Fournier's gangrene in a patient with obesity and B-lymphoma.

We present a case of Fournier's gangrene disease in a young obese patient with coexistent B-lymphoma. It remains controversial if obesity constitutes a predisposing factor for an individual to develop necrotizing fasciitis. On the other hand, only few cases of patients with coexistence of B-lymphoma and Fournier's gangrene disease have been reported. A 30-years-old obese man was admitted to emergency department with fever (38.7 °C), pain, erythema and swelling extended from the left scrotum to the left lower abdominal quadrant. He was confused, with low urinary excretion and septic shock's signs. The clinical findings were characteristics of Fournier's gangrene disease. Furthermore during physical examination a massive, painless and motionless mass in the left breast was revealed. The patient required urgent surgical debridement of the affected area and pus drainage. Biopsies of the breast mass were received by excision. Pus and blood cultures yielded Staphylococci coagulase(-), Klebsiella and Proteus sp. Intravenous antibiotic treatment with Meropeneme and Clindamycine started immediately. Repeated debridement was often performed. Pathology examination of the massive tissue revealed a diffuse B-lymphoma of large cells (Germinal center B-cell like- GCB). The patient was discharged from the hospital 35 days later. Afterwards, he was treated with chemotherapeutic agents for malignant lymphoma at the oncological department. The aim of this case's presentation is to mention that young obese patients with Fournier's gangrene disease should be particularly investigated due to the possible occurrence of another not obvious predisposing factor, such as a malignant disease.

Immunoscintigraphy with iodine-131-labelled monoclonal antibody AUA1 in patients with transitional cell carcinoma of the bladder.

The monoclonal antibody AUA1, labelled with 2 or 3 mCi iodine-131, was administered intravesically to 11 patients with known or suspected bladder carcinoma and was kept in the bladder for 1 h. All patients underwent immunoscintigraphy of the bladder at 2 h and three patients also at 20 h after instillation. Conventional histological and immunohistochemical examinations were performed on tissue samples from tumour and normal areas taken during cystoscopy, carried out 24-h after the instillation. Transitional cell carcinoma of the bladder was present in nine patients whereas dysplastic and normal urothelium was found in the remaining two patients, respectively. Six out of nine tumours were successfully imaged at the 2-h scan. Normal urothelium showed no uptake while dysplastic urothelium was positive on imaging. Successful detection was correlated with size and grade of tumour in almost all cases. Tumors with a diameter of 1 cm or less were not detected. Four out of five grade II tumours and two out of three grade III tumours were detected with this method. The method is a promising one although further studies using more suitable isotopes and/or monoclonal antibodies are required to increase its sensitivity.