Stromal luteoma of the ovary: a clinicopathological analysis of 25 cases

The clinical and pathological features of 25 stromal luteomas were reviewed. The patients ranged in age from 28-74 (average 58.4) years. The most common initial manifestation (60%) was abnormal vaginal bleeding; three patients (12%) were virilized. The tumors, only one of which was bilateral, ranged from 0.25-2.9 (average 1.3) cm in greatest diameter. They were all well circumscribed. Microscopic examination revealed unencapsulated nodules composed of rounded polyhedral cells that were arranged either diffusely or in nests and cords. Twenty percent showed degeneration within aggregates of cell resulting in the formation of pseudoacinar structures. The cytoplasm of the neoplastic cells was generally eosinophilic and granular, and lipochrome granules were present in over half the tumors. In 92% of the cases hyperthecosis was present in the adjacent ovarian stroma. Follow-up of 6 months to 17 years was available for 19 patients. Sixteen of them were alive and free of disease; the remaining three died of other causes. The benign course in all the cases in which follow-up data were available was expected in view of the small size of the tumors and their benign microscopic appearance.     

Immunocytochemical localization of placental lactogen and chorionic gonadotropin in the normal placenta and trophoblastic tumors, with emphasis on intermediate trophoblast and the placental site trophoblastic tumor

This report presents preliminary observations on the immunocytochemical localization of human chorionic gonadotropin (hCG) and human placental lactogen (hPL) in placental site trophoblastic tumors, hydatidiform moles, and choriocarcinomas and compares the findings with those of a similar immunocytochemical analysis of the placenta at various stages of development. In addition to cytotrophoblast (CT) and syncytiotrophoblast (ST), a third form of trophoblast designated "intermediate trophoblast" (IT) is present during normal pregnancy and in trophoblastic disease. Intermediate trophoblastic cells are mononucleate, larger than CT, and contain more abundant eosinophilic cytoplasm, resulting in a partial resemblance to ST. Intermediate trophoblast has distinctive immunocytochemical features that distinguish it from CT and ST. The localization of hPL and hCG in both IT and ST varies with the age of the placenta, with the type of trophoblastic neoplasm, and from one specimen to another within each category of tumor. Syncytiotrophoblast may contain both hormones in large amounts, whereas IT contains hPL predominantly and hCG focally. Cytotrophoblast is devoid of hCG and hPL except in choriocarcinoma, which may show focal weak staining for hCG. Immunocytochemical identification of hCG and hPL has proved helpful in clarifying the histogenesis of trophoblastic neoplasms and may also be of value in establishing their diagnosis and in determining their prognosis.     

Correlation of ascitic fluid cytology with histologic findings before and after treatment of ovarian cancer

One hundred thirteen specimens of ascitic fluid from 97 patients with primary, persistent, or recurrent ovarian cancer were examined cytologically. Advanced stage of disease, involvement of the ovarian surface, a moderate or large volume of fluid, and nonbloody serous ascites were factors that correlated with a high rate of positive findings in ascites in these patients. Other factors influencing the positive rate appeared to be the invasive as opposed to borderline malignant histology of the tumor. Involved external surface and volume of ascites were influencing factors only in advanced cases. Therefore, the most important factor influencing the positive rate of ascites cytology was the proportion of cases in advanced stages to total cases.     

Prosthetic heart valves with silver-coated sewing cuff fabric: early morphological features in two patients

BACKGROUND: The current generation of prosthetic heart valves are excellent examples of engineering that work well, for long periods of time. Unfortunately, host-related problems and consequent valve failure continue to occur, including infective endocarditis. St Jude Medical Inc introduced a new model of mechanical heart valve prosthesis with silver-treated fabric to try to reduce the incidence of infective endocarditis. Two cases of failure of this prosthesis, with a clinical diagnosis of infective endocarditis, are presented. MATERIALS AND METHODS: Of the 176 St Jude Medical Silzone-coated prostheses implanted, two were explanted in the first half of 1998. The clinical status of the patients was reviewed, and a detailed gross, histological and stereomicroscopic examination of the prosthetic valves was undertaken. RESULTS: Clinically, both patients developed symptoms of infective endocarditis. The first patient developed features of a stroke and two months later underwent a second valve replacement. The prosthesis showed pannus and thrombus. A paravalvular leak was revealed in the second patient, who underwent a second valve replacement six months after the initial surgery. Blood and tissue cultures were negative in both cases. CONCLUSIONS: The new model St Jude Medical Silzone mechanical heart valve prosthesis, designed to prevent infective endocarditis, was associated with clinical features of endocarditis in these two cases. Significant pannus and thrombus were seen on both prostheses, which likely led to emboli and stroke in the first case. The cause of the paravalvular abscess in the second case has not yet been established. The early failure of these prostheses suggests that patients with this prosthesis be followed up carefully.     

Sweet's syndrome: recurrent oral ulceration,pyrexia, thrombophlebitis,and cutaneous lesions

We report a case of Sweet's syndrome with recurrent oral ulceration, pyrexia, skin lesions, and migratory thrombophlebitis, with no detectable systemic cause, during a 2-year follow-up. Biopsy examination both of oral lesions and the skin eruption showed a characteristic dense, perivascular, neutrophilic infiltrate in the lamina propria. Laboratory investigations confirmed an inflammatory syndrome with an increased erythrocyte sedimentation rate, but no underlying cause was found. Sweet's syndrome is a rare immunologically mediated condition that belongs to the group of neutrophilic dermatoses that must be differentiated particularly from Behcet's disease. It is characterized by red-brown plaques and nodules that are frequently painful and occur primarily on the head, neck, and upper extremities. Often the patients also have neutrophilia and fever and may have oral ulceration. In approximately 10% of patients with Sweet's syndrome, there is an associated malignancy--most commonly acute myelogenous leukemia--but some cases, as here, are unassociated with detectable malignant or other disease, although the syndrome may precede the onset of definable systemic disease.     

HIV topic update: oro-genital transmission of HIV

Several viruses, including the human immunodeficiency virus (HIV), can be found in blood and many body fluids including saliva, and are transmissible sexually across genital and particularly anal mucosae. A persisting concern has been the question of transmission of HIV by oral sexual practices. This review discusses the evidence for oro-genital transmission of HIV, detailing the presence and infectivity of HIV in genital fluids and saliva, the case reports and epidemiology of oro-genital HIV transmission, and the evidence from animal studies. Oral intercourse is not risk-free. The evidence suggests that the risk of HIV transmission from oro-genital sexual practices is substantially lower than that from penile-vaginal or penile-anal intercourse, that exposure to saliva presents a considerably lower risk than exposure to semen, and that oral trauma and ulcerative conditions might increase the risk of HIV transmission.     

Griseofulvin in the treatment of oral lichen planus: adverse drug reactions, but little beneficial effect.

An open trial was conducted of systemic griseofulvin in the treatment of oral lichen planus. Eleven patients completed the trial. Symptomatic benefit was noted in 21% of the twenty-three patients starting the trial, but there was no clinical improvement, and about one half of the group starting the trial suffered adverse drug reactions.     

Oral manifestation of Rett's syndrome.

Severe dental attrition has several causes but may be the result of bruxism in neurological or psychological disturbances. Rett's syndrome is an uncommon but increasingly recognised neurological disorder, characterised by acquired microcephaly, progressive dementia, bruxism, and loss of purposeful movements of the hands. A patient with Rett's syndrome who demonstrated masseteric hypertrophy, bruxism, and severe attrition is reported.