Syphlis of the gastrointestinal tract

Six cases of syphilis of the stomach and 2 of the colon are presented. All of these lesions showed x-ray findings of annular deformity with smooth edges like a funnel leading into a tube. The gross specimens had the appearance of inflammatory tissue, the lumen was markedly constricted and the mucous membrane ulcerated. The gross and microscopic pictures presented from Case VIII are typical of the disease and of all of these cases. Two deaths resulted from severe damage to other organs by long-standing syphilis, one liver failure from degeneration and the other severe secondary anemia. A third patient died from gastric hemorrhage. A review of the various intestinal lesions is given.     

Clinicostatistical study of lower lip mucoceles

We reviewed 70 patients with lower lip mucoceles for patient characteristics, clinical features, and histopathologic findings. These cases represented approximately 75% of oral mucoceles seen in the Department of Otolaryngology, Takeda General Hospital, between February 1985 and July 1988. Patients were divided almost equally between males and females, with ages ranging from 2 to 63 years, with the highest incidence of lesions occurring in the second decade. Duration of the lesions varied greatly from a few days to 3 years, with no correlation to size. The most commonly affected site was opposite the upper lateral incisor, with the incidence divided almost equally between right and left side. Of 70 biopsies, 68 were mucous extravasation cysts and 2 were mucous retention cysts. Surgical excision was the treatment of choice, with recurrence of the lesion in only 2 cases.     

Primary malignant melanoma of the bladder

Primary malignant melanomma of bladder is extremely rare: 18 cases are reported to date. An 82 year-old man underwent trans-urethral resection of bladder for a bleeding tumor of the posterior wall. Histological diagnosis was melanoma of the bladder. There was no history of previous or regressed cutaneous malignant melanoma. Margins of the bladder lesion contained atypical melanocytes similar to those commonly seen in the periphery of primary mucous membrane lesions. Clinical studies and radiological examinations were negative for other primary site of melanoma. The patient had a bladder recurrence that was consistent with primary tumor and died of widespread disease 9 months after diagnosis.     

Cytoplasmic mucous globules in lobular carcinoma in situ. Diagnosis and prognosis

In 87 cases of lobular carcinoma in situ, 64 contained mucous globules in more than 25% of the cells. Eighteen, however, had no or only a few mucous globules. In cancerization of lobules by duct carcinoma and in benign hyperplastic lesions, only a few cells contained mucous globules. The presence of many of these globules may be helpful in the diagnosis of lobular carcinoma in situ. On the other hand, the quantitation of mucous globules in lobular carcinoma in situ is not of prognostic significance.     

Pyogenic granuloma - the quest for optimum treatment: audit of treatment of 408 cases.

Pyogenic granuloma is a common, acquired, benign vascular lesion of skin and mucous membranes which may occasionally present intravascularly or subcutaneously. Pyogenic granuloma occur in all age groups and although they may eventually regress, removal of unsightly, bleeding or uncomfortably positioned lesions is usually sought before this takes place. This is a retrospective study of 408 cases of pyogenic granuloma that were analysed by the Stoke Mandeville Histopathology laboratory between 1994 and 2004. This study was carried out to review the sex, age and anatomic distribution of the lesions and to assess the most successful form of treatment on the basis of recurrence risk and other measures such as aesthetic result, acceptability and appropriateness of the procedure with respect to the patient. There was a slight male preponderance especially among children. The exception to this was lesions on mucous membranes, which were more common in women. Head and neck was the most common anatomical location, in particular the cheek and intraoral locations. Fewest recurrences were noted following excision and direct closure although all techniques investigated showed an acceptably low recurrence rate. Whatever technique is used it must yield material for histopathological analysis to ensure the exclusion of differential diagnoses.     

Pemphigus vulgaris triggered by rifampin and emotional stress

A 56-year-old Jewish woman of Ashkenazi origin had a history of tuberculosis since the age of 1 year, contracted while she was in hiding in Poland during the Holocaust. She developed bronchiectasis in 1972 for which she was being treated 4 times a year for 1-month periods with 600 mg/d rifampin. During the Persian Gulf War in February 1991, a month after a rifampin treatment, she was admitted to the dermatology department with cutaneous and oral mucous eruptions. Physical examination revealed crusting bullae and erosions on the trunk and lower limbs. The mucous membranes were affected in the vagina, oral cavity, and pharynx. Histologic and immunofluorescence studies on a biopsy specimen confirmed the diagnosis of pemphigus vulgaris. There was no family history of the disease. Systemic treatment with prednisone,100 mg/d, resulted in regression of the eruption within a month, and the dose was tapered to 10 mg every second day. Although she received anti-tuberculosis treatment, the steroids caused an exacerbation of the tuberculosis, and after a massive hemoptysis in 1993, a right upper and middle lobectomy was performed. The operation put an end to the vicious cycle of drug-induced pemphigus outbreaks by eliminating the need for rifampin, but the patient reported the appearance of new lesions during periods of emotional stress.     

Primary palmoplantar Kaposi's sarcoma: an unusual presentation

A 65-year-old diabetic Saudi Arabian man taking glibenclamide for 9 years presented with painful reddish patches and plaques involving the palms and soles of 6 months' duration. These lesions started as small faint purple-red macules and gradually increased in number and size. The patient did not seek any medical advice other than for these painful lesions. His medical history was insignificant. On examination, the patient had multiple, discrete, dull red-to-violaceous and tender patches and plaques of variable sizes on both palms and soles (Figure 1 and Figure 2). His mucous membranes, scalp, and nails were normal. A systemic clinical examination was unremarkable other than an amputation of the distal phalanx of the left index. Result of routine laboratory investigations including complete blood cell count, liver and renal function tests, and chest x-ray were normal. An HIV test was negative. A punch skin biopsy taken from the left palm showed acanthosis and spongiosis in the epidermis. The dermis showed a large number of dilated, medium-sized capillaries with scanty extravasated red blood cells, marked infiltration of lymphocytes and histiocytes, and a few plasma cells (Figure 3 and Figure 4). Immunohistochemistry results were positive for CD34 and CD68. Polymerase chain reaction for human herpesvirus 8 was also positive. The treatment options, including cryotherapy and intralesional chemotherapy, were discussed with the patient but, unfortunately, he did not return for follow-up.     

Bullous-hemorrhagic Darier disease

A 48-year-old man presented with a 4-month history of papular hyperkeratotic diffuse lesions on his trunk, arms, and neck that were highly pruritic (Figure 1). He also had "V"-shaped nicks in the nails, mucous white papules on his palate, and diffuse desquamation on the scalp. Abnormal laboratory values included elevated levels of uric acid and triglycerides. Serum electrolytes, blood sugar, and renal and liver function test results were within normal range. X-ray film and abdominal ultrasonography findings were also normal. Histopathologic study of the biopsy from the thorax revealed acantholysis with suprabasal clefting, intraepidermal lacunae, and dyskeratosis with corps ronds. The clinical features and results of the histopathologic studies suggested a diagnosis of Darier disease (Figure 2), but the course was not typical of this entity because the patient had no family or personal history of previous cutaneous lesions and the age of onset was older than usual. In the course of the disease, he developed blisters and small black hemorrhagic macules with jagged borders on the back of his hands (Figure 3). Nikolsky's sign was negative. A biopsy of a blister was performed, which confirmed Darier disease, studied by means of immunofluorescence. Measurement of porphyrins in the urine was also ordered. Direct immunofluorescence did not show deposition of immunoglobulins or complement, and the study of porphyrins was normal. The patient was treated with an oral retinoid (acitretin 10 mg daily), but treatment was stopped because he developed an increase in triglycerides; therefore, control of the disease with oral antihistamines, 5-fluorouracil 1% cream, and topical tazarotene was used, with mild improvement.     

Common bile duct stones: an unusual case of diarrhoea through a mucous fistula

We present a very unusual case of diarrhoea in a 77-year-old man. He had a previously complicated surgical history, with a loop ileostomy and a colonic mucous fistula. He developed a sudden onset of diarrhoea from his mucous fistula. A contrast enema suggested a cholecystocolonic fistula and subsequent computed tomography demonstrated a common bile duct stone caused a degree of obstruction. The patient was treated successfully by endoscopic retrograde cholangiopancreatography and stone extraction. This case demonstrated the role that contrast enema may still play in unusual cases of diarrhoea.     

Mucous gland adenoma of the trachea: case report and literature review

Adenoma arising from bronchial mucous glands is extremely rare. Such tumors are truly benign, in contradistinction to other tumors previously grouped under the term "bronchial adenoma." We present the first case reported of mucous gland adenoma arising in the trachea. This case was initially misdiagnosed as asthma, a common error with obstructing tracheo-bronchial lesions.     

Chronic granulomatous disease: two members of a single family with different dermatologic manifestations

Case 1: A 33-year-old man with a 14-year history of localized skin disease on the face and scalp was evaluated at the department of dermatology. The physical examination revealed plaques with papules, pustules, and a golden yellow crusting on the forehead, cheeks, upper lip, and chin (Figure 1). The scalp presented fine, whitish scales. At the beginning of his disease, the patient presented large red and painful purulent boils. The 14-year clinical course of these lesions was characterized by partial remissions and recurrences, but he did not specify any treatment related to improvement. The clinical diagnosis given for the scalp lesions was seborrheic dermatitis. For the facial lesions, many differential diagnoses were considered, among them: seborrheic dermatitis, acneiform dermatitis, impetigo, folliculitis, seborrheic pemphigus, and demodicidosis. The histopathologic study of a biopsy taken from the cheek (Figure 2) showed superficial spongiform dermatitis with neutrophils and folliculitis that are compatible with the diagnosis of seborrheic dermatitis. Both Gram and periodic acid-Schiff stains were negative. Follow-up of the patient was not possible since he did not come back. The disease in this patient initially manifested at age five by the presence of recurrent ganglionic abscesses. At age 15, he presented a pulmonary abscess of a left lobule that was surgically removed; at this point the diagnosis of chronic granulomatous disease was established. At age 28, an exploratory laparotomy was performed due to peritonitis and multiple hepatic abscesses. At that time, he was treated with antibiotics (mainly trimethoprim-sulfamethoxazole) and interferon-g. The patient had two brothers who died due to complications of chronic granulomatous disease. In addition, both his mother and sister presented a history of discoid lupus-like lesions. Case 2: Coincidentally, his 27-year-old sister was seen in our department of dermatology 5 years before, presenting infiltrated and erythematous plaques with fine scales (Figure 3) on the right side of the nose and the left annular finger. No other cutaneous or mucous lesions were seen. She referred onset in childhood with similar lesions on sun-exposed areas that disappeared without scarring. A biopsy was performed and the results were compatible with the diagnosis of discoid lupus erythematosus (Figure 4). Direct immunofluorescence was not available. At that time, she did not mention the family history of chronic granulomatous disease. Clinical follow-up was not possible, but his brother referred that she afforded complete remission only with sun protection.     

Benign cystic mesothelioma, a rare tumor of the peritoneum

We report the case of a 28-year-old woman, who presented with acute abdominal and pelvic pain, the appearance of appendicitis. Because of her symptoms urgent operation was performed. Appendicetomy was performed, during the operation multiple cystic lesions were discovered on the right ovary and the peritoneal surface of the mesentery. Laparatomy was performed with removal of the visible cystic lesions, which contained mucous fluid. Final histology revealed benign cystic mesothelioma, which is a rare lesion of the peritoneum, occurring mainly in women in reproductive age. The etiology of cystic mesothelioma is still unclear. The short-term prognosis is favourable, but high recurrence rate. Some authors reported effective intraperitoneal chemotherapy, but no clinical study is available about long term outcome. We hope that surgical eradication was effective to prevent recurrence. One year after the operation the patient is complaint and symptom free.     

Leishmaniasis in patients with chronic renal failure: a diagnostic and therapeutic challenge for the clinician

BACKGROUND: The role of leishmaniasis in dialyzed or transplanted patients for chronic renal failure is generally neglected. In this study, the authors present a series of three cases of leishmaniasis (one visceral, one mucous and one muco-visceral) in patients with end-stage renal failure characterized by an atypical presentation and/or resistance to therapy. CASE DESCRIPTION: Two patients had an atypical infection: the first patient demonstrated a mucosal form, while the second had visceral and mucosal involvement. These two presentations are very rare and, to the best of our knowledge, other autoctonous disease cases have never been described in Italy. In the first patient, a cycle of oral itraconazole was scarcely effective and poorly tolerated, while treatment with 15% topical paromomycin sulfate was successful. Patients two and three failed to respond to meglumine antimonate and amphotericin B lipid complex. A second cycle with liposomal amphotericin B was effective in both cases. In addition, a superior safety profile for liposomal amphotericin B in comparison with the lipid complex amphotericin B was observed. CONCLUSIONS: These three cases highlight the problem of leishmaniasis in both renal transplanted and dialyzed patients and suggest that this infection could be far from infrequent in addition to being resistant to therapies. Leishmaniasis should be considered in the differential diagnosis of fevers of unknown origin and mucosal lesions in these patients, even in countries not at risk for mucosal leishmaniasis.     

严重烧伤后肠粘液成分变化与肠源性感染的关系

为探讨烧伤后回肠粘膜的病理变化,肠粘液及其中 IgA 成分的变化及这些变化与肠源性感染的关系,我们利用小鼠制作 TBsA 25%Ⅲ度烧伤模型,分别于伤后0.5、1、6、12、24小时观察;①小肠末端的病理病变;②测定小肠粘液层厚度及粘液中蛋白、己糖、唾液酸的含量;③检测粘液 IgA 血清 IgA及粘膜固有层中分泌 IgA 浆细胞数;④各时相小肠系膜淋巴结的细菌培养。结果表明:伤后小肠出现病理改变。粘液成分有变化,粘液中 IgA 含量持续下降且与肠源性感染发生关系密切。     

严重烧伤后肠粘液成分变化与肠源性感染的关系

为探讨烧伤后回肠粘膜的病理变化，肠粘液及其中ＩｇＡ成分的变化及这些变化与肠源性感染的关系，我们利用小鼠制作ＴＢｓＡ２５％Ⅲ度烧伤模型，分别于伤后０．５、１、６、１２、２４小时观察；①小肠末端的病理病变；②测定小肠粘液层厚度及粘液中蛋白、己糖、唾液酸的含量；③检测粘液ＩｇＡ血清ＩｇＡ及粘膜固有层中分泌ＩｇＡ浆细胞数；④各时相小肠系膜淋巴结的细菌培养。结果表明：伤后小肠出现病理改变，粘液成分有变化，粘液中ＩｇＡ含量持续下降且与肠源性感染发生关系密切。     

Technical considerations in laparoscopic resection of gastric neoplasms

Background: The purpose of this study was to determine the use of different laparoscopic approaches in the management of gastric neoplasms based on tumor type and location. Methods: We retrospectively reviewed the records of seven patients (3 men and 4 women) with 11 gastric lesions who were referred to our facility between March 2000 and October 2001 for laparoscopic excision of gastric neoplasms. Results: Two patients had gastrointestinal stromal lesions (3 lesions); two patients had hyperplastic polyps (3 lesions); one patient had carcinoid tumor (2 lesions); one patient had a carcinoma in situ and an adenoma; and one patient had an ectopic pancreas. Extraluminal laparoscopic wedge resection was used in four patients with lesions at the anterior gastric wall or along the lesser or greater curvature. Intragastric excision was used in two patients with small posterior wall lesions, and a transgastrotomy approach was used in one patient with a posterior wall lesion that could not be removed by the intragastric approach. All the lesions were completely excised with clear margins. The median hospital stay was 3 days. Complications developed in two patients. One patient presented with a perforated ulcer 2 weeks after surgery, and a second patient had postoperative pyloric edema that resolved with conservative treatment. Conclusions: The use of different laparoscopic approaches based on gastric neoplasm type and location facilitates tumor access and resection.     

Pancreatic cystadenoma. A clinicopathologic study of 45 cases

Forty-five patients with pancreatic cystadenoma were treated surgically at the Mayo Clinic between 1939 and 1975. Each lesion was classified as mucous or serous. The most frequent lesion site was the tail of the pancreas. The typical patient was a middle-aged woman with upper abdominal pain and a palpable mass on initial examination. Total extirpation of the cystadenoma was the treatment of choice; internal drainage or external drainage of these cysts should not be done. Occasionally, the nearness of the tumors to the mesenteric vessels precluded excision. The mucous type had malignant potential whereas the serous does not. None of the cystadenomas subsequently underwent malignant degeneration. Because of the slow-growing characteristics of the tumor, undue operative risks should not be taken.     

Toxic shock syndrome originating from the foot

The most familiar etiology of toxic shock syndrome (TSS) is that of menstruation and tampon use. Nonmenstrual TSS has been described in all types of wounds including postsurgical, respiratory infection, mucous membrane disruption, burns, and vesicular lesions caused by varicella and shingles. A case of TSS occurring in a diabetic male patient with foot blisters is presented. Early recognition by an infectious disease specialist and appropriate medical management led to complete recovery. There have been no reported cases of Staphylococcus aureus TSS originating in the foot to date.     

Treatment of mucous cysts of the toes

The outcome of surgically treated mucous cysts of the foot is poorly documented in the orthopaedic literature. This study reports on the treatment of mucous cysts of the toes by simple excision and joint debridement. This is in contrast to treatment of similar lesions in the fingers which is often treated by excision of the cyst, joint debridement, and rotational flap. Following this procedure on 15 patients (15 cysts), at a minimum of 2 years postoperatively, only one cyst had recurred at 9 months. All patients were satisfied by the cosmetic appearance of their toe. The authors reviewed the available literature on this condition and suggest that this method of treatment provides good functional and cosmetic results with a minimal rate of recurrence.