Altered gene expression profile in vaginal polypoid endometriosis resembles peritoneal endometriosis and is consistent with increased local estrogen production.

BACKGROUND: In a university hospital setting, a 25-year-old woman presented with large vaginal and cervical polyps. Past medical history was significant for stage IV endometriosis. Polypectomy was performed and the polyps were histologically consistent with endometriosis. Gene expression was compared with control vaginal tissue to assess if the altered gene expression profile was similar to peritoneal endometriosis. METHODS AND RESULTS: Using quantitative reverse transcription, real-time PCR, estrogen receptor-ß expression was found to be upregulated 10-fold while estrogen receptor-α expression was downregulated 5-fold in the vaginal polyp relative to control vaginal tissue. The estrogen-synthesizing enzyme aromatase was upregulated 8-fold and 3ß-hydroxysteroid dehydrogenase was upregulated 400-fold in the polyp. Immunohistochemical staining revealed altered cell type localization for progesterone receptor in the polyp and increased cell proliferation in polyp stromal cells relative to control. CONCLUSIONS: Increased proliferation in the vaginal polypoid endometriotic tissue may be due to increased local estrogen production. The altered gene expression profile was very similar to the altered gene expression profile seen in peritoneal endometriosis.

Dermal nerve sheath myxoma of the hallux: a case report.

Dermal nerve sheath myxoma is a rare tumor with a predilection for the upper extremity, head, neck, and shoulder. It usually arises during childhood or early adult life. We present a case of a young woman who has this type of myxoid tumor of the hallux. To preserve viability of the hallux, debulking of the tumor was performed rather than complete marginal excision. This case and a literature review suggest that this tumor may be satisfactorily managed with debulking or marginal resection. Histology and pathology of dermal nerve sheath myxoma are reviewed.

A case of Whipple's disease in Missouri.

Whipple's disease is a rare disorder which has fascinated physicians since its description in 1907. The onset is usually indolent, the symptoms are protean and multisystemic, and disease has often been present for years before a diagnosis is made. Although rare, its identification is important since therapy is simple and effective. We report a case of Whipple's disease in a lifelong resident of Missouri and review the important features of the disease.

Follicular carcinoma with clear cell change arising in lingual thyroid.

A case of follicular carcinoma arising in the lingual thyroid of a 23-year-old woman is added to the 22 previous reports. The embryology and the clinical and pathologic differential diagnoses are discussed. Histologic criteria useful in diagnosing follicular malignancy in this area include local and vascular invasiveness, hypercellularity, mitotic activity, and necrosis. The use of the immunohistochemical marker thyroglobulin and electron microscopy are described for the first time and confirm a thyroid follicular cell origin.

Familial urticaria pigmentosa.

We describe urticaria pigmentosa in three generations of a kindred. Unique to this family is the marked diversity of their skin disease. Classic lesions of urticaria pigmentosa, telangiectasia macularis eruptiva perstans, and clinically normal skin with positive dermal infiltrates of excess mast cells were found in individual family members. Urticaria pigmentosa is rarely reported as an inherited disease. To our knowledge, this is the largest American kindred of familial mast cell disease and is the second report documenting disease in three generations.

Nonpalpable occult testis tumor.

We present a case study of a patient with seminoma who had normal testicles on palpation. Testicular ultrasound is the technique of choice to locate occult nonpalpable testis lesions. We recommend its use in the search for the source of any retroperitoneal mass of undetermined origin.

Posttraumatic lobular squamous metaplasia of breast. An unusual pseudocarcinomatous metaplasia resembling squamous (necrotizing) sialometaplasia of the salivary gland.

Squamous metaplasia arising in nonneoplastic breast parenchyma is reportedly rare. We present a unique case which occurred following severe blunt trauma to the right breast of a 59-yr-old woman. The lesion contained sheets of squamous cells with a lobular growth pattern, bland cytology with few mitoses, and keratin and keratohyalin granules. It bore a striking resemblance to squamous (necrotizing) sialometaplasia of the salivary gland in that it exhibited lobular, pseudocarcinomatous growth. The patient has remained free of disease 49 mo after segmental resection of the lesion. Four previous cases of squamous metaplasia of the female breast have been reported, though none presented with a history of trauma or previous surgical manipulation. It is important to differentiate this entity from pure squamous cell carcinoma, and metaplastic change in ductal breast carcinoma, fibroadenoma, and other lesions. Breast aspiration biopsies revealing squamous cells cannot exclude carcinoma; thus, caution must be exercised.

Gastritis and Campylobacter pylori in healthy, asymptomatic volunteers.

A high prevalence of histologic gastritis in asymptomatic individuals has been reported in the literature. The studies have been poorly controlled for gastritis risk factors. We evaluated 20 healthy, asymptomatic volunteers free of known risk factors for gastritis with endoscopy, mucosal biopsy, culture, and gastric pH determination. The prevalence of gastritis on histologic examination was found to be 20%. There was no relationship between the presence of macroscopic findings at endoscopy and the presence of histologic gastritis. In all instances where histologic gastritis was documented, Campylobacter pylori was observed in the gastric mucus. Mucosal tissue invasion by C pylori was not observed. The presence of gastritis and C pylori was associated with fasting hypochlorhydria. Follow-up evaluation was performed eight to 13 months after the initial endoscopic evaluation in three of the volunteers with positive test results. Persistence of C pylori and gastritis was observed. These findings suggest that histologic gastritis is common in healthy, asymptomatic individuals and is strongly associated with the presence of C pylori.

Neuroendocrine (carcinoid) tumor of the lung and type I multiple endocrine neoplasia.

We have described a case of MEN-I in association with a benign pulmonary carcinoid tumor. Two other members of our patient's family also had MEN-I and benign carcinoid or adenomatous lung tumors. Hormonal assays of our patient's carcinoid lesion showed the production of gastrin, gastrin-releasing peptide, neurotensin, and somatostatin, but not serotonin, a hormonal profile distinct from those previously reported in carcinoid lung tumors unassociated with MEN-I.

Intimal integrity and fibrinolytic potential of reversed and in situ vein grafts.

The improved patency rates of in situ vein grafts are attributed to better flow characteristics, anastomotic "fit," and intimal preservation. This study compared the early changes in intimal morphology and fibrinolytic activity of in situ and reversed vein bypass grafts from mongrel dogs. Four to six centimeter in situ and reversed vein segments were used to bypass left and right femoral and internal carotid arteries, respectively. Heparin (100 U/kg) was administered before arterial clamping. Anastomoses were fashioned end to side and the intervening artery was ligated. Fifty-two grafts were harvested at day 1 (12 grafts), day 7 (16 grafts), day 14 (12 grafts), and 12 weeks (12 grafts). The veins were analyzed for histologic changes by light microscopy and scanning electron microscopy. The fibrinolytic activity of the grafts was assayed by the fibrin slide and fibrin plate techniques. There were no significant differences in morphology or fibrinolytic activity between the reversed and in situ grafts at any time period. These findings indicate that the improved patency rates associated with in situ grafts are not dependent on improved preservation of intimal structure or fibrinolytic activity.

Plasma-cell granuloma producing calcitriol and hypercalcemia.

A teenage boy presented with hypercalcemia and a large intrathoracic mass. Results of an extensive evaluation, including normal findings on parathyroid hormone and urinary 3', 5'-cyclic adenosine monophosphate assays, failed to explain his hypercalcemia. During surgery, a large plasma-cell granuloma of the right middle and lower lobes was resected. Within 2 weeks, serum calcium levels returned to normal. Serum calcitriol (1,25-dihydroxyvitamin D3) levels were elevated before surgery and decreased to normal afterward, correlating with the serum calcium level. Homogenates of the plasma-cell granuloma synthesized a compound indistinguishable from calcitriol.