39-YEAR-OLD FEMALE WITH MILD RESPIRATORY DISTRESS AND HYPOXIA.

The diagnosis of cryptogenic organizing pneumonia is usually delayed for several weeks due to treatment for presumed infectious pneumonia. We present a case of cryptogenic organizing pneumonia in a 39-year-old female who presented with shortness of breath and cough. She had both rapid clinical and radiological response to treatment with corticosteroids.

A 56-Year-Old-Man With Common Variable Immunodeficiency and Worsening Dyspnea.

CASE PRESENTATION: A 56-year-old man with a history of common variable immunodeficiency (CVID), in addition to recurrent bronchitis and pneumonia, presented with progressively worsening shortness of breath over a period of a few months. He was able to conduct his activities of daily living at baseline; however, his condition declined over a period of months to the point of shortness of breath with climbing a flight of stairs. The patient also developed a frequent dry cough and wheezing. He denied fever, chest pain, weight loss, and hemoptysis. He had been diagnosed with CVID in 1968, at 7 years of age, after recurrent episodes of bronchitis and pneumonia, and was treated with IV immunoglobulin monthly for decades. The patient was a lifelong nonsmoker and had no significant environmental or occupational exposures. He was referred to our hospital for further management.

Pelvic pleomorphic rhabdomyosarcoma presenting as oliguria in a 61-year-old woman.

Rhabdomyosarcomas (RMSs) are malignant soft-tissue tumors arising from skeletal muscle progenitor cells. They are most commonly diagnosed in children and adolescents and are rare in adults. These tumors arise from a variety of anatomical sites, including the head and neck, urogenital tract, and extremities. Classification of RMSs depends on histopathologic and immunohistochemical features. Embryonal and alveolar subtypes are more common in children and adolescents, whereas the pleomorphic subtype is seen almost exclusively in adults. Adult RMS is associated with poor outcomes and high recurrence rate. Because of the low incidence of adult RMS, most published reports of RMS in adults are either case series or retrospective analyses, and most treatment protocols are extrapolated from clinical trials performed in children. The present report describes a 61-year-old woman with RMS whose presentation included atypical symptoms.

Periprostatic subendothelial intravascular granulomatosis: a mimic of high-grade intravascular prostatic adenocarcinoma.

A rare case of intravascular granulomatous inflammation mimicking intravascular prostatic adenocarcinoma is reported. To the author's knowledge, there have been no previous reports of prostatic or periprostatic intravascular granulomatous inflammation. A 67-year-old man presented with elevated serum prostate specific antigen (PSA) and was found to have a high-grade adenocarcinoma of the prostate. A radical prostatectomy revealed intravascular subendothelial granulomatous inflammation mimicking vascular invasion of a high-grade adenocarcinoma found elsewhere in the prostate. Immunoperoxidase stains confirmed that the subendothelial infiltrate was composed of histiocytes and not tumor cells. Periprostatic subendothelial intravascular granulomatosis is a rare event, which may mimic vascular involvement of high-grade prostatic adenocarcinoma and may result from a previous needle biopsy of the prostate. Possible mechanisms for this finding are discussed. It is important to distinguish this process from high-grade prostatic adenocarcinoma involving blood vessels for obvious clinical reasons.

Clostridial enteritis necroticans versus secondary clostridial infection superimposed upon ischemic bowel disease.

Clostridial enteritis necroticans, or pig-bel, as seen in Papua New Guinea, is a necrotizing, segmental gangrene of the small intestine occurring in members of a malnourished population, who become ill after consuming large quantities of pork contaminated with Type C. Clostridium perfringens. We report a case of possible Clostridial enteritis necroticans with concomitant ischemic intestinal disease secondary to superior mesenteric arterial thrombosis occurring in a 53-year-old woman with a long history of diabetes mellitus, hypertension, and peripheral vascular disease. The differential diagnosis and the pathogenesis of C. perfringens enteritis necroticans are discussed.

Sclerosing cervicitis: report of a skull base lesion with literature review.

BACKGROUND: Invasive fibrosclerotic lesions of the head and neck outside of the thyroid and orbit are extremely rare. To date 13 cases of sclerosing cervicitis have been described in the literature. METHODS: We present a case of a sclerosing inflammatory lesion encountered at the skull base in a 49-year-old woman. RESULTS: After surgical excision and pathologic examination, this lesion was identified as sclerosing cervicitis. CONCLUSIONS: This case report contributes to an awareness of a rare lesion of the head and neck that presents clinical and treatment challenges for surgeons managing these patients.