Cardiac ruptures in northern Norway. A retrospective study of 104 cases

In 4,649 autopsies performed, in 1972-1985, 824 cases of acute myocardial infarction were found. Of these, 104 (12.6%) had cardiac rupture. Ten cases had rupture of the interventricular septum. The clinical and pathological records were reviewed, and the rupture group was compared with a control group of 100 patients who died from acute myocardial infarction without rupture. Of the patients with rupture, 85% died during the first week after the onset of myocardial infarction; three patients with rupture died suddenly without previous clinical evidence of myocardial infarction. Rupture occurred only in hearts with transmural infarcts, and predominantly in the anteroseptal wall. Patients with rupture had significantly higher blood pressure, fewer previous infarcts, higher frequency of coronary thrombi, less myocardial scar tissue and lower heart weight compared to the control group. There were no significant differences regarding age and sex distribution, physical effort at the symptom debut or death, medication, previous and present diseases other than infarcts, complications or the degree of atherosclerosis in the coronary arteries or aorta.     

Onychomycosis among children. A retrospective study of 233 Mexican cases

BACKGROUND: Worldwide recent reports point towards a rising prevalence ofonychomycosis in the pediatric population, especially among adolescents. Dermatophytes are the most common etiologic agents. MATERIAL AND METHODS: We carried out a retrospective review of the last 12 years, comprising 332 medical records from children with clinical suspicion of onychomycosis. We analyzed the following variables: gender, age, predisposing factors, affected nails, other concurrent superficial mycoses and potassium hydroxide direct examination and culture. RESULTS: A total of 233 onychomycosis cases were identified, cases constituted 33% of superficial mycoses of children seen at our unit. Two thirds were adolescents with no significant difference among the sexes. Toenails were more affected (94%) than fingernails (4.2%) with distal and lateral subungueal onychomycosis being the most common clinical presentation. In 70% of cases infection was caused by dermatophytes (mainly Trichophyton rubrum). CONCLUSIONS: Onychomycosis constitute 33% of superficial mycoses among children seen at our medical facility. We confirm a rise in prevalence, toenails were the most common (94%) and had a dermatophytic etiology (70%). We suggest to all physicians caring for children and adolescents, to become familiar with diagnostic and therapeutic tools for this type of mycosis.     

Pure acute monocytic leukemia. A study of 12 cases.

Twelve cases of pure acute monocytic leukemia in adults were studied. They were selected on the basis of the morphology of the blast cells on Romanowsky-stained smears of blood and bone marrow, as well as positivity of the cells for the naphthol ASD acetate esterase reaction specifically inhibited by sodium fluoride. There was no sex predominance. Neoplastic involvement of the skin and/or gingiva was very frequent. The leukemic proliferation in blood and bone marrow consisted of monoblasts, promonocytes and monocytes. The peroxidase reaction was negative or only faintly positive. Serum and urinary lysozyme levels were increased. The blast cells retained their ability to stimulate, in vitro, colony formation by normal bone marrow cells used as targets. All of these characteristics permit specific identification of this type of acute leukemia. The prognosis is grim: only five of 12 patients achieved complete remission, and four of these five had relapses in less than 14 months; the median survival was five months.     

Haemophilus influenzae and parainfluenzae in children. A retrospective study of 52 cases

Fifty-two children hospitalized in the Pediatric service of a general hospital between January 1978 and December 1979 were found to be infected with Haemophilus influenzae or para-influenzae (43 with H. influenzae and 9 with para-influenzae). Most of these children (34/52) were less than 4 years of age. The localizations of infections were as follow: 5 meningitis with satisfactory resolution except for 1 who developed slight deafness, 1 epiglotitis, 11 pneumonias or bronchopneumonias, 1 arthritis, 10 otitis medias, 6 conjunctivitis, 3 sinusitis, 10 upper airway infections and 1 neonatal infection. On 8 of these cases the patients were felt to be carriers of H. influenzae or para-influenzae, the signs and symptoms beeing not related to these bacteria. These results are compared with those found in the literature.     

Thymic tumours in Denmark. A retrospective study of 213 cases from 1970-1993.

Histological slides of 213 thymic tumours were reviewed twice and classified according to Kirchner and Müller-Hermelink into 122 thymomas (syn. organotypic thymic epithelial tumours (TET)), 58 thymic carcinomas (syn. non-organotypic TET) and 16 lymphomas. Tumour heterogeneity (i.e. features of two subtypes in one tumour) appeared in 38% of the organotypic TET. The overall diagnostic correspondence between the reviews of the 122 organotypic TET was 48%. By reducing the five diagnostic groups to three: organotypic TET benign (medullary and mixed thymomas), organotypic TET low-grade (organoid and cortical thymomas and well-differentiated thymic carcinoma (WDTC)) and non-organotypic TET (usually high-grade thymic carcinomas), and minimising the effect of tumour heterogeneity in this way, the diagnostic correspondence increased to 82%. Correlating histological type with stage, we found that 80% of medullary and 87% of mixed thymomas were stage I, that 85% of cortical and 81% of WDTC were stage II or III, and that non-organotypic TET were stage II or III (86%) or stage IV (14%), respectively. It is suggested to report on the heterogeneity of a given case of thymic epithelial tumour in the pathology reports and give the approximate percentage of each component, telling the clinician which component may determine the prognosis.     

Granulomatous myositis. Clinicopathologic study of 12 cases.

Granulomatous inflammation is infrequently encountered in skeletal muscle biopsy material. Of 2,985 muscle biopsy specimens reviewed over 12 years, 12 (0.4%) with granulomatous inflammation were identified. The patients included 9 women who ranged in age from 24 to 76 years (mean 50.3 years). The most common clinical findings included decreased strength or weakness in the extremities (n = 8), muscle pain (n = 5), and weight loss (n = 3). All muscles exhibited nonnecrotizing granulomas; an associated vasculitic process was identified in 2. Endomysial chronic inflammation consisting primarily of lymphocytes and plasma cells was present in 10 muscles, and perivascular chronic inflammation in 8. Degenerating muscle fibers were noted in 10 cases, and regenerating fibers in 11. Evidence of neurogenic atrophy was seen in 8 muscles. Increased endomysial fibrosis was observed in 5 muscles, and type II muscle fiber atrophy in 5 muscles. Stains for acid-fast bacilli and Gomori methenamine silver stain were performed in all but 2 cases and failed to demonstrate organisms. In 3 cases, concomitant sural nerve biopsies were performed, and granulomas were identified in 2 of those cases. Clinicopathologic diagnoses included sarcoidosis (n = 6), vasculitis (n = 2), and granulomatous myositis not otherwise specified (n = 2). In 2 cases, there was insufficient clinical information or follow-up data to determine a cause. In conclusion, granulomatous myositis is infrequently found in muscle biopsy specimens (0.5% of all biopsies in this series); most muscles demonstrate evidence of chronic endomysial or perivascular inflammation accompanied by muscle fiber degeneration and regeneration; and the most common cause for granulomatous myositis was sarcoidosis in this series.     

功能静止型嗜铬细胞瘤29例临床分析简

 目的 回顾性分析29例功能静止型嗜铬细胞瘤的临床资料，以提高其诊治水平。 方法 分析2010年5月至2013年5月在北京协和医院接受手术并经病理证实的功能静止型嗜铬细胞瘤患者29例，总结患者年龄、肿瘤部位、肿瘤最大径、手术方式、术中血压变化、尿儿茶酚胺以及术前核医学检查等方面的临床特点。结果 患者血压正常，尿儿茶酚胺正常或稍高，肿瘤位于双侧肾上腺1例，右侧肾上腺13例，左侧肾上腺15例，直径1.5~14cm。腹腔镜手术切除25例，开放手术切除4例。23例术前接受药物准备，术中血压平稳，6例术前未行药物准备，其中2例术中出现血压剧烈波动。23例术前行生长抑素受体显像的患者中，有11例未见异常；11例术前行131IMIBG显像，1例未见异常。结论 对于功能静止型嗜铬细胞瘤，尿儿茶酚胺及生长抑素受体显像敏感性较低，对于CT表现可疑的，建议术前行131IMIBG显像，一旦确诊，应该在充分药物准备的基础上接受手术治疗。     

Acinic cell carcinoma of the salivary glands: a retrospective clinicopathologic study of 12 cases

Acinic cell carcinoma (ACC) is the third most common epithelial malignancy of the salivary glands in adults, with a low-grade malignancy that mainly occurs in the parotid gland and at a relatively younger age than other salivary gland tumors. We made a retrospective study on our acinic cell carcinoma casuistry aiming their clinico-pathological characterization and comparison with literature data. From 2000 through 2011 in our hospital were diagnosed only 12 cases of ACC. The clinico-epidemiological study revealed prevalence of these tumors in women, in the fourth decade of life and especially occurring in the parotid gland. The most common morphologic pattern of these tumors was a mixture of two or more variants with the solid/lobular and microcystic patterns more frequent associated. In 75% of investigated cases, the pTNM stage was I/II, with no cases of perineural or vascular invasion, but with lymph node dissemination presented in only three cases. Summing all these clinicopathological features, we conclude that for our casuistry the biological behavior of these tumors has been of low-grade malignancy.     

Usefulness of immunohistochemistry in delineating renal spindle cell tumours. A retrospective study of 31 cases

AIMS: To assess the usefulness of immunohistochemistry in delineating tumour diagnoses on a series of morphologically diagnosed renal spindle cell tumours (RSCTs). METHODS AND RESULTS: Formalin-fixed paraffin-embedded tissues from 31 morphologically diagnosed tumours were reinterpreted in light of newly obtained immunohistochemical information. By morphology, six had originally been classified as sarcomatoid carcinoma, five as spindle cell tumour (NOS), four as sarcoma (NOS), three as leiomyoma, three as leiomyosarcoma, and one each as fibrous polyp, hamartoma, neurilemmoma, mesoblastic nephroma, medullary fibroma, angiomyolipoma, haemangiopericytoma, malignant rhabdoid tumour, malignant Triton tumour, and carcinosarcoma. The application of immunohistochemistry verified the original diagnosis in 18 cases (18/31, 58%), confirming the diagnosis of sarcomatoid renal carcinoma (4/6), leiomyoma (2/3), leiomyosarcoma (3/3), sarcoma (NOS) (2/4), carcinosarcoma (1/1), malignant rhabdoid tumour (1/1), malignant Triton tumour (1/1), fibrous polyp (1/1), mesoblastic nephroma (1/1), hamartoma (1/1), and angiomyolipoma (1/1). Different tumour designations were suggested in 13 cases (13/31, 42%), including carcinosarcoma, sarcoma (NOS), leiomyosarcoma, solitary fibrous tumour, monomorphic/biphasic angiomyolipoma, endometrial stromal tumour, and congenital mesoblastic nephroma. CONCLUSIONS: Our data indicate that although morphology is most important in formulating the initial differential diagnosis, the addition of immunohistochemistry is vital in arriving at the correct classification of RSCTs.     

Prognostic factors in squamous cell carcinoma of the oral cavity. A retrospective study of 80 cases.

A multiparameter analysis of 80 squamous cell carcinomas of the oral cavity was performed to determine the relative prognostic weight of the location of the tumor, tumor size (T), microscopic grade (G) and DNA content measured by means of flow cytometry. Tumors of the lip have an invariably favourable outcome, while at the other locations they have high rates of mortality (total 5 years of survival less than 35%). A simple statistical analysis was performed using the concepts of death sensitivity (DS), death specificity (DSp), life sensitivity (LS) and life specificity (LSp): the best measure of unfavourable outcome was represented by G3 (DS = 0.69; DSp = 1) and by DNA aneuploidy (DS = 0.76; DSp = 0.45), while the best measure of favourable outcome was represented by G1 (LS = 0.53; LSp = 0.96), T1 (LS = 0.81; LSp = 0.78) and by DNA diploidy of the tumor cells (LS = 0.45; LSp = 0.86). A survival analysis using a step by step regression model according to Cox was carried out in order to evaluate more precisely the relative importance of prognostic factors: traditional prognostic factors (histological grade = G and tumor size = T) showed a strong statistical significance, while DNA content added some additional prognostic information only if associated to the macroscopic features of the tumor.