Adenocarcinoma and (extragonadal) choriocarcinoma of the gallbladder in a young woman.

This study represents the second case of coexisting adenocarcinoma and choriocarcinoma of the gallbladder reported in the English language medical literature, and the first such case documented by: (1) positive immunostaining of tumor cells for the beta subunit of human chorionic gonadotrophin, and (2) evidence of gonadotrophin secretion in blood and urine. The patient reported herein survived only 1 month following diagnosis, and exemplifies the reportedly lethal behavior of extragonadal choriocarcinoma.

Mesangial IgG in childhood minimal change disease: clinical relevance.

The clinical courses of five children with the nephrotic syndrome and renal biopsies diagnosed as minimal change disease (MCD) by light microscopy but with mesangial immune deposits of IgG (> or = 2+) and no dominant or codominant IgA were reviewed retrospectively to determine if the presence of significant mesangial deposits of IgG has prognostic implications and to evaluate the treatment these patients received. All five of the children were steroid dependent or resistant initially, and four received cyclosporine or cytotoxic agents later. After a mean follow-up period of 2.9 years for four and 20 years for one, all are in remission. All have normal renal function with no hypertension. These results suggest that the deposition of IgG in the mesangium of biopsies from patients with MCD by light microscopy may predict a more difficult course initially and may require more aggressive treatment to achieve permanent remission.

Neuropathology of two fatal cases of measles in the 1988-1989 Houston epidemic.

The clinical course and autopsy findings of 2 patients with measles encephalitis that occurred during the 1988-1989 Houston epidemic are reported. A previously healthy 25-month-old boy had serologically-proved measles, hemophagocytic syndrome, and acute disseminated demyelinating encephalitis. A 19-year-old male with acute lymphocytic leukemia had proved measles pneumonia and acute hemorrhagic leukoencephalitis. These patients represent a broad spectrum of measles-induced immunopathic complications of the central nervous system.

Heart allograft involvement with Epstein-Barr virus-associated posttransplant lymphoproliferative disorder.

We describe a 60-year-old man who underwent heart transplant and died 5 months later. At autopsy, the patient was found to have posttransplant lymphoproliferative disorder (PTLD), which was not suspected ante mortem. The PTLD involved the lung, lymph nodes, spleen, and kidney and the intima of right coronary artery of the transplanted heart. Epstein-Barr virus infection was demonstrated on direct gel and dot blot after polymerase chain reaction amplification. In situ hybridization for Epstein-Barr virus DNA confirmed the presence of Epstein-Barr virus-infected lymphocytes in the intima of the right coronary artery of the cardiac allograft. To our knowledge, this case represents the first report of involvement of a heart allograft by PTLD in which Epstein-Barr virus infection of the atypical cells is documented. Although primary allograft involvement by PTLD has rarely been reported in heart transplant recipients, recognition that this may occur is important, since the lymphoid infiltrate of PTLD must be distinguished from the lymphoid infiltrate of acute rejection to avoid inappropriate therapy.

Fine-needle aspiration of triton tumor: morphology, immunohistochemistry, electron microscopy, and cell image analysis.

A single a case of malignant triton tumor, presented as a neck mass in a 34 year old female diagnosed solely by fine needle aspiration, is reported. The diagnosis was supported by immunohistochemical staining and electron microscopic examination that showed evidence of both schwannian and rhabdomyoblastic differentiation. Cell image analysis was also performed on the case and showed an aneuploid peak with a DNA index of 1.7. Diagnosing rare tumors with fine needle aspiration is feasible; particularly with the help of ancillary studies.

Prognostic factors in bronchoalveolar lavage in 77 patients with bone marrow transplants.

OBJECTIVE: To study the prognostic implications of the following factors in bronchoalveolar lavage (BAL) specimens in bone marrow transplant (BMT) patients: number of lymphocytes per high-power field (HPF), presence of hemosiderin-laden macrophages (HLMs), presence of infections and presence of reactive epithelial cellular changes in bronchial and alveolar cells. STUDY DESIGN: A retrospective study of 77 bone marrow transplant patients who required BAL. Each specimen was studied for the number of lymphocytes per HPF, presence of HLMs, presence of infection and presence of reactive epithelial cells. RESULTS: Patients who had < or = 5 lymphocytes per HPF had a much higher death rate than did patients who had > 5 lymphocytes per HPF (P < .001). Eighty-nine percent of patients who had < or = 5 lymphocytes per HPF died within 30 days of undergoing BAL (P < .001). Patients without HLMs had a better prognosis than did patients with HLMs (P < .005). Thirty-six documented viral or fungal infections occurred in 33 patients. Patients with infections had a greater chance of dying than did those who were infection free (P < .05). Multiple logistic regression analysis showed that the previous three factors are statistically significant. Reactive epithelial cellular changes were seen primarily in patients with autologous BMT (11 of 14 cases) and in those with hematologic malignancies, but they had no statistical significance prognostically. CONCLUSION: The following factors in BAL have a good prognostic value: number of lymphocytes > 5 per HPF, absence of HLMs and absence of infections. Reactive epithelial cellular changes have no prognostic value.

Symptomatic, endoscopic and histological assessment of upper gastrointestinal tract in renal transplant recipients.

AIM: To assess the prevalence of gastrointestinal symptoms, endoscopic findings, and histological abnormalities in renal transplant recipients. SETTING: Teaching hospital in northern Jordan. METHODS: Seventy-six renal transplant recipients with stable renal function were interviewed for gastrointestinal symptoms, and underwent upper gastrointestinal endoscopy; gastric antral biopsies were evaluated for inflammatory changes and the presence of Helicobacter pylori. One hundred consecutive patients attending the general medical outpatient for various medical problems served as controls; 41 of them consented to undergo endoscopy and biopsy examination. RESULTS: Upper gastrointestinal symptoms were present in 50% of patients compared to 47% of controls (p=0.80). Endoscopic abnormalities were found in 71% versus 63.4%. One patient in each group had duodenal ulcer. H. pylori were found in 60.5% versus 46.3% (p=0.20), and histological gastritis in 40 (52.6%) with acute inflammatory changes in 22 (28.9%), compared to 21 (51.2%) and 15 (36.6%) controls, respectively. Monilial and cytomegalovirus esophagitis were found in 2 (2.6%) and one patient, respectively. CONCLUSIONS: Prevalence of gastrointestinal symptoms and endoscopic and histological findings in stable renal transplant recipients are similar to those in controls. Also, there was no increase in opportunistic infections of the gastrointestinal tract or of gastric H. pylori in these patients.

Compositional correlation and anticorrelation in quaternary alloys: competition between bulk thermodynamics and surface kinetics.

We analyze the atomistic mechanisms driving the compositional correlation of In and N in the quaternary Inx Ga1-xAs1-yNy alloys combining atomic scale chemical analysis in transmission electron microscopy and density-functional theory calculations. Our results show that for typical growth conditions surface kinetics prevail over bulk thermodynamics resulting in a hitherto unexpected compositional anticorrelation between In and N.

Isolated vasculitis involving the female genital tract: clinicopathologic spectrum and phenotyping of inflammatory cells.

Isolated vasculitis involving the female genital tract (IVF) is rare. Although both giant cell arteritis (GCA) and polyarteritis nodosa (PAN) types of involvement have been documented, several clinicopathologic features of IVF are not clearly understood. We wish to report two cases of IVF (one GCA and one PAN) and compare them with previously reported cases. Including our two cases, we found a total of 33 reported cases of IVF, which included 18 GCA and 15 PAN. In cases of GCA, all parts of the female genital tract were involved with roughly comparable frequency, whereas in the case of PAN, the cervix is uniformly involved, with the vulva and myometrium being affected once and twice, respectively. In all cases of GCA and most cases of PAN, the vasculitis represented an incidental finding upon microscopic examination of the female genital tract removed for unrelated problems; however, in one case of PAN, vaginal bleeding probably related to vasculitis-induced cervical ulcer was reported. In either category, no clearcut pattern of predisposing factors was identified and, at the time of diagnosis, none of the patients had any diseases known to be associated with vasculitis, such as connective tissue disease, rheumatoid arthritis, or drug hypersensitivity. Although antineutrophilic cytoplasmic antibodies were recently described as sensitive and specific markers for systemic vasculitis, tests for these antibodies were not done on previously reported cases and were negative for both current cases. Long-term follow-up in IVF indicates that even without any specific treatment for vasculitis, systemic involvement did not occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Tumors of smooth-muscle origin in HIV-infected children.

We report the occurrence of multiple leiomyomata and leiomyosarcomata in three children with the acquired immunodeficiency syndrome. The children were infected with human immunodeficiency virus as infants (one perinatally and two through transfusions) and each was profoundly immunosuppressed (absolute CD4 cell count, less than 75/mm3). They experienced multiple infections prior to the diagnosis of neoplasms at ages 4, 5, and 8 years, respectively. The tumors in each case were mainly involving the lungs and gastrointestinal tract. The smooth-muscle origin of the tumors was proved by light and electron microscopy and immunohistochemical staining for muscle-specific actin and desmin. Leiomyomata and leiomyosarcomata are rare tumors in childhood, suggesting a nonrandom association of tumors of smooth-muscle origin and the acquired immunodeficiency syndrome. We postulate that human immunodeficiency virus infection may play a direct or indirect role in tumor formation.

Symptomatic, endoscopic and histological assessment of upper gastrointestinal tract in renal transplant recipients.

AIM: To assess the prevalence of gastrointestinal symptoms, endoscopic findings, and histological abnormalities in renal transplant recipients. SETTING: Teaching hospital in northern Jordan. METHODS: Seventy-six renal transplant recipients with stable renal function were interviewed for gastrointestinal symptoms, and underwent upper gastrointestinal endoscopy; gastric antral biopsies were evaluated for inflammatory changes and the presence of Helicobacter pylori. One hundred consecutive patients attending the general medical outpatient for various medical problems served as controls; 41 of them consented to undergo endoscopy and biopsy examination. RESULTS: Upper gastrointestinal symptoms were present in 50% of patients compared to 47% of controls (p=0.80). Endoscopic abnormalities were found in 71% versus 63.4%. One patient in each group had duodenal ulcer. H. pylori were found in 60.5% versus 46.3% (p=0.20), and histological gastritis in 40 (52.6%) with acute inflammatory changes in 22 (28.9%), compared to 21 (51.2%) and 15 (36.6%) controls, respectively. Monilial and cytomegalovirus esophagitis were found in 2 (2.6%) and one patient, respectively. CONCLUSIONS: Prevalence of gastrointestinal symptoms and endoscopic and histological findings in stable renal transplant recipients are similar to those in controls. Also, there was no increase in opportunistic infections of the gastrointestinal tract or of gastric H. pylori in these patients.