Poorly differentiated Sertoli-Leydig tumor with heterologous, high-grade, sarcomatoid features: A case report.

•Treatment of sex-cord stromal tumors with carboplatin and taxane is both feasible and safe.•FOXL2 mutations account for approximately 50% of these tumors.•Carboplatin and taxane may afford a favorable outcome.

Malignant peritoneal mesothelioma without asbestos exposure: An ovarian cancer imitator.

•Malignant peritoneal mesothelioma is a rare aggressive tumor with approximately 400 new cases annually in the US.•In optimal cytoreduction HIPEC is the standard treatment.•In suboptimal cytoreduction IV cisplatin and pemetrexed have high efficacy.

Primary intraplacental gestational choriocarcinoma: histologic and genetic analyses.

Gestational choriocarcinoma is a highly malignant form of gestational trophoblastic tumors. Placental involvement of the tumor is exceedingly rare. We describe a case of intraplacental choriocarcinoma in a full-term placenta.

Malignant melanoma arising in mature cystic teratoma of the ovary.

► Teratomas are composed of elements of all three germ layers, all potentially capable of undergoing malignant transformation. ► A case of malignant melanoma arising in a mature teratoma is presented.

Impact of clinical and histologic correlates of maternal and fetal inflammatory response on gestational age in preterm births.

Objective: To evaluate the impact of clinical and histopathologic correlates related to maternal and fetal inflammatory responses (MIR and FIR) on degree of preterm birth.

Methods: Pathology reports and clinical data from 577 singleton preterm births (<37 weeks of gestation) that took place between 1998 and 2004 were analyzed according to decreasing gestational age (>or=33 weeks, 29-32 weeks, and <29 weeks). MIR was defined by presence of subchorionitis, chorioamnionitis, deciduitis, or free membranitis; FIR was defined by presence of funisitis or chorionic plate vasculitis.

Placental calcium pump: clinical-based evidence.

Placenta can be considered as a pump of calcium necessary for the normal development of the fetus. We believe that the location of this pump is in the placental basement membrane. The calcification of this membrane has been described only in cases of in utero fetal death.

Vaginal hyperpigmentation due to ochronosis.

Background: Ochronosis is a manifestation of alkaptonuria, a rare metabolic disorder. It results in the accumulation of pigment in connective tissues. After several years, ochronosis may produce a distinctive form of degenerative arthritis.

Barking up the wrong tree? Use of polymerase chain reaction to diagnose syphilitic aortitis.

The presentation of syphilitic aortitis is often atypical and available serological tests are non-specific. The diagnostic gold standard remains direct identification of microorganisms in tissue. We present a case of syphilitic aortitis that presented as a mediastinal mass and report the use of polymerase chain reaction for Treponema pallidum to diagnose syphilitic aortic disease.

Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent.

Background: Infliximab is a humanized antibody against tumor necrosis factor alpha (TNF-alpha) that is used in the treatment of Crohn's disease and rheumatoid arthritis. Approximately 147,000 patients throughout the world have received infliximab. Excess TNF-alpha in association with tuberculosis may cause weight loss and night sweats, yet in animal models it has a protective role in the host response to tuberculosis.

Symptomatic arteriovenous malformation of Bartholin's gland. A case report.

Background: Arteriovenous malformations are composed of large, tortuous arteries and misshapen, veinlike structures. They are extremely uncommon in the genital tract.

Case: An arteriovenous malformation in a Bartholin gland presented as intermittent vaginal bleeding in a 43-year-old woman.

What criteria reliably distinguish melanoma from benign melanocytic lesions?

The differential diagnosis of melanocytic lesions is fraught with difficulty and a common source of litigation either if a lesion misreported as 'benign' recurs locally or re-presents with nodal metastases or if an atypical naevus is called 'malignant' leading to a cosmetically unsatisfactory wider resection, unwarranted anxiety about prognosis and adverse life insurance prospects. Several authors have claimed that there are valid morphological criteria which, alone or in combination, enable reliable distinction between benign and malignant melanocytic lesions. Others question these criteria and, doubting the extent to which unequivocal diagnoses can be rendered in all cases, believe that the diagnosis is purely subjective and that most diagnostic errors are non-negligent.

TNP-470 inhibits intraabdominal adhesion formation.

Background/purpose: Angiogenesis plays an integral role in wound healing and tissue remodeling. The authors hypothesized that inhibition of angiogenesis would reduce intraabdominal adhesion formation.

Methods: In 98 C57BL6/J mice, a 2-cm midline laparotomy was performed and a 5 mm2 SILASTIC (Dow Corning, Midland, MI) patch fixed to the right side of the peritoneum.

Papillary fibroelastoma: increasing recognition of a surgical disease.

Papillary fibroelastomas are uncommon benign tumors usually involving the heart valves, which historically have been diagnosed at autopsy. With the advent of echocardiography, however, the number of patients diagnosed in life has increased. Papillary fibroelastomas represent a surgically treatable cause of cerebrovascular and cardiovascular ischemia and infarction making their identification clinically important.

Cathepsin B activity and protein levels in thyroid carcinoma, Graves' disease, and multinodular goiters.

Cathepsin B (CB) is involved in the hydrolysis of thyroglobulin (Tg) and thought to be regulated by thyroid stimulating hormone (TSH) in the normal thyroid. Our analyses of 91 thyroid tissues from 71 patients with Graves' disease (GD), multinodular goiter (MNG), papillary carcinoma (PC), or follicular carcinoma (FC), demonstrated a 2-fold increase in expression of CB in GD and an average increase of 1.5-fold in MNG (varying from 10-fold below normal to 6-fold above normal in MNG nodules), as might be predicted by the altered functional status of thyroid follicular cells in those diseases.

Telangiectatic osteosarcoma of the skull base.

We present a patient with a distinctive lesion of the skull base, which, at imaging, showed expansile destruction of the sphenoid bone, hemorrhage with fluid-fluid levels, and contrast enhancement of a solid portion. These features ordinarily suggest either giant cell tumor or aneurysmal bone cyst; however, pathologic examination confirmed instead a rare variant of osteosarcoma of the telangiectatic type. Although imaging findings can indicate any of these possibilities, biopsy is an essential step in arriving at the diagnosis.

Usual interstitial pneumonitis responsive to corticosteroids following varicella pneumonia.

Varicella pneumonia usually resolves after treatment, and occasionally miliary calcification develops on the roentgenogram of the chest years afterward. A case of varicella pneumonia is presented that followed a previously unreported course. In this case, usual interstitial pneumonitis (UIP) developed.

Right-sided high origin of diaphragm associated with accessory lobe of liver, lobulated right atrial appendage, and ipsilateral phrenic nerve hamartoma: a case report.

A case of a rare condition of congenital right anterior high origin of the diaphragm in a stillborn fetus is reported. Associated findings at autopsy were a hornlike subdiaphragmatic intrathoracic accessory lobe of the liver and a lobulated right atrial appendage of the heart. At the superiormost aspect of the malpositioned right anterior diaphragmatic leaf a small phrenic nerve hamartoma was found.

Comparison of topoisomerase II alpha and MIB-1 expression in uterine cervical squamous lesions.

The aim of this study was to assess the role of MIB-1 in the classification of cervical squamous lesions and to compare it with a novel proliferation marker, topoisomerase II alpha (TP II alpha). We classified 46 archival uterine cervical cases into 6 groups: normal (n = 3); human papillomavirus (n = 15); mild (n = 10), moderate (n = 7), and severe (n = 6) cervical intra-epithelial neoplasia; and invasive carcinoma (n = 5). The formalin-fixed, paraffin-embedded tissue sections were stained with monoclonal antibodies to Ki-67 (MIB-1) and TP II alpha with a standard streptavidin immunohistochemical technique, with antigen retrieval to assess enzyme presence.

Adenocarcinoma of the ileum with an enterotubal fistula presenting as an adnexal mass.

Small bowel adenocarcinomas account for 3% of gastrointestinal malignancies, and 20 to 25% of these arise in the ileum. Clinical presentation is variable, and early diagnosis is difficult. A 56-year-old postmenopausal woman presented with crampy abdominal pain, anorexia, and weight loss.

Septic shock, adult respiratory distress syndrome, and disseminated intravascular coagulopathy following midtrimester genetic amniocentesis.

Background: Midtrimester genetic amniocentesis is a commonly performed procedure, with acknowledgment of some risk to mother and fetus.

Case: We present an unusual case of midtrimester genetic amniocentesis with bowel injury and resulting septic shock, adult respiratory distress syndrome, and disseminated intravascular coagulation. A total abdominal hysterectomy and bilateral salpingoophorectomy were required for resolution of sepsis.