Synovial sarcoma of the pericardium

Differences between the type B neurotoxin gene sequence of Clostridium botulinum type A(B) and Cl. botulinum type B, including a six nucleotide deletion, were recently proposed as a cause of the lack of expression of this gene in the type A toxigenic strains. A polymerase chain reaction (PCR) based on two sets of primers was designed to investigate the absence of the 6-nucleotide sequence in the apparently unexpressed type B toxin gene of 42 strains of Cl. botulinum type A(B). Thirty-five strains were shown to exhibit a deletion in their type B toxin gene; two strains did not have the deletion and actually produced small amounts of type B toxin when tested by the mouse bioassay. This two-step PCR might be useful for the rapid determination of the presence of the six nucleotide deletion and consequently, whether the type B toxin is likely to be produced.     

Interhemispheric lipoma associated with subcutaneous lipoma

We report an extremely rare case of intracranial lipoma that was associated with subcutaneous lipoma situated on the anterior fontanelle. During ultrasonographic examination of the subcutaneous lesion, intracranial lipoma was incidentally diagnosed. Computed tomography revealed corpus callosum agenesis, interhemispheric lipoma extending into the choroid plexus. Magnetic resonance imaging demonstrated the subcutaneous lipoma and also the exact extent of the lesion. The pathogenesis of lipomas is discussed and the literature is reviewed.     

Injuries of the heart and pericardium

The authors experience with surgical treatment of heart and pericardium injuries is summarized. A total of 38 patients were operated upon. The surgical aid consisted in simultaneous performance of the complex of reanimation measures, urgent thoracotomy and suturing of the heart wound. Thirty six patients have recovered, two died. One patient died due to mediastinitis, the other -- due to progressive cardiovascular insufficiency.     

Metastases of the heart and pericardium

Tumours metastasizing to the heart are one of the least investigated subjects in clinical oncology. Nevertheless, this problem holds great practical significance in relation to the operability and type of treatment of neoplastic patients. Of 4769 patients autopsied at the Institute of Pathological Anatomy of Trieste from 1994 through 1995, 1148 males (42%) and 780 females (38%) had a primary tumour. Among them, 162 subjects had cardiac metastases (8.4%) of all cancers), with a significant decrease in frequency in elderly patients. Mesothelioma, melanoma and lung cancer showed the highest frequency of heart involvement in males (100, 50 and 31%, respectively). Melanoma, lung tumours and renal neoplasms had the highest percentages of secondary heart lesions in females (45, 26 and 20%, respectively). In lung cancer, anaplastic small-cell carcinoma (37%) and adenocarcinoma (33%) showed the most frequent heart involvement in males, while squamous carcinoma (43%) and anaplastic small-cell carcinoma (29%) had the highest frequency of heart metastases in females. Adenocarcinoma (82%) and anaplastic small-cell carcinoma (74%) of the lung, mesothelioma (100%) and breast tumours (73%) had the highest frequency of metastases to the pericardium. A particularly high frequency of myocardial involvement was observed in squamous cell carcinoma of the lung (62%), urinary tract tumours (60%) and melanoma (45%).     

Infiltrating lipoma

BACKGROUND: Deep or infiltrating lipoma is an often misdiagnosed clinical entity. We report two typical cases. CASE REPORTS: Two women, aged 92 and 62 years, were seen for a tumefaction on an upper limb with progressively increasing volume. The clinical presentation suggested deep lipoma, confirmed by magnetic resonance imaging and histology which eliminated liposarcoma, the main differential diagnosis. Surgical excision was successful. There has been no recurrence. DISCUSSION: These two observations recall the clinical, diagnostic and therapeutic features of infiltrating lipoma.     

Polypoid lipoma of the palatine tonsil

A polypoid, pedunculated tumour of the left palatine tonsil was incidentally detected in a 42-year-old female. It was composed of mature fat and was covered by a nonkeratinizing squamous epithelium with an underlying rim of fibrous tissue. The literature on tonsillar lipoma is reviewed and the differential diagnosis of polypoid lesions of the tonsil is discussed.     

Spindle-cell lipoma of the preseptal eyelid

To identify immunological markers that could be used to monitor relapsing-remitting multiple sclerosis (RRMS) course/activity during interferon beta 1b (IFN beta 1b) therapy, we longitudinally studied HLA-DR and CD25 expression by T lymphocytes in 15 IFN beta 1b-treated RRMS patients. Peripheral blood T cell subsets were analysed before therapy (T0), and after 1 (T1), 2 (T2), 3 (T3), 6 (T4) and 12 (T5) months after therapy initiation. HLA-DR expression and the CD3+HLA-DR+ T cell number showed a peculiar trend in almost all (14/15) the patients: a significant decrease at T1 and T2 followed by a return to pre-treatment levels from T3 to T5. At T1 and T2, eight patients showed an up-regulation of CD25 on CD4, as well as an increase in the CD4+CD25+ cell number. However, a marked, significant reduction of this T cell subset was observed in all the patients at T3, followed by the progressive return to pre-treatment values from T4 to T5. All the patients developed anti-IFN beta 1b 'binding' antibodies within the first three months of therapy. Our findings demonstrate that: (1) the expression of HLA-DR and CD25 on T cells, as well as the number of circulating CD3+HLA-DR+ and CD4+CD25+ cells, are only transiently reduced in vivo in IFN beta 1b-treated RRMS patients, (2) the expression of HLA-DR and CD25 on T lymphocytes cannot be used to monitor MS course/activity during IFN beta 1b therapy, (3) the long-lasting beneficial effect of IFN beta 1b on RRMS reported in the literature cannot be explained by the down-regulation of MHC class II antigens and/or interleukin-2 receptor expression induced by this cytokine.     

Rectosigmoid lipoma an unusual colonic lipoma. Case report and review of the literature

This is a case report of a male patient admitted with a huge rectosigmoid mass that had eroded into the lumen, causing persistent rectal bleeding. Special procedures such as double contrast Barium Enema, abdomino-pelvic CT-Scan and proctosigmoidoscopy addressed us to identify it as an intramural lipoma. Rectosigmoid lipoma with its differential diagnosis and surgical approach is reviewed together with the most pertinent literature.     

Spindle cell lipoma

A clinical, light- and electronmicroscopic study of 14 patients with spindle cell lipoma is presented. Spindle cell lipoma is considered to be a distinctive lipomatous tumour histologically characterized by a mixture of fat cells and fibroblast-like spindle cells, ultrastructurally similar to fibroblasts, in a matrix with varying amounts of collagen and mucosubstances. The tumours showed a predominance for elderly men and all but one were situated in the posterior neck, shoulder region or upper back. The tumours varied between 1 and 9 cm, with a median value of 5 cm, in the widest diameter and were entirely or almost entirely situated in the subcutaneous tissue. A follow-up study of 11 patients, observed for 1-25 years, confirmed that the clinical course is benign. The differential diagnosis is discussed and it is emphasized that spindle cell lipoma is easily misinterpreted as sarcoma. Three tumours showed a pronounced nuclear polymorphism without mitotic activity, thought to be regressive in nature. The cellular change in these three tumours are presumed to be analogous with those in so called ancient neurilemmoma and therefore the name ancient spindle cell lipoma is proposed for the polymorphic spindle cell lipomas.     

Middle ear lipoma

We report a case of primary middle ear lipoma diagnosed in the right ear of a five-year-old child with concurrent bilateral middle ear effusions. The lipoma occupied a site favoured by congenital cholesteatoma and was occlusive to the eustachian tube contributing to its dysfunction. This is the first case of de novo middle ear lipoma diagnosed in the UK, and the third in world literature. Our CT scans are suggestive of a similar but smaller lesion in the left ear of the same child.     

A large lipoma

The paper presents a female with lipoma of a such magnitude that its size and localization rendered impossible walking without assistance.     

The X-ray diagnosis of congenital absence of the pericardium

The X-ray signs of such a rare abnormality as the congenital absence of the pericardium are presented. The results of examinations and follow-up of 4 patients with this abnormality are analyzed. The patients underwent X-ray, echocardiographic studies, cardiac catheterization and angiography. The diagnosis of the absence of pericardium was confirmed at surgery and in one case at autopsy.     

Mediastinal lipoma in children

Mediastinal masses are uncommonly encountered in childhood. These tumours are often interesting because of the varied mediastinal tissues from which they arise. Despite extensive investigations, a large percentage of these lesions remain undiagnosed prior to operation. We describe two rare cases of mediastinal lipoma. The first was incidentally diagnosed whereas the second patient presented with respiratory symptoms. The definitive diagnosis was established at surgery, which was curative.     

Ultrasonographic characteristics of lipoma of the soft tissues

This study includes 72 subjects with 90 soft tissue lipomas examined with high-resolution US. Forty-one lipomas were found in subcutaneous fat tissue, 29 in superficial muscles, 1 in the inguinal channed and 1 in the retroperitoneum. All the lesions were studied for: site, position in the body, number, shape, outline, size, echotexture, echogenicity and US beam transmission beyond the lesion. Sixty-seven lipomas were slightly ovalar (93%), 53 had regular margins (73.6%) and 21 exhibited a poorly- or well-defined capsule (29.2%). Twenty-two per cent of lipomas was homogeneous, 54.2% was slightly inhomogeneous and the extant 23.6% was inhomogeneous. Forty-five lesions were hypoechoic (62.5%), 13 hyperechoic (18.1%), 10 isoechoic (13.9%) and 4 exhibited a mixed echostructure (5.5%). In 24 cases (33.3%) sound was transmitted better through lipoma than through surrounding soft tissues. Posterior US beam attenuation was observed in one case (1.4%). Fifty-one lipomas (70.9%) exhibited the typical "striped" pattern, i.e., inner hyperechoic bands parallel to the skin. The clinical diagnosis of lipoma is based on patients' clinical history and on the palpation of a soft, well-defined and mobile mass. The US findings of an ovalar, well-defined, sometimes capsulated and, most important, "striped" mass, suggest the diagnosis of lipoma. Indeed, in our opinion, this pattern is characteristic of lipoma and represents the US appearance of its fibrous stroma. Therefore, we recommend US as the first-step method in the study of lipomas.     

Traumatic rupture of the pericardium. A rare diagnosis

HIV-1 variability may have an important impact on transmission and pathogenicity. Better characterization of the HIV epidemic in Brazil is necessary for the development of vaccine trials in this country. We analyzed sera from 108 HIV-1-infected volunteers from S?o Paulo City to determine serotype and reactivity for V3 motifs of HIV in this population, and the relationship to transmission mode. We concluded that the HIV-1 B serotype is frequent among heterosexually infected women, even in the absence of anal sex, and that two major V3 motifs, GPGR and GWGR, had similar prevalence among women (48% and 52%, respectively) and men (56% and 44%, respectively). We also observed an equal distribution of these strains regardless of their CD4+ T cell counts, clinical status, and mode of transmission. Even though V3 serology for HIV-1 subtyping is an inexpensive tool for use in developing countries, additional methods, such as heteroduplex mobility assay and direct DNA sequencing, should be included to determine HIV-1 genetic diversity.