Gastric cancer can be divided into two histologic types: intestinal and diffuse. To determine whether Helicobacter pylori, a bacterium linked with gastritis, was associated with either cancer type, we reviewed histologic sections from stomachs of patients who had undergone gastrectomy for gastric cancer. Of 37 of the sections with evidence of intestinal-type cancer, 33 (89.2%) contained H pylori in noncancerous tissue compared with 7 (31.8%) of 22 of the sections with evidence of diffuse-type cancer (odds ratio = 17.7; P less than .001). This association remained strong when controlled for age, sex, site, and number of sections reviewed. The prevalence of H pylori in intestinal-type gastric cancer far exceeded the prevalence of H pylori in diffuse disease and that described in the normal US population. This finding suggests that H pylori may be a cofactor in development of intestinal-type gastric cancer.

Meningioangiomatosis (MA) is a rare malformative lesion of the central nervous system. It has generally been thought that the main cells forming this lesion are derived from arachnoidal cap cells. We report a case of MA in which histochemical, immunoperoxidase and electron microscopic studies did not support a meningothelial origin of this lesion. Rather, the lesion in this case appears to be a vascular malformation with the dominant cells being fibroblastic, derived from vessel walls; however, their origin from arachnoid cap cells that differentiated into fibroblast-like cells could not be totally ruled out. Residual neurons within the lesion contained neurofibrillary tangles with ultrastructural and immunostaining properties identical to those seen in Alzheimer's disease except for the absence of A4 amyloid.

The authors report five patients with adrenal cortical tumors in whom the preoperative diagnosis of pheochromocytoma was made. All patients had biochemical evidence of elevated catecholamine secretion in serum or urine. Clinically, two patients presented with symptoms suggestive of pheochromocytoma, and one patient had systemic hypertension that resolved following surgical excision of the tumor. Histologically, the findings were typical of adrenal cortical tumors: two adrenal cortical carcinomas and three adrenal cortical adenomas. Nevertheless, the immunohistochemical studies showed evidence of neuroendocrine differentiation in four tumors. Three tumors were positive for neuron-specific enolase and synaptophysin and a fourth tumor was positive for synaptophysin only. All neoplasms were negative for chromogranin. Electron microscopic studies in three tumors showed abundant endoplasmic reticulum and tubulovesicular cristae consistent with adrenal cortical cell origin. Neurosecretory granules, 150-300 mu in diameter, were found in one tumor. This current series of patients provides evidence that adrenal cortical neoplasms may be associated with clinical findings that simulate pheochromocytoma (so-called pseudo-pheochromocytoma). These clinical findings may be mediated by the presence of neuroendocrine features in these tumors.

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