Breast cancer metastasis to the gastrointestinal tract is relatively rare. Patients with such disease often develop gastrointestinal symptoms, but it is sometimes asymptomatic. Endoscopic findings of gastric metastasis from breast cancer markedly vary from benign to malignant, and even in suspected malignant cases, it is often difficult to differentiate between primary and metastatic disease. We experienced a case in which an endoscopic examination performed during the treatment for metastatic breast cancer resembled an early-stage gastric cancer. A 71-year-old woman underwent curative surgery for right breast cancer 16 years previously. She underwent endoscopic submucosal dissection for early-stage gastric cancer 5 years ago. Two years ago, she developed metastatic disease in the lungs and mediastinal lymph nodes, and endocrine therapy was administered. At the same time, a follow-up endoscopy revealed a new elevated lesion, suspected to be an early-stage gastric cancer. However, histological diagnosis of the biopsy was metastasis of breast cancer. One and a half years later, a follow-up endoscopy revealed a gastric lesion that had reduced in size. She is still alive, having received a variety of systemic treatments. Patients with metastatic breast cancer are experiencing prolonged survival. Thus, follow-up endoscopy should be considered after the diagnosis of gastrointestinal metastasis considering the risk of lethal conditions, such as gastrointestinal bleeding and perforation. Our case serves as a reminder to clinicians how difficult it is to determine whether a gastric lesion is primary or metastatic based on endoscopic findings and the importance of communication with endoscopists and pathologists.
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Tobin's team, led by Joseph Saelens, Mollie Sweeney and Gopinath Viswanathan, ran genetic sequencing on the Raleigh bug and found it most resembled an ancestral strain from a group of strains called lineage 1. In the U.S. we tend to see the modern strains, lineages 2, 3, and 4, but lineage 1 is still out there, mostly in South and Southeast Asia.
Aroma production by L. lactis was clearly affected by the type of medium (CDM, MCI or milk) and the cultivation method (batch, retentostat or milli-cheese). Aroma formation in a milli-cheese model system was best resembled using retentostat cultivation in which the bacteria hardly grew mimicking cheese ripening conditions. Retentostat cultivation resulted in the highest number of known cheese aroma compounds (52) and increase in esters, methyl ketones, diketones and unsaturated ketones, which are important cheese flavours and/or have cheese-like or buttery flavours. In the retentostat cultures as well as in batch cultures with CDM and MCI, free fatty acids and their corresponding degradation products (methyl ketones, secondary alcohols and primary alcohols) were underrepresented compared to the milli-cheese. Addition of a mixture of free fatty acids to CDM and MCI could help to enhance flavour formation in these media to better resemble flavour formation in cheese. This study shows that typical cheese aroma compounds can be produced by lactic acid bacteria outside the cheese matrix, which offers opportunities for future applications as food supplements in dairy or non-dairy products.
In 1997, scientists discovered a large rock on Mars they named "Pooh Bear." And in 1976, NASA's Viking 1 spacecraft spotted a mesa that resembled a human face, nearly two miles from end to end, on a region of Mars called Cydonia.
OBJECTIVE AND IMPORTANCE: Necrotizing sarcoid granuloma (NSG) has been recognized as a histological variant of sarcoidosis. Two cases of neurosarcoidosis (NS) with NSG with concomitant systemic disease have been described previously. We present an unusual case of primary NS-NSG that resembled an en plaque cranial base meningioma. CLINICAL PRESENTATION: A 51-year-old man presented with a 3-month history of progressive left visual deterioration and proptosis. Brain magnetic resonance imaging demonstrated a large cranial base lesion occupying the left anterior clinoid process and sphenoid wing, extending to the left frontotemporal convexity. A second dura-based lesion was observed in the right parietal convexity. Both lesions enhanced homogeneously after administration of intravenous contrast medium. Magnetic resonance imaging characteristics were consistent with a typical clinoidal meningioma with an en plaque extension laterally. INTERVENTION: A left frontotemporal craniotomy with extradural removal of the anterior clinoid process was performed. When the dura was opened, a red fibrous mass was identified. Intraoperative histological analysis revealed the presence of necrotizing and noncaseating granulomas. Postoperatively, cerebrospinal fluid, erythrocyte sedimentation rate, C-reactive protein, and serum and cerebrospinal fluid angiotensin-converting enzyme values were normal. The search for acid-fast bacilli or fungi was negative. A diagnosis of primary NS-NSG was made. The patient began long-term high-dose corticosteroid therapy. One and a half years after surgery, his vision had improved significantly and the lesions were stable as revealed by magnetic resonance imaging. CONCLUSION: The first case of primary NS-NSG in the absence of systemic sarcoidosis is reported. NS should be included in the differential diagnosis of dura-based lesions resembling meningioma.
Structures which superficially resembled microfilariae were found on blood films and in other types of clinical material. These organisms, however, apparently are airborne spores of helicosporous fungi and represent contaminants on the blood films. It is believed that these objects have been mistakenly identified by other workers as microfilariae or as other species of worms. 2ff7e9595c
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