Primary angiitis of the central nervous system associated with Hodgkin's disease.

An unusual case of primary angiitis of the central nervous system associated with Hodgkin's disease in a 55-year-old-man is reported. After a 10-month history of acute transverse myelitis, the patient was diagnosed as having nodular sclerosing-type Hodgkin's disease involving the retroperitoneal lymph nodes. The patient died of a brainstem hemorrhage 1 week after a 15-day course of chemotherapy. Primary angiitis was documented on autopsy examination. To our knowledge, only nine similar cases have been reported in the literature, and none of them was associated with a sole initial spinal cord presentation. Owing to the rarity of this disease entity, a high index of suspicion and awareness of the association between primary angiitis and Hodgkin's disease are essential for early diagnosis.

Cytologic features of Kimura's disease in fine-needle aspirates. A study of eight cases.

Kimura's disease is a chronic inflammatory disorder of unknown etiology, presenting usually as painless subcutaneous swellings in the head and neck region or in the salivary glands. The cytologic features of fine-needle aspirates of eight cases of Kimura's disease were studied with reference to the histologic appearance of the subsequent surgical specimens. In the cytologic smears, the prominent feature was the presence of significant numbers of eosinophils in a background of lymphoid cells. Fragments of collagenous tissue and Warthin-Finkeldey polykaryocytes occasionally were seen. In the cell block, vascular proliferation and fibrosis were useful features, providing further support to the diagnosis. The constellation of these features is characteristic of Kimura's disease and should suggest this diagnosis in the appropriate clinical setting. For initial diagnosis, excisional biopsy is important for the exclusion of malignant lymphoma, histiocytosis X, angiolymphoid hyperplasia with eosinophilia and other reactive lymphadenopathies. Nonetheless, fine-needle aspiration cytology may be valuable in the diagnosis of recurrent lesions of Kimura's disease and may spare the patient from repeated biopsies.

Solitary necrotic nodule of the liver: parasitic origin?

AIMS: To report further cases of solitary necrotic nodule of the liver and to study its nature. METHODS: Seven nodules were retrieved from 4000 necropsy and surgical liver specimens coming to light over the past five years. All of them satisfied the diagnostic criteria of solitary necrotic nodule: a solid lesion with a central necrotic core and a hyalinised fibrotic capsule containing elastic fibres. Their clinicopathological features were reviewed. RESULTS: The nodules were incidental findings at surgery or necropsy in four men and three women whose ages ranged from 48 to 79 years (mean 63.7 years). Four were found in the right lobe and three in the left. Six were subcapsular and only one deep in the parenchyma, with sizes ranging from 0.3-2.5 cm. Each of them was solitary, well demarcated, and round to oval with a firm, whitish rim and a core of yellowish white cheese-like to solid material. In addition to the basic architecture, there were a number of common and undescribed histological features: presence of varying numbers of small mural vessels with intimal fibrosis and obliteration, presence of cholesterol clefts and foamy cells among necrotic material, and sparsity of inflammatory cells. In the two cases where ghosts of degenerated cells and partially preserved liver reticulin pattern were noted, worms were identified, one being Clonorchis sinensis. CONCLUSIONS: The entity is believed to be a "burnt-out phase" of a variety of benign lesions. Parasitic infestation is another possible cause, and presence of ghosts of degenerate cells, partially preserved liver reticulin pattern, cholesterol clefts and foamy cells among necrotic material are auxiliary features pointing to such an aetiology. The variation in morphological fine details reflects both the lesion's diverse pathogenesis and the fact that it can be of varying duration.

Fine-needle aspiration of gastric leiomyoblastoma metastatic to the subcutis.

Leiomyoblastomas are rare tumors, and there have been few reports on their fine-needle aspiration (FNA) cytologic morphology. We herein describe the FNA features of a gastric leiomyoblastoma with subcutaneous metastasis. The cells had eosinophilic cytoplasm and oval eccentric nuclei, occasionally with intranuclear cytoplasmic inclusions. An organoid pattern was obvious in cell block sections. The tumor was positive for vimentin but negative for desmin, S-100 protein, and the common epithelial markers. The histogenesis is discussed, as are reasons why this tumor is better termed epithelioid mesenchymal tumor.

Malignant lymphoma with myxoid stroma: a new pattern in need of recognition.

We report a case of malignant lymphoma in the soft tissues exhibiting prominent myxoid stromal changes and cord-like cellular arrangement, mimicking the architectural as well as cytological features of myxoid chondrosarcoma, except for the absence of tumour lobulation. The only clue to the possible lymphomatous nature of the lesion was the past history of lymphoma. Immunohistochemical studies showed that this represented a B-cell lymphoma, staining positively for leucocyte common antigen and five B-lineage markers L26, MB2, B1 (CD20), B4 (CD19) and To15 (CD22). We conclude that malignant lymphoma should not be excluded from consideration when one encounters a myxoid tumour.

Kikuchi's histiocytic necrotizing lymphadenitis. Diagnosis by fine needle aspiration.

Two cases of Kikuchi's histiocytic necrotizing lymphadenitis diagnosed by fine needle aspiration (FNA) of enlarged lymph nodes are reported. The FNA smears contained randomly activated lymphoid cells, necrotic debris, karyorrhectic cells and prominent histiocytes, suggesting the presence of reactive lymph nodes. The true nature of the lesions was evident from the examination of cell block sections prepared from tissue fragments in the aspirates, which preserved the architectural relationships of the different cell types. The same patterns were found in retrospectively and subsequently examined excised lymph nodes from these cases. The differential diagnosis of this entity, which may simulate a malignant lymphoma because of the presence of large numbers of activated lymphoid cells, is discussed and the value of preparing FNA cell blocks is emphasized. Though this rare benign disease may be suspected clinically in the more typical cases, such as young women with cervical lymphadenopathy, fever, neutropenia and otherwise excellent condition, the diagnosis cannot be made without a lymph node biopsy, which FNA may be able to provide in some instances.

Optimal formalin fixation and processing schedule of cell blocks from fine needle aspirates.

In fine needle aspiration cytology, cell blocks may provide diagnostic information complementary or additional to that obtained from examination of cell smears. However, the morphological preservation is often unsatisfactory in cell blocks processed by routine schedules used for surgical specimens. This study investigates the effects of different formalin concentrations and processing schedules on cellular morphology. We conclude that 7.5% buffered formalin is the optimal formalin solution and a shortened processing time through xylene is desirable.

Fine needle aspiration of the thyroid. Distinction between colloid nodules and follicular neoplasms using cell blocks and 21-gauge needles.

Although fine needle aspiration (FNA) of the thyroid has been found to be useful in selecting patients for surgery in most cases, the cytologic differentiation of cellular colloid nodules from follicular neoplasms has not been possible because of the scanty amount of tissue obtained by this technique and because of the infrequent preparation of cell blocks, thus precluding appreciation of the tissue architecture. Review of the histology of nodular goiters and follicular neoplasms and comparison of their morphology in smears and cell blocks from FNA specimens with the histology of the surgically excised specimens in 74 cases revealed the presence of hyperplastic papillae and fragments of dilated follicles in the aspirates of most cases of colloid nodules. These two features appear to be specific for colloid nodules and are useful for distinguishing colloid nodules from follicular neoplasms. The merits of using a 21-gauge needle and of preparing cell blocks in thyroid studies are also discussed.

Granulocytic sarcoma presenting as bleeding gastric polyp.

Granulocytic sarcoma may develop before, after or at the time of presentation of acute myeloid leukemia. We report an unusual case in which the first manifestation of leukemic conversion of myelodysplastic syndrome was bleeding from a polypoid gastric granulocytic sarcoma.

Endogenous opiates modulate release of growth hormone in response to electroacupuncture.

The effect of electroacupuncture on serum growth hormone levels was investigated in 5 normal subjects and in 10 patients with chronic musculoskeletal pain. Serum growth hormone did not change in the normal subjects but there was an approximate 5-fold increase in the chronic pain subjects. This effect was partially inhibited by prior administration of the opiate antagonist naloxone, suggesting that the rise in growth hormone was mediated via release of central nervous system opioids.

Embolism in thyrotoxic atrial fibrillation.

Of 210 patients with thyrotoxicosis, 21 (10%) had atrial fibrillation. Five of these patients (24%) had systemic emboli (which were multiple in three patients, one of whom died) and two other patients had pulmonary embolism. Embolic disease is common in thyrotoxic atrial fibrillation, and anticoagulant therapy should be considered for all patients.

Aspiration cytology in the diagnosis of autoimmune thyroiditis.

We have found aspiration cytology to be a useful and reliable procedure in the diagnosis of autoimmune thyroiditis. This disorder affected more than half of 50 patients who presented with bilateral non-toxic goitre.

The response to acupuncture therapy in patients with chronic disabling pain.

Twenty-one patients had acupuncture treatment for chronic, disabling pain. Ten (47.5%) thought they had obtained worthwhile relief by the time treatment was completed. Six (30%) had no or negligible benefit and five (25%) had some aggravation of their pain at some stage of the procedure. In this group of patients, with the technique we describe, we were unable to achieve the high degree of short-term success claimed by other workers. Until further scientific studies can confirm the value of acupuncture in medical practice, we urge caution in the use of this procedure.

Serum insulin levels in diabetics after subcutaneous administration of Rapitard insulin.

Circulating levels of immunoreactive inculin were measured in six diabetics after the subcutaneous injection of Rapitard insulin. Serum insulin levels rose within 15 minutes, with a peak level generally at one to three hours. A biphasic effect was observed in some but not all patients. There was poor correlation among the six patients between the blood glucose levels and serum insulin levels, and between the injected dose and the serum levels.