Human immunodeficiency virus (HIV) infection in men with penile carcinoma is associated with increased prevalence of human papilloma virus infection and younger age at presentation.

BACKGROUND: We investigated the prevalence of HIV and human papilloma virus (HPV) infection in men with penile carcinoma. METHODS: This retrospective study investigated all men with penile carcinoma at the Universitas Academic Hospital in Bloemfontein, South Africa (January 2000-December 2008). Patients' age, HIV status, histological type of carcinoma and evidence of HPV infection were recorded. Statistical analyses included Student's t-test and Fisher's exact test where appropriate (2-tailed p-value < 0.05 indicated statistical significant). RESULTS: Among 65 patients (mean age 50.9 years, range 37-69), the most common histological type was squamous cell carcinoma (80.0%). HIV status was known for 48 patients; 27 (56.2%) were HIV-positive. The mean age at presentation was 43.7 years (range 26-69) years in the HIV-positive and 57.2 years (range 26-89) years in the HIV-negative group. Approximately 55% of HIV-positive and 24% of HIV-negative patients showed histological evidence of HPV infection (p = 0.04). No significant difference was found with regard to histological type of carcinoma. CONCLUSION: Patients with penile carcinoma had a high prevalence of HIV infection. The HIV-positive group were significantly younger at presentation, with a higher prevalence of HPV infection, suggesting that HIV may contribute to HPV-associated penile cancer at a younger age.

Human immunodeficiency virus (HIV) infection in men with penile carcinoma is associated with increased prevalence of human papilloma virus infection and younger age at presentation

Background: We investigated the prevalence of HIV and human papilloma virus (HPV) infection in men with penile carcinoma.Method: This retrospective study investigated all men with penile carcinoma at the Universitas Academic Hospital in Bloemfontein, South Africa (January 2000­December 2008). Patients' age, HIV status, histological type of carcinoma and evidence of HPV infection were recorded. Statistical analyses included Student's t-test and Fisher's exact test where appropriate (2-tailed p-value < 0.05 indicated statistical significant).Results: Among 65 patients (mean age 50.9 years, range 37­69), the most common histological type was squamous cell carcinoma (80.0%). HIV status was known for 48 patients; 27 (56.2%) were HIV-positive. The mean age at presentation was 43.7 years (range 26­69) years in the HIV-positive and 57.2 years (range 26­89) years in the HIV-negative group. Approximately 55% of HIV-positive and 24% of HIV-negative patients showed histological evidence of HPV infection (p = 0.04). No significant difference was found with regard to histological type of carcinoma.Conclusion: Patients with penile carcinoma had a high prevalence of HIV infection. The HIV-positive group were significantly younger at presentation, with a higher prevalence of HPV infection, suggesting that HIV may contribute to HPV-associated penile cancer at a younger age

Malignant mesothelioma with intracytoplasmic crystalline inclusions.

A 60-year-old female presented with a history of hoarseness, cough, chest pain, and dyspnea and a needle biopsy sample was submitted for histology. Light microscopy showed sheets of tumor cells with eosinophilic cytoplasm containing multiple crystals and eccentrically located nuclei. Electron microscopy showed large intracytoplasmic crystalloid inclusions. No crystalloid structures were found extracellularly. The tumor cells also had long slender microvilli and cell junctions, the features being consistent with a malignant epithelial mesothelioma. In the authors' experience this is a rare finding. The clinical information initially received was poor and electron microscopy was essential in making the correct diagnosis.

The ultrastructural features of plasmablastic lymphoma.

Plasmablastic lymphoma was originally described in 1997 by Delecluse et al. and is an aggressive variant of diffuse large B-cell non-Hodgkin lymphoma seen predominantly in a setting of acquired immunodeficiency syndrome and nearly always in extranodal sites. The authors have seen 10 cases in their department between 2001 and 2005. The patients' ages ranged from 24 to 39 years and there were 7 females and 3 males. In 7 cases where human immunodeficiency virus had been tested it was positive. Eight cases were extranodal and 2 cases involved lymph nodes. Five cases were followed up and 4 were confirmed dead within 5 months of diagnosis, verifying the aggressive nature of this condition. Histology showed large, polygonal tumor cells some of which had a slightly plasmacytic appearance. Six cases had a "starry sky" background. Immunohistochemical stains were negative in 1 case, while the other 9 cases were positive for CD138. Electron microscopy showed concentrically arranged rough endoplasmic reticulum in the cytoplasm in 9 cases. In 1 case the cells were too degenerate for evaluation. This study shows that the ultrastructural features are well developed and can help in distinguishing plasmablastic lymphoma from other light microscopically undifferentiated tumors.

Orbital rhabdomyosarcoma presenting as an apparent orbital subperiosteal abscess.

We present a patient with acute sinusitis whose CT scan showed a ring-enhancing lesion within the orbit typical of an orbital subperiosteal abscess. On exploration of the orbit, there was no pus present but a tumour was found, which on histological examination was found to be a rhabdomyosarcoma. The clinical signs and CT characteristics of orbital subperiosteal abscesses and rhabdomyosarcomas are discussed. A ring-enhancing lesion within the orbit on CT scan should not be regarded as being pathognomonic for a subperiosteal abscess and the possibility of other diagnoses should be considered.

The diagnosis of skeletal tuberculosis by polymerase chain reaction.

OBJECTIVE: To determine the potential of the polymerase chain reaction (PCR) for detecting Mycobacterium tuberculosis in skeletal samples by comparing results obtained by 1) Ziehl Neelsen staining, Lowenstein-Jensen and Bactec culture, 2) histopathology and clinical findings at the level of agreement, sensitivity and specificity. DESIGN: Cross sectional study. SETTING: Department of Medical Microbiology, Orthopaedics and Anatomical pathology, University of the Orange Free State Bloemfontein, South Africa. SUBJECTS: 45 consecutive patients were extensively investigated, 30 patients with clinical presumptive active tuberculosis and 15 with other pathology. RESULTS: Detection using culture could confirm only three of the 26 clinically diagnosed tuberculosis cases while PCR detection confirmed disease in 15 cases. The use of PCR increased the confirmation of clinically probable tuberculosis from 14 using standard laboratory techniques and histology to 18 of 26 cases. Calculated sensitivity and specificity for PCR employing culture as the "gold standard" were 100% (with 95% CI 29.2; 100.0) and 71.4% (55.4; 84.3), which due to low detection levels, basically excludes culture as a standard for statistical analysis. Sensitivity and specificity for PCR using histology as the "gold standard" were 78.6% (49.2; 95.3) and 87.1% (70.2; 96.4) respectively with positive and negative predictive values of 73.3% (44.9; 92.2) and 90% (73.5; 97.9) respectively. Positive agreement between PCR and histology was 0.64 (0.4; 0.9) indicating fair agreement. CONCLUSION: Although numbers in the study were too low to effectively draw statistically valid conclusions the importance of the relevance of PCR for rapid detection of low numbers of acid-fast bacilli and confirmation of mycobacterial infection in spinal biopsies has been established.

The nature of the spondylolytic defect. Demonstration of a communicating synovial pseudarthrosis in the pars interarticularis.

We injected methylene blue dye into 32 of the facet joints immediately above the defects in 17 consecutive patients with bilateral spondylolysis (34 defects). In 30 of these the dye flowed into a central cavity in the defect of the pars interarticularis and in 20 it passed into the facet joint below the defect. We found macroscopic cavities in 32 of the defects which communicated with the adjacent facet joints and had fibrous capsules. Histological examination showed focal areas of synovial lining consistent with a synovial pseudarthrosis. In most patients requiring surgery for spondylolysis, the defect is a synovial pseudarthrosis which communicates with the facet joint above it, and less often with the facet joint below it. We suggest that stress fractures of the pars may fail to heal because of the presence of synovial fluid from a nearby facet joint.

Megacyst of the penis.

A neonate presented with a penis 23 cm. long and 5 cm. in diameter. The relevant embryology of the penis is reviewed and a possible explanation for the anomaly is presented.

Placental site trophoblastic tumour (trophoblastic pseudotumour). A case report.

The term 'gestational trophoblastic disease' includes hydatidiform mole (invasive and non-invasive), choriocarcinoma and a rare condition initially called trophoblastic pseudotumour and more recently placental site trophoblastic tumour. Originally this condition was viewed as benign, but recent reports indicate that it may be fatal. The first report of a South African patient with this uncommon condition is presented.

A South African family with antithrombin III deficiency.

Antithrombin III is the most important natural inhibitor of coagulation. Reduced levels of antithrombin III are a well-documented cause of hypercoagulability. Several families have been described with hereditary antithrombin III deficiency, including one from South Africa. We report a second South African family with this defect.

Metamorphosis of chronic granulocytic leukaemia, lytic bone lesions and hypercalcaemia. A case report.

Chronic granulocytic leukaemia may undergo metamorphosis characterized by diffuse granulocytic sarcomas resulting in lytic bone lesions and hypercalcaemia. A patient with this rare complication is reported.