Bile duct adenoma with oncocytic features.

Bile duct adenomas are benign bile duct proliferations usually encountered as an incidental finding. Oncocytic bile duct neoplasms are rare and the majority are malignant. A 61-year-old male with a diagnosis of colorectal adenocarcinoma was undergoing surgery when a small white nodule was discovered on the surface of the right lobe of his liver. This lesion was composed of cytologically bland cells arranged in tightly packed glands. These cells were immunopositive for cytokeratin 7, negative for Hep Par 1, contained mucin, and had a Ki67 proliferation index of 8%. The morphology, immunophenotype, presence of mucin, and normal appearing bile ducts, as well as the increased Ki67 proliferation rate, were consistent with a bile duct adenoma with oxyphilic (oncocytic) change. Oncocytic tumors in the liver are rare; the first described in 1992. Only two bile duct adenomas with oncocytic change have been reported and neither of them had reported mucin production or the presence of normal appearing bile ducts within the lesion.

Angiofollicular lymphoid hyperplasia (Castleman disease) presenting as an isolated neck mass.

Castleman disease is a relatively uncommon lymphoproliferative disorder. A presentation as an isolated lesion in the neck is extremely rare. We report the case of a 26-year-old man who presented with a 4-month history of an enlarging right neck mass that was identified as Castleman disease on excisional biopsy. The biopsy was curative. In localized forms of Castleman disease, excisional biopsy is both diagnostic and curative. However, in multicentric forms, additional treatment is required.

Scar carcinoma of the lung: a historical perspective.

Lung scar carcinoma (SC) was first described by Friedrich in 1939 as a type of lung cancer that originates around peripheral scars in the lung. Scarring in the lung can result from a variety of infections, injuries, and lung diseases. Scars can also be due to repeated episodes of tumor necrosis and healing. SCs are typically found as subpleural adenocarcinomas with retraction or puckering of the overlying pleura. They were considered a histologic curiosity that was promoted for decades until doubts about their existence were raised in the 1980s. Finding type III collagen, type V collagen, and myofibroblasts characteristic of fibrosis in the scars, finally reversed the original SC concept. The presence of type III collagen and extracellular matrix suggested an ongoing fibrosing process secondary to host response to the neoplasm. The high concentration of type III collagen in SC indicates that the fibrous tissue is in an active immature state compared with noneuplastic fibrous tissue, which is mature and contains type I and type V collagen. A recent cohort analysis of data from the PLCO (Prostate, Lung, Colorectal and Ovarian) cancer screening trial demonstrated a correlation between the presence of scar and the development of carcinoma, but the causation of this association has to be determined by future studies. The role of inflammation, infections, and smoking in the development of cancer is discussed in this article. Additional research is necessary to determine if lung scarring detected by imaging requires clinical monitoring in the context of the development of lung cancer when a defined set of risk factors is identified.

Bravo (wireless) ambulatory esophageal pH monitoring: how do day 1 and day 2 results compare?

AIM: To investigate if differences exist for patients' gastroesophageal reflux as measured by the Bravo ambulatory esophageal pH system between d 1 and d 2. METHODS: A retrospective study of 27 consecutive adult patients who underwent Bravo esophageal pH monitoring was performed. Patients underwent EGD under IV conscious sedation prior to Bravo placement. Acid reflux variables and symptom scores for d 1 were compared to d 2. RESULTS: The mean doses of fentanyl and midazolam were 90.4 microg and 7.2 mg, respectively. D 1 results were significantly more elevated than d 2 with respect to total time pH < 4, upright position reflux, and mean number of long refluxes. No statistical difference was noted between the two days for supine position reflux, number of refluxes, duration of longest reflux, episodes of heartburn, and symptom score. CONCLUSION: Patients undergoing Bravo esophageal pH monitoring in association with EGD and moderate conscious sedation experience significantly more acid reflux on d 1 compared to d 2. The IV sedation may be responsible for the increased reflux on d 1. Performed this way, 48-h Bravo results may not be entirely representative of the patients' true GE reflux profile.