563. Mycobacterial Spindle Cell Pseudotumor: Epidemiology and Clinical Outcomes.
Session: Poster Abstract Session: Tuberculosis Treatment and Outcome
Thursday, October 27, 2016
Room: Poster Hall
Background:

Mycobacterial spindle-cell pseudotumor (MSP) is a rare lesion characterized by local proliferation of spindle-shaped histiocytes containing acid-fast positive mycobacteria. The aim of this study is to describe the clinical parameters and treatment outcomes of patients with MSP.

Methods:

A Pubmed search was conducted using the search terms related to mycobacteria and spindle cell tumors. A previously unreported stem cell transplant recipient from our institution diagnosed with MSP was also included. Demographics, comorbidities, site of infection, treatment, and clinical outcomes were analyzed. Success was defined as clinical and radiologic response. Failure was defined as disease progression and/or death.

Results:

Twenty-three patients were reviewed. Two other cases were excluded because of inadequate data. Mean age was 49±2.1 yrs; 20 (87%) patients were males. Ten (43%) had HIV/ AIDS, 4 (17%) had solid organ transplants, 1 had allogeneic stem cell transplant with graft versus host disease, 4 (17%) received immunosuppressive therapy for diseases other than transplant, 2 (9%) had diabetes mellitus, and 2 (9%) did not have any underlying condition. Mycobacterium avium complex was the most frequent organism isolated in 10 (44%), M. tuberculosis in 3 (13%) cases, M. chelonae in 2 (9%), and 1 (4%) each of M. xenopi, M. haemophilum, and M. simiae. The site of infection included skin in 9 (39%), lymph nodes in 5 (22%), intraabdominal organ involvement in 4 (17%), lungs in 3 (13%) and brain in 2 (9%). Five (22%) received antimycobacterial agents, 11 (48%) underwent surgical resection, 3 (13%) received antimycobacterial agents plus surgery, 2 (9%) were not treated, and 2 (9%) lacked information. Treatment was successful in 8 (35%) and failed in 7 (30%); 5 of these 7 died. Antimycobacterial therapy was significantly associated with successful outcome (6/8 vs 1/7; 95% IC [1.14, 43], p=0.001).

Conclusion:

MSP is a rare condition associated primarily with immunodeficiencies. Antimycobacterial therapy is significantly associated with successful outcome.

Maroun Sfeir, MD, MPH1, Rosemary Soave, MD, FIDSA2, Koen Van Besien, MD, PhD2, Michael Satlin, MD3, Stephen Jenkins, PhD4, Lars Westblade, PhD5, Thomas Walsh, MD, PhD (hon), FIDSA, FAAM6 and Catherine Small, MD2, (1)Medicine/ Division of Infectious Disease, New York Presbyterian Weill Cornell Medical Center, New York, NY, (2)New York-Presbyterian Weill Cornell Medical Center, New York, NY, (3)New York-Presbyterian, New York, NY, (4)Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, (5)Pathology and Laboratory Medicine, New York Presbyterian Weill Cornell Medical Center, New York, NY, (6)Professor of Medicine, Pediatrics, Microbiology & Immunology, Weill Cornell Medicine of Cornell University/New York Presbyterian Hospital, New York City, NY

Disclosures:

M. Sfeir, None

R. Soave, None

K. Van Besien, None

M. Satlin, Allergan: Grant Investigator , Grant recipient

S. Jenkins, None

L. Westblade, None

T. Walsh, None

C. Small, None

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