Calcifying aponeurotic fibroma features seen on fine-needle aspiration biopsy: case report and brief review of the literature.

Calcifying aponeurotic fibroma is a rare benign soft tissue proliferation, which occurs in the distal extremities in children. We describe a case of calcifying aponeurotic fibroma of the hand in a 9 year-old male diagnosed by FNA. Clinically and radiographically this mass was felt to be suspicious for sarcoma, likely alveolar rhabdomyosarcoma. Cytologic examination revealed benign appearing spindled cells, chondroid cells, multinucleated giant cells and calcific debris. These features recapitulate the classic histologic features of calcifying aponeurotic fibroma. Conservative excision was performed and histologic exam confirmed the diagnosis. To the authors' knowledge, this is the first description of the cytologic features of this entity.

Isolated intra-abdominal esophageal cyst. Case report and review of the literature.

We describe the first case of an isolated intra-abdominal esophageal cyst. The cyst was unilocular, smooth-surfaced, and attached to the superior border of the pancreas, and it contained clear mucoid material. The gross and in situ features most closely resemble four previously reported cases of isolated intra-abdominal bronchogenic cyst. Histologically, the cyst contained a simple and pseudostratified, ciliated, mucus-secreting, columnar epithelium and a wall composed of two distinct layers of smooth muscle. Both bronchogenic cysts and esophageal cysts may have ciliated epithelium; however, the presence of two smooth-muscle layers, along with the absence of cartilage or respiratory glands, allows for a definitive diagnosis of esophageal cyst.

Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection.

BACKGROUND: Peliosis hepatis is characterized by cystic, blood-filled spaces in the liver and is seen in patients with chronic infections or advanced cancer and as a consequence of therapy with anabolic steroids. Cutaneous bacillary angiomatosis is a bacterial infection that occurs in patients with human immunodeficiency virus (HIV) infection; its histologic appearance is that of a pseudoneoplastic vascular proliferation. METHODS: We studied liver tissue from eight HIV-infected patients with peliosis hepatis, two of whom also had cutaneous bacillary angiomatosis. For comparison we examined tissue from four patients who had peliosis hepatis without HIV infection. Tissues were examined histologically on routine sections and with special stains and electron microscopy. RESULTS: The histologic features seen in peliosis hepatis associated with HIV infection, but not in the four cases unrelated to HIV infection, were myxoid stroma and clumps of a granular purple material that on Warthin-Starry staining and electron microscopy proved to be bacilli. The bacilli, which could not be cultured, were morphologically identical to those found in the skin lesions of cutaneous bacillary angiomatosis. The clinical courses of two of the patients with this "bacillary peliosis hepatis" indicate that it responds to antibiotic treatment. CONCLUSIONS: HIV-associated bacillary peliosis hepatis is an unusual, treatable opportunistic infection, probably caused by the same organism that causes cutaneous bacillary angiomatosis. Our failure to find bacilli in non-HIV-associated cases implies that other pathogenetic mechanisms may also be responsible for peliosis hepatis.

Proliferative sialometaplasia arising in an intraparotid lymph node.

A case of florid proliferative sialometaplasia arising in salivary ductal inclusions in an intraparotid lymph node is described. This lesion probably represents an exuberant response to sialadenitis. Other entities that enter into its differential diagnosis in this particular location are discussed. Except for Warthin tumors, lesions of clinical import originating from such inclusions are rare.

Kikuchi's necrotizing lymphadenitis.

Kikuchi's necrotizing lymphadenitis has recently been reported in the United States where it has not previously been recognized. In the past year three cases were seen in a community hospital in San Francisco. The histologic appearance and clinical features were felt to be sufficiently characteristic to be diagnostic.

Two-stage argon laser trabeculoplasty in open-angle glaucoma.

Forty-five adults with primary open-angle glaucoma received argon laser trabeculoplasty in two stages (180 degrees in each session) separated by one month. The indication for argon laser trabeculoplasty in each case was uncontrolled glaucoma consisting of progressive optic disk cupping and visual field loss despite maximally tolerable medication. A P value of .01 by Student's two-tailed paired t-test was used for statistical significance in the analysis of the intraocular pressure data. In most cases, the greatest reduction in intraocular pressure followed stage 1. Some patients received no additional benefit from stage 2; in other cases, the second stage was not only beneficial but provided most of the reduction in pressure. The pretreatment intraocular pressure level influenced the response to laser therapy. Patients with the highest pretreatment intraocular pressures received the most benefit. Both stages were complicated by a transient postoperative increase of 5 mm Hg or more in 12 patients (approximately 19%).

A dose-response study of piloplex for duration of action.

The duration of reduction in intraocular pressure after single-dose administration of three concentrations of piloplex and the vehicle of the drug was evaluated in 12 patients with open-angle glaucoma in a randomized, double-masked, crossover study. Piloplex lowered intraocular pressure in a dose-related fashion, with a duration of action of at least 14 hours.

Necrobiotic granulomas of the uterine cervix. A probable postoperative reaction.

Three cases of necrobiotic granulomas of the uterine cervix occurring in patients with a history of previous cervical surgery are described. This distinctive lesion histologically resembles a rheumatoid nodule but is not associated with infection or connective tissue disease. The clinicopathologic features of these cases are virtually identical to analogous postoperative lesions that have been described in the prostate. Such necrobiotic granulomas seem to be a result of prior surgery and should not be confused with other more portentous granulomatous diseases.

Ectopic prostatic tissue in bladder trigone. Distinctive cause of hematuria.

A rare instance of ectopic prostatic tissue involving the bladder trigone is documented. This distinctive lesion probably arises from a vestigial prostatic remnant and may cause hematuria in the post-pubertal male.

Mucinous transformation of synovium.

A unique case of mucinous transformation of knee joint synovium associated with recurrent mucinous joint effusions and severe osteoarthritis is presented. The lesion probably represented an extreme pathologic expression of physiologic synoviocytic synthesis of hyaluronic acid. It did not appear to be related to other myxoid lesions that may occur in this area.

Herpes simplex type 1 retinitis in an adult with systemic herpes zoster.

A 72-year-old man developed bullous skin lesions two months before he was discovered to have malignant lymphoma. Herpes zoster virus grew from the skin bullae. He developed encephalitis, keratitis in the left eye, and bilateral retinitis 18 months later. Herpes simplex virus type 1 grew from cultures of the eyelid vesicles and corneal scrapings from the left eye. The patient died two years after the diagnosis of malignant lymphoma. Virus particles believed to be herpes simplex virus were demonstrated on electron microscopy in the necrotic retinal cells.

Pulmonary hyalinizing granulomas in a patient with malignant lymphoma, with development nine years later of multiple myeloma and systemic amyloidosis.

In our patient, multiple bilateral nodular pulmonary densities appeared on a chest x-ray at the time of diagnosis of stage IV diffuse lymphocytic lymphoma. After localized radiation therapy, the patient received no further systemic therapy. The pulmonary nodules slowly became larger and more numerous. Nine years later the patient developed proven multiple myeloma. Pulmonary hyalinizing granulomas have not heretofore been associated with proven lymphoreticular neoplasia, although this has long been suspected. The occurrence of two B-cell tumors at different points in time associated with systemic amyloidosis is an extremely rare event. The authors discuss the possibility that these conditions represent an abnormality in a common cell of origin with differing expression over time. Coincidence, however, remains a likely explanation for the different immunopathies that occurred in our patient.

Adenoid squamous cell carcinoma of the oral cavity: report of the first case arising in the tongue.

A case of adenoid squamous cell carcinoma arising in the tongue is presented. This histologic variety of squamous cell carcinoma originates almost exclusively in the skin, and the few examples of oral mucosal lesions have heretofore been restricted to the lip. In the oral mucosa, the neoplasm should be differentiated from several types of adenocarcinoma of salivary origin. Surgical excision in our case was followed by rapid local recurrence and death. This behavior is in contrast to the generally favorable prognosis of analogous cutaneous and lip neoplasms, and may indicate a more aggressive course in lesions of lingual origin.

Occult pulmonary haemorrhage in leukaemia.

Through gleeding into the lung parenchyma is responsible for morbidity and mortality in patients with leukaemia pulmonary haemorrhage is seldom diagnosed during life. We diagnosed occult pulmonary haemorrhage in five leukaemic patients with unexplained infiltrates on chest roetgenograms by examining alveolar macrophages retrieved by bronchopulmonary lavage. Macrophage haemosiderin content was greatly increased in the patients with pulmonary haemorrhage as compared to normal and thrombocytopenic control subjects. Haemoglobin and intact erythrocytes in alveolar macrophages were taken as evidence of recent haemorrhage. Intrapulmonary bleeding may occur often in patients with leukaemia, and bronchopulmonary lavage offers a safe approach to diagnosis and allows for concomitant identification of pulmonary infection.