Laparoscopic-guided biopsy for diagnosis of hepatic candidiasis.

Histopathological evaluation of infected tissue is critical in the diagnosis of hepatic candidiasis since cultures are unreliable. Percutaneous techniques are inaccurate because lesions often are small and multifocal, and open biopsy is not always well-tolerated in acutely ill patients. The authors investigated the feasibility of laparoscopically guided biopsy in patients suspected of having hepatic candidiasis. Preliminary results suggest that laparoscopically guided biopsy is highly accurate and less invasive than open biopsy.

Incidental detection of hematopoietic hyperplasia on routine knee MR imaging.

An unusual appearance of the marrow of the distal femur, characterized by confluent foci of diminished signal intensity replacing the normally expected bright signal of fatty marrow on all pulse sequences, was encountered in 10 asymptomatic patients undergoing routine knee MR imaging. This prompted initial concern about the possibility that this appearance was due to lymphoma or occult myeloproliferative malignancy. All patients were mild to moderately obese, and all but one were women. Peripheral blood analysis was obtained in nine patients and was normal in five. The other four were cigarette smokers with a peripheral leukocytosis. Bone-marrow biopsy of the distal femur in two patients and of the iliac crest in three, performed to exclude malignancy, showed hypercellular but otherwise normal-appearing hematopoietic (red) marrow. The patients have been followed for 4-15 months without evidence of malignancy. We conclude that extensive foci of hematopoietic marrow may be encountered incidentally in patients undergoing MR examination. Careful follow-up to date suggests that this most likely represents a benign process and that patients in whom this appearance is encountered can be managed conservatively.

True histiocytic lymphoma: an immunohistochemical and ultrastructural study of two cases.

Immunologic studies demonstrate that non-Hodgkin's lymphomas are derived predominantly from B- or T-lymphoid cells, while node-based tumors of true histiocytic derivation are rare, with few documented cases. This report describes the clinical, histologic, immunohistochemical, and ultrastructural features of two cases of node-based true histiocytic lymphoma. Distinctive ultrastructural features included numerous cytoplasmic lysosomes, surface microvillous processes, and occasional cell junctions, and the cells stained strongly for alpha-napthyl acetate esterase and alpha one-antitrypsin. Since there are few specific histologic features, special technics may be essential in confirming the diagnosis of true histiocytic lymphoma, and determining appropriate therapy.

Central nervous system involvement in non-Hodgkin's lymphoma: an analysis of 105 cases.

Records of 105 patients with central nervous system (CNS) lymphoma were analyzed in order to better define the incidence, setting, and management of CNS lymphoma and the role for CNS prophylaxis. Survival was best for patient under 30 years of age treated with whole-brain irradiation and intrathecal (IT) chemotherapy whose CNS involvement was an isolated event (median survival time, 1.8 years). Survival was worst for patients over 30 years of age whose CNS invasion occurred at a time of progressive systemic lymphoma (median time ten weeks if treated with whole-brain irradiation with or without IT chemotherapy). The risk of CNS invasion was greatest for those with lymphoblastic lymphoma. Among patients with Stage IIE, III, or IV histiocytic lymphoma, the risk of CNS involvement was greatest for those with progressive or relapsing disease or involvement of the testes, peripheral blood, or epidural space of the spinal cord.