ABSTRACT
A patient with type I cryoglobulinemia and monoclonal gammopathy of uncertain significance was found to have acute gallbladder vasculitis. The most prominent manifestation was upper abdominal pain in the setting of normal liver tests. An abdominal ultrasound demonstrated a thickened gallbladder wall, along with gallstones. HIDA scanning showed a nonfunctioning gallbladder with an edematous and thickened wall. There was characteristic leukocytoclastic vasculitis affecting the gallbladder. The patient recovered uneventfully subsequent to cholecystectomy. Gallbladder vasculitis should be considered in patients with unexplained upper abdominal pain and systemic vasculitis.
Subject(s)
Cryoglobulinemia/classification , Cryoglobulinemia/complications , Gallbladder Diseases/etiology , Vasculitis/etiology , Abdominal Pain/etiology , Adult , Biopsy , Cholecystectomy , Cholecystitis/etiology , Cholelithiasis/etiology , Cryoglobulinemia/diagnosis , Female , Gallbladder Diseases/pathology , Gallbladder Diseases/surgery , Humans , Nausea/etiology , Vasculitis/pathology , Vasculitis/surgery , Vomiting/etiologyABSTRACT
PURPOSE: Prior reports have indicated that adhesive glycoprotein receptors expressed by tumor cells enhance their invasive and metastatic properties. We have recently isolated and characterized a platelet immunorelated GPIb receptor expressed by cultured breast tumor cell lines that participates in initial adhesive events in the metastatic process. Whether expression of this receptor predicts tumor behavior or clinical prognosis remains unknown. PATIENTS AND METHODS: Forty sequential breast tissue specimens were examined for GPIb alpha, GPIb/IX, and alpha IIb beta 3 (GPIIb/IIIa) expression by immunohistochemical staining. Of 35 assessable breast specimens, 20 were invasive ductal carcinomas or lobular invasive carcinomas, six were ductal carcinomas in situ (DCIS), and the remaining nine consisted of nonmalignant pathologies. RESULTS: The expression of an immunorelated GPIb alpha and GPIb/IX complex by invasive mammary carcinoma specimens was highly significant (P < 0.0001). However, there was no correlation between alpha IIb beta 3 expression and invasive breast cancer. A GPIb alpha or GPIb/IX staining score of < or = 2.0 and > 2.0 correlated highly with the diagnosis DCIS and invasive carcinoma, respectively (P < 0.0039). Invasive breast carcinoma specimens demonstrated a 120% (P < 0.001) and 140% (P < 0.027) increase in GPIb alpha and GPIb/IX staining score in comparison with DCIS specimens. Expression of GPIb alpha and GPIb/IX correlated significantly with a tumor stage of > or = III (P < 0.008), a tumor size of > 3 cm (P < 0.012), involved axillary nodes (P < 0.004), and estrogen receptor negativity (P < 0.008). Finally, a significant correlation was observed between this receptor's expression and the presence of nodal and/or visceral metastases (P < 0.0035). DISCUSSION: These results demonstrate a significant correlation between GPIb expression and breast malignancy. The expression of the GPIb receptor appears to represent an unfavorable prognostic factor and a biomarker predictive of aggressive disease.
Subject(s)
Breast Neoplasms/metabolism , Platelet Glycoprotein GPIIb-IIIa Complex/metabolism , Adult , Aged , Antibodies, Monoclonal , Breast Neoplasms/pathology , Humans , Immunohistochemistry , Middle Aged , Neoplasm Metastasis , PrognosisABSTRACT
A 34-year-old male acutely presented with widely disseminated malignant melanoma, a microangiopathic hemolytic anemia, and disseminated intravascular coagulation. Although the patient had a history of intense childhood exposure to ultraviolet light and an occupational exposure to organic dyes, he had no history of a precursor skin lesion. The histopathology of the patient's bone marrow revealed sheets of malignant cells immunoreactive with S-100, HMB-45, and vimentin and also staining positively for melanin. A bone marrow aspirate revealed myeloid precursors filled with melanin-bearing vacuoles. Immunophenotypic analysis of the patient's bone marrow by flow cytometry revealed a paucity of hematopoietic cells. A karyotypic analysis of the patient's tumor cells demonstrated an abnormal hypertriploid composite clone characterized by multiple numerical and structural abnormalities. Although the patient was treated aggressively with transfusional support, heparin, and chemotherapy, he expired 3 weeks after diagnosis. This is the first recognized case of metastatic melanoma occurring in association with a microangiopathic hemolytic anemia.
Subject(s)
Anemia, Hemolytic/pathology , Bone Marrow Neoplasms/secondary , Melanoma/pathology , Melanoma/secondary , Adult , Anemia, Hemolytic/complications , Axilla , Bone Marrow Neoplasms/pathology , Disseminated Intravascular Coagulation/complications , Disseminated Intravascular Coagulation/pathology , Fatal Outcome , Hepatomegaly/pathology , Humans , Lung Neoplasms/secondary , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Splenomegaly/pathologyABSTRACT
Between 1981 and 1987, valvular surgery was performed in 988 patients, 27 of which were dead before discharge. Among them, 14 patients of cardiac deaths due to low cardiac output syndrome (LOS) and arrhythmias were analyzed to withdraw factors correlated with their cause of death. There was a tendency for the patients with stenotic valvular disease to die of LOS and regurgitant valvular lesions of arrhythmias. Statistical analysis showed the cause of deaths were multifarious including pulmonary, hepatic and renal failure, so no definite factor was pointed out. Case study of typical limited and extended surgical indications revealed (1) the patients with mitral stenosis combined with organic tricuspid regurgitation and RV/LV EDVI ratio over 1.5, and (2) the patients with aortic insufficiency and LVEDVI over 400 ml/m2 or LVESVI over 300 ml/m2 were candidate for hospital death after valve replacement. Extended approach for those patients should be two staged heart transplantation using ventricular assist device.
