A study of lipomas collected over the past 20 years in a university hospital indicated that there are two types of angiolipoma, namely noninfiltrating and infiltrating. Noninfiltrating angiolipoma is seen in young individuals and presents as painful, soft, cutaneous nodules. Occasional compression of nerve fibers that accompany the vascular channels could be demonstrated. Treatment is merely enucleation. Infiltrating angiolipoma is rather rare. Only 23 cases have been reported in the English literature. Though histologically benign, the tumor can infiltrate bony, muscular, neural, and fibrocollagenous tissues to cause unusual symptoms and signs and can clinically simulate malignant neoplasms. Wide excision to include the normal tissue surrounding the tumor is mandatory. Radiotherapy should be rendered to cases with recurrence.

SUMMARY It is generally stated that ulceration of the carotid bifurcation plaque may give rise to embolization and symptoms of cerebral ischemia. It has been suggested that prophylactic carotid endarter ectomy is indicated in asymptomatic patients if the angiogram is interpreted as showing ulceration.We therefore determined the accuracy of the radiologic diagnosis of ulceration by comparing the radiologic and morphologic findings in 155 carotid endarterectomies. Ulceration was diagnosed in 54% of the angiograms and 47% of the surgical specimens and was not related to the degree of stenosis. Angiography had a sensitivity of 73 %, a specificity of 62% and an overall accuracy of 67%. For the non-flow-restrictive lesions these figures were 65%, 66%, and 66%. If surgery were based on the angiographic diagnosis of ulceration in plaques with less than 50% stenosis, 16 out of 42 operations (38%) would have been done unnecessarily. Variability of the angiographic diagnosis of ulceration is also shown by a high interobserver variability; two sets of two authors read the angiograms independently and disagreed in 24% of the cases. The decision to operate should not depend entirely upon the angiographic diagnosis of ulceration.

No abstract

Pseudolymphoma is a benign pathological process that morphologically resembles malignant lymphoma. Its occurrence in the mammary tissue has been described but has not been well investigated. We conducted a prospective and retrospective study of 8,654 consecutive mastectomies and tylectomies of the breast and found only 9 cases (0.1%) of primary lymphoreticular lesions. Of these 9, 5 were pseudolymphomas; 3, histiocytic lymphomas; and 1, Hodgkin's disease. Clinically, pseudolymphoma of the breast was described as an enlarging mass giving a dull, aching sensation. A history of physical trauma to the affected area could be traced in 3 patients with certainty. The mean patient age of the entire series was 36 years. Grossly, the tumor was a solid, firm nodule without any evidence of fibrocystic disease. Microscopically, it showed a lymphoid infiltrate with a nodular pattern. Three of the 5 cases revealed distinct germinal centers. Atypical lymphoid cells were not observed in any of these cases. After local excision, no patients had recurrence over a period of two to eight years. In view of a history of trauma, accompany fat necrosis in some cases, IgG gammopathy, it is postulated that pseudolymphoma of the breast, probably akin to pseudolymphoma of the lung, may represent an overwhelming local response to an injury. This lesion, reactive in nature, should be differentiated from a malignant lymphoma so that patients are not subjected to unnecessary mastectomy, radiation, or chemotherapy.