Cutaneous epithelioid angiomatous nodule of the chest wall with expression of estrogen receptor: a mimic of carcinoma and a potential diagnostic pitfall.

Cutaneous epithelioid angiomatous nodule (CEAN) is a rare vascular proliferation that develops on the trunk and extremities. The lesion arises over weeks to months and affects both sexes without age predilection. Histologically, CEAN is characterized by a circumscribed proliferation of epithelioid endothelial cells in the superficial dermis with a background of lymphocytes, plasma cells and eosinophils. The epithelioid cells are positive for CD31, CD34 and/or D2-40. We report a case of CEAN that had remained stable for more than 30 years on the chest wall of a woman with a history of breast cancer. The lesional cells were epithelioid in appearance and positive for estrogen receptor (ER), raising suspicion for breast carcinoma. However, the cells were positive for CD31, CD34, D2-40 and EMA (epithelial membrane antigen); they were negative for cytokeratins, carcinoembryonic antigen (CEA), CD1a, gross cystic disease fluid protein (GCDFP-15), S-100, a melanocytic cocktail, HHV-8 and progesterone receptor. The histologic and immunohistochemical features, including a low proliferation index (10% by Ki-67), helped to distinguish this lesion from carcinoma and other vascular lesions. This is the most comprehensive immunohistochemical profile reported for CEAN to date and the first time that ER expression has been described.

Bartonella henselae aortic valve endocarditis mimicking systemic vasculitis.

A 28-year-old man with a bicuspid aortic valve presented with facial droop and slurred speech with several months of constitutional symptoms of night sweats, weight loss and productive cough. Examination confirmed aortic regurgitation, palpable spleen and left facial droop. Multiple peripheral blood cultures were negative. Inflammatory markers, cytoplasmic staining antineutrophil cytoplasmic antibodies (cANCA) and anti-PR3 antibody were all elevated. MRI of the brain and CT of the chest and abdomen confirmed embolic infarcts to brain, kidney and spleen. Transoesophageal echocardiogram (ECG) showed valve vegetations and severe aortic regurgitation. Endocardial Wegener's granulomatosis was considered. Aortic valve replacement was performed. Grindings from aortic valve leaflets were analysed for rpoB gene, which confirmed the presence of Bartonella henselae. Serological assays demonstrated B henselae IgM 20 (normal <20) and IgG >2048 (normal < 64). The patient completely recovered after prolonged antibiotic treatment. Culture-negative infective endocarditis may mimic vasculitis and be associated with positive cANCA. Serology and molecular techniques may aid diagnosis.

Localized bacillary angiomatosis in the oral cavity: observations about a neoplasm with atypical behavior. Description of a case and review of the literature.

Bacillary angiomatosis is a rather frequent infectious pathology appearing mainly in the skin but can also affect the liver, spleen, heart, bones, lungs, muscles, central nervous system and other organs. The localization of the lesion in the oral cavity is rather rare, as it is evident in the literature. Bacillary angiomatosis can be clinically similar to the Kaposi's sarcoma and histologically confused with angiosarcoma, epitheloid hemangioma and pyogenic granuloma. A case of bacillary angiomatosis of the oral cavity in an immuno-competent patient is described. The high tendency to relapse, the capability in migration and to involve several localizations at the same time have induced the authors to deepen the research to exclude the possibility that it could be a Kaposi's sarcoma or a pyogenic granuloma and to get to an accurate diagnosis in order to resolve the disease.

Role of Bartonella henselae endocarditis in the nucleation of aortic valvular calcification.

A 6-year-old boy presented with fatigability, shortness of breath, and bulging neck veins. Echocardiography revealed large vegetations, aortic insufficiency, a dilated left ventricle, and bicuspid aortic valve. There was no history of immunocompromise, fevers, or feline exposures. Blood cultures were negative; antibodies against Bartonella henselae were positive. Gentamicin was administered intravenously. Ross procedure was performed and patient was discharged on antibiotics in 5 days. Native valve was thickened by scar and fibrinous vegetations. Warthin-Starry stain demonstrated coccobacilli. Light and ultrastructural morphology, and monoclonal staining implicated B. henselae. Bacterial membranes contain calcium apatite crystals. Antigenic material was present in bacteria and calcified nodules. This case illustrates calcified protobacteria becoming incorporated into scar tissue during endocarditis.