Primary cardiac lymphoma: B- and T-cell cases at a specialist UK centre.

BACKGROUND: Primary cardiac lymphoma is a very rare malignancy, which is typically of a non-Hodgkin's type, and involves only the heart and pericardium with no or minimal evidence of extracardiac involvement. In the past, they were frequently diagnosed at autopsy but modern imaging technology now permits early diagnosis and treatment which allows for improved prognosis. PATIENTS AND METHODS: This report describes the wide spectrum of clinical presentation, difficulty with correct clinical diagnosis, complications of treatment and pathologic findings of one of the largest series of primary cardiac lymphomas at a specialist UK centre. Our series comprised five males and one female with an age range of 10-81 years. RESULTS: Most cases involved at least two chambers with the ventricles being the most common site. Clinical presentation included arrhythmias, valve incompetence, cardiac failure, pericardial effusion, embolic stroke and sudden death. Our study, in contrast to other series, included both B- and T-cell lymphomas. CONCLUSIONS: All six cases illustrate the wide spectrum of clinical presentation of lymphomas presenting primarily in the heart and emphasise that histology of all mass lesions is essential. Other series are small like ours highlighting the rarity of these tumours in the heart with the emphasis on imaging, early diagnosis and treatment.

Nosocomial outbreak of extended-spectrum ß-lactamase-producing Enterobacter cloacae among cardiothoracic surgical patients: causes and consequences.

BACKGROUND: Enterobacteriaceae are recognized as leading pathogens of healthcare-associated infections. AIM: To report the investigation of a nosocomial outbreak of extended-spectrum ß-lactamase-producing Enterobacter cloacae affecting cardiothoracic surgery patients in a Belgian academic hospital. METHODS: Cases were defined based on epidemiological and microbiological investigations, including molecular typing using repetitive element-based polymerase chain reaction and multi-locus sequence typing. Case-control studies followed by field evaluations allowed the identification of a possible reservoir, and the retrospective assessment of human and financial consequences. FINDINGS: Over a three-month period, 42 patients were infected or colonized by CTX-M-15-producing E. cloacae strains that belonged to the same clonal lineage. Acquisition mainly occurred in the intensive care unit (N = 23) and in the cardiothoracic surgery ward (N = 16). All but one patient had, prior to acquisition, undergone a cardiothoracic surgical procedure, monitored by the same transoesophageal echocardiography (TOE) probe in the operating room. Despite negative microbiological culture results, the exclusion of the suspected probe resulted in rapid termination of the outbreak. Overall, the outbreak was associated with a high mortality rate among infected patients (40%) as well as significant costs (€266,550). CONCLUSION: The outbreak was indirectly shown to be associated with the contamination of a manually disinfected TOE probe used per-operatively during cardiothoracic surgery procedures, because withdrawal of the putative device led to rapid termination of the outbreak.

Capillary apposition and density in the diagnosis of alveolar capillary dysplasia.

AIM: Alveolar capillary dysplasia (ACD) is a rare disorder, typically presenting with persistent pulmonary hypertension of the newborn. The aim was to characterise further the histological features of patients suspected of having ACD and to correlate histopathological features with outcome. METHODS AND RESULTS: Three pathologists retrospectively reviewed 21 surgical lung biopsy specimens (SLBx) where ACD entered the differential diagnosis. Semi-quantitative assessment showed that there was a spectrum of muscular arterial hypertrophy, capillary apposition to epithelium and capillary density within the interstitium, with the latter being more disordered in ACD. Misalignment of pulmonary vessels was also frequently seen. Four of 19 patients survived beyond the neonatal period, these having higher degrees of capillary apposition and density. Associated extrapulmonary abnormalities were common, most frequently with ACD. CONCLUSION: Poor capillary apposition and density, allied with medial arterial hypertrophy and misalignment of pulmonary vessels are the strongest diagnostic features of ACD. Of the four patients alive, all had high capillary apposition and density, suggesting that these features may be of prognostic value. SLBx remains useful in such cases as it may help predict patients who survive the neonatal period and also identify patients with disorders that are not primarily vascular anomalies.