An unusual Aspergillus, herpes and strongyloides triple infection in a patient with chronic pulmonary disease: A case report with literature review.

We report a case of a 75 year old non-known cancer or organ transplant male with an unusual concurrent triple infection of Aspergillus, strongyloides stercoralis and herpes simplex virus in a bronchoalveolar lavage. He presented to an outside hospital with worsening respiratory distress and an open tracheostomy was performed due to concern he would not extubate. Following tracheostomy, there was concern for a possible esophageal perforation. A bronchoalveolar lavage (BAL) were performed and Strongyloides, herpes viral cytopathic changes and aspergillus microorganisms were identified. The patient subsequently expired following discharge.

Extensive placental choriovascular infiltration by maturing myeloid cells in down syndrome-associated transient abnormal myelopoiesis.

Transient abnormal myelopoiesis (TAM), a clonal proliferation of predominantly megakaryocytic precursor cells, affects 4%-10% of newborns with Down syndrome. Approximately 20%-30% of TAM survivors are at risk of development of acute myeloid leukemia (myeloid leukemia associated with Down syndrome, ML-DS). We report unusual placental findings in a female infant with trisomy 21 born at 38 weeks of gestation. In line with previous descriptions of placental pathology in infants with TAM, abundant blast-like cells were present in the lumen of chorionic and stem villous vessels. In addition, there was multifocal extensive infiltration of the wall of chorionic vessels by maturing myeloid cells in a pattern reminiscent of TAM- or leukemia-associated systemic infiltration. The clinical significance of this unusual choriovascular involvement of the placenta in TAM is undetermined.

Lethal hypoplasia and developmental anomalies of the lungs in a newborn with intrauterine adrenal hemorrhage and cerebral infarcts: a proposed pulmonary disruption sequence.

We report a case of a 31-week-gestation male newborn who died soon after birth from intractable respiratory failure and persistent pulmonary hypertension. The pregnancy had been complicated by intermittent bleeding between 13 and 20 weeks' gestation, attributed to peripheral placental separation, as well as bilateral fetal adrenal hemorrhage, first detected at 17 weeks' gestation. Postmortem examination revealed small, calcified adrenal glands as well as several remote cerebral and cerebellar infarcts. The lungs were hypoplastic (lung weight/body weight ratio: 1.64%; 10th percentile for 28-36 weeks' gestation: 2.27%) and distorted by exaggerated lobulation. Microscopically, the lungs exhibited several developmental anomalies, including focal acinar dysgenesis suggestive of arrested development in the pseudoglandular stage of development (8-16 weeks' gestation) (mainly in the upper lobes), and features of bronchial obstruction, including focal lobular hyperplasia and microcystic maldevelopment (mainly in the lower lobes). The adrenal and cerebral findings were consistent with a severe early-gestation hypoxic-ischemic insult, likely related to peripheral placental separation and chronic abruption. The co-occurrence and timing of these well-recognized hypoxic lesions provide further evidence that certain developmental lung anomalies, such as focal acinar dysplasia, focal lobular hyperplasia, and microcystic maldevelopment, may, at least in some cases, have a hypoxic/ischemic etiology.

Polyploidy in spitz nevi: a not uncommon karyotypic abnormality identifiable by fluorescence in situ hybridization.

Fluorescence in situ hybridization (FISH) often reveals imbalanced chromosomal gains in melanoma, whereas Spitz nevi typically have a normal complement of chromosomes. However, there may be a subset of Spitz nevi that are perfectly tetraploid by FISH analysis, and these cases may be confused diagnostically with melanoma. This study evaluates 41 cases of Spitz nevi that were histologically confirmed to be benign. Four of these lesions demonstrated polyploidy by FISH. Three of the 4 cases were from the same patient, a 17-year-old woman; 1 lesion was from the wrist, whereas the other 2 were from the buttocks. The other case was from a 14-year-old man from the ankle. All 4 cases that were polyploid were confirmed using a probe for the X chromosome. This article highlights the importance of polyploidy as a feature of some benign Spitz nevi.

Fluorescence in situ hybridization as a tool for microstaging in malignant melanoma.

Up to 30-50% of melanomas arise in association with a nevus. Accurately defining, the nevus from the melanoma can significantly affect microstaging. Recently, we showed that a targeted fluorescence in situ hybridization (FISH) assay could distinguish between benign nevi and melanoma with a sensitivity of 87% and specificity of 95%. In this study, we evaluated the potential of this same assay for use in the microstaging of melanoma. We performed FISH on 36 cases of melanoma occurring in association with a nevus and 6 cases of nevoid melanoma with deep dermal involvement. In the melanomas with associated benign nevi, FISH enumeration was performed separately on the histologically malignant and benign components. In the nevoid melanomas, FISH was performed on the deep dermal areas. On the basis of the criteria developed in our earlier studies, we determined the sensitivity of the assay within the malignant areas and the specificity within the benign areas of melanomas with associated nevi. In addition, we evaluated the sensitivity and specificity within a group of six nevoid melanomas with deep dermal involvement. Among melanomas with associated nevi, 28 of 36 cases (78%) tested positively in the histologically malignant areas. The benign nevus components were uniformly negative for all criteria. Six of six nevoid melanomas (100%) tested positively in the deep dermal area. FISH analysis with probes targeting 6p25, 6q23, 11q13 and CEP6 can effectively discriminate the malignant and benign components of melanomas with associated nevi and can be used as an adjunctive tool for microstaging. The assay has high sensitivity for the malignant areas of nevus-associated melanomas and outstanding specificity for the benign areas. The sensitivity is independent of the morphological features, and the assay performs well in nevoid melanoma cases.

Cutaneous T-cell lymphoma and Staphylococcus aureus colonization.

BACKGROUND: Bacterial infections are a common complication of cutaneous T-cell lymphoma (CTCL). The most common pathogen of cutaneous infections in CTCL patients is Staphylococcus aureus. OBJECTIVE: The purpose of this study was to assess S aureus colonization rates among CTCL subjects compared to control subjects. METHODS: Fifty subjects with CTCL, 25 psoriasis control subjects, and 25 healthy control subjects were included in this study. Culture swabs were obtained from nares and lesional skin or normal skin in the healthy controls. RESULTS: S aureus colonization rates were 44% in CTCL subjects, 48% in psoriasis subjects, and 28% in healthy control subjects (P = .29). LIMITATIONS: The sample size was small, and the exclusion criteria resulted in an underestimation of the colonization rate. CONCLUSION: There was a trend for higher methicillin-sensitive S aureus colonization in the CTCL group compared with healthy control subjects. S aureus colonization may be directly related to body surface area of CTCL.

In vitro studies of pigment epithelium-derived factor in human Schwann cells after treatment with axolemma-enriched fraction.

Pigment epithelium-derived factor (PEDF) is a multifunctional protein with known anti-angiogenic and trophic properties, capable of promoting the survival and growth of Schwann cells (SC). Normal rat SCs and ganglioneuroma-derived human SCs secrete PEDF. The ability of normal SC to secrete a number of trophic factors is controlled by axonal contact. Normal human Schwann cells (HSC) and malignant peripheral nerve sheath tumors (MPNST) cell lines synthesize and secrete PEDF as determined by reverse transcription PCR analysis for PEDF mRNA, immunocytochemistry, and Western blot analysis for PEDF protein. Two MPNST cell lines secreted higher levels of PEDF than did HSC. A 90.3% decrease in PEDF mRNA and a 29.3% decrease in secreted PEDF were observed after treatment of HSC with axolemma-enriched fraction (AEF, 100 microg/ml), a neuronal membrane fraction of the axonal plasma membrane used with cultured SC to mimic axonal contact in vitro. PEDF levels remained unchanged, however, in MPNST-derived SC conditioned media under the same treatment paradigm. These results suggest that MPNST SC lose the ability to downregulate PEDF upon axonal contact, which is characteristic of HSC. The elevated PEDF levels expressed by MPNST cell lines may serve to promote their proliferation and survival.