Benign cystic mesothelioma of the peritoneum in a male child.

The benign cystic mesothelioma of the peritoneum is a rare lesion that occurs predominatly in women of reproductive age and has a high propensity for local recurrence. It is very rare in childhood, especially in boys, being reported in only 4 cases. A new case of benign cystic mesothelioma of the peritoneum in an 11-year-old boy is reported. The lesion occupied the entire left abdomen, arising from the transverse mesocolon, and it was accompanied by 4 small cysts. The patient had a coexistent right-sided renal agenesis. The mesothelial nature of the cysts epithelial lining cells was confirmed by immunopositivity for calretinin, cytokeratin 5/6, HBME1, and epithelial membrane antigen (EMA). No recurrence of the lesion was noted in the 7-month follow-up. Pathologists and clinicians should be aware of the existence of this rare entity in childhood to establish an accurate diagnosis and provide close follow-up after the surgery.

Nerve transfers using collateral branches of the brachial plexus as donors in patients with upper palsy--thirty years' experience.

BACKGROUND: Nerve transfers in cases of directly irreparable or high-level extensive brachial plexus traction injuries have been done using a variety of donor nerves with various success, but an ideal method has not been established. The purpose of this study is to analyze the results of nerve transfers using the thoracodorsal and medial pectoral nerves as donors in patients with upper palsy. METHODS: This retrospective study included 40 patients with 29 procedures using the thoracodorsal nerve and 33 procedures using the medial pectoral nerve as donors for reinnervation of the musculocutaneous or axillary nerve. Both nerves were used simultaneously in 22 of these patients. The thoracodorsal nerve was transferred in 13 patients to the musculocutaneous nerve and in nine patients to the axillary nerve. The medial pectoral nerve was transferred in nine patients to the musculocutaneous nerve and in 13 patients to the axillary nerve. The results were analyzed according to the donor nerve, the age of the patient, and the timing of surgery. RESULTS: The total rate of recovery for elbow flexion was 94.1%, for shoulder abduction 89.3%, and for shoulder external rotation 64.3%. The corresponding rates of recovery using the thoracodorsal nerve were 100, 93.7, and 68.7%, respectively. The rates of recovery with medial pectoral nerve transfers were 90.5, 83.3, and 58.3%, respectively. Despite the obvious differences in the rates of recovery, statistical significance was found only between the rates and quality of recovery for the musculocutaneous and axillary nerve using the thoracodorsal nerve as donor. CONCLUSIONS: According to our findings, nerve transfers using collateral branches of the brachial plexus in cases with upper palsy offer several advantages and yield high rate and good quality of recovery.

Histological features of gastric cardia in adults: an autopsy study.

BACKGROUND AND AIMS: The existence, histology and origin of gastric cardiac mucosa are controversial. The aim of the present study was to determine the existence, histological characteristics and length of cardiac mucosa and to correlate these features with the patients' age and the presence of inflammation in the gastric cardia and/or esophagus. METHODS; The cardiac mucosa within the whole esophagogastric junction was histologically analyzed in 38 consecutive autopsy specimens and measured in 24 cases. RESULTS: The cardiac mucosa was identified in all specimens from all cases, with a mean length of 6.7 mm, range 0.927-19.5 mm. In the majority of cases, the length of cardiac mucosa was less than 10 mm (87.5%) and greater than 5 mm (71%). Cardiac mucosa was composed of a combination of pure mucous glands and mucous glands with parietal cells in 74% of cases, and only of mucous glands with parietal cells in 26% of cases. Carditis was recorded in 23.7% cases and reflux esophagitis in 15.8%. The length of cardiac mucosa was not significantly different between cases with and without carditis (p>0.05), between those with and without esophagitis (p>0.05), and between age groups older and younger than 60 years (p>0.05). CONCLUSION: In the adult population, a short histological segment of gastric cardia was consistently present as a normal histological structure. The type, length and circumferential presence of cardiac mucosa were not significantly associated with carditis, esophagitis or age.

Clear cell myoepithelial carcinoma of the skin. A case report.

Myoepitheliomas are tumors of myoepithelial cells, most frequently diagnosed in the salivary glands. Cutaneous location is very rare, especially for malignant variant. We report a case of recurrent cutaneous myoepithelial carcinoma of the femoral region in a 51-year-old woman. Histologically, the tumor was confined to the dermis and superficial subcutaneous fat tissue, exhibiting typical multinodular pattern. The majority of tumor cells were of clear cell type, although rare epithelioid and spindle cells were also present. Nuclear atypia, mitotic activity of 12 mitoses per 10 microscopic high power fields and Ki-67 labeling index of 20%, as well as three recurrences, corroborated the malignant nature of the tumor. Immunohistochemistry showed positivity for cytokeratin, epithelial membrane antigen, vimentin, S-100 protein and myogenic markers (alpha-smooth muscle actin and muscle-specific actin HHF-35) in keeping with the myoepithelial cell immunophenotype. Staining for CD34, desmin and HMB-45 was negative. Myoepithelial carcinoma should be considered in the differential diagnosis of cutaneous neoplasms composed predominantly of clear cells.

Intestinal intussusception due to a pyogenic granuloma.

Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a benign vascular tumor, most commonly arising on the skin and the oral mucosa. Gastrointestinal localization of PG, except for the oral cavity, is exceptionally rare. We describe a case of ileal PG occurring in a 13-year-old girl, presenting with intestinal obstruction. Histological examination revealed proliferation of capillary-sized vessels, with prominent intravascular component, involving the entire thickness of the intestinal wall. Immunohistochemistry showed positivity for CD31, CD34 and von Willebrand factor, whereas immunostaining for glucose transporter-1 protein (GLUT1) and for human herpes virus 8 (HHV-8) was negative. We suggest that PG should be considered in the differential diagnosis of childhood gastrointestinal polypoid lesions.

Intramuscular hemangioma of the retropharyngeal space.

BACKGROUND: Intramuscular hemangioma (IMH) is a distinctive type of hemangioma occurring within skeletal muscle. Most IMH are located in the lower extremity, particularly in the muscles of the thigh. When present in the head and neck region, the masseter and trapezius muscle are the most frequently involved sites. CASE REPORT: We reported a case of unusual localization of the head and neck IMH occurring within the retropharyngeal space (RPS). To our knowledge, this is the second such case reported in the English literature. The tumor presented as a left-sided neck mass with bulging of the posterior and left lateral oropharyngeal wall on indirect laryngoscopy. Computed tomography (CT) scan revealed an ill-defined mass in the RPS at the oropharyngeal level. The lesion was excised via a transoral approach and microscopically diagnosed as IMH, the complex malformation subtype. Although surgical margins were positive, no recurrence of the tumor was noted in the 17-month follow-up. CONCLUSION: Intramuscular hemangioma should be considered in the differential diagnosis of deep head and neck masses. The knowledge of the infiltrative nature and recurrence rate of an IMH is useful for appropriate managment.

Soft tissue myoepithelial carcinoma.

BACKGROUND: Myoepitheliomas are tumors composed predominantly or exclusively of myoepithelial cells, usually arising in salivary glands. Cutaneous/soft tissue localization is very rare, especially for the malignant myoepitheliomas. CASE REPORT: We presented a case of myoepithelial carcinoma involving subcutaneous adipose tissue of the left forearm in a woman aged 62 years. The tumor was composed of epithelioid and hyaline cell types, arranged in diffuse sheets, nests and loose clusters within hyalinized and myxoid matrix. The neoplasm displayed high-grade cytologic atypia with some cells having pleomorphic, hyperchromatic nuclei, and others showing vesicular nuclei, large nucleoli with scattered bizarre giant cells. High mean mitotic count of 7 mitoses/10 high power filds and extensive necrosis favoured the diagnosis of malignancy. Immunohistochemical staining was positive for cytokeratin (AE1/AE3), epithelial membrane antigen, S-100 protein, glial fibrillary acidic protein, and vimentin. CONCLUSION: Considering the subcutaneous localization, myoepithelial immunophenotype and high-grade cytologic atypia the neoplasm was classified as a soft-tissue myoepithelial carcinoma.

A well-differentiated liposarcoma co-existent with leiomyoma.

BACKGROUND: The coexistence of a well-differentiated liposarcoma (atypical lipomatous tumor) and benign smooth muscle component in a single soft tissue neoplasm is extremely rare. CASE REPORT: Histologic and immunohistochemical characteristics of tumor, which represented the recurrence of a retroperitoneal atypical lipoma in a 50-year-old female patient are presented in this paper. The tumor represented the recurrence of a retroperitoneal atypical lipoma. Lipomatous component consisted of a mixture of lipoma-like and sclerosing variant of well-differentiated liposarcoma. Characteristically, the heterologous smooth muscle differentiation was manifested as a macroscopically visible nodular growth in the form of a leiomyoma within the adipocytic component. It consisted of intersecting fascicles of spindle cells, which lacked mitoses and significant atypia, and were immunopositive for smooth muscle markers. CONCLUSION: This case of well-differentiated liposarcoma with benign smooth muscle is the first reported tumor of retroperitoneal localization. It is also the first one to exhibit the heterologous smooth muscle component as a distinct leiomyoma.

[Nerve transfer in traction injuries of the brachial plexus]. / Nervni transfer kod trakcijskih povreda brahijalnog pleksusa.

BACKGROUND: The aim of this study was to analyze the results of nerve transfer to the musculocutaneous and axillary nerves, using some technical modalities such as intercostal, spinal accessory or intraplexal transfer, and on the basis of the results to try to clarify the most common controversies concerning these operations. METHODS: The study included 82 patients with brachial plexus traction injuries, who were operated on using various techniques of nerve transfer. The follow-up period was at least two years. The analysis of biceps and deltoid muscles recovery was performed according to the type of the donor nerve. RESULTS: The corresponding rates of recovery for the musculocutaneous and axillary nerves were 46.7% and 68.1% in intercostal nerve transfer, 71.4% and 75% in accessory nerve transfer, 93.1% and 88.8% in nerve transfer of the brachial plexus collateral branches, and 55.5% and 60% in classical intraplexal nerve transfer, respectively. Comparative statistical analysis demonstrated significantly better final outcome and quality of recovery in regional nerve transfers in comparison to the other methods. CONCLUSION: Our findings suggest that nerve transfer of collateral branches, where possible, (such as in cases with upper or extended upper brachial plexus palsy) might be a method of choice, offering better results and quality of recovery.

Transfer of the medial pectoral nerve: myth or reality?

OBJECTIVE: Transfer of the medial pectoral nerve is one of the most controversial procedures used to reinnervate the paralyzed upper arm because of brachial plexus spinal nerve root avulsion or directly irreparable proximal lesions of spinal nerves. The purpose of this study was to determine the value of this type of nerve transfer to the musculocutaneous and axillary nerves. METHODS: The 25 patients included in the study comprised 14 patients who had nerve transfer to the musculocutaneous nerve and 11 who underwent nerve transfer to the axillary nerve. These patients' functional recovery and the time course of their recovery were analyzed according to the type of transfer of one donor nerve or the donor nerve in combination with other donors. RESULTS: Useful functional recovery was achieved in 85.7% of patients who had nerve transfer to the musculocutaneous nerve and in 81.8% of patients who underwent nerve transfer to the axillary nerve. There was no significant difference in results with regard to the type of nerve transfer and which recipient nerves were involved. A strong trend toward better results after procedures involving the use of a donor nerve combined with other donors was observed, however. CONCLUSION: Our surgical results suggest that the transfer of the medial pectoral nerve to the musculocutaneous nerve and also to the axillary nerve may be a reliable and effective procedure.