To identify the minimum time necessary for consistent immunohistochemical estrogen receptor (ER) results in our laboratory, we evaluated results in timed fixation blocks and cases with disparate and similar needle core biopsy and partial mastectomy specimens. Tissue sections of 24 ER-positive, invasive breast carcinomas were fixed for 3, 6, 8, and 12 hours and 1, 2, and 7 days. ER values were quantified using the Q score (0-7). In timed fixation blocks, the mean Q score per block was 2.46 for blocks fixed for 3 hours, 5.75 for blocks fixed for 6 hours, and 6.70 for blocks fixed for 8 hours (P < .001). The difference between the case maximum and mean block Q scores was a plateau of almost 0 at 6 to 8 hours of formalin fixation. For needle core biopsy specimen fixation times, the means for specimens with ER-disparate and ER-similar results were 1.2 and 6.3 hours, respectively (P = .01). The minimum formalin fixation time for reliable immunohistochemical ER results is 6 to 8 hours in our laboratory, regardless of the type or size of specimen.

The clinical outcome and optimum classification of patients who have sigmoid resection specimens that show the histologic features of Crohn's disease (CD) and diverticulitis is not well defined. Historically, these patients were considered to have coexistent diseases, but recent studies have suggested that the CD-like changes are part of the inflammatory reaction of the diverticulitis. Sorting out these issues has been complicated by the lack of distinction between patients with and without CD in other regions of the bowel, short clinical follow-up periods, and small numbers of patients. We report on the clinical outcome and histology of 29 patients who had sigmoid resection specimens with diverticulitis and CD-like changes. Of the 25 patients who had no prior or concurrent CD at the time of surgery, 23 remained free of CD during the follow-up period (median, 6.0 yrs) and two developed CD in other regions of the bowel. All four patients with CD prior to their sigmoid resection continued to have active CD postoperatively. There were no histologic features of the sigmoid resection specimens that could be associated with the outcome of the patient. These results suggest that CD-like changes within the sigmoid resection specimen are an idiosyncratic inflammatory response to the diverticulosis rather than coexistent CD in the overwhelming majority of patients who do not have prior or concurrent CD at the time of sigmoid resection. Pathologists should be wary about making the diagnosis of sigmoid CD in the context of diverticulitis unless there is CD in other parts of the bowel.

To identify the minimum time necessary for consistent immunohistochemical estrogen receptor (ER) results in our laboratory, we evaluated results in timed fixation blocks and cases with disparate and similar needle core biopsy and partial mastectomy specimens. Tissue sections of 24 ER-positive, invasive breast carcinomas were fixed for 3, 6, 8, and 12 hours and 1, 2, and 7 days. ER values were quantified using the Q score (0-7). In timed fixation blocks, the mean Q score per block was 2.46 for blocks fixed for 3 hours, 5.75 for blocks fixed for 6 hours, and 6.70 for blocks fixed for 8 hours (P < .001). The difference between the case maximum and mean block Q scores was a plateau of almost 0 at 6 to 8 hours of formalin fixation. For needle core biopsy specimen fixation times, the means for specimens with ER-disparate and ER-similar results were 1.2 and 6.3 hours, respectively (P = .01). The minimum formalin fixation time for reliable immunohistochemical ER results is 6 to 8 hours in our laboratory, regardless of the type or size of specimen.

A b s t r a c tAdenocarcinoma of the lung constituted 9% of all lung carcinomas in men 30 years ago.1 During the last several decades, its incidence has been increasing. [2][3][4][5][6][7][8] It is the most common cell type in females and in nonsmoking patients, and it is the most common tumor subtype in some regions of the world. 9-14 The incidence of bronchioloalveolar carcinoma (BAC) is also increasing. 15-17Many studies have evaluated pathologic prognostic features of adenocarcinomas, including cell types, architectural patterns, and stage. The majority these studies have not specifically examined Tl NO MO adenocarcinomas. Some studies used the previous definition of a stage I carcinoma and included patients with Nl metastases, other studies grouped adenocarcinomas with non-small cell carcinomas, and many have grouped Tl with T2 carcinomas.18~38 This has left a dearth of attention directed toward identifying prognostic factors for patients with Tl NO MO adenocarcinomas and BACs that undergo curative surgical excision. Prognostic features for this group of patients are important because the 5-year disease-free survival of patients with Tl NO MO adenocarcinoma is 66% to 85%. 39^6 Separation of adenocarcinomas from other pulmonary carcinomas and examining the subset of patients with Tl disease is essential to understand the metastatic potential and prognostic strength of pathologic factors of the different tumors included under the rubric of stage I adenocarcinoma and BAC. 43 In addition, the prognostic significance of distinguishing between BAC and conventional adenocarcinoma and the threshold for amount of central fibrosis allowable within the BAC category for prognostication has not been defined fully. Finally, the identification of prognostic variables within this group of patients is important for future adjuvant therapy studies to identify the subset of patients that are at higher risk of having an adverse carcinoma-related outcome.We retrospectively studied 218 cases of completely resected, surgically staged, Tl NO adenocarcinomas and

Cervical cone biopsy has become an important surgical procedure for endocervical adenocarcinoma in situ (AIS), especially for patients who desire to retain their fertility. Establishing the usefulness of the endocervical margin status in cone biopsy specimens as a predictor of residual AIS is paramount. We examined the status of the endocervical margin in the cone biopsy specimen, the distance between the most proximal AIS and the endocervical margin in the cone biopsy specimen, and the endocervical curettage (ECC) specimen performed at the time of cone biopsy and residual AIS in the hysterectomy specimens of 61 patients with specimens accessioned from 1968 through 1997; 43 (30%) of patients with a negative endocervical margin had residual AIS in the hysterectomy specimen. Conversely, 10 of 18 (56%) patients with a positive endocervical margin in the cone biopsy Endocervical adenocarcinoma in situ (AIS) is an acknowledged precursor lesion of invasive endocervical adenocarcinoma.1-3 Hysterectomy has been the traditional surgical procedure for AIS. However, its routine use has been questioned because m a n y patients with AIS are in their childbearing years and desire to retain their fertility. [4][5][6][7][8] In this context, the cervical cone biopsy has become an important surgical procedure for AIS. The major concern of using the cone biopsy as a definitive surgical procedure is its ability to completely excise the AIS, because any AIS that is left in the uterus has the potential to progress to invasive a d e n o c a r c i n o m a . Predicting w h i c h patients have a high likelihood of having residual AIS in the uterus after cone biopsy is paramount. The specimen had no AIS in the hysterectomy specimen. All 6 patients with AIS in the ECC specimen had residual AIS. No patient with an endocervical margin in the cone biopsy specimen greater than 10 mm had residual AIS. Patients with distances less than 10 mm had equal percentages of residual AIS. In general, more patients with a negative endocervical margin in the cone biopsy specimen had no residual AIS in the hysterectomy specimen than those with a positive endocervical margin in the cone biopsy specimen. However, the status of this margin is not useful for p r e d i c t i n g the p r e s e n c e of r e s i d u a l AIS. Pathologists should report the distance between the endocervical cone biopsy margin and the closest AIS. (Key words: Cervix; Endocervix; Adenocarcinoma in situ; Cone biopsy; Margins) Am J Clin Pathol 1998,109:727-732. status of the margins in the cone biopsy specimen is a histologic feature that would seem to be predictive of residual AIS in the uterus, but some studies have suggested that this may not be the case. Furthermore, the optimum minimal distance between the endocervical margin in a cone biopsy specimen and AIS that would markedly reduce the likelihood of residual AIS has yet to be established. We retrospectively studied the specimens of patients with AIS who had undergone a cervical cone biopsy followed by hysterectomy to determin...