Tonsillar Kaposi sarcoma in a patient with membranous glomerulonephritis on immunosuppressive therapy.

Kaposi sarcoma is a malignant vascular neoplasm uncommonly seen in immunosuppressed patients. Herein we report an unusual case of tonsillar Kaposi sarcoma in a patient with membranous glomerulonephritis treated with prednisolone and cyclosporine. The patient presented after 10 months of starting the treatment with a tonsillar mass. Histological examination was typical of monomorphic spindle cell proliferation with slit-like vascular channels. The tumor cells expressed CD34, D2-40 and positive nuclear stain for HHV-8. Kaposi sarcoma is associated with immunosuppression and rarely occurs in the tonsil. Clinicians should be aware of this rare presentation of Kaposi sarcoma.

Changing demography of leprosy: Kuwait needs to be vigilant.

INTRODUCTION: Leprosy is an ancient, chronic, communicable disease. It is claimed that it has been 'eliminated' as a public health problem at the global level. However, sporadic new cases are increasingly being encountered, even in non-endemic countries such as ours. A more disturbing fact is the increase in the number of cases in the indigenous population. OBJECTIVES: The aim of this study was to analyze the magnitude of the leprosy problem in the region of Farwaniya, in which most of the immigrants in Kuwait live, based on detection and prevalence rates over the last 6 years, in addition to a clinico-pathological analysis of the collected data. PATIENTS AND METHODS: All clinically diagnosed cases of leprosy seen over a period of 6 years, from January 2003 to December 2008, were included in the study. Socio-demographic details and clinical features were recorded on a proforma. The results were compared to similar previous data from Kuwait, and to that from other countries in the region. RESULTS: Forty-six patients (38 male and eight female) aged 22-48 years (average 33.6 years), clinically diagnosed with leprosy, were enrolled. Of the enrolled patients, 89.1% were expatriates, while 10.9% were Kuwaiti citizens. The majority of patients (n=24) were from India, followed by Bangladesh (n=6), Egypt (n=5), Pakistan (n=3), and Indonesia, Philippines and Sri Lanka (n=1 each). The duration of signs and symptoms ranged from 1 to 24 months (average 4.7 months). A total of 58.5% of expatriate patients developed their symptoms 2-5 years after entry into Kuwait. Delayed diagnosis (after 12 weeks) was observed in 70.8%. Thirty-one patients (67.4%) had multibacillary leprosy (borderline lepromatous n=15, borderline type n=7, borderline tuberculoid n=5, and lepromatous leprosy n=4), while 15 patients (32.6%) had the paucibacillary form of leprosy (tuberculoid type n=8, borderline tuberculoid n=7). The detection of lepra bacilli in tissue sections was the most common diagnostic tool (67.4%), while nasal smears showed positive results in 28.3% of cases and the slit skin smear in 17.4%. CONCLUSIONS: This study shows that leprosy in the region of Farwaniya, Kuwait, which has predominantly been a disease of immigrants, has started to infect the Kuwaiti population; such cases may just represent the tip of the iceberg. Careful examination of immigrants on arrival and subsequent periodic regular check-ups are required to prevent the spread of the disease. Furthermore, early referral of suspected cases and screening of contacts, with initiation of treatment as early as possible, are essential to control the spread of leprosy in Kuwait.

Giant fibroepithelial polyp of the penis associated with long-term use of condom catheter. Case report and literature review.

BACKGROUND: A condom catheter is a commonly used drainage system for incontinent patients. However, it is associated with different complications including infection and erosion. One very rare complication that has been recognized is the development of giant fibroepithelial polyps in the penis; to date, to the best of our knowledge, seven cases have been reported in the literature. We report a new case of giant fibroepithelial polyp associated with long-term condom catheter use. CASE SUMMARY: A 43-year-old incontinent man who had been using a condom catheter for 14 years following a motor vehicle accident presented with a mass on the ventral aspect of his penis; the mass had appeared a year ago. The patient underwent excisional biopsy. Grossly, there was a mass with a maximum dimension of 4.0 cm, which had an irregular surface. Histological examination revealed a fibroepithelial polyp with vascular proliferation and edematous stroma with prominent bundles of smooth muscle. Perivascular lymphoid aggregates were seen. The morphology was similar to that in the previously reported cases; the presence of smooth muscle was distinct. CONCLUSION: Giant fibroepithelial polyps can be associated with long-term condom catheter use and pathologists and urologists should be aware of this rare complication as their size can mimic carcinoma.