Fatal pulmonary bile embolism following acute acalculous cholecystitis.

A 52-year-old man died during reoperation for bleeding after the development of acute postoperative acalculous cholecystitis. While the liver was being manipulated during surgery, the pulmonary artery diastolic pressure increased suddenly, cardiac output and blood pressure decreased, and soon afterward the patient had a cardiac arrest from which he could not be resuscitated. During resuscitative efforts, the maximum partial arterial oxygen pressure achieved was only 55 mm Hg despite 100% inspired oxygen. At autopsy, bile aggregates were found within necrotic liver parenchyma, portal and central vein branches, and numerous pulmonary arterioles and capillaries. The pulmonary arterial bile most likely resulted from embolization of inspissated hepatic bile aggregates during surgical manipulation.

Rhinosporidiosis: ultrastructural study of an infection in South Carolina.

We have morphologically described and ultrastructurally analyzed Rhinosporidium seeberi, the causative agent of rhinosporidiosis, obtained from a nasal polyp of a man who had never traveled to India or Ceylon. The morphology, endosporulation phases, and cell wall were similar to those in previously described infections. A common etiology is suggested and potential therapy is discussed.

Multiple congenital septal atresias of the intestine: histomorphologic and pathogenetic implications.

Congenital atresias of the gastrointestinal tract are usually single and divided into three forms on a morphologic basis. The septal or diaphragmatic type (type I) is the least common. We report an infant with multiple type I atresias involving both the small and large intestine and describe the unique histologic features of the septa: fragmentation of muscularis mucosa, multiple septal cysts lined by columnar epithelium, circular and longitudinal muscular layers, and absence of inflammation. This infant had a sibling who died with multiple intestinal atresias of the septal type. The histologic features suggest that type I gastrointestinal atresias may be due to failure of complete recanalization rather than result from healing of vascular of inflammatory events.

Stratification of risk factors in renal cell carcinoma.

One hundred fifteen patients underwent surgical treatment of renal cell carcinoma. Survival time was analyzed by statistical regression methods in order to determine the joint significance of stage, using both the Robson and TNM classifications, histologic grade, cell type, and demographic features of the patient sample. Grade and cell type were essentially interchangeable with respect to predicting survival in patients with and without metastatic disease. The strong association between these two factors explains and supports this result. The presence of metastases dramatically altered survival. Local extent of the tumor was an important indicator of survival in the nonmetastatic group of patients, but was not a statistically significant factor in those patients presenting with widespread disease. Venous involvement was not found to be of prognostic significance in either group. Age and weight loss contributed to predicting survival in the nonmetastatic patient group in addition to the measures of disease extent already discussed. Sex and race were not significant indicators of length of survival. In the group of patients with metastatic disease, no difference in survival was observed between soft tissue and bony metastases.

Late intrascrotal metastases from renal cell carcinoma.

A case of bilateral epididymal metastases appearing sixteen years after nephrectomy for renal cell carcinoma is reported. A literature review of intrascrotal metastases from renal cancer reveals that they are uncommon. The possible mechanisms of spread are discussed.

Correlation of mean nuclear area with estrogen receptor content in aspiration cytology of breast carcinoma.

Thin needle aspirates of 42 consecutive breast carcinomas were obtained at the time of excisional biopsy. Nuclear diameters of 100 cells from each case were measured, and the nuclear areas were calculated. The concomitantly acquired histologic sections were reviewed and assigned a histologic grade according to the National Surgical Adjuvant Breast Project protocol no. 4. Estrogen receptor (ER) content was analyzed by both the DCCA and SDGA techniques. The ER content of each case was then compared to both the mean nuclear area of the cells on the cytologic smears and the histologic grade. All 16 cases with mean nuclear areas of less than 60 sq micrometer contained significant levels of ER (greater than 10 fmol/mg protein), as did 6 of 11 cases with nuclei between 60 and 90 sq micrometer. Only 5 of 15 cases with nuclei larger than 90 sq micrometer contained significant ER levels. Comparison of the sensitivity, specificity and predictive values of both techniques suggests that a quantitative assessment of nuclear area in cytologic thin needle aspirates correlates more closely with ER content than does histologic grading.

Adenomyomatous hyperplasia of the human gallbladder.

Adenomyomatous hyperplasia of the human gallbladder, an infrequently observed alteration, has a controversial pathogenesis and clinical significance. In the nine gallbladders and patient profiles discussed, the morphologic alterations and associated clinical phenomena are compared to other mucosal-stromal reactions of the gastrointestinal tract. It is suggested that adenomyomatous hyperplasia represents a reaction to injury that occurs after an initial structural degenerative process and is followed by a proliferative repair.

Incidence and nature of primary granulomatous inflammation in surgically removed material.

A large number of cases (303) of primary granulomatous inflammation, present in surgically removed specimens from a broad range of locations, were reviewed and examined in detail. The granulomas were characterized as to morphology, location, and etiology. Epithelioid granulomas without necrosis were most frequently due to sarcoidosis and mycobacterial infection, while epithelioid granulomas with necrosis were most commonly due to mycobacterial infection, fungal infection, rheumatoid arthritis and sarcoidosis. Mature granulomas, most of which did not contain necrosis, were generally due to foreign bodies. The responsible etiologic agents were generally identified in granulomas due to fungi, bacteria, or foreign bodies (92%). However, mycobacteria were infrequently identified in granulomas, even when the lesions were examined by the auramine-O technique (31%). Overall, the majority of the granulomas (76%), were due to five causes: sarcoidosis, mycobacterial infection, particulate inclusions, fungal infection, and rheumatoid arthritis. The frequency of a given etiology, however, varied widely depending on the location of the lesion. By classifying granulomas morphologically and knowing their location, useful predictive information concerning the etiology of a given granuloma, beyond that obtained by histochemical stains, could be derived.

Bronchial collapse in obstructive lung disease.

A 57-year-old man who died suddenly with severe bilateral mainstem bronchial collapse is described, and an alteration of the elastic tissue in the membranous portion of the bronchi is identified. The morphologic abnormalities, physiologic dynamics, and potential clinical consequences of such an alteration are discussed.

Fatal Rocky Mountain spotted fever. Hematologic and lymphoreticular observations.

Generalized histiocytic proliferation with a component of phagocytosis and thrombocytopenia accompanies a number of infectious diseases and malignant neoplasms. Its extent and occurrence were studied in the hematopoietic and lymphoreticular tissues of fatal childhood cases of Rocky Mountain spotted fever. Its frequent occurrence and morphologic similarities to other associated causes were documented.

Multicentric renal oncocytoma.

Renal cell oncocytomas are benign tumors of tubular epithelial origin. They usually occur as single nodules and may be confused clinically with renal cell carcinoma. We report an unusual case of multiple, discrete renal cell oncocytomas. The characteristic gross and light microscopic, and ultrastructural features are described. The potential of multicentricity is confirmed and its implications for therapy are discussed.

Infantile pulmonary hypertension associated with foreign body vasculitis.

An infant dying with pulmonary hypertension had a pulmonary vessel foreign body vasculitis as identified by light microscopy and characterized ultrastructurally by scanning electron microscopy and energy-dispersive x-ray analysis. The inclusions were of two distinct types: those containing silicon and titanium, and others consisting of talc. The possible sources of these inclusions and the importance of considering foreign body vasculitis in the pathogenesis of clinically idiopathic pulmonary hypertension are discussed.