Pseudotumoral Form Research Articles

Renal tuberculosis mimicking renal cell carcinoma: a\xa0case report

BackgroundUrogenital tuberculosis is still a frequent presentation, and it constitutes a current public health problem in endemic areas. The clinical presentation of this form of the disease may be misleading. The pseudotumoral type of renal tuberculosis is extremely uncommon.Case presentationWe present a case of a 52-year-old African woman who presented with urogenital tuberculosis in its pseudotumoral form. This case was initially diagnosed and managed as renal cancer. Histopathology confirmed the diagnosis of pseudotumoral renal tuberculosis.ConclusionsThe pseudotumoral form of urinary tuberculosis can be difficult to diagnose. Only bacteriological or histological confirmation allows diagnosis for adequate treatment.

The Colonic Pseudotumoral Form of Crohn’s Disease: About a Case at the Sourô Sanou University Hospital Center in Bobo-Dioulasso

Crohn's disease is a chronic inflammatory bowel disease (IBD) that can affect all segments of the digestive tract. For long time, it is a pathology considered to be uncommon among African blacks. It constitutes a heterogeneous group both in its etiopathogenesis and in its clinical and progressive presentation. The pseudotumoral form remains exceptional. We report a case of this form, observed in a 44-year-old patient. The pseudotumoral form of colonic Crohn's disease was diagnosed based on morphological, histological and progression criteria. This illustrates the need for multiple and repeated biopsies to eliminate malignant tumor, tuberculosis, intestinal parasitosis and other causes of digestive granulomatosis.

Spinal Cord Schistosomiasis: Report on Seven Adult Patients

Background: Spinal Cord Schistosomiasis (SCS) is the most disabling ectopic form of Schistosomal infection. It may or may not have clinical manifestations. They include low back pain and/or lower limb pain and weakness, and double incontinence. Early diagnosis and treatment provide a good outcome. Aim: To describe the clinical, radiologic, and therapeutic data of 7 patients with Spinal Schistosomiasis. Patients and Methods: In this retrospective clinical case study, the medical records of 7 patients with spinal cord pathologies admitted to Aswan University Hospital from May 2014 to May 2017 were reviewed. All were male aged from 17 to 30 years old (mean ± SD, 20 ± 9.5 yr.; median 21 yr.), with neurological deficit in the form of lower limb weakness and sphincter disturbance. All were treated by decompressive laminectomy and debulking of the intramedullary lesion followed by medical treatment. Results: The outcome of our patients was good as 4/7 patients (57%) presented a full recovery, 3/7 patients (43%) presented a partial recovery without functional limitations and none presented a partial recovery with limitations or no response. Conclusion: High index of suspicion should be raised in the differential diagnosis of patients with clinical or radiological evidence of Spinal Cord Schistosomiasis, as early diagnosis can guarantee a better prognosis and avoid the occurrence of serious sequels. The association of corticosteroids and antischistosomal drugs is related to the best outcome. The role of surgery is decompression, particularly in the granulomatous or pseudotumoral form, and to obtain material for definite histopathological diagnosis in doubtful cases.

Hepatic Tuberculosis of Pseudotumor Form

Tuberculosis involving the liver in the absence of active pulmonary tuberculosis is very rare. The inflammatory pseudotumoral form is an entity difficult to diagnose. We report a case of an inflammatory pseudotumor of the liver due to tuberculosis, who didn’t underwent hepatectomy because of the size of the tumor. The diagnosis of tuberculosis was made on biopsy and Polymerase Chain Reaction (PCR).

Pulmonary pseudotumoral tuberculosis in an old man: A rare presentation

The pseudotumoral form of tuberculosis is very rare in healthy immunocompetent subjects and can simulates lung carcinoma causing diagnosis dilemma or lead to abusive surgical resection. Here we report a case of pulmonary tuberculosis in its pseudotumoral form in an immunocompetent old men who presented with cough, fatigue and fever. A computerized tomography of the chest indicated a dishomogeneous mass that compressed and deformed the left main bronchus that was referable to a primary tumor. The hystopatological exam from the bioptic samples obtained by bronchoscopy was negative for neoplasia. Moreover, an abdomen CT scan showed hypodense solid lesions of the liver likely to be considered as metastasis; the histological analysis of these hepatic lesions was negative for neoplasia. It was necessary to perform a second CT scan of the chest and another bronchoscopy with biopsy and histopathological examination before establishing the diagnosis of the pulmonary pseudotumoral form. The case report confirm, as previously described, the difficulties in the diagnosis of this rare form of tuberculosis that lead to a delay in therapy, and suggest that the pseudotumor has to be included as different diagnosis of pulmonary mass also in healthy immunocompetent subjects.

Pseudotumoral Abdominal Tuberculosis in Immunocompetent Adults: Report of Three Cases and Review of the Literature

Purpose: To highlight diagnostic challenges of pseudotumoral abdominal tuberculosis. Materials and methods: Three cases of pseudotumoral abdominal tuberculosis were compiled in our department between 2014 and 2015. They were aged 34 years, 42 years and 61 years respectively. They were immunocompetent and had no personal or family history of tuberculosis. Clinical presentations were non-specific, represented by abdominal pain and weight loss in the three patients and chronic diarrhea in one patient. Abdominal ultrasound and computed tomography CT were performed in all patients. Abdominal MRI was performed in one case as well as a colonoscopy. Results: Retroperitoneal tuberculosis and colic tuberculosis were noted in the 1st and 2nd case. Macro-nodular and biliary hepatic tuberculosis was retained in the third case. The diagnosis was based upon histopathology in the 3 cases showing tubercular granuloma with caseation. Anti-tuberculosis therapy was prescribed for 6 months. Evolution was favorable in all patients. Conclusion: Tuberculosis continues to present diagnostic difficulties, particularly in its pseudo-tumoral form, even in endemic tuberculosis countries like ours.

The Pseudotumoral Form of Schistosomiasis mansoni, intestinal and peritoneal, reported in 108 years of publications on Schistosomiasis in Brazil and Abroad.

The Pseudotumoral Form of Schistosomiasis mansoni, intestinal and peritoneal, reported in 108 years of publications on Schistosomiasis in Brazil and Abroad.

PSEUDOTUMORAL FORM OF MULTIPLE SCLEROSIS WITH SYMPTOMATIC CONVULSIVE SEIZURES (A CLINICAL CASE)

Multiple sclerosis (MS) is prominent among central nervous system diseases. It affects chiefly young people and almost inevitably results in disability. In the past decade, there has been an upward trend for the prevalence of MS worldwide; in particular, the higher prevalence of this disease has been registered in the Moscow Region, which is associated with both an objective increase in its morbidity and improvement of specialized care to the population in the region. MS is characterized by a variety of clinical manifestations. However, paroxysmal disturbances are referred to as the rare symptoms of MS: the incidence of epileptic seizures in this condition is 0.89 to 7.5% according to the literature data. In addition to the clinical form of MS, there are its rare malignant atypical forms that also include its pseudotumoral form characterized by intrinsic neuroimaging and clinical signs that are different from the classical form of MS and another abnormality of the central nervous system. The pseudotumoral form of MS is characterized by the development of acute focal demyelination that appears as a large focus of an increased magnetic resonance signal with perifocal edema as evidenced by magnetic resonance imaging. A pseudotumoral focus of demyelination can occur both at the onset of MS and during its recurrent course. The atypical onset of MS is a special challenge because of diagnostic problems, which may lead to erroneous therapeutic policy and have a negative impact on the late prognosis of the disease. The authors provide a clinical case of the pseudotumoral form of MS with convulsive seizures at the onset of demyelinating disease. The problems of diagnosis and therapeutic approaches are discussed.

Overall Outcomes of Bing-Neel Syndrome after Treatment - a Review of 40 Cases

Background: Bing-Neel syndrome (BNS) or central nervous system (CNS) involvement in Waldenströms macroglobulinemia (WM) is rare and typically results from the infiltration of CNS by neoplastic lympho-plasmacytoid cells. The aim of this study is to present a review of the clinical characteristics, practices for treatment and overall prognosis of BNS. We present the largest systematic review to date of BNS cases reported in the literature.Material and Methods: A systematic review of PUBMED (http://www.pubmed.gov) was conducted to search for primary articles and case reports under keywords "Bing-Neel syndrome" and "Waldenströms macroglobulinemia", "leptomeningeal", "central nervous system", and "lympho-plasmacytoid cells". The search was extensive, ranging from 1955 to 2014. All adult cases written in English language were included. The search yielded 35 results and was individually examined by two authors. All studies that described hyperviscosity due to WM aside from BNS were excluded. The effect of regimens with high CSF penetration or intrathecal chemotherapy (IT) on overall survival (OS) was analyzed using Kaplan-Meier curves and Wilcoxon test.Results: This review summarizes the clinical characteristics and treatment modalities for 40 patients with BNS reported in the literature. The mean age at diagnosis was 62 years (range 36-82 years); 37.5% were females and 62.5% were males. Mean time from diagnosis of WM to BNS was 4.8 years, however about 10% (n=4) had neurologic symptoms due to BNS at the time of diagnosis of WM. The longest time from diagnosis of WM to BNS was 17 years. Patients presented with a wide spectrum of neurological symptoms and signs. Most common clinical manifestation was a progressive cognitive decline, seen in 43% (n=17) of patients. Other common presenting symptoms were acute or insidious neurologic deficits, memory impairment, persistent headaches and ataxic gait. Ninety percent of patients (n=36) had an elevated serum IgM (average 7.8 g/L), of which 97% (n=35) had IgM kappa, compared to 3% (n=1) with IgM lambda paraproteinemia. CSF lymphoplasmacytic pleocytosis was present in 89% (n=25/28) of patients, with a mean CSF WBC count of 76/µL at diagnosis. Most commonly these clonal B cells had an immune phenotype profile characterized by CD5+/-, CD10-, CD19+, CD20+, CD79b+, sIgM with light chain restriction (κ/λ). Tissue histology was performed in 55% (n=22/40) of cases and revealed either a diffuse perivascular or tumor like infiltration by small mature lymphocytes or lymphoplasmacytoid cells, immunohistochemically positive for CD20, surface IgM and light chain restriction.Radiographically, BNS presents either as a pseudo-tumoral form (mass lesions) or diffuse form (infiltration into cerebral parenchyma, cranial/spinal nerves or leptomeninges). Two-thirds (n= 30/40) of all cases presented with a diffuse pattern of CNS involvement, 15% (n=6/40) with pseudo-tumoral form, and 5% (n=2/40) had a combined diffuse and tumoral pattern. Magnetic resonance imaging (MRI) is the most sensitive imaging modality, used for diagnosis in 90% of patients (n=35/40). Characteristic findings on MRI are hyperintensities on T2 weighted imaging (diffuse or localized), increased signal intensity on FLAIR and diffusion weighted imaging with low ADC values.Mean time from diagnosis to death, reported in 15 publications, was 7 months (range: death during work up-2 years). Twenty patients were alive at last follow-up, with a mean time from diagnosis to last follow-up of 33.2 months (range 3 months - 14 years). Patients treated with multi-agent chemotherapy (R-DHAC, R-DT-PACE, FR,BR) along with IT chemotherapy (MTX or AraC) or CNS penetrating systemic therapy (HD MTX, RHyperCVAD), with or without RT or ASCT (3 patients only) had improved outcomes, with 71% (n=15/21) of such patients reported alive at last follow up (mean follow of 25 months). Median OS in this group was 19.6 months compared to 3.3 months (p=0.045) in patients receiving older systemic chemotherapy alone (cyclophosphamide, 2Cda, chlorambucil etc.), suggesting that CNS penetrating regimens may improve outcomes.Conclusion: BNS is a rare and aggressive complication of WM. Newer multi-agent chemotherapy combined with CNS penetrating systemic therapy or intra-thecal chemotherapy may improve outcomes. This study highlights an unmet need in this subset of patients with WM. DisclosuresAtrash:University of Arkansas for Medical Sciences: Employment. Alapat:University of Arkansas for Medical Sciences: Employment.

Sarcoïdose profuse associée à des carcinomes épidermoïdes cutanés multiples

The cutaneous signs of sarcoidosis are polymorphous and occasionally misleading. Herein, we report a rare case of profuse sarcoidosis involving various rare cutaneous signs specific to the disease associated with multiple cutaneous squamous cell carcinomas. A seventy-three-year-old man had been presenting dry ichthyosiform erythroderma for 2 years. The examination also revealed diffuse cutaneous atrophy with ulceration, superficial adenopathy and pseudotumoral hypodermic masses. Ophthalmological examination revealed conjunctival nodules. Biopsy samples for the various cutaneous lesions, salivary glands, conjunctival nodules, a hypodermic nodule and an adenopathy yielded similar images evocative of epithelioid granulomas and giant cells without caseous necrosis. Infectious causes were ruled out. Respiratory function tests showed a restrictive respiratory disorder. ACE levels were extremely high. Proteinuria was noted for 24-hour urine tests and renal punch biopsy showed an appearance of membrane-proliferative glomerulonephritis. Oral corticosteroids produced clinical and laboratory improvement. Furthermore, the patient was also presenting several invasive cutaneous squamous cell carcinomas in a setting of marked helioderma. Erythrodermic, ichthyosiform, atrophied, ulcerated and pseudotumoral forms of cutaneous sarcoidosis are very uncommon and their simultaneous appearance in the same patient is extremely rare. Further, the existence of numerous cutaneous carcinomas in this patient raises the question of an association between sarcoidosis and cancer, with fortuitous association appearing unlikely.

Pseudotumoral form of soft-tissue tuberculosis of the wrist

Tuberculosis is a major public health problem in developing countries. Hand and wrist is a rare localization for extra-pulmonary tuberculosis, a pseudotumoral form of soft tissue tuberculosis of the wrist is exceptional.We report the case of a 45-year-old male presenting with a painful swelling of the dorsal aspect of the right wrist evolving for six months. Clinical study was evoking a ganglion cyst of the wrist. Intraoperatively a pseudotumoral mass with rice bodies was found, suggesting tuberculous tenosynovitis. The histopathological study revealed caseating giant cell granulomas with epithelioid cells. Cultures on Löwenstein–Jensen medium detected Mycobacterium tuberculosis.Synovectomy with removal of all the rice bodies followed by anti-tuberculous chemotherapy provided uneventful recovery.

Problems of diagnosis and treatment of echinococcosis

The lack of specificity of clinical and laboratory manifestations of echinococcosis allocates to the fore diagnostic tool methods of research, which are at present leading in identifying the disease. The widespread introduction into clinical practice of modern highly informative instrumental methods such as ultrasonography (US) and computed tomography (CT), significantly improved the early detection of liver echinococcosis. In conjunction with the serological reactions to echinococcosis they allow in most cases the diagnosis of the disease. However, false-negative results of serological tests in more than 10–20 % of the patients and the difficulty of differential diagnosis with small brush size and pseudotumoral forms of ultrasound often lead to delayed diagnosis, and thus to a deterioration of treatment results. Moreover, failure to identify at an early stage of echinococcosis virtually eliminates the possibility of conservative treatment of echinococcosis without performing surgery. It is given the profound immune disorders in patients with echinococcosis, treatment should be complex and along with the surgical removal of hydatid cyst should be included in it and biostimulating. Immunocorrecting lechebnye event. Recent require further development. Methods. The work is based on an analysis of 25 cases operated on echinococcosis in the period from January 2013 to December 2014. To confirm the diagnosis using tools (ultrasound, computed tomography, X-ray), serology (detection of antibodies to echinococcus ELISA), histological (after removal of cysts) methods. The data are processed by the method of variation statistics. Results. An analysis of 25 cases of echinococcosis showed that among the 15 cases dominated by women (60 %) versus 10 (40 %) men. Treatment – removal of cysts of 25 patients with echinococcosis is made surgically. Among the analyzed cases in 6 (20.4 %) patients had the relapsing form of the disease. The factors leading to relapse of the disease are saved in the patient's body small residual cyst, inaccessible modern instrumental methods of diagnosis; preservation of fibrous tissue capsule and pericystic embedded germ cells that can transform into the cyst; seeding germ elements during the operation. Relapses of the disease usually associated with the colonization of the abdominal cavity with the cysts rupture, incomplete removal of the child bubbles, technical errors in surgery. Therefore, one of the most pressing issues is the chemoprophylaxis echinococcosis recurrence after surgical treatment. Conclusion. The difficulties caused by polymorphism of clinical diagnosis of symptoms and the lack of adequate diagnosis. Frequent recurrence of echinococcosis (20.4 %) after surgery indicates the need for preventive treatment of disease

Pseudotumoral Forms of Multiple Sclerosis: Report of 14 Cases and Review of the Literature

Background: The pseudotumoral form of multiple sclerosis (MS) is a rare condition with few descriptions in the literature. It supposes a diagnostic challenge especially when appearing at the onset of disease. Methods: We retrospectively describe a case series of pseudotumoral MS patients that attended our hospital from 2004, analyzing demographic, clinical and radiological variables. We classified the lesions according to the recently proposed morphologic classification (infiltrative, megacystic, Baló or ring-like) and according to the contrast enhancement pattern (nodular, complete ring, incomplete ring and diffuse). Results: Fourteen patients (11 female, 3 male), with a mean age of 35 years, were identified. All of them suffered from a relapsing-remitting form of MS. Eleven patients (78.57%) had symptomatic pseudotumoral lesions (PL), being the form of clinical presentation in the majority of those patients that were symptomatic (81.81%). Several patients presented atypical clinical manifestations such as cognitive impairment (21.42%) and epileptic seizures (14.28%). Full recovery was found in 53.84% of all symptomatic episodes. After a mean follow-up of 43 months, recurrent PL episodes were seldom observed (21.42%), the annualized relapse rate was 0.95 and the mean final Expanded Disability Status Scale score was 1.5. The majority of PLs were supratentorial, coexisted with typical demyelinating plaques and showed the ring-like morphology and the ring pattern of contrast enhancement. Three patients had more than one PL on the same scan, all of the lesions with similar morphology. Conclusions: Our findings contribute to a better characterization of pseudotumoral forms of MS. However, larger studies are required to define this atypical entity more exactly.

Sinusite aspergillaire d’origine dentaire dans sa forme pseudo-tumorale

Sinonasal aspergillosis is caused by the interaction between the sinonasal mucosa with a cosmopolite fungus (Aspergillus), it is on the increase, this is an infection whose evolution is unpredictable requiring early diagnosis and appropriate support. We report a case of Aspergillus rhinosinusitis of dental origin in pseudo-tumoral form with a review of the literature. A 31 years-old, women, consulted for a right nasal obstruction with purulent rhinorrhea after dental treatment. On examination, there was a bulge of the inner canthus of the right eye and a mass in the right nasal cavity. The CT scanner showed a process of the left naso-sinus cavity centered by calcic image density. The patient underwent a total excision of the mass endoscopically. Mycological and pathological examination concluded that the etiology was Aspergillus fumigatus. The patient had not received any antifungal treatment. The postoperative course was uneventful. The evolution was favourable with no recurrence after 9 months. Aspergillus rhinosinusitis of dental origin is usually due to the emergence of canalicular filling paste into the maxillary sinus through and oral cavity and sinus fistula, neglected it can progress to invasive pseudo-tumoral form. The clinical presentation is nonspecific and the diagnosis often involves imaging (scanner). Mycological and histological examinations are essential for diagnosis. The treatment is based on surgery sometimes associated with antifungal treatment.

Optic perineuritis: A further cause of visual loss and disc edema in children

Optic perineuritis is a rare form of orbital inflammatory pseudotumor in which the specific target tissue is the optic nerve sheath. Patients are mainly represented by adult women. Differential diagnosis with demyelinating optic neuritis is essential in terms of prognosis and treatment. An 8-year-old Caucasian girl presented with bilateral loss of vision, disc edema, eye movement impairment, and diplopia. Brain MRI findings were suggestive of optic perineuritis. The patient received steroid pulse therapy followed by prolonged course of oral steroid therapy. The visual acuity recovered dramatically within 2 days. Two months later, a new MRI investigation was normal. No clinical relapse was observed at the follow-up. We first report on a child affected by optic perineuritis. Our observation suggests that optic perineurits should be considered in the differential diagnosis of children presenting with visual loss and disc edema. An early and correct diagnosis may lead to an appropriate therapeutic approach with very good outcome.

Usefulness of Magnetic Resonance Spectroscopy in the Assessment of Brain Chagas Disease: A Case Report

Chagas disease, or American trypanosomiasis, is a parasitic infection caused by the flagellate protozoan Trypanosoma cruzi, an organism that is endemic to Latin America. While Chagas disease is primarily a vector-borne illness, new cases are emerging in non-endemic areas due to globalization of immigration and non-vectorial transmission routes. Once the infection has started, the main target organs are the heart, the alimentary tract, and the nervous system. However in immunosupressed patients, focal encephalitis due to T. cruzi infection may occur which tends to acquire a necrotizing feature with mass effect, perilesional edema, and pseudotumoral form (CTLAT, “cerebral tumor-like American trypanosomiasis”). In recent years, a few reports have described HIV-positive patients with central nervous system lesions due to Chagas disease. Here we report the clinical, neuroimaging, and histopathological findings of a patient with CTLAT and acquired immunodeficiency syndrome. To our knowledge, this is the first report in literature of the metabolite pattern assessed by magnetic resonance spectroscopy in these lesions. doi: http://dx.doi.org/10.4021/jnr237w

Histoplasmose : aspects clinicopathologiques chez l’immunocompétent et l’immunodéprimé. À propos de deux cas d’infection à Histoplasma capsulatum sur l’Île de la Réunion

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum var. capsulatum. It shows pulmonary or multivisceral involvement. Infective spores are inhaled from soils that contain bat or bird guano. The clinical picture depends on the intensity of the exposure and the immune status of the host. We report two cases of histoplasmosis that reflect its variability in clinical and histopathological expression: a pseudo-tumoral nodular form or histoplasmoma in a pauci-symptomatic immunocompetent patient and a disseminated form with severe respiratory and mucocutaneous involvement in an immunocompromised patient. The histoplasmoma presented as a spiculated, hypermetabolic, solitary pulmonary nodule. Histopathological examination showed well-formed epithelioid granulomas with caseous central necrosis containing numerous histoplasma yeasts. In the patient with disseminated infection, the diagnosis was confirmed by seeing yeast forms in bronchoalveolar lavage fluid and skin biopsy. These patients are the second and third cases of histoplasmosis reported on Reunion Island. Both had traveled in endemic areas several years previously. The most likely pathophysiological mechanism is the reactivation of an old latent infection. There is, therefore, no argument at present in favor of the presence of contaminated soils on Reunion Island.

Pseudo-tumoral pulmonary tuberculosis in immunocompetent adult

Introduction: The pseudo-tumoral form of tuberculosis is exceptional, it accounts for only 1 to 5% of the pulmonary tuberculosis. Because it simulates lung carcinoma, diagnosis can be delayed and lead to abusive surgical resection. Observation: a 23-year-old Tunisian immunocompetent adult without pathological history was explored for trailing fever, cough and thoracic pains which did not improved by the symptomatic treatment. The somatic examination found a feverish patient with 38.5 °C. Biology revealed a marked inflammatory syndrome. Chest x-ray showed a round parenchymal masse of the right upper lobe. The patient was treated like a bacterial pneumonitis but without improvement. Lung CT scan objectified a well limited parenchymal masse occupying the entire right upper lobe with annular catch of contrast. Tumor makers were normal. Bronchoscopic examination was normal without neoplastic cells on the aspiration. Direct exam for mycobacterium tuberculosis was negative. Transbronchial lung biopsy showed granulomas with caseation and Langhans giant cells. Under anti-tubercular therapy the evolution was favorable with the disappearance of the functional complaints and sub-total radiological cleaning at the end of a few weeks. Conclusion: This particular form of pulmonary tuberculosis deserves to be known especially in a country as ours where tuberculosis remains frequent.

Pulmonary tuberculosis in its pseudotumoral form; one new case

Pulmonary tuberculosis in its pseudo tumoral form is a rare entity. This pseudo tumor is suggested by a radiological parenchymal lesion or neoplastic-like presence in bronchoscopy of a bud or lung infiltration. The diagnosis is confirmed by bacteriological and/or different histological samples. We report a patient aged 26 with no history conditions, no notion of contagious tuberculosis and without toxic habits, who reports with three months isolated type left chest pain operating in a context of significant weight loss but not encrypted, evening fever and altered general condition. The clinical syndrome is a condensation of apical left and the rest of the examination is unremarkable. The chest radiograph shows an opaque round, dense and homogeneous apical left chest scan objective mass density tissue. Bronchoscopy was performed of a small bud at the apex of the segmental left upper lobe whose biopsy was inconclusive. Transparietal puncture with histological study confirmed the diagnosis of pulmonary tuberculosis. The patient was then put under treatment with antibacillaire. The diagnosis of tuberculosis should be considered in any tumor-like lung, as well as to step up bronchoscopic radiation, especially in an epidemiological context and is suggestive. This will allow early treatment of tuberculosis. The aim of our study is to report the rare and special appearance of pulmonary tuberculosis pseudo-tumoral form in imaging.

Recalcitrant Pseudotumoral Anogenital Herpes Simplex Virus Type 2 in HIV-Infected Patients: Evidence for Predominant B-Lymphoplasmocytic Infiltration and Immunomodulators as Effective Therapeutic Strategy

In patients with human immunodeficiency virus (HIV) infection, genital herpetic lesions may be extensive and tend to persist for longer periods; in addition, atypical hypertrophic, ulcerative, or pseudotumor forms have been reported, frequently showing resistance to acyclovir (ACV) treatment. Between 2003 and 2011, 10 HIV-1-infected patients presenting with chronic pseudotumoral anogenital herpes simplex type 2 (HSV-2) infections were studied. All patients developed chronic, hypertrophic HSV-2 anogenital lesions with multilesional presentation in 7 cases and involvement of 2 anatomical sites in 6 of them. At the time of diagnosis, the median CD3(+)CD4(+) absolute blood count was 480.5 cells/µL (range, 165-632 cells/µL), whereas the plasma HIV load was undetectable in all cases. Histopathologic analysis of lesion biopsies showed a moderately dense dermal polytypic plasma cell infiltrate. Detection of HSV-2 by culture and/or polymerase chain reaction was positive for all patients, with evidence for ACV-resistant strains in 6 of 8 cases. In addition, viral resistance to ACV was found only in HSV-2 isolated from ulcerative lesions, whereas purely pseudotumoral ones harbored sensitive strains. Durable control was observed with HSV DNA polymerase inhibitors in only 2 cases, and the immunomodulators imiquimod and thalidomide allowed 5 patients to reach sustained complete response. HSV-2-related pseudolymphoma in HIV-infected patients is characterized by a predominant polyclonal lymphoplasmacytic infiltration, and is frequently refractory to antiherpetic drugs. Immunomodulatory therapeutic strategies using thalidomide showed consistent efficacy, and should be considered early during the course of disease.