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Surgical pathology of lung neoplasms
HUMAN PATHOLOGY
Volume 22, No. 10 (October
specific than RNA probes prepared from large segments of the HPV genome (including homologous late regions). Therefore, the possibility that the RNA probes used by Brandwein et al cross-react with an unidentified HPV type cannot be excluded. However, we recently re-examined our case material using generic PCR primers and probes, and detected no additional positive cases, confirming our earlier results (unpublished data). 3. Although the location of a sinonasal papilloma certainly could influence its growth pattern, it is interesting to note that we identified HPV 11 in all three of the fungiform/exophytic lesions, while all nine of the inverted papillomas in our series were negative for HPV. It is hazardous to draw conclusions from such a small number of cases, but our results suggest a closer correlation between HPV infection and growth pattern than between location of the lesion and growth pattern. It also seems very unlikely that HPV 11 would selectively infect only the nasal septal mucosa and spare the lateral nasal wall. What is clearly needed at this point is a careful study of a large series of cases, ideally including fungiform and inverted lesions of both the nasal septum and lateral nasal wall, and using a well-controlled, sensitive, and specific technique. Only then can we hope to sort out the relative importance of HPV infection and location in determining the growth pattern of sinonasal papillomas. SHERIF R. ZAI(I, MD, PHD
RANDYJUDD, MD LISA M. COFFIELD, BS BRUCE L. EVATT, MD Centers for Disease Control Atlanta, GA
1. Brandwein M, Steinberg B, Thung S. et al: Human papillomavirus 6/ II and 16/18 in Schneiderian inverted papillomas. In-situ hybridization with HIV RN.4 probes. Cancer 63:1708-1713, 1989 2 Judd R, Zaki SR. Coffield LM, et al: Sinonasal papillomas and human papillomavirus: Human papillomavirus I 1 detected in fungiform Schneiderian papillomas by in situ hybridiration and the polymerasc chain reaction. Htw PATHOI.22:550-556, 199 1 3. Sarkar FH. Zarbo RJ, Crissmarl JD: Smonasal itwerted papillomas: Humall papillomavirus ryping by polymerase chain rextion. Mod Pathol 3:89A. 1990 4 Ting Y, Mannos MM: Detection and typing of genital human papillomaviwses, in Irmis MA, Gelfard DH, Suinsky,jJ. et al (eds): PCR Protocols, A Guide to Methods and Application. San Diego. CA. Academic, 1990. pp 356. 367 Stryker Spinal Column Blade 159.5 mm Cut Edge, Product #I 105 To the Editor:-Recently. one of our experienced autopsy dieners used a new spinal column saw blade which, immediately on initial use. came off its fitting and flew across the room, fortunately not hitting anyone. This blade, supplied by Stryker Surgical, is designated Spinal Column Blade 159.5 mm Cut
1991)
Edge, Product #1105, Lot #90090491. Inspection of this blade showed it to be apparently pressed onto a narrow rim on the shaft and without any other retaining device. This failure was related to Stryker Surgical and the blade returned for their inspection. I consider this blade a potential hazard for its users, although Stryker apparently does not. I suggest that pathologists check their equipment for this blade and decide for themselves if this appears to be a safe design. A copy of this letter has been sent to other major pathology journals. BERNARD J. PANNER, MD
University of Rochester Medical Center Rochester, NY
The above letter was referred to the company in question, which offers the following reply: To the Editor:-Stryker takes complaints by its customers
very seriously. On initial written contact with Stryker by Dr Panner, our Quality Assurance Manager spoke to him and relayed essentially the same information as contained herein. This same information was confirmed in writing to Dr Panner the following day. Additionally, our manager offered to make a personal visit to him at the University of Rochester Medical Center, which he declined. All appropriate and responsible measures were taken by our Quality Assurance and Product Engineering functions as soon we were made aware of Dr Panner’s concern. These include 1. The product was placed on immediate internal shipping hold, with no further shipments of that design distributed by Stryker. Product engineering testing was performed, without a duplication of the failure mode reported by Dr Panner. Records were checked to determine whether other incidents of this nature had ever been reported by other users of the several hundred blades of this type sold. None were found. Design alternatives were pursued and tested. After nearly 6 months of preparation, the revised design is now being distributed. It has been Stryker’s experience that, based on similar blade designs, a prying technique applied by users can cause blades to fatigue and break. Our product inserts and labels clearly caution against this. Stryker is proactive in anticipating our customer requirements and responding positively to customer needs. We have demonstrated that commitment in this matter and hope your readers will recognize our efforts. HARMON H. WOC)DUVRTH, Director Corporate Regulatory Affairs Stryker Corporation Kalamazoo, MI
BOOK REVIEWS Surgical Pathology of Lung Neoplasms. Albert0 M. Marchevsky (ed). Lung Biology in Health and Disease, ~0144. New York, NY, Marcel Dekker, 1990, 704 pages, 403 illustrations. As stated in the preface, this text provides a current, concise, and well-illustrated review of the surgical pathology of
1060
pulmonary neoplasms. The editor, who has contributed a number of the chapters. has fulfilled this purpose. This work covers all the current information on lung tumors, and includes short chapters on epidemiology of lung cancer, experimental models of lung cancer, and ultrastructural, immunohistochemical, and new techniques for studying and classifying lung neoplasms. The chapters are well referenced.
Volume 22, No. 10 (October
specific than RNA probes prepared from large segments of the HPV genome (including homologous late regions). Therefore, the possibility that the RNA probes used by Brandwein et al cross-react with an unidentified HPV type cannot be excluded. However, we recently re-examined our case material using generic PCR primers and probes, and detected no additional positive cases, confirming our earlier results (unpublished data). 3. Although the location of a sinonasal papilloma certainly could influence its growth pattern, it is interesting to note that we identified HPV 11 in all three of the fungiform/exophytic lesions, while all nine of the inverted papillomas in our series were negative for HPV. It is hazardous to draw conclusions from such a small number of cases, but our results suggest a closer correlation between HPV infection and growth pattern than between location of the lesion and growth pattern. It also seems very unlikely that HPV 11 would selectively infect only the nasal septal mucosa and spare the lateral nasal wall. What is clearly needed at this point is a careful study of a large series of cases, ideally including fungiform and inverted lesions of both the nasal septum and lateral nasal wall, and using a well-controlled, sensitive, and specific technique. Only then can we hope to sort out the relative importance of HPV infection and location in determining the growth pattern of sinonasal papillomas. SHERIF R. ZAI(I, MD, PHD
RANDYJUDD, MD LISA M. COFFIELD, BS BRUCE L. EVATT, MD Centers for Disease Control Atlanta, GA
1. Brandwein M, Steinberg B, Thung S. et al: Human papillomavirus 6/ II and 16/18 in Schneiderian inverted papillomas. In-situ hybridization with HIV RN.4 probes. Cancer 63:1708-1713, 1989 2 Judd R, Zaki SR. Coffield LM, et al: Sinonasal papillomas and human papillomavirus: Human papillomavirus I 1 detected in fungiform Schneiderian papillomas by in situ hybridiration and the polymerasc chain reaction. Htw PATHOI.22:550-556, 199 1 3. Sarkar FH. Zarbo RJ, Crissmarl JD: Smonasal itwerted papillomas: Humall papillomavirus ryping by polymerase chain rextion. Mod Pathol 3:89A. 1990 4 Ting Y, Mannos MM: Detection and typing of genital human papillomaviwses, in Irmis MA, Gelfard DH, Suinsky,jJ. et al (eds): PCR Protocols, A Guide to Methods and Application. San Diego. CA. Academic, 1990. pp 356. 367 Stryker Spinal Column Blade 159.5 mm Cut Edge, Product #I 105 To the Editor:-Recently. one of our experienced autopsy dieners used a new spinal column saw blade which, immediately on initial use. came off its fitting and flew across the room, fortunately not hitting anyone. This blade, supplied by Stryker Surgical, is designated Spinal Column Blade 159.5 mm Cut
1991)
Edge, Product #1105, Lot #90090491. Inspection of this blade showed it to be apparently pressed onto a narrow rim on the shaft and without any other retaining device. This failure was related to Stryker Surgical and the blade returned for their inspection. I consider this blade a potential hazard for its users, although Stryker apparently does not. I suggest that pathologists check their equipment for this blade and decide for themselves if this appears to be a safe design. A copy of this letter has been sent to other major pathology journals. BERNARD J. PANNER, MD
University of Rochester Medical Center Rochester, NY
The above letter was referred to the company in question, which offers the following reply: To the Editor:-Stryker takes complaints by its customers
very seriously. On initial written contact with Stryker by Dr Panner, our Quality Assurance Manager spoke to him and relayed essentially the same information as contained herein. This same information was confirmed in writing to Dr Panner the following day. Additionally, our manager offered to make a personal visit to him at the University of Rochester Medical Center, which he declined. All appropriate and responsible measures were taken by our Quality Assurance and Product Engineering functions as soon we were made aware of Dr Panner’s concern. These include 1. The product was placed on immediate internal shipping hold, with no further shipments of that design distributed by Stryker. Product engineering testing was performed, without a duplication of the failure mode reported by Dr Panner. Records were checked to determine whether other incidents of this nature had ever been reported by other users of the several hundred blades of this type sold. None were found. Design alternatives were pursued and tested. After nearly 6 months of preparation, the revised design is now being distributed. It has been Stryker’s experience that, based on similar blade designs, a prying technique applied by users can cause blades to fatigue and break. Our product inserts and labels clearly caution against this. Stryker is proactive in anticipating our customer requirements and responding positively to customer needs. We have demonstrated that commitment in this matter and hope your readers will recognize our efforts. HARMON H. WOC)DUVRTH, Director Corporate Regulatory Affairs Stryker Corporation Kalamazoo, MI
BOOK REVIEWS Surgical Pathology of Lung Neoplasms. Albert0 M. Marchevsky (ed). Lung Biology in Health and Disease, ~0144. New York, NY, Marcel Dekker, 1990, 704 pages, 403 illustrations. As stated in the preface, this text provides a current, concise, and well-illustrated review of the surgical pathology of
1060
pulmonary neoplasms. The editor, who has contributed a number of the chapters. has fulfilled this purpose. This work covers all the current information on lung tumors, and includes short chapters on epidemiology of lung cancer, experimental models of lung cancer, and ultrastructural, immunohistochemical, and new techniques for studying and classifying lung neoplasms. The chapters are well referenced.