Horseshoe kidney is associated with an increased relative risk of primary renal carcinoid tumor

PURPOSE: Carcinoid tumor is a rare neoplasm of the kidney with an unknown histogenesis. Of only 31 cases previously reported in the literature 4 arose within horseshoe kidneys. We report a case of primary carcinoid tumor arising within a horseshoe kidney and discuss the unique insight it provided into the pathogenesis of this tumor. MATERIALS AND METHODS: We reviewed in detail all 31 reported cases of renal carcinoid tumor and, using reported incidence rates of horseshoe kidney, we calculated the relative risk of renal carcinoid tumor arising within a horseshoe kidney. Immunohistochemical staining for neuroendocrine related markers was performed on tissue sections from the present carcinoid tumor, the adjacent kidney and 5 control samples of normal renal parenchyma. RESULTS: Of the reported tumors 15.6% occurred in horseshoe kidneys, yielding a calculated relative risk of 62. The present tumor was multifocal, arising from the wall of a cystic lesion and possibly representing a dilated calix within the isthmus. Intestinal epithelium lining the cyst cavity exhibited multifocal neuroendocrine cell hyperplasia with an immunohistochemical profile identical to that of the carcinoid tumor cells. CONCLUSIONS: The relative risk of renal carcinoid tumor developing in a horseshoe kidney is markedly greater than that for Wilms tumor or transitional cell carcinoma. The clinical course of renal carcinoid tumor arising within a horseshoe kidney appears to be more benign than that of the nonhorseshoe variant. Our observations support the hypothesis that renal carcinoid tumors may arise from neuroendocrine cells within foci of metaplastic or teratomatous epithelium within the kidney.     

Endometrial stromal sarcoma of the broad ligament arising in an area of endometriosis in a paramesonephric cyst. Case report

A 63-year-old Jamaican negress had an endometrial stromal sarcoma arising in a paramesonephric cyst of the broad ligament. Morphological evidence is presented to show that the tumour arose from an area of endometriosis within the cyst wall. Subsequent metastases responded for a few months to cyclophosphamide therapy and the patient died 14 months after the onset of symptoms.     

Successful treatment of refractory type 1 autoimmune hepatitis with methotrexate

We present a case in which the growth of an intraosseous cyst arising from the proximal tibiofibular joint appeared to have been increased by polyethylene wear particles from a medial unicompartmental knee replacement. Histological examination of the cyst wall showed a histiocytic response associated with numerous polyethylene wear particles. This case demonstrates that there is a direct communication between the joint cavity and the cyst. Such communication is probably through openings in the articular cartilage large enough to allow the passage of these particles.     

Fluid turnover in renal cysts

Cystic puncture was performed percutaneously in 18 patients with solitary renal cysts and in 22 with multiple, congenital renal cysts. With the aid of tritiated water it was possible to estimate the fluid turnover in the cysts and compare it with their volume, pressure and potassium and creatinine levels. Fluid turnover was rapid in all the renal cysts. Two to five hours after i.v. injection of tritium, the tritium concentration in cystic fluid averaged 88% of the concentration in plasma fluid in patients with polycystic kidneys and 73 percent in patients with solitary cysts. Fluid turnover was more rapid in small than in large cysts, but there was no such difference between cysts with high and low pressure. It is possible that the fluid turnover was slightly faster in cysts with high potassium and creatinine levels than in those with low levels. The results show that the fluid turnover in a renal cyst of 10 ml is considerable--probably more than 100 ml/24 hours. This indicates that fluid inflow to the cyst comes mainly from cells in the cyst wall and not from a single glomerule. Fluid probably leaves the cyst actively via cells in the cyst wall, since the fluid turnover does not increase with high cyst pressure. The fluid turnover is probably secondary to the active solute transportation, which is performed by the cyst cells. This means that these cells have a tubular cell-like function and should respond to pharmacotherapy.     

Congenital mediastinal bronchogenic cyst with malignant transformation: an autopsy report

A rare autopsy case of mediastinal bronchogenic cyst with malignant transformation is presented. The cyst had been located in the anterior mediastinum for at least 28 years in a 52 year old male. Chest X-ray findings showing rapid enlargement of the cyst and biopsy of the spine for lumbago made a clinical diagnosis as suspicious mediastinal cystic teratoma with malignant transformation metastasizing to the spine. Postmortem examination revealed that the cyst was located in the anterior mediastinum extending to the left pulmonary hilum and had no connection with the tracheobronchial tree. The cyst wall consisted of bronchus-like tissue including ciliated epithelium, hyaline cartilage, smooth muscle and mucoserous glands. There were no teratomatous components in the wall. Malignant tumor predominantly consisting of round cells occurred in the thickened cyst wall and grew into the cyst cavity with direct invasion of the lung and metastases to the liver, adrenal glands, bone marrow of the lumbar spine and lymph nodes. An immunohistochemical study showed that the tumor cells frequently expressed cytokeratin, epithelial membrane antigen and carcino-embryonic antigen, occasionally CA19-9, vimentin and neuron-specific enolase. From these findings, the tumor was diagnosed as undifferentiated carcinoma arising in the mediastinal bronchogenic cyst.     

Botulinum toxin in the therapy of gustatory sweating

A case of mucin-producing adenocarcinoma arising from a mature cystic teratoma of the right ovary is reported in a 67-year-old multiparous Japanese woman. The patient underwent total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and adjuvant chemotherapy containing cisplatin, Adriamycin, and cyclophosphamide with the diagnosis of ovarian cancer, probable stage Ic. Treatment was successful even though the tumor extended through the cyst wall.     

Preoperative diagnosis of hypernephroma in a renal cyst wall by selective renal angiography

Presented is a case in which preoperative diagnosis of a hypernephroma in the wall of a renal cyst was made by selective renal arteriography. Reviewed are the incidence and possible causative relationship between the two lesions and the potential and limitations of presently available diagnostic procedures for this entity.     

Renal hydatidosis. Discussion of a clinical case complicated by post acute pancreatitic cyst

In this paper the authors describes a rare case of renal hydatidosis complicated by post acute pancreatitic cyst. There have been no reports up till now either of any physiopathological between the development of hydatid cysts in the vicinity of the pancreas and subsequent pancreatitis, or of any correlation between long-term albendazole therapy and acute pancreatitis. In our particular case, however, the volumetric increase of the renal cyst caused external compression of the pancreas and the consequent slowing-down of bilio-pancreatic flow, which probably led to the development of acute pancreatitis. Since, in our opinion, the pancreatic pseudocyst required surgical removal, we decided to perform the operation there and then; intraoperative examination of the cystic fluid and the presence of daughter cysts confirmed the suspected diagnosis of hydatidosis, of clear renal origin since it was closely attached to the upper pole and continued along the upper calyces renales; the cyst was easily detached from the lower and posterior edge of the liver, and was completely removed, together with its pericystium, which was detached from the lower surface of the liver and from the inferior subhepatic vein; only a tiny disk of pericystium was left in communication with a calyx, sutured to the rest of the kidney. The pancreatic cyst was drained by means of a mesocolic Roux-loop cysto-jejunostomy.     

Endoscopic sonography of the stomach: findings in benign and malignant lesions

Endoscopic sonography combines direct visualization of the luminal surface of the gut with sonographic examination of the gut wall and surrounding structures. Lesions arising from different layers of the wall can be identified, staged, and in some cases characterized. Endoscopic sonography is complementary to endoscopy, barium studies, transabdominal sonography, and CT examination of gastrointestinal lesions. A thorough examination with endoscopic sonography may determine the layer of origin, size, echogenicity, and extent of gastric lesions and allows differentiation of lesions arising in the stomach from lesions arising outside the stomach. The purpose of this essay is to illustrate the findings from endoscopic sonography of a variety of benign and malignant lesions of the stomach.     

Cystic degeneration of heterotopic pancreas

The case of a large cyst arising from heterotopically-situated pancreatic tissue in an 11-month-old girl is reported. This is the first published report of childhood pancreatic cyst that developed in heterotopic pancreatic tissue. There is strong evidence to suggest that the cyst became symptomatic as a result of secondary infection, an additional unreported phenomenon. This case serves to underscore the fact that pancreatic cysts should be considered in the differential diagnosis of intestinal duplication cysts of childhood.     

Effect of mebendazole on free amino acid composition of cyst wall and cyst fluid of Echinococcus granulosus harbored in mice

Eighteen and 23 FAA components were detected in the cyst wall and cyst fluid of E granulosus, respectively, by using automatic amino acid analyzer. The concentrations of most of the determined FAA were higher in the cyst fluid than those in the cyst wall, especially the taurine was 5-fold higher. Mebendazole treatment resulted in an increase in the concentration of alanine, valine, lysine, and taurine in both cyst wall and cyst fluid, the most notable being the alanine in the cyst wall. The results are interpreted as a coupling of glycolysis and amino acid metabolism, suggesting an involvement of FAA metabolism in the mechanism of Meb action.     

Pituitary growth hormone release and gene expression in cafeteria-diet-induced obese rats

PURPOSE: To determine prospectively the feasibility and accuracy of combined gadolinium-enhanced magnetic resonance (MR) angiography, MR urography, and MR nephrography in the presurgical evaluation of potential renal transplant donors. MATERIALS AND METHODS: Twenty-two potential donors for renal transplantation were evaluated with 1.5-T MR imaging. MR angiograms were evaluated for the number of renal arteries, presence of early arterial branches, and renal artery stenoses. The renal collecting system and ureters were evaluated on the MR urograms. Renal parenchyma was assessed on the MR nephrogram. Prospective interpretation of MR images was compared with that of conventional angiograms and excretory urograms and with surgical findings. RESULTS: Gadolinium-enhanced MR angiography enabled correct identification of the arterial supply to all 44 native kidneys (44 single or dominant renal arteries and nine accessory renal arteries), four of five early arterial branches arising in the proximal 2 cm of the renal artery, a mild truncal stenosis in one renal artery, and two anomalies of the draining renal veins. The MR urogram accurately depicted a duplicated collecting system and mild unilateral pelvicalicectasis. The MR nephrogram showed renal size and a solitary cyst in one kidney, confirmed with sonography. CONCLUSION: Combined gadolinium-enhanced MR angiography, MR urography, and MR nephrography can accurately depict the arterial supply, collecting system, and renal parenchyma of donor kidneys.     

Globulomaxillary cysts

Globulomaxillary cyst is a non odontogenic cyst arising in the upper lateral incisor and canine region. Evaluation of clinical picture and careful histologic examination are essential for distinguishing it from other odontogenic and non odontogenic cystic growths. Presenting five new cases of globulomaxillary cysts, authors discuss and accept the "fissural" histogenetic hypothesis.     

屏式过热器管泄漏分析

利用金相显微镜和扫描电镜等分析手段,对电厂屏式过热器管泄漏原因进行分析。结果表明:屏式过热器管泄漏发生在内弯侧局部区域,局部破坏是从钢管外壁表面开始,泄漏的原因是由于局部管壁受到外界高速烟气强烈冲刷而引起的腐蚀减薄所造成的。     

Studies on constituents of medicinal plants. XVI. The constituents of Spiraea species (author''s transl)

A rare case of downward displacement of the left kidney caused by marked development of an ectopic ovarian cyst in the left subphrenic region is presented. Exact diagnosis could not be made preoperatively but a satisfactory result was obtained by removal of the cyst. Histological diagnosis of the tumor was serous cystadenoma arising from the left ovary.     

Breastfeeding

We report a renal adenoma associated with renal cyst formation in a 49-year-old male. A small renal mass inside a right renal cyst was discovered incidentally by ultrasonography. A right nephrectomy was performed. A pathologic examination revealed a well-differentiated, benign papillary tumor which was composed of slightly eosinophilic cells. We therefore diagnosed this patient as having a renal adenoma with hemorrhage.     

Total cavopulmonary anastomosis: selection criteria related to postoperative results

Cystitis cystica, a common urothelial pathology whose aetiology, morphology and clinical significance are poorly understood, affects the human urinary bladder and trigone in both sexes. We have studied the fine structure of urothelial cysts in 11 patients diagnosed cystoscopically as suffering from cystitis cystica. Several abnormal features were observed in the adjacent urothelium, including large intracellular vacuoles (4 patients), Brunn's nest (5), lymphocyte infiltration (10) and generally disorganised urothelial architecture (10). Squamous metaplasia was observed in one case. The wall of each cyst consisted of a 2-3 layered epithelium with either tall columnar or flattened cells lining the fluid-filled lumen. Both types of lining cell possessed short microvilli, while the columnar type also contained numerous membrane-bound, electron dense secretory granules in the apical cytoplasm. Rough endoplasmic reticulum, mitochondria and Golgi membranes were plentiful in the surface cells. Junctional complexes joined adjacent lining cells. The deeper cells contained relatively fewer organelles, while a basal lamina separated the cyst wall from the underlying connective tissue.     

Squamous cell carcinoma arising in thyroglossal duct remnant cyst epithelium

The extremely rare occurrence of invasive squamous cell carcinoma arising from normal epithelial lining of a thyroglossal duct remnant cyst is documented by demonstrating the histopathologic transition from normal squamous epithelium to squamous cell carcinoma. The requirements that must be fulfilled to accept a lesion as arising de novo from the epithelial lining are outlined, and all requirements are achieved. The lesion is differentiated from the less rare papillary or papillary-follicular adenocarcinoma of residual thyroid tissue of the thyroglossal duct tract remnants. This is the sixth report in the world literature of invasive squamous cell carcinoma arising from benign thyroglossal remnant squamous epithelium, and the second demonstrating the transition from normal squamous epithelium to invasive squamous cell carcinoma.     

The princess and the pea. An unusual complication after a laparoscopic cholecystectomy

A vena porta choledochal fistula caused by an adenocarcinoma arising from a type I choledochal cyst was detected in a 42-year-old woman. The diagnostic and therapeutic aspects of this malignancy are discussed.     

Complications of renal cyst puncture

One hundred nineteen renal cyst punctures have been reviewed. There have been four complications (3.4 per cent), three requiring surgery. This should be expected, as all invasive diagnostic procedures are accompanied by some morbidity. The relative benefit of nonoperative diagnostic procedures in differentiating benign renal cyst from adenocarcinoma is discussed.