Pulmonary tuberculosis in Asian elephants (Elephas maximus): histologic lesions with correlation to local immune responses.

Although Mycobacterium tuberculosis infection is an important health concern for Asian elephants (Elephas maximus), no studies have evaluated the associated local immune responses or histologic lesions. In primates including humans, latent tuberculosis is distinguished by well-organized granulomas with TH1 cytokine expression, whereas active disease is characterized by poorly organized inflammation and local imbalance in TH1/TH2 cytokines. This study examined archival, formalin-fixed, paraffin-embedded lung samples from 5 tuberculosis-negative and 9 tuberculosis-positive Asian elephants. Lesions were assessed by light microscopy, and lymphoid infiltrates were characterized by CD3 and CD20 immunolabeling. Expression of TH1 (interferon [IFN]-γ, tumor necrosis factor [TNF]-α) and TH2 (interleukin [IL]-4, IL-10, transforming growth factor [TGF]-ß) cytokines was determined using in situ hybridization. In 6 of 9 samples, inflammation was similar to the pattern of primate active disease with low to moderate numbers of lymphocytes, most of which were CD20 positive. In 1 sample, inflammation was most similar to latent tuberculosis in primates with numerous CD3-positive lymphocytes. Expression of IFN-γ was detected in 3 of 8 tuberculosis-positive samples. Expression of TNF-α was detected in 3 of 8 positive samples, including the one with latent morphology. Low-level expression of IL-4 was present in 4 of 8 positive samples. Only single positive samples displayed expression of IL-10 and TGF-ß. Tuberculosis-negative samples generally lacked cytokine expression. Results showed heterogeneity in lesions of elephant tuberculosis similar to those of latent and active disease in primates, with variable expression of both TH1 and TH2 cytokines.

Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis.

OBJECTIVE: To report the presence of microscopic neoplasms of the testis in men with anti-Ma2-associated encephalitis (Ma2-encephalitis) and to discuss the clinical implications. METHODS: Orchiectomy specimens were examined using immunohistochemistry with Ma2 and Oct4 antibodies. RESULTS: Among 25 patients with Ma2-encephalitis younger than 50 years, 19 had germ-cell tumors, and 6 had no evidence of cancer. These 6 patients underwent orchiectomy because they fulfilled five criteria: 1) demonstration of anti-Ma2 antibodies in association with MRI or clinical features compatible with Ma2-encephalitis, 2) life-threatening or progressive neurologic deficits, 3) age < 50 years, 4) absence of other tumors, and 5) new testicular enlargement or risk factors for germ-cell tumors, mainly cryptorchidism or ultrasound evidence of testicular microcalcifications. All orchiectomy specimens showed intratubular-germ cell neoplasms unclassified type (IGCNU) and other abnormalities including microcalcifications, atrophy, fibrosis, inflammatory infiltrates, or hypospermatogenesis. Ma2 was expressed by neoplastic cells in three of three patients examined. Even though most patients had severe neurologic deficits at the time of orchiectomy (median progression of symptoms, 10 months), 4 had partial improvement and prolonged stabilization (8 to 84 months, median 22.5 months) and two did not improve after the procedure. CONCLUSIONS: In young men with Ma2-encephalitis, 1) the disorder should be attributed to a germ-cell neoplasm of the testis unless another Ma2-expressing tumor is found, 2) negative tumor markers, ultrasound, body CT, or PET do not exclude an intratubular germ-cell neoplasm of the testis, and 3) if no tumor is found, the presence of the five indicated criteria should prompt consideration of orchiectomy.

Transitional cell carcinoma in fishing cats (Prionailurus viverrinus): pathology and expression of cyclooxygenase-1, -2, and p53.

A high prevalence of urinary bladder transitional-cell carcinoma (TCC) has been noted in captive fishing cats (Prionailurus viverrinus). Of the 91 adult deaths between 1995 and 2004, 12 (13%) were attributed to TCC. To help elucidate mechanisms of carcinogenesis, archival sections of urinary bladder from 14 fishing cats were examined histologically and immunohistochemically for p53, cyclooxygenase (COX)-1, and COX-2 expression. Ten cats had TCC, and 4 were unaffected. The average age at death was 10.8 years in affected individuals and 10.5 years in unaffected individuals. There was no sex predilection. Fishing cat TCCs were characterized histologically as papillary and infiltrating (n = 6), nonpapillary and infiltrating (n = 3), or carcinoma in situ (n = 1). Glandular and squamous metaplasia, necrosis, and lymphatic invasion were prominent histologic features. Two individuals had documented metastasis. p53 nuclear immunolabeling was detected in 4/10 (40%) TCCs. In two cases, immunolabeling was limited to less than 10% of the neoplastic cellular population and was comparable to staining of normal fishing cat bladder. Therefore, p53 gene mutation did not appear to be an essential component of TCC carcinogenesis in examined fishing cats. COX-1 immunohistochemistry was negative in all cases. All TCCs had some degree of COX-2 cytoplasmic immunolabeling, which was exclusively within the invasive portions of the neoplasms. Papillary portions were uniformly negative. COX-2 overexpression was a prominent feature in the majority of the examined fishing cat TCCs, suggesting that COX-2-mediated mechanisms of carcinogenesis are important in this species and that COX-inhibiting drugs may be of therapeutic benefit.

Chronic malignant pain in cancer patients.

Although the incidence of cancer and cancer-related deaths has declined in recent years, undertreatment of cancer-related pain continues to be a significant problem. By thoroughly assessing chronic malignant pain (CMP) as it relates to cancer and achieving a more complete understanding of the CMP syndromes experienced by cancer patients, psychiatrists and neurologists can formulate accurate diagnoses of patients' clinical pain syndromes and construct well-defined, individual management plans for each patient.

Adult brainstem gliomas.

OBJECTIVE: To evaluate prognostic factors and survival of adult patients with brainstem gliomas. BACKGROUND: Brainstem glioma is a disease found primarily in children, with a median survival of only 9 to 12 months. However, the prognosis and survival of adults with this disease has not been determined with precision. METHODS: We conducted a retrospective analysis of patients older than 16 years at Memorial Sloan-Kettering Cancer Center with histologically proved or presumed brainstem glioma diagnosed between 1989 and 1997. We assessed the effect of gender, age at diagnosis, cranial nerve involvement, duration of symptoms, exophytic component, MRI enhancement, site of disease, treatment, and Karnofsky performance status on survival. RESULTS: Twenty-three patients were identified, but complete information was available in only 19 (12 males and 7 females). Patients ranged in age from 17 to 70 years (median, 40 years). Twelve patients were treated with radiotherapy at diagnosis and seven were observed, three of whom received subsequent radiotherapy. Median survival is 54 months (range, 3 to 98 months) and the 5-year survival is 45%. There was a trend for patients with a higher performance status at diagnosis to have longer survival, but this did not reach statistical significance. Other factors did not affect survival. CONCLUSION: Adults with brainstem gliomas may survive significantly longer than children, suggesting the disease may be less aggressive in adults. Furthermore, some patients with a long duration of symptoms or tectal or cervicomedullary tumors may be managed initially with observation alone.

Elefantiasis genital y de miembro inferior derecho, en un paciente con paracoccidioidomicosis a forma ganglionar recidivada. / Genital and right lower limb elephantiasis, in a patient with a recurrent ganglionar variant paracoccidioidomycosis

Es presentado un enfermo con elefantiasis genital y de miembro inferior derecho. El edema comenzo en bolsas y se extendio a pene y miembro inferior, habiendose manifestado con intensidad 5 meses antes de la consulta. Esta sintomatologia coincidio con la reactivacion de su paracoccidioidomicosis a forma ganglionar, por falta de tratamiento durante 8 anos. Los estudios realizados permiten descartar otras multiples causas de elefantiasis, permaneciendo como firme la posibilidad de destruccion ganglionar en la primera manifestacion de su padecimiento micotico. Histopatologicamente se encontro fibrosis de ganglios axilares y desaparicion de ganglios inguinales derechos

Elefantiasis genital y de miembro inferior derecho, en un paciente con paracoccidioidomicosis a forma ganglionar recidivada. / Genital and right lower limb elephantiasis, in a patient with a recurrent ganglionar variant paracoccidioidomycosis

Es presentado un enfermo con elefantiasis genital y de miembro inferior derecho. El edema comenzo en bolsas y se extendio a pene y miembro inferior, habiendose manifestado con intensidad 5 meses antes de la consulta. Esta sintomatologia coincidio con la reactivacion de su paracoccidioidomicosis a forma ganglionar, por falta de tratamiento durante 8 anos. Los estudios realizados permiten descartar otras multiples causas de elefantiasis, permaneciendo como firme la posibilidad de destruccion ganglionar en la primera manifestacion de su padecimiento micotico. Histopatologicamente se encontro fibrosis de ganglios axilares y desaparicion de ganglios inguinales derechos

Necrosis grasa profusa del recien nacido. / Diffuse fat necrosis of the newborn infant

Es presentado un caso de necrosis grasa del recien nacido, de desarrollo profuso, dando origen en el dorso a una gran tumoracion. Se destacan en el curso del trabajo las dificultades diagnosticas a que pueden dar lugar las circunstancias etiologicas y la evolucion con restitucion integral, o bien con secuelas

Liquen-psoriasis. Caso con aspecto clinico de liquen plano e histologico de psoriasis. / Lichen-psoriasis. A case with clinical aspect of lichen planus and histological aspect of psoriasis

Se presenta un caso de liquen-psoriasis, donde se analizan las distintas situaciones que este diagnostico puede suponer, a saber: liquen con aspecto psoriasiforme, coexistencia de liquen y psoriasis, situaciones indefinidas entre las dos enfermedades y aun con la parapsoriasis en gotas y por fin nuestro caso con clinica de liquen e histologia moderada de psoriasis. Se hacen consideraciones, sobre el diagnostico diferencial para estas situaciones, que son excepiciolanes y en las que no podra sin duda prescindirse en el futuro de los metodos inmunologicos e histoquimicos

Dermatofibromas multiples, con histologia en un elemento de tipo histiocitofibroma seudosarcomatoso. / Multiple cutaneous fibromas, with histology in an element type seudosarcomatous histiocytofibroma

Se comunica la presentacion en el mismo enfermo de 5 lesiones fibromatosas cutaneas, aparecidas en el lapso de 1 ano. Cuatro de ellas mostraron histologia de dermatofibromas ricos en fibroblastos y colageno. El quinto elemento estaba constituido por un predominio de formas celulares histiociticas con imagenes que simulan la "rueda de carro" y con aumento del indice mitotico tipico (histiocitofibroma dermico seudosarcomatoso). En el curso del trabajo son analizadas tambien las formaciones seudosarcomatosas con las cuales debe realizarse el diagnostico diferencial

Necrosis grasa profusa del recien nacido. / Diffuse fat necrosis of the newborn infant

Es presentado un caso de necrosis grasa del recien nacido, de desarrollo profuso, dando origen en el dorso a una gran tumoracion. Se destacan en el curso del trabajo las dificultades diagnosticas a que pueden dar lugar las circunstancias etiologicas y la evolucion con restitucion integral, o bien con secuelas

Liquen-psoriasis. Caso con aspecto clinico de liquen plano e histologico de psoriasis. / Lichen-psoriasis. A case with clinical aspect of lichen planus and histological aspect of psoriasis

Se presenta un caso de liquen-psoriasis, donde se analizan las distintas situaciones que este diagnostico puede suponer, a saber: liquen con aspecto psoriasiforme, coexistencia de liquen y psoriasis, situaciones indefinidas entre las dos enfermedades y aun con la parapsoriasis en gotas y por fin nuestro caso con clinica de liquen e histologia moderada de psoriasis. Se hacen consideraciones, sobre el diagnostico diferencial para estas situaciones, que son excepiciolanes y en las que no podra sin duda prescindirse en el futuro de los metodos inmunologicos e histoquimicos

Dermatofibromas multiples, con histologia en un elemento de tipo histiocitofibroma seudosarcomatoso. / Multiple cutaneous fibromas, with histology in an element type seudosarcomatous histiocytofibroma

Se comunica la presentacion en el mismo enfermo de 5 lesiones fibromatosas cutaneas, aparecidas en el lapso de 1 ano. Cuatro de ellas mostraron histologia de dermatofibromas ricos en fibroblastos y colageno. El quinto elemento estaba constituido por un predominio de formas celulares histiociticas con imagenes que simulan la "rueda de carro" y con aumento del indice mitotico tipico (histiocitofibroma dermico seudosarcomatoso). En el curso del trabajo son analizadas tambien las formaciones seudosarcomatosas con las cuales debe realizarse el diagnostico diferencial

[Multiple applications of closed permanent wet dressings. Their mode of action]. / Las múltiples aplicaciones de las curas húmedas permanentes cerradas. Su mecanismo de acción.

New applications and forms of Darier's humid permanent closed cures are analysed specially in connection with concepts of cutaneous hydratation. The multiplicity of their application however makes it necessary to find an explanation for their excellent effects which are probably related to the anti-inflammatory, antipruritic and antiinfectious actions as well as the permanent draining effect from the deeper layers to the surface of the epidermis. The hydratation affected by HPCC is very important in dry and exudative stasis dermatitis with both a complete or a partial loss of stratum corneum. Cutaneous eutrophia is restored quite rapidly and an anti-infectious effect is brought about simultaneously. Especially in cases of stasis dermatitis with excessive secretions and pus formation the permanent drainage and hydratation make possible rapid healing. The preference for sodium borate does not exclude the use of other substance both alone or in combination. On the contrary, HPCC may be employed with especific antibiotics. Topical corticosteroid and antibiotic combination is frequently used in stasis dermatitis. In cases of pyoderma, the results obtained are definitively better when antibiotics are of the treatment. Eventually systematic corticoids may be included in the therapeutic arsenal.

Papiloma venereo perianal a forma clinica cronica tumoral. / Tumoral chronic clinical form of perianal venereal papilloma

Una forma muy especial del papiloma venereo es descripta, asignandole el nombre de papiloma venereo a forma tumoral cronica. Se realiza asimismo su ubicacion dentro de todas las formas conocidas de papihaber precedido al epitelioma/

Epitelioma espinocelular de pene versus papiloma venereo. / Spinocellular epithelioma of the penis us venereal papilloma

Se presenta un caso de tumor del glande en el que se constata histologicamente epitelioma espinocelular, junto a un papiloma venereo de tipo comun, desarollado en su vecindad. Clinicamente el papiloma parece haber precedido al epitelioma.

Papiloma venereo perianal a forma clinica cronica tumoral. / Tumoral chronic clinical form of perianal venereal papilloma

Una forma muy especial del papiloma venereo es descripta, asignandole el nombre de papiloma venereo a forma tumoral cronica. Se realiza asimismo su ubicacion dentro de todas las formas conocidas de papihaber precedido al epitelioma/

Epitelioma espinocelular de pene versus papiloma venereo. / Spinocellular epithelioma of the penis us venereal papilloma

Se presenta un caso de tumor del glande en el que se constata histologicamente epitelioma espinocelular, junto a un papiloma venereo de tipo comun, desarollado en su vecindad. Clinicamente el papiloma parece haber precedido al epitelioma.

[Folliculitis and abscessed nodular perifolliculitis of the upper limb caused by Trichophyton mentagrophytes, presumably corticoid-related]. / Foliculitis y perifoliculitis nodular abscedada de miembro superior por Trichophyton mentagrophytes, presumiblemente cortisónica.

The authors present a follicolitis and perifolliculitis case with abscess and profound nodules, unfolded on a patient who had been subjected to an abusive local an general treatment with corticoids. That process had progressed with similar characteristics to Majocchi's tricophytic granuloma, although this case appeared over the application of that therapeutic. The allergological study could prove a depression of the cellular immunity, but at the same time it demonstrated an abnormal reaction, as an anaphylactoid one, at trychophytin and penicillin.