Cytology of pigmented renal cell carcinoma. A case report

We used a new combined chemo- (COP/ABVD), radiation and interferon-alpha (10 x 10(6) IU s.c. 3x per week/12 months) therapy regimen to treat severe multicentric Castleman's disease (CD) complicated by relapsing Behcet's disease (BD) manifestations. More than 16 years after diagnosis of CD the patient remains in very good clinical condition, with remission of all CD and BD manifestations 13 months after discontinuation of the interferon-alpha treatment. In addition, our clinicopathological, immunohistological and virological data suggest a pathogenetic link between CD and BD via activation of pre-existing BD-specific plasma cells due to CD-related HHV8-induced overexpression of interleukin-6.     

Silicone elastomer microshards in fluid from a painful metatarsophalangeal implant site. A case report

Histopathologic studies have demonstrated microshards from silicone elastomer metatarsophalangeal joint implants in adjacent tissues in a setting of chronic inflammation and in inguinal lymph nodes. Cytologic smears of synovial fluid from symptomatic implanted joints should show these refractile, nonpolarizing microshards in the reactive inflammatory context. Nonspecific enzymatic inflammatory activity contributes to further destabilization of the implants, eventuating in symptoms and signs requiring prosthesis removal. Cytopathologic examination of aspirated fluid from the vicinity of a symptomatic implanted joint demonstrates foreign body reaction to silicone elastomer, predicting a need for intervention before the local damage is severe and disabling.     

Malignant melanoma in a 7-year-old child. A report of a dramatic case

Malignant melanoma developed on the scalp at the site of a congenital nevus in a 7-year-old girl. At birth, simple observation was proposed, despite the recognized desirable but non-urgent indication for excision, in order to avoid subjecting the infant to general anesthesia. At the first sign of a change in the macroscopic appearance of the nevus, surgical resection was performed, but the short-term outcome was fatal.... This case focuses our attention on malignant progression of even small congenital nevi and emphasizes the need for early preventive and systematic resection even when the patient's age of the patient requires general anesthesia.     

Delayed cerebrospinal fluid leakage after head and facial trauma resulting in meningitis: a case report

BACKGROUND: Several years ago, a successful surgical technique for treating depigmentation resulting from burn injuries was developed. OBJECTIVE: The purpose of this study was to investigate results of dermabrasion with melanocyte transplantation using new modifications of the technique in patients with vitiligo. METHODS: We performed 17 procedures on 12 patients with stable vitiligo. The epithelium of the vitiliginous areas was removed by dermabrasion. The dermabraded area was then reepithelialized with ultra-thin sheet grafts, which more recently were meshed and partially expanded. RESULTS: Good to excellent repigmentation was observed in 88% of the procedures. Scarring did not develop in the repigmented or donor site regions. The final color match has been good to excellent. CONCLUSIONS: This technique has proven beneficial in 88% of the procedures on our patients. Both our patients and we feel that this provides a valuable treatment option in patients who have failed medical management.     

Amniotic fluid embolism in trial of labor. A case report

Amniotic fluid embolism is a rare complication of pregnancy, which accounts for about 10% of all maternal deaths. A case of acute embolic episode occurred during labor in a 36-year-old patient with spontaneous rupture of membranes is described. Caesarean section was performed immediately, followed by hysterectomy; the baby survived but the mother died because of DIC and cardiorespiratory arrest.     

MR findings of primary central nervous system lymphoma in a child. A case report

Huntington's disease is an autosomal dominant, inherited disorder that results in progressive degeneration of the basal ganglia (especially the neostriatal caudate nucleus and putamen) and other forebrain structures and is associated with a clinical profile of movement, cognitive and psychiatric impairments for which there is at present no effective therapy. Neuropathological, neurochemical and behavioral features of the disease can all be reproduced in experimental animals by local injection of excitotoxic or metabolic toxins into the neostriatum. All these features of the disease can be alleviated, at least in rats, by transplantation of embryonic striatal tissue into the degenerated striatum, which was the basis for commencing the first clinical trials of striatal transplantation in Huntington's patients. However, although rat striatal xenografts may temporarily reduce apomorphine-induced dyskinesias in monkeys, there has been no demonstration that allograft techniques that work well in rats translate effectively to the much larger differentiated striatum of primates. Here we demonstrate good survival, differentiation and integration of striatal allografts in the primate neostriatum, and recovery in a test of skilled motor performance. Long-term graft survival in primates indicates probable success for clinical transplants in Huntington's disease; in addition, our data suggest that graft placement has a direct influence on the pattern and extent of functional recovery.     

Hysteroscopic cervical cannulation under ultrasound guidance. A case report

BACKGROUND: Ultrasound guidance has been recommended for various operative hysteroscopic procedures as an alternative to laparoscopic guidance. Ultrasound is noninvasive and may decrease the incidence of uterine perforation. CASE: A 30-year-old nulligravida presented for the evaluation of amenorrhea of two months' duration. She was diagnosed as having cervical obstruction and underwent operative hysteroscopy with cervical cannulation under ultrasound guidance. The patient's menstrual flow returned at the appropriate time without dysmenorrhea. CONCLUSION: Ultrasound guidance during hysteroscopy assisted in the proper orientation and position of the hysteroscope at the time of cannulation, potentially minimizing the risk of uterine perforation.     

Aspiration cytology of ectopic cervical thymoma mimicking a thyroid mass. A case report

BACKGROUND: Ectopic cervical thymoma, first described in 1941 by Boman, is an uncommon tumor of the neck displaying the same histologic features as mediastinal thymoma. Since it is commonly located in the anterolateral part of the neck or is subjacent to or inside the lower pole of the thyroid, the mass is often confused as being of thyroid origin. CASE: A 68-year-old female presented with dyspnea and an anterior neck mass found on routine chest roentgenography. The thyroid scan showed a cold nodule in the lower pole of the left part of the thyroid. Fine needle aspiration (FNA) cytology revealed large numbers of small lymphocytes with hyperchromatic nuclei and frequent clumping pattern in the pale, eosinophilic, fluid background. A few clusters of epithelial cells without atypism were interpreted as thyroid follicular cells. The overall cytologic features were misinterpreted as malignant lymphoma of the thyroid. However, the histologic diagnosis was thymoma, predominantly cortical type. CONCLUSION: The ectopic cervical thymoma is sometimes misdiagnosed as Hashimoto's thyroiditis, anaplastic carcinoma and malignant lymphoma of thyroid on FNA cytology or frozen diagnosis due to its rarity. Therefore, the differential diagnosis of a neck mass showing a variable composition of lymphocyte and epithelial component in a pale, eosinophilic, fluid background should also include ectopic cervical thymoma, especially in elderly females.     

Hypnotherapy for the child with chronic eczema. A case report

Chronic eczema in a child usually produces much discomfort and distress. Associated behaviour problems further complicate the issue. A comprehensive approach to treatment is therefore essential. Hypnotherapy may be a useful adjunct in the overall management. An illustrative case history is presented. Combining hypnotherapy with child guidance and medical treatment led to the relief of symptoms and improved behavioural pattern in a boy aged 10 years.     

Hypertrophic olivary degeneration: case report in a child

We report a case of hypertrophic olivary degeneration (HOD) detected by MRI, in a 14-year-old girl, 13 months after surgical excision of a brainstem cavernous malformation. As in vivo diagnosis of this condition has only become possible with the advent of MRI, the number of reported cases remains relatively small and they are almost exclusively in adults. Many radiologists and particularly paediatric radiologists, may therefore be unfamiliar with this entity. To our knowledge, this is the first specific report of HOD diagnosed by MRI in a child.     

Exfoliative cytology of invasive neuroendocrine small cell carcinoma in a cervical cytologic smear. A case report

BACKGROUND: Neuroendocrine small cell carcinoma of the cervix (NSC) is cytologically identical to its counterparts at other sites, such as the lung, and can be suspected on a cervical cytologic smear. It has to be distinguished from poorly differentiated nonkeratinizing squamous small cell carcinoma, adenocarcinoma with carcinoid features, embryonal neuroblastoma, embryonal rhabdomyosarcoma, stromal sarcoma and non-Hodgkin's lymphoma. CASE: An 18-year-old woman had invasive NSC. Exfoliative cytology of the cervix showed tumor cells, single or in small clusters and files, with darkly staining nuclei. The chromatin pattern was coarse, with small, prominent chromocenters, and the nuclei were often invisible. The cytoplasm was so reduced as to be barely discernible. Mutual molding of adjacent nuclei was frequent. Immunohistochemistry showed positive staining for pancytokeratin and neuron-specific enolase. Flow cytometry showed aneuploidy, with a DNA index of 1.93. CONCLUSION: The cytologic appearance of NSC in a cervical cytologic smear is characteristic. The diagnosis, nevertheless, has to be proven by the identification of neuroendocrine differentiation.     

Cervical lymphadenitis due to Mycobacterium malmoense in a child: case report and differential diagnosis of cervical lymphadenitis and lymphadenopathies

Cervical lymphadenitis and lymphadenopathy are common in children and may be caused by local or systemic infection. There are a large number of possible etiologies. We report the case of a five-year-old boy with unilateral cervical lymphadenitis who was in good health and showed neither clinical nor laboratory signs of systemic infection. Despite repetitive empirical antimicrobial treatment, the lymph nodes increased in size. After surgical excision Mycobacterium malmoense grew from the lymph node culture. Based on a literature search (Embase and Medline 1980-1992), the most frequent infectious etiologies of pediatric cervical lymphadenitis and lymphadenopathies are summarized. Nontuberculous mycobacterial lymphadenitis is most frequent in children between one and five years of age, and is more common in girls than boys. The treatment of choice is surgical excision. In immunocompetent children treatment with antimycobacterial drugs is not needed even if relapse occurs.