Endosalpingiosis in association with ovarian surface papillary tumor of borderline malignancy

A 40-year-old woman underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic/paraaortic lymphadenectomy, and omentectomy for Stage IA ovarian surface papillary tumor of borderline malignancy. Microscopic examination revealed endosalpingiosis of ovaries, the peritoneum of uterus, pelvic lymph nodes, and omentum. There was no evidence of disseminated peritoneal malignancy. The several proposed theories of the pathogenesis of endosalpingiosis are reviewed, but that involving metaplasia of the multipotential peritoneal cells is presented as the most acceptable.

Multiple inverted papilloma of the urinary bladder associated with glandular metaplasia of colic type. A case report

A case of inverted papilloma of the urinary bladder associated with glandular metaplasia is presented. A bladder urothelial carcinoma was suspected after clinic and endoscopic findings, but the diagnosis was established only on histological picture. Morphological and histochemical peculiarities of the lesions are described, considering the case being the first with such an association-according to our knowledge. The malignant potential of inverted papilloma and glandular metaplasia are discussed.

Hypnotherapeutic intervention for voice disorders related to recurring juvenile laryngeal papillomatosis

Recurring juvenile laryngeal papillomatosis is resistant to cure, and thus usually requires multiple operations which may lead to the extensive proliferation of vocal fold scar tissue. Severe hoarseness, sharply lower pitch, and weak loudness levels are common sequelae. Adjunctive hypnotherapy can increase motivation for change, speed up the acquisition of vocal skills, and possibly even facilitate or sustain remission of growths in selected patients. An 8-year-old girl with severe active eruptions went into remission after 16 sessions, and a 12-year-old boy, already in remission at the beginning of the intervention period, remained free of neoplasms throughout the regimen. Whether or not hypnosis contributed significantly to the sanguine results, it is probable that, at the least, the hypnotic intervention facilitated the achievement of certain technical objectives in voice therapy.

Multiple biliary papillomatosis

Diffuse biliary papillomatosis is a rare bile duct tumour. We report a case of multiple biliary papillomatosis treated surgically with a transhepatic stent. Diffuse biliary papillomatosis involving intra and extrahepatic bile ducts is extremely rare. It is regarded as having low grade malignant potential. In this report a case of diffuse biliary papillomatosis with obstructive jaundice is presented.

Tracheal papilloma presenting as asthma in a child

This report describes a child with a tracheal papilloma who was initially diagnosed and treated as having asthma. The case illustrates that all wheezing in children should not be attributed to asthma.

Familial occurrence of tumours of the choroid plexus

The case histories of two children of consanguineous parents with papillomas of the choroid plexus are presented. Although exogenic factors in the genesis of these neoplasms can not be excluded, autosomal recessive inheritance is proposed.

[Exploration of the intra-renal collecting system using flexible fibroscopy]

23 cases of flexible retrograde nephroscopy system for undiagnosed hematuria or filling defect are reviewed. The introduction was carried out by combining hydraulic dilation, rigid ureterorenoscopy and a working sheath. The indications were merely diagnostic (filling defects and/or haematuria). The success rate was very high (22 of 23). 9 cases of papillary tumors, 4 cases of small radiolucent stones and 1 case of papillary necrosis were diagnosed. In 8 cases no pathology was found. The complication rate was extremely low and the postoperative course was uneventful. Flexible instruments offer a very good chance to explore the intrarenal collecting system and transureteral nephroscopy through a 10.8 F flexible scope is a feasible and effective procedure.

Florid cutaneous papillomatosis, malignant acanthosis nigricans, and pulmonary squamous cell carcinoma

A 72-year-old man had florid cutaneous papillomatosis (FCP), which is an obligatory paraneoplastic syndrome always associated with an internal malignancy. The cancer, which is usually intraabdominal and most often gastric in origin, evolves parallel to the FCP. This patient is the first case of FCP occurring in association with a lung malignancy. An association of FCP with other signs of internal cancer is common, with malignant acanthosis nigricans usually appearing many times with the sign of Leser-Trélat. FCP, malignant acanthosis nigricans, and the sign of Leser-Trélat are part of a continuum, developing by a common or similar pathogenic pathway due to an underlying malignancy producing a factor possibly similar to human epidermal growth factor.

Inverted squamous papilloma with neuro-ophthalmic features

The schneiderian or inverted papilloma is an infrequent and usually benign tumor of the paranasal sinuses. It most commonly manifests as unilateral nasal obstruction. This is a case of an inverted papilloma in a 92-year-old woman who presented with severe proptosis, loss of vision in the left eye, and rhinorrhea. The mass was visible in her left nostril; neuroimaging studies showed that the lesion extended from the left paranasal sinus into the frontal sinuses. In addition, there was secondary spread into the cranial cavity and brain substance.

CA125-positive papillary tumor of the peritoneum

A 71-year-old female visited our outpatient unit with chief complaints of anorexia and a sense of abdominal distension. The abnormalities found after admission were conspicious increases in CA125 levels in serum and ascites as well as anemia, accelerated erythrocyte sedimentation and increased serum LDH. The patient underwent an emergency operation for ileus. The histological diagnosis was serous papillomatous cancer. Immunohistologic staining of the cancer tissue demonstrated the production of CA125. In this very rare the remnant of the Müllerian duct in the peritoneum is thought to have been cancerous.

Solitary bronchial papilloma presenting with recurrent dyspnea attacks: case report with computed tomography findings

A case of solitary bronchial papilloma is reported which, because of its unusual location near the carina and marked mobility, presented with attacks of dyspnea that were misdiagnosed as asthma for many years. It caused no abnormality on a plain chest X-ray, but could be visualized on linear and computed tomograms. The computed tomograms further demonstrated the absence of extraluminal extension of the tumor or mediastinal lymphadenopathy which could not be excluded by linear tomography or bronchoscopy. Transbronchial resection resulted in complete relief of symptoms.

Testing for human papillomavirus: basic pathobiology of infection, methodologies, and implications for clinical use

New molecular biological evidence has recently emerged, strongly implicating the human papillomavirus (HPV) as playing an etiologic role in the development of neoplasias of the genital tract. As technologies advance, the ability to test for the presence of HPV has become simpler, more reliable, and less expensive. A great deal of controversy has arisen regarding the effective and proper utilization of these new tests in the management of HPV infections. This review will detail the new evidence implicating the putative role of HPV in neoplasia and the current methodologies available for assessing the presence of HPV in clinical samples and will describe the current controversy surrounding their utilization.

Increased epidermal growth factor receptors in seborrheic keratoses and acrochordons of patients with the dysplastic nevus syndrome

Seborrheic keratoses and acrochordons may change in biologic behavior with pregnancy or during treatment with sex steroids. Because epidermal growth factor receptor localization may change in hyperproliferative skin diseases, we compared epidermal growth factor receptor immunolocalization in seborrheic keratoses and acrochordons from women who were or were not pregnant or taking oral sex steroid hormones. Epidermal growth factor receptor was further investigated in growing and quiescent seborrheic keratoses and acrochordons from women with and without the dysplastic nevus syndrome. The epidermal growth factor receptor concentration was strikingly elevated in suprabasilar keratinocytes of growing seborrheic keratoses and acrochordons from patients with the dysplastic nevus syndrome who were pregnant or taking sex steroid hormones and less elevated in growing seborrheic keratoses from other patients. In contrast, the epidermal growth factor receptor distribution pattern in acrochordons did not correlate as well with the history of growth of these lesions in normal patients. These data suggest sex steroids may affect epidermal growth factor receptor metabolism in benign epidermal hyperproliferative lesions, particularly in patients with the dysplastic nevus syndrome.

[Indicators of immunologic reactivity in children with chronic laryngostenosis]

Immunological examinations of 40 children with papillomatosis and chronic cicatricial stenosis of the larynx included measurements of circulating immune complexes (CIC) and lysozyme in the saliva and serum as well as complement activity in serum. The examinations were performed regularly during treatment. It was found that immunobiological factors played an important part in the pathogenesis of papillomatosis and cicatricial stenosis of the larynx in children. It was shown that CIC and lysozyme concentrations in the saliva and serum as well as complement activity in serum increased. In the course of treatment all the groups displayed an increase of lysozyme in the saliva; patients with papillomatosis showed a decrease of the CIC concentration and those with cicatricial stenosis a decline of complement activity in serum. Involvement of the autoimmune component in the pathogenesis of the above diseases is discussed. Applicability of the results for controlling the therapeutic efficacy and predicting the outcome of diseases is considered.

[Inverted papilloma of the bladder. Apropos of 2 cases]

Two cases of transitional cell inverted papilloma are described. The first case was a 44-year-old male patient who presented with hematuria. The second case was an incidental finding during a retropubic adenomectomy procedure. We describe the clinical features of this condition and discuss its histogenesis and treatment. Because of the possibility, although very small, of its evolving to malignancy, these patients must be followed carefully.

Recurrent conjunctival papilloma causing nasolacrimal duct obstruction

We treated two patients who had recurrent conjunctival papillomas that invaded the nasolacrimal sac and caused complete canalicular and nasolacrimal duct obstruction. The ophthalmologist should be aware of the possibility of a conjunctival papilloma invading the lacrimal sac when treating patients with conjunctival papillomas. Excision should be complete, and adjunctive therapy such as cryotherapy should be considered to reduce the chance of tumor recurrence.

Correlation of clinical and pathological features in surgically treated craniopharyngiomas

Surgical specimens of 104 craniopharyngiomas from 93 patients were reviewed and characterized histopathologically. They were found to have either a classic adamantinous or a squamous papillary structure. The clinical features of each group were then assessed. The frequently solid (50%), always uncalcified squamous papillary tumor type was found in one-third of the adult patients (greater than or equal to 20 years) but did not occur in children. It was associated with a good functional postoperative outcome (84.6%). There have been no cases of tumor recurrence in the squamous papillary group. However, in the group with the adamantinous type of craniopharyngioma, the recurrence rate was 13% in adult patients and 9% in children. When compared to the adult adamantinous cases, the incidence of visual deficits was lower in the squamous papillary group (75% vs. 84%) but the incidence of endocrine abnormalities was higher (75% vs. 52%). Thus, the preoperative, operative, and postoperative features of the two types of craniopharyngioma were found to be distinctly different in adults and children.

A squamous cell papilloma as a cause of dysphagia and vomiting

Squamous cell papillomas occur relatively commonly intra-orally. Patients are usually unaware of their presence. A case is described of a squamous cell papilloma arising from the uvula, which presented as an unusual cause of dysphagia and vomiting.

Papilloma of renal pelvis in childhood

A papilloma in the renal pelvis of a five-year-old girl is reported. The transitional cell tumors of the renal pelvis in the pediatric age group are reviewed, and this is found to be the first case of a benign papilloma in childhood. We believe this pathologic entity should be included in the differential diagnosis of hematuria in a child.

Inverted papilloma of the maxillary sinus: an unusual cause of a non-healing extraction socket. Case report

Although the healing of extraction sites is generally a rapid and uncomplicated process, delayed healing or overt infection of recent extraction sockets may involve a variety of causes and the clinician must be aware pre-operatively of both local and systemic influences. Retarded or non-healing extraction sites always require investigation. This paper looks broadly at the subject of non-healing extraction sites and reports an unusual case involving an inverted papilloma of the maxillary antrum. To the authors' knowledge this is the first reported case of an antral papilloma causing delayed extraction wound healing.

Management of inverted papilloma

This paper updates a 1981 report on the management of inverted papilloma. In that report, routine lateral rhinotomy with en bloc resection of the lateral nasal wall, including the entire schneiderian membrane, was recommended. This report emphasizes the use of computed tomography scanning in management planning. Of 33 patients with inverted papilloma treated between 1969 and 1987, 7 had associated squamous cell carcinoma. Twenty-two patients with IP alone were treated with medial maxillectomy; however, 3 patients have been successfully treated with either a Caldwell-Luc/ethmoidectomy or an external ethmoidectomy for localized disease. The use of computed tomography capable of higher resolution allowed preoperative determination of the extent of disease, enabling the surgeon to plan the surgery more precisely. Patients were followed for an average of 9.6 years. Recurrent disease occurred in one patient (4%) following a lateral rhinotomy/medial maxillectomy approach. The principles set forth in this series of patients remain the same as those previously described due to the unique characteristics of this tumor: its ability to destroy bone, its tendency to recur, and its association with malignancy. The technique of lateral rhinotomy and en bloc excision of the lateral nasal wall, followed by meticulous removal of all mucosa in the ipsilateral paranasal sinuses, remains the standard therapy.

Endobronchial epithelial papilloma associated with a foreign body

Noninvasive papillary endobronchial lesions are among the least common of pulmonary neoplasms. We describe the occurrence of a papillary squamous tumor surrounding an aspirated sunflower seed foreign body, and briefly review the subject of endobronchial papilloma. This tumor should be a red flag for the presence of a foreign body, and foreign body removal may obviate the need for thoracotomy.

Stridor and airway compromise

A graduated approach to the diagnosis of airway lesion will rarely fail. The availability of state-of-the-art optical equipment, excellent anesthesia, and high-quality medical care have remarkably reduced the morbidity and mortality of airway diseases. Electrodiagnosis of vocal cord paralysis will differentiate fixed arytenoids from neurogenic paralysis in candidates for laryngeal repair and will help define the prognosis of neurogenic paralysis. The excellent results from epiglottoplasty in treating laryngomalacia and laryngotracheal reconstruction for stenosis make obsolete any management with tracheotomy and watchful waiting. Close cooperation and good communication between the pediatrician and the otolaryngologist remain the key points for successful management.

Unusual and intraoperative epicardial echocardiographic features of a papillary tumour of the aortic valve

A mass with a diameter of 0.8 cm was detected in the aortic root of a 53 year old woman during routine preoperative cross sectional echocardiographic assessment of a secundum atrial septal defect. Intraoperative epicardial echocardiography showed that the mass was attached by a slender stalk to the tip of the left coronary cusp of the aortic valve, and histological examination showed that it was a papillary tumour. Intraoperative epicardial echocardiography can help in planning the excision of papillary tumours, and excision is advised even when there are no symptoms.

Inverted papilloma: an analysis of 87 cases

A group of 87 patients with inverted papilloma, a locally aggressive benign sinonasal tumor, were treated over the past 15 years. Selection of therapy depends on an accurate radiographic assessment of the extent of tumor. The tumor's local aggressiveness, high rate of recurrence, associated malignancy, and multicentric tendency have led most workers to advocate radical surgical removal of the tumor by lateral rhinotomy and en bloc resection of the ethmoid labyrinth. Radiographic evaluation by computed tomography scanning and magnetic resonance imaging permits identification of a small group of patients who have limited lesions and may be candidates for conservative tumor resection by intranasal or transantral sphenoethmoidectomy. Among our ten patients treated with conservative surgery, there was recurrence in one case (10%). Seventy-five patients underwent rhinotomy and medial maxillectomy, with seven cases recurring (9%). The overall recurrence rate was 9% (8 of 87). Among the 87 cases, 5 patients had carcinoma (6%). The literature is reviewed and the principles of case selection and management are discussed.

Spontaneous regression of a conjunctival intraepithelial neoplastic tumor

A case history is presented documenting regression of a limbal intraepithelial neoplastic lesion following diagnostic biopsy of a small specimen and removal of an adjacent basal cell papilloma of the eyelid.

Chronic cavitary respiratory papillomatosis

A 19-year-old white man with multiple recurrences of respiratory papillomatosis was admitted for recurrent left lower lobe pneumonia and lung abscesses. He was found to have a single large laryngeal papilloma, widespread bronchial papillomatosis, and large cavitary lesions of the left lower lobe. A lobectomy was performed. The smooth-walled, squamous-lined cavities contained large numbers of papillomas, which were strongly positive for human papillomavirus type 11 by in situ DNA hybridization. Findings of evaluation of the patient's humoral and cell-mediated immunity were within normal limits. Cavitation appears to have resulted from bronchial obstruction, postobstructive pneumonia, and liquefactive necrosis. We speculate that squamous metaplasia allowed the continued proliferation of papillomavirus within the cavities.

Cutaneous defects of focal dermal hypoplasia: an ectomesodermal dysplasia syndrome

The 5 major cutaneous defects of development found in focal dermal hypoplasia, an ectomesodermal dysplasia syndrome, are: aplasia cutis congenita, multiform atrophy-like areas, striate, papillomatous, and lipomatous lesions of skin. Subepidermal lipomatosis, present in some lesions, has been reported to be due to absence of dermis or a striking underdevelopment of connective tissue with replacement by adipose tissue from herniation of subcutaneous fat through multiple areas of hypoplasia. We believe this theory to be a major error in interpretation of the microscopic findings. We have had the unique experience of studying 2 patients periodically for 27-30 years and 2 additional patients for a shorter time. Biopsy specimens were removed at intervals for analysis from the same or similar lesions (43 specimens) from these 4 individuals. Our evidence strongly supports the concept that the cutaneous defects of development involving fat cells represent heterotopic fat i.e. a fat nevus resulting from dysplasia, not hypoplasia followed by herniation of subcutaneous fat.

[Adenomatosis of the bile ducts as a rare cause of cholestasis]

Biliary obstruction of uncertain aetiology in a 69-year-old women led to a cholecystectomy and exploration of the bile tract: a nearly complete cast of the hepatic ducts and intrahepatic bile ducts was extracted. Histological examination of the gall bladder and liver biopsy failed to provide a diagnosis, but a bile duct biopsy taken at the time of an endoscopic retrograde cholangiography revealed the diagnosis of papillomatosis. This disease has a poor prognosis because there is no known cure.

Focal dermal hypoplasia syndrome with incomplete transverse facial cleft and tumour of the lips

A case of Goltz's syndrome complicated with both incomplete transverse facial cleft and characteristic tumour of the upper and lower lips is presented. Tumour excision and repair of defect were successfully performed.

Left ventricular papillary fibroelastoma with coronary embolization

We describe a patient who survived an acute myocardial infarction caused by coronary embolization from a left ventricular papillary fibroelastoma. The tumour, which was detected by 2-D echocardiography, was successfully excised.

Diffuse papillomatosis of the gallbladder complicated with tuberculosis

A rare case of diffuse papillomatosis of the gallbladder complicated with tuberculosis is reported. The mucosa of the gallbladder displayed a diffuse papillary pattern composed of excrescences that varied in size and height. The proliferative glands contained many Paneth cells, and the diffuse papillomatosis appeared to be derived from metaplastic-type epithelium. Tuberculous granulomas were observed in the serous layer of the gallbladder. The relationship between diffuse papillomatosis and tuberculosis of the gallbladder is discussed.

Acantholytic acanthoma

This article describes 31 examples of acantholytic acanthoma, a newly recognized, solitary, benign cutaneous tumor. Acantholytic acanthoma was typically an asymptomatic, keratotic papule or nodule. Patients ranged in age from 32 to 87 years (median 60 years); the ratio of men to women was 2:1; the most frequent clinical diagnosis was keratosis; and half of the growths were on the trunk of the body. Histologically, the lesions showed hyperkeratosis, papillomatosis, and acanthosis. Acantholysis was an outstanding finding in all cases; the patterns resembled pemphigus vulgaris, pemphigus vegetans, superficial pemphigus, or Hailey-Hailey disease, but no patient had evidence of any of these disorders. The term acantholytic is used because acantholysis is the outstanding histologic feature in these neoplasms; acanthoma was chosen because the growths are benign tumors of epidermal keratinocytes. The relationship of acantholytic acanthoma to acantholytic blistering disease is similar to that of solitary lichen planus-like keratosis to lichen planus and epidermolytic acanthoma to bullous congenital ichthyosiform erythroderma.

Do skin tags constitute a marker for colonic polyps? A prospective study of 100 asymptomatic patients and metaanalysis of the literature

Several reports have suggested that skin tags may be a marker for the presence of colonic polyps in symptomatic patients referred for colonoscopy. In a prospective study of 100 asymptomatic patients, we found no association between skin tags and colonic polyps. A review of the literature and results of a metaanalysis show a significant association between skin tags and colonic polyps in 777 symptomatic patients, but no association in 268 asymptomatic patients. To explain this discrepancy, several possible biases are analyzed. As skin tags constitute a marker for colonic polyps only in symptomatic patients for whom a colonoscopy is already indicated, their detection is of no diagnostic value in asymptomatic patients.

Obstructing tumors of the subglottic larynx and cervical trachea: airway management and treatment

A series of 11 patients presenting with airway obstruction secondary to tumors involving the subglottic larynx and cervical trachea was treated with either carbon dioxide or neodymium:yttrium aluminum garnet laser tumor ablation. Choice of ventilation varied according to the site of airway obstruction: Venturi jet with ventilation laryngoscope for glottic and subglottic tumors and a specially designed ventilation laser fiber tracheoscope for tumors obstructing the cervical trachea. All patients subsequently had definitive treatment of the tumor and were relieved of the compromised airway. No complications associated with ventilation and treatment techniques were recorded.

Subsets of vulvodynia

The frustrated patient with vulvar "burning" seldom has grossly abnormal physical findings, and the clinical significance and prognosis of vulvodynia have eluded both gynecologists and dermatologists. Evaluation of the physical findings on initial and follow-up visits of such patients during various treatment protocols has revealed distinct subsets of vulvodynia. In one series of 52 patients at the Emory Clinic, the following subsets were identified in decreasing order of frequency: (1) vulvar dermatoses, (2) cyclic candidiasis, (3) squamous papillomatosis, (4) vulvar vestibulitis, and (5) essential vulvodynia. These subsets may occur alone, simultaneously or sequentially; treatment for one condition may affect the onset of another. Vulvodynia may have multiple causes; use of the term for a patient's problem should prompt a thorough diagnostic evaluation. Although the subsets are not entirely exclusive of one another, each is identified by an improvement with specific therapeutic modalities. The recognition of multiple factors in vulvodynia is important to appropriate patient evaluation and management.

Choroid plexus papillomas of neonates, infants and children

Case descriptions of 17 patients with choroid plexus papillomas of neonates, infants and children are presented. Fourteen (82%) were diagnosed and treated during the first 24 months of life (5 were in the neonatal period). Choroid plexus papillomas were located in the lateral ventricle in 11 (bilateral in 1), the third ventricle in 4, both the lateral and third ventricle in 1 and the fourth ventricle in 1. All patients were evaluated by computed tomography. All tumors were excised and histologically verified. There were no surgical or case mortalities. Ten patients needed permanent shunting postoperatively. Follow-up observations show that 13 patients exhibit normal neurological and psychomotor development. Three are retarded and have seizure disorders. One is hemiparetic but normal otherwise. Aggressive surgical resection and appropriate management of associated hydrocephalus should be performed for the patients with choroid plexus papillomas.

[Papillomatosis of the mitral valve as an unusual cause of myocardial ischemia. Description of a case and review of the literature]

Papilloma is a rare primary heart tumour; only 75 cases have been reported and most were casual findings at autopsy. We describe another case of this tumour in a 9 years girl. The neoformation had produced a picture of angina pectoris, followed by death due to an occluded left coronary orifice. To our knowledge, this is the first report of this type of tumour with electrocardiographic documentation.

Successful surgical repair of a vascular shunt of the corpus cavernosum penis and penile fibropapillomata in a bull

A single vascular connection between the corpus cavernosum penis and the superficial penile vasculature was diagnosed in an 18-month old Holstein bull with a history of acquired failure to maintain penile erection. Previously normal serving ability had been documented. Multiple penile fibropapillomata were also found. The vascular shunt was identified by contrast cavernosography and ligated, and the fibropapillomata excised. The bull returned to normal function within three months after surgery, and no recurrence of either problem had been experienced by 12 months after surgery.

[Follow-up of patients with microhematuria]

Out of 100 patients with asymptomatic microhaematuria 21 patients showed an underlying pathological condition. In 23 patients glomerular (= dysmorphic) erythrocytes were seen on phase-contrast microscopy. Follow-up of the remaining 56 patients (over 2 to 10 years) showed the subsequent appearance of pathological urological findings in 14.3% of cases including three tumours (hypernephroma, cancer of the renal pelvis and bladder papilloma) 24 to 30 months after the diagnosis of microhaematuria. The necessity of prolonged urological observation in patients with non-glomerular (eumorphic) microhaematuria is discussed.

Massive oropharyngeal papillomatosis causing obstructive sleep apnea in a child

Obstructive sleep apnea in children is most often secondary to severe adenotonsillar hypertrophy. A 5 1/2-year-old boy presented with loud snoring, increasing dysphagia, nocturnal choking, and apnea. Extensive papillomatosis of the uvula, soft palate, and nasopharynx was found to be causing the obstruction. Although multiple papillomas of the larynx and tracheobronchial tree are well known, the occurrence of extensive papillomas of the oral cavity is rare. The unusual clinical presentation and pathologic significance are discussed.