Dirofilariasis Presenting as an Infiltrative Mass in the Right Buccal Space.

Dirofilariasis is caused by filarial nematodes (roundworms) of the genus Dirofilaria Dirofilariasis of the oral mucosa is very rare. Herein, we report a case of a 79-year-old man who had a slowly growing infiltrative mass in the right buccal space. Histopathologic examination showed an inflammatory infiltrate with eosinophilia, histiocytes, and small organisms (0.2-0.3 mm). Digital images were sent to the Centers for Disease Control and Prevention, which identified the parasite as a nematode in the genus Dirofilaria It appeared to be dead and degenerating, but external, fine longitudinal cuticular ridges and the presence of tall muscle cells were diagnostic. Thus, Dirofilaria, despite its rarity, should be considered in the differential diagnosis of tumor-like lesions in the buccal mucosa.

Concomitant mycosis fungoides and vitiligo: how mycosis fungoides may contribute to melanocyte destruction.

BACKGROUND: Few reports have described vitiligo developing in patients with cutaneous T-cell lymphoma (CTCL). OBJECTIVE: We sought to identify possible factors that might predispose patients with CTCL to vitiligo. METHODS: Patient demographics, CTCL disease characteristics and treatments were analyzed in 25 patients with CTCL who developed vitiligo. Cox proportional hazards modeling was used to identify associations of risk factors with the development of vitiligo. RESULTS: Younger age, later CTCL disease stage (stages IIB-IV) and presence of a CD8+CD4- mycosis fungoides phenotype were associated with the development of vitiligo. After adjusting for disease stage, increased risk of vitiligo was associated with methotrexate and CD4 antibody therapies (although the total number of patients with these was small), while decreased risk was associated with nitrogen mustard and PUVA therapies. CONCLUSIONS: No single feature was common to all of our patients, suggesting that multiple factors may contribute to the development of vitiligo in a patient-specific fashion.

Clinical characteristics and outcomes with specific BRAF and NRAS mutations in patients with metastatic melanoma.

BACKGROUND: Hotspot mutations in BRAF and NRAS are the most common somatic events in patients with melanoma. These mutations occur at highly conserved residues, but include several different substitutions. To determine whether specific mutations are clinically important to differentiate, tumor characteristics and clinical outcomes were compared among patients with advanced melanoma with 1) BRAF V600E versus V600K mutations and 2) NRAS exon 1 versus exon 2 mutations. METHODS: Retrospective clinical and pathologic data were collected for patients with advanced melanoma with BRAF or NRAS mutations. The demographics, tumor characteristics, and clinical outcomes of the patients were compared to identify significant mutation-specific associations. RESULTS: Among 302 patients with activating BRAF mutations, 76% had BRAF V600E and 24% had V600K substitutions. Compared with V600E, the presence of a V600K mutation was significantly associated with older age (median, 60.0 years vs 44.7 years; P < .001), male sex (80% vs 59%; P = .001), head/neck primary tumor location (30% vs 15%; P = .0026), shorter interval to stage IV disease (0.98 years vs 2.8 years; P = .015), and a shorter overall survival from the time of diagnosis of stage IV disease (median, 2.44 years vs 1.25 years; hazards ratio, 1.68 [P = .014]). Comparison of 136 patients with NRAS exon 1 (18%) and exon 2 (82%) mutations found an association with primary tumor histology (P = .0096) only. CONCLUSIONS: The presence of different substitutions at BRAF V600 correlates with patient demographics, tumor characteristics, and prognosis. These findings demonstrate the presence of mutation-specific clinical differences between different BRAF genotypes in patients with melanoma, and support the incorporation of this information in patient evaluation and clinical trial design.

Comparison between 1-needle technique versus 2-needle technique for bone marrow aspiration and biopsy procedures.

CONTEXT: Bone marrow examination is essential for diagnosis and staging of hematologic disorders. Traditionally, the bone marrow biopsy and aspirate are obtained with 2 needles at 2 separate sites. This approach is associated with significant discomfort, procedural time, and occasionally, morbidity. Although previous observations had suggested that a single-needle technique at one site is a simpler and less-painful procedure, there had been concern that the 1-needle technique may yield a suboptimal biopsy for diagnosis. OBJECTIVE: To conduct a systematic comparison of multiple parameters of bone marrow biopsy specimens obtained by the traditional 2-needle technique versus the 1-needle technique for bone marrow collection. DESIGN: We retrospectively evaluated 20 biopsy specimens obtained by each of the 2 mentioned techniques by comparing the morphologic quality of the biopsy, biopsy length, and biopsy cellularity. RESULTS: We found that the 1-needle technique yielded an adequate biopsy for diagnosis. The measured parameters of the samples obtained by the 1-needle versus 2-needle techniques were similar. CONCLUSION: This study suggests that the 1-needle technique may be preferred for bone marrow aspirate and biopsy.

Effect of Chinese medicines Chan Su, Asian ginseng, Siberian ginseng, and American ginseng on a new digoxin immunoassay based on luminescent oxygen channeling technology.

BACKGROUND: Chan Su, Asian ginseng, Siberian ginseng, and American ginseng are known to interfere with various digoxin immunoassays. Recently, a homogeneous sequential chemiluminescent assay for digoxin based on the luminescent oxygen channeling technology (LOCI digoxin) for application on the Dimension and Vista platform has been introduced into the market. The effects of interference by Chan Su and various ginsengs on this new immunoassay have not yet been reported. MATERIALS AND METHODS: Aliquots of a drug-free serum pool were supplemented with Chan Su, Asian ginseng, Siberian ginseng, and American ginseng representing the expected in vivo concentrations after normal usage and cases of overdose. Serum digoxin concentrations were measured using the LOCI digoxin assay on the Vista 1500 analyzer. We also prepared 3 digoxin pools from patients receiving digoxin. Two digoxin pools were supplemented with these traditional medicines to investigate their effect on serum digoxin measurements. Mice were fed Chan Su extract to determine the potential of in vivo derived interfering factors. The possibility of eliminating interference of Chan Su on serum digoxin measurement was also investigated, by measuring free digoxin concentration after supplementing aliquots of the third digoxin pool with various amounts of Chan Su extract. RESULTS: A clinically significant interference by Chan Su with serum digoxin measurement was observed using the LOCI digoxin assay. The various ginsengs demonstrated negligible effects. In addition, apparent digoxin concentrations were observed in sera of mice after feeding them with Chan Su; the half-life of digoxin-like immunoreactive components was approximately 1 hour. Moreover, serum digoxin concentrations were significantly elevated in the presence of Chan Su, whereas the various ginsengs exhibited no effect. Monitoring free digoxin can only partly eliminate the interference of Chan Su in serum digoxin measurement. CONCLUSIONS: Chan Su interferes with serum digoxin measurement using the LOCI Digoxin, whereas the ginsengs demonstrated no measurable interference at clinically relevant concentrations.