Clostridioides difficile infection leading to fulminant colitis with toxic megacolon

Clostridioides difficile infection (CDI) is the culprit of millions of nosocomial infections in the United States. Programsthat successfully decrease its incidence, therefore, render cost savings for the healthcare system. Toxic megacolon andperforation are two of the most significant complications with increased mortality rates. We report a 23-year-old nursinghome resident hospitalized for fever, cough, and green sputum. After 3 days of antibiotic therapy, he developed abdominaldistension, diarrhea, and vomiting and underwent a total colectomy. The colon was dilated to a maximum of 11 cmwith markedly edematous mucosa and yellow pseudomembranes. Qualitative PCR of the stool detected Clostridioidesdifficile toxin B gene. While there is no consensus for the required interval between antibiotic treatment and CDI, thispresentation 3 days after starting the antibiotic therapy is earlier than most proposed ranges

Papillary renal cell carcinoma with extensive spindle cell foci: mimicker of mucinous tubular and spindle cell carcinoma

Papillary renal cell carcinoma (PRCC) is the second most common renal cell carcinoma (RCC), accounting for 10-15% of cases. Mucinous tubular and spindle cell carcinoma (MTSCC), on the other hand, accounts for only 1% of renal tumors and has a more favorable prognosis compared to PRCC. We report a 75-year-old female with a left upper pole solid renal mass displaying features of both papillary renal cell carcinoma (PRCC) and mucinous tubular and spindle cell carcinoma (MTSC). In this case, a shaggy luminal surface, multiple papillations, and psammoma bodies, absence of E-cadherin expression, and strong CD10 expression favored PRCC. Both immunohistochemistry and genomic analysis are critical to diagnose and differentiate tumors that may have overlapping features accurately

Beyond Triple-Negative: High Prevalence of Quadruple-Negative Breast Cancer in African Americans

Quadruple-negative breast cancer (QNBC) is a triple-negative breast cancer (TNBC) subtype that lacks expression of the androgen (AR) receptor. Few studies have focused on this highly aggressive breast cancer, portending worse survival rates. We aimed to determine the following: (1) QNBC’s molecular and clinical characteristics and compare them with other subtypes and (2) QNBC’s association with clinicopathological factors and prognostic markers. We performed immunohistochemical evaluations of ARs on tissue tumor microarrays from FFPE tumor blocks of invasive ductal breast carcinomas in 202 African American women. Univariate analysis was performed using the chi-square test, with survival rates calculated using Kaplan–Meier curves. Overall, 75.8% of TNBCs were AR-negative. Compared to the luminal subtypes, TNBC and QNBC tumors were likely to be a higher grade (p p < 0.001). They also expressed increasing mean levels of proteins involved in invasion, such as CD44, fascin, and vimentin, as well as decreasing the expression of proteins involved in mammary differentiation, such as GATA3 and mammaglobin. We found no association between QNBC and stage, recurrence-free survival, or overall survival rates. The high prevalence of TNBC AR-negativity in these women could explain observed worse outcomes, supporting the existence of the unique QNBC subtype

Lipase hypersecretion syndrome: A rare cutaneous manifestation of advanced pancreatic acinar cell carcinoma

Careful recognition of cutaneous lesions in patients with malignancies may aid in avoiding additional morbidity during end of life care