Congenitally corrected transposition of the great arteries: Morphologic study of 32 cases

The detailed anatomy of the heart is described in 32 autopsy cases of congenitally corrected transposition of the great arteries. This condition is defined as the combination of atrioventricular (A-V) discordance and transposition of the great arteries. Examples of primitive (single) ventricle with “inverted” (that is, left-sided in situs solitus) outlet chamber are excluded. Six hearts with A-V discordance and pulmonary atresia are described in an appendix. In 29 cases of corrected transposition the heart was in situs solitus; in 3 it was in situs inversus totalis. Only 5 of these 32 hearts had no potential for intracardiac shunting. Anomalies of the tricuspid valve (91 percent of cases), ventricular septal defect (78 percent) and pulmonary outflow tract obstruction (44 percent) occurred with sufficient frequency to be considered part of the basic malformation and are described in detail. The precise anatomy and disposition of the A-V valve tension apparatus, the coronary arteries and the conducting tissues are described with special reference to possible surgical approaches for repair of the anomalies. In two hearts with situs solitus the aortic valve was right-sided with respect to the pulmonary valve. This finding is important for both diagnosis and nomenclature.     

The Light and Electron Microscopic Features of Early and Late Phase Radiation-Induced Proctitis

The light and electron microscopic features of rectal biopsies from 10 symptomatic patients treated with irradiation for pelvic malignancies are detailed. They are divided into two groups. Group I: biopsies taken during or shortly after the course of irradiation (six patients). Group II: biopsies taken 4 months or more after course completion (four patients). The distinguishing light microscopic features in the first group are epithelial meganucleosis, lack of mitotic activity, and patchy fibroblastic proliferation in the lamina propria. The blood vessels appear normal. In the second group, there are severe vascular changes characterized by narrowing of the arterioles by subintimal fibrosis, telangiectasia of capillaries and post-capillary venules, endothelial degeneration, and platelet thrombi formation. These vascular changes are always associated with severe fibrosis of the lamina propria and crypt distortion. The ultrastructural and light microscopic findings indicate that the cellular epithelial reaction and fibroblastic proliferation antedate the vascular injury, and the latter has no role in the acute phase reaction.     

Adrenocorticotropic hormone‐producing thymic neuroendocrine carcinoma with oncocytic features: A case report and review of literature

Thymic neuroendocrine carcinomas are the most common mediastinal neuroendocrine tumor. These malignancies are not often diagnosed by fine‐needle aspiration (FNA), as they are more commonly diagnosed by biopsy or excision. We describe a case of a FNA of a paratracheal mass from a 38‐year‐old man who presented with Cushing syndrome. A low‐grade neuroendocrine carcinoma with oncocytic features was diagnosed, which was later confirmed by excision of the thymus, anterior mediastinal and paratracheal soft tissue, and lymph nodes. Oncocytic features in these tumors are a rare finding and bring metastatic medullary thyroid carcinomas as well as other metastases into the differential diagnosis. The prognosis of neuroendocrine carcinomas in this location is worse than neuroendocrine carcinomas in other areas, and close follow‐up is recommended. Diagn. Cytopathol. 2015;43:329–334. © 2014 Wiley Periodicals, Inc.