History Of Significant Weight Loss Research Articles

A rare case of scapular metastasis from bronchogenic carcinoma with ipsilateral malignant pleural effusion.

A rare case of scapular metastasis from bronchogenic carcinoma with ipsilateral malignant pleural effusion.

Letter by De Mattia et al Regarding Article, “Digital Clubbing”

In the first part of his very interesting Clinician Update focused on digital clubbing (DC),1 Rutherford described the case of a patient presenting with a 3-month history of significant weight loss, occasional night sweats, and fatigue, in whom physical examination revealed a fast resting heart rate and bilateral DC. The …

Non-tropical endomyocardial fibrosis associated with sarcoidosis

A 50-year-old female was admitted with a 2-year history of significant weight loss and a pyrexia of unknown origin. Hepatosplenomegaly and mildly enlarged retroperitoneal and mediastinal lymph nodes were seen on a computed tomography scan. The patient was profoundly cachectic with severe muscle wasting. Following an episode of acute pulmonary oedema, a transthoracic echocardiogram (TTE) was performed, revealing …

Symptomatic Esophageal Granular Cell Tumor in a Young Female

Introduction: Granular cell tumors (GCTs) are rare forms of submucosal tumors that are infrequently found in the gastrointestinal tract (10% cases). However, in the gastrointestinal tract, the esophagus is the most commonly involved site (65% cases). Most GCTs are benign, asymptomatic, and less than 5 mm in size. Larger lesions are more likely symptomatic and have a higher malignant potential. We present the case of a young female with unresolving epigastric symptoms and weight loss caused by esophageal GCT which was diagnosed on endoscopic biopsy. Case Description: A 28-year-old, Caucasian, non-smoking female with no significant medical or family history was referred due to epigastric discomfort for 6 months. This was associated with a burning sensation and 15 pounds weight loss. She denied dysphagia, nausea, vomiting, blood in the stool, changes in her appetite or bowel habit. She had regular menses. Prior to presentation the patient was empirically treated with maximal doses of proton pump inhibitors, H 2 blockers and for Helicobacter pylori with no relief of symptoms. At current presentation, physical exam was unremarkable. All laboratory results including blood counts, amylase, lipase, and routine chemistries were within normal limits. In view of her history of significant weight loss and unresolving symptoms, endoscopy was performed. This revealed a 5 mm, whitish, submucosal nodule in the distal esophagus with positive biomarker staining (Figure 1a and 1b) suggestive of GCT. Subsequently, she underwent endoscopic mucosal resection of the lesion that resulted in complete resolution of symptoms.FigureDiscussion: GCTs are more frequent in males with a mean age at diagnosis of 45 years. They are often benign, asymptomatic, and usually less than 5 mm in size. They are most commonly found incidentally on endoscopy with an estimated incidence of 0.033%, representing about 1% of benign esophageal tumors. Although considered to be benign, GCTs have a malignant potential. The symptoms, if any, are often mild and include dysphagia, nausea, and burning sensation. Endoscopic mucosal resection is the recommended treatment especially if the lesions are >1 cm. There has been no described recurrence and prognosis is excellent. Although rare, it is important to consider GCT as a differential, especially in young patients presenting with mild, non-specific symptoms.

Dual Tracer PET Imaging with FDG and FLT Differentiates Tuberculous Lymphadenopathy from Metastases in a Case of Carcinoma Cervix.

A forty-year-old woman with a known case of carcinoma cervix underwent 18-fluorodeoxyglucose positron emission tomography–computed tomography (18-FDG PET/CT) for evaluation of abdominal lymphadenopathy. Her treatment history included radical hysterectomy and radiotherapy 6 months ago. She complained of weight loss of 7 kg over last 5 months. The maximum intensity projection (MIP) image (Fig. 1a, arrows) revealed multiple areas of intense FDG uptake, which on CT and fused PET/CT images were localized to multiple lymph nodes in bilateral cervical region, right axilla, mediastinum and abdomen. The SUVmax of right axillary lymph nodes (most FDG avid of all lymph node groups) was 15.3. There was no evidence of metabolically active disease or CT demonstrable abnormality in rest of the body. Fig. 1 (a) FDG PET of a forty-year-old woman with known carcinoma cervix, maximum intensity projection (MIP) image showing metabolically active extensive lymphadenopathy; (b) FLT PET scan of same patient, showing no appreciable uptake in lymphadenopathy; physiological ... Presence of metabolically active disease in extensive supradiaphramatic lymphadenopathy was unusual for a case of carcinoma cervix. This finding, along with history of significant weight loss and absence of extranodal disease, was suspicious for unrelated pathology like lymphoproliferative disorder or granulomatous disease. Mixed malignant and benign lymphadenopathy was also considered a possibility. To solve the conundrum, 18- fluoro-L-thymidine (FLT) PET/CT was performed on the next day. This scan was performed to assess the proliferation rate in various above-mentioned lymph nodes, and to plan the optimum site of biopsy. The FLT PET scan (Fig. 1b) showed physiological distribution of the tracer in bone marrow, liver, gall bladder and urinary bladder. There was minimal FLT uptake in the enlarged, FDG avid lymph nodes (Fig. 1c & d). SUVmax of FLT uptake in right axillary lymph nodes was 1.4 (SUVmax of FDG uptake = 15.8). The SUVmax of FLT uptake in cervical, mediastinal and abdominal lymph nodes were 1.3, 1.4 and 1.0 respectively. (SUVmax of FDG uptake 12.1, 12.7 and 11.9, respectively). Considering avidity for FDG and non-avidity of proliferation marker tracer (FLT), possibility of infective/inflammatory pathology was raised in the final report. Considering maximum metabolic activity on FDG PET and feasibility, open biopsy of right axillary lymph node was performed; which revealed tuberculosis. Patient was started on anti-tuberculosis therapy and she reported gradual weight gain with no new symptoms over last 3 months. Though extensively used for evaluation of malignancies, FDG is not a cancer-specific tracer. Non-specific uptake is often seen in active macrophages in infective and inflammatory pathologies [1, 2]. Hence, a tracer that is more specific marker for malignancy can help to identify false-positive FDG PET findings. Use of dual tracer imaging with FDG and FLT to differentiate between benign and malignant lesions has been described in the literature for characterization of pulmonary lesions [3]. FLT is thought to be relatively more specific compared to 18F-FDG, in that it is a cell proliferation tracer; FLT usually does not concentrate in benign lesions [4]. Our case demonstrates the usefulness of a dual tracer imaging approach to identify benign cause of FDG avid lymphadenopathy in a known case of malignancy. This approach may play a vital role when clinical and/or FDG PET findings point toward unrelated benign disease in patients with malignancy.

Primary renal lymphoma in patient of tinea incognito: Rare clinical entity

A middle aged male patient, suffering from tinea incognito for 3 months along with history of significant weight loss for last 2 months, was admitted for hematuria in emergency ward. He was subsequently diagnosed with left renal mass. Computed tomography scan of abdomen showed a large lobulated density mass in lower pole of left kidney, over circling the left pelviureteric junction causing hydronephrosis and no hepatosplenomegaly. There was no evidence of retroperitoneal lymphadenopathy, peritoneal nodules, or ascites. Clinically suspecting renal cell carcinoma, the patient declined radical left-sided nephrectomy as the primary choice of treatment. Tru-cut renal biopsy revealed diffuse large Bcell non-Hodgkin's lymphoma. Following six cycles of chemotherapy along with antifungal medications, both tinea lesions and renal mass were cured.

Sebaceous gland hyperplasia of the caruncle: an uncommon diagnosis

Dear Editor, We report this interesting case of a 79-year-old black male who presented with a 2-month history of a fleshy growth in his right eye. He had no associated redness, irritation nor discharge, nor history of significant weight loss, loss of appetite, or constitutional symptoms. The vision was count fingers in his right eye due to a mature cataract. The left eye was blind from ocular trauma in childhood. Significant findings were localized to his right conjunctiva, where a smooth, flesh-coloured multinodular lesion (5 mm×8 mm) was arising from the right caruncle (Fig. 1a). There was an associated mucoid discharge. There was no associated pigmentation, ulceration, or telangiectasia. In the right eye, the cornea, anterior chamber, and iris were normal; however, he had a mature cataract. The left cornea was opacified and no fundal view was possible. His intraocular pressures were 15 mmHg and 12 mmHg in the right and left eyes respectively. The differential diagnosis included sebaceous gland hyperplasia, sebaceous adenoma, and to rule out a sebaceous carcinoma of the caruncle. His haemoglobin level was 14.5 g/l, and the VDRL was non-reactive and HIV I-II Ag/Ab was negative. Excisional biopsy of the caruncle was done under local anaesthesia. Histopathology showed well-demarcated sebaceous gland lobules, composed of mature cells with foamy cytoplasm grouped around a central sebaceous duct (Fig. 2a and b). There was no cellular atypia. These features were consistent with sebaceous hyperplasia. Post-operatively, the patient healed well (Fig. 1b). He had no further complaints or symptomology of ocular surface disease. He has had no recurrence after 1 year. Caruncular lesions are uncommon, occurring in 0.003 % of ocular biopsies [1–3]. Sebaceous gland hyperplasia (SGH) of the caruncle is rare. In several clinicopathological series on caruncular lesions, the incidence of SGH varied from 2 to 8 % [1–4]. The commonest caruncular lesions have been papillomas (7.1–32 %) and nevi (24–59.5 %), with the incidence varying widely according to the study [2–4]. SGH have a slow painless growth, a yellow nodular appearance, and associated overlying telangiectatic vessels. Because of the older age of the patient, the long history and yellow nodular appearance our differential diagnosis of SGH was made. This was confirmed with an excisional biopsy. SGH is clinically similar to a sebaceous adenoma This paper has never been presented at a conference

Severe paraneoplastic hypereosinophilia in metastatic renal cell carcinoma

BackgroundRenal cell carcinoma can cause various paraneoplastic syndromes including metabolic and hematologic disturbances. Paraneoplastic hypereosinophilia has been reported in a variety of hematologic and solid tumors. We present the first case in the literature of severe paraneoplastic hypereosinophilia in a patient with renal cell carcinoma.Case presentationA 46 year-old patient patient with a history of significant weight loss, reduced general state of health and coughing underwent radical nephrectomy for metastasized renal cell carcinoma. Three weeks after surgery, the patient presented with excessive peripheral hypereosinophilia leading to profound neurological symptoms due to cerebral microinfarction. Systemic treatment with prednisolone, hydroxyurea, vincristine, cytarabine, temsirolimus and sunitinib led to reduction of peripheral eosinophils but could not prevent rapid disease progression of the patient. At time of severe leukocytosis, a considerable increase of cytokines associated with hypereosinophilia was measurable.ConclusionsParaneoplastic hypereosinophilia in patients with renal cell carcinoma might indicate poor prognosis and rapid disease progression. Myelosuppressive therapy is required in symptomatic patients.

Renal Transplant Wound Complications in the Modern Era of Obesity

Obesity is a known risk factor for wound complications following kidney transplantation (KTX), and obese transplant candidates are often encouraged to lose weight. The implications of this weight loss for post-KTX wound healing and morbidity have not been examined. Our aim was to study potential risk factors for post-KTX wound complications, with a specific focus on a history of significant weight loss. Single-center retrospective review of all KTX recipients ≥ 18 y performed 04/2004-03/2009. We studied potential donor-, transplant-, and recipient-related risk factors for wound complications by univariate and multivariate analyses. Graft and patient survival comparisons were done by Kaplan-Meier curves and two-sided log-rank test. Overall wound complication incidence among the 487 study recipients was 6.4%. Significant independent risk factors for wound complications were BMI (odds ratio [OR] = 1.14 per 1 kg/m(2) increase), and history of significant weight loss (OR = 13.46), peri-KTX transfusion (OR = 5.42), and desensitization (OR = 60.34). Wound complications had no significant impact on graft and patient survival. Our study demonstrates for the first time that besides BMI, pre-KTX desensitization, and peri-KTX transfusion, a history of significant pre-KTX weight loss is also an independent risk factor for post-KTX wound complications (potentially at least in part due to body contour changes resulting in an unfavorable abdominal panniculus). Further study of KTX candidates who have lost a significant amount of weight is warranted to (1) identify the exact causes for their increased propensity for complications and (2) devise measures to minimize added cost and morbidity. Finally, our findings suggest that the impact of weight loss on the outcomes of non-transplant operations also warrants further investigation.

Weight Loss in an Asian Man

Question: A 28-year-old Filipino man, a known chronic hepatitis B carrier, presented with a 1-year history of significant weight loss. He did not have fever or cough, or any other systemic complaints. Physical examination was unremarkable. His blood results were: Protein, 98 g/L; albumin, 24 g/L; bilirubin, 21 μmol/L; alkaline phosphatase, 165 U/L; alanine aminotransferase, 433 U/L; aspartate aminotransferase, 394 U/L; alpha-fetoprotein, 117 μg/L; hemoglobin, 12.9 g/dL; white cell count, 5.61 × 109/L; platelets, 204 × 109/L; and erythrocyte sedimentation rate 103 mm/hr. Multiphasic contrast-enhanced computed tomography (CT) scan of the liver was performed (Figure A). Chest radiograph (not shown) was normal. What is the likely diagnosis from the CT scan? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Liver CT shows several centrally calcified nodular lesions in the right lobe with relatively low-density soft tissue surrounding them, best seen in the portal venous phase (Figure B,arrows). Similar lesions were present in the left lobe (not shown). There is no arterial enhancement or venous washout pattern to suggest multicentric hepatocellular carcinoma. The most likely cause of hypovascular infiltrative liver lesions with coarse nodular calcified foci are granulomatous infections, especially macronodular tuberculosis. Ultrasound-guided fine needle and core biopsy of the liver nodules was performed. Histopathologic analysis showed stromal fibrosis and chronic inflammation, residual bile ductular structures and epithelioid histiocytes (Figure C) Liver tissue culture grew Mycobacterium tuberculosis complex. Fungal culture was negative, as were serum cryptococcal, Histoplasma, and Treponema serologies. He was treated with a combination of 4 antituberculosis drugs for 2 months followed by 2 drugs for another 4 months. There was marked clinical improvement with return of his weight to baseline and normalization of liver function tests. There are 2 main radiologic manifestations of hepatic parenchymal tuberculosis.1Mortelé K.J. Segatto E. Ros P.R. The infected liver: radiologic-pathologic correlation.Radiographics. 2004; 24: 937-955Crossref PubMed Scopus (245) Google Scholar, 2Yu R.S. Zhang S.Z. Wu J.J. et al.Imaging diagnosis of 12 patients with hepatic tuberculosis.World J Gastroenterol. 2004; 10: 1639-1642Crossref PubMed Scopus (77) Google Scholar, 3Vanhoenacker F.M. De Backer A.I. Op de B.B. et al.Imaging of gastrointestinal and abdominal tuberculosis.Eur Radiol. 2004; 14: E103-E115PubMed Google Scholar Miliary hepatic involvement is seen in patients with miliary pulmonary tuberculosis and is characterized by innumerable tiny 0.5–2 mm nodules, which may sometimes be missed at CT, manifesting often as hepatomegaly only. Macronodular hepatic tuberculosis although less uncommon, is easily detected at CT and are typically low-density, hypovascular lesions measuring about 1–3 cm each and may show irregular, ill-defined margins. Tuberculomas eventually tend to calcify over time, and the presence of calcified granulomas at CT in the absence of a known primary malignancy should always raise suspicion for tuberculosis. Other granulomatous infections such as histoplasmosis typically occur in the setting of disseminated disease and presents with miliary sized lesions. Calcified metastases, typically from primary colorectal carcinoma, especially the mucinous histologic subtype, may also have this appearance, but this is highly unlikely in the given clinical context. This case also demonstrates the value of tissue culture over tissue staining in diagnosis of hepatic tuberculosis.

Multiple myeloma presenting as bilateral orbital proptosis

A 58-year-old-man presented with painful rapidly progressive bilateral proptosis with restricted ocular movements of 15 days duration. There was history of significant weight loss in the recent past. Computed tomography scan of the head and orbit revealed bilateral multiple, well-defined, round, soft tissue masses, isointense with muscles in intraconal and extraconal space. Fine needle aspiration cytology and incision biopsy from the lesion, urine for Bence-Jones proteins and immunofixation clinched the diagnosis of multiple myeloma. Skeletal survey did not reveal any bony involvement.The diagnosis of multiple myeloma should be kept in mind in cases of bilateral proptosis. Bony involvement is not universal in cases of orbital myeloma. Early diagnosis can be established with extensive biochemical and histopathological investigations and timely treatment is life saving for these patients.

Postoperative enteral immunonutrition in head and neck cancer patients

Aims: to determine if postoperative feeding of head and neck cancer patients, using an enteral diet supplemented with arginine, improves immunological and nutritional status, and clinical outcome, i.e., reduces postoperative infectious/wound complications and length of stay, when compared with an isocaloric, isonitrogenous control diet.Methods: at operation 44 patients were randomized into two groups to receive: a) an enriched diet (n=23);b) an isocaloric, isonitrogenous control diet (n=21). Thirteen patients with a history of significant weight loss (≥10% over the last 6 months) were considered malnourished. Preoperatively and on postoperative days 1, 4 and 8 the following parameters were evaluated: albumin, prealbumin, transferrin, total number of lymphocytes, lymphocyte subsets (CD3, CD4, CD8 and CD4/CD8 ratio) and immunoglobulins. Postoperative complications and length of stay were recorded.Results: ‘visceral’ serum proteins and immunological parameters decreased on postoperative day 1 in both groups. However, only the enriched group demonstrated a significant increase (P<0.05) in the total number of lymphocytes, CD4, CD4/CD8 on postoperative day 4, and total number of lymphocytes, CD3, CD4, CD4/CD8 on postoperative day 8. In the malnourished subgroup the administration of the enriched formula significantly reduced both postoperative infectious/wound complications and length of stay compared with the control group (P<0.05).Conclusions: enteral immunonutrition of head and neck cancer patients improves postoperative immunological response. Significant clinical advantages were observed in malnourished patients.

Severe, Protracted Intestinal Cryptosporidiosis Associated with Interferon Deficiency: Pediatric Case Report

We describe a human immunodeficiency virus-negative infant with chronic intractable diarrhea due to Cryptosporidium parvum; he had a history of significant weight loss since the second week of life. A preliminary study of his immune function was negative for primary immunodeficiency. To further study his immune function, proliferation of peripheral blood mononuclear cells (PBMCs) was elicited by crude antigenic extract from C. parvum oocysts (CCE). Supernatants of CCE-stimulated PBMCs contained interleukin 10 but not interferon gamma (IFN-gamma), while PBMCs from a control (a 2-year-old immunocompetent infant who had recovered from cryptosporidiosis) showed a strong response to IFN-gamma when stimulated with CCE. These results stress the role of IFN-gamma in recovery from cryptosporidiosis.

Apathetic thyrotoxicosis in adolescence

We here describe a case of apathetic thyrotoxicosis in a 16-year-old female subject who presented with a range of non-specific symptoms. Apart from a history of significant weight loss, there were no other signs or symptoms indicative of hyperthyroidism. The diagnosis was made incidentally upon thyroid function testing, and there was a prompt clinical response to anti-thyroid therapy. The diagnostic pitfalls of this unusual presentation in the young are highlighted. A history of weight loss and a clinical index of suspicion will lead to the diagnosis, which is readily confirmed biochemically.

A Young Man with Left Renal Mass – A Case of Primary Renal Lymphoma

Renal involvement in lymphoma is not very uncommon but primary renal lymphoma is very rare and prognosis is poor. A 20 years male presented with localized, dull, constant pain and progressive swelling in left upper abdomen. He also gave history of significant weight loss. Examination findings revealed that he was anaemic, left kidney was hugely enlarged and hepatomegaly. Initially it seemed to be a case of renal cell carcinoma. But after doing invasive investigations it was proved to be a case of lymphoma, which considering all clinical and laboratory findings was diagnosed as a case of primary renal lymphoma. Keywords: Young man, Primary, Renal mass, Lymphoma DOI: http://dx.doi.org/10.3329/jom.v12i2.8424 JOM 2011; 12(2): 174-176