Papillary carcinoma in wall of simple renal cyst

The second case of microscopic focal papillary carcinoma discovered in the wall ofsimple serous renal cyst, which showed negative results on cytologic examination, is presented. This lesion would have remained undiagnosed except for surgery. A modification of the accepted classification of coexistent renal tumor and cyst is proposed on the basis of histologic findings.     

Challenges in the Management of the HIV Patient in the Third Decade of AIDS

The epidemic of AIDS has been increasingly recognized as a major health and socioeconomic problem, not only in the United States or Africa, but also the rest of the world. The face of the epidemic has changed. The role that mental health providers play has also significantly grown as the epidemic continues on. Prior to the introduction of Highly Active Anti-Retroviral Therapy (HAART) and other advances in HIV care, the patients faced issues that related to death and dying. These advances brought with them renewed hope and resurrected lives. The patients fought with issues related to living new lives with HIV no longer an imminent death threat. In the third decade of AIDS, the struggles of the post-HAART era continue but bring with it more challenges. Mental health providers need to familiarize themselves with these issues so that they can better help HIV patients cope with this devastating disease.     

Focal cytomegaly of the adult adrenal cortex. A rare variant of black adenoma

A pigmented adrenocortical nodule was found incidentally in an adrenal gland resected for endocrine manipulation of breast carcinoma. The sharply circumscribed, nonencapsulated nodule was composed of cells with diameters as large as 95 micron. The cells had ample eosinophilic cytoplasm and contained much lipofuscin pigment. Electron microscopy disclosed tubulovesicular mitochondria, lipofuscin pigment, cytoplasmic vacuolization, and lipid without degenerative changes or intranuclear inclusions. This unusual lesion of adult adrenal glands is best considered as a rare variant of adrenocortical black adenoma.     

Nephrogenic adenoma of the urinary bladder and urethra

The histologic and ultrastructural features of nephrogenic adenomas of the urinary bladder and urethra were studied in multiple specimens obtained from eight patients. Three of these were studied by indirect immunofluorescence for Tamm-Horsfall uromucoprotein. The lesions are uncommon benign metaplastic proliferations of urothelium, occurring most frequently in males as small cystic, papillary, or nodular masses and most often presenting with hematuria. Typically the metaplastic tubules resemble nephronic tubules. A florid atypical and pseudoinfiltrative proliferation of these tubules may lead to an erroneous diagnosis of adenocarcinoma. Ultrastructural features of proximal convoluted tubules were identified in some of the tubules, but resemblance to specific segments of distal tubules was less certain. The ultrastructural features combined with the absence of Tamm-Horsfall protein in tubular lumina or cells suggest a mesonephric rather than metanephric homology. The lesions are appropriately treated by transurethral resection or fulguration, but persistent lesions were present in three patients up to 18 years after initial treatment.