Fournier's Gangrene Masking as Perineal and Scrotal Cellulitis.

Fournier's gangrene (FG) is a very serious and life threatening emergency. FG is a polymicrobial subset of necrotizing fasciitis affecting the genital region. Most cases have a perianal or colorectal focus; less often the gangrene originates from the urogenital tract or is preceded by trauma or a surgical procedure. FG is a surgical emergency that requires early intervention. Therefore, early recognition by emergency physicians is imperative. The diagnosis of FG during its early stages is often challenging and misdiagnosis is common. If FG is suspected, emergency department management should always include antimicrobial treatment with parenteral broad-spectrum antibiotics, aggressive hemodynamic stabilization and surgical consultation. We report a case of FG in an elderly male with no major risk factors, who presented with right groin and perineal pain that was initially diagnosed as scrotal cellulitis. He was later diagnosed with FG and subsequently developed multi-organ failure, required multiple surgical debridements, and was later transferred to a long-term care facility with poor prognosis. This case is important because it calls attention to the challenges of diagnosing this potentially fatal disease. Emergency physicians must recognize the symptoms of FG because early diagnosis can improve outcomes.

Cobblestone-area forming cells derived from patients with mantle cell lymphoma are enriched for CD133+ tumor-initiating cells.

Mantle cell lymphoma (MCL) is associated with a significant risk of therapeutic failure and disease relapse, but the biological origin of relapse is poorly understood. Here, we prospectively identify subpopulations of primary MCL cells with different biologic and immunophenotypic features. Using a simple culture system, we demonstrate that a subset of primary MCL cells co-cultured with either primary human mesenchymal stromal cells (hMSC) or murine MS-5 cells form in cobblestone-areas consisting of cells with a primitive immunophenotype (CD19-CD133+) containing the chromosomal translocation t (11;14)(q13;q32) characteristic of MCL. Limiting dilution serial transplantation experiments utilizing immunodeficient mice revealed that primary MCL engraftment was only observed when either unsorted or CD19-CD133+ cells were utilized. No engraftment was seen using the CD19+CD133- subpopulation. Our results establish that primary CD19-CD133+ MCL cells are a functionally distinct subpopulation of primary MCL cells enriched for MCL-initiating activity in immunodeficient mice. This rare subpopulation of MCL-initiating cells may play an important role in the pathogenesis of MCL.