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ABSTRACT: The central nervous system (CNS) is frequently involved in patients with Whipple's disease and is the most common site of disease relapse. Antibiotics such as trimethoprim-sulfamethoxazole (TMP-SMX) that have reliable CNS penetration, are therefore recommended as first-line therapy. We report a patient with Whipple's disease who was treated with TMP-SMX and presented 14 months after initiation of therapy with visual decline and severe headaches. The patient was also treated concurrently with low-dose weekly methotrexate for severe psoriasis. Evaluation by magnetic resonance imaging revealed bilateral posterior white matter abnormalities that pathologically were consistent with Whipple's disease. He was ultimately treated with cefixime, an orally administered third-generation cephalosporin. Visual function improved on this regimen and follow-up magnetic resonance imaging showed regression of the lesions. This case represents the first report of both CNS relapse during therapy with TMP-SMX and successful treatment with cefixime. We also speculate that methotrexate, which impairs cell-mediated immunity, may have contributed to the relapse.
Gastroenterology 04/1994; 106(3):782-6. · 11.68 Impact Factor
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ABSTRACT: We report two patients with ovarian cancer who were diagnosed with primary endometrial cancer when detached fragments of adenocarcinoma were identified in their dilatation and curettage specimens. Retrospectively, a fragment of fallopian tube and ovarian stroma were identified in the specimens. These findings served to alert the pathologist to the possibility that extrauterine sampling had occurred as a result of perforation of uterine wall during dilatation and curettage. Previous studies have focused on the cytologic detection of extrauterine cancer or on cases where metastasis to the endometrium has led to a misdiagnosis of primary endometrial cancer.
International Journal of Gynecological Pathology 11/1993; 12(4):355-9. · 1.45 Impact Factor
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ABSTRACT: We report a 45-year-old female who had symptomatic gastrointestinal involvement, eosinophils in the cellular infiltrate, and who proved to have L-tryptophan-associated eosinophilia-myalgia syndrome. This case illustrates that gastrointestinal disease can be a major, seemingly primary clinical presentation in this syndrome, and that a drug history, specifically L-tryptophan, needs to be included in the differential diagnosis of "eosinophilic gastroenteritis."
Digestive Diseases and Sciences 06/1992; 37(5):697-701. · 2.12 Impact Factor
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ABSTRACT: Fine needle aspiration (FNA) cytology is an effective modality in the diagnosis of soft tissue lesions. Previous studies compared FNA with surgical biopsies and reported high sensitivity and specificity rates. No study has evaluated the diagnostic yield of FNA to that of needle core biopsies (NCBs). One hundred seventeen FNAs were performed by our clinical staff for soft tissue lesions (1980-1992). The FNAs were divided into three categories: diagnostic 53 (37 sarcoma, 16 benign); unsatisfactory, 44; normal/inflammatory cells present, 20. Of these, 59 had concomitant NCBs: 37 on patients with sarcoma on FNA, 22 on unsatisfactory FNA and none on those with normal/inflammatory cells (followed clinically). There was 100% correlation between FNA and NCB when sarcoma was diagnosed. In 7 of these cases, the NCB further specified the type of sarcoma. No NCBs were employed to confirm the diagnosis of benign tumor on FNA; excisional biopsies showed a total correlation. The 22 NCBs for unsatisfactory FNA yielded 15 sarcomas, 2 fibromatosis and 5 benign lesions. Seventeen patients with unsatisfactory FNA had surgical biopsies (3 sarcoma, 14 benign), and 5 were lost to follow-up. In our experience, diagnostic FNA gave a yield identical to that of NCB, and the latter did not contribute to patient management. Core biopsies may have the advantage of subtyping selected sarcomas diagnosed by FNA. Unsatisfactory FNA should be evaluated further by a repeat aspirate or NCB. Performance of FNA by cytopathologists can reduce the number of unsatisfactory specimens and allow repeat aspiration. In our study most of the unsatisfactory FNAs were from retroperitoneal and pelvic lesions, were performed under radiographic guidance and could have been minimized by immediate cytologic assessment. Many of these lesions, however, may be as readily accessible via NCB as they are via FNA. Utilization of each of these modalities and of their full benefits ultimately depends on the proper clinical setting and the experience of the clinician and pathologist.
Acta cytologica 38(3):381-4. · 0.49 Impact Factor
