Angiocentric immunoproliferative lesion and angiocentric lymphoma of lymph node in children. A report of two cases

AIM

To report two examples of an angiocentric immunoproliferative lesion (AIL) and angiocentric angiodestructive lymphoma (AL) presenting in lymph nodes in children. Most commonly involving extranodal sites, AIL/AL rarely presents in the spleen and lymph nodes.

METHODS/RESULTS

Case 1 presented as a cervical lymphadenopathy in a 3 year old girl being treated for pre-B cell acute lymphoblastic leukaemia. Histological and immunohistochemistry studies revealed an Epstein-Barr virus positive (EBV+), large B cell (CD20 and CD30+) AIL with large areas of necrosis, the whole resembling lymphomatoid granulomatosis. Case 2 presented as a large supraclavicular lymphadenopathy in a 13 year old boy. Histology and immunohistochemistry revealed an EBV-, large T cell (CD45RO, CD56, and CD30+) AL, presenting the features of so called angiocentric T cell/natural killer cell lymphoma, nasal type.

CONCLUSIONS

The term AIL/AL refers to a heterogeneous group of conditions not unique to a particular type of lymphoid cell. These lesions are easily recognised by the histopathologist because of their extremely unusual angiocentric pattern. Although rare, AIL/AL may present as nodal lesions in children ab initio.

Extracutaneous infantile haemangioma is also Glut1 positive

AIM

To investigate whether extracutaneous infantile haemangioma-like tumours are immunohistochemically similar to cutaneous infantile haemangiomas.

METHODS

Mammary, salivary gland, liver (one each), and placental (two cases) capillary haemangiomas and typical examples of cutaneous (eight cases) infantile haemangioma were investigated immunohistochemically for alpha smooth muscle actin and Glut1, a proposed marker for the skin localised lesion. Positive internal controls included red blood cells, perineurium, trophoblast, and endothelial cells of the placental capillaries. Extralesional vessel endothelium acted as a negative control (except in the placenta). The liver haemangioma and both chorioangiomas presented in patients with Beckwith-Wiedemann syndrome.

RESULTS

The endothelial cells of all the vascular lesions were Glut1 positive. These were consistently surrounded by a rim of alpha smooth muscle actin positive pericytic cells. Controls reacted appropriately.

CONCLUSIONS

All infantile haemangiomas were immunohistochemically positive for Glut1: expression of this molecule was not limited to infantile haemangiomas of the skin. These tumours comprise proliferations of both endothelial and pericytic cells. The association with Beckwith-Wiedemann syndrome may provide a clue to the molecular genetics of infantile haemangioma.

Metastatic metanephric adenoma with foci of papillary carcinoma in a child: a combined histologic, immunohistochemical, and FISH study

We report an example of metastatic metanephric adenoma containing foci of papillary carcinoma in the primitive tumor arising in the left kidney of an 11-year-old girl. Histology revealed a monomorphous population of small cells with bland cytology arranged in pseudoglandular, tubular, papillary, and glomeruloid structures with frequent psammoma bodies. Intermixed there were foci of and small cavities lined by larger cells with eosinophilic cytoplasm and larger nuclei with small nucleoli. A regional lymph node contained metastatic deposits with the former histologic pattern. By immunohistochemistry the small cells were negative for carcinoembryonic antigen (CEA) and keratin 7 while these antibodies reacted positively in the larger cells. A fluorescent in-situ hybridization (FISH) study for chromosome 17 in imprints from the primitive tumor revealed 3 signals in about 10% of the nuclei while the rest was disomic. Disaggregated cells from the metastatic lymph node consistently revealed 2 signals for chromosomes 7, 16, and l7. Histology of the primitive tumor resembled the epithelial component of the so-called metanephric adenofibroma while the metastatic lymph node exhibited histologic and FISH genomic features of metanephic adenoma. Int J Surg Pathol 9(3):241-247, 2001

Primary angiocentric T-cell intestinal lymphoma with Epstein-Barr virus in a 5-year-old boy

A case of peripheral T-cell lymphoma affecting the small bowel of a 5-year-old boy is reported. The cells did not form a tumoral mass but infiltrated diffusely, arranged in an angiocentric pattern and associated with numerous ulcers, one of which perforated. Immunohistochemistry proved them to be CD45RO-, CD3-, and CD8-positive. CD20, CD4, and CD56 markers were negative. The presence of EBV in the lymphomatous cells was demonstrated by in-situ hybridization. Polymerase chain reaction study revealed T-cell receptor (TCR) gene rearrangement. Notably the hemophagocytic syndrome present on admission reverted after surgery. The authors are not aware of a previous report of intestinal T-cell lymphoma in a child.

Lymphohistiocytic and granulomatous phlebitis in penile lichen sclerosus

Lichen sclerosus (LS) is a chronic inflammatory disease of unknown etiology that may affect the genital and/or extragenital skin of individuals of either sex at all ages. In boys, the prepuce is the most common site of involvement. The diagnostic criteria of LS include the presence of inflammatory infiltrates mainly composed of T lymphocytes. We report on two cases of LS of the prepuce because of the unusual feature of lymphocytic (CD45RO+ and CD20+), histiocytic (CD68+), and granulomatous phlebitis. This lesion was not present in a group of another 18 cases of childhood penile LS. We have not been able to find any references describing and illustrating inflammatory involvement of the dermal vein walls in LS. Unlike the data reported in the literature, the dermal inflammatory infiltrates of these two cases showed a similar proportion of B and T lymphocytes in addition to frequent CD68+ histiocytes.

Association of sympathomimetic drugs with malformations

We observed 2 cases of severe limb defects in infants following the use of sympathomimetic drugs during pregnancy. The mother of I had taken large doses of Primatene (ephedrine, theophylline, phenobarbital) as tablets and mist throughout pregnancy. The infant was born with oligoectrosyndactyly. In the other infant, maternal ingestion of sympathomimetic drugs including Triaminic (pseudoephedrine, phenylephrine, phenylpropanolamine) was associated with distal limb defects. Experimental studies in pregnant rabbits using Primatene in both low and high dosage resulted in limb reduction defects and other malformations in a significant number of the offspring compared with controls. Limb defects in the offspring of chicks following exposure to sympathomimetic drugs had previously been observed. We suggest that these agents may be teratogenic in the human and should be used with great caution or avoided during pregnancy.

Solitary unilocular cyst of the lung with features of persistent interstitial pulmonary emphysema: report of four cases

Neonatal interstitial pulmonary emphysema (IPE) is a well-characterized lesion usually presenting in preterm newborns as a complication of respiratory distress syndrome and/or assisted ventilation. Occasionally, IPE may occur spontaneously in infants with no underlying pulmonary disease. Persistence of IPE (PIPE) may be diffuse or localized. Localized PIPE usually presents as multiple cysts 0.3 to 3 cm in one or more lobes of the lung. In this report, we describe four cases of unilocular large cysts (up to 5 cm in diameter) partially lined by uni- and multinucleated histiocytes in a foreign body type reaction and showing gas dissection of the surrounding parenchyma (present in case 1). These histological features favored the diagnosis of PIPE and the cases were interpreted as such, since no other clear-cut diagnosis could be defined. However, because the lesion was limited to one lobe, and the children were full term, asymptomatic at birth and without history of respiratory distress or assisted ventilation, differential diagnosis with other pulmonary cystic lesions of infancy is mandated.

Adnexal-centered giant congenital melanocyte nevus with extensive ganglioneuromatous component and trisomy 7

Adequate interpretation of clinical and histopathologic features of giant congenital melanocytic nevus (GCMN) in newborns is a continued challenge. A GCMN with three large nodules and three polypoid exophytic tumors presented in the dorsum of a female full-term newborn, the borders exhibiting a spotted grouped pattern. Microscopic examination revealed a peculiar adnexal-centered (eccrine sweat gland ducts, acrosiringia, and hair infundibula) compound nevus expressing pagetoid intraepidermal spreading of epithelioid melanocytes. The nodules represented an extensive ganglioneuromatous component. The neurons and their neuropil were positive for neuron-specific enolase, S-100, synaptophysin, tyrosine hydroxilase, and PGP 9.5. In addition to these components, a poorly differentiated, fusiform, low-mitotic rate population of cells undergoing epithelioid differentiation (and probably neuronal differentiation) with nodular arrangement was also present in the polypoid tumors and deeper parts of the nevus, in part intermixed with the neurons. These cells were vimentin positive but S-100 negative. FISH studies revealed these cells to express three signals for the centromeric probe for chromosome 7 whereas the neuronal component showed just two. Adnexal-centered arrangement of melanocytes has not been emphasized in GCMN. Ganglioneuromatous differentiation has been rarely reported in this condition. Trisomy 7 in GCMN has been reported only once previously.

Yolk sac tumor of the placenta in Wiedemann-Beckwith syndrome

The present report describes an example of multifocal (two) yolk sac tumor (YST) with mesenchyme-like and enteroid patterns found in the placenta (730 g) of a newborn (4200 g) with Wiedemann-Beckwith syndrome (WBS) phenotype (macroglossia, omphalocele, hemihypertrophy, cardiomegaly, hypoglycemia). YST has not been previously reported to develop in the placenta. This case expands further the spectrum of alterations found in the placenta in the WBS and fits in the list of tumors related to WBS. ¿KW¿

Presence of human papillomavirus in extrahepatic biliary atresia

BACKGROUND

In a previous study the human papillomavirus DNA was detected in seven cases of so-called idiopathic neonatal giant cell hepatitis by using nested polymerase chain reaction. The purpose of the present study was to study the prevalence and possible common causes of human papillomavirus-associated idiopathic neonatal giant cell hepatitis and extrahepatic biliary atresia.

METHODS

Formalin-fixed, paraffin-embedded archival tissues obtained in 18 cases of extrahepatic biliary atresia were studied for human papillomavirus DNA by nested polymerase chain reaction. In addition, in situ hybridization was performed on tissue obtained in 6 cases.

RESULTS

Tissue in 16 of the 18 cases studied showed amplified human papillomavirus DNA, whereas no human papillomavirus was amplified in any of 30 control samples. Main human papillomaviruses detected were types 6 and 18. Punctate intranuclear positive signals were detected in the hepatocytes after in situ hybridization for human papillomavirus DNA.

CONCLUSIONS

The high prevalence of human papillomavirus DNA in liver tissue in cases of extrahepatic biliary atresia suggests a strong correlation between this disorder and idiopathic neonatal giant cell hepatitis. It further suggests that this virus may be one of the causative agents in extrahepatic biliary atresia and may represent part of the spectrum of lesions associated with neonatal human papillomavirus-induced hepatic damage.

Massive myocardial calcification in the perinatal period

Massive myocardial calcification (MMC) in the perinatal period is an unusual finding considered to be a unique tissue reaction. This report summarizes the clinical and pathologic findings of seven cases of perinatal MMC. All patients presented clinical evidence of myocardial damage. In two cases arrhythmia was detected in utero. Four cases presented with hydrops, one of which was associated with major heart malformation. One case was a trisomy 13. Three cases had polyhydramnios. Our results demonstrate that calcification follows progressive stages from patches of calcified myocardial cells (stage I), to coagulative and colliquative myocytolysis with clusters of interstitial mononucleated cells (stage II), to collapsing fibrosis with granulation tissue and multinucleated regenerative myocardial cells (stage III), and finally to fibrous scars containing entrapped remaining myocardial cells (stage IV). Literature review and our findings suggest that perinatal MMC results from different conditions inducing hypoxic-ischemic damage that later is followed by progressive scarring if the patient survives the acute stage. The lesion may represent the human counterpart of the so-called dystrophic cardiac calcinosis in mice. This disease is related to an abnormality at the Dyscalc locus of proximal chromosome 7 (syntenic with human chromosome 19q13 and 11p15).

[Human papillomavirus, neonatal giant cell hepatitis and biliary duct atresia]

We previously recognized the presence of HPV-DNA in cases of idiopathic neonatal giant cell hepatitis (INGCH) and extrahepatic biliary duct atresia (EBDA) in archivated tissue using the PCR technique. In order to investigate a possible vertical transmission we looked for the presence of HPV-DNA in cervical swabs in the mothers along with formalin-fixed paraffin-embedded hepatic tissue from 3 infants with INGCH and 4 patients with EBDA by nested-PCR. Cervical smears showed koilocytosis consistent with HPV infection in 2 cases. Delivery was vaginal except for one that was by cesarean section. All infants were males. Amplification of HPV-DNA was demonstrated in all cases, the types being concordant in infants and mothers. Although this is a small group, the findings appear in line with previous data. The presence of the same type of HPV-DNA in the infants' livers and their mothers' cervical swabs is another argument supporting the possibility of vertical transmission of the virus.

Human papillomavirus is present in some cases of childhood penile lichen sclerosus: an in situ hybridization and SP-PCR study

Lichen sclerosus (LS) is a skin disease that may affect both sexes at all ages and at any site. Its etiology remains unknown. The observation of focal koilocytotic-like changes in the stratum malpighii in prepuce samples of LS in children prompted us to investigate the presence of HPV-DNA. Twenty-three paraffin-embedded samples of LS lesions from children aged 4 to 14 years were studied using nested-PCR and in situ hybridization (ISH). Twelve out of 23 cases amplified HPV-DNA (8 cases corresponded to HPV-DNA type 6; 2 cases each to HPV-DNA types 16 and 18). ISH detected HPV sequences in the nuclei of koilocytotic and some parakeratotic cells in 13 cases (9/13 also HPV-DNA positive by PCR). Our results demonstrated the presence of HPV-DNA in roughly 70% of cases of LS of the prepuce in children. We highlight the observation of koilocytotic-like changes in the prepuce and its association with HPV. The possible pathogenetic significance between the virus and the lesion is not settled.

Human papillomavirus (HPV)-associated neonatal giant cell hepatitis (NGCH)

Neonatal giant cell hepatitis (NGCH) is a clinicopathological syndrome that has been related to perinatal infections and metabolic disorders. In a great number of cases no apparent etiology has been found. To characterize the possible relationship between human papillomavirus (HPV) and idiopathic NGCH (INGCH) we analyzed paraffin-embedded hepatic biopsies from seven cases of INGCH for the presence of both HPV and cytomegalovirus (CMV) DNA. Clinically, jaundice, detected within the first 3 days of life (except in one case), and raised levels of serum transaminases and bilirubin, mainly the direct fraction, were recorded in all. Follow-up of six patients revealed complete recovery. In a "blind" experiment, samples were studied along with appropriate controls [2 cases of CMV hepatitis, one case of postinfantile GCH, 12 cases of juvenile laryngeal papillomatosis (JLP), and 5 normal neonatal liver samples] by polymerase chain reaction (PCR). All DNA samples from INGCH consistently showed positive HPV DNA amplification. This was also found in the samples from postinfantile GCH and JLP. In addition, a second biopsy performed 11 months later in one of the cases of INGCH revealed scattered multinucleated hepatocytes and was still positive for HPV DNA. CMV-DNA was detected only in the cases of CMV hepatitis. All five normal livers were negative for HPV and CMV-DNA. These data seem to indicate that HPV may be closely related to a subset of "idiopathic" NGCH with good outcome.

Nonimmune fetal hydrops and placentomegaly: diagnosis of familial Wiedemann-Beckwith syndrome with trisomy 11p15 using FISH

We have studied a family in which four members of the same generation were affected with Wiedemann-Beckwith syndrome (WBS). Trisomy 11p15 was demonstrated using molecular probes in interphase nuclei of formalin-fixed paraffin-embedded placenta from a stillborn fetus and in peripheral blood lymphocytes from two liveborn female relatives. Clinical examination showed nonimmune hydrops and placentomegaly in two siblings and multiple phenotypic abnormalities consistent with WBS in the two other relatives. Paternal karyotype of the stillborn infants demonstrated a reciprocal translocation (46,XY,t(10;11) (q26;p15)) explaining the origin of the extra 11p15 material. This study illustrates the advantages of FISH for interphase analysis of chromosome aberrations otherwise not detected even by conventional cytogenetic analysis and documents that nonimmune hydrops associated with placentomegaly may be the presenting features in familial WBS.

EBV-associated Kaposi's sarcoma in a pediatric renal transplant recipient

A 7-year-old boy had undergone kidney transplantation for chronic renal failure secondary to bilateral renal hypoplasia. He developed acute and chronic rejection and received immunosuppressive therapy. A year later he died with EBV-associated hemophagocytic syndrome. The main pathologic findings disclosed visceral (lung and stomach) and abdominal lymph node involvement of Kaposi's sarcoma and EBV-positive immunoblasts in several organs. In the lungs and lymph nodes these had the features of polymorphous lymphoimmunoblastic lesions. Because of the peculiar distribution of Kaposi's sarcoma lesions a pathogenetic hypothesis is proposed based on the site of entry of the virus. This case contributes to expanding the relationship between Kaposi's sarcoma and kidney transplantation in the pediatric population.

Demonstration of Epstein-Barr viral DNA in paraffin-embedded tissues of Burkitt's lymphoma from Argentina using the polymerase chain reaction and in situ hybridization

Burkitt's lymphoma (BL) is the most frequent non-Hodgkin's lymphoma in children in Argentina. Although epidemiologic studies have linked Epstein-Barr virus (EBV) to more than 90% of African BL cases but to only 10-20% of American and French cases, increased EBV-specific antibody titers were demonstrated in 73% of Argentinian patients with BL. To characterize the relationship between EBV and BL in Argentina, we analyzed paraffin-embedded tissues from 16 cases of BL for the presence of EBV DNA using the polymerase chain reaction (PCR) and in situ hybridization (ISH). PCR analysis showed that only 4 of 16 specimens contained the EBV BamW fragment, and these specimens were all from cases diagnosed in 1984. Results of ISH performed with a specific biotinylated DNA probe against the NotI/PstI fragment of EBV correlated with the PCR findings. EBV sequences were detected with ISH in 70-90% of the tumor cells from the 4 positive cases. These data may suggest an epidemic outbreak of EBV-related BL in 1984 superimposed on sporadic cases of BL, for which EBV may not have been an essential factor. This study also demonstrates the value of using molecular techniques on archival tissue to track epidemiologic trends.

Use of fluorescence in situ hybridization for retrospective detection of aneuploidy in multiple myeloma

In malignancies with a low mitotic index such as multiple myeloma (MM), conventional cytogenetic studies may not be informative. This study's purpose was to assess specific numerical chromosomal aberrations in non-dividing MM cells by fluorescence in situ hybridization (FISH) of DNA chromosome probes on bone marrow smears. Old air-dried bone marrow smears from 18 MM patients were probed with alpha satellite DNA sequences for chromosomes 7, X, and Y, and a whole painting probe for chromosome 11. Plasma cells were identified by their morphologic characteristics so that counts of fluorescent signals in the nuclei of MM cells could be differentiated from those of normal marrow cells. Numerical chromosome aberrations were found in 66.7% of the cases (12 of 18), including 5 cases of trisomy 7, 2 cases of tetraploidy, 2 cases of monosomy X in females, 2 cases of disomy X in males, and 1 case of nullisomy Y. In addition, 2 of the 7 cases probed with chromosome 11 paint demonstrated 3 signals in about 15% of the cells. This study illustrates the advantages of FISH for interphase analysis of chromosome aberrations in slowly dividing cells, as well as the ability to use old slides for retrospective studies.

Nonimmune hydrops fetalis, hydramnios, microcephaly, and intracranial meningeal hemangioendothelioma

Necropsy findings in a male stillborn at 31 weeks gestational age included nonimmune hydrops, hydramnios, and microcephaly secondary to a hemangioendotheliomatous malformation at the tentorium. The vascular lesion was composed by large and small tortuous endothelium-lined vessels and leiomuscular septa. The lesion is thought to be related to the more frequent arteriovenous malformation of the vein of Galen.

Use of fluorescent in situ hybridization to detect trisomy 13 in archival tissues for cytogenetic diagnosis

The present report describes the use of molecular probes to investigate the chromosomal constitution of interphase nuclei of formalin-fixed, paraffin-embedded tissue from three infants with multiple congenital malformations and a provisional diagnosis of trisomy 13 in two. Fluorescent in situ hybridization with the probe for the 13 and 21 centromeric regions revealed five nuclear signals in two of the cases, indicating the presence of an extra chromosome, and only four nuclear signals in the other case. Only the two positive cases had phenotypic features consistent with trisomy 13. Routine cytogenetic analysis was performed on one child and confirmed an additional chromosome 13. The child without an extra chromosome had features consistent with Ivemark syndrome. This study demonstrates the utility of fluorescent DNA probes for the retrospective diagnosis of aneuploidies in archival material.

Poorly organized parasitic conjoined twins: report of four cases

We report four examples of parasitic conjoined twins (PCT) that created difficulties in diagnosis and treatment because of their unusual presentation and poor internal organization. Case 1 appeared as a tumor on the back containing an adrenal gland and part of the small bowel and stomach; two spines with spinal cords were present. Case 2 was similar, but mature and immature renal tissue were included and a meningocele with Arnold-Chiari type II malformation was recognized in the autosite spine. Retrospective interpretation of both cases suggested that the left lower limb and pelvis were part of the parasites. In case 3 the parasite was attached at the perineum and lower abdomen, contained a rudimentary spine in continuity with the coccyx of the autosite, and was partially covered by scalp. Case 4 presented as a limblike tumor attached at the suprapubic region. All cases were complicated by disruptions in the autosites. Surgical treatment was successful in cases 1, 2, and 3. These four anatomically poorly organized PCT are best categorized as intermediate between teratomas and the more common types of PCT.

Hyperplasia of lymphoglandular complexes in colon segments in Hirschsprung's disease: a form of diversion colitis

This is a study of the size and number of lymphoglandular complexes (LGDs) in the resected segment of aganglionic left colon of 20 children (mean age 26 months) obtained several months to years after being defunctionalized by proximal colostomy, compared with 5 controls (mean age 20 months). All the resected aganglionic segments had a nodular mucosa. The number of LGCs/mm of muscularis mucosae was 0.58 +/- 0.2; in controls the number was 0.24 +/- 0.12 (P less than .0025). The mean size of LGCs in aganglionic colon was 1.23 +/- 0.27 mm, and in controls it was 0.57 +/- 0.21 (P less than .0005). Because LGCs have been related to antigen processing, hyperplasia of LGCs in defunctionalized colonic segments of Hirschsprung's disease may represent a reaction to stagnant contents. Its combination with cryptitis (present in six cases) may represent a form of diversion colitis, a condition recognized in adults in bypassed colonic segments after surgical diversion of the fecal stream.

Nail-patella syndrome in a spontaneously aborted 18-week fetus: ultrastructural and immunofluorescent study of the kidneys

Nail-patella syndrome (NPS), hereditary onycho-osteodysplasia, is an autosomal dominant disorder of nail dystrophy, patellar absence or hypoplasia, incomplete elbow extension, conical posterior iliac horns, and nephropathy. We studied the kidneys of an 18-week spontaneously aborted fetus of a mother with the NPS. Ultrastructural examination of the kidney showed thickening of the capillary walls of the glomeruli and mesangium. There was irregular thickening of basement membranes with subendothelial fibrillar electron-dense deposits. Immunofluorescence showed fibrinogen deposition in glomerular basement membranes. Fibrinogen deposition in utero may ultimately lead to glomerular fibrosis and intrabasement membrane collagen deposition as seen in the adult renal lesion of this syndrome. This is the first report of the NPS in which the renal abnormalities have been studied in a fetus. These findings provide support for possible prenatal diagnosis of NPS by intra-uterine kidney biopsy.

Hepatic hemangioendotheliomas, placental chorioangiomas, and dysmorphic kidneys in Beckwith-Wiedemann syndrome

A 4-month-old female, birth weight 3150 g, had a history of maternal eclampsia, multiple placental chorioangiomas, and persistent neonatal hypoglycemia. Macroglossia and enlarged kidneys were recorded. Autopsy revealed multiple hepatic hemangioendotheliomas (type 1), massive cardiomegaly, and bilateral nephromegaly. Both kidneys were lobulated with active glomerulogenesis and clusters of immature tubules and foci of dysplastic medullary ducts. The features suggest that the nephrogenesis was secondary to the persistence of actively branching nephron-inducing ducts. Nodular hyperplasia of the adrenal cortex (adrenoblastomatosis) was present. This report expands the list of tumors to be found in Beckwith-Wiedemann syndrome (BWS).

Mature presacral sacrococcygeal teratoma associated with a sacral "epignathus"

We report an example of sacrococcygeal teratoma presenting as a "supernumerary limb" in the left gluteal area with a rudimentary hemipelvis, femur, tibia, fibula, and tarsal bones. This monocephalus tripus dibrachius-appearing complex with associated with a deep seated but separate pararectal mature teratoma. This combination of a well-developed external limb with a deep but separate teratoma has been described.

Mesangiolytic poststreptococcal glomerulonephritis

We describe two children with poststreptococcal glomerulonephritis associated prolonged oligoanuria (12, 13 days). Kidney biopsies at 10 and 6 days, respectively, revealed acute glomerulonephritis with prominent mesangiolysis. Both patients recovered uneventfully. It is proposed that damage to the mesangium accounts for the clinical course.

Congenital cutaneous candidiasis diagnosed in cytologic scrapings

Cytologic scrapings of skin vesicles from an eight-day-old newborn who had a generalized maculopapular, vesicular and pustular rash contained mycelia and ovoid spores of fungal organisms. The cytodiagnosis of cutaneous candidiasis was confirmed by the study of a direct smear and a skin biopsy. The candidiasis was congenital; the 15-year-old mother had had vulvar pruritus prior to delivery. Since the variable clinical picture of this disease must be differentiated from those of other types of congenital dermatitis, an early cytologic study of skin scrapings may prove useful for its rapid diagnosis and treatment.

Measles pneumonia in a newborn

We report a 21-day-old preterm infant who had severe respiratory distress of 6 days' duration and whose lungs revealed a giant cell pneumonia at necropsy. Measles antigen was demonstrated in mononuclear and multinucleated epithelial cells of the lung by immunoperoxidase staining. We recommend the immunostaining procedure to differentiate measles from other viruses, such as parainfluenza 2 or 3, and respiratory syncytial virus, all of which may produce giant cell pneumonias.

Rhabdomyomatous dysplasia of the lung

This article deals with the presence of nontumoral striated muscle fibers in the lungs of 3 neonates. These cells were diffusely distributed in one lung (case 1) or in both (case 2), or focally localized to the lung parenchyma adjacent to the liver in a case with a large right diaphragmatic hernia (case 3). The striated muscle fibers were located in the walls of small bronchi and bronchioli or in the alveolar interstitium. Other major lung malformations found simultaneously were absence of lobation, hypoplastic lungs, and hypoplastic pulmonary vessels. The origin of striated muscle fibers in the neonatal lung has been attributed to anomalous differentiation of mesoblastic cells (as in cases 1 and 2). The presence of striated muscle cells in the lower margin of a hypoplastic lung associated with a right diaphragmatic hernia (case 3) suggests that intrapulmonary inclusion of diaphragmatic muscle fibers might be a source as well. Striated muscle fibers in the lung are commonly associated with major malformations involving heart and lungs, suggesting a much wider morphogenetic error.

Thyrocalcitonin-containing cells in the Di George anomaly

The Di George syndrome is an anomaly characterized by the complete or partial absence of derivatives of the third and fourth pharyngeal pouches often associated with defective development of the third, fourth, and sixth aortic arches leading to absence or hypoplasia of the thymus and parathyroid glands and to cardiovascular anomalies. The fifth pharyngeal pouch, often considered a part of the fourth pouch, gives rise to the ultimobranchial body (UB), which becomes incorporated into the thyroid gland and is thought to be the source of thyroid C cells. Robinson suggested that complete or partial absence of the UB should be considered a part of the Di George anomaly. To substantiate this theory, the thyroid glands of 11 patients with the Di George syndrome and 11 age-matched control infants were examined immunohistochemically using the immunoperoxidase technique for presence or absence of thyrocalcitonin (TC)-containing cells. Only three of 11 patients with the Di George syndrome had TC-containing cells in their thyroid glands (27 per cent), and nine of 11 control infants had these cells (82 per cent). It is concluded that thyroid C cell deficiency is present in most patients with Di George anomaly, suggesting a relationship between these cells and development of derivatives of the third through fifth visceral pouches. Furthermore, there is a spectrum of deficiency of thyroid C cells in these individuals comparable with the spectrum of partial to complete absence of third and fourth pharyngeal pouch derivatives regarding thymus and parathyroid glands. Immunostaining for TC of the lungs of all infants with the Di George syndrome and control infants revealed similar numbers of thyrocalcitonin-containing cells in both groups. Asynchronous development of thyroid and lung thyrocalcitonin-containing cells in those with the Di George syndrome favors the theory that the latter develop independently of derivatives of the third through fifth visceral pouches. This study further supports a neural crest origin of the Di George anomaly and strengthens the concept that the Di George anomaly is a neurocristopathy.

An immunohistochemical study of islet cells with macronuclei in infancy

The presence of hypertrophic islet cells in infancy as evidenced by nuclear enlargement (2 to 6 times normal size) has been mentioned as a morphological accompaniment of hyperinsulinemic hypoglycemia of infancy. We report an immunohistochemical and semiquantitative study of hypertrophic islet cells in 14 infants with neonatal hypoglycemia (10 with documented persistent neonatal hypoglycemia and 4 with probable persistent neonatal hypoglycemia) and 6 infants born to diabetic mothers (IDM), using an indirect immunoperoxidase methods for the demonstration of insulin, somatostatin, and glucagon. Quantitation of immunoreactivity was performed in each case on 20 hypertrophic cells. Polyploid cells were positive for insulin and somatostatin but negative for glucagon; insulin-positive cells outnumbered somatostatin-positive cells in both groups. As nuclear hypertrophy is considered to be a sign of hyperfunction, our findings are in accordance with the concept that IDM involves reactive beta-cell hypertrophy and similar findings in the pancreases of infants with persistent neonatal hypoglycemia (PNH) suggest a primary dysfunction of their beta cells, too.

Focal giant-cell cardiomyopathy

A newborn with supraventricular arrhythmia diagnosed during fetal life was found at autopsy to have a small nodule with hypertrophic and multinucleated myocardial cells in the atrial septum, near the atrioventricular node. There were no stigmata of Beckwith-Wiedemann syndrome or tuberous sclerosis. This focal giant-cell cardiomyopathy has been described only once, in an infant with Beckwith-Wiedemann syndrome. It is suggested that these dysplastic myocardial cells may be responsible for the atrial arrhythmia and that this hamartomatous lesion has the potential for malignant transformation.

Giant-cell myocarditis in a newborn with congenital herpes simplex virus (HSV) infection: an immunohistochemical study on the origin of the giant cells

Giant-cell myocarditis is a rare inflammatory disorder characterized by degeneration and necrosis of myocardial fibers and presence of chronic inflammatory infiltrates associated with multinucleated giant cells forming a granulomatous inflammatory reaction. The etiology of giant-cell myocarditis is unknown. Many conditions have been reported as associated with this phenomenon such as fungi, virus, sarcoidosis, and hypersensitivity or autoimmune reactions. We are reporting a case of giant-cell myocarditis discovered in a newborn with congenital herpetic sepsis. The myogenic origin of the giant-cells of this case is supported by the positivity for desmin and myoglobin and negativity for muramidase and alpha-1-antichymotrypsin after immunoperoxidase procedure. The presence of Herpes simplex virus type II was confirmed by indirect immunoperoxidase reaction in most of the viscera including the heart, but is not considered a factor in the production of giant cells.

Congenital herpes simplex virus infection diagnosed by cytology of aspirated tracheobronchial material

Aspirated tracheal secretions from a ten-day-old newborn having signs of sepsis showed small clusters of cells with cytopathic changes consistent with herpes simplex virus (HSV) infection. The presence of type 2 HSV was confirmed by an immunoperoxidase procedure on the aspirated bronchial mucus and at necropsy in most of the viscera. Since prompt antiviral chemotherapy may favorably affect the outcome of HSV infections, early cytologic studies of tracheobronchial secretions may prove useful for rapid diagnosis.