Autopsy report with clinical and pathophysiologic discussion of autosomal dominant adult polycystic kidney disease.

The average weight of a kidney is approximately 135 gm, measuring on average 10 × 6 × 4 cm. In hereditary conditions, autosomal dominant and autosomal recessive polycystic kidney disease, the shape, size, and the weight can be significantly abnormal, causing progressive renal failure, often necessitating dialysis or renal transplant for survival. We report a case of adult polycystic kidney disease in a 50-year-old female without a family history, who died of complications of the disease which included accelerated hypertension, and renal and cardiac failure.

Esophageal plasmacytoma diagnosed in a patient presenting with cardiac symptoms: a novel case.

Extramedullary plasmacytoma is the uncommon phenomenon of a plasma cell neoplasm occurring outside of the bone marrow. Primary plasmacytoma is a rare occurrence in the gastrointestinal tract and exceptional to originate in the esophagus. We present a novel case of a 62-year-old man who presented to our emergency department with chest pain. A cardiovascular workup was negative, and an endoscopy was subsequently performed. The endoscopy findings showed evidence of Grade IV esophagitis with ulcerations extending from 25 cm to 32 cm. Histopathological examination revealed marked acute and chronic inflammation, granulation tissue, and overlying necroinflammatory exudate. However, sheets of plasma cells, some with prominent nucleoli, were also seen. Immunohistochemically, the plasma cells expressed CD138 and MUM1 and were IgG kappa restricted. A bone marrow biopsy was performed which was negative for involvement. This is a novel case of esophageal plasmacytoma diagnosed on endoscopy in a patient presenting with acute chest pain.

Angiosarcoma of small bowel presenting with obstruction: novel observations on a rare diagnostic entity with unique clinical presentation.

We present a case of angiosarcoma in small bowel, presenting with partial small bowel obstruction in a 79-year-old man with no history of radiation, chemotherapy, toxin exposure, or previous operative intervention. Angiosarcoma of small bowel is a rare entity which may present with nausea, abdominal pain, recurrent bleeding, and usually a history of prior radiation or exposure to specific toxins (polyvinyl chloride). Angiosarcoma of small bowel tends to spread rapidly and has a poor prognosis. We review the surgical and oncologic challenges. We report unique macroscopic findings of raised hyperemic margins, which are suggestive of a vasogenic lesion and the histologic feature of a partially retiform pattern with dense basement membrane material in an otherwise poorly differentiated lesion.

Renal pelviceal keratinizing squamous metaplasia with sparing of pyramidal zones.

Metaplastic changes in the urothelium of the upper urinary tract are relatively infrequent. Metaplasia may present as either squamous or less often glandular differentiation. The process may be associated with chronic inflammation or associated chronic infections. There may be malignant transformation to either squamous cell carcinoma or adenocarcinoma. The demarcation of the metaplastic process in the minor calyces has not been well documented to date. We report the case of a 74-year-old female patient who presented with a history of chronic renal disease and acute pyohydronephrosis. The patient underwent a nephroureterectomy which revealed keratinizing desquamative squamous metaplasia throughout the renal pelvis and upper urinary tract with abrupt termination of metaplasia at the junction of the renal pelvis and the minor calyx (pyramidal zone). Immunohistochemical evaluation documents metaplastic urothelium stained positive for CK5, before converting sharply to simple cuboidal epithelium in the minor calyx (pyramidal zones) which stained positive CK7. At the junction of the metaplastic components and low cuboidal lined minor calyceal surfaces, the underlying stroma showed loss of ureteral muscularis mucosa with transition to renal parenchymal type stroma. We believe that this observation is unique and potentially relevant to the etiology and pathophysiology of pelviceal metaplasia.

Economic impact of extracolonic findings at computed tomographic colonography.

OBJECTIVE: To determine the prevalence of extracolonic findings at computed tomographic colonography (CTC) and estimate the cost of the workup of newly discovered potentially significant lesions. SUBJECTS AND METHODS: An electronic information system was used to review all patient data before and after the CTC in a mixed cohort of 376 patients. Extracolonic findings were categorized into the CT Colonography Reporting and Data System classification. The impact of additional diagnostic workup was estimated using Medicare reimbursement for relevant extra services. RESULTS: There were 51 patients (13.6%) with E3 and 16 (4.3%) with E4 findings. At least 1 extracolonic finding was found in 272 patients (72.3%). There were 520 extracolonic findings, of which, 447 (86.0%) were classified as low clinical significance, E2. Only 7 (12.5%) of 56 E3 lesions and 7 (41.2%) of 17 E4 lesions received additional diagnostic workup. The total additional cost of evaluating E3 and E4 lesions was $13.07 per CTC. CONCLUSIONS: A mixed (screening and nonscreening) CTC population has a low prevalence of high-risk lesions, and the additional cost of their evaluation is relatively small.

Subperitoneal placenta accreta succenturiate in the case of a successful near-term extrauterine abdominal pregnancy.

Placenta from an extrauterine abdominal pregnancy was examined after a 37-week healthy infant gestation. The placenta, with its fetal surface down and maternal surface up, protruded from the pelvic area to peritoneal cavity in the wall of the amniotic sac containing fetus. The placenta was implanted under the thin subperitoneal layer of maternal tissue completely covered by peritoneal serosa and was formed by several small lobes connected by intramembranous placental vessels. Insertion of the trivascular umbilical cord was velamentous. Partially remodeled arteries infiltrated by intermediate trophoblast and frequent veins directly communicating with the placental intervillous space were identified in the subperitoneal maternal tissue. The term "placenta accreta" is appropriate in this case because villi in the basal plate implanted directly in the maternal subserosal connective tissue without intervening decidua.

Cutaneous anthrax: conservative or surgical treatment?

This article summarizes the diagnostic features and treatment recommendations for cutaneous anthrax, exemplified by a case report of nontypical cutaneous anthrax. The treatment of choice is medical, with ciprofloxacin or doxycycline the preferred antibiotics. However, surgical biopsy may be used if the clinical setting and microbiologic examination of swabs are not diagnostically conclusive. Histopathologic findings explain the clinical observation that most cutaneous anthrax lesions heal without scar formation.