Synchronous Small Cell Neuroendocrine Carcinoma and Adenocarcinoma of the Colon: A Link for Common Stem Cell Origin?

Synchronous carcinomas have been recognized for over a century, with synchronous primary adenocarcinoma of the colon reported to range from 2-11% of cases involving this type of malignancy. Small cell carcinomas occur frequently with colorectal adenomas; however, despite these reports and a known adenoma-to-carcinoma sequence, scarce literature exists on synchronous colorectal adenocarcinoma and small cell carcinomas. We present a rare cancer of synchronous small cell neuroendocrine carcinomas and discuss a possible link between these two cancers.

Germ cell cancer presenting as gastrointestinal bleeding and developing brain metastases: case report and review of the literature.

This paper describes a rare case of germ cell cancer with duodenum, brain and lung metastases. The patient presented with melena and left testicle enlargement. Orchiectomy revealed mixed germ cell cancer, enteroscopy revealed duodenal choriocarcinoma, and chest x-ray and computed tomography (CT) showed bilateral lung metastases. The patient received and tolerated cisplatinum-based chemotherapy, and responded well. However, he developed seizures 3 months later. MRI showed brain metastases and he was treated with whole-brain radiation. One month later, he developed progressive dyspnea. Chest CT showed worsening lung metastases. He received second-line chemotherapy, but died due to multiorgan failure. Germ cell cancer with nonpulmonary metastases has poor prognosis and the management of these patients requires a multimodal approach. Head CT should be considered as routine screening for all germ cell cancer patients on initial diagnosis and brain MRI should be considered for high-risk patients (with an embryo- or choriocarcinoma histology, dramatically elevated ß-human chorionic gonadotropin and lung involvement).

Toxic megacolon from fulminant Clostridium difficile infection induced by topical silver sulphadiazine.

Pseudomembranous colitis and toxic megacolon (TM) are well-known complications of Clostridium difficile infections. Systemic antibiotic is considered as the major risk factor for the development of C difficile colitis. However, topical antibiotics are rarely associated with the infection. As previously thought, the use of topical antibiotic is capable of systemic absorption in damaged and denuded skin; sufficient enough to suppress the normal bowel flora. Here, we present an unusual case of TM from C difficile infection induced by topical silver sulphadiazine in a 60-year-old man with immune-bullous pemphigus vulgaris. The diagnosis is further complicated by the absence of diarrhoea as the initial presentation. Despite adequate medical and surgical intervention, the patient had an unfavourable outcome.

Cutaneous inflammatory malignant fibrous histiocytoma presenting with a leukemoid reaction: a case report and review of the literature.

Malignant fibrous histiocytoma (MFH) is the most common sarcoma found in adults. We discuss a case of inflammatory MFH of dermal/epidermal origin presenting with a severe leukemoid reaction (LR). A 60 years old white male presented to hematology/oncology clinic complaining of mild shortness of breath on exertion. Past medical history was remarkable for removal of a left upper extremity necrotic mass 4.4 × 3 × 3 cm. Microscopy of the specimen showed clear surgical margin, and tumor cells restricted to the dermis without lymphovascular invasion. Immunohistochemestry was positive for CD 68 and CD 99. Chest x-ray was negative for metastatic disease. White blood cell count was 109.4 k/mm(3) with 24 k/mm(3) band neutrophils, and absolute neutrophil count of 69 k/mm(3). CT scan of the thorax revealed numerous bilateral pulmonary nodules suspicious for metastasis. Based on these findings patient was diagnosed with metastatic cutaneous IMFH associated with a LR. Following review of medical literature, this appears to be the first reported case of inflammatory cutaneous MFH associated with LR. This histological variant is rare, and carries a poor prognosis. Thus, we would like to emphasize the need for investigating alternative therapies capable of improving the survival of these patients.

A solid organising cryptogenic liver abscess and its association with a colonic tubullovillous adenoma.

Cryptogenic liver abscess (CLA) is a well-known disease entity that has puzzled clinicians for centuries. With the advancement of diagnostic modalities, comes the decreasing incidence of liver abscess labelled as 'cryptogenic' in nature. Colonic diseases have been identified as a possible underlying condition found in patients with liver abscesses. Although rare, tubullovillous adenomas have been implicated as one of the colonic causes of a CLA. We present a case of a CLA in a 53-year-old man with a potentially associated tubullovillous adenoma found via colonoscopy.

Pathologic Rupture of the Spleen in Mantle-Cell-Type Non-Hodgkin's Lymphoma.

Mantle cell lymphoma (MCL) accounts for less than 10 percent of all non-Hodgkin's lymphoma (NHL). Pathologic or spontaneous rupture of the spleen has been reported in patients with lymphoma; however only 5 cases have been reported in patients with MCL. Although splenomegaly occurs frequently in patients with MCL, spontaneous splenic rupture is rare. We present a case of a 51-year-old female with MCL, who presented to the medical emergency room with splenic rupture. This case illustrates that clinicians should be aware of the incidence and presentation of patients with MCL and spontaneous splenic rupture, as early detection and heightened suspicion may prevent potentially fatal outcomes.

Colonic metastases from pleomorphic carcinoma of the lung presenting as an ileocecal intussusception.

Pleomorphic carcinoma is a rare aggressive type of lung cancer that uncommonly metastasizes to the bowel, leading to bleeding, perforation, obstruction, and rarely intussusception. Serving as a lead point, metastatic lesions in the bowel may precipitate intussusception and require immediate surgical intervention. We present a rare case of colonic metastases from a primary lung malignancy, causing ileocecal intussusception in a 57-year old male.

Public hospital-based laboratory experience during an outbreak of pandemic influenza A (H1N1) virus infections.

The experience of a public hospital virology laboratory during a springtime 2009 outbreak of a novel influenza A (H1N1) virus in New York State is described. Influenza virus was isolated from 145 of 613 respiratory swab specimens. Symptoms of fever (temperature, 102.7 +/- 0.32 degrees F), cough, upper respiratory infection, myalgia, and headache were reported. Atypical symptoms of nausea/vomiting and diarrhea were also observed. Illness occurred mainly in patients or=65 years old. Compared to the results of traditional culture methods, the sensitivities of a rapid chromatographic influenza A and B virus immunoassay and rapid shell vial culture were 70.3% and 98.6%, respectively. A sensitivity of 80% was obtained by testing 50 specimens by a direct fluorescent-antibody (DFA) assay. The observation of adequate numbers of cells on the DFA assay slides suggests that the low sensitivity of the chromatographic immunoassay may result from its intrinsic nature and not from improper specimen collection. A reverse transcription-PCR (RT-PCR) assay of 45 specimens performed off-site yielded 21 novel (H1N1) viruses and 2 seasonal (H3N2) influenza viruses. The mean time interval of 5.69 +/- 0.37 days from specimen collection to the availability of RT-PCR results limited the value of this assay for patient care. In laboratories lacking on-site molecular capabilities, shell vial techniques can rapidly (about 1 day) confirm negative results and/or identify false-negative chromatographic immunoassay results. Laboratories lacking culture capabilities may also use the DFA assay to confirm or replace the results obtained by these immunoassays. Increasing testing demands caused shortages in commodities and personnel. Alternative testing strategies and planning are necessary in order to optimize virus detection and ensure appropriate resource allocation.