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Permanent ischemia-induced testicular damage may occur as early as 30 min in prepupertal rats. With the goal of potentially enhancing testicular function and fertility preservation, we performed testis-sparing surgery (TSS) without ischemia for testicular lesions in select children with negative markers and high likelihood of benignity on ultrasonography. Preliminary experience suggests that off-clamp TSS should be more liberally encouraged, especially in infants and prepubertal children, given their particularly vulnerable spermatic cord elements.

Lymphomas presenting and mimicking soft-tissue masses are important to recognize, to avoid unnecessary treatment delays or extensive surgery. We describe a case of primary anaplastic large cell lymphoma (ALCL) arising from a deep skeletal muscle in a middle-aged male. He presented with a two-month history of swelling of his right thigh and mild fever, which led to a diagnosis of abscess formation. Antibiotics were prescribed for two weeks, with little improvement of symptoms. Subsequently, an exploratory surgery, with excision of the mass, demonstrated a ALCL of the psoas muscle, ALK-1 positive.

Primary intra-hepatic pregnancy is an extremely rare condition. The purpose of this study was to report a case of 24-year-old Gravida 2 para 1+0 who presented at 35 weeks of amenorrhea with vaginal bleeding and mild right upper abdominal tenderness. Ultrasonography revealed a non-viable extra-uterine fetus located around the right upper part of the abdomen with a bulky uterus. Laparotomy was preferred in view this clinical dilemma and a fetus free abdominal cavity and uterus was observed, a macerated female baby was delivered from inside the liver with birth weight of 2.7kilogram. Placenta was left in situ and methotrexate given to hasten its resorption. Maternal outcome during the 18 days of intense follow up was uneventful. This case is a rare occurrence in our setting and it has diagnostic challenges in low resource settings like ours, however intra-hepatic pregnancy can grow to considerable size and weight.

PurposeGastric infection withStrongyloides stercoralis(SS) usually occurs in immunocompromised patients. The unexpected observation of this parasite in an otherwise healthy young lady who had undergone upper endoscopy and biopsy sampling of the gastro-duodenal mucosa, prompted us to review the literature to ascertain the conditions favouring gastric colonization bySS.MethodsPathology files of gastroduodenal biopsies received at St. Mary’s hospital, Northern Uganda, between 2007 and 2017 were reviewed. Pubmed search was performed under the headings “Strongyloides stercoralis”, “Gastric parasitosis”.ResultsHistology of the only gastroduodenal biopsy with SS infection showed parasite eggs, immature rhabditiform larvae, and numerous adult worms in gastric pits and rhabditiform larvae in interepithelial parasitic tunnels, causing reactive changes of the glandular epithelium. There was no significant acute inflammatory cell infiltrate surrounding the parasites. Literature review showed that gastricSSinfection appears to be very uncommon and was, as expected, largely prevalent in immunodeficient individuals (84.2% of published cases). The rare gastricSSinfection is a complication of systemic strongyloidiasis, either hyperinfective, or disseminated form. It is also commonly associated with duodenal infection at microscopical examination.ConclusionInvolvement of gastric mucosa in the absence of duodenal strongyloidiasis appears to be quite rare and false-negative histopathological exams are reported if only the stomach is biopsied.

We performed next generation sequencing of DNA extracted from the neoplastic tissues obtained from a patient who underwent surgery for a large right ovarian carcinoma (OC) of endometrioid type associated with endometrial cancer (EC). This was done in order to ascertain whether the tumors were synchronous endometrial/ovarian cancers or an advanced metastatic stage from either the ovary or the uterus. Pathologic criteria favoured synchronous EC/OC. We identified a PTEN c.959 T > G (p.L320X) truncating mutation occurring with similar allele frequency in both neoplastic tissues (ovary: 88 %, endometrium 89 %) and a CTNNB1 c.100C > G (p.S37C) activating mutation, with a comparable allelic frequency in both tumor tissues (ovary 51 %, endometrium 52 %). The shared genetic mutations, and the presence of PTEN c.959 T > G (p.L320X) truncating mutation, albeit at low allelic frequency (6 %), in the healthy peritumoral endometrial tissue, appear to confirm the recent literature on a primary endometrial origin for synchronous EC/OC. A third mutation was CTNNB1 c.92 T > C (p.L31 P), a missense mutation occurring with a low allele frequency (3.7 %) only in the ovarian cancer tissue. This mutation is only occasionally described in hepatocellular carcinomas.

This report documents an uncommon case of choristomatous cervical polyp-containing fat tissue. The patient was a 24-year-old female who presented with irregular intermenstrual bleeding. On examination, a polypoid lesion with smooth outlines, measuring 1 cm in diameter was removed. Microscopic examination demonstrated abnormal fibrous stroma, devoid of endocervical glands, containing mature adipose tissue, and thick-walled blood vessels. The lesion was covered by a typical mature squamous cell outer lining. To the best of our knowledge, this is only the second report of an adipose tissue arising from the cervical wall. Further clinicopathologic considerations are needed to elucidate the origin of the fatty component in cervical polyps.

Objectives. Primary SS is an autoimmune disease characterized by chronic lymphocytic inflammation and ectopic germinal centre (GC) formation within salivary glands. Fractalkine (CX3CL1), associated with the pathogenesis of RA, is the sole member of the CX3C chemokine (CK) family and acts as an adhesion and chemotactic molecule. The objectives of this work are to determine to what extent CX3CL1 and its receptor CX3CR1 expression might be altered in salivary glands obtained from patients and to establish whether these CKs might be involved in SS ectopic lymphoneogenesis. Methods. We assessed the presence of CX3CL1 protein in sera by ELISA in 21 patients with primary SS, 11 patients with Sicca syndrome (Sicca), 20 RA patients and 10 blood donors. Histological evaluation was performed on sequential sections of salivary gland tissue. Using TaqMan RT-PCR we studied CX3CL1 and CX3CR1 mRNA expression in salivary gland tissues from a molecular point of view. Results. Increased serum levels of CX3CL1 protein were observed in SS patients compared with controls (P < 0.0001) and in RA patients compared with controls (P < 0.0001), but no difference was found between Sicca patients and controls (P = 0.22). We identified histologically the cells expressing CX3CL1 and CX3CR1 in salivary glands of SS patients and we localized the molecule within tertiary lymphoid structures. Finally, the mRNA levels of the CK and its receptor were up-regulated in SS salivary glands. Conclusion. We believe that our findings point to the need for future studies on CX3CL1 and CX3CR1 proteins as contributors to the formation of ectopic GCs and possibly as a new tool in the evaluation and diagnosis of SS.

Adenoma of the nonpigmented ciliary epithelium developed in a 36-year-old woman, causing decreased visual acuity and a total cataract in the involved eye. Ultrasound biomicroscopy disclosed associated persistent hyperplasic primary vitreous (PHPV). Sectoral cyclectomy with removal of the mass and intracapsular cataract extraction were performed, and the tumor was submitted for histological examination. Although ciliary adenomas arising in adults are considered to be acquired, the associated PHPV suggests a congenital origin in view of the tumor's possible interference in the normal replacement of the primary vitreous by the secondary vitreous.

Background: The changing trend of GI disorders has not been expounded in our setting, there is need to examine the extent to which major endoscopically diagnosed upper GI disorders have changed in the last 10 years (2005 to 2015). Methods: This was a retrospective study in which endoscopically diagnosed GI disorders of Jan-Jun 2005 were compared with 2015 (10 years) for the same period Results: In the 10 years (2005 to 2015), the prevalence of peptic ulcer disease (PUD) reduced from 9.6% to 2.9% (P value 0.000), followed by esophageal varices from 10.3% to 4.0%, and duodenitis from 3.2% to 0.7% respectively. Gastritis increased from 18.4% to 48.2% (P value 0.000), followed by cancer esophagus from 3.2% to 5.1%. Conclusion: As the prevalence of PUD decreases in our community, gastritis increases hence patients with upper GI symptoms tend to suffer gastritis thus clinicians should focus on treating gastritis and eradication of Helicobacter pylori. Keywords: Peptic ulcer disease, Gastritis, GI Disorders

Uterine sarcomas and small bowel neuroendocrine tumours are both uncommon neoplasms. We report the case of a patient affected by an undifferentiated uterine sarcoma and synchronous adenocarcinoid of the ileum, in which surgery played a key role. A 57-year-old postmenopausal woman presented with a 6-month history of pelvic pain and uterine bleeding. Examination revealed a polypoid mass of 15 mm in diameter protruding from external os. Abdomino-pelvic MRI identified another solid nodule of 20 mm in diameter in the ileal wall. Histology demonstrated an undifferentiated uterine sarcoma. However, the ileal nodule proved to be an adenocarcinoid and not a metastatic deposit of the uterine malignancy. Histological evaluation of uncertain lesions may help in providing appropriate treatment and hence, a better survival.

Heterotopic secondary ossification of the eye usually affects intraocular tissues. Although calcium deposition in the scleral lamellae is not uncommonly observed, bone formation is only rarely associated with chromosomal abnormalities or colobomatous eyes. Herein two cases of both scleral and intraocular ossification in patients with long-standing ocular phthisis are reported. The cases of idiopathic scleral ossification, albeit exceedingly rare, suggest that osteogenic precursor cells may reside in the sclera, as well and though very rarely, these cells can also be stimulated to form heterotopic bone by a traumatic or inflammatory local event.

Microphthalmos with cyst is a rare condition characterized by a small globe and an inferior uveoretinal coloboma. There is also a defect in the posterior aspect of the eye through which a cyst lined by neuroectodermically derived tissue protrudes into the orbit. A case of isolated bilateral colobomatous and cystic microphthalmos is reported in an otherwise healthy child, showing no evidence of chromosomal abnormalities. Microscopic findings in the enucleated eye consisted of iris and retinal dysgenesis, ectopia lentis, persistent anterior tunica vasculosa lentis and pupillary membrane, intrachoroidal smooth muscle, and optic nerve hypoplasia. In the orbital cyst, a thick membrane reminiscent of the retinal inner limiting membrane lay between the fibroadipose and vascularised outer wall and the inner neuroectodermal lining.

This chapter describes the diseases of the orbit, lacrimal gland, and the lacrimal drainage system. The embryology and anatomy of these structures is described shortly. All disease processes are discussed subsequently: congenital abnormalities, inflammation and infection, degenerations, and neoplasms. In order to prevent doublures, certain disease processes and diseases are described in detail as orbital diseases which may be subsequently referred to in the paragraphs of the lacrimal gland and drainage system.

Forty allograft nephrectomies (28 males and 12 females, mean age of 33.2 years), performed between 1986 and 1999, were selected. Twenty patients had been grafted from cadaveric donors; of the remaining cases, 15 had received a kidney from a living related donor. Except for six patients who received steroid-azathioprine immunosuppression, all recipients were treated with cyclosporine A and low doses of steroids. None had primary or acquired hyperoxaluria as the cause of original end-stage renal disease, and none had a history of kidney stones or urinary infection. Kidney failure occurred after a time period ranging from 2 days to 11 years posttransplant and was secondary to acute rejection in 17 cases, chronic rejection in 15, ischemic necrosis in five, acute or chronic pielonephritis in two, and allergic microangiopathy in one. No blood chemistry evaluations for oxalemia were performed. Clinical data are summarized in Table 1. Multiple sections cut from formalin-fixed, paraffin-embedded blocks and stained with haematoxylin-eosin (H&E) were examined using partially crossed polarizing screens. The presence of calcium oxalate crystals in different segments of the nephron or in the interstitium was recorded. Birefringent deposits with characteristic green iridescence, presenting as large plate-like or diamondshaped crystals, or any shape, provided that the crystals displaced tissue structures, were studied. Confirmation of the crystal nature was obtained using Yasue’s method, a histochemical stain considered to be specific for calcium oxalate, while usual stains for calcium (alizarin red and von Kossa’s method) were negative. Silver nitrate–rubeanic acid with 5% acetic acid pretreatment (Yasue’s method) stains only calcium oxalate, since calcium phosphate and calcium carbonate are dissolved with the acetic acid. A thyroid with multiple deposits of calcium oxalate and hydroxyapatite crystals was used as a positive control for the histochemical stains.

A large mass in the right orbit, causing proptosis, ptosis of the right upper eyelid, and limitation to eye movements, was surgically removed from a 51-year-old woman suffering from Paget's bone disease (PBD). Histologically, a giant cell tumor of the bone (osteoclastoma) was diagnosed. No bony involvement was apparent either operatively, microscopically, or on preoperative computed tomographic scans. The neoplasm has not recurred in a 3-year follow-up. In addition to the fact that osteoclastoma complicating PBD is rare, the extraskeletal origin of the tumor is a matter of interest and can be tentatively explained by an unusually powerful systemic stimulus acting on circulating osteoclast precursors. HUM PATHOL 31:1527-1531.

75-year-old woman reporteddecreased vision and metamorp-hopsia in her right eye of 15 days’duration. Both eyes showed a visualacuity (VA) of 20⁄40 and normalanterior segments and intraocularpressure. Ophthalmoscopical examina-tion suggested a macular detachmentof the retinal pigment epithelium(RPE), but failed to disclose any hae-morrhages or exudates (Fig. 1). Theleft eye was entirely normal.Fluorescein angiography (FA) inthe right eye revealed a pooling of dyecorresponding to the serous RPEdetachment visible on fundus exam-ination (Fig. 2), and late-phase indo-cyanine green (ICG) angiographydemonstrated a prominent leakageinto the RPE, with no evidence ofchoroidal neovascularization.Six months later, the patient noted asudden decrease in vision in her righteye (VA 20⁄200). Funduscopy, per-formed 1 week later, demonstrated amacular serosanguineous RPE detach-ment (Fig. 3). While FA confirmed thefunduscopic findings (Fig. 4), opticalcoherence tomography (OCT) showed,in addition, a prominent orange subre-tinal mass protruding anteriorly, nextto the RPE detachment (Fig. 5). Inearly-phase ICG videoangiography,the mass corresponded to a typical,small vascular network with three poly-poidal structures, not detectable onFA, located inferiorly in the papilloma-cular area (Fig. 6). The polypoidal

Purpose: In a Strampelli osteo-odonto-keratoprosthesis, a patch of oral mucosa is frequently used to cover the ocular surface after implantation of an osteodental lamina into the eye. In many cases, gross modifications inthe eye covering become apparent a few years later. The aim of this study was to investigate the histologic findings in the clinically modified ocular surface. Method: Biopsies were performed in 7 patients at the junction between the osteodental acrylic lamina and surrounding modified oral mucosa, during surgery for local plastic reconstruction or positioning of antiglaucoma silicone tubes. Specimens were examined by light microscopy. Results: Six of the 7 clinically modified specimens corresponded microscopically to conjunctiva. Typical oral mucosa could still be observed overlying the osteodental acrylic lamina. Conclusions: The production of local regulatory factors is a possible explanation for the survival of oral mucosa over the osteodental acrylic lamina, whereas their absence in distant areas may have induced the oral mucosa to transdifferentiate into a conjunctival-type lining. Alternatively, conjunctival regrowth from forniceal stem cells should be taken into consideration.

Objective: To report a case of palpebral solitary fibrous tumour (SFT). Clinical Presentation and Intervention: An elderly man presented with a slow-growing painless mass in the lower conjunctival fornix in the left eye. The lesion was excised and it measured 0.9 cm in maximum diameter. The microscopic features were characteristic of a benign SFT, with immunohistochemical reactivity for vimentin, CD34 and Bcl-2 protein. Nuclear staining for progesterone receptor was also observed. Conclusion: This tumour displayed a benign course, with no recurrence after excision. CD34 immunohistochemistry proved to be a useful adjunct to the microscopic diagnosis.

Case report: A 34-year-old man presented with anterior scleral thinning in the right eye (RE) and a painful nodular scleritis in the left eye (LE). Fundus examination showed a healed vasculitis and an inferior epiretinal neovascular membrane in the LE. Topical and systemic oral steroids and antiviral medication were prescribed. One year later, optic disc hyperaemia and swelling and macular oedema became apparent in the LE. Pulsed intravenous steroids were administered for 1 year, when a nasal septum perforation and vitreous haemorrhage in the LE were diagnosed. The eye was enucleated 3.5 years after the initial complaint. Necrotizing granulomatous tissue replacing the sclera and subconjunctival granulomatous tissue were observed. Six months later, oedema and neovascularization of the right optic disc were observed and cyclophosphamide was started, with regression of the clinical signs. No systemic abnormalities have so far become apparent. Discussion: Posterior scleritis is most often observed in patients with no signs of associated systemic autoimmune disease. The diagnosis in this case is most probably one of Wegener's granulomatosis (WG). In WG, the diagnosis is based on necrotizing granulomas of the respiratory tract, generalized focal necrotizing vasculitis and focal necrotizing glomerulonephritis. Eye involvement with WG has been reported in up to 58% of cases. Evaluation of the scleritis patient should include a detailed medical history, chest X-rays, blood tests, autoantibody serology and analysis of urinary sediment. Cyclophosphamide is the treatment of choice for patients with ocular manifestations of WG, polyarteritis nodosa or rheumatoid arthritis, either alone or in combination with systemic steroids. Visual loss is expected in 85% of individuals with severe necrotizing posterior scleritis.

Primary NHL of the female genital tract are relatively uncommon, accounting for only 2% of all extranodal primary lymphomas, and for less than 0.5% of gynaecologic cancers. Primary endometrial lymphomas can be considered a rarity, with less than 50 instances reported in the literature. We describe a case of primary marginal zone B-cell MALT-type lymphoma of the endometrium, of which there were only other 5 case reports in the literature. We also present a review of the literature.

PURPOSE To report the histological and immunohistochemical findings in a cornea removed from a patient who had undergone collagen cross-linking (CXL) with riboflavin and ultraviolet-A for progressive keratoconus. CXL was performed following the Siena protocol. Two years post-CXL, a visual acuity impairment in the treated eye secondary to corneal stromal opacity had occurred, together with corneal thinning and flattening. METHODS The excised cornea was formalin-fixed, paraffin-embedded, and examined microscopically. Deparaffinized 4-μm sections were stained with hematoxylin-eosin and Masson trichrome. Further tissue sections were subjected to immunohistochemical evaluation of CD34 and Ki-67 antigens. RESULTS Histologically, there was no scar tissue in the failed cornea. The biomicroscopic stromal opacity corresponded microscopically to an acellular area, devoid of keratocytes, and to compaction of the lamellar collagen. Amorphous, weakly eosinophilic interlamellar deposits, extending from the anterior to the posterior two thirds of the stroma, were noted. CONCLUSIONS CXL is a promising procedure for the treatment of progressive keratoconus with minimal reported side effects. In the present case, we speculate that the short corneal soaking time (15 minutes according to the Siena protocol) may have resulted in inefficient ultraviolet-A blocking, thermal injury, and deeper keratocyte death. Inadequate keratocyte stem cells reservoir could also play a role in individual cases.

Purpose To evaluate capsular bag size and accommodative movement before and after cataract surgery using ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT). Setting Ophthalmology Unit, Fabia Mater Clinic, Rome, Italy. Design Cohort study. Methods Eyes having cataract surgery and monofocal intraocular lens (IOL) implantation were studied using UBM. The following parameters were measured preoperatively and 1, 2, and 12 months postoperatively: anterior chamber depth (ACD) (also by AS-OCT), capsular bag thickness, capsular bag diameter, ciliary ring diameter, sulcus-to-sulcus (STS) diameter, ciliary process–capsular bag distance, ciliary apex–capsular bag plane, and IOL tilting. The preoperative and postoperative capsular bag volumes were calculated at 12 months. The results were compared with the changes during accommodation. Results The study comprised 24 eyes. With the exception of the ciliary apex–capsular bag plane, which appeared to be unmodified postoperatively, all measured parameters showed significant variation after IOL implantation. Only the ACD did not change significantly during accommodation. Conclusions After cataract surgery, the capsular bag stretched horizontally and with reduced vertical diameter as a result of adaptation to the implanted IOL. The capsular bag–IOL complex filled all available space, compressing the zonular fibers and almost abolishing the space between the ciliary apex and the capsular bag. There was anterior chamber deepening and a decrease in the ciliary ring diameter and STS diameter. In the absence of zonular fiber tension, the shape of the ciliary processes may be modified. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

A case of massive well-differentiated, superficially invasive, squamous cell carcinoma of the cornea is described. This patient did not have any common identifiable risk factors in the development of SCC of the ocular surface, such as excessive solar exposure, HPV infection, immunocompromised state, or chronic ocular irritation. A perforating injury in the cornea of the same eye had occurred 11 years before. The possible role of trauma in causing subsequent neoplastic development is discussed, as well as the immunohistochemical results for p53 and p63.

Background Gastric cancer commonly follows a long-standing inflammation, mainly due to Helicobacter pylori (HP) infection. After resection, the stump develops precancerous alterations. Design Prospective study of patients undergoing endoscopy from April 1, 2000, through March 31, 2006. Setting University departments of Surgery and Experimental Medicine and Pathology. Patients One hundred eighty-seven patients receiving upper gastrointestinal tract endoscopy many years after surgery for duodenal ulcer or gastric cancer. Ten to 12 postoperative endoscopic biopsy samples were taken from the remnant stomach. Main Outcome Measure The risk of gastric cancer precursor lesions associated with HP infection. Results The gastric cancer precursor lesions were more common in the entire HP-positive population (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.25-4.49; P = .007). However, HP-positive patients undergoing resection for cancer had a higher risk of the precursor lesions compared with HP-negative patients in the same diagnostic group (OR, 4.20; 95% CI, 1.10-15.96) and all patients undergoing resection for duodenal ulcer (OR, 1.59; 95% CI, 0.44-5.73). Conclusion The results of this investigation support the role of HP in gastric carcinogenesis and suggest that the HP eradication therapy might prevent the development of metachronous gastric cancer after gastric resection.

A case of basal cell carcinoma (BCC) with intratumoural bone formation affecting the eyelid of a 77-year-old lady is described. Bone formation in BCCs is an uncommon event. We revised the 23 cases described in the literature: most of them occurred on the face. The pathophysiological mechanism responsible for ossification in cutaneous lesions remains unclear. The bone often develops adjacent to, or within hair follicles. We evaluated the immunohistochemical expression in the present case of Cbfa1/Runx2, an early marker for osteoblastic progenitor cells. A well-developed lamellar bone with adipose bone marrow was observed both in the superficial stroma and intratumourally. Cbfa1/Runx2 was localised in the osteocytes of the heterotopic bone and in the keratin cysts of the BCC. The expression of Cbfa1/Runx2 in the present BCC suggests a possible role of this protein in the induction of the heterotopic bone.

We report a case of collision tumor of the cecum in a 50-year-old woman and discuss the morphological criteria used for classifying mixed glandular-endocrine neoplasms of the digestive tract in a large series of reported cases. The cecal tumor showed clear geographic polarization, with no admixture or transition of the 2 neoplastic components. A lymph nodal metastatic deposit contained both tumors. Immunohistochemical stainings were consistent with the carcinomatous and carcinoidal nature of the 2 neoplasms, except for a minute area of carcinoembryonic antigen positivity in the carcinoid. A review of the literature shows that many mixed glandular-endocrine tumors of the digestive tract escape precise classification using established morphological criteria. Collision and composite tumors can share common histological and immunohistochemical features, including polyclonal metastases and carcinoembryonic antigen expression in the carcinoidal area. Mixed tumors of the cecum showing a collision-like morphology appear to behave more aggressively than other colonic adenoendocrine carcinomas.

We evaluated the microscopical changes that occurred when bone and dental tissue were exposed to such a foreign environment as the ocular surface and anterior chamber in 17 osteo-odonto-keratoprostheses removed from the recipient's eye after 1 to 20 years. Histochemical methods were performed to demonstrate elastic and precursor fibers, while immunohistochemical procedures were used to study the distribution of collagen types I to VI. Islands of heterotopic, newly formed bone were observed in the dentin and the periodontal space, leading to focal dentoalveolar ankylosis. Remodelling and disappearance of the periodontal ligament was never diffuse.

A solitary neurofibroma arising from the thyroid capsule in a 64 year-old woman is reported. The tumor was adherent to the lower margin of the thyroid gland and extended into the anterior mediastinum. The unusual nature of the lesion, both its relationship to the thyroid gland and to the occurrence of a neural tumor in the anterior mediastinum is discussed.

The histological features are reported of osteo-odonto-acrylic laminae removed from three patients who for differing underlying causes received Strampelli's osteo-odonto-keratoprostheses (OOK) 20, 16, and 12 years previously. It appears that preservation of the alveolar-dental ligament plays a definitive role in the maintenance of the prosthesis. If this tissue undergoes necrosis as a consequence of an inflammatory disease the implanted material is eventually lost. However when no such event occurs the OOK is well preserved and well tolerated even 20 years after implantation.

In a series of 98 consecutive eyeballs enucleated at postmortem from 86 patients dying with AIDS, the incidence of calcium deposits was 14 and 18.6%, respectively, for oxalates and calcium hydroxyapatite. The calcific eyes were examined by scanning electron microscopy (SEM) coupled with energy-dispersive X-ray microanalysis to confirm the elemental nature of the precipitates. Transmission electron microscopy was used in 2 of the cases with oxalosis. Oxalates with a free end exhibited a plate-like shape at SEM and appeared acicular at TEM, due to the reduced thickness of ultrathin sections. Crystals that were embedded in tissues such as the sclera or degenerate detached retinal tissue formed either spherules or plates at SEM. No clear relationship with intracellular structures could be found at TEM, possibly due to postmortem autolysis phenomena. Calcium hydroxyapatite deposits appeared at SEM as fine granules distributed over the collagen fibers of the corneal and conjunctival stroma and the scleral lamellae, but were also present intracellularly, both in the nucleus and cytoplasm of epithelial cells.

We report the presence of peculiar nonbanded calcification of the cornea in three patients with acquired immunodeficiency syndrome, discovered on postmortem histological examination of the globes. In one patient, multiple calcium salt precipitates also affected other ocular and orbital structures. Calcium deposits were present in the corneal stroma but spared Bowman's layer, as is usually seen in primary and secondary corneal calcification. The calcified areas were positive to von Kossa, alizarin red, alcian blue, and colloidal iron stains. Electron probe analysis of the three cases showed the presence of calcium and phosphorus in a ratio characteristic for hydroxyapatite. No predisposing factors could be found. The possible role of associated alterations in the mucopolysaccharide content or composition in the calcified areas is unclear.

We report a case of calcium oxalate deposition in a renomedullary interstitial cell tumor (RICT) in a patient dying of full-blown AIDS. The precipitates showed birefringence using a partially polaris ed light and were stained black in Yasue’s silver nit rate-rubeanic acid method. The combination of calcium oxalosis and RICT has not been reported before and might possibly be due to systemic biochemical alterations of the glycosaminoglycans as a result of profound metabolic disturbances in AIDS patients.

Background: Intraocular smooth muscle tumors have long been a subject of controversy. The advent of immunohistochemistry with antibodies against HMB-45, S-100, smooth muscle actin, desmin, and vimentin has helped greatly in the distinction between smooth muscle tumors and melanocytic lesions. Methods: Twenty-seven archival tissue blocks from patients who had had intraocular leiomyomas or leiomyosarcomas diagnosed were located and fresh sections cut and stained for the above markers. The cases constituted 24 iris lesions and 3 ciliary body lesions. Results: All 24 iris tumors were reclassified as iris melanocytic lesions. Two of the three ciliary body leiomyomas retained their classification, and the third was reclassified as a spindle B-cell melanoma. Conclusion: The authors suggest that intraocular leiomyomas are much rarer than previously suggested and that many of the cases previously reported in the literature are open to question.

Exfoliative urinary cytology was used for two amyotrophic lateral sclerosis patients treated with 3 mg/kg/day cyclosporine (CsA) therapy in order to detect the onset of the nephrotoxic side-effects of the drug before the apparent deterioration of the patients' clinical condition. Of the two patients, only one showed clear morphological features of drug-related damage in a one year course of cyclosporine therapy, but these followed the increase in the serum kidney and liver laboratory parameters and did not prove useful for the early detection of nephrotoxicity. However, in this patient the renal damage was hallmarked by an increasing number of tubular cells or clusters of ill-defined renal cells in the urinary specimen, suggesting an ongoing tubular injury. The slight cytological alterations may possibly be due to the low CsA dosage used for these patients. The significance of these observations is tempered by the limited number of patients and specimens studied to date and further studies in non-transplanted patients are therefore advocated, particularly when higher CsA doses are employed.