PMC7844590_01
Facial manifestations of acromegaly.
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F1
Physical examination showed evidences of acromegaly: Acral overgrowth of the hands and feet, frontal bossing, and enlargement of the tongue and lips (Figure 1).
Hypertrophy of glomeruli, mild proliferation of mesangial cells, ischemic sclerotic glomeruli, focal atrophy of renal tubules, focal lymphocyte and monocyte infiltration with fibrosis in renal interstitium, and thickening of arteriolar wall (A). Glomerular segmental sclerosis with podocyte hypertrophy, protein casts in renal tubule lumen. Focal atrophy, mononuclear cell infiltrate in renal interstitial with fibrosis (B,C). Immunofluorescence study identified granular deposition of immunoglobulin A (+-?+) and immunoglobulin M (++) in the mesangial area (D). Electron microscopy showed that the foot processes of the glomerular visceral epithelial cells were widely fused, the segments of the basement membrane atrophy, and the deposition of electron density was occasionally seen in the mesangial area. The thickness of the basement membrane was 356.74 nm (E).
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F2
The pathologic diagnosis was focal segmentular glomerular sclerosis [FSGS-NOS (not otherwise specified)] with ischemic renal injury and IgA deposition in the mesangial area (Classification based on Colombian typing in 2004) (Figure 2).
Irregular tumors could be observed in the sellar fossa, and the size was about 11 mm x 18 mm (upper and lower diameter x left and right diameter). T1 signal hyperintensity (A) and T2 signal heterogeneous intensity (B), the lesion boundary was not clear. T1 signal isointensity could be seen on the left side of pituitary stalk, slightly high signal intensity on T1 could be seen on the right side of pituitary stalk (C). The left side of pituitary stalk was enhanced, the range was 6 mm x 9 mm x 19 mm (left and right diameter x up and down diameter x front and rear diameter) (D).
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F3
The pituitary enhanced magnetic resonance imaging was abnormal as shown in Figure 3.
Pituitary adenoma (sellarr region) immunohistochemistry: CK (+), Syn (+/-), P53 (10%+), Ki-67 (2%+), PRL(+), GH (+/-), ACTH(-), TSH (-), FSH (-), and LH (-).
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F4
The pituitary adenomas was confirmed by pathology as shown in Figure 4.
Scatter plot graph of GH and 24h-TP.
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F5
Figure 5 is a scatter plot graph drawn with two sets of data, GH and 24h-TP.