Pulmonary Coccidiomycosis Masquerading as Refractory Metastatic Ewing Sarcoma.
ABSTRACT We report the case of a patient who presented with a large pelvic mass, which was biopsy-proven to be Ewing sarcoma. The patient was also found to have 18 pulmonary lesions on a staging CT that were presumed to represent metastatic disease. After induction chemotherapy, a PET/CT scan revealed a marked reduction in his pelvic mass along with improvement in nearly all his pulmonary lesions except 2, which increased in size. The mixed response to chemotherapy was unusual and the decision was made to resect one of the growing lesions. Fungal culture from the excised lesion grew Coccidioides immitis.
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ABSTRACT: The purpose of the study was to develop a prediction rule regarding the factors that most accurately predict the diagnosis of a malignancy in a lung nodule in the pediatric oncology patient. A retrospective review of pediatric oncology patients that underwent lung nodule resection between 1998 and 2007 was performed. Multivariable logistic regression was used to create a prediction rule. Fifty pediatric oncology patients underwent 21 thoracotomies and 48 thoracoscopies to resect discrete lung nodules seen on computed tomographic scans during workup for metastasis or routine surveillance. The mean nodule size was 10.43 ± 7.08 mm. The most significant predictors of malignancy in a nodule were peripheral location (odds ratio [OR], 9.1); size between 5 and 10 mm (OR, 2.78); location within the right lower lobe (OR, 2.43); and patients with osteosarcoma (OR, 10.8), Ewing sarcoma (OR, 3.05), or hepatocellular carcinoma (OR, 2.38). Lesions that are between 5 and 10 mm in size and peripherally located in patients with osteosarcoma, Ewing sarcoma, or hepatocellular carcinoma are most likely to be malignant. Use of a prediction rule can help guide clinical practice by determining which patients should undergo surgical resection of lung nodules and which patients may be closely observed with continued radiologic studies.Journal of Pediatric Surgery 05/2011; 46(5):833-7. · 1.31 Impact Factor
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ABSTRACT: Serologic tests are valuable in the management of patients with suspected or confirmed coccidioidomycosis. Qualitative tests (immunodiffusion, enzyme immunoassay, or latex particle agglutination) permit detection in the serum of the major antibody responses-coccidioidal IgM in early coccidioidomycosis, and complement fixing (CF) IgG, which appears later and is more persistent. Quantitation of the level (titer) of coccidioidal IgG is useful in prognosis and diagnosis. The preferable antigen for these tests is coccidioidin from the hyphal phase of Coccidioides immitis. When coccidioidal disease has disseminated to an extrapulmonary site, the corresponding fluid-cerebrospinal, synovial, peritoneal (as well as pleural)-can be tested for coccidioidal antibody provided that the serum is known to be positive. Some immunocompromised patients may have a limited humoral responsiveness; therefore, it will be important to develop a practical method for the detection of coccidioidal antigen.Seminars in Respiratory Infections 01/2002; 16(4):242-50.
- Journal of Clinical Microbiology 02/2007; 45(1):26-30. · 4.23 Impact Factor