Mycobacterium Tuberculosis Infection within a Warthin Tumor: A Case Report and Literature Review.

CONTEXT: The co-existence of tuberculosis and a Warthin tumor in the parotid gland is extremely rare. CASE REPORT: A 46-year-old male presented with a mass in the left parotid region of 6-month duration. The patient's history was only remarkable for a facial swelling, night sweats and a 38.5 C° fever. A 2 × 3-cm mobile, non-tender, mass with a smooth surface was palpated on left parotid tail. CT examination showed a well-defined 30 mm in diameter tumor mass in the left superficial lobe of the parotid gland. A superficial parotidectomy was performed. The final pathological diagnosis of the parotidectomy specimen was reported as a Warthin tumor and epitheloid granulomas with caseification necrosis. Purified protein derivative (PPD) was 30 mm in enduration. Two weeks after the antituberculosis treatment fever declined to normal values and night sweats decreased. CONCLUSION: Tuberculosis can also be seen in parotid tumors which can coexist or mimic pleomorphic adenoma, Warthin tumor.

Methotrexate in the management of idiopathic granulomatous mastitis: review of 108 published cases and report of four cases.

This study aimed to discuss the role of agents, such as steroids and methotrexate (MTX), in the treatment of patients with idiopathic granulomatous mastitis (IGM). Using Pubmed and Google Scholar data bases, a retrospective study was carried out on IGM cases treated with steroids and/or MTX between 1972 and 2010. Four IGM cases treated with MTX at our clinic were also summarized in this study. A total of 541 IGM cases since 1972, including ours, were retrospectively analyzed. Steroid treatment 5-85 mg was administered over 5 days-22 months to 112 patients aged 21-48 years. Recurrence occurred in 22 patients, steroid-induced diabetes mellitus in 5 patients, no response to treatment was observed in 4 patients, in 2 patients, the mass decreased in size, and static disease was observed in one. The steroid treatment was changed to MTX treatment in 4 patients who had recurrence, 5 with steroid-induced DM and in 4 who were nonrespondents. Three patients were started on steroid together with MTX as a primary treatment. Of the patients treated with MTX, a satisfactory result was obtained in 14 cases and in 2, mastectomy was performed because of recurrence despite the treatment with MTX. IGM is a troublesome condition that presents management problems due to the side effects of steroids. Our study demonstrates that the use of MTX in IGM cases has been effective in preventing complications, in resolving the inflammatory process, and in limiting side effects of corticosteroids.

Thyroid tuberculosis in southeastern Turkey: is this the resurgence of a stubborn disease?

BACKGROUND: While tuberculosis (TB) has been found in many parts of the body, involvement of the thyroid gland is rare. In this study we describe the clinicopathological characteristics of seven patients with primary thyroid tuberculosis (TTB). METHODS: This report is a retrospective case study of seven patients with thyroid tuberculosis who were treated surgically in our clinic between 2004 and 2010. Data collected from the cases included age, sex, clinical presentation, concurrent medical illness, initial diagnosis, and history of pulmonary tuberculosis. Testing used to establish the diagnosis of TTB included thyroid function tests, histopathological examination, a tuberculin skin test, and FNAC (fine needle aspiration cytology). Surgical procedures, antitubercular therapy, and follow-up data were also analyzed. RESULTS: All seven cases were females between the age of 30 and 60 years (mean = 44.1 ± 9.5 years). Four cases had neck swelling and three had additional complaints of dysphagia and dyspnea. While total thyroidectomy was performed in six patients with multinodular goiter, a lobectomy was performed in one patient in whom a solitary thyroid nodule was detected. Histopathologic changes consistent with thyroid tuberculosis were detected in all patients. Thoracic X-ray, erythrocyte sedimentation rate (ESR) test, and tuberculin skin test (PPD) were performed and all patients were screened for other possible foci of infection. In conclusion, all seven cases were diagnosed with primary tuberculosis. While the lobectomy patient was administered a 6-month antitubercular treatment, the total-thyroidectomy patients did not receive any medical treatment postoperatively. During the postoperative follow-up period, which lasted between 6 and 53 months (mean = 37.3 ± 18.6 months), none of the patients had a recurrence of disease. CONCLUSION: Tuberculosis should be considered in the list of differential diagnoses for thyroid abscesses and nodular lesions in people living in geographic regions with a high tuberculosis prevalence.

Primary retroperitoneal hydatid cyst: report of 2 cases and review of 41 published cases.

This paper gives an overview of the literature between 2000 and 2010 on primary retroperitoneal hydatid cyst. We reported 2 cases of primary retroperitoneal hydatid cyst, and studies published in English literature on hydatid cyst developing in the retroperitoneal space were accessed via Pubmed and Google Scholar databases. Forty-one published primary retroperitoneal hydatid cyst cases were evaluated, and 2 patients (1 man, 78 years old; 1 woman, 75 years old) who presented with abdominal mass caused by retroperitoneal hydatid cyst were reported. Twenty-five of the patients were men (including our patient), and 18 were women; patients ranged in age from 3 to 80 years, and the median +/- standard deviation age was 41.37 +/- 20.4 years. On presentation, 72% of the patients complained of back or abdominal pain; 13.9% had urinary tract symptoms, and 65.1% were determined as having a palpable mass. Ultrasonography was performed on 93% of the patients, computed tomography was performed on 81.4%, magnetic resonance imaging was performed on 18.6%, and intravenous pyelography test was performed on 13.9%. The results of these tests showed a cystoid mass located on the left in 32.5% of the patients, on the right in 37.2%, and in the retrovesical area in 16.2%. Serologic tests determined 67.8% of the patients were indirect hemagglutination positive, and 71.4% were positive on enzyme-linked immunosorbent assay. As a surgical approach, total exision was performed on 55.8% of patients, partial cystectomy was performed on 39.5%, and 4.6% of patients underwent unroofing. If a cystic lesion is determined in the retroperitoneal area in a patient living in an area of endemic hydatid disease, a differential diagnosis of hydatid cyst should be considered. Clinical, radiologic, serologic, and histopathologic evaluations should be made for a differential diagnosis.

Acute appendicitis together with chylous ascites: is it a coincidence?

Acute chylous ascites is a rarely seen clinical picture, therefore, examination findings are often confused with acute appendicitis. To the best of our knowledge, there is no publication to date showing the occurrence of them together. This study presents the treatment plan for a 25-year-old male patient with both acute chylous ascites and appendicitis. Surgical findings were retrocaecal appendicitis, evident lymphangiectasia in the proximal segment of jejunum, and approximately 3 lt of chylous fluid. An appendectomy was performed and drainage was applied. Low-fat total parenteral nutrition (TPN) and octreotide treatment were administered for 7 days postoperatively. We also present a general review of some studies on chylous ascites, which have been published in the English language medical literature since 1910.

Giant inflammatory fibroid polyp of ileum causing intussusception: a case report.

Inflammatory fibroid polyps are rare, localized, non-neoplastic lesions originating in the submucosa of the gastrointestinal tract. Intussusception due to inflammatory fibroid polyps is uncommon; moreover, ileo-ileal intussusception has only rarely been reported. Here, we report an 11 x 7 cm giant inflammatory fibroid polyp of the small bowel that presented as intussusception in a 73-year-old woman. Ultrasonography demonstrated a solid, homogeneous, echogenic mass surrounded by the typical mural layers of an invaginated ileum. The immunohistopathological diagnosis after segmental ileal resection was an ileal inflammatory fibroid polyp. Although encountered rarely in adults, physicians should be aware of invagination and consider it in each case of acute abdomen because of the wide spectrum of clinical settings.

[Evaluation of cystic echinococcosis cases given a histopathologic diagnosis from 2002 to 2007 in Diyarbakir]. / 2002-2007 yillari arasinda Diyarbakir'da histopatolojik tani alan kistik ekinokokkozis olgularinin degerlendirilmesi.

Echinococcosis is a common parasitic disease manifesting as cyst formation in humans and animals, caused by the platyhelminth, Echinococcosis and it is an important health problem in our country. The aim of this study was to acquire knowledge about the topographic features, the prevalence of cystic echinococcosis and to predict its frequency in the Diyarbakir region. From 2005 to 2007, 234 patients who had been given a histopathological diagnosis of cystic echinococcosis were analysed retrospectively. Based on the pathological records age, sex and location of the parasite were evaluated, and if a patient had the parasite in more than one location, it was counted as one. Female patients constituted 60.25% of the cases, and males, 39.74%. The average age of the patients was 27.01 years (28.2 years in females and 25.3 years in males). The most frequent location of echinococcus was in the liver (44.01%), and the second in the lung (31.19%). In general the characteristics of the patients correlated with the characteristics of previous literatures results but the age of the patients when diagnosed was earlier than that previously reported in the literature. Cystic echinococcosis was found to be an important public health problem in Diyarbakir region. For the eradication of echinococcosis it is necessary to get reliable data, and to implement an appropriate eradication program.