Malignant Sertoli cell tumor of the ovary metastatic to the lung mimicking neuroendocrine carcinoma: report of a case.

A Sertoli cell carcinoma of the ovary with lung metastases mimicking neuroendocrine carcinoma is presented. Lung metastases frequently occur. Primary and secondary tumors may exhibit similar growth patterns and differentiating primary from secondary tumors may be troublesome. This process may be more difficult when metastases occur from a tumor in which metastases are uncommon and morphologically resemble only a small portion of the primary tumor. We report the case of a 52-year-old woman who underwent resection of a 4,550-g Sertoli cell tumor of the ovary. Histologically, in addition to the characteristic tubular pattern of growth, 5% of the tumor consisted of poorly differentiated areas with tumor cells in sheets, a high mitotic rate, and areas of necrosis. Eleven months after this surgery she presented at a different institution with multiple pulmonary nodules. Microscopic examination of a subsequently resected lung nodule showed histologic findings similar to those of the poorly differentiated areas of the ovarian tumor and initial immunohistochemical studies showed positive staining for cytokeratin, neuron-specific enolase, and focal positivity for synaptophysin. Without knowledge of the ovarian tumor the lung lesion was interpreted as large-cell neuroendocrine carcinoma. On review of the clinical history and comparison with the previous surgical material, however, both tumors showed similar light microscopy and immunohistochemical reactivity, and a final diagnosis of metastatic Sertoli cell tumor was made. Immunohistochemical staining for inhibin revealed weak positivity in the poorly differentiated areas of the ovarian tumor but not in the lung metastasis. This is one of the rare reports of ovarian Sertoli cell tumor metastasizing to the lungs and it emphasizes the importance of complete clinical histories, ancillary studies, appropriate sampling, and review of archival material in such unusual cases.

American Society of Clinical Pathologists--Resident Physician Section. Results of autopsy survey (Winter 1994-1995)

The recent debate on autopsy and the role of this unique doctor-patient relationship in the modern medical profession prompted the Resident Physician Section of the American Society of Clinical Pathologists to conduct a survey on postmortem practice as it relates to pathology residents. A total of 102 of 176 (58%) Resident Physician Section (RPS) liaisons from pathology residency programs in the United States, Canada, and Puerto Rico responded to a survey that consisted of 30 questions. The findings of the survey confirm the decrease in autopsy numbers, highlighting the problem of providing sufficient autopsy training to pathology residents. Interestingly, the majority of programs showed a striking similarity with regard to basic autopsy protocol procedures. Liaisons identified incorporation of clinical pathology, basic science, and clinicopathologic interaction as areas of weakness. In the final analysis, the majority of liaisons had a favorable opinion of their autopsy experience.

Hodgkin's disease associated with chronic lymphocytic leukemia. Eight additional cases, including two of the nodular lymphocyte predominant type.

Several reports of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) and of coexisting or subsequent Hodgkin's disease (HD) have raised the question how these two disorders are related. The authors have identified eight new cases of B-cell low-grade lymphoproliferative disorders (LGLPD) and HD. Six of these cases were similar to those previously reported on by others in that the HD were mixed cellularity, nodular sclerosing, and lymphocyte depleted subtypes. The morphology in these cases was typical of HD, as was the immunohistochemical profile. However, the two remaining cases were notable in that the HD was of the nodular lymphocyte predominant type (NLPHD). To our knowledge, this association has not been well documented previously. In the two cases in this study, CLL and NLPHD were found simultaneously when each patient presented with lymphadenopathy and a lymphocytosis that was comprised of small monoclonal B lymphocytes coexpressing CD5. Lymph node biopsies in each case revealed typical NLPHD, with large, indistinct nodules containing scattered lymphocytic-histiocytic (L&H) cells. Focal, but distinct areas of CLL/SLL were also present. Immunostaining of the lymph node biopsy specimens showed the L&H cells to be CD20- and CD45 positive, and to lack CD15 or evidence of light chain restriction. In one of these patients, a NLPHD-associated large cell lymphoma developed 8 months later. The large cells were CD20- and CD45 positive, with lambda light chain restriction. In contrast, the original CLL cells in this patient expressed kappa light chains. This report indicates that LGLPD can be associated with all subtypes of HD, including the NLP type. The discordant light chain restriction between the CLL and the NLPHD-associated large cell lymphoma in one of these cases indicates that the CLL and HD were probably not derived from the same clone.

Magnetic resonance imaging of rodent tumors using radiofrequency gradient echoes.

This paper evaluates the use of radiofrequency (RF) magnetic field gradient echoes to provide contrast in magnetic resonance (MR) images of model tumors. Decay of RF gradient echoes as a function of evolution time was measured and sensitivity of the decay to changes in blood pressure was evaluated. Previous investigators have demonstrated that static field (B0) gradient echoes provide MR image contrast which is sensitive to the rate of self-diffusion of tissue water and may also be sensitive to the rate of tissue perfusion. Gradient echoes produced by RF magnetic field gradients provide a useful alternative to the conventional B0 methods. Unlike B0 gradient echoes RF gradient echoes are relatively insensitive to local magnetic susceptibility gradients and to magnetic field gradients produced by eddy currents. Differences between the two methods may be particularly significant for studies of tumors where large concentrations of deoxyhemoglobin and other paramagnetic substances may cause significant susceptibility gradients. Mammary adenocarcinomas subcutaneously implanted in the flanks of female Fisher rats were studied. Magnetic resonance experiments were performed at 2 T. A surface coil was used to provide an RF gradient and to excite and detect signals from the tumors. The decay of echo amplitude as a function of evolution time was measured and the decay at short and long evolution times was analyzed independently to calculate two apparent diffusion coefficients (ADCs). The preparation was extremely stable and the standard error for 10 consecutive measurements of gradient echo amplitude made over 30-60 min with an RF gradient strength of 50 kHz/cm, gradient duration of 1 ms (i.e., 50 cycles/cm), and echo evolution time (td) of 1 s was generally +/- 0.8%. The ADC calculated from the decay at short evolution times was approximately 3 x 10(-5) cm2/s. The ADC calculated from the decay at longer evolution times was approximately 0.5 x 10(-5) cm2/s. Both ADCs decreased immediately following sacrifice and administration of Hydralazine. The experiments demonstrate that measurements of RF gradient echo amplitudes in tumors can be made in vivo with a high degree of reproducibility and suggest that RF gradient echo amplitudes are sensitive to acute physiological changes in tumors. This method may be useful for characterization of tumors and prediction and monitoring of effects of therapeutic agents.

Bordetella bronchiseptica pneumonia in a koala.

A 3-year-old male koala (Phascolarctos cinereus) was evaluated because of severe acute respiratory distress. Despite medical treatment, the koala died. Gross and histologic lesions consistent with acute bacterial pneumonia were identified at necropsy and Bordetella bronchiseptica was isolated from pulmonary tissue. There are 2 prior reports from Australia of fatal B bronchiseptica pneumonia in captive koalas.

Menetrier's disease associated with formula protein allergy and small intestinal injury in an infant.

Menetrier's disease in infancy is extremely rare, and its natural course has not been studied in detail. The present case report describes an infant whose initial diagnosis was formula protein allergy and who developed gastric outlet obstruction by 3 months of age. The diagnosis of Menetrier's disease was suggested by characteristic radiological, pathological, and functional abnormalities of the stomach. Small intestinal partial villous atrophy, malabsorption, and protein loss from both the stomach and the intestine were documented. Cytomegalovirus infection was excluded. There was no evidence for an immune deficiency. The described features and an unrelenting course suggest that infantile Menetrier's disease may be an entity distinct from the childhood and adult forms.

Mushroom poisoning: the role of orthotopic liver transplantation.

Mushroom poisoning, mycetismus, is a well-recognized cause of fulminant hepatic failure in Western Europe and is increasingly seen in the United States. We present a case of fulminant hepatic failure secondary to mushroom poisoning treated successfully with an orthotopic liver transplant.

Globular changes in cytomegaloviral inclusions after Ganciclovir treatment.

Ganciclovir treatment induced eosinophilic intranuclear globules and loss of DNA staining in pulmonary CMV-infected cells. Nuclear capsids contained ring-shaped cores. Cytoplasmic vacuoles contained altered, enveloped, mostly coreless viral particles.

Differential enlargement of artery segments in response to enlarging atherosclerotic plaques.

We studied the relationships among intimal plaque area, lumen area, and artery size in 481 sections of the left anterior descending (LAD) coronary artery taken at four standard sampling sites in 125 pressure-perfusion-fixed postmortem adult human hearts. The internal elastic lamina area was considered to be a measure of artery size or potential lumen area. Artery size correlated strongly with intimal plaque area at each LAD level (p less than 0.0001). Stepwise regression analysis revealed that plaque area was the principal determinant of artery size at each LAD level (r2 = 0.20 to 0.33). Sections of arteries with the most intimal plaque (highest quartile) were compared with those with the least plaque (lowest quartile) at each sample site. In the proximal LAD artery, the most severely diseased arteries increased in size 62% but lumen area decreased 25%. In the midportion of the LAD artery, plaque area was 10 times greater in the most diseased arteries, but lumen area remained normal because of an 80% increase in artery size. In the most severely diseased distal LAD artery sections, despite a fourteenfold increase in plaque area, lumen area almost doubled because of a marked increase in artery size. If no enlargement had occurred, the most severely diseased arteries in the proximal LAD segment would have developed a 92% lumen stenosis rather than the observed 25% lumen stenosis. In the distal LAD artery, without enlargement there would have been a 65% lumen stenosis rather than the 85% increase in lumen area that was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Compensatory enlargement of human atherosclerotic coronary arteries.

Whether human coronary arteries undergo compensatory enlargement in the presence of coronary disease has not been clarified. We studied histologic sections of the left main coronary artery in 136 hearts obtained at autopsy to determine whether atherosclerotic human coronary arteries enlarge in relation to plaque (lesion) area and to assess whether such enlargement preserves the cross-sectional area of the lumen. The area circumscribed by the internal elastic lamina (internal elastic lamina area) was taken as a measure of the area of the arterial lumen if no plaque had been present. The internal elastic lamina area correlated directly with the area of the lesion (r = 0.44, P less than 0.001), suggesting that coronary arteries enlarge as lesion area increases. Regression analysis yielded the following equation: Internal elastic lamina area = 9.26 + 0.88 (lesion area) + 0.026 (age) + 0.005 (heart weight). The correlation coefficient for the lesion area was significant (P less than 0.001), whereas the correlation coefficients for age and heart weight were not. The lumen area did not decrease in relation to the percentage of stenosis (lesion area/internal elastic lamina area X 100) for values between zero and 40 percent but did diminish markedly and in close relation to the percentage of stenosis for values above 40 percent (r = -0.73, P less than 0.001). We conclude that human coronary arteries enlarge in relation to plaque area and that functionally important lumen stenosis may be delayed until the lesion occupies 40 percent of the internal elastic lamina area. The preservation of a nearly normal lumen cross-sectional area despite the presence of a large plaque should be taken into account in evaluating atherosclerotic disease with use of coronary angiography.

Hexachlorobenzene in human milk: a polyhalogenated risk.

Hexachlorobenzene (HCB) produces a spectrum of biological and toxic conditions that are characteristic of polyhalogenated aromatic compounds. In humans, HCB is easily absorbed through the lymphatic system to accumulate in fat tissues, and persists for many years since it is highly lipophilic and resistant to metabolic conditions. With a view to assessing the HCB risk to humans, human exposure was measured in milk fat. A hundred individual milk samples were collected, 99 of which contained HCB. The mean HCB concentration on a fat basis was 0.08 ppm (range 0.01-0.70 ppm). Most samples contained less than 0.1 ppm HCB, 11% contained 0.1-0.2 ppm and two samples greater than 0.2 ppm. The results obtained were compared with surveys carried out in other countries, and were correlated with levels of polychlorinated biphenyls because these compounds resemble HCB in their source of contamination, absorption, metabolism, fat affinity and toxicological spectrum. There is a need to develop comparative approaches which consider the effects of a single compound against the whole spectrum of likely contaminants, to take account of the possibility of joint action leading to additive or synergistic effects. Further studies are needed on the toxicological effects of polyhalogenated compounds in human milk, since these compounds will be present in the body for many decades and reach infants at an early stage through placental transfer and breast-feeding.