Mesorchial testicular torsion: case report and a review of the literature.

Testicular torsion can be extravaginal, intravaginal, or mesorchial. Mesorchial torsion is less well defined and has an atypical presentation. Here we present the case of a 13-year-old with severe, intermittent right scrotal pain, erythema, and a large hydrocele. Color Doppler ultrasound examination showed epididymal enlargement and normal flow. Weeks after presentation, serial color Doppler ultrasound examinations showed epididymal enlargement and decreased perfusion. A literature review for testicular torsion etiology and clinical and radiologic findings documents this as the only recorded case of mesorchial testicular torsion with clinical and radiologic findings. Atypical pain, if persistent, requires careful reassessment, radiologic studies, and surgical exploration.

Comparison of HER-2/neu oncogene amplification detected by fluorescence in situ hybridization in lobular and ductal breast cancer.

BACKGROUND: Abnormal expression of the HER-2/neu oncogene, a tyrosine kinase-type transmembrane growth factor receptor localized to chromosome 17q, has been associated with poor prognosis and the prediction of therapy response in invasive breast cancer. The comparative incidence and significance of HER-2/neu gene amplification for lobular and ductal breast cancer have not been previously characterized. DESIGN: Formalin-fixed, paraffin-embedded primary breast cancer tissue sections from 71 women diagnosed with invasive lobular carcinoma were tested for HER-2/neu gene amplification by fluorescence in situ hybridization (FISH) method using the Ventana unique sequence probe (Ventana Medical Systems, Tucson, AZ). A series of 106 cases of invasive ductal carcinoma was similarly processed and tested. Lymph node status was available for 155 (88%) of the 177 cases and 82 (46%) were lymph node-negative (LN-) and 73 (41%) were lymph node-positive (LN+). Patients were treated for a mean of 65 months (range 1-169 months). RESULTS: 9 of 71 (13%) cases of lobular cancer featured HER-2/neu gene amplification, whereas 51 (48%) of 106 cases of ductal cancer showed amplification (P < 0.0001). On univariate analysis of combined lobular and ductal cases, HER-2/neu gene amplification detected by FISH predicted disease-related death (P < 0.0001). HER-2/neu gene amplification also predicted disease-related death in lobular cases alone (P = 0.003), LN+ lobular cases separately (P = 0.019), and LN- and LN+ ductal cases separately and alone (P < 0.0001). Multivariate analysis of the lobular group alone revealed that LN+ status (P = 0.015) and stage (P = 0.01) were independent predictors of disease-related death, and HER-2/neu gene amplification reached near significance (P = 0.086). In the ductal carcinoma group alone, HER-2/neu gene amplification (P = 0.03), lymph node status (P = 0.0001), tumor stage (P = 0.0001), and tumor grade (P = 0.044) were independent predictors of overall disease survival. CONCLUSIONS: HER-2/neu gene amplification detected by FISH was identified at a significantly lower rate in lobular compared with ductal breast cancer. HER-2/neu gene amplification when present in lobular breast cancer is a significant adverse prognostic factor.

Splenic marginal zone lymphoma: a case report and review of the literature.

Splenic marginal zone lymphoma is a recently described primary splenic lymphoproliferative disorder that mainly affects older individuals. We report the case of a 22-year-old woman with morphologic and immunophenotypic findings consistent with splenic marginal zone lymphoma. This woman is one of the youngest patients ever described with this disease. The patient presented with complaints of left-sided abdominal fullness and was noted to have splenomegaly on physical examination. Laboratory evaluation revealed pancytopenia and a serum M component. The spleen was removed and weighed 1550 g. Histology showed prominent white pulp with an expanded marginal zone. The neoplastic cells were marginal zone-type cells with small to intermediate-sized nuclei with occasional conspicuous nucleoli and moderate amounts of pale to amphophilic cytoplasm. Immunophenotypic analysis revealed a B-cell population (CD20 positive) with kappa-light-chain restriction. The patient was treated with adjuvant therapy, but developed progressive disease less than 2 years after initial diagnosis.