Mesenteric infarction secondary to tumor emboli from primary aortic sarcoma. Guidelines for diagnosis and management.

Primary aortic tumors are rare, difficult to diagnose, and often fatal. This case and a review of the literature identified aortic tumors as a potential source of emboli leading to acute mesenteric insufficiency. The case showed the efficacy of magnetic resonance imaging in diagnosing and determining the extent and location of an aortic tumor.

Jejunal vasculitis with protein-losing enteropathy after bone marrow transplantation.

A 37-yr-old white man experienced crampy abdominal pain beginning 21 days after successful bone marrow transplantation for chronic myelogenous leukemia. Generalized edema and hypoproteinemia developed. Symptoms persisted until 61 days post-transplant, when the patient developed an acute abdomen. At laparotomy, an edematous segment of jejunum was resected. Pathological examination showed submucosal vasculitis and necrotizing enteritis. Serum protein and albumin levels returned to normal within a few weeks after surgery. Vasculitis of the gastrointestinal tract should be considered in the differential diagnosis of protein-losing enteropathy after bone marrow transplantation.

Development of hepatic cholestasis and fibrosis in patients with massive loss of intestine supported by prolonged parenteral nutrition.

We studied the effect of 1 yr of parenteral nutrition on liver function tests and, when indicated, liver histology and ultrastructure of 18 patients with no (n = 6), modest (n = 6), and massive (n = 6) loss of intestine. The resection was for Crohn's disease and infarction, respectively. The liver function tests remained normal in all patients with no loss and modest loss of intestine. Four patients with massive loss of intestine, 4-10 mo after initiation of parenteral nutrition, began to develop progressive, marked increases in serum alkaline phosphatase (2-10 times normal), glutamic oxaloacetic transaminase (7-20 times normal), and glutamic pyruvic transaminase (5-14 times normal) activity levels, and bilirubin concentration (5-22 times normal). Light microscopic examination of liver showed cholestasis, bile ductular proliferation, periportal inflammation, fibrosis, and mild steatosis. Electron microscopic examination of liver showed cholestasis with nonspecific organelle changes. None of the patients had any evidence of extrahepatic obstruction. Our data suggest that massive loss of intestine is a contributing factor to hepatic cholestasis and fibrosis in patients maintained on prolonged parenteral nutrition.

Celiac sprue complicated by lymphoma presenting with multiple gastric ulcers.

A 40-yr-old woman with celiac sprue, which had responded clinically and histologically to gluten elimination, subsequently developed gastrointestinal lymphoma. Although this has been described in the small intestine of patients with celiac sprue, the unique feature in this patient was her initial presentation with multiple gastric ulcers refractory to conventional medical therapy. This case demonstrates that lymphoma complicating celiac sprue may present with multiple refractory gastric ulcers in addition to those occurring in the small intestine.

Primary intracranial germinoma with massive ventriculoperitoneal shunt metastases.

Ventriculoperitoneal shunt metastases from primary intracranial germinomas are extremely rare. To date, only three case reports of this phenomenon have appeared in the literature. We present the case of a 25-year-old black male who developed ventriculoperitoneal shunt metastases 10 months following diagnosis of an intracranial germinoma. Radiotherapy destroyed most of the intracranial tumor, but abdominal metastases became progressive and were not treated with radiotherapy. The role of radiotherapy in the treatment of ventriculoperitoneal shunt metastases is examined and previous cases in the literature are reviewed.

Loiasis in an American naturalist.

In March 1981, a 32-year-old male naturalist involved with collecting mammals for study was found to have an unexpected eosinophilia. Serum parasitic screening done at the Centers for Disease Control showed filarial titer by indirect hemagglutination of 1:1,024 and of 1:40 by bentonite flocculation. His travel history disclosed 3 months spent in Cameroon in 1978. He also gave a history of intermittent arm swelling for at least a year. Peripheral blood, collected repeatedly at mid-day and midnight and tested for microfilariae by the Knott technique, was negative. He was begun empirically on diethylcarbamazine, and on day 11 of treatment he removed a worm, identified as a male Loa loa, from his leg. He completed treatment without difficulty and has done well.

Hepatic angiosarcoma associated with short-term arsenic ingestion.

In a 45 year old man, hepatic angiosarcoma developed 33 years after medicinal arsenic ingestion of only six months' duration. In addition, the patient had a history of basal cell carcinomas without having had excessive sunlight exposure. Factor VIII staining of the tumor supports an endothelial cell origin of the tumor. The development of skin cancers and hepatic angiosarcoma in this patient suggests that there may be no safe threshold of arsenic exposure. A careful history concerning even short-term arsenic exposure in all patients with hepatic angiosarcoma may uncover more examples of this association.

Pathological correlation of CT ring in recurrent, previously treated gliomas.

The meaning of the enhancing ring commonly seen on computerized tomographic (CT) scans in patients with recurrent, treated glioblastoma has long been of concern. Does the ring represent radiation necrosis, pseudocapsule formation, compressed adjacent brain, or, in fact, a peripheral zone of viable tumor? We employed a multiple intratumoral biopsy technique at the time of reoperation to investigate this ring. Pathological evidence is presented documenting the content of the ring to the viable tumor. It is suggested that perhaps treatment failure may be determined on sequential CT examinations by comparing the volume and degree of contrast enhancement.

Paradoxical cerebral air embolism without an intracardiac septal defect. Case report.

Cerebral air embolism occurred in a patient undergoing trigeminal rhizotomy in the sitting position. During the acute episode, a murmur was detected by the Doppler probe and foam was aspirated from the central venous catheter. The patient did not regain consciousness postoperatively, and computerized tomography demonstrated diffuse cerebral infarction. Subsequently, the patient died, and neuropathological examination revealed multifocal discrete infarcts in the gray and white matter with normal intervening brain. No intracardiac septal defects were present. This is the first fully documented case of cerebral air embolism of venous origin in the absence of intracardiac septal defects, and reemphasizes the hazards of operative procedures in the sitting position.

Amyloidosis and chronic intestinal pseudoobstruction.

A 39-year-old woman with multiple myeloma developed chronic intestinal pseudoobstruction associated with gastrointestinal amyloidosis. Motor abnormalities of the lower esophageal and anal sphincters correlated closely with amyloid infiltration in affected areas. Manometric abnormalities of esophageal and anal sphincter function may provide indirect evidence of amyloid deposition of gastrointestinal smooth muscle in an appropriate clinical setting.

Primary glioblastoma multiforme of the pineal region with leptomeningeal metastases: a case report.

The incidence of primary intracranial glioblastoma multiforme originating in the pineal region is exceedingly rare. Diffuse leptomeningeal involvement, including spinal subarachnoid metastases, by a primary glioblastoma multiforme of the pineal region has not been reported. A report of a case of primary glioblastoma multiforme of the pineal region accompanied by diffuse leptomeningeal and nodular spinal subarachnoid metastases is presented. Extensive evaluation of the complete neuraxis, including histologic examination, in all cases of primary pineal neoplasm appears to be of both diagnostic and therapeutic value.

Workload recording by microcomputer.

Workload recording as designed by the College of American Pathologists has proven to be an invaluable aid in the assessment of overall laboratory operation. The administrative information derived from the compilation of these workload statistics is utilized to provide effective and these workload statistics is utilized to provide effective and efficient laboratory management. A microcomputer-based system for the pathology department that permits the accumulation of daily raw workoad data is descirbed. A monthly cummulative summary report is subsequently produced, complete with computer-derived College of American Pathologists workload units.

Comparison of the effects between ursodeoxycholic and chenodeoxycholic acids on liver function and structure and bile acid composition in the Rhesus Monkey.

The hepatotoxic potential of the cholelitholytic bile acids, chenodeoxycholic (chenic), and ursodeoxycholic acids, was compared in the rhesus monkey. A placebo-controlled treatment trial with 40 and 120 mg/kg/day doses of chenic acid and ursodeoxycholic acid, respectively, was conducted in 20 animals. Both chenic and ursodeoxycholic acids induced comparable abnormalities of liver function and structure. Liver biopsies, performed before and after 6 mo of treatment, showed the development of distinct light microscopic changes, including inflammation, fibrosis, and ductular proliferation in the portal fields as well as lobular rearrangement with formation of septa and regenerative nodules. Electron microscopy confirmed light microscopy, but showed no specific changes of cell organelles. Light microscopic examination of the kidneys, lungs, heart, intestine, and brain in 10 monkeys, which were sacrificed after 6 mo of controlled bile acid treatment, showed no abnormalities. Biliary lithocholic acid, all of which was unsulfated, increased several-fold to comparable levels in the bile acid-treated groups. Follow-up studies 6 mo after termination of bile acid treatment showed normalization of liver function tests and of bile acid composition as well as a considerable improvement of the histologic abnormalities. However, the restitution of normal liver structure was incomplete, with fibrosis and mild inflammation persisting in the portal fields. Our studies show that, in this primate species, chenic and ursodeoxycholic acids have comparable hepatotoxic effects, which are associated with similar increases of unsulfated lithocholic acid in bile.

Pathology accessioning and retrieval system with encoding by computer (PARSEC). A microcomputer-based system for anatomic pathology featuring automated SNOP coding and multiple administrative functions.

A pathology accessioning and retrieval system with encoding by computer (PARSEC) has been developed, employing a relatively inexpensive microcomputer. PARSEC performs a variety of administrative functions for anatomic pathology, including accessioning of surgical specimens, storage of patient demographic information, editing, retrieval, and archiving of patient data, as well as CAP (college of American Pathologists) workload units, billing, and inventory functions for histopathology. In addition, appropriate gross and microscopic descriptions and pathologic diagnoses can be entered into the system by a text editor. Automatic assignment of SNOP (Systematized Nomenclature of Pathology) codes, is accomplished via an online SNOP lexicon, allowing the ultimate generation of completed surgical pathology reports. The data base management system employed makes optimum use of disk storage space, while permitting rapid data retrieval. Data file maintenance is automatically accomplished by the system, requiring no user intervention.

Endodermal sinus tumor originating in the region of the pineal gland: ultrastructural and immunohistochemical study.

This is a case report of an endodermal sinus tumor (EST) arising in the pineal region of a 19-year-old girl (first case studied by electron microscopy). The ultrastructure of the tumor was similar to that of the previously reported cases of EST of ovaries, mediastinum, and sacrococcygeal area. A characteristic basement membrane-like material has been identified within endoplasmic reticulum of tumor cells and in intercellular spaces. Alphafetoprotein has been detected in the spinal fluid of the patient by radioimmunoassays and within tumor tissue by immunohistochemical techniques. Combination therapy consisting of radiation, surgical decompression, chemotherapy (BCNU), and prednisone has been employed in the treatment of this patient without significant benefit. The patient expired three months after the surgery, no autopsy was obtained.

Acquired toxoplasma lymphadenitis.

Toxoplasmosis is a common parasitic infection that is widely distributed throughout the world, including the United States. Its occurrence in the oral cavity, however, is uncommon. This report concerns a case of toxoplasmosis that manifested as an intraoral lymphadenitis in a 14-year-old white girl. The etiology, clinical, microscopic, and laboratory findings, and treatment are reviewed. The importance of recognizing lymphadenopathy as a clinical sign of this disorder is discussed.

Mandibular metastasis of an extraskeletal myxoid chondrosarcoma arising on the plantar surface of the foot: report of case.

This paper presented a discussion of the initial appearance and atypical clinical course, histopathology, treatment, and prognosis of a case of extraskeletal myxoid chondrosarcoma that originated on the plantar surface of the left foot and that metastasized to the mandible. The clinical behavior of this neoplasm, as reported, is distinctively less aggressive and therefore thought to have a better prognosis than chondrosarcoma of bone. Contrary to the biologic behavior reported in the literature, however, our patient had a less than six-year remission from the neoplasm.