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Cervical spondylosis may be the most common cause of arm pain in the elderly. Although patients describe this pain as "severe," they seem able to ease it by massaging the area, which is not the case with other painful rheumatoid conditions. Elevated serum uric acid in an arthritis patient is not always a sign of gout. A definite diagnosis of gout can be made only when urate crystals are found in the joint fluid.
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In seven patients with intracranial meningioma whose presenting signs and symptoms were ophthalmologic the underlying problem was initially misdiagnosed. Three patients had sphenoidal meningiomas with compression of the anterior visual pathways, but the initial diagnoses were acute optic neuritis, chronic optic neuritis and glaucoma. Two other patients had large frontal meningiomas causing in one case unilateral pain and swelling of the upper lid plus ptosis and hypotropia, and in the other case bilateral frontal morning headaches and intermittent blurring of vision in one eye; they were thought to have a frontal lobe osteoma and migraine respectively. A sixth patient had a large parietal meningioma causing unilateral papilledema in an eye with a corneal graft; the papilledema was not initially recognized because of severe astigmatism in that eye. The last patient had an occipital meningioma that had caused a fixed homonymous field defect and many years of "classic migraine".
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Some technical aspects of micturition cysto-urethrography, particularly important in the male infant, are emphasized. The catheter used for installation of the contrast medium must be removed before the examination. Unless films are exposed in the true lateral projection and the patient voids with a constant stream, abnormalities of the urethra may easily become overlooked.
A 39 year-old patient suffered bilateral painless visual loss while consuming abusively alcohol and cigarettes. Family history was remarkable for a similar episode in the patient's brother 21 years ago, while drinking and smoking heavily. A diagnosis of toxic optic neuropathy was made in another institution, but due to the positive family history, mitochondrial DNA was studied for a point mutations associated with Leber's hereditary optic neuropathy. A homoplasmic mutation at nucleotide 11778 was found. The patient's brother could not be studied. This case emphasizes the probable deleterious effects of epigenetic factors such as alcohol and cigarette smoke in patients harbouring mitochondrial DNA mutations associated with Leber's hereditary optic neuropathy and the need for mitochondrial DNA studies in atypical cases of optic neuropathy.
OBJECTIVE: To describe the neuropathologic findings in four cases of meningeal melanocytoma, a rare benign melanocytic tumor of the central nervous system. DESIGN: Retrospective analysis of surgical pathology and autopsy material. RESULTS: Grossly, all four tumors were well-circumscribed pigmented lesions, and three of four were attached to dura. Microscopically, the neoplasms were composed of spindle cells with epithelioid foci. Mitoses were not seen and only one case exhibited minimal necrosis. Immunohistochemistry and electron microscopy demonstrated the melanocytic nature of the lesions; all four cases showed S100 protein and neuron-specific enolase staining, and three cases exhibited melanoma-specific antigen staining. Immunostaining for epithelial markers and vimentin was uniformly negative. The single case in which electron microscopy was performed demonstrated premelanosomes. CONCLUSIONS: Meningeal melanocytoma is a benign pigmented neoplasm that can easily be confused with melanoma, especially on frozen section analysis. Practicing surgical pathologists should be aware of this entity.
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Irritable bowel syndrome and (or) non complicated diverticulosis, associated with fever, could simulate diverticulitis. Cancer of the sigmoid colon appears the main differential diagnosis, when diverticulitis is associated with an atypical or complete colonic stenosis on opaque enema, with a vesicoenteric fistula or with a peritonitis due to a colonic perforation. Even at laparotomy, a pseudotumoral diverticulitis cannot easily be differentiated from a colonic carcinoma. Acute diverticulitis of the caecum or ascending colon is usually mistaken for acute appendicitis. When massive and life-threatening bleeding occurs, the diverticular origin is difficult to assess. Bleeding due to peptic ulcer disease and thermometric ulceration being precluded, arteriography performed on emergency is necessary to differentiate between diverticular bleeding and angiodysplasia.
Clinical and imaging features of liver abscesses are not specific. Necrotic hepatic neoplasms, primary or secondary, can mimic abscesses, and vice versa. Thirty-eight patients who had cytologic confirmed abscesses were analyzed. There was clinical, radiologic and cytologic concurrence in 27 patients. In six cases the clinically suspicious lesion turned out to be inflammatory. The remaining five were malignant. There were four amebic and three tuberculous cases in this series. Cytologically, pyogenic abscesses contained a heavy, neutrophilic, inflammatory exudate with nuclear debris. By comparison, amebic cases contained more necrotic debris, with degenerating hepatocytes and fewer inflammatory cells. Acid-fast bacilli were identified in two tuberculous abscesses; however, only one contained caseous necrotic material and epithelioid cells. A potential pitfall in the cytologic diagnosis of a case of inflammatory pseudotumor is emphasized. The diagnosis of liver abscess should be established by clinical and imaging findings in conjunction with needle aspiration.
Recent reports of an association between tamoxifen treatment for breast cancer and endometrial pathology prompted a screening program for women receiving tamoxifen. Twenty-two women were examined; 15 were asymptomatic, and 7 were referred because of abnormal vaginal bleeding. All underwent vaginal ultrasonography followed by endometrial sampling. The sonographic studies showed endometrial abnormalities in all 22 women--typically, irregular thickening of the endometrium. Some had cystic formations, and three had fluid in the endometrial cavity. No pathology or inadequate material was found in the endometrial samples from the 15 asymptomatic women. Endometrial polyps were suspected sonographically and removed from two of the five women with vaginal bleeding. The discrepancy between the sonographic findings and histology in the asymptomatic women could have been due to stromal edema from tamoxifen treatment. Abnormal ultrasonographic findings in asymptomatic women treated with tamoxifen probably represent insignificant changes in the endometrial architecture and not a true abnormality. The need for routine endometrial sampling or hysteroscopy in every case is therefore questionable.
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Cutaneous lesions of the lower limbs are not always of venous origin. Only careful examination of the skin and of the leg can detect other causes. Such examination is important not only for understanding the pathophysiological origin but especially for treatment decision. Certain possible causes should be routinely sought such as arterial abnormalities and cutaneous vasculitis. Some ulcerations from the onset have an atypical appearance, such as necrotic angiodermatitis and pyoderma gangrenosum. Rarer causes (tumoural, haematologic, infectious or congenital) should be considered in case of resistance to usual treatments for severe venous insufficiency.
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Twelve cervical smears from nine women who had cervical cone biopsies performed at least six months preceding the smears contained atypical glandular cells that raised the possibility of adenocarcinoma in situ (AIS). However, these smears differed from those usually seen in AIS in that the abnormal cells were less frequent and part of a spectrum of more benign-appearing cells, some of which appeared to be endometrial. A separate review of cervical smears following 31 consecutive cone biopsies showed that 16 of 54 contained crowded glandular cells. However, in only one case were they suggestive of AIS. Alteration of the microscopic anatomy of the endocervix following cone biopsy may be responsible for the exfoliation of such cells.
Hepatic 'pseudotumours' are radiological abnormalities which give the appearance of tumour. They may be focal areas of disease such as fatty infiltration or areas of focal sparing in diffuse processes. We present four cases of hepatic 'pseudotumours' due to diffuse fatty infiltration with focal sparing and emphasise the need for further radiological assessment of focal lesions found on ultrasound scanning. Measurement of CT attenuation allows a confident diagnosis of fatty infiltration with focal sparing, thus preventing unnecessary investigation. Other forms of hepatic pseudotumour may require further investigation.
A surgically excised lesion from the breast of a 33 year old woman showed apart from cystic disease sclerosing adenosis with distinct myoid differentiation. The myoid bundles were wrapped around original ductules producing a misleading picture which simulated tangentially cut nerves, infiltrated by tumour glands. Immunohistochemically, actin positivity and S-100 protein negativity confirmed the nature of the lesion as sclerosing adenosis.