Mammary-type fibroepithelial neoplasms of the vulva are rare lesions of uncertain histogenesis. Origin from ectopic breast tissue and from anogenital glandular tissue that shares similar histologic homology with breast tissue has been postulated. We report the case of a 45-year-old woman who presented with a vulvar mass of several years duration. Excision of the lesion and subsequent histologic examination showed a mammary-type fibroadenoma with apocrine change. No ectopic breast tissue was identified outside the lesion. The theories of histogenesis of these neoplasms and additional cases of mammary-type lesions of the vulva reported in the medical literature are reviewed.

Empyema necessitatis is a rare complication of empyema in which the pleural infection spreads outside of the pleural space to involve the soft tissues of the chest wall. Most cases of empyema necessitatis are related to Mycobacterium tuberculosis and, less commonly, to Actinomyces spp. and Streptococcus spp. Staphylococcus aureus has rarely been reported as the causative agent of empyema necessitatis, with the majority of S. aureus isolates being methicillin sensitive. Only two cases of empyema necessitatis due to methicillin-resistant S. aureus (MRSA) have been reported in the medical literature. We report the case of a 59-year-old Caucasian male who presented to our institution with complaints of pain in and swelling of his left upper chest of 2-months duration. A computed tomography scan of the chest showed an 8.1-by 6.5-cm lesion which extended from the left upper lobe of the lung into the extrathoracic soft tissues beneath the left upper pectoralis muscle. A wedge resection of the left upper lung lobe revealed lung tissue with an organized pneumonia-like pattern associated with marked acute pleuritis. Blood and urine cultures and cultures of the left chest soft tissue mass grew MRSA. The patient was successfully treated with vancomycin followed by a 10-day outpatient course of ciprofloxacin and trimethoprim-sulfamethoxazole. This case represents an extremely rare manifestation of an increasingly dangerous bacterial pathogen. CASE REPORTA 59-year-old Caucasian male presented to our institution with complaints of progressive pain in and swelling of his left upper chest of 2-months duration. He had a significant past medical history of hypertension, insulin-dependent diabetes mellitus, chronic renal failure, cirrhosis, and bleeding esophageal varices requiring esophageal banding. He also had a history of heavy alcohol and tobacco use. On physical examination, his temperature was 98.1°F, his pulse was 71 beats per minute, his respiratory rate was 18 breaths per minute, his blood pressure was 142/84 mmHg, and his oxygen saturation was 97% on room air. His white blood cell count at the time of admission was 14.6. The patient's left upper chest wall was erythematous and tender to palpation. A computed tomography scan of the chest showed an 8.1-by 6.5-cm lesion which extended from the left upper lobe of the lung into the extrathoracic soft tissues beneath the left upper pectoralis muscle (Fig. 1). The central portion of the lesion showed fluid accumulation and air within the fluid-filled cavity. Erosion and bony destruction of the left lateral portion of the sternum and the distal end of the first rib were identified. Bilateral pleural effusions were present, and thrombosis of the left subclavian vein was seen. The radiographic differential diagnosis included abscess versus neoplasm. Blood cultures were drawn at the time of admission, and a subsequent Gram stain revealed Gram-positive cocci in clusters.The patient was started on empirical vancomycin therapy. Urine culture and susceptibility studies were performed t...

No abstract

No abstract

Background: Accuracy in the clinical diagnosis of asbestosis has significant implications for the future health of affected patients as well as serious medicolegal implications for both patients and asbestos-associated industries. The radiographic gold-standard for diagnosis of asbestosis has been the plain chest radiograph, and in many asbestosis-screening clinics, chest radiograph abnormalities in conjunction with a history of asbestos exposure have been the mainstay of diagnosis. No studies have yet compared the antemortem chest radiographic diagnosis of asbestosis with the subsequent presence of pulmonary fibrosis and lung tissue ferruginous bodies at autopsy.