Mucinous adenocarcinoma arising in a neovagina.

The development of carcinoma in a neovagina is a rare occurrence. A case of mucinous adenocarcinoma of a neovagina is presented. A neovagina was formed in 1945 to correct a congenital anomaly. Subsequently the patient developed a chronic rectovaginal fistula. It is thought that the mucinous adenocarcinoma developed as a result of chronic inflammation secondary to the fistula. Although rare, development of a malignancy in ectopic tissue can occur. Clinicians need to be aware of this as they follow these patients.

Combination chemotherapy for advanced adenocarcinoma of the cervix.

A patient with advanced adenocarcinoma of the cervix was treated only with cisplatin and mitomycin C (MMC). The regimen achieved a complete response, confirmed by chest radiograph and computed axial tomography scan, lasting 50 months. The patient is alive with recurrent disease 59 months after diagnosis. No severe drug-related toxicity occurred.

Pathologist agreement in the interpretation of colorectal polyps.

Practicing physicians commonly perform flexible sigmoidoscopy in their offices. Polyploid lesions are frequently biopsied and sent to community hospitals for pathological interpretation. The pathologist's opinion often determines the course of medical follow-up for the patient, especially in cases in which early malignancy is suspected. This paper addresses the agreement of community-based pathologists regarding the interpretation of colorectal polyp pathology. Ten pathological slide sections were sent to 22 different community-based pathologists in southeast Michigan. These pathologists were asked to record their diagnosis of the specific histologies represented in each of the slides. The results indicated a high level of agreement of histologies in the dichotomous categories of hyperplasia versus adenoma. However, there was considerable disagreement on the presence of moderate or severe atypia. The results of this study indicate that clinicians performing biopsies on patients at risk for colorectal cancer should be aware of the potential for diagnostic variability among pathologists, and should plan follow-up strategies which may include seeking second pathological opinions when a significant patient management decision must be made.

Prenatal diagnosis of and midtrimester pathology with karyotype 46,XY,del(4)(q22q26). A case report.

A prenatal diagnosis of an interstitial deletion with chromosome 4,46,XY,del(4)(q22q26) was obtained on amniotic fluid cells drawn at 19 weeks' gestation from a 35-year-old gravida. Counseling on the basis of unusual or tenuous data is always difficult, but comparisons with similar deletions in 4q suggested a substantial risk of anomalies. A comparison of the postabortal autopsy findings with those from other reported cases of interstitial deletions of chromosome 4q suggested different pathology with this area of deletion than previously reported for other areas of 4q.

Ultrasonographic prenatal diagnosis and fetal pathology of Langer mesomelic dwarfism.

In a family at risk for Langer mesomelic dwarfism, we document the onset of disproportionate growth in the second trimester by sonographic biometry. Midtrimester pathologic correlation of this condition demonstrates primary changes in the growthplate in the regions of proliferating cartilage and hypertrophic and degenerative chondrocytes.

Fatal echovirus type 7 in a premature infant.

Echovirus 7 infections have not been previously recognized as fatal in neonates. A premature male member of a twin gestation developed an echovirus 7 infection at 5 days of age and succumbed to it. The clinical manifestations were similar to an echovirus 11 infection described in neonates. The second twin was free of illness as well as of virus shedding.

Obstructive mucocele of the cervix after subtotal hysterectomy. A case report.

A benign obstructive mucocele of the cervix presented as a pelvic mass after a subtotal hysterectomy. Hypertrophy of the smooth muscle of the leiomyoma, under the influence of circulating estrogen, resulted in distortion and obstruction of the endocervical canal, forming a mucocele.

Fetal hemorrhage from umbilical cord hemangioma.

Hemangiomas of the umbilical cord are rare. In this case, an acute, massive fetal hemorrhage from a ruptured umbilical hemangioma occurred after spontaneous rupture of membranes. Ectopic small intestinal mucosa covered the proximal surface of the umbilical cord. Fetal anomalies included a patent vitellointestinal duct remnant and distal ileal atresia. Fetal hemorrhage appears to be another previously unreported and potentially life-threatening complication of umbilical hemangiomas.

Physician accuracy in diagnosing colorectal polyps.

Since the medical management of persons with adenomatous colorectal polyps differs from that of those with hyperplastic polyps, accuracy of diagnosis is essential. Although many physicians have grown confident that their skills of visual diagnosis are adequate, few data exist to support this confidence. In order to examine the accuracy of physicians' judgments regarding colorectal polyp histology, the visual diagnosis of physicians experienced in endoscopy was compared with the histologic report. Eighty-one polyps were discovered by flexible sigmoidoscopy among 718 participants in a colon cancer screening program. Eighty percent of all polyps were detected accurately. The diagnostic sensitivity of detecting adenomas was 69 percent, while specificity (accurate diagnosis of hyperplastic polyps) was 86 percent, and there were an additional eight false negative and eight false positive diagnoses. Further analyses revealed that there are individual patterns of diagnostic mistakes made by physicians and that mistakes frequently are related to polyp size. These findings are particularly important in light of the expanding numbers of relatively inexperienced primary care providers performing flexible sigmoidoscopy whose diagnoses may be strongly dependent on polyp size.

Vaginal müllerian stromal sarcoma. A case report.

Primary malignancies of the vagina are among those encountered most rarely in the female reproductive tract. Even more rare are primary vaginal sarcomas. The fourth case of vaginal müllerian stromal sarcoma is reported on here.

Analysis of adenocarcinoma in Barrett's esophagus utilizing a staging system.

Based on a retrospective review of nine patients with adenocarcinoma in a Barrett's esophagus and the reports of similar cases in the literature, a staging system for this malignancy was devised. A progression of changes could be identified that corresponded to the stages. These changes consisted of dysplasia progressing to carcinoma in situ and invasive malignancy with metastases. Stage III disease carried the same grim prognosis as a similar stage of squamous cell carcinoma of the esophagus. Earlier stages of adenocarcinoma of the esophagus appeared to have a better prognosis. White men with symptoms of reflux esophagitis, esophageal strictures, and/or hiatal hernias who have Barrett's esophagus extending proximal to the distal 10 cm of the esophagus appear to have a propensity to develop adenocarcinoma of the esophagus. Consideration should be given to antireflux surgery and close follow-up by periodic esophagoscopy and biopsy of the esophagus in these patients. If neoplasia is found, the thoracic esophagus should be totally removed with the stomach or left colon anastomosed to the cervical esophagus. Because of the poor prognosis of Stage III disease, postoperative chemotherapy should be considered.