BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,pa...BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,particularly in children.This report describes a DPB case resolved with long-term azithromycin therapy,em-phasizing the need for a timely and accurate diagnosis.CASE SUMMARY A 12-year-old girl,diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists,developed a history of chronic productive cough and chronic sinusitis for a year.On examination,she exhibited wheezing and coarse crackles.Despite receiving treatment for an asthma exacer-bation,her symptoms did not improve.A chest X-ray revealed reticulonodular infiltration in both lower lungs,prompting further evaluation with high-resolu-tion computed tomography(HRCT).The HRCT confirmed centrilobular nodule opacities,a'tree-in-bud'pattern,and non-tapering bronchi,suggesting DPB.Elevated cold hemagglutinin titers at 128 further supported the diagnosis.Her cough and sinusitis resolved within a month after starting azithromycin therapy,chosen for its anti-inflammatory and immunomodulatory effects.Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.CONCLUSION This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.展开更多
BACKGROUND Hepatic hemangioma represents the most common benign primary hepatic neo-plasm.Although most such tumors are small and asymptomatic,giant cavernous hemangioma(GCH)is frequently symptomatic,and needs interve...BACKGROUND Hepatic hemangioma represents the most common benign primary hepatic neo-plasm.Although most such tumors are small and asymptomatic,giant cavernous hemangioma(GCH)is frequently symptomatic,and needs intervention.More-over,diffuse hepatic hemangiomatosis(DHH)is not rare in the liver parenchyma adjacent to a GCH.The management strategy for hepatic hemangiomas can differ depending on the presence of associated hemangiomatosis and the amount and distribution of the residual hepatic parenchyma.CASE SUMMARY Herein,we report two patients with GCH coexistent with DHH successfully treated by laparoscopic microwave ablation.The two GCHs were ablated com-pletely and the ablated zone atrophied obviously in imaging follow-ups after ablation.Surprisingly,there was a trend toward gradual reduction and dimini-shment of DHH.CONCLUSION Thermal ablation treatment might be an effective and less invasive treatment for GCH coexistent with DHH around the hemangioma.展开更多
BACKGROUND Drug-induced lung injury is a common adverse effect of chemotherapeutic agents.Diffuse alveolar hemorrhage(DAH)is a fatal complication associated with druginduced lung injury.Early diagnosis and treatment o...BACKGROUND Drug-induced lung injury is a common adverse effect of chemotherapeutic agents.Diffuse alveolar hemorrhage(DAH)is a fatal complication associated with druginduced lung injury.Early diagnosis and treatment of DAH is critical,as delayed management can lead to respiratory failure and poor outcomes.However,the diagnosis of DAH is difficult because of the nonspecific clinical manifestations;as such,bronchoscopy is necessary to establish a diagnosis.CASE SUMMARY The patient presented with fever and dry cough.He had been receiving fluoropyrimidine and oxaliplatin therapy for esophageal squamous cell carcinoma.Chest imaging revealed diffuse ground-glass opacities.Bronchoscopy with bronchoalveolar lavage was performed,which confirmed the diagnosis of DAH.Although the patient’s respiratory status rapidly worsened,high-dose corticosteroid therapy with respiratory support gradually improved the patient’s condition and he was successfully extubated.CONCLUSION Prompt DAH diagnosis and bronchoscopy in patients receiving oxaliplatincontaining chemotherapy presenting with acute respiratory failure are critical for improving outcomes.展开更多
BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion o...BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion of the inner esophageal wall. Midesophagealdiverticula are relatively rare and may coexist with diffuse esophagealspasm. However, the potential esophageal motility disorders associated withthese lesions are frequently overlooked in clinical practice. The use of endoscopicinterventions may offer a novel approach for the alleviation of dysphagia associatedwith this condition.CASE SUMMARYWe present a case of a 74-year-old woman with dysphagia, diagnosed with midesophagealdiverticulum and diffuse esophageal spasm. Due to her physical condition,submucosal tunneling endoscopic septum division (STESD) was initiallyperformed for the diverticulum. One month later, the esophageal spasm wastreated using per-oral endoscopic myotomy (POEM). This combined treatmentsignificantly improved her dysphagia, and she was discharged.CONCLUSIONSTESD and POEM are effective and safe for the treatment of dysphagia caused bymid-esophageal diverticula with diffuse esophageal spasm.展开更多
BACKGROUND Primary testicular lymphoma(PTL)is a rare,aggressive malignancy,representing a small fraction of testicular tumors and non-Hodgkin lymphomas,yet it is the most common testicular malignancy in older men.Diff...BACKGROUND Primary testicular lymphoma(PTL)is a rare,aggressive malignancy,representing a small fraction of testicular tumors and non-Hodgkin lymphomas,yet it is the most common testicular malignancy in older men.Diffuse large B-cell lymphoma(DLBCL),which is typically the aggressive subtype,dominates PTL and shows diffuse B-cell infiltration.Venous tumor thrombus,uncommon in lymphomas,is uniquely reported in this case of testicular DLBCL with gonadal vein involvement.CASE SUMMARY A 62-year-old man presented with a two-month history of painless left testicular swelling and stiffness.Diagnostic imaging[ultrasonography,computed tomography(CT),and 18F-fluorodeoxyglucose positron emission tomography/CT(18FFDG-PET/CT)]revealed bilateral testicular masses and a gonadal vein tumor thrombus(SUVmax 16.5).Left orchiectomy confirmed DLBCL with CD20,Bcl-2,and MUM1 positivity(Ki-67:approximately 80%).The disease was staged as Ann Arbor stage IVA(International Prognostic Index score 3,high-intermediate risk).The patient received Rituximab,Polatuzumab Vedotin,Cyclophosphamide,Epirubicin,and Prednisolone chemotherapy,completing the first cycle with good tolerability.No adverse events were reported,and follow-up is ongoing to assess long-term outcomes.This case highlights the diagnostic utility of 18F-FDGPET/CT and the importance of multidisciplinary management in rare PTL presentations with tumor thrombus.CONCLUSION This case demonstrates the diagnostic complexities of PTL with gonadal vein tumor thrombus,underscoring the importance of considering lymphoma in elderly patients with testicular masses and venous involvement.A multi-disciplinary team including urologists,hematologists,and radiation oncologists is needed to ensure appropriate therapy.展开更多
BACKGROUND It is difficult to restore the cognitive functions of patients with impaired cognition caused by brain injury.Diffusion tensor imaging can visualize the integrity of neural tracts in the white matter(WM)thr...BACKGROUND It is difficult to restore the cognitive functions of patients with impaired cognition caused by brain injury.Diffusion tensor imaging can visualize the integrity of neural tracts in the white matter(WM)three-dimensionally.It is unclear whether encephalitis following scrub typhus damages the WM.For the first time,we aimed to report diffusion tensor tractography(DTT)findings in a chronic patient with cognitive impairment following scrub typhus encephalitis,which revealed injury to the Papez circuit of the WM.CASE SUMMARY A 70-year-old male patient was affected by encephalitis caused by scrub typhus that occurred 23 years ago.He had poor cognition and his clinical examination findings were as follows:Mini-Mental Status Examination score,14;and handgrip strength(right/left,kg),32.3/31.3.DTT revealed serious injuries of the left thalamocingulate tract and right mammillothalamic tract in the Papez circuit,and a partial injury of the anterior part of the fornix.CONCLUSION Using DTT,we found a relationship between cognitive impairment and the integrity of the Papez circuit following scrub typhus.展开更多
An optimal algorithm for the retrieval of chlorophyll, suspended sediments and gelbstoff of case Ⅱ waters in the Pearl River estuary was established with the optical parameters derived from the in-situ data obtained ...An optimal algorithm for the retrieval of chlorophyll, suspended sediments and gelbstoff of case Ⅱ waters in the Pearl River estuary was established with the optical parameters derived from the in-situ data obtained in Jan. 2003 in the same area. And then, the chlorophyll, suspended sediments and gelbstoff of the SeaWiFS pixels on Jan. 29, 2003 corresponding to the in-situ sites of Jan. 25 and 26, 2003 were synchronously retrieved, with average relative errors of 14.9%, 12.1% and 13.6% for chlorophyll, suspended sediments and gelbstoff, respectively. The research results indicated that the optimal retrieval algorithm established here was relatively fit for the retrieval of the chlorophyll, suspended sediments and gelbstoff of case Ⅱ waters in the Pearl River estuary, and had quite good retrieval accuracy.展开更多
BACKGROUND Warthin’s tumor(WT)is composed of several cysts that are lined with tall,bilayered oncocytic columnar cells and lymphoid stroma.Within WT,the two components rarely transform into carcinoma or lymphoma,and ...BACKGROUND Warthin’s tumor(WT)is composed of several cysts that are lined with tall,bilayered oncocytic columnar cells and lymphoid stroma.Within WT,the two components rarely transform into carcinoma or lymphoma,and when it does,carcinoma is the most common type.Approximately 28 cases of lymphoma with WT have been reported,most of which were non-Hodgkin lymphomas,and only a few cases were Hodgkin lymphomas.In the present report,we studied a case of diffuse large B cell lymphoma(DLBCL)arising from follicular lymphoma(FL)with WT in the parotid gland and its immunophenotypic and genetic features.CASE SUMMARY A 67-year-old man presented with a slowly enlarging right cheek mass for 12 years,and the mass began to change in size over a 2-mo time period.Over time,the patient felt mild local pain and right cheek discomfort.His medical history included a hepatitis B virus infection for 20 years and 30 years of smoking.Gross examination of the excised specimen showed a gray-red and gray-white appearance and a soft texture lobulated external surface neoplasm that measured 9 cm×8 cm×7 cm and was well circumscribed by relative normal parotid gland tissue.In cross section,the cut surfaces of the neoplasm were multicystic and had a homogeneous scaly appearance.A small fluid was discovered in the cyst.Bilateral oxyphilic,cuboidal or polygonal epithelium cells and lymphoid intraparenchymal components were observed.Many medium-to large-sized lymphoid cells were observed diffusely in part of the neoplasm,and a few secondary lymphoid follicles were observed at the center or edge of the neoplasm.Immunohistochemical staining showed that the columnar oncocytic cells were positive for AE1/AE3;neoplastic cells located in coarctate follicular were positive for CD20,Pax-5,bcl-2 and bcl-6;and the adjacent diffusely medium-to large-sized lymphoid cells were positive for Pax-5,bcl-6,CD20,MUM-1,bcl-2 and CD79a.The bcl-6(3q27)break-apart rearrangement was observed,and an Epstein Barr virus test was negative in the tumor cells.The patient survived 6 months after being diagnosed without any treatment.CONCLUSION WT-associated lymphoma is a very rare neoplasm in the parotid gland.Most cases are B cell non-Hodgkin lymphomas and involve middle-age and older males.This case highlights the extremely rare association of DLBCL arising from FL with WT and the importance of deliberate evaluation of the WT intraparenchymal stroma.Molecular detection techniques have potential advantages in the diagnosis of lymphoma with WT.展开更多
BACKGROUND Diffuse uterine leiomyomatosis(DUL)is a benign uterine smooth muscle neoplasm with unknown etiology.Since DUL is rarely reported,knowledge regarding it is limited.The rate of early diagnosis is low,and DUL ...BACKGROUND Diffuse uterine leiomyomatosis(DUL)is a benign uterine smooth muscle neoplasm with unknown etiology.Since DUL is rarely reported,knowledge regarding it is limited.The rate of early diagnosis is low,and DUL is often misdiagnosed as common multiple uterine leiomyomas before surgery.CASE SUMMARY A 27-year-old patient with no sexual activity presented to the Emergency Department of our hospital complaining of heavy vaginal bleeding.She had a history of uterine fibroids and menorrhagia.Pelvic examination showed a regularly enlarged uterus,similar in size to that associated with a 4-mo pregnancy.Pelvic magnetic resonance imaging(MRI)revealed numerous multiple uterine fibroids,and a transabdominal myomectomy(TM)was performed.Intraoperative exploration revealed that the myometrium was full of myoma nodules of variable sizes.Over 50 leiomyomas were removed.The pathology report confirmed leiomyoma.The patient was discharged and received a gonadotropin-releasing hormone analog(3.75 mg)for 6 mo.Ten months after surgery,the patient presented to the hospital again for abnormal uterine bleeding.MRI showed an irregular mass with a diameter of 5.2 cm without sharp demarcation in the uterine cavity.Submucosal leiomyoma was considered first,and the patient underwent a hysteroscopic myomectomy plus hymen repair.Intraoperative exploration showed that there were several leiomyomatosis masses in the cavity.Postoperative pathological exam-ination confirmed submucosal leiomyoma and necrotic and generative tissue.Although the menstrual cycle was still irregular,the patient did not have symptoms of menorrhagia for a period of 28 mo after the second surgery.CONCLUSION Individuals with DUL are easily misdiagnosed due to the lack of specific manifestations of this disease.MRI is helpful for early identification and preoperative evaluation.There is currently no unified method of diagnosis.For women who want to preserve fertility,conservative surgery should be made an option.When TM is chosen,a modified new myomectomy should be considered to avoid the drawbacks of traditional TM.展开更多
BACKGROUND Secondary cardiac involvement by lymphoma has received limited attention in the medical literature, despite its grave prognosis. Although chemotherapy improves patients' survival, a subgroup of treated ...BACKGROUND Secondary cardiac involvement by lymphoma has received limited attention in the medical literature, despite its grave prognosis. Although chemotherapy improves patients' survival, a subgroup of treated patients dies suddenly due to myocardial rupture following chemotherapy initiation. Reducing the initial chemotherapy dose with dose escalation to standard doses may be effective in minimizing this risk but the data are limited. We report on the successful management of a patient with disseminated diffuse large B-cell lymphoma(DLBCL) involving the heart using such approach.CASE SUMMARY An 18-year-old male presented to our hospital with six months history of progressive dyspnea, orthopnea and cough. On physical examination, the patient was found to have a plethoric and mildly edematous face, fixed elevation of the right internal jugular vein, suggestive of superior vena cava obstruction, and a pelvic mass. Investigations during admission including a thoracoabdominal computed tomography(CT) scan with CT guided biopsy of the pelvic mass,echocardiography and cardiac magnetic resonance imaging led to the diagnosis of disseminated DLBCL with cardiac involvement. The patients were successfully treated with chemotherapy dose reduction followed by dose escalation to standard doses, under the guidance of cardiac imaging. The patient completed chemotherapy and underwent a successful bone marrow transplant. He is currently in remission and has a normal left ventricular function.CONCLUSION Imaging-guided chemotherapy dosing may minimize the risk of myocardial rupture in cardiac lymphoma. Data are limited. Management should be individualized.展开更多
In the present paper, a method is proposed to improve the performance of Artificial Neural Network (ANN) based algorithms for the retrieval of oceanic constituents in Case Ⅱ waters. The ANN-based algorithms have been...In the present paper, a method is proposed to improve the performance of Artificial Neural Network (ANN) based algorithms for the retrieval of oceanic constituents in Case Ⅱ waters. The ANN-based algorithms have been developed based on a constraint condition, which represents, to a certain degree, the correlation between suspended particulate matter (SPM) and pigment (CHL), coloured dissolved organic matter (CDOM) and CHL, as well as CDOM and SPM, found in Case Ⅱ waters. Compared with the ANN-based algorithm developed without a constraint condition, the performance of ANN-based algorithms developed with a constraint conditions is much better for the retrieval of CHL and CDOM, especially in the case of high noise levels; however, there is not significant improvement for the retrieval of SPM.展开更多
BACKGROUND Patient satisfaction with facial appearance at the end of orthodontic camouflage treatment is very important, especially for skeletal malocclusion. This case report highlights the importance of the treatmen...BACKGROUND Patient satisfaction with facial appearance at the end of orthodontic camouflage treatment is very important, especially for skeletal malocclusion. This case report highlights the importance of the treatment plan for a patient initially treated with four-premolar-extraction camouflage, despite indications for orthognathic surgery.CASE SUMMARY A 23-year-old male sought treatment complaining about his unsatisfactory facial appearance. His maxillary first premolars and mandibular second premolars had been extracted, and a fixed appliance had been used to retract his anterior teeth for two years without improvement. He had a convex profile, a gummy smile, lip incompetence, inadequate maxillary incisor inclination, and almost a class I molar relationship. Cephalometric analysis showed severe skeletal class Ⅱ malocclusion(A point-nasion-B point = 11.5°) with a retrognathic mandible(sella-nasion-B point = 75.9°), a protruded maxilla(sella-nasion-A point = 87.4°), and vertical maxillary excess(upper incisor to palatal plane = 33.2 mm). The excessive lingual inclination of the maxillary incisors(upper incisor to nasion-A point line =-5.5°)was due to previous treatment attempts to compensate for the skeletal class Ⅱ malocclusion. The patient was successfully retreated with decompensating orthodontic treatment combined with orthognathic surgery. The maxillary incisors were repositioned and proclined in the alveolar bone, the overjet was increased, and a space was created for orthognathic surgery, including maxillary impaction, anterior maxillary back-setting, and bilateral sagittal split ramus osteotomy to correct his skeletal anteroposterior discrepancy. Gingival display was reduced, and lip competence was restored. In addition, the results remained stable after 2 years. The patient was satisfied with his new profile as well as with the functional malocclusion at the end of treatment.CONCLUSION This case report provides orthodontists a good example of how to treat an adult with severe skeletal class Ⅱ malocclusion with vertical maxillary excess after an unsatisfactory orthodontic camouflage treatment. Orthodontic and orthognathic treatment can significantly correct a patient’s facial appearance.展开更多
BACKGROUND Diffuse large B-cell lymphoma(DLBCL)is a common non-Hodgkin's lymphoma.R-CHOP is a protocol for long-term chemotherapy for DLBCL patients.Longterm chemotherapy can lead to low immunity and increase the ...BACKGROUND Diffuse large B-cell lymphoma(DLBCL)is a common non-Hodgkin's lymphoma.R-CHOP is a protocol for long-term chemotherapy for DLBCL patients.Longterm chemotherapy can lead to low immunity and increase the risk of opportunistic pathogen infections in immunocompromised patients.CASE SUMMARY We report a case of coinfection with Pneumocystis jirovecii(P.jirovecii)and Legionella pneumophila(L.pneumophila)in a patient with DLBCL.The patient was a 40-year-old female who was diagnosed with DLBCL and was admitted due to pulmonary infection.P.jirovecii and L.pneumophila were detected in her bronchoalveolar lavage fluid by hexamine silver staining,isothermal amplification and metagenomic sequencing.CONCLUSION To the best of our knowledge,this is the first case of P.jirovecii and L.pneumophila coinfection found in a DLBCL patient.Clinicians should be aware of the risk of complicated infection in patients undergoing long-term chemotherapy.展开更多
BACKGROUND Diffuse idiopathic skeletal hyperostosis(DISH)is a disorder characterised by the calcification and ossification of ligaments and entheses.It is a frequent occurrence in elderly males,but rarely encountered ...BACKGROUND Diffuse idiopathic skeletal hyperostosis(DISH)is a disorder characterised by the calcification and ossification of ligaments and entheses.It is a frequent occurrence in elderly males,but rarely encountered in younger individuals.CASE SUMMARY A 24-year-old male was admitted to the hospital due to low back pain accompanied with numbness in both lower limbs for 10 d.Upon clinical examination and imaging tests,the patient was diagnosed with DISH with Scheuermann disease and thoracic spinal stenosis.Before the operation and medical treatment,the patient had hypoesthesia of the skin below the xiphoid process.Afterward,a standard laminectomy was conducted using ultrasonic bone curette and internal fixation was applied.Subsequently,the patient was given corticosteroids,neurotrophic drugs,hyperbaric oxygen and electric stimulation.As a result of the treatment,the patient’s sensory level decreased to the navel level and there was no major change in the muscle strength of the lower limbs.During follow-up,the patient’s skin sensation has returned to normal.CONCLUSION This case is a rare instance of DISH co-existing with Scheuermann’s disease in a young adult.This provides a valuable reference point for spine surgeons,as DISH is more commonly observed in middle-aged and elder adults.展开更多
BACKGROUND Seminal vesicle abscess(SVA)is the manifestation of a relatively rare urinary system infection.In response to urinary system inflammation,an abscess forms in special locations.However,acute diffuse peritoni...BACKGROUND Seminal vesicle abscess(SVA)is the manifestation of a relatively rare urinary system infection.In response to urinary system inflammation,an abscess forms in special locations.However,acute diffuse peritonitis(ADP)induced by SVA is unusual.CASE SUMMARY We report a case of a left SVA in a male patient complicated with pelvic abscess,ADP,multiple organ dysfunction syndrome,infectious shock,bacteremia,and acute appendiceal extraserous suppurative inflammation as a result of a long-term indwelling urinary catheter.The patient received a course of morinidazole+cefminol antibiotics but showed no obvious relief,so the perineal SVA underwent puncture drainage and abdominal abscess drainage+appendectomy was performed.The operations were successful.After the operation,anti-infection,anti-shock,and nutritional support treatments were continued and various laboratory indicators were regularly reviewed.The patient was discharged from the hospital after recovery.This disease is a challenge for the clinician because of the unusual spreading path of the abscess.Moreover,appropriate intervention and adequate drainage of abdominal and pelvic lesions are necessary,especially when the primary focus cannot be determined.CONCLUSION The etiology of ADP varies,but acute peritonitis secondary to SVA is very rare.In this patient,the left SVA not only affected the adjacent prostate and bladder but also spread retrogradely through the vas deferens,forming a pelvic abscess in the loose tissues of the extraperitoneal fascia layer.Inflammation involving the peritoneal layer led to ascites and pus accumulation in the abdominal cavity,and appendix involvement led to extraserous suppurative inflammation.In clinical practice,surgeons need to consider the results of various laboratory tests and imaging examinations to make comprehensive judgments involving the diagnosis and treatment plan.展开更多
BACKGROUND Diffuse lamellar keratitis(DLK)is a complication of laser-assisted in situ keratomileusis(LASIK).This condition can also develop after small-incision lenticule extraction(SMILE)with a distinctive appearance...BACKGROUND Diffuse lamellar keratitis(DLK)is a complication of laser-assisted in situ keratomileusis(LASIK).This condition can also develop after small-incision lenticule extraction(SMILE)with a distinctive appearance.We report the case involving a female patient with delayed onset DLK accompanied by immunoglobulin A(IgA)nephropathy.CASE SUMMARY A 22-year-old woman was referred to our department for DLK and a decline in vision 1 mo after undergoing SMILE.The initial examination showed grade 2 DLK in the flap involving the central visual axis of the right eye.She was immediately administered with a large dose of a topical steroid for 30 d.However,the treatment was ineffective.Her vision deteriorated from 10/20 to 6/20,and DLK gradually worsened from grade 2 to 4.Eventually,interface washout was performed,after which her vision improved.DLK completely disappeared 2 mo after washout.Six months after SMILE,the patient was diagnosed with IgA nephropathy due to a 4-year history of interstitial hematuria.CONCLUSION DLK is a typical complication of LASIK but can also develop after SMILE.Topical steroid therapy was ineffective in our patient,and interface washout was required.IgA nephropathy could be one of the factors contributing to the development of delayed DLK after SMILE.展开更多
BACKGROUND Metastasis to the thyroid gland(TM)from primary breast cancer is uncommon and usually presents as thyroid nodules;however,diffuse goiter without thyroid nodules is the first sign of TM in rare cases.Skip me...BACKGROUND Metastasis to the thyroid gland(TM)from primary breast cancer is uncommon and usually presents as thyroid nodules;however,diffuse goiter without thyroid nodules is the first sign of TM in rare cases.Skip metastases(SMs)to the lymph nodes in breast cancer,defined as discontiguous higher-level metastases in the absence of lower levels of contiguous metastases,have been reported in the contralateral cervical area of the primary tumor site in rare cases.CASE SUMMARY A 49-year-old previously healthy Chinese woman was diagnosed with right lateral invasive ductal carcinoma and underwent neoadjuvant chemotherapy treatment and bilateral mastectomy with axillary lymph node dissection.No malignancy of the left breast or axillary or distant metastases were identified preoperatively.However,enlarged left cervical lymph nodes were detected 36 mo after surgery,and rapidly enlarging thyroid glands without nodules were detected 42 mo after surgery.Fine-needle aspiration cytology was performed on the left cervical lymph nodes and left lobe of the thyroid,which were both revealed to contain metastases from the primary breast cancer.Additionally,the immunostaining profiles changed in the process of metastases.The patient was discharged with the NP(vinorelbine and cisplatin)regimen for subsequent treatment,and stable disease was determined when the curative effect was evaluated.CONCLUSION Diffuse goiter may be the first sign of TM,and enlarged lymph nodes in the contralateral cervical area may be SMs of primary breast cancer.展开更多
BACKGROUND Anti-glomerular basement membrane(GBM)disease is a rare rapidly progressive glomerulonephritis,frequently associated with alveolar hemorrhage in the lungs and involving the kidney by crescentic glomerulonep...BACKGROUND Anti-glomerular basement membrane(GBM)disease is a rare rapidly progressive glomerulonephritis,frequently associated with alveolar hemorrhage in the lungs and involving the kidney by crescentic glomerulonephritis.It has been described in association with other glomerulonephritides[such as anti-neutrophilic antibody(ANCA)-glomerulonephritis,membranous nephropathy,and immunoglobulin(Ig)A nephropathy].CASE SUMMARY Herein we present an unusual case of concurrent anti-GBM disease,ANCAassociated crescentic glomerulonephritis and diffuse proliferative immune complex mediated glomerulonephritis with predominant staining for IgA and C3 by immunofluorescence.The patient is a 46-year-old Caucasian male who presented to the emergency department with acute onset of flank pain and was found to have high serum creatinine levels of 15 mg/dL,proteinuria,and hematuria.He rapidly deteriorated and became anuric.He was found to have high anti-GBM antibodies titers(151 units)and high anti-neutrophil cytoplasmic-ANCA.Despite prompt and early treatment,the patient’s condition worsened,and he succumbed to his illness.CONCLUSION Our case emphasizes the importance of a renal biopsy in anti-GBM disease,even in the presence of positive serum anti-GBM antibodies,to identify other potential causes of rapidly progressive glomerulonephritis.The challenge in treating such cases lies in the different therapy modalities.展开更多
BACKGROUND Diffuse alveolar hemorrhage(DAH)is a multicause pulmonary capillary hemorrhage or pulmonary vascular small vessel injury(mainly capillaries,including arteries and veins),causing pulmonary microcirculation b...BACKGROUND Diffuse alveolar hemorrhage(DAH)is a multicause pulmonary capillary hemorrhage or pulmonary vascular small vessel injury(mainly capillaries,including arteries and veins),causing pulmonary microcirculation blood to accumulate in the alveolar space.DAH is classified by the histological absence or presence of pulmonary capillaritis(PC)and is rarely reported in the literature.CASE SUMMARY This is a report of three girls aged 6-11 years with DAH and PC.Two patients had decreased hemoglobin and one had increased erythrocyte sedimentation rate.High-resolution computed tomography showed bilateral diffuse pulmonary infiltrate,and diagnosis of PC was confirmed by lung biopsy.Immunofluorescence test in one case showed granular IgG and a small amount of granular IgA deposit on the alveolar walls,and was negative in the other two cases,describing isolated pauci-immune PC.Treatment was with glucocorticoid alone or combination with immunosuppressants,and the symptoms resolved in all patients.CONCLUSION PC is classified as isolated and immune-mediated PC associated with systemic disease.It can be controlled in most children with glucocorticoid alone or combined with immunosuppressants.展开更多
文摘BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,particularly in children.This report describes a DPB case resolved with long-term azithromycin therapy,em-phasizing the need for a timely and accurate diagnosis.CASE SUMMARY A 12-year-old girl,diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists,developed a history of chronic productive cough and chronic sinusitis for a year.On examination,she exhibited wheezing and coarse crackles.Despite receiving treatment for an asthma exacer-bation,her symptoms did not improve.A chest X-ray revealed reticulonodular infiltration in both lower lungs,prompting further evaluation with high-resolu-tion computed tomography(HRCT).The HRCT confirmed centrilobular nodule opacities,a'tree-in-bud'pattern,and non-tapering bronchi,suggesting DPB.Elevated cold hemagglutinin titers at 128 further supported the diagnosis.Her cough and sinusitis resolved within a month after starting azithromycin therapy,chosen for its anti-inflammatory and immunomodulatory effects.Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.CONCLUSION This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.
文摘BACKGROUND Hepatic hemangioma represents the most common benign primary hepatic neo-plasm.Although most such tumors are small and asymptomatic,giant cavernous hemangioma(GCH)is frequently symptomatic,and needs intervention.More-over,diffuse hepatic hemangiomatosis(DHH)is not rare in the liver parenchyma adjacent to a GCH.The management strategy for hepatic hemangiomas can differ depending on the presence of associated hemangiomatosis and the amount and distribution of the residual hepatic parenchyma.CASE SUMMARY Herein,we report two patients with GCH coexistent with DHH successfully treated by laparoscopic microwave ablation.The two GCHs were ablated com-pletely and the ablated zone atrophied obviously in imaging follow-ups after ablation.Surprisingly,there was a trend toward gradual reduction and dimini-shment of DHH.CONCLUSION Thermal ablation treatment might be an effective and less invasive treatment for GCH coexistent with DHH around the hemangioma.
文摘BACKGROUND Drug-induced lung injury is a common adverse effect of chemotherapeutic agents.Diffuse alveolar hemorrhage(DAH)is a fatal complication associated with druginduced lung injury.Early diagnosis and treatment of DAH is critical,as delayed management can lead to respiratory failure and poor outcomes.However,the diagnosis of DAH is difficult because of the nonspecific clinical manifestations;as such,bronchoscopy is necessary to establish a diagnosis.CASE SUMMARY The patient presented with fever and dry cough.He had been receiving fluoropyrimidine and oxaliplatin therapy for esophageal squamous cell carcinoma.Chest imaging revealed diffuse ground-glass opacities.Bronchoscopy with bronchoalveolar lavage was performed,which confirmed the diagnosis of DAH.Although the patient’s respiratory status rapidly worsened,high-dose corticosteroid therapy with respiratory support gradually improved the patient’s condition and he was successfully extubated.CONCLUSION Prompt DAH diagnosis and bronchoscopy in patients receiving oxaliplatincontaining chemotherapy presenting with acute respiratory failure are critical for improving outcomes.
基金Supported by Natural Science Foundation of Shandong Province,No.81700472Clinical+X Project Fund of Binzhou Medical College,No.BY2021LCX11and Binzhou Medical University Science and Technology Program Projects,No.BY2019KJ13.
文摘BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion of the inner esophageal wall. Midesophagealdiverticula are relatively rare and may coexist with diffuse esophagealspasm. However, the potential esophageal motility disorders associated withthese lesions are frequently overlooked in clinical practice. The use of endoscopicinterventions may offer a novel approach for the alleviation of dysphagia associatedwith this condition.CASE SUMMARYWe present a case of a 74-year-old woman with dysphagia, diagnosed with midesophagealdiverticulum and diffuse esophageal spasm. Due to her physical condition,submucosal tunneling endoscopic septum division (STESD) was initiallyperformed for the diverticulum. One month later, the esophageal spasm wastreated using per-oral endoscopic myotomy (POEM). This combined treatmentsignificantly improved her dysphagia, and she was discharged.CONCLUSIONSTESD and POEM are effective and safe for the treatment of dysphagia caused bymid-esophageal diverticula with diffuse esophageal spasm.
文摘BACKGROUND Primary testicular lymphoma(PTL)is a rare,aggressive malignancy,representing a small fraction of testicular tumors and non-Hodgkin lymphomas,yet it is the most common testicular malignancy in older men.Diffuse large B-cell lymphoma(DLBCL),which is typically the aggressive subtype,dominates PTL and shows diffuse B-cell infiltration.Venous tumor thrombus,uncommon in lymphomas,is uniquely reported in this case of testicular DLBCL with gonadal vein involvement.CASE SUMMARY A 62-year-old man presented with a two-month history of painless left testicular swelling and stiffness.Diagnostic imaging[ultrasonography,computed tomography(CT),and 18F-fluorodeoxyglucose positron emission tomography/CT(18FFDG-PET/CT)]revealed bilateral testicular masses and a gonadal vein tumor thrombus(SUVmax 16.5).Left orchiectomy confirmed DLBCL with CD20,Bcl-2,and MUM1 positivity(Ki-67:approximately 80%).The disease was staged as Ann Arbor stage IVA(International Prognostic Index score 3,high-intermediate risk).The patient received Rituximab,Polatuzumab Vedotin,Cyclophosphamide,Epirubicin,and Prednisolone chemotherapy,completing the first cycle with good tolerability.No adverse events were reported,and follow-up is ongoing to assess long-term outcomes.This case highlights the diagnostic utility of 18F-FDGPET/CT and the importance of multidisciplinary management in rare PTL presentations with tumor thrombus.CONCLUSION This case demonstrates the diagnostic complexities of PTL with gonadal vein tumor thrombus,underscoring the importance of considering lymphoma in elderly patients with testicular masses and venous involvement.A multi-disciplinary team including urologists,hematologists,and radiation oncologists is needed to ensure appropriate therapy.
基金National Research Foundation of Korea funded by the Ministry of Education,No.2013R1A1A4A01013178.
文摘BACKGROUND It is difficult to restore the cognitive functions of patients with impaired cognition caused by brain injury.Diffusion tensor imaging can visualize the integrity of neural tracts in the white matter(WM)three-dimensionally.It is unclear whether encephalitis following scrub typhus damages the WM.For the first time,we aimed to report diffusion tensor tractography(DTT)findings in a chronic patient with cognitive impairment following scrub typhus encephalitis,which revealed injury to the Papez circuit of the WM.CASE SUMMARY A 70-year-old male patient was affected by encephalitis caused by scrub typhus that occurred 23 years ago.He had poor cognition and his clinical examination findings were as follows:Mini-Mental Status Examination score,14;and handgrip strength(right/left,kg),32.3/31.3.DTT revealed serious injuries of the left thalamocingulate tract and right mammillothalamic tract in the Papez circuit,and a partial injury of the anterior part of the fornix.CONCLUSION Using DTT,we found a relationship between cognitive impairment and the integrity of the Papez circuit following scrub typhus.
文摘An optimal algorithm for the retrieval of chlorophyll, suspended sediments and gelbstoff of case Ⅱ waters in the Pearl River estuary was established with the optical parameters derived from the in-situ data obtained in Jan. 2003 in the same area. And then, the chlorophyll, suspended sediments and gelbstoff of the SeaWiFS pixels on Jan. 29, 2003 corresponding to the in-situ sites of Jan. 25 and 26, 2003 were synchronously retrieved, with average relative errors of 14.9%, 12.1% and 13.6% for chlorophyll, suspended sediments and gelbstoff, respectively. The research results indicated that the optimal retrieval algorithm established here was relatively fit for the retrieval of the chlorophyll, suspended sediments and gelbstoff of case Ⅱ waters in the Pearl River estuary, and had quite good retrieval accuracy.
文摘BACKGROUND Warthin’s tumor(WT)is composed of several cysts that are lined with tall,bilayered oncocytic columnar cells and lymphoid stroma.Within WT,the two components rarely transform into carcinoma or lymphoma,and when it does,carcinoma is the most common type.Approximately 28 cases of lymphoma with WT have been reported,most of which were non-Hodgkin lymphomas,and only a few cases were Hodgkin lymphomas.In the present report,we studied a case of diffuse large B cell lymphoma(DLBCL)arising from follicular lymphoma(FL)with WT in the parotid gland and its immunophenotypic and genetic features.CASE SUMMARY A 67-year-old man presented with a slowly enlarging right cheek mass for 12 years,and the mass began to change in size over a 2-mo time period.Over time,the patient felt mild local pain and right cheek discomfort.His medical history included a hepatitis B virus infection for 20 years and 30 years of smoking.Gross examination of the excised specimen showed a gray-red and gray-white appearance and a soft texture lobulated external surface neoplasm that measured 9 cm×8 cm×7 cm and was well circumscribed by relative normal parotid gland tissue.In cross section,the cut surfaces of the neoplasm were multicystic and had a homogeneous scaly appearance.A small fluid was discovered in the cyst.Bilateral oxyphilic,cuboidal or polygonal epithelium cells and lymphoid intraparenchymal components were observed.Many medium-to large-sized lymphoid cells were observed diffusely in part of the neoplasm,and a few secondary lymphoid follicles were observed at the center or edge of the neoplasm.Immunohistochemical staining showed that the columnar oncocytic cells were positive for AE1/AE3;neoplastic cells located in coarctate follicular were positive for CD20,Pax-5,bcl-2 and bcl-6;and the adjacent diffusely medium-to large-sized lymphoid cells were positive for Pax-5,bcl-6,CD20,MUM-1,bcl-2 and CD79a.The bcl-6(3q27)break-apart rearrangement was observed,and an Epstein Barr virus test was negative in the tumor cells.The patient survived 6 months after being diagnosed without any treatment.CONCLUSION WT-associated lymphoma is a very rare neoplasm in the parotid gland.Most cases are B cell non-Hodgkin lymphomas and involve middle-age and older males.This case highlights the extremely rare association of DLBCL arising from FL with WT and the importance of deliberate evaluation of the WT intraparenchymal stroma.Molecular detection techniques have potential advantages in the diagnosis of lymphoma with WT.
文摘BACKGROUND Diffuse uterine leiomyomatosis(DUL)is a benign uterine smooth muscle neoplasm with unknown etiology.Since DUL is rarely reported,knowledge regarding it is limited.The rate of early diagnosis is low,and DUL is often misdiagnosed as common multiple uterine leiomyomas before surgery.CASE SUMMARY A 27-year-old patient with no sexual activity presented to the Emergency Department of our hospital complaining of heavy vaginal bleeding.She had a history of uterine fibroids and menorrhagia.Pelvic examination showed a regularly enlarged uterus,similar in size to that associated with a 4-mo pregnancy.Pelvic magnetic resonance imaging(MRI)revealed numerous multiple uterine fibroids,and a transabdominal myomectomy(TM)was performed.Intraoperative exploration revealed that the myometrium was full of myoma nodules of variable sizes.Over 50 leiomyomas were removed.The pathology report confirmed leiomyoma.The patient was discharged and received a gonadotropin-releasing hormone analog(3.75 mg)for 6 mo.Ten months after surgery,the patient presented to the hospital again for abnormal uterine bleeding.MRI showed an irregular mass with a diameter of 5.2 cm without sharp demarcation in the uterine cavity.Submucosal leiomyoma was considered first,and the patient underwent a hysteroscopic myomectomy plus hymen repair.Intraoperative exploration showed that there were several leiomyomatosis masses in the cavity.Postoperative pathological exam-ination confirmed submucosal leiomyoma and necrotic and generative tissue.Although the menstrual cycle was still irregular,the patient did not have symptoms of menorrhagia for a period of 28 mo after the second surgery.CONCLUSION Individuals with DUL are easily misdiagnosed due to the lack of specific manifestations of this disease.MRI is helpful for early identification and preoperative evaluation.There is currently no unified method of diagnosis.For women who want to preserve fertility,conservative surgery should be made an option.When TM is chosen,a modified new myomectomy should be considered to avoid the drawbacks of traditional TM.
文摘BACKGROUND Secondary cardiac involvement by lymphoma has received limited attention in the medical literature, despite its grave prognosis. Although chemotherapy improves patients' survival, a subgroup of treated patients dies suddenly due to myocardial rupture following chemotherapy initiation. Reducing the initial chemotherapy dose with dose escalation to standard doses may be effective in minimizing this risk but the data are limited. We report on the successful management of a patient with disseminated diffuse large B-cell lymphoma(DLBCL) involving the heart using such approach.CASE SUMMARY An 18-year-old male presented to our hospital with six months history of progressive dyspnea, orthopnea and cough. On physical examination, the patient was found to have a plethoric and mildly edematous face, fixed elevation of the right internal jugular vein, suggestive of superior vena cava obstruction, and a pelvic mass. Investigations during admission including a thoracoabdominal computed tomography(CT) scan with CT guided biopsy of the pelvic mass,echocardiography and cardiac magnetic resonance imaging led to the diagnosis of disseminated DLBCL with cardiac involvement. The patients were successfully treated with chemotherapy dose reduction followed by dose escalation to standard doses, under the guidance of cardiac imaging. The patient completed chemotherapy and underwent a successful bone marrow transplant. He is currently in remission and has a normal left ventricular function.CONCLUSION Imaging-guided chemotherapy dosing may minimize the risk of myocardial rupture in cardiac lymphoma. Data are limited. Management should be individualized.
文摘In the present paper, a method is proposed to improve the performance of Artificial Neural Network (ANN) based algorithms for the retrieval of oceanic constituents in Case Ⅱ waters. The ANN-based algorithms have been developed based on a constraint condition, which represents, to a certain degree, the correlation between suspended particulate matter (SPM) and pigment (CHL), coloured dissolved organic matter (CDOM) and CHL, as well as CDOM and SPM, found in Case Ⅱ waters. Compared with the ANN-based algorithm developed without a constraint condition, the performance of ANN-based algorithms developed with a constraint conditions is much better for the retrieval of CHL and CDOM, especially in the case of high noise levels; however, there is not significant improvement for the retrieval of SPM.
文摘BACKGROUND Patient satisfaction with facial appearance at the end of orthodontic camouflage treatment is very important, especially for skeletal malocclusion. This case report highlights the importance of the treatment plan for a patient initially treated with four-premolar-extraction camouflage, despite indications for orthognathic surgery.CASE SUMMARY A 23-year-old male sought treatment complaining about his unsatisfactory facial appearance. His maxillary first premolars and mandibular second premolars had been extracted, and a fixed appliance had been used to retract his anterior teeth for two years without improvement. He had a convex profile, a gummy smile, lip incompetence, inadequate maxillary incisor inclination, and almost a class I molar relationship. Cephalometric analysis showed severe skeletal class Ⅱ malocclusion(A point-nasion-B point = 11.5°) with a retrognathic mandible(sella-nasion-B point = 75.9°), a protruded maxilla(sella-nasion-A point = 87.4°), and vertical maxillary excess(upper incisor to palatal plane = 33.2 mm). The excessive lingual inclination of the maxillary incisors(upper incisor to nasion-A point line =-5.5°)was due to previous treatment attempts to compensate for the skeletal class Ⅱ malocclusion. The patient was successfully retreated with decompensating orthodontic treatment combined with orthognathic surgery. The maxillary incisors were repositioned and proclined in the alveolar bone, the overjet was increased, and a space was created for orthognathic surgery, including maxillary impaction, anterior maxillary back-setting, and bilateral sagittal split ramus osteotomy to correct his skeletal anteroposterior discrepancy. Gingival display was reduced, and lip competence was restored. In addition, the results remained stable after 2 years. The patient was satisfied with his new profile as well as with the functional malocclusion at the end of treatment.CONCLUSION This case report provides orthodontists a good example of how to treat an adult with severe skeletal class Ⅱ malocclusion with vertical maxillary excess after an unsatisfactory orthodontic camouflage treatment. Orthodontic and orthognathic treatment can significantly correct a patient’s facial appearance.
文摘BACKGROUND Diffuse large B-cell lymphoma(DLBCL)is a common non-Hodgkin's lymphoma.R-CHOP is a protocol for long-term chemotherapy for DLBCL patients.Longterm chemotherapy can lead to low immunity and increase the risk of opportunistic pathogen infections in immunocompromised patients.CASE SUMMARY We report a case of coinfection with Pneumocystis jirovecii(P.jirovecii)and Legionella pneumophila(L.pneumophila)in a patient with DLBCL.The patient was a 40-year-old female who was diagnosed with DLBCL and was admitted due to pulmonary infection.P.jirovecii and L.pneumophila were detected in her bronchoalveolar lavage fluid by hexamine silver staining,isothermal amplification and metagenomic sequencing.CONCLUSION To the best of our knowledge,this is the first case of P.jirovecii and L.pneumophila coinfection found in a DLBCL patient.Clinicians should be aware of the risk of complicated infection in patients undergoing long-term chemotherapy.
文摘BACKGROUND Diffuse idiopathic skeletal hyperostosis(DISH)is a disorder characterised by the calcification and ossification of ligaments and entheses.It is a frequent occurrence in elderly males,but rarely encountered in younger individuals.CASE SUMMARY A 24-year-old male was admitted to the hospital due to low back pain accompanied with numbness in both lower limbs for 10 d.Upon clinical examination and imaging tests,the patient was diagnosed with DISH with Scheuermann disease and thoracic spinal stenosis.Before the operation and medical treatment,the patient had hypoesthesia of the skin below the xiphoid process.Afterward,a standard laminectomy was conducted using ultrasonic bone curette and internal fixation was applied.Subsequently,the patient was given corticosteroids,neurotrophic drugs,hyperbaric oxygen and electric stimulation.As a result of the treatment,the patient’s sensory level decreased to the navel level and there was no major change in the muscle strength of the lower limbs.During follow-up,the patient’s skin sensation has returned to normal.CONCLUSION This case is a rare instance of DISH co-existing with Scheuermann’s disease in a young adult.This provides a valuable reference point for spine surgeons,as DISH is more commonly observed in middle-aged and elder adults.
文摘BACKGROUND Seminal vesicle abscess(SVA)is the manifestation of a relatively rare urinary system infection.In response to urinary system inflammation,an abscess forms in special locations.However,acute diffuse peritonitis(ADP)induced by SVA is unusual.CASE SUMMARY We report a case of a left SVA in a male patient complicated with pelvic abscess,ADP,multiple organ dysfunction syndrome,infectious shock,bacteremia,and acute appendiceal extraserous suppurative inflammation as a result of a long-term indwelling urinary catheter.The patient received a course of morinidazole+cefminol antibiotics but showed no obvious relief,so the perineal SVA underwent puncture drainage and abdominal abscess drainage+appendectomy was performed.The operations were successful.After the operation,anti-infection,anti-shock,and nutritional support treatments were continued and various laboratory indicators were regularly reviewed.The patient was discharged from the hospital after recovery.This disease is a challenge for the clinician because of the unusual spreading path of the abscess.Moreover,appropriate intervention and adequate drainage of abdominal and pelvic lesions are necessary,especially when the primary focus cannot be determined.CONCLUSION The etiology of ADP varies,but acute peritonitis secondary to SVA is very rare.In this patient,the left SVA not only affected the adjacent prostate and bladder but also spread retrogradely through the vas deferens,forming a pelvic abscess in the loose tissues of the extraperitoneal fascia layer.Inflammation involving the peritoneal layer led to ascites and pus accumulation in the abdominal cavity,and appendix involvement led to extraserous suppurative inflammation.In clinical practice,surgeons need to consider the results of various laboratory tests and imaging examinations to make comprehensive judgments involving the diagnosis and treatment plan.
基金Supported by National Natural Science Foundation of China,No.81660169The Education Teaching Reform Project of First Clinical Department of Zunyi Medical College,No.202009.
文摘BACKGROUND Diffuse lamellar keratitis(DLK)is a complication of laser-assisted in situ keratomileusis(LASIK).This condition can also develop after small-incision lenticule extraction(SMILE)with a distinctive appearance.We report the case involving a female patient with delayed onset DLK accompanied by immunoglobulin A(IgA)nephropathy.CASE SUMMARY A 22-year-old woman was referred to our department for DLK and a decline in vision 1 mo after undergoing SMILE.The initial examination showed grade 2 DLK in the flap involving the central visual axis of the right eye.She was immediately administered with a large dose of a topical steroid for 30 d.However,the treatment was ineffective.Her vision deteriorated from 10/20 to 6/20,and DLK gradually worsened from grade 2 to 4.Eventually,interface washout was performed,after which her vision improved.DLK completely disappeared 2 mo after washout.Six months after SMILE,the patient was diagnosed with IgA nephropathy due to a 4-year history of interstitial hematuria.CONCLUSION DLK is a typical complication of LASIK but can also develop after SMILE.Topical steroid therapy was ineffective in our patient,and interface washout was required.IgA nephropathy could be one of the factors contributing to the development of delayed DLK after SMILE.
基金Supported by National Natural Science Foundation of China(General Program),No.81571694(to Peng YL).
文摘BACKGROUND Metastasis to the thyroid gland(TM)from primary breast cancer is uncommon and usually presents as thyroid nodules;however,diffuse goiter without thyroid nodules is the first sign of TM in rare cases.Skip metastases(SMs)to the lymph nodes in breast cancer,defined as discontiguous higher-level metastases in the absence of lower levels of contiguous metastases,have been reported in the contralateral cervical area of the primary tumor site in rare cases.CASE SUMMARY A 49-year-old previously healthy Chinese woman was diagnosed with right lateral invasive ductal carcinoma and underwent neoadjuvant chemotherapy treatment and bilateral mastectomy with axillary lymph node dissection.No malignancy of the left breast or axillary or distant metastases were identified preoperatively.However,enlarged left cervical lymph nodes were detected 36 mo after surgery,and rapidly enlarging thyroid glands without nodules were detected 42 mo after surgery.Fine-needle aspiration cytology was performed on the left cervical lymph nodes and left lobe of the thyroid,which were both revealed to contain metastases from the primary breast cancer.Additionally,the immunostaining profiles changed in the process of metastases.The patient was discharged with the NP(vinorelbine and cisplatin)regimen for subsequent treatment,and stable disease was determined when the curative effect was evaluated.CONCLUSION Diffuse goiter may be the first sign of TM,and enlarged lymph nodes in the contralateral cervical area may be SMs of primary breast cancer.
文摘BACKGROUND Anti-glomerular basement membrane(GBM)disease is a rare rapidly progressive glomerulonephritis,frequently associated with alveolar hemorrhage in the lungs and involving the kidney by crescentic glomerulonephritis.It has been described in association with other glomerulonephritides[such as anti-neutrophilic antibody(ANCA)-glomerulonephritis,membranous nephropathy,and immunoglobulin(Ig)A nephropathy].CASE SUMMARY Herein we present an unusual case of concurrent anti-GBM disease,ANCAassociated crescentic glomerulonephritis and diffuse proliferative immune complex mediated glomerulonephritis with predominant staining for IgA and C3 by immunofluorescence.The patient is a 46-year-old Caucasian male who presented to the emergency department with acute onset of flank pain and was found to have high serum creatinine levels of 15 mg/dL,proteinuria,and hematuria.He rapidly deteriorated and became anuric.He was found to have high anti-GBM antibodies titers(151 units)and high anti-neutrophil cytoplasmic-ANCA.Despite prompt and early treatment,the patient’s condition worsened,and he succumbed to his illness.CONCLUSION Our case emphasizes the importance of a renal biopsy in anti-GBM disease,even in the presence of positive serum anti-GBM antibodies,to identify other potential causes of rapidly progressive glomerulonephritis.The challenge in treating such cases lies in the different therapy modalities.
文摘BACKGROUND Diffuse alveolar hemorrhage(DAH)is a multicause pulmonary capillary hemorrhage or pulmonary vascular small vessel injury(mainly capillaries,including arteries and veins),causing pulmonary microcirculation blood to accumulate in the alveolar space.DAH is classified by the histological absence or presence of pulmonary capillaritis(PC)and is rarely reported in the literature.CASE SUMMARY This is a report of three girls aged 6-11 years with DAH and PC.Two patients had decreased hemoglobin and one had increased erythrocyte sedimentation rate.High-resolution computed tomography showed bilateral diffuse pulmonary infiltrate,and diagnosis of PC was confirmed by lung biopsy.Immunofluorescence test in one case showed granular IgG and a small amount of granular IgA deposit on the alveolar walls,and was negative in the other two cases,describing isolated pauci-immune PC.Treatment was with glucocorticoid alone or combination with immunosuppressants,and the symptoms resolved in all patients.CONCLUSION PC is classified as isolated and immune-mediated PC associated with systemic disease.It can be controlled in most children with glucocorticoid alone or combined with immunosuppressants.
