An unusual presentation of adenoid cystic carcinoma of the lacrimal gland

Adenoid cystic carcinoma of the lacrimal gland is a highly malignant tumor usually characterized by symptoms of less than 1 year's duration. Computed tomographic (CT) findings of adjacent bony erosion or focal tumor sclerosis are also suggestive. We present a 57-year-old female patient who manifested symptoms of an enlarging mass in the right lacrimal fossa for almost 3 years prior to the establishment of the diagnosis of adenoid cystic carcinoma. CT findings during those years were not supportive for malignancy. The treatment included en bloc resection of the mass and adjacent bone and radiotherapy.

[Brucella infection of the testis mimicking malignancy]

A testicular mass is a diagnostic challenge, as it may include both benign and malignant processes. Due to the difficulty in diagnosis and the need to prevent complications, it is sometimes necessary to perform orchiectomy. We present an unusual case of brucellosis in which the presenting features were persistent cough for 6 months and a right testicular mass. The clinical picture and ultrasound findings suggested malignancy. Orchiectomy and medical treatment resulted in rapid resolution of symptoms.

Cured Multiple Myeloma Followed by Primary Malignant Lymphoma of the Lung

A 56-year-old patient was found to have smouldering myeloma which remained asymptomatic and untreated for 13 years. Localised osteolytic lesions then appeared, which responded to local irradiation. Six years later, an increased serum M-protein became evident (IgG$LD, 3 gr/dl) associated with 35% plasma cells in the bone marrow, which necessitated melphalan/prednisone therapy. A prolonged complete remission was achieved lasting 6 years. Thereafter, the patient developed a myelodysplastic syndrome with leukopenia and refractory anemia and he finally died of pulmonary disease. Autopsy revealed extensive thoracic involvement by a primary malignant lymphoma of the lungs (IgMK) with no evidence of myeloma. Such a long follow-up with subsequent cure is rare in multiple myeloma as is the appearance of a second B cell malignancy, which may either be associated with the myeloma and/or chemotherapy given, or a coincidental occurrence.

Isolated necrosis of the tubal fimbriae in a prepubertal girl

A report of haemorrhagic necrosis of the tubal fimbriae in a prepubertal girl is presented. The presumptive aetiology for this is the isolated torsion of the fimbrial end which, to the best of our knowledge, has not been previously described. A high index of suspicion of torsion and early intervention is emphasised. Laparoscopy should usually precede laparotomy in doubtful cases but during laparotomy as little as possible should be done in order to retain future fertility.

Lupus-like syndrome in a mother and newborn following administration of hydralazine; a case report

A very-low-birth-weight infant died from pericardial effusion and cardiac tamponade confirmed by the post-mortem findings. The mother suffered from lupus-like syndrome consequent to hydralazine treatment for pregnancy-induced hypertension. The possible relationship between mother-infant pathology and hydralazine administration is discussed.

Ovarian malignancies in pregnancies complicated by colonic perforation

Primary or secondary ovarian carcinoma in pregnancy is very rare. The entity is difficult to diagnose and is not infrequently fatal. Two unusual cases of ovarian carcinoma during pregnancy, complicated by perforation of the colon, are described. Treatment depends upon the time of diagnosis, the stage of growth, and possible complications. More attention should be paid to complaints concerning bowel function during pregnancy, and pelvic sonography and bowel studies may enable earlier diagnosis.

Ovarian carcinoma masquerading as ovarian hyperstimulation syndrome

Two patients receiving ovulation-inducing drugs were found to have ovarian carcinoma. Since patients receiving such medication are prone to develop enlarged ovaries with or without the fully developed hyperstimulation syndrome, the diagnosis of ovarian tumors in such patients may be delayed or missed. It is therefore being suggested that an ovarian enlargement persisting for more than 4 weeks, or the finding of ovarian solid masses by sonography in patients receiving ovulation-inducing drugs, should lead to a thorough work-up for neoplasia, sometimes including even laparotomy.

Granulomatous reaction in lymph nodes draining laryngeal carcinoma

Presented are two cases of simultaneous occurrence of epithelioid granulomas and metastatic squamous cell carcinoma in cervical lymph nodes draining supraglottic carcinoma. Laboratory tests and radiological and clinical findings ruled out sarcoidosis, as well as mycotic, mycobacterial, or other bacterial infection. Upon finding of epithelioid granulomas in cervical lymph nodes, a malignant tumor of the head and neck region should be considered as a differential diagnostic possibility. Uncritical acceptance of a diagnosis based solely on the histological appearance may lead to erroneous treatment.

Noma in a full-term neonate

Noma is an uncommon gangrenous process usually affecting malnourished children. A full-term neonate with orofacial noma, bilateral choanal atresia, and transient neutropenia with B cell deficiency is reported. This unusual appearance of noma in a well-nourished newborn might be related to the combination of choanal atresia and transient immune deficiency.

Crohn's ileitis complicated by amyloidosis: observations and therapeutic considerations

We present a patient with clinically asymptomatic amyloidosis associated with Crohn's ileitis. A distinction should be made between immunocytic dyscrasia associated with amyloidosis (formerly primary or myeloma-associated amyloidosis) and acquired systemic amyloidosis (formerly secondary amyloidosis). We compare the natural course of amyloidosis complicating Crohn's disease with these complicating familial Mediterranean fever (FMF), and discuss the role of resection and the rationale behind colchicine therapy. Our patient is the first reported case in which colchicine therapy alone has been successful in the prophylactic treatment of amyloidosis complicating Crohn's ileitis.

Retroperitoneal fibrosis in association with urothelial tumor

One of the less common associations of retroperitoneal fibrosis is malignancy. Although there have been many reports on tumors associated with retroperitoneal fibrosis urothelial tumors are rare. We report a case of retroperitoneal fibrosis and urothelial malignancy of the renal pelvis.

Primary squamous cell carcinoma of the pilonidal area

Two patients with primary squamous cell carcinoma of the pilonidal area are presented. No chronic infection or any other lesion predisposing to malignant transformation was present in either patient. Physicians and surgeons should be aware of the possibility of skin cancer appearing in this area in elderly patients. Biopsy of the lesion, leading to an early diagnosis, may prompt surgical treatment. Complete excision of the lesion is a prerequisite for cure.

Production of the hydroxylated metabolites of vitamin D in a neonate with a single hypoplastic-dysplastic kidney

The ability to produce dihydroxylated metabolites of vitamin D was studied in a term neonate suffering from severe renal insufficiency. The infant died at age 26 days owing to end-stage renal failure and the necropsy examination showed a single dysplastic kidney weighing 1.5 g. At age 2 weeks the serum levels of the dihydroxylated metabolites of vitamin D were found to be normal and a pronounced increase was noted 24 hours after injection of 100 000 IU vitamin D2. The study suggests that during the neonatal period a small renal mass is sufficient to maintain optimal circulating levels of the dihydroxylated metabolites of vitamin D.

A limited form of Churg-Strauss syndrome: ocular and cutaneous manifestations

A case that supports the concept of a limited form of Churg-Strauss allergic granulomatosis was studied. The patient had a syndrome that was initially confined to the conjunctiva and subsequently displayed cutaneous and subcutaneous lesions. At no time was there any evidence of systemic involvement. Asthma appeared ten years before the onset of the present disease. The characteristic histologic findings consisted of diffuse tissue eosinophilia, and eosinophilic necrotizing and nonnecrotizing granulomatosis. The last, as well as conjunctival involvement, has not been previously described in Churg-Strauss syndrome to our knowledge. Thus, this entity most likely represents a variant of the classic Churg-Strauss syndrome, lacking the multiple organ system involvement that occurs in the latter. The patient responded well to therapy with corticosteroids and as of this writing has been free of disease for about 2 1/2 years.

Subcutaneous fat necrosis of the newborn

A case of subcutaneous fat necrosis of the newborn is described. Severe perinatal asphyxia preceded the appearance of the skin lesions. Premature rupture of membranes and the presence of foul-smelling meconium raised the possibility of infection by anaerobes as an additional etiologic factor. The main hypotheses concerning the cause and pathogenesis of this condition are reviewed. The alarming clinical picture that stands in sharp contrast to the benign prognosis is stressed.

Hidradenoma papilliferum of the external auditory canal

This is a report of a 32-year-old woman who presented with a hidradenoma papilliferum of the external auditory canal. The lesion bears a marked histologic resemblance to vulvar hidradenoma papilliferum and to intraductal papillioma of the breast and, as in the latter neoplasm it may malignancy. However, these are benign tumours and warrant only local resection. Clinical symptoms related to obstructure of the external ear and some hearing loss.

This report emphasizes again the variety of neoplasms which occur under the generic name of ceruminoma. It is recommended that each of these tumours be classified according to its characteristic histologic features and that the term ceruminoma, as used at present, be abandoned.

Adenomas of the ceruminous glands located in the external auditory canal are rare tumours (Batsakis et al., 1967; Cankar and Crowley, 1964; Pluec, 1977). About forty cases have so far been reported in the literature (Dehner and Chen, 1980). The histological classification of these benign ceruminous tumours is similar to that used for sweat gland tumours in other locations (Neldner, 1968; Pahor and O'Hara, 1975; Wetli et al., 1978).

The most common type demonstrates features of glandular or tubular adenoma with epithelial structures which are similar to those of normal apocrine glands (Althaus and Ross, 1970; Anagnostou et al., 1974; Leitner, 1952; Camkar and Crowley, 1964). The second type of benign ceruminoma is the pleomorphic adenoma (Mark and Rothberg, 1951; Smith and Duarte, 1962; Pahor and O'Hara, 1975). Its histogenesis from ceruminous or ectopic salivary glands is still debated.

The purpose of this paper is to report still another type of benign ceruminoma, namely the hidradenoma papilliferum which so far has only been mentioned as a theoretical possibility (Dehner and Chen, 1980).

Tuberculoid cornstarch granulomas with caseous necrosis. A diagnostic challenge

We studied a patient in whom peritoneal granulomas developed with caseous-type necrosis after exposure to cornstarch from surgical gloves. This necrotizing type of lesion, which is the least common among cornstarch granulomas, can simulate tuberculous infection and lead to initiation of antituberculous therapy. A review of the literature suggests that there are two basic types of cornstarch granulomas: the phagocytic, foreign body type, and the tuberculoid granuloma with and without central necrosis. The morphologic features and possible mechanism of formation of these types of granulomas are being discussed. Although the cornstarch particles can be identified with a variety of stains, the most reliable method is that of examination with polarized light, which is recommended in all cases of granulomas, especially abdominal ones.

Skin petechiae and ecchymoses (vasculitis) due to anticoagulant therapy

The appearance of petechiae and ecchymoses following anticoagulant and fibrinolytic therapy is an unusual and rare complication. The mechanism of the vasculitis is obscure but may be related to a chemical vasotoxic reaction. During anticoagulant and fibrinolytic therapy, 6 patients developed petechiae and ecchymoses which was accompanied by pain and fever. There were no disturbances of blood clotting factors. In spite of the varied action of the different anticoagulants and fibrinolytic drugs, the clinical course and the histological examination demonstrated a similar identical vasculitis.