Malignant fibrous histiocytoma with myofibroblastic differentiation of the vulva in an adolescent female.

Malignant fibrous histiocytoma is a rare sarcoma. Only seven cases in the vulva have been reported. We present a case of malignant fibrous histiocytoma of the vulva in an adolescent female. The elected treatment was local wide resection.

Metastatic thyroid carcinoma masquerading as lacrimal gland tumor.

A 56-year-old woman presented with orbital signs and symptoms suggestive of lacrimal gland tumor. An excised biopsy specimen was obtained and showed glandular tissue, which could be confused with lacrimal gland acini. Closer microscopic examination and immunohistochemical studies revealed a metastatic tumor of thyroid gland origin. Initially, there was no identifiable nodule in the thyroid, but 3 months later a thyroid nodule was found by ultrasound and radioisotope scan. The histopathologic appearance of the thyroid nodule was similar to that found in the orbit. This case demonstrates the usefulness of immunohistochemistry in establishing a diagnosis when the microscopic appearance is inconclusive.

Paget's disease of the nipple resembling an acantholytic disease on microscopic examination.

Two biopsies of an erosive lesion of the nipple had an appearance of an acantholytic disease without showing malignant cells. Only a third biopsy through the nipple with removal of a larger portion revealed some nests of atypical, large cells with clear cytoplasm, typical of Paget's disease. Immunohistochemical findings with carcinoembryonic antigen confirmed the diagnosis of Paget's disease of the nipple. This is the first case of Paget's disease which shows extensive acantholysis on microscopic examination and which resembles pemphigus vulgaris histologically. Acantholytic diseases are easily distinguished from Paget's disease and have never been mentioned in the differential diagnosis of this disease. A large biopsy through the nipple with the removal of a liberal portion of the nipple is suggested in every case of a suspected unilateral lesion of the nipple in order to avoid the overlooking of small nests of Paget's cells, as in our first biopsies, showing a histological picture of an acantholytic disease.

Thoracic sympathetic trunk compression by osteophytes associated with arthritis of the costovertebral joint. Anatomical and clinical considerations.

Hyperostosis (lipping) due to costovertebral arthritis was found frequently (84.3%) impinging on the sympathetic trunks (ganglia and cord), rami communicantes and roots of the splanchnic nerves on both sides of the spine in more than 1,000 dissecting room cadavers examined and 34 cadavers of adult and elderly people specially dissected. As a result of the compression, the affected sympathetic structures were angulated, deflected from their course, enlarged and often infiltrated with connective tissue. The possible symptoms which may result from this kind of compression are discussed.

Malignant cystic meningioma with spike and wave EEG pattern.

A 23 year old woman suffering from grand mal epilepsy showed generalized spike and wave activity on her EEG. The CT showed a cystic tumor in the cortex and the white tissue of the right parietal region. On operation the tumor was diagnosed as malignant infiltrating cystic meningioma. After removal of the tumor the spike and wave pattern disappeared. Cortical localized tumors are rarely associated with a generalized spike and wave pattern.