Amyloidosis and systemic lupus erythematosus.

A 59 year old man with systemic lupus erythematosus developed proteinuria and renal insufficiency. Renal biopsy revealed both crescentic glomerulonephritis and amyloid in glomeruli and blood vessels. The amyloid was characterized as secondary because of its sensitivity to potassium permanganate pretreatment of Congo red stained sections. Amyloidosis is very uncommon in systemic lupus erythematosus but may be a cause of steroid unresponsive proteinuria and renal insufficiency.

Clival chordoma presenting with acute brain stem hemorrhage.

The authors present a case of a 29-year-old man who developed rapidly progressive cranial nerve palsies and a right hemiparesis secondary to a pontine hemorrhage. The rare but correct diagnosis of a clival chordoma which had invaded the brain stem and subsequently hemorrhaged was based on computed tomography and magnetic resonance imaging. The diagnosis was confirmed at surgery when the patient underwent a successful operative decompression of tumor and clot from the pons via a sub-occipital craniotomy. This represents the first case of a clival chordoma to hemorrhage into the brain stem, which was diagnosed preoperatively and the patient survived.

Tubular adenoma of breast.

A recent classification of adenomas of the breast included tubular adenoma. This uncommon lesion can be distinguished from fibroadenoma by the predominance of epithelium and relative lack of stroma. This is, to our knowledge, the first report of a tubular adenoma studied by aspiration cytology as well as light and electron microscopy. A 4-cm, slightly tender mass was found in the upper outer quadrant of the breast of a 26-year-old woman. Aspiration cytology showed abundant epithelial fragments, similar to those seen in fibroadenoma, but without the spindle cell component often seen in aspirates of that lesion. Light microscopic study of the excised mass showed a well-demarcated tumor of tubular glands and scanty stroma. By electron microscopy, the epithelial stromal junction was intact. This contrasts with the findings in fibroadenoma, and confirms that this difference can distinguish these lesions.

Filariasis of the breast.

Filariasis of the breast is usually seen in endemic areas. Involvement may, however, present years after leaving an endemic area and be associated with circulating microfilariae. We describe the findings in a woman who developed a breast mass three years after a visit to her native India.

Preoperative liver biopsy and survival after portasystemic shunting.

The value of preoperative liver biopsy in predicting the outcome of portasystemic shunting was investigated. Using coded slides, the authors examined liver biopsy specimens from 41 patients with alcoholic cirrhosis who underwent portasystemic shunting. The degree of fatty change, alcoholic hyalin, alcoholic hepatitis, central hyalin sclerosis and the activity and severity of the cirrhosis were assessed and possible correlations were noted with the preoperative Child's classification, postoperative encephalopathy and with early and late mortality. A correlation was found between the presence of alcoholic hyalin in more than 10% of hepatocytes and early mortality; all of the six patients who died within 30 days of operation had this finding in the liver biopsy specimen. Early mortality correlated better with alcoholic hyalin than with the Child's classification. There was some correlation between late mortality and the degree of hyalin sclerosis and with the activity and severity of cirrhosis. The authors conclude that the findings of a liver biopsy done preoperatively are valuable in indicating prognosis and operative mortality in alcoholic cirrhosis.