Faculty Bibliography

We report an incidental small hepatocellular carcinoma in a patient with chronic hepatitis C infection without cirrhosis. The existence of portal triads and the Meyenburg complexes within the lesion and atypical subnodules suggests that the carcinoma has arisen in the context of a macroregenerative nodule rather than the whole nodule being an early, spreading carcinoma. A growing body of evidence supports macroregenerative nodules as being precursor lesions in the development of hepatocellular carcinoma. Although they are generally thought of as being large cirrhotic nodules, this case suggests that they may be lesions that develop in the context of chronic liver disease, parallel to, but independently of, cirrhosis. Moreover, the development of carcinoma within the nodule suggests that macroregenerative nodules may play a role in carcinogenesis in noncirrhotic livers

Pneumocystis carinii, a frequent cause of pneumonia in immunocompromised patients, rarely disseminates to involve other organs. This report describes a patient with acquired immunodeficiency syndrome and pneumocystis pneumonia in whom extrapulmonary P. carinii infection was diagnosed on duodenal and esophageal endoscopic biopsy specimens. Autopsy revealed dissemination to multiple organs.