bromochloroacetic-acid and Pulmonary-Embolism

Topics: Biopsy; Carcinoma, Signet Ring Cell; Cicatrix; Fatal Outcome; Humans; Keratins; Linitis Plastica; Male; Middle Aged; Pulmonary Embolism; Skin Neoplasms; Stomach Neoplasms

Although pulmonary trophoblastic embolism is now considered a physiologic phenomenon of normal pregnancy, this phenomenon has not been demonstrated in a living asymptomatic patient. Recently we encountered a 26-year-old woman suspected of pulmonary embolism of villotrophoblastic tissues after therapeutic abortion. Although her serum beta-hCG was low, a computed tomography scan showed multiple nodules in both lungs. Histological examination of a nodule in a lung-biopsy specimen showed granulation tissue surrounding a hemorrhagic mass within which were structures resembling degenerating chorionic villi. Immunohistochemical study on the patient's lung nodule, and a second endometrial-curettage specimen, six control endometrial and tubal specimens containing degenerating chorionic villi, and four endometrial specimens containing viable chorionic villi were performed. The patterns of immunostaining for cytokeratin, human chorionic gonadotropin, human placental lactogen, placental alkaline phosphatase, and inhibin-alpha of the chorionic villus-like structures in the lung nodule were almost identical to those in the degenerating chorionic villi, but different from those of viable villi. This is a unique case of embolism of chorionic villi and trophoblast to the lung in a living patient after therapeutic abortion.

Topics: Abortion, Induced; Adult; Alkaline Phosphatase; Chorionic Gonadotropin, beta Subunit, Human; Chorionic Villi; Curettage; Endometrium; Female; Humans; Immunohistochemistry; Inhibins; Keratins; Placental Lactogen; Pregnancy; Pulmonary Embolism; Tomography, X-Ray Computed; Trophoblasts; Ultrasonography

Pulmonary microvascular tumor embolization is a recognized cause of respiratory distress in cancer patients that is rarely diagnosed antemortem. Previous studies with relatively few patients have reported high diagnostic yield using wedged pulmonary artery catheter-derived blood samples to evaluate dyspneic cancer patients for possible microembolization. From 1991 to 1993, 21 cancer patients with respiratory distress of relatively acute onset and varying severity who required pulmonary artery catheterization for hemodynamic monitoring were evaluated using this technique. Pulmonary microvascular cytology (PMC) was interpreted as positive for malignant cells in nine of 21 patients presenting with a range of tumor types, including carcinomas of the breast, colon, and pancreas as well as non-Hodgkin's lymphoma. In 11 patients the PMC was interpreted as negative. One case was considered nondiagnostic. Megakaryocytes, noted in most PMC specimens as well as in several samples of simultaneously drawn peripheral blood, may mimic epithelial tumor cells. Immunocytochemical stains for factor VIII and cytokeratins were used to resolve occasional diagnostic dilemmas. Clinical and/or pathologic follow-up information was available for all patients. Diagnostic accuracy was highest for epithelial malignancies. Two false-negative results occurred in patients with metastatic choriocarcinoma and breast carcinoma. Circulating malignant cells in the peripheral blood of a patient with non-Hodgkin's lymphoma led to one false-positive diagnosis. Benign lymphoid elements in PMC generally have a reactive and variable appearance that should not be misinterpreted as lymphoma. We conclude that PMC is a useful tool in the evaluation of dyspneic cancer patients requiring pulmonary artery catheterization for hemodynamic monitoring and its use potentially avoids additional diagnostic procedures.

Topics: Catheterization, Peripheral; Factor VIII; False Negative Reactions; Hemodynamics; Humans; Immunohistochemistry; Keratins; Lung; Lung Neoplasms; Megakaryocytes; Microcirculation; Pulmonary Artery; Pulmonary Embolism

Sections of lung from four maternal deaths have been stained with an antibody raised to human keratin. This method has been found to be a more sensitive technique for determining amniotic fluid emboli than other special stains and has shown a higher incidence than expected.

Topics: Adult; Embolism, Amniotic Fluid; Female; Humans; Immune Sera; Immunoenzyme Techniques; Keratins; Pregnancy; Pulmonary Embolism

Topics: Humans; Keratins; Male; Middle Aged; Phagocytosis; Pulmonary Embolism; Punctures; Skin; Veins