Chinese Male Patient Research Articles

Unusual combined thymic mucoepidermoid carcinoma and thymoma: a case report and review of literature

BackgroundIn rare condition, combined thymic epithelial tumors showing either type A or type B thymomas areas combined with thymic carcinoma components may occur in thymus. Mucoepidermoid carcinoma (MEC) of the thymus is rare in thymic carcinoma, and so far there is no report to describe a combined epithelial tumor of thymus with MEC component. We report an unusual case of combined thymic MEC/type B2 thymoma in a middle-aged male occurring in a mass of anterior mediastinum. Case report: A 51-year-old Chinese male patient presented with a 6-month history of right ptosis and progressive muscle weakness. Computed tomography (CT) examination revealed a solitary, well-circumscribed mass was in the anterior mediastinum with mild heterogeneous enhancement. Histologically, the mass contained two separated components and displayed typically histological features of low-grade MEC and type B2 thymoma, respectively. There was no gradual transition of these two components observed in mass, and no enlarged lymph node was found in the surrounding tissues. A diagnosis of combined thymic MEC/type B2 thymoma was made. The patient received thymectomy to resect the mass totally. After surgery, chemotherapy with regiments of cisplatin and mitomycin, and radiotherapy of the main tumor bed were performed on the patient. There was no evidence of tumor recurrence during the period of 12 months follow-up.ConclusionTo our best knowledge, this is the first report of combined thymic epithelial tumor with MEC component. Although this tumor is rare, the diagnosis of a thymic MEC should be taken into consideration when a combined epithelial tumor is occasionally encountered in thymus.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/9721397571157894

QT Interval Prolongation Associated with Intramuscular Ziprasidone in Chinese Patients: A Case Report and a Comprehensive Literature Review with Meta-Analysis.

Intramuscular (IM) ziprasidone has been associated with QTc interval prolongations in patients with preexisting risk factors. A 23-year-old male Chinese schizophrenia patient experienced an increase of QTc interval of 83 milliseconds (ms) after receiving 20 mg IM ziprasidone (baseline and increased QT/QTc were, respectively, 384/418 and 450/501). This was rated as a probable adverse drug reaction (ADR) by the Liverpool ADR causality assessment tool. A systematic review including all types of trials reporting the effect of IM ziprasidone on the QTc interval prolongation identified 19 trials with a total of 1428 patients. Mean QTc change from baseline to end of each study was −3.7 to 12.8 ms after IM ziprasidone. Four randomized trials (3 of 4 published in Chinese) were used to calculate a meta-analysis of QTc interval prolongation which showed no significant differences between IM ziprasidone and IM haloperidol groups (risk ratio 0.49 to 4.31, 95% confidence interval 0.09 to 19.68, P = 0.06 to 0.41). However, our review included two cases of patients who experienced symptoms probably related to QTc prolongation after IM ziprasidone. Thus, careful screening and close monitoring, including baseline ECG, should be considered in patients receiving IM ziprasidone for the first time.

Plasma Vitamin D Levels are Lower among Ethnic Indians in Matched Pairs of Male Acute Ischaemic Stroke Patients of Indian and Chinese Ethnicity

Introduction: Ethnic Indians have a high burden of vascular disease. Vitamin D deficiency is associated with an increased risk of vascular disease including ischaemic stroke. Vitamin D levels are lower among ethnic Indians compared to ethnic Chinese in healthy individuals. We compared the plasma 25-hydroxyvitamin D [25(OH)D] levels between ethnic Indians and Chinese male ischaemic stroke patients. Methods: We prospectively recruited consecutive ethnic Indian acute ischaemic stroke male patients within seven days of symptom onset, who were admitted to the Singapore General Hospital. The subsequent ethnic Chinese acute ischaemic stroke male patient matched for age and diabetes status was recruited. Plasma 25(OH)D was measured using DiaSorin radioimmunoassay. Results: We studied 22 matched pairs of ethnic Indian and Chinese ischaemic stroke male patients. Mean plasma 25(OH)D level was lower among ethnic Indians (16.7 ± 6.1 μg/L) than ethnic Chinese patients (19.7 ± 4.4 μg/L) ( p=0.04). The mean difference was 2.9 ± 6.46 μg/L corresponding to 12.9 ± 33.1%. Conclusion: Ethnic Indian male ischaemic stroke patients had lower vitamin D levels compared to matched ethnic Chinese counterparts. Thus it is important to consider ethnicity in the understanding of stroke risk due to vitamin D deficiency.

Bone-Anchored Maxillary Expansion and Bilateral Interoral Mandibular Distraction Osteogenesis in Adult With Severe Obstructive Sleep Apnea Syndrome

Severe obstructive sleep apnea syndrome (OSAS) threatens patients' lives. To solve ventilation problem, snoring, and avoid another orthognathic surgery for mandibular advancement, bone-anchored rapid maxillary expansion and bilateral interoral mandibular distraction osteogenesis were tried on a 20-year-old Chinese male patient with severe skeletal class II malocclusion and OSAS.The patient had polysomnography (apnea-hypopnea index 54.2), body mass index measurement (19.7 kg/m), and cephalometry before the treatment. Bone-anchored rapid maxillary expansion was performed for the correction of maxillary transverse and minor sagittal deficiency and the improvement of nasal airflow by decreasing nasal resistance. Bilateral interoral mandibular distraction osteogenesis was operated to lengthen the small, retruded mandible by 15 mm. Orthodontic treatment after the maxillary expansion and mandibular distraction osteogenesis can help obtain stable occlusion.The Epworth Sleepiness Scale, a questionnaire for temporomandibular joint, cephalometric analysis, polysomnography, acoustic rhinometry, and multislice spiral computed tomography were performed to evaluate changes from the treatment. All the results showed that the patient had a significantly alleviated OSAS. In addition, an acceptable occlusion was also obtained.

Open triple-branched stent graft applied to patient of acute type a aortic dissection with Aberrant Right Subclavian Artery

A 57-year-old Chinese male patient presented with Standford type A aortic dissection with an aberrant right subclavian artery (ARSA). At operation, the ascending aorta was replaced by a mono–branch vascular prosthesis with the branch bypassing to the ARSA; the triple-branched stent graft was inserted into the true lumen of the arch and proximal descending aorta (covering the origin of the ARSA) with each sidearm graft being positioned into the aortic branches; and then its proximal end was sutured to mono–branched vascular prosthesis. Follow-up computed tomography angiography showed false lumen of the dissection disappeared with satisfactory position of the triple-branched stent graft.

A case of enteropathy-associated T-cell lymphoma (Type I) arising in stomach without refractory celiac disease

Enteropathy-associated T-cell lymphoma (EATL) is a rare peripheral T-cell lymphoma which was classified into 2 types based on histology. EATL is often, but not always, associated with celiac disease. EATL type I is a large cell lymphoma which is more common in frequency and highly associated with celiac disease compared with type II. Jejunum and ileum are the common sites, although EATL can rarely occur in the duodenum, stomach and colon or outside the gastrointestinal tract. We herein presented one case of gastric EATL, which happened in a 73-year-old Chinese male patient. Histologically, the tumor was composed of polymorphic (pleomorphic, anaplastic, immunoblastic) lymphoid cells and numerous inflammatory cells, including histiocytes, neutrophils and eosnophils in the background. The pleomorphic lymphoid cells were diffuse and strongly positive for CD3 and partially positive for CD30, while negative for CD4, CD5, CD8 or CD56. The gastric EATL should be distinguished from other gastric lesions, such as peptic ulcer, poorly-differentiated adenocarcinoma and other types of lymphoma.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1174320824810970

Culture-negative subacute bacterial endocarditis masquerades as granulomatosis with polyangiitis (Wegener’s granulomatosis) involving both the kidney and lung

BackgroundSubacute bacterial endocarditis (SBE) occasionally exhibits positive cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA) of the anti-proteinase-3 (PR-3) type. Clinically, it mimics ANCA-associated vasculitis, such as Wegener's disease with glomerulonephritis. Lung abscesses are the most common manifestation of lung involvement. We herein report a case of culture-negative SBE strongly c-ANCA/PR3-positive accompanied by pulmonary involvement and glomerulonephritis. In this case, we took biopsies of both the lung and kidney, although renal biopsy is usually preferred over lung biopsy. The lung biopsy showed severe alveolar capillaritis, suggesting vasculitis consistent with polyangiitis. The renal biopsy revealed glomerulonephritis with a membranoproliferative pattern. To our knowledge, this is the first such reported case.Case presentationA 68-year-old Chinese male patient presented to our hospital with a fever, cough, chest pain, and recurrent peripheral edema. He had a past medical history significant for treated schistosomiasis 20 years previously. Physical examination revealed palpable purpura, mild hypertension, hepatosplenomegaly, and a holosystolic cardiac murmur (Levine 2/6). Echocardiography showed tricuspid valve vegetations with moderate to severe regurgitation. Serum c-ANCA/PR3 and cryoglobulin were strongly positive. Renal biopsy results indicated membranoproliferative glomerulonephritis with several crescents. Chest CT revealed multiple intraparenchymal and subpleural nodules, and lung biopsy showed polyangiitis. The patient’s ANCA titers, glomerulonephritis, and pulmonary injury all resolved after antibiotic therapy.ConclusionSBE may present with positive c-ANCA/PR3, multiple pulmonary nodules, pulmonary polyangiitis, and glomerulonephritis clinically mimicking granulomatosis with polyangiitis (Wegener's granulomatosis).

Health-Related Quality of Life (HRQoL) in Co-Morbid Tuberculosis Relapse Patient: A Case Report from Malaysia

Purpose: To describe changes in HRQoL of pulmonary tuberculosis (PTB) patient and illustrate impact of malnutrition and Type II diabetes on relapse of PTB. Case: A Chinese male patient with complaints of productive cough, and loss of weight and appetite was registered; sputum smear confirmed that patient had PTB. Diagnosis was also supported by routine investigations. Patient had past history of PTB and Type II diabetes mellitus. For management of secondary tuberculosis, he was prescribed WHO recommended therapy. Elevated HbA1c levels and history of drop-off serum albumin concentration at the start of treatment demonstrated inappropriate glycaemic control and malnutrition over the past months. SF-36v2 was used to estimate HRQoL scores at start, after two months and at the end of TB therapy. Although patient’s perception of mental and physical health improved with progress of treatment, vitality (VT), social functioning (SF) and role emotion (RE) scores were still lower than Malaysian norms. Patient was declared ‘cured’ but state of ‘health’ as defined by WHO was not achieved. Conclusion: Relapse of PTB might be a consequence of inappropriate glycaemic control and malnutrition. This case report demonstrates the need for more comprehensive efforts at TB programs to improve HRQoL of TB patients.Keywords: Health-Related Quality of Life, Pulmonary tuberculosis, Malnutrition, Type II diabetes, SF 36v2

Giant Gingival Pseudoepitheliomatous Hyperplasia in Lung Squamous Cell Carcinoma

We here describe a case of giant primary gingival pseudoepitheliomatous hyperplasia in a 53-year-old Chinese male patient with lung squamous cell carcinoma (SCC). The pathogenesis of the lesion and the deferential diagnosis from invasive SCC are also discussed. To our knowledge, such a hugeous primary pseudoepitheliomatous hyperplasia of the gingiva accompanied with lung SCC is unusual.

Surgical Reconstruction of Auricular Relapsing Polychondritis

Relapsing polychondritis (RP) is a multiple system disease of unknown cause characterized by episodic inflammation of cartilage and potentially progressive degeneration of cartilaginous tissue. Solitary auricular cartilage involvement without any inflammatory symptoms is very uncommon and surgical treatment is rarely recommended. We present a 53-year-old Chinese male patient who had undergone a mass resection on the right ear in December 2008 and 1 year later had developed another mass at the same spot. A mass resection and reconstructive surgery were performed and the pathologic result of the mass was auricular RP. Although RP is rarely seen by plastic surgeons, we should have sufficient information about this disease. This case demonstrates a simple and straight surgical approach to obtain an excellent ear appearance.

Secondary cutaneous Epstein-Barr virus-associated diffuse large B-cell lymphoma in a patient with angioimmunoblastic T-cell lymphoma: a case report and review of literature

Only a few cases of extranodal Epstein-Barr virus (EBV)-associated B-cell lymphomas arising from patients with angioimmunoblastic T-cell lymphoma (AITL) have been described. We report a case of AITL of which secondary cutaneous EBV-associated diffuse large B-cell lymphoma (DLBCL) developed after the initial diagnosis of AITL. A 65-year-old Chinese male patient was diagnosed as AITL based on typical histological and immunohistochemical characteristics in biopsy of the enlarged right inguinal lymph nodes. The patient initially received 6 cycles of chemotherapy with CHOP regimen (cyclophosphamide, vincristine, adriamycin, prednisone), but his symptoms did not disappear. Nineteen months after initial diagnosis of AITL, the patient was hospitalized again because of multiple plaques and nodules on the skin. The skin biopsy was performed, but this time the tumor was composed of large, polymorphous population of lymphocytes with CD20 and CD79a positive on immunohistochemical staining. The tumor cells were strong positive for EBER by in situ hybridization. The findings of skin biopsy were compatible with EBV-associated DLBCL. CHOP-R chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab) was then administered, resulting in partial response of the disease with pancytopenia and suppression of cellular immunity. To our knowledge, this is the first case of cutaneous EBV-associated DLBCL originated from AITL in Chinese pepole. We suggest the patients with AITL should perform lymph node and skin biopsies regularly in the course of the disease to detect the progression of secondary lymphomas.Virtual slidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1197421158639299

Establishment, Characterization, and Successful Adaptive Therapy against Human Tumors of NKG Cell, a New Human NK Cell Line

Natural killer (NK) cells play important roles in adoptive cellular immunotherapy against certain human cancers. This study aims to establish a new human NK cell line and to study its role for adoptive cancer immunotherapy. Peripheral blood samples were collected from 54 patients to establish the NK cell line. A new human NK cell line, termed as NKG, was established from a Chinese male patient with rapidly progressive non-Hodgkin's lymphoma. NKG cells showed LGL morphology and were phenotypically identified as CD56(bright) NK cell with CD16(-), CD27(-), CD3(-), αβTCR(-), γδTCR(-), CD4(-), CD8(-), CD19(-), CD161(-), CD45(+), CXCR4(+), CCR7(+), CXCR1(-), and CX3CR1(-). NKG cells showed high expression of adhesive molecules (CD2, CD58, CD11a, CD54, CD11b, CD11c), an array of activating receptors (NKp30, NKp44, NKp46, NKG2D, NKG2C), and cytolysis-related receptors and molecules (TRAIL, FasL, granzyme B, perforin, IFN-γ). The cytotoxicity of NKG cells against tumor cells was higher than that of the established NK cell lines NK-92, NKL, and YT. NKG cell cytotoxicity depended on the presence of NKG2D and NKp30. When irradiated with 8 Gy, NKG cells were still with high cytotoxicity and activity in vitro and with safety in vivo, but without proliferation. Further, the irradiated NKG cells exhibited strong cytotoxicity against human primary ovarian cancer cells in vitro, and against human ovarian cancer in a mouse xenograft model. The adoptive transfer of NKG cells significantly inhibited the ovarian tumor growth, decreased the mortality rate and prolonged the survival, even in cases of advanced diseases. A number of NKG cells were detected in the ovarian tumor tissues during cell therapy. In use of the new human NK cell line, NKG would a promising cellular candidate for adoptive immunotherapy of human cancer.

Pulmonary arterial hypertension in a Kartagener syndrome patient: Treatment with beraprost sodium

Kartagener syndrome, a rare and autosomal recessively inherited disease, is characterized by the triad of situs inversus, bronchiectasis and chronic sinusitis [1]. Patients usually present with chronic recurrent rhinosinusitis, pulmonary infections. Here, we report a rare case of pulmonary arterial hypertension (PAH) secondary to Kartagener syndrome in a Chinese male patient who is effectively treated with beraprost sodium (BPS).

Extranodal follicular dendritic cell sarcoma in mesentery: A case report

Extranodal follicular dendritic cell (FDC) sarcomas are not a common phenomenon. Due to the scarcity of the identified cases reported in the literature, FDC is probably under-recognized and commonly misdiagnosed. The diagnosis of FDC sarcomas is based on node-based spindle cell lesions, and the expression of CD21, CD35 and clusterin. The most commonly involved extranodal sites include the oral cavity, tonsil, gastrointestinal tract and liver. With the aid of immunohistochemical analysis and the two most reliable FDC markers, CD21 and CD35, the diagnostic accuracy has improved. When FDC sarcoma is suspected histologically, immunohistochemical stains for FDC differentiation should be performed to avoid potential misdiagnosis. This case report concerns the evaluation of a 43-year-old male Chinese patient with a large extranodal FDC sarcoma (20×18×9 cm) in the mesentery with elevated serum CA125 (76.9 U/ml). The diagnosis and treatment of this disease are also discussed.

Kaposi’s sarcoma developed after allogeneic hematopoietic stem cell transplantation

A 33-year-old Chinese male patient with severe aplastic anemia received matched sibling allogeneic hematopoietic stem cell transplantation using antithymocyte globulin containing conditioning regimen after 4 months of unsuccessful treatment with cyclosporine A. Following transplantation, the patient was immunosuppressed demonstrated by intermittent infections, including a varicella 3 months after transplantation. Although DNA-STR results on day +30 confirmed complete donor engraftment, repeat DNA-STR analysis performed more than 3 months after transplantation showed a mosaic phenotype. Cyclosporine tapering commenced early, but the last DNA-STR result confirmed complete graft rejection. On day +198, the patient presented with fever, skin boil in the right temporal region, severe pancytopenia, intrabodominal lymphadenopathy and hepatosplenomegaly. Within 1 month, superficial lymphadenopathy and right exophthalmos developed. Excisional lymph node biopsy pathology confirmed Kaposi's sarcoma (KS). The patient succumbed due to intracranial bleeding as a result of thrombocytopenia. This is the first study of KS that developed following stem cell transplantation for severe aplastic anemia. The precipitating factors underlying KS development in this case and its differentiation from post-transplant lymphoproliferative disorders are analyzed.

Oral acyclovir induced acute renal failure.

The study aimed to investigate the clinical characteristics of acute renal failure (ARF) caused by oral acyclovir. A 45-year-old Chinese male patient with acyclovir-induced ARF suffered from abdominal pain for one day. The pain was extended to the epigastric area from the right lower quadrant. Transient oliguria was seen in addition to microscopic hematuria and proteinuria. The serum creatinine concentration was 304 μmol/L. Eight days before the occurrence of ARF, the patient took oral acyclovir for facial neuritis. His renal function was restored completely following the discontinuation of acyclovir, with continuous renal replacement therapy for 54 hours and some symptomatic treatment. The presentation of acute renal failure caused by acyclovir can be diverse, but the prognosis is good after active treatment.

A Case Report on Eosinophilic Meningitis Caused by Angiostrongylus cantonensis

Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis in humans. It is usually caused by ingestion of raw or inadequately cooked intermediate hosts or food contaminated with infective third-stage larvae. We describe a case of eosinophilic meningitis caused by A. cantonensis in a male Chinese patient. The patient had a history of eating raw fish and snail. We describe the clinical features of the patient, the diagnostic process and treatments. We also provide a brief update for physicians on the characteristics, diagnosis and treatment of eosinophilic meningitis caused by A. cantonensis, with particular emphasis on the update of prevalence and treatment of the disease in China.

G6PD deficiency-induced hemolysis in a Chinese diabetic patient: a case report with clinical and molecular analysis

A 59-year-old Chinese male patient was admitted at diagnosis of type 1 diabetes with ketoacidosis. During the normalization of blood glucose with insulin, the patient developed acute hemolysis. The factors predisposing to hemolysis were not found, except the significantly diminished activity of glucose-6-phosphate dehydrogenase (G6PD). DNA analysis did not show any coding or intronic mutation in the G6PD gene. This is the first reported case of a Chinese patient in diabetic ketoacidosis with hemolysis induced by G6PD deficiency in the absence of mutations in the G6PD gene.

Stroke after treatment with bortezomib and dexamethasone in a Chinese patient with extramedullary relapse of multiple myeloma

Thromboembolic complications commonly occur in patients with multiple myeloma (MM). The risk of such complications may be elevated by the use of immunomodulatory agents such as thalidomide and lenalidomide as initial therapy for MM. However, arterial thrombosis after treatment with bortezomib is rare. Herein we report a case of a 70-year-old Chinese male patient with extramedullary relapse of MM. After treatment with bortezomib and dexamethasone he developed a nonfatal thrombotic stroke. Administration of bortezomib and dexamethasone was then discontinued and he obtained partial remission.

Allergic shock and death associated with protamine administration in a diabetic patient

Background: Insulin is used to treat patients with both type 1 and type 2 diabetes mellitus. Allergic reac- tions to insulin might be triggered by insulin itself or inactive ingredients in the insulin formulation, includ- ing proteins such as protamine in neutral protamine Hagedorn (NPH) insulin. The use of highly purified animal insulin and human recombinant insulin has reduced the incidence of anaphylactic reactions to insulin from ~30% to <1%. Objective: We report a case of fatal allergic shock after the administration of protamine in a patient with a history of allergy to fish and a protamine-containing insulin. Case summary: A 72-year-old Chinese male patient (height, 175 cm; weight, 80 kg) with a history of diabetes and progressive limb weakness was diagnosed with spinal vascular malformations after admission to the Xuan Wu Hospital of Capital Medical University, Beijing, People's Republic of China. He underwent epidural spinal cord arteriovenous fistula embolization with a liquid embolic agent (ethylene vinyl alcohol copolymer) after spinal cord angiography. During the operation, heparin was infused every hour with 6250, 2500, 2500, and 1250 IU, respectively. The last dose of heparin was administered ~10 minutes before the opera- tion was completed. This was followed by the admin-istration of protamine to neutralize the remaining heparin in the patient's body. Blurry vision and dizziness 5 minutes after protamine administration were followed by pruritus and hives over his neck and face. Oxygen was administered and 10 mg of dexamethasone with 2 mg of epinephrine was injected. The patient's heart rate dropped, his blood pressure decreased, and his arterial oxygen saturation (SaO 2) declined progressively. About 10 minutes after the administration of protamine sulfate, the patient developed bradycardic arrest. Cardiopulmonary resuscitation efforts were undertaken and the patient was administered epinephrine 2 mg IV, atropine 0.5 mg IV, and subsequently, intravenous dopamine (50 mg/h). Ten minutes later, the patient's heart rate gradually increased, but blood pressure fluctuated, and SaO 2 ranged from 90% to 100%. Despite the initial response, the patient lost consciousness and heart rate declined progressively within 5 hours. Vasoactive agents including dopamine, norepinephrine, and adrenaline were administered. After all these measures proved inef- fectual, the patient died. It was later determined that the patient had a history of allergic reactions to fish as well as to a premixed insulin that contained soluble human insulin 30% and low-protein intensive insulin zinc 70% (NPH). The Naranjo adverse drug reaction probability scale score for the association of protamine with the allergic reaction was 4, suggesting a possible relationship. Conclusion: This case report highlights a preventable fatal allergic reaction possibly associated with protamine administration in a patient with a history of allergy to a protamine-containing insulin.