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Total lymphoid irradiation is employed in the preparative regimens for allogeneic bone marrow and solid organ transplantation, solid organ transplant rejection, and chronic graft-versus-host disease. Linear accelerator-based radiotherapy, typically involving opposed anteroposterior and posteroanterior beams, has been commonly used; however, extended source-to-skin patient setup and/or field matching are required, and all organs within the beam coverage receive the entire prescribed dose. Megavoltage helical tomotherapy represents a technological advance in terms of both treatment delivery and patient positioning. The continuously rotating multileaf collimated fan beam allows highly conformal coverage of complex target geometries, in turn allowing avoidance of radiosensitive adjacent organs. In addition, the megavoltage computed tomographic scans allow potentially more accurate, targetbased setup verification. The present case report describes tomotherapy-based total lymphoid irradiation in an adult patient with late-onset cardiac transplant rejection. Treatment planning allowed dose minimization to the spinal cord, kidneys, intestinal compartment, and lungs. The patient tolerated treatment well without acute adverse effects, and he is now in early follow-up.

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Ciliated cells encountered outside of an expected anatomical location (e.g., the respiratory tract, fallopian tube, etc) can represent a diagnostic difficulty for the cytopathologist, especially during preliminary assessment of a fine needle aspiration (FNA) for adequacy or malignancy. We present the cytologic and histologic features of a FNA and needle core biopsy, respectively, of an abdominal mass, likely from a gastrointestinal duplication cyst, foregut cyst or a bronchogenic cyst. We also briefly review the differential diagnosis for ciliated cells encountered in abdominal or pelvic FNAs.

Chorangioma, localized chorangiomatosis, chorangiosis, and diffuse multifocal chorangiomatosis are a group of related, yet distinct vascular lesions found in placental tissue. These lesions are often asymptomatic and underappreciated both grossly and microscopically. Chorangiomas and localized chorangiomatosis have been associated with hypoxia and ischemia and are often found concurrently with disease processes that predispose the placenta to these conditions including preeclampsia, intrauterine growth restriction, and multiple gestations. Small chorangiomas are generally considered clinically insignificant, but when large chorangiomas are present, they have been found to cause polyhydramnios, hydrops fetalis, platelet sequestration, and occasionally fetal death. These can be detected by prenatal ultrasound and embolization can provide a theoretical cure when symptomatic. Chorangiosis is a diffuse increase in terminal villi capillaries and has been associated with diabetes and placental overgrowth syndromes. Multifocal chorangiomatosis is a recently described lesion associated with extreme prematurity (Ͻ32 weeks), congenital malformations, IUGR, delayed villous maturation, avascular villi, and placentomegaly. No treatment currently exists for either chorangiosis or multifocal chorangiomatosis.A 24-year-old white gravida 1 para 0 female at 36 and 2/7 weeks gestation presented for induction of labor secondary to worsening pre-eclampsia and polyhydramnios. Her medical history was significant for 2 separate remote cerebrovascular accidents in 2003 and 2005 requiring continued anticoagulation. Her remaining laboratory evaluation was unremarkable with the exception of group B strep infection treated with ampicillin. Labor failed to progress, and she was taken for a low transverse cesarean section secondary to arrest of dilation the following day. She delivered a viable female infant weighing 2485 g with Apgar scores of 4 and 9. The placenta was submitted for pathologic evaluation.Upon receipt in the gross room, the placenta was noted to weigh 342 g corresponding to a weight less than the tenth percentile for gestational age. The umbilical cord, membranes, fetal surface, and maternal surface were otherwise unremarkable. No gross lesions were noted on sectioning. Microscopically, acute chorioamnionitis was identified with an associated funisitis and chorionic vasculitis. Additionally decidual vasculopathy was seen, which was consistent with the clinical diagnosis of pre-eclampsia. Several small chorangiomas were visualized measuring up to 0.5 cm in greatest dimension. These were not appreciated grossly.