Generalized perforating granuloma annulare.

Generalized perforating granuloma annulare is characterized by 1 to 4 mm umbilicated papules on the extremities, and is most commonly seen in children and young adults. Transepithelial elimination of mucinous, degenerating collagen fibers and surrounding palisading lymphohistiocytic granulomas are important histologic features. Perforating sarcoidosis and perforating granuloma annulare may be difficult to differentiate because of a similar clinical appearance and the presence of sarcoidal granulomas in biopsy specimens. A particularly high incidence of perforating granuloma annulare has been reported in the Hawaiian Islands.

Histology of proximal tubal obstruction in cases of unsuccessful tubal canalization.

OBJECTIVE: To determine possible etiologies of unsuccessful fluoroscopically guided tubal canalization, we studied the histology of tubal segments in cases of failed canalization for proximal tubal obstruction. Factors contributing to cases of unsuccessful fluoroscopically guided tubal canalization remain unclear. DESIGN: Prospective. SETTING: Reproductive Endocrinology Clinic. MATERIALS: Twenty-seven cornual and/or isthmic tubal segments from 15 patients who underwent proximal tubal surgery after fluoroscopically guided tubal canalization were studied. Specimens were prepared with hemotoxylin-eosin and Masson trichrome stains. RESULTS: Histologic examination of excised cornual and isthmic tubal segments revealed abnormalities in 93% of specimens. Obliterative fibrosis (61%), chronic salpingitis (57%), and salpingitis isthmica nodosa (42%) were the most commonly found histologic tubal abnormalities. One case of complete tubal occlusion and tubal schistosomiasis was also detected. CONCLUSIONS: These data suggest that cases of failed fluoroscopically guided tubal canalization may be secondary to severe intrinsic tubal disease and tubal occlusion and not to the technique. Fluoroscopically guided tubal canalization may provide a means of differentiating a functional obstruction amenable to conservative management from true occlusion requiring management by microsurgical techniques or in vitro fertilization.

Fine-needle aspiration biopsy of cold thyroid nodules.

This study analyzes the results of fine-needle aspiration biopsy (FNAB) of hypofunctioning thyroid nodules performed by one physician. There were 68 patients (age range, 20 to 73 years) with 83 aspirations; 30 were interpreted as positive for neoplasm (adenoma or carcinoma), 43 were negative, and ten (12%) were technically unsatisfactory. Thyroidectomy was performed on 25 patients who had positive aspirates. Subsequent morphologic study showed that 13 patients had carcinomas, ten had adenomas, and two had adenomatoid nodules (false-positive rate of FNAB for neoplasms was 8%). One of three thyroidectomy patients with negative preoperative aspirates had a carcinoma and two had adenomas (estimated minimal false-negative rate of FNAB was 9%). Nineteen patients who underwent thyroidectomies had dynamic radioisotopic thyroid angiography. There was no correlation between the pattern of vascularity and the type of neoplasm. Ultrasound (US) study was performed on 17 patients. Both adenoma and carcinoma can be solid or partially cystic. Although approximately 33% of the nodules initially diagnosed by FNAB as follicular or papillary neoplasms had different interpretations on subsequent examination of thyroidectomy specimens, 93% of the patients selected to be operated on had either adenoma or carcinoma. Thus, in this series, FNAB of cold thyroid nodules gave more useful diagnostic information than nodule size, dynamic radioisotopic scan, or US studies.

Malignant fibrous histiocytoma of the pelvis.

A case of a 33-year-old Caucasian female with a malignant fibrous histiocytoma arising in the left ischiorectal fossa just under the left posterolateral vaginal wall is presented. Transvaginal simple excision of the tumor was followed by 5000 rad external beam whole pelvis irradiation and 6000 rad to the tumor bed. The patient is without evidence of disease 24 months after therapy and maintains normal vaginal function.

Porokeratosis punctata palmaris et plantaris (punctate porokeratosis). Case report and literature review.

A case of porokeratosis punctata palmaris et plantaris (punctate porokeratosis) in a 60-year-old man of Korean ancestry is reported. The patient presented with a 15-year history of numerous asymptomatic pits measuring 1 to 3 mm in diameter and having keratotic plugs irregularly distributed on the plantar aspects of both feet and on the palmar aspects of both hands, including the flexor portions of the digits. Histologic examination revealed distinct epidermal depressions containing cornoid lamellae. Six previous case reports of this unusual dermatosis are reviewed and compared to our case.

Eccrine hidrocystomas.

Little has been written about eccrine hidrocystomas since the condition was first described in 1893. This paper presents a "classic" case of this disorder, and reviews current knowledge about clinical and histologic features. New information concerning the etiology, histochemistry, and electron microscopy of eccrine hidrocystomas is presented, as well as the first description of an effective, safe, and rational method of treatment.