Case of Successful Radiofrequency Ablation of Multiple Bilateral Renal Cell Carcinomas in von Hippel-Lindau Disease / 대한내과학회지

Von Hippel-Lindau (VHL) disease is an inherited, autosomal dominant syndrome that manifests as a variety of benign and malignant tumors in various organs. Notably, renal cell carcinoma (RCC) in patients with VHL disease tends to be multifocal and bilateral, and tends to recur or new tumors develop after removal. Radiofrequency ablation (RFA) has recently been introduced as a minimally invasive treatment for small hereditary RCCs with a low complication rate and a minimal decrease in renal function. We present a case of successful RFA of multiple bilateral RCCs in a 24-year-old female with VHL. Computed tomography (CT) of the abdomen revealed multiple bilateral RCCs. The patient received sequential RFA for the bilateral RCCs, resulting in a complete response. At the time of writing, there was no sign of recurrence or renal failure. In conclusion, percutaneous RFA is a promising treatment for VHL patients who cannot undergo surgery, with excellent treatment outcomes and minimal change in renal function.

Case of Successful Radiofrequency Ablation of Multiple Bilateral Renal Cell Carcinomas in von Hippel-Lindau Disease / 대한내과학회지

Von Hippel-Lindau (VHL) disease is an inherited, autosomal dominant syndrome that manifests as a variety of benign and malignant tumors in various organs. Notably, renal cell carcinoma (RCC) in patients with VHL disease tends to be multifocal and bilateral, and tends to recur or new tumors develop after removal. Radiofrequency ablation (RFA) has recently been introduced as a minimally invasive treatment for small hereditary RCCs with a low complication rate and a minimal decrease in renal function. We present a case of successful RFA of multiple bilateral RCCs in a 24-year-old female with VHL. Computed tomography (CT) of the abdomen revealed multiple bilateral RCCs. The patient received sequential RFA for the bilateral RCCs, resulting in a complete response. At the time of writing, there was no sign of recurrence or renal failure. In conclusion, percutaneous RFA is a promising treatment for VHL patients who cannot undergo surgery, with excellent treatment outcomes and minimal change in renal function.

Native Aortic Valve Thrombosis Resembling Papillary Fibroelastoma

The differential diagnosis of cardiac mass is important in determining the therapeutic plan and avoiding unnecessary surgical intervention. Non-invasive imaging methods would be useful in the diagnosis of suspected cardiac mass, because they may provide earlier diagnosis and more accurate assessment of cardiac mass. Native aortic valve thrombosis is a rare disorder and difficult to differentiate from a tumor, and in particular, a papillary fibroelastoma. Thus, the clinical decision making with imaging modalities should be performed cautiously. We recently met a female patient who had a aortic valve mass resembling papillary fibroelastoma in normal native valve. The patient underwent a surgical resection and the pathologic finding showed an organized thrombus with no evidence of papillary fibroelastoma.

Severe Scrub Typhus with Enterocolitis by the Ikeda Strain of Orientia tsutsugamushi / 감염과화학요법

Scrub typhus is a mite-borne bacterial infection of humans that is caused by Orientia tsutsugamushi, which causes generalized vasculitis. The disease may involve the tissues of any organ system but no case with involvement of the lower gastrointestinal tract has been reported. We report a case of a 39-year old Korean male with enterocolitis of severe scrub typhus, of which the serotype was Ikeda strain. The patient was admitted to hospital with fever, abdominal pain and shock. He developed multi organ failure and frequent watery diarrhea. Abdominal computed tomography revealed diffuse edematous thickening of the entire small and colon with inflammation. Three days after admission, the antibody to O. tsutsugamushi was reported to be 1:320. He improved with doxycycline and azithromycin, and the persistent watery diarrhea stopped at 24 hours. This study shows that scrub typhus should be considered when the small and large intestine are affected. For the genotype of O. tsutsugamushi in Korea, additional studies of the impact of changes in the vector distribution on the genotype distribution will be needed.