Sclerosing Mediastinitis Masquerading As A Lymphoma.

Fibrosing retroperitoneal changes can mimic malignant tumours. The correlation with beta-blockers has long been known where practolol was the prototype agent. It is now possible to report supradiaphragmatic occurrence of a similar pathology and its link with later generation beta adrenergic receptor blocking drugs leading to a diagnosis of lymphoma. This rare association needs to be included in the differential diagnosis of mass lesions in both abdomen and chest.

Superior vena cava syndrome caused by an intrathoracic plasmacytoma.

A case of an extramedullary intrathoracic plasmacytoma causing superior vena cava syndrome is described. Review of the literature on intrathoracic plasmacytomas and superior vena cava syndrome revealed that no similar cases have been described to date. The initial presentation, management, and response to treatment are described.

Severe colonic dysplasia in a child with familial adenomatous polyposis.

Familial adenomatous polyposis (FAP), is a genetic premalignant condition which, if untreated, will ultimately manifest with the development of colorectal carcinoma. It is a disease of young adulthood. Rectal and colonic polyps are seldom seen before 10 years of age. Screening of clinically asymptomatic relatives thus generally starts during the teenage years. Carcinoma of the colon is exceedingly rare in children with FAP. While all adult patients should be surgically treated before the appearance of any carcinoma, early detection of dysplasia is paramount. The present case history relates to an 8-year-old boy with FAP who was found to have a significant degree of dysplasia in a polyp. This case remains the exception and a uniform approach to the screening and treatment of patients with FAP is still encouraged.

Primary thyroid lymphomas. A clinicopathological study of 8 cases.

Eight elderly women with primary non-Hodgkin's lymphoma were treated with a combination of surgery, chemotherapy and radiation with excellent outcome. Clinically, the patients presented with thyromegaly and did not have lymphadenopathy or hepatosplenomegaly. On histological examination, the lymphomas resembled diffuse follicle-centre cell tumours. All patients showed extension beyond the thyroid capsule and lympho-epithelial lesions; 3 displayed kappa-light-chain restriction and 2 lambda-monoclonality. Thyroid lymphomas fall into the spectrum of mucosa-associated lymphomas, which have a better prognosis than their equivalent nodal-based counterparts.

Chemotherapy for metastatic non-small-cell lung cancer. A case report.

The role of chemotherapy for patients with metastatic non-small-cell lung carcinoma (NSCCL) is controversial. A patient with intrathoracic metastatic NSCCL, who was treated by moderate dose cisplatin combination chemotherapy and who remained clinically free of disease more than 5 years after presentation, is described. This treatment has not previously been reported. A trial of moderate-dose cisplatin combination chemotherapy in selected patients with good performance status seems justified.

Endocarditis caused by Lactobacillus casei subspecies rhamnosus. A case report.

A case of subacute endocarditis in a 66-year-old man with mitral incompetence is described. The causative agent was identified as Lactobacillus casei subspecies rhamnosus, which is a normal commensal in the mouth. Despite the ubiquitous presence of these mouth commensals, this type of endocarditis appears to be rare. It is emphasised that a Lactobacillus species should be considered in cases of clinically obvious endocarditis with 'negative' blood cultures, including 'negative' subcultures following a significant radioactive count in the Bactec system. Suitable media for subculture should be used and incubation for at least 48 hours is required. Other possible reasons for the rarity of this type of endocarditis are discussed.

B-cell prolymphocytic leukaemia--clinical and haematological features.

Prolymphocytic leukaemia is an unusual but distinctive variant of chronic lymphocytic leukaemia which generally responds poorly to chemotherapy. Four cases are described to illustrate typical clinical and haematological features and to emphasise the unsatisfactory outcome with combination chemotherapy, radiotherapy and plasma exchange in 3 patients, and to draw attention to the prolonged disease control which followed splenectomy in the fourth. These observations illustrate the relative ease with which the diagnosis can be made and also the difficulties in management, which requires exploration of alternative treatment options.