ABSTRACT
Intermittent intestinal bleeding persisted in a 77-year-old male, who had undergone grafting for abdominal aortic aneurysm. Each attack lasted for a few weeks and spontaneously resolved. Only a minute abnormality was found in the third portion of the duodenum; barium studies showed a segmental narrowing, but endoscopy disclosed only a small erosion in that portion. Massive and fatal gastrointestinal hemorrhage broke out 6 months after the onset of bleeding. Autopsy revealed an adhesion area with a small fistula formation between the duodenum and aorta. Even slight endoscopic findings should be considered suggestive of aortoenteric fistula in patients after aortic surgery.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Diseases/etiology , Duodenal Diseases/etiology , Gastrointestinal Hemorrhage/etiology , Intestinal Fistula/etiology , Postoperative Complications/etiology , Vascular Fistula/etiology , Aged , Aortic Diseases/diagnosis , Blood Vessel Prosthesis Implantation/adverse effects , Duodenal Diseases/diagnosis , Duodenoscopy , Fatal Outcome , Humans , Intestinal Fistula/diagnosis , Male , Postoperative Complications/diagnosis , Vascular Fistula/diagnosisABSTRACT
A report is presented of a follicular dendritic cell (FDC) tumor arising in the lymph nodes and inguen of a 55-year-old Japanese female, who had suffered from schizophrenia for 25 years. The left submandibular lymph nodes had completely lost their normal architecture, except for the capsule, due to tumor cell infiltration. Occasional nodular structures resembling epithelioid granulomas, attributable, at least in part, to follicular involvement of tumor cells, were observed. These nodules were composed of epithelioid- or fibroblast-like tumor cells forming interwoven fascicles, to which small lymphocytes were attached. Tumor cells were also scattered in the internodular areas. For more atypical tumor cells, arranged in a sheet-like structure, were present in the inguinal specimen, the tumor cells of which expressed Ki-M4p, CD21, CD35 and other antigens known to be expressed on FDC. Furthermore, they also expressed the monocyte/macrophage antigens, alpha 1-antitrypsin, alpha 1-antichymotrypsin, lysozyme, CD14, CD33, CD68 and Mac387 and fibroblastic antigen. Ultrastructural studies demonstrated lysosomal granules as well as a few desmosomes, indicating the tumor cells possessed fibrohistiocytic and FDC characteristics.
