Gastric carcinoma in patients younger than age 36 years.

The clinical and pathologic features of 18 patients with gastric carcinoma younger than age 36 years were studied. Of these patients, 36.8% were Hispanics of Mexican origin. Eighteen percent of the Mexican population with gastric carcinoma were younger than 36 years as compared to 2.8% of the overall population (P less than 0.05). Fifty percent of the gastric ulcers in the Mexican population were malignant as compared to 6% in the non-Mexican population (P less than 0.05). In addition, a subset of aggressive carcinomas were found. Patients presenting with symptoms of less than 6 months' duration had a survival of less than 6 months, compared to the less aggressive subset, in which patients had symptoms for greater than 6 months and survived longer than 6 months. Racial, environmental influences, or selection bias may account for the differences in gastric carcinoma in the Mexican and non-Mexican population. Factors contributing to a more aggressive form of carcinoma are unclear and require further study.

Identification of coccidioidomycosis of the lung by fine needle aspiration biopsy.

A solitary coin lesion in the lung is a frequent presentation of coccidioidomycosis; these lesions may be radiologically indistinguishable from cancer. In a series of 112 fine needle aspiration (FNA) biopsies performed in the San Joaquin Valley on solitary pulmonary nodules, 8 cases were identified as coccidioidomycosis by the presence of spherules in the aspirated material. The immature sporangia ranged in size from 4 micron to 40 micron. The smaller spherules did not show endospores and could have been confused with red blood cells. A methenamine silver or periodic acid-Schiff stain was helpful in identifying the spherules following decolorization of Papanicolaou-stained material; this was especially important when the background material was bloody. Older nonviable spherules showed a folded collapsed cell membrane, which may be associated with long-standing cavitary disease. A complement fixation titer was frequently not elevated. This study demonstrates the utility of FNA biopsy in the identification of cocci granulomas in the lung.

Symptomatic maternal intraperitoneal meconium granulomata: report of two cases.

We present two cases of histologically proven maternal intraperitoneal granulomata following cesarean section delivery. One patient presented during the immediate postpartum period with clinical symptoms consistent with subphrenic abscess. The other patient required operative intervention for a suspected ruptured tubo-ovarian abscess. In both cases, microscopic examination of the tissue obtained at the time of reoperation showed granuloma reaction, lanugo hair, and fetal squamous cells consistent with meconium deposition. The authors conclude that meconium granuloma should enter the differential diagnosis in cesarean section patients with unexplained postoperative pain.

Rapid recurrence of papillary squamous cell carcinoma of the canaliculus.

We treated a 76-year-old man who had an epithelial carcinoma that involved the canaliculus and extended into the lacrimal sac. Despite what appeared to be adequate resection (the surgical margins were completely free of tumor on both frozen and paraffin section), the tumor recurred less than one month later. The patient underwent wide local incision, including en bloc removal of the medial third of both eyelids and inner canthi, canaliculi, lacrimal sac, and nasolacrimal duct, and resection of the anterior lacrimal crest, lacrimal bone, anterior portion of the ethmoid bone, anterior medial wall of the maxilla, and subjacent periosteum and mucous membranes. Sixteen months later, the tumor has not recurred. This infiltrating papillary squamous cell carcinoma histologically demonstrated the most rapid and destructive recurrence of any such tumor originating in the lacrimal system.