Central Calcification Research Articles

A huge retroperitoneal solitary fibrous tumor

Solitary fibrous tumors (SFTs) are infrequent fibrous neoplasms that arise most commonly in the thoracic cavity. Although initially described as arising from the pleura, SFTs have been reported at a wide range of anatomic sites. Owing to their rarity, accurate diagnosis of SFTs remains a challenge for clinicians. A 38-year-old man presented complaining of difficulty in defecation and a progressive perineal mass. A computed tomography scan revealed a huge pelvic mass characteristic of central necrosis and calcification with a severely compressed adjacent rectum. Magnetic resonance imaging demonstrated a well-delineated mass with a maximal diameter of 15 cm. During surgery, an encapsulated tumor was excised via simultaneous abdominal and perineal approaches because of its huge size. SFT should be kept in mind for differential diagnosis of retroperitoneal tumors.

CT diagnosis of a large peritoneal loose body: a case report and review of the literature

We report a case of a large peritoneal loose body (LPLB), diagnosed on CT. The loose body appeared as a round pelvic mass with central calcifications and a distinct fat plane separating it from adjacent organs. The mass changed its location from the left to the right side of the pelvis within 9 days on repeat imaging. The typical cross-sectional characteristics of a LPLB include a mobile well-circumscribed soft-tissue mass usually with coarse central calcifications. The accurate diagnosis of a LPLB is vital to prevent unnecessary surgical intervention in an asymptomatic patient with an incidentally discovered LPLB.

Liver mass with central calcification

A previously healthy 29-year-old woman of Spanish origin presented with a 1-month history of right upper quadrant pain associated with fever and night sweats. The physical examination demonstrated a temperature of 38.5°C, a normal blood pressure, a normal heart rate, and mild right upper quadrant tenderness with no peritoneal signs. Laboratory tests showed a slightly raised white blood cell count of 12,000/mm3 with a normal differential count and a C-reactive protein level of 230 mg/L. Liver function tests were normal. The abdominal computed tomography (CT) scan showed a hypodense lesion in the right hepatic lobe with a central calcified deposit (Fig. 1). The blood culture and serological tests for hydatidosis and amebiasis were negative. A definite diagnosis was made by a positive polymerase chain reaction test for Brucella melitensis in the abscess fluid (the abscess fluid culture was negative). The patient was initially managed by CT-guided percutaneous drainage and a combination of doxycycline (100 mg/day by mouth) and rifampin (600 mg/day by mouth). A laparoscopic liver exploration was subsequently performed to improve drainage and to remove the calcified deposit (Fig. 2). The patient responded well to treatment with 8 weeks of oral antibiotics. Contrast-enhanced CT assessment. Laparoscopic exploration showing the abscess cavity with a calcified deposit (arrow) between the right liver lobe and the abdominal wall. CT, computed tomography. Brucellosis is a zoonosis caused by Brucella, a genus of gram-negative coccobacillary microorganisms. It occurs worldwide, but major endemic areas include countries of the Mediterranean basin (including Spain, to which the patient had been frequently traveling), the Arabian Gulf, the Indian subcontinent, and parts of Central and South America. Humans can acquire brucellosis by the ingestion of infected food (especially unpasteurized milk), by direct contact with an infected animal (sheep, cattle, or pigs), or by aerosols.1 In humans, brucellosis is a chronic granulomatous infection that is associated with nonspecific, mild clinical symptoms such as fever, fatigue, night sweats, anorexia, and weight loss. It is, therefore, difficult to diagnose, and screening for Brucella should be performed in the case of fever of unknown origin. Almost every organ and system can be affected, but osteoarticular complications are the most common, with peripheral arthritis, sacroiliitis, and spondylitis occurring.2 Laboratory studies are nonspecific in patients with brucellosis, and white blood cell counts are usually normal to low. Although the presence of some degree of hepatitis is frequent, the development of a liver abscess (brucelloma) is rare and occurs in only approximately 1% of patients with brucellosis.3 It most commonly represents a chronic form of the disease that has remained latent. The typical CT scan pattern of liver brucelloma is a rounded or ovoid hypodense area with central calcification5 and is similar to the pattern found in this case. Confirmation of the diagnosis of brucellosis can be achieved by various techniques, including blood cultures, serological tests, and real-time polymerase chain reaction with blood or pus.4 The classic treatment for brucellosis is based on doxycycline and rifampin. In the case of liver abscess, surgery is most often required because the risk of recurrence after conservative management is at least 50%.3 After surgery, which can be performed laparoscopically (as in the present case), a patient's chance of being cured is extremely good.

A Double-Orifice, Severely Stenotic Aortic Valve: Is Leaflet Perforation or Extensive Central Calcification With Near Fusion the Culprit?

AN 83-YEAR-OLD, 71-kg, 168-cm man was admitted to the authors' medical center for the evaluation of progressive chest tightness, dyspnea on exertion, and dizziness of 6 months' duration. His past medical history was notable for essential hypertension; type 2 diabetes mellitus; and hyperlipidemia for which he was treated with hydrochlorothiazide, oral hypoglycemic drugs, and simvastatin, respectively. A harsh, grade III to IV of VI systolic murmur was heard throughout the precordium, but the remainder of the physical examination was noncontributory. Transesophageal echocardiography was performed as part of the evaluation and revealed the presence of a very heavily calcified, trileaflet aortic valve (Fig 1). Continuous-wave Doppler interrogation indicated that the peak and mean gradients across the valve were 68 and 44 mmHg, respectively (Fig 2), which is consistent with the diagnosis of severe aortic stenosis. The aortic valve area was estimated as 0.72 cm2 using the continuity equation. A midesophageal aortic valve long-axis color Doppler image indicated 2 distinct routes of aortic blood flow through the stenotic valve during systole (Fig 3 and Video 1 [supplementary videos are available online]) and diastole (Fig 4). What is the cause of this dual pattern of aortic blood flow? Is a leaflet perforation responsible for these findings? Fig 2Continuous-wave Doppler echocardiographic velocity-time waveforms obtained from the deep transgastric imaging plane showing peak and mean gradients across the aortic valve of 68 and 44 mmHg, respectively. View Large Image Figure Viewer Download Hi-res image Fig 3A midesophageal aortic valve long-axis color Doppler image obtained during mid–left ventricular systole showing blood flow through a central zone between the aortic valve leaflets and a second region adjacent to the posterior annulus. View Large Image Figure Viewer Download Hi-res image Fig 4A midesophageal aortic valve long-axis color Doppler image obtained during left ventricular diastole showing 2 small jets of aortic regurgitation from a central zone and adjacent to the posterior annulus (trace). View Large Image Figure Viewer Download Hi-res image

Florid Lobular Intraepithelial Neoplasia with Signet Ring Cells, Central Necrosis and Calcifications: A Clinicopathological and Immunohistochemical Analysis of Ten Cases Associated with Invasive Lobular Carcinoma

In its most florid form, classic lobular intraepithelial neoplasia (LIN) proliferates to form a solid mass of tumor cells that fill and expand the duct within the terminal duct lobular unit lumen. Foci such as these can develop central necrosis and calcifications, detectable on mammograms. The immunohistochemical expression of E-cadherin has been found to be absent in all reported examples of LIN with necrosis. The occurrence of LIN composed entirely of signet ring cells with central necrosis is extraordinarily rare. We described 10 of these cases to illustrate this uncommon morphologic pattern of LIN. The cases were encountered during routine clinical practice of the authors over a 5-year period at the Oncology Hospital of the Mexican Social Security Institute in Mexico City. Cases were comprised of several (>6) foci of LIN with signet ring cells as well as with comedo-type necrosis. Age of patients ranged from 45-75 years (mean age: 51.2 years). The indications for biopsy were calcifications (n = 7) and mass (n = 3) on mammograms. Luminal necrosis was seen in all ten cases and calcifications in seven cases. Eight cases had associated invasive carcinoma, including six lobular carcinomas and one composite carcinoma (lobular and ductal). All cases showed a lack of E-cadherin membrane staining and a diffuse cytoplasmic immunoreactivity for high molecular weight keratin, positivity for estrogen receptors and progesterone receptors was present in 9/10 and 8/10 of cases, respectively. LIN composed entirely of signet ring cells can develop macro-acini, central necrosis and calcifications. These cases are frequently associated with invasive lobular carcinoma at the time of initial presentation.

Serous microcystic adenoma of the pancreatic head: Report of two cases and review of the literature

Serous microcystic adenomas (SMAs), also known as glycogen-rich cystadenomas, are uncommon exocrine tumors mainly involved in the body and tail of the pancreas. In this study, we report two SMA cases of the pancreatic head. In case 1, a 47-year-old woman was referred to our hospital for abdominal bloating and back pain; in case 2, a pancreatic space-occupying lesion was incidentally discovered in an asymptomatic 71-year-old female during an ultrasound. In both cases, a computer tomography scan showed well-demarcated and multilocular cysts in the head of the pancreas, and a central scar and calcifications were noted in case 1. During the exploratory laparotomies, the multiple cystic masses were found in the pancreatic head. A segmental resection of the pancreas and pancreatic jejunal anastomosis were performed. Histologically, the tumors were composed of tiny cysts that were filled with clear fluid and lined by a single layer of cuboidal cells with round, centrally located nuclei and clear cytoplasm, without cellular atypia. Immunohistochemical studies showed that the neoplastic cells were positive for cytokeratin 7 and vimentin but negative for synaptophysin and cytokeratin 20. A postoperative follow-up indicated no recurrence in the patients. We reviewed the literature regarding the etiology, clinical presentation, imaging characteristics, features and management of this lesion.

Bony sequestrum: a radiologic review

According to a pathological definition, a bony sequestrum is defined as a piece of devitalized bone that has been separated from the surrounding bone during the process of necrosis. However, the radiological definition of a sequestrum is different and refers to an image of calcification visible within a lucent lesion, completely separated from the surrounding bone, without referring to the vascular status and histological nature of the calcified tissue. The term "button sequestrum" has been used in calvarial lesions. The prototype conditions that may present with a bony sequestrum are osteomyelitis and skeletal tuberculosis. Other conditions such as radiation necrosis, eosinophilic granuloma, metastatic carcinoma, primary lymphoma of bone, aggressive fibrous tumors may also manifest as osteolytic lesions containing a sequestrum. In addition, some primary bone tumors produce a matrix that may mineralize and sometimes simulate a bone sequestrum. These include osteoid tumors (osteoid osteoma, osteoblastoma), cartilaginous tumors (chondroma and chondroblastoma), lipomatous tumors (lipoma), and benign fibrous tumors (fibromyxoma, myxoma, and desmoplastic fibroma). Therefore, various conditions may present at imaging as a small area of osteolysis containing central calcifications. However, a careful analysis of the sequestrum as well as the associated clinical and radiological findings often enables to point toward a limited number of conditions.

Osteoid osteoma and osteoid osteoma-mimicking lesions: biopsy findings, distinctive MDCT features and treatment by radiofrequency ablation

To report the biopsy findings of osteoid osteoma (OO) and OO-mimicking lesions, assess their distinctive multidetector computed tomography (MDCT) features and evaluate treatment by radiofrequency ablation (RFA). In this multicentric retrospective study, 80 patients (54 male, 26 female, mean age 24.1years, range 5-48) with presumed (clinical and MDCT features) OO were treated by percutaneous RFA between May 2002 and June 2009. Per-procedural biopsies were always performed. The following MDCT features were assessed: skeletal distribution and location within the bone, size, central calcification, surrounding osteosclerosis and periosteal reaction. Clinical success of RFA was evaluated. Histopathological diagnoses were: 54 inconclusive biopsies, 16 OO, 10 OO-mimicking lesions (5 chronic osteomyelitis, 3 chondroblastoma, 1 eosinophilic granuloma, 1 fibrous dysplasia). OO-mimicking lesions were significantly greater in size (p = 0.001) and presented non-significant trends towards medullary location (p = 0.246), moderate surrounding osteosclerosis (p = 0.189) and less periosteal reaction (p = 0.197), compared with OO. Primary success for ablation of OO-mimicking lesions was 100% at 1month, 85.7% at 6 and 12months, and 66.7% at 24months. Secondary success was 100%. Larger size, medullary location, less surrounding osteosclerosis and periosteal reaction on MDCT may help differentiate OO-mimicking lesions from OO. OO-mimicking lesions are safely and successfully treated by RFA.

Osteoid Osteoma Invading the Posterior Labyrinth of the Petrous Bone

We report a painless osteoid osteoma of the inner ear in an elderly woman presenting with hearing loss, tinnitus, and vertigo. CT showed a heterogeneous mass containing calcifications involving the posterior labyrinth, which heterogeneously enhanced on postcontrast MR images. Osteoid osteoma should be included in the differential diagnosis of an osteolytic petrous bone lesion with central calcification and enhancement.

Solitary synovial osteochondroma

Solitary synovial osteochondroma (SSO) is a rare variant of extraskeletal osteochondroma. The aim of this study was to review 5 cases of SSO, including clinical, radiographic, and histopathologic features. Five cases of SSO were retrieved from our files. Histopathologic and radiographic findings were reviewed, and a clinicopathologic correlation was performed. Patients' ages ranged from 33 to 63 years. Knee mass was the most common presentation. All cases were well circumscribed and had multiple cartilaginous lobules surrounded by fibroadipose tissue. Microscopically, lobulated adult-type hyaline cartilage with central calcification was noted. Cytologic atypia was present in one case, but malignant features were absent. Two cases were suggestive of chondrosarcoma on imaging studies. Patients underwent surgery, which was curative in cases for which follow-up was available. In conclusion, SSO is a rare lesion that may mimic low-grade chondrosarcoma at times. Correct recognition of SSO depends on radiographic and clinicopathologic analysis.

Calcific Myonecrosis of the Antetibial Area

Calcific myonecrosis is a rare late post-traumatic condition, in which a single muscle is replaced by a fusiform mass with central liquefaction and peripheral calcification. Compartment syndrome is suggested to be the underlying cause. The resulting mass may expand with time due to recurrent intralesional hemorrhage into the chronic calcified mass. A diagnosis may be difficult due to the long time between the original trauma and the symptoms of calcific myonecrosis. We encountered a 53-year-old male patient diagnosed with calcific myonecrosis in the lower leg. We report the case with a review of the relevant literature.

The Spectrum of Ossifying Fibroma

An ossifying fibroma is a monostotic lesion that occurs in craniofacial bones.  It usually presents as a painless well-circumscribed, slow-growing mass in the 3rd and 4th decade.  It is a benign fibro-osseous lesion that is part of the bigger spectrum of fibro-osseous lesions which includes fibrous dysplasia, juvenile active ossifying fibroma, psammomatous ossifying fibroma, and extragnathic ossifying fibroma of the skull.    An ossifying fibroma, because of its well-circumscribed nature, lends itself to surgery better than does fibrous dysplasia.  Simple enucleation is usually sufficient for ossifying fibromas whereas curettage is probably better suited for fibrous dysplasia.    Radiographically, it is seen as a well-demarcated radiolucency in the mandible or maxilla, more common in the former than the latter.  It typically measures anywhere from 1 to 5 cm.  There may or may not be a central opacity or calcification, depending on the maturity of the lesion.  An immature lesion may present as completely radiolucent whereas a mature lesion may be completely radiopaque, although most lesions demonstrate varying degrees of radiopacity.  The images above show 2 samples of the same lesion on opposite sides of the spectrum.  Both are well-circumscribed but one is relatively radiolucent while the other is floridly sclerotic.   Is there a pathognomonic finding on x-ray?  Unfortunately, there is not one single finding that will distinguish an ossifying fibroma from other fibro-osseous lesion.  Does it matter?  Yes.  X-rays will lead the clinician to one diagnosis or the other and help plan the intended surgery.        

Solid-pseudopapillary neoplasm of the pancreas with massive central calcification in an old man

Solid-pseudopapillary neoplasm (SPN) is a rare pancreatic tumor primarily affecting women in their twenties. It is characterized by a well-demarcated or encapsulated mass, indolent behavior and favorable prognosis. Capsular or punctate calcification is occasionally observed. Reported herein is a case of SPN of the pancreas with massive calcification in a 76-year-old Japanese man. Macroscopically, the pancreatic tumor appeared to be a simple calcified nodule, but histological examination revealed that it was an epithelioid tumor with massive calcification. The tumor cells, forming nests and cords, had eosinophilic cytoplasm and small eccentric nuclei. They were immunohistochemically positive for vimentin, CD56 and neuron-specific enolase. Nuclear accumulation of β-catenin protein and a point mutation of the β-catenin gene by genomic DNA sequencing confirmed that the tumor was SPN. This is a very rare case of pancreatic SPN with massive calcification in an old man.

An unusual cause of forefoot pain: diagnosis and discussion

Osteoid osteoma is a relatively uncommon osteoblastic lesion of the bone that accounts for approximately 10% of all benign bone tumors and occurs predominantly in children and young adults, with a male-to-female ratio of 3:1 [1, 2]. More than half of osteoid osteomas occur in the femur and tibia, and the proximal femur is by far the most common location [2]. Its incidence in the small bones of the foot ranges from 2% to 11%, with the talus being the most common site of pedal involvement [2, 3]. No case specifically involving the fibular sesamoid has been reported in the literature. Except for its location, this case presents a classic history of OO, occurring in a 19-year-old woman and producing nighttime pain, relieved to some extent by salicylates. The classic presentation is a single small (<1.5 cm) round or oval lytic focus, which may contain a variable amount of ossification with a zone of reactive sclerosis [4]. The radiographic appearance of OO may be classified according to its location into cortical, cancellous, and subperiostal regions of bone [1, 5–7]. Typically, the tumor is cortical , comprising a small area of radiolucency less than 1 cm in diameter, subcortically placed, and associated with dense adjacent bone sclerosis and periostal reaction. The cancellous variety of OO displays less radiographic sclerosis than does the cortical type. The cancellous and subperiostal varieties have been reported to be more prevalent in the small bones of the hand and foot [7]. In our case there was a radiolucent nidus surrounded by an illdefined sclerotic rim, with central calcification as in the cancellous subtype. In patients with OO computed tomography demonstrates the radiolucent nidus with a smooth inner surface, and, in some cases, a radiodense center can be visualized, as in our case. This central calcification is suggested to represent the osteoblastic center of the lesion [8]. Bone scanning almost always produces positive findings and is valuable when plain radiographs are equivocal. A typical ‘hot spot’ is shown, due to intense radionuclide uptake by the lesion, as in our case [9]. The histopathologic appearance of the nidus may vary, depending on the maturity of the lesion [2]. The pathologic appearance of the nidus is of a small, round, mass of tissue which can be either soft or sclerotic, red, and surrounded by normal or sclerotic bone. Microscopic Skeletal Radiol (2009) 38:831–832 DOI 10.1007/s00256-009-0711-0

Metanephric adenoma of the kidney: clinical and radiological study of nine cases

OBJECTIVE To analyse the clinical and radiological features of metanephric adenoma (MA, a rare benign renal tumour) in nine patients, and to review previous reports. PATIENTS AND METHODS From 1992 to 2007, we identified nine patients (eight women and one man) with MA at our institution. Four patients had a radical nephrectomy and five a partial nephrectomy. Preoperative imaging was reviewed by a senior radiologist. Renal colour Doppler ultrasonography (US), abdominal computed tomography and abdominal magnetic resonance imaging were used in seven, eight and four patients, respectively. RESULTS The mean (range) age of the patients was 46.8 (19-79) years. Six tumours were discovered incidentally. Three patients were symptomatic (two with haematuria and one with polycythaemia). There was no vascular flow on colour Doppler US within the tumours. There were peripheral and/or central calcifications in six of the tumours. All the tumours were well-circumscribed with minimal enhancement after injection with non-ionic intravenous contrast or gadolinium. CONCLUSIONS Renal MA is a benign tumour occurring mainly in young and middle-aged women. Polycythaemia is associated in approximately 10%. Generally, MA is solid, well-circumscribed and hypovascular, often with calcifications. Based on a combination of clinical and imaging features, it might be possible to suspect the diagnosis of MA and propose a preoperative diagnostic biopsy, a partial nephrectomy or active surveillance.

Multiple desmoplastic trichoepitheliomas with ossification and cholesterol deposition

Conflict of interest: none declared. A 51‐year‐old Japanese man presented with a 20‐year history of two annular plaques on the face. There was no history of traumatic injury preceding these growths and his other medical history was not relevant. On physical examination, each plaque was found to be annular, hard and skin‐coloured, with a depressed centre and raised edge, measuring 12 × 11 mm on the forehead (Fig. 1, arrow) and 10 × 9 mm on the glabella (Fig. 1, arrowhead). Results of laboratory tests were normal. Both tumour lesions were surgically excised. Histological examination revealed narrow strands of basaloid tumour cells, multiple horn cysts and dense collagenous stroma (Fig. 2a, b). Foreign‐body granulomas with epithelioid and multinucleated giant cells and calcification were seen, predominantly around ruptured horn cysts. The tumour from the glabella showed an eosinophilic lamellar structure with central calcification, indicative of ossification (Fig. 2c). In both tumours, foci of needle‐shaped and fusiform clefts showing cholesterol crystals accompanied by a moderate infiltrate of epithelioid cells and foreign‐body giant cells were found (Fig. 2d). A diagnosis of desmoplastic trichoepithelioma (DT) was made.

Bone–Vascular Axis in Chronic Kidney Disease

Chronic kidney disease (CKD) is characterized by changes in mineral metabolism associated with alterations of its hormonal regulation and various forms of bone disease. In the past, these associations focused attention on the kidney–bone axis. The last decade has seen renewed interest on interactions among mineral metabolism disorders and extraosseous and cardiovascular calcifications observed in CKD or end-stage renal disease (ESRD). Vascular calcification is an active process similar to bone formation that implicates a variety of proteins involved in bone and mineral metabolism (1,2) and is considered part of a systemic dysfunction defined as CKD–mineral and bone disorder (3). Growing evidence linking bone with different functional and structural characteristics of the arterial tree has contributed to developing the concept of the bone–vascular axis (4). The first observations suggesting the existence of the bone–vascular axis were the frequent associations of osteoporosis and atherosclerotic vascular calcifications observed in postmenopausal women (5–7). Longitudinal population-based studies revealed a relationship between the progression of vascular calcifications and bone demineralization, and others were identified between bone mineral density (BMD) and aortic or central artery calcifications (6), or coronary arteries in type 2 diabetes (8). The osteopenia–osteoporosis association was also linked with arterial functional indexes, such as aortic stiffness and interactions independent of calcifications, suggesting broader biologic interplay (9,10). Relationships between bone and vascular modifications were also observed in CKD and ESRD patients. In dialysis patients, coronary artery calcification score was found to be inversely correlated with vertebral bone mass (11,12). In addition, a high systemic arterial calcification score combined with bone histomorphometry suggestive of low bone activity was observed in hemodialysis patients (13,14). Arterial stiffening and low spine BMD or calcaneal osteopenia were significantly associated in CKD and hemodialysis patients (15–17). …

Synchronous primary carcinoid tumor and primary adenocarcinoma arising within mature cystic teratoma of horseshoe kidney: a unique case report and review of the literature

BackgroundMalignant transformation of mature cystic teratoma is a rare complication. While any of the constituent tissues of a teratoma has the potential to undergo malignant transformation, squamous cell carcinoma is the most commonly associated malignancy. Renal carcinoid tumors are rare and frequently associated with horseshoe kidney and renal teratoma. Renal teratoma rarely presents together with carcinoid tumor or adenocarcinoma. To the best of our knowledge, there has never been a report of renal teratoma coexisting with both carcinoid tumor and adenocarcinoma.MethodsHere, we present a unique and first case of synchronous primary carcinoid tumor and moderately differentiated adenocarcinoma arising within mature cystic teratoma of horseshoe kidney in a 50-year-old female. Lumbar spine X-ray, done for her complaint of progressive chronic low back pain, accidentally found a large calcification overlying the lower pole of the right kidney. Further radiologic studies revealed horseshoe kidney and a large multiseptated cystic lesion immediately anterior to the right renal pelvis with central calcification and peripheral enhancement. She underwent right partial nephrectomy.ResultsMacroscopically, the encapsulated complex solid and multiloculated cystic tumor with large calcification, focal thickened walls and filled with yellow-tan gelatinous material. Microscopically, the tumor showed coexistent mature cystic teratoma, moderately differentiated adenocarcinoma and carcinoid tumor. Immunohistochemically, alpha-methylacyl-coenzyme A-racemase, calretinin, CD10 and thyroid transcription factor-1 were negative in all the three components of the tumor. The teratomatous cysts lined by ciliated epithelium showed strong staining for cytokeratin 7 and pancytokeratin, and those lined by colonic-like epithelium showed strong staining for CDX2, cytokeratin 20 and pancytokeratin, but both were negative for calretinin. Additionally, the teratomatous cyst wall showed strong staining for smooth muscle actin, and weak staining for carbonic anhydrase IX, CD99, chromogranin and synaptophysin. The adenocarcinoma component was strongly positive for cytokeratin 7 and pancytokeratin, weakly positive for synaptophysin and CD56, and negative for carbonic anhydrase IX, CD99, CDX2, chromogranin, cytokeratin 20 and smooth muscle actin. The carcinoid tumor component was strongly positive for CD56, chromogranin and synaptophysin, weakly positive for pancytokeratin, and negative for carbonic anhydrase IX, CD99, CDX2, cytokeratin 7, cytokeratin 20 and smooth muscle actin. She received no adjuvant therapy and is alive without evidence of disease six months after diagnosis and surgery.ConclusionThis unique and first case herein presented with synchronous primary carcinoid tumor and primary adenocarcinoma arising within mature cystic teratoma of horseshoe kidney emphasizes the need for thorough sectioning and entire submission for histologic evaluation of mature cystic teratomas, in order to avoid missing multiple additional histogenetically distinct neoplasms.

Longitudinal Study of New Eye Lesions in Children with Toxoplasmosis Who Were Not Treated During the First Year of Life

To determine the incidence of new chorioretinal lesions in children with toxoplasmosis diagnosed after, and therefore not treated during, their first year. Prospective longitudinal cohort study. Thirty-eight children were evaluated in Chicago between 1981 and 2005 for new chorioretinal lesions. Thirty-eight children and mothers had serum IgG antibody to Toxoplasma gondii. Twenty-eight of 38 children had one of the following: diagnosis with serum antibody to T. gondii indicative of chronic infection at age 24 months, central nervous system calcifications, hydrocephalus, illness compatible with congenital toxoplasmosis perinatally but not diagnosed at that time. Twenty-five returned for follow-up during 1981 to 2005. Their mean (range) age at last exam was 10.9 +/- 5.7 (range, 3.5 to 27.2) years and mean follow-up was 5.7 +/- 2.9 years. Eighteen (72%) children developed at least one new lesion. Thirteen (52%) had new central lesions, 11 (44%) had new peripheral lesions, and six (24%) had both. Thirteen (52%) had new lesions diagnosed at age > or =10 years. New lesions were found at more than one visit in four (22%), and bilateral new lesions developed in seven (39%) of 18 children who developed new lesions. Of 10 additional children with eye findings and serologic tests indicative of chronic infection, six returned for follow-up, four (67%) developing new lesions at > or =10 years of age. More than 70% developed new chorioretinal lesions. New lesions were commonly diagnosed after the first decade of life.

Granulomatous Pneumonia, Lymphadenopathy, and Hepatopathy in an Adult Horse with Repeated Injection of BCG

R. van den Boom, E.J.B. Veldhuis Kroeze, W.R. Klein, D.J. Houwers, A.G.M. van der Zanden, and M.M. Sloet van Oldruitenborgh-Oosterbaan