Successful treatment of patients with paraquat intoxication: three case reports and review of the literature

Objective  

To report on three patients with paraquat (PQ) intoxication surviving after combined therapy with hemoperfusion (HP), cyclophosphamide (CTX), and glucocorticoid.     

Granulomatous hypophysitis: two case reports and literature review

Granulomatous hypophysitis (GRH) is extremely rare and commonly presents with chronic inflammatory of the enlarged pituitary gland. In our study, 66-year-old and 57-year-old women, both Chinese, were diagnosed with GRH presenting preoperatively definite imageology characters as pituitary adenoma. The 66-year-old woman presented with a year of headache,half a year of gradual decrease of visual acuity, and one month of right ptosis. Serum prolactin level was slightly elevated.Screening computed tomography (CT) scanning revealed typical low density mass found on the enlarged sella, which demonstrated invasive extension from the sella to the right cavernous sinus by contrast enhanced magnetic resonance imaging (MRI).Consequently, the patient was diagnosed with probable invasive pituitary adenoma. The other 57-year-old woman complained a light headache and had been previously treated as nonfunctional pituitary adenoma in other hospital. Finally these two patients underwent transsphenoidal microsurgery and were diagnosed with GRH according to postoperative histopathology. They then were treated with steroid. During the follow-up, the clinical symptoms such as headache, visual damage, and ptosis vanished, and the mass of the sellae dramatically shrank on repeated MR images. Clinically and radiologically, GRH is a rare sellar entity easily to be misdiagnosed as a pituitary adenoma. Trans-sphenoidal surgery can decompress the optical nerve or oculomotornerve as a therapeutic strategy, and support biopsy or further pathological diagnosis. However, the hormonal therapy should be emphasized both as diagnostic and therapeutic strategies. Conservative and tentative steroid treatment should be performed in preoperative period without acute nerve damage.     

Gorham-Stout syndrome in mainland China: a case series of 67 patients and review of the literature

Objective:Gorham-Stout syndrome (GSS) is a rare disorder of uncertain etiology and unpredictable prognosis. This study aims to present a comprehensive understanding of this rare entity. Methods:A literature search in PubMed and three Chinese databases was performed to screen histologically proven GSS cases among Chinese residents in the mainland. We analyzed the patients’ clinical characteristics, the value of different treatment modalities and their influence on the clinical outcome. Results:Sixty-seven cases were finally enrolled. There were 43 men (64.2%) and 24 women (35.8%). The mean age at diagnosis was 28 years (1.5-71 years). The most common clinical symptoms included pain (n=40, 59.7%), functional impairment (n=13, 19.4%), and swelling (n=12, 17.9%). The radiographic presentation of 37 cases (55.2%) was disappearance of a portion of the bone. The others presented as radiolucent foci in the intramedullary or subcortical regions. A total of 42 cases provided data on therapy, these included surgery (n=27, 40.3%), radiation therapy (n=6, 9.0%), surgery combined with radiation therapy (n=2, 3.0%), and medicine therapy (n=7, 10.4%). For 30 of these 42 cases, follow-up data were available:21 cases had the disorder locally controlled and 9 had a symptom progression. Fortunately, the disease is not fatal in the majority of cases. Conclusions:GSS has no specific symptoms and it should be taken into consideration when an unclear massive osteolysis occurs. The efficacies of different treatment modalities are still unpredictable and further research is required to assess the values of different treatments.     

Gastric carcinoma with osteoclast-like giant cells: a case report and review of the literature

Gastric carcinoma with osteoclast-like giant cells (OGCs) is an extremely rare tumor. So far, only six cases have been reported in the literature. Here we report an additional case of this tumor in a Chinese 78-year-old man presented with abdominal pain, vomiting, and hematemesis. Physical examination and gastroscopy revealed a tumor in the gastric antrum. The biopsy and pathological findings indicated a gastric adenocarcinoma with OGCs, which were present in both the tumor and the metastatic lymph nodes. Further immunohistochemical staining indicated that OGCs were reactive with CD68, CD45, and vimentin protein, but not with pancytokeratin, carcinoembryonic antigen, or epithelial membrane antigen, suggesting the monocytic/histiocytic derivation of these OGCs. In situ hybridization for Epstein-Barr virus showed no nuclear positivity in either adenoearcinoma or OGCs. Postoperative follow-up showed that the patient had survived for at least 6 months without recurrence. Further investiga-tion is warranted to clearly define the prognostic significance of OGCs in gastric carcinoma.     

Metachronous contralateral testicular and bilateral adrenal metastasis of chromophobe renal cell carcinoma: a case report and review of the literature

Chromophobe renal cell carcinoma(ChRCC) metastatic to the testis has not,to the best of our knowledge,been reported in the literature.Nor have there been reports of delayed bilateral adrenal metastasis of ChRCC.Here we report a case of metachronous contralateral testicular and bilateral adrenal metastasis of ChRCC in a 70-year-old man who underwent right radical nephrectomy for RCC six years ago.He was admitted to the hospital because of left intrascrotal enlargement of two-month duration.Ultrasonography re...     

Primary tuberculous infection of breast： experiences of surgical resection for aged patients and review of literature

Primary mammary tuberculosis is a rare entity that usually occurs in female of reproductive age. Herein three such patients including two males with ages over 80 years, who underwent surgical resection, are reported. Fine needle biopsy failed to achieve specific diagnosis before surgical operation. All of their conditions got satisfactory improvement and anti-tuberculosis chemotherapy was administered postoperatively. Previous literature related to the epidemiology, diagnosis and treatment for mammary tuberculosis will be also reviewed. Mammary tuberculosis is usually related to breast feeding women and is extremely rare in aged man. The possible mechanisms resulting in this disease in our three patients, including direct extension, reactivation, or transmitted by staffs or peers of the nursing home, would also be discussed.     

Fulminant type 1 diabetes in China: a case report and review of the literature

Fulminant type 1 diabetes is a recently discovered subtype of idiopathic type 1 diabetes, defined as diabetes with an extremely rapid process of β-cell destruction and progression to hyperglycemia and ketoacidosis. In this report, we present a case of fulminant type 1 diabetes in a 45-year-old Chinese woman, along with a review of the literature. The patient presented with sudden onset of polydipsia and polyuria after flu-like symptoms. Findings on admission included a high blood glucose level and ketoacidosis, but normal HbA1c level. The C-peptide stimulation test showed severe impairment of insulin secretion. Autoantibodies to glutamic acid decarboxylase (GAD) were negative. These results are compatible with the diagnosis of fulminant type 1 diabetes. Human leukocyte antigen-DR7 (HLA-DR7) was available in this case. It is concluded that this rapidly progressing type of diabetes exists, and we propose that HLA-DR7 might be predisposed to fulminant type 1 diabetes in Chinese patients.     

Adenoma of nonpigmented epithelium in ciliary body： literature review and case report

Adenomas of the nonpigmented ciliary epithelium （NPCE） are often clinically indistinguishable from amelanotic malignant melanomas of the ciliary body or metastatic carcinomas. This paper reports a case study of a distinctive variant of adenoma of the NPCE, which clinically appears as epiretinal membrane in the macular region. Histopathologic studies have revealed this is an adenoma of the NPCE. Identification of this clinic feature is important because it will miss the diagnosis of the adenoma of the NPCE. In this case study, B-scan ultrasonography as well as computerized tomography （CT） has been used to provide help in diagnosing the ciliary body tumor. Because of their anterior location in the ciliary body, partial lamellar sclerouvectomy is an effective method of treatment.     

Wernicke encephalopathy following splenectomy in a patient with liver cirrhosis: a case report and review of the literature

Objective  

To report a case of Wernicke encephalopathy in the early stage after surgery.     

Bacteremia due to Rhodococcus equi：a case report and review of the literature

Rhodococcus equi, previously known as Corynebacterium equi, is one of the most important causes of zoonotic infections in grazing animals. Increased cases of human infection with R. equi have been reported, especially in immunocompromised patients, within recent years. We present a case of R. equi bacteremia in a 51-year-old man with diabetes and liver cirrhosis, on long-term corticosteroid therapy after skin-grafting surgery. The patient recovered soon after he was treated with vancomycin. This review focuses on the microbiological characteristics of this organism, and the diagnosis and treatment of this infection.     

Case Report:Fulminant type 1 diabetes in China:a case report and review of the literature

Fulminant type 1 diabetes is a recently discovered subtype of idiopathic type 1 diabetes,defined as diabetes with an extremely rapid process ofβ-cell destruction and progression to hyperglycemia and ketoacidosis.In this report,we present a case of fulminant type 1 diabetes in a 45-year-old Chinese woman,along with a review of the literature.The patient presented with sudden onset of polydipsia and polyuria after flu-like symptoms.Findings on admission included a high blood glucose level and ketoacidosis,but normal HbA1c level.The C-peptide stimulation test showed severe impairment of insulin secretion.Autoantibodies to glutamic acid decarboxylase(GAD) were negative.These results are compatible with the diagnosis of fulminant type 1 diabetes.Human leukocyte antigen-DR7(HLA-DR7) was available in this case.It is concluded that this rapidly progressing type of diabetes exists,and we propose that HLA-DR7 might be predisposed to fulminant type 1 diabetes in Chinese patients.     

Case Report:Adenoma of nonpigmented epithelium in ciliary body:literature review and case report

Adenomas of the nonpigmented ciliary epithelium (NPCE) are often clinically indistinguishable from amelanotic malignant melanomas of the ciliary body or metastatic carcinomas. This paper reports a case study of a distinctive variant of adenoma of the NPCE, which clinically appears as epiretinal membrane in the macular region. Histopathologic studies have revealed this is an adenoma of the NPCE. Identification of this clinic feature is important because it will miss the diagnosis of the adenoma of the NPCE. In this case study, B-scan ultrasonography as well as computerized tomography (CT) has been used to provide help in diagnosing the ciliary body tumor. Because of their anterior location in the ciliary body, partial lamellar sclerou-vectomy is an effective method of treatment.     

Primary leiomyosarcoma of the nipple-areola complex： Report of a case and review of literature

Primary leiomyosarcoma of the nipple-areola complex is extremely rare. Less than ten such cases have been reported in English literature so far. Herein we describe a 52-year-old female presenting with a 1.5 cm× 1.1 cm×0.7 cm nodular lesion over her left nipple, and leiomyosarcoma was proved by pathological examination of the excised specimen. Positron emitted tomogram (PET) revealed no abnormal signal other than the primary site. Microscopically, this poorly circumscribed tumor was composed of interlacing bundles of smooth muscle cells with bizarre and pleomorphic nuclei, as well as prominent nucleoli. Its mitotic count was up to 7 mitoses per 10 high power fields (HPF). Immunohistochemical study of tumor cells revealed positive stain for α-smooth muscle actin and vimentin; and negative for cytokeratin, CD34 and S-100. Left simple mastectomy was undertaken and no residual mass lesion was noted on the resected specimen. Related literatures about the diagnosis and treatment for breast leiomyosarcoma will be presented here.     

Case Report:Wernicke encephalopathy following splenectomy in a patient with liver cirrhosis:a case report and review of the literature

Objective:To report a case of Wernicke encephalopathy in the early stage after surgery.Methods:A nonalcoholic female patient with hepatitis B-related cirrhosis and hypersplenism underwent splenectomy in a local hospital.No surgical complications occurred and the patient recovered well.However,on the eighth postoperative day she developed psychiatric and neurological disturbance without an obvious cause.She was then admitted to our hospital.Brain magnetic resonance imaging(MRI) with FLAIR T2 showed symmetric high-signal intensities in the periaqueductal area of the midbrain,which were consistent with Wernicke encephalopathy.She was thus given in-tramuscular thiamine immediately.Results:After the administration of thiamine,the patient's confused mental state resolved within 3 d,and her dystaxia gradually improved over the next 5 d.The brain MRI with FLAIR T2 was re-examined one month after the episode,and showed nearly complete resolution of the previously abnormal signal intensities in the periaqueductal area of the midbrain.Conclusion:Physicians should be aware of the possibility of acute Wernicke encephalopathy,especially in patients with liver dysfunction.     

Weathering the storm: COVID-19 infection in patients with hematological malignancies

The coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Within a matter of months, this highly contagious novel virus has led to a global outbreak and is still spreading rapidly across continents. In patients with COVID-19, underlying chronic diseases and comorbidities are associated with dismal treatment outcomes. Owing to their immunosuppressive status, patients with hematological malignancies (HMs) are at an increased risk of infection and have a worse prognosis than patients without HMs. Accordingly, intensive attention should be paid to this cohort. In this review, we summarize and analyze specific clinical manifestations for patients with coexisting COVID-19 and HMs. Furthermore, we briefly describe customized management strategies and interventions for this susceptible cohort. This review is intended to guide clinical practice.     

Case Report:Bacteremia due to Rhodococcus equi: a case report and review of the literature

Rhodococcus equi, previously known as Corynebacterium equi, is one of the most important causes of zoonotic infections in grazing animals. Increased cases of human infection with R. equi have been reported, especially in immunocom-promised patients, within recent years. We present a case of R. equi bacteremia in a 51-year-old man with diabetes and liver cirrhosis, on long-term corticosteroid therapy after skin-grafting surgery. The patient recovered soon after he was treated with vancomycin. This review focuses on the microbiological characteristics of this organism, and the diagnosis and treatment of this infection.     

Ciliated hepatic foregut cyst: report of first case in China and review of literature

Objective: To report the first case of ciliated hepatic foregut cyst in China, and review of literature to introduce the characteristics of this disease for doctors to recognize this disease. Method: Report the clinical procedure of diagnosis and treatment for the first case of ciliated hepatic foregut cyst in China, and to review the embryologic genesis, incidence, clinical manifestation, radiologic features and therapeutic principle of this disease. Results: We performed the resection for ciliated hepatic foregut cyst under laparoscopy; the patient recovered well after the procedure. Conclusion: Ciliated hepatic foregut cyst is quite rare clinically, belongs to non-parasitic, solitary and unilocular cystic lesion, is always less than 4 cm in diameter, mostly seen in the left lobe, and has the tendency of malignant change. It should be removed as soon as diagnosed.     

Ciliated hepatic foregut cyst: report of first case in China and review of literature

INTRODUCTIONCysticlesionofliverisgenerallydividedintoparasiticandnon-parasiticones.Ciliatedhepaticforegutcyst(CHFC)isnon-parasitic,andfirstusedbyWheelerandEdomondson(1984)todescribethehepaticcysticlesionarisingfromtheembryologicforegut.Ciliatedforegutcystmostlyoccursinthetracheobronchialtreeandesophagus,andisrarelyfoundintheliver.Accordingtotheforeignlitera-ture,therewere72casesreported,noneinChina.Recentlyweperformedalaparoscopichepatectomyforamassintheleftlobe.Thepostoperativepatho-l…     

Metastasis of gastric carcinoma to the thyroid and lung: a case report and review of literature

Cancer metastasis to the thyroid is extremely rare. The more commonly reported primary sites for metastasis to the thyroid are the kidney, breast, lung, colon, esophagus, and uterus. Thyroid metastasis from the stomach has only been reported in three cases. Herein, we report a 71-year-old man presenting with bilateral thyroid multinodular lesions. Bilateral near-total thyroidectomy was performed due to airway compression with related symptoms. Wedge resection of a suspicious pulmonary nodule, detected on CT, was performed for diagnosis. Polypoid lesions in the stomach were examined by trans-scopic biopsy. Poorly differentiated adenocarcinomas with the same histological profiles were noted at these three sites. The immunohistochemical staining for thyroglobulin of these specimens was negative. We conclude that a new thyroid mass appearing in a patient with present or prior malignancies should raise the concern of metastatic disease.