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The diagnosis of cryptogenic organizing pneumonia is usually delayed for several weeks due to treatment for presumed infectious pneumonia. We present a case of cryptogenic organizing pneumonia in a 39-year-old female who presented with shortness of breath and cough. She had both rapid clinical and radiological response to treatment with corticosteroids.

Background: Invasive fibrosclerotic lesions of the head and neck outside of the thyroid and orbit are extremely rare. To date 13 cases of sclerosing cervicitis have been described in the literature., Methods: We present a case of a sclerosing inflammatory lesion encountered at the skull base in a 49-year-old woman., Results: After surgical excision and pathologic examination, this lesion was identified as sclerosing cervicitis., Conclusions: This case report contributes to an awareness of a rare lesion of the head and neck that presents clinical and treatment challenges for surgeons managing these patients., (Copyright 2003 Wiley Periodicals, Inc. Head Neck 25: 778-783, 2003)

Clostridial enteritis necroticans, or pig-bel, as seen in Papua New Guinea, is a necrotizing, segmental gangrene of the small intestine occurring in members of a malnourished population, who become ill after consuming large quantities of pork contaminated with Type C. Clostridium perfringens. We report a case of possible Clostridial enteritis necroticans with concomitant ischemic intestinal disease secondary to superior mesenteric arterial thrombosis occurring in a 53-year-old woman with a long history of diabetes mellitus, hypertension, and peripheral vascular disease. The differential diagnosis and the pathogenesis of C. perfringens enteritis necroticans are discussed.

Pulmonary blastoma is a rare malignant neoplasm that histologically resembles airway structures and mesenchymal supporting tissues seen in the early phases of fetal lung development. The tumor either is biphasic with immature epithelial and stromal components or consists solely of an epithelial component. The preferred terminology for the latter is pulmonary endodermal tumor resembling fetal lung. Pulmonary blastoma is usually peripheral in location, and rarely does this tumor present intrabronchially. We report a case of pulmonary endodermal tumor resembling fetal lung presenting as a polypoid intrabronchial mass.

Multilocular renal cyst is an uncommon lesion of controversial histogenesis. The authors report a case of renal multilocular cyst with müllerian (ovarian)-like stroma. We suggest that this finding would support a dysontogenetic origin for the lesion.

A 70-year-old former shipyard worker presented with dyspnea and edema of the upper thorax suggesting the diagnosis of superior vena cava syndrome. Further evaluation revealed mesothelioma with both epithelial and spindled histologic patterns. The extensive mesothelioma had invaded the adventitia of the superior vena cava, the pleura of the lungs bilaterally, the superficial myocardium, and the liver. A terminal hyercoagulable state with great vein thrombosis was also contributory. To our knowledge this is the first documented case of superior vena cava syndrome associated with malignant mesothelioma.

Giant cell interstitial pneumonia is a distinctive and uncommon form of interstitial pneumonia. It is distinguished by the prominence of large, actively phagocytic alveolar giant cells of histiocytic origin in the presence of chronic interstitial pneumonia. Multinucleated type 2 granular pneumocytes are also identified. The multinucleated cells lack viral intranuclear inclusions of the type seen in measles pneumonia. Giant cell interstitial pneumonia may be idiopathic or it may occur with occupational exposure to hard metals or cobalt. We report this case to give recognition to an uncommon interstitial pneumonia.

A case of metastatic malignant melanoma simulating a giant cell tumor of bone is reported. This case typifies the diversity of expression of malignant melanoma. Osteoclast-like giant cells were present only in the femoral head metastasis and were not present in the primary lesion. The giant cell component may be reflective of an inherent and indiscriminant expression which may be seen in a variety of neoplastic bone lesions.

We report this case to further document in the literature morphologic changes encountered in a black thyroid gland. It is only through an expanding data base that future conclusions may be reached regarding the role, if any, of minocycline in some of these alterations.

Metaplastic bone is an uncommon finding in cases of fasciitis. It has been reported only in occasional cases in series of patients with nodular fasciitis, parosteal fasciitis, proliferative fasciitis, and proliferative myositis. Ossification is relatively common in cranial fasciitis of childhood, a form of fasciitis that may originate in cranial periosteum. We studied a patient with ossifying fasciitis that occurred along the adventitia of the femoral artery, at the site of an earlier angiographic study.

We report a patient who developed pulmonary hypertension following repeated intravenous injection of dissolved pentazocine tablets. Through analysis of lung biopsy material, this was shown to be due to embolization of the cellulose filler in the tablet and the tissue reaction it produced. Administration of prednisone appeared to improve the patient's clinical state.

Findings of a histochemical and ultrastructural study of the mucogenic cells of congenital adenomatoid malformation of lung indicate that these cells share features with goblet cells of bronchial or intestinal origin and do not indicate a similarity to normal gastric epithelium or glands, as has been previously suggested.

A 60-year-old man developed a widely metastatic spindle cell neoplasm with admixed osteoclast-like giant cells indistinguishable from malignant giant cell tumor of soft parts. Autopsy revealed a bronchogenic sarcomatoid squamous cell carcinoma that was the primary source of the sarcomatoid metastases. The osteoclast-like giant cells in the metastatic lesions were negative for lysozyme on immunoperoxidase staining. This finding suggested that the multinucleated giant cells were not formed as a cellular response to hemorrhage or to cellular debris induced by the tumor. Extraosseous neoplasms with osteoclast-like giant cells are rare neoplasms that may occur in a variety of organs. This case is the second reported case of a primary neoplasm in the lung that contained these osteoclast-like giant cells. These tumors may cause considerable diagnostic confusion.

Basaloid carcinoma is an uncommon tumor of the uterine cervix which has received little recognition in the medical literature. It is characterized by: 1) an ulcerated infiltrating growth pattern, 2) nests or cords of small basaloid cells, 3) prominent peripheral palisading of cells in the tumor nests, and 4) no significant stromal reaction. This cervical neoplasm is an entity distinguishable from adenoid cystic carcinoma, undifferentiated small-cell carcinoma, carcinoid tumor, and regional basaloid patterns in otherwise typical squamous cell carcinoma.

Tumors containing smooth muscle are rare in the breast. A myoepithelial origin for the myoid component of such lesions was postulated in previous reports. Myoepithelial hyperplasia has long been recognized as a common component of some breast lesions, including sclerosing adenosis, papillomas, and fibroadenomas. Three breast tumors composed of variable admixtures of adipose tissue, fibrous tissue, and smooth muscle are described. The authors postulate that the myoid component of two of the three lesions may have arisen in a milieu of myoepithelial hyperplasia. The origin of the myoid component in the third case is not clearly defined.

Two cases of primary adenovillous carcinoma of the bladder are presented: one in a normally placed bladder and the other in an exstrophied bladder. The close association of these 2 neoplasms with coexistent cystitis glandularis would seem to support the possible precancerous nature of the latter entity. The remarkable similarity of these neoplasms to villous adenocarcinomas of the rectum is also described, a finding which may reflect the close embryologic origin of the rectum and bladder neck. A brief review of the classification of vesical adenocarcinomas is also given.

Lipoadenoma is a rare tumor of the parathyroid gland composed of adult adipose tissue and irregular trabeculae of parathyroid cells. This variant of adenoma is poorly documented. Similar lesions that have been either functional or apparently nonfunctional have been reported as adenoma with unusual stromal development and as parathyroid hamartoma, respectively. In this report, the second case of a functional lipoadenoma of the parathyroid gland is described.

Congenital hepatic fibrosis (CHF) is a morphologic entity characterized by (1) abnormal fibrous septation, (2) preservation of the basic lobular architecture, and (3) hyperplasia and dilatation of bile ductules. Congenital hepatic fibrosis may present as a cause of portal hypertension in adolescents, in young adults, and, rarely, in older adults. It is this form of the disorder that has been emphasized in the literature. However, CHF may also be seen in association with the infantile polycystic kidney syndrome. In the latter, the hepatic disorder is usually clinically silent. Cholangiocarcinoma is a rare complication of comgenital hepatic fibrosis, with only two previously documented cases reported, to our knowledge. We report a third case and suggest that CHF may represent a dysplastic hamartoma that, with prolonged survival, may eventuate in the development of intrahepatic biliary neoplasia.