ABSTRACT
Antibody-mediated rejection [ABMR] jeopardises short- and long-term transplant survival and remains a challenge in the field of organ transplantation. We report the first use of the anticomplement agent eculizumab in Oman in the treatment of a 61-year-old female patient with ABMR following a living unrelated kidney transplant. The patient was admitted to the Sultan Qaboos University Hospital in Muscat, Oman, in 2013 on the eighth day post-transplantation with serum creatinine [Cr] levels of 400 [micro]mol/L which continued to rise, necessitating haemodialysis. A biopsy indicated ABMR with acute cellular rejection. No improvement was observed following standard ABMR treatment and she continued to require dialysis. Five doses of eculizumab were administered over six weeks with a subsequent dramatic improvement in renal function. The patient became dialysis-free with serum Cr levels of 119 [micro]mol/L within four months. This case report indicates that eculizumab is a promising agent in the treatment of ABMR
ABSTRACT
Breast cancer is the most common cause of metastatic deposits in the skeleton, and bone is the most common site of recurrence of breast cancer. Breast cancer metastasis most commonly affects the spine, ribs, pelvis, and proximal long bones; however, only 3.5% of breast cancer patients develop long-bone metastases. The humerus is the most common upper-extremity site for bony metastasis, and pathologic fractures can result. The patient in the current study presented with breast cancer and discovered to have humeral head metastasis during initial workup. The dilemma was in investigation the modality to confirm humeral head metastasis as there are many differential diagnoses with similar findings. After staging workup, the patient was treated with neoadjuvant chemotherapy followed by modified radical mastectomy and radiotherapy of the chest wall and the shoulder. The lesion in humerus was well healed.
ABSTRACT
Pseudoangiomatous stromal hyperplasia [PASH] is a rare proliferative breast disease. It is characterized by fibrosis of the mammary stroma surrounding breast ducts and lobules with formation of anatomizing capillary-like spaces lined by myofibroblastic cells. Commonly, patients present with a palpable breast mass or continuous breast enlargement. We report a case of a 25 year old lady who presented with painless unilateral swelling of her right breast. Ultrasonography showed heterogeneous, hypoechoic benign appearing breast tissue. Histopathology revealed dense collagenous stroma separated by slit like spaces that were lined by bland spindle cells showing no cytological atypia. With immunohistochemistry, these cells were positive for CD-34 and SMA and negative for the endothelial marker CD-31. Some of these cells were also positive for ER and PR.
ABSTRACT
Bronchogenic cysts originate from abnormal budding of the tracheal diverticula during the embryological period. Inaccuracy in the process of growing of the ventral foregut will give rise to bronchogenic cyst. Scapular bronchogenic cyst is an extremely rare form of this anomaly. A three years old boy suffered for 2 years with left sided suprascapular cystic lesion which was gradually increasing in size. The swelling was 4x3 cm in size and non tender. The cyst was evaluated by CT scan that showed complex cystic lesion over the left scapular spine. Total excision of the cyst was done and histopathology showed cutaneous bronchogenic cyst. The proposed mechanism for such cutaneous lesion is that the accessory buds from the tracheobronchial tree/primitive foregut migrated from the thorax in an aberrant manner to lie in periscapular positions. The definitive treatment of scapular lesions is total surgical excision. The final diagnosis is based on the histopathological findings in the majority of cases