We have illustrated intraductal papillomas that have a variety of alterations not found in "ordinary" or typical papillomas. Many of these changes are indistinguishable from ductal carcinoma in situ. A priori, one might expect that patients with papillomas associated with changes identical to ductal carcinoma in situ would be at an increased risk for subsequent invasive carcinoma. We suspect that there is an increased risk based on the fact that seven of our 26 cases (27 percent) had fully diagnostic ductal carcinoma in situ or invasive carcinoma in the breast. However, the degree of increased risk has not been definitely established.
HCV infection occurs de novo in 10 percent of liver transplant recipients, reflecting transmission of the virus by the donor organ or blood transfusions. A much more common scenario, however, is recurrent allograft infection following liver transplantation for HCV-associated end-stage liver disease. Removal of the native liver in this clinical setting does not lead to eradication of infection. The virus persists in the blood and subsequently replicates under immunosuppression, resulting in a positive PCR test for HCV in most patients following transplantation. Clinically significant hepatitis develops in 44 percent of patients at the University of Pittsburgh, but the reported incidence worldwide varies from 32 to 100 percent. Most patients show mild to moderately active disease, but in our experience, approximately 10 percent of patients develop progressive liver damage evolving into cirrhosis. The 3-year graft survival at Pittsburgh after a mean follow up period of 20 +/- 14 months is 68 percent, which compares with 82 percent graft survival for patients transplanted for diseases other than HCV. The long-term consequences of allograft HCV infection are not yet completely defined, but HCV-associated cirrhosis remains a valid indication for liver transplantation.
Epithelioid hemangioendothelioma is an uncommon vascular tumor which, in most cases, pursues a clinical course intermediate between hemangioma and angiosarcoma. Only four completely documented cases of central nervous system involvement by this tumor appear in the literature. We present an additional case, which is remarkable in its occurrence at the site of a previously excised atypical meningioma and in its unusually aggressive clinical course. To our knowledge this is the first report of intracranial epithelioid hemangioendothelioma with postmortem documentation. The patient initially presented with a 7 cm right post frontal tumor; an atypical meningioma was excised and removal appeared complete on immediate post-operative scans. Seven months later the patient re-presented with tumor recurrence at the previous operative site; a second craniotomy was performed and, on this occasion, the excised tumor had the histological features of an epithelioid hemangioendothelioma without evidence of meningioma: both morphologically and immunohistochemically the two tumors were quite distinctive. Further recurrence prompted radiotherapy but the patient continued to deteriorate and died five months later. Massive recurrence of intracranial tumor was found at postmortem examination.
For almost 20 years, interest in endocrine tumors of the pancreas has been unflagging. In these tumors, the biologist has found a remarkable research model of the physiology of hormonal secretions. The clinician, armed with new methods of biologic diagnosis, has discovered that this pathology may be much more frequent than previously imagined (gastrinoma) and has acquired new therapeutic ammunition (somatostatin). To this model, the pathologist has added theories that go far beyond purely pancreatic and even digestive pathology. The radiologist, who has always encountered difficulties in exploring the pancreas, has forged new arms (intraoperative and endoscopic ultrasonography, functional methods of radioendocrinologic localization) specifically adapted to the detection problems presented by these tumors.
