Paratesticular Fibrous Pseudotumor: A New Entity of IgG4-Related Disease?

INTRODUCTION: Paratesticular fibrous pseudotumor (PFP) represents a benign tumor-like lesion confined to intrascrotal, paratesticular areas. Due to its rarity, only less than 200 cases have been reported to date, of which both pathogenesis and clinical management are little understood. Recently, PFP has been postulated to be among the spectrum of so-called immunoglobulin G4-related diseases (IgG4-RD). Here we describe a case of PFP focusing on the clinical, morphological features and the utility of immunohistochemistry to support the theory that PFP might be a potential member of IgG4-RD family. CASE PRESENTATION: A 41-year-old man presented with a slowly growing, right intrascrotal mass An MRI scan revealed a diffuse-proliferative nodular mass around the paratesticular area. The patient underwent right orchiectomy and a diffuse multinodular tumor with testicular compression was discovered without intratesticular infiltration. Postoperatively, the patient has been well for 2 years up to the recent follow up. On histological examination, the lesion consisted of hyalinized fibrotic tissue with storiform patterns. There were scattered germinal centers; lymphocytic vasculitis was also noted. The immunoglobulin G4 staining showed infiltration of positive plasma cells with highest count 52 per high-power field, whereas the mixed Kappa and Lambda immunoglobulin light chain expression indicated the polyclonality of the plasma cell population. CONCLUSIONS: The morphological and immunohistochemical features in our case support the theory of PFP being part of IgG4-RD. Familiarity to this tumor-like lesion is crucial, since it may respond to corticosteroid therapy, which may save patients from more aggressive surgical procedures.

[Criticism of physicians by Johannes Gregorius Macer Szepsius (1530-after 1579)]. / Johannes Gregorius Macer Szepsius (1530-1579 után) kritikája az orvosokról.

Humanist author J. G. Macer Szepsius (1530-after 1579) born in Szepsi, Upper Hungary (today Slovakia, Moldava and Bodvou) lived in Krakow and was a typical author of Latin occasional poetry. In a part of his work De vera gloria libellus (Booklet on the true glory) published in 1562 he deals with certain professions and criticizes them. Physicians are described as being garrulus (loquacious), mendicus (beggar), and having a big belly due to a luxury. The Physician doesn´t read books, is lazy and not characterized by his knowledge, but rather by ignorance, arrogance and pride. Physicians prescribe medications without knowing their effects. Such a criticism is surprising, because Macer Szepsius was probably closely related to medicine.

[FIRST WOMEN DOCTORS FROM TURKEY: AMALIA FRISCH (1882-1941)].

Amália Frisch was born in Edirne/Adrianople, Turkey, in 1882 to an immigrant Jewish family from Hungary. Following her graduation from the American College for Girls in Istanbul in 1901, she traveled to Switzerland for her medical education. Amália Frisch graduated from the school of medicine in Bern in 1907, and received her MD (Doctor universae medicinae) degree from the Zurich University in 1908. She specialised in gynaecology at the Vienna University Clincs, before returning to Istanbul. In the December of 1908, Dr. Amália Frisch was appointed intern to the Austro-Hungarian Hospital in Galata to attend the women's ward. During the Balkan Wars of 1912-13 the hospital housed the wounded of the Turkish Army in its Pancaldi premises, and Amália Frisch received medals of merit for her services both from the Habsburg Emperor Franz Josef and the Ottoman Sultan Mehmed Reschad V. Amália Frisch was an active member of the Ottoman Society for the Protection of Women's Rights (est. 1913). She was deported by the French occupation command in 1919 and returned to Budapest, after which she altered her profession to stomatology and dentistry. Amália Frisch passed away in Budapest during war, in 1941.

The library of the Royal Society of Physicians in Budapest becomes today's Semmelweis Medical History Library.

OBJECTIVES: The 170-year history of the library of the Royal Society of Medicine in Budapest illustrates both that political and cultural context matter and that "medical" libraries, if they survive, in due course become primarily "medical history" libraries. METHODS: Two of the authors are on the staff of the Semmelweis Medical History Library; the third is a US scholar who makes frequent use of the library. Together, they avail themselves of archival and published materials-and personal experience with the collection-to establish the context that produced the original library, trace its evolution, and describe its present-day incarnation. RESULTS: A tale of transformation emerges that reflects how collections are likely to change. The authors present events and individuals in the life of the Royal Society's library and paint a picture of the value of today's Semmelweis Medical History Library. Unique treasures in the collection are described. CONCLUSION: The story told here is of how a particular nineteenth-century library became a twenty-first-century institution. The authors establish its peculiarly Hungarian context and potential value to librarians and historians from outside Hungary. The overall message is that general medical libraries everywhere are perforce likely to become medical historical libraries over time.