A Benign Ulcerating Gastric Mass Presenting as Acute Gastrointestinal Hemorrhage.

Gastrointestinal lipomas are rare, often colonic tumors. The stomach is an unusual site of involvement of lipomas, accounting for less than 5% of all gastrointestinal lipomas and less than 3% of all benign gastric neoplasms. They are usually asymptomatic, and symptoms develop as the tumor grows. Gastric lipomas can present with massive bleeding from an ulcerating tumor and can be life-threatening if left untreated. We present a case of an ulcerating gastric lipoma that presented as an acute upper gastrointestinal hemorrhage. The patient was treated with Billroth II procedure and final pathology showed an ulcerating submucosal lipoma. The diagnosis of gastric lipoma is often suspected incidentally on imaging, then confirmed via biopsy. Definitive treatment of large lesions typically requires surgery, however, newer endoscopic techniques are being utilized for resection of these benign tumors.

Aggressive Differentiated Thyroid Cancer due to EML4e13-ALKe20 Fusion: A Case Presentation and Review of the Literature.

BACKGROUND: Differentiated thyroid cancer (DTC) is an indolent malignancy. It rarely presents with aggressive local invasion and/or distant metastatic disease. Patient findings. We describe a case of a 30-year-old man with a locally aggressive form of papillary thyroid cancer with EML4e13-ALKe20 fusion (EML4: echinoderm microtubule-associated protein-like 4; ALK: anaplastic lymphoma kinase). He presented with right-side cervical lymphadenopathy with a highly suspicious right-side thyroid nodule. Total thyroidectomy and level IV lymph node resection showed extensive bilateral disease, with extrathyroidal and extranodal extension. FDG-PET CT scan following surgery confirmed the presence of significant residual disease in the neck area. He underwent bilateral lateral lymph node dissection followed by radioactive iodine treatment. Somatic mutation testing showed EML4e13-ALKe20 fusion. Summary. This case represents an aggressive form of DTC with EML4e13-ALKe20 fusion. The rapid progression of clinical signs and symptoms and the local extension beyond the thyroid and lymph nodes with the persistence of high-volume local disease after thyroidectomy highlight the aggressive nature of this mutation and the importance of performing genetic analysis to guide future treatments and determine prognosis. CONCLUSION: This case highlights the importance of using molecular diagnostics in patient care, especially if the presentation is unusual for DTC. A thorough evaluation of the tumor pathology and the somatic mutational profile analysis are important for obtaining vital therapeutic and prognostic guidance.

Paecilomyces in an immune competent host.

Paecilomyces species was first recognized to cause human disease in 1963. It is a rare cause of invasive fungal infection, with cases sporadically reported in immunocompromised patients. Here we report the first case of pulmonary Paecilomyces in an immunocompetent patient that was successfully treated with amphotericin B and posaconazole.

A series of two cases of rare tumors: Solitary fibrous tumor of the pleura.

Solitary fibrous tumors of the pleura (SFTPs) are rare neoplasms of mesenchymal origin most commonly arising in the pleura and have a benign biological behavior in the majority of cases. Most patients with SFTPs are asymptomatic; however, symptoms are mostly related to the mass effect within the thoracic cavity. Chest computed tomography (CT) scanning is the radiographic test of choice, but findings lack specificity. Surgical resection is the treatment of choice for most patients. Long-term survival after resection of benign SFTPs is excellent. In this case series, we present two females, one presented with shortness of breath (SOB) and nonproductive cough and the other one was referred because of abnormal x-ray findings. The histological as well as the immunohistochemical examination revealed the mass to be a solitary fibrous tumor of the pleura.

Gemcitabine-induced skin necrosis.

Since its emergence as a chemotherapy agent, gemcitabine has been associated with cutaneous adverse reactions. Rash is reported to be the most common cutaneous adverse effect. Other reported cutaneous reactions in the literature include bullous dermatosis, pseudocellulitis, subacute cutaneous lupus alopecia, and palmar-plantar erythrodysesthesia. Skin necrosis is a very rare adverse effect of this otherwise well-tolerated chemotherapeutic agent. In searching the literature, only one other case has been reported. In our report, we present a 74-year-old male with adenocarcinoma of the pancreas, status-post pancreaticoduodenectomy (Whipple procedure), who developed a rare case of skin necrosis of the lower leg 2 weeks after completing six cycles of monotherapy gemcitabine treatment.

pNaKtide Attenuates Steatohepatitis and Atherosclerosis by Blocking Na/K-ATPase/ROS Amplification in C57Bl6 and ApoE Knockout Mice Fed a Western Diet.

We have previously reported that the α1 subunit of sodium potassium adenosine triphosphatase (Na/K-ATPase), acts as a receptor and an amplifier for reactive oxygen species, in addition to its distinct pumping function. On this background, we speculated that blockade of Na/K-ATPase-induced ROS amplification with a specific peptide, pNaKtide, might attenuate the development of steatohepatitis. To test this hypothesis, pNaKtide was administered to a murine model of NASH: the C57Bl6 mouse fed a "western" diet containing high amounts of fat and fructose. The administration of pNaKtide reduced obesity as well as hepatic steatosis, inflammation and fibrosis. Of interest, we also noted marked improvement in mitochondrial fatty acid oxidation, insulin sensitivity, dyslipidemia and aortic streaking in this mouse model. To further elucidate the effects of pNaKtide on atherosclerosis, similar studies were performed in ApoE knockout mice also exposed to the western diet. In these mice, pNaKtide not only improved steatohepatitis, dyslipidemia, and insulin sensitivity, but also ameliorated significant aortic atherosclerosis. Collectively, this study demonstrates that the Na/K-ATPase/ROS amplification loop contributes significantly to the development and progression of steatohepatitis and atherosclerosis. And furthermore, this study presents a potential treatment, the pNaKtide, for the metabolic syndrome phenotype.

Measurements of monopolar and bipolar current spreads using forward-masking with a fixed probe.

OBJECTIVES: This research employed a forward-masking paradigm to estimate the current spread of monopolar (MP) and bipolar (BP) maskers, with current amplitudes adjusted to elicit the same loudness. Since the spatial separation between active and return electrodes is smaller in BP than in MP configurations, the BP current spread is more localized and presumably superior in terms of speech intelligibility. Because matching the loudness requires higher current in BP than in MP stimulation, previous forward-masking studies show that BP current spread is not consistently narrower across subjects or electrodes within a subject. METHODS: The present forward-masking measures of current spread differ from those of previous studies by using the same BP probe electrode configuration for both MP and BP masker configurations, and adjusting the current levels of the MP and BP maskers so as to match them in loudness. With this method, the estimate of masker current spread would not be contaminated by differences in probe current spread. Forward masking was studied in four cochlear implant patients, two females and two males, with speech recognition scores higher than 50%; that is, their auditory-nerve survival status was more than adequate to carry out the experiments. RESULTS: The data showed that MP and BP masker configurations produce equivalent masking patterns (and current spreads) in three participants. A fourth participant displayed asymmetrical patterns with enhancement rather than masking in some cases, especially when the probe and masker were at the same location. DISCUSSION: This study showed equivalent masking patterns for MP and BP maskers when the BP masker current amplitude was increased to match the loudness of the MP masker, and the same BP probe configuration is used with both maskers. This finding could help to explain why cochlear implant users often fail to accrue higher speech intelligibility benefit from BP stimulation.

FT-IR microspectroscopy of mouse colon tissues: insight into the chemistry of carcinogenesis and diagnostic potential.

We studied colon carcinogenesis using Fourier-transform infrared (FT-IR) microspectroscopy, an evolving method that allows the nondestructive assessment of the chemical composition of cells and tissues and of the in situ relationship between molecules, and assessed its diagnostic potential. Mid-FT-IR spectra were obtained from frozen colon tissue samples of normal (C57BL/6J) and Min (Apc(Min) mutant) mice, the latter recapitulating key features of human colon carcinogenesis. Classic spectroscopic analysis demonstrated marked differences in the Mid-FT-IR spectra between normal and dysplastic tissues, especially regarding peak positions and band intensity ratios in the regions 1800 to 985 cm(-1) and 3000 to 2700 cm(-1), reflecting changes in cellular nucleic acids, phosphates, and carbohydrates. Analysis of the spectra using the multivariate methods backpropagation neural networks, decision tree, adaboost with decision tree, and support vector machine, which interrogated the intrinsic dimensionality of IR spectra, revealed that their sensitivity was between 91.1% and 100% and their specificity between 94.1% and 100%, with the outcomes of the Support Vector Machine algorithm being identical to those of histologic analysis. FT-IR microspectroscopy holds great promise not only as a method of ascertaining changes in the chemistry of the neoplastic cells but also as a diagnostic tool, especially for early stages of carcinogenesis not detectable by other means.

The Movat pentachrome stain as a means of identifying microcrystalline cellulose among other particulates found in lung tissue.

CONTEXT: Microcrystalline cellulose (MCC) is extensively used as a filler material in pharmaceutical tablets. When injected intravenously in aqueous tablet suspensions, MCC may contribute to embolic pulmonary hypertension and be identified histologically in lung tissue samples. In this study, we evaluated a modified Russell Movat pentachrome stain (MMPS) as a means of recognizing MCC and distinguishing it from other birefringent crystals in lung specimens. OBJECTIVE: To study the staining properties of MCC versus other crystalline materials using the MMPS stain. DESIGN: Archival, formalin-fixed, paraffin-embedded lung specimens that contained birefringent crystals, including MCC (3 cases of intravenous drug abuse), talc (2 cases of intravenous drug abuse, 1 talc pleurodesis), mixed silicates (1 case of silicate pneumoconiosis), and calcium oxalate (1 case of aspergillosis from Aspergillus niger infection), were evaluated with MMPS. Crystal identification was confirmed by morphology, other histochemical stains, infrared spectroscopy (1 case), and cellulose controls. RESULTS: The MMPS stained the MCC bright yellow in tissue and control specimens. Talc stained light greenish-blue; mixed silicates appeared either greenish-blue or unstained. Oxalate crystals stained sea-green. Crospovidone, a nonbirefringent tablet filler substance, stained yellow to dark green with MMPS and was easily distinguished from MCC. Starch granules were unstained by MMPS. CONCLUSIONS: The MMPS is an excellent method for the histochemical identification of MCC in tissue and its separation from other birefringent crystals with which MCC might be confused. The MMPS is especially useful in the evaluation of pulmonary foreign body embolization in cases of suspected intravenous substance abuse.

Frictional asymptomatic darkening of the extensor surfaces.

Frictional asymptomatic darkening of the extensor surfaces (FADES), also known as hyperkeratosis of the elbows and knees, is commonly seen by dermatologists but has never been well characterized. Patients present with uniform, asymptomatic, brown darkening over the extensor surfaces of the elbows and knees with minimal scaling. Both frictional stress and family history may play a role in the pathogenesis of this condition. The results of cutaneous biopsy specimens typically reveal hyperkeratosis, acanthosis, and mild papillomatosis with minimal inflammation. Keratolytic agents such as lactic acid and urea cream along with avoiding frictional stress can be effective in the management of this condition. We describe a series of cases of FADES and its etiology and management options.