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Lymphadenopathy in leprosy
LOCALIZEDAMYLOIDOSISOF HEARTVALVES[Cooper]
13. 14. 15. 16.
17.
deterioration. Springfield, I11., Charles C Thotnas, Publishers, 1970, p 107 Kula RW, Engel WK, Line BR: Scanning for soft-tissue amyloid. Lancet 1:92, 1977 Symmers W St C: Primary amyloidosis: a review.J Clin Pathol 9:187, 1956 Cooper JH: A histochemical construct of the amyloid fibril (abstract). European Amyloidosis Research Symposium program, 1981, p 48. Coffin Y, Cornwell GG, Murdoch W: Microdeposition ofamyloid in sternoclavicular discs and sclerocalcified heart valves: a combined immunofhtorescence and Ifistochemical sntdy (abstract). European Amyloidosis Research Symposittm, 1981, p 19 Pepys MD, Dash AC, Munn EA, et ah Isolation of anayloid P
18. 19. 20. 21. 22.
component (protein AP) from normal serum as a calciumdependent binding protein. Lancet 1: 1029, 1977 Linder E, Lehto VP, Virtanen I: Atnyloid-like green birefringence in cytoskeletal 10-nm filaments after staining with Congo red. Acta Pathol Microbiol Scand [A] 87:299, 1979 Christensen HE, Sorensen KH: Local atnyloid formation of capsula fibrosa in arthrosis coxae. Acta Pathol Microbiol Scand [A] 233(snppl):128, 1972 Teglbjaerg PS, Ladefoged C, Sorensen KH, et al: Local articular amyloid deposition in pyrophosphate arthritis. Acta Pathol Microbiol Scand [A] 87:307, 1979 Ladefoged C, Christensen HE: Congophilic substance with, green dichroism in Ifipjoints in autopsy material. Acta Pathol Microbiol Scand [A] 88:55, 1980 Goffin YA, Thoua Y, Potvliege PR: Microdeposition of amyloid in the joints. Ann Rheum Dis 40:27, 1981
CORRESPONDENCE Lymphadenopathy in Leprosy
To the Editor:--In r e f e r e n c e to tile article by R.-E. Cytowic et al. entitled "Chronic Relapsing Polyneuropathy Associated with h n m u n o b l a s t i c L y m p h a d e n o p a t h y , ''t I wonder whether tile diagnosis of leprosy was taken into consideration. Lymphadenopathy in leprosy is known, although not with immunoblastic features. However, the painful neuritis, the sensoritnotor neuropathies, and especially tile features a p p a r e n t in figure 2 of their report suggest nerve involvement by Mycobacterium leprae. 2 JonAs D E WiT, MD Black Lion Hospital of the Medical Faculty of Addis Ababa University, Addis Ababa, Ethiopia 1. CytowicRE, Challa VR, Buss DH, et al: Chronicrelapsingpolyneuropathy associated with immunoblasticlymphadenopathy.Hum Pathol 13:167, 1982 2. Binford CH, Connor DH: Pathology of Tropical and Extraordinary Diseases Vol 1. Washington,DC, Armed Forces Institute of Pathology, 1976, pp 205-225 Perianal Spindle Cell Lipoma
To theEditor:--Spindle ceil Iipoma is a benign fatty neoplasm whose histologic characteristics have been well docu m e n t e d in the literature.' Several articles and monographs have stressed the clinicopathologic correlation of its occurrence in the region of the posterior neck and shoulders of older men. i n a recent case report, Robb and Joues~"described an otherwise classic spindle cell lipoma in the perianal location. We have had the opportunity to observe another such case. REPORT OF A CASE. A 51-year-old man presented with a chief complaint of a lump at the "end of his spine," which had been present for )'ears. He had had no problems with altered bowel habits or b l e e d i n g but had had a h e m o r rhoidectomy 30 years previously. T h e r e was a 6.0 x 5.0crn pedunculated lesion in the coccygeal region at the apex of the cleft arising from the skin and subcutaneous tissue. Figure 1 illustrates the typical microscopic appearance
FIGURE 1. Perianal spindle cell lipoma. The histologic appearance is identical to that of spindle cell lipamas of the neck and back. the more typical locations.
653
13. 14. 15. 16.
17.
deterioration. Springfield, I11., Charles C Thotnas, Publishers, 1970, p 107 Kula RW, Engel WK, Line BR: Scanning for soft-tissue amyloid. Lancet 1:92, 1977 Symmers W St C: Primary amyloidosis: a review.J Clin Pathol 9:187, 1956 Cooper JH: A histochemical construct of the amyloid fibril (abstract). European Amyloidosis Research Symposium program, 1981, p 48. Coffin Y, Cornwell GG, Murdoch W: Microdeposition ofamyloid in sternoclavicular discs and sclerocalcified heart valves: a combined immunofhtorescence and Ifistochemical sntdy (abstract). European Amyloidosis Research Symposittm, 1981, p 19 Pepys MD, Dash AC, Munn EA, et ah Isolation of anayloid P
18. 19. 20. 21. 22.
component (protein AP) from normal serum as a calciumdependent binding protein. Lancet 1: 1029, 1977 Linder E, Lehto VP, Virtanen I: Atnyloid-like green birefringence in cytoskeletal 10-nm filaments after staining with Congo red. Acta Pathol Microbiol Scand [A] 87:299, 1979 Christensen HE, Sorensen KH: Local atnyloid formation of capsula fibrosa in arthrosis coxae. Acta Pathol Microbiol Scand [A] 233(snppl):128, 1972 Teglbjaerg PS, Ladefoged C, Sorensen KH, et al: Local articular amyloid deposition in pyrophosphate arthritis. Acta Pathol Microbiol Scand [A] 87:307, 1979 Ladefoged C, Christensen HE: Congophilic substance with, green dichroism in Ifipjoints in autopsy material. Acta Pathol Microbiol Scand [A] 88:55, 1980 Goffin YA, Thoua Y, Potvliege PR: Microdeposition of amyloid in the joints. Ann Rheum Dis 40:27, 1981
CORRESPONDENCE Lymphadenopathy in Leprosy
To the Editor:--In r e f e r e n c e to tile article by R.-E. Cytowic et al. entitled "Chronic Relapsing Polyneuropathy Associated with h n m u n o b l a s t i c L y m p h a d e n o p a t h y , ''t I wonder whether tile diagnosis of leprosy was taken into consideration. Lymphadenopathy in leprosy is known, although not with immunoblastic features. However, the painful neuritis, the sensoritnotor neuropathies, and especially tile features a p p a r e n t in figure 2 of their report suggest nerve involvement by Mycobacterium leprae. 2 JonAs D E WiT, MD Black Lion Hospital of the Medical Faculty of Addis Ababa University, Addis Ababa, Ethiopia 1. CytowicRE, Challa VR, Buss DH, et al: Chronicrelapsingpolyneuropathy associated with immunoblasticlymphadenopathy.Hum Pathol 13:167, 1982 2. Binford CH, Connor DH: Pathology of Tropical and Extraordinary Diseases Vol 1. Washington,DC, Armed Forces Institute of Pathology, 1976, pp 205-225 Perianal Spindle Cell Lipoma
To theEditor:--Spindle ceil Iipoma is a benign fatty neoplasm whose histologic characteristics have been well docu m e n t e d in the literature.' Several articles and monographs have stressed the clinicopathologic correlation of its occurrence in the region of the posterior neck and shoulders of older men. i n a recent case report, Robb and Joues~"described an otherwise classic spindle cell lipoma in the perianal location. We have had the opportunity to observe another such case. REPORT OF A CASE. A 51-year-old man presented with a chief complaint of a lump at the "end of his spine," which had been present for )'ears. He had had no problems with altered bowel habits or b l e e d i n g but had had a h e m o r rhoidectomy 30 years previously. T h e r e was a 6.0 x 5.0crn pedunculated lesion in the coccygeal region at the apex of the cleft arising from the skin and subcutaneous tissue. Figure 1 illustrates the typical microscopic appearance
FIGURE 1. Perianal spindle cell lipoma. The histologic appearance is identical to that of spindle cell lipamas of the neck and back. the more typical locations.
653