Vibronic spectra of protonated hydroxypyridines: contributions of prefulvenic and planar structures

The UV photofragmentation spectra of cold protonated hydroxypyridines display well resolved vibrational structures, interpreted with calculations at the CC2 level.

Occult cancer of the fallopian tube in BRCA-1 germline mutation carriers at prophylactic oophorectomy: a case for recommending hysterectomy at surgical prophylaxis

OBJECTIVE

BRCA-1 and BRCA-2 germline mutations increase the risk of ovarian and breast cancer. Primary cancer of the fallopian tube is rare; however, recent evidence suggests that patients harboring a germline mutation conferring an increased risk of ovarian cancer may be at risk for fallopian tube cancer as well. We discuss the finding of occult fallopian tube cancer diagnosed at surgical prophylaxis in women harboring BRCA-1 mutations.

METHODS/RESULTS

Two patients undergoing surgical prophylaxis to address an increase in ovarian cancer risk were discovered to harbor occult primary fallopian tube carcinoma on final pathology review. Mutational analysis confirmed the presence of a deleterious mutation in BRCA-1 in both patients.

CONCLUSION

Currently, consensus opinions regarding ovarian cancer surgical prophylaxis in gene mutation carriers do not include hysterectomy as part of the preventative procedure. This report as well as a growing number of cases of fallopian tube cancer reported in known BRCA-1 and BRCA-2 mutation carriers has important implications for recommendations regarding surgical prophylaxis in these women.

Spindle cell lipoma of the oral cavity. Report of a rare intramuscular case with fine needle aspiration findings

BACKGROUND

Spindle cell lipoma (SCL) is a benign neoplasm characterized by a mixture of mature fat, bland spindle cells and wiry collagen in a variably myxoid background. Oral SCLs are rare, and only four cases of intramuscular SCL exist in the literature. We report the first case of intramuscular SCL of the oral cavity with fine needle aspiration (FNA) findings.

CASE

A 61-year-old woman presented with a 3-cm mass in the right gingivobuccal sulcus. Papanicolaoustained FNA smears were hypocellular and contained loose collections of spindle cells in a myxoid background, numerous mast cells, rare capillary fragments and portions of skeletal muscle. The spindle cells had mild nuclear enlargement, focal nuclear irregularities, rare intranuclear inclusions and occasional small nucleoli. No lipoblasts or mitoses were identified. There was intermingling of the spindle cells with the skeletal muscle fragments.

CONCLUSION

Intraoral SCL is a rare lesion but should be considered in the differential for a benign spindle cell neoplasm in the oral cavity. Clues to diagnosis on cytology include mature fat, bland spindle cells, a myxoid background and mast cells.

Differential expression of mammalian TRP homologues across tissues and cell lines

Mammalian homologues of the Drosophila trp gene have been invoked as the structural basis for the currents associated with capacitative Ca2+ entry (CCE) in many cell types. Trp homologues are members of a large protein family that may associate as channel subunits providing an explanation for the functional diversity of store-operated channels observed in these cells. However, there is little information as to which of these genes are co-expressed at the cellular level. We have examined the tissue specific expression of five mammalian trp genes and determined which are co-expressed in five different cell lines. The results show tissue- and cell-specific co-expression of multiple trp forms. This implies that the subunit composition of a particular CCE channel may vary depending on the cell type.

Concomitant and hormonally regulated expression of trp genes in bovine aortic endothelial cells

Recent findings have suggested that the vertebrate trp family of channel proteins is the structural basis for Ca2+ influx through the capacitative calcium entry (CCE) pathway. We have discerned, in bovine aortic endothelial cells, the concomitant expression of four such vertebrate genes: trp-1 (two splice variants), trp-3, trp-4 and trp-5. Exogenous hormones rendered dynamic effects on the transcript levels of these genes. Most notably, beta-estradiol significantly down-regulated trp-4 while trans-retinoic acid dramatically up-regulated trp-5; yet these hormones rendered little change in CCE. These findings suggest that the extent of a given trp channel's participation in CCE is not reflected in alterations of its transcript level.

Expression of neurotrophin-3 in the growing velvet antler of the red deer Cervus elaphus

Antlers are organs of bone which regenerate each year from the heads of male deer. In addition to bone, support tissues such as nerves also regenerate. Nerves must grow at up to 1 cm/day. The control of this rapid growth of nerves is unknown. We examined the relative expression of neurotrophin-3 (NT-3) mRNA in the different tissues of the growing antler tip and along the epidermal/dermal layer of the antler shaft of the red deer Cervus elaphus, using semi-quantitative reverse transcription-polymerase chain reaction. Expression in the tip was found to be highest in the epidermal/dermal layer and lowest in the cartilaginous layer in all developmental stages examined. These data correlate well with the density and pattern of innervation of these tissues. Along the epidermal/dermal layer of the antler shaft, expression was highest in the segments subjacent to the tip and lowest near the base, arguing for differences in the temporal expression of NT-3 in these segments. The expression of NT-3 in cells isolated from the different layers of 60-day antlers did not mirror that observed when whole tissues were used and may suggest regional specificity of NT-3 expression within antler tissues.

The structure, sequence and developmental pattern of expression of the white gene in the blowfly Lucilia cuprina

We have sequenced the complete coding region of the white gene of Lucilia cuprina. Strong sequence identity exists between this gene and its homologue from Drosophila melanogaster at both nucleotide and derived amino acid levels (68% and 78% respectively). The exon/intron structure of the two genes is also largely conserved, although the Lucilia gene contains one extra intron. Expression of the gene peaks during mid-pupal stage, with secondary peaks in late larval and early adult stages. Comparisons between this and other white genes will contribute to a better understanding of ATP-binding transmembrane transport proteins. The white gene should also serve as a useful marker gene in the development of a gene transformation system for the sheep blowfly.

Prostatic intraepithelial neoplasia: significance and management

Prostatic intraepthelial neoplasia (PIN) is a putative premalignant change that bears a morphological similarity to prostatic cancer and shows increased frequency, severity, and extent in patients with prostate cancer. This article discusses the evidence for PIN as a premalignant lesion, reviews the morphology, terminology, appropriate grading system, and diagnostic significance of PIN, as well as describes management recommendations for further evaluation when PIN is diagnosed in prostate resection and biopsy specimens. Clinical management of high-grade PIN found in transurethral resection of the prostate (TURP) or prostate biopsy specimens should include repeat transrectal ultrasound (TRUS) and prostate biopsy for early detection of prevalent coexistent prostate cancer. In cases of high-grade PIN, increased surveillance methods have the potential to decrease morbidity and mortality by early cancer diagnosis.

Distribution of Leu-7 antigen (HNK-1) in thyroid tumors: Its usefulness as a diagnostic marker for follicular and papillary carcinomas

The reactivity of the anti-Leu-7 monoclonal antibody was tested in 39 neoplastic and nonneoplastic thyroid tissue specimens. These included eight colloid goiters, 14 follicular adenomas, nine papillary carcinomas, five follicular carcinomas, two medullary carcinomas, and one metastatic follicular carcinoma in bone. We observed strong cytoplasmic and/or cell membrane positivity in all follicular and papillary carcinomas, in both primary and metastatic tumors. However, the medullary thyroid carcinomas tested were negative. We also observed weak and only occasional staining with anti-Leu-7 antibody in colloid goiter and follicular adenomas. The staining in the benign thyroid lesions was usually focal, less than 10% of the cells; however, in cases of follicular and papillary carcinomas, both in primary and metastatic tumors, the staining was diffuse and strong. Some of the colloid material in colloid goiters and follicular adenomas showed faint homogenous staining with anti-Leu-7 antibody. Our findings suggest that anti-Leu-7 monoclonal antibody is a marker that may facilitate the differentiation between benign and malignant thyroid lesions, with the exception of medullary carcinoma. In addition, caution should be taken when using this antibody to diagnose metastatic lesions, as other metastatic carcinomas have also been reported to be positive. This antibody should be used in conjunction with a panel of antisera to complement a morphologic diagnosis.

Platelets mediate glomerular cell proliferation in immune complex nephritis induced by anti-mesangial cell antibodies in the rat

We investigated whether platelets, which are rich in growth factors, could mediate glomerular cell proliferation in immune complex glomerulonephritis (GN) in the rat induced with an antibody directed against the Thy-1 antigen present on mesangial cells. Rats were depleted of platelets (mean platelet count less than 20,000/mm3) with goat anti-rat platelet IgG before induction of GN and platelet depletion was maintained for 48 hours. At 72 hours sections were immunostained for cyclin, an S-phase-related nuclear antigen, to identify proliferating cells, and for the common leukocyte antigen (CD45) to identify infiltrating leukocytes. Platelet depleted rats had fewer proliferating resident glomerular cells (CD45-, cyclin+) compared to controls (0.8 +/- 0.5 vs. 2.8 +/- 1.4 cells/glom cross section, P less than 0.01) and better renal function (creatinine 1.07 +/- 0.12 vs. 1.27 +/- 0.15 mg/dl, P less than 0.05). These effects were not due to changes in circulating or glomerular leukocyte counts, complement, or glomerular antibody binding. These studies provide the first direct evidence that platelets mediate glomerular (probably mesangial cell) proliferation in antibody-mediated GN.

Analysis of proliferative grade using anti-PCNA/cyclin monoclonal antibodies in fixed, embedded tissues. Comparison with flow cytometric analysis

Cell kinetic information is an important adjunct to histologically-based tumor classifications. Presently, cell kinetic data can be obtained from slide-based material only with monoclonal antibodies such as Ki-67, which require the use of frozen sections and cannot be applied to archival, paraffin-embedded material. Monoclonal antibodies have recently been generated to PCNA/cyclin, a 36 kd, S-phase-associated nuclear protein. The authors investigated whether monoclonal antibody 19A2 could be used to identify proliferating cells within fixed, embedded tissue sections. Deparaffinized sections of 41 methacarn-fixed human tumors were immunostained with 19A2 using a streptavidin biotin immunoperoxidase system. A semiquantitative scoring system was used to evaluate the fraction of cells that were PCNA/cyclin-positive, and this score was compared with cell kinetic data obtained from parallel flow cytometric S-phase analysis that had been performed on fresh samples of the same tumors. While there was general agreement between the slide-based, antibody-derived and the flow cytometrically-derived cell kinetic information, some discrepancies were observed. Some of the latter represented cases in which the anti-PCNA/cyclin antibody preparations demonstrated significant heterogeneity in the numbers of proliferating cells in different regions of the tumor. In other cases, a significant fraction of the positive cells corresponded to nontumor stromal and/or inflammatory cells. In these cases, the slide-based method provided more information about the tumor cell population than did the flow cytometry data. It is concluded that semiquantitative immunocytochemical analysis with anti-PCNA/cyclin antibodies may represent a simple, reproducible, yet powerful technique for the routine analysis of cell kinetic data in alcohol-fixed, paraffin-embedded tissue by the surgical pathologist.

Intraspinal primitive neuroectodermal tumor arising from the sacral spinal nerve root

An unusual case of intraspinal primitive neuroectodermal tumor arising from the sacral spinal nerve root is presented with the first documentation of myelographic, computed tomographic, and magnetic resonance imaging findings.

Steroid sulfatase activity in amnion tissue and amnion cells maintained in monolayer culture

Phenolic steroid sulfatase activity in amnion tissue, amnion homogenate, subcellular fractions, and amnion epithelial cells in culture was demonstrated with radiolabeled estrone sulfate as the substrate. Sulfatase activity could not be detected in either amnion tissue or cells when evaluated with dehydroisoandrosterone sulfate as the substrate. Phenolic steroid sulfatase activity in amnion tissue was linear with incubation time up to 3 h and with amnion tissue weight up to 800 mg/ml. The rate of estrone sulfate hydrolysis in amnion tissue increased in a linear manner with temperature from 3 to 60 C. The apparent Km of amnion tissue sulfatase for estrone sulfate was 9 microM. The highest specific activity of the enzyme was found in both the mitochondrial-lysosomal and microsomal fractions. In studies with amnion epithelial cells in monolayer culture, phenolic steroid sulfatase activity was linear with incubation time up to 4 h and with cell number up to 2 X 10(5)/ml. The apparent Km of amnion cell sulfatase for estrone sulfate was 5.5 microM. The product of hydrolysis, i.e. estrone, was metabolized in situ to 17 beta-estradiol in both amnion tissue and cells. The hydrolysis of estrone sulfate (and possibly other phenolic steroid sulfates present in amniotic fluid) by amnion cells may be important in providing biologically potent estrogens for in situ action.

Diagnosis of Pneumocystis carinii pneumonia by cytologic examination of bronchial washings

During the last three years, bronchial washings from patients in whom Pneumocystis carinii pneumonia was clinically suspected were cytologically examined. These were predominantly cases of suspected or confirmed acquired immunodeficiency syndrome. To determine the effectiveness of cytologic diagnosis by means of a bronchial wash, retrospective analysis of bronchial washings with available simultaneous transbronchial biopsy specimens was carried out in 181 cases. Comparison of the results of both methods revealed an excellent correlation. Pneumocystis carinii was identified in 108 specimens of washes and in 103 specimens of biopsies. Our data indicate that P carinii can be consistently and reliably identified in the smears from bronchial washes, without lung tissue biopsy, thus sparing the patient the latter procedure if contraindications exist.

17 beta-Hydroxysteroid oxidoreductase: a ubiquitous enzyme. Interconversion of estrone and estradiol-17 beta in BALB/c mouse tissues

A survey was conducted to define the sites of 17 beta-hydroxysteroid oxidoreductase activity in organs and tissues of male and female BALB/c mice, as well as the favored direction of the oxidoreductase reaction in intact tissues. The enzyme activity was assayed by use of radiolabeled estrone and estradiol-17 beta as substrates. Estrone formation from estradiol-17 beta was demonstrated in all tissues. The formation of estradiol-17 beta from estrone was demonstrated in most tissues, however, it was barely detected or was undetectable in the glandular stomach, small intestine, cecum, and large intestine. Thus, 17 beta-hydroxysteroid oxidoreductase activity is expressed in all BALB/c mouse organs and tissues. Approximately two-thirds of the tissues and organs examined, including those of the reproductive tracts, favored the conversion of estrone to estradiol-17 beta rather than the reverse reaction. The results of this study, however, represent qualitative estimates of 17 beta-hydroxysteroid oxidoreductase activity in BALB/c mouse tissues that are uncorrected for conversion to hydroxylated metabolites. These in vitro findings suggest that the 17 beta-hydroxysteroid oxidoreductase catalyzed reduction of estrone may contribute to the maintenance of physiologic levels of estradiol-17 beta in estrogen responsive tissues.

Gastric choriocarcinoma and yolk sac tumor in a man: observations about its possible origin

The case of a 65-year-old man who had a gastric tumor with components of choriocarcinoma and yolk sac tumor is presented. The presence of a small component of adenocarcinoma in the primary tumor and the absence of any gonadal or other primary tumor at autopsy confirm its origin. Despite the common association of embryonal and trophoblastic elements in gonadal tumors, this is the first case in which such an association was clearly depicted in the stomach. This and the usual coexistence of adenocarcinoma with choriocarcinoma in the stomach suggest the possibility of a different mode of development of these tumors in the two sites: forward differentiation of neoplastic germ cells in the gonads and retrodifferentiation (opisthoplasia) of neoplastic mucosal epithelial cells in the stomach.

Steroid sulfatase and 17 beta-hydroxysteroid oxidoreductase activities in mouse tissues

The metabolism of estrone sulfate and dehydroisoandrosterone sulfate to the free, unconjugated steroids, estrone and dehydroisoandrosterone, was demonstrated in more than thirty different tissues from male and female BALB/c mice. The activity of steroid sulfatase, when expressed per mg tissue, was greatest in both the pituitary gland and the adrenal glands. The pituitary gland, however, had the lowest capacity for hydrolysis of steroid sulfates while the liver had the greatest capacity. 17 beta-Hydroxysteroid oxidoreductase activity also was demonstrated in all mouse tissues by the formation of estradiol-17 beta when using estrone sulfate as the substrate. The highest apparent activity for 17 beta-hydroxysteroid oxidoreductase was found in lung tissue, and the greatest capacity to form estradiol-17 beta from estrone sulfate was found in liver, lungs, kidneys and testes. This study demonstrates that the majority of mouse tissues have steroid sulfatase and 17 beta-hydroxysteroid oxidoreductase activities.

Fluorescence of Pneumocystis carinii in Papanicolaou smears

Pneumocystis carinii organisms can be identified in routine cytologic smears stained by the Papanicolaou method and viewed under ultraviolet light in a fluorescence microscope. The organisms can be identified easily in thin, well-preserved cytologic smears. No false-positive results were obtained when 55 Papanicolaou smears of bronchial washings were observed by this method. Twenty-three of these smears were from patients with Pneumocystic carinii pneumonia in whom the acquired immunodeficiency syndrome (AIDS) had been well documented with Gomori's methenamine silver stain. With this method no additional special stains are required, no time delay for special stains is involved, and no additional material for the preparation of extra smears for special stains is needed. An additional advantage is the possibility of the retrospective analysis of smears already stained by the Papanicolaou method.

Prostatic adenocarcinoma with carcinoidal features producing adrenocorticotropic syndrome. Immunohistochemical study and review of the literature

An autopsy case of disseminated, military-type, composite adenocarcinoma and carcinoid tumor associated with adrenocorticotropic syndrome is discussed. Prostatic origin and functional activity were demonstrated by immunohistochemical techniques. Of interest in this case is that the tumor had the characteristics of amine precursor uptake and decarboxylation (APUD) cells and also kept the antigenicity of its prostatic origin. The APUD system perhaps should be considered as one form of functional differentiation of cells of different origin rather than an exclusive derivative of the neural crest.

Colonic polyps and adenocarcinoma complicating ureterosigmoidostomy: report of a case

A case of bilateral juvenile polyps and unilateral adenocarcinoma at the ureterocolic junctions occurring 40 years after ureterosigmoidostomy for exstrophy of the bladder is reported. Although adenocarcinoma of colon at the anastomotic site represents an uncommon late complication of ureterosigmoidostomy, patients undergoing this form of urinary diversion have a risk of developing colonic carcinoma that is 100 to 550 times greater than the normal population. Moreover this complication is being reported with increasing frequency in the literature. Different pathogenetic factors may play a role in carcinogenesis, but none has been satisfactorily proven. We suggest the possibility that polyps developing at the site of a ureterocolic junction may represent precancerous lesions.

Occlusion amblyopia secondary to a mixed capillary-cavernous hemangioma

We report a case of amblyopia that developed in an infant and was secondary to occlusion of the visual axis by a capillary-cavernous hemangioma. In addition to occlusion amblyopia, hemangiomas can cause astigmatic and myopic refractive errors, which usually persist throughout life. Indications for treatment and therapeutic modalities are discussed. Patients with cavernous and/or capillary hemangiomas of the periorbital region need ophthalmologic consultation and close follow-up during the first year of life. Therapy should be started promptly if growth of the hemangioma threatens to occlude vision or induce refractive error.

Steroid sulfatase activity in human lung tissue and in endothelial pulmonary cells in culture

The conversion of tritium-labeled estrone sulfate to [3H]estrone was evaluated in human lung tissue in vitro. Under standardized conditions, the rate of hydrolysis of [3H] estrone sulfate to [3H]estrone was linear with time of incubation up to 4 h and with wet tissue weight up to 400 mg/ml. The apparent Km of sulfatase for estrone sulfate was 9 microM, and the maximum velocity was 1.4 nmol substrate hydrolyzed/100 mg lung . h. The lung tissue also metabolized the primary metabolite of [3H]estrone sulfate, [3H]estrone, to 17 beta-[3H]estradiol. The hydrolysis of [3H]dehydroisoandrosterone sulfate to [3H]dehydroisoandrosterone by human lung tissue was also measured. Sulfatase activity with this substrate was linear as a function of wet tissue weight up to 800 mg/ml. The apparent Km of sulfatase for dehydroisoandrosterone sulfate was 7 microM, and the maximum velocity was 1.0 nmol substrate hydrolyzed/100 mg lung . h. The highest specific activity of lung sulfatase for [3H]dehydroisoandrosterone sulfate was found in a microsomal fraction of lung homogenate. The primary metabolite, [3H]dehydroisoandrosterone, was metabolized further by lung tissue to [3H]androstenedione and [3H]5-androstene-3 beta, 17 beta-diol. Although isolated segments of human pulmonary arteries also metabolized both [3H] estrone sulfate and [3H]dehydroisoandrosterone sulfate, cultures of pulmonary arterial endothelial cells lacked sulfatase activity. The cell(s) source of sulfatase activity in human lung tissue and isolated arteries has not yet been identified. Our findings suggest that the metabolism of sulfated steroids by the lung should be considered in evaluating homeostasis.

The pathologic effect of ureteral ligation, with clinical implications

Inadvertent, ureteral ligation is a frequent occurrence with pelvic surgery. We determined the effect of the ureteral ligation of varying lengths of time in an animal model in order to provide a rational basis for the clinical management of such injuries in humans. In the rat, simple deligation of a ureter that has been ligated for as long as 24 hours results in complete resolution of the injury with no gross or microscopic evidence of the trauma. After 48 and 72 hours of ligation, hydroureter was apparent.

Peliosis of the spleen with rupture

A case of peliosis of the spleen without apparent involvement of the liver or other organs is presented. The peliosis was discovered following rupture of the spleen after minimal trauma and was successfully treated by surgery. None of the common associations of peliosis was present (i.e., tuberculosis or intake of steroid compounds). Drugs addiction and chronic alcoholism were the only coexisting debilitating conditions exhibited by this patient.

Papillated squamous cell carcinoma in situ arising in a seborrheic keratosis

A 73-year-old man had developed a 27 x 60-mm seborrheic keratosis on his trunk. Some months previously, an 18 x 19-mm cauliflower-like area had developed within this seborrheic keratosis. Histologic examination showed a papillated squamous cell carcinoma in situ arising in a seborrheic keratosis. Seborrheic keratoses are the most common cutaneous neoplasms in man. Malignant changes are most unusual but should be suspected in lesions of unusual clinical appearance.

Interstitial irradiation of carcinoma of the prostate with 125iodine and simultaneous extraperitoneal pelvic lymphadenectomy in 32 patients: trials, tribulations and possible triumphs

A series of 32 patients with carcinoma of the prostate who underwent 125iodine interstitial irradiation to the prostate and simultaneous extraperitoneal pelvic lymphadenectomy was reviewed. The patients were segregated into 3 groups: group 1-patients with early localized low grade disease, group 2-patients with advanced localized high grade disease and group 3-patients with early localized high grade disease and those with advanced localized low grade disease. Owing to the high degree of predictability of the absence or presence of pelvic lymph node metastasis in patients in groups 1 and 2 and the morbidity associated with superficial pelvic lymphadenectomy we do not advocate this procedure in these patients. However, we advocate pelvic lymphadenectomy in patients in group 3 because of the unpredictability of lymph node metastasis. Furthermore, our data indicate that 1) the morbidity of the combined procedures is relatively low, with no patients becoming incontinent and only 12.5 per cent becoming impotent, 2) 125iodine interstitial irradiation of the prostate after transurethral prostatectomy is safer in terms of postoperative complications than is radical prostatectomy and 3) while superficial pelvic lymphadenectomy is not an innocuous procedure it generally is safe and, at times, an important diagnostic staging procedure.

Simultaneous occurrence of gastric carcinoma in identical twins

Gastric carcinoma is a rare entity in twins at any age. A 31-year old black male presented with a nine-month history of epigastric pain and was found to have cancer of the stomach. His asymptomatic twin was therefore evaluated and also found to have gastric carcinoma. Both patients underwent gastric resection. Pathologically the cancers were similar, although the associated changes of the gastric mucosa showed some remarkable differences. The uniqueness of carcinoma in twins has resulted in extensive utilization of twin studies in an attempt to clarify genetic, environmental and immunological factors in the development of cancer. The results of these studies reported in the literature, however, are inconclusive. Gastric cancer is quite uncommon in the younger population but must be promptly excluded when symptoms doe not quickly respond to usual therapy.

Benign lipoblastomatosis: ultrastructure and histogenesis

Ultrastructural study of a case of benign lipoblastomatosis revealed a cellular spectrum which included undifferentiated mesenchymal cells, stellate myxoid cells, fibroblasts, lipoblasts, lipocytes and many intermediate forms. The uni- and multivacuolated fat cells contained membrane and non-membrane bound cytoplasmic vacuoles, predominatly of saturated lipid. Their cytoplasm also contained simple-structured mitochondria devoid of intramatrical or crystalloid bodies. The fine structure of the cellular components of lipoblastomatosis supports the concept that this is a neoplasm related to fetal white fat rather than to brown fat.

Oligosymptomatic Melkersson-Rosenthal syndrome

A patient with cheilitis granulomatosa and sialopenia is presented herein as a variant of the oligosymptomatic type of Melkersson-Rosenthal syndrome. Evidence is presented to support its possible neurotrophic origin.

Halo congenital nevus

A case of halo congenital nevus is reported in a fifteen year old Mexican-American girl with pre-existing vitiligo.

Topical tretinoin, hydroquinone, and betamethasone valerate in the therapy of melasma

Twenty adult female patients with melasma were followed over a ten week clinical trial in which a combination of depigmenting agents was used daily. Past clinical experience and objective assessment point to enhanced efficacy of this simple depigmenting combination. Certainly, most of depigmenting agents at our command to date have been relatively ineffective. Even this new combination is not the final answer. The purpose of this study is to provide the clinician with a simple yet effective and readily accessible combination of commercially-formulated and available depigmentary agents. A stable combination in a single vehicle with greater efficacy remains to be perfected.

Factitious pseudoainhum of the nipple

A patient with a cosmetically disfiguring swelling of his nipple for many years was found to have factitious mechanical pseudoainhum. The possibility of occult mechanical constriction as the cause of acute or chronic deformities of appendages is emphasized.

Endobronchial metastasis from cancer of the breast

Endobronchial metastasis is reported to occur in less than 5% of the autopsies of patients dying with extrathoracic malignant neoplasms. Frequently associated primary tumors include those of the kidney, pancreas, colon, ovary, and thyroid. To our knowledge, this is the first report of a case of cancer of the breast which metastasized to the mucosa of a major bronchus. The possible factors involved in the widespread, early unusual spread in this 25-year-old woman are discussed.