Vibrio vulnificus is an opportunistic pathogen that contaminates oysters harvested from the Gulf of Mexico. In humans with compromising conditions, especially excess levels of iron in plasma and tissues, consumption of contaminated seafood or exposure of wounds to contaminated water can lead to systemic infection and disfiguring skin infection with extremely high mortality. V. vulnificus-associated diseases are noted for the rapid replication of the bacteria in host tissues, with extensive tissue damage. In this study we examined the virulence attributes of three virulent clinical strains and three attenuated oyster or seawater isolates in mouse models of systemic disease. All six V. vulnificus strains caused identical skin lesions in subcutaneously (s.c.) inoculated iron dextran-treated mice in terms of numbers of recovered CFU and histopathology; however, the inocula required for identical frequency and magnitude of infection were at least 350-fold higher for the environmental strains. At lethal doses, all strains caused s.c. skin lesions with extensive edema, necrosis of proximate host cells, vasodilation, and as many as 10 8 CFU/g, especially in perivascular regions. These data suggest that the differences between these clinical and environmental strains may be related to growth in the host or susceptibility to host defenses. In non-iron dextran-treated mice, strains required 10 5 -fold-higher inocula to cause an identical disease process as with iron dextran treatment. These results demonstrate that s.c. inoculation of iron dextran-treated mice is a useful model for studying systemic disease caused by V. vulnificus.Vibrio vulnificus is a gram-negative, halophilic, marine bacterium that is the most common cause of seafood-related deaths in the United States (17, 18). Infection by V. vulnificus occurs through the consumption of raw oysters or contamination of wounds. Individuals with high levels of circulating iron, for example, people suffering from hemochromatosis or cirrhosis, are at highest risk for developing disease after contact with V. vulnificus (7,9,26,50). V. vulnificus causes a rapid and severe disease process resulting in extensive tissue damage. In fact, death can occur within 24 h after contact with the bacterium. Typically, individuals infected by V. vulnificus exhibit fever, chills, hypotension, and characteristic bullous skin lesions, which are rapidly progressive. The rapid nature of the disease process makes intervention difficult, yielding mortality rates of greater than 50% in septicemic individuals (17). Using pulsed-field gel electrophoresis, more than 100 strains of V. vulnificus have been identified in individual oysters (8). However, not all strains of V. vulnificus have equal ability to cause disease. Single strains of V. vulnificus were recovered from the blood of septicemic individuals who consumed oysters contaminated with numerous strains of V. vulnificus (19).Several putative virulence factors have been proposed for V. vulnificus, including metalloprotease, hemolysin-cytolysin...

BACKGROUND: The importance of interinstitutional consultation (IC) has been documented across a variety of surgical pathology organ systems. However, to the authors' knowledge, few studies exist regarding this practice within cytopathology and specifically within fine‐needle aspiration cytology (FNAC). METHODS: All FNAC cases between September 2002 and January 2007 were reviewed. Original diagnoses and second opinion diagnoses (SODs) were categorized as either no diagnostic disagreement, or minor diagnostic disagreement, or major diagnostic disagreement, and the latter was defined as either a 2‐step deviation on a scale of “unsatisfactory, benign, atypical, suspicious, and malignant” or a change in treatment and/or prognosis. Outcome was determined by a review of the electronic medical record. RESULTS: Among 742 FNAC cases from outside laboratories, there were minor disagreements in 132 cases (17.8%) and major disagreements in 69 cases (9.3%) compared with the SODs from the authors' laboratory. Follow‐up was available for 60 of 69 major discrepancies. The SOD was supported on follow‐up in 65% of major discrepancies, and the initial diagnosis was supported better in 33% of major discrepancies. In 55% of cases in which the original institution diagnosis was supported better, either no case slides were received for examination or the slides contained material that was considered nondiagnostic by the authors. An SOD prompted a change in clinical management in 32 of 742 patients (4.3%). Aspirates that were most prone to change in management or therapy were from the thyroid (13 cases), neck (soft tissue and lymph nodes; 9 cases), salivary gland (2 cases), and liver (2 cases). Of 60 major diagnostic disagreements, board‐certified cytopathologists rendered an SOD in 44 cases, and 75% of the diagnoses were supported better by follow‐up, whereas pathologists who were not board certified in cytopathology had only 38% of SODs supported. CONCLUSIONS: Of 742 FNAC cases, 9.3% had major diagnostic disagreements; and, in 4.3%, patient management and therapy were altered. These results were similar to studies in surgical pathology emphasizing the importance of IC in FNAC. The authors concluded that FNAC IC benefits patient care. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

Although the numbers are small, our findings raise further awareness of the significance between histologic type and grade, and RS in breast cancer. In some special histologic types of breast cancer, particularly those considered to follow either an excellent or poor clinical course by histology alone, it is unclear whether the ODXRS results are as meaningful as in carcinomas of no special type. Further investigation with higher numbers and outcome data is needed.

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