Biomedical subjects
C L Otrakji
Publications and source records attributed to C L Otrakji.
Hepatobiliary cryptosporidiosis and cytomegalovirus infection mimicking metastatic cancer to the liver.
A cholestatic syndrome caused by sclerosing cholangitis and papillary stenosis has been described in patients with the acquired immunodeficiency syndrome and hepatobiliary cryptosporidiosis and cytomegalovirus infection. The case of a 41-year-old homosexual man with the acquired immunodeficiency syndrome who presented with abdominal pain, diarrhea, fever, and cholestasis is reported. A percutaneous transhepatic cholangiogram showed that the extrahepatic and right-sided intrahepatic ducts were normal. Computerized tomography of the abdomen showed multiple hypodense lesions in the liver. Guided needle biopsies of several of these lesions showed severe confluent necrotizing pericholangitis with cytomegalovirus-infected cells. Numerous cryptosporidia were seen attached to biliary epithelium. The unique histopathologic and radiographic features of this case should be added to the spectrum of hepatobiliary manifestations of the acquired immunodeficiency syndrome.
Intravascular malignant lymphomatosis.
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Small cell carcinoma of the large intestine presenting as central nervous systems signs and symptoms. Two case reports with literature review.
Extrapulmonary small cell carcinoma is rare. Small cell carcinoma of the colorectum has been reported in 73 patients. Patients with colorectal small cell carcinoma present with signs and symptoms related to the primary site. Usually patients present with advanced stage. Rarely do patients with colorectal small cell carcinoma present with signs and symptoms related to the central nervous system (CNS). We report two patients who presented with CNS signs. The two patients underwent craniotomy for definitive diagnosis and resection in one patient. In both cases, pathology was consistent with pure small cell carcinoma. Post-operatively, a search for a primary revealed the rectum and the hepatic flexure of the colon to be the sites. Patients were started on combination chemotherapy. One patient achieved a complete remission and the second is currently receiving chemotherapy with a partial response. This is the first report of colorectal small cell carcinoma presenting as CNS lesion(s).
Small cell carcinoma of the stomach. Case report and review of the literature.
Small cell carcinoma of the stomach is an unusual and rare neoplasm with only eight reported cases in the world literature. Like small cell carcinomas elsewhere, they possess rapid growth ability and high propensity to metastasize with short survival. Clinically, small cell carcinoma is indistinguishable from adenocarcinoma. Because of the rarity of gastric small cell carcinoma, there is minimal information available on the optimal treatment. Herein, we report on a patient with metastatic pure small cell carcinoma of the stomach. He underwent palliative surgery and postoperative combination chemotherapy with transient partial response. He died 10 months after diagnosis with progressive widespread disease.
Combination chemotherapy and radiotherapy for small-cell carcinoma of the esophagus. A case report of long-term survival and review of the literature.
Small-cell carcinoma of the esophagus is a rare tumor and has received little attention until recent years. It should be differentiated from the far more common poorly differentiated squamous-cell carcinoma of the esophagus, because treatment by surgical resection alone or by radiation therapy results in limited survival of a few months. It is now recognized that esophageal small-cell carcinoma presents with early widespread dissemination and is chemosensitive, similar to primary small-cell carcinoma of the lung. We report on a patient with small-cell carcinoma of the esophagus treated with combination chemotherapy consisting of cyclophosphamide, vincristine, and VP-16 followed by local radiation therapy. Pathologic complete remission was achieved. The patient is currently in remission 22 months after diagnosis, the longest survival reported thus far.
Gastric malignant lymphoma with superimposed amebiasis.
A case of primary B, large cell lymphoma of the stomach with superimposed amebiasis due to Entamoeba histolytica is reported. This represents the second recorded case of such an association. A review of the subject and possible mechanisms of infection are discussed.
Pathologic quiz case 2. Malignant melanoma.
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Response of eccrine adenocarcinoma to tamoxifen.
One of two patients with systemic metastases from a poorly differentiated eccrine adenocarcinoma of the scalp was found to have a tumor positive for estradiol receptors. In the receptor positive patient, after tamoxifen therapy, the lymph node metastasis regressed completely and was associated with full relief of pain from osseous metastases for nearly 3 years. Subsequently, progressive painful osseous metastases in the spine, skull, pelvis, and femur were palliated for shorter periods with sequential systemic therapy with megestrol acetate and fluoxymesterone. Osseous metastases were also palliated with external radiation therapy. In contrast, despite external radiation therapy, brain metastases proved fatal. Tamoxifen was ineffective in the estradiol receptor negative patient. Based on this report, it may be valuable to determine the presence of estradiol receptor protein in eccrine carcinoma as a predictor of response to hormonal therapy.
Malignant angioendotheliomatosis--a true lymphoma: a case of intravascular malignant lymphomatosis studied by southern blot hybridization analysis.
Malignant angioendotheliomatosis is a rare, systemic, usually fatal disease characterized by a massive proliferation of large, bizarre-looking mononuclear cells within small and medium-sized blood vessels. The histogenesis of the neoplastic cells has been the subject of long-standing controversy since the disease's initial description. Early investigators concluded that the entity represented a neoplasm of endothelial cells, but recently others have suggested that it is of lymphoid origin. We studied a case of malignant angioendotheliomatosis by Southern blot hybridization analysis which showed clonal rearrangements of the immunoglobulin heavy-chain gene strongly suggesting a B-lymphocyte origin. Our results provide additional evidence that malignant angioendotheliomatosis is an intravascular malignant lymphomatosis.
Reactive follicular hyperplasia of intraparotid lymphoid tissue presenting as a recurrent parotid enlargement.
A patient who had reactive lymphoid hyperplasia of intraparotid lymphoid tissue, clinically presenting as a recurrent parotitis, is described. The case offers a new etiologic mechanism for recurrent parotitis.