Dawn P. Bradly

There has been an increasing prevalence of lymphogranuloma venereum (LGV) or Chlamydia trachomatis (C. trachomatis) cases among the men who have sex with men (MSM) population, particularly in Europe and North America. These cases may present with an incomplete or undisclosed history and proctosigmoiditis without characteristic adenopathy syndrome. During the initial evaluation and colonoscopy, there is a strong clinical and endoscopic suspicion of inflammatory bowel disease (IBD) by virtue of presentation and endoscopic and histological findings. The diagnosis of IBD is subsequently modified to LGV proctosigmoiditis when one or more of the following transpire: (1) there is failure of response to IBD therapy; (2) additional components of history (MSM/travel) may be identified; (3) return of initially performed Chlamydia antibody test is positive; and (4) response to antibiotics effective against Chlamydia. We describe three such cases initially suspected to be an inflammatory bowel disease and subsequently identified as C. trachomatis proctosigmoiditis.

PURPOSE: Non-small cell lung cancer (NSCLC) occurs most frequently in individuals older than 60 years of age. Currently, no biological indicators associated with NSCLC in younger patients (30 to 60 y) have been identified. To explore epigenetic influences, promoter methylation of selected tumor suppressor genes was analyzed in early-stage NSCLC patients ranging in age from 30 to 87 years at diagnosis. EXPERIMENTAL DESIGN: The analysis was performed on formalin-fixed tumor tissue from 193 surgically treated NSCLC patients (127, older than 60 y; 66, 60 y and younger). Methylation was quantified in p16, MGMT, DAPK, RASSF1, CDH1, LET7-3-a, NORE1(RASSF5), and PTEN promoters by pyrosequencing. p16 protein expression was assessed by immunohistochemistry (IHC). Outcome, defined by time to recurrence and overall survival, was evaluated by Kaplan-Meier analysis. RESULTS: Promoter methylation levels were generally higher in patients older than 60 years of age than in patients 60 years or younger at diagnosis. Of the genes tested, methylation levels of the p16 promoter showed age-related differences. Although p16 promoter methylation was significantly lower using cut-points of 50 years or younger and 40 years or younger (P=0.001 to 0.012, respectively), p16 protein expression increased with age. Patients 60 years or younger with p16 promoter hypermethylation had a significantly shortened time to recurrence (P=0.002) and a shortened survival time (P=0.011). No effect of p16 hypermethylation was seen in patients older than 60 years. CONCLUSIONS: p16 promoter hypermethylation was associated with a worse outcome in patients with age at diagnosis of 60 years or younger, but was not associated with the outcome in the older than 60-year age group. Overall, these data support methylation-dependent and methylation-independent age-related regulation of p16 expression with differential effects on the outcome after surgical resection for early-stage NSCLC.

Epstein-Barr virus–associated smooth muscle tumors (EBV-SMTs) occur predominantly in immunocompromised patients, either in the setting of solid organ transplantation or with HIV/AIDS.1 The role of EBV in the development of smooth muscle tumors was first described in the 1990s, after studies consistently showed high levels of EBV replication, EBV in-situ hybridization positivity (EBV encoded RNA [EBER]), and expression of viral genes in neoplastic cells.2-4 A small number of cases of EBV-SMTs have been reported in adults, but it is the second most common malignancy seen in children with AIDS.3-6 Typically, the disease has an indolent course, is locally invasive, and is rarely the cause of death.3,7 Treatment options include surgical resection, radiation therapy, chemotherapy, or improvement of the immune system with highly active antiretroviral therapy (HAART) in patients with HIV/AIDS. Another option in post-transplantation patients is changing the immunosuppressive therapy to sirolimus (Rapamune, Wyeth). No studies have been done to compare these treatment modalities, and a standard approach remains undefined. We report a case of an EBVSMT presenting as a superficial pelvic soft tissue mass in a patient with AIDS, which was successfully treated with surgical resection alone.

This case study is the ninth case reported since the last large series in 2003. Before establishing the diagnosis of cap polyposis, 4 of the 9 patients were initially diagnosed with ulcerative colitis and 1 patient was diagnosed with mucosal prolapse syndrome. Upon treatment, 4 of the 9 patients were treated for H. pylori infection, which resulted in the eradication of their gastritis and polyps. Resolution of cap polyposis was experienced after infliximab (Remicade, Centocor) in 1 patient, polypectomy in another patient, and total colectomy in a third patient; a fourth patient experienced complete resolution without any treatment. Many researchers attribute cap polyposis to mucosal prolapse syndrome; however, the exact mechanism of the underlying cause and the appropriate treatment strategy have not yet been elucidated.