The cases of 14 patients seen 6 weeks to 7 years after gunshot wounds with painful, restrictive joint disease and retained intra-articular bullets were reviewed. Twelve patients had radiographic findings characteristic of lead synovitis. The earliest finding was a fine, punctate deposition of radiopaque lead on the articular cartilage that resembled chondrocalcinosis but was of greater density. This was followed by more discrete lead speckling of hypertrophied synovium. The opacities became larger, coarser, and more confluent over time, ultimately outlining the synovium, articular cartilage, and joint capsule. Synovial hypertrophy and diffuse chronic inflammation and fibrosis were seen in seven patients on gross pathologic examination. The lead was deposited extracellularly in the subsynovial layer and within the marrow spaces of subarticular and periarticular bone. Electron-microscopic study suggests that lead is initially incorporated within cells and secondarily deposited extracellularly after cell death. Bullets in joints are not physiologically inert and should be removed when encountered.
Synovial sarcoma most commonly occurs in the peri-articular regions of the extremities. The present report describes a rare case of primary biphasic synovial sarcoma of the pleura in an 18-year-old female. The diagnosis was made on the basis of light microscopy, immunohistochemistry, electron microscopy and the characteristic translocation found on cytogenetic analysis. Synovial sarcoma should be included in the differential diagnoses of pleural tumors.
Ultrastructural study of a case of benign lipoblastomatosis revealed a cellular spectrum which included undifferentiated mesenchymal cells, stellate myxoid cells, fibroblasts, lipoblasts, lipocytes and many intermediate forms. The uni- and multivacuolated fat cells contained membrane and non-membrane bound cytoplasmic vacuoles, predominatly of saturated lipid. Their cytoplasm also contained simple-structured mitochondria devoid of intramatrical or crystalloid bodies. The fine structure of the cellular components of lipoblastomatosis supports the concept that this is a neoplasm related to fetal white fat rather than to brown fat.
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