- The use of low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion terminology brings order and simplicity to these lesions, correlates with the current understanding of the biology of human papillomavirus infections, and helps to promote accurate diagnosis of and appropriate treatment for these lesions.

Myelolipomas are rare tumors consisting of both adipose and hematopoietic tissue and are typically found within the adrenal gland. Extra-adrenal involvement is rare, especially those tumors involving the perirenal space and collecting system. We report a case of a patient with an incidentally discovered perirenal mass that was initially concerning for a retroperitoneal liposarcoma. Following surgical resection and pathological analysis, the lesion was found to be an extra-adrenal myelolipoma. This case report and review of the literature demonstrates the importance of the proper work-up and management of perirenal lipoma variants while addressing the issues of tissue biopsy, surgical intervention, and pre- and post-operative surveillance.

IgA nephropathy is the most common glomerulonephritis worldwide and typically has minimal signs for chronicity in histopathology at the time of initial presentation. Pseudotumor cerebri (PTC) is characterized by increased intracranial pressure in the absence of any intracranial lesions, inflammation, or obstruction. PTC has been reported in renal transplant and dialysis patients, but we are unaware of any reports of pseudotumor cerebri in patients with IgA nephropathy. We report a case of a young female who presented with signs and symptoms of pseudotumor cerebri and was subsequently diagnosed with IgA nephropathy and end-stage renal disease. To our knowledge this is the first report of IgA nephropathy presenting as end-stage renal disease in a patient who presented with pseudotumor cerebri.

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Objective: Tumor-induced osteomalacia (TIO), caused predominantly by phosphaturic mesenchymal tumor (PMT), is a rare paraneoplastic syndrome characterized by renal phosphate wasting and 1,25-dihydroxyvitamin D deficiency. Resection is curative; however, diagnosis is frequently delayed or missed due to the inherent characteristics of the tumor and poor recognition. Methods: We report the case of a 44-year-old male with PMT, with a focus on work-up progression and the elusiveness of diagnosis. Results: The patient presented with hip pain and difficulty in ambulation and was found to have numerous skeletal fractures and avascular necrosis of the hips. Serum laboratory studies showed very low phosphorus, normal calcium, and high parathyroid hormone levels. Ultrasound and nuclear imaging showed no parathyroid adenoma. 25-Hydroxyvitamin D level was low, suggesting a secondary hyperparathyroidism. This might have been the leading differential diagnosis; however, a mass was noted on the volar aspect of the patient's left hand. This was biopsied, and pathology demonstrated features consistent with PMT. A fibroblast growth factor 23 (FGF-23) level returned extremely elevated, confirming the diagnosis of TIO secondary to PMT. The mass was resected. Six weeks postresection, FGF-23 and phosphorus had returned to within normal limits, and the patient was improving clinically. Conclusion: PMT causes severe osteomalacia and debilitation in relatively young individuals; skeletal fractures and hypophosphatemia result in extreme pain and weakness. Resection is curative if the tumor is identified; however, TIO/PMT can be missed despite a thorough work-up if not specifically suspected. PMT should be considered any time a patient presents with osteomalacia and hypophosphatemia. (AACE Clinical Case Rep. 2017;3:e313-e316