18 years old male.

4 months ago the patient was hospitalized due to epigastric abdominal pain, lack of appetite and weight loss. He was diagnosed with Crohns disease.
Hepatic biopsy, that was performed during this hospitslization, showed evidence of an overlap syndrome picture (cholangitis/hepatitis). He was initially treated with Cortisone and Azathioprine.

The patient was hospitalized 7 times. He had recurrent attacks of infective cholangitis. He was treated with antiobiotics and papillotomy through ERCP. Abdominal pain Light pancreatitis Intra- and extrahepatic bile duct dilatation Overlapped cholangitis

From First to fifth hospitalizations:

IgG4 (2937)

Amylase (600 U/L) -Glutamyl Transferase

(197 U/L) 281 U/L APC 2.02 mg/dL

AST 114 U/L ALT 248 U/L

With leukocytosis (WBCs 13,000, Nuetrophyls 88%, Lymphocytes 7.9%)

Sixth hospitalization
CRP=1.92 mg/dl GGT 129 U/L AST= 29 U/L ALT=97 U/L.

Antibiotic therapy has been started with Meropenem 1 g x 3 and an ERCP was carried out.

Prognosis: The patient is at risk for liver transplant. Developing - Strictures - Cirrhosis - Bile duct cancer.

71-year-old-male had been diagnosed as having multiple myeloma (MM), apparently of the IgA-Lambda type, with renal involvement. The disease course is characterized by "ups and downs responding to anti-MM therapy. During the disease course, several problems and complications developed: Renal failure, Bone lesions and Neuropathy.

First to third days: creatinine (1.8 mg/dL) Slight anaemia (11.5 g/dL) Slight proteinuria (30 mg/dL) medullary plasma cell infiltration amounting to 40% Hemoglobin (8.7 g/dL) vascular nephropathy associated with chronic parenchymal alterations (damage from cyclosporine)

Fourth days: Creatinine at 7 mg/dl Proteinuria to 300 mg/24h Medullary plasma cell infiltration to 10%

Due to the appearance of more intense pain in the area of the left ribcage and vertebral column a new PET scan was

Results: hyperfixation of the indicator is detected in: multiple rib areas, in particular on the right at the II, IV and XI rib at the back and on the left at VII and XII rib at the back; left ilium in the parasacral area.

Presence of heteroplastic tissue with elevated glucidic metabolism Small normal-hypocellulated fragments. Megacariocytes present. Clear excess of plasma cells (approx. 30-40%) Erythropoesis and granulopoiesis, normally raping Moderate interstitial plasmocytosis (approx. 8%) politi pica on the background of hyporepresented hematopoietic tissue.

Paresthesia in the lower limbs Sensitive chronic motor polyneuropathy, primarily sensitive and axonopathic in nature, distal and symmetrical, severe in the lower limbs

2-year-old female had been diagnosed with Pleuropulmonary Blastoma. The disease extent included the lung and pleura with no signs of metastatic spread. It was decided to start with 3 cycles of chemotherapy and afterwards to carry out a CT scan reassessment and surgical operation. The expert agrees that patients treated with combination of chemotherapy and complete surgical resection do better. Achieving total resection of the tumor results in a significantly better prognosis, whereas extrapulmonary involvement at diagnosis results in worse prognosis.

Case History: Diagnosis of pneumonia for the appearance of hyperpyrexia and cough treated with antibiotic by oral way. Chest radiography: right basal opacity with associated effusion and a bullous area Hypertensive pneumothorax with the mediastinum mobility At the thorax level a slight reduction in the inspiratory airflow

The hematochemical examinations performed showed:

WBC: 9 750/mrnc; N: 3i00/mmc Platelets: 864 000 Hb: 10.5 g/dI ERS: 58 mm/h APC: 0.26 mg/dl Ferritin: 71.36 ng/ml Haepatic and renal function, electrolytes within normal limits LDH:336U/L IgG: 946 rng/dl; IgA: 110 mgldl IgM: 172 mg/dl CA 125: 39.14 U.LmL CA 19-9: 4.25 U.L1ml CEA: 1,19 ng/ml

Staging of neoplasia has been carried out by means of: Bone scintigraphy: Negative Cranial, neck, chest and abdomen CT scan: Some small lymph nodes of around a centimeter size are observed in the laterocervical area, posterior to the carotid space bilaterally and in left inguinal fossa. At the right chest level various ovalar air bubbles are observed (2.5 cm). Focal pleural thickening over the diaphragm. The disease seems to be located at the pleural/pulmonary level without any sign of long-term metastasis.

Prognosis: Tumor - completely cystic or had some solid

elements Pleuropulmonary blastoma is a rare, malignant intrathoracic pediatric tumo It is subclassified as type I (purely cystic), type II (both cystic and solid elements), and type III (completely solid). Type II and type III may be associated with metastasis, with the brain being the most common metastatic site.

OD of Blk OD of Test

Amylase Activity = OD of Blk 0.001 0.002 = 0.001

x 750

x 750

= - 750 U/L *FALSE-NEGATIVE Result (due to expired Amylase)

Abs. of Unknown

Value of Unknown = Abs. of Std 0.222 = 0.275 = 19.37 U/L

x 24

x 24

*NORMAL

Abs. of Unknown

Value of Unknown = Abs. of Std 0.272 = 0.310 = 24.57 U/L

x 28

x 28

*NORMAL