Recurrent hemorrhage from an invaginated Meckel's diverticulum in a 78-year-old man.

Complications arising from Meckel's diverticulum are uncommon in adults and are seldom, if ever, seen in the elderly. When they do occur in adults, intestinal obstruction or inflammation is the usual mode of presentation, hemorrhage being much less common. The patient described in this case report was 78 yr old, presented initially with iron deficiency anemia and, later, developed severe acute hemorrhage. The cause of the hemorrhage was ulceration at the tip of an invaginated Meckel's diverticulum. The ulceration was not peptic in origin, as is usually the case in similar presentations in children, no ectopic oxyntic mucosa being detected in the diverticulum of our patient. In previous reports, invaginated Meckel's diverticula have always been accompanied by intussusception, and abdominal pain has been an important part of the symptom complex in such patients. Our patient had no abdominal pain, and no intussusception was noted at surgery. This case emphasizes the need for considering a Meckel's diverticulum as the source of acute or chronic hemorrhage, irrespective of the patient's age. The utility of radionuclide blood pool imaging in arriving at a diagnosis in these cases is discussed.

Hepatocellular carcinoma in Wilson's disease. Case report and review of the literature.

A 33-year-old man with Wilson's disease developed hemoptysis and radiographic evidence of nodular pulmonary infiltrates. A premortem diagnosis of hepatocellular carcinoma was made on the basis of alpha-naphthylannidase stains of pulmonary tissue obtained by open lung biopsy. We review all previous cases of Wilson's disease with this unusual complication and discuss the role of copper in hepatic oncogenesis as well as the alpha-naphthylannidase stain for the diagnosis of hepatocellular carcinoma.

Pneumocystis carinii thyroiditis.

A 38-year-old black man with a history of acquired immunodeficiency syndrome associated with intravenous drug abuse presented with two weeks of left-sided neck swelling. Results of thyroid function tests were within normal limits. Thyroid scan demonstrated nonvisualization of the left lobe. Fine-needle aspiration of the thyroid revealed the presence of Pneumocystis carinii organisms in the thyroid tissue. Although chest radiography and computerized tomography of the chest detected several nodules and cavitary lesions, the results of bronchoalveolar lavage and transbronchial biopsy were negative for P. carinii. The patient showed a response to treatment with trimethoprim/sulfamethoxazole. Thyroidal involvement with P. carinii has previously been documented only in the setting of overwhelming, fatal pulmonary infection. The current case expands the clinical spectrum of extrapulmonary pneumocystosis and documents its successful treatment.

Immunologic alterations in bronchoalveolar lavage fluid in the acquired immunodeficiency syndrome (AIDS).

The association of Pneumocystis carinii pneumonia and cytomegalovirus infection in apparently healthy intravenous drug abusers or homosexual males recently has been described. Two patients with this syndrome were seen recently at our institution. Bronchoalveolar lavage samples from these two patients, taken at the time of bronchoscopy, were analyzed. In both patients a significant increase in inflammatory cells (polymorphonuclear cells) and evidence for polyclonal B cell activation, as measured by a reverse hemolytic plaque assay was seen compared to normal persons (p less than 0.01 both comparisons). IgM and IgG anti-Pneumocystis carinii antibody titers were elevated in the lavage fluid of one patient each. One patient, originally diagnosed as having "Hamman-Rich Syndrome," demonstrated unequivocal chest X-ray improvement with prednisone therapy alone. These observations suggest that the lungs of these two patients were the site of an intense inflammatory response, which was not reflected in studies with peripheral blood.

Necrotizing sialometaplasia: report of five cases.

The natural history of necrotizing sialometaplasia as a self-healing process makes it essential for the surgeon and the pathologist to distinguish this entity from carcinoma. Seventeen of the 39 early cases were initially misdiagnosed as malignant. Occasionally, residual glands can be trapped in mucous lakes, giving the appearance of mucoepidermoid carcinoma. An awareness of the entity and adequate clinicopathologic correlation should lead to a correct diagnosis. A limited biopsy specimen may create a problem in diagnosis and may necessitate more adequate tissue for proper evaluation. Necrotizing sialometaplasia can present as an ulceration or a swelling beneath the mucosa, either of which can be painless or painful with radiation of pain to the ear, eye, or pharynx. Lesions presenting as a swelling will either convert to an ulceration or heal spontaneously, never forming an ulcer. The most commonly involved area is the palate (79 percent), but any area where glandular oral mucosa is present can be involved. The male-to-female ratio is 3:1, and it shows no predilection for race. The etiology of the disease remains unknown, but it may be associated with tobacco, alcohol, the use of dentures, and local trauma. Most investigators seem to favor an ischemic basis. Lesions heal spontaneously without treatment, and the only invasive procedure required is a biopsy.

Idiopathic portal hypertension in a renal transplant recipient.

A renal transplant recipient developed a noncirrhotic form of portal hypertension, idiopathic portal hypertension, several years after the transplantation. The liver histology by light microscopy disclosed only chronic portal inflammation and portal fibrosis; however, a prominent collagen deposition with the space of Disse seen only by electron microscopy evolved during the course of the liver disease. This report, in association with other reports of the same disorder in renal transplant recipients, suggests that idiopathic portal hypertension may occur as a direct consequence of renal transplantation.

Improved reliability in tumor diagnosis by fine needle aspiration.

A simple but useful modification of sample preparation of fine needle aspirates of soft tissue masses is presented, in conjunction with its assessment by a controlled study. The modification, employing routine histologic techniques, reduces the requirement for cytopathologic expertise. The potential utility of fine needle aspiration is thereby significantly expanded. In addition, this modification allows the pathologist to use special tissue strains or electron microscopy as options, when necessary, to enhance diagnostic accuracy.

Pathologists' assistant training programs: a report.

This report describes the training of pathologists' assistants in three training programs: at Duke University, at Quinnipiac College associated with Yale University, and at the University of Maryland School of Medicine. The role of this new health profession is described as well as the job situation, experience, and current status of accreditation.

Verrucous carcinoma arising in an odontogenic cyst. Report of a case.

A verrucous carcinoma arising in an odontogenic cyst is described for the first time. The clinical, radiographic, and microscopic features of this tumor are presented. It is mandatory to correlate the clinical and histopathologic findings to establish a diagnosis.