Primary cryptococcal prostatitis in an apparently uncompromised host.

BACKGROUND: Systemic spread from a primary focus of cryptococcal infection commonly involves the central nervous system, manifested as meningitis or meningoencephalitis. Untreated meningitis and meningoencephalitis are invariably fatal, following a subacute or chronic course of cyclic remission and relapse, followed by progressive deterioration over weeks to months. Occasional patients with fulminating meningoencephalitis die within a few days. Incorrect diagnosis may be the most common cause of fatality in this disease. Thorough histopathologic examination and blood and body fluid studies should minimize misdiagnosis. METHODS: We studied the case of an initially misdiagnosed 64-year-old apparently immunologically competent man with primary cryptococcal prostatitis that subsequently disseminated to the central nervous system and the left eye. All immunologic findings including workup for AIDS viruses were normal. Laboratory studies confirmed cryptococcal infection. RESULTS: After initial misdiagnosis, our patient received improper treatment for 10 months. He developed meningitis and severe left endophthalmitis with optic nerve and retinal involvement. Toxic medications led to kidney insufficiency with about 66% loss of function. Following therapy, reevaluation of his immune system showed marked abnormality in cell-mediated immunity. CONCLUSIONS: Cryptococcosis is easily misdiagnosed in uncompromised hosts, both clinically and pathologically, because of misconception that the disease affects only immunocompromised individuals and that primary cryptococcal prostatitis is virtually unheard-of in "normal" males.

Multiple hepatocellular adenomas in a patient with a history of oral contraception.

We report a previously undescribed association between multiple hepatocellular adenomas and the use of oral contraceptives in a 29-year-old woman. She underwent trisegmentectomy, with 90% of the liver resected. Based on the rather large size of some of the adenomas at the time of diagnosis, most likely, the lesions were already present years before they were discovered. The liver was fully regenerated 6 months after surgery. Four years later, multiple adenomas recurred. During work-up for a liver transplant, she was found to have cryptococcal meningitis and pneumohydrocephalus which caused her demise.

Familial hemophagocytic lymphohistiocytosis (FHLH).

Clinical course and histopathologic features of a typical case of familial hemophagocytic lymphohistiocytosis (FHLH) are presented. FHLH, initially known as familial hemophagocytic reticulosis (FHR), is rare and without proper treatment is invariably rapidly fatal, usually accompanied by fever, anorexia, vomiting, irritability and pallor. Sporadic examples with prolonged survival have been reported. Other significant findings include hepatosplenomegaly, progressive anemia, leukopenia, thrombocytopenia, hyperlipidemia and hypofibrinogenemia. Varying degrees of hemophagocytosis by widely disseminated histiocytes in different organs and structures is one hallmark of the disease. Hemophagocytosis may also occur in viral and bacterial infections and in certain malignant processes. Very high parental consanguinity in FHLH was mentioned in two relatively recent reports. A probable immunologic defect has been the focus of recent investigations. The genetic defect is believed to be transmitted as an autosomal recessive trait.

Adenocarcinoma of colon in a child.

The diagnosis of adenocarcinoma of the colon in juvenile subjects usually poses a difficult problem due to its clinical presentation, which usually mimics disorders that are commonly found in children. This article presents the case of a 13-year-old boy who was admitted 2 weeks earlier to another hospital, where his condition was not recognized. He presented with abdominal signs and symptoms suggestive of diseases such as gastroenteritis, appendicitis, and intussusception which are common in this age group. The x-ray film showed dilated loops of small bowel and the proximal portion of colon, suggesting intestinal obstruction. At surgery, a 4 X 4 cm tumor in the transverse colon was resected. Microscopically, the lesion showed moderately differentiated adenocarcinoma with foci of mucin production.

An unruptured tubal pregnancy at term.

We report a case of advanced, unruptured tubal pregnancy proceeding beyond term. A 25-year-old woman was admitted at 42 weeks' gestation because of lower abdominal pain and inability to feel fetal movements. An ultrasound examination suggested fetal death. At laparotomy three weeks after admission, a right-sided, unruptured tubal mass containing a macerated fetus was found.

Enchondroma protuberans masquerading as osteochondroma.

Two cases of enchondroma protuberans are presented. The term enchondroma protuberans is designed to indicate a previously unrecognized and probably rare entity occurring in a long bone in an exaggeratedly eccentric fashion and, radiographically, remarkably resembling an osteochondroma. However, the morphologic differences between these two lesions are quite obvious and are easily demonstrable. Two young male patients, 10 and 15 years of age, had essentially similar lesions that developed, coincidentally, in the upper end of the left humerus. Improper radiographic interpretation of the lesions in both cases resulted in unnecessary second operations.

The mechanism of metastasis in the so-called "benign giant cell tumor of bone".

A case of so-called "benign giant cell tumor of bone" with an incidental histologic finding of intratumor vascular invasion is reported. The mechanism and biology of metastasis are briefly discussed. For the purposes of this presentation, the mechanism of metastasis is divided into two types--active and passive. An active type of metastasis indicates malignancy, whereas a passive type denotes a benign process. The malignant features of the conventional or typical giant cell tumor of bone are demonstrated. It is proposed that this neoplasm be labeled malignant despite its seemingly benign histologic appearance. Relative to the degree of malignancy, a lesion of this nature may be classified as either a low or a high grade type of malignant giant cell tumor.