Arye Kremer

Metastatic prostate carcinoma mimicking primary anal cancer.

A 71-year-old man with a history of castration-refractory prostate cancer was initially treated with hormonal therapy. He responded with a decreasing prostate-specific antigen level and improved symptoms. Chemotherapy was initiated later, after an increasing prostate-specific antigen level and findings of distant metastases. Nine months after his initial diagnosis, he presented with a large multinodular perianal mass that was suspicious for primary anal cancer. Biopsy revealed poorly differentiated metastatic prostate carcinoma. The patient died 2 months after the initial presentation with perianal skin metastasis.

Falsely elevated salicylate concentration in a patient with hypertriglyceridemia

ABSTRACT Because salicylism is a clinical diagnosis, the serum concentration should be interpreted in conjunction with the clinical presentation. A 26-year-old man presented to the Emergency Department with abdominal painand had extremely elevated serum triglycerides (>7000 mg/dL). Ethanol, acetaminophen, and salicylate concentrations were checked because of concern of self-injurious behavior, which returned at 13.1 mg/dL, undetectable, and >100 mg/dL, respectively. His basic metabolic panel revealed a bicarbonate of 23 mEq/L and an anion gap of 11. An arterial blood gas showed a pH 7.39 and a PCO2 of 36.6 mmHg. On physical examination, he was awake and alert, and had a respiratory rate of 12–14/min. The possible effect of hyperlipidemia to falsely elevate the salicylate concentration was recognized. He was treated for severe hypertriglyceridemia and as his triglyceride level dropped, his repeat salicylate concentration was <1 mg/dL. Since dfferent sized lipoproteins contribute variably to serum sample turbiditythey have the potential to interfere with the absorption of light thereby producing erroneous laboratory results . Clinicians need to be aware of the implications of severe hyperlipidemia and interference to prevent clinical errors based on false positive laboratory results.

Spontaneous Kidney Rupture With Incidental Renal Cell Cancer in Patient With Castleman's Disease

A 65-year-old man with a history of Castlemans disease presented with abdominal and right flank pain. He denied any recent trauma. On admission, his hemoglobin was 7.0 g/dL, and the blood urea nitrogen and serum creatinine concentration was 30 and 1.62 mg/dL, respectively. Computed tomography of the patients abdomen revealed a large right perinephric hematoma. The patient underwent emergency nephrectomy. Microscopic examination of the specimen revealed an incidental renal cell carcinoma.