Case report of a clinically indolent but morphologically high-grade cutaneous mast cell tumor in an adult: Atypical cutaneous mastocytoma or mast cell sarcoma?

We present a case of an adult male with a solitary mast cell tumor of the skin with unusual nuclear pleomorphism and mitotic activity. The tumor was excised, recurred within 2 years, was reexcised after 4 years and did not recur >6 years after diagnosis. The tumor showed progressive cytonuclear atypia and a high mitotic and proliferation rate by Ki67-staining from the onset. No KIT mutations were identified in the tumor and bone marrow. Serum tryptase levels and a bone marrow aspirate and trephine biopsy were normal. Although the histomorphology of the skin tumor was consistent with mast cell sarcoma, the clinical behavior without systemic progression argued against this diagnosis. The tumor was finally considered as atypical mastocytoma, borderline to mast cell sarcoma. Currently, the patient is in close follow-up and still in complete remission.

Epidemiology of clinically relevant bacterial pathogens in a burn center in the Netherlands between 2005 and 2011.

The aim of this study was to analyze the epidemiology in the bacteriological profile and susceptibility of clinically relevant bacterial pathogens in a burn center in the Netherlands over a 7-year period. The swab results of 693 patients of the period 2005 to 2008 and 539 patients of the period 2009 to 2011 were studied for change of microorganisms and antibiotic resistance. Definitions according to the Working Party on Infection Prevention were used as a tool for assessing the scale of the resistance problem at a local level. Between the studied periods only small changes were found in the bacteriological profile. Staphylococcus aureus showed a slight increase of prevalence in inventory swabs during the second period. In both inventory and wound swabs, S. aureus is the most frequently isolated clinically relevant bacterial pathogen. Resistance for ciprofloxacin in Escherichia coli increased from 3% in 2005 to 2008 to 7% in 2009 to 2011 (P = .028). Resistance for cefotaxim in E. coli increased from 4% in 2005 to 2008 to 14% in 2009 to 2011, although this decrease was not statistically significant (P = .24). The prevalence of highly resistant microorganisms (HRMOs) remained low in both time periods, 4.9% in 2005 to 2008 and 7.4% in 2009 to 2011 (P = .063). The Netherlands is considered a low-prevalence country for antimicrobial resistance, and the occurrence of HRMOs in our center is relatively rare. A large percentage of HRMO isolates were extended spectrum ß-lactamase producers, indicating the rapid increase in the production of this resistance mechanism in recent years. The transmission of HRMOs in our center is controlled effectively, using well-established transmission-based precautions.