Spinal Infection Due to Enterococcus faecalis as the First Manifestation of Colorectal Cancer.

Spinal epidural abscess is a relatively infrequent surgical indication, but it may be neurologically compromising. The most frequent pathogen is Staphylococcus aureus, present in two-thirds of the cases. Enterococcus faecalis is part of the intestinal flora and is uncommon in this condition. Colorectal cancer is reported to be a cause of hematogenic translocation and distant infection. We present a case of an 82-year-old patient admitted for acute low back pain with increased inflammatory markers and negative blood cultures. An MRI revealed an epidural lumbar abscess with adjacent spondylitis. After surgical treatment, E. faecalis was identified, and antibiotics were adjusted accordingly. A colonoscopy revealed colon cancer. This is the first case in the literature of a spinal epidural abscess by E. faecalis as the first manifestation of a newly diagnosed colorectal cancer. When facing a spinal infection caused by atypical intestinal bacteria and no other clear sources, a colonoscopy should be considered.

Atypical Presentation of a Hemorrhagic Glioblastoma Multiforme Mimicking a Cerebral Contusion.

The emergency room management of a patient with external signs of cranial trauma and imaging showing brain hemorrhage can be dangerously misleading. This case of a patient with glioblastoma could only be timely diagnosed because of cautious evaluation of imaging findings. A 60-year-old patient presented to the emergency room after being found down with external signs of cranial trauma and a reduced level of consciousness. Computed tomography revealed a right frontal polar cortical hemorrhage of around 12 mm diameter with no perilesional edema or contrast enhancement. Likewise, the MRI showed no contrast enhancement. Before the scheduled MRI follow-up was performed the patient became symptomatic leading to an earlier repeat that showed massive progression. She underwent surgical resection that revealed the lesion to be an aggressive glioblastoma. High suspicion of an underlying neoplastic lesion in atypical brain hemorrhage in trauma patients is paramount. Short MRI follow-up is recommended as soon as the hematoma resorbs to prevent delays with potential impact or patient outcome.

A novel eGFP-expressing immunodeficient mouse model to study tumor-host interactions.

A NOD/Scid mouse expressing enhanced green fluorescent protein (eGFP) is described, in which human and mouse tumors marked with red fluorescent protein can be established in vivo, both at subcutaneous and orthotopic locations. Using light microscopy as well as multiphoton confocal microscopy techniques, we visualized in detail the intricate colocalization of tumor and host cells in situ. Moreover, using fluorescence-activated cell sorting (FACS), we were able to completely separate the host cells from the tumor cells, thus providing a system for detailed cellular and molecular analysis of tumor-host cell interactions. The fact that tumor and host cells can be reliably identified also allowed us to detect double-positive cells, possibly arising from cell fusion events or horizontal gene transfer. Similarly, the model can be applied for the detection of circulating metastatic cells and for detailed studies on the vascular compartments within tumors, including vasculogenic mimicry. Thus, the model described should provide significant insight into how tumor cells communicate with their microenvironment.