Giant lipomas in unusual locations

3 patients with giant lipomas located in unusual anatomic locations are described. All 3 cases had clinical features similar to those of the malignant counterpart, liposarcoma. All were operated on and the tumors removed. Follow-up ranged from 12 years, with no recurrence during that period. The treatment of choice for these lesions is surgical removal and long-term follow-up.     

Disseminated infection due to an unusual strain of Nocardia farcinica

Nocardia farcinica, isolated by Nocard in 1888, has recently been redefined as a separate species to asteroides and has been recognised as human pathogen since 1975. Following airborne contamination, lung infection is most usual with frequent dissemination especially to central nervous system. Usually drug resistance makes treatment difficult. The authors describe the first case of Nocardia farcinica disseminated infection in France with lung primarily affection, empyema and encephalitis.     

Disseminated tuberculosis in non-immunocompromised host: three case reports

INTRODUCTION: Disseminated tuberculosis, i.e., tuberculosis involving lung, liver, spleen, bone marrow and lymph nodes is rare (2.8%), particularly when immunocompromised diathesis is lacking. EXEGESIS: We report three cases of disseminated tuberculosis confirmed by bacteriology or histology, which occurred in non-immunocompromised patients. Disease evolution under antituberculous treatment was favorable in two cases and fatal in the third one. CONCLUSION: Disseminated tuberculosis must be suspected when miliary pulmonary lesions are associated with hematologic abnormalities, even in non-immunocompromised host. Early treatment is mandatory to avoid fatal outcome.     

Extrapulmonary tuberculosis. An unusual case

Skeletal tuberculosis with extravertebral location is rare. We report a case of tuberculous osteomyelitis simultaneously affecting two right ribs and the left ulna. We emphasize the diagnostic problems (failure or delay in diagnosis) in extrapulmonary tuberculosis interesting uncommon sites and having relatively indolent presenting symptoms.     

Spinal tuberculosis in an unusual location

OBJECTIVE: To study the effect of transforming growth factor beta 1 on tumor cells. METHOD: HL-60 cells were transfected with transforming growth factor beta 1 expression vector by electroporation. Stable cell clones resistant to G 418 were obtained after 2-3 week growth with the drug-containing medium. A series of malignant phenotype were compared between transfected and untransfected HL 60 cells. RESULTS: The growth speed of HL-60 cells which overexpressed transforming growth factor beta 1 mRNA decreased significantly. Clonigenecity in soft agarase and tumor formation in athymic mice were lower than those untransfected HL-60 cells. CONCLUSION: Suppression effect of transforming growth factor beta 1 on malignant phenotype in HL-60 cells were demonstrated.     

Disseminated histoplasmosis associated with disseminated tuberculosis: a case report

Disseminated histoplasmosis is reported in a 70-year-old White man. There was also evidence of a previous disseminated tuberculosis infection. This is the 9th reported case of disseminated histoplasmosis in the Republic of South Africa.     

Renal tuberculosis associated with renal adenocarcinoma: unusual association

We present a patient 50 years old, complaining of right lumbar pain and miccional syndrome for three weeks. After analytic and x-ray studies, renal tuberculosis and renal cell carcinoma was the diagnosis. We started with specific antibiotic therapy and a radical nephrectomy was developed. According with the literature revised, just three cases has been published before. Because is an unusual clinic presentation we present these clinical note, we discuss the pathogenic and therapeutic procedures.     

Disseminated miliary tuberculosis of the skin in patients with AIDS: report of four cases

During the course of long-term follow-up, we examined the efficacy of interferon (IFN) in the improvement of liver function and prevention of hepatocellular carcinoma (HCC) in hepatitis C virus (HCV) associated cirrhosis patients. Fifty-five cirrhotic patients, in whom HCC nodules in the liver were not detected by ultrasonography (US) or computed tomography (CT), received 3 or 6 million units of human lymphoblastoid IFN daily for two weeks and 3 times a week for 22 weeks. Complete response (CR) was defined as normalization of serum alanine aminotransferase (ALT) together with negative HCV RNA at 6 months after IFN therapy completion. Any other pattern of response was defined as non-response (NR). After IFN therapy the patients were followed up every 1-3 months for at least 1 year (average follow-up period, about 40 months) with serological tests and US or CT. In the 8 CR patients, the serum ALT levels remained normal and HCV RNA remained negative. Platelet count, white blood cell count, serum albumin and zinc turbidity test have recovered to the normal range at final follow-up. Ten of the 47 patients with NR have developed HCC, whereas no patients with CR has developed HCC during follow-up. We conclude that IFN improves the liver function and may prevent the development of HCC even in cirrhotic patients who show CR to IFN therapy.     

Primary giant granulomatous basal meningitis: an unusual presentation of tuberculosis

A case of granulomatous tuberculous meningitis in a 3-year-old child without any known primary disease in any other organ is presented. Tuberculous meningitis is an uncommon presentation of tuberculosis and is characterized by diffuse or circumscribed granulomatous involvement of the meninges, particularly at the base of the brain. Early diagnosis and treatment are essential to prevent the worst events it can bring and to improve the chances of survival. Diagnosis remains difficult because of the lack of reliable clinical diagnostic criteria.     

Disseminated strongyloidiasis

It is known that the susceptibility of experimental autoimmune uveitis (EAU) is controlled by both major histocompatibility antigen complex (MHC) and non-MHC genes. In this report, we studied the role of non-MHC gene in the induction of EAU. LEW, WKAH, (LEW x WKAH) F1 and (LEW x WKAH) F2 rats were examined for their incidence and severity to develop EAU by immunization with bovine S-antigen (S-Ag). We found that all LEW rats developed severe EAU within 2 weeks after immunization, but no WKAH rat did. Most F1 rats developed mild inflammation in 3-4 weeks after immunization. A quarter of F2 rats developed EAU within 2 weeks, half of them developed it in 3-6 weeks after immunization, and the others did not. These findings suggest that only one non-MHC gene controls the susceptibility to S-Ag induced EAU in rats.     

Disseminated peritoneal leiomyomatosis

Disseminated peritoneal leiomyomatosis is usually discovered incidentally and symptoms are unusual. It occurs only in women. The lesions are completely benign and apparently undergo spontaneous regression, therefore minimal or no treatment is indicated after the diagnosis is confirmed by biopsy.     

Disseminated cutaneous rhinosporidiosis

Two cases of longstanding rhinosporidiosis developed widespread asymptomatic nodular skin lesions. Cutaneous examination showed multiple, discrete, sessile and pedunculated, smooth and warty, friable nodular lesions of variable sizes and shapes. Histopathology of representative skin lesions showed hyperplastic epidermis with sporangia containing spores in the upper dermis diagnostic of rhinosporidiosis. Epidemiological data about rhinosporidiosis at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, is presented. Possible modes of dissemination to the skin and differential diagnosis are discussed in relation to this rare manifestation of rhinosporidiosis.     

Disseminated epidermolytic acanthoma

A 39-year old male developed multiple verrucous papules on his back following a severe sunburn. Both the clinical features and pathology were typical for disseminated epidermolytic acanthomas. These benign skin lesions resemble the papules of Darier's disease, seborrhoic keratoses or verrucae planae. The light-exposed skin of the back is the site of predilection. Electron microscopy reveals a premature and altered cornification of keratinocytes. Epidermolytic acanthomas are acquired, harmless lesions and must be differentiated from more serious, congenital ichthyoses of the skin, showing the same histopathologic picture.     

Disseminated intravascular coagulation

The diagnosis of disseminated intravascular coagulation associated with intracranial pathology is discussed. This pathological entity is characterized by a diffuse bleeding diathesis. Laboratory studies suggest a consumption of all clotting and fibrinolytic factors with an elevation of fibrin split products as a sign of the fibrinolytic activity. The treatment consists of the administration of packed platelets and fresh frozen plasma to replace the consumed coagulation factors. Heparinization is recommended early to prevent further consumption of coagulation factors and epsilon-aminocaproic acid is recommended later after acute fibrinolysis is diagnosed. Constant coaguloanalytic monitoring is necessary. Although the etiology with massive injury to brain tissue is possibly secondary to autotransfusion of brain tissue thromboplastin, other causes such as hypotension, anoxia, acidosis and hemolysis must be considered.     

Seminoma in extragonadal locations

The pathogenesis, clinical picture and treatment of extragonadal seminoma are reviewed. For illustration a case is reported of a patient treated in the Regional Oncology Centre in Bydgoszcz.     

Disseminated miliary cerebral candidiasis

We present a case of disseminated intracranial infection by Candida albicans in a 5-year-old girl who had fever and a change of consciousness after surgery for complex congenital heart malformation. MR imaging revealed multiple small ring-enhancing hemorrhagic abscesses. One year after antifungal treatment, the abscesses and ventriculomegaly were almost completely resolved. The patient was discharged in a stable but vegetative condition.