Post molar choriocarcinoma with solitary renal metastasis in the absence of primary uterine tumor: a case report and review of the literature.

BACKGROUND: Choriocarcinoma is a rare and highly malignant form of gestational trophoblastic disease that may develop following pregnancy, abortion, or a hydatiform mole. Renal metastatic involvement by post molar choriocarcinoma is even rarer. In this case report, we describe a unique case of post molar choriocarcinoma with a solitary renal metastasis in the absence of a primary uterine tumor and metastases in other sites, which presented with urological symptoms and spontaneous renal hemorrhage. CASE PRESENTATION: A 41-year-old Persian woman with history of complete hydatiform mole presented with severe flank pain, nausea, vomiting, gross hematuria, and vaginal bleeding. Laboratory tests demonstrated a serum beta human chorionic gonadotropin hormone level of 60,000 mIU/mL. Imaging studies showed a lesion at the lower pole of the left kidney with active bleeding surrounded by hematoma, as well as an empty uterine cavity. Additionally, bilateral pleural effusion was detected without any lesion within the lungs. Subsequently, the patient underwent laparotomy, partial nephrectomy, and left para-ovarian cystectomy. Endometrial curettage was also carried out. The histopathology report revealed choriocarcinoma renal metastasis with high expression of beta human chorionic gonadotropin, cytokeratin 7, and Ki 67. Moreover, there were no malignant cells in the endometrial curettage specimens, and a corpus luteum cyst was found within the para-ovarian cyst. Further investigations revealed that the pleural effusion was free of malignant cells, and there was no evidence of metastatic lesions in the brain. As a result, the patient was referred to the oncology department to receive chemotherapy, and the beta human chorionic gonadotropin levels dropped to 5 mIU/mL after receiving courses of a standard regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovin over 3 weeks. Finally, monthly measurements of beta human chorionic gonadotropin levels for 6 months indicated that levels have constantly remained within normal ranges, showing no evidence of recurrence or new metastasis. CONCLUSIONS: Urological symptoms such as hematuria or spontaneous renal hemorrhage might be the only presentation of post molar choriocarcinoma with renal involvement. Thus, it can be beneficial to measure serum beta human chorionic gonadotropin levels among females of childbearing age who present with unexplained urological symptoms, especially if there is a history of prior hydatiform mole.

Unilateral cerebellar hypoplasia in a 9-year-old child with chronic granulomatous disease: A case report.

Unilateral cerebellar hypoplasia is a rare neurological condition that affects the development of the cerebellum, causing symptoms like poor coordination, balance issues, tremors, and speech problems. Unilateral cerebellar hypoplasia can occur as an isolated finding or as part of a larger neurological disorder or hereditary disease. There have been rare recorded instances where patients with chronic granulomatosis disease have been found to have neurological symptoms, such as brain abscesses or persistent inflammation, even though that CGD primarily affects the immune system and causes recurrent infections. A 9-year-old male with a known diagnosis of CGD presented to our neurology outpatient department with complaints of frequent falls and speech abnormalities. His parents described suspicious seizure-like movements and poor scholarly performance. Neurologic examination showed ataxic gait, slurred speech, and right-sided plantar extensor reflex. Initial laboratory findings were normal. MRI revealed marked reduced volume of the left cerebellar hemisphere with intact vermis and asymmetry of the posterior fossa. The residual left cerebellar hemisphere showed a normal folia and gray-white matter differentiation pattern. CSF filled the space created by the left hypoplastic cerebellum. A diagnosis of unilateral cerebellar hypoplasia was made. There is no known direct association between chronic granulomatous disease and unilateral cerebellar hypoplasia. However, more research is required to discover whether there is any connection between them. Although it is possible for a child to have CGD and UCH, managing such cases requires a multidisciplinary approach involving neurologists, immunologists, and other specialists to provide appropriate care and treatment.

Agenesis of the right external iliac artery in a 23-year-old woman with left leg ischemia.

External iliac agenesis is an uncommon congenital issue characterized by the absence or incomplete development of the external iliac artery, a significant blood vessel supplying the lower limbs, potentially causing symptoms like pain, weakness, ischemia, and numbness. We are currently discussing a case of a 23-year-old woman who complained of pain in her left lower limb. A thorough work-up was conducted to rule out ischemia, and during the diagnostic process, a CT scan revealed the complete absence of the right external iliac artery. It can be concluded that this is a rare vascular anomaly that can lead to significant morbidity and mortality. Early diagnosis and prompt management are crucial for preventing complications such as limb ischemia and gangrene.

Rare central nervous system manifestation of granulomatosis with polyangiitis in a 12-year-old child: A case report.

To share a unique case of granulomatosis with polyangiitis (GPA) identified in a child with CNS involvement, specifically PRES (posterior reversible encephalopathy syndrome). Discuss this uncommon manifestation's clinical characteristics, diagnostic process, and treatment. We are currently discussing a 12-year-old female patient who presented with a chronic cough, shortness of breath, and a new-onset fever. Upon further examination, the patient was diagnosed with GPA, confirmed through positive cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA), a renal biopsy, and multiple lung cavitary lesions. During her hospitalization, the patient also experienced neurological symptoms, including a severe headache, blurred vision, loss of consciousness, and an abnormal neurological exam, which led to brain MR imaging. The imaging revealed evidence of small vessel vasculitis with confluent T2 hyper signal intensity of gray-white matter junctions in both parietooccipital and frontal lobes containing hemorrhagic components, suggesting Posterior reversible encephalopathy syndrome. This case of Wegener's granulomatosis is noteworthy due to its occurrence in a pediatric patient with CNS involvement, specifically (posterior reversible encephalopathy syndrome). This event highlights the importance of recognizing that autoimmune disorders can present infrequently in young patients. Diagnosing Wegener's granulomatosis can be challenging, particularly when the CNS is affected. However, when appropriate treatment is initiated promptly, favorable outcomes can be achieved, as evidenced by the patient's improved condition with the prednisolone, captopril, and Rituximab treatment plan. Further research is necessary to understand better the underlying pathophysiology and optimal management of CNS involvement in GPA, particularly in the pediatric population.

Pelvic neurofibroma in a patient presenting with pelvic pain and urinary frequency: A case report.

Pelvic neurofibromas are benign and uncommon retroperitoneal masses. They arise from Schwann cells. One of the most common types of these benign tumors is intraneural neurofibromas, which are solitary, sporadic, and not associated with neurofibromatosis type 1. Here we discuss a case of pelvic neurofibroma in a 20-year-old male who presented with chronic pelvic pain. He had no positive family history of genetic disorders. On physical exam, just a partly firm mass without mobility in the hypogastric region was detected. Ultrasound and Computed tomography scan showed pelvic retroperitoneal mass superior to the urinary bladder with extension to the rectovesical pouch and invasion of the posterior wall and dome of the bladder. The patient underwent laparotomy revealing an infiltrative retroperitoneal mass with the invasion of the posterior wall, dome, and trigone of the bladder. Histopathological findings showed neurofibroma.