A 19-year-old man with paroxysmal nocturnal hemoglobinuria treated for 3 years with Methandienone was admitted to the hospital with hemoperitoneum due to the rupture of an hepatic tumor. Histology revealed that it was a benign liver cell adenoma, with a pathologic appearance and mode of clinical presentation closely resembling those of cases observed to develop in association to contraceptive steroids. " Doubt has been raised about the histologic diagnosis of the latter, for the data presented are not always convincing as to the malignant nature of these growths.' Recently, a patient with a hepatic adenoma after prolonged treatment with oxymetholone was described. 2 ' We report a patient with a benign liver cell adenoma associated with Methandienone treatment, who seems to be the second recorded case of adenoma associated with androgenicanabolic steroids. CASE REPORTA 19-year-old man, treated for paroxysmal nocturnal hemoglobinuria (PNH) with Methandienone for 3 years, was admitted to hospital in May, 1975 patient was included in a cooperative therapeutic trial of the effect of androgenic-anabolic steroids on bone marrow insufficiency* and administered Methandienone in a dose of 65 mg daily. After 20 months of treatment a slight improvement of the pancytopenia was noted. In January, 1975, he had the first crisis of PNH, which reappeared in April, in spite of the treatment. In May, 1975, he was readmitted to the hospital complaining of left hypocondrial pain. Physical examination showed signs of peritonitis and an abdominal tap revealed the presence of blood. At laparotomy two small tumors were found in the left lobe of the liver. One of the tumors was ruptured and was responsible for the hemoperitoneum. Resection of the affected liver was done and the postoperative course was uneventful. Serum alpha-1-fetoprotein was negative in blood taken immediately after operation. Histological ExaminationAt microscopic examination both tumors, 10 X 60 X 30 cm and 80 X 45 X 25 mm in size, were pale and capsulated. The larger one had an extensive area of hemorrhagic necrosis at the surface.Microscopic examination showed a well-differentiated lesion, composed of liver cells resembling normal hepatocytes, arranged in plates thicker than in normal liver. Within the tumor there were no portal tracts, or biliary structures. Many dilated sinusoids and large spaces containing blood were seen, some of them with endothelium layer and other with no wall, as well as large areas of hemorrhagic necrosis (Fig.

Two cases of papillary‐cystic neoplasm of the pancreas are reported in women aged 22 and 23 years. The patient in the first case presented with acute abdominal pain and hemoperitoneum. This form of presentation has not been previously reported. This type of pancreatic tumor is very rare, exclusively affecting young women, and has a good prognosis despite its various histologic features, which suggest a malignant appearance. The authors consider this neoplasm as having an acinar origin because in the cells of one of the patients we observed ultrastructurally the presence of abundant rough endoplasmatic reticulum with formation of annulate lamellae and a few prezymogen granules.

A patient who had a polyneuropathy compatible with a chronic inflammatory demyelinating polyneuropathy and was initially negative for anti-myelin-associated glycoprotein (MAG) antibodies developed a double monoclonal gammopathy, IgM kappa and IgM lambda, two years after the diagnosis. The IgM kappa, but not the IgM lambda, exhibited strong anti-MAG antibody activity. The late appearance of the anti-MAG immunoreactivity suggests that in patients with an initial diagnosis of chronic inflammatory demyelinating polyneuropathy, the search for anti-MAG antibodies should be repeated during the course of the neuropathy.