Invasive inflammatory pseudotumor of the pelvis: a case report with review of the literature.

Inflammatory pseudotumor (IPT) is a rare benign lesion of unknown etiology, which mimics malignant neoplasm and may arise from various organs. A 53-year-old woman was submitted to diagnostic evaluation because of bilateral, hydroureteronephrosis and oedema of the left leg after a 3-month history of fever of unknown origin. On bimanual vaginal and rectal examination, a mass was involving the uterus, parametria and mostly left adnexa, while the cervix appeared normal. Computed tomographic (CT) scan revealed a 13x10.5 cm mass in the pelvis, mostly at the place of the left adnexa, uterus and both parametria, also involving the surrounding tissues and producing bilateral hydroureteronephrosis. At laparotomy, a grey solid mass was seen, mainly involving the reproductive system. As no radical operation could be performed, the mass was only biopsied and histology showed an inflammatory pseudotumor. Antibiotic therapy was given for one month. Follow-up CT 4 and 8 months after laparotomy showed local regression of IPT. The last follow-up CT, 20 months after laparotomy, revealed no evidence of tumor.

Conventional conformal radiotherapy vs intracavitary brachytherapy for the adjuvant postoperative treatment of cervical cancer: a comparative dosimetric study.

OBJECTIVES: The aim of this pilot study is to evaluate the feasibility of 3D-conformal radiotherapy (3D-CRT) in the adjuvant postoperative radiotherapy of the vaginal cuff and upper third of present vaginal tissue. METHODS: The representative patient (FIGO IB; PH: squamous cell carcinoma) was referred for adjuvant post-hysterectomy radiotherapy. A whole pelvis irradiation with concomitant high-dose-rate intracavitary brachytherapy (HDR-ICBT) was applied. HDR-ICBT total dose of 24 Gy in four fractions/one fraction per week was delivered to the vaginal cuff using two Fletcher-Suit ovoids. The feasibility of change from HDR-ICBT to CRT was evaluated by generating of three different plans using 10 MV photon beams shaped by multileaf collimator. RESULTS AND DISCUSSION: The referent volume received HDR-ICBT prescribed dose. The maximum ICBT percentage dose to the rectum and urinary bladder was 101% and 106% respectively. In all 3D-CRT plans almost 100% of planning target volume (PTV) was covered by 95% therapy isodose surface. From 12 - 13% of the rectum and 1-3% urinary bladder volume were covered by 100% isodose surface, with the highest maximum dose of 104% and 101%, respectively. Comparison of the PTV dose coverage and the maximum dose to the rectum and urinary bladder for HDR-ICBT and 3D-CRT plans showed no major difference. CONCLUSION; 3D-CRT could be considered as adequate replacement for ICBT in the adjuvant postoperative treatment of the vaginal cuff and upper thi-rd of present vaginal tissue. Time-dose-fractionation pattern for HDR-ICBT may be safely applied for 3D-CRT.

Hodgkin's lymphoma of the parotid gland: report of a case and literature review.

Hodgkin's lymphoma with its primary manifestation in the parotid gland is a very rare entity. In previously published reports the diagnosis was established by postoperative histopathological examination. The present report describes a case of primary Hodgkin's lymphoma of the parotid gland, diagnosed by fine needle aspiration (FNA) cytology, and includes a short review of the diagnostic approaches to the parotid gland tumors.

Clinical, pathologic, and toxicologic findings in asthma deaths in Cook County, Illinois.

To identify factors contributing to asthma mortality and improve our understanding of airway pathology in fatal asthma, we studied 44 cases of fatal asthma using records of one pathologist in the Office of the Medical Examiner. Records included death certificates, autopsies, toxicology, accounts by family and friends of the terminal episode, medical history of the deceased, police and paramedic reports, and hospital charts. Additionally, we interviewed by telephone surviving family and friends. Six (17%) of 35 patients were using inhaled corticosteroids at time of death. Of the nine patients who had seen a physician within 2 weeks of death, two were using corticosteroids. Toxicology was positive in 16 (38%) of 42 cases. Of the 20 patients with sudden-onset asthma (prodrome of increasing symptoms < 1 hour before death), 9 (45%) had positive toxicology. Patients with both sudden-onset and slow-onset asthma (prodrome > 3 hours before death) had airway mucosal or submucosal eosinophilic or neutrophilic infiltrates or both, as well as airways with and without mucus plugging. These findings indicate that asthma deaths are confounded by substance abuse and lack of anti-inflammatory therapy, and there is a heterogeneity in histological findings in sudden-onset and slow-onset asthma.

Sudden death in an 8-week-old infant with Beckwith-Wiedemann syndrome.

The authors report a case of a 2-month-old girl diagnosed with Beckwith-Wiedemann syndrome (BWS) who was born prematurely and died suddenly in the hospital just before being discharged. BWS is a malformation syndrome associated with an increased risk of childhood tumors. The major features of BWS are macroglossia, abdominal wall defects, and visceromegaly, frequently leading to premature birth. Due to complex inheritance patterns, a predominance of nonfamilial cases, and the variability in expression of the features (termed incomplete penetrance), the risk of delayed diagnosis is evident. Secondary to hyperplastic pancreatic islands, hypoglycemia occurs frequently, and if not anticipated, adequate measures for prevention of hypoglycemic episodes may be delayed, resulting in possible intellectual deficits. The infant presented here died of natural causes: immaturity of the lungs resulting in marginal respiratory function and compounded by increased risk for asphyxia secondary to the enlarged tongue. The clinical history and findings in this infant are discussed in respect to the genetic syndrome with their relevance to medicolegal examination and the causes and manner of death.

Age and species-dependent differences in the neurokinin B system in rat and human brain.

Neurokinin B and its cognate neurokinin-3 receptor are expressed more in the forebrain than in brain stem structures but little is known about the primary function of this peptide system in the central processing of information. In general, few studies have specifically addressed age-related changes of tachykinins, notably the changes in number and/or distribution of the neurokinin B-expressing and neurokinin-3 receptor-bearing neurons. Data on functions and changes of neurokinins in physiological aging are limited and apply mainly to the substance P/neurokinin-1 receptor system. In the present study, we analyzed neurokinin B/neurokinin-3 receptor system in young (5 months) versus middle aged (15 months) and old rats (23-25 months) and also in aging human brains. For the majority of the immunohistochemically examined regions of the rat brain, there was no statistically significant change in neuronal number and size of the neurokinin B and neurokinin-3 receptor staining. In the adult human brain, there was no age-associated change of the number or size of neurokinin-B-positive neurons. However, we found a major decline in number of neurokinin-3 receptor-expressing neurons between young/middle aged (30 years to 69 years) versus old (70 years and older) adults. Interestingly, numbers of neurokinin-3 receptor-positive microglia increased whereas the neurokinin-3 receptor-positive astrocytes remained unchanged in both aging rat and human brains. Finally, in addition to assessing the morphological and quantitative changes of the neurokinin B/neurokinin-3 receptor system in the rat and human brain, we discuss functional implications of the observed interspecies differences.

Fatal Chaetomium cerebritis in a bone marrow transplant patient.

The number of opportunistic infections in the central nervous system (CNS) has been steadily increasing because of a rising number of immunocompromised patients. A rare form of CNS infection can be caused by Chaetomium species, one of the largest genera of saprophytic ascomycetes. The CNS lesions in the present case were caused by Chaetomium atrobrunneum. The main characteristic of almost all Chaetomium species is presence of hairs or setae covering the ascomata. Microbiological studies are the only definitive way to correctly identify this fungal organism. The rapid evolvement of the cerebral infection suggests that the brain tissue provides a favorable environment for growth and proliferation of these fungi. This is the second documented case of a fatal brain abscess caused by Chaetomium atrobrunneum, and the first case report in a bone marrow transplant patient.

Neurokinin-3 receptor distribution in rat and human brain: an immunohistochemical study.

Autoradiographic and immunohistochemical studies have shown that the neurokinin-3 receptor is widely distributed in the rodent CNS. Expression of the neurokinin-3 receptor in human brain, however, has been debated. These conflicting findings, as well as the poor resolution of autoradiographic images, prompted us to develop a polyclonal antibody against an oligopeptide derived from the carboxy-terminus consensus sequence of both the rat and human neurokinin-3 receptor ([C]ASTTSSFISSPYTSVDEYS, amino acids 434-452 of the rat neurokinin-3 receptor). Western blot analysis of both human and rat brain tissue revealed a major band in the molecular weight range 65,000-67,000, the proposed molecular weight of the neurokinin-3 receptor based on its amino acid sequence and presumed glycosylation state. The distribution of selective high affinity neurokinin-3 receptor agonist [3H]senktide binding and neurokinin-3 receptor immunoreactivity were virtually identical in the brains of male Fischer 344 rats. The highest concentrations of neurokinin-3 receptors were observed in cortical layers IV-V; the basolateral amygdaloid nucleus; the hypothalamic paraventricular, perifornical and supraoptic nuclei; the zona incerta; and the entopeduncular and interpeduncular nuclei. [3H]senktide binding and neurokinin-3 receptor immunoreactivity were compared in homologous cortical areas of the human and rat brain. In contrast to the rat, autoradiographic analysis of normal control human brains (35-75 years) revealed a distinct and predominant superficial cortical labeling in the glia limitans and the cortical layer I. However, neurokinin-3 receptor immunoreactivity could be found not only in the superficial cortical layers, but also on pyramidal neurons and astrocytes in the neuropil and white matter. These findings suggest species differences in both the cellular and anatomical distribution of the neurokinin-3 receptor.

[Treatment of locally advanced esophageal cancer by combined intralumenal brachytherapy and external beam radiotherapy]. / Lecenje lokalno uznapredovalog karcinoma jednjaka kombinovanom endoluminalnom i transkutanom radioterapijom.

The prognosis of patients with esophageal cancer is poor, due to frequent local recurrence and distant metastasis. The last decade has also seen that brachytherapy as a treatment with real potential to improve the therapeutic ratio of external irradiation. From March 1993 to October 1994 at the Institute of oncology and radiology in Belgrade, 18 patients with locally advanced esophageal cancer were treated by combined intralumenal brachytherapywith external beam irradiation. Median age was 59.6 years (range 43-70) and male/female ratio 2.6:1. Biopsy via endoscopy showed squamous cell carcinoma in 17 patients and adenocarcinoma in one case. External beam radiotherapywas applied on linear accelerator by locoregional texhnique with tumor dose of 30-60 Gy in 10-30 fractions. Intralumenal brachytherapy was eprformed on microselectron with tumor dose 5-20 Gy in 1-4 fractions. Response rate (complete response rate + partial response rate) was registrated in 13/18 (72%) patients. The good paliative effect for dysphagia, continuated passage for any food and increase body weight was shown in 16/18 (88%) patients. Six months after treatment, 7/13 patients were free of disease. Acute complications as irradiation pesophagitis occured in majority of patients.

[Mammographic structure of breast parenchyma and the manifestations of breast cancer]. / Mamografska struktura parenhima dojke i pojava raka dojke.

The occurrence of breast carcinoma in regard to mammographic parenchyma samples applying the technique of Wolfe was analyzed. In the examined group of patients (n = 105) after clinical and mammographic examination mastectomy was performed with evacuation of axillary tissue. The malignancy was confirmed pathohistologically as well as the degree of spreading. The control group consisted of (n = 105) patients of the same age in whom at the time of examination and 6 months later malignancy was not confirmed. P-2 was more frequent in the group of the sick, while N-1 sample (X2 = 17.15, p < 0.01) was rarer. In patients older than 50 years of age Dy sample (x2 = 11.95, p < 0.01) was also more frequent. The difference can be explained by the fact that P-2 and Dy mammographic samples represent the picture of dysplastically changed breast tissue and depending on the presence of histologic elements of proliferation and cell atypias point to an increased risk of cancer. Consequently the samples are divided into "highly risky" (P-2 and Dy) and "of low risk" (N-1 and P-1). Women with mammographic parenchymal samples of a higher risk together with other risk factors should be frequently controlled.