Adult atypical sellar teratoid tumor presenting as diabetes insipidus

Objective: Atypical teratoid /rhabdoid tumor (ATRT) is a rare and aggressive central nervous system tumor that usually occurs in childhood but has rarely been reported in adults. We were able to identify 50 reported adult cases, 12 of which were sellar. We report a case of adult sellar ATRT who died within 2 months of presentation with headaches, visual deficits, polyuria, and polydipsia. Our case aims to highlight the importance of considering ATRT in the differential of sellar masses especially in adults presenting with rapid progression of symptoms. Case Presentation: A 62-year-old female was transferred to our institution for management of a pituitary mass. Her symptoms developed over 2 months, starting with daily headaches, nausea, followed by polyuria, polydipsia and finally double vision. She had left 6th nerve palsy on admission. She was diagnosed with central hypothyroidism and diabetes insipidus (DI). Magnetic resonance imaging (MRI) revealed a sellar mass with extension into superior sellar margin, an adjacent mass within the anterior third ventricle, with minimal connection between these adjacent masses with intraventricular and subarachnoid hemorrhage. She rapidly deteriorated, developed seizures, head CT demonstrated pituitary apoplexy and worsening intraventricular hemorrhage. She underwent emergent craniotomy, a large pituitary mass was found and decompressed, and third ventricular clot was removed. Histopathological study revealed malignant epithelioid neoplasm, consistent with ATRT infiltrating the pituitary gland and fibrocollagenous stroma. The neoplastic cells showed divergent phenotypes based on immunophenotypes - cytokeratin+, EMA +, SMA+, CD 34+ and loss of SMARCB1/ INI1 protein. Radiation therapy was started but her condition continued to deteriorate. She underwent left frontal ventriculoperitoneal shunt with external ventricular drain placement for progressive hydrocephalus, without significant improvement. MRI brain demonstrated leptomeningeal spread. She expired within 2 months of diagnosis. Conclusion: ATRT is very rare in adults and has a very poor prognosis. The more common presenting symptoms of sellar ATRT are headaches and visual symptoms. DI has not been previously reported and increased the suspicion for a non-adenoma etiology in our patient. Definite diagnosis is based on immunohistochemical features. Treatment modalities in adults include surgery, chemotherapy and radiotherapy. ATRT should be considered in the differential for patients with sellar masses presenting with atypical features or rapid progression. Early recognition and aggressive combination therapy is reported to be associated with improved outcomes

Hepatocellular carcinoma presenting as hypercalcemia

Objective: Humoral hypercalcemia is commonly seen associated with squamous cell cancers and breast cancers, but is also reported in other cancers. This is usually mediated through parathyroid hormone-related peptide (PTH-rP). PTH-rP interacts with the PTH/PTH-rP receptor that activates renal calcium reabsorption and promotes resorption of calcium from the bone. Hepatocellular carcinoma (HCC) may present with paraneoplastic syndromes and hypercalcemia was reported in 4-7% of patients. HCC presenting with hypercalcemia without bone metastasis is uncommon. We present one such case along with the discussion of mechanism of hypercalcemia. Case Presentation: 67 year old woman with a history of intravenous drug abuse and alcohol abuse presented with confusion, epigastric pain and generalized weakness of 2 week duration. Her vital signs were normal. She appeared drowsy and was oriented to person only. A magnetic resonance imaging of the brain ruled out a cerebrovascular event. Her labs showed ionized calcium 1.50 (1.0 - 1.35 mmol/L), intact parathyroid hormone 14 (15 - 65 pg/ mL), PTH-rP 39 (14 - 27 pg/mL), 25 hydroxy vitamin D 10 (\u3e 20 ng/mL), 1, 25 dihydroxy vitamin D 24 (20 - 74 pg/mL), alkaline phosphatase 153 (0 - 140 IU/L), creatinine 0.53 (\u3c 1.16 mg/dL) and GFR 110 (\u3e 60 ml/ min/1.73m2). Liver function tests were abnormal and hepatitis C antibody was positive. Computed tomography of the abdomen revealed nodular cirrhotic liver with a 10 x 10 cm right hepatic mass compatible with HCC. She had elevated alpha fetoprotein and cancer antigen 19-9 levels. Due to hepatic cirrhosis, initially she was treated with gentle intravenous hydration with no improvement in calcium levels. Ionized calcium worsened to 1.90 mmol/L. She received intravenous zoledronic acid without significant improvement in her calcium levels and mental status. She is planned for further cancer directed therapy. Conclusion: 80% of hypercalcemia in cancer patients is estimated to be PTH-rP mediated. However, additional mechanisms that cause bone resorption or decreased renal excretion may be responsible. Bisphosphonates inhibit osteoclast bone resorption, and are used for paraneoplastic hypercalcemia associated with malignancy because of their favorable efficacy and lower toxicity. Refractory hypercalcemia has been reported in patients with HCC as noted in our patient. The PTH-rP level in our case was not very high in contrast with the expected direct association between severity of hypercalcemia and degree of PTH-rP elevation suggesting other contributing factors. We believe immobilization and volume contraction were the other driving mechanisms for her refractory hypercalcemia

Effects of Malathion on the egg production and hatchability of Pimpla turionellae L., Hymenoptera: Ichneumonidae

The effects of Malathion, an organophosphate insecticide, on the egg production and hatchability of the adult females of Pimpla turionellae L. (Hymenoptera: Ichneumonidae) reared on pupae of the wax moth Galleria mellonella L were investigated. The hatchability ratio of eggs, which are left in the host during the life cycle of P. turionellae, have became less at all concentrations (1.000, 0.100, 0.010 and 0.001 ppm). It is remarkable that the highest reduction in egg production appeared between days 25 and 40 with an average of 43% at a concentration of 0.100 ppm. A concentration of 0.010 ppm increased the egg production with an average of 14% between days 10 and 40. © by PSP

Effects of malathion on the egg production and hatchability of Pimpla turionellae L., Hymenoptera : Ichneumonidae

WOS: 000229458600013The effects of Malathion, an organophosphate insecticide, on the egg production and hatchability of the adult females of Pimpla turionellae L (Hymenoptera: Ichneumonidae) reared on pupae of the wax moth Galleria mellonella L were investigated. The hatchability ratio of eggs, which are left in the host during the life cycle of P. turionellae, have became less at all concentrations (1.000, 0.100, 0.010 and 0.001 ppm). It is remarkable that the highest reduction in egg production appeared between days 25 and 40 with an average of 43% at a concentration of 0.100 ppm. A concentration of 0.010 ppm increased the egg production with an average of 14% between days 10 and 40

New-onset diabetes after renal transplantation: Risk assessment and management

SCOPUS: re.jinfo:eu-repo/semantics/publishe