Cured Multiple Myeloma Followed by Primary Malignant Lymphoma of the Lung.

A 56-year-old patient was found to have smouldering myeloma which remained asymptomatic and untreated for 13 years. Localised osteolytic lesions then appeared, which responded to local irradiation. Six years later, an increased serum M-protein became evident (IgG$LD, 3 gr/dl) associated with 35% plasma cells in the bone marrow, which necessitated melphalan/prednisone therapy. A prolonged complete remission was achieved lasting 6 years. Thereafter, the patient developed a myelodysplastic syndrome with leukopenia and refractory anemia and he finally died of pulmonary disease. Autopsy revealed extensive thoracic involvement by a primary malignant lymphoma of the lungs (IgMK) with no evidence of myeloma. Such a long follow-up with subsequent cure is rare in multiple myeloma as is the appearance of a second B cell malignancy, which may either be associated with the myeloma and/or chemotherapy given, or a coincidental occurrence.

Granulomatous reaction in lymph nodes draining laryngeal carcinoma.

Presented are two cases of simultaneous occurrence of epithelioid granulomas and metastatic squamous cell carcinoma in cervical lymph nodes draining supraglottic carcinoma. Laboratory tests and radiological and clinical findings ruled out sarcoidosis, as well as mycotic, mycobacterial, or other bacterial infection. Upon finding of epithelioid granulomas in cervical lymph nodes, a malignant tumor of the head and neck region should be considered as a differential diagnostic possibility. Uncritical acceptance of a diagnosis based solely on the histological appearance may lead to erroneous treatment.

Tuberculoid cornstarch granulomas with caseous necrosis. A diagnostic challenge.

We studied a patient in whom peritoneal granulomas developed with caseous-type necrosis after exposure to cornstarch from surgical gloves. This necrotizing type of lesion, which is the least common among cornstarch granulomas, can simulate tuberculous infection and lead to initiation of antituberculous therapy. A review of the literature suggests that there are two basic types of cornstarch granulomas: the phagocytic, foreign body type, and the tuberculoid granuloma with and without central necrosis. The morphologic features and possible mechanism of formation of these types of granulomas are being discussed. Although the cornstarch particles can be identified with a variety of stains, the most reliable method is that of examination with polarized light, which is recommended in all cases of granulomas, especially abdominal ones.

A limited form of Churg-Strauss syndrome: ocular and cutaneous manifestations.

A case that supports the concept of a limited form of Churg-Strauss allergic granulomatosis was studied. The patient had a syndrome that was initially confined to the conjunctiva and subsequently displayed cutaneous and subcutaneous lesions. At no time was there any evidence of systemic involvement. Asthma appeared ten years before the onset of the present disease. The characteristic histologic findings consisted of diffuse tissue eosinophilia, and eosinophilic necrotizing and nonnecrotizing granulomatosis. The last, as well as conjunctival involvement, has not been previously described in Churg-Strauss syndrome to our knowledge. Thus, this entity most likely represents a variant of the classic Churg-Strauss syndrome, lacking the multiple organ system involvement that occurs in the latter. The patient responded well to therapy with corticosteroids and as of this writing has been free of disease for about 2 1/2 years.

Lupus-like syndrome in a mother and newborn following administration of hydralazine; a case report.

A very-low-birth-weight infant died from pericardial effusion and cardiac tamponade confirmed by the post-mortem findings. The mother suffered from lupus-like syndrome consequent to hydralazine treatment for pregnancy-induced hypertension. The possible relationship between mother-infant pathology and hydralazine administration is discussed.

Primary squamous cell carcinoma of the pilonidal area.

Two patients with primary squamous cell carcinoma of the pilonidal area are presented. No chronic infection or any other lesion predisposing to malignant transformation was present in either patient. Physicians and surgeons should be aware of the possibility of skin cancer appearing in this area in elderly patients. Biopsy of the lesion, leading to an early diagnosis, may prompt surgical treatment. Complete excision of the lesion is a prerequisite for cure.

Subcutaneous fat necrosis of the newborn.

A case of subcutaneous fat necrosis of the newborn is described. Severe perinatal asphyxia preceded the appearance of the skin lesions. Premature rupture of membranes and the presence of foul-smelling meconium raised the possibility of infection by anaerobes as an additional etiologic factor. The main hypotheses concerning the cause and pathogenesis of this condition are reviewed. The alarming clinical picture that stands in sharp contrast to the benign prognosis is stressed.

Noma in a full-term neonate.

Noma is an uncommon gangrenous process usually affecting malnourished children. A full-term neonate with orofacial noma, bilateral choanal atresia, and transient neutropenia with B cell deficiency is reported. This unusual appearance of noma in a well-nourished newborn might be related to the combination of choanal atresia and transient immune deficiency.

[Brucella infection of the testis mimicking malignancy].

A testicular mass is a diagnostic challenge, as it may include both benign and malignant processes. Due to the difficulty in diagnosis and the need to prevent complications, it is sometimes necessary to perform orchiectomy. We present an unusual case of brucellosis in which the presenting features were persistent cough for 6 months and a right testicular mass. The clinical picture and ultrasound findings suggested malignancy. Orchiectomy and medical treatment resulted in rapid resolution of symptoms.

Skin petechiae and ecchymoses (vasculitis) due to anticoagulant therapy.

The appearance of petechiae and ecchymoses following anticoagulant and fibrinolytic therapy is an unusual and rare complication. The mechanism of the vasculitis is obscure but may be related to a chemical vasotoxic reaction. During anticoagulant and fibrinolytic therapy, 6 patients developed petechiae and ecchymoses which was accompanied by pain and fever. There were no disturbances of blood clotting factors. In spite of the varied action of the different anticoagulants and fibrinolytic drugs, the clinical course and the histological examination demonstrated a similar identical vasculitis.

Crohn's ileitis complicated by amyloidosis: observations and therapeutic considerations.

We present a patient with clinically asymptomatic amyloidosis associated with Crohn's ileitis. A distinction should be made between immunocytic dyscrasia associated with amyloidosis (formerly primary or myeloma-associated amyloidosis) and acquired systemic amyloidosis (formerly secondary amyloidosis). We compare the natural course of amyloidosis complicating Crohn's disease with these complicating familial Mediterranean fever (FMF), and discuss the role of resection and the rationale behind colchicine therapy. Our patient is the first reported case in which colchicine therapy alone has been successful in the prophylactic treatment of amyloidosis complicating Crohn's ileitis.

Production of the hydroxylated metabolites of vitamin D in a neonate with a single hypoplastic-dysplastic kidney.

The ability to produce dihydroxylated metabolites of vitamin D was studied in a term neonate suffering from severe renal insufficiency. The infant died at age 26 days owing to end-stage renal failure and the necropsy examination showed a single dysplastic kidney weighing 1.5 g. At age 2 weeks the serum levels of the dihydroxylated metabolites of vitamin D were found to be normal and a pronounced increase was noted 24 hours after injection of 100 000 IU vitamin D2. The study suggests that during the neonatal period a small renal mass is sufficient to maintain optimal circulating levels of the dihydroxylated metabolites of vitamin D.

Isolated necrosis of the tubal fimbriae in a prepubertal girl.

A report of haemorrhagic necrosis of the tubal fimbriae in a prepubertal girl is presented. The presumptive aetiology for this is the isolated torsion of the fimbrial end which, to the best of our knowledge, has not been previously described. A high index of suspicion of torsion and early intervention is emphasised. Laparoscopy should usually precede laparotomy in doubtful cases but during laparotomy as little as possible should be done in order to retain future fertility.

Retroperitoneal fibrosis in association with urothelial tumor.

One of the less common associations of retroperitoneal fibrosis is malignancy. Although there have been many reports on tumors associated with retroperitoneal fibrosis urothelial tumors are rare. We report a case of retroperitoneal fibrosis and urothelial malignancy of the renal pelvis.

An unusual presentation of adenoid cystic carcinoma of the lacrimal gland.

Adenoid cystic carcinoma of the lacrimal gland is a highly malignant tumor usually characterized by symptoms of less than 1 year's duration. Computed tomographic (CT) findings of adjacent bony erosion or focal tumor sclerosis are also suggestive. We present a 57-year-old female patient who manifested symptoms of an enlarging mass in the right lacrimal fossa for almost 3 years prior to the establishment of the diagnosis of adenoid cystic carcinoma. CT findings during those years were not supportive for malignancy. The treatment included en bloc resection of the mass and adjacent bone and radiotherapy.