Hyperplastic mesothelial cells within abdominal lymph nodes: mimic of metastatic ovarian carcinoma and serous borderline tumor--a report of two cases associated with ovarian neoplasms.

Two cases of hyperplastic mesothelial cells within intra-abdominal lymph nodes were encountered in staging procedures in a 59-year-old woman with bilateral ovarian serous borderline tumors and in a 21-year-old woman with a Sertoli-Leydig cell tumor of intermediate differentiation. Both patients also had mesothelial hyperplasia of the pelvic and abdominal peritoneum; in one of them, the hyperplasia was striking. The intranodal mesothelial cells occupied the sinusoids of the lymph nodes and were initially suspected of being metastatic from the ovarian tumor in each case. The appearance of the cells on routine stains suggested the correct diagnosis, which was confirmed by histochemical and immunohistochemical staining. These cases represent the first reported examples of mesothelial cells within abdominal lymph nodes, although similar involvement of mediastinal lymph nodes has been described in three patients with pleural effusions. Intranodal mesothelial cells should be distinguished from metastatic tumor, an error that could result in inaccurate staging in a patient with a known tumor or prompt a futile search for an occult primary tumor. Moreover, it is important that in studies evaluating the frequency of nodal involvement by serous borderline tumors, intranodal mesothelial cells should not be misinterpreted as metastatic borderline tumor, a distinction that can be difficult with only routinely stained sections.

Argyrophilic cell hyperplasia and an atypical carcinoid tumor in chronic ulcerative colitis.

An unusual case of chronic ulcerative colitis, is presented in which an atypical carcinoid tumor was seen. Many areas of the mucosa showed glandular changes of chronic injury and dysplasia, and in these areas, argyrophilic cell hyperplasia was identified. Data is presented describing the evolution of argyrophilic cell hyperplasia as a reaction to injury, the evolution of carcinoid tumors in argyrophilic cell hyperplasia, and the relationship of the proliferating argyrophilic cells to the proliferating glandular cells in ulcerative colitis.

Influence of histologic type on survival after curative resection for undifferentiated lung cancer.

Undifferentiated carcinoma of the lung carries a worse prognosis overall than other cell type, but it is unclear whether these tumors represent a homogeneous group with uniformly poor survival. This study identifies certain histologic subtypes of large cell and small cell undifferentiated carcinoma which have a better prognosis after curative resection than other similarly treated undifferentiated carcinomas. From 1947 through 1975, a total of 2,352 patients with lung cancer were admitted to one hospital. Follow-up to death was available in 98%. Pathological material was reviewed from 1,979 cases by a team of three pathologists during a single 6 month period without knowledge of clinical outcome. Curative resection was carried out in 632, with 170 (27%) 5 year survivors. Small cell cancer occurred in 481 patients and nine (1.6%) survived 5 years. Curative resections were performed in 34 with polygonal small cell carcinoma, 20 with normal lymph nodes and 14 with diseased lymph nodes. Seven survived 5 years (21%), six of 20 with normal and one of 14 with diseases lymph nodes. Eleven with nonpolygonal small cell carcinoma (eight oat cell, three fusiform) (five normal, six diseases nodes) underwent curative resection, with no survivors. Large cell carcinoma occurred in 151 and 19 survived 5 years. Curative resection was performed in 24 having large cell carcinoma with stratification (16 normal, eight diseased nodes), and 12 (50%) survived 5 years. In 26 with nonstratified large cell carcinoma undergoing curative resection (18 normal, eight diseases nodes); six (23%) survived 5 years (chi 2 = 4.06 p less than 0.05). Thus patients with resectable polygonal small cell carcinoma appear to have a better prognosis than those with nonpolygonal small cell carcinoma, and their prognosis approaches that of all patients with resectable lung cancer. Patients having resectable large cell carcinoma with stratification have a significantly better prognosis than those with nonstratified large cell carcinoma. Patients with these subtypes should therefore not be denied an attempt at curative resection because of the diagnosis of undifferentiated lung cancer.

The clinical and pathologic correlations in mechanical biliary obstruction and acute cholangitis.

Recently reported series of patients with cholangitis have shown no consistently recognizable differences in clinical presentation between patients with and patients without purulence in the biliary tree, in spite of a clearly higher mortality associated with suppurative cholangitis. To determine whether microscopic changes in the liver ductular system more accurately correspond to clinical status than does the gross finding of suppuration in the common bile duct, a retrospective study was made of 70 patients operated upon for mechanical biliary obstruction and in whom liver biopsy was obtained. Forty patients had benign obstruction, and 30 had malignant disease. The severity of morphologic cholangitis in liver biopsies was graded in a semiquantitative fashion based on inflammatory changes within the portal triads. No significant correlation (chi-square analysis) was found between liver histology and clinical presentation, laboratory data, or mechanism of biliary obstruction. In fact, three patients exhibiting clinical cholangitis had but mild histologic changes; conversely, four patients with minimal symptoms had multiple hepatic microabscesses. The clinical presentations of patients with mechanical biliary obstruction fail to correspond uniformly to either gross or microscopic pathologic findings in the biliary tree. Symptoms and signs of cholangitis may be attributed to some other as yet undefined factors.

Variability of histologic pattern in recurrent soft tissue sarcomas originally diagnosed as liposarcoma.

The histopathologic classification of liposarcoma and its clinicopathologic significance are well delineated in previous studies, but the literature is inexplicably mute on recurrent liposarcomas. Supposition and experience may have led to the assumption that the microscopic features remained static over a period of years and multiple recurrences. Thirteen sarcomas originally classified as liposarcoma were reviewed to assess patterns of histologic change with recurrence. A total of 52 recurrences was studied. In 7 of the 13 cases, multiple morphologic sarcomatous patterns were identified, either as a change with recurrence or as multiple discrete patterns within a tumor. All changes except in one case occurred before irradiation or chemotherapy. The variations included patterns such as malignant fibrous histiocytoma, hemangiopericytoma, malignant schwannoma, and unclassified spindle-cell sarcoma as well as the various liposarcoma subtypes. This variability of patterns can cause significant diagnostic difficulties and can cause one to question the validity of using monomorphic diagnoses in all cases. In addition, the polymorphic differentiation of these tumors supports the concept that soft tissue sarcomas are derived from a pluripotential mesenchymal stem cell.

Hepatic veno-occlusive disease caused by 6-thioguanine.

Clinically reversible veno-occlusive disease of the liver developed in a 23-year-old man with acute lymphocytic leukemia after 10 months of maintenance therapy with 6-thioguanine. Serial liver biopsies showed the development and resolution of intense sinusoidal engorgement. Although this disease was clinically reversible, some subintimal fibrosis about the terminal hepatic veins persisted. This case presented a unique opportunity to observe the histologic features of clinically reversible hepatic veno-occlusive disease over time, and may be the first case of veno-occlusive related solely to 6-thioguanine.

Filiform polyposis in Crohn's colitis mimicking toxic megacolon.

A patient with filiform polyposis in Crohn's colitis is reported. Unlike previous reports of filiform polyposis, this patient's colitis was of rapid onset and antedated development of pseudopolyps by a short duration. Additionally, unlike previous reports, the disease process was quite aggressive. The extensive degree of fissuring found throughout the bowel wall may have produced the unusually shaped polyps and caused the toxic colonic atony.

Granulomatous hepatitis secondary to carbamazepine.

Three cases of carbamazepine-induced granulomatous hepatitis are reported. Each patient had ingested carbamazepine for less than 1 month before presenting with a febrile illness suggestive of biliary tract infection. After withdrawal of carbamazepine, symptoms disappeared rapidly. Histologically, all patients had granulomatous hepatitis. Two patients also had acute cholangitis. Carbamazepine-induced liver injury can be confused clinically and pathologically with biliary tract infection.

Cholangitis due to malignant obstruction of biliary outflow.

This study reports the clinical presentation and hospital course of 21 patients with cholangitis and malignant diseases, obstructing the biliary tree. Eleven of 21 patients had cholangitis as the initial presentation of biliary disease, and the diagnosis of carcinoma was made at operation or autopsy examination. A total of 14 patients with cholangitis had no prior biliary surgery. Patients who underwent operations to relieve biliary obstructions during episodes of cholangitis had greater incidences of resolution of cholangitis (eight of 14 patients) than those patients treated non-operatively (none of eight patients). Only five patients survived long enough to leave the hospital, but each of these patients were palliated by some sort of drainage procedure. These data suggest that a small portion of this high risk group of patients may benefit significantly from early operative therapy of their cholangitis.

Diffuse mucosal ganglioneuromatosis of the colon associated with adenocarcinoma.

A case of diffuse (nonpolypoid) ganglioneuromatosis of the colon found in association with an adenocarcinoma is described. The virtual confinement of this process to the mucosa implies a mucosal origin. A possible relationship of this lesion to multiple endocrine neoplasia type 2b is briefly discussed.

Cytomegalic inclusion disease diagnosed endoscopically.

Two patients who received renal transplants developed erosions or ulcers in the upper gastrointestinal tract. In both cases endoscopic evaluation enabled a diagnosis of cytomegalovirus (CMV) infection to be made quickly and safely. We emphasize the importance of early diagnosis of CMV infection and how endoscopy may be helpful.

Giant hyperplastic polyposis of the colon.

A patient with multiple large hyperplastic (metaplastic) polyps of the colon is reported. Hundreds of polyps, some over 3 cm in size, were distributed uniformly throughout the large bowel. There was no evidence of polyps in the stomach or small intestine. The polyps, except for their large size, had the histologic features of hyperplastic polyps. This condition can be clinically confused with adenomatous polyposis coli.

Amyloid in a patient with Reiter's syndrome - secondary or coincidental? Differentiation with potassium permanganate.

A patient with Reiter's syndrome developed a pulmonary nodule composed of amyloid. Reiter's syndrome has been reported as 1 of the diseases associated with secondary systemic amyloidosis. Isolated nodular pulmonary amyloid has not been reported to become systemic. Potassium permanganate treatment of amyloid abolishes congo red stain affinity for amyloid of unknown origin found in secondary amyloidosis. However, the amyloid of immunoglobulin origin, characteristic of primary amyloid, is resistant to KMnO4. The amyloid deposit from our patient was resistant to KMnO4 which suggested that the pulmonary amyloid was a coincidental nodular amyloid deposit in the lung rather than secondary amyloidosis.

Simultaneous ulcerative colitis and Crohn's disease. Report of a case.

This report describes a patient with simultaneous Crohn's disease of the terminal ileum and ulcerative colitis of the left colon and rectum. Well documented cases of "mixed" ileocolitis are quite rare.

Metastatic carcinoma presenting as fulminant hepatic failure.

An unusual cause of fulminant hepatic failure is described. The patient, who presented with symptoms of liver disease, proved to have a small primary oat cell carcinoma of the lung with massive hepatic metastases. The clinical evolution was rapid, with marked elevations of SGOT (this without a prior hypotensive episode) and hepatic coma. Examination of the liver showed two types of necrosis: 1. infarction secondary to multiple tumor emboli in portal vessels and 2. overrunning of hepatic cell plates by expanding masses of tumor cells (somewhat analogous to piecemeal necrosis).

Thymus related tumors and tumor-like lesions in childhood with rapid clinical progression and death.

Tumor and tumor-like lesions of the thymus, excluding Hodgkin and nonHodgkin lymphomas, are among the least frequent mediastinal tumors in childhood. For this reason the diagnosis is often overlooked. The clinical and pathologic features of four thymus related masses, three of which were thymomas and one a thymic cyst, are reported in children between the ages of five and 15 years. The thymic cyst occurred in a child with a five year history of aplastic anemia. A rapid clinical course to death occurred in all four cases. The behavior of these lesions is compared with that described in the literature. The impression exists that thymomas in the pediatric age group are much more aggressive than those in adults. There are also some signifant differences in their histopathologic appearance.

Colitis cystica profunda.

Colitis cystica profunda is a benign disease characterized by variably sized mucin-filled cysts beneath the muscularis mucosae. The clinocpathologic features of five patients are described. The accumulated evidence suggests that awareness of this entity both by clinicians and pathologists with help differentiate it from carcinoma and decrease the need for radical surgery.