Recurrent endometrial stromal sarcoma resembling intravenous leiomyomatosis.

A case of recurrent low-grade endometrial stromal sarcoma (endolymphatic stromal myosis) presenting as an intracardiac neoplasm is reported. Pronounced leiomyomatous differentiation was noted in the recurrence. This together with the gross pathology closely resembled intravenous leiomyomatosis.

Myoepithelial cells in needle aspirations of two cases of unusual breast lesions: an aid in differential diagnosis.

The observation of myoepithelial cells bordering abnormal epithelial cells in fine-needle aspiration smears of two unusual breast lesions helped to prevent misdiagnosis of these lesions as malignant. The presence of myoepithelial cells has been a well-established criterion for histologically benign lesions. Their presence or absence appears to be equally valuable in fine-needle aspiration smears of breast lesions.

Squamous differentiation in colorectal adenomas. Literature review, histogenesis, and clinical significance.

Patterns of stratified squamous epithelium have been recognized recently in colorectal adenomas. Light microscopic and keratin immunohistochemical analysis of four cases in the present report suggested origin from large intestinal reserve cells, with impaired and disorderly maturation in the squamous foci. One case had an invasive adenocarcinoma separately in the same polyp, bringing the reported incidence of malignant transformation in these adenomas to seven of 48 (15 percent). Evidence is presented to support the notion that squamous differentiation may be an inherently neoplastic phenomenon in colorectal adenomas, which may be added to the list of markers for colorectal polyps at higher risk for malignant transformation.

Visceral CT findings associated with Thorotrast.

Plain radiography and CT of the abdomen were reviewed in four patients who had undergone angiography with thorium dioxide (Thorotrast). In three patients CT showed irregularly scattered focal punctate collections of Thorotrast in the liver parenchyma, predominantly in the subcapsular zone, associated with areas of low or nonhomogeneous attenuation. These areas of low attenuation were identified on microscopic studies as sites of hepatic fibrosis or neoplasia. Computed tomography identified intrahepatic Thorotrast deposits more definitively than plain radiography.

Vasculopathic hepatotoxicity associated with E-Ferol syndrome in low-birth-weight infants.

A fatal syndrome characterized by progressive clinical deterioration with unexplained thrombocytopenia, renal dysfunction, cholestasis, and ascites developed in certain infants throughout the United States who had received E-Ferol, an intravenous vitamin E supplement. We reviewed the clinical course of all 36 infants from one (index) nursery who had received E-Ferol, which contains 25 units per milliliter of dl-alpha-tocopheryl acetate solubilized with 9% polysorbate 80 and 1% polysorbate 20. The syndrome was recognized in eight of the 36 infants; affected infants had a lower birth weight (less than 1,200 g) and had received a higher total dose of E-Ferol for longer periods than the unaffected cases. We reviewed autopsy-derived tissue from 20 infants (six from the index nursery and 14 from three other collaborating nurseries) who had received the intravenous vitamin E preparation in a reported dose of 25 to 137 units/kg/day for six to 45 days between October 1983 and March 1984. The hepatic histology in the affected cases indicated a progressive injury characterized initially by Kupffer cell exfoliation, central lobular accumulation of cellular debris, and centrally accentuated panlobular congestion. Prolonged exposure to E-Ferol was associated with progressive intralobular cholestasis, inflammation of hepatic venules, and extensive sinusoidal veno-occlusion by fibrosis. We propose that vasculocentric hepatotoxicity is the basis for the observed clinical syndrome that represents the cumulative effect of one or more of the constituents of E-Ferol.

Total occlusion of the intracervical internal carotid artery secondary to vasculitis.

A case of total occlusion of the cervical internal carotid artery secondary to vasculitis is presented. Although vasculitis rarely causes total occlusion of the internal carotid artery, it directly contributed to a left hemispheric stroke in our patient. In the absence of the usual etiologic factors for internal carotid artery occlusion, vasculitis should be considered.

Fine needle aspiration biopsy of the liver. A study of 102 consecutive cases.

One hundred five CT-guided or ultrasound-guided fine needle aspirations of liver in 102 consecutive patients were reviewed. Adequate histologic confirmation or clinical follow-up of the final diagnosis was available for 86 of the 105 aspirations. A definite diagnosis of malignancy was made in 53 of the 61 aspirations performed on patients with malignant hepatic disease (86.9%). There were no false positives. The most common tumors detected were metastatic adenocarcinomas from an unknown primary or from the colon and rectum. The tumors were typed correctly in nearly all cases. Benign lesions encountered included cysts, abscesses, hemangiomas, cirrhosis and fatty metamorphosis. No serious complications were encountered as a result of aspiration. Guided fine needle aspiration biopsy of focal liver lesions appears to be an accurate, safe and relatively inexpensive method of diagnosis.