Menetrier's disease presenting with iron deficiency anemia.

Menetrier's disease (MD) or polyadenomes en nappe is a form of hypertrophic gastropathy occurring primarily in middle-aged males. Patients generally present clinically with dyspepsia and, on occasion, with hypoproteinemic edema and anemia. The latter feature, when combined with the radiographic appearance of the stomach in MD, can lend to confusion with carcinoma and malignant lymphoma. To illustrate this diagnostic problem, a case is reported of a 41-year-old female who initially presented to her family physician with symptoms of easy fatigue and dyspnea on exertion and signs of pallor and ankle edema. Pertinent laboratory findings included a hemoglobin of 2.8 g/dL, hematocrit of 10.3 percent, mean corpuscular volume of 63.4 mu 3, a serum albumin of 2.7 g/dL, and heme positive stools. Endoscopic examination revealed a circumferential polypoid mass involving the cardia and fundus of the stomach with relative sparing of the antrum. A CT scan of the abdomen and pelvis showed a large mass in the stomach which the radiologists and gastroenterologists believed probably represented a lymphoma or gastric carcinoma. A total gastrectomy specimen exhibited features of MD. Routine bright-field microscopy and immunohistochemical reactivity for transforming growth factor-alpha confirmed the diagnosis of MD. Moreover, ulceration of the tips of some of the hypertrophied gastric folds provided an explantation for the iron deficiency anemia. Awareness that MD may present with anemia will help in the differential diagnosis with lymphoma and carcinoma.

Cartilaginous tumors of the larynx. A report of two cases with definitive diagnosis by fine needle aspiration and computed tomography.

BACKGROUND: Cartilaginous tumors of the larynx are rate tumors with an indolent course. In the past they were diagnosed by radiographic or computed tomographic imaging and laryngoscopic or surgical biopsy. The literature contains few examples of fine needle aspiration biopsy of these tumors. CASES: Smears of the fine needle aspirates from two cases of cartilaginous tumors of the larynx consisted of a mucinous background containing chondroid fragments of benign-appearing lacunar cells. Cytomorphologic and architectural features of smears and cell block preparations correlated well with histologic sections for subsequent surgical specimens. Both tumors were classified by cytology and histology as low grade cartilaginous tumors. CONCLUSION: Fine needle aspiration biopsy, together with typical computed tomographic images, is adequate for diagnosis, cost-effective and safe and can be performed in an outpatient setting.

Synchronous Hodgkin's disease and non-Hodgkin's lymphoma in an adult with acquired immunodeficiency syndrome (AIDS).

A 26-year-old male seropositive for human immunodeficiency virus (HIV) infection presented with atypical Hodgkin's disease. Subsequently, synchronous, aggressive non-Hodgkin's lymphoma was identified in this patient. Atypical Hodgkin's disease appears to be an opportunistic neoplasm in patients seropositive for HIV infections and should be considered as an indicator disease for the definition of acquired immunodeficiency syndrome (AIDS).

Extraskeletal osteogenic sarcoma of the mediastinum.

This report describes the clinical and pathologic aspects of a mediastinal extraskeletal osteogenic sarcoma. This is a rare tumor that presented clinically as a thymoma. The literature on extraskeletal osteogenic sarcomas is reviewed with respect to location, age, sex, treatment, and course. The potential role of fine-needle aspiration biopsy in the diagnosis of this lesion is discussed.