scholarly journals A unique case of an alpha-fetoprotein-producing lung cancer with testicular metastasis

2012 ◽  
Vol 6 (5) ◽  
Author(s):  
Jennifer M Willder ◽  
Andrew M Thomson ◽  
Kenneth M Grigor ◽  
Grahame Howard ◽  
Grant D Stewart
Keyword(s):  
Lower Lobe ◽  
Lung Lesion ◽  
Alpha Fetoprotein ◽  
Lung Tumour ◽  
Unique Case ◽  
First Case ◽  
Overwhelming Evidence ◽  
Metastatic Lung ◽  
History Of ◽  
Poorly Differentiated

Alpha-fetoprotein (AFP)-producing primary lung tumours are rare; we present the first case of an AFP-producing lung tumour with metastasis to testes. The patient, a 72-year-old man, presented with a history of flu-like symptoms and abdominal pain. On examination he had a hard, tender left scrotal mass. Imaging showed a 4.4-cm right lower lobe lung mass and the serum-AFP was raised (1189 ng/mL). Left orchidectomy excised a necrotic tumour. Microscopy showed complete hemorrhagic infarction and immunohistochemistry showed a lack of staining for AFP. Serum-AFP rose 3 days post-orchidectomy to 1466 ng/mL. The patient subsequently developed melaena and died. Autopsy revealed a 9 × 5-cm necrotic right lower lobe lung tumour. Immunohistochemistry showed the tumour cells reacted with a pan-cytokeratin antibody and less than 5% expressed AFP. Bilateral adrenal tumour deposits were also identified in addition to those in the bowel and spleen. The expression of AFP solely in the lung lesion and lack of expression in both testes, together with a rise in serum-AFP post-orchidectomy and the bilateral adrenal metastases, is overwhelming evidence for the reversal of the usual situation: a poorly differentiated AFP-secreting metastatic lung adenocarcinoma

scholarly journals A Rare Presentation of Poorly Differentiated Lung Carcinoma with Duodenal Metastasis and Literature Review

2020 ◽  
Vol 14 (1) ◽  
pp. 186-196
Author(s):  
Ahmed Ahmed ◽  
Umair M. Nasir ◽  
Paul Delle Donna ◽  
Vanessa Swantic ◽  
Shahida Ahmed ◽  
...  
Keyword(s):  
Lung Carcinoma ◽  
Neuroendocrine Differentiation ◽  
Needle Aspiration ◽  
Gi Tract ◽  
Rare Presentation ◽  
Metastatic Lung ◽  
History Of ◽  
Multiple Blood ◽  
Poorly Differentiated ◽  
Metastatic Lung Carcinoma

Lung cancer is a common malignancy which is frequently found to metastasize to distant sites including bone, liver, and adrenal glands. There are rare reports of metastases to the gastrointestinal (GI) tract, with the duodenum being the most uncommon. We present a rare case of a poorly differentiated lung carcinoma metastasizing to the duodenum. This case enhances the medical literature as it provides additional distinct features to the clinical and histological presentation of metastatic lung carcinoma to the GI tract. A 61-year-old male with a history of poorly differentiated lung carcinoma presented with worsening dizziness, fatigue, and early satiety. He had extensive workup done in the past for hemoptysis including a computerized tomography scan of the chest which showed a new lobulated, apical lesion and hilar lymphadenopathy. He ultimately had a transthoracic fine-needle aspiration (FNA) of the mass and was later diagnosed with poorly differentiated lung carcinoma. On examination, the patient was noted to be pale, tachycardic, and hypotensive. The patient was noted to have an acute drop in his hemoglobin requiring fluid resuscitation, multiple blood transfusions, and evaluation with an esophagogastroduodenoscopy. He was found to have an oozing ulcer in the third portion of the duodenum whose biopsies showed poorly differentiated carcinoma with areas of neuroendocrine differentiation, similar to his lung biopsy results, which was consistent with metastatic lung carcinoma.

scholarly journals Persistent hiccups as the presenting symptom of a pulmonary embolism

2012 ◽  
Vol 2 (1) ◽  
pp. 2
Author(s):  
Steven Durning ◽  
David J. Shaw ◽  
Anthony J. Oliva ◽  
Michael J. Morris
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Chest Radiograph ◽  
Pulmonary Embolus ◽  
Lower Lobe ◽  
Initial Evaluation ◽  
Unique Case ◽  
Case Presentation ◽  
History Of ◽  
Symptomatic Bradycardia

An 81-year-old male with a history of symptomatic bradycardia controlled by a pacemaker presented to our institution with three days of persistent hiccups. He denied any pulmonary symptoms and his initial evaluation showed no evidence of tachypnea, tachycardia, or hypoxia. Pacemaker malfunction or migration of the pacer leads was ruled out as an etiology and no intracranial pathology was present. Admission chest radiograph was normal but a computed tomography of the chest demonstrated a left lower lobe pulmonary embolus. After treatment with anticoagulation was initiated, the hiccups resolved within the next week. This is a unique case presentation of hiccups as the only presenting symptom of an otherwise asymptomatic pulmonary embolism.

scholarly journals An Unconventional Diagnostic Method for Cryptosporidial Enteritis in a Healthy Host: Never Call It Quits!

2019 ◽  
Vol 13 (3) ◽  
pp. 526-531
Author(s):  
Shivantha Amarnath ◽  
Cheikh Talal El Imad ◽  
Kingsley Ebare ◽  
Hueizhi Wu ◽  
Stephen Mulrooney
Keyword(s):  
Diagnostic Method ◽  
Stool Culture ◽  
Watery Diarrhea ◽  
Peptic Ulcers ◽  
Unique Case ◽  
First Case ◽  
The Usa ◽  
History Of ◽  
Rising Incidence ◽  
Systemic Symptoms

Cryptosporidial enteritis has a rising incidence in the USA, mostly affecting immunocompromised individuals and children. It has a self-limiting course in healthy hosts. Herein, we present a unique case of a healthy middle-aged female who presented with a 1-month history of voluminous watery diarrhea and acute blood loss anemia. Cryptosporidial enteritis was diagnosed based on endoscopy with biopsy-proven evidence of 2 jejunal peptic ulcers infected with Cryptosporidiumspp. that was originally missed on routine stool culture, ova and parasite tests. The patient was successfully treated with nitazoxanide,and eradication of the protozoan was also confirmed on repeat endoscopic biopsies of the ulcer that were carried out 6 months later. To our knowledge, this is the first case to be reported in the literature with infective colonization of peptic ulcers with Cryptosporidiumspp.with consequent systemic symptoms.

Tumor-to-tumor metastasis: esophageal carcinoma metastatic to an intracranial paraganglioma

2009 ◽  
Vol 110 (4) ◽  
pp. 744-748 ◽  
Author(s):  
Jian-Qiang Lu ◽  
Moosa Khalil ◽  
William Hu ◽  
Garnette R. Sutherland ◽  
Arthur W. Clark
Keyword(s):  
Esophageal Carcinoma ◽  
Tumor Metastasis ◽  
Histopathological Examination ◽  
Unique Case ◽  
Blurred Vision ◽  
Poorly Differentiated Carcinoma ◽  
History Of ◽  
Poorly Differentiated ◽  
Tumor To Tumor Metastasis ◽  
Upper Gastrointestinal

Tumor-to-tumor metastasis (TTM) is a relatively rare but well-documented phenomenon. The authors report a unique case of esophageal carcinoma metastatic to an intracranial paraganglioma. A sellar and suprasellar tumor was found using MR imaging in an 81-year-old man who presented with a 3-week history of progressive headache and blurred vision. A subtotal excision of the tumor was achieved. Histopathological examination of the tumor disclosed a neoplasm with two distinct components: one showing the classic Zellballen pattern of a paraganglioma, the other exhibiting malignant features leading to the diagnosis of a poorly differentiated carcinoma metastatic to a sellar/suprasellar paraganglioma. The primary esophageal carcinoma was not uncovered until 2 months later, after the patient presented with upper gastrointestinal bleeding. The patient died 4 months after initial presentation. This case expands the spectrum of TTM, and emphasizes the importance of TTM in the practice of pathology.

scholarly journals Severe hemoptysis in post-tuberculosis bronchiectasis precipitated by SARS-CoV-2 infection

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Julien Lopinto ◽  
Marion Teulier ◽  
Audrey Milon ◽  
Guillaume Voiriot ◽  
Muriel Fartoukh
Keyword(s):  
Oxygen Therapy ◽  
Lower Lobe ◽  
High Flow ◽  
Distal Embolization ◽  
Case Presentation ◽  
First Case ◽  
High Flow Oxygen ◽  
Chronic Pulmonary Diseases ◽  
History Of ◽  
Multi Detector Computed Tomography

Abstract Background Since the beginning of SARS-CoV-2 outbreak in China, severe acute respiratory syndrome has been widely descripted. Hemoptysis has rarely been observed in SARS-CoV-2 infection. We report here a case of severe hemoptysis in post-tuberculosis bronchiectasis precipitated by SARS-CoV-2 infection and managed in a referral center. Case presentation A 58-year-old man was admitted to our intensive care unit for severe hemoptysis with history of post-tuberculosis bronchiectasis. At ICU admission the patient had fever and severe acute respiratory failure requiring high flow oxygen therapy. Respiratory tract sampling was positive for SARS-CoV-2. Multi-detector computed tomography angiography pointed out localized bronchiectasis on the left lower lobe and enlarged left bronchial and phrenic arteries; bronchial arteriography with distal embolization was performed with favorable outcome and no bleeding recurrence. Conclusions To our knowledge, this is the first case of acute exacerbation of bronchiectasis related to SARS-CoV-2 infection and complicated by severe hemoptysis. Whether the virus may play a role in the dysregulation of airway haemostasis, and contribute to episodes of hemoptysis in patients with chronic pulmonary diseases and predisposing factors might be investigated.

scholarly journals A unique case of multiple calvarial hemangiomas with one large symplastic hemangioma

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Najwa Abdalkabeer A. Bantan ◽  
Ahmed H. Abouissa ◽  
Muhammad Saeed ◽  
Mustafa Hassan Alwalily ◽  
Kamal Bakour Balkhoyour ◽  
...  
Keyword(s):  
Preoperative Embolization ◽  
Unique Case ◽  
First Case ◽  
Lytic Lesions ◽  
Level Of Consciousness ◽  
Cavernous Hemangiomas ◽  
History Of ◽  
Surgical Field ◽  
The Right ◽  
Epileptic Fits

Abstract Background Symplastic hemangioma is a benign superficial abnormal buildup of blood vessels, with morphological features which can mimic a pseudo malignancy. A few cases have been reported in the literature. We report here, a unique case of calvarial symplastic hemangioma, which is the first case in the calvarial region. Case presentation A 29-year-old male patient, with a left occipital calvarial mass since childhood, that gradually increased in size with age, was associated with recurrent epileptic fits controlled by Levetiracetam (Keppra), with no history of trauma. He presented to the emergency room with a recent headache, vomiting, frequent epileptic fits and a decrease in the level of consciousness 1 day prior to admission. A CT scan showed three diploic, expansile, variable sized lytic lesions with a sunburst appearance; two that were biparietal, and one that was left occipital, which were all suggestive of calvarial hemangiomas. However, the large intracranial soft tissue content, within the hemorrhage of the occipital lesion was concerning. The patient had refused surgery over the years; however, after the last severe presentation, he finally agreed to treatment. The two adjacent, left parietal and occipital lesions were treated satisfactorily using preoperative embolization, surgical resection, and cranioplasty. Histopathology revealed cavernous hemangiomas, in addition to symplastic hemangioma (pseudo malignancy features) on top at the occipital lesion. The right parietal lesion was not within the surgical field; therefore, it was left untouched for follow-up. Conclusions Histopathology and radiology examinations confirmed the diagnosis as symplastic hemangioma, on top of a pre-existing cavernous hemangioma. To the best of our knowledge, this is the first case of a calvarial symplastic hemangioma, which we report here.

scholarly journals Asbestosis Mimicking Metastatic Lung Cancer: Case Report

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 402
Author(s):  
Jin An ◽  
Minjeong Song ◽  
Boksoon Chang
Keyword(s):  
Lung Cancer ◽  
Interstitial Fibrosis ◽  
Lower Lobe ◽  
Lung Lesion ◽  
Cancer Case ◽  
Metastatic Lung Cancer ◽  
Pleural Thickening ◽  
Metastatic Lung ◽  
The Right ◽  
Thoracoscopic Biopsy

The clinical diagnosis of asbestosis is primarily based on chest radiographic evidence of pleural thickening and interstitial fibrosis combined with a history of exposure to asbestos. We report herein the case of a 65-year-old man with asbestosis pathologically diagnosed after surgical lung biopsy. He had a work history including farming, cementing, and casting and was admitted with dyspnea. Chest computed tomography revealed multiple well-defined nodules in both lungs and a 4.1 cm peribronchial consolidation with fibrotic changes in the right lower lobe. We suspected metastatic lung cancer and video-assisted thoracoscopic biopsy was performed in the lung lesion of the right lower lobe. Asbestosis was confirmed following histological examination. The patient is currently completing outpatient visits without significant changes.

Haemoptysis following shallow breath-hold diving in a cannabis user

2020 ◽  
Vol 13 (6) ◽  
pp. e234921
Author(s):  
Janice Borg ◽  
Julian Cassar ◽  
Sarah Bonello ◽  
Peter Fsadni
Keyword(s):  
Lower Lobe ◽  
Lung Damage ◽  
Alveolar Haemorrhage ◽  
Cannabis User ◽  
Breath Hold ◽  
Diffuse Alveolar Haemorrhage ◽  
First Case ◽  
History Of ◽  
High Index Of Suspicion ◽  
Parenchymal Damage

We report the first case of a healthy 24-year-old male with a 6-year history of regular cannabis use, who presented with haemoptysis after a shallow 3 m breath-hold dive. Blood investigations showed mild neutrophilia. CT thorax revealed focal ground-glass changes in the superior segment of the lower lobe. With a suspicion of pneumonia, oral antibiotics were initiated to poor effect. Through bronchoscopic visualisation and lavage, a diagnosis of diffuse alveolar haemorrhage was established. The clinical course was benign with resolution of symptoms and changes on CT thorax within 6 weeks of stopping marijuana use. Since all other causes of haemoptysis were excluded, pathophysiology was attributed to cannabis-induced lung parenchymal damage, exacerbated by a shallow breath-hold dive. To ensure appropriate management, a clinician should therefore have a high index of suspicion for drug use and other factors known to cause chronic lung damage in whom other causes of diffuse alveolar haemorrhage are excluded.

Pseudochylothorax: An unusual mode of revelation of pleural metastasis from solid tumor

2018 ◽  
Vol 104 (6) ◽  
pp. NP46-NP49 ◽  
Author(s):  
Arthur Streit ◽  
Francesco Guerrera ◽  
Matthieu Kouki ◽  
Joelle Siat ◽  
Paraskevas Lyberis ◽  
...  
Keyword(s):  
Solid Tumor ◽  
Lower Lobe ◽  
Pulmonary Nodules ◽  
Talc Pleurodesis ◽  
Cholesterol Crystals ◽  
First Case ◽  
Pleural Metastasis ◽  
Oropharynx Carcinoma ◽  
History Of ◽  
High Level

Introduction: Pseudochylothorax is a rare cause of pleural effusion. Sometimes confounded with chylothorax, firm diagnosis relies on analysis of the pleural liquid: exudative liquid (protein >30 g/L, lactate dehydrogenase >200 UI/L) with a high level of cholesterol (usually >200 mg/dL), low level of triglyceride (usually <110 mg/dL), cholesterol total/triglyceride ratio >1, absence of chylomicron, and in some cases the presence of cholesterol crystals. Pseudochylothorax is secondary to tuberculosis and rheumatoid arthritis in nearly 90% of cases. Its oncologic etiologies are mainly represented by malignant hematologic disorders. Methods: We report the first case of pseudochylothorax whose cause was the pleural metastasis of an extrathoracic solid tumor in a 61-year-old man with a medical history of oropharynx carcinoma. Results: Computed tomography scan disclosed a left partitioned effusion of high abundance, responsible for a passive atelectasis of the left lower lobe and multiple bilateral pulmonary nodules. A drainage tube was inserted to allow the evacuation of serous liquid; biochemical examination revealed an exudative effusion with pseudochylothorax criteria. Because the daily chest drainage output remained greater than 1 L per day, videothoracoscopy pleural biopsies and talc pleurodesis were performed. Histopathologic examination of the pleural biopsies found a pleural localization of oropharynx carcinoma. Conclusion: Because its occurrence is probably underestimated, when pseudochylothorax is diagnosed, oncologic causes should be considered.

The first case of BRG (SMARCA4)/INI Deficient Tracheal Carcinoma: A Case Report and Review of the Literature

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S150-S151
Author(s):  
A C Omo-Ogboi ◽  
W Wang ◽  
B Zhao
Keyword(s):  
Case Report ◽  
High Grade ◽  
Primary Tumors ◽  
First Case ◽  
Tobacco Abuse ◽  
History Of ◽  
Classification Of Tumors ◽  
Poorly Differentiated

Abstract Introduction/Objective Primary tumors of the trachea are rare, they account for less than 0.1% of tumors in humans. In adults, 90% of primary tracheal tumors are malignant, with squamous cell carcinoma and adenoid cystic carcinoma accounting for two-thirds, with other forms occurring less frequently. The BRG (SMARCA4)/INI deficient tumor is a relatively new defined entity which is recently introduced in the WHO Classification of Tumors, 5th edition, 2021. The gene SMARCA4 is located at 19p13. Loss of SMARCA4 has been reported in several aggressive tumors with high- grade undifferentiated rhabdoid morphology but has not been reported in the trachea. Hence, we report the first case of BRG (SMARCA4)/ INI deficient tracheal carcinoma. Methods/Case Report We present a 60-year-old male with a history of tobacco abuse, shortness of breath, and a tracheal mass on chest imaging. Bronchoscopy was performed and showed a fleshy friable lesion at the anterior trachea with evidence of blood dripping into the distal airways. Results (if a Case Study enter NA) Microscopic examination showed a high grade, poorly differentiated carcinoma with tumor necrosis, high mitotic counts, and marked nuclear pleomorphism. Immunohistochemical stains were performed. The tumor cells were strongly and diffusely positive for CK-7 and weakly positive for synaptophysin, negative for pan-cytokeratin, TTF-1, CK-20, p40, CK5/6, and chromogranin. Then BRG (SMARCA4) and INI 1 (BAR47) were performed and showed negative staining on BRG expression, while INI 1 is intact (nuclear expression). These features are consistent with BRG (SMARCA4)/ INI deficient carcinoma. Conclusion BRG (SMARCA4)/ INI deficient carcinoma is a new entity in the trachea, which is very aggressive with a poor prognosis. Targeted therapy or clinical trials may be available as additional cases are diagnosed in the future.

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