Gastric adenocarcinoma with a yolk sac component: a case report and review of the literature

Gastric yolk sac tumors (YST) are very rare and are mainly reported in elderly people. We present a case of a 36-year-old man with a poorly differentiated gastric cancer showing a mixture of adenocarcinoma and yolk sac tumor that metastasized to Virchow's node. Both biopsies, Virchow's node and gastric tumor, contained areas of adenocarcinoma and yolk sac tumor that stained strongly positive for alpha fetoprotein (AFP) by the immunohistochemistry method. A high level of serum AFP (38,200 ng/mL) was also noted in this case. The response to chemotherapy in this case of mixed gastric yolk sac tumor and adenocarcinoma was not as favorable as would be expected in a pure primary germ cell tumor.

Clinically silent primary adrenal lymphoma: a case report and review of the literature

Primary adrenal lymphoma (PAL) is extremely uncommon. We describe a case of clinically silent non-Hodgkin's B-cell lymphoma of diffuse large cell type with exclusive left adrenal localization. The tumor was discovered by computed tomography (CT) as a 2.5-cm dense mass and diagnosed at autopsy. Literature concerning this unusual neoplasm is reviewed. During the early stage, particularly when the lesion is small, PAL is likely to be missed. This unusual entity should be included in the differential diagnosis of adrenal masses so that early diagnosis may be made and intervention might dramatically affect the clinical outcome.

The pathogenesis and prevention of thromboembolic complications in patients undergoing total hip replacement

A 1987 survey of U.S. orthopedic surgeons found that 84% used some form of DVT prophylaxis. Ten percent used prophylaxis only for their "high-risk patients," and 6% never used prophylaxis. Twenty percent of the surgeons had at least one THR patient die from a fatal PE in the last five years. Fifty percent of the surgeons using warfarin had subsequently discontinued its use because of bleeding complications and monitoring difficulties. Compared with a survey done 13 years previously, this recent study showed a dramatic rise in the number of surgeons using DVT prophylaxis. The majority, however, were using methods that are ineffective: 67% used aspirin and 17% used fixed doses of subcutaneous heparin. Because the incidences of DVT and PE in THR patients are high, all of these patients should receive prophylaxis. The standard LDH regimen, effective for patients receiving gynecologic, general, and most orthopedic procedures, is ineffective for THR patients. The available prophylactic methods proven to reduce DVT and PE in THR patients are adjusted-dose subcutaneous heparin, dextrans, low-dose warfarin, and EPC. Comparative studies have not clearly demonstrated superiority of any one method. However, low-dose warfarin may offer better protection in very high-risk patients. External pneumatic compression offers protection without increasing bleeding risks. Dextrans are effective but are expensive and may be associated with significant side effects. Adjusted-dose subcutaneous heparin is also effective but is cumbersome to use. Low-molecular-weight heparin appears to be a promising alternative. We recommend the routine use of EPC and reserve low-dose warfarin fro patients with histories of prior thromboembolic or venous disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Prolonged survival with unresected pulmonary metastases

The cases of 3 selected patients who had prolonged survival with pulmonary metastases that doubled in size yearly are reported. The experience with these patients and another, whose disease rapidly progressed after resection of pulmonary metastases, admonishes that the selection criteria for resection of pulmonary metastases require further refinement.