BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thrombo...BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and obesity.Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.CASE SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus.She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months.Laboratory analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of polycythemia.Arterial blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 mmHg.Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 cm.To reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic hysterectomy.The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma.We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue.There were no complications.On postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,respectively.Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg.These results suggested the diagnosis of myomatous erythrocytosis syndrome.The patient was discharged on the second postoperative day in very good condition with no symptoms.CONCLUSION We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and obesity.Multiple VTE risk factors warranted a laparoscopic approach.展开更多
BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.A...BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.After undergoing hysterectomy,all her hematological parameters returned to normal.Immunohistochemical staining of her myoma for erythropoietin showed strong positivity,which suggested that erythropoietin may be the cause of her erythrocytosis.A multidisciplinary team played a significant role in treating the disease.CASE SUMMARY A 47-year-old woman visited our department complaining that her abdomen had been continuously growing for the past 2 years.After careful examinations,she was suspected of having a very large leiomyoma.She was also diagnosed with erythrocytosis because her RBC count was 6.49×10^(12)/L,hemoglobin was 197 g/L.Following a multidisciplinary team consultation,bilateral ureteral stents were placed,and 800 m L blood was removed by phlebotomy.The patient then underwent hysterectomy and bilateral salpingectomy.She recovered well from the operation,and her hemoglobin level decreased sharply following the surgery.Low-molecular-weight heparin was administered daily to prevent postoperative thrombosis.She was discharged from the hospital on the fourth postoperative day.Two months later,all her hematological parameters returned to normal.Pathological analysis of the myoma revealed that it was a benign leiomyoma,with partial hyalinization,and strong positivity for erythropoietin in immunohistochemical staining suggested that erythropoietin may be responsible for the erythrocytosis.CONCLUSION Erythropoietin ectopically produced from the myoma was responsible for the erythrocytosis in this patient.A multidisciplinary team is strongly recommended.展开更多
Background:Erythrocytosis,a rare paraneoplastic syndrome,generally occurs in patients with clear cell renal cell carcinoma and has never been reported in patients with chromophobe renal cell carcinoma.Case presentatio...Background:Erythrocytosis,a rare paraneoplastic syndrome,generally occurs in patients with clear cell renal cell carcinoma and has never been reported in patients with chromophobe renal cell carcinoma.Case presentation:We report a case of a young man suffering from a giant(22-cm) mass on his left kidney.Because of a history of polycythemia vera,the patient had been treated for the condition for 9 years.Radical nephrectomy was successfully performed,and the postoperative pathologic examination confirmed a diagnosis of chromophobe renal cell carcinoma.Unexpectedly,the symptom of erythrocytosis disappeared after the surgery.Further examination and analysis were performed,and we finally attributed his erythrocytosis to chromophobe renal cell carcinoma.Conclusions:Chromophobe renal cell carcinoma could cause erythrocytosis,but the clear-cut mechanism needs further research.Secondary erythrocytosis such as those related with renal tumors should be taken into consideration during the diagnosis of polycythemia vera.展开更多
Polycythemia vera (PV) is characterized by leukocytosis, thrombocytosis, and low mean capsular volume (MCV). No specific hematological findings are observed in patients with erythrocytosis of other origins. However, r...Polycythemia vera (PV) is characterized by leukocytosis, thrombocytosis, and low mean capsular volume (MCV). No specific hematological findings are observed in patients with erythrocytosis of other origins. However, recombinant erythropoietin (EPO) increases the number of mononuclear cells in the peripheral blood. Therefore, we hematologically examined monocytes in patients with erythrocytosis. The medical records of 48 erythrocytosis patients (hemoglobin: men, >18.5 g/dL;women, >16.5 g/dL) collected between August 2005 and July 2012 were reviewed for age, gender, hematology, and serum erythropoietin level. Patients were divided into 3 groups: PV (N = 17), reactive erythrocytosis (RE, N = 25), and EPO-elevated erythrocytosis (EPO-E, N = 6). We compared monocytes in the hemogram among the 3 groups and examined the correlation between hematological data and serum EPO level. The percent monocytes in the hemogram were 3.4% ± 0.3%, 7.4% ± 0.4%, and 12.3% ± 1.1% for the PV, RE, and EPO-E groups, respectively, which were significant (p < 0.05). Absolute monocyte counts in the EPO-E group (1.0 ± 0.1 × 109/L) were significantly higher than those in the PV (0.6 ± 0.1 × 109/L) and RE (0.5 ± 0.3 × 109/L) groups. There were 2 (12%), 0, and 3 (50%) patients with monocytosis (>1.0 ′ 109/L) in the PV, RE, and EPO-E groups, respectively. A significant correlation was observed between percent monocyte or absolute monocyte count and serum EPO level. In conclusion, monocyte count in hemograms may be useful for diagnosing EPO-elevated erythrocytosis.展开更多
Post-transplant erythrocytosis(PTE)is defined as persistently elevated hemoglobin>17 g/dL or hematocrit levels>51%following kidney transplantation,independent of duration.It is a relatively common complication w...Post-transplant erythrocytosis(PTE)is defined as persistently elevated hemoglobin>17 g/dL or hematocrit levels>51%following kidney transplantation,independent of duration.It is a relatively common complication within 8 months to 24 months post-transplantation,occurring in 8%-15%of kidney transplant recipients.Established PTE risk factors include male gender,normal hemoglobin/hematocrit pre-transplant(suggestive of robust native kidney erythropoietin production),renal artery stenosis,patients with a well-functioning graft,and dialysis before transplantation.Many factors play a role in the development of PTE,however,underlying endogenous erythropoietin secretion pre-and post-transplant is significant.Other contributory factors include the renin-angiotensin-aldosterone system,insulin-like growth factors,endogenous androgens,and local renal hypoxia.Most patients with PTE experience mild symptoms like malaise,headache,fatigue,and dizziness.While prior investigations showed an increased risk of thromboembolic events,more recent evidence tells a different story-that PTE perhaps has lessened risk of thromboembolic events or negative graft outcomes than previously thought.In the evaluation of PTE,it is important to exclude other causes of erythrocytosis including malignancy before treatment.Angiotensin converting enzyme inhibitors(ACE-I)and angiotensin receptor blockers(ARBs)are the mainstays of treatment.Increased ACE-I/ARB use has likely contributed to the falling incidence of erythrocytosis.In this review article,we summarize the current literature in the field of post-transplant erythrocytosis after kidney transplantation.展开更多
文摘BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and obesity.Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.CASE SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus.She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months.Laboratory analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of polycythemia.Arterial blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 mmHg.Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 cm.To reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic hysterectomy.The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma.We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue.There were no complications.On postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,respectively.Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg.These results suggested the diagnosis of myomatous erythrocytosis syndrome.The patient was discharged on the second postoperative day in very good condition with no symptoms.CONCLUSION We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and obesity.Multiple VTE risk factors warranted a laparoscopic approach.
文摘BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.After undergoing hysterectomy,all her hematological parameters returned to normal.Immunohistochemical staining of her myoma for erythropoietin showed strong positivity,which suggested that erythropoietin may be the cause of her erythrocytosis.A multidisciplinary team played a significant role in treating the disease.CASE SUMMARY A 47-year-old woman visited our department complaining that her abdomen had been continuously growing for the past 2 years.After careful examinations,she was suspected of having a very large leiomyoma.She was also diagnosed with erythrocytosis because her RBC count was 6.49×10^(12)/L,hemoglobin was 197 g/L.Following a multidisciplinary team consultation,bilateral ureteral stents were placed,and 800 m L blood was removed by phlebotomy.The patient then underwent hysterectomy and bilateral salpingectomy.She recovered well from the operation,and her hemoglobin level decreased sharply following the surgery.Low-molecular-weight heparin was administered daily to prevent postoperative thrombosis.She was discharged from the hospital on the fourth postoperative day.Two months later,all her hematological parameters returned to normal.Pathological analysis of the myoma revealed that it was a benign leiomyoma,with partial hyalinization,and strong positivity for erythropoietin in immunohistochemical staining suggested that erythropoietin may be responsible for the erythrocytosis.CONCLUSION Erythropoietin ectopically produced from the myoma was responsible for the erythrocytosis in this patient.A multidisciplinary team is strongly recommended.
基金financially supported by National Natural Science Foundation of China(Nos.81372335,81402108)the China Postdoctoral Science Foundation(No.2014M551915)
文摘Background:Erythrocytosis,a rare paraneoplastic syndrome,generally occurs in patients with clear cell renal cell carcinoma and has never been reported in patients with chromophobe renal cell carcinoma.Case presentation:We report a case of a young man suffering from a giant(22-cm) mass on his left kidney.Because of a history of polycythemia vera,the patient had been treated for the condition for 9 years.Radical nephrectomy was successfully performed,and the postoperative pathologic examination confirmed a diagnosis of chromophobe renal cell carcinoma.Unexpectedly,the symptom of erythrocytosis disappeared after the surgery.Further examination and analysis were performed,and we finally attributed his erythrocytosis to chromophobe renal cell carcinoma.Conclusions:Chromophobe renal cell carcinoma could cause erythrocytosis,but the clear-cut mechanism needs further research.Secondary erythrocytosis such as those related with renal tumors should be taken into consideration during the diagnosis of polycythemia vera.
文摘Polycythemia vera (PV) is characterized by leukocytosis, thrombocytosis, and low mean capsular volume (MCV). No specific hematological findings are observed in patients with erythrocytosis of other origins. However, recombinant erythropoietin (EPO) increases the number of mononuclear cells in the peripheral blood. Therefore, we hematologically examined monocytes in patients with erythrocytosis. The medical records of 48 erythrocytosis patients (hemoglobin: men, >18.5 g/dL;women, >16.5 g/dL) collected between August 2005 and July 2012 were reviewed for age, gender, hematology, and serum erythropoietin level. Patients were divided into 3 groups: PV (N = 17), reactive erythrocytosis (RE, N = 25), and EPO-elevated erythrocytosis (EPO-E, N = 6). We compared monocytes in the hemogram among the 3 groups and examined the correlation between hematological data and serum EPO level. The percent monocytes in the hemogram were 3.4% ± 0.3%, 7.4% ± 0.4%, and 12.3% ± 1.1% for the PV, RE, and EPO-E groups, respectively, which were significant (p < 0.05). Absolute monocyte counts in the EPO-E group (1.0 ± 0.1 × 109/L) were significantly higher than those in the PV (0.6 ± 0.1 × 109/L) and RE (0.5 ± 0.3 × 109/L) groups. There were 2 (12%), 0, and 3 (50%) patients with monocytosis (>1.0 ′ 109/L) in the PV, RE, and EPO-E groups, respectively. A significant correlation was observed between percent monocyte or absolute monocyte count and serum EPO level. In conclusion, monocyte count in hemograms may be useful for diagnosing EPO-elevated erythrocytosis.
文摘Post-transplant erythrocytosis(PTE)is defined as persistently elevated hemoglobin>17 g/dL or hematocrit levels>51%following kidney transplantation,independent of duration.It is a relatively common complication within 8 months to 24 months post-transplantation,occurring in 8%-15%of kidney transplant recipients.Established PTE risk factors include male gender,normal hemoglobin/hematocrit pre-transplant(suggestive of robust native kidney erythropoietin production),renal artery stenosis,patients with a well-functioning graft,and dialysis before transplantation.Many factors play a role in the development of PTE,however,underlying endogenous erythropoietin secretion pre-and post-transplant is significant.Other contributory factors include the renin-angiotensin-aldosterone system,insulin-like growth factors,endogenous androgens,and local renal hypoxia.Most patients with PTE experience mild symptoms like malaise,headache,fatigue,and dizziness.While prior investigations showed an increased risk of thromboembolic events,more recent evidence tells a different story-that PTE perhaps has lessened risk of thromboembolic events or negative graft outcomes than previously thought.In the evaluation of PTE,it is important to exclude other causes of erythrocytosis including malignancy before treatment.Angiotensin converting enzyme inhibitors(ACE-I)and angiotensin receptor blockers(ARBs)are the mainstays of treatment.Increased ACE-I/ARB use has likely contributed to the falling incidence of erythrocytosis.In this review article,we summarize the current literature in the field of post-transplant erythrocytosis after kidney transplantation.
