Adenomatoid Tumor of the Right Adrenal Gland in a Patient with AIDS

An autopsy case with an incidentally discovered adenomatoid tumor (AT) arising in the right adrenal gland of a 34-yr-old man with AIDS is presented. The immediate cause of death was disseminated coccidioidomycosis. The affected right adrenal gland was partially substituted by a firm 3.0 cm nodule enclosed by cortical adrenal tissue. Histologically, the tumor had the typical appearance of those adenomatoid neoplasms described in the genital tract. The mesothelial origin of the neoplasm was confirmed by immunopositive cells for low weight cytokeratin and vimentin. Uncommon neoplasms in the adrenal glands of AIDS patients include leiomyosarcomas, leiomyomas, and malignant nerve sheath tumors. This report may represent the first case of an adrenal gland AT in a patient with AIDS, and probable the third well-documented histologically and immunohistochemically adrenal gland AT.     

A Rare Cause of Gross Hematuria Due to Placing a Patient with Distended Bladder in Prone Position

How to cite this article: Seema S, Trivedi S, Padala SRAN, Kiran M. A Rare Cause of Gross Hematuria Due to Placing a Patient with Distended Bladder in Prone Position. Indian J Crit Care Med 2023;27(1):73–74.     

Flank ulcer in a patient with primary antiphospholipid syndrome

A 32-year-old woman had a recurrent shallow ulcer on the flank. A biopsy specimen showed thromboses in the dermal vessels and she was found to have circulating antiphospholipid antibody with no associated systemic disease. A clean ulcer developed on the flank of a patient with primary antiphospholipid syndrome is considered to be a rarely encountered/unusual presentation of this syndrome.     

Hematuria and acanthocyturia in patients with diabetes

It has been suggested that the finding of acanthocyturia in patients with hematuria points to the presence of glomerulonephritis. However, little attention has been paid to the finding of acanthocyturia in diabetic patients with hematuria. Here we studied 93 consecutive diabetic patients and explored the prevalence of microscopic hematuria and acanthocyturia in association with normoalbuminuria (NO; urinary albumin excretion (UAE) of < 30 mg/g x creatinine), microalbuminuria (MI; UAE of 30-299mg/g x creatinine), macroalbuminuriaMA; UAE of > or = 300mg/g x creatinine), or chronic renal failure (CRF; serum creatinine levels of > or = 1.1mg/dl for male and > or = 0.9mg/dl for female). We defined microscopic hematuria as > or = 5 erythrocytes per high-power field and acanthocyturia as > or = 5% acanthocytes (erythrocytes of doughnut-like appearance with vesicle-shaped protrusions) among 100 erythrocytes in the centrifuged urinary sediment. Microscopic hematuria was found in 12 (24%) out of 49 patients with NO, in 9 (43%) out of 21 patients with MI, in 6 (75%) out of 8 patients with MA, and in 7 (47%) out of 15 patients with CRF. Patients with microscopic hematuria showed a significant increase in urinary albumin excretion as compared to those without (836 +/- 265 vs. 135 +/- 56, p < 0.01). Of patients with microscopic hematuria, acanthocyturia was observed only in 2 (22%) out of 9 patients with MI and in 2 (33%) out of 6 patients with MA. Two of 4 patients with acanthocyturia had elevated serum levels of IgA and chronic tonsillitis, which indicated the occurrence of IgA nephropathy in these patients. Thus, microscopic hematuria was common and associated with elevated UAE, while acanthocyturia was rare and observed only in patients with elevated UAE. We propose that more attention should be paid to the finding of acanthocyturia in diabetic patients with hematuria and albuminuria.     

Infected Branchial Cleft Cyst Due to Bordetella bronchiseptica in an Immunocompetent Patient

A healthy 23-year-old man with fever and a tender mass in his right anterior neck was found to have a branchial cleft cyst infected with Bordetella bronchiseptica. Initial testing suggested a Brucella species, but further laboratory testing identified the organism definitively. B. bronchiseptica infection in healthy adults is an unusual event.     

Adrenal adenomas in a patient with Gardner's syndrome

Gardner's syndrome is an autosomal dominant condition characterized by multiple colorectal polyposis, associated with various soft- and hard-tissue tumors. The occurrence of adrenal adenomas in patients with the syndrome has not been fully appreciated. The following is a report of a member of the original Utah kindred #109, first described in the early 1950's, who was found at autopsy to have bilateral adrenal adenomas. A review of the literature resulted in the identification of six cases with adrenal adenomas and one with a primary adrenal carcinoma. The association with the syndrome of these adrenal tumors, as well as other endocrine tumors, especially thyroid tumors, is discussed.     

Successfully Treated Escherichia coli-Induced Emphysematous Cyst Infection with Combination of Intravenous Antibiotics and Intracystic Antibiotics Irrigation in a Patient with Autosomal Dominant Polycystic Kidney Disease

A 62-yr-old woman with an autosomal dominant polycystic kidney disease (ADPKD) was admitted to our hospital for further evaluation of intermittent fever, nausea and left flank discomfort. The computed tomography (CT) scan revealed a gas-forming, infectious cyst of approximately 8.1 cm in size in left kidney lower pole. Escherichia coli was identified from the cyst fluid culture examination. Her symptoms improved only after the concomitant use of intravenous ciprofloxacin and an intracystic irrigation of ciprofloxacin through a percutaneous cystostomy drainage. Our case presents the successfully treated emphysematous cyst infection with combination of intravenous antibiotics and intracystic antibiotic therapy instead of surgical management.     

Hospital Stress and Patient Reports of Pain and Physical Status

Abstract

The Hospital Stress Rating Scale was used to measure stress due to the experience of hospitalization for 535 medical and surgical patients in a community hospital. Patients were also asked to rate the pain they experienced on a pain thermometer, and a recovery inventory was used to score patient self-reports of their physical status, both during hospitalization and subsequent to discharge. With statistical control for patient characteristics correlated with self-reports of pain and physical status, associations between hospital stress and these variables were observed. Patients scoring high in hospital stress tended to report more pain, lower physical status during hospitalization, and less improvement after discharge than patients scoring low in hospital stress.     

Case 10: Fluctuating Flank Tumor in a Young Woman

A case is reported of atypical glomus tumor occurring in the posterior inferior mediastinum of a 26-year-old woman complaining of severe back pain. The tumor was composed of atypical small, round tumor cells with scattered mitotic figures. In addition to sheet-like, diffuse proliferation of the tumor cells, some areas of the tumor contained small “glo-moid” cells arranged in organoid and hemangiopericytoma-like patterns. Immunohistochemically, many tumor cells were positive for muscle-type actins and a few cells were focally positive for desmin. Ultrastructural studies revealed smooth muscle features of tumor cells, that is, pinocytotic vesicles, external laminas, dense plaques, and occasional thin filaments with dense bodies. The patient remained well for 5 years and 4 months after the operation without additional radiation and chemotherapy. The tumor was diagnosed as an atypical, or low-grade malignant, glomus tumor morphologically. It seems important to recognize the presence of this type of tumor in sites other than extremities and to differentiate it from other malignant small, round cell tumors.     

Mesothelial cell inclusions in pelvic and para-aortic lymph nodes: a clinicopathologic analysis

Benign lymph node inclusions are commonly encountered during surgery for gynecologic neoplasms and are potential mimics of metastatic tumor. The presence of mesothelial cell inclusions in pelvic lymph nodes is extremely rare. We report the clinicopathologic features of 10 patients with ovarian tumors and mesothelial cell inclusions detected in the sinuses of pelvic and paraaortic lymph nodes. All patients had concurrent massive ascites and mesothelial cell hyperplasia at the time of lymph node dissection. Histologically, nodal mesothelial cells were identified predominantly within the subcapsular, trabecular and medullary sinuses. Moreover, intra- and extranodal lymphatics also contained mesothelial cells, confirming their mode of lymphatic transport to nodal sinuses. This finding, together with mesothelial cell hyperplasia and massive ascites suggest that mesothelial cells derive from reactive serosal mesothelium and are dislodged into draining lymphatics. This study indicated the pathogenic significance of the lymphatic transport mechanism. Nodal mesothelial cell inclusions should be distinguished from metastatic tumor to avoid inaccurate staging in a patient with a known tumor or the false negative diagnosis of an occult primary tumor. Recognition of this entity by immunohistochemical evaluation in addition to routinely stained sections is important to prevent a diagnosis of metastatic carcinoma or malignant mesothelioma.