediate-grade groups. RESULTS: Correlations with DFS and DSS in univariate analysis included ≤ 2 mitoses per 50 high-power fields (P = .001, P = .002), vascular invasion (P = .02, P = .04), size ≤ 2 cm (P = .01, P = .05), metastases (P = .0002, P = .07), necrosis (P = .002, P = .16), and nuclear grade (P = .04, P = .33), respectively. By multivariate analysis, for DFS, tumor necrosis and presence of metastases retained significance (P = .01, P = .04, respectively). For DSS, only mitotic rate was a prognostic factor (P = .02). Among the 18 macroadenomas, eight borderline tumors, and 48 low-grade carcinomas, there was no significant difference in DSS between any groups (P = .3). However, in evaluating our newly proposed groups, the differences in DFS and DSS between low- and intermediate-grade groups were highly significant (P = .0007, P = .006, respectively). CONCLUSION: Pancreatic endocrine neoplasms exhibit a spectrum of biologic behavior, and the proposed benign (macroadenoma) and borderline groups contain potentially aggressive tumors. An alternative system based on mitotic rate and necrosis correlates strongly with survival without specifically designating any group as benign.

Oral juvenile xanthogranuloma is a rare condition, with only 10 histologically proven cases previously described. A histologically unusual variant is reported here, diagnosis of which was aided by the use of immunohistochemical stains. Previously reported cases are reviewed, and their characteristics are tabulated and discussed.