BACKGROUND Cytologic findings of pancreatic oncocytic-type intraductal papillary mucinous neoplasms (IPMNs)/intraductal oncocytic papillary neoplasms (IOPNs) are largely unknown. METHODS Five IOPNs encountered by the authors were analyzed. RESULTS Four IOPNs were located in the pancreatic head, and 1 was located in the pancreatic body/tail in 2 men and 3 women ages 56 to 84 years (mean age, 66 years). Radiologic diagnoses included pancreatic ductal adenocarcinoma (PDAC) in 2 patients, invasive cancer associated with IPMN in 1 patient, IPMN versus mucinous cystic neoplasm in 1 patient, and cystic mass in 1 patient. Cytologic findings included: hypercellular smears (4 of 5 cases) containing well formed clusters of oncocytic cells (5 of 5 cases) with prominent, slightly eccentric nucleoli (4 of 5 cases), predominantly arranged in sheets/papillary units (5 of 5 cases), with punched-out intercytoplasmic spaces (4 of 5 cases), and with occasional 3-dimensional groups and focal necrosis (3 of 5 cases). The intracytoplasmic mucin and thick extracellular mucin typical of other IPMNs were observed only in 2 cases and were very limited. The mean size on resection was 4.5 cm. Invasion was observed in 3 cases (0.1, 0.3, and 2.0 cm) of tubular-type IPMN. Initial cytologic evaluation was performed by the authors in 4 of 5 cases, which were diagnosed as IOPN (n = 3) and IPMN versus cystic PDAC (n = 1). One case was initially misdiagnosed as PDAC and, on resection, proved to be noninvasive IOPN. CONCLUSIONS Cytologic features of IOPNs are classical, similar to their histologic counterparts, and differ significantly from other IPMN subtypes. Because of their highly complex appearance, they are often radiologically misdiagnosed as PDAC; thus, failure to recognize their characteristic features on fine-needle aspiration may lead to inappropriate treatment. Patients with IOPN have an incomparably better prognosis than patients with ordinary PDAC, even when their neoplasms are invasive.

This is the first report, to our knowledge, of recurrent PTLD involving simultaneous lesions in the larynx and the trachea. PTLD in the head and neck can present as lymphoid hypertrophy, airway obstruction, stridor, or cough. A high degree of clinical suspicion is essential for prompt diagnosis of this life-threatening complication.

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bLegionella londiniensis has been isolated from aqueous environments. However, to our knowledge, this organism has never been isolated from clinical specimens. A case of Legionnaires' disease in a hematopoietic stem cell transplant recipient caused by this organism is described, which confirms that L. londiniensis can be an opportunistic pathogen. CASE REPORTA 57-year-old female presented to a primary care clinic in Charlotte, NC, with fever, chills, and a productive cough of thick green-brown sputum for 2 days' duration, for which she was prescribed ciprofloxacin. She left for vacation in South Carolina, where she experienced worsening sputum production, increased shortness of breath, and a fever of 38.3°C. Her oxygen saturation was noted as 72% on 2 liters of oxygen/min. One day later, she was taken to a local emergency department for further evaluation.Her medical history was significant for chronic lymphocytic leukemia (status, postmyeloablative), a sibling allogeneic bone marrow transplant 7 months prior, cytomegalovirus pneumonia, Pneumocystis jirovecii pneumonia, and parainfluenza respiratory viral infection 5 months prior, which left her oxygen dependent. Current medications included acyclovir, voriconazole, atovaquone, and long-term prednisone therapy.On physical examination, the patient was febrile at 38.5°C, tachycardic at 123 beats per minute, and tachypneic at 30 breaths per minute. She was hypoxic, with oxygen saturation of 78% on room air. Auscultation of the lungs revealed coarse breath sounds. Pitting edema (grade 2 to 3ϩ) was present in the lower extremities. Hematologic studies revealed a white blood cell count of 2,620/mm 3 , hemoglobin of 9.1 g/dl, hematocrit of 27.8%, and a platelet count of 43,000/mm 3 . Results of comprehensive metabolic panel tests were all within normal limits. Computed tomography of the chest revealed extensive consolidation within the left upper lobe and patchy consolidation in the left lower lobe. A small left pleural effusion and mediastinal lymphadenopathy were also present. The patient was intubated and admitted to the intensive care unit. She was empirically treated for pneumonia in an immunocompromised host with cefepime, linezolid, azithromycin, and trimethoprim/sulfamethoxazole.The following tests were obtained: respiratory virus panel PCR (xTAG RVP; Luminex, Austin, TX), a procalcitonin test (Vidas BRAHMS; bioMérieux, Durham, NC), a serum cryptococcal antigen test, aerobic and anaerobic bacterial blood cultures, a Legionella urinary antigen test (Binax/Alere, Waltham, MA), a cytomegalovirus plasma viral load, a urine culture, and sputum cultures for bacteria, acid-fast bacilli, and fungi. The respiratory virus panel was positive for parainfluenza virus type 3. The procalcitonin test result was 6.34 ng/ml. The urine culture was positive for Esherichia coli at greater than 100,000 colonies/ml. All other tests were negative. Due to the severity of her symptoms, the patient underwent bronchoalveolar lavage (BAL), and the sample was sent for cytologic examination ...

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Enterobius vermicularis is a parasite that inhabits the human digestive tract. We present two pediatric patients with symptoms mimicking acute appendicitis who were found to have E. vermicularis infection. The first case is a 5-year-old female who presented with flank and abdominal pain associated with low-grade fever and anorexia. She had localized tenderness in the right lower quadrant and a leukocytosis with left shift. Intraoperative findings included a normal-appearing appendix, but ex vivo examination revealed Enterobius vermicularis. The second case is a 7-year-old female who presented with periumbilical abdominal pain, anorexia, and emesis. She had tenderness at McBurney's point, and ultrasound revealed a small echogenic focus within the appendix. Intraoperatively, the distal tip of the appendix appeared inflamed. Again, ex vivo examination revealed E. vermicularis. Enterobius vermicularis infection of the appendix can present with a clinical picture similar to acute appendicitis. In at-risk populations, it should be included in the differential diagnosis for children with right lower quadrant abdominal pain. Complete therapy requires treatment with mebendazole.