Acquired cystic kidney disease (ACKD), a common complication in patients with end-stage renal disease, is characterized by more than three kidney cysts and normal or decreased sizes of both kidneys without any familial history of cystic kidney disease. In autosomal dominant polycystic kidney disease (ADPKD), however, both kidneys are usually enlarged. Extrarenal manifestations are common in ADPKD, including hepatic cysts, seminal vesicle cysts, mitral valve prolapse. A 40-year-old man presented to the emergency clinic at Inha University Hospital with severe abdominal pain, nausea, and vomiting for 3 days. He had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 15 years, but it was recently changed to hemodialysis owing to sclerosing encapsulating peritonitis (SEP). Radiologic imaging studies revealed bilateral enlarged kidneys with multiple eggshell calcified cysts and some hepatic cysts, which suggested ADPKD. He underwent left nephrectomy, and pathological tests revealed ACKD-associated renal cell carcinoma (RCC) confined to the resected kidney. He was treated with steroids for SEP, and the symptoms resolved. We herein report a case of ACKD-resembling ADPKD-that progressed to RCC in a patient with concurrent SEP who had been undergoing CAPD for 15 years.
Abdominal Pain ; Adult ; Carcinoma, Renal Cell* ; Emergencies ; Humans ; Kidney ; Kidney Diseases, Cystic ; Kidney Failure, Chronic ; Mitral Valve Prolapse ; Nausea ; Nephrectomy ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Polycystic Kidney, Autosomal Dominant ; Renal Dialysis ; Renal Insufficiency, Chronic ; Seminal Vesicles ; Steroids ; Vomiting

Hepatitis-associated aplastic anemia is a rare disease, but can be fatal if it is diagnosed late or untreated. Despite the previous case report of severe aplastic anemia following hepatitis, hepatitis A virus (HAV)-associated aplastic anemia is very rare, and a case with bone marrow transplantation (BMT) has not been reported in the literature. Here, we report the case of a 13-year-old boy, who developed severe aplastic anemia after full recovery of acute HAV infection, and eventually received BMT for aplastic anemia following HAV infection. It is a very rare case and the first case that recovered after BMT. The aim of this case report is to highlight the potential of progression to aplastic anemia after acute HAV infection and the importance of suspicion when pancytopenia is developed.
Adolescent ; Anemia, Aplastic* ; Bone Marrow Transplantation ; Hepatitis ; Hepatitis A ; Hepatitis A virus* ; Humans ; Male ; Pancytopenia ; Rare Diseases

Since its first description in 1989, lymphoepithelial cyst of the thyroid gland (LEC-T) has been generally considered a branchial cleft derivative similar to its presentation in other sites, including thymus, parathyroid, and pancreas. However, its characterization has mainly focused on histologic and sonographic findings, and cytological findings are generally described simply or left out entirely. Fine needle aspiration cytology (FNAC) of our case showed large tissue fragments of epithelial cells on a background of lymphocytes. Some areas showed sheets or small nests of squamoid cells, which were closely admixed with clusters of lymphoid cells. Squamous cells contained relatively moderate to large amounts of eosinophilic cytoplasm and vesicular nuclei with occasional nuclear grooves that lacked intranuclear inclusions. Some cells demonstrated keratinization and nuclear atypia. Herein, we describe FNAC findings of LEC-T and review other possible diagnoses.
Biopsy, Fine-Needle* ; Branchial Region ; Branchioma ; Cytoplasm ; Diagnosis ; Eosinophils ; Epithelial Cells ; Intranuclear Inclusion Bodies ; Lymphocytes ; Pancreas ; Thymus Gland ; Thyroid Gland* ; Thyroid Neoplasms* ; Ultrasonography

Prevotella bivia (P. vivia) has a high proliferative potential in the presence of estrogen. Therefore, its involvement in vaginal tract infections, such as endometritis and pelvic inflammatory disease, has been well described in the literature. We experienced a very rare case of a 40-year old woman with a 6-cm abscess on the cuff who presented with a large amount of vaginal discharge and nausea two months after laparoscopic supracervical hysterectomy. Our case indicates that clinicians should be aware of the possibility of P. vivia infections although rare.
Abscess ; Endometritis ; Estrogens ; Female ; Humans ; Hysterectomy* ; Nausea ; Pelvic Inflammatory Disease ; Prevotella* ; Vaginal Discharge

Although the prognosis of papillary thyroid cancer (PTC) is extremely good, locoregional recurrences after initial treatment occur. Thyroglobulin (Tg) is a reliable tumor marker to detect recurrence or persistence of PTC. However, occasionally serum Tg may miss the detection of a recurrence. We report a 54-year-old female presented with hoarseness due to cervical recurrence without concomitant elevation of serum Tg and anti-Tg antibody, in contrast to extremely increased needle-washout Tg, who had undergone a total thyroidectomy and radioiodine ablation as initial therapies for PTC. Several factors causing such discrepancy between needle-washout Tg and serum Tg can be suggested including site of recurrence, volume of tumor, interference by some kind of plasma antibodies other than anti-Tg antibody, and any conformational defect of Tg protein. Among them, the most convincing explanation is that any conformational defect of Tg may lead to impaired secretion of Tg to blood. We suggest that more studies are needed to find the cause for potential mechanisms involved in PTC recurrences without increased serum Tg.
Antibodies ; Female ; Hoarseness ; Humans ; Middle Aged ; Plasma ; Prognosis ; Recurrence ; Thyroglobulin* ; Thyroid Neoplasms* ; Thyroidectomy

A 38-year-old female presented with abdominal pain, radiating to her back. Her medical history included type 2 diabetes, which had been uncontrolled for 8 months. Her initial laboratory tests showed marked hyperglycemia, metabolic acidosis, and elevated serum amylase and lipase levels, although the results were inconclusive in terms of a direct diagnosis of acute pancreatitis (AP). Abdominal computed tomography showed only minimal fluid collection at the pancreas tail. As her serum triglyceride (TG) level was 9,884 mg/dL, we made a working diagnosis of AP due to hypertriglyceridemia, and she was treated with massive hydration with an insulin infusion. Subsequently, she recovered rapidly from the abdominal pain, her serum glucose was controlled, and her serum TG decreased. Hypertriglyceridemia is a well-accepted underlying cause of AP. When extremely high hypertriglyceridemia is detected in patients with type 2 diabetes or metabolic syndrome, complications should be considered and managed.
Abdominal Pain ; Acidosis ; Adult ; Amylases ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Diagnosis ; Female ; Humans ; Hyperglycemia ; Hypertriglyceridemia ; Insulin ; Lipase ; Pancreas ; Pancreatitis* ; Triglycerides

Coronary artery fistula draining into lung parenchymal vasculature has not been reported. Herein, we describe a case of an 81-year-old woman who presented with a localized pulmonary edema on right upper lobe associated with coronary fistula emptied into vasculature in right upper lobe. She underwent transcatheter closure of the fistula with an Amplatzer Vascular Plug 4, which resulted in complete occlusion and improved localized pulmonary edema.
Aged, 80 and over ; Coronary Vessels* ; Female ; Fistula* ; Humans ; Lung* ; Pulmonary Edema*

Acute mesenteric venous thrombosis (MVT) is an uncommon form of intestinal ischemia with high mortality and usually occurs in the setting of preexisting comorbidities including thrombophilia and abdominal inflammatory conditions. Hyperhomocysteinemia has been known to be a risk factor for thromboembolism, often located on an unusual site. Considering that homocysteine metabolism is determined genetically to a high degree, a mutant of methylenetetrahydrofolate reductase (MTHFR) C677T causes hyperhomocysteinemia, leading to thrombophilia. Until now, there have been few reports of MVT associated with MTHFR gene mutation. We, herein, report a case of small bowel infarction associated with MVT by MTHFR gene mutation in an adult without any other risk factors of thrombophilia.
Adult ; Comorbidity ; Homocysteine ; Humans ; Hyperhomocysteinemia ; Infarction* ; Ischemia ; Mesenteric Veins ; Metabolism ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Mortality ; Risk Factors ; Thromboembolism ; Thrombophilia ; Thrombosis ; Venous Thrombosis*

A rare case of mixed carcinoma of the cervix is reported, composed of a small and large cell neuroendocrine carcinoma. Neuroendocrine cervical carcinomas are very rare and aggressive. The prognosis is very poor despite multimodal treatment. Earlier reports have shown that the majority of patients present with advanced stage disease, have lymph node metastasis, and are at a high risk for recurrence and disease progression. In this study, we report the case of a 26-year-old woman with composite small and large cell neuroendocrine carcinoma of the cervix. A woman presented with vaginal bleed since 2 months of presentation. Gynecologic examination revealed cervical enlargement, and punch biopsy of the cervical lesion was performed. The biopsy was disclosed a large cell neuroendocrine carcinoma. The patient underwent a radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection. The final histopathologic findings are mixed small and large cell neuroendocrine carcinoma of cervix.
Adult ; Biopsy ; Carcinoma, Neuroendocrine* ; Cervix Uteri* ; Combined Modality Therapy ; Disease Progression ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Uterine Cervical Neoplasms

We report a case of intrathyroidal and ectopic parathyroid hyperplasia in a 47-year-old female patient with secondary hyperparathyroidism. During evaluation for end stage renal disease, hypercalcemia and hyperparathyroidism were detected in laboratory exam and thyroid nodules were found in computed tomography, and thyroid ultrasonography. In subsequent dual-phase technetium-99m methoxyisobutrlisonitrile (Tc-99m MIBI) scan, delayed focal uptakes were found in thyroid gland and the upper mediastinum. I-123 scan showed photon defects in thyroid gland and no uptake in the upper mediastinum. The imaging findings indicate intrathyroidal and mediastinal ectopic parathyroid hyperplasia. The intrathyroidal and ectopic parathyroid hyperplasia were confirmed by surgical approach. Tc-99m MIBI scan was useful for detecting ectopic parathyroid hyperplasia concomitant intrathyroidal parathyroid lesion.
Female ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Hyperplasia* ; Incidental Findings* ; Kidney Failure, Chronic ; Mediastinum ; Middle Aged ; Parathyroid Neoplasms ; Technetium Tc 99m Sestamibi ; Thyroid Gland ; Thyroid Nodule ; Ultrasonography