Successful treatment of aortic rupture with endovascular stent grafting in a patient with mantle cell lymphoma.

PURPOSE: To present a case of spontaneous aortic rupture in the course of mantle cell lymphoma and successful management with endovascular repair. CASE REPORT: A 69-year-old woman presented with a cervical mass. The patient was found to have stage IIIA and Mantle Cell Lymphoma International Prognostic Index (MIPI) 4. She was placed in an intermediate-risk group. The patient received an initial cycle of systemic chemotherapy consisting of rituximab, anthracycline, vincristine and methyl prednisolone. During follow-up, she developed abdominal aortic rupture secondary to intramural hematoma which was successfully managed with endovascular exclusion. CONCLUSION: Hemodynamic changes can be seen during the course of lymphoma subsequent to systemic chemotherapy. These changes might be related to the spontaneous rupture of the main vessels. Endovascular repair may be a more appropriate treatment option than open surgery, especially in a patient with multiple comorbidities.

Kaposi's Sarcoma following Chronic Lymphocytic Leukemia: A Rare Entity.

Cutaneous manifestations can occur in the wide range of internal malignancy. They can occur by metastases or local spread, direct infiltration, or a site of primary malignancy itself. Sometimes these manifestations are related with an underlying malignancy but they do not contain malignant cells as paraneoplastic dermatological syndromes. Chronic lymphocytic leukemia (CLL) is the most common leukemia all over the world. Cutaneous lesions occur in up to 25% of patients. Most commonly seen cutaneous lesions in CLL are those of infectious or hemorrhagic origin. Skin cancer risk was also increased eightfold in CLL when compared with normal population, so cutaneous lesions in CLL can be the first manifestation of secondary skin malignancy. Herein, we report an interesting case of Kaposi's sarcoma which was diagnosed during the course of CLL.

Detecting methylation patterns of p16, MGMT, DAPK and E-cadherin genes in multiple myeloma patients.

Multiple myeloma (MM) is a B-cell neoplasia characterized by the clonal proliferation of plasma cells. Besides known genetic abnormalities, epigenetic changes are also known to effect MM pathogenesis. DNA methylation is an epigenetic mechanism that silences genes by adding methyl groups to cytosine-guanine dinucleotides at the promoter regions. In this study, the methylation status of four genes; p16, O6-methyl guanine DNA methyl transferase (MGMT), death-associated protein kinase (DAPK) and E-cadherin (ECAD); at the time of diagnosis was investigated using methylation-specific polymerase chain reaction (MS-PCR). In the 20 cases studied; methylation of the promoter regions of p16, MGMT, DAPK and ECAD genes was detected in 10%, 40%, 10% and 45% of the cases, respectively. In 65% (13/20) of cases, at least one of the genes studied had promoter methylation; while 35% of cases (7/20) had methylated promoters of more than one gene. There was a significant correlation between promoter hypermethylation of MGMT and the presence of extramedullary involvement; but for the other genes no correlation was found regarding disease properties like age, disease stage, clinical course and the presence of lytic bone lesions. Determining the methylation profiles of genes in MM, could lead to a new understanding of the disease pathogenesis and guide the assessment of treatment options.

Extramedullary plasmacytoma of the septum.

PROBLEM: Extramedullary plasmacytoma of the head and neck is a rare neoplasm characterized by monoclonal proliferation of plasma cells. The nasal cavity and nasal septum are the most common sites of occurrence and the neoplasm can be solitary or multiple. Extramedullary plasmacytoma is associated with the initial appearance of multiple myeloma and may precede overt manifestations of systemic disease by months or years. METHODOLOGY: A seventy-year-old female presented to our clinic with a one-month history of nasal obstruction. We performed a systematic approach to diagnosis using clinical, laboratory, and radiologic investigations in order to exclude systemic involvement. RESULTS: The patient was diagnosed with extramedullary plasmacytoma and the mass was excised completely via transnasal endoscopy. CONCLUSION: Extramedullary plasmacytoma of the nasal cavity is rare and should be considered in the differential diagnosis of nasal cavity masses.

Necrotizing lymphadenitis of the neck.

Necrotizing lymphadenitis of the neck. Histiocytic necrotizing lymphadenitis is a rare cause of cervical lymphadenopathy. It is a benign, self-limiting disease whose etiology is unknown. Cervical lymphadenopathy and fever are the most important signs. Here we report a 25-year-old female presenting with complaints of fever and a painless swelling in the neck for three months. An excisional biopsy of a posterior cervical lymph node was performed, and histological evaluation revealed histiocytic necrotizing lymphadenitis. This article discusses our case of histiocytic necrotizing lymphadenitis of the neck as well as the relevant literature.

Peripheral intrapulmonary lipoma: a case report.

Lipomas are common benign neoplasms but they rarely occur in visceral organs. Pulmonary lipomas are rare, and most of them are seen in endobronchial localization. Peripherally located pulmonary lipomas are extremely uncommon. There are only eight cases reported in the literature and only one of the patients was female. Our case is the second peripheral pulmonary lipoma in a female patient. The patient is a 38-year old female, who has an incidentally found solitary pulmonary nodule, revealed by X-ray, during routine check-up procedure. A 1.5 cm diameter soft tissue mass was seen in the superior segment of the lower lobe of right lung in computerized thorax tomography. Wedge resection was performed with frozen section evaluation. Histopathologically the well-circumscribed lesion consisted of mature adipose tissue, containing areas of myxoid degeneration, organized as lobules surrounded by respiratory epithelium. The lesion was diagnosed as lipoma. Radiological imaging techniques have high sensitivity detecting the solitary pulmonary lesions but their ability to give information about their nature is limited. Although they are rare, intrapulmonary lipomas should be considered in the differential diagnosis of solitary pulmonary nodules. Wedge resection with frozen section evaluation seems to be the best choice for both diagnosis and treatment.

Relation between actinomycosis and histopathological and clinical features of the palatine tonsils: a comparative study between adult and pediatric patients.

OBJECTIVE: To find out the incidence of actinomyces in the palatine tonsil of the adult and pediatric patients, and evaluate our results relevant to the clinical diagnoses and histopathological features of tonsillectomy specimens. METHODS: The medical records of 1820 tonsillectomies, which were performed in the Department of Otolaryngology between 1987 and 2002 were retrospectively reviewed. The paraffin embedded specimens of the patients were also obtained for histopathologic assessment, and Hematoxylin-Eosin stained sections re-evaluated mainly for cryptitis and actinomycosis. RESULTS: There was actinomyces in 122 (6.7%) of 1820 patients, of whom 62 were adult and 60 were pediatric patients. That is, actinomyces was present in 62 (10.9%) of 568 adult patients, and 60 (4.8%) of 1252 pediatric patients. The rate of actinomyces was significantly higher in adults than children (p < 0.01). There was no correlation between the clinical diagnoses and the histopathologic parameters assessed (p > 0.05). On histopathology, the cryptitis was encountered in 53 (85%) of 62 adult patients and 47 (78%) of 60 pediatric patients with actinomyces (p > 0.05). The rate of cryptitis was significantly higher in the presence of actinomyces both in adult and pediatric patients (p < 0.05). CONCLUSION: There was no correlation between the clinical diagnosis of tonsillar disease and the presence of actinomycosis both in adult and pediatric patients. Histopathologic findings of adult and pediatric tonsillectomy material was similar except for the higher rate of actinomycosis in the adults than in children. However, cryptitis was a substantial finding in the presence of actinomycosis. Based on the significant association of cryptitis with actinomycosis, cyptitis can be considered a histopathologic indicator for tonsillar actinomycosis.

Early diagnosed intramural ectopic pregnancy associated with adenomyosis: report of an unusual case.

Intramural pregnancy is the rarest type of ectopic pregnancy and almost always is diagnosed intraoperatively. It constitutes less than 1% of ectopic pregnancies and the world literature contains only 33 cases. We present an additional case of an uncomplicated intramural pregnancy in a patient with extensive adenomyosis, which is the earliest preoperatively diagnosed (sixth week of gestation) case in the literature.