Solitary fibrous tumours (SFTs) are rare neoplasms derived from mesenchymal cell lines. They are often asymptomatic, follow an indolent growth pattern and are more often benign than malignant. Here, we present a case of a very large, asymptomatic mediastinal SFT in an otherwise healthy man. A 67-year-old Irish man was referred for workup of an asymptomatic murmur. Auscultation of the lung fields revealed diminished breath sounds on the right side. Chest X-ray identified a 20 cm mass localised within the thorax. CT of the thorax confirmed a pleural based, solid lesion with no local invasion. CT-guided core biopsies were reported as consistent with SFT. Primary excision of the lesion was undertaken via median sternotomy. Histological examination confirmed a diagnosis of SFT. The patient remains well at this time. Primary excisive surgery is a safe and effective treatment modality for SFTs.
Blood flow in diabetic foot lesions: S. T. Irwin et al. 36.
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Case reportA 29-year-old Asian women presented with a 2-day history of right iliac fossa pain, malaise, fever and vomiting. There were no urinary or gynaecological symptoms and no previous history of similar complaints, although her past medical history included laparotomy during childhood for unknown reason. On examination she was flushed with a tachycardia of 100 beats/min and in sinus rhythm. Pyrexia of 38.5"C was noted and there was no cervical lymphadenopathy. Abdominal examination revealed an upper midline scar and tenderness with guarding in the right iliac fossa.Vaginal examination was normal. Rectal examination showed she was tender on the right side. Routine investigations showed Hb 12.3, WBC 5.0 (differential 0.8 per cent lymphocytes, 0.4 per cent monocytes, 3.8 per cent granulocytes). A mid-stream urine was acellular with no organisms seen on microscopy.As the nature of her previous surgery was unknown, a presumptive diagnosis of acute appendicitis was made. Laparotomy through a grid iron incision revealed florid lymphadenopathy of the mesenteric nodes of the terminal ileum and caecum with haemorrhagic areas in the overlying omentum. The terminal ileum and small bowel, caecum and ovaries were normal. The appendix was absent, presumably following previous laparotomy. One of the lymph nodes was removed for histological and microscopic examination before abdominal closure. Her postoperative course was uneventful with her fever settling on the second postoperative day.During the postoperative period blood was taken for blood culture, double stranded DNA, rheumatoid factor, Yersinia, Mycoplasma and Toxoplasma and viral serology and all proved negative. Lymph node culture and staining for acid alcohol-fast bacillus was negative.
HistologyThere was a necrotizing process which predominantly affected the medulla of the lymph node extending into the cortex, involving 90 per cent of the node. This was characterized by areas of cellular proliferation, followed by apoptotic (single cell) death, culminating in total cell death associated with zones of eosinophilic fibrinoid material and scattered nuclear dust. Remaining germinal centres were present at the periphery of the node. Immunocytochemical staining with UCHLI and MB2, antibodies to the T200 and CD4S antigens of T and B lymphocytes respectively, showed that the majority of the proliferating cells were UCHLI positive, i.e. they were T cells; there was also a marked T reaction product lying free in the necrotic areas.These are the features for necrotizing lymphadenitis of Kikuchi's disease.
Discussion
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