A 78-year-old woman with a medical history of hypertension and diabetes mellitus who underwent surgery for lumbar stenosis died of sudden cardiac arrest two days after the operation. An autopsy was performed; however, the cause of death was not identified macroscopically. Congo red staining detected amyloid deposits in the systemic organs, including the heart, lungs, liver, thyroid, and kidney. Immunohistochemical staining revealed an immunoglobulin lambda light chain, which can cause the primary form of systemic amyloidosis. The prognosis of patients with systemic amyloidosis is directly associated with cardiac involvement. In this case, amyloid formation was noted in the myocardial interstitium and intramyocardial vascular wall, which caused luminal narrowing, subsequently causing arrhythmia and ischemic heart disease in each tissue, respectively. We present a case of primary systemic amyloidosis with severe cardiac involvement that was diagnosed after a comprehensive postmortem examination.
Testicular carcinoid tumors are very rare, accounting for less than 1% of all testicular tumors. We report a rare case of a testicular carcinoid tumor with extensive lymphatic invasion. A 42-year-old man presented with a painless, enlarged right testicular mass. There was no history of injury or discomfort in this region. Right radical orchiectomy was performed, which showed a well-defined, non-encapsulated solid white mass with calcification (7.0 × 4.5 × 3.5 cm) and absence of cystic components. Microscopic examination using hematoxylin and eosin staining of the tumor sections identified organoid, trabecular, and solid patterns with rosette formation. Extensive multifocal lymphatic invasion was observed. Immunohistochemistry was positive for synaptophysin, chromogranin, and CD56. Testicular carcinoid tumors usually show good prognoses; however, there was extensive lymphovascular invasion in this case. Thus, in the case of unusual presentation of the disease, close follow-up is necessary.
Rice body formation is a rare response to chronic inflammation of the synovial membrane. It is most commonly associated with rheumatoid arthritis and tuberculosis. Recently, there have been reports of rice bodies caused by non-tuberculous mycobacterial infection. We describe a case of rice body formation in a 69-year-old man who presented with pain and swelling in his third finger for six months after being punctured by a wire 1 year ago. He had no other notable recent medical history. Magnetic resonance imaging showed a large amount of fluid collection with diffuse thickening and enhancement of the synovium and rice bodies along the flexor tendon of the third finger. During surgery, multiple granular white rice bodies were found from the third carpal bone to the distal phalanx. Mycobacterium intracellulare was identified through mycobacterial culture and the patient was treated with rifampin, ethambutol, and clarithromycin, without recurrence. This case reveals that Mycobacterium intracellulare infection can cause tenosynovitis with rice bodies.
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