[Toxic epidermal necrolysis induced by phenytoin and whole brain radiotherapy]

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) have been associated with some drugs, particularly anticonvulsants such as phenytoin. Some authors have pointed out an increased risk of TEN/SJS when phenytoin is associated with whole brain radiotherapy. We report a patient diagnosed with breast adenocarcinoma and brain metastases that was on treatment with phenytoin and, shortly after receiving whole brain radiotherapy, developed toxic epidermal necrolysis.

Systematics of the genus Chaetosphaeria and its allied genera: morphological and phylogenetic diversity in north temperate and neotropical taxa

Chaetosphaeria is a common saprobic pyrenomycete genus with simple, homogeneous teleomorphs and complex, diverse anamorphs. As currently circumscribed in the literature, the genus encompasses 30 species distributed in four 'natural groups', and includes morphological entities in 11 anamorphic genera. Species frequently have been defined primarily based on characters of the anamorphs resulting in species with almost indistinguishable teleomorphs. This study aimed to assess the value and significance of morphological characters in resolving phylogenetic relationships in Chaetosphaeria and its allied genera. Phylogenetic relationships of 42 taxa, representing 29 species distributed in Chaetosphaeria and five related genera, were estimated with partial sequences of the nuclear LSU rDNA and beta-tubulin genes. Sequences were analyzed with maximum parsimony, maximum likelihood and Bayesian methods. Phylogenetic analyses of these two genes combined revealed two major lineages. The Chaetosphaeria lineage includes 21 species possessing both typical and new sexual and asexual morphologies. The lineage contains a strongly supported monophyletic clade of 13 species and eight paraphyletic taxa; the latter includes C. innumera, the type species of the genus. The second major lineage includes groupings concordant with the morphological circumscriptions of the genera Melanochaeta, Melanopsammella, Striatosphaeria, Zignoëlla and the new genus Tainosphaeria.

Molecular systematics of the Coronophorales and new species of Bertia, Lasiobertia and Nitschkia

The Nitschkiaceae has been placed in the Coronophorales or the Sordariales in recent years. Most recently it was accepted in the Coronophorales and placed in the Hypocreomycetidae based on sequence data from large subunit nrDNA. To confirm and corroborate the taxonomic placement and monophyly of the Coronophorales, additional taxa representing the diversity of the group were targeted for phylogenetic analysis using partial sequences of the large subunit nrDNA (LSU). Based on molecular data, the Coronophorales is found to be monophyletic and its placement in the Hypocreomycetidae is maintained. The order is a coherent group with morphologies that include superficial, often turbinate, often collabent ascomata that may or may not contain a quellkorper and asci that are often stipitate and at times polysporous. Three species with accepted Nitschkia names, together with Fracchiaea broomeiana and Acanthonitschkea argentinensis, comprise the paraphyletic nitschkiaceous complex. Two new families, Chaetosphaerellaceae and Scortechiniaceae fams nov., are described for the clades containing Chaetosphaerella and Crassochaeta and the taxa having a quellkorper (Euacanthe, Neofracchiaea and Scortechinia) respectively. The Bertiaceae is accepted for the clade containing Bertia species. Three new species are described: Bertia tropicalis, Lasiobertia portoricensis, and Nitschkia meniscoidea spp. nov.

Molecular systematics of the Sordariales: the order and the family Lasiosphaeriaceae redefined

The Sordariales is a taxonomically diverse group that has contained from seven to 14 families in recent years. The largest family is the Lasiosphaer-iaceae, which has contained between 33 and 53 genera, depending on the chosen classification. To determine the affinities and taxonomic placement of the Lasiosphaeriaceae and other families in the Sordariales, taxa representing every family in the Sordariales and most of the genera in the Lasiosphaeriaceae were targeted for phylogenetic analysis using partial sequences of the large-subunit (LSU) nrDNA. Based on molecular data, only genera within the families Chaetomiaceae, Lasiosphaeriaceae and Sordariaceae are retained within the redefined Sordariales. The order is a coherent group with morphologies that vary along well-defined lines, including large ascomata with large-celled membraneous or coriaceous walls and ascospores that show variation on a distinctive developmental theme, often with appendages or sheaths. The paraphyletic chaetomiaceous complex and the strongly supported Sordariaceae are nested among taxa traditionally placed in the Lasiosphaeriaceae. Analyses also indicate that 11 genera belong in the paraphyletic lasiosphaeriaceous complex. These taxa share a similar developmental pattern in their ascospore morphology that extends to the Sordariales as a whole. Based on these similarities in morphology, 13 additional genera are retained within the lasiosphaeriaceous complex and more than 35 genera have relationships in the order overall. Based on LSU data, 17 genera that have been assigned to the Lasiosphaeriaceae sensu lato are transferred to other families outside the Sordariales and 22 additional genera with differing morphologies subsequently are transferred out of the order. Two new orders, Coniochaetales and Chaetosphaeriales, are recognized for the families Coniochaetaceae and Chaetosphaeriaceae respectively. The Boliniaceae is accepted in the Boliniales, and the Nitschkiaceae is accepted in the Coronophorales. Annulatascaceae and Cephalothecaceae are placed in Sordariomycetidae inc. sed., and Batistiaceae is placed in the Euascomycetes inc. sed.

Ophiorosellinia costaricensis gen. et sp. nov., a xylariaceous fungus with scolecosporous ascospores

A pyrenomycete featuring uniperitheciate stromata embedded in a subiculum and asci with iodine-positive apical ascal rings that bear scolecosporous ascospores is described as new. The fungus, Ophiorosellinia costaricensis, is known only from the type location in Costa Rica. It has been cultured, but no anamorph was discovered.

[The moral conscience in the depressive patient]

The two fundamental forms of the depressive guilt are the feeling of guilt and the delusion of guilt. Both phenomena emanate from a conscience distorted because of the depressive mood by means of an holothymic and catathymic mechanism. Also the other three dimensions of depression (anergy, discommunication and rhythmopathy) take part in producing this moral distortion. The appearance of the depressive guilt happens only when these two factors are present: a previous personality with a great spiritual development and a complete or tetradimensional depression. Shame and distrust replace the guilt in the asiatic and african countries.

Polypoid (pedunculated) subepicardial lipoma: a cardiac lesion resembling the epiploic appendage

This report describes a 75-year-old woman with an asymptomatic pedunculated lipoma involving the epicardium of the right atrium. The lipoma was an incidental finding at autopsy. The twisted lesion showed many similarities with the infarcted epiploic appendages observed in the visceral peritoneum.

Predictors of axillary lymph node metastases in patients with invasive breast carcinoma by a combination of classical and biological prognostic factors

The presence of axillary lymph node metastases (ALNMs) is the most important prognostic factor in breast carcinoma. If ALNMs were predictable without performing axillary lymph node dissection (ALND), this procedure would not be necessary in selected patients. Using a combination of some of the new biological markers with the classical ones, our objective was I) to identify the best set of predictors of ALNMs, and II) to define predictive models with either high or low probability of ALNMs. We studied 102 patients with invasive breast carcinoma. All patients underwent ALND, and at least 10 axillary lymph nodes per case were obtained. In the primary tumour we evaluated size, histological subtype and grade, lymphatic/vascular invasion and margin. Hormone receptor status, MIB1 index, microvessel density, c-erbB-2 and cathepsin D expression were assessed by immunohistochemistry, and DNA ploidy and S-phase by flow cytometry. Risk factors for ALNMs were estimated by nonlinear logistic regression analysis. The best predictors of ALNMs were: tumour size > 2 cm [OR 6.45, 95% confidence interval (CI) 21.74 to 1.91], presence of lymphatic/vascular invasion [OR 4.95, CI (14.50 to 1.69)], infiltrative margin [OR 9.87 CI (37.44 to 2.60)] and high MIB-1 index [OR 8.39, CI (33.47 to 2.10)]. Two subsets had a very high risk of ALNMs: I) tumour size > 2 cm, with lymphatic/vascular invasion and infiltrative margin; 26 (89.66%) of 29 patients of this subgroup had ALNMs, and (II) tumour size > 2 cm, with lymphatic/vascular and high MIB1 index.; eight of the nine (89%) patients of this subgroup had ALNMs. We could also identify a two-variable model with a very low risk of ALNMs constituted by tumour with circumscribed margin and low MIB-1 index. Of the 19 patients showing these features, only 1 (5.26%) had ALNMs. Therefore, pathological features of the primary tumour can help to assess the risk for ALNM in invasive breast carcinoma. Such risk assessment might avoid regional surgical overtreatment.

Amyloidosis of the rectum mimicking collagenous colitis

Gastrointestinal involvement in cases of systemic amyloidosis is very common. In the colorectal mucosa, amyloid deposition is ordinarily seen around vessels or diffusely in the lamina propria. We report two cases in men aged 69 and 29 years, whose rectal biopsies revealed prominent subepithelial amyloid deposits mimicking collagenous colitis. The amyloid deposits were composed of AA protein. A review of the literature has yielded only one previously reported case. Pathologists should be aware of this deposition pattern of amyloid to prevent misdiagnosis. Our cases underline the importance of the routine use of histochemical stains for amyloid in all cases of colorectal biopsies showing histologic changes suggestive of collagenous colitis.

Solitary neurofibroma of the gallbladder. A case report and review of the literature

Benign non-epithelial neoplasms of the gallbladder are rare. A case of incidental neurofibroma of the gallbladder in a 44-year-old man without neurofibromatosis 1 is reported. The intramural tumor, located in the neck of the gallbladder, was associated with lithiasis, chronic cholecystitis and localized fundic adenomyomatosis. Seven cases including the present one are reviewed. The seven patients ranged in age from 44 to 77 years, with an average age of 61.6 years. Four of the seven patients were women. Five tumors appeared as mural nodules, and two showed intraluminal growth. The most common location was the body of the gallbladder. The size of the lesion varied from 0.3 to 5.3 cm, with a mean size of 1.3 cm. Five of the seven cases were incidentally found in a gallbladder resected for cholelithiasis. Using ultrasonography, two cases with no lithiasis were detected preoperatively, presenting as intracavitary growing lesions by ultrasonography. It is possible that neurofibroma of the gallbladder may be more common than the small number of known cases indicates.

Perianal basal cell carcinoma: a comparative histologic, immunohistochemical, and flow cytometric study with basaloid carcinoma of the anus

Perianal basal cell carcinoma is a very rare tumor accounting for only 0.2% of the anorectal tumors. It must be distinguished from basaloid carcinoma of the anus, which resembles it histologically but shows a much more aggressive behavior, metastasizes early, and often proves fatal, thus requiring different therapy. Differential diagnosis of both entities by light microscopy may be difficult. Five cases of perianal basal cell carcinoma and five cases of basaloid carcinoma were studied by means of immunohistochemistry and flow cytometry. Some immunohistochemical markers, such as epithelial membrane antigen, carcinoembrionic antigen, and keratins, as well as the lectin Ulex europaeus agglutinin I stained basaloid carcinoma and were negative for basal cell carcinoma. In contrast, the monoclonal antibody Ber-EP4 seems to be a good marker for perianal basal cell carcinoma and useful in differentiating it from basaloid carcinoma of the anus. Basaloid carcinomas are associated with a significantly higher S-phase fraction than are perianal basal cell carcinomas (p < 0.01).

Metastasis from small cell carcinoma of the lung producing acute appendicitis

A case of acute gangrenous appendicitis with perforation caused by metastatic small cell carcinoma of the lung in a 65 year old man is reported. The manifestation of appendicitis occurred more than 4 years after the diagnosis of the bronchogenic carcinoma. With longer survival of patients with disseminated tumors it is probable that new manifestations of those malignancies will be discovered. Acute appendicitis due to metastasis from a distant neoplasm should be considered in the differential diagnosis of right lower abdominal pain in the oncology patient.

Metastasis of malignant neoplasms to skeletal muscle

Malignant neoplasms were found at 194 of 723 autopsies carried out at the Marqués de Valdecilla National Medical Center in the period 1980-1982, and in 50 of these there was secondary involvement of skeletal muscle. In 16 cases (8.2%) the primary tumour and/or its metastases had invaded skeletal muscle, but in 34 (17.5%) true macroscopic or microscopic metastases were present. It was this latter finding which prompted us to carry out a detailed analysis. Below are given the percentages of malignant neoplasms of each type in which the tumours had metastasized to skeletal muscle and, in brackets, the number of metastases found in skeletal muscle as a percentage of all metastatic tumours. Acute leukaemias 17.2% (14.7%), lymphomas 20.6% (17.6%), carcinomas 17.7% (64.6%): for the various sub-categories of carcinoma the figures were: epidermoid carcinoma 10% (5.8%), adenocarcinoma 29.6% (47%) and anaplastic carcinoma 5.8% (2.9%). The muscles most commonly involved were the diaphragm (67.6%) and the iliopsoas (29.4%). The patients ranged in age from 26 to 84 years, mean age 62.8 years. The male/female ratio was 2.8/1. In advanced cancer an appreciable percentage of metastases occur in skeletal muscle.