Introduction/Objective Regular assessment and analysis of diagnostic criteria for any type of human pathology is a prerequisite for ensuring the highest level of patient care. Hemophagocytic lymphohistiocytosis, also known as hemophagocytic syndrome, is a life-threatening condition. The syndrome can develop in critically ill patients with malignancies, severe infections, during chemotherapy, and may be associated with currently known genetic abnormalities, but this list is incomplete. We draw attention to the accuracy of diagnostic criteria, association with a variety of clinical conditions, pathophysiological mechanisms, and outcomes of the disease. Methods From the medical records in our hospital, we were able to extract several cases over a 10-year period. Based on hemophagocytosis features, our list included 13 patients representing 11 bone marrow aspirates, 4 lymph node biopsies, 1 liver biopsy, and 1 spleen sample; repeated examination of the slides confirmed the accuracy. Analyzing medical documentation, we evaluated the sequence and competence of the criteria used, the time required for diagnosis, management, and outcomes. Results We found that not all criteria were used for diagnosis, and the most sensitive and specific tests were bypassed. The preliminary diagnosis was made by a consultant (a rheumatologist or an oncologist-hematologist) on the 5th day of the hospital stay that delayed treatment. Of all the available treatment options, only a few were used. Conclusion The hemophagocytic syndrome is a very rare and fatal entity, it requires highly sensitive and specific diagnostic criteria for prompt diagnosis, targeted management, and thorough follow up. Every patient admitted to the hospital with a life-threatening condition should be suspected and tested for hemophagocytic syndrome on the first day. The criteria for hemophagocytic lymphohistiocytosis should be revised, with the most sensitive and specific ones are done in 100% of cases. Subsequently, each patient should be tested for the presence of genetic abnormalities that correlate with the syndrome.
Preoperative embolization of hypervascular bone metastasis is an effective measure for reducing blood loss during open orthopedic surgery. When the clinician is experienced with the procedure, the risks of the procedure are minimal and final outcomes are typically good.In this study, we report a case of a 50-year-old female patient who presented with a delayed metastatic renal cell tumor in the left proximal femur one year after radical nephrectomy. The patient underwent an effective preoperative embolization, which resulted in a remarkable absence of bleeding and a successful response subsequent to surgical fixation.
Introduction/Objective A thyroid nodule requires multiple steps in the identification of its nature, which determines its management. In most cases, low TSH levels support a benign origin. However, examples of hyperfunctioning thyroid carcinoma have been reported. Recent observations show that the number of thyroid cancer increases with the prevalence in young patients. The ambiguity of some cases necessitates the use of a full range of diagnostic methods up to molecular cytological diagnostics. Methods We present a report on the case of an 11-year-old boy complaining of weight loss despite having a good appetite. Results The blood test showed free T4 1.51 (0.81 - 1.35 ng/dL), free T3 6.04 (3.31 - 4.88 pg/mL), and TSH 0.01 (0.662 - 3.90 mU/L). During sonography, the left thyroid lobe was almost completely replaced by an isoechogenic circumscribed mass with multiple colloid cystic spaces. No suspicious microcalcifications or abnormal cervical lymph nodes were identified. A thyroid scan revealed the presence of a toxic autonomously functioning thyroid nodule in the left lobe. Methimazole and propranolol were prescribed, with subsequent left hemithyroidectomy on 10/21/2019. Grossly, the left thyroid lobe was 3.4 x 2.5 x 2 cm. The sectioning revealed light brown homogeneous stroma with a well-defined yellow-tan nodule (1.1 x 1.1 x 1 cm) in the middle of the lobe. The specimen was entirely submitted for permanent fixation in formalin. Microscopically, an encapsulated nodule was seen with the follicular and focal papillary pattern; nuclear features strongly and multifocally suggested a diagnosis of papillary carcinoma. HBME1 and calcitonin immunostains were negative; CK19 immunostain was multifocally positive. Next-generation sequencing supported the diagnosis of toxic adenoma with atypical features. Conclusion Every case of thyroid neoplasm should be fully investigated using modern and high-tech technologies, regardless of the functioning state of the gland. Molecular testing is supportive, especially in ambiguous situations, which benefits the patient.
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