Renal inflammatory pseudotumor.

A previously healthy 37-year-old man had evaluation of abdominal pain, which had persisted after abrupt onset with fever and hematuria. Although the fever and hematuria had spontaneously resolved after 1 week, the abdominal pain had worsened over a 4-month period. Predicated upon computed tomography and with a presumed diagnosis of renal cell adenocarcinoma, left radical nephrectomy was done. Histopathologic analysis was negative for malignancy but compatible with inflammatory pseudotumor of the urogenital tract--a pathologic entity that is common in the urinary bladder and prostate gland but is rarely diagnosed in the kidney.

CD5 negative diffuse mantle cell lymphoma with splenomegaly and bone marrow involvement.

We report the case of a 78-year-old man in whom routine physical examination revealed cervical adenopathy and splenomegaly. Peripheral blood showed a normal white blood cell count with an absolute lymphocytosis, which included a population with slightly indented nuclei. Lymph node biopsy showed morphology compatible with mantle cell lymphoma. Bone marrow biopsy showed replacement by a lymphoid proliferation composed of lymphocytes with features similar to those found in the peripheral blood. Immunophenotypic analysis of both peripheral blood and lymph node showed positivity for CD19, CD20 and CD22, with lambda light chain restriction. Tests for CD5 and CD10 were negative. Cytogenetic analysis and polymerase chain reaction studies confirmed the presence of t(11,14) supporting a diagnosis of mantle cell lymphoma. This unusual case of CD5-negative mantle cell lymphoma exemplifies the importance of combined molecular, cytogenetic, and morphologic evaluation when confronted with a lymphoma having an atypical phenotype.

Microbial growth in small-volume pharmaceuticals.

The ability of aseptically filled pharmaceuticals to support microbial growth was tested on 43 small-volume products (mainly parenterals). These were inoculated with a variety of microorganisms which were known to be associated with contamination of pharmaceutical products. In general, Gram-negative bacteria were found to be much more likely to grow than Gram-positive. It was possible for an inoculum of a few cells to multiply to levels up to 10(7)/mL. The presence of preservatives also influenced the likelihood of growth, 12 out of 19 (63%) of the pharmaceuticals without preservatives supporting growth of one or more microorganisms; only 3 out of 24 (12%) of those with preservatives supported growth. The importance of these observations is discussed with reference to formulation of aseptically filled products, environmental sampling and the quality of cleanroom conditions necessary for production. It is suggested that those pharmaceuticals which are designed to be sterile but not to be terminally sterilized, should be tested before production begins, for their ability to support microbial growth. In this way, the risks involved in aseptically filling can be ascertained. A test is proposed in which "indicator" microorganisms would predict the likelihood of pharmaceutical formulations supporting growth.

Microbial contamination of pharmaceutical injections at the site of administration.

The administration of a subcutaneous injection was simulated by piercing the skin of volunteers with syringe needles. Interiors of 2.4% of the needles were found to be contaminated with micro-organisms from the skin as were 3.8% of the exterior surfaces.