Yellow-nail syndrome: report of three cases.

The yellow nail syndrome, a combination of yellow discolouration of and dystrophic changes in the nails, pleural effusions and lymphedema, is thought to be relatively rare; to date 44 cases have been reported. Of a further three patients with this syndrome, one had all three features, one had the yellow nails alone and the other had pleural effusions and lymphedema without classic nail changes. Each had recurrent lower respiratory tract infections; and of all 47, chronic pulmonary infections occurred in approximately one quarter and were frequently associated with chronic sinus infections. The underlying abnormality is presumed to be a congenital defect of the lymphatics, but so far this has not been demonstrated to be the cause of the nail changes, the pathogenesis of which remains obscure.     

Gastrointestinal zygomycosis: a report of three cases

Three cases of gastrointestinal zygomycosis, probably caused by Basidiobolus ranarum, are described. The diagnosis was based on morphology of the fungal elements in infected tissues and histopathologic findings. All the three patients responded favorably to management strategy that included surgical resection of the infected portion of the bowel and institution of specific antifungal therapy.     

Roentgencephalometric measurements in trisomy 8 mosaicism: report of three cases

Roentgencephalometric anomalies in three cases of Warkany syndrome (trisomy 8 mosaicism) are described. These include asymmetry of the mandible with a wide gonial angle and a high and narrow symphysis; SNA (anteroposterior position of maxilla) and SNB (anteroposterior position of mandible) values indicate a backward position of the mandible. Other findings point to a disturbance in the vertical growth of the facial skeleton. These measurements may explain at least part of the facial phenotype and may aid in diagnosis, especially in those cases with an uncertain clinical diagnosis and "normal" karyotype in peripheral blood lymphocytes.     

Childhood pentastomiasis: A report of three cases with the following-up data

Pentastomiasis, a zoonotic parasitic disease, has been reported commonly in Africa and Asia. It is caused by pentastomes, which are annulated but unsegmented blood-sucking endoparasites. Fewer than 20 cases have been reported during the past two decades in China, and cases in children have been especially rare. Herein, we report three cases of pediatric patients with severe systemic symptoms, focusing on the clinical features, diagnosis, and therapy of this disease. The patients were two boys and one girl aged 3 to 13 years. They all had a history of snake or worm ingested from snake and initial symptoms of fever, abdominal pain, diarrhea, and weight loss. Eosinophilia, anemia and elevated serum IgE levels were noted. Moreover, the large numbers of nodules, or even calcification, in the liver and/or lungs were noted by ultrasound, CT or MRI scans. These pentastomes were identified as Armillifer moniliformis, Porocephalus taiwana and Armillifer agkistrodontis. Praziquantel and mebendazole deworming treatments were adopted for the patients. Hence, pentastomiasis should be considered in the differential diagnosis for patients with multiple organ or system lesions, especially abdominal signs, that develop after the ingestion of snakes. Ultrasound, CT and MRI scans and laparoscopic approaches might be helpful for the diagnosis.     

Granular cell ameloblastoma of the jaw. A report of two cases with fine needle aspiration cytology

BACKGROUND: Fine needle aspiration cytology (FNAC) of jaw tumors has not been studied extensively. Ameloblastomas are jaw tumors that show a wide morphologic spectrum and thus may pose some diagnostic difficulties. Of the many types, granular cell ameloblastoma (GCA) is an uncommon variant that possesses distinctive features. To the best of our knowledge, there have been no previous reports on the cytologic findings of GCA. We present two cases diagnosed by FNAC. CASES: Two cases of GCA were diagnosed on cytology and subsequently confirmed on histology. Both patients presented with a large, lytic jaw tumor. FNAC smears showed characteristic granular cells along with spindle and basaloid cells. CONCLUSION: Although GCAs are rare tumors, they possess distinctive features that permit an accurate diagnosis, provided that this entity is kept in mind. This tumor has to be differentiated from cystic odontogenic lesions, epulis and granular cell myoblastoma. An accurate preoperative diagnosis also helps the surgeon to plan more extensive surgery as these tumors show a great propensity for malignant change and metastases.     

Fine needle aspiration biopsy for preoperative workup of pancreatic cystic neoplasms: report of 4 cases

BACKGROUND: Cystic neoplasms of the pancreas comprise a pathologically heterogeneous group of lesions that usually present with similar, nonspecific clinical features. Based on the diagnosis, treatment varies from watchful observation of the lesion to total surgical resection of the pancreas. Therefore the importance of a precise and accurate diagnosis on fine needle aspiration (FNA) biopsy cannot be overemphasized from the patient management standpoint. There is debate regarding the accuracy of FNA diagnosis of cystic lesions of the pancreas. We report 4 cases and review the literature to explore and highlight the cytologic findings and diagnostic pitfalls that may help the cytopathologist accurately distinguish mucinous cystic neoplasm (MCN), intraductal papillary mucinous neoplasm (IPMN), serous cystadenoma (SCA) and ductal adenocarcinoma (DAC). CASES: We present 4 cases of patients with abdominal masses who underwent either computed tomography (CT)-guided or endoscopic ultrasound (EUS)-guided FNA biopsy as preoperative workup. Based on the cytologic diagnosis, the patients underwent surgery. CONCLUSION: Our cases illustrate the cytologic criteria that help the cytopathologist distinguish among MCN, IPMN, SCA and DAC. Correlation with clinical and radiologic findings is strongly advocated for accurate diagnosis. We describe the diagnostic pitfalls frequently encountered in these cases and how to avoid them.     

Role of fine needle aspiration cytology in the preoperative presumptive diagnosis of ameloblastoma

OBJECTIVE: To determine the role of fine needle aspiration cytology (FNAC) on the preoperative presumptive diagnosis of ameloblastoma. STUDY DESIGN: Sixty-three patients, diagnosed preoperatively and postoperatively with ameloblastoma, were evaluated between 1990 and 2003. The patients were classified according to whether they were diagnosed with ameloblastoma preoperatively or postoperatively, on histologic examination. RESULTS: The accuracy rate for ameloblastoma was 0.95% for all biopsy methods, while the incisional biopsy rate was 75.00%. Concerning clinical diagnosis, ameloblastoma was mistaken mostly (56.41%) for odontogenic cysts (22 of 39). CONCLUSION: FNAC should be utilized more commonly on intraosseous and soft tissue lesions in the oral and maxillofacial regions, to obtain sufficient material. It is convenient, inexpensive and noninvasive as compared with other biopsy methods.     

Abnormal carotid arteries in the velocardiofacial syndrome: a report of three cases

Internal carotid arteries of unusual size and tortuosity were found before or at the time of pharyngeal flap surgery in three children who had the velocardiofacial syndrome with velopharyngeal insufficiency. In two cases, medial displacement of the arteries prevented surgery, and in the other, hypernasality persisted because only a narrow, asymmetrical flap could be raised. Medial displacement of the internal carotid arteries inhibits surgical treatment of velopharyngeal insufficiency, necessitating treatment with a prosthetic speech device in such children. Since displacement and tortuosity may be associated findings in the velocardiofacial syndrome, the exact location of the internal carotids should be ascertained when pharyngeal flap surgery is planned.     

Staphylococcus aureus cholecystitis: a report of three cases with review of the literature

Infection of the hepatobiliary system is most commonly due to enteric bacteria. We report three unusual cases of acute cholecystitis in which Staphylococcus aureus was the primary pathogen. Infection of the gallbladder with this organism has been rarely described and may be associated with gallstones and obstructive disease as well as acalculous cholecystitis in the setting of staphylococcal bacteremia and endocarditis. Two of our patients had multiple chronic medical conditions and were infected with oxacillin-resistant S. aureus (ORSA) suggesting nosocomial acquisition. Including our cases with a review of the literature, three of nine reports of S. aureus cholecystitis were associated with infectious endocarditis. Thus, the finding of S. aureus cholecystitis with bacteremia is rare and should prompt an investigation for a possible endovascular focus of infection.