False negative hepatitis B surface antigen detection in dialysis patients due to excess surface antigen: postzone phenomenon.

Renal dialysis patients are well known to have a high incidence of hepatitis B carrier state. In studying a group of 63 long-term dialysis patients, 10 were found to be positive for hepatitis B surface antigen by radioimmunoassay (RIA). Surprisingly, however, only three of these RIA positive patients were positive by counter immunoelectrophoresis (CIEP). The discrepancy could not be accounted for by the difference in sensitivity of the two methods. The cause for the negative reactions by CIEP in seven patients was found to be the marked excess surface antigen in these sera which produced false negative results by the postzone phenomenon. After dilution all seven sera were positive by CIEP, requiring a dilution up to 1/20 to produce a positive result. Also, all seven sera were positive by the less sensitive Ouchterlony double diffusion.

Inverted papilloma of bladder.

The fifth reported case of a rare variant of transitional papillary tumor of the bladder termed inverted papilloma is reported with a brief review of the literature. This tumor is likely to be confused with invasive malignant papillary carcinoma although it has adistinct histologic pattern, and it is for this reason that attention is drawn to the entity.

Umbilical metastasis from prostatic carcinoma--Sister Joseph nodule.

A case of umbilical metastasis from prostatic carcinoma is presented. This diagnosis was supported by positive prostate specific antigen immunoperoxidase staining. Umbilical metastasis is usually associated with other types of tumors and has a grave prognosis.

Late occurrence of malignancy following resection of a histologically mature sacrococcygeal teratoma. Report of a case and literature review.

A sacrococcygeal adenocarcinoma is reported in a male patient nearly 40 years old following resection of a histologically mature sacrococcygeal teratoma. The adenocarcinoma arose within soft tissue of the presacral area and residual coccyx and extensively invaded the coccygeal stump that had not been removed in toto with the teratoma during initial surgery at 2 months of age. The patient died nearly 2 years later with local and regional recurrence of tumor and metastases to lymph nodes, liver, lung, bone, and brain. At autopsy there was no evidence of origin from deep internal organs such as the stomach, pancreas, or other sites. Brief comments are made about malignant tumors complicating sacrococcygeal teratomas in both the pediatric age group and adults, and attention is focused on other lesions entering into the differential diagnosis, particularly retrorectal cyst/hamartoma or tailgut cysts. This case underscores an extremely rare but potentially fatal outcome of a patient with sacrococcygeal teratoma.

Epitheloid sarcoma masquerading as Peyronie's disease.

A 23-year-old man presented witha firm plague-like penile mass with pain and deviationon erection, suggesting Peyronie's disease. Biopsy was erroneously interpreted asconformatory. Irradiation was the one mode of therapy which gave temporary subjective relief. Extension of the mass and focal gangrene led to rebiopsy 6 years later. Epithelioid sarcoma was present microscopically, and was also found on re-examination of theoriginal biopsy. Partial penectomy was performed, but pulmonary metastasis had alreadyoccurred. He was treated with chemotherapy and radiotherapy and is now alive with disease 2 years later. The diagnosis of possible penile sarcoma, although rare, must be considered in patients with symptons suggesting Peyronie's disease, especially if the lesion continues to enlarge.

Inherited hemolytic uremic syndrome in adults.

Familial hemolytic uremic syndrome (HUS) in children may be due to environmental factors or may be an inherited trait, usually with autosomal recessive inheritance. Familial HUS in adults is less well described, and can be associated with autosomal recessive or dominant inheritance. We report a family with autosomal dominant inheritance of HUS. The proband was an adult male. His adult sister developed HUS while taking oral contraceptives, and their mother developed HUS during the third trimester of pregnancy. The prognosis for these patients is poor. Pregnancy and oral contraceptive use may be risk factors for development of HUS in adult women with a family history of HUS or the related disorder thrombotic thrombocytopenic purpura (TTP).

Eosinophilic gastroenteritis.

A 4-month-old boy presented with signs of intermittent pyloric obstruction. Peripheral eosinophilia, along with radiographs showing antral-pyloric and duodenal narrowing, suggested the diagnosis of eosinophilic gastroenteritis. A brief discussion of the disease process follows.