Insulin resistance in pulmonary arterial hypertension.

Although obesity, dyslipidemia and insulin resistance (IR) are well known risk factors for systemic cardiovascular disease, their impact on pulmonary arterial hypertension (PAH) is unknown. The present authors' previous studies indicate that IR may be a risk factor for PAH. The current study has investigated the prevalence of IR in PAH and explored its relationship with disease severity. Clinical data and fasting blood samples were evaluated in 81 nondiabetic PAH females. In total, 967 National Health and Nutrition Examination Surveys (NHANES) females served as controls. The fasting triglyceride to high-density lipoprotein cholesterol ratio was used as a surrogate of insulin sensitivity. While body mass index was similar in NHANES versus PAH females (28.6 versus 28.7 kg.m(-2)), PAH females were more likely to have IR (45.7 versus 21.5%) and less likely to be insulin sensitive (IS; 43.2 versus 57.8%). PAH females mostly (82.7%) had New York Heart Association (NYHA) class II and III symptoms. Aetiology, NYHA class, 6-min walk-distance and haemodynamics did not differ between IR and IS PAH groups. However, the presence of IR and a higher NYHA class was associated with poorer 6-months event-free survival (58 versus 79%). Insulin resistance appears to be more common in pulmonary arterial hypertension females than in the general population, and may be a novel risk factor or disease modifier that might impact on survival.

Primary hepatic lymphoma: report of two cases diagnosed by fine-needle aspiration.

Primary hepatic lymphoma (PHL) is a rare disease which tends to progress slowly in the absence of other disorders and remains confined to the liver until late in its course. We report two patients with PHL diagnosed by fine-needle aspiration (FNA). Histopathologically, PHL can be misdiagnosed as poorly differentiated carcinoma or hepatocellular carcinoma. On FNA, cellular smears with artifactual grouping of malignant cells may result in similar errors. Since PHL has an excellent prognosis and is not usually the working diagnosis in patients who present with a solitary liver mass, a high index of suspicion is necessary to make the diagnosis. We report two cases of PHL in which the diagnosis of lymphoma was rendered on FNA. In one patient, who carried a clinical diagnosis of cavernous hemangioma for 18 mo, FNA showed large-cell lymphoma, B-cell type. Subsequent extensive workup did not reveal extrahepatic disease. The other patient, followed for sclerosing cholangitis, was clinically thought to have developed cholangiocarcinoma. FNA revealed high grade lymphoma, B-cell type. We present the clinical, radiologic, and pathologic findings and differential diagnoses of PHL as well as the various clinical settings in which PHL has been described.

Necrotizing lymphadenitis (Kikuchi's disease). Report of four cases of an unusual pseudolymphomatous lesion and immunologic marker studies.

The clinical and histologic features of four cases of necrotizing lymphadenitis (Kikuchi's disease), an unusual pseudolymphomatous lesion, are presented. Three patients were female and one was male. All were under 40 years of age. Cervical and juxtaparotid lymph nodes were affected. Immunological staining in two cases demonstrated a population of T cells and monocytes in the necrotic areas. Necrotizing lymphadenitis is a peculiar reactive condition with a predilection for cervical lymph nodes in young women. Although the histologic features may be confused with those of malignant lymphoma, to our knowledge the natural history has been benign in all cases to date.