10 Leake RD, Weitzman RE, Glatz TH, Fisher DA. Plasma oxytocin concentrations in men, nonpregnant, and pregnant women before and during spontaneous labor. ] Clin Endocrinol M,etab 1981;53:730- Objective-To determine the prevalence of hypernatraemic dehydration and to assess the hydration and nutritional state of patients in a large hospital for the mentally and physically handicapped; also to assess the efficacy of an intervention programme to reduce the prevalence of hypernatraemic dehydration in the hospital.
A 67 year old woman presented with dry skin, facial hair, hoarse voice, and weight gain. She was hypertensive (168/ 96 mm Hg), her haemoglobin concentration was 19 g/l, and haematocrit was 55.7%. The diagnosis of probable secondary polycythaemia was made. Blood testosterone concentration was 44 nmol/l (normal < 5) and was not suppressed by dexamethasone, suggesting a neoplastic source rather than a pituitary abnormality. Transvaginal ultrasound revealed a hypoechoic solid mass in the left ovary suggestive of a solid ovarian tumour. Hysterectomy and bilateral salpingooophorectomy were performed following which testosterone concentration returned to normal. Immunocytochemistry provided evidence of renin synthesis. This is a case of an unusual steroid cell tumour that caused virilisation accompanied by symptoms of secondary polycythaemia presumably as a result of erythropoietin production. This is the second case of a steroid cell tumour with an erythropoietic eVect and the first that shows evidence of renin synthesis. (J Clin Pathol 1998;51:75-77) Keywords: ovarian steroid cell tumour; polycythaemia; renin secretion.Ovarian steroid cell tumours were first described by Scully in 1979. 1 Steroid cell tumours are now included in the World Health Organisation classification and account for approximately 0.1% of all ovarian neoplasms. Ovarian steroid cell tumours comprise three groups: stromal luteomas, Leydig cell tumours (hilus cell tumours, and Leydig cell tumours non-hilar type), and steroid cell tumours not otherwise specified (NOS). The last group accounts for about 60% of steroid cell tumours. 2Steroid cell tumours NOS are androgenic in about half the cases, oestrogenic in about 10%, and in a few cases there is evidence of a progestogenic eVect.3 4 There are five reports of cortisol secreting steroid cell tumours causing Cushing's syndrome, and three further cases with increased plasma cortisol concentrations but without Cushing's syndrome.3 4 One case was associated with aldosterone secretion. 5 To our knowledge, there is a single reported case associated with polycythaemia. 6 We present a case of a steroid cell tumour NOS that was probably synthesising erythropoietin, renin, and inhibin. Case reportA 67 year old woman presented with dry skin, facial hair, hoarse voice, and weight gain. Her symptoms had begun two years earlier with loss of her "singing voice". Her vocal cords at that time were normal. She was hypertensive (168/ 96 mm Hg), her haemoglobin concentration was 190 g/l, and haematocrit was 55.7%. A blood film, other haematological indices, and examination of aspirated bone marrow were normal. The diagnosis of probable secondary polycythaemia was made. Blood urea and electrolytes, in particular serum potassium, were normal as were arterial blood gases, thereby excluding chronic pulmonary disease and renal disease as causes of the secondary polycythaemia. Abdominal ultrasound was also normal. Investigation of her virilisation was initiated.Blood testosterone concentration was 44 nmol/l...
A 67 year old woman presented with dry skin, facial hair, hoarse voice, and weight gain. She was hypertensive (168/ 96 mm Hg), her haemoglobin concentration was 19 g/l, and haematocrit was 55.7%. The diagnosis of probable secondary polycythaemia was made. Blood testosterone concentration was 44 nmol/l (normal < 5) and was not suppressed by dexamethasone, suggesting a neoplastic source rather than a pituitary abnormality. Transvaginal ultrasound revealed a hypoechoic solid mass in the left ovary suggestive of a solid ovarian tumour. Hysterectomy and bilateral salpingooophorectomy were performed following which testosterone concentration returned to normal. Immunocytochemistry provided evidence of renin synthesis. This is a case of an unusual steroid cell tumour that caused virilisation accompanied by symptoms of secondary polycythaemia presumably as a result of erythropoietin production. This is the second case of a steroid cell tumour with an erythropoietic eVect and the first that shows evidence of renin synthesis. (J Clin Pathol 1998;51:75-77) Keywords: ovarian steroid cell tumour; polycythaemia; renin secretion.Ovarian steroid cell tumours were first described by Scully in 1979. 1 Steroid cell tumours are now included in the World Health Organisation classification and account for approximately 0.1% of all ovarian neoplasms. Ovarian steroid cell tumours comprise three groups: stromal luteomas, Leydig cell tumours (hilus cell tumours, and Leydig cell tumours non-hilar type), and steroid cell tumours not otherwise specified (NOS). The last group accounts for about 60% of steroid cell tumours. 2Steroid cell tumours NOS are androgenic in about half the cases, oestrogenic in about 10%, and in a few cases there is evidence of a progestogenic eVect.3 4 There are five reports of cortisol secreting steroid cell tumours causing Cushing's syndrome, and three further cases with increased plasma cortisol concentrations but without Cushing's syndrome.3 4 One case was associated with aldosterone secretion. 5 To our knowledge, there is a single reported case associated with polycythaemia. 6 We present a case of a steroid cell tumour NOS that was probably synthesising erythropoietin, renin, and inhibin. Case reportA 67 year old woman presented with dry skin, facial hair, hoarse voice, and weight gain. Her symptoms had begun two years earlier with loss of her "singing voice". Her vocal cords at that time were normal. She was hypertensive (168/ 96 mm Hg), her haemoglobin concentration was 190 g/l, and haematocrit was 55.7%. A blood film, other haematological indices, and examination of aspirated bone marrow were normal. The diagnosis of probable secondary polycythaemia was made. Blood urea and electrolytes, in particular serum potassium, were normal as were arterial blood gases, thereby excluding chronic pulmonary disease and renal disease as causes of the secondary polycythaemia. Abdominal ultrasound was also normal. Investigation of her virilisation was initiated.Blood testosterone concentration was 44 nmol/l...
Malignant fibrous histiocytoma is the most common type of soft tissue sarcoma in late adulthood. The myxoid variant of malignant fibrous histiocytoma, also known as myxofibrosarcoma, can develop in subcutaneous rather than deep soft tissue, and the true extent of these superficial tumors is often underestimated. Patients with these low-grade myxoid malignant fibrous histiocytomas have an excellent 5-year survival rate, and it is therefore important to recognize them. We present a case with a superficial cutaneous accumulation of mucin that was diagnosed clinically and histologically as papular mucinosis. In retrospect, a subcutaneous presentation of myxofibrosarcoma should have been considered.
Introduction Open access breast clinics are now widely available and immediate reporting of FNAs of the breast has become an established part of the triple approach to the management of breast disease1. We report the unexpected findings of a case of Hodgkin's disease at such a clinic. The patient was a young woman who initially was thought by both her general practitioner and surgeon to have a fibroadenoma in the axillary tail region of her right breast. The FNA of this lump showed the features of Hodgkin's disease but with widespread necrosis, which was unusual and potentially misleading and which we wish to highlight. A lymph node biopsy confirmed the diagnosis and showed that the patient was suffering from the syncytial variant of nodular sclerosing Hodgkin's disease (NSHD). This variant probably accounts for about 5% of cases of Hodgkin's disease2. Necrosis is a common feature of NSHD; it can range from minute scattered foci to more extensive necrosis of nodules or even involve the entire lymph node.
A case is described of osteochondroma of the tongue and the literature on osteomata, chondromata and osteochondromata of the tongue is reviewed. The tendency for these tumours to arise in the region of the foramen caecum has been noted in previous reports as has the female preponderance. It has been suggested that they arise from remnants of branchial arch cartilage. The variation in the duration and age at presentation of the lesion has not been explained and an alternative theory is suggested.
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