Peripheral in-continuity tissue examination.

When treating skin cancers, it is essential to remove the entire neoplasm if possible. Immediate reconstruction is most helpful in returning the patient to a useful and satisfactory life. The Mohs histologic technique can be time-consuming and cumbersome. Reconstruction can be delayed. A modification of Mohs technique, peripheral in-continuity tissue examination (PITE), is described in which the surgeon and the pathologist combine their talents to remove the tumor. All margins are evaluated, and the surgical defect is closed primarily. Larger and more complex tumors can be removed and defects immediately reconstructed using this efficient technique, obviating the inconvenience, pain, and expense of multiple, separate procedures.

Liver tumor in long-term user of oral contraceptives.

Oral contraceptives are implicated in the development of some liver tumors. Paralleling the widespread use of these drugs has been an increase in reported cases of hepatic cell adenomas. Large, multiple tumors, often manifested by spontaneous rupture and hemoperitoneum, have been associated with prolonged use of oral contraceptives. When use of oral contraceptives is discontinued, the hepatic cell adenoma regresses.

PIP: A 36 year old obese and hypertensive woman visited her family physician because she felt dizzy and generally weak for 3 days. Even though she had been advised to stop taking the combined oral contraceptive (OC) containing 50 ug ethinyl estradiol and .5 mg norgestrel, at the time she consulted the physician she had been using it for 6 years. Upon admission to a South Carolina hospital, she stopped taking the OC. After appropriate treatment, her condition soon stabilized. The next day, however, she had a fever of 39.44 degrees Celsius, abdominal pain, generalized abdominal tenderness, and rebound tenderness. These symptoms continued through a 2nd day and a laparotomy was warranted. A 15x10 cm hepatic cell adenoma on the right lobe of the liver caused hemorrhaging in the peritoneal cavity. In addition, a 5-6 cm mass was found on the inferior surface of the left lobe. A liver spleen scan 3 weeks following surgery indicated diminished activity at the tumor site on the right lobe. 1 1/2 years later, physicians excised the now reduced tumor (4x2 1/2 cm) on the left lobe and the right lobe adenoma had necrotized and regressed. 15 months following excision of the left lobe tumor, a needle liver biopsy showed a mild, fatty change in the liver. No further liver problems have developed. Research demonstrates that prolonged use of OCs predisposes women to the development of hepatic cell adenoma, and large multiple tumors are associated with especially lengthy use. Research also indicates that when OC use stops, these tumors regress, but can reoccur if OC use or any estrogen therapy is reinstituted or if pregnancy occurs.

Parathyroid cyst.

Although parathyroid cyst has been infrequently reported until the past decade, its presumed rarity is attributed to nonrecognition. First reported in 1905, only 58 cases of parathyroid cyst had been documented in the world literature by 1967. Since then, however, substantial literature about this entity has been accumulating. The three cases we are reporting bring the cumulative total to 149. All three have been examined histologically and treated by aspiration or surgical excision. There is confusion clinically with thyroid cysts, and assay of fluid aspirate for parathormone and thyroxine may not accurately distinguish the origin of the cyst. Tissue diagnosis is confirmatory. Parathyroid cysts may be developmental, arising from vestigial remnants of the third and fourth branchial clefts; or coalescence of microcysts with associated hypersecretion may enlarge into macrocysts; or an adenoma may degenerate into a pseudocyst. Hyperparathyroidism, if present, is associated with only the last two.