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PURPOSE To report the clinicopathological correlation of extramedullary hematopoiesis (EMH) of the conjunctiva in a patient with a history of myelofibrosis. METHODS Case report. RESULTS Elevated pink conjunctival lesions developed bilaterally in a 73-year-old man who had been treated for myelofibrosis for 13 years. EMH was detected in the examination of tissue from the lesion of the inferior fornix of the right eye. CONCLUSIONS The appearance of conjunctival lesions in a patient with myelofibrosis may indicate underlying pathology of EMH that may necessitate a change in systemic treatment of this condition.

Purpose The aim of the study was to evaluate the 10-year treatment outcome of utilizing adjuvant high-dose whole abdominal irradiation (WAPI technique) with a pelvic/vaginal boost in patients with stage I–III endometrial carcinoma at high risk for intra-abdominopelvic recurrence, including serous-papillary and clear cell histologies. Material and methods In a prospective nonrandomized trial, 132 patients were treated with adjuvant WAPI between November 1981 and October 2001. Forty-three patients (32%) were 1998 FIGO stage I–II and 89 (68%) were stage III. Pathological features included the following: 66 (52%) with deep myometrial invasion, 50 (38%) with positive peritoneal cytology, 89 (67%) with high-grade lesions, 25 (19%) with positive pelvic/para-aortic lymph nodes, and 58 (45%) with serous-papillary or clear cell histology. Results The mean follow up was 6.4 years (range 0.6–16.1). For the entire group, the 5- and 10-year cause-specific survival (CSS) was 77 and 72%, whereas the disease-free survival (DFS) was 55 and 45%. When stratified by histology the 5- and 10-year CSS for adenocarcinoma was 75 and 70%, while serous-papillary/clear cell was 80 and 74% ( P = 0.314). The 5- and 10-year DFS for adenocarcinoma was 59 and 49%, whereas serous-papillary/clear cell was 49 and 38% ( P = 0.563). For surgical stages I–II, the 5-year CSS was 83% for adenocarcinoma and 89% for serous-papillary ( P = 0.353). For stage III, it was 73 and 62% ( P = 0.318), respectively. Forty-six patients (35%) relapsed. The first site of failure was the abdomen/pelvis in 27/46 (59%). When stratified by histologic variant, 34% of patients with adenocarcinoma and 41% with serous-papillary developed recurrent disease. In multivariate regression analysis only advancing age was of prognostic significance for CSS ( P = 0.025) and DFS ( P = 0.026). Chronic grade 3/4 GI toxicity was seen in 14%, and 2% of patients developed grade 3 renal toxicity. Conclusion High-dose adjuvant WAPI is very effective treatment with excellent 10-year results for stage I–III endometrial carcinoma with risk factors for intra-abdominopelvic recurrence, including serous-papillary or clear cell histology. The low long-term complication rate with high CSS makes high-dose WAPI the treatment of choice for these patients with significant comorbidities.

A 67-year-old white man with esophageal adenocarcinoma presented with Peutz-Jeghers-like macules on the lips, face, nipples, and rectal mucosa. Pathological examination of the macules showed atypical melanocytes in the epidermis. The pleomorphic large melanocytes resembled the neoplastic cells seen in melanoma in situ. This is the first report of proliferation of atypical melanocytes in Peutz-Jeghers-like melanosis associated with a primary esophageal adenocarcinoma.

The spleen can be involved in a variety of cystic lesions ranging from cystic neoplasms and parasitic cysts to "true" and "false" cysts. Epidermoid splenic cyst is a rare true cyst that is developmental in origin. We present two young patients with such a cyst and illustrate their features on ultrasound, CT, and MRI with pathologic correlation.

Purpose: Clinical protocols utilizing pulsed low dose rate bracbytherapy (PDR) to replace traditional continuous low dose rate brachytherapy (CLDR) employ irradiation in individual pulses given at intervals of a few hours. A critical factor in determining whether PDR will produce equivalent or greater late-occurring normal tissue toxicity is the dose per pulse. A rat rectal model was used to determine the role of pulse size in modifying dose effectiveness in producing late-occurring toxicity. Methods and Materials: A rat model in which the rectum is irradiated with 19*Ir sources was used in conjunction with an intracavitary applicator. A section of rectum 1.3 cm in length was irradiated with either 0.75 Gy/h CLDR or one of five schemes of PDR. The schemes applied 0.375, 0.75, 1.5, 3.0, or 6.0 Gy pulses at 0.5, 1.0, 2.0, 4.0, or 8.0 h intervals, respectively. Rats were observed for up to 300 days after completion of irradiation for rectal obstruction. Rectal specimens were taken at the time of sacrifice for obstruction or at the end of follow-up and analyzed histologically for injury. Results: Effectiveness of irradiation was analyzed by calculating the EDSo for incidence of obstruction and severe histological injury. The EDso for obstruction after treatment with CLDR and pulse sizes of 0.375, 0.75, and 1.5 Gy were 70.5, 68.0, 68.6, and 68.8 Gy, respectively. These values were not significantly different. Compared to CLDR, the EDs0 for obstruction after pulse sizes of 3.0 and 6.0 Gy were significantly different at 60.9 and 46.3 Gy, respectively. The relative changes in ED5,, for the different radiation schemes in producing ulceration, fibrosis, and vascular sclerosis injury were similar to that observed for obstruction. The endpoints of colitis cystica profunda and atypical epithelial regeneration varied less with increasing pulse size. Conclusions: We have demonstrated that for late rat rectal injury, dose responses to PDR pulse sizes up to 1.5 Gy at 2-h intervals are not distinguishable from that seen with CLDR at a dose rate of 0.75 Gy/h. 0 1997 Elsevier Science Inc.

Purpose: Newer brachytherapy techniques, such as pulse-simulated low dose rate (PDR) and high dose rate (IIDR) offer cliical and technical advantages over the conventional continuous low dose rate (CLDR) irradiation. The impact of these techniques on late normal tissue toxicity has remained largely undefined, with mathematical modeling and limited clinical experience providing some guidelines. We sought to develop a reproducible rat model for quantifying and comparing late rectal toxicity from different brachytherapy techniques. Methods and Materials: An intrarectal applicator has been designed and techniques have been developed to deliver clinically relevant doses of CLDR to allow comparison to PDR and HDR. Female Wistar rats are utilized. The endpoints assessed are rectal obstruction and a histological grading of late rectal injury. Results: Analysis of 65 rats given either sham or single acute pulse irradiation has demonstrated the model to be reproducible and reliable in evaluating late rectal toxicity. Conclusions: The use of this rat model to compare late rectal injury from various doses, dose rates, and fractionation parameters utilized by CLDR, PDR, and HDR will provide another tool for safely implementing these techniques into the clinical setting. 0 1997 Elsevier Science Inc.

We report a case of Giant cell tumor of the tendon sheath involving the ankle, wherein spin-echo (T1- and T2-weighted), gradient-echo, and dynamic contrast-enhanced sequences were performed, and the tumor was noted to be very vascular. To the best of our knowledge, the use of gradient-echo sequences and the pattern of enhancement by time-intensity curves has not been reported earlier.

Five patients with a palpable mass at presentation underwent magnetic resonance (MR) imaging. The final diagnosis was myositis ossificans (MO). MR imaging features, particularly after injection of gadopentetate dimeglumine, mimicked those of an inflammatory mass or neoplasm. The lesions were excised in three patients, and the images were correlated with histologic findings. Three different appearances were noted on MR images, corresponding to the stages of maturation of MO. Two cases involved early-stage lesions, and T1-weighted MR images showed a mass with homogeneous intermediate signal intensity. Both lesions showed rim enhancement after contrast agent injection and high signal intensity on T2-weighted images. Pathologic specimens demonstrated stroma with masses of spindle cells in which osteoid production was interspersed. The enhanced rim of the lesion mimicked the expected MR appearance of an abscess or necrotic tumor. Areas of enhancement in adjacent muscle were also seen on postcontrast T1-weighted images. Intermediate-stage MO was present in one case; there was evidence of a thin rim of calcification on plain radiographs and fatty changes in the lesion on T1-weighted images, corresponding with histologic findings. One case of a mature lesion showed a considerable degree of peripheral calcification both on MR images and at histology. MR imaging is nonspecific in the diagnosis of early-stage MO.

2 cases of unifocal T-cell lymphomas, predominantly large cell type, one restricted to the midline of the palate and the other involving the nasal cavity are reported. Monoclonal antibodies served as a useful adjunct to light microscopy in diagnosing these tumors.

A case of traumatic perforation of the uterus with subsequent omental implantation in the endometrial cavity clinically presenting 16 years later as an endometrial lipoma is discussed. This case should alert clinicians to the existence of such a complication to be included in their differential diagnosis of lipomatous lesions of the uterus.