BACKGROUND:Bacillary angiomatosis (BA) is a localized infectious process that affects primarily patients with the acquired immunodeficiency syndrome. The microorganisms implicated in the pathogenesis of this disease belong to the Rickettsiaceae family.CASE:A 43-year-old, human immunodeficiency syndrome-positive male presented with diffuse swelling in the right deltoid area. A neoplastic process was considered in the differential diagnosis. Fine needle aspiration biopsy showed proliferation of blood vessels lined with plump endothelial cells, and the interstitial space was occupied by neutrophilic infiltrate, leukocytoclastic debris and clumps of characteristic amphophilic, granular material. Warthin-Starry stain demonstrated clusters of bacilli diagnostic of bacillary angiomatosis.CONCLUSION:The diagnosis of this entity, made by fine needle aspiration cytology (as the only diagnostic procedure), was instrumental in preventing further surgical manipulation and in initiating appropriate and immediate antibiotic therapy.

An automated, fluid-based method for the preparation of cervical Papanicolaou smears/slides was compared to the conventional Papanicolaou smear (CPS) method used for the screening of neoplasia. We determined diagnostic agreement and sources of error for diagnostic disagreement. For 665 patients, one cervical sample was collected to make one CPS. The collection devices, a wooden Ayre spatula and endocervical brush, were rinsed into a vial with fluid medium to be processed in the automated device. All slides were distributed among five cytotechnologists in a blind fashion. Exact diagnostic agreement was 94.6%. The results were not statistically significant (P > or = .70, McNemar's test) but were clinically important, as evidenced by the detection of low grade lesions (LGL), during initial screening, on three slides prepared by the automated device but not on their matched-pair CPSs (0.5% of all specimens). After reevaluation, the three matched CPSs demonstrated LGL. Sources of diagnostic error on the CPSs were: air-drying artifact, obscuring blood/inflammation, crowding/overlapping of cells and/or absence of diagnostic cells. The only source of error in the automated-method smears was absence of diagnostic cells.

A unique case of parapharyngeal meningioma identified on a tomographic scan and diagnosed preoperatively by fine needle aspiration (FNA) cytology is reported. The FNA smear showed the spindle-shaped cells in concentric whorls and scattered psammoma bodies that are characteristic of meningioma. The FNA diagnosis was subsequently confirmed on the excised specimen. The preoperative cytologic diagnosis was very helpful in planning the surgical removal of the tumor by a team of otolaryngologists and neurosurgeons.

A case of endometrioid carcinoma of the fallopian tube is reported with histologic description and clinical follow-up of four years. Only two other cases have been documented previously. This case is thought to be unique as the carcinoma arose in a benign endometrioid tumor. Inferences concerning Mullerian duct expression and neoplasia are reviewed.

A 72-year-old man presented with several months of increasing lumbar pain, sciatica, lower extremity weakness, numbness in his buttocks and posterior thighs, burning sensations in his scrotum, and urinary incontinence. Myelogram-computed tomography scan demonstrated a high grade incomplete block at the T12-L1 level due to bilateral synovial cysts and simultaneously a high grade partial block at L4-L5 due to spinal stenosis. Laminectomy of the T-12 vertebra and partial laminectomy of the L-1 vertebra with excision of both synovial cysts and laminectomies of the L-4 and L-5 vertebrae with foraminotomies resulted in a reversal of the patient's symptomatology.

An adenocarcinoma of Bartholin's gland was diagnosed by a smear of a swollen lesion of the left vulva, with confirmation on the subsequent surgical specimen. This appears to be the second such case in which the diagnosis was established by cytologic examination of the smear. This rare tumor should be considered in patients presenting with vulvar swellings; cytologic examination can be useful in its early diagnosis, as demonstrated by this case.

A symptomatic pelvic-abdominal mass in a 29 year old female was found to be bilateral ovarian serous cystadenomata of borderline malignancy. In addition, a thickened region of the omentum was removed and proved to be endometriosis. Endometriosis of the omentum is rarely reported and this case may mark a unique association with ovarian serous cystadenoma of borderline malignancy. The possible origins of omental endometriosis include metastasis and metaplasia. Omental endometriosis is rare and should be included in the differential diagnosis of omental tumors.

During the last three years, bronchial washings from patients in whomPneumocystis cariniipneumonia was clinically suspected were cytologically examined. These were predominantly cases of suspected or confirmed acquired immunodeficiency syndrome. To determine the effectiveness of cytologic diagnosis by means of a bronchial wash, retrospective analysis of bronchial washings with available simultaneous transbronchial biopsy specimens was carried out in 181 cases. Comparison of the results of both methods revealed an excellent correlation.Pneumocystis cariniiwas identified in 108 specimens of washes and in 103 specimens of biopsies. Our data indicate thatP cariniican be consistently and reliably identified in the smears from bronchial washes, without lung tissue biopsy, thus sparing the patient the latter procedure if contraindications exist. (JAMA1985;254:1950-1951)

The clinical presentation and histopathology of three cases of papillary metaplasia of the endometrium are reported. This lesion is usually found with unopposed estrogen stimulation. Two of these patients were perimenopausal, and one was postmenopausal. In two of these patients chronic endometritis was found. Papillary metaplasia of the endometrium is infrequently cited and must be recognized as a benign entity.

Two cases of mixed tumors or pleomorphic adenomata of the vulva are reported with histologic description and clinical follow-up of 2 and 5 years. Only five other cases have been documented previously in the literature: four benign and one malignant. This rare tumor must be considered in the differential diagnosis of a solid vulvar tumor.

Two cases of mixed tumors or pleomorphic adenomata of the vulva are reported with histologic description and clinical follow-up of 2 and 5 years. Only five other cases have been documented previously in the literature: four benign and one malignant. This rare tumor must be considered in the differential diagnosis of a solid vulvar tumor.

Anal warts (condylomata acuminata) from seven homosexual men revealed intraepithelial carcinoma (carcinomain situ) within the condylomatous tissue or in adjacent anal mucosa. All lesions displayed morphologic evidence of papillomavirus infection and two of the seven revealed histologic changes characteristic of herpes simplex infection. This association of viral infection with malignant transformation indicates that persistent or recurrent anal warts should be excised and thoroughly examined by histologic techniques. Since four of the seven patients had histories suspicious for or diagnostic of the acquired immunodeficiency syndrome (AIDS), we further suggest that homosexual men with persistent or recurrent perianal lesons be evaluated for the presence of the syndrome.

42 homosexual or bisexual men with persistent generalised lymphadenopathy not attributable to an identifiable cause have been followed longitudinally since February, 1981. Lymphadenopathy was accompanied by fatigue, low-grade fever and/or night sweats (57%), splenomegaly (29%), leucopenia (40%), hypergamma-globulinaemia (76%), and diminished proportion and absolute numbers of helper T cells (95%). Of the 26 patients who had lymph node biopsy, all showed benign reactive hyperplasia. After 15-30 (median 22) months, 8 patients have met criteria for the diagnosis of acquired immunodeficiency syndrome (AIDS). This outcome was associated with previous heavy nitrite inhalant use, with the presence of night sweats, with leucopenia, and with the triad of constitutional symptoms, splenomegaly, and leucopenia. In addition, a lower mean absolute helper T cell count and an increased frequency of anergy to mumps intradermal antigen and of herpes simplex virus isolation distinguished these patients from those remaining in the cohort, who seem to be stable and in some cases to have improved.

Clinical and microscopic pathologic findings at second look surgery for ovarian neoplasm were evaluated in 31 patients to assess the changes induced by chemotherapy and to evaluate prognostic signs. Significant microscopic changes were found in one-third of cases including nuclear hyperchromasia, and decreased differentiation. Minimal changes in inflammatory response were noted as well as a suggestion of an effect on clot organization. Differences between clinical and microscopic response were marked. Good clinical response was generally associated with minimal or absent tumor found at the second look.

Female adnexal tumor of probable wolffian origin is a rare and usually benign, solid neoplasm of the broad ligament. Two cases with good clinical outcome are described and the microscopic features which identify this entity are cited.

A poorly differentiated adenocarcinoma of the human oviduct was studied by light and transmission electron microscopy. Cells contained abundant mitochondria, bound and free ribosomes, prominent Golgi's bodies and aggregates of membrane-bound dense bodies. The small glandular lumina with numerous microvilli were generally devoid of cilia and contained secretory material. The neoplasm was ultrastructurally similar to poorly differentiated ovarian serous carcinomas.

A case of clear cell adenocarcinoma of endometrium was studied by means of light and electron microscopy, and was compared with gestational Arias-Stella cells, as well as with progestin-treated hyperplastic endometrium. The clear appearance of the cytoplasm of the neoplastic cells was due to supra-nuclear pools of glycogen, associated with prominent membranes of granular endoplasmic reticulum. Although Arias-Stella cells did not contain similar ultrastructural features, progestin-treated hyperplastic endometrial cells contained evidence of an increased glycoprotein synthesis. The cytoplasmic organization of the neoplastic endometrial clear cell neoplasms was similar to that previously reported in the ovary, vagina, and cervix, supporting the concept of a common Müllerian, rather than mesonephric, origin for these histologically similar, but spatially separated, neoplasms.