Pediatric tuberculosis in rural South Africa--value of directly observed therapy

The case is reported of a 27-year-old patient who developed multiple recurrences of a carcinoma arising from richly stromal pleomorphic adenoma of the parotid gland over 13 years. Originally the tumor was classified as a benign pleomorphic adenoma because there were no cytological characteristics of malignancy. Later on the diagnosis had to be modified to that of a carcinoma arising from a pleomorphic adenoma because of the infiltrating growth pattern of the tumor. A multicentric local recurrence and metastases on the left side of the neck supported the correct diagnosis. This case demonstrates that, beside the classic cytological criteria of malignancy invasion and penetration of the capsule can be decisive for the diagnosis of malign transformed pleomorphic adenoma. Treatment and prognosis of salivary gland tumors assume a clear determination of their diguity. The unusual course in this case of a pleomorphic adenoma originally diagnosed as benign demonstrates the importance of regular follow-up.     

Tubular apocrine adenoma with eccrine and apocrine immunophenotypes or papillary tubular adenoma?

A case of papillary tubular adenoma is reported. On microscopic examination the lesion, located on the scalp, showed a tubular-branching pattern, opening on the skin surface, and features of decapitation secretion. Immunohistochemical evidence of both eccrine and apocrine differentiation was found. This case, which on a clinicopathological basis alone could be classified as tubular apocrine adenoma, illustrates the difficulties in contrasting the latter to its eccrine counterpart (papillary eccrine adenoma) and suggests that the terms papillary tubular adenoma or tubulopapillary hidradenoma more accurately describe these lesions.     

A bladder nephrogenic adenoma. A case report

OBJECTIVE: To report an additional case of nephrogenic adenoma of the bladder. METHODS/RESULTS: A case of nephrogenic adenoma of the urinary bladder in a 28-year-old female is described. Patient clinical history and diagnostic imaging findings are presented. CONCLUSIONS: Nephrogenic adenoma of the bladder is a rare benign tumor with specific histological features that has been associated with previous surgery, trauma, infections and lithiasis. Although it is currently not considered to be a premalignant lesion, its rate of recurrence is high (37%-49%). The treatment of choice is by transurethral resection and yearly cytological, ultrasound and cystoscopic follow-up evaluation to detect recurrence.     

Significant correlations between tissue factor and thrombin markers in trauma and septic patients with disseminated intravascular coagulation

The authors report on the morphological features of a pituitary adenoma that produced growth hormone (GH) and adrenocorticotropic hormone (ACTH). This hormone combination produced by a single adenoma is extremely rare; a review of the available literature showed that only one previous case has been published. The tumor, which was removed from a 62-year-old man with acromegaly, was studied by histological and immunocytochemical analyses, transmission electron microscopy, immunoelectron microscopy, and in situ hybridization. When the authors used light microscopy, the tumor appeared to be a bimorphous mixed pituitary adenoma composed of two separate cell types: one cell population synthesized GH and the other ACTH. The cytogenesis of pituitary adenomas that produce more than one hormone is obscure. It may be that two separate cells--one somatotroph and one corticotroph--transformed into neoplastic cells, or that the adenoma arose in a common stem cell that differentiated into two separate cell types. In this case immunoelectron microscopy conclusively demonstrated ACTH in the secretory granules of several somatotrophs. This was associated with a change in the morphological characteristics of secretory granules. Thus it is possible that the tumor was originally a somatotropic adenoma that began to produce ACTH as a result of mutations that occurred during tumor progression.     

Papillary mucinous adenoma arising in adenomyomatous hyperplasia of the gall bladder

A case of papillary mucinous adenoma arising in adenomyomatous hyperplasia (AMH) of the gall bladder is reported. The lesion was unsuspected and discovered by routine palpation of the gall bladder during laparotomy. The adenoma developed within fundal AMH and showed cytological atypia. This case illustrates that neoplastic proliferation is indeed possible in AMH and challenges the classical opinion that AMH is devoid of neoplastic potential.     

Adrenomedullary hyperplasia associated with cortisol producing adenoma

We report a case of a 58-year-old man with adrenal medullary hyperplasia associated with cortisol producing adenoma. Preoperative examination showed both adrenocortical and adrenomedullary hyperfunction. No Cushingoid sign was present and pheochromocytoma-like symptoms were predominant. Abdominal computerized tomography revealed a left adrenal tumor stained by contrast medium. Histologically, the adrenal tumor was found to be a cortical adenoma, and medullary hyperplasia was observed in the remaining parenchyma.     

Radiation induced intracranial leiomyosarcoma: its histopathological features

This is a case of intracranial sarcoma which was recognized 23 years after irradiation therapy for pituitary adenoma. Four operations were performed because of recurrences with a short interval between each operation. Immunohistochemically, the tumour cells were stained for smooth muscle actin, human muscle actin and vimentin. It was verified as a leiomyosarcoma. This report is the first case of intracranial leiomyosarcoma associated with radiation therapy in pituitary adenoma.     

Alveolar adenoma of the lung: further characterization of this uncommon tumour

Alveolar adenoma of the lung is a poorly characterized, uncommon pulmonary lesion with proliferation of alveolar epithelium and septal mesenchyme. We describe the electron microscopy, immunohistochemistry and DNA flow cytometry in a case of alveolar adenoma in a 55-year-old woman. Alveolar adenoma appears to be a distinct benign neoplasm of the alveolar structures. Our findings further suggest that it is not a precursor of bronchioloalveolar carcinoma or other type II pneumocyte lesions of presumed malignant potential.     

Spiradenoma associated with apocrine adenoma component

We present a case of spiradenoma associated with an apocrine adenoma component. The transitions between the spiradenoma and apocrine adenoma components were gradual. It could be observed that the small dark cells seen at the peripheries of the cell nodules of the spiradenoma component were replaced by the peripheral flat myoepithelial cell layer in the apocrine component. Similarly, the large pale cells within the centers of the cell nodules of the spiradenoma component were replaced by the brightly eosinophilic secretory cells with decapitations secretion in the apocrine component of the tumor. The reported case proves that at least some spiradenomas are tumors with distinct apocrine instead of eccrine differentiation.     

Non-Hodgkin''s lymphomas and myeloid disorders: deletions associated with t(2;5) and t(3;5) detected by FISH

Tubulovillous adenoma of the duodenum is a rare tumor. Almost all of the lesions have been reported endoscopically and are recognized as small, sessile, polypoid lesions. This article discusses an unusual case of pedunculated tubulovillous adenoma of the duodenum in a 48-yr-old woman. The lesion was discovered on the upper part of the descending duodenum during a gastric mass survey. The polyp was removed using an electrocautery snare and was histologically diagnosed as tubulovillous adenoma.     

A case of parasellar tumor with double histological texture: chromophobe pituitary adenoma and epidermoid cyst

A rare case of a 42-year-old woman with an intra- and suprasellar tumour with double histological texture (chromophobe pituitary adenoma and epidermoid cyst) is presented. Elevated serum prolactin levels were found on admission. After the surgery symptoms of diabetes insipidus appeared. On the ground of the presented case and review of references it seems that the coexistence of an epidermoid cyst and a pituitary adenoma suggest their common histogenetic origin.     

Conn's syndrome

Adrenal hypertension is an uncommon phenomenon. When seen in association with hypokalemia the existence of primary aldosteronism, the most frequent cause of which is an adenoma of the adrenal gland cortex, should be suspected. This paper contributes one case of primary aldosteronism treated by unilateral resection of the adrenal adenoma, with no surgical complications and good medium-term results.     

Primary hyperthyroidism 1996

55 prospectively documented patients aged 20-84 (median 67) years (47 women, 8 males) underwent surgery for primary hyperparathyroidism (pHPT). The most frequent symptoms and associated conditions were nephrolithiasis (42%) and neuropsychiatric symptoms (39%). Only one case of asymptomatic and one case of "normocalcemic" pHPT were found in this series. 47 patients (89%) were cured following initial neck exploration, and 3 further patients (6%) were cured by a second operation. Reoperation also led to cure in 2 patients operated on elsewhere in the first instance. 6 patients (11%) had double adenoma (bilaterally) and 36% of the adenomas had an ectopic location, with an intrathyroidal adenoma in 2 cases. In 2 patients sternotomy was carried out. Persistent pHPT was observed in 3 patients (following initial exploration in 2 cases and reoperation in one). These patients had a supernumerary adenomatous gland with ectopic location in 2 cases and a double adenoma with ectopic position of one adenoma in a further case. One 80-year-old patient died post-operatively from intestinal ischemia. 2 patients had permanent postoperative hypoparathyroidism; in no case was a permanent recurrent laryngeal nerve palsy observed. Bilateral parathyroid exploration with thyroid mobilization by capsular dissection is the procedure of choice for pHPT. In 2 patients with the MEN 2A-syndrome and with medullary thyroid carcinoma thyroidectomy, lymphadenectomy and autotransplantation of normal parathyroids to the arm was performed, with normal parathyroid function in both cases.     

Consideration on a case of carcinoma ex pleomorphic adenoma of the parotid gland

The authors report a case of carcinoma in an ex pleomorphic adenoma of the parotid gland that was recently referred to their attention. This form of carcinoma is not very frequent and in the literature it is reported in a percentage of cases ranging from 1.5 to 12%. The pathogenesis of this neoplasia is controversial and at the present state of the art there are authors who support the hypothesis of a malignant transformation of a previous pleomorphic adenoma, and those who sustain the onset of the tumour ex novo. At present, there is a tendency to differentiate the carcinoma ex pleomorphic adenoma from the malignant mixed tumour: the histological analysis of the former in fact shows a benign stromal component typical of pleomorphic adenoma associated with a malignant epithelial component, whereas in the malignant mixed tumour both the mesenchymal and epithelial components are malignant. The authors use this case report as a starting point to review their 20-year experience, of pleomorphic adenoma in order to evaluate the behaviour of this tumour, above all in relation to the phenomenon of recidivation and cancerization. They report recidivation in 3.5% of cases and no malignant degeneration. The surgical approach used varied depending on the site and size of the neoformation, as well as on whether the tumour was primary or recurrent.     

A monomorphic adenoma of the minor salivary glands presenting at the base of the tongue: a case report and review of the literature

A case of a monomorphic adenoma of the minor salivary glands situated at the base of the tongue in a 49-year-old female is reported. The patient had a prolonged clinical course of eight years' duration. The histopathologic, immunohistologic and ultra-structural findings are described. A review of the literature concerning minor salivary gland tumors and their location in the oral cavity is presented. This is the first case, to our knowledge, of a monomorphic adenoma presenting at the base of the tongue. The difficulties in its diagnosis are discussed specifically in regard to its location.     

Selective angiography and transcervical exeresis in mediastinal parthyroid adenoma with anomalous drainage

A personal case of hyperparathyroidism due to parathyroid adenoma is reported: selective angiography enabled the neoplasia to be precisely localized in an unusual site and made it possible to identify its abnormal venous drainage. Transcervical surgery was used to remove the adenoma and the patient cured with no relapse up to the present. In the light of this expecience and a review of the recent literature on diagnostic techniques, emphasis is laid on the effectiveness of angiography in the localization of parathyroid adenoma, a localization which should always be sought preoperatively to avoid the risk of pointless surgical exploration.     

Fine needle aspiration cytology of adenoma of the nipple. A case report

BACKGROUND: Adenoma (papillary adenoma, florid papillomatosis, subareolar duct papillomatosis, erosive adenomatosis) of the nipple is an uncommon lesion and can be mistaken clinically for Paget's disease and pathologically be misinterpreted as an adenocarcinoma. CASE: A case of adenoma of the nipple was studied by cytology and histopathology. CONCLUSION: Recognition of this benign lesion on cytology will prevent unnecessary radical surgery. Local excision alone suffices.     

Hormonal regulation and germ cell-specific expression of heat shock protein 60 (hsp60) in the testis of macaque monkeys (Macaca mulatta and M. fascicularis)

FNA smears from six histologically documented cases of tubular adenoma of breast were critically analysed and compared with 10 histologically confirmed cases of fibroadenoma (five pericanalicular and five intracanalicular). Initially a cytological diagnosis of tubular adenoma was rendered only in one case. On review, two cases could be characterized as tubular adenoma, while the findings were suggestive in two others. The features helpful in diagnosis of tubular adenoma were the presence of benign ductal cells as three-dimensional cohesive balls and tubular structures in highly cellular smears. Stroma was conspicuously scanty or absent. Myoepithelial cells were present along with sheets of ductal cells as well as bipolar naked nuclei. Confusion with fibroadenoma occurred in two cases due to presence of a stag-horn pattern of ductal cells.     

Syringomatous tumor of the nipple. A case report and review of the literature]

The authors report a case of syringomatous tumor of the nipple in a 35-year-old woman, discovered incidentally during investigation of dysmenorrhea. After limited resection-biopsy of a cystic nipple tumor, histological results indicated the need for a partial central mastectomy with areola and nipple amputation. Although this tumor is classified as an adenoma, considered to be a benign lesion, syringomatous adenoma of the nipple is a potentially locally aggressive tumor, at risk of local recurrence and deep invasion of the mammary gland. This is a rare tumor (only 18 cases have been reported in the literature), and the histological diagnosis can be difficult, with possible confusion with a nipple duct adenoma, or tubular carcinoma.     

Heredity and symptoms in acromegaly

The author has performed clinical and follow-up studies of 80 acromegalic patients treated by transanthro-sphenoidal removal of the pituitary adenoma. Heredity for acromegaly or gigantism was recorded in 3.8% of the patients and other hereditary factors in 13.8%. Head trauma, meningitis or encephalitis was recorded in the case histories in 18.8%. The predominant symptoms were sweating, paraesthesiae, headache and joint pain. Acromegaly was in 37.6% associated with goitre, parathyroid adenoma, gastric or duodenal ulcer, parotid tumours of submandibular swelling. The fecundity among the married patients was good, 34.4% having three or more children. Successful pregnancies occurred after the transanthro-sphenoidal removal of the adenoma.