Autopsy case of alcoholic hepatitis and cirrhosis treated with corticosteroids and affected by Pneumocystis carinii and cytomegalovirus pneumonia

A case of the very early phase of Pneumocystis carinii pneumonia in a human immunodeficiency virus (HIV)-negative man with alcoholic hepatitis and cirrhosis treated with steroids is presented. A 40-year-old man with a 10-year history of alcohol abuse was admitted to hospital with jaundice, fever and macrohematuria. Laboratory examinations revealed neutrophilic leukocytosis and a serum bilirubin level of 13.9 mg/dL. The serum bilirubin level rose to 28.5 mg/dL over 1 month. Prednisolone administered orally for 10 days produced a slight improvement in the jaundice and fever. After an interval of a week, it was resumed and maintained for 22 days (total dose, 1555 mg) until the patient died of a massive hemorrhage from ruptured vessels of a gastric ulcer. An autopsy disclosed P. carinii pneumonia in the lower lobe of the left lung, cytomegalovirus infection in both lungs and the esophagus, and esophageal candidiasis. To our knowledge, this is the first report of P. carinii pneumonia together with cytomegalovirus infection in an HIV-negative alcoholic patient. The present case suggests that a rare opportunistic infection such as P. carinii pneumonia might be caused by treating cirrhosis and alcoholic hepatitis with corticosteroids, even if only for a relatively short period.

Intracardiac ectopic thyroid mass

Intracardiac ectopic thyroid mass is an extremely rare occurrence. We describe a case of this rare disorder. The mass was clearly visualized by echocardiography, MRI, and cineangiography. The thyroid mass was excised successfully, and 50 months later the patient was well.

Metastasizing uterine leiomyoma. A case with cardiac and pulmonary metastasis

A case of histologically benign cardiac and pulmonary metastases from a uterine leiomyoma in a 45-year-old woman is reported. The solitary cardiac tumor consisted of five lobules with a stalk attached to the anterior papillary muscle of the right ventricle, which occupied the right ventricular cavity and almost completely obstructed the pulmonary main trunk in the systolic cycle. Multiple small nodules were found throughout both lungs. The cardiac tumor was resected at open heart surgery and open lung biopsy of the pulmonary lesion was simultaneously performed. Both of them were histologically identical to the apparently histologically benign uterine leiomyoma which had been resected five years previously. Based on the clinical and laboratory findings, it is postulated that antegrade metastases via the venous system resulted in the cardiac metastasis from the uterine leiomyoma and the secondary pulmonary metastasis from the cardiac tumor. In contrast to the light microscopic findings, ultrastructural examination suggested the possibility of malignancy associated with the presence of immature smooth muscle cells. This is the first reported case of a so-called benign metastasizing leiomyoma occurring in the heart.

Overexpression of p53, c-erbB-2 and epidermal growth factor receptor in human breast carcinomas

Overexpression of p53 protein, epidermal growth factor receptor (EGF-R), and c-erbB-2 protein was assessed by immunohistochemical staining of formalin-fixed, paraffin-embedded tissue from 64 invasive breast tumors. The correlation between abnormal expression of each protein and various disease parameters, including lymph node metastasis and histopathologic type and grade was analyzed. Despite the previous proposal, no significant correlation was found between lymph node metastases and overexpression of each gene in the primary tumors. In addition, some metastatic lesions did not always exhibit overexpression, even if it was evident in the primary tumors. Overexpression of c-erbB-2 protein correlated well with Bloom's histological grading. p53 expression was detected most often in tumors with hyperchromatism and more frequent mitosis. Overexpression of c-erbB-2 protein occurred more frequently in p53-positive tumors. The results indicate that abnormal expression of p53 protein causes genetic instability in the early stage of tumor development, resulting in subsequent overexpression of other oncogenes.

Infected abdominal aortic aneurysm due to Salmonella: CT evaluation

Two cases of infected abdominal aortic aneurysm (IAAA) caused by salmonella are reported and the computed tomography (CT) features are discussed and compared with the pathologic findings. Additionally, a review of the literature was performed. A well-enhanced para-aortic mass (PAM) beyond the calcified intima of the abdominal aorta on the CT, which was initially considered to represent a leakage from the infected aneurysm, was observed in 5 of the 6 reported cases (including ours) and identified as a pseudoaneurysm. In one case, multiple gas collections within the PAM were demonstrated for the first time in IAAA due to salmonella.

Xanthine urolithiasis: ultrastructure analysis of renal and bladder calculi

The surface structure of a xanthine stone from a patient with hereditary xanthinuria was examined using scanning electron microscopy. This revealed that the xanthine stone was composed of at least two very different structures. One was a spherical protrusion with craters and a fine granular surface and the other consisted of a granular growth of plate-like crystals.

Phyllodes tumor of the breast: a clinicopathologic study of 34 cases

Thirty-four cases of phyllodes tumor of the breast were studied to evaluate the clinical and pathological features, which correlate with local recurrence. Histologically, local recurrence correlated with the finding of more than ten mitotic figures per ten high-power fields, marked cellularity, prominent nuclear pleomorphism, and stromal overgrowth. Older patients and patients with larger tumors had a higher probability of local recurrence. Stromal overgrowth correlated with the other histological parameters, with rapid tumor growth, a tumor diameter of over 10 cm, and with local recurrence. It was thus considered to be a histological indicator of the malignant potential of phyllodes tumor of the breast.

Compression syndrome of the popliteal vein and artery caused by popliteal cyst

Popliteal vein compression caused by popliteal cyst was detected in 53-year-old man with venostasis of the lower limb. Deviation of the popliteal artery was also demonstrated by arteriography. The cyst communicating with the knee joint and partly covered by the lining of synovial cells was totally excised without damage to the vein. An analysis revealed hyaluronic acid to be the major component of glycosaminoglycan in the cyst and was 3 or 4 times in excess of that in the synovial fluid. The postoperative course was uneventful and symptoms were almost relieved.

Adult T cell leukemia. Histological classification and characteristics

Adult T cell leukemia was classified into two distinct types, monomorphic and pleomorphic, according to their histological and cytological features. The former type is composed of uniform neoplastic cells with round or slightly indented nuclei without any marked deformation. The latter type, on the other hand, occupies a unique position in lymphocytic leukemias with the following characteristics: a) onset in adulthood, b) an acute and subacute course, c) well-differentiated T cell origin of the neoplastic cells, d) pleomorphism of the neoplastic cells with markedly deformed nuclei, e) diffuse proliferation of the neoplastic cells without nodular pattern, f) histologically heterogeneous features of lymph nodes frequently admixing a cluster of normal lymphocytes, proliferation of macrophages and dendritic cells, and well-developed high endothelium venules, g) high incidence of skin lesions due to the infiltration of neoplastic cells, and h) exclusively limited localization of patients' birth places.