Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumor representing 0.3% to 5% of all malignant mesotheliomas. Gross examination of testicular mesotheliomas typically reveals tumor nodules studding the thickened tunica vaginalis and, in some cases, infiltrating the testicular parenchyma, leading to diagnostic challenges. Microscopically, the tumor is characterized by epithelioid cells arising from the tunica vaginalis with papillary, tubulopapillary, or solid architectural patterns. The papillae are usually lined by a single layer of cells with relatively bland cytologic features. An epithelial cell phenotype admixed with a sarcomatoid pattern has also been described in a few cases. Immunohistochemically, the tumor is usually positive for calretinin, Wilms tumor-1, epithelial membrane antigen, D2-40, thrombomodulin, cytokeratin 7, and cytokeratin 5/6. Electron microscopic studies reveal epithelial cells joined by tight junctions, forming lumina, and displaying long microvilli with length to width ratios often greater than 10. The most important differential diagnostic considerations include florid mesothelial hyperplasia, adenomatoid tumor, carcinoma of the rete testis, and serous papillary tumors. In addition, the various types of testicular germ cell tumors should be considered, including seminomas, embryonal carcinomas, and intratubular germ cell tumors, particularly in tumors with testicular parenchymal involvement. Pleomorphic sarcomas should also be considered, particularly when dealing with the biphasic variant. The prognosis for this entity is grave, with a median survival of 23 months. Aggressive therapy with radical orchiectomy remains the mainstay of treatment.

Inflammatory myofibroblastic tumor (IMT) is an uncommon neoplasm that is usually located in the lung in the pediatric population. These tumors contain a variety of cell types with the myofibroblast being dominant. When located in the upper airway, IMTs tend to be less aggressive, but have the potential for local invasion and recurrence. We present an unusual case of IMT in the pediatric larynx and review the medical literature describing the common locations, diagnosis, etiology, histology, and treatment of this tumor. The mainstay of treatment is complete surgical excision. Careful and frequent follow-up including frequent fiberoptic laryngoscopy and CT scans are recommended to evaluate for recurrence. More aggressive resection may be necessary if multiple recurrences occur.

An unusual case of primary adenocarcinoma occurring in the inguinal region of an elderly woman is reported. It appeared to have arisen from the mesothelium of the canal of Nuck. It recurred and involved one inguinal lymph node three years after the diagnosis and seven years after the initial appearance of the mass. The absence of associated peritoneal tumor distinguishes this case from other reported primary malignant neoplasms of the hernial sac.

We report a case of granular cell tumor, a rare neoplasm of the penis.

Schistosomiasis is a worldwide parasitic infestation.The species, Schistosoma haematobium, is endemic in Africa and the Middle East. It predominantly affects the urinary system; the diagnosis of schistosomiasis is usually made through detection of ova in the urine. Observation of ova in cervical smears has occasionally been reported in endemic areas in Africa. 1-3 The diagnosis is rarely made by examination of cervicovaginal smears in nonendemic areas such as North America. In this communication we report such a rare case in a women who was evaluated for infertility.A 22-yr-old black Liberian woman presented to the gynecology clinic with the complaint of infertility for four years. She had been taking Clomiphene for 8 mo which was discontinued 6 mo prior to her current visit. Physical examination was unremarkable with the exception of a small pruritic fistula in the perianal region. A cervicovaginal smear and a urine specimen were obtained and the patient was referred to dermatology.Two urine specimens as well as stool samples were negative for parasites. The cervicovaginal smear stained by the Papanicolaou method revealed that scattered among the inflammatory cells were a number of Schistosoma haematobium ova in various stages of development similar to what has been previously described by Berry. The majority of the ova contained miracidium, showing an eosinophilic cytoplasm, abundant hematoxylin-stained granular material, and the pathognomonic terminal spine. One egg was found in which the miracidiurn appears to be hatching from the egg shell (Fig. 1). Occasional empty egg shells were present; they showed a light refractile morphology with crumpled edges and terminal spines (Fig. 2). A number of free miracidium were noted. They contained eosinophilic cytoplasm, prominent bull's-eye cells which are stained basophilic with hematoxylin stain, and cilia which were discernible by careful focusing (Fig. 3).A skin biopsy of the perianal fistula showed a granulom-atom reaction with a calcified structure suggestive of a schistosome ovum.The patient was treated with Praziquantel and is currently being monitored by the gynecology service.The incidence of schistosomiasis in the female genital tract ranks next to that of urinary and gastrointestinal systems. The vagina and cervix are most frequently involved. 4i5 The eggs can also be found in the subserosa of the uterus, ovary, and fallopian tubes, especially in cases where there is heavy infestation, which likely occurs as a result of communication between the pelvic venous plexuses.Negative urine examination in our patient, as has been reported in other cases, underscores the difficulty in making an accurate diagnosis by a single urine examination. This should not be surprising in view of the diurnal nature of egg excretion by the parasite^.^,^ In endemic areas, rectal biopsy is a well-recognized method of investigation in suspected cases with negative urine results. ' Infertility has been reported in association with pelvic schistosomiasis, and it appears not to be an un...