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SPUC December 15, 2008 [email protected] CASE 1. CASE 1 Diagnosis: Coccidioidomycosis. Coccidioidomycosis. Diagnosis Coccidioidomycosis - Endemic fungal infection of the desert southwestern United States - Generally a self-limited illness in healthy persons.

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December 15, 2008

[email protected]


Diagnosis Coccidioidomycosis

- Endemic fungal infection of the desert

southwestern United States

- Generally a self-limited illness in healthy persons.

- Immunosuppressed persons who contract it

are at increased risk for disseminated infection

Janis E. Blair, MD; Jerry D. Smilack, MD; Sean M. Caples, DO. Coccidioidomycosis in Patients With Hematologic Malignancies

Arch Intern Med. 2005;165:113-117


Mesenchymal tumors of the gastrointestinal tract are less frequent than epithelial neoplasms but they are by no means rare.

  • Gastrointestinal stromal tumors (GISTs):
  • Most common mesenchymal tumor of the GI tract
  • Histopathology:
    • cellular spindled
    • epithelioid
    • pleomorphic lesions
    • express KIT (CD117) and CD34 proteins

True leiomyomas of the muscularis propria:

  • Common in the esophagus and rare in the gastric body and antrum
  • Most frequent mesenchymal tumor of the esophagus:
    • Leiomyomas outnumber GIST by a ratio of 3 to 1

Fibrous dysplasia, benignt tumor (developmental arrest)

Components of normal bone are present, but they fail to

differentiate into mature structures.

Occurs as one of three clinical patterns:

1. involvement of a single bone (monostotic)

2. involvement of multiple bones( polyostotic)

3. Polyostotic disease, associated with cafe au lait skin pigmentations and endocrine abnormalities, precocious puberty (McCune- Albright syndrome). Somatic, not hereditary. Skeletal, skin, and endocrine lesions from G protein that constitutively activates adenyl cyclase with resultant cyclic adenosin monophosphate overproduction and cellular hyperfunctioning.



  • - Very common in current clinical practice.
  • Changes usually more prominent in the prepyloric region
  • The usual underlying causes include chronic bile reflux and long-term NSAID intake.


  • The histopathologic features:
  • mucosal edema
  • congestion
  • fibromuscular hyperplasia in the lamina propria
  • foveolar hyperplasia with a corkscrew appearance in the most severe forms
  • The foveolar epithelium characteristically: reactive nuclear features and reduction of mucin.
  • The epithelial changes occur with little background chronic inflammation.

Arch Pathol Lab Med—Vol 132, October 2008