Subacute measles encephalitis with AIDS diagnosed by fine needle aspiration biopsy. A case report.

BACKGROUND: Subacute measles encephalitis (SME), or measles inclusion body encephalitis (MIBE), is a rare central nervous system (CNS) complication following infection by the measles (rubeola) virus. It usually occurs in young patients with defective cellular immunity from either congenital or acquired causes. In the United States, with the resurgence of measles infection and the human immunodeficiency virus (HIV) pandemic, subacute measles encephalitis should be added to the differential diagnosis in acquired immune deficiency syndrome (AIDS) patients presenting with unexplained CNS manifestations. CASE: A 2-year-old, HIV-positive, white male was admitted for generalized convulsive seizures. Vaccination was described as "up to date." Despite treatment with anticonvulsive drugs, the child continued to develop frequent partial and generalized seizures. Cephalic computed tomography and magnetic resonance imaging revealed a hypodense area in the right parietotemporal cortex without an associated mass effect. Fine needle aspiration biopsy (FNAB) of the affected area showed neuronal reduction, degeneration with eosinophilic intranuclear inclusions, perivascular lymphoplasmacytic infiltration and gliosis. Electron microscopy of the intranuclear inclusions revealed fine, fibrillar, tubular nucleocapsids, consistent with the measles virus. CONCLUSION: Acute measles encephalitis (AME), subacute sclerosing panencephalitis (SSPE), and SME are the three CNS syndromes associated with measles infection. Serum and cerebrospinal fluid (CSF) antibody titres against measles virus are usually high and helpful in the diagnosis of AME and SSPE. In SME, neither serum nor CSF antibody titres against measles are high. Therefore, FNAB is necessary for a definitive diagnosis.

Fine needle aspiration biopsy of progressive multifocal leukoencephalopathy in a patient with AIDS. A case report.

BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is one of the most common opportunistic infections, with a range of 4-7% in acquired immunodeficiency syndrome (AIDS) patients. Clinical diagnosis is often difficult, and the specific pathologic agent requires cytologic and pathologic confirmation. CASE: A 38-year-old, Haitian male was admitted with a new-onset seizure disorder. On computed tomography (CT), there were right frontoparietal cortex, right external capsule and right basal ganglia lucencies. Fine needle aspiration biopsy (FNAB) of the radiolucent area revealed foci of white matter demyelination and a few eosinophilic inclusions in oligodendrocytes plus abnormal giant astrocytes. Ultrastructurally, JC virions were observed in the nuclei and cytoplasm of the oligodendrocytes. CONCLUSION: Diagnostic cranial CT-guided FNAB, with cytologic and histologic studies, is extremely valuable in evaluating the nature of central nervous system demyelinated and space-occupying lesions in AIDS.

Strongyloides stercoralis infection in AIDS.

Strongyloides stercoralis infection in humans continues to be a subject that has frequently inspired reviews and papers. Within the AIDS epidemic, interest gathered momentum with the inclusion of this infection in the indicator diseases list, and its subsequent removal 5 years later by the CDC. These actions have prompted a debate as to whether this infection has special significance in patients with AIDS and whether its exclusion from the CDC criteria is justified. A detailed review of the world literature reveals an increased awareness and diagnosis of this infection in patients with AIDS which takes the form of dissemination, a rapid course, and a usually fatal outcome.

Fine needle aspiration cytology of a recurrent malignant tumor of the kidney with rhabdoid features in an adult. A case report.

BACKGROUND: Malignant rhabdoid tumor of the kidney in children is considered a distinct entity. Malignant tumors with rhabdoid features in adults in extrarenal locations and in children over the age of 5 years are considered phenotypic variants. CASE: In a case of recurrent transitional cell carcinoma with rhabdoid features of the kidney in an adult, confirmed immunohistochemically and ultrastructurally, fine needle aspiration cytology showed discohesive, large- to medium-sized polygonal cells with eccentric nuclei; prominent nucleoli; abundant, pink cytoplasm; and paranuclear, eosinophilic density, corresponding to cytoplasmic eosinophilic globules seen in the histologic sections and cytoplasmic filamentous inclusions seen ultrastructurally. CONCLUSION: The cytologic features of malignant rhabdoid tumors are characteristic.

Giant collagen plaques in Creutzfeld-Jakob disease. Report of two cases with ultrastructural studies.

We report two cases of Creutzfeld-Jakob disease with clusters of giant collagen fibers. To our knowledge, these abnormally large collagen fibers have never been described in patients with degenerative diseases of the central nervous system. The significance of the formation of such plaque-like large collagen fibers has as yet not been elucidated. It is felt that these represent a product of the degenerative process.

Spinal cord toxoplasma lesion in AIDS: MR findings.

Toxoplasma gondii is the cause of the most common opportunistic infection of the brain in AIDS but is extremely rare as the cause of a solitary lesion of the spinal cord. Symptoms are weakness of the lower limbs followed closely by paralysis unless diagnosed and treated early. We present such a case in an intravenous drug abuser with AIDS and emphasize that MRI is the diagnostic tool of choice and that the index of suspicion should be high in immunosuppressed patients.

Histochemical determinations of copper, zinc, and iron in pigmented nevi and melanoma.

Histochemical determinations of copper, zinc, and iron in intradermal pigmented nevi and melanomas revealed the presence of copper and iron in melanoma but not in nevi. Zinc was not detected in either melanomas or nevi. However, melanin was removed from the tissues prior to staining; therefore, it is possible that zinc was also removed by the procedure. Although the function of copper and iron in the melanoma cell is not known, they may be components of abnormal enzymes.

Chronic follicular pyeloureteritis.

A case of chronic follicular pyeloureteritis is presented. This rare lesion, not previously published in the American literature, must be differentiated from primary renal lymphoma and generalized malignant lymphoma of the nonHodgkin type.

CT features of primary cerebral lymphoma in AIDS and non-AIDS patients.

Computed tomographic study of six cases with primary cerebral non-Hodgkin lymphoma are reviewed. Three had a history of intravenous drug abuse and were diagnosed as having acquired immunodeficiency syndrome (AIDS). All cases presented with space occupying lesions in the frontal lobe with the exception of Case 4. Computed tomography demonstrated multiple lesions in AIDS cases whereas non-AIDS lesions were invariably single. The AIDS patients died within 1 year despite radiotherapy as compared with the non-AIDS patients.

Invasive ovarian endometrioid adenofibroma with omental implants and collision with endometrial adenocarcinoma.

A case of endometrioid adenofibroma of the ovary with omental implants, extensive invasion into the wall of the ipsilateral fallopian tube, and collision with an endometrial papillary adenocarcinoma is reported. Fewer than 35 malignant cystadenofibromas and adenofibromas have been reported. In all of these cases, the malignant epithelium was believed to originate from preexisting benign tumors. This case is unusual in that it demonstrated no malignant epithelium beyond that of a borderline tumor, but met the criteria of malignancy because of its invasiveness and metastasis.

Histochemical determination of copper, zinc, and iron in some benign and malignant tissues.

Histochemical tests for copper, iron, and zinc revealed their presence in the stratum germinativum of normal skin and skin from which an early melanoma and basal cell and squamous cell carcinomas originated. However, only copper was seen in invasive cells of basal and squamous cell carcinomas originating from skin. The normal oral mucous membrane was free of copper, iron, and zinc, but cells of invasive squamous carcinoma originating from the oral mucous membrane contained copper. The fluorescent brightening agent, applied as a counterstain, aided in the location of the specimen.

Pseudogaucher cells in Mycobacterium avium intracellulare infections in acquired immune deficiency syndrome (AIDS).

This report describes a 28-year-old woman with the acquired immune deficiency syndrome (AIDS) with culture-proven disseminated Mycobacterium avium intracellulare infection. The histopathologic and cytologic features in this case were unique in that these organisms that stained positively with the Ziehl-Neelsen and periodic acid-Schiff (PAS) stains were numerous, present intracellularly within histiocytes, transforming them into pseudogaucher cells. Differential diagnostic criteria for pseudogaucher cells and abnormal macrophage handling of the intracellular organisms in AIDS are discussed.

Diffuse alveolar damage and interstitial fibrosis in acquired immunodeficiency syndrome patients without concurrent pulmonary infection.

Patients with acquired immunodeficiency syndrome (AIDS) characteristically present with repeated pulmonary infections. We present the pathologic findings in lung biopsy specimens from 12 patients with AIDS in whom the histologic spectrum ranged from mild diffuse alveolar damage to frank interstitial fibrosis. In all of these patients, there was no evidence of any concurrent infectious process in the lung. Diffuse alveolar damage is a pattern of response of the lung to many kinds of infectious processes and immunologic injury, both of which are potential possibilities in patients with AIDS. This study underscores the development of diffuse alveolar damage or interstitial fibrosis and their presentation as the sole histologic findings in lung biopsy specimens from patients with AIDS. We discuss the possibility that these changes may be long-term sequelae to repeated pulmonary infections with or without an immunologic defect.

A testicular tumor resembling the sex cord with annular tubules in a case of the androgen insensitivity syndrome.

Sex cord tumor with annular tubules (SCTAT) is a distinctive neoplasm with indifferent cells of sex cord derivation in a characteristic arrangement of ring-like tubules. Much attention has been drawn to its association with the Peutz-Jeghers syndrome (PJS) with reported occurrence of the tumor in the testis of a boy with PJS. The authors present two cases of the androgen insensitivity syndrome (AIS), one of the cases being distinctive in having a large multicystic tumor resembling the SCTAT in the immature gonad. Additionally, the focal areas of the tumor, the large Sertoli cells lining the tubules, resembled those of a large cell calcifying Sertoli cell tumor (LCCSCT) although no calcific areas were discernible. Although the occurrence of neoplasms like germinomas and tubular adenomas is well known in the AIS, SCTAT has hitherto not been reported in a gonad of the AIS. SCTAT has been placed under an "unclassified sex cord-stromal" category in the World Health Organization (WHO) Classification, yet, opinions are divided as to its origin from a granulosa or Sertoli cell, although an overlap in the histologic features of the two cell categories is to be anticipated in view of their homologous nature. In the case presented, the close resemblance of the tumor cells to the Sertoli cells of the uninvolved gonad would further support the concept of a Sertoli line of differentiation of the SCTAT.