Victor Tchertkoff

The Kidney in Rheumatoid Arthritis

Renal biopsies were performed on 18 patients afflicted with moderately severe or severe rheumatoid arthritis ranging from 20 to 58 years in age and with minimal to mild urine abnormalities. No abnormality was found in 11 cases. Seven biopsies revealed minimal increase in mesangial cells and matrix on light microscopy with focal tubular atrophy in some. Electron microscopy showed slight increase in mesangium, presence of ‘deposits’ in the latter and epithelial cells and fusion of podocytes in several places. Microtubular structures were found in one case. Immunofluorescent studies were negative in all cases.

Cylindroma of the cervix.

Abstract The first cylindroma of the cervix is reported. The patient also had squamous cell carcinoma of the cervix and basal cell carcinoma of the bridge of the nose. The exact histogenesis of cervical cylindromas still remains to be elucidated. It is urged that the original term, “cylindroma,” be limited to those lesions fulfilling Billroths criteria.

A testicular tumor resembling the sex cord with annular tubules in a case of the androgen insensitivity syndrome

Sex cord tumor with annular tubules (SCTAT) is a distinctive neoplasm with indifferent cells of sex cord derivation in a characteristic arrangement of ring‐like tubules. Much attention has been drawn to its association with the Peutz‐Jeghers syndrome (PJS) with reported occurrence of the tumor in the testis of a boy with PJS. The authors present two cases of the androgen insensitivity syndrome (AIS), one of the cases being distinctive in having a large multicystic tumor resembling the SCTAT in the immature gonad. Additionally, the focal areas of the tumor, the large Sertoli cells lining the tubules, resembled those of a large cell calcifying Sertoli cell tumor (LCCSCT) although no calcific areas were discernible. Although the occurrence of neoplasms like germinomas and tubular adenomas is well known in the AIS, SCTAT has hitherto not been reported in a gonad of the AIS. SCTAT has been placed under an “unclassified sex cord‐stromal” category in the World Health Organization (WHO) Classification, yet, opinions are divided as to its origin from a granulosa or Sertoli cell, although an overlap in the histologic features of the two cell categories is to be anticipated in view of their homologous nature. In the case presented, the close resemblance of the tumor cells to the Sertoli cells of the uninvolved gonad would further support the concept of a Sertoli line of differentiation of the SCTAT.

Fine needle aspiration cytology of a recurrent malignant tumor of the kidney with rhabdoid features in an adult : A case report

BACKGROUND Malignant rhabdoid tumor of the kidney in children is considered a distinct entity. Malignant tumors with rhabdoid features in adults in extrarenal locations and in children over the age of 5 years are considered phenotypic variants. CASE In a case of recurrent transitional cell carcinoma with rhabdoid features of the kidney in an adult, confirmed immunohistochemically and ultrastructurally, fine needle aspiration cytology showed discohesive, large- to medium-sized polygonal cells with eccentric nuclei; prominent nucleoli; abundant, pink cytoplasm; and paranuclear, eosinophilic density, corresponding to cytoplasmic eosinophilic globules seen in the histologic sections and cytoplasmic filamentous inclusions seen ultrastructurally. CONCLUSION The cytologic features of malignant rhabdoid tumors are characteristic.

Ameloblastic adenomatoid tumor (adenoameloblastoma). Case reports and review of the literature.

Abstract Two additional cases of ameloblastic adenomatoid tumor (adenoameloblastoma) are reported, bringing the total number of recorded cases of this rare lesion to 50. The tumor occurs most frequently in patients between 12 and 20 years of age, it is located most often in the maxilla, and it has a 2:1 male: female ratio. Regardless of therapy, no recurrences have been reported after complete removal, a fact which emphasizes the need for clear differentiation from ameloblastoma. To avoid confusion, the term ameloblastic adenomatoid tumor should be utilized more widely.

Bartter's syndrome: an overview.

Bartters syndrome, which is characterized by hypokalemic hypochloremic alkalosis, renal juxtaglomerular hyperplasia, elevated renin and aldosterone, and normal or low blood pressure, has been ascribed to a variety of etiologies. Most recently, the prostaglandins have been in the forefront of the pathophysiologic discussion. Two cases with appropriate renal biopsies are reviewed, as are the clinicopathologic pathways. It is important that strict criteria be applied, and confirmation by renal biopsy is urged.

Fine needle aspiration biopsy of Progressive multifocal leukoencephalopathy in a patient with AIDS : A case report

BACKGROUND Progressive multifocal leukoencephalopathy (PML) is one of the most common opportunistic infections, with a range of 4-7% in acquired immunodeficiency syndrome (AIDS) patients. Clinical diagnosis is often difficult, and the specific pathologic agent requires cytologic and pathologic confirmation. CASE A 38-year-old, Haitian male was admitted with a new-onset seizure disorder. On computed tomography (CT), there were right frontoparietal cortex, right external capsule and right basal ganglia lucencies. Fine needle aspiration biopsy (FNAB) of the radiolucent area revealed foci of white matter demyelination and a few eosinophilic inclusions in oligodendrocytes plus abnormal giant astrocytes. Ultrastructurally, JC virions were observed in the nuclei and cytoplasm of the oligodendrocytes. CONCLUSION Diagnostic cranial CT-guided FNAB, with cytologic and histologic studies, is extremely valuable in evaluating the nature of central nervous system demyelinated and space-occupying lesions in AIDS.

Renal Lesions in Chronic Pancreatitis

Many patients with chronic pancreatitis (CP), even in the absence of intrinsic renal disease, are found to have abnormal urine, with persistent proteinuria, cylindruria, microhematuria and leukocyturia. The kidneys of 12 necropsy cases with CP showed mild to moderate arterial and arteriolar nephrosclerosis and no other significant changes. Renal biopsies were performed in 10 patients with CP without evidence of systemic disease or intrinsic renal disease, but with persistent urinary abnormalities. By light microscopy, mild arterial and arteriolar nephrosclerosis was present in 5 instances. In 1 patient, evidence of the reparative phase of acute tubular necrosis was noted. In 5 biopsies, electron microscopy revealed minimal to mild increase in mesangial matrix. Mild thickening of the glomerular basement membrane (GBM) was found in three instances but there was no clear-cut evidence of diabetic glomerulosclerosis. The presence of subendothelial electron-lucent material in 3 cases suggests the possibility of previous subclinical episodes of intravascular coagulation. The most consistent finding was the presence of lipid material in the cytoplasm of glomerular and tubular cells. The renal lesions associated with CP are mild, nonspecific and nonprogressive. Various pathogenetic factors can be invoked to account for their presence and for the urinary abnormalities found in patients with CP.

Membranous Nephropathy: An Overview

Membranous nephropathy (MN) accounts for about 20 percent of cases of the nephrotic syndrome. The importance of renal biopsy in establishing the diagnosis is emphasized. In the great majority of MN patients, no etiologic factor can be discerned. In a significant minority, MN appears to be a manifestation of sarcoidosis, diabetes, lupus, syphilis, malaria, or toxicity from heavy metals or drugs. In some cases the “cause” is neoplasia (including lymphoma) or a viral infection. Massive proteinuria, hypoproteinemia and edema are the principal manifestations of MN, finally resulting in renal failure. Treatment consists chiefly of diet and diuretic drugs. In the more pronounced cases, corticosteroids may have a favorable effect and in very resistant cases, cyclophosphamide is indicated. Judicious use of these modalities if often associated with the diminution or disappearance of the clinical signs of MN.

Adrenal Adenoma and Hypertension

Excerpt To the editor: The article by Spark and Melby in the December issue [75:831-836, 1971] on hypertension and low plasma renin activity sheds some light on the puzzling and fascinating relatio...