Case Reports in Clinical Pathology 

About: Case Reports in Clinical Pathology is an academic journal published by Sciedu Press. The journal publishes majorly in the area(s): Biopsy & Carcinoma. It has an ISSN identifier of 2331-2726. It is also open access. Over the lifetime, 239 publications have been published receiving 238 citations. The journal is also known as: CRCP.

Unique metastases of ALK mutated lung cancer activated to the adnexa of the uterus

Abstract: Anaplastic lymphoma kinase (ALK) fusion positive non-small cell lung cancer (NSCLC) is a relatively novel molecular subtype in lung cancer. ALK targeted therapies such as crizotinib increase survival benefit in this patient population. However, further understanding of the disease subtype including patterns of metastasis and pathways of treatment resistance are needed. We describe a 50 year-old-woman diagnosed with stage IV NSCLC, T2N3M1b, ALK fusion positive disease. Although her initial sites of metastasis included the liver and bone, her story is notable for crizotinib resistant growth of a metastatic lesion to her adnexa. This report brings to attention unique mechanisms of metastasis in ALK positive patients.

Cutaneous metastases from cervical squamous cell carcinoma in a 55 year-old woman: a rarely reported manifestation

Abstract: Squamous cell carcinoma of the cervix was once the most common gynecologic cancer in the world, accounting for significant morbidity and mortality With the advent of routine Papanicolaou screening in the United States during the latter half of the twentieth century, cervical cancer now accounts for a much smaller proportion of cancer deaths Despite the advances that have been made in screening and early detection, women of low socio-economic status and immigrants from other countries who may not have access to health care continue to present with high-stage disease Manifestations of advanced disease include direct invasion of structures adjacent to the cervix and distant metastases to the lung, bone, and liver In approximately 05-1 percent of cases, metastases to the skin and soft tissue occur, most commonly to the abdominal wall and vulva, followed less frequently by the perineum and extremities This particular manifestation has come to be regarded as a sign of terminal disease, with most patients surviving 3-6 months despite chemotherapy Clinically, this may not be a diagnosis that is anticipated by the pathologist examining the biopsy We present the case of a 55 year-old woman with a history of untreated squamous cell carcinoma of the cervix who presented with rapidly spreading, painful erythematous papules of the vulva, lower anterior abdominal wall, and proximal lower extremities This case highlights a rare presentation of metastatic squamous cell carcinoma of the cervix, and underscores the importance of obtaining adequate clinical history, investigating a wide range of diagnoses as part of the differential diagnosis, and distinguishing primary cutaneous squamous cell carcinoma from a metastasis

Proinsulinoma causing severe hypoglycemia in a patient with type 1 diabetes mellitus

Abstract: Case presentation: A 49 year male a 35 year history of Type 1 Diabetes Mellitus (T1DM) was evaluated for recurrent episodes of hypoglycemia. After being weaned off of all exogenous insulin, the patient continued to have frequent and severe episodes of hypoglycemia often associated with seizures. Results: During an observed hypoglycemic reaction in our office he was found to have a serum glucose level of 64 mg/dl, a serum insulin level of 64 μIU/ml (reference range is <17 μIU/ml) and a C-peptide level of 0.6 ng/ml (reference range is 0.8 ng/ml – 3.1 ng/ml). Serum and urine sulfonylurea levels were negative. During a formal diagnostic 72 hour fast, he developed severe hypoglycemia within four hours of beginning the fast and seized. No diagnostic laboratory studies were obtained during the hypoglycemic event! He underwent surgical exploration, where a 0.8 cm well-differentiated, islet cell tumor was resected. Following resection of the tumor, the spontaneous hypoglycemia resolved, and maintenance exogenous insulin was reinstituted. Histoimmunochemical staining was positive for chromogranin, synaptophysin, amylin, and proinsulin but negative for insulin. Immunostaining of the tumor was also positive for Toll-like receptors-3 (TLR3) and Wnt5a. Conclusion: This is the first case report of a patient with a long history of T1DM who developed a recurrent hypoglycemia due to a proinsulin-secreting islet cell tumor which resolved following its resection.

Leiomyosarcoma of vascular origin: case report

Abstract: Leiomyosarcomas of vascular origin are uncommon. Originated from the smooth muscles of tunica media of major blood vessels leiomyosarcoma of venous origin is 5 times more common than those of arterial origin, 50% of cases originated in the lower vena cava. Most cases are presented in women with a median age of 50 years. We reported a 65-year-old woman, onset of symptoms 3 months before diagnosis with: pain, palpable tumor (9 cm × 5 cm), edema of the left lower extremity and unilateral intermittent claudication. CT with a vascularized mass, unrelated to adjacent muscle (tibialis posterior) of the left lower pelvic member, it displaces the path of the neurovascular bundle, with a probable origin in the posterior tibial vein. Total tumor resection was performed. Pathology reports a high-grade vascular leiomyosarcoma. T2a, Nx, Mx. Stage IIc. The diagnosis was confirmed by immunohistochemistry. The patient had adequate postoperative recovery without complications. Later the patient received 37 cycles of post-operatory radiotherapy. Currently (July 2015) the patient is asymptomatic. We present this case because although the frequency of this type of tumor is low, should be considered as a differential diagnosis in patients with mass, claudication and pain in lower pelvic member.

Acute cocaine-induced hepatotoxicity with features of shock liver

Abstract: Background: Cocaine-induced toxicity has been described to be associated with severe adverse clinical health outcomes, affecting multiple organs systems with very limited clinical recommendations or guidelines for management of some of its associated complications. Case report: We present a case of middle-aged female with acute severe hepatotoxicity after ingestion of alcohol and non-intravenous cocaine. She had markedly elevated liver enzymes and lactate dehydrogenase suggestive of shock liver but with minimal overt systemic manifestations. Patient was managed conservatively with intravenous fluids and treatment of con-current co-morbidities and liver enzymes and lactate dehydrogenase declined rapidly over a 5-day hospital course. Discussion: We hypothesize that cocaine may play a role in diminishing hepatic perfusion, mimicking an ischemic hepatitis type clinical presentation and suggest that similar management, based on volume resuscitation, will potentially be more helpful than harmful for patient’s presenting with acute cocaine-induced liver injury.