"Nasal gliomas" and related brain heterotopias: a pathologist's perspective

Brain heterotopias are rare congenital malformations embryologically related to encephaloceles. They present as a mass in or about the nose (nasal glioma) or in the nasopharynx. We present the clinical and pathological features of 5 cases of heterotopic brain tissue. Four nasal gliomas consisted of mature neuroglial tissue, including neurons in 2 cases, embedded in a fibrovascular stroma. A nasopharyngeal brain heterotopia showed histologic features of mature neuroglial tissue including neurons and ependymal-lined cystic structures. The finding of mature neuroglial tissue in a mass from the head and neck region raises three differential diagnostic possibilities: teratoma, encephalocele, or heterotopic tissue. A teratoma can be ruled out by examination of the entire specimen. Encephaloceles and brain heterotopias can be distinguished only after correlation with the patient's clinical and radiologic findings.

Detection of herpes simplex infection in cytologic smears

We compare the results of direct immunofluorescence (IF) with cytology (Papanicolaou's stains) for diagnosis of herpes simplex infection. Thirty smears were examined. Yellow-green fluorescence was seen in 17 smears. Only eight of these smears had diagnostic cytology, and nine of the smears with positive fluorescence had none (four) to minimal (five) cytologic changes, suggesting that direct IF is a much more sensitive method for diagnosis of herpes simplex infection in cytologic smears.

Evolution of membranous nephropathy from a proliferative and exudative glomerulonephritis--a report of three cases studied by serial biopsies

Three adolescents with clinical nephrotic-nephritic picture were noted to have diffuse proliferative and exudative glomerulonephritis. Although focal membranous changes were noted in two of the initial biopsies, evolution into classical membranous glomerulopathy was seen in subsequent biopsies. This study suggests a relationship between these two different patterns of immune complex-associated glomerular injury, and confirms extrapolations made from experimental models of chronic serum sickness.

Focal giant cell cardiomyopathy with Beckwith-Wiedemann syndrome

Cardiac involvement in Beckwith-Wiedemann syndrome is mostly limited to mild cardiomegaly. Although these patients have visceromegaly, macroglossia, gigantism, and adrenal cytomegaly, no significant myocardial changes have been described. An infant with dysmorphic features of this syndrome had supraventricular tachycardia since birth. Nodular lesions were present in the right atrium. Morphologically these lesions were composed of hypertrophic myocardial fibers admixed with multinucleated giant cells of myogenic origin. The exact nature of these lesions remains undetermined. It is postulated that hypertrophic myocardial cells may represent cardiac cytomegaly as a manifestation of the accelerated growth potential of cells seen with this syndrome.

Herpes simplex virus and congenital malformations

We have reported a case of transplacentally transmitted herpes simplex virus (HSV) infection in association with both congenital malformations and other serious abnormalities, including facial abnormalities, microcephaly, cerebral atrophy, and microscopic cranial calcifications. Before death, the infant showed marked neurologic deficits, seizures, and respiratory distress. Serum IgM and complement fixing antibodies to HSV were elevated at birth. Light and electron microscopy and immunofluorescence studies confirmed the presence of the virus.

Rapid tissue diagnosis of herpes simplex infections in the newborn

The presence of intranuclear inclusions in tissues is considered to be consistent with viral infections. Further identification is done by viral cultures. In this study, the direct immunofluorescence technique was utilized to identify herpes simplex virus in the tissues. Positive fluorescence was seen in 8 of 12 specimens. In all these specimens, diagnosis was further confirmed by electron microscopy, viral cultures, or both. Thus, the technique is a specific, sensitive method of diagnosis for herpes simplex infections. Rapidity and simplicity of the technique warrant regular use.

Reconstruction of the renal artery after unsuccessful percutaneous transluminal angioplasty in children

The use of percutaneous transluminal angioplasty as the primary treatment of renovascular stenosis in adults has recently been described. Previously, only three children have been reported to have undergone transluminal angioplasty for stenosis of the renal artery and hypertension. At our hospital, transluminal angioplasty was attempted in four children with renal artery stenosis; one attempt was successful and three were unsuccessful. The three patients who required surgical repair of the renal artery after unsuccessful transluminal angioplasty have been described in detail. The histopathology of the stenotic vessels is also discussed. Based on the analysis of the three children, certain criteria have been derived to select pediatric patients with renovascular hypertension either for attempted transluminal angioplasty or for primary surgical revascularization.

Medical practice and genetics in the mid-Michigan area

In this report the authors provide information on the knowledge of and attitudes on genetics of allopathic and osteopathic physicians of the Mid-Michigan area. The type of degree (M.D. or D.O.) made no difference with respect to physicians' knowledge of genetics, while their specialty and year of graduation from medical school each had a significant impact on the physicians' genetic performance. Although there are important differences by specialty area, the average score on a multiple-choice genetic knowledge test was approximately 50 percent correct. Respondents were more likely to indicate a lack of knowledge than to choose an incorrect answer, but the overall level of knowledge was low. Ninety-two percent of the respondents stated that their present knowledge was inadequate and preferred continuing medical education courses and case-related conferences to increase their knowledge.

Early failures of Ionescu-Shiley bioprosthesis after mitral valve replacement in children

Two infants, 101/2 and 11 1/2 months of age, underwent mitral valve replacement with Ionescu-Shiley bovine bioprosthesis for congenital cardiac defects. Both patients had early valve failure, 19 months and 4 months after implantation, due to the growth of excessive collagen on the ventricular surface of the bioprosthesis with adherence of the collagen primarily to the sewing rings and struts of the valves. The cause of this excessive collagen reaction is unknown. Further study is needed to document the true incidence of this problem.

Hepatocellular adenoma in a young woman with beta-thalassemia and secondary iron overload

The occurrence of a hepatocellular adenoma is described in a young woman with beta-thalassemia and secondary iron overload. This patient had no history of oral contraceptive use, and in fact was hypogonadal as a result of iron deposition in pituitary and gonadal tissue. Although hepatocellular carcinoma frequently occurs in diseases associated with iron overload, this is the first report of a benign liver tumor associated with secondary iron overload.

Familial occurrence of congenital pulmonary lymphangiectasis. Genetic implications

Congenital pulmonary lymphangiectasis (CPL) is a rare, generalized disease of the lung, consisting of lymphatic cysts in the subpleural and interlobular connective tissue. This disorder typically manifests a clinical picture of acute respiratory distress with cyanosis shortly after birth, with death occurring in the neonatal period. Several cases of this disorder have been described in the literature, but there has been no family with more than one affected child. We report the first instance, to our knowledge, of familial cases of CPL, which raises an important question regarding a possible genetic component in this disorder. The implications of this are discussed.

Omphalocele in half-siblings

A family is described in which half-siblings, a boy and a girl born to unrelated mothers and a phenotypically normal father, were affected with omphalocele. The suggested mode of transmission remains unclear. Prenatal diagnosis to detect an affected fetus should be offered to relatives of omphalocele-affected individuals.

Malakoplakia of the brain. A report of two cases occurring in childhood

Malakoplakia was found in the brain biopsy specimens of two children with meningoencephalitis probably due to herpes simplex. Histologically, there was extensive parenchymal destruction and cellular infiltration. Numerous von Hansemann histiocytes and typical Michaelis-Gutmann bodies were present. Ultrastructurally these bodies had a dense central core and concentric alternating rings. Large intracytoplasmic phagolysosomes were present. Malakoplakia most frequently involves the urinary tract of adults. Only a few children with malakoplakia have been described. There are two previous reports of cerebral malakoplakia associated with neonatal herpes simplex. The pathogenesis is obscure. Several reports suggest an altered histiocytic response to a bacterial agent as the pathogenetic mechanism. Our findings raise the possibility of an etiologic role of a virus, such as herpes simplex.

Focal glomerulosclerosis in children: correlation of histology with prognosis

The clinical and pathologic data of 32 nephrotic children diagnosed as having focal glomerulosclerosis were retrospectively analyzed to determine what factors were responsible for progression to renal failure in 12 of these children. The patients were classified into three groups based on the histologic findings in their initial renal biopsies: Group I (n = 19) had a combination of global and segmental lesions; Group II (n = 8) had only globally sclerotic or obsolescent glomeruli; and Group III (n = 5) had only segmentally sclerosed glomeruli. Ten of the 12 patients with end-stage renal failure came from Group I and two from Group II. The median period from recognition of symptoms to renal failure was four years. Clinical features were of little prognostic value. However, comparison of the histopathologic data of the ten patients in Group I with renal failure (Group Ia) and Groups Ib, II, and III revealed that the risk of progressing to renal failure was significantly higher in patients having greater than 20% of their glomeruli involved by both global and segmental lesions (P = 0.005). Furthermore, patients in Group I and III had a lower probability of responding to treatment as compared to patients in Group II (P less than 0.025).

Acute radiation nephritis. Light and electron microscopic observations

Light and electron microscopy were used to observe acute radiation nephritis. By light microscopy the changes were of fibrinoid necrosis of the arteries and atrerioles with segmental necrosis of the glomerular tufts. By electron microscopy the endocapillary cells reacted by hypertrophy and hyperplasia with increase in cytoplasmic organelles. In addition, disruption of endothelial and epithelial cells from the basement membranes were seen. It is concluded that the electron microscopic changes were unique and may be helpful in differentiating the necrotizing glomerulitis seen in other conditions, especially malignant hypertension.