Giant cell reparative granuloma of the small bones of the hands and feet: a report of three cases.

Giant cell reparative granuloma (GCRG) involving the small tubular bones of the hands and feet is a rare entity that can have a wide range of morphologic presentations and can be confused with more aggressive tumors. Awareness of this lesion is important to avoid diagnostic errors and potential mismanagement. We report three cases of GCRG that involve the small tubular bones of the hands and feet, with long-term follow-up periods that confirm a benign course. Previous reports included the differential diagnosis of giant cell tumor, brown tumor of hyperparathyroidism, aneurysmal bone cyst, and non-ossifying fibroma. The presence of chondroid material in two of our cases, one of which also shows atypical nuclei and a periosteal reaction, expands the differential diagnosis to include bone- and cartilage-forming neoplasms.

Transmission electron microscopy: evaluation of damage in human oviducts caused by different surgical instruments.

Different wave length lasers (CO2, Nd-YAG, KTP-532), electrocautery and radiofrequency instruments were used to assess the degree of tissue damage in human oviducts. Excision of the human fallopian tube for tuboplasty is achieved most often by electrocautery, scalpel and, more recently, the Carbon Dioxide (CO2) Laser. There is not enough evidence at the present time to scientifically justify using one particular mode of incision which would show minimal damage to surrounding healthy tissue, especially heat lateral damage. The present study compares the tissue damage produced by the microelectrocautery, the CO2, the KTP-532, the Nd-YAG lasers and the radiofrequency surgical instrument, utilizing different power densities on the fallopian tubes freshly removed at the isthmic portion, taken from healthy women ages 30-42. Transmission electron microscopy sections at the cellular level show that the electrosurgical radiofrequency surgical instrument produces the least damage to surrounding healthy tissue. The CO2 laser with intermittent superpulse mode showed the second lowest amount of damage. The most damage was observed with the Nd-YAG laser at high power densities.

Broad immunocytochemical localization of the formylpeptide receptor in human organs, tissues, and cells.

The formylpeptide receptor (FPR), previously found only on polymorphonuclear leukocytes and monocytes/macrophages, responds to both synthetic N-formyl oligopeptides and those produced by bacteria. The cDNA for human FPR has been cloned and a rabbit polyclonal antiserum directed against a synthetic 11-amino-acid peptide corresponding to the deduced carboxy-terminus has been produced. We have now extensively characterized and used the antibody to detect FPR on normal human tissues and cell types. The receptor antigen is present on some epithelial cells, especially those with a secretory function, and on some endocrine cells, e.g., follicular cells of the thyroid and cortical cells of the adrenal. Liver hepatocytes and Kupffer cells are positive. Smooth muscle and endothelial cells are also generally positive. In the brain and spinal cord, the neurons of the motor, sensory, and cerebellar systems, and those of the parasympathetic and sympathetic systems stain positively. These data suggest that the putative endogenous agonist for FPR or an antigenically similar receptor reacts with cellular targets in the neuromuscular, vascular, endocrine, and immune systems.

Immunoperoxidase staining of tumors by an antibody to Xenopus pNiXa.

pNiXa, a serpin from oocytes and embryos of Xenopus laevis, was tested as a tumor marker in human and rodent tissues. A peptide corresponding to the histidine-rich domain of pNiXa was conjugated and administered to rabbits to produce a polyclonal antibody, which was purified by antigen-affinity and used for immunoperoxidase staining of formalin-fixed, paraffin-embedded tissue sections. Staining with pNiXa-antibody was positive in 23/187 human tumors (12 percent) and negative in 119 specimens of normal human tissues. Positive reactions were more frequent in liver (38 percent) and colon (34 percent) tumors than breast (18 percent), prostate (9 percent), mesothelioma (20 percent) or lung (0 percent) tumors. Staining was negative in human tumors from other sites. Rodent tumors and preneoplastic foci induced by chemical carcinogens were surveyed for staining with pNiXa-antibody. Staining was positive in 10/10 hepatic lesions (hepatocellular foci, adenomas, carcinomas) induced in hybrid D2B6F1 mice by diethylnitrosamine and phenobarbital, whereas murine mammary tumors and thyroid, pituitary, renal, and colon tumors of F-344/CNr rats were negative. Thus, immunostaining with pNiXa-antibody identifies a subset of human and murine tumors; further studies are needed to determine if reactivity of pNiXa-antibody has diagnostic or prognostic significance.

Diagnostic pitfalls in the diagnosis of soft tissue bladder tumors in pediatric patients.

This is a case report of a low-grade leiomyosarcoma of the bladder in a four-year-old girl. The pitfalls in diagnosing a soft tissue tumor of the bladder in pediatric patients are discussed. This case is particularly instructive because the differential diagnosis was broad, difficult, and of serious consequence. This report discusses the process by which histologic, immunohistologic and ultrastructural data were used to sidestep the pitfalls in diagnosing this unusual tumor. Clinical follow-up data bearing out our conclusion are also presented.

Cyclic neutropenia: a case of asymptomatic appendicitis.

A seven year old boy with a history of cyclic neutropenia (CN) was admitted to the hospital after developing fever and chills following a bicycle accident. After admission, he had a rapidly deteriorating hospital course leading to shock and death. At autopsy, acute appendicitis with resultant peritonitis and sepsis was diagnosed. The peculiar clinical and microscopic aspects of this case will be presented and contrasted with the more usual signs and symptoms of this cyclic disease.

Histopathology of sinonasal and lung cancers in nickel refinery workers.

Histopathological diagnoses were compiled for 100 sinonasal cancers and 259 lung cancers in nickel refinery workers, including cases from Wales, Canada, and Norway. The sinonasal cancers comprised squamous cell carcinomas (48 percent), anaplastic and undifferentiated carcinomas (39 percent), adenocarcinomas (6 percent), transitional cell carcinomas (3 percent), and other malignant tumors (4 percent). The lung tumors comprised squamous cell carcinomas (67 percent), anaplastic, small cell, and oat cell carcinomas (15 percent), adenocarcinomas (8 percent), large cell carcinomas (3 percent), other malignant tumors (1 percent), and cancers not otherwise specified (6 percent). Possible selection bias in these data cannot be excluded, since the histological diagnoses represent 63 percent, 68 percent, and 100 percent of cases of sinonasal cancer and 24 percent, 47 percent, and 86 percent of cases of lung cancer in the Welsh, Canadian, and Norwegian workers. This study suggests that (a) the sinonasal cancers in nickel refinery workers conformed to the usual distribution of histological types observed in the general population (in contrast to the predilection for adenocarcinomas in wood workers), and (b) the lung cancers in nickel-refinery workers showed preponderance of squamous cell carcinomas and deficit of adenocarcinomas, compared to prevalent proportions of these neoplasms, possibly reflecting the paucity of women in the cohorts and temporal trends during the six decades in which the tumors were diagnosed.

Early colonic anastomotic edema. Evaluation of stapled vs. hand-sewn anastomoses.

Early dysfunction of intestinal anastomoses is sometimes blamed on anastomotic edema. This study compares stapled and hand-sewn anastomoses for the development of early anastomotic edema. After segmental colon resections, one group of dogs was reconstructed with two-layered handsewn anastomoses, and the other group had stapled anastomoses. Controls were untouched small bowel in each operated animal and untouched colon in a separate group of dogs. At 24 hours postoperatively, all animals were given 125I albumin and at 28 hours the animals were killed, venous blood was obtained, and the anastomoses were harvested. Tissue levels of 125I albumin were measured at 1-mm and 1-cm distances from each anastomosis and compared with controls. This quantitative measure of edema was compared with the histologic appearance of the tissue specimens. The results show significant edema formation in both stapled and handsewn anastomoses compared with control tissues (P less than .05 for each animal). Although quantitative and histologic results demonstrate less edema in the stapled group, the difference is not significant by the Wilcoxin rank test. These and similar studies may allow improvement in surgical technique.

Cholesterol embolism causing bleeding gastric ulcers.

Two cases of atheromatous embolism of the small arteries of the stomach are reported. Insofar as has been ascertained, they are the first reported cases in the literature which presented symptoms of severe gastric bleeding and were found to have bleeding gastric ulcers on endoscopy. Both patients were successfully treated surgically, and their ulcers were found to be secondary to small arteriolar occlusions owing the atherosclerotic embolization. Awareness of clinicians as well as pathologists of this phenomenon in elderly males with symptoms of abdominal pain and other upper gastrointestinal symptoms unrelated to the ingestion of food is stressed. Pathophysiology of atherosclerotic emboli is also discussed.

Medullary thyroid carcinoma with radioiodide transport. Effects of iodine-131 therapy and lithium administration.

A 37-year-old woman presented with a neck mass that proved to be medullary thyroid carcinoma by histologic and immunoperoxidase examinations. Serum calcitonin values were greatly elevated (over 100,000 pg/ml). There were widespread metastases in bone and liver. As the peripheral lesions showed only slight response to chemotherapy and local radiation therapy, potential use of radioiodine was studied. The bone lesions showed uptake of both Tc-99m MDP and radioiodide (I-131). Metastatic lesions were similar to the primary tumor in terms of histology, presence of calcitonin, and absence of thyroglobulin. Hence, the patient had a medullary thyroid carcinoma that took up radioiodide in its metastases. Two large oral doses of radioiodide (over 100 mCi each) did not significantly alter the serum calcitonin values, although there was a slight response in the activity of bone lesions. The whole body turnover of radioiodide was rapid (T 1/2 = 0.7 days). Upon oral administration of lithium carbonate, whole-body radioiodide turnover slowed slightly (T 1/2 = 1 day). If this effect were reflected in greater tumor retention of radioiodide (slower release), then agents that block radioiodide egress might have a role to play in therapy.

Hydralazine hoarseness. A new appearance of drug-induced systemic lupus erythematosus.

Otolaryngologic involvement is rarely a manifestation of drug-induced systemic lupus erythematosus (SLE). Hoarseness developed in a 60-year-old man that was secondary to ulcerated lesions, which involved the epiglottis and aryteno-epiglottic folds, with serologic evidence of SLE after he had been treated with hydralazine for six months. Histopathologic study of an epiglottic "pseudotumor" disclosed necrotizing vasculitis. To our knowledge, this is the first reported case of laryngeal involvement as a complication of hydralazine-induced SLE.

The effect of chemotherapy on hepatoblastoma.

A 15-month-old girl had a case of mixed hepatoblastoma. The unresectable tumor became surgically resectable after treatment with doxorubicin hydrochloride and cisplatin, which was also continued postoperatively. This regimen had a remarkable necrotizing effect on the fetal epithelial component of the hepatoblastoma. The patient's high alpha-fetoprotein level and extreme thrombocytosis, which resolved with treatment, were used as indicators of the disease's activity. An unaffected mesenchymal component and a few microscopic foci of undisturbed embryonal hepatoblastoma were found. The finding of a mature intestinal epithelial island in this case is unique.

Filiform polyposis of the colon presenting as massive hemorrhage: an uncommon complication of Crohn's disease.

A case of localized filiform polyposis of the colon is presented. This lesion was part of a more generalized inflammatory bowel disease with clinicopathological features indicative of Crohn's disease. An unusual feature of this case was profuse rectal bleeding, initially from a solitary sigmoid ulcer and later from the area of filiform polyposis. A step by step clinicopathological follow-up emphasizing the development of filiform polyps is provided.

Morphologic study of carcinoid-like tumors and their relation to true carcinoids, using tumors of the breast as a model.

Two cases of an unusual type of infiltrating ductal carcinoma of the breast are presented. Both cases demonstrated a carcinoid-like pattern and were indistinguishable from carcinoid tumors of the breast by light microscopy. However, Grimelius stains and electron microscopic evaluation showed no evidence of membrane bound secretory granules. In regard to the prognostic significance and proper classification of carcinoids of the breast, awareness of carcinoid-like morphologic variants of infiltrating ductal or lobular carcinoma is important. It is also apparent that there is a spectrum of tumors which demonstrate some properties of true carcinoids, however, only the true carcinoids show a better prognosis and it serves no useful purpose to separate the rest of these tumors. The diagnosis of carcinoid tumors requires demonstration of secretory granules on electron microscopic examination or in special stains; conventional light microscopic studies alone are insufficient for this diagnosis. All these principles may be applied to carcinoid like tumors of other sites.

Lymph node biopsy for early diagnosis in Kawasaki disease.

Kawasaki disease or mucocutaneous lymph node syndrome is an acute exanthematous illness of childhood of unknown etiology with a recent marked increase in incidence. Occasional fatalities occur usually as a result of coronary thromboarteritis. Diagnosis is based on a spectrum of clinical signs and symptoms, some of which occur late in the acute phase of the illness. We recently examined cervical lymph node biopsies from two children during the early stage of illnesses which subsequently met the clinical criteria of Kawasaki disease and in which electron microscopy, cultures, serology, and other special studies failed to identify an etiologic agent. Both lymph node biopsies revealed multiple foci of necrosis and fibrin thrombi within the microvasculature, changes which have received little attention in the pathologic literature. These pathologic alterations are distinctive and probably characteristic. Early presumptive diagnosis of Kawasaki disease in our second case was based on the histopathologic findings and resulted in prompt institution of antithrombotic therapy. Lymph node biopsy has been underutilized in the diagnosis, and characteristic acute pathologic changes which may occur have been underpublicized.