Clinical Case of the Month: Hypereosinophilia in a Young Woman with a History of Childhood Asthma.

Hypereosinophillia is a rare clinical entity. It is associated with a wide differential diagnosis including neoplasm, infection, and allergic etiologies. Clinicians should have a well defined approach to hypereosinophilia in order to find treatable causes. We present a case of hypereosinophillia caused by parasitic infection with Toxocara canis. We also review epidemiology, transmission, microbiology, and management of Toxocara canis.

Sialadenoma papilliferum of the parotid gland: case report and review of literature.

Sialadenoma papilliferum is a rare benign salivary gland tumor. We present an unusual case of sialadenoma papilliferum of the parotid gland, discuss clinical presentation, diagnostic challenges, and review of the literature. A 65-year-old male smoker presented with a large, exophytic, fungating, painless mass in the tail parotid for 8 years. The tumor developed an exophytic component 2 years before presentation. The patient subsequently underwent superficial parotidectomy with facial nerve preservation. Initial pathological analysis suggested a variant of Warthin's tumor. The pathology underwent extensive internal and external review. Final diagnosis was consistent with sialadenoma papilliferum. We present the fourth reported case of sialadenoma papilliferum within the parotid gland and only the second that has presented with breach of the overlying skin. The clinical presentation may mimic an advanced parotid malignancy. However, facial nerve preservation and good surgical outcomes can be obtained.

Mandibular metastasis from a skull base chordoma: report of a case with review of literature.

This article reports an unusual presentation wherein the first evidence of distant failure from a locally controlled, recurrent skull base chordoma was a metastasis to the mandible. We present a case report from a tertiary-care academic skull base referral center and a review of literature. A 33-year-old woman with a locally recurrent spheno-occipital chordoma that was stabilized with multimodality therapy presented with a right mandibular mass. Immunohistochemical stains demonstrated the tumor cells staining positive for vimentin, cytokeratin, epithelial membrane antigen (EMA), and S100 consistent with metastatic chordoma. Positron emission tomography-computed tomography imaging further revealed widespread distant failure. Chordomas are rare tumors with only four previous reports of metastasis to the mandible. This is the first presentation of a mandibular metastasis from a spheno-occipital chordoma. We present a review of literature and summarize the demographic, clinical, pathological, treatment-related data, and discuss follow-up information from previous reports of metastatic chordomas to the mandible.

p63 Immunocytochemistry improves accuracy of diagnosis with fine-needle aspiration of the breast.

Breast fine-needle aspiration (FNA) is highly sensitive and specific for detecting carcinoma under most circumstances. Immunostaining for the myoepithelial cell marker p63 has been shown to be useful to separate noninvasive from invasive breast lesions in histologic examination. Its usefulness for breast FNA specimens is less certain. We performed p63 immunostains on 17 clinical samples and 29 aspirates from excised surgical specimens. One Papanicolaou-stained ThinPrep slide (Cytyc, Marlborough, MA) from each case was scored as benign, atypical, "suspicious," or positive. Cytospin (Shandon, Pittsburgh, PA) slides stained with p63 antibody were scored as to the percentage of positive single cells and percentage of positive clusters. The staining pattern of p63 was significantly different (P < .0001) between malignant and benign lesions. Based on cytology alone, the sensitivity, specificity, and positive and negative predictive values were 88%, 90%, 83%, and 93%, respectively. The application of p63 staining to specimens with a less-than-definitive diagnosis (atypical and suspicious) improved the specificity and positive and negative predictive values to 97%, 94%, and 97%, respectively. When used in conjunction with morphologic examination, p63 immunostaining may be useful to categorize cases problematic by Papanicolaou staining.

A prospective trial of fungal colonization after laser resurfacing of the face: correlation between culture positivity and symptoms of pruritus.

BACKGROUND: After full-face laser resurfacing of the face, patients often complain of pruritus, which may be intense. It has been suggested that some cases of postresurfacing pruritus may be associated with subclinical fungal infection. OBJECTIVE: To determine whether intense pruritus after laser resurfacing of the face is correlated with simultaneous fungal growth of the treated skin. METHODS: Twelve adult female patients undergoing combined full-face laser resurfacing with CO2 and erbium:YAG lasers for chronic photodamage or acne scarring were enrolled in a prospective study. Fungal cultures were obtained by swabbing the facial skin of each patient immediately before, 3 days after, and 6 days after the laser procedure. At the same points in time, investigators completed objective assessments of the patients' facial skin, and patients reported the sensations that they were experiencing. RESULTS: Six patients (50%) complained of significant pruritus (3 or greater on a scale of 0 to 5). In four of the six cases (67%), at least one of the three fungal cultures obtained grew fungal organisms, including Candida albicans (2 cultures), Candida parapsilosis, Aureobasidium pullulans, and Fusarium species. In no instances did culture positivity occur in the absence of significant pruritus. A statistically significant relationship (P=0.0143) was found to exist between at least one of the three cultures being positive and the emergence of significant posttreatment pruritus. Physician ratings of clinical signs did not correlate with patient reports of pruritus, other symptoms, or culture positivity. CONCLUSION: Colonization or subclinical infection with fungi, particularly Candida spp., may be associated with significant postlaser resurfacing pruritus. Antifungal prophylaxis may mitigate this discomfort. Further research is required to confirm and expand these results.

Synthesis and Characterization of Novel Oxo-Bridged Dinuclear and Hydroxo-Bridged Trinuclear Chromium(III) Assemblies.

The structural and spectroscopic properties of a novel dinuclear chromium-oxo and a trinuclear chromium-hydroxo complex are reported. The dinuclear assembly, [Cr(2)(&mgr;-O)(2)(&mgr;-O(2)CMe)(bpy)(2)(H(2)O)(2)]ClO(4).bpy.[bpyH]ClO(4) (1), crystallizes in the monoclinic space group Cc with a = 16.8259(8) Å, b = 21.9622(11) Å, c = 14.6056(8) Å, beta = 122.1830(10) degrees, V = 4568.0(4) Å(3), and Z = 4. The structure was refined with 4378 observed reflections having F > 2.0sigma(F), giving final R factors of 0.0721 and 0.1305 for R and R(w2), respectively. The [Cr(2)(&mgr;-O)(2)(&mgr;-O(2)CMe)](+) core is structurally akin to those of recently reported isoelectronic [Mn(2)(&mgr;-O)(2)(&mgr;-O(2)CMe)](3+) complexes. The trinuclear assembly, [Cr(3)(&mgr;-OH)(2)(&mgr;-O(2)CMe)(4)(O(2)CMe)(2)(bpy)(2)]ClO(4) (2).5CHCl(3) crystallizes in the triclinic space group P&onemacr; with a = 16.104(5) Å, b = 17.623(5) Å, c = 12.236(3) Å, alpha = 93.33(1) degrees, beta = 92.81(1) degrees, gamma = 64.84(1) degrees, V = 3136.68 Å(3), and Z = 2. The structure was refined with 6732 observed reflections having F > 2.33sigma(F), giving final R factors of 0.0602 and 0.0616 for R and R(w), respectively. Results of electronic, (1)H and (2)H NMR, and EPR spectroscopy, fast atom bombardment mass spectrometry, and variable-temperature magnetic susceptibility studies of these materials and the use of Cr-oxo assemblies as isoelectronic models of the photosynthetic manganese assembly in high-S states are discussed.