Reports (MDPI)最新文献

Background and Clinical Significance: Henoch-Schönlein purpura (HSP), also known as Immunoglobulin A (IgA) vasculitis (IgAV), is a common systemic vasculitis in children characterized by palpable purpura, abdominal pain, and joint and kidney involvement. While respiratory tract viral or bacterial infections are the most common causes of HSP, parasitic infections, such as giardiasis, are occasionally reported. Giardia lamblia is the most common parasite infecting humans and a major cause of infectious diarrhea, which can lead to post-infection complications. To our knowledge, this is the first report in Greece describing a pediatric patient with HSP secondary to giardiasis. A review of pediatric HSP cases caused by parasitic infections is also included. Case presentation: An 8-year-old girl presented with a purpuric rash, joint tenderness, severe abdominal pain, and bloody diarrhea, raising suspicion of HSP. Laboratory tests revealed elevated IgA levels, and stool analysis tested positive for Giardia lamblia antigen. The diagnosis of HSP secondary to giardiasis was confirmed, and the patient was successfully treated with supportive care, metronidazole, and corticosteroids. Conclusion: This case report and literature review highlight parasitic infections as an underrecognized but important trigger of pediatric HSP. Although giardiasis is linked to various post-infectious complications, its association with HSP is rarely reported. Pediatricians should maintain a high level of suspicion for underlying infectious diarrhea, such as giardiasis, in patients with HSP, especially in children with prominent gastrointestinal symptoms. Early recognition can reduce complications and facilitate faster recovery. Further research is needed for the immunopathogenic mechanisms linking parasitic infections and HSP in children.

Background and Clinical Significance: Urothelial carcinoma is one of the most commonly diagnosed malignant diseases. However, it has a much more favorable prognosis than other significantly less common malignancies. This statement, however, is true only for conventional urothelial carcinomas, not for those with divergent differentiation or a special type of urothelial carcinoma. Case Presentation: Herein, we present a case report of an 80-year-old female patient with multiple predominantly cardiovascular comorbidities and vascular dementia, who presented to our institution with genital bleeding. Clinical and diagnostic tests were difficult due to patient noncooperation; however, abdominal computer tomography and cystoscopy showed an advanced tumor originating from the ventral bladder wall. Histology of the tumor showed an invasive urothelial malignancy with foci of clear-cell (glycogen-rich) variant and dispersed, pleomorphic cells, which were immunohistochemically positive for beta-human chorionic gonadotropin. Hence, the diagnosis of high-grade urothelial carcinoma with clear-cell (glycogen-rich) morphology and divergent trophoblastic differentiation was established. Patient outcome was poor. Conclusions: While conventionally having a somewhat favorable prognosis, special subtypes and divergent differentiation in urothelial carcinomas, which warrant a high-grade diagnosis are not only rare but also highly aggressive conditions. Further challenges arise in their differential diagnosis with other advanced malignancies, which can develop in adjacent organs in both genders.

Background and Clinical Significance: Cutaneous lupus erythematosus (CLE) is an autoimmune condition characterized by a wide range of cutaneous manifestations, classified into three major subtypes-chronic (CCLE), subacute (SCLE), and acute (ACLE)-based on clinical morphology and lesion duration. Discoid lupus erythematosus (DLE), the most common form of CCLE, predominantly affects sun-exposed areas and presents as erythematous macules that progress to well-demarcated, disc-shaped plaques. If left untreated, DLE may lead to scarring and permanent alopecia. Diagnosis is primarily clinical, with skin biopsy performed when indicated. Management includes photoprotection and topical corticosteroids, with systemic immunosuppressive therapy reserved for severe cases. Case Presentation: We report a case of a 38-year-old female patient presenting with confluent lesions with indurated borders and multiple pustules, initially raising suspicion of cutaneous infection. A broad differential diagnosis was considered, including fungal and bacterial infections, demodicosis, and cutaneous tuberculosis, all of which were excluded through comprehensive clinical and laboratory investigations. Ultimately, DLE was diagnosed based on serologic and histopathologic findings. During the course of immunosuppressive therapy, her condition deteriorated, and she developed pulmonary tuberculosis. Conclusions: The presented case underlines the rarity and broad differential diagnosis of DLE as well as the possibility of complications.

Background and Clinical Significance: Inflammatory fibroid polyp (IFP), also known as Vanek's tumor, is a rare, benign mesenchymal lesion of the gastrointestinal (GI) tract that frequently mimics neoplastic conditions due to its submucosal location and radiologic appearance. Although most commonly found in the gastric antrum, IFPs may occur throughout the GI tract and present with a range of symptoms, from incidental findings to obstruction or bleeding, depending on size and location. Case Presentation: This article presents two distinct cases of gastric IFP managed at the University Hospital of Messina: one endoscopically resected polyp in a 70-year-old man and one surgically excised infiltrative lesion in a 64-year-old woman with high-grade obstruction. Histological analysis in both cases confirmed the diagnosis of IFP, demonstrating spindle cell proliferation with eosinophilic infiltrates and a characteristic perivascular "onion-skin" pattern. Immunohistochemical staining showed strong CD34 positivity and absence of CD117 and DOG1, aiding in differentiation from gastrointestinal stromal tumors (GISTs). Conclusions: Recent evidence suggests a neoplastic origin for IFPs, supported by the presence of PDGFRA mutations and telocyte involvement, prompting a reevaluation of their pathogenesis. These cases underscore the diagnostic challenges posed by IFPs and highlight the importance of histological and immunohistochemical analysis in guiding appropriate treatment. While endoscopic resection is preferred for localized lesions, surgical intervention remains necessary in complex or obstructive cases. Understanding IFPs' molecular profile and cellular origin may refine future diagnostic and therapeutic approaches.

Background and Clinical Significance: Visual agnosia and speech production deficits are well-described sequelae of neurosurgical interventions, but their selective dissociation remains rare. This report presents an unusual combination of postoperative deficits following awake resection of a left frontal low-grade glioma. Case Presentation: We present the case of a right-handed female with left hemisphere language dominance who had a left frontal low-grade glioma. Preoperatively, she exhibited anomia and dysexecutive syndrome, including difficulty completing everyday goal-directed tasks such as sending emails and paying for parking. Following awake tumor resection, she developed two rare, dissociated deficits: (1) speech restricted to infinitive verb forms and (2) selective visual agnosia for static images, with preserved recognition of dynamic stimuli. Conclusions: This uncommon clinical constellation highlights the vulnerability of left frontal language and ventral visual processing networks during surgery and supports the dual-stream model of vision and language production. We describe a selective form of static visual agnosia affecting static images with relative preservation of dynamic and object recognition, for which we use the descriptive label "astatopsia". This peculiar clinical condition is rarely documented in this particular combination and has not, to the best of our knowledge, previously been denominated in such a manner in the literature.

Background and Clinical Significance: Splenic artery pseudoaneurysm (SAP) is a rare but life-threatening complication of chronic pancreatitis. Although endovascular embolization achieves high technical success, recurrence and delayed rupture may occur, particularly in patients with ongoing pancreatic inflammation or alcohol use disorder (AUD). Case Presentation: A 47-year-old woman with alcohol-associated chronic pancreatitis presented with hematochezia, melena, and syncope. CT angiography revealed a 3.6 cm SAP adjacent to a 4.2 cm pancreatic head pseudocyst, and she underwent successful coil embolization. Despite initial stability, she relapsed into heavy alcohol use, experienced recurrent pancreatitis flares, and developed progressive multisystem comorbidities. Surveillance imaging up to three months post-embolization showed pseudocyst fluctuations without early recanalization, but long-term follow-up lapsed. Eight months after embolization, she presented in hemorrhagic shock from recurrent SAP rupture and died despite massive transfusion and emergent splenic artery ligation. Conclusions: Fatal SAP rupture may occur months after technically successful embolization. Sentinel bleeding, AUD relapse, and progressive systemic decline are critical warning signs. Structured post-embolization imaging and multidisciplinary management are essential to improve long-term outcomes.

Background: Recent advancements in regenerative medicine have introduced mesenchymal stem cell-derived exosomes (MSC-Exos) as a novel therapeutic approach. Exosomes are extracellular vesicles containing proteins, lipids, and RNAs capable of modulating cellular behavior and promoting tissue regeneration. A systematic review of human studies is warranted to summarize outcomes, assess therapeutic value, and guide clinical applications. Objectives: This systematic review synthesizes current evidence on mesenchymal stem cell-derived exosomes for cutaneous scars, aging, and hyperpigmentation, with a focus on functional and aesthetic outcomes. Method: A comprehensive search of PubMed, Scopus, Embase, Web of Science, and Google Scholar (January 2010-July 2025) was performed following 2020 PRISMA guidelines. Eligible studies included studies that were randomized controlled trials, pilot studies, case series, and case reports involving human participants treated with MSC-Exos. Outcomes assessed were scar remodeling, pigmentation, skin regeneration, recurrence, and adverse events. Data extraction and bias assessment were conducted independently. Result: Six studies (n = 99; age 19-72 years) from diverse regions, including the United States, the Republic of Korea, and México, were included. MSC-Exos therapy showed promising improvements in reducing scar thickness (32.5% vs. 19.9%, p < 0.01), wrinkle parameters were reduced by 1 (2.4-14.4% vs. 6.6-7.1%, p < 0.05), and elasticity was enhanced (+11.3% vs. -3.3%, p = 0.002) Additional benefits included hydration (+6.5% vs. +4.5%, p = 0.37) and reduced melanin index (-9.9% vs. -1%, p = 0.44). The Global Aesthetic Improvement Scale score showed significant improvement (p = 0.005). Using the Investigator Global Assessment, 16 out of 25 areas treated with exosomes showed significant improvement (grade ≥ 2), compared to 12 out of 25 areas in the control group (p = 0.02), indicating that exosome treatment led to more visible improvement. Complete resolution of icepick scars, partial improvement of boxcar/rolling scars, and no recurrence of keloids (18/21) were reported. Adverse events were mild and transient. Conclusions: Early human evidence suggests that MSC-Exos may offer potential therapeutic benefits for scars, hyperpigmentation, and skin aging, with favorable short-term safety profiles. However, the current evidence remains preliminary due to small sample sizes, heterogeneous study designs, and limited follow-up durations. Larger, well-designed randomized trials are needed to confirm long-term efficacy and safety.

Background and Clinical Significance: Cesarean scar pregnancy (CSP) is a rare complication that can occur after cesarean delivery, potentially exposing the patient to severe and life-threatening complications. This case report aimed to illustrate the evolution of CSP cases following initial conservative surgical treatment. Case Presentation: We present two cases involving pregnant women aged 29 and 36 years, both diagnosed with type 2 CSP based on ultrasound findings between 6 and 8 weeks of gestation. In these cases, we initially performed an aspirative curettage after administering systemic Methotrexate (MTX) or Mifepristone. Unfortunately, both patients experienced severe bleeding during the aspirative curettage, which necessitated emergency abdominal hysterectomy along with bilateral salpingectomy. Additionally, we provide an updated review of the related literature. Conclusions: For optimal outcomes, treatment must be tailored to various factors, including gestational age at diagnosis, gestational sac size, anterior myometrial thickness, and the presence of embryonic cardiac activity.

Inferior vena cava (IVC) disruption with continuation of the azygos is a rare congenital vascular abnormality that can be detected prenatally via high-resolution ultrasound. We present a case of isolated discontinuation of IVC, diagnosed during a routine abnormal scan of the second trimester, confirmed by fetal echocardiography, with an uneventful neonatal outcome. In accordance with the literature, we discuss the diagnostic approach, clinical significance and long-term implications of this vascular variant. We want to emphasize the importance of recognizing this anomaly and differentiating isolated cases from those associated with other congenital malformations.

Background and Clinical Significance: Cryotherapy, particularly with the CryoBalloon Focal Ablation System (CbFAS), has emerged as a minimally invasive modality delivering targeted ablation through liquid nitrous oxide. While its role in treating Barrett's esophagus and dysplasia is well established, its application in early esophageal adenocarcinoma (EAC) salvage treatment remains limited. Case Presentation: We report the case of an 84-year-old male with Barrett's esophagus and multiple comorbidities who underwent endoscopic submucosal dissection (ESD) for a 3 cm esophageal adenocarcinoma (pT1bN0M0). Histology revealed deep submucosal invasion, perivascular infiltration, and positive margins, rendering the resection non-curative. Given surgical ineligibility, the patient underwent cryoballoon ablation six months later for recurrent intramucosal carcinoma proximal to the ESD scar. At three months, surveillance endoscopy showed residual Barrett's esophagus with low-grade dysplasia. Conclusions: This case highlights the feasibility and safety of cryoballoon ablation as salvage therapy after non-curative ESD in inoperable EAC. To our knowledge, this represents the first report of salvage CbFAS in T1bN0M0 EAC, underscoring the need for further studies to define its role in the multimodal management of EAC.