Uterine atypical polypoid adenomyoma and ovarian endometrioid carcinoma: metastatic disease or dual primaries?

Atypical polypoid adenomyoma (APA) is an uncommon uterine tumor that rarely metastasizes, although it closely resembles a well-differentiated endometrioid carcinoma. A 37-year-old woman with a history of pelvic endometriosis and oral contraceptive use developed an APA and later presented with bilateral ovarian endometrioid carcinomas. DNA ploidy analysis and human papilloma virus (HPV) typing of the APA and ovarian carcinomas were performed to characterize the primary or metastatic nature of the tumors. Both tumors were aneuploid. The APA had a DNA index of 1.53, compared with 1.19 for the ovarian carcinoma. The APA contained HPV 18, and the ovarian carcinoma a mixed infection of HPV 6, 11, 16, and 18, with types 6 and 11 predominating. These differences in DNA index and HPV type supported the autonomous nature of the APA and the ovarian carcinomas. The report affirms the benign outcome of APA, highlights its complication by a second malignancy, and suggests an etiological role for endometriosis, steroid hormones, and possibly the HPV in the formation of one or both tumors.

Signet-ring chondrosarcoma: a new morphologic entity.

A 65-year-old, otherwise healthy white man presenting with an asymptomatic anterior chest wall mass diagnosed from a routine preoperative chest x-ray is reported. A fine needle aspirate of the mass was initially interpreted as a metastatic adenocarcinoma with prominent "signet-ring" features, but ultrastructural study of the cell block later suggested a chondrosarcoma. The resected surgical specimen confirmed the diagnosis of a grade 2 chondrosarcoma, with most of the tumor cells containing a large, clear, single vacuole shown to be lipid. The positive immunostaining for vimentin and S-100 as well as the ultrastructural appearance confirmed the diagnosis of a chondrosarcoma. Flow cytometric DNA analysis of the tumor on two separate occasions documented a very large aneuploid cell population (50% to 60%) which, when interpreted with the histologic appearance, suggested an aggressive tumor. This case illustrates the first published example of a "signet-ring" chondrosarcoma.

Phlegmonous duodenitis complicating multiple myeloma: a successfully treated case.

A patient receiving chemotherapy for multiple myeloma suddenly developed an acute abdomen, fever, and neutrophil leukocytosis. At laparotomy, the distal two-thirds of the duodenum was swollen and hemorrhagic and was surgically excised. The specimen displayed an acute phlegmonous (suppurative) duodenitis with submucosal and transmural acute inflammation and edema despite an intact mucosa. Blood cultures grew Group B, beta-hemolytic streptococci and gram-positive cocci were present histologically. The patient recovered uneventfully following the surgery and a course of broad spectrum antibiotic therapy. This case illustrates that localized suppurative intestinal infection should be considered when immunosuppressed patients present with an acute abdomen, and that aggressive surgical and antibiotic therapy is warranted.