Ronald M. Angeles

Lobular Capillary Hemangioma of the Neonatal Larynx

OBJECTIVE To describe a previously unreported condition of the neonatal larynx. DESIGN Case series of 4 neonates with an uncommon laryngeal lesion. SETTING Tertiary care childrens hospital. PATIENTS Four neonates in the first 10 days of life with stridor, hoarseness, and respiratory distress. INTERVENTION The patients were examined using flexible fiberoptic laryngoscopy, and laryngeal lesions were identified and subsequently removed using microlaryngoscopy. Photodocumentation of the lesions was performed. Microscopic evaluation of biopsy specimens by a pathologist followed. MAIN OUTCOME MEASURES Each patients medical record was carefully reviewed for prenatal history, birth history, neonatal history, pathologic findings, and office follow-up. RESULTS All 4 neonates were delivered atraumatically and developed symptoms of upper airway obstruction within the first few minutes to days of life. Each neonate was found to have an obstructive laryngeal lesion requiring surgical intervention. No child had other congenital abnormalities or a history of obvious laryngeal trauma. Pathologic review of each laryngeal specimen revealed inflammatory lesions with characteristic features of a lobular capillary hemangioma (or a pyogenic granuloma). CONCLUSIONS The diagnosis of a lobular capillary hemangioma of the larynx should be considered in the differential diagnosis of a newborn with stridor, hoarseness, or respiratory distress. The cases seem to be of congenital origin, although acquired pathogenesis cannot be ruled out. Treatment of these lesions includes microscopic surgical excision.

Primary Pancreatic Sinus Histiocytosis With Massive Lymphadenopathy (Rosai-Dorfman Disease): An Unusual Extranodal Manifestation Clinically Simulating Malignancy

Abstract Sinus histiocytosis with massive lymphadenopathy (SHML), also called Rosai-Dorfman disease, is a rare entity. Its etiology and pathogenesis are still essentially unclear. The histologic hallmark of this disease is proliferation of distinctive histiocytes within lymph node sinuses and in extranodal sites. Approximately 23% of patients with SHML, documented in the SHML Registry, presented with disease primarily in extranodal sites, and very few cases of SHML (<1%) involving the gastrointestinal system have been described in the literature. We report an unusual case of primary pancreatic SHML with infiltration of the process into peripancreatic, perinephric, and perisplenic adipose tissue, simulating malignancy.

A Closer Look at Sarcoptes scabiei

This image was taken from a skin scraping, prepared with mineral oil, from the chest of a 79-year-old man who complained of papular pruritic rash on his torso, arms, and legs for 6 months. He was living in a nursing care facility, unable to perform most of the daily activities because of left-sided hemiparesis secondary to a cerebrovascular accident. His white blood cell count was 8100 cells/mL with absolute eosinophilia of 2000 cells/mL (25%). He was treated with 5% permethrin, and his symptoms were relieved with fewer than 10 days of therapy. Scabies organisms produce this clinical picture after a patient acquires the organisms, Sarcoptes scabiei, from direct skin-to-skin contact or from contaminated fomites. They are ovoid organisms with a small anterior cephalic portion and a caudal thoracoabdominal portion with hairlike projections coming off from the rudimentary legs. The female mite is 0.3 mm to 0.4 mm in size, and the male mite is half the size of the female. This image shows a 6legged protonymph (original magnification 3400). Organisms burrow beneath the skin, eliciting a delayed-type hypersensitivity reaction. The diagnosis is made based on the typical distribution of the rash (interphalangeal, wrist, hands, axillary folds, and waist area) and direct examination of skin scrapings showing the mites, eggs, or scybala (packets of feces). 1 The major problem of scabies infection is the public health concern. Many infections occur in institutions caring for the elderly, such as assisted-living and nursing homes. Also at risk are infants and young children, health care workers, and immunocompromised patients. The risk factors among nursing homes for acquiring this infection include size and age of the institution and ratio of beds to

Acute Myeloid Leukemia With Myelodysplasia- Related Changes A New Entity Defined by the WHO 2008 Classification of Hematopoietic and Lymphoid Neoplasms

In 2008, the revised World Health Organization (WHO) classification of hematopoietic neoplasms introduced a new entity as a subcategory in the classification of acute myeloid leukemias (AMLs) entitled “acute leukemia with myelodysplasia-related changes (AML-MRC),” replacing the previously suggested new entity in the 2001 classification “acute myeloid leukemia with multilineage dysplasia (AML-MLD).” Here, we describe 2 cases of AML which were easily classified as AML-MRC due to the improved and expanded criteria of the 2008 WHO classification. Accurate diagnosis is a prerequisite for therapeutic choices and prognosis. Morphologic evaluation of dyspoiesis can be unreliable when the blast count is high and there are very few residual hematopoietic cells as demonstrated by our second case. Unlike the AML-MLD category, which relied heavily on morphology, this new AML-MRC category provides ample criteria for diagnosis, including cytogenetics.