Complications of extrahepatic echinococcosis:Fistulization of an adrenal hydatid cyst into the intestine

Echinococcal cysts are usually found in liver and lungs, but any other organ can potentially be involved. Extrahepatic disease due to hydatid cyst may develop in the abdominal and pelvic cavity, aside from in other less common locations, which may make both diagnosis and treatment more complex. We present a rare case of extrahepatic echinococcosis in a 70-year old patient with a 4-d history of dull abdominal pain, anemia within the transfusion range and fever. She underwent surgery for left renal hydatid cysts 30 years ago. After non operative treatment, imaging studies showed a calcified hydatid cyst in a retrogastric location communicating with a proximal jejunal loop. En-block resection of the mass together with the adrenal gland was performed including closure of the enteric fistula. Anatomic pathology confirmed the diagnosis of a calcified hydatid cyst of left adrenal origin. Surgery is the treatment of choice and most authors recommend removal of cyst and adrenal gland.

IgG4相关慢性间质性肾炎并肾包膜纤维化一例报告暨文献复习

目的 通过报道1例IgG4相关慢性间质性肾炎合并肾包膜纤维化的病例,结合文献复习,探讨本病的临床病理特点及肾活检注意事项,以提高临床医生对该病的认识.方法 描述患者发病及诊治经过,系统回顾相关文献,总结临床病理特点及肾活检操作注意事项.结果 本例患者尿比重1.011、尿蛋白±、尿糖3+,血红蛋白53 g/L,血肌酐1665μmol/L,IgG49.39 g/L,CT示双肾体积稍增大,双肾密度降低,肾周见低密度影环绕,增强扫描双肾见不规则低密度强化区,边界不清.第1次肾活检取出2条组织未见肾实质,主要为玻璃样变性的胶原纤维组织,重复肾活检取出3条组织示慢性间质性肾炎,IgG4阳性浆细胞热点区约60个/HPF,IgG4阳性浆细胞/IgG阳性浆细胞>40%,明确诊断IgG4相关慢性间质性肾炎.经足量激素治疗,患者摆脱透析,血肌酐降至502μmol/L.结论 IgG4相关疾病引起肾脏损害表现各异,需留意其累及肾周组织的情况,对肾包膜增厚的患者行肾活检时需权衡出血与取材不佳的风险.