Renal cell carcinoma presenting with skull metastasis: a case report and literature review

The occurrence of metastasis to the head and neck region in renal cell carcinoma is extremely rare. An 80-year-old man presented with a soft nodule in the left parietal calvarium and was admitted to our hospital. Biopsy of the nodule showed nests of clear tumor cells, suggesting metastatic renal cell carcinoma. Computed tomography of the abdomen revealed a well-defined hypervascular tumor, measuring around 7 x 7 x 8 cm, exophytic from the lower pole of the right kidney. Since there were no other systemic metastases, right nephrectomy and complete resection of the skull lesion were performed. No adjunctive therapy was given postoperatively. After 22 months of follow-up, the patient was well and without evidence of disease.     

Renal cell carcinoma with unusual metastasis to the gallbladder

Gallbladder involvement in patients with renal cell carcinoma (RCC) is extremely rare. We present a report of a 61-year-old man with a synchronous RCC metastasis to the gallbladder presenting as an intraluminal polypoid mass simulating primary gallbladder carcinoma. Enhanced abdominal computed tomography demonstrated a well-enhanced polypoid lesion in the gallbladder. Intraoperative rapid pathological examination of the gallbladder tumor showed clear cell-type cancerous cells. Microscopically, tumor cells of both the resected kidney and gallbladder had round uniform nuclei, clear cytoplasm, and well-defined cytoplasmic borders, forming alveolar patterns. Immunohistochemically, the tumor cells were negative for cytokeratin 7 (CK7) and carcinoembryonic antigen (CEA), which is usually positive in primary clear cell carcinoma of the gallbladder. Therefore, the final diagnosis was RCC with a synchronous gallbladder metastasis.     

Symptomatic hypoglycemia in a patient with chronic hemodialysis

We describe the case of a 71-years-old man in chronic hospital hemodialysis who was admitted to the hospital because of symptomatic hypoglycemia. We discovered that this was due to a documented intoxication with cibenzoline, an antiarrhythmic drug, used to treat (supra-)ventricular tachyarrhythmia. In addition we made a short review of the literature concerning cibenzoline intoxication.     

Spontaneous regression of a large hepatocellular carcinoma with skull metastasis

Spontaneous regression of hepatocellular carcinoma (HCC) is a rare phenomenon. This case of a 65-year-old Korean man with HCC and metastatic frontal bone mass that regressed after radiotherapy for frontal bone mass without any other therapeutic modalities is described. The clinical diagnosis of HCC was made because of the presence of a liver mass on abdominal computed tomography (CT) scan, high serum alpha-fetoprotein value and tissue diagnosis on frontal bone biopsy. The patient refused any other recommended treatments, but accepted the radiation therapy due to a painful frontal bone mass, and ingested mushroom called Phellinus linteus for one and a half years. Ten months after radiation therapy, he experienced a reduction in size of the frontal bone mass and improvement of lesions in the liver, sternum and ribs. The patient is alive and in good condition without any symptoms or tumor aggravation in August 2002. It was concluded that a rare case of spontaneous regression of HCC had occurred.     

Trigeminal neuralgia caused by nasopharyngeal carcinoma with skull base invasion--a case report

We report a case of nasopharyngeal carcinoma with skull invasion, whose chief complaint was left-sided facial pain, which mimicked trigeminal neuralgia, and in whom there was no palpable neck mass. The magnetic resonance imaging (MRI) revealed an infiltrated lesion with abnormal signal intensity in the left nasopharynx, involving the left retro- and parapharyngeal space. The lesion was pathology-proven through biopsy of the nasopharynx to be a non-keratinizing carcioma. The patient received 6000 rad radiotherapy combined with 5-Fluorouracil(5-FU) and Cisplatin, and has been well after 2 years' follow-up.     

Candida parapsilosis in a patient receiving chronic hemodialysis

A case of Candida parapsilosis involving the left wrist in an immunocompromised host is described. The arthritis followed an indolent course, present for about 1 year before specific treatment was started. There was no response to 2-month ketoconazole therapy, and an open drainage had to be performed. In addition to crystal arthropathies and the more common infectious arthritides, one should be aware of arthritides with opportunistic microorganisms in immune compromised hemodialysis patients.     

Nasopharyngeal carcinoma with skull base invasion and hydrocephalus: a case report

We describe a case of nasopharyngeal carcinoma (NPC) with diffuse skull base bony destruction, resulting in obstructive hydrocephalus. Previously, these lesions were reported to be NPC with brain metastasis, without diffuse bony destruction of the skull base or hydrocephalus. We found no other cases of NPC with brain metastasis and diffuse bony destruction of the skull base resulting in hydrocephalus in the literature.     

Acinar cell carcinoma of the pancreas in a young patient with chronic pancreatitis

BACKGROUND:Acinar cell carcinoma (ACC) is a rare malignancy of the pancreas arising from acinar cells.Unlike ductal adenocarcinoma,this tumor rarely presents with pancreatitis.METHODS:We present a case of ACC associated with chronic calcifying pancreatitis,and a review of the literature focusing on diagnosis and management.RESULTS:A 43-year-old man was proposed for Wirsungojejunal derivation for chronic pancreatitis.Histopathological examination of the tissue extracted revealed an ACC.Duodenopancreatectomy ...     

Prolonged vancomycin-associated neutropenia in a chronic hemodialysis patient

A chronic hemodialysis patient developed severe marrow granulocytic hypoplasia and peripheral blood neutropenia related to vancomycin therapy for an infected arteriovenous fistula. Neutropenia was prolonged and associated with sustained serum levels of vancomycin that persisted for more than 4 weeks following the last dose of vancomycin. No vancomycin-dependent leukoagglutinins were demonstrable in the patient's serum. Although a direct toxic effect on marrow granulocyte production seems likely, a vancomycin-dependent immune suppression of granulopoiesis cannot be ruled out.     

Heparin-induced cardiac tamponade and life-threatening hyperkalema in a patient with chronic hemodialysis

Heparin, a commonly used anticoagulant agent, is frequently used in patients undergoing hemodialysis. As with most medications, heparin has a significant side effect profile. Two of its most important side effects, major bleeding and hyperkalemia, may be devastating without immediate diagnosis and treatment. Major bleeding such as gastrointestinal, genitourinary or intracranial bleeding is occasionally encountered and rarely neglected. However, heparin-induced cardiac tamponade is rarely encountered and may be easily overlooked. Another side effect, heparin-induced hyperkalemia, an unusual but well-described side effect, is frequently forgotten until life-threatening arrhythmia has occurred. We report a case involving a 40-year-old male patient with uremia, who had received heparin for 10 days for deep vein thrombosis in the left lower extremity. Hemopericardium with cardiac tamponade and life-threatening hyperkalemia were both noted in this patient.