Intestinal ganglioneuromatosis with the mucosal neuroma --medullary thyroid carcinoma-- pheochromocytoma syndrome. A case report and review of the literature

A case of intestinal ganglioneuromatosis associated with medullary thyroid carcinoma, bilateral pheochromocytoma, mucosal neuromas and marfanoid habitus is reported. To our knowledge, only ten previous cases of intestinal ganglioneuromatosis associated with mucosal neuromas and medullary carcinoma of the thyroid have been reported. Our case represents the 11th such case, the seventh with the concomitant finding of pheochromocytoma and the second with documented parathyroid hyperactivity. The intestinal ganglioneuromatosis may represent a variation of the mucosal neuroma component of this rare syndrome and the multiorgan abnormalities may result from a genetically related disorder of a single cell system, the neural crest. The characteristic marfanoid habitus with the presence of mucosal neuromas raises the possibility of a serious underlying polyendocrine-neural disorder and should alert the clinician accordingly.

Squamous cell carcinoma of the skin and lip in renal homograft recipients

Forty-four squamous cell carcinomas (SCC) of the skin and lip were observed in 9 of 464 renal homograft recipients. Clinically and histologically the SCC's fell into two groups. Two patients with widespread warts, suggestive of epidermodysplasia verruciformis, showed multiple SCC's predominantly on the upper extremities which were associated with minimal solar elastosis of the adjacent dermis. The other seven patients did not have widespread warts; their SCC's occurred predominantly on the head and neck and were associated with prominent solar elastosis of the adjacent dermis. The degree of solar elastosis was particularly striking in view of the young age of this group (mean age: 37 years). Inflammatory cellular response to the transplant SCC's was significantly diminished in comparison with a group of control SCC's from non-immunosuppressed patients. In both transplant groups sunlight appears to be an important etiologic factor; in the first group viruses may also be important.

[Association of angiomas and osseous abnormalities excluding Klippel-Trenaunay disease]

The author shows that a combination of vascular diseases or anomalies with bone malformations other than the triad described by Klippel and Trenaunay or the Recklinghausen syndrome is not too rare. The author cites half-a-dozen such cases of different types, with anomalies in different parts of the body, from the cranium to the toes. The angiomas varied from naevus vinosus cavernoma, and the bone phy. In some cases the EEG shows pathological features.

Pigmented villonodular synovitis in multiple joints. Occurrence in a child with cavernous haemangioma of lip and pulmonary stenosis

A case is presented of pigmented villonodular synovitis involving three joints in a 7-year-old girl. The diagnosis was confirmed at surgery and by histology. The patient also exhibited a haemangioma of the upper lip and a congenital pulmonary stenosis of mild degree. Subtotal synovectomy of the right knee and of both ankles was performed. The lesion recurred in both ankles after 6 months. Review of the literature failed to reveal any previous report of multiple joint involvement by pigmented villonodular synovitis in childhood and it appears that simultaneous involvement of three joints has not previously been described. Scintiscanning with 99mTc stannous pyrophosphate showed increased vascularity of the involved joints immediately after injection, but no increased osteoblastic activity was seen on the delayed scan. This radionuclide scanning technique is therefore helpful in distinguishing pigmented villonodular synovitis from other arthropathies.

[Diagnostic and therapeutic problems in lichen ruber ulcerosus]

Report on two patients with ulcerative lichen planus (l.r. u.) of the feet. The experience which results from these two cases and 22 others which have been reported in the literature were the following: 1. After long periods of standing such lesions show a pronounced tendency to become malignant. 2. The only treatment which offers a lasting succes is skin-grafting, the chances of which are the better the earlier it is performed. 3. Early diagnosis of L. r. u. may be impossible on clinical and histopathological grounds only; application of immunofluorescence methods may yield additional diagnostic criteria.

Focal dermal hypoplasia

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