Vulvar intravascular papillary endothelial hyperplasia or Masson's tumor: A case report.

Masson's tumor, also known as intravascular papillary endothelial hyperplasia (IPEH), is a rare and benign vascular disease in which there is a reactive hyperplasia of intravascular endothelial cells. This tumor is most commonly found in soft tissues in the head, neck and upper extremities. We report a rare case of IPEH on the vulva. A Hispanic woman in her mid-thirties presented with a painful and pruritic left vulvar mass. On physical examination, a pedunculated mass was visualized on the left labia majora. Under pathologic examination, it was concluded the lesion was IPEH and it was surgically excised. This is a rare case of IPEH located on the vulva. However, despite this rarity, a simple local excision could be used to manage IPEH.

BK polyomavirus in renal transplants: role of electron microscopy and immunostaining in detecting early infection.

Reactivation of BK polyomavirus (BKV) is increasingly recognized as a cause of failure of renal allografts. Since no specific treatment is available for this infection, early diagnosis is important, as it allows for early intervention and possible recovery of renal function. Forty-four consecutive renal transplant biopsies performed over a 2-year period were included in the study. In addition to evaluation of renal biopsy tissue sections using routine histochemical stains, CD3, CD20, BK virus immunostains using the specific BK virus and the SV40 antibodies and electron microscopy studies were performed. None of the transplant cases but one exhibited classical histologic viral changes. Viral particles were seen by EM in 19%, and BK-virus positivity was identified in only 43% of these cases. CD20-rich inflammatory infiltrates predominated in cases in which either positive BK stain and/or viral particles were identified ultrastructurally. A combined approach using electron microscopic and immunohistochemical evaluation can be utilized effectively to identify BK virus-associated nephropathy at an early phase facilitating early clinical intervention.

Electron microscopy in the diagnosis of BK-polyoma virus infection in the transplanted kidney.

BK polyomavirus has become an important etiologic agent responsible for significant morbidity in renal transplant recipients. This virus can be detected in transitional cells in the urine (decoy cells) using cytology, but correlation with allograft function status and histologic evidence of renal involvement is poor. Accurate diagnosis of BK polyomavirus infection requires a high index of suspicion and utilization of ancillary diagnostic techniques in many cases. Electron microscopy is very sensitive in depicting the presence of BK virions, but the finding of viral particles is not by itself diagnostic of BK interstitial nephritis. Management of patients with polyoma virus nephropathy is difficult since there is no specific antiviral therapy available at this time.

Atypical amyloidosis: diagnostic challenges and the role of immunoelectron microscopy in diagnosis.

Renal AL-amyloidosis is usually lambda-light-chain-related, particularly lambda type 6. Kappa-light-chain-related renal amyloidosis is a rare entity. Relatively few cases have been reported in the literature. The pathologic findings in some of these cases may mimic other disease processes. It is important to recognize the different morphologic expressions of this entity in order to render the right diagnosis. The authors discuss one such case in which the initial pathologic impression was erroneous and, upon further studies, including ultrastructural immunogold labeling, the diagnosis of kappa-light-chain-related renal amyloidosis was established.

Evaluation of fluorescence in situ hybridization as an ancillary tool to urine cytology in diagnosing urothelial carcinoma.

Our purpose was to evaluate the feasibility of performing fluorescence in situ hybridization (FISH) on routine urine samples and to compare the relative sensitivities of urine cytology and FISH for detecting urothelial carcinoma. Light microscopy (LM) using cytologic evaluation and FISH were used to study 121 consecutive urine samples. A mixture of fluorescent probes to chromosomes 3, 7, 17, and the 9p21 locus were used for detection of numerical chromosomal abnormalities (UroVysion, Vysis/Abbott). Biopsy specimens from patients in the study were reviewed if available. FISH analysis was performed without knowledge of cytology or biopsy findings. The urine cytology of 121 samples was interpreted as 59 negative, 41 reactive, 16 atypical, 2 suspicious and 3 insufficient cells for diagnosis. 85 samples were successfully analyzed by FISH. Thirty-one of these showed chromosomal abnormalities and these samples were initially regarded on the original cytology reading as follows: 10 negative, 10 reactive, 9 atypical, and 2 suspicious. FISH demonstrated chromosomal abnormalities in a significant number of cases (67%) that were initially diagnosed as normal or reactive by LM. Twenty-five patients were identified who had biopsy-proven TCC and successful FISH. Thirteen of the 25 patients (52%) were abnormal by FISH (cytology: 2 suspicious, 6 atypical, 4 reactive, 1 negative). One patient was atypical by cytology with normal FISH results but had TCC on biopsy. Hyperdiploidy for chromosomes 3 (77%) and 7 (67%) were seen consistently. Multiple chromosomal abnormalities were seen in 67% of these cases. We conclude that FISH has a greater sensitivity in detecting urothelial carcinoma when coupled with urine cytology. It is not entirely clear at this time whether a positive FISH may indicate frank neoplastic urothelial transformation or merely be an indicator of unstable urothelium capable of or primed for malignant transformation thus detecting patients at significant risk. The use of FISH in conjunction with urine cytology can potentially reduce urothelial carcinoma morbidity and mortality by diagnosing these tumors earlier.

Hepatoblastoma in a 15-month-old male: cytomorphology, electron microscopy, and differential diagnosis.

The authors describe a case of hepatoblastoma in a 15-month-old male and discuss the differential diagnosis and electron microscopic features of small round cell tumors. The patient was found to have an enlarged liver and was admitted to the hospital for further investigation. Fine-needle aspiration of the liver revealed small. uniform cells with increased nuclear/cytoplasmic ratio and focal rosette formation. A diagnosis of small blue cell neoplasm favoring hepatoblastoma was made, but neuroblastoma could not be ruled out. Electron microscopic analysis performed on the liver aspirate showed features of hepatic differentiation as well as absence of neuroblastic differentiation. The diagnosis of hepatoblastoma was made. Serum alpha-fetoprotein level of 33,250 mg/L confirmed the diagnosis. Liver biopsy performed subsequently showed tumor cells arranged in nests, acini, and trabeculae with mitotic figures. Electron microscopy showed the same findings as described above. The patient underwent chemotherapy for 4 months and subsequently a partial liver resection was performed. This case illustrates the important role of electron microscopy in evaluating small round cell tumors in children.

Association between prostate cancer and serum testosterone levels.

BACKGROUND: The purpose of the current study was to determine whether the presence of prostate cancer altered serum testosterone levels. METHODS: Initially, we evaluated both serum total and free testosterone levels in patients with either high-grade (n = 18) or moderate-grade (n = 146) prostate cancer, detected by prostate needle biopsies. Then both serum total and free testosterone levels, before and after prostatectomy, were compared in 79 of the 164 men with prostate cancer. RESULTS: In the first setting, serum total and free testosterone levels (307 +/- 24 ng/dl and 1.14 +/- 0.09 ng/dl) in patients with high-grade prostate cancer were significantly lower than those in patients with moderate-grade prostate cancer (452 +/- 12 ng/dl and 1.51 +/- 0.04 ng/dl) and those without prostate cancer (451 +/- 17 ng/dl and 1.55 +/- 0.06 ng/dl). After prostatectomy in 79 patients with prostate cancer, serum levels of both total and free testosterone (511 +/- 15 ng/dl and 1.78 +/- 0.05 ng/dl) were found significantly elevated when compared with their respective presurgical total and free testosterone levels (450 +/- 17 ng/dl and 1.60 +/- 0.06 ng/dl). CONCLUSION: Our findings show that serum total and free testosterone levels in patients with prostate cancer are altered, supporting the possibility that prostate cancer may inhibit serum testosterone levels.