The metaplastic variant of Warthin tumor of the parotid gland: dynamic multislice computerized tomography and magnetic resonance imaging findings with histopathologic correlation in a case.

Metaplastic Warthin tumor is a rarely seen subtype of Warthin tumor. It can resemble squamous carcinomas histopathologically, because it contains atypical squamous cells on the necrotic surface. Making a diagnosis can become easier by knowing this entity of Warthin tumor well and by correlating the radiologic findings with pathology. In this case presentation, imaging features of a metaplastic Warthin tumor are presented together with its histopathologic findings. When a solid mass with peripheral enhancing cystic-necrotic component and well defined contour and capsule that shows early enhancement and washout is identified with imaging methods in parotid gland, metaplastic Warthin tumor should be indicated in the differential diagnosis before the histopathologic evaluation.

Chondroid syringoma of the hand.

Chondroid syringoma is a rare cutaneous tumour that usually arises in the head and neck region and is rarely seen on the hands; it is rarely malignant at sites other than the head and neck. However, it should be included in the differential diagnosis of tumours of the hand. We present a 56-year-old man with a chondroid syringoma of the hand that clinically resembled a vascular tumour.

Intestinal mucus accumulation in a child with acute myeloblastic leukemia.

Intestinal mucus accumulation is a very rare situation observed in some solid tumors, intestinal inflammation, mucosal hyperplasia, elevated intestinal pressure, and various other diseases. However, it has never been described in acute myeloblastic leukemia. The pathogenesis of intestinal mucus accumulation is still not clear. Here, we report a 14-year-old girl with acute myeloblastic leukemia and febrile neutropenia in addition to typhlitis. She was also immobilized due to joint contractures of the lower extremities and had intestinal mucus accumulation, which was, at first, misdiagnosed as intestinal parasitosis. We speculate that typhlitis, immobilization and decreased intestinal motility due to usage of antiemetic drugs might have been the potential etiologic factors in this case. However, its impact on prognosis of the primary disease is unknown.

Eosinophilic ulcer of the tongue.

A 76-year-old woman presented with a 1-month history of a rapidly expanding painful ulcerated nodule on her tongue following tooth extraction. Triamcinolone acetonide ointment was applied twice daily for 1 month without any benefit. The histopathology of the excision specimen was consistent with an eosinophilic ulcer of the oral mucosa. There has been no recurrence 12 months later.

Follicular dendritic cell sarcoma of the tonsil: case report.

Follicular dendritic cell sarcomas are unusual, and extranodal origin is extremely rare. The English literature contains only eight cases in which this sarcoma has been presented as a tonsillar mass. We report a new case of follicular dendritic cell sarcoma of the tonsil in a 76 year old woman. The patient underwent diagnostic tonsillectomy for a left tonsillar mass, and follicular dendritic cell sarcoma was diagnosed based on histopathological and immunoperoxidase findings. Postoperative radiotherapy was performed. The patient is alive and disease-free at 4 years of follow-up. Without a high index of suspicion, this entity can easily be missed. We believe that follicular dendritic cell sarcoma should be included in the differential diagnosis for any tonsillar mass.

Febrile neutropenia as the presenting sign of appendicitis in an adolescent with acute myelogenous leukemia.

The diagnosis and management of a surgical abdomen in patients with acute leukemia is quite difficult because of the complications and treatment of disease itself. A 13-year-old boy with acute myelogenous leukemia developed 2 episodes of febrile neutropenia during induction therapy. The second one was treated with a 5-day course of parenteral antimicrobial therapy, but the patient then presented with right lower quadrant abdominal tenderness, guarding, and rebound tenderness. Abdominal ultrasonography and computed tomography revealed appendicitis. Conservative medical management was unsuccessful, and appendectomy was performed 5 days after appendicitis was diagnosed. The patient's clinical manifestations resolved 5 days later. The case illustrates that fever may be the first manifestation of appendicitis in a child with acute myelogenous leukaemia who is neutropenic. Surgery is acceptable as first-line treatment in such cases.

Prenatal diagnosis of bilateral diaphragmatic hernia by fetal sonography.

This report describes a case of prenatally diagnosed bilateral diaphragmatic hernia. At 22 weeks' gestation, ultrasound revealed a cystic structure behind the fetus's heart on the axial image at the level of the cardiac four-chamber view. This suggested a left-sided congenital diaphragmatic hernia with herniation of the stomach into the left hemithorax. However, the left-to-right midline shift of the heart was minimal, which is not typical of left-sided congenital diaphragmatic hernia. Throughout the 30th week of gestation, the right and left branches of the pulmonary artery were hypoplastic compared with the values in normal fetuses of the same gestational age. The presumptive diagnosis was bilateral congenital diaphragmatic hernia. A female newborn weighing 2900 g was delivered at 37 weeks' gestation, and she died at 7 h of age. An autopsy revealed large defects on both sides of the diaphragm. In conclusion, prenatal diagnosis of bilateral diaphragmatic hernia is possible with fetal sonography.

Isolated fibrous dysplasia of the sphenoid sinus.

Fibrous dysplasia is an uncommon benign bone disorder of unknown etiology in which normal medullary bone is replaced by fibrotic and osseous tissue. Solitary involvement of the sphenoid sinus is unusual. Here, we present the case of a 28-year-old man complaining of occipital and vertical headache. Imaging modalities demonstrated an expansile lesion filling the entire sphenoid sinus. Biopsy specimen was obtained by endoscopic sphenoidotomy. Diagnosis of fibrous dysplasia was made by imaging results and pathologic examination.

Cryptococcal necrotizing fasciitis with multiple sites of involvement in the lower extremities.

BACKGROUND: Cryptococcal necrotizing fasciitis that is localized to the lower extremities is very rare. OBJECTIVE: We describe a case of a renal transplant recipient who presented with necrotizing fasciitis of the legs caused by Cryptococcus neoformans, a fungus that is rarely associated with this disease. METHODS: This is a case report with literature review. RESULTS: The patient was hospitalized, and the site of infection was debrided to the level of the periosteum. Cultures and histopathologic examination of biopsy material revealed an invasive deep-seated infection with a fungal organism that was consistent with C. neoformans. After 21 days on parenteral amphotericin B (Ambisome; Er-Kim Pharmaceuticals) treatment, the patient was switched to oral itraconazole (Itraspor; Janssen-Cilag Pharmaceuticals) 200 mg/day. He was discharged after 30 days of hospitalization with his wounds completely healed. He continued on oral fluconazole for a total course of 6 weeks. CONCLUSION: Systemic fungal infections continue to be an important cause of morbidity and mortality in transplant recipients. The insidious nature and atypical manifestations of these infections often delay diagnosis and therapy. In immunosuppressed patients, persistent fever that does not respond to antibacterial therapy should alert the physician to the possibility of fungal infection.