James G. Caya

Clostridial septicemia complicating the course of leukemia

The authors report an analysis of 47 leukemia patients (including 9 from our own medical center) whose courses were complicated by 48 episodes of clostridial septicemia. There were 36 adults and 11 children; acute myelogenous leukemia and acute lymphoblastic leukemia accounted for 61.7% and 14.9% of cases, respectively. All patients for whom remission status was known were in leukemic relapse. Fever was a presenting complaint in at least 36 patients whereas neutropenia, thrombocytopenia, and gastrointestinal lesions were noted in 100%, 90.9%, and 87.9%, respectively, of the patients for whom information on these parameters was available. Overall mortality from clostridial septicemia was 78%; none of the children and none of the patients with intravascular hemolysis survived. Overall, antibiotic therapy resulted in a 40% survival rate. However, among patients receiving beta lactam and/or chloramphenicol therapy, 57% survived their episode of clostridial septicemia. Prompt initiation of appropriate antimicrobial therapy offers the best chance of survival in leukemia patients with clostridial septicemia.

Hyperplastic gastropathy. Clinicopathologic correlation.

Assessment of gastric histology in patients with hyperplastic gastritis is now possible using new endoscopic biopsy techniques that obtain a full-thickness gastric mucosal biopsy. Thirty-one patients with hyperplastic gastropathy and full-thickness gastric mucosal biopsies or gastric resections were seen during a 13-year period. Six patients had Zollinger-Ellison syndrome (ZE) with gastric gland hyperplasia; six had Menetriers disease with foveolar hyperplasia and gland atrophy; and a single patient with hyperplastic hypersecretory gastropathy (HHG) was seen. The majority of patients, 18 of 31 with large folds, had peptic disease. The enlarged gastric folds were due to edema and inflammation. Discordant clinical findings and gastric pathology were seen in four patients: three of the 18 patients with peptic disease had histology typical of ZE (two patients) or Menetriers disease. None of the three patients have developed a syndrome on follow-up ranging up to 5 years. Also, the patient with HHG had the gastric histology seen in Menetriers disease. One patient with Menetriers disease had areas of atrophic gastritis interspersed between the hyperplastic gastritis. In summary, the majority of patients with endoscopic hyperplastic gastropathy had gastritis on histologic examination. Most patients with a clinical syndrome associated with hyperplastic gastritis showed histology typical for the syndrome; however, clinical-histologic concordance was not absolute. In a small minority of cases, a patient with one clinical syndrome had the histology typical of another.

Pityrosporum Folliculitis after Bone Marrow Transplantation: Clinical Observations in Five Patients

A skin rash in marrow graft recipients often poses difficult diagnostic problems because multiple causes may be implicated, and clinical and histopathologic findings may be nonspecific. Five recipients of allogeneic bone marrow transplants had pityrosporum folliculitis diagnosed by skin biopsy in the early weeks (less than 18 days) after transplantation. In all cases, patients were febrile and leukopenic (granulocyte count, less than 500 cells/mm3), and were receiving broad-spectrum antibiotics at onset of the skin rash. Erythematous macules and papules were distributed primarily over the chest, shoulders, and upper back, and pustules and crusts developed in some cases. Granulocyte counts of more than 500 cells/mm3 were associated with resolution of the rash. Pityrosporum infection should be considered in the differential diagnosis of skin rashes in marrow graft recipients.

Cutaneous malakoplakia. Report of a case and review of the literature.

Cutaneous malakoplakia occurring in the perianal region of a 64-year-old man is reported and the features by light and electron microscopy are described. Review of the literature disclosed that cutaneous malakoplakia is rare, there having been only seven previous cases reported. Current concepts on the pathogenesis of this condition are discussed.

Hodgkin's disease followed by mycosis fungoides in the same patient. Case report and literature review.

Hodgkins disease and mycosis fungoides are only rarely reported to occur in the same individual. The authors report a patient who initially presented with Hodgkins disease but later died with massive visceral mycosis fungoides. This sequence of events is unique in the worlds reported lymphoma experience.

The morphologic spectrum of large gastric folds: utility of the snare biopsy

The differential diagnosis of large gastric folds is diverse, and endoscopic biopsies are often too small to permit adequate morphologic evaluation. This article describes the morphology of large gastric folds obtained by electrosurgical endoscopic snare biopsy in a series of 52 patients. The great majority of patients with enlarged rugae presented with peptic ulcer symptoms. This series included 16 patients with hyperplastic gastropathies, 15 with chronic nonspecific gastritis, seven with gastric polyposis, three with adenocarcinoma, five with benign lymphoid hyperplasia, and the remainder with miscellaneous conditions. In all cases, the snare biopsy provided a full thickness mucosal biopsy adequate to fully evaluate the enlarged rugae.

Benign mesothelial proliferation with effusion: Clinicopathologic entity that may mimic malignancy

The clinical and pathologic features of five cases of a previously poorly defined syndrome, benign mesothelial proliferation with effusion, are described. Although this is a benign process, both the gross and the microscopic findings may mimic metastatic papillary adenocarcinoma. Three of five patients had dysynchronous involvement in more than one body cavity developing over intervals of one, two, and six years. The clinical course is unpredictable and is usually associated with a good prognosis, but two of three patients with pericardial involvement required pericardectomy for pericardial tamponade. The entity of benign mesothelial proliferation with effusion and its distinction from true malignant conditions are discussed.