Animal-type melanoma: report of five cases with sentinel node biopsy and fluorescence in-situ hybridization analysis.

Animal-type melanoma (ATM) is a rare tumor, characterized histologically by a predominantly dermal proliferation of heavily pigmented epithelioid and spindle dendritic melanocytes. Five patients with ATM, who had undergone sentinel node biopsy, were studied: three male and two female, between 4 and 62 years of age (mean, 28.0). Lesion size ranged from 4 to 18 mm and thickness from 0.7 to 5.1 mm. Nodal deposits were found in three patients. Of the patients with positive sentinel nodes, the first showed a minimal nodal involvement in one node, the second multiple deposits in one node, and the third multiple deposits in one sentinel node and a single deposit in another; this last patient also had additional tumor deposits in a nonsentinel regional node. Fluorescence in-situ hybridization tumor analysis proved negative in all cases. All patients are alive and free of disease at 36-95-month follow-up (mean, 53 months). Results showed ATM as a neoplasm characterized by a somewhat high rate of lymph node involvement but relatively low rate of visceral metastases and mortality, appearing as a low-grade malignant tumor.

Pathology of the thoracic aorta: a morphologic review of 338 surgical specimens over a 7-year period.

A total of 338 surgical specimens of the thoracic aorta were studied morphologically. These were obtained from patients (238 males, 100 females) operated on for aortic aneurysm or dissection at the Careggi Hospital, Florence, Italy, between January 1999 and June 2005. Medial degeneration was diagnosed in 299 cases (138 aneurysms, 161 dissections), atherosclerosis with extensive medial destruction was seen in 32 cases (26 aneurysms, 6 dissections), and giant cell arteritis (GCA) was found in 7 cases (all aneurysms). These data show that medial degeneration was a common nonspecific histologic diagnosis in aortic resection after the occurrence of aneurysm or dissection. Considering that this diagnosis was made in as many as 118 patients over 70 years of age and in 175 patients over 65, normal advancing age would appear as the most frequent correlation with these aortic events. Ageing is also associated with the increasing number of cases of GCA with aortic involvement. Angiogenesis, always observed next to areas of medial damage whatever the underlying pathology, may contribute to the pathogenesis of aortic dissection and aneurysm.

Malignant fibrous histiocytoma as a primary cardiac tumor.

We describe the case of a malignant fibrous histiocytoma (MFH) of the heart, presenting with an obstinate cough and clinically misdiagnosed as myxoma, in an 80-year-old woman. Fourteen months after surgical removal, an embolic episode revealed recurrence of the tumor. To plan the best surgical management, MFH, rare as it is, should be borne in mind when evaluating a cardiac intracavitary mass, especially if located in the left atrium.

Annuloaortic ectasia and giant cell arteritis.

BACKGROUND: Thoracic aortic aneurysm, aortic dissection and aortic valve regurgitation have been widely described in patients with Horton disease, also known as giant cell arteritis. We present our midterm experience with patients with these features. METHODS: A total of 386 cases of ascending aorta and aortic valve replacement performed for thoracic aortic aneurysm and aortic insufficiency between 1998 and 2004 were reviewed. Among them 10 cases of histopathologically confirmed GAA were identified. Patients were predominantly female (90%); the mean age was 74.5 +/- 4.6 years. RESULTS: Eight patients (80%) showed typical annuloaortic ectasia, leading to significant aortic valve regurgitation. These subjects underwent a Bentall operation. Two patients whose sinuses seemed undilated and macroscopically normal had separate valve graft replacement at first operation and underwent reoperation due to dilatation of the native sinuses. Eight patients had partial aortic arch replacement (hemiarch), and 1 underwent total arch replacement. Six-year survival was 0.9 +/- 0.09; freedom from reoperation at 6 years was 0.77 +/- 0.13. CONCLUSIONS: Annuloaortic ectasia is a common finding in giant cell arteritis. In patients with Horton disease, the aortic root should always be replaced regardless of macroscopic findings.

Isolated inflammatory aneurysm of superior mesenteric artery: unexpected pathologic diagnosis.

A 78-year-old woman was admitted to our department because of the incidental finding during routine abdominal ultrasound examination of a large aneurysm of the superior mesenteric artery. Presence of the aneurysm was confirmed at computed tomography and digital subtraction angiography, but its inflammatory origin was not recognized. No other aneurysm localization was found. Macroscopic intraoperative findings suggested the inflammatory nature of the lesion, but only histopathologic examination was diagnostic. Aneurismorraphy with prosthetic in-line reconstruction was performed. This report presents the previously undescribed possibility of an isolated inflammatory aneurysm of the superior mesenteric artery.

Constrictive pericarditis associated with hydrops fetalis.

We report a rare case of constrictive pericarditis coexistent with a unique heart malformation in a fetus. Cardiac abnormalities, possibly due to a transplacental viral infection, were responsible for severe hydrops fetalis.

Giant cell arteritis presenting with annuloaortic ectasia.

Four cases of giant cell arteritis causing severe aortic regurgitation secondary to an aneurysm of the ascending aorta are described. In two cases, the nature of the aortic pathology could be suspected considering the past clinical evidence of temporal arteritis and/or polymyalgia rheumatica. In the two other cases, the cardiothoracic manifestations represented the onset of Horton disease.

Secundum atrial septal defect and pulmonary hypertension in an 86-year-old woman: a case report and review of the literature.

A case of well tolerated secundum atrial septal defect in a woman who died at 86 years of age is described and the lesions responsible for pulmonary hypertension are discussed. Previous reports of over-70-year-old patients with untreated secundum atrial septal defect are also reviewed.