Aspergillus thyroiditis in a renal transplant recipient mimicking subacute thyroiditis.

Fungal pathogens are increasingly encountered after renal transplantation. Aspergillus causes significant morbidity and mortality in transplant patients. Fungal thyroiditis is a rare occurrence owing to unique features of the thyroid gland. Most cases are caused by Aspergillus species and have been described in immunocompromised patients. Presentation may be identical with that of subacute thyroiditis, in which hyperthyroidism features and painful thyroid are the prominent findings. Diagnosis can be ascertained by fine-needle aspiration of thyroid showing branching hyphae of Aspergillus. We describe a renal transplant patient who developed Aspergillus thyroiditis as part of a disseminated infection successfully treated with voriconazole.

Hydatid cyst of the breast.

Cystic hydatid disease is caused by the Echinococcus granulosus parasite. Most frequently, cysts develop in liver and lung. The breast is rarely a primary site of the hydatid cyst. A case of hydatid cyst of the breast is presented, the diagnosis of which was missed both pre-operatively and intra-operatively.

The diagnostic value of on-site cytopathological evaluation and cell block preparation in fine-needle aspiration cytology of liver masses.

OBJECTIVE: The aims of this study were to evaluate the typing accuracy of conventional smear (CS), cell block (CB) preparations and combined use of both procedures (CS + CB) for the diagnosis of hepatic malignancies and to determine whether immediate on-site cytopathological evaluation improves the diagnostic yield of liver fine-needle aspiration cytology (FNAC). METHODS: Ultrasound-guided FNABs were performed on 323 consecutive cases with liver masses between December 2002 and December 2004. Histologically and/or clinically correlated 167 cases were included in the study. Preliminary FNAB results, results of CS, CB, and combined use of CS and CB were compared regarding diagnostic sensitivity, specificity, and accuracy for the diagnosis of malignancy. Subtyping accuracies of different methods were also compared. RESULTS: The sensitivity of on-site cytopathological examination and CS were both 92.8%. The sensitivity of CS + CB was slightly better than that of CB (93.5% versus 84.8%). Specificity of all procedures was achieved 100%. Diagnostic accuracy of on-site cytopathological evaluation, CS, CB, and CS + CB were 93.9%, 93.9%, 87.2%, and 94.5%, respectively. A specific subtype diagnosis of malignant tumours could be rendered accurately on the basis of preliminary diagnosis in 71%, CS in 75.4%, CB in 78.3% and combined approach in 92% of cases. In terms of typing accuracy, 87.5% of HCCs, 93.2% of adenocarcinomas, 92.3% of neuroendocrine carcinomas, 100% of lymphomas and 100% of other malignant tumours were correctly subclassified in the final cytopathological diagnosis. The agreement between preliminary diagnosis and final cytopathological diagnosis was 77.2%. CONCLUSION: With use of on-site cytopathological evaluation and combined use of CS and CB, the diagnostic accuracy of liver tumours approaches 100% and also significantly improve diagnostic and subtyping accuracy of liver malignancies.

The effect of montelukast on eosinophil apoptosis: induced sputum findings of patients with mild persistent asthma.

BACKGROUND: Apoptosis may be important in limiting airway eosinophilia. Treatment with leukotriene antagonists decreases the number of eosinophils in both peripheral blood and sputum. AIM: To assess the effect of montelukast on eosinophil apoptosis in a group of patients with mild persistent asthma (MPA) and to compare this effect with the apoptotic effect of fluticasone propionate (FP). METHODS: Randomly selected patients with MPA (n = 22) who had not taken anti-inflammatory therapy within the preceding 12 months were included in the study. The sputum induction procedure was performed and the patients were divided into two groups: group 1 (n = 10) received FP 250 microg/day and group 2 (n = 22) received montelukast 10 mg/day orally for 4 weeks. Sputum induction was repeated after the treatment period. The resulting cytospin slides were stained by Wright's stain and morphologic changes in apoptotic eosinophils were assessed by the use of light microscopy by two blinded expert pathologists. Serum soluble Fas ligand (sFasL) concentrations were measured by an ELISA method at baseline and after treatment in both groups, as well as in a group of healthy subjects. RESULTS: In within-group comparisons, the apoptotic ratio (AR) increased at the end of the study period in group 1 (p = 0.05). In the group treated with FP the ratio of sputum eosinophils significantly decreased (p = 0.02), and the AR significantly increased (p < 0.005). No differences were found in the two study groups in serum sFasL levels at the end of the treatment period compared with baseline values (p > 0.05). CONCLUSION: Our findings demonstrate that 4 weeks' treatment with a CysLT receptor antagonist (montelukast) resulted in an increase in eosinophil apoptosis comparable to that produced by FP, suggesting that induction of apoptosis may be a potential mechanism for the mode of action of CysLT receptor antagonists in asthma.

The effect of montelukast on eosinophil apoptosis: induced sputum findings of patients with mild persistent asthma

Background: Apoptosis may be important in limiting airway eosinophilia. Treatment with leukotriene antagonists decreases the number of eosinophils in both peripheral blood and sputum. Aim: To assess the effect of montelukast on eosinophil apoptosis in a group of patients with mild persistent asthma (MPA) and to compare this effect with the apoptotic effect of fluticasone propionate (FP). Methods: Randomly selected patients with MPA (n = 22) who had not taken anti-inflammatory therapy within the preceding 12 months were included in the study. The sputum induction procedure was performed and the patients were divided into two groups: group 1 (n = 10) received FP 250 mg/day and group 2 (n = 22) received montelukast 10 mg/day orally for 4 weeks. Sputum induction was repeated after the treatment period. The resulting cytospin slides were stained by Wright’s stain and morphologic changes in apoptotic eosinophils were assessed by the use of light microscopy by two blinded expert pathologists. Serum soluble Fas ligand (sFasL) concentrations were measured by an ELISA method at baseline and after treatment in both groups, as well as in a group of healthy subjects. Results: In within-group comparisons, the apoptotic ratio (AR) increased at the end of the study period in group 1 (p = 0.05). In the group treated with FP the ratio of sputum eosinophils significantly decreased (p = 0.02), and the AR significantly increased (p 0.05). Conclusion: Our findings demonstrate that 4 weeks’ treatment with a CysLT receptor antagonist (montelukast) resulted in an increase in eosinophil apoptosis comparable to that produced by FP, suggesting that induction of apoptosis may be a potential mechanism for the mode of action of CysLT receptor antagonists in asthma

Contexto: La apoptosis puede ser importante para limitar los eosinófilos de las vías respiratorias. El tratamiento con antagonistas de los leucotrienos reduce el número de eosinófilos tanto en la sangre periférica como en el esputo. Objetivo: Evaluar el efecto del montelukast (M) sobre la apoptosis eosinofílica en un grupo de pacientes con asma leve persistente (ALP) para compararlo con el efecto apoptótico del propionato de fluticasona (PF). Métodos: Para el estudio se seleccionaron aleatoriamente pacientes con ALP (n = 22) que no habían recibido terapia antiinflamatoria durante los 12 meses previos. Tras proceder a la inducción del esputo, los pacientes se dividieron en dos grupos: uno recibió 250 mg/día de propionato de fluticasona (grupo 1, n = 10) y el otro 10 mg/día de M por vía oral (grupo 2, n = 12) durante 4 semanas. Tras el período de tratamiento se repitió la inducción del esputo. Los preparados resultantes obtenidos por citocentrifugación se tiñeron con colorante de Wright y dos patólogos expertos que desconocían el origen de las muestras las observaron al microscopio de luz para evaluar los cambios morfológicos de los eosinófilos apoptóticos. Se midieron las concentraciones séricas del ligando Fas soluble (sFasL) mediante el método ELISA antes y después del tratamiento en ambos grupos, midiéndose simultáneamente en un grupo de sujetos sanos. Resultados: Comparando los resultados en un mismo grupo, el índice apoptótico (IA) aumentó al final del período de estudio en el grupo 1 (p = 0,05). En el grupo tratado con PF, el índice de eosinófilos en el esputo disminuyó significativamente (p = 0,02), mientras que hubo un aumento significativo del IA (p 0.05). Conclusión: Nuestros hallazgos demuestran que un tratamiento de cuatro semanas con un antagonista de los receptores de Cis-LT, el montelukast, produce un aumento de la apoptosis eosinofílica comparable al que produce el propionato de fluticasona, lo que sugiere que la inducción de la apoptosis puede ser un mecanismo de acción de los antagonistas de los receptores de Cis-LT en el asma

[Malignant melanoma of the lung: is it easy to determine its origin?]. / Melanoma pulmonar maligno: es fácil determinar su origen?

Malignant melanoma involving the respiratory tract is nearly always metastatic. True primary tumors are very rare, and only approximately 28 cases have been reported in the literature. Extensive clinical and histopathological examinations are needed to ascertain that the lung is the primary site. We present the case of a 67-year-old man with an apparent primary malignant melanoma of the lung in the right lower lobe. We also review the literature.

Melanoma pulmonar maligno: ¿es fácil determinar su origen? / Malignant melanoma of the lung: is it easy to determine its origin?

El melanoma maligno que afecta al sistema respiratorio tiene un origen casi siempre metastásico y los tumores primarios verdaderos son muy frecuentes. En la bibliografía se han publicado aproximadamente 28 casos. Son necesarios estudios clínicos y anatomopatológicos detallados para considerar que el pulmón es la localización primaria del tumor. En este artículo se presenta el caso de un varón de 67 años de edad con un melanoma pulmonar maligno primario en el lóbulo inferior derecho. También se realiza una revisión de la bibliografía

Malignant melanoma involving the respiratory tract is nearly always metastatic. True primary tumors are very rare, and only approximately 28 cases have been reported in the literature. Extensive clinical and histopathological examinations are needed to ascertain that the lung is the primary site. We present the case of a 67-year-old man with an apparent primary malignant melanoma of the lung in the right lower lobe. We also review the literature

Infratemporal and intraorbital metastasis of the glioblastoma multiforme. A case report.

Primary brain tumors rarely metastasize outside of the central nervous system. A case of 37-year-old woman with a temporal lobe glial tumor which shows infratemporal and orbital invasion is presented. She had undergone a cranial operation because of temporal lobe epilepsy 8 years ago. Defects on the dura and bone flap were thought to be the mechanisms of the infratemporal fossa invasion. The case illustrates extra-axial metastasis of glioblastoma multiforme, an exceptional finding.

An intensive approach to the treatment of disseminated BCG infection in a SCID patient.

There is an appreciable mortality associated with BMT in patients with SCID and advanced BCG infection. We present a girl with T-B+ SCID complicated by spina ventosa and disseminated BCG osteitis after receiving a fully matched sibling marrow transplant. Considerable progression characterised by two clinical activations and multiple pleural and perivertebral abscess formations occurred with conventional anti-mycobacterial chemotherapy. She finally recovered with full immune reconstitution after BMT and intensive treatment comprising five conventional and alternative agents that she received for 36 months. No side-effects and/or complications have been seen other than hearing loss.

A randomized trial of four cycles of adjuvant AC (adriamycin + cyclophosphamide) +/- two cycles of EP (etoposide + cisplatin) in node positive patients with breast cancer.

BACKGROUND: Four cycles of AC have been accepted as the standard chemotherapy in breast cancer. In the present randomized study we aimed to assess the efficacy of adjuvant etoposide + cisplatin (EP) combination following four cycles of standard adriamycin + cyclophosphamide (AC) in premenopausal patients with operable breast cancer and axillary lymph node metastasis. PATIENTS AND METHODS: Premenopausal patients with positive axillary lymph nodes following curative modified radical mastectomy were randomized to either four cycles of AC (82 patients) or four cycles of AC + two cycles of EP (83 patients). RESULTS: Median follow-up is 72 months. All randomized and eligible patients are included in the analysis (AC: 80 patients, AC + EP: 78 patients). The five-year disease-free survival (DFS) for the AC + EP group was significantly better when compared to AC group (45.5% vs. 30.4%; P = 0.048). Again, the five-year overall survival (OS) of the whole group was in favor of AC + EP arm, though without statistical significance (68.6% vs. 59.1%; P = 0.247). CONCLUSION: Two cycles of EP following four cycles of AC decreased the relapse rate in operable breast cancer patients.

Primary lymphoma of bones.

Primary malignant lymphoma of bone (PLB) is an uncommon tumour. A survey of 278 primary malignant cases in our clinic showed that 20 cases of PLB were registered between 1986 and 1997. Fourteen of the 20 cases underwent surgical excision. The mean follow-up time was 36.3 months. The rate of response to treatment was 65% with a rate of complete recovery of 55%. The clinical stage of tumours correlated well with the prognosis. Our results seem worse than most of the series in the literature. A high proportion of stage IV disease and pathological fractures at presentation may be a factor.

Post-traumatic intradiploic epidermoid cyst. A case report.

A patient with an intradiploic epidermoid cyst of calvarium was presented. Head injury that may cause the inclusion of epidermal cells into the diploe of the bone was present in his medical history. Skull radiographs and cranial magnetic resonance imaging (MRI) demonstrated the tumor. The tumor was totally removed and the patient was discharged free of symptoms.

Angiomyolipoma of the kidney with lymph node involvement in a 17-year old female mimicking renal cell carcinoma: a case report.

Angiomyolipoma with extrarenal involvement is very uncommon. Herein we report a case of angiomyolipoma with lymph node involvement in a 17-year-old female. The diagnosis and treatment of the case is discussed.

Dysplastic changes in idiopathic thrombocytopenic purpura and the effect of corticosteroids to increase dysplasia and cause hyperdiploid macropolycytes.

This study evaluates the dysplastic hematological changes in nine patients with idiopathic thrombocytopenic purpura (ITP) in 11 attacks, before and after corticosteroid treatment. The pretreatment blood smears of patients with ITP, displayed more neutrophils with bizarre nuclei (P < 0.001), Döhle or Döhle-like inclusions (P < 0. 01), irregular distribution of granules (P < 0.05), hypo-agranulation (P < 0.05), pseudo-Pelger-Huet-like cells (P < 0. 01), and nuclei with chromatine clumping (P < 0.01) than the normal children. The eosinophils of ITP patients were also dysplastic, before treatment. The pretreatment diameter of the neutrophils and the percentage of macropolycytes were greater than those of the patients with viral infections and normal group (P < 0.05 for all). The percentage of neutrophils with bizarre nuclei and nuclei with chromatine clumping and the diameter of neutrophils and macropolycyte percentage increased with corticosteroid therapy (P < 0.01, < 0.01, < 0.01, and < 0.05, respectively). The neutrophil diameter, percentage of macropolycytes, and number of neutrophils with bizarre nuclei decreased within 1-4 weeks after the therapy was stopped. In the neutrophils of two patients, diploidy and hyperdiploidy were established before and on the last day of therapy, respectively, and diploidy reversed after therapy was stopped. In conclusion, ITP patients display dysplastic findings in both neutrophils and eosinophils before treatment and corticosteroids cause transient significant increase in some of the dysplastic changes in neutrophils.

Remission of nephrotic syndrome after removal of localized Castleman's disease.

Renal complications of Castleman's disease are uncommon. Among the various renal disorders, including mesangial proliferative glomerulonephritis, membranous glomerulonephritis, and minimal change disease, nephrotic syndrome attributable to renal amyloidosis is very rarely reported. We report a case of mixed type of localized Castleman's disease complicated with nephrotic syndrome. Renal biopsy was performed. The deposition of AA amyloidosis was shown. After the removal of two mesenteric lymphoid masses, the proteinuria was gradually decreased and disappeared. Renal biopsy was repeated after 14 months, and, despite complete remission of nephrotic syndrome, no regression in amyloid deposition was found.

Intrathoracic desmoid tumor of the posterior mediastinum with transdiaphragmatic extension. Report of a case.

We report on a de novo desmoid tumor of the posterior mediastinum with transdiaphragmatic extension in a 40-year-old man. The tumor was inoperable because of its location and the invasion of adjacent structures. Although extremely rare, desmoid tumors of the posterior mediastinum should be considered in the differential diagnosis of posterior mediastinal masses.

Giant cell tumor of bone.

Seventy-two cases of giant cell tumor (GCT) of bone were diagnosed in our clinic between 1986 and 1998. The mean age of the patients was 35 (range: 11 to 63 years) and the female to male ratio was 1.3:1. Fifty-four percent of the cases had involvement about the knee (distal femur, upper tibia, and upper fibula). Four patients had a malignant form of the disease and another four had the disease before closure of the physis. There was no case of multicentric involvement. Nine patients presented with pathological fracture. Forty-seven patients had histological grading done. Twenty three (49%) had grade I, 17 (36%) had grade II, and seven (15%) had grade III disease. The mean follow-up time was 59.6 months (range: 24 to 142 months) for patients at least two years follow-up. There was a 33% complication rate.