Recurrent Metastatic Chordoma to the Liver: A Case Report and Review of the Literature.

Chordoma is a rare malignant neoplasm derived from notochordal tissue that primarily affects the axial skeleton. Almost 40% of patients have non-cranial chordoma metastases. The most common metastatic sites are the lungs, bones, lymph nodes, and subcutaneous tissue. We present a 52-year female with a history of sacral chordoma presenting with abdominal fullness, early satiety, and a palpable abdominal mass. Abdominal magnetic resonance imaging (MRI) revealed an isolated, highly vascularized, and multilobed liver mass in the left lateral segment. The mass was surgically removed using a clean surgical margin. A histological examination and immunohistochemical staining were consistent with a metastatic chordoma. Two years later, follow-up imaging studies showed a 6.5 × 4.0 × 2.0 cm right liver lesion with multiple lungs, chest wall, pleural, and diaphragmatic lesions. Microscopic- and immunohistochemical staining revealed a recurrent metastatic chordoma. Herein, we present a unique case of metastatic recurrent chordoma in the liver with the involvement of other sites. To the best of our knowledge, no other case of recurrent liver metastasis has been reported.

Retraction: Idiopathic CD4+ Lymphocytopenia Due to Homozygous Loss of the CD4 Start Codon.

[This retracts the article DOI: 10.7759/cureus.15251.].

Idiopathic CD4+ Lymphocytopenia Due to Homozygous Loss of the CD4 Start Codon.

Idiopathic CD4+ lymphocytopenia (ICL) is an extremely rare condition characterized by low numbers of CD4+ cells (<0.3 K/µL) without human immunodeficiency virus (HIV) infection or any other cause of immunodeficiency. In this case report, we report a case of idiopathic CD4+ lymphocytopenia in a 22-year-old woman initially presenting with insomnia, fatigue, and a sore throat. However, this rapidly progressed to shortness of breath and chest pain, ultimately leading to acute respiratory distress syndrome (ARDS) over the span of a few days. Broad-spectrum antimicrobials were administered, resulting in prompt recovery. Serological studies were negative for malignancy and severe infections, including HIV1 and HIV2. Flow cytometry revealed an absence of CD4+ cells and an increase in double-negative T-cells. Further genetic workup revealed that in the second exon of the CD4 gene, the patient had a homozygous c.1ATG>GTG (p.Met1Val; p.M1V) mutation. Family screening showed that the patient's mother, father, and brother all had a single p.M1V mutation, allowing for deleterious effects to be partially offset by the normal copy of the gene. We have provided an organized analysis of the existing literature in addition to a concise overview of this case, with the intention of identifying patterns in presentation, clinical course, and outcomes. This case discusses the effects of the loss of the CD4+ start codon in the patient. Although this specific form of lymphocytopenia is very uncommon, it illustrates the importance of genetic testing and the integral nature of laboratory testing in therapy charting.

Scientometric Analysis: University Hospital Versus University College of Medicine.

Many medical specialties use scientometrics to assess the impact of publications, journals, and authors. The aim of this study was to analyze and compare trends of publications from a hospital medical center to publications from a college of medicine connected to that hospital and compare collaboration rates between them to other domestic and international institutions. We used Elsevier's SCOPUS database to compare Penn State College of Medicine (PSCOM) publications to Hershey Medical Center (HMC) publications, analyzing 31,856 total publications. We hypothesized that HMC and PSCOM have room to improve on both internal and international collaborations. Our results show that despite PSCOM's international collaboration being nearly three times higher than HMC, overall international collaboration is less than 2%, far below the US national average.