Carcinoma of the esophagus with adenoid cystic differentiation.

Adenoid cystic carcinoma of the esophagus is a relatively rare lesion which characteristically exhibits a clinically aggressive behavior. In spite of this aggressive nature, it is most often referred to as a counterpart of the more common adenoid cystic carcinoma of salivary gland origin, a comparatively indolent tumor. In this report, the clinical and pathologic findings in a series of six cases of esophageal adenoid cystic carcinomas are contrasted with those of typical salivary gland lesions, and also compared to similar tumors exhibiting "adenoid cystic" differentiation arising in other extrasalivary gland sites. It is concluded that the esophageal tumors, as well as certain similar lesions arising in other extrasalivary gland sites, represent a class of poorly differentiated basaloid neoplasms distinct both clinically and morphologically from the common adenoid cystic carcinoma of salivary gland origin.

Fetal tachycardia associated with intrauterine fetal thyrotoxicosis.

Tachycardia in both fetuses of a twin gestation was documented in a mother who had undergone subtotal thyroidectomy 8 years prior to her present pregnancy. Maternal and fetal plasma concentrations of long-acting thyroid stimulator (LATS) and amniotic fluid 3,3',5'-triiodothyronine (reverse T3) were determined. All values were consistent with the diagnosis of fetal thyrotoxicosis, as were cord blood studies performed on the fetuses post partum. Significant concentrations of LATS were present in fetal cord blood. The first fetus survived but suffered hyperthyroidism during the first 3 neonatal weeks. The second twin died, possibly of fetal thyrotoxicosis. These studies suggest that in women with a history of thyrotoxicosis, high levels of maternal LATS may in some instances provoke fetal thyrotoxicosis, which can be diagnosed by the measurement of amniotic fluid reverse T3.

Systemic mastocytosis in a patient with polycythemia vera treated with radioactive phosphorus.

Systemic mastocytosis occurred as a fatal event in a patient with long-standing polycythemia vera. The patient had been treated over the course of 21 yr with radioactive phosphorus. Possible relationships between mastocytosis and polycythemia vera, and also between mastocytosis and treatment with ionizing radiation, are discussed. Histopathologic and electron microscopic findings are illustrated. Difficulties in establishing the diagnosis of mast cell disease in this setting are also described.