Congenital blood cysts of the heart valves.

Congenital blood cysts of the heart valves are found most commonly on the tricuspid and mitral valves of fetuses and infants. Hearts available following 38 random autopsies of fetuses and infants 2 years of age or younger were examined. Blood cysts were found in 18 cases (47 per cent) in which ages ranged from 26 weeks of gestation to 11 months. The cysts varied in diameter, from microscopic to 3 mm. Affected valves had from one to 20 cysts. Light microscopic examination of serially sectioned paraffin-embedded tissue and plastic-embedded tissue and scanning electron microscopic examination revealed connections between the cyst lumens and ventricles via small endothelium-lined channels. The cyst structure suggested formation from ventricular endothelial infoldings in the valve leaflet base, which bulged into the atrium because of the pressure gradient present during valve closure. Blood cysts are a common finding in neonates dying of various causes and probably have no clinical significance. There is no association with asphyxia as previously described. Blood cysts may persist and enlarge to form giant cysts of the heart valves.

Histochemical and ultrastructural features of an unusual pulmonary carcinosarcoma.

An autopsy case is presented in which a pulmonary carcinosarcoma filled the left chest of a 61 year old man. The extensive pleural involvement that this neoplasm exhibited has not been reported previously. By light microscopy the neoplasm initially was considered a mesothelioma because of the pattern of glands and undifferentiated sarcomatous stroma. However, by electron microscopy the sarcomatous component was found to show rhabdomyoblastic differentiation. Neither histochemical stains nor electron microscopy supported a mesothelial origin for the glandular component. Differential diagnostic considerations of pleuropulmonary neoplasms showing rhabdomyosarcomatous differentiation are discussed. This case illustrates the importance of detailed study in order to characterize and properly classify these neoplasms.

Ribosome-lamellae complexes in benign plasma cells accompanying neoplastic infiltrates.

Two examples of ribosome-lamellae complexes (RLCs) occurring in benign plasma cells are presented. These were seen utilizing transmission electron microscopy in a case of mycosis fungoides in skin and a fibrosarcoma of a lower extremity. In both cases the accompanying plasmacytic infiltrate was interpreted as reactive and not malignant. Once thought to be a specific marker for hairy cell leukemia, RLCs now have been described in a wide variety of neoplastic diseases (mostly hematologic) and in a few examples of nonneoplastic conditions. RLCs have not been described previously in benign plasma cells. A review of the literature with respect to occurrence and significance of RLCs is presented.

Fine-needle aspiration biopsy of pulmonary coccidiodomycosis. Spectrum of cytologic findings in 73 patients.

Coccidioides immitis, the causal agent of coccidiodomycosis, is endemic in the arid desert regions of Mexico and the southwestern United States. Individuals may acquire the disease through the inhalation of conidia. The majority of infected patients are asymptomatic or exhibit flu-like symptoms. Two percent of infected individuals ultimately demonstrate a solitary pulmonary nodule that may be radiographically indistinguishable from neoplasms or other infectious lesions. This report describes the spectrum of cytologic findings in 73 patients who were diagnosed with pulmonary coccidiodomycosis by fine-needle aspiration (FNA) biopsy. The patients ranged in age from 30 to 92 years. Ten had a previous history of malignancy. The smears were characterized by a large amount of granular, eosinophilic debris with a paucity of acute or chronic inflammation. Granulomatous inflammation was present in only three cases. The diagnosis was confirmed by the cytologic observation of C. immitis spherules that ranged in size from approximately 20 to 200 microns. Many of these spherules had a crushed or fractured appearance, and occasional calcified forms were seen. Endospores were observed in intact spherules and were rarely observed outside these spherules. Mycelial elements occasionally were present. C. immitis were cultured in 9 of 44 cases in which fungal cultures were obtained. The cytologic differential diagnosis, which includes contaminant, other infectious diseases and malignancies, is discussed.

Ochronosislike pigmentation from hydroquinone bleaching creams in American blacks.

Two patients had pitch-black pigmentation and colloid milium formation following the use of 2% hydroquinone-containing bleaching creams. These are among the first known cases in American blacks, although this phenomenon has been recognized previously in African blacks. Ultrastructural studies indicated that the pigment was due to the formation of elastotic fibers. These fibers attained an enormous size and disintegrated, leaving irregular fibers and fragments dispersed in the dermis. It is important that this clinical picture be recognized, since the use of these bleaching creams is widespread.

Nerve invasion by benign proliferating ductules in vasitis nodosa.

Vasitis nodosa is a benign reactive condition characterized by nodular thickening of the vas deferens which usually develops following vasectomy. In addition to chronic inflammation, fibrosis and sperm granulomas, an exuberant proliferation of ductules resembling invasive adenocarcinoma is seen. A review of vasa deferentia from 210 patients submitted to the surgical pathology service at Arizona Health Sciences Center yielded ten cases of vasitis nodosa. In two of these cases ductular epithelium was found within the endoneurium of small nerve fascicles. Two additional cases were referred to us, one of these showing ductular epithelium around a small peripheral nerve. The aggressive and infiltrative nature of the proliferating ductules in this relatively common benign lesion is important to recognize. Since nerve involvement has also been reported in fibrocystic disease of the breast, normal and hyperplastic prostate, and normal pancreas, it cannot be used as evidence for malignancy in these situations.