ABSTRACT
Wegener's granulomatosis is an uncommon inflammatory disease that manifests as vasculitis, granulomatosis, and necrosis. It usually involves the upper and lower respiratory tracts and kidneys. Although it may essentially involve any organ, gastrointestinal [GI] involvement is notably uncommon. A 20-year-old male patient presented with epigastric pain, vomiting, hematemesis, and melena. On physical examination, he was pale. There was no abdominal tenderness or organomegaly. Upper GI endoscopy revealed dark blue-colored infiltrative lesions in prepyloric area. Evaluation of the biopsy sample showed mononuclear cell infiltration in the submucosal area, hyperplastic polyp, and chronic gastritis. High dose proton pump inhibitor and adjunctive supportive measures were given but no change in the follow-up endoscopy was detected. During hospital course, he developed intermittent fever and serum creatinine elevation. 12 days after admission, he developed dyspnea, tachypnea, and painful swelling of metacarpophalangeal joints, and maculopapular rash in extensor surface of the right forearm. Chest radiography showed pulmonary infiltration. Serum c-ANCA titer was strongly positive and skin biopsy revealed leukocytoclastic vasculitis. The patient received methylprednisolone pulse, which resulted in complete recovery of symptoms and gastric lesion. The present case indicates that GI bleeding may be the first manifestation of Wegener's granulomatosis. Moreover, it should be emphasized that gastric biopsy is not characteristic or diagnostic in such patients
ABSTRACT
The clinical relevance of bone marrow micrometastasis [BMM] in non-small-cell lung cancer is undetermined, and the value of such analyses in advanced stage patients has not been clearly assessed previously. This study was conducted to estimate the accuracy of both polymerase chain reaction [PCR] and immunohistochemistry [IHC] in micrometastases detection and determine the best site for bone marrow biopsy in order to find micrometastasis. This prospective cross-sectional study was performed in the Department of Thoracic Surgery, Alzahra University Hospital from September 2008 to June 2009. To evaluate the bone marrow, a 3-cm rib segment and an aspirated specimen from the iliac bone prior to tumor resection were taken. PCR and IHC were performed for each specimen to find micrometastasis. Of 41 patients, 14 [34%] were positive for BMM by PCR compared with two positive IHC [4.8%]. All BMMs were diagnosed in rib segments, and iliac specimens were all free from metastatic lesion. Our data showed no significant association between variables such as age, sex, histology, tumor location, side of tumor, involved lobe, smoking, or weight loss and presence of BMM. PCR could use as a promising method for BMM detection. BMM in a sanctuary site [rib] is not associated with advanced stages of lung cancer. In addition, when predictor variables such as age, sex, histology, tumor location, smoking, or weight loss are analyzed, no correlation can be found between micrometastasis prevalence and any of those variables
ABSTRACT
Cervical thymic cyst is not a common pathology encountered in either an adult or a child. Our case presentation is of an infant girl with a right cervical soft mass. It was totally resected and histological analysis revealed a thymic cyst. The diagnosis of thymic cyst is not possible prior to histological examination. Therefore, in children the disorder should be considered as a differential diagnosis of each cervical soft tissue mass and evaluation of mediastinum should be done for the presence of thymic tissue