Infiltration of histiocytes and multinucleated giant cells in the myocardium of a patient with multicentric reticulohistiocytosis.

Multicentric reticulohistiocytosis (MRH) is a rare multisystem disease characterized by skin nodules and a destructive polyarthritis. We describe cardiac disease in a 42-year-old African American female with a history of MRH for 29 years and dilated cardiomyopathy for 5 years. During a congestive heart failure flare, the patient was slow to respond to standard treatment. A left/right heart catheterization and endomyocardial biopsy were performed, and the patient was found to have evidence of myocardial MRH infiltration.

Angiomyofibroblastoma of the retroperitoneum: a case report.

BACKGROUND: Angiomyofibroblastoma is a rare soft tissue neoplasm that presents most frequently in the genital region of young to middle-aged women. CASE: A 28-year-old woman presented with nausea, vomiting and pelvic pain. Computed tomography revealed a well-circumscribed, brightly enhancing pararectal mass in the retroperitoneum. A core needle biopsy suggested the diagnosis of angiofibromyoblastoma. Due to the highly vascular nature of the lesion, the patient underwent angiographically guided embolization in an effort to minimize surgical blood loss. This was followed by exploratory laparotomy and resection of the mass. CONCLUSION: This case illustrates an unusual presentation of angiomyofibroblastoma in the pelvic retroperitoneum and its management with preoperative selective embolization, which may have contributed to the minimal blood loss at the time of resection.

Spontaneous Heterotopic Pregnancy: Dual Case Report and Review of Literature.

Introduction. Heterotopic pregnancy is a rare complication usually seen in populations at risk for ectopic pregnancy or those undergoing fertility treatments. It is a potentially dangerous condition occurring in only 1 in 30,000 spontaneous pregnancies. With the advent of Assisted Reproduction Techniques (ART) and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. Other risk factors include a history of pelvic inflammatory disease (PID), tubal damage, pelvic surgery, uterine Mullerian abnormalities, and prior tubal surgery. Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles. Most commonly, heterotopic pregnancy is diagnosed at the time of rupture when surgical management is required. Case. This paper represents two cases of heterotopic pregnancies as well as a literature review. Conclusion. Heterotopic pregnancy should be suspected in patients with an adnexal mass, even in the absence of risk factors. Clinicians must be alert to the fact that confirming an intrauterine pregnancy clinically or by ultrasound does not exclude the coexistence of an ectopic pregnancy. A high index of suspicion in women is needed for early and timely diagnosis, and management with laparotomy or laparoscopy can result in a favorable and successful obstetrical outcome.

Successful treatment of esophageal cancer with transhiatal esophagectomy after heart transplantation.

A 55-year-old heart transplant recipient with reflux esophagitis presented for routine endoscopic surveillance of an area of Barrett's metaplasia initially seen 3 years previously. Esophagogastroduodenoscopy revealed adenocarcinoma at 33 cm from the incisors. The preoperative clinical stage was T1N0M0 by endoscopic ultrasound. Transhiatal esophagectomy was performed with R0 resection of the cancer, and the patient recovered uneventfully. Pathologic examination confirmed esophageal adenocarcinoma (T1N0M0) in Barrett's mucosa. The patient is doing well, and has no evidence of disease after 18 months.

Infecciones causadas por Candida spp. resistentes al fluconazol en pacientes con el síndrome de inmunodeficiencia adquirida (SIDA): Reporte de un caso / Infection due to Candida spp. resistant to fluconazole, in patients with AIDS. A case report

Large, ulcerative lesions over the skin, scalp, and oral mucosa were observed in a patient with acquired inmunodeficiency syndrome (AIDS) receiving chronic suppressive therapy with fluconazole. Candida glabrata was recovered in culture from biopsy material, and was found to be resistant to fluconazole and itraconazole. Treatment with amphotericin B resulted in marked improvement. The reported frequency of infections with Candida spp. resistant to fluconazole has increased in recent years. We review the literature regarding fluconazole resistant infections in patients with AIDS, discuss the possible mechanisms of resistance, and management options