RESUMEN
Epithelioid angiomyolipomas (EAMLs) are mesenchymal tumors that are part of the family of the perivascular epithelioid cell neoplasms (PEComas). These tumors portray a potential aggressive behavior with metastatic lesions found in around 30% of reported cases. EAMLs might present sporadically or in association with the tuberous sclerosis complex (TSC). They typically involve the kidneys, liver, and lungs. It is extremely rare for these tumors to arise from other organs. The present report describes an unusual case of an adult patient with a history of TSC who developed EAML of the adrenal gland. Moreover, he presented with metastatic disease to the liver, a feature rarely described. The diagnosis of EAMLs can be challenging as they are hard to distinguish from other adrenal or renal tumors without a thorough histopathologic and immunohistochemical evaluation. Due to the potential aggressive behavior of these malignancies, timely diagnosis is extremely important and has significant therapeutic and prognostic implications.
RESUMEN
The testicular seminomas are germ-cell tumors which account for approximately 50% of all testicular tumors. Most primary testicular germ cell tumors metastasize through a lymphatic system in a predictable pattern with the retroperitoneal lymph nodes being the most common initial metastatic site. Hematological metastasis to the distant organs is less common, and except for pulmonary metastasis, changes the classification from good to intermediate prognosis. Metastasis of testicular seminoma to the prostate is an extremely rare entity with only five reported cases in the literature. In this report, we present a 63-year-old male with recurrent testicular seminoma presenting in prostate.
RESUMEN
Gastrointestinal (GI) involvement by multiple myeloma is a rare entity. Clinical manifestations depend on the site and extent of involvement. GI bleeding, obstruction, and perforation can complicate the disease course. We report a rare case of an extramedullary plasmacytoma ulcerating through the gastric mucosa and presenting as a massive upper GI bleed, which was controlled surgically with en-bloc resection of the mass infiltrating the stomach, distal pancreas, and spleen. To our knowledge, this is the first case of immunoglobulin A (IgA) myeloma with multiple GI organ involvement presenting with massive upper GI bleeding.
RESUMEN
Introducción: el neumococo es causa importante de morbi-mortalidad en niños en países en vías de desarrollo. En los últimos años han aparecido a nivel mundial cepas de neumococo resistentes a penicilina y a otros antibióticos utilizados frecuentemente en pediatría. A nivel local hay pocos estudios recientes que describen este problema. Objetivo: el objetivo principal del estudio fue determinar el porcentaje de resistencia antibiótica del neumococo en portadores nasofaríngeos en niños sanos entre dos meses y un año en los Consultorios de Crecimiento y Desarrollo y/o Vacunación de los hospitales Cayetano Heredia, Edgardo Rebagliati, San Bartolomé e Instituto Nacional de Salud del Niño en Lima, Perú. Materiales y métodos: se tomaron muestras de hisopado nasofaríngeoen 400 niños (noviembre 2007-junio 2008) para cultivo de neumococo y determinación de su sensibilidad a la penicilina y a otros antibióticos con la prueba de sensibilidad en disco. Resultados: se encontró 28 por ciento (111/400) de portadores nasofaríngeos de neumococo. De las 111 cepas aisladas, 60 (55 por ciento) fueron resistentes a cotrimoxazol, 52 (47 por ciento) a penicilina y 30 (35 por ciento) a azitromicina. No se encontró ninguna asociación entre los factores estudiados y la condición de portador y/o resistencia antibiótica. Conclusión: la resistencia del neumococo al cotrimoxazol y a la penicilina fue alta. Sin embargo, se necesita completar el estudio con la determinación de la concentración inhibitoria mínima para poder usar los nuevos puntos de corte para penicilina para cepas no-meníngeas. Con estos nuevos criterios es muy probable que la penicilina continúe siendo la droga de elección para infecciones no severas fuera del sistema nervioso central.
Introducction: Pneumococcus is a major cause of morbidity and mortality in children in developing countries. Over the last few years, pneumococcal strains resistant to penicillin and other antibiotics commonly used in pediatrics have emerged. There are few recent local studies that describe this problem. Objectives: The main purpose of the study was to determine the pneumococcal resistance rates in healthy nasopharyngeal carriers 2 to12 months of age, who attended the outpatient clinic for a routine well child and/or vaccination visit at Cayetano Heredia, Edgardo Rebagliati, San Bartolomé Hospitals and Instituto Nacional de Salud del Niño in Lima-Peru. Methods: Nasopharyngeal samples were obtained from 400 children (November 2007-June 2008) for S. pneumoniae culture and determination of the susceptibility to penicillin and other antibiotics by disk diffusion. Results: The pneumococcal carriage rate was 28 per cent (111/400). From the 111 strains isolated, 60 (55 per cent) were resistant to cotrimoxazole, 52 (47 per cent) to penicillin and 30 (35 per cent) to azythromycin. We did not find any association between the factors analyzed and the carrier state and/or antibiotic resistance. Conlusions: We found high resistance rates of pneumococcus to cotrimoxazole and penicillin. However, this study needs to be complemented with minimal inhibitory concentrations in order to use the new penicillin breakpoints for non-meningeal strains. With the new breakpoints, it is likely that penicillin will continue to be the drug of choice for non-severe infections outside the central nervous system.