Clinical findings and kidney morphology in chronic kidney disease of unknown cause in India.

BACKGROUND: Chronic kidney disease of unknown cause (CKDu) is an emerging health problem in India and other countries worldwide. However, clinical descriptions, including kidney pathology, are scarce. METHODS: This is a descriptive case series of patients with CKDu from an endemic region in India, with a focus on clinical and biochemical characteristics, kidney biopsy findings, and environmental exposure. Patients with suspected CKDu, aged 20-65, and eGFR 30-80 mL/min/1.73 m2 from rural areas with endemic prevalence of CKDu were included. The exclusion criteria were diabetes mellitus, uncontrolled hypertension, proteinuria >1 g/24 h, or other known kidney diseases. The participants underwent kidney biopsies, and blood and urine samples were collected. RESULTS: Fourteen participants (3 females, 11 males) with a mean eGFR of 53 (range 29-78) mL/min/1.73 m2 were included. Kidney biopsies showed a combination of chronic tubulointerstitial damage, glomerulosclerosis, and glomerular hypertrophy, with varying degrees of interstitial inflammation. Eight participants had polyuria (diuresis ≥ 3 L/day). The urinary sediments were bland, with no haematuria. Serum potassium and sodium levels were, in most cases, normal but within the lower reference interval. CONCLUSION: The kidney morphology and clinical characteristics in patients with CKDu in India were similar to those described for CKDu in Central America and Sri Lanka.

A Trespasser in Lymph Node: A Case Report.

Cryptococcal meningitis is a prevalent, opportunistic fungal disease seen in human immunodeficiency virus (HIV)-infected individuals. A lymph node is an unusual presentation site for Cryptococcus and can mimic tuberculosis. Disseminated cryptococcosis is a life-threatening disease that is seen commonly in acquired immunodeficiency syndrome (AIDS). We report a case of an HIV patient who presented with mild pleural effusion, multiple mediastinal, axillary lymphadenopathy with a low CD4:CD8 lymphocyte ratio, and favored clinically disseminated tuberculosis. Further cerebrospinal fluid (CSF) and tracheal aspirate have been done. Tracheal aspirate culture shows a fungal organism resembling Cryptococcus. Later, India ink staining on CSF highlighted the fungal organism Cryptococcus. Cytopathological investigation showed necrotizing inflammation along with fungal organisms, confirming the presence of cryptococcal lymphadenitis.

Cytological Diagnosis Suggesting Candidal Infection of the Nasolacrimal Duct in an Uncontrolled Diabetic Patient With Gingival Abscess.

In this unique cytology case of a 64-year-old diabetic male who presented with left-sided facial swelling between the ala and lateral canthus of the left eye, conventional fine-needle aspiration cytology (FNAC) was done. FNAC of the swelling showed desquamated epithelial cells from the nasolacrimal duct and abundant proteinaceous material admixed with fungal organisms like that of budding yeast forms, morphologically resembling Candida on May-Grunwald-Giemsa stain. Special stain with periodic acid-Schiff revealed positivity for budding yeast forms. In this case report, we discuss the causes and clinical effects of nasolacrimal duct obstruction, cytological diagnostic features, and microscopic recognition of fungal organisms on routine staining as well as on special fungal stains.

Biphasic squamoid alveolar renal cell carcinoma: A rare entity with an even rarer presentation as cutaneous metastases - A case report.

Biphasic squamoid alveolar renal cell carcinoma (BSARCC) is a newly emerging distinct and rare morphologic variant of renal cell carcinoma (RCC). Morphological, immunohistochemical, and molecular data have shown that BSARCC is closely related to papillary RCC type 1. We report a case of Biphasic squamoid alveolar renal cell carcinoma with a rare presentation as cutaneous metastases. This variant tends to show an aggressive behavior. Hence, accurate histopathological diagnosis can help in effective treatment and for close follow-up of the patients.

A huge retroperitoneal Castleman's disease - rare entity.

ABSTRACT: Castleman's disease is a rare angio-follicular lymph node hyperplasia[1,2] have varying presentation and can mimic malignancy. The common locations are mediastinum, neck, axilla, and pelvis but extra nodal sites can also be affected.[3] A 56-year-old patient incidentally found to have mass in the retroperitoneal region by Contract-enhanced computerized tomography (CT). Positron emission tomography scan showed well defined intensely enhancing fluorodeoxyglucose (FDG) avid lesion in the left iliac region with vascularity. Surgery was performed, and pathological diagnosis was hyaline vascular type-stroma-rich variant of Castleman disease. Here, we report a case of huge retroperitoneal Castleman's disease in a 56-year-old female patient.[4].

Phaeohyphomycosis in Renal Transplant Recipients: A Case Series.

Phaeohyphomycosis is a rare fungal infection in renal transplant recipients. We describe here five cases of phaeohyphomycosis in renal transplant recipients, two with deep-seated unusual sites of infection. All patients received antifungals, and surgical excision was done where feasible. Outcomes included complete resolution of infection in three, partial resolution in one, and mortality in one case.

Utility of immunohistochemical expression of E-cadherin in colorectal carcinoma.

Introduction: Reduced expression of E-cadherin, an intercellular junction protein, is associated with differentiation and metastasis of multiple cancers, including colorectal cancer. Aim: To investigate the utility of the immunohistochemistry of E-cadherin as a prognostic marker for colorectal cancer (CRC). Material and methods: Immunohistochemical analysis for E-cadherin was performed on 100 paraffin blocks retrieved from resected specimens of CRC patients. The collected data were statistically analysed. Results: Among the 100 patients, men comprised 58% and the majority had tumour size of 5-10 cm (55%). Grade II CRC was more common (74%) than grade I and III (13% each). The correlation of E-cadherin expression with lymph node involvement was statistically significant, as revealed by p-value < 0.01, with about 27% in N1 and 13% in N2 stage. E-cadherin expression was significantly correlated with tumour differentiation pattern (p < 0.01), wherein out of 13 poorly differentiated carcinomas, 38.5% and 30.5% of samples showed negative and weak E-cadherin staining, respectively. Conclusions: Furthermore, a shift from membranous E-cadherin staining in normal cells to cytoplasmic and mixed staining was observed in cancer cells. The study indicates that immunohistochemical E-cadherin expression has prognostic value, as revealed by its loss of expression in poorly differentiated cells and lymph node metastasis.

A Solitary Facial Nodule with an Uncharacteristic Histopathology.

Collision or contiguous tumors refer to the combined existence of two or more tumors in a single lesion. In the skin, these growths could closely mimic other cutaneous tumors, thus making diagnosis difficult. We hereby report a dual tumor, comprising pilomatricoma, and eccrine syringofibroadenoma, which to the best of our knowledge have not been previously reported in medical literature.