Hyperparathyroidism complicating pregnancy: a diagnostic challenge?

Primary hyperparathyroidism (PHPT) is a rare etiology of hypercalcemia-induced pancreatitis, contributing about 0.4% to 1.5% of cases in the general population and up to 13% of cases during pregnancy. PHPT that occurs during pregnancy is a challenging diagnosis as the physiological changes in calcium homeostasis mask the symptoms of hypercalcemia. PHPT during pregnancy often remains undiagnosed and untreated, and may result in serious clinical implications for the mother and fetus. Most clinicians consider surgery within the second trimester of pregnancy as the treatment of choice in this group of patients. This article refers to a case of a 24-year married woman in whom PHPT was diagnosed for the first time in postpartum period. She succumbed to complications on Day 20 postpartum. Pathological findings revealed metastatic calcification in lungs, pancreas and uterine vessels, chronic pancreatitis and renal cortical necrosis.

Anaplastic thyroid carcinoma with osteoclast-like giant cells.

A case of anaplastic thyroid carcinoma with osteoclast-like giant cells is reported. This is an unusual malignant thyroid neoplasm with morphologic resemblance to giant cell tumor of bone. Light microscopy disclosed an undifferentiated carcinoma. Pleomorphic cells and tumour giant cells were accompanied by numerous osteoclast-like multinucleated giant cells.

A clinico-pathological study of 70 cases of pemphigus.

A clinicopalhological study of 70 cases of pemphigus observed over a span of four and a half years from January 1992 to June 1996 at the Sir J.J. Group of Hospitals and Grant Medical College, Mumbai is reported. Pemphigus vulgaris constituted the single largest group of 43 cases, followed by pemphigus foliaceus (25 cases) and pemphigus vegetans (2 cases). Majority of the cases were seen in the age group of 21-60 years, with a slight male predominance. The youngest patient was 14 years while the eldest was aged 75 years. Mucosal involvement was seen in 31 cases of pemphigus vulgaris, as opposed to only 5 cases of pemphigus foliaceus. Flaccid bullae were present in 100% cases. Pruritus was complained of in 14 cases, though it was more common in pemphigus vegetans and vulgaris. Salient histopathological features of pemphigus vulgaris observed were (I) intraepidermal suprabasal blisters (35 cases), (2) presence of acantholytic cells (40 cases), (3) "Row of tombstone appearance" (I8 cases) and (4) acantholysis involving follicular sheath (20 cases). Main histopathological features of pemphigus foliaceus were (1) subcorneal blister (15 case), (2) acantholysis (24 cases) and (3) bulla cavity containing inflammatory infiltrate (12 cases). Both cases of pemphigus vegetans showed hyperkeratosis, papillomatosis and irregular acanthosis with intra-epidermal eosinophilic abscesses besides suprabasal lacunae.

Systemic amyloidosis in Hodgkin's disease.

Secondary amyloidosis as a complication of Hodgkin's disease has been described as being unusual to rare in occurrence. We report a case in which the clinical picture was that of a renal failure, etiology of which could not be determined but which proved to be amyloidosis secondary to clinically unrecognised Hodgkin's disease.

Renovasculopathies in elderly normotensives of Bombay, India.

In essential hypertension, specific vasculopathies distinguish the kidney of nephrosclerosis. The severity of renovasculopathy can be measured histologically at autopsy. A previously determined equation uses the measurements to calculate mean blood pressure levels. That equation did not encompass elderly subjects with minimal vasculopathy, because they were deficient in the previous data set. Such subjects were abundant in a series of 86 autopsies conducted at the J.J. Hospital in Bombay. That newly reviewed series now provides many instances of normotension accompanying minimal vasculopathy at ages greater than 40-50 years. These conditions are seldom observed in the U.S.A. The newly examined elderly normotensives manifest degrees of renovasculopathy equivalent to those of youthful normotensives with comparable blood pressure levels. The elderly subjects who escaped a rise of blood pressure with age were those with long delayed progression of renovasculopathy; this may be the explanation for avoidance of hypertension in old age. The outcome places the J.J. Hospital patients among the populations of the world with the slowest rates of progression of hypertension.