Invasive Candida pneumonia, in association with Candida esophagitis and gastritis, in a presumably immunocompetent patient.

Candida pneumonia remains a difficult diagnosis and is most common in immunocompromised individuals. It has been rarely reported in immunocompetent individuals. We present a case of unsuspected Candida pneumonia associated with Candida esophagitis and gastritis discovered on postmortem examination in a presumably immunocompetent patient. The patient was a 71-year-old male who presented with chest pain and was subsequently found to have a myocardial infarction treated with angioplasty and drug-eluting stent placement. The patient's recovery was complicated by pneumonia refractory to antibiotics, and he went on to experience acute hypoxic respiratory failure, sepsis, disseminated intravascular coagulation (DIC), and ultimately expired. Autopsy revealed evidence of myocardial infarction as well as unsuspected Candida albicans pneumonia, esophagitis, and gastritis. Our case highlights how a presumably immunocompetent individual can develop this infection and how Candida esophagitis and Candida gastritis can be seen in association with Candida pneumonia. Due to the difficulty in diagnosing Candida pneumonia antemortem, autopsies provide a key opportunity to better understand these cases and the factors that may contribute to their development.

Concurrent Splenic Marginal Zone B Cell Lymphoma and Metastatic Pancreatic Adenocarcinoma Diagnosed on Splenectomy for Suspected Splenic Abscess.

Splenic marginal zone lymphoma (SMZL) is an uncommon low-grade B-cell lymphoma. It is an indolent lymphoma with a median survival rate of greater than 10 years. Most patients are asymptomatic, but some patients may present with upper abdominal pain and distention, while others may present with splenomegaly, emaciation, fatigue, or weight loss. Due to the long median survival, patients with SMZL may develop a second primary malignancy. Pancreatic adenocarcinoma is the most common malignant neoplasm of the pancreas. It has a poor prognosis with a five-year survival rate of 10%. Fifty percent of patients have metastatic disease on presentation. However, the spleen is not a common site of metastasis for malignant tumors from other primary sites including the pancreas. Here we present a case of a 78-year-old African American patient, who was found to have previously undiagnosed, concurrent metastatic pancreatic adenocarcinoma and SMZL diagnosed on splenectomy for a suspected splenic abscess.

Invasive Candida pneumonia, in association with Candida esophagitis and gastritis, in a presumably immunocompetent patient

ABSTRACT Candida pneumonia remains a difficult diagnosis and is most common in immunocompromised individuals. It has been rarely reported in immunocompetent individuals. We present a case of unsuspected Candida pneumonia associated with Candida esophagitis and gastritis discovered on postmortem examination in a presumably immunocompetent patient. The patient was a 71-year-old male who presented with chest pain and was subsequently found to have a myocardial infarction treated with angioplasty and drug-eluting stent placement. The patient's recovery was complicated by pneumonia refractory to antibiotics, and he went on to experience acute hypoxic respiratory failure, sepsis, disseminated intravascular coagulation (DIC), and ultimately expired. Autopsy revealed evidence of myocardial infarction as well as unsuspected Candida albicans pneumonia, esophagitis, and gastritis. Our case highlights how a presumably immunocompetent individual can develop this infection and how Candida esophagitis and Candida gastritis can be seen in association with Candida pneumonia. Due to the difficulty in diagnosing Candida pneumonia antemortem, autopsies provide a key opportunity to better understand these cases and the factors that may contribute to their development.

Cotyledonoid Dissecting Leiomyoma: A Rare Variant of Leiomyoma of the Uterus.

Cotyledonoid dissecting leiomyoma is a rare variant of leiomyoma and has only been reported a few times in the literature. As a result of its alarming gross and radiologic appearance, it must be differentiated from other malignant smooth muscle tumors. We report a case of cotyledonoid dissecting leiomyoma in an African American premenopausal woman with a medical history of anemia, abnormal uterine bleeding, and a cervical mass. A total hysterectomy was performed on the patient. On pathological examination, the gross and microscopic appearance of the tumor was consistent with that described in previous reports of cotyledonoid dissecting leiomyoma. However, our case showed focal areas of increased mitotic activity with 5 mitoses per high power field but no tumor cell necrosis or cellular atypia. This tumor does not have malignant potential, but clinicians and pathologists must be aware of its existence to avoid overtreating patients.