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We describe two cases of isolated langerhans cell histiocytosis (LCH) of the thyroid gland, one of which was found in conjunction with an incidental papillary carcinoma. The first case was that of a 43-year-old man who presented with a 1- to 2-cm nodule within the left lobe of the thyroid. Fine-needle aspiration cytology revealed atypical cells with convoluted nuclei in a background of eosinophils and lymphocytes. The findings prompted a recommendation for excision secondary to the high suspicion of a hematologic malignancy. Histologic sections demonstrated LCH in association with a small focus of papillary carcinoma. The second case involved a 43-year-old woman who presented with a 1.8-cm nodule within the right lobe of the thyroid. Fine-needle aspiration in this case demonstrated abundant hemosiderin-laden macrophages, occasional lymphocytes, and a single benign sheet of follicular cells. No eosinophils were seen; however, a single group of atypical histiocytic cells with cleaved nuclei was noted. The nodule was subsequently resected. Histologic examination demonstrated LCH in association with follicular nodular hyperplasia with cystic degeneration. Immunohistochemical studies were performed in both cases, revealing CD1a and S100 immunoreactivity in the Langerhans' cells. Although LCH may occur as a manifestation of systemic disease, its occurrence as an isolated finding in the thyroid is rare. Its occurrence in association with papillary carcinoma of the thyroid is even more uncommon. We present two cases of isolated LCH of the thyroid, one of which was found in association with papillary carcinoma of the thyroid. The cytologic, histologic, immunohistochemical, and radiologic features are described in each case. The ultrastructural findings from the first case are also presented.
The authors present a case of thrombosis of the umbilical vein in a foetus in the 27th week of pregnancy, discovered via ultrasound diagnosis. The foetus presented with marked ascites and anasarca. Despite foetal death there were no visceral malformations, and no pathological criteria presented by the mother. The characteristic features and sensitivity of sonographic diagnosis in umbilical vein thromboses are discussed as part of the extensive pathology of the umbilical cord.
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To determine whether characteristics of focal hepatic parenchymal perfusion defects detected with computed tomographic arterial portography (CTAP) correlate with underlying pathologic processes, 245 perfusion defects detected with CTAP in 60 patients who subsequently underwent definitive hepatic surgery were characterized by shape, location within the liver, and relative attenuation value and were prospectively correlated with sectioned pathologic specimens. Of 177 round perfusion defects, 102 (58%) were malignant and 75 (42%) were benign. Only one (2%) of 53 peripheral wedge-shaped defects was malignant. All 15 peripheral flat defects were benign. Defects in characteristic locations anterior to the porta hepatis (n = 15) and adjacent to the intersegmental fissure (n = 7) were uniformly benign. While 83 (56%) of 147 soft-tissue attenuation defects were malignant, only four (6%) of 68 intermediate-attenuation defects were malignant. Although these characteristics of parenchymal perfusion defects aid in differentiation of benign from malignant processes, all other types of perfusion defects are nonspecific and may require biopsy.
Fibroepithelial lesions of the breast are commonly seen in clinical practice. The masses are composed of a combination of prominent stroma and varying glandular elements. Fibroadenomas, benign lesions that derive from the terminal duct lobular unit, are the most common and are often identified at clinical examination or mammography as circumscribed masses. Benign mesenchymal tumors include focal fibrosis, pseudoangiomatous stromal hyperplasia, and fibromatosis or desmoid tumor. Phyllodes tumor, which is similar to fibroadenoma but has increased cellularity in the stroma, is typically benign but has malignant potential. Diabetic fibrous mastopathy, a stromal proliferation found in patients with juvenile-onset insulin-dependent diabetes, is a reactive fibrous lesion. Most of these lesions manifest as masses at clinical and/or mammographic examination. Some (eg, fibroadenomas) may be associated with calcifications. Except for fibromatosis and phyllodes tumor, fibroepithelial lesions need not be excised if the diagnosis is confirmed by the results of histologic analysis at percutaneous biopsy. To correctly differentiate between fibrous breast lesions that are benign and those that should be resected, the physician must be familiar with the correlated radiologic-pathologic findings in the various lesion types.
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We gave three adult rhesus monkeys seven IV injections of manganese chloride at approximately 1-week intervals. We evaluated neurologic status by serial clinical examinations and performed a levodopa test if the animal developed features of basal ganglia dysfunction. After the animals were killed, we performed neuropathologic, neurochemical, and laser microprobe mass analysis (LAMMA) studies. Two of three animals developed a parkinsonian syndrome characterized by bradykinesia, rigidity, and facial grimacing suggestive of dystonia but not tremor. Neither animal responded to levodopa. Autopsy demonstrated gliosis primarily confined to the globus pallidus (GP) and the substantia nigra pars reticularis (SNr). We detected focal mineral deposits throughout the GP and SNr, particularly in a perivascular distribution. LAMMA studies noted that mineral deposits were primarily comprised of iron and aluminum. The severity of pathologic change correlated with the degree of clinical dysfunction. These studies demonstrate that, in contrast to Parkinson's disease (PD) and MPTP-induced parkinsonism, manganese primarily damages the GP and SNr and relatively spares the nigrostriatal dopaminergic system. Further, the results suggest that Mn-induced parkinsonism can be differentiated from PD and MPTP-induced parkinsonism by the clinical syndrome and response to levodopa. The accumulation of iron and aluminum suggests that iron/aluminum-induced oxidant stress may contribute to the damage associated with Mn toxicity.
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Forty-eight patients with prostatic disease (benign prostatic hyperplasia (B.P.H.), carcinoma, cysts, myoma and prostatitis) and 10 normal volunteers underwent magnetic resonance imaging (M.R.I.) of the prostate. The prostatic parenchyma was best evaluated by a T2-weighted spin-echo pulse sequence. The prostate in patients with B.P.H. often had a homogeneous or more rarely a nodular appearance on T2-weighted images. In most cases, a peripheral dark rim is observed. All prostate in patients with carcinoma had an heterogeneous appearance on T2-weighted images. While most of the prostatic carcinomas appeared hypo-intense relative to adjacent prostatic parenchyma, some of the neoplasms had a high or mixed-high and low signal. The myoma showed a low-signal nodule like carcinoma. The cyst appears as a liquid tumor. The prostatitis had an homogeneous bright signal. With the used methodology, MRI can differentiate prostatic diseases in many cases. Nevertheless the technique has to be optimized to improve its accuracy.
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