A Rare Case of Cavernous Haemangioma of the Adrenal Gland: A Case Report and Review of Literature.

Cavernous haemangiomas, also known as cavernoma or cavernous angiomas, are clusters of vasculature malformations arising from the endothelial layer of blood vessels. They are commonly found in the central nervous systems, skin, or liver. Rarely, they can also affect adrenal glands, a phenomenon with only 66 cases since the first case was reported in the literature in 1955 and 2018. Adrenal cavernous haemangiomas are typically non-functioning and found incidentally on radiological imaging. Here, we present the case of a 79-year-old male who was referred by a district general hospital to our tertiary centre with an incidentaloma of the left adrenal gland which was first noted in 2014 measuring 6 cm. A repeat computed tomography in 2020 revealed the mass was 20.8 cm. In 2020, the growing mass was causing anaemia and abdominal discomfort due to displacement of the surrounding viscera. The initial radiological impression performed in another hospital of the indeterminate mass was highly suspicious of primary adrenal malignancy. The decision was made to operate prior to biopsy as biopsy was deemed high risk for dissemination of primary malignancy of the adrenal. The patient subsequently underwent a radical open left adrenalectomy in September 2020. The diagnosis of adrenal cavernous haemangioma was made on histopathological examination post-surgery. Published literature on this rare adrenal tumour between 2019 and 2021 is also reviewed in this paper.

Acute interstitial nephritis due to sodium-glucose co-transporter 2 inhibitor empagliflozin.

Biopsy-proven acute interstitial nephritis (AIN) secondary to sodium-glucose co-transporter 2 (SGLT2) inhibitors has not been described previously. Here, we report on the management of a patient with severe acute kidney injury that developed 6 weeks after starting empagliflozin. The cause was confirmed as AIN on renal biopsy. Our patient recovered, without the need for dialysis, with discontinuation of empagliflozin and corticosteroid treatment. This novel clinical observation is likely to occur more frequently as these drugs are increasingly being prescribed, given that recent randomized controlled trials including EMPA-REG (Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes) showed SGLT2 inhibitors can decrease cardiovascular mortality, among other benefits, in high-risk diabetic populations.

Rectal metastasis from breast cancer: an interval of 17 years.

Metastasis to gastrointestinal (GI) tract from breast cancer is rare. Commonly affected organ in GI tract is stomach, followed by colon and then rectum. The authors report a case of a 61-year-old woman who had a mastectomy for lobular carcinoma of the breast 17 years ago and was referred to colorectal clinic with increased frequency of stools. Colonoscopy showed a stricture in the rectum, but biopsy was inconclusive. As she was symptomatic, she had a Hartmann's resection 5 months after she initially presented to the clinic. Histopathology of the resected specimen showed it to be metastasis from lobular carcinoma of the breast. Awareness of potential long delays in the presentation of metastatic breast cancer especially lobular carcinoma helps in the earlier diagnosis and clinical management.