Epithelioid renal angiomyolipoma is a recently recognized pathologic variant of angiomyolipoma, which represents a more malignant course than a classical renal angiomyolipoma. We report a case of histologically proven renal angiomyolipoma. The patient presented with the symptoms and signs of spontaneous rupture of the kidney. On surgical exploration, the ruptured kidney with upper pole kidney mass was resected. The enlarged regional lymph nodes were also removed, which showed the same pathology.
Angiomyolipoma* ; Epithelioid Cells ; Humans ; Kidney ; Lymph Nodes ; Pathology ; Rupture, Spontaneous

Spontaneous renal rupture with hemoperitoneum in patients receiving continuous ambulatory peritoneal dialysis (CAPD) is very rare. Hemoperitoneum in peritoneal dialysis patients is often attributed to mechanical, gynecological or intraperitoneal abdominal pathology. Few cases have been described with retroperitoneal bleeding in CAPD patients. Hence we report one case of spontaneous renal rupture with retroperitoneal hemorrhage and haemoperitoneum in a CAPD patient with acquired cystic kidney disease.
Hemoperitoneum* ; Hemorrhage ; Humans ; Kidney Diseases, Cystic ; Pathology ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Rupture* ; Rupture, Spontaneous

OBJECTIVETo investigate the ultrastructure of small artery wall in patients with spontaneous rupture of hepatocellular carcinoma (HCC).

METHODSTransmission electron microscopy was used to study 11 specimens from ruptured HCC and 11 cases with non-ruptured HCC.

RESULTSThe phenomenon of activated phagocytosis in macrophage could be found in 3 cases with ruptured HCC and 10 cases with non-ruptured HCC, respectively (P < 0.05). In 9 specimens with ruptured HCC, the evidence of vascular injury characterized as less cell junctions and larger fenestrae in endothelial cells, broken elastic lamina, proliferated and fragmented elastin and damaged structure of collagen was found in small arteries. The phenomenon of electron-dense deposit in the elastic lamina, and signs of more protein synthesis in endothelial cells were also present in these specimens. In the patients with non-ruptured HCC, the evidence of vascular injury can be found only in 2 cases (P < 0.01). Less cell junctions and larger fenestrae could increase the permeability of vascular wall. The electron-dense deposition in elastic lamina may represent the deposition of antigen-antibody complex in elastic membrane which had been found in our previous study. The vascular injury was postulated to be caused by the deposition of antigen-antibody complex in vascular wall which was identified by our previous study. The vascular wall in the patient with ruptured HCC could become stiff and weak due to the proliferated fragment elastin and damaged collagen which would make the blood vessels more prone to splitting and result in hemorrhage and the rupture of HCC.

CONCLUSIONSThe vascular injury caused by antigen-antibody complex deposition might related to the spontaneous rupture of HCC.

Carcinoma, Hepatocellular ; pathology ; ultrastructure ; Humans ; Liver Neoplasms ; pathology ; ultrastructure ; Macrophages ; immunology ; Microscopy, Electron ; Rupture, Spontaneous ; pathology

Malignant transformation of teratoma in the anterior mediastinum is rare; the mass usually has a long history and is seen in older patients. We report a case of teratoma with malignant transformation in the anterior mediastinum, complicated by rupture. CT revealed a lobulated, inhomogeneous cystic mass with a fat com-ponent and wall calcifications. The lateral wall was disrupted and consolidation in the adjacent left upper lobe was noted, suggesting rupture. A heterogeneously enhanced solid portion, obliterating the fat plane between the mass and the great vessels was present in the medial aspect of the mass, and pathologic examina-tion demonstrated the presence of adenocarcinoma.
Adenocarcinoma/pathology ; Human ; Male ; Mediastinal Neoplasms/pathology/*radiography ; Mediastinum/pathology ; Middle Age ; Rupture, Spontaneous ; Teratoma/pathology/*radiography

Female ; Fibromatosis, Abdominal ; diagnostic imaging ; pathology ; surgery ; Humans ; Middle Aged ; Radiography ; Rupture, Spontaneous ; surgery

Spontaneous splenic rupture (SSR) in a patient undergoing hemodialysis has been described as an extremely rare and potentially fatal complication. We report here spontaneous splenic rupture in a 52-year-old woman undergoing regular hemodialysis for end-stage renal disease (ESRD). She complained of colicky abdominal pain in the left upper quadrant area and dizziness when she assumed an upright posture. Her vital signs revealed low blood pressure and tachycardia, which was suggestive of hypovolemic shock. Abdomen CT scan showed splenic hematoma and hemoperitoneum. However, she had no history of any event triggering the splenic rupture. An exploratory laparotomy showed a ruptured spleen and an emergency splenectomy was performed. We suggest that spontaneous spleen rupture may be attributed to uremic coagulopathy and heparin-induced coagulopathy.
Female ; Humans ; Kidney Failure, Chronic/*complications ; Middle Aged ; *Renal Dialysis ; Rupture, Spontaneous ; Spleen/*pathology ; Splenic Diseases/*complications/*pathology

This case demonstrates a rare variation in the pattern of injury and the presentation of acute lateral compartment syndrome of the leg. Although uncommon, lateral compartment syndrome of the leg after an ankle inversion leading to peroneus longus muscle rupture has been previously documented. This case was unusual because there was no overt ankle injury and the patient was able to continue physical activity, in spite of a significant rupture of the peroneus longus muscle that was determined later. This case highlights the necessary vigilance clinicians must maintain when assessing non-contact injuries in patients with possible compartment syndrome.
Acute Disease ; Adult ; *Compartment Syndromes/pathology/surgery ; Humans ; *Leg/pathology/surgery ; Male ; *Muscle, Skeletal/injuries/surgery ; Rupture, Spontaneous ; Young Adult

Cervical Vertebrae ; Hemangioma, Cavernous ; diagnosis ; pathology ; Humans ; Male ; Middle Aged ; Rupture, Spontaneous ; Spinal Canal ; pathology ; Spinal Neoplasms ; diagnosis ; surgery

OBJECTIVETo study the clinical significance of interstitial cell of Cajal (ICC) in spontaneous neonatal gastric perforation by examining the expression of c-kit and Cx43 in neonates with this disorder.

METHODSThe gastric specimens of 19 cases of neonatal gastric perforation from 2001 to 2010 and 8 cases of accidental death without digestive tract malformations (control) were collected. Immunohistochemical staining was employed to examine the expression of c-kit and Cx43 (immunomarkers of ICCs) in gastric tissues.

RESULTSThe muscular layer of the stomach wall became thinner or deficient in the gastric perforation group. C-kit and Cx43 positive cells in gastric tissues decreased significantly in the gastric perforation group compared with those in the control group (P＜0.01).

CONCLUSIONSThe development of spontaneous neonatal gastric perforation is associated with the decreased quantity of ICCs and damaged gap junction structure of the stomach wall.

Connexin 43 ; analysis ; Female ; Humans ; Infant, Newborn ; Interstitial Cells of Cajal ; pathology ; Male ; Proto-Oncogene Proteins c-kit ; analysis ; Rupture, Spontaneous ; Stomach ; chemistry ; Stomach Rupture ; congenital ; metabolism ; pathology

Bleeding in patients with liver cirrhosis is primarily caused by gastroesophageal varix in association with extensive collateral circulation, portal hypertensive gastropathy, a Mallory-Weiss tear and peptic ulcer disease. The spontaneous rupture of an artery, as a result of coagulopathy, is extremely rare in patients with liver cirrhosis; however, we recently observed a case of a spontaneous rupture of the lateral thoracic artery in a 47 year-old male patient with alcoholic liver cirrhosis. The patient expired despite repeated transcatheter arterial embolization of the lateral thoracic artery and best supportive care. This is, to our knowledge, the first documented case of the spontaneous rupture of the lateral thoracic artery in a patient with liver cirrhosis.
Aneurysm, Dissecting/*etiology ; Fatal Outcome ; Humans ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Rupture, Spontaneous/*etiology ; Thoracic Arteries/*pathology ; Time Factors