Fine-needle aspiration cytology of pleuropulmonary blastoma: case report and review of the literature.

This report describes the fine-needle aspiration (FNA) cytology of a case of pleuropulmonary blastoma in a 3-yr-9-mo-old male. Pleuropulmonary blastoma is considered by most authors to be distinct from pulmonary blastoma and is a rare malignant tumor of the intrathoracic cavity. FNA smears were cellular with numerous small ovoid to spindled cells with oval to elliptical nuclei exhibiting finely granular chromatin and inconspicuous nucleoli. The cytoplasm was scant and eosinophilic with indistinct borders. Focal chondroid material and blastema-like cells were noted. The differential diagnosis suggested by the cytologic findings included rhabdomysosarcoma, teratoma, neuroblastoma, malignant mesenchymoma, pleuropulmonary blastoma, and metastatic tumor. To our knowledge, this is the first report of the cytology of this tumor.

Paraplegia due to ossification of ligamenta flava in X-linked hypophosphatemia. A case report.

STUDY DESIGN: Spinal canal decompression at the most prominent of multiple posterior calcified thoracic lesions in a case of X-linked hypophosphatemia was undertaken for treatment and diagnosis purposes, as well as to assess possible nature of the pathophysiology underlying the presenting deficits. OBJECTIVES: To discuss the clinical assessment diagnostic and treatment aspects of this rare coincidence of ossification of ligamenta flava in the patient with the skeletal deformities of X-linked hypophosphatemia. SUMMARY OF BACKGROUND DATA: The patient with the stigmata and chemical findings of an X-linked hypophosphatemia presented with paraplegia and multiple calcified posterior spinal thoracic lesions. This was studied with magnetic resonance imaging and electrophysiologic studies of the spinal sensory pathways of the legs. These data constituted the preoperative information required to assess later results of surgical intervention. METHODS: Presurgical clinical, imaging and electrophysiologic studies and laboratory and pathologic investigations of the surgical specimens. RESULTS: Resolution of the paraplegia with walking and return to work in a physically demanding job for the last 4 or 5 years of postoperative follow-up after surgical decompression of the spinal cord only at the worst and highest of the effected spinal levels. CONCLUSION: The coincidence of X-linked hypophosphatemia and ossification of ligamenta flava has been reported only in two or three cases in the literature. Removal of the offending ossifying lesion is known to result in resolution of the clinical deficits but similar lesions at other spinal levels are suspected of producing recurrences. The return of function and of the corresponding electrophysiologic correlates indicate a neurono-apractic nature of the neurologic symptoms.

Chorionic villi or trophoblastic tissue in uterine samples of four women with ectopic pregnancies.

The diagnosis of early ectopic pregnancy remains challenging for the gynecologist. Although early detection of a suspected pregnancy has been facilitated by quantitative beta human chorionic gonadotropin studies and ultrasonography, a patient subgroup remains with an ambiguous presentation. In this group of patients, the clinician must rely on microscopic examination of products of conception in a uterine curettage specimen to rule out the presence of an extrauterine pregnancy. The presence of an implantation site, chorionic villi, or trophoblastic tissue in uterine curettage samples is conventionally held as definitive evidence of an intrauterine pregnancy. We present a series of four cases that challenge this convention. In these cases, chorionic villi or an implantation site were identified in uterine samples of pregnant women who each ultimately proved to have an ectopic pregnancy. If clinical suspicion is high, the finding of either chorionic villi or an implantation site should not preclude further workup of a possible ectopic pregnancy. In cases where only a few villi or a single chorionic villus are identified, other signs of intrauterine implantation such as intermediate trophoblastic cells, hyalinized vessels, and a fibrinoid matrix should be sought to establish firmly the diagnosis of an intrauterine pregnancy.

Fatal disseminated herpes simplex in pregnancy with maternal and neonatal death.

Disseminated herpes is rare in the adult and usually occurs in the immunocompromised. Twenty-one cases have been reported in which healthy women contracted life-threatening disseminated herpes simplex virus (HSV) infections in the third trimester of pregnancy. Most of these patients had nonspecific symptoms, and many did not have mucocutaneous lesions. On physical examination, they were usually febrile and anicteric and had markedly elevated aminotransferase values, without a corresponding elevation in bilirubin level. In our review of the literature, we found that prompt acyclovir therapy resulted in 100% survival. Those patients not receiving treatment or treated late in the terminal stages of their disease had a 63% mortality rate. We report a case of maternal disseminated HSV with subsequent maternal death at an estimated 31 weeks' gestation in which the diagnosis was made at the time of necropsy. The infant was started on acyclovir therapy but died of disseminated HSV.

Massive hepatic necrosis and death following repeated isoflurane exposure: case report and review of the literature.

Multiple exposures to halothane have been shown to produce hepatic injury and subsequent hepatic failure often leading to death. Isoflurane, a related haloalkane, is considered a nonhepatotoxic alternative to halothane and its potential to cause injury has been greeted with skepticism. Described is a 30-year-old woman who developed hepatic failure and died after being exposed twice to isoflurane. Recent exposure to anesthetic agents must be considered when death is caused by massive hepatic necrosis.

Transitional cell carcinoma of the endometrium.

Only one case of endometrial transitional cell carcinoma (TCC) has been previously reported in the literature. We report a second case. In both the previously reported case and in this case there was a separate focus of TCC in the adnexa. Both patients were treated with adjuvant whole pelvic radiation and are alive and without evidence of disease at 5 years and 15 months, respectively. Study of more cases of endometrial TCC is needed to determine whether this type of endometrial carcinoma has a more favorable response to radiation therapy than other types of endometrial carcinoma with extrauterine spread.

A rock in a hard place. A brief case report.

Radiographs are often of assistance in locating foreign bodies, particularly bullets, at autopsy. It must be remembered, however, that all bullet-shaped radioopacities that appear to be within the skull are not necessarily projectiles. Described is a radiographic conundrum caused by a piece of gravel that pierced the scalp when the victim of a gunshot wound to the head fell to the ground. The stone, although bullet shaped, differed in radiodensity to metal and could have been recognized for what it was prior to much consternation on the part of the prosecutors. This case serves as a reminder of two pitfalls in the interpretation of gunshot wounds to the head. First, the radiodensity of a foreign body must be considered as important as its shape. Second, a foreign body outside of the convex surface of the skull may appear intracranial on both anteroposterior and lateral radiographs. Last, the prosecutor is encouraged to remain open minded and not to simply "see what he/she wants to see."

Immunostaining for P-glycoprotein in the diagnosis of thyroid carcinomas.

The morphologic distinction between thyroid carcinoma and certain benign thyroid conditions can be difficult in selected cases. P-glycoprotein (Pgp), a glycoprotein associated with tumor multidrug resistance, has been reported to be expressed in thyroid carcinoma but not in benign thyroid conditions. To determine the specificity of immunostaining for Pgp in the diagnosis of thyroid carcinoma, we studied formalin-fixed, paraffin-embedded tissue from 69 cases of various thyroid lesions using a commercially available monoclonal antibody to Pgp (C219, Centocor, Malvern, PA) and an avidin-biotin-peroxidase complex technique. Positive reactivity was seen in 15 of 37 (41%) benign thyroid conditions and in 23 of 32 (72%) thyroid carcinomas. We conclude that immunostaining for Pgp is not specific in the diagnosis of thyroid carcinoma.