A 49-year-old woman with severe thrombocytopenia was admitted after an episode of syncope. She also had anemia, fever, pleural effusion and ascites, and multiple lymphadenopathies subsequently appeared. Her bone marrow showed increased megakaryocytes with mild fibrosis, whereas her lymph nodes lacked histologically specific findings. Her presentation was not consistent with multicentric Castleman's disease, angioimmunoblastic T-cell lymphoma, systemic lupus erhythematosus or any other well-recognized entities. Her clinical features were, however, thought to be compatible with TAFRO (thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly) syndrome. Corticosteroid therapy induced a partial remission of fever and systemic fluid retention, but thrombocytopenia persisted. After additional immunosuppressive therapy with cyclosporin A, her symptoms showed full resolution. 〔J Clin Exp Hematop 53(1) : 95-99, 2013〕
In Southern China, distillers' grain is the main feed ingredient for small beef cattle farms. High intake of distillers' grain may lead to abomasum impaction, a disorder caused by the accumulation of solid content within the organ. For treatment, there are non-surgical and surgical options. In this study, we aimed to describe the clinical presentation, diagnosis, and treatment of beef cattle with abomasum impaction due to high intake of distillers' grain. Forty-nine Simmental beef cattle from 13 farms in Chongqing, China, were diagnosed with abomasum impaction. Animals were male, aged ≤2 years, and weighed between 200 and 350 kg. In this retrospective study, information on distillers' grain intake and clinical data were collected for 49 beef cattle diagnosed with abomasum impaction. The animals were treated between 2011 and 2019 with either non-surgical therapy or surgery. Animals diagnosed with mild abomasum impaction (n = 14) fully recovered after non-surgical treatment. Among moderate cases (n = 19), 12 cattle recovered after non-surgical treatment (63%), while the remaining seven did not respond well and underwent surgery. Three of those animals were subsequently cured (3/7). Among the severe cases (n = 16), four cattle were cured after non-surgical treatment (25%) (4/16). Of the remaining 12 cattle, six were slaughtered, and six died after surgery. Non-surgical treatment is efficient for mild abomasum impaction caused by a high intake of distillers' grain and may be considered for both moderate and severe cases. However, the treatment success rate for more severe cases decreases as the disease severity worsens.
Rationale: Double primary clear cell carcinomas of the liver (PCCCL) and kidney are extremely rare; moreover, there have been no reported cases of adrenal metastasis from primary clear cell tumors of the liver. Patient concerns: A 47-year-old male patient was admitted to our clinic with space-occupying lesions in the left kidney and liver during a regular medical examination. Diagnoses: The tumors in the kidney and liver were diagnosed as primary clear cell carcinoma by histopathological examination. Interventions: The patient subsequently underwent nephron-sparing surgery of the left kidney and radical partial excision of the right liver lobe by laparoscopic surgery. Transcatheter arterial chemoembolization (TACE) was performed for the patient 2 weeks after tumor resection. One month after the operation, the patient started adjuvant therapy with sorafenib (400 mg twice per day orally). However, follow-up CT imaging revealed a solid mass measuring 1.9 × 2.0 × 2.0 cm3 in the right adrenal gland at 2 months postoperatively, and then the patient underwent radiofrequency ablation (RFA) for the right adrenal tumor. Outcomes: The patient remained cancer free for 2 years following the diagnosis despite early right adrenal metastasis. Lessons: Hepatocyte immunostaining is sufficient for the diagnosis of PCCCL.
Primary carcinoid tumor of the kidney is an extremely rare well-differentiated neuroendocrine tumor, which is generally a low-grade malignant cancer with a good prognosis. Carcinoid tumors are rarely found in the urinary system. Here, we report a 34-year-old woman with primary renal well-differentiated neuroendocrine tumor who underwent nephron sparing surgery and no evidence of recurrence or distant metastasis was found during routine follow-up. We searched the case of renal carcinoid with the search phrase “carcinoid [title] and kidney [title]” and “carcinoid [title] and renal [title]” using the PubMed and restricted the search to articles published in English since 2013. The clinical manifestations, age, sex, tumor size, location, gross pathology, light microscopy and immunohistochemistry were analyzed. A total of 28 cases of renal carcinoid were retrieved from PubMed. Higher proportion of positive labeling of CgA, Syn, NSE and CD56 are most valuable in the diagnosis of primary renal well-differentiated neuroendocrine tumor. At present, radical nephrectomy remains the gold standard in the curative-intent therapy for well-differentiated neuroendocrine carcinoma of kidney, in metastatic renal carcinoid, long-term use of octreotide may be an effective adjuvant therapy.
Renal fibrosarcoma is a rare tumor, with only a few cases reported so far, and simultaneous occurrence of ipsilateral renal fibrosarcoma and renal pelvic carcinoma in a patient is extraordinarily rare. A 66-year-old man admitted to our hospital with right renal percutaneous nephrostomy and recurrent fever. And the patient underwent laparoendoscopic nephrectomy and partial ureterectomy for pyonephrotic nonfunctioning kidneys. Postoperative pathology showed fibrosarcoma of right kidney and carcinoma of the renal pelvis. This is the first case of simultaneous occurrence of ipsilateral renal fibrosarcoma and renal pelvic carcinoma in a patient. The diagnosis of fibrosarcoma is one of ultimate immunohistologic exclusion, because there are no specific immunologic markers for fibroblasts. Electron microscopy combined with light microscopy and IHC is helpful for the case of renal fibrosarcoma which is difficult to diagnose. Clinically, radical nephrectomy is the main strategy for primary localized renal fibrosarcoma. At present, it is still necessary to carry out basic biology research to better understand etiology and therapeutical strategy of renal fibrosarcoma.
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