Gastric carcinoid associated with ranitidine in a patient with renal failure.
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Carcinoid Tumor↗
Biomedical subjects
F A Mitros
Publications and source records attributed to F A Mitros.
Fine-needle aspiration findings of the liver in a case of Q fever.
This report describes the cytologic findings in Q fever involving the liver in a 59-yr-old man. The fine-needle aspiration findings are correlated with a surgical needle biopsy performed concurrently. Cytopathologists should include Q fever in their differential diagnosis of granulomatous inflammation. Ring granulomas, which can be seen in an aspiration biopsy, should suggest the diagnosis of Q fever.
Biopsy, Needle↗
Lipogranulomas and gold in the liver in rheumatoid arthritis.
Liver biopsies have been performed routinely as part of a protocol to evaluate methotrexate therapy in severe rheumatoid arthritis. All patients in the study had failed standard medical therapy, including gold treatment. Twenty-three of 41 patients (56%) had well-formed lipogranulomas (LGs) in the lobules, compared with an incidence of approximately 5% in our general biopsy population. Twenty-seven of 41 patients (66%) had a unique pigment in their livers. In 20 of these, the pigment was in LGs; in the seven patients with pigment not associated with lobular LG, it was found in lipid droplets in portal triads. The pigment varied from irregular pale brown granules slightly larger than those of hemosiderin, to smaller black round granules. Lipogranuloma-associated pigment of this type is an unusual finding, reminiscent of argyria. There was a variable appearance upon polarization, the black granules at times being strikingly refractile. There was a positive correlation between the prominence of LG and the quantity of pigment. The pigment resembled that described with gold deposition in other tissues. Radiographic microanalysis of both brown and black granules was performed in three cases. Characteristic spectra (energy-dispersive spectroscopy) demonstrated the presence of gold in each case. Silver was not identified. The high incidence of LG may reflect the frequent administration of gold in an oily vehicle. Gold may remain trapped in the liver for a prolonged time. Thus far, we have not detected any adverse effect from the presence of LG-associated gold.
Arthritis, Rheumatoid↗
Multifocal colitis associated with an epidemic of chronic diarrhea.
An outbreak of a chronic diarrheal syndrome was detected between May and August 1987 in rural Henderson County, Illinois. Seventy-two individuals were affected. Epidemiological studies performed by the Center for Disease Control implicated the water of a local restaurant as the source of the outbreak. Five patients underwent a comprehensive evaluation. Their mean age was 51 years, and they had a mean of 12 watery stools daily (range, 6-40). Detailed microbiological evaluations failed to identify a pathological organism. Stool studies showed a mean stool weight of 392 g/24 h with a normal fat content. Results of all biochemical studies of serum were normal. Chemical analysis of stool water suggested a secretory diarrhea. Colonoscopy revealed patchy erythema, and light microscopic examination of colonic biopsy specimens revealed multifocal areas of acute inflammation in the superficial mucosa in 4 of 5 patients. Electron microscopy of the affected areas revealed no viral particles. After 2 years, all of our patients continued to experience chronic diarrhea. One patient agreed to a follow-up colonoscopy; histological abnormalities of the colonic mucosa persisted after 2 years. We speculate that an infectious process arising from a contaminated water system induced a chronic, secretory diarrhea characterized by multifocal colitis. This histological abnormality may serve as a marker of an infectious, chronic diarrhea.
Adolescent↗
Adenocarcinoma of the vermiform appendix.
Primary adenocarcinoma of the appendix is rare. Eleven patients with this rare neoplasm have been evaluated at our institution over a 50-year period. We have reviewed the presentation and clinical course of these patients, and have compared them with those described in the literature. The presenting signs and symptoms, physical findings, and treatment were similar to those described in the literature. However, the 5-year survival of 20% is lower than most series, and reflects the advanced stage of disease at the time of diagnosis in this group of patients. Despite the low 5-year survival, we feel that aggressive therapy (right hemicolectomy) is necessary to obtain long-term survival.
Adenocarcinoma↗
Clonal immunoglobulin gene rearrangement in nodular lymphoid hyperplasia of the gastrointestinal tract associated with common variable immunodeficiency.
The authors report a case of common variable immunodeficiency associated with nodular lymphoid hyperplasia of the gastrointestinal tract in which a clonal population of lymphoid cells was detected by immunophenotypic and genotypic studies on tissue obtained by colonoscopic biopsy. The patient has been followed up for more than 50 months without clinical, radiographic, or pathologic evidence of lymphoma. The significance of clonal rearrangement in the setting of immunodeficiency and the role of genotypic studies in defining lymphoid malignancy are discussed.
Adolescent↗
Immunophenotypic and genotypic characterization of primary non-Hodgkin's lymphoma of the gastrointestinal tract.
Antigen receptor gene rearrangement studies have been applied to gastrointestinal (GI) lymphoid proliferations in only a limited number of cases, and their use and contribution to the diagnosis and characterization of GI lymphomas is unknown. We retrospectively studied 17 cases of primary GI lymphoma using fresh/frozen tissue with a combination of immunophenotypic and genotypic techniques. The vast majority of the neoplasms were B-cell lymphomas (88%) with rare T-cell tumors. The most common B-cell immunophenotype was IgM-kappa (40%), while five of the B-cell lymphomas (33%) lacked surface light chain immunoglobulin. Immunophenotypic evidence of histiocytic differentiation was not identified. Clonality was confirmed in 59% (10/17) of the neoplasms by immunophenotyping and 88% (15/17) by antigen receptor gene rearrangement studies. All of the 15 B-cell lymphomas (100%) demonstrated clonally rearranged immunoglobulin gene rearrangement. The two lymphomas with T-cell immunophenotypes did not demonstrate T-cell receptor beta-chain gene rearrangement. Antigen receptor gene rearrangement data can be useful and may even be necessary in certain cases for the proper classification and/or diagnosis of GI lymphoid proliferations.
Adult↗
Invasive adenocarcinoma of bladder response to cisplatinum, methotrexate, and vinblastine chemotherapy.
Primary invasive adenocarcinoma of the bladder was diagnosed in a fifty-two-year-old male with a two-month history of irritative voiding symptoms. He was treated with three courses of cisplatinum, methotrexate, and vinblastine with marked regression of tumor shown radiographically and cystoscopically. Subsequent prostatocystectomy and ileal loop diversion revealed invasive tumor through the bladder wall to regional lymph nodes. The patient had two postoperative courses of the same chemotherapeutic regimen and is without evidence of disease recurrence at one year.
Adenocarcinoma↗
Solitary ulcer syndrome of the rectum in children.
We present two children with solitary ulcer syndrome of the rectum (SUSR): a 7-year-old and an 11-year-old. Although well recognized in the adult literature, the pediatric experience with this condition is limited. We review the clinicopathologic features of SUSR with emphasis on the pediatric experience. Greater awareness of this syndrome by both the pediatrician and pathologist may lead to more diagnosed cases in children.
Biopsy↗
Alpha 1-antitrypsin deficiency (Pi SZ) and biliary atresia.
We report an infant who presented at 2 days of age with conjugated hyperbilirubinemia. Serological, radiographic, and surgical investigations revealed the concurrence of alpha-1-antitrypsin deficiency, protease inhibitor type SZ, and extrahepatic biliary atresia.
Biliary Atresia↗
Gastrointestinal carcinoid tumor metastatic to the orbit.
Primary gastrointestinal carcinoid tumors rarely metastasize to the orbit, but an aggressive approach is warranted for any patient with a history of carcinoid tumor and ocular complaints. The diagnosis can be established only by obtaining tissue for histologic examination. Treatment, usually with radiation, can result in symptomatic improvement and should be considered after confirmation of the diagnosis.
Aged↗
Effect of irradiation on morphology and motility of canine small intestine.
In addition to severe damage to the intestinal mucosa, there is evidence based on altered transit that irradiation affects intestinal motor function. A single dose of 938 cGy to the intestine of dogs consistently produced an acute intestinal radiation syndrome consisting of vomiting and diarrhea but was not lethal. In the fasting state, the migrating myoelectric complex was uniformly interrupted. After a meal, jejunal myoelectric activity analyzed by a computer program showed a progressive decline in the number, duration, and length of migration of spike bursts. There were occasionally bizarre motility patterns consisting of clusters of migrating spike bursts. Slow waves demonstrated irregular rhythm and nonuniform morphology. They occasionally migrated in an orad direction and at times were totally uncoupled. At 24 hr and four days after irradiation, the muscle and the neural plexus were nearly normal by light microscopy, but the mucosa exhibited severe necrosis. Therefore, irradiation produces profound functional abnormalities in intestinal muscle even though the morphology is minimally altered.
Animals↗
Changes in colorectal function in patients with chronic colonic pseudoobstruction.
Motility studies of the lower bowel, radiology to exclude other gastrointestinal involvement, and rectal biopsies were carried out in 11 patients, age 21-60 years, with isolated chronic colonic pseudoobstruction. Repeated plain abdominal x-rays during symptomatic periods revealed massive gaseous colonic distension in all. Seven patients had the primary form while four patients had an underlying disease which could have been responsible for the chronic colonic pseudoobstruction. Lower bowel motility was decreased in patients with the primary form. Rectal wall elasticity was increased in both the primary and secondary form. Some of the abnormalities measured may suggest myogenic abnormalities of the sigmoid or rectal wall. No specific neural or muscular morphologic defect was identified in colonic transmural sections in eight patients except in the patient with Hirschsprung's disease. Five of seven patients with primary colonic pseudoobstruction achieved symptomatic relief only after subtotal colectomy and ileoproctostomy.
Adult↗
Successful treatment of hepatic venocclusive disease in a bone marrow transplant patient with side-to-side portacaval shunt.
Hepatic venocclusive disease developed in a 14-yr-old white girl after allogenic bone marrow transplantation from an HLA-identical sibling donor. Clinical diagnosis of venocclusive disease was based on the development of ascites, hepatomegaly, and jaundice 3 wk after transplantation. Current treatment of hepatic venocclusive disease is ineffective. The pathophysiology of the hepatic lesion suggests that construction of a side-to-side portacaval shunt should be beneficial in relieving the ascites and preventing further hepatic damage. Because the ascites was refractory to medical therapy and she was clinically deteriorating, a side-to-side portacaval shunt was performed. Histologic examination of a liver biopsy specimen obtained at surgery documented the presence of venocclusive disease. Postoperatively, the patient diuresed and returned to her baseline weight. One year after surgery the patient was doing well, her weight was stable, and she was being maintained on salt restriction alone. While the resolution of ascites and improvement of hepatic function in our patient after side-to-side portacaval shunt does not guarantee that such an approach will be uniformly successful, it should serve to encourage others to consider such therapy for this frequently devastating complication of chemoradiation therapy.
Adolescent↗
Chronic intestinal pseudoobstruction in young children.
We studied 8 young children (4 boys and 4 girls) with chronic intestinal pseudoobstruction. Intestinal pseudoobstruction, recurrent urinary tract infections, and dysuria occurred between the ages of a few weeks to 5 yr old. All had marked dilatation of the entire gastrointestinal tract distal to the esophagus, and megacystis. Conventional pathologic examinations of the full-thickness specimens of the gastrointestinal tract were normal in 5 and abnormal in 2 patients. The abnormalities included increased fibrosis and lipofuscin pigment in the smooth muscle cells. Myenteric plexus examination, using the Smith's method in 2 patients, was normal. Biopsy specimens from urinary bladders examined in 3 patients revealed separation of individual smooth muscle cells by collagen fibers. Intestinal manometric studies performed in 3 patients showed only weak and infrequent contractions during fasting and after feeding. Severe and extensive dysfunction of the gastrointestinal and urinary tracts with relatively normal histologic appearance are typical for these children.
Abdomen↗
A familial visceral myopathy with dilatation of the entire gastrointestinal tract.
We are reporting a new kindred in which familial visceral myopathy was identified in four siblings. There was no other symptomatic case identified in this 75-member, four-generation family, suggesting an autosomal recessive inheritance. All patients had recurrent symptoms of intestinal obstruction, and 3 died from malnutrition. Gastrointestinal lesions showed marked dilatation of the entire digestive tract from the esophagus to the rectum, which is different from other types of familial visceral myopathies. Microscopic examination of the gastrointestinal smooth muscle showed degeneration and increased fibrosis indistinguishable from other types of familial visceral myopathy.
Adult↗
A case of stenotic obstruction of the jejunum secondary to slow-release potassium.
This case report describes the clinical, radiographic, and pathological findings in an adult male presenting with small bowel obstruction caused by an annular, fibromuscular abnormality of the jejunal muscularis mucosa. No clinical or pathological evidence of trauma or neoplasm was found. The patient had, however, been taking a wax matrix potassium chloride preparation. The nature of the annular lesion strongly suggests that it arose as a repair phenomenon after focal, potassium-induced ulceration of the jejunum.
Delayed-Action Preparations↗
Cholestatic liver dysfunction after long-term phenytoin therapy.
Cholestatic jaundice developed in a 64-year-old woman who had received phenytoin sodium for more than 40 years. Discontinuation of phenytoin therapy resulted in resolution of the hepatic abnormalities, which recurred on rechallenge, strongly suggesting a causal relation to the drug. Phenytoin therapy was discontinued again, with complete resolution of the hepatic abnormalities. The liver biopsy specimen obtained during therapy showed cholestasis compatible with obstruction of the biliary tree, although an obstructive process was never demonstrated. The biochemical abnormalities and histologic features observed most likely represent an unusual response to phenytoin therapy.
Chemical and Drug Induced Liver Injury↗