PMC5228645_01
Enhanced chest computed tomography scan of the patient at admission (baseline). (A) Coronal plane view. (B) Transverse plane view.
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F1
Computed tomography (CT) scans of the chest revealed right pulmonary and pleural metastases with a malignant mass in the anterior mediastinum (Fig. 1A and B).
A kidney needle biopsy suggested focal segmental glomerulosclerosis. (A) Upon light-microscopic examination, most glomeruli were normal in size and cellularity, but there were global glomerulosclerosis and interstitial lymphocytic infiltrations, which are not compatible with minimal change disease (hematoxylin and eosin stain, 200x). (B) Electron microscopic examination showed diffuse effacement of epithelial foot processes, which is compatible with focal segmental glomerulosclerosis.
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F2
Light-microscopic findings of global glomerulosclerosis and interstitial lymphocytic infiltrations were not compatible with minimal change disease (Fig. 2A). Electron-microscopic examination showed diffuse effacement of epithelial foot processes compatible with focal segmental glomerulosclerosis (Fig. 2B).
Pathology of the right pleural biopsy (hematoxylin and eosin stain seen under light microscopy, 200x).
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F3
Lymphocytes and epithelial cells from the thymus were confirmed in a right pleural biopsy specimen (Fig. 3).
Results of serial follow-up of the patient. (A) Trend of serum sodium level, daily urine output, and body weight. (B) Trend of proteinuria (spot urine protein/creatinine ratio and spot urine microalbumin/creatinine ratio) and serum albumin levels.
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F4
With no water restriction, hyponatremia improved and body weight returned to normal (Fig. 4A). The overall trends of proteinuria, hypercholesterolemia, and hyponatremia improved throughout the 2 cycles of chemotherapy (Fig. 4B), suggesting that the nephrotic syndrome was paraneoplastic and was associated with the malignant thymoma.