Mucinous tumors of the vermiform appendix and ovary, and pseudomyxoma peritonei: histogenetic implications of cytokeratin 7 expression.

Cytokeratin 7 (CK-7) has been shown to be uncommonly expressed in colonic epithelial tumors, as opposed to ovarian epithelial tumors, which are always CK-7 positive. The authors investigated the expression of CK-7 in 17 appendiceal cystadenomas and carcinomas, 20 mucinous borderline tumors of the ovary, 10 cases of simultaneous mucinous tumors of the appendix and ovary, three so-called high-stage mucinous borderline tumors of the ovary, and three cases of pseudomyxoma peritonei (PP) of unknown origin. Nine appendiceal cystadenomas were CK-7 negative; two of these were associated with PP, and the peritoneal lesions were negative as well. Three cystadenomas were CK-7 positive. Three appendiceal carcinomas were CK-7 negative, and in one case the metastases were also negative. Two carcinomas were CK-7 positive. All 20 ovarian borderline tumors were CK-7 positive. Six cases of simultaneous mucinous tumors of the ovary and appendix were CK-7 negative, as were their peritoneal mucinous deposits. Four cases showed a positive reaction in both appendiceal and ovarian sites. Two of three so-called high-stage ovarian borderline tumors were CK-7 negative. All three cases of PP of unknown origin were CK-7 negative. In conclusion, appendiceal cystadenomas are often CK-7 negative, whereas ovarian mucinous borderline tumors are always CK-7 positive. The concordant staining pattern for CK-7 of simultaneous mucinous tumors involving the appendix and ovary (60% of which were CK-7 negative) supports an appendiceal origin for these tumors. Our results also support an appendiceal (or colonic) source for any CK-7-negative mucinous tumor involving the ovary or the peritoneum. Furthermore, our findings are in agreement with the assumption that mucinous borderline-like tumors in the ovary associated with PP are not ovarian in origin but are often, if not always, metastatic from an appendiceal (or other) mucinous tumor.

Immunoglobulin inclusions in Burkitt's-like malignant lymphoma: a case report.

A case of acquired immune deficiency syndrome (AIDS)-related Burkitt's-like lymphoma (BLL), demonstrating an as yet unreported occurrence of intracytoplasmic immunoglobulin inclusions, is reported. Histologic, immunocytochemical, and ultrastructural features are described with a review of the literature on signet-ring cell lymphoma.

Primary malignant lymphoma of the anorectum in homosexual men.

Two homosexual men presented with primary malignant lymphomas of the anorectum. Each patient presented with a painful mass, diagnosed by biopsy and immunologic cell marker studies. One patient, who had a reversed T4/T8 cell ratio, developed a local relapse of the tumor 11 months after radiotherapy, and Pneumocystis carinii pneumonia. The other patient, with a normal T4/T8 ratio, remained lymphoma-free and without evidence of opportunistic infection 25 months after combined chemotherapy and radiotherapy. Anorectal pathologic findings in homosexual men includes proctitis, inflammatory stricture, fissure, or anal warts. Malignant anorectal diseases, such as Kaposi's sarcoma, and cloacogenic or squamous cell carcinomas have been described in homosexual men. Primary malignant lymphoma of the anorectum is rare in both the homosexual and general populations.

Respiratory cryptosporidiosis in the acquired immune deficiency syndrome. Use of modified cold Kinyoun and Hemacolor stains for rapid diagnoses.

We report three cases of primary intestinal cryptosporidiosis with bilateral interstitial pneumonia. The diagnoses were made using two rapid (one-minute) staining procedures, modified cold Kinyoun's solution and a Hemacolor set, on touch preparations of lung biopsy material, sputum, and stool. Intracellular cryptosporidia oocysts in alveolar macrophages suggest possible hematogenous spread of this agent. Opportunistic cryptosporidiosis should be included in the differential diagnosis of pneumonia in patients with acquired immune deficiency syndrome.

Treatment of keloids by combined surgical excision and immediate postoperative X-ray therapy.

Sixty-eight histopathologically confirmed keloids were excised in 40 patients from 1970 to 1979. Surgery involved intrakeloidal excision with wound closure by direct, multilayered advancement repair or split-thickness skin grafting. All patients received x-ray therapy totaling 1,500 rads delivered in 3 equal doses, the first within several hours after surgery and the rest at two- to three-day intervals. There was a minimum of one year's follow-up in all cases, with a mean follow-up time of approximately twenty-four months. Recurrence rates of 21% per lesion and 28% per patient were obtained for the series. Earlobe keloids had recurrence rates similar to those noted for the series of a whole. Seventy-five percent of recurrences were evident within twelve months following treatment. Intrakeloidal excision combined with immediate postoperative x-ray therapy is effective in treating keloids.

Aorticopulmonary paraganglioma and gastric leiomyoblastoma in a young woman.

The 16th report of a patient with "Carney's triad" is presented. The triad consists of an extra-adrenal paraganglioma, gastric leiomyoblastomas and a pulmonary chondroma. The diagnosis is made by discovery of the presence of at least two of these individually rare tumors. The patient described as 15 year old girl who presented with a pericardial effusion caused by an invasive mediastinal paraganglioma. She was subsequently found to have multiple gastric leiomyoblastomas. The leiomyoblastomas have been resected. The paraganglioma was unresectable, and the patient underwent sequential radiation therapy and chemotherapy without response. Concomitant 5-fluorouracil chemotherapy with radiation resulted in an objective regression of tumor mass.

Treatment of early cancer of the breast (T1N0M0 and T2N0M0) on the basis of histologic characteristics.

This is a retrospective study of the results of various types of surgical treatment of early breast cancer staged histologically using the following characteristics: (1) poor cytologic differentiation, (2) lymphatic permeation, (3) blood vessel invasion, or (4) invasion of the tumor into the surrounding soft tissue. Four hundred and three patients who had early tumors of the breast--228 T1N0M0 (tumor 2 cm or less in diameter, no nodal involvement, and no metastasis) and 175 T2N0M0 (tumor 2 to 5 cm in diameter, no nodal involvement, and no metastasis)--were treated at St. Vincent's Hospital and Medical Center between January 1, 1965, and December 31 1976. Eighty-three were classified as being at low risk 190 at intermediate risk, and 130 at high risk. At 10 years, 100% of the low-risk group were alive; 99% were free of disease, and any type of mastectomy performed--radical, modified radical, or total--was adequate. At 10 years, 44% of those at high risk were alive, and 30% were free of disease. Radiotherapy improved life expectancy when added to radical mastectomy in the high-risk group. We recommend a prior excisional biopsy for proper histologic evaluation to allow a more appropriate choice of surgical procedure.

Transitional-cell cloacogenic carcinoma of the anal canal: Case report.

A case is presented of transitional-cell cloacogenic carcinoma of the anal canal in a 66-year-old woman. Eight years previously she had received radiation therapy for early carcinoma of the uterine cervix, but there was no evidence of recurrence. The rectal carcinoma was therefore regarded as a second primary malignant tumor. This point in differential diagnosis was considered important because of its bearing on the plan of treatment. After abdominoperineal resection of the tumor, the prognosis seemed favorable.