Various coronavirus disease 2019 (COVID-19) vaccines are being developed, which show practical preventive effects. Here, we report a 51-year-old healthy man with nephrotic syndrome secondary to minimal change disease (MCD) after Ad26.COV.2 (Janssen) vaccination. He had no comorbid disease and received Ad26.COV.2 on April 13, 2021. Seven days after vaccination, he developed edema and foamy urine. Edema rapidly aggravated with decreased urine volume. He was admitted to the hospital 28 days after vaccination, and his body weight increased by 21 kg after vaccination. His serum creatinine level was 1.54 mg/dL, and 24-h urinary protein excretion was 8.6 g/day. Kidney biopsy revealed no abnormality in the glomeruli and interstitium of the cortex and medulla under the light microscope. Electron microscopy revealed diffuse effacement of the podocyte foot processes, thus, he was diagnosed with MCD. High-dose steroid therapy was applied, and his kidney function improved three days after steroid therapy. Three weeks after steroid use, his serum creatinine decreased to 0.95 mg/dL, and spot urine protein-to-creatine decreased to 0.2 g/g. This case highlights the risk of new-onset nephrotic syndrome secondary to MCD after vectored COVID-19 vaccination. Although the pathogenesis is uncertain, clinicians need to be careful about adverse renal effects of COVID-19 vaccines.
Background and aim: Xanthogranulomatous inflammatory reaction (XGI) is a rare diagnosis in the gastrointestinal tract. It could be misinterpreted as an invasive cancerous lesion. The pathogenesis of XGI in the gastrointestinal tract (GIXGI) is not well understood. We clinicopathologically studied six cases of GIXGI associated with endoscopic biopsy, mucosal resection, and submucosal dissection of gastric and colonic adenocarcinoma. Methods: Immunohistochemical, special histochemical stains, and tuberculosis‐polymerase chain reaction (PCR) were performed. All radiological images and medical records of the patients were reviewed. Results: All cases showed XGI with foamy histiocytes, lymphocytes, and foreign body‐type giant cells, which were positive for CD68 and negative for CD117, S‐100, and cytokeratin. Acid‐fast, Gomori's methenamine silver, periodic acid Schiff stains, and nontuberculous Mycobacterium and Mycobacterium tuberculosis‐PCR were also negative. Two of four gastric adenocarcinomas were suspected to be advanced gastric cancer by computed tomography staging. However, the microscopic examination revealed only XGI with a mucosal carcinoma or without any residual tumor cells in the gastric wall. Conclusions: GIXGI may simulate advanced carcinoma clinicoradiologically. GIXGI should be included in the differential diagnosis in the case suggestive of a rapid transition to advanced gastrointestinal carcinoma within 12 weeks from the preoperative endoscopic procedure.
We report a patient with gastric adenocarcinoma with choriocarcinomatous and hepatoid differentiation. A 67-year-old man visited our hospital for further evaluations due to gastric adenocarcinoma. The gastric cancer was located in the prepyloric area and appeared to be a protruding mass with an infiltrative growth pattern. Initial pancreatic and postoperative hepatic and pulmonary metastases were detected radiologically. Microscopically, choriocarcinomatous and hepatoid differentiation was observed with a moderately differentiated adenocarcinoma. The choriocarcinomatous components were positive for b-hCG and the hepatoid components were positive for a-fetoprotein (AFP). These uncommon pathological patterns are supposed to arise from the retrodifferentiation pathway of primary gastric adenocarcinoma. The preoperative laboratory data revealed elevated serum AFP (773.4 ng/mL) and carcinoembryonic antigen (62.2 ng/mL), whereas other tests were unremarkable. The prognosis of gastric adenocarcinoma with choriocarcinomatous and hepatoid differentiation is very poor; our patient died 4 months after the operation.
Congenital pulmonary lymphangiectasia (CPL) is very rare. It shows diffuse pulmonary lymphatic dilatation without lymphatic proliferation. CPL can occur as a primary disorder or arise secondarily from other diseases such as the obstruction of pulmonary veins or lymphatics. The prognosis of CPL is very poor. Approximately 50% of infants are stillborn and most others usually die within the first day of life. The present case showed diffuse lymphangiectasia in the subpleural, interlobular, and peribronchovascular areas. The flat lining cells were immunohistochemically positive for D2-40 and CD31. CPL is usually diagnosed by clinicoradiological or postmortem examinations. However, our case was diagnosed by an antemortem lung biopsy. We report a case of CPL with total anomalous pulmonary venous return.
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