RESUMEN
INTRODUCTION AND IMPORTANCE: Myelolipoma is a rare benign neoplasm composed of mature elements of fatty and hematopoietic tissues. In addition to its low incidence, myelolipoma in kidney transplant patients is much rarer, with only a few cases of this entity reported in the literature. CASE PRESENTATION: A 37-year-old diabetic patient was admitted to the hospital due to severe left abdominal pain and elevated creatinine levels of 4.4 mg/dl. The patient has a history of two kidney transplantations. The patient was investigated with different modalities of imaging, which revealed a mass adjacent to the renal graft that was suspicious for malignancy. Histopathological assessment of the resected lesion showed findings consistent with myelolipoma. CLINICAL DISCUSSION: Although it's uncommon, myelolipoma should be considered in the differential diagnosis of any renal or extra-renal lesion in kidney transplant patients, including those with a history of graft rejection as in our patient. CONCLUSION: In light of the rarity of the lesions, we affirm the significance of the clinicians' reporting such cases that they encounter in order to better understand the disease's biological behavior.
RESUMEN
BACKGROUND: Cystic echinococcosis (CE) is classified by the WHO as a neglected disease inflicting economic losses on the health systems of many countries worldwide. The aim of this case-series study was to investigate the burden of human CE in Palestine during the period between 2010 and 2015. METHODOLOGY/PRINCIPAL FINDINGS: Records of surgically confirmed CE patients from 13 public and private hospitals in the West Bank and Gaza Strip were reviewed. Patients' cysts were collected from surgical wards and formalin-fixed paraffin-embedded (FFPE) blocks were collected from histopathology departments. Molecular identification of CE species /genotypes was conducted by targeting a repeat DNA sequence (EgG1 Hae III) within Echinococcus nuclear genome and a fragment within the mitochondrial cytochrome c oxidase subunit 1, (CO1). Confirmation of CE species/genotypes was carried out using sequencing followed by BLAST analysis and the construction of maximum likelihood consensus dendrogram. CE cases were map-spotted and statistically significant foci identified by spatial analysis. A total of 353 CE patients were identified in 108 localities from the West Bank and Gaza Strip. The average surgical incidence in the West Bank was 2.1 per 100,000. Spot-mapping and purely spatial analysis showed 13 out of 16 Palestinian districts had cases of CE, of which 9 were in the West Bank and 4 in Gaza Strip. Al-Khalil and Bethlehem were statistically significant foci of CE in Palestine with a six-year average incidence of 4.2 and 3.7 per 100,000, respectively. CONCLUSIONS/SIGNIFICANCE: To the best of our knowledge, this is the first confirmation of human CE causative agent in Palestine. This study revealed that E. granulosus sensu stricto (s.s.) was the predominating species responsible for CE in humans with 11 samples identified as G1 genotype and 2 as G3 genotype. This study emphasizes the need for a stringent surveillance system and risk assessment studies in the rural areas of high incidence as a prerequisite for control measures.