Andrew Jackson's exposure to mercury and lead: poisoned president?

Historians have suggested that US president Andrew Jackson (1767-1845) experienced lead and mercury poisoning following his therapeutic use of calomel (mercurous chloride) and sugar of lead (lead acetate). To evaluate these claims, we performed direct physical measurement of 2 samples of Jackson's hair (1 from 1815, 1 from 1839). Following pretreatment and acid digestion, mercury was measured using cold vapor generation techniques, while lead levels were measured by electrothermal atomic absorption spectrophotometry. Mercury levels of 6.0 and 5.6 ppm were obtained from the 1815 and 1839 hair specimens, respectively. Lead levels were significantly elevated in both the 1815 sample (mean lead level, 130.5 ppm) and the 1839 sample (mean lead level, 44 ppm). These results suggest that Jackson had mercury and lead exposure, the latter compatible with symptomatic plumbism in the 1815 sample. However, Jackson's death was probably not due to heavy metal poisoning.

Perianal Paget's disease: distinguishing primary and secondary lesions using immunohistochemical studies including gross cystic disease fluid protein-15 and cytokeratin 20 expression.

BACKGROUND: Extramammary Paget's disease most commonly occurs on the female external genitalia and rarely occurs in the perianal region and male external genitalia. We present the clinical and pathologic features of 5 cases of perianal Paget's disease and review the literature. METHODS: Clinical and pathologic data were recorded for 5 cases of perianal Paget's disease. Cases were studied retrospectively with special stains, including periodic acid-Schiff, mucicarmine, Alcian blue, carcinoembryonic antigen, S100 protein, pan-keratin, gross cystic disease fluid protein-15 (GCDFP-15), lysozyme, CD15 (Leu-M1), cytokeratin 7 (CK7), and cytokeratin 20 (CK20). RESULTS: Three (60%) of 5 patients had concurrent rectal adenocarcinomas. All cases reacted positively for pankeratin, although the intensity and distribution of staining varied. Both cases not associated with an underlying carcinoma showed strong GCDFP-15 and CK7 expression and an absence of CK20 expression. The 3 cases associated with an underlying malignancy demonstrated CK7 and CK20 expression and an absence of GCDFP-15 expression. All cases were negative for lysozyme and CD15 (Leu-M1). CONCLUSIONS: The 5 cases reported herein demonstrate that perianal Paget's disease is a heterogeneous entity. The high frequency of associated underlying malignancies and resultant poor clinical outcomes highlight the importance of an aggressive search for a second malignancy. In some cases, perianal Paget's disease merely represents a cutaneous manifestation of an underlying rectal adenocarcinoma and demonstrates a CK7+/CK20+/GCDFP-15-/lysozyme-/Leu-M1- immunophenotype and signet ring Paget's cells. Other cases represent primary adenocarcinomas of the skin, which are associated with a CK7+/CK20-/GCDFP-15+/lysozyme /Leu-M1- immunophenotype and an excellent prognosis if adequately resected. Immunohistochemical studies, particularly CK20 and GCDFP-15, are useful adjuncts in distinguishing primary and secondary perianal Paget's disease.

Hormone-dependent, aggressive angiomyxoma of the vulva.

BACKGROUND: Aggressive angiomyxoma is a rare neoplasm of undetermined etiology that occurs mainly in the female vulva and perineum. It tends to recur but does not metastasize. This case report describes findings suggestive of the possible hormone dependency of this neoplasm. CASE: A 41-year-old gravid woman developed an aggressive angiomyxoma of the left vulva with growth apparently related to the length of the pregnancy. The neoplasm marked strongly for progesterone receptors by immunohistochemical methods but was estrogen-receptor negative. CONCLUSION: The growth of the neoplasm during pregnancy and the nuclear-positive staining for progesterone receptors suggest a possible hormone (progesterone) dependency for at least some cases of aggressive angiomyxoma.

Endoscopically removed malignant colorectal polyps: clinicopathologic correlations.

BACKGROUND/AIMS: Treatment options for patients with endoscopically removed malignant colorectal polyps are polypectomy alone vs. polypectomy followed by surgery. The aim of this study was to define histopathologic parameters that can be used for clinically relevant treatment decisions. METHODS: Five pathologists evaluated 140 polyps for the presence or absence of unfavorable histology. Unfavorable histology was tumor at or near (< or = 1.0 mm) the margin and/or grade III and/or lymphatic and/or venous invasion. Adverse outcome was recurrent and/or local cancer and/or lymph node metastasis. RESULTS: Adverse outcome was 19.7% (14 of 71), 8.6% (2 of 23), and 0% (0 of 46) when unfavorable histology was present, indefinite (lack of agreement), and absent, respectively (P < 0.0005, present vs. absent). Four patients with cancer > 1.0 mm from the margin had an adverse outcome (2 with lymphatic invasion and 2 indefinite for lymphatic invasion). Four patients with negative resections later developed distant metastases. Eight patients (6.3%) died of disease, and 2 of 69 without unfavorable histology (both indefinite for lymphatic invasion) had an adverse outcome. Interobserver strength of agreement was substantial to almost perfect for margin, grade, and venous invasion and fair to substantial for lymphatic invasion. CONCLUSIONS: This system is usable clinically. Patients with unfavorable histology are probably best managed by resection postpolypectomy, whereas in the absence of unfavorable histology, they probably can be treated by polypectomy only.

Gastric xanthelasma in hyperplastic gastric polyposis.

Hyperplastic polyps of the stomach are uncommon, while xanthelasma of the gastric mucosa has a variable reported frequency. The frequency of both lesions appear increased in association with chronic gastritis and previous gastrointestinal anastomosis. The present article consists of a case report that documents for the first time (to our knowledge) the coexistence of these two lesions in a patient with a history of erosive gastritis.

Gastric epithelial polyps. A 10-year study.

We have reviewed the 10-year experience of a community teaching hospital with gastric epithelial polyps and have analyzed 121 polyps removed from 35 patients. Hyperplastic polyps constituted nearly 75% of the polyps examined; fundic gland polyps constituted 17%, and adenomatous polyps were infrequent (8.6%). No clinical or endoscopic finding distinguished the variants of polyp before histologic examination. The majority of hyperplastic and fundic gland polyps were multiple. Whenever there were multiple polyps, all polyps were of the same histologic type. In no case did adenocarcinoma originate within a benign polyp. In only a single case was there an associated adenocarcinoma elsewhere in the stomach. None of the adenomatous polyps was linked with gastric adenocarcinoma.

Cervical melanosis.

The third case of melanosis of the exocervix reported in the English literature is presented. Discovery was incidental at surgery for unrelated findings. The pathogenesis of melanosis is unknown, but the lesion apparently is innocuous. Biopsy should distinguish this entity from other pigmented lesions of the cervix, eg, malignant melanoma and blue nevus.

Squamous cell carcinoma of the urachus.

The third documented case of primary squamous cell carcinoma of the urachus in the English literature is reported. The interesting coincidental occurrence of the dermoid cyst of the right ovary and a complete longitudinal septum of the vagina and uterine cervix is described.

Coronary embolism and myocardial infarction associated with nonbacterial thrombotic endocarditis.

Six cases of coronary embolism and myocardial infarction associated with nonbacterial thrombotic endocarditis were seen at the Mount Sinai Hospital over a ten-year period. Every patient had an underlying malignant neoplasm. The vegetations were found on aortic, mitral, tricuspid and pulmonic valves and were located on the free or closure margins. The clinical diagnosis of this condition is difficult because of simultaneous embolization to the brain, causing widespread neurologic symptoms, but could be made by electrocardiographic and serum enzyme studies. Myocardial infarction caused the deaths of three patients. The relationship between nonbacterial thrombotic endocarditis, hypercoagulability, and disseminated intravascular coagulation is discussed.

Cytomegalovirus oophoritis: ovarian cortical necrosis.

Three of eight female patients with cytomegalovirus disease had evidence of ovarian infection at autopsy. All three patients with ovarian lesions were postmenopausal; the remaining five were premenopausal. The lesions, which may be bilateral and may occur without evidence of cytomegalovirus infection elsewhere, are distinctive macroscopically, pathognomonic microscopically, and characterized by acute focal ovarian cortical necrosis with numerous cytomegalic cells and a variable but usually severe inflammatory reaction. It is suggested that reduced ovarian cortical vascular perfusion reactivates a latent infection in cortical stromal cells. This elicits inflammatory necrosis and the characteristic morphological lesions. This previously unreported lesion is not likely to have clinical importance.

Non-bacterial thrombotic endocarditis: clinicopathologic correlations.

Sixty-five cases of nonbacterial thrombotic endocarditis (NBTE) were discovered at autopsy during a 10 year period--an incidence of 1.6 per cent in the adult autopsy population. In 51 cases, one or more malignant neoplasms were associated; adenocarcinoma represented the most frequent histologic type of related neoplasm. Coagulation abnormalities suggestive of disseminated intravascular coagulation (DIC) were present in 18.5 per cent of the cases. It is possible that both the valvular and peripheral intravascular thromboses in at least some cases of NBTE represent the abnormal coagulation of DIC. Arterial thrombosis with infarction occurred in many peripheral organs. Splenic and renal were most frequent, but cerebral and cardiac consequences were the most significant.