Osteoclast-like giant cells in leiomyomatous tumors of the uterus. A case report and review of the literature.

Osteoclast-like giant cells (OLGC) in leiomyomatous tumors of the uterus are rarely seen, and their significance is unknown. We present a case of a large leiomyomatous tumor in which OLGC were found in only few sections showing leiomyosarcoma whereas the majority of sections revealed a leiomyoma. Though radically operated, the patient died a few months later with recurrent tumor in the pelvis and metastases to the lungs.

[Polyarteritis nodosa diagnosed in acute cholecystectomy]. / Polyarteritis nodosa diagnosticeret ved akut kolecystektomi.

Polyarteritis nodosa (PAN) is a serious systemic vasculitis, which untreated has a five year survival rate of less than 15%. In the present case PAN was diagnosticed in a 72-year old Asian woman by microscopy of a gall bladder in acalculous cholecystitis. We conclude that PAN must be considered in patients with symptoms from several different organs and evidence of vascular involvement can be obtained by histological investigation of material from involved organs or mesenterial angiography.

Evaluation of pneumonia diagnosis in intensive care patients.

The aims of this study were to investigate the frequency of bronchopneumonia diagnosed by histological criteria among autopsied intensive care unit (ICU) patients and to compare these with rates of pneumonia diagnosed by conventional clinical methods. The study material comprised 141 autopsied ICU patients from 7 ICUs in university hospitals in Copenhagen from a 1-y period. A total of 20 lung tissue specimens were sampled from each patient and the histopathological diagnoses were classified as no, mild, moderate or severe bronchopneumonia. Inter-observer variation was calculated using kappa statistics. Demographic data and diagnoses of pneumonia were registered from the patient files. Twenty-six percent of the patients had pneumonia diagnosed whilst in the ICU. Histological evidence of pneumonia, found for every second patient, was regarded as the gold standard. Diagnosis of pneumonia in the ICU had a sensitivity of 29% and if diagnoses of pneumonia during the month before ICU-admission were included, a sensitivity of 60% was found. Specificity for pneumonia diagnosed in the ICU was 77%. The percentage of all ICU-patients with pneumonia was calculated to be between 36% and 56%, depending on the extent of excess mortality attributable to pneumonia. Pulmonary segments with histologically diagnosed pneumonic lesions were distributed diffusely, although the upper segments tended to be affected less. Nearly all patients had other histopathological findings than bronchopneumonia. The reliability coefficient among the 6 pathologists was found to be moderately good (kappa = 0.45).

Observer variation in the assessment of the histopathologic diagnosis of acute appendicitis.

BACKGROUND: The objectives of this study were to determine observer variation in the assessment of the histopathologic diagnosis of acute appendicitis. METHODS: Two consultant pathologists independently evaluated 415 appendectomy specimens (set I). After a consensus conference at which the observers unified the criteria of the diagnosis of acute appendicitis, another 396 appendectomy specimens (set II) were evaluated. To calculate the intra-observer variation, one observer evaluated set II once more. Finally, using the consensus diagnosis as the final diagnosis, the diagnostic accuracy of the surgeon, the primary pathology report, and the two observer evaluations was calculated. RESULTS: In set I no difference was found in the level of agreement on the diagnosis of acute appendicitis versus other diagnoses, and a kappa value of 0.85 was obtained. In set II a kappa value of 0.88 was obtained, which was not significantly different from the kappa value in set I. However, the consensus conference did increase the level of agreement on the diagnosis of acute appendicitis. The intra-observer variation was calculated, and a kappa value of 0.88 was obtained. The cases in which the observers disagreed on a positive diagnosis were cases of mild appendicitis. The question remains how many specimens would have shown these changes if all tissue had been developed for microscopy. The observers' diagnoses were the most reliable, and there was a significant decrease in the diagnostic accuracy compared with both the primary pathology report and the surgeon's opinion, the last one being the least accurate. CONCLUSIONS: These observations stress how important it is for the pathologist to discuss the diagnostic criteria of the diagnosis of acute appendicitis and for the surgeon to go back to the patient's record and look up the histopathologic diagnosis.

The soil fungus Chaetomium in the human paranasal sinuses.

Chaetomium is a soil fungus of which more than 180 species are now known. Most species cause degradation of cellulose-rich substrates, such as components in soil, straw or wood. Growth of Chaetomium globosum is often stimulated in the presence of Aspergillus fumigatus, which excretes such compounds as sugar phosphates and phospho-glyceric acid. A 73-year-old woman, with long-standing pain and secretion from her left maxillary sinus, was admitted to hospital where an infundibulectomy was performed. Histological examination showed necrotic material with hyphae of A. fumigatus and perithecia of Chaetomium sp. The latter fungus is rarely pathogenic to man.

Glassy cell carcinoma of the colon with human chorionic gonadotropin-production. A case report with immunohistochemical and ultrastructural analysis.

An unusual tumor in the descending colon with human chorionic gonadotropin-beta (HCG-beta) production and histological features of a "glassy cell" carcinoma is presented. Glassy cell carcinoma has been described in the uterus and fallopian tubes as well as the cervix, but in these locations the tumor is not HCG-beta producing. Glassy cell carcinomas have been described in some cases as having glandular and squamous differentiation as well as marked cellular pleomorphism. The tumors are generally associated with a poor prognosis.

[Hemodynamic assessment at rest and during dynamic physical exercise in young subjects with and without hypertensive parents]. / Comportamento dei parametri emocardiodinamici a riposo e durante escercizio fisico dinamico in giovani soggetti con e senza familiarità ipertensiva.

The aim of this research was to identify any early cardiovascular changes that may be predictive of future hypertension in young subjects with family history of hypertension. The study was conducted on 25 offspring of hypertensive parents, mean age 17 years (22 with hypertension only in 1 parent and 3 with both hypertensive parents) and 20 offspring of both normotensive parents, matched by age. Subjects were divided into children (7-13 years) and young adults (19 years on). All subjects underwent three office blood pressure measurements with a mercury sphygmomanometer. On the third control, BoMed thoracic electrical bioimpedance at rest and during upright bicycle exercise was performed. Physical characteristics were similar in subjects matched by age in the two groups. Systolic blood pressure was similar in offspring of normotensives and hypertensives, both at rest and during exercise; diastolic blood pressure was greater in offspring of hypertensive parents at rest (73.1 +/- 10.5 vs 63.5 +/- 7.1 mmHg, p < 0.05), during the first minutes of exercise and during the recovery phase (p < 0.05). Moreover, at the third blood pressure measurement at rest, diastolic blood pressure decreased, with respect to the first measurement, only in children and young adult offspring of normotensive parents, while systolic blood pressure decreased in the two groups of child subjects. No differences in heart rate were observed, both at rest and during physical exercise, between offspring of normotensives and hypertensives. Left ventricular end-diastolic volume, stroke volume, ejection fraction, cardiac output and systemic vascular resistance at rest and their response to decubitus changes and exercise were normal and similar in offspring of normotensive and hypertensive parents both in children and young adults. In conclusion, a different behavior of diastolic blood pressure was found in offspring of hypertensive parents compared to that of normotensive parents, both in children and, to a higher degree, in young adults. This may be an expression of early vascular change in subjects with a genetic predisposition to hypertension.

[Focal myositis]. / Myositis focalis.

Focal myositis is a rare benign pseudotumor of skeletal muscle, of unknown cause. Clinically it presents as an enlarging mass within a muscle, usually in en extremity. Biopsy shows characteristic histological changes of inflammation, focal degeneration and regeneration. The natural course of this disorder is spontaneous regression. This report describes the case of a 17-year-old boy with focal myositis of the thigh and a review of the relevant literature.

Stereological estimates of nuclear volume in primary lung cancer.

The aim of this study is to provide unbiased, objective and reproducible morphometric data on primary lung carcinomas by using the stereological principle of estimating volume weighed mean volume of particles of arbitrary shape. The study includes 30 lung specimens; 10 from small cell carcinoma, 10 from squamous cell carcinoma, and 10 from adenocarcinoma. After standard fixation, embedding, sectioning and hematoxylin eosin staining, the mean nuclear volume was estimated using the formula: v upsilon = pi/3 . l0(3), where l0 is the length of the intercept through a test point hitting a nucleus measured in a random direction through the test point. The collection of the data took less than 10 min per specimen. The mean nuclear volume of small cell carcinomas varied from 109 to 238 microns 3 (group mean 152 microns 3), in squamous cell carcinomas from 407 to 826 microns 3, and in adenocarcinomas from 411 to 1046 microns 3 (group mean 736 microns 3). This simple and rapid method seems to provide unbiased, objective and reproducible data useful in the description and separation of primary lung carcinomas.

Synovitis in chronically unstable ankles.

Histopathologic synovial changes were studied prospectively in 69 patients with 75 ankles operated on for radiographically verified chronic lateral instability. The median duration of instability was 2(0.5-20) years. Before the operation, 73 ankles were painful. After a peroneus brevis tenodesis, all but 1 patient felt improved. Twenty-eight of 75 ankles had moderate or extreme degrees of synovitis. The degree of ankle instability did not influence the severity of changes. Factors that influenced the degree of synovitis were duration of instability of more than 4 years, degenerative changes--such as old bony avulsions, chondral fibrillations and clefts--and high activity level of the patient. To improve stability, alleviate pain, and perhaps to prevent the development of arthrosis, we recommend ligamentous repair in painful active patients with long-standing lateral instability of the ankle with degenerative changes in or around the ankle joint.

Characteristic and specific histological findings in rheumatoid pleurisy.

The histological findings in rheumatoid pleuritis (RP), as seen in thoracoscopical biopsies, are found to be: A slightly inflamed stroma with a wave-like surface due to vessel-containing flattened papillae. The surface is covered by layers of pseudostratified epithelioid cells and scattered multinucleated giant cells, layers that easily detach as membranes, leaving the stroma surface "naked". These findings, in combination with the absence of mesothelial cell covering, are viewed as characteristic and specific, as based on a blind review of 17 pleural biopsies from RP patients and 14 biopsies from a control group.

Rheumatoid pleurisy. Specificity of cytological findings.

The cytological findings in pleural exudates from patients with rheumatoid arthritis are epithelioid cells, giant cells, cholesterol crystals and an amorphous granulated material. An important additional feature, we find, is lack of mesothelial cells. Based on 23 pleural fluids from 7 patients with rheumatoid arthritis and 44 pleural fluids from patients with various other diseases, a blind study showed, that these typical cytological findings in combination with lack of mesothelial cells were specific in pointing towards the determined diagnosis rheumatoid pleurisy.

Vaccination against the gastrointestinal helminths Trichinella spiralis and Hymenolepis nana: relationship between routes of immunization and effective protection.

Mice immunized with antigens derived from Trichinella spiralis muscle larvae or Hymenolepis nana embryos were found to be protected against the homologous challenge infection. Intraperitoneal route was found the most effective in stimulating protection compared with subcutaneous or intravenous administration. Even a single dose of antigen administered intraperitoneally stimulated a significant protection. The results of our experiments confirm that the route of administration has a noteworthy influence on the effectiveness of the immunization. The possible mechanism involved in rejection of both worms population are discussed.

Colitis cystica profunda lokalisata.

A 33-year-old man had a three-year history of ulcerative colitis. After 14 months of treatment he developed localized colitis cystica profunda mimicing a stenosating cancer of the rectum. The process developed over a short period. The diagnosis is based on a histological examination revealing benign submucosal cysts lined by columnar epithelium. A conservative surgical attitude is recommended.