A 46-year-old man was admitted to our hospital with a chief complaint of hemoptysis for 2 months. Taken from local clinic, multiple metastatic pulmonary nodules on both lung fields were noted on chest X-ray. On our evaluation for primary lesion, IVP showed suspected space occupying lesion at the upper pole of left kidney. Ultrasonogram and abdominal CT of kidneys showed bilateral renal solid masses and a simple renal cyst of right kidney. Bilateral selective renal angiogram showed a huge hypervascular mass on the upper pole of left kidney and a small hypervascular solid mass on the middle pole of contralateral mate kidney. Under the clinical diagnosis of synchronous bilateral renal cell carcinoma, right partial nephrectomy with marsupialization of right renal cyst and left radical nephrectomy with lymphadenectomy was performed by Chevron's incision The patient was discharged from the hospital without any complication on 12th postoperative day. Three weeks after surgery, alpha interferon injection was started as 3 mega units intramuscularly once daily for 2 months and then 5 times per week, with cimetidine 200mg p.o. 4 times daily and continued until now for the control of pulmonary metastasis. On postoperative 10 months; control chest X-ray shows partial response of pulmonary metastasis.
Angiolymphoid Hyperplasia with Eosinophilia* ; Carcinoma, Renal Cell ; Cimetidine ; Diagnosis ; Hemoptysis ; Humans ; Interferon-alpha ; Kidney ; Lung ; Lymph Node Excision ; Middle Aged ; Neoplasm Metastasis ; Nephrectomy ; Thorax ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: This study was performed to determine the natural history of histologically confirmed IgA nephropathy in pediatric patients who presented with hematuria and proteinuria. PATIENTS AND METHODS: We reviewed the clinical course of 57 patients diagnosed with IgA nephropathy at the age of 15 years or younger from 1981 to 2000. All patients presented with hematuria or minimal proteinuria(<40 mg/m2/day) and had normal renal function and blood pressure at the time of renal biopsy. Based on the clinical and pathological findings at the time of diagnosis, we sought for complications of IgA nephropathy such as heavy proteinuria(> or =40 mg/m2/day), hypertension, and chronic renal failure. RESULTS: The mean age at presentation was 9.5+/-2.8 years(4 to 15 years) and 42(74%) were male. Isolated gross hematuria was observed in 20 patients(35%), microscopic hematuria in 3(5%), minimal proteinuria in 4(7%), both gross hematuria and minimal proteinuria in 15(26 %), and both microscopic hematuria and minimal proteinuria in 15(26%). During a median follow-up of 7.0+/-3.5 years, 38(67%) had complete resolution of hematuria and proteinuria, 12(21%) had persistently abnormal urinalysis without development of adverse events. Only 7(12%) developed adverse events:4(7%) developed severe proteinuria, 1(2%) became hypertensive, and 2(3%) developed impaired renal function. By univariate analysis using the chi-square test, the age at presentation(>10 years)(P<0.01) and poor histological classes of the Lee or Haas classification at onset(P<0.05) were significantly correlated with adverse events, whereas sex and clinical signs at onset were less concordant. CONCLUSION: We can conclude that the prognosis of IgA nephropathy diagnosed in early childhood is better and a good correlation exists between the clinical manifestations of this disease and the histological classes.
Biopsy ; Blood Pressure ; Child* ; Classification ; Diagnosis ; Follow-Up Studies ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Hypertension ; Immunoglobulin A* ; Kidney Failure, Chronic ; Male ; Natural History ; Prognosis* ; Proteinuria ; Urinalysis

We report a case of testicular tunica albuginea cyst with psammoma body which was treated with excision and testicular preservation. The presumptive diagnosis of a simple intratesticular cyst was made by ultrasound. The intraoperative pathological diagnosis was benign serous cyst and then simple excision of the lesion with testicular masses, and it may permit identification of lesions that can be excised locally with testicular preservation. To our knowledge tunica albuginea cyst with psammoma body, a characteristic histological finding, has not been reported. Its histogenesis was also discussed.
Diagnosis ; Testis ; Ultrasonography

Hyperfunctioning thyroid carcinoma is very rare. Hence, radionuclide imaging of thyroid hot nodules usually suggests a benign tumor, and less than 4% of cases have been reported as malignant. We would like to present a case of a hyperfunctioning papillary thyroid carcinoma that was initially treated with radioactive iodine. A 58-year-old woman was referred to our hospital for palpable thyroid nodule and a 5-kg weight loss within 6 months. Thyroid function test revealed thyrotoxicosis, and thyroid autoantibodies were absent. 99mTc thyroid scintigraphy showed a 2 x 2 cm-sized hyperactive hot nodule at the left lobe. Despite radioactive iodine treatment with a dose of 10 mCi 131I, thyroid function did not improve. Fine needle aspiration revealed papillary thyroid cancer. The patient underwent total thyroidectomy. Although clinical features and thyroid scans suggest a benign nodule, the possibility of malignancy should not be ruled out. Malignant thyroid hot nodules are rare; however, its possibility should be taken into account. Therefore, we suggest that ruling out malignancy by existing diagnostic guidelines can misdiagnose even a typical case with benign features. As thyroid nodule detection is getting sensitive and accurate, we present this case to discuss whether additional diagnostic approaches would be necessary for thyroid nodules.
Autoantibodies ; Biopsy, Fine-Needle ; Carcinoma ; Female ; Humans ; Iodine ; Middle Aged ; Thyroid Function Tests ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyrotoxicosis ; Weight Loss

In small children with left ventricular outflow tract obstruction, a few methods of surgical treatment could be considrred. The pulmonary autogrart provides a promising options for aortic valve replacement as part of the aortoventriculoplasty procedure in children. We report a successfully treated congenital aortic stcnoinsufricicncy with severe left ventricular dysfunction in an early infant with the aortoventriculoplasty using thc pulmonary autograft (the Ross-Konno procedure).
Aortic Valve ; Autografts* ; Child ; Dronabinol ; Humans ; Infant ; Transplantation, Autologous ; Ventricular Dysfunction, Left ; Ventricular Outflow Obstruction

Pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals is a rare and complex lesion in which great morphologic variability exists regarding the sources of pulmonary blood flow. We report a case of this disease with no true central pulmonary arteries in a 9-month-old-boy successfully treated by one-stage complete unifocalization and repair from a midline sternotomy approach.
Heart Septal Defects, Ventricular* ; Pulmonary Artery ; Pulmonary Atresia* ; Sternotomy