1011/2496. Pulmonary hyalinizing granuloma. Twenty patients with pulmonary nodules consisting of concentric hyaline lamellae, usually accompanied by perivascular collections of plasma cells and lymphocytes, were studied. In most instances, the lesions were multiple, bilateral, and mildly symptomatic. Many of these nodules showed all of the staining characteristics of amyloid, but others had an atypical birefringence pattern. No infectious agents were identified, and no consistent pattern of dysproteinemia was observed. Two of the patients had prior histories of tuberculosis. In other cases, the nodules were of unknown origin and pathogenesis. Four cases were complicated by sclerosing mediastinitis, and one, by retroperitoneal fibrosis and amyloidosis. Our current working hypothesis is that these lesions represent an exaggerated and, possibly, continuing immune response, perhaps to one of a number of agents. ( info) |
1012/2496. Masquerade of eyelid tumours. Space-occupying processes in the eyelids can either be due to lesions which are specific for the eyelids, such as a chalazion or a meibomian carcinoma, or to non-specific lesions of the skin or ocular adnexa. An incorrect interpretation on clinical or histological grounds is often made; in other words, some eyelid processes masquerade as others. The correct diagnosis should be made on the basis of case history, localisation, the appearance of the tumour and the histological findings, so that adequate treatment can be given. One must be aware of the danger of mistaking one space-occupying process for another. In the Leiden Ophthalmological Clinic a study was made of the incidence of eyelid tumours in the period 1981-1987, with special attention to the most important masquerade phenomena observed. In a group of 956 eyelid tumours histological examination was necessary in 126 cases. Basal-cell carcinoma was the most frequent diagnosis, but other less common tumours such as a trichilemmoma, an eosinophilic granuloma, a haemangio-endothelioma, a metastasis from a mammary carcinoma and a granuloma annulare were also diagnosed. ( info) |
1013/2496. The forgotten cause of sicca complex; sarcoidosis. sarcoidosis is a chronic systemic disease of unknown cause with prominent symptoms from the respiratory system. It can occasionally affect the exocrine glands presenting with xerophthalmia and xerostomia similar to sjogren's syndrome. We present 5 such patients who visited our rheumatology clinic complaining of dry eyes and mouth. Investigation for xerophthalmia and xerostomia showed positive rose bengal tests in all patients, positive Schirmer's I tests in 4 and decreased parotid flow rate in 3. Minor salivary gland biopsy showed noncaseating granulomas compatible with sarcoidosis in 3. In the other 2 patients the diagnosis was obtained with transbronchial lung biopsy that revealed noncaseating granulomas. Transbronchial lung biopsy also showed granulomas in 2 patients with positive minor salivary gland biopsy. Our results suggest that sarcoidosis can present with initial symptoms of dry eyes and dry mouth. When this happens, transbronchial and minor salivary gland biopsy are very valuable in differentiating sarcoidosis from sjogren's syndrome. ( info) |
1014/2496. Generalized sarcoidlike granulomas with systemic angiitis, crescentic glomerulonephritis, and pulmonary hemorrhage. Report of an autopsy case. A 19-year-old woman showed rapidly progressive renal and respiratory failure and died after a short clinical course. The autopsy revealed that death was due to crescentic glomerulonephritis and pulmonary hemorrhage. The intrathoracic lymph nodes, lungs, kidneys, and other organs contained numerous epithelioid granulomas, some of which had foci of central coagulative necrosis. The aorta, its major branches, and small- to medium-sized vessels of various organs also had multiple areas of granulomatous angiitis. This is, to our knowledge, the first report of such autopsy findings. A discussion of the etiopathogenesis of the disease is presented. ( info) |
| dapsone has been suggested as a useful drug in the treatment of granuloma annulare; however, adverse reactions include a potentially life-threatening agranulocytosis. We report the case of a 50-year-old woman in whom agranulocytosis and septicemia developed after 7 weeks of therapy with dapsone for granuloma annulare. Full recovery followed cessation of this drug, but caution is advised in prescribing dapsone for relatively benign skin conditions. ( info) |
1016/2496. Rheumatoid papules: lesions showing features of vasculitis and palisading granuloma. Whether palisading granuloma formation occurs with leukocytoclastic vasculitis in rheumatoid nodules and in histopathologically similar conditions is debatable. patients with high titers for rheumatoid factor and severe erosive rheumatoid arthritis are at risk for both rheumatoid vasculitis and rheumatoid nodules. A patient with all of these features developed a papular eruption. These papules showed clinicopathologic features both of leukocytoclastic vasculitis and of early palisading granuloma. Lesions resolved slowly with low-dose oral corticosteroid therapy. It is proposed that these lesions be called rheumatoid papules and that they may represent a link between vasculitis and the palisaded granulomatous reaction seen in rheumatoid nodules. ( info) |
1017/2496. Granulomatous angiitis masquerading as a mass lesion. magnetic resonance imaging and stereotactic biopsy findings in a patient with occult Hodgkin's disease. Granulomatous angiitis is a frequently fatal central nervous system vasculitis of unknown pathogenesis sporadically associated with Hodgkin's disease, mixed cellularity type. We describe a 58-year-old woman presenting with headaches, progressive spastic paraparesis, equivocal computed tomography findings, and magnetic resonance imaging findings of increased signal intensity biparietally on T2-weighted imaging in a relatively discrete pattern. magnetic resonance imaging-directed serial stereotactic biopsies revealed granulomatous angiitis throughout the right parieto-occipital region and splenium. Simultaneous biopsy of an enlarged submandibular mass revealed Hodgkin's disease, lymphocyte-predominant type. This case shows that granulomatous angiitis may be associated with magnetic resonance imaging findings suggesting a mass lesion in lymphocyte-predominant as well as mixed cellularity Hodgkin's disease. ( info) |
1018/2496. Plasma-cell granuloma of the gingiva. A case of plasma-cell granuloma of the attached gingiva has been presented. The lesion was pedunculated and, clinically, resembled a traumatic fibroma. The microscopic picture was that of plasma-cell granuloma. serum electrophoresis and radiographs were normal. A diagnosis of plasma-cell granuloma confirms a benign lesion of the oral cavity which must not be confused with the plasmacytoma, a possible precursor to multiple myeloma. This case emphasized the need for biopsy of lesions in order to establish a diagnosis. Only by biopsy and histologic study can rare lesions be diagnosed and their incidence studied. ( info) |
| This case report describes the occurrence of a lesion of granuloma annulare in the buccal mucosa. This skin condition occurs rarely on the mucous membranes and has not been previously described in the oral cavity. It was initially seen as a raised, firm lesion with a 1-month history in a 31-year-old patient with acquired immune deficiency. ( info) |
1020/2496. Cowden disease in a young girl: gynecologic and immunologic overview in a case and in the literature. There is an increased risk of cancer (mainly breast cancer) in patients with Cowden disease. Little is known of the etiopathogenic mechanisms of this condition, but immunologic abnormalities may be evoked. A young patient with Cowden disease was submitted for gynecologic examination and immunologic investigations. Although no neoplastic disorder had appeared, laboratory investigations disclosed abnormalities of the humoral and cellular immune compartments in the peripheral blood. This rare observation of gynecologic involvement in a very young girl with family antecedents of Cowden disease prompted a review of the gynecologic features and etiopathogenic bases of Cowden disease. The possible role of neoplasia such as breast cancer in this syndrome makes early diagnosis a criterion for good prognosis. ( info) |