Diagnostic reproducibility of hydatidiform moles: ancillary techniques (p57 immunohistochemistry and molecular genotyping) improve morphologic diagnosis

Distinction of hydatidiform moles (HMs) from nonmolar specimens (NMs) and subclassification of HMs as complete hydatidiform moles (CHMs) and partial hydatidiform moles (PHMs) are important for clinical practice and investigational studies; yet, diagnosis based solely on morphology is affected by interobserver variability. Molecular genotyping can distinguish these entities by discerning androgenetic diploidy, diandric triploidy, and biparental diploidy to diagnose CHMs, PHMs, and NMs, respectively. Eighty genotyped cases (27 CHMs, 27 PHMs, and 26 NMs) were selected from a series of 200 potentially molar specimens previously diagnosed using p57 immunostaining and genotyping. Cases were classified by 3 gynecologic pathologists on the basis of H&E slides (masked to p57 immunostaining and genotyping results) into 1 of 3 categories (CHM, PHM, or NM) during 2 diagnostic rounds; a third round incorporating p57 immunostaining results was also conducted. Consensus diagnoses (those rendered by 2 of 3 pathologists) were determined. Genotyping results were used as the gold standard for assessing diagnostic performance. Sensitivity of a diagnosis of CHM ranged from 59% to 100% for individual pathologists and from 70% to 81% by consensus; specificity ranged from 91% to 96% for individuals and from 94% to 98% by consensus. Sensitivity of a diagnosis of PHM ranged from 56% to 93% for individual pathologists and from 70% to 78% by consensus; specificity ranged from 58% to 92% for individuals and from 74% to 85% by consensus. The percentage of correct classification of all cases by morphology ranged from 55% to 75% for individual pathologists and from 70% to 75% by consensus. The κ values for interobserver agreement ranged from 0.59 to 0.73 (moderate to good) for a diagnosis of CHM, from 0.15 to 0.43 (poor to moderate) for PHM, and from 0.13 to 0.42 (poor to moderate) for NM. The κ values for intraobserver agreement ranged from 0.44 to 0.67 (moderate to good). Addition of the p57 immunostain improved sensitivity of a diagnosis of CHM to a range of 93% to 96% for individual pathologists and 96% by consensus; specificity was improved from a range of 96% to 98% for individual pathologists and 96% by consensus; there was no substantial impact on diagnosis of PHMs and NMs. Interobserver agreement for interpretation of the p57 immunostain was 0.96 (almost perfect). Even with morphologic assessment by gynecologic pathologists and p57 immunohistochemistry, 20% to 30% of cases will be misclassified, and, in particular, distinction of PHMs and NMs will remain problematic.     

Report of two cases

Two patients underwent thoracotomy for resection of pulmonary or esophageal carcinoma. Postoperatively, epidural catheters were inserted for pain management. Complaints of severe injection pain over the abdomen or lower extremities were made during one administration of pain medication. Progressive weakness and numbness developed over the lower trunk and lower extremities, with subsequent respiratory difficulties. Potassium chloride (KCl) was suspected to have been mistaken for normal saline as the diluent for morphine. In addition to endotracheal intubation and ventilatory support, steroids were administered both intravenously and epidurally to suppress spinal cord irritation. The two patients regained motor and sensory functions 14 and 18 hours later, respectively, without sequelae.     

Multicentric liposarcoma: Report of two cases

We present herein two unusual cases of multicentric liposarcoma which highlight the problems associated with the management of this disease entity. When the surgeon is confronted with multicentric liposarcomas, it is necessary to define whether they are secondary tumors or independently arising multicentric liposarcomas, since the latter situation merits a more aggressive approach. Guidelines for this differentiation are suggested in the discussion following the case reports. Surgery, which is often multiple, remains the mainstay of treatment, although adjuvant chemotherapy and radiotherapy are also usually required.     

Mesenteric thrombosis-operation-recovery: Report of two cases

Two cases of mesenteric thrombosis are reported. The most outstanding clinical feature was the severity of the abdominal pain. Vomiting was of secondary importance in the symptomatology, thereby reversing the usual picture of small intestinal obstruction. Recovery followed resection of 9 feet of ileum in one patient and $\text{4}\text{1}\text{2}$ feet in the other.     

Postpartum appendicitis: Report of two cases

The literature of postpartum appendicitis is reviewed and two cases occurring in the early puerperium are presented.The outstanding features of these cases are discussed in relation to the differential diagnosis of some of the common complications of the early postpartum period, namely, pyelitis, early puerperal sepsis and salpingitis.It is suggested that the cathartic given to both patients shortly before their onset of symptoms may have been an etiological factor.The treatment recommended is surgery as soon as the diagnosis is made.     

Intratesticular varicocele: Report of two cases

Intratesticular varicocele is a rare entity and describes dilated intratesticular veins radiating from the mediastinum testis into the testicular parenchyma. Scrotal ultrasonography of two patients who presented to our urology clinic due to left scrotal pain revealed multiple tubular structures in the testes with diameters of more than 2 mm. Duplex spectral analysis showed a reversed flow response to Valsalva's maneuver. Apropos of two cases, intratesticular varicocele is reviewed.     

Sellar tuberculoma: Report of two cases

Summary Hypophyseal tuberculomas are exceptionally rare. We report two patients with sellar tuberculoma but with no evidence of concurrent extrasellar disease. Although the lesion is often mistaken for adenoma, there are characteristic radiological features: intense enhancement on contrast CT and thickening of the pituitary stalk on MRI in 86% of cases. Accurate diagnosis is important because pituitary tuberculoma is curable.     

Lymphocytic adenohypophysitis: Report of two cases

Two women with lymphocytic adenohypophysitis not related to pregnancy are reported on. In obtaining a differential diagnosis of lymphocytic adenohypophysitis preoperatively, it is useful to note swelling of the anterior hypophyseal tissue and the existence of a posterior pituitary lobe on sagittal sections of magnetic resonance imaging scans. Hypofunction of the anterior hypophyseal gland is more severe in lymphocytic adenohypophysitis than in pituitary adenomas. Marked adhesion of fibrotic pituitary capsule to the dura is a characteristic observation during surgery for lymphocytic adenohypophysitis.     

逆行尿路造影在现代影像学中对肾盂输尿管连接部梗阻的诊断价值(附55例报告)

目的：对比分析逆行尿路造影与其他影像学方法对肾盂输尿管连接部梗阻（UPJO）的诊断，评价逆行尿路造影在现代影像学方法中对该疾病的诊断价值。方法：回顾分析55例UPJO患者的临床资料。结果：B超检查48例，确诊15例，所有病例皆提示不同程度肾积水，未能做出病因诊断。静脉肾盂造影检查42例，20例确诊，8例做出病因诊断。逆行尿路造影检查28例，皆获确诊，25例做出病因诊断。MRU检查7例，皆获确诊，5例做出病因诊断。结论：逆行尿路造影确诊率高且有良好的病因诊断，但仍有其不足之处，检查对象应针对其他诊断方法未能诊断者和成人，可在手术前检查为手术提供指导。MRU检查对UPJ0诊断效果好，在某些方面具有逆行尿路造影无可替代的优势。B超仅做为初步筛选和随访检查。静脉肾盂造影对肾积水和梗阻段病变严重的UPJO未能显示出临床诊断价值。     

The value and limitations of the CT scan in the diagnosis of giant intracranial aneurysms (two cases)

Summary Two cases of giant cerebral aneurysms, the diagnosis of which was made by angiography after a dubious CT scan, are reported.     

A new cause for iatrogenic lesion of the ulnar nerve at the arm: contraceptive hormonal implant. Report of two cases

The authors describe two cases of iatrogenic lesions of the ulnar nerve at the arm level after insertion of contraceptive hormonal implants. The presence of only a thin subcutaneous fat layer on the medial side of the arm in slim women, exposes the ulnar nerve to danger during the insertion or withdrawal of the implant. We therefore advise the insertion of such implants on the medial side of the thigh in slim women. We equally recommend that withdrawal of non-tangible devices implanted on the medial side of the arm or in case of neurologic symptoms, even transitory, be done by a trained microsurgeon.     

The role of MR imaging in the diagnosis and treatment of anterior sacral meningocele. Report of two cases

Anterior sacral meningoceles are rare. This report describes familial anterior sacral meningoceles in a father and daughter who underwent magnetic resonance imaging as part of the preoperative evaluation. Magnetic resonance imaging showed a pelvic teratoma in the daughter and confirmed the absence of abnormal tissue in the father--findings not clearly provided by ultrasound studies, myelography, or contrast-enhanced computerized tomography. It is believed that MR imaging is the most useful preoperative diagnostic technique available in establishing a treatment plan for anterior sacral meningocele.     

Early carcinoma in the periampullary region: Report of two cases

Two cases of early carcinoma in the periampullary region detected microscopically are reported. In Case 1, the carcinoma was found in part of an adenomatous polyp resected transduodenally. In Case 2, carcinoma was located within 1 cm from the main pancreatic duct hidden in the surrounding inflammatory tissue of the pancreatic head excised by radical pancreatoduodenectomy. Case 1 survived more than 3 years after the operation and Case 2 more than 5 years without any evidence of recurrence. The practical significance of such early carcinoma is discussed.     

Gastric ulcers in the premature newborn: Report of two cases

The incidence of gastric ulcer is noted. Two cases of premature newborn infants having perforated gastric ulcers are reported, one with a perforation and a congenital partial obstruction of the ileocecal valve, the other with two perforations, the second occurring between operation and death. Both mothers were free from syphilis, although one was a chronic cardionephritic. The births were without trauma, one spontaneous, the other cesarean. One baby had delayed respiration. Neither child had any apparent infection. No stool from either showed melena. One child never vomited, the other's vomitus contained no blood. One ulcer was definitely hemorrhagic but the primary cause of the gastric lesions was not determined.     

Heterotopic gastric mucosa in the gallbladder: Report of two cases

This report presents two cases of heterotopic gastric mucosa in the gallbladder. In case 1, the patient was a 43-year-old man who presented with diarrhea and fever. Abdominal ultrasonography showed a sessile polypoid lesion in the body of the gallbladder that grew over 2 months. Gallbladder carcinoma was suspected and a cholecystectomy was performed. Examination of an intraoperative frozen specimen of the elevated lesion in the body of the gallbladder suggested a gallbladder carcinoma invading the subserosal layer. A bile duct resection and regional lymph node dissection were performed. However, the postoperative permanent sections revealed heterotopic gastric mucosa in the gallbladder. Case 2 was an 80-year-old man. Screening abdominal ultrasonography revealed a sessile polypoid lesion in the gallbladder. This lesion was correctly diagnosed as heterotopic gastric mucosa in the gallbladder by the intraoperative frozen examination. The pertinent literature on this topic is reviewed.     

Mesenteric cystic neoformations: Report of two cases

(Received for publication on Apr. 28, 1997; accepted on May 15, 1998)