Cancer
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A 14-month-old infant had a classical Wilms' tumor of the left kidney and subsequently developed a tumor showing predominantly mature mesenchymal elements and lack of cellular atypia in the right kidney. His father had classical Wilms' tumor of the left kidney. ⋯ The possible relation of chemotherapy to mesenchymal differentiation and maturation in Wilms' tumor is considered. The possibility of an unusual, histologically benign, mesenchymal variant in the spectrum of infantile nephroblastic neoplasia is also suggested.
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A case of fatal myeloencephalopathy secondary to accidental intrathecal administration of vincristine is reported in a 16-year-old boy. He underwent a progressive ascending chemical meningoencephalitis leading to coma, and died 36 days after the injection. Multiple samples of cerebrospinal fluid (CSF) and serum were assayed for vincristine sulfate. ⋯ The presence of numerous gemistocytic astrocytes, some in arrested mitosis, was a conspicuous feature in these areas. Three previous reports of intrathecal vincristine instillation are reviewed. No treatment for this devastating iatrogenic error exists, underscoring the importance of preventive measures in chemotherapy administration.
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Vasitis nodosa is a benign reactive condition characterized by nodular thickening of the vas deferens which usually develops following vasectomy. In addition to chronic inflammation, fibrosis and sperm granulomas, an exuberant proliferation of ductules resembling invasive adenocarcinoma is seen. A review of vasa deferentia from 210 patients submitted to the surgical pathology service at Arizona Health Sciences Center yielded ten cases of vasitis nodosa. ⋯ Two additional cases were referred to us, one of these showing ductular epithelium around a small peripheral nerve. The aggressive and infiltrative nature of the proliferating ductules in this relatively common benign lesion is important to recognize. Since nerve involvement has also been reported in fibrocystic disease of the breast, normal and hyperplastic prostate, and normal pancreas, it cannot be used as evidence for malignancy in these situations.