ABSTRACT
A case of malignant islet-cell tumor with oncocytic features occurring in a 54-year-old woman with symptoms of organic hypoglycemia is reported. The tumor was composed of ribbons of cells arranged in an endocrine pattern. The cytoplasm of these cells was eosinophilic and finely granular. Ultrastructurally, the cells contained numerous mitochondria and dense-core neurosecretory granules. Tumor cells were focally immunoreactive for neuron-specific enolase, insulin, glucagon and VIP. Capillaries invasion and metastases to lymph nodes argued in favor of malignancy but there was no subsequent malignant involvement during a 3-year follow-up after surgery. Such insulinomas with oncocytic features have not been previously described. Endocrine features in oncocytomas of the pancreas and of other locations are discussed.
Subject(s)
Adenoma, Islet Cell/pathology , Adenoma/pathology , Hypoglycemia/etiology , Pancreatic Neoplasms/pathology , Adenoma/complications , Adenoma/metabolism , Adenoma/surgery , Adenoma, Islet Cell/complications , Adenoma, Islet Cell/metabolism , Adenoma, Islet Cell/surgery , Female , Follow-Up Studies , Hormones/metabolism , Humans , Immunohistochemistry , Microscopy, Electron , Middle Aged , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/metabolism , Pancreatic Neoplasms/surgeryABSTRACT
The authors discuss four cases of gastric leiomyosarcoma explored by various imaging techniques (barium examinations, ultrasound, CT scans). Barium examinations were normal in two cases, abnormal but insufficient for diagnosis in one, and sufficient to allow topographic diagnosis in one. Ultrasonography gave abnormal findings insufficient for diagnosis in two cases and allowed topographic diagnosis in the other two cases. CT scans were abnormal but insufficient for diagnosis in one case, allowed topographic diagnosis in 3 cases, and in two of the cases permitted initial diagnosis of a connective tissue malignancy. Due to the frequently subserosal nature of leiomyosarcoma of the stomach and of the digestive tract in general, analysis by CT in mandatory. Analysis of tumor relations with the spleen, the left kidney and the pancreas is facilitated by ultrasonography.
Subject(s)
Barium Sulfate , Leiomyosarcoma/pathology , Stomach Neoplasms/pathology , Tomography, X-Ray Computed , Ultrasonography , Adult , Aged , Female , Humans , Leiomyosarcoma/secondary , Liver Neoplasms/secondary , Male , Middle Aged , Stomach/pathologyABSTRACT
The authors report on 13 cases of gangrene of the perineum. Eight of the patients presented with a pre-existing infectious or tumoral anorectal lesion. In two cases, gangrene was a complication of a surgically treated prostatic pathology; two other patients had Fournier's disease. The last case was termed "spontaneous" as no causative factor was found. The unexpected recrudescence of this pathology, its severe nature, our limited knowledge of the pathogenic factors involved, and the difficulties encountered in treatment make analysis of this series of cases particularly interesting; moreover, despite the apparent etiological disparity of these observations, there were common anatomic, bacteriologic, and therapeutic elements. As concerns treatment, emphasis is placed on three points: prime role of surgery, the only means of obtaining precise information on lesions, broad indications for bypass colostomy, value of treatment with hyperbaric oxygen. The mortality rate remains high: 4 of the 13 patients died.
Subject(s)
Gas Gangrene/therapy , Genitalia , Perineum , Adult , Aged , Aged, 80 and over , Bacterial Infections/diagnosis , Combined Modality Therapy , Female , Gas Gangrene/diagnosis , Gas Gangrene/microbiology , Humans , Male , Middle AgedABSTRACT
Concerning one case of autonomous hepatic tuberculosis in a pseudo-tumoral aspect, the difficulties of making the diagnosis are brought to light. Liver biopsy is the best examination to clarify things, either performed under ultrasonic control or during surgery. This biopsy permits pathologic examination and culture of a liver fragment in Lowenstein medium. But in fact, only isolation of the tubercle bacillus at the liver level confirms presence of tuberculosis.
Subject(s)
Tuberculosis, Hepatic/pathology , Aged , Biopsy , Diagnosis, Differential , Female , Humans , Liver Neoplasms/pathologyABSTRACT
The authors relate a case of acute functional obstruction, appearing after treatment of a cancer of rectum with extension to prevertebral plexus. The cause of the colic trouble appears to be neurological and due to a sympathetic and parasympathetic transmission block, while intrincic plexus was normal. Inefficacy of the contractions was established by radiology and endoscopy (electrical and pharmacodynamic stimulation and measure of pressure); it predominated in the left transverse colon. Caecal perforation has been avoided up till now after two years, without modification of clinical course, the patient evacuated his colon with the help of enemas. It seems probable that this case can be classified as Ogilvie's syndrome, the bibliography of which has been looked up and criticized.
