No abstract

The alveolar adenoma of the lung is a rare benign tumor in which the normal parenchymal architecture is imitated by a proliferation of both the alveolar epithelial cells and the mesenchymal septal cells. The first description, based on six cases, was published in 1986 by Yousem and Hochholzer. From their ultrastructural findings they presumed a type II pneumocytes differentiation of the epithelial cells. We investigated an alveolar adenoma of the lung immunohistochemical by means of antibodies against apoprotein B and C of human surfactant. Both the lining cells and the macrophages in the alveolar-like spaces were stained. The septal connection tissue cells did not react. These findings confirm the expression of surfactant constituents and, hence, the differentiation into type II pneumocytes of the epithelial cells of the alveolar adenoma.

Acute leptospirosis in Europe (Weil's disease) is a rare and in more than 90% of the cases undiagnosed febrile, self-limited disease. We report the case of a 39-year-old sewerage worker, who was admitted to our hospital with fever, jaundice, pain in his calves and acute renal failure. Serology revealed elevated antibody titers against Leptospira canicola, L. icterhaemorrhagica and L. sejroe. The patient developed disseminated intravascular coagulation (DIC) with diffuse gastrointestinal bleeding due to thrombocytopenia. The ECG showed atrial fibrillation with irregularly irregular rhythm. Cardiac arrest developed, most likely due to hypoxia, with a drop in the blood pressure. Despite immediate resuscitation efforts the patient developed severe hypoxic brain damage and died a few days later. Autopsy disclosed histologic signs of a generalized leptospiral infection, signs of shock and within the lungs a necrotizing herpes simplex virus pneumonia causing the death of the patient. The virus pneumonia most probably was caused by retrograde canalicular dissemination of oral secretions since herpetic tracheitis and esophagitis were found and herpetic lesions were readily identified on the lips and tongue. A medical opinion asked for by the professional association having liability for occupational safety and insurance was given, the disease being recognized as an occupational disease.

We report on a patient who at 61 years of age presented with two nodular melanomas in the right nasal cavity. These tumors were limited to the mucosal membrane and were accompanied by a large amount of atypical hyperplasia of the melanocytes within the glandular and surface epithelium of various other samples of the mucous membrane, a finding also verified immunohistochemically. These tumors were treated surgically. In the clinical course, after a prolonged tumor-free interval, a malignant melanoma of the contralateral nasal cavity occurred, in addition to recurrences in the area of the primary tumor. It seems likely that the large, diffuse proliferation of atypical melanocytes observed could have been the starting point of both the tumor recurrences and the second primary. Thus, in a histologically proven melanoma in the mucous membranes of the upper respiratory system, a more intense preoperative histological diagnostic procedure, in given cases with the assistance of immunohistochemical methods, could be useful to demonstrate intraepithelial atypical melanocytes. It is possible that by doing this the present poor prognosis for mucosal melanomas of the upper respiratory tract might be improved.

No abstract