Clindamycin: An Effective Treatment for Granulomatous Mastitis Caused by Corynebacterium Kroppenstedtii in a Pregnant Patient.

Corynebacterium spp. are Gram-positive bacteria, and recent studies have proposed a potential link between granulomatous mastitis and Corynebacterium kroppenstedtii infections, posing a challenge in selecting appropriate antibiotics, particularly in pregnant women. A young pregnant woman presented with a palpable lump in her left breast. Subsequent assessment revealed the presence of necrotising granulomatous mastitis attributed to C. kroppenstedtii. Initially treated with amoxicillin/clavulanate, the patient showed no improvement. Consequently, clindamycin was administered based on culture and sensitivity results, which resulted in a favourable response with no recurrence of symptoms. This report aims to emphasise the efficacy of clindamycin as a treatment option for granulomatous mastitis caused by C. kroppenstedtii. LEARNING POINTS: Alternative antibiotics for treatment of granulomatous mastitis can be effective.The safety and efficacy of antibiotics in pregnancy is important.

Mycobacterium abscessus urinary tract infection in an immunocompetent host: A case report and literature review.

Mycobacterium abscessus is one of the nontuberculous mycobacteria (NTM), which can cause many clinical spectra, predominantly pulmonary infections followed by skin and soft tissue infections. The prevalence of Mycobacterium abscessus infections has been growing worldwide over the last two decades. Urinary tract infection (UTI) secondary to M. abscessus is a rare condition, and only five cases have been described in the literature so far. Therefore, managing such a condition is challenging and based on limited evidence. Here, we report a case of an adult male with a history of previous urological procedures who presented with lower urinary tract symptoms (LUTS) and was found to have a UTI secondary to Mycobacterium abscessus. In this case, we described our successful management approach of this rare entity of Mycobacterium abscessus infection, and we reviewed similar cases in the literature.

A case of crescentic glomerulonephritis in a patient with COVID-19 infection: A case report and literature review.

RATIONALE: Kidney involvement with COVID-19 infection is a well-known complication, and the majority of kidney involvement is related to ischemic injury/acute tubular injury. However, there are some cases of glomerulonephritis, the etiology of which is not yet known, but an immune process is likely to be the trigger. PATIENT CONCERNS: A 27-year-old man presented to our hospital with facial puffiness and lower-limb swelling. DIAGNOSIS: Laboratory assessment revealed features of impaired kidney function with proteinuria and hematuria; COVID-19 polymerase chain reaction was positive, which was consistent with pauci-immune crescentic focal segmental glomerulonephritis. INTERVENTION: After renal biopsy, the patient was started on methylprednisolone and rituximab. Due to worsening kidney parameters, he underwent intermittent hemodialysis as needed. OUTCOME: Kidney function tests partially improved; he was discharged on oral steroids with follow-up in the nephrology clinic to observe for the need for further hemodialysis. LESSONS: We conducted a literature review of cases of glomerulonephritis associated with COVID-19 and described numerous types of glomerulonephritis. This report highlights the importance of recognizing emerging glomerulonephritis with COVID-19, the different pathological patterns of renal biopsies, and management interventions and responses.

Pleural Effusion Revealing a Diagnosis of Ewing Sarcoma.

Pleural effusion can rarely present as an initial manifestation of Ewing sarcoma. We illustrate a case of a young male adult who was admitted with pleural effusion that led to the diagnosis of Ewing sarcoma.

Anti-glomerular Basement Membrane Disease: What Have We Learned?

Since the first clinicopathologic description by Ernest Goodpasture of a patient whom he considered to have died of influenza in 1919, substantial progress has been made in our knowledge of anti-glomerular basement membrane disease. This has led to a significant decrease in the morbidity and mortality associated with this disease. In this paper, we aim to review the literature that has enhanced our understanding of classic anti-glomerular basement membrane disease and its clinic-pathologic variants in the key areas of immunopathogenesis and histopathology. We also summarize varied clinical presentations and therapeutic strategies.

A case of xanthogranulomatous orchitis and its preoperative diagnostic challenges.

Xanthogranulomatous orchitis (XGO) is an extremely rare inflammatory disease of the testis which can mimic testicular tumors. We report a 42-year-old man who presented with left scrotal swelling for one-month duration associated with pus discharge from the overlying scrotal skin. Scrotal ultrasonography revealed an atrophic heterogenous left testis with scrotal wall collection. Surgical scrotal exploration with left simple orchidectomy was performed. By histopathology, the diagnosis of XGO was rendered. The preoperative diagnosis of XGO can very challenging and the diagnosis mainly relies on histopathologic examination. Adequate pathologic sampling is essential to rule out the possibility of co-existing testicular neoplasms.

Diabetic Kidney Disease: Past and Present.

Diabetes mellitus (DM) afflicting humans has been recognized as a disease for >3000 years. However, very little was known about its etiology and pathogenesis until about a century ago when increasing knowledge about anatomy and physiology of the human body gradually led to our understanding that the hormone insulin produced by the Islets of Langerhans in the pancreas plays a crucial role in the metabolism of glucose and maintaining the blood sugar level within a normal range. DM is caused by inadequate insulin production (type 1) or insulin resistance (type 2). For thousands of years, DM has been considered as a disease of the kidney; however, with the understanding of the pathogenesis of DM, it became clear that diabetic kidney disease (DKD) is a complication and not a cause of DM. DKD is associated with increased matrix expansion that manifests morphologically as a diffuse or nodular expansion of the mesangium and diffuse thickening of the glomerular and tubular basement membranes. Hyperglycemia plays a crucial role in the development of pathologic changes within the kidney. Once established, DKD usually undergoes a slow but relentless progression to end-stage renal disease. However, recent studies have shown that its progression can be slowed or even reversed by strict control of hyperglycemia. Morphologically, DKD may resemble several other glomerular diseases that must be ruled out before a definitive diagnosis. Patients with DM may also develop nondiabetic glomerular or interstitial diseases with or without DKD. The findings in nephrectomy specimens and the differential diagnoses are presented in detail.

Intrinsic Molecular Subclassification of Urothelial Carcinoma of the Bladder: Are We Finally there?

Bladder cancer is a highly prevalent disease throughout the world usually encountered in older patients, and associated with substantial morbidity, mortality, and cost. The treatment of bladder cancer has remained unchanged for the last several decades. However, in recent years the availability of comprehensive genomic data from The Cancer Genome Atlas and other large projects have considerably improved our understanding of the pathogenesis of these tumors. These studies demonstrated that bladder cancers can be grouped into 2 broad categories namely basal and luminal molecular subtypes with recognizable subgroups in each of these categories. Clinical data suggest that invasive basal cancers are more sensitive to neoadjuvant chemotherapy (NAC), such that most patients with basal cancers who are aggressively managed with NAC have excellent outcomes. Patients with luminal cancers do not appear to derive much clinical benefit from NAC, but some may appear to be sensitive to anti-programmed death-ligand 1 (PDL1) antibodies and possibly other immune checkpoint inhibitors. It is hoped that future studies will also identify biomarkers such as immunohistochemical markers which may be used to predict therapeutic response of these tumors. This will contribute substantially toward efficient and cost-effective diagnosis and management of these neoplasms.

Urothelial Carcinoma In Situ (CIS): New Insights.

Urothelial carcinoma in situ (CIS) is a high-grade noninvasive malignancy with a high tendency of progression. Although it is typically grouped with other nonmuscle invasive bladder cancers, its higher grade and aggressiveness make it a unique clinical entity. Urothelial CIS is histologically characterized by replacement of the urothelium by cells which fulfill the morphologic criteria of malignancy including nuclear pleomorphism, hyperchromasia, prominent nucleoli, and increased numbers of normal and abnormal mitoses. Urothelial CIS may be categorized as primary when it is not associated with any past or present urothelial carcinoma. It is termed as secondary when there is concomitant or previous urothelial carcinoma in the patient. In recent years detailed molecular studies have provided valuable data for intrinsic molecular subclassification of urothelial carcinoma into 2 broad categories namely luminal and basal types with significant implications for prognosis and therapy. Similar studies on urothelial CIS are limited but have provided crucial insight into the molecular basis of CIS. These studies have revealed that urothelial CIS may also be divided into luminal and basal subtypes, but luminal subtype is much more common. It has also been shown that in many cases, luminal type of urothelial CIS may undergo a class switch to basal type during progression to an invasive carcinoma. Additional studies may be required to confirm and further elaborate these findings.

Outcome of sirolimus-based immunosuppression, fifteen years post-live-donor kidney transplantation: Single-center experience.

In a prospective randomized controlled trial, between May 2001 and January 2003, 132 live-donor kidney transplant recipients were randomized to receive sirolimus primary immunosuppression, either in combination with low dose tacrolimus (Tac group) or in combination with mycophenolate mofetil (MMF group). We have previously reported on 2- and 5-year follow-up results, with favorable patient and graft outcomes obtained in both groups. In view of recent published reports of increased risk of inferior outcomes among sirolimus-treated patients, we herein present results of an observational extension of the previously randomized patients 15 years post-transplantation. Mortality rates were 10.8% and 3% in Tac and MMF groups respectively after mean follow-up period of 11.2-11.8 years. Comparable graft survival rates were obtained in both groups ranging from 60% to 62.7%. The (MMF) group continued to have the advantage of remaining on primary plan of immunosuppression (56.7% of patients) as well as to maintain better graft function in terms of serum creatinine level. Herein, we presented longest term published data for sirolimus-based immunosuppression among live-donor kidney transplants with favorable outcome in terms of survival and graft function.

Secondary malignant involvement of gynecologic organs in radical cystectomy specimens in women: is it mandatory to remove these organs routinely?

PURPOSE: We report the incidence of concomitant secondary malignancy of gynecologic organs (uterus, ovaries and vagina) and the incidence of benign lesions affecting these organs in female radical cystectomy specimens. MATERIALS AND METHODS: Between January 1983 and December 2001, 2,055 radical cystectomies were performed, including 609 in females. Pathological findings in gynecologic organs in female cystectomy specimens were reviewed. These data were correlated with different tumor characteristics. RESULTS: Mean age of the female patients +/- SD was 47 +/- 9 years (range 20 to 73). Mean followup was 4.3 +/- 4.2 years (range 0.5 to 19). Of these women 390 (64%) had squamous cell bladder carcinoma. Gynecologic organ involvement was documented in 16 of 609 patients (2.6%). Benign ovarian lesions (49 cases or 8%), a simple serous cyst (31), a dermoid cyst (1), a hemorrhagic cyst (3), bilharzial granuloma (6) and corpus albicans (8) were detected. Benign uterine lesions (30 cases or 5%), endometrial hyperplasia (20), endometriosis (4) and fibroids (6) were diagnosed. No primary genital cancers were detected in this study. Gynecologic organ involvement was more frequent in high grade tumors and the transitional cell cancer type than low grade tumors and the squamous cell type (p = 0.01 and 0.05, respectively). Posterior wall tumors were more frequently associated with genital involvement than other sites, although the difference was not statistically significant. CONCLUSIONS: Evidence is provided that the risk of secondary malignant involvement of genital organs in female cystectomy specimens is low. This low risk together with the low risk of primary cancers of genital organs in this group of patients does not strongly support the routine removal of uninvolved gynecologic organs during radical cystectomy in women.