John R. Craig

Fibrolamellar carcinoma of the liver: A tumor of adolescents and young adults with distinctive clinico‐pathologic features

Clinical and pathologic features of 23 patients with a distinctive histologic and clinical variant of hepatocellular carcinoma are summarized. The variant pattern of hepatocellular carcinoma is most common in the age group 5–35 years and occurs equally in either sex. The distinctive histologic features include 1) deeply eosinophilic neoplastic hepatocytes, many of which contain intracytoplasmic hyaline globules and distinct pale bodies and 2) fibrosis arranged in a lamellar fashion around the neoplastic hepatocytes.

Cirrhosis associated with partial deficiency of alpha-1 antitrypsin in an adult.

Abstract A 63-year-old woman developed ascites that led to a diagnosis of cryptogenic cirrhosis. Eosinophilic cytoplasmic inclusions were found in hepatocytes on examination of liver biopsy specime...

Extragenital adenomatoid tumor: Evidence for the mesothelial theory of origin.

The histogenesis of so‐called adenomatoid tumors has been contested. Doubts as to a mesothelial derivation often have been based on the belief that adenomatoid tumors originate exclusively in or nearby genital tract organs. This report documents a histologically typical adenomatoid tumor which developed in the mesentery of the small intestine. Extensive clinical investigations and an uneventful 3‐year postoperative follow‐up interval confirmed that the tumor was not a metastatic adenocarcinoma or malignant mesothelioma. The extra‐genital site of origin of this neoplasm provides additional corroborative evidence for the mesothelial origin of adenomatoid tumors. Regardless of their anatomic location, these distinctive neoplasms should be classified as benign adenomatoid mesotheliomas.

Metastatic uterine leiomyomata. A case report

Pulmonary metastases from uterine leiomyomata are extremely rare and unpredictable, despite the high frequency of uterine leiomyoma. Review of the literature reveals seven previous examples of pulmonary metastasis from uterine leiomyomata; other cases may exist, but they were not considered because there was little evidence to distinguish them from leiomyosarcoma. The case we report is unusual in: 1) its prolonged course of 21 years, 2) its lack of pulmonary symptoms, despite extensive multiple nodules; and 3) the cystic change of the multiple lesions, which mimicked cystic lung disease.

Cirrhosis associated with partial deficiency of alpha-1-antitrypsin: a clinical and autopsy study.

A 63 year old woman with cryptogenic cirrhosis, ascites, portal hypertension, and intermediate levels of alpha-1-antitrypsin of protease inhibitor SZ phenotype who died of esophageal variceal hemorrhage is described. The partial deficiency of alpha-1-antitrypsin and the diagnosis of cirrhosis were suspected one year prior to death because a needle biopsy of liver showed PAS positive, diastase resistant cytoplasmic bodies within hepatocytes. This report illustrates three previously undescribed features: (1) Heterozygous protease inhibitor SZ phenotype may be associated with coarsely nodular cirrhosis in the older adult. (2) The large intracytoplasmic glycoprotein droplets that are distinctive by light microscopy are probably formalin induced aggregates of submicroscopic flocculent material. (3) In the older patients with aberrant alpha-1-antitrypsin the flocculent material is present not only in the granular endoplasmic reticulum but also in smooth endoplasmic reticulum vesicles and cytolysosomes.

Clinical and Laboratory Findings on Admission to an Alcohol Detoxification Service

A review of 260 consecutive admissions for alcoholic withdrawal to the Alcohol Detoxification Service of the Los Angeles County--University of Southern California Medical Center shows that 98% of the patients fulfill the criteria for alcoholism as stated by the National Council of Alcoholism Criteria Committee. Previous alcoholic history, current symptoms, physical findings, and laboratory tests indicate frequent multiple organ dysfunction in acute alcohol withdrawal. Hallucinations occurrred in more than 46% of patients with a blood alcohol over 100 mg%. More than 90% of the patients had one or more abnormal laboratory values, and the serum gamma glutamyl transpeptidase was the most commonly elevated laboratory test.