ABSTRACT
Objective:By analyzing the clinical and pathologic manifestations of systemic mastocytosis (SM) to improve the recognition of the disease.Methods:Clinical manifestations, diagnosis and treatment of a middle-aged male patient with SM was reported with multidisciplinary discussions.Results:A middle-aged man with bone pain, thyroid nodules and lymphadenectasis came to our clinic. Thyroid cancer with lymph node and bone metastasis was suspected by imaging examination. The pathological results showed cell proliferation with transparent cytoplasm and irregular nuclear in the trabecular bone. Toluidine blue staining showed the proliferated cells were mast cells(+). Immunohistochemistry showed proliferating mast cells stained with CD117 and CD2. SM with extensive bone marrow involvement was diagnosed and treated with thalidomide and calcitriol.Conclusion:Knowing the characteristics of SM is helpful for accurate diagnosis and treatment.
ABSTRACT
Hypercalcemia is an abnormal calcium metabolism, which can be caused by many diseases. Hypercalcemia caused by sarcoidosis is unusual. Sarcoidosis is a systemic granulomatous disease, it is lack of specificity in initial manifestations and easy to be misdiagnosed. In this paper, we report a patient with hypercalcemia and mediastinal lymphadenectasis, which the first diagnosis was misdiagnosed as tumour. Finally, sarcoidosis was diagnosed by mediastinal lymph node biopsy, and the patient was subsequently treated with glucocorticoid. Prednisone treatment improved symptoms of sarcoidosis, normalised serum calcium and mediastinal lymph nodes were diminished. This case suggests that clinicians need to raise awareness of sarcoidosis to identify and diagnose it correctly.
ABSTRACT
Objective To analyze the clinical prevalence,distributed characteristic of different ages,clinical characteristics and pathogenic factors of chronic abdominal pain in children.Methods A database in which outpa-tient and inpatient of abdominal pain during 2 -14 years old were collected from January 2011 to December 2015 was established by utilizing HIS system.A statistical analysis was made in age,sex,onset time,time of duration,mesenteric lymph node status and surgical situation.Results A total of 13 256 times abdominalgia were enrolled from January 2011 to December 2015.7 390 patients were diagnosed as unexplained abdominal pain,including 1 005 patients (13.59%)were diagnosed as chronic abdominal pain.A male -to -female ratio was 1.06:1.The average age was 6 years(ranged 2 -14 years).The average age of the boys was (6.02 ±2.87)years,which of the girls was (5.93 ± 2.79)years,there was no statistically significant difference between them(t =0.47,P =0.63).The peak age of chro-nic abdominal pain in children was mainly from 3 to 7 years old.The incidence decreased with age increased.The average time of duration was (16.70 ±11.69)months,that of the boys was (17.39 ±12.12)months,and that of the girls was (15.96 ±11.19)months,there was statistically significant difference between them(t =1.93,P =0.05). Mesenteric lymphadenectasis was detected in 731 patients(72.74%).The age constituent ratio decreased with age increased.The peak age of the prevalence coincided with peak age of the mesenteric lymphadenectasis.21 patients underwent surgical procedures,organic lesions accounted for 2.08%.Conclusion The peak age of the prevalence of chronic abdominal pain in children is mainly from 3 to 7 years old.Potential organic causes are rarely linked to chronic abdominal pain in children.Most of them are functional abdominal pain.The appendix and mesenteric lymphadenecta-sis might play an important role in children with chronic abdominal pain.The therapeutic aim of CAP in children is to make the children back to their normal life by exclude the organic causes and relieve their pain.The natural history of chronic abdominal pain suggests that symptoms remit spontaneously with increasing age.
ABSTRACT
Objective To investigate etiological factors, clinical characteristic and related laboratory findings of subacute necrotizing lymphadenitis and improve the acknowledgement of subacute necrotizing lymphadenitis. Methods We analyzed 14 cases of subacute necrotizing lymphadenitis who had been diagnosed by lymph node biopsy retrospectively. Results The most of patients were school children with mean age of 10.4 ± 2.9) years. The ratio of male to female was 1.8∶1 .The main clinical symptoms were that lymph nodes were swelling and pressing-pain in 14 cases (100%) and fever in 13 cases (92.9%), rash in 2 cases (14.3%),hepatosplenomegaly in 2 cases (14.3%).The white blood cell count was (2.3 ～ 7.4) × 109/L in 14 cases and average count was (3.90 ± 0.35) × 109/L. The white blood cell count showed leukopenia in 10 cases (71.4%) and none showed heighten. Twelve cases were tested by CRP and the result of 8 cases elevated slightly (10 ～ 30 mg/dl). Thirteen cases underwent ESR examination and the result of 11 cases showed higher than that of normal level (20mm/h)(82.6%). The average ESR risen value was 40mm/h and topmost value was 70 mm/h. Eight cases underwent anti-nuclear antibody test and 2 cases of them were positive. Twelve cases underwent EB virus antibody test and 4 cases of them were positive. Eleven cases underwent blood Mycoplasma-IgM examination and one of them was positive. Six cases underwent coxsackie virus antibody and one of them was positive.Coxsackie and EB virus infected in one case. Lymph node biopsy was found necrotic fragments in different sizes. The cellular hyperplasia was found around the necrotic area and plasma cells, neutrophils, and eosinophils were found rarely in these areas. The DNA of EB virus was negative in lymph nodes. Eight cases of all were treated by prednisone and effect showed well 1.5 ～ 2.0 mg/(kg·d)). One of all was recurrence and the rest recovered well. Blood routine examination was used when they were under a stable condition, five cases of them showed normal white blood cells. Conclusion Those with fever of unknown origin combined with lymphadenectasis are suggested to have an early lymph node biopsy. The process is self-limited and glucocorticoid therapy is effective to those impatients. The long-term follow up is required as recurrence and development of SLE have reported. EB virus was not an etiological factor of SNL. Leucocyte can be used as one of the indicators of improvement.