No abstract

A case of fibrolamellar hepatocellular carcinoma (FL-HCC) associated with adjacent focal nodular hyperplasia (FNH) is described. These two regions were adjacent but distinct, both on gross and microscopic examination. Currently, it is unclear whether FL-HCC rarely arises in preexisting FNH, or whether FNH is a typical response to this vascular variant of hepatocellular carcinoma (HCC). The FNH region, which is peripheral, may be biopsied to exclude the underlying carcinoma, and thus lead to inadequate therapy. Previous reports of this association are reviewed. importance of this observation in terms of patient management and proposed pathogenesis is discussed. Case ReportA 19-year-old woman with a 3-year history of oral contraceptive use (type unknown) was admitted for liver mass evaluation. One and one half months before she was admitted, sharp, episodic, left-sided chest pain developed. Hepatomegaly without splenomegaly was detected at evaluation. A computed tomography (CT) scan showed a hepatic mass. She was transferred to the Hospital of the University of Pennsylvania for further examination. The results of the physical examination were normal except for an 1 I-cm liver (by percussion), which was nontender but palpable 5.0 cm below the right costal margin. Complete blood count and serum electrolytes were normal, as were the alanine and aspartate aminotransferases and gamma glutamyl transpeptidase. Serum alkaline phosphatase was minimally elevated at 256 IU/L (compressed normal hepatic parenchyma < 140 IU/L). Serum alpha-fetoprotein and carcinoembryonic antigen were less than 10 ng/ml and 3 ng/ml, respectively. A nonenhanced and contrast-enhanced abdominal CT scan showed a large, relatively hypodense mass in the right hepatic lobe, with an enhancing central septate region. Selective right hepatic arteriography demonstrated a large hypervascular mass in the inferior portion of the right lobe, with a peripheral arterial supply radially penetrating into the center of the lesion (Figure 1). The parenchymal phase showed a dense capillary blush with a stellate septate pattern and central lucency compatible with a central scar. Vascular encasement. portal vein thrombosis, or arteriovenous shunting were not detected. The lesion was considered consistent with FNH.The patient was operated on and the anterior segment of the right hepatic lobe was removed and sent for pathologic con- 3049

We report a case of Waterhouse-Friderichsen syndrome associated with group A streptococcus (GAS) toxic shock syndrome in a previously healthy man. The patient presented with neck pain and fevers of 2 days' duration. Computed tomography of the neck revealed a mass in the retropharyngeal space, suggesting an abscess. Despite prompt treatment with appropriate antibiotics, the patient experienced a fulminant course and died within 8 hours of presentation. Antemortem blood cultures grew GAS positive for exotoxins A, B, and C. Postmortem examination revealed bilateral adrenal hemorrhage, consistent with Waterhouse-Friderichsen syndrome. Immunohistochemical analysis of the adrenal glands revealed the presence of GAS antigens. However, no disseminated intravascular coagulation was evident. This case demonstrates that adrenal hemorrhage can occur without associated coagulopathy and may result directly from the action of bacterial toxins.

Clinical and histologic features of 38 cases of neuroblastoma were compared with data obtained by flow cytometric DNA analysis. Favorable clinical outcome was associated with an aneuploid stem line (P < 0.01) and a low percentage of tumor cells in the S, G I , and M phases of the cell cycle (P < 0.005).These favorable cytometric features were also associated with a favorable clinical stage (1, 2, 4s), and histologic evidence of Schwann's cell and ganglion cell differentiation. Consideration of cytometric data improved the sensitivity, specificity, and predictive efficiency of a current system for histologic grading of neuroblastoma.Cancer 58:2453-2458, 1986. HE PROGNOSIS OF CHILDREN WITH TUMORS Of theT sympathetic nervous system has been shown to correlate highly with several clinical, biochemical, and histologic Shimada et al. have recently shown that three morphologic features are particularly useful in predicting the behavior of these tumors: (1) the proportion of neuroblastic and Schwann's cells; (2) the extent of ganglion cell differentiation; and (3) the percentage of mitotic figures and karyorrhectic nuclei (mitotic karyorrhectic index, MKI). Flow cytometric DNA analysis (FCDA), like the MKI, provides information concerning growth lunetics. FCDA is also used to detect abnormal tumor DNA content (aneuploidy), which has been associated with a favorable outcome in cases of neur~blastoma.~ Previous studies from this and other laboratories have also demonstrated the usefulness of FCDA in the diagnosis of neoplastic and preneoplastic disorders of the uterine cervix, bladder, lung, breast, gastrointestinal tract, and other site^.^,^ In order to evaluate the prognostic value of FCDA of neuroblastoma and ganglioneuroblastoma, a retrospective study of 38 cases was undertaken. The percentage of cells in the S and G2/M phase ofthe cell cycle (%SG*M) showed a highly significant association with clinical outcome, and when incorporated into the histologic classi-