[Vaginal pressure trauma: a complication of jet-skis]. / Traumatisme vaginal par hyperpression: une complication du jet-ski.

Vaginal trauma was caused by a jet-ski fall. The lesion occurred due to hyperpressure of the upper half of the vagina. A protocol for diagnosis and treatment are proposed with emphasis on laparoscopy which is not always used.

Perforation of a Meckel's diverticulum caused by ingestion of a coin.

A 25-year-old woman ingested a quarter. Three days later, lower abdominal pain, fever, chills, and physical findings compatible with pelvic inflammatory disease developed. Radiographic examination showed the coin in the middle pelvis. Persistent abdominal complaints, abnormal physical examination, and failure of the coin to progress through the gastrointestinal tract despite conservative management led to surgical intervention. Exploration revealed an inflammatory process in the posterior uterine culde-sac with multiple omental, small bowel, and uterine adhesions due to perforation of a Meckel's diverticulum. Excision of the Meckel's diverticulum was done, and the patient recovered satisfactorily.

Adult respiratory distress syndrome with or without systemic disease associated with infections due to Mycoplasma fermentans.

An unusual but typical clinicopathological presentation was noted among several groups of previously healthy, human immunodeficiency virus-negative patients who had an apparent fulminant infectious disease but had no etiologic agent identified. The clinical courses were characterized by rapid progression and development of adult respiratory distress syndrome with or without systemic disease. Histopathological changes in the diseases tissues (other than lung) obtained by biopsy or at autopsy ranged from extensive necrosis with only minimal inflammatory reaction to prominent lymphohistiocytic infiltrate with focal areas of acute inflammation. This report focuses on pulmonary changes in three patients. The alveolar epithelial (type I) cells and type II pneumocytes are diffusely damaged. There is interstitial edema and thickened septa. An eosinophilic alveolar membrane may form, and the alveolar space may fill with foamy macrophages. Immunohistochemical studies identified Mycoplasma fermentans infection in the patients' lungs and liver. Mycoplasma-like particles could also be identified by electron microscopy. There is a previously unrecognized form of fulminant disease in humans that is associated with M. fermentans infections.

Traumatic seromuscular rupture of intestine.

A vehicular accident victim sustained multiple transverse split-thickness intestinal lacerations. This rare and distinctive seatbelt injury results from the impact of intestinal loops against the abdominal restraint, whereby the rigid muscle coat ruptures, while the integrity of inner layers is preserved.

Streptococcus salivarius meningitis and colonic carcinoma.

Streptococcus salivarius caused fulminant meningitis in an elderly patient. A gastrointestinal diagnostic workup revealed an asymptomatic colonic adenocarcinoma. This first reported instance of S salivarius sepsis associated with a colonic neoplasm is not unexpected, since the organism is bacteriologically similar to S bovis, the prime bacterial indicator of occult malignancy. Exact speciation of streptococcal strains is fraught with technical difficulties, and gastrointestinal investigation may be warranted in an expanded variety of streptococcal infections.

Immunohistochemical evaluation of seven monoclonal antibodies for differentiation of pleural mesothelioma from lung adenocarcinoma.

A panel of seven monoclonal antibodies including anti-vimentin, anti-keratin markers AE1/AE3 and EAB902, human milk fat globule (HMFG-2), B72.3, anti-carcinoembryonic antigen (CEA), and anti-Leu-M1 were used for an immunoperoxidase staining assay to determine their value in the differentiation of pleural mesothelioma from lung adenocarcinoma. Anti-vimentin positively identified 86% of the mesotheliomas and none of the adenocarcinomas. AE1/AE3, EAB902, and B72.3 reacted with a high percentage of both mesothelioma and adenocarcinoma specimens. With HMFG-2, both membrane and cytoplasmic staining was observed in 92% of the adenocarcinomas and in 14% of the mesotheliomas, whereas 26% of the mesotheliomas only exhibited membrane staining. Eighty percent of the adenocarcinomas and 8% of the mesothelioma tissues stained with anti-Leu-M1. Anti-CEA did not react with any of the 50 mesotheliomas tested but did react with 95% of the lung adenocarcinomas tested. From this study, it was concluded that anti-CEA and anti-Leu-M1 were the most effective of the seven tumor markers evaluated; and that 100% of the pleural mesothelioma tissues could be correctly differentiated from lung adenocarcinomas using a panel consisting of anti-vimentin, HMFG-2, anti-CEA and anti-Leu-M1 monoclonal antibodies.

Malignant epithelioid pleural mesothelioma versus peripheral pulmonary adenocarcinoma: a histochemical, ultrastructural, and immunohistologic study of 103 cases.

The distinction between malignant epithelioid pleural mesothelioma (MEPM) and peripheral adenocarcinoma of the lung with pleural invasion (PAL) continues to represent a diagnostic challenge in selected cases. In order to provide comparative data on histologic, histochemical, and immunohistochemical features of these neoplasms, we analyzed 51 ultrastructurally categorized MEPMs and 52 PALs with the periodic acid-Schiff-diastase (PAS-D), mucicarmine, and colloidal iron stains, and a panel of immunohistologic reagents. Antibodies to cytokeratin, vimentin, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), Leu M1, the B72.3 antigen, blood group isoantigens (BGI), placental alkaline phosphatase, amylase, S100 protein, and Clara cell antigen were used, as applied to paraffin sections with the avidin-biotin-peroxidase complex technique. Ultrastructural studies revealed long, branching microvilli in MEPM cells in all cases, with length-to-diameter ratios (LDR) of 10:1 or more. In contrast, PAL manifested short, nonbranching microvilli with LDR of 8:1 or less. Reactivity with PAS-D and mucicarmine stains was strictly confined to PAL, and hyaluronidase-sensitive colloidal iron-positivity was restricted to MEPM. However, only 63% and 41% of these respective neoplasms demonstrated such histochemical reactivity. Immunohistologic results correlated well with electron microscopic classification. All MEPMs and PALs were reactive for cytokeratin; in addition, the majority of tumors in each group expressed EMA, and a minority were reactive for vimentin. In adenocarcinomas of the lung, Leu M1 was observed in all cases, CEA was apparent in 96%, B72.3 labeled 84%, and BGI were present in 67%; all PALs expressed at least two of these determinants, but none was seen in any mesothelioma. The other markers included in this study also were observed in some PAL cases, but not in MEPM. These findings suggest that immunohistology parallels electron microscopy in efficacy in the diagnostic separation of MEPM and PAL. Using antibodies to Leu M1, CEA, and the B72.3 antigen, reactivity for at least two of these three markers appears to exclude a diagnosis of pleural mesothelioma. The other glycoproteinaceous, oncoplacentofetal, and cytoplasmic antigens we studied can be used to reinforce such a determination, since their distribution is confined to adenocarcinomas.

Flow cytometric analysis of ploidy in immunohistochemically confirmed examples of malignant epithelial mesothelioma.

Flow cytometry was used to compare the DNA content of 28 fresh effusion specimens that contained abundant proliferating mesothelial cells, with the ploidy profiles for 19 formalin-fixed, paraffin-embedded examples of malignant epithelial mesothelioma. Each mesothelioma lacked staining with periodic acid-Schiff (PAS) after diastase pretreatment. Nineteen of 19 mesotheliomas were immunoreactive for cytokeratin, 13 of 19 for epithelial membrane antigen, 0 of 19 for Leu-M1, and 0 of 19 for carcinoembryonic antigen. Each benign fluid specimen was DNA diploid. Nine of the deparaffinized mesotheliomas were DNA diploid, and seven had additional G0G1 peaks signifying DNA aneuploidy. Histograms from the remaining three mesotheliomas showed G0G1 peaks with prominent shoulders, probably indicating low-degree hyperdiploidy. The results suggest that ploidy analysis by flow cytometry might be useful for the separation of mesothelioma from proliferating mesothelial cells in effusion specimens. Although only 53% of the mesotheliomas were DNA aneuploid, the finding of DNA aneuploidy in an effusion specimen that contains atypical mesothelial cells would strongly support a diagnosis of mesothelioma.

So-called sclerosing hemangiomas of lung. An immunohistochemical study supporting a respiratory epithelial origin.

Sclerosing hemangiomas are benign pulmonary neoplasms. They were initially believed by Liebow and Hubbell to be of endothelial origin; however, subsequent ultrastructural studies have suggested an alveolar pneumocyte and mesothelial derivation. Using a panel of various antibodies on eight cases, the authors found that sclerosing hemangiomas expressed cytokeratin (seven cases), epithelial membrane antigen (seven cases), carcinoembryonic antigen (five cases), vimentin (seven cases), surfactant apoprotein (eight cases), and Clara cell antigen (five cases). These results support the hypothesis that sclerosing hemangiomas represent an epithelial tumor showing simultaneous bronchiolar epithelial and alveolar pneumocyte differentiation.

Localized primary (AL) amyloid tumor of the breast. Cytologic, histologic, immunocytochemical and ultrastructural observations.

Two examples of localized primary amyloid tumor of the breast are presented, including one patient with metachronous bilateral lesions. Our findings and review of the literature indicate that this rare lesion occurs predominantly in elderly females and can be mammographically and clinically confused with carcinoma. Fine-needle aspiration biopsy can be a useful procedure to make a preliminary diagnosis. Congo red staining with prior potassium permanganate incubation confirmed the AL type of amyloid in our two cases; this might be the predominant type in the localized form involving the breast. Immunofluorescence studies demonstrated IgA, with kappa and lambda light-chain deposition within the amyloid foci in one case, and intracytoplasmic IgG with both light chains within plasma cells and amyloid deposits of the second case. Ultrastructural examination of one of the cases showed characteristic findings of straight, nonbranching fibrils of 4-9 nm, diagnostic of amyloid. From our findings and a review of the literature, we conclude that amyloid tumors of the breast can occur in three separate settings: secondary amyloidosis, systemic or multiple myeloma associated amyloidosis, and as a localized primary type having a benign course.

Intracranial fibromuscular dysplasia: report of two cases, one with autopsy verification.

We report two patients with fibromuscular dysplasia (FMD) involving intracranial arteries. In the first patient the diagnosis was made at autopsy. Both patients were symptomatic from this disease and, in addition, displayed unusual hormonal abnormalities which may well have contributed to the genesis or evolution of FMD.