A wide spectrum of pathological lesions including opportunistic infections was seen in GI endoscopic biopsies in renal transplant patients. Endoscopic biopsies play an important role in the diagnosis and management of GI disease in renal transplant patients.

Kikuchi disease (KD) or also known as Kikuchi Fujimoto disease is named after scientists Kikuchi and Fujimoto who describe the disease in Japan in 1972. KD originally reported from Asia but later case reports from different regions of world have been published. It is a benign condition of necrotizing histiocytic lymphadenitis which mimic like Lymphoma, diagnosis of KD is based on histo-pathological findings from lymphnodes. It is a rare condition and mostly case reports have been published, it can have an association with other pathologies. We aim to report a case where KD has been found in a young woman in association with hemolytic uremic syndrome and acute kidney injury. How to cite this:Khan ST, Naqvi R, Rashid R, Naqvi SA. A rare presentation of Kikuchi Disease with Hemolytic Uremic Syndrome. Pak J Med Sci. 2019;35(2):586-588. doi: https://doi.org/10.12669/pjms.35.2.735 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background Benign fibrous histiocytomas are among the most common soft tissue tumors and are made up of a mixture of fibroblasts, histiocytes, and chronic inflammatory cells. These are commonly found in skin and less commonly in deep soft tissues. There are reports of the presence of a malignant counterpart of fibrous histiocytoma in the breast; however, existence of benign fibrous histiocytoma in breast is a very rare occurrence. Case presentation We present here a case of benign fibrous histiocytoma at an uncommon location with a common presentation. This is a case of 45-year-old female patient, who complained of a painless focal area of hardness and itching in the left areolar region that developed gradually for 1 year, with recent onset of areolar skin thickening, erythema, and mastalgia on the left side. Physical examination revealed a focal area of nodular thickening in the areolar region on the left side with erythema and skin excoriation. No mass was palpable in either breast or axilla. A subsequent mammogram showed an area of focal thickening in the areolar region. Ultrasound also showed a similar finding of nodular skin thickening. Paget’s disease was suspected based on clinical and imaging findings. The contralateral breast was normal. Afterward, a core needle biopsy was done, but the histopathology report was inconclusive and showed only a spindle cell lesion. In due course, excisional biopsy was performed and on the basis of morphology and immune-histochemical markers, a diagnosis of benign fibrous histiocytoma was made. Conclusions Benign fibrous histiocytomas are varying soft tissue tumors that show wide variations in anatomic locations, biologic behavior, and pathologic features. Its diagnosis can be very challenging by imaging and even on histopathology. It must be based on the combination of morphological features and immunohistochemistry. Breast is an extremely uncommon location, and its presentation can mimic invasive carcinomas. A number of other benign and malignant skin lesions may be considered as probable differential diagnosis. It is worthwhile to keep these diverse entities in mind as differential diagnosis, with regards to this particular clinical presentation, which can be beneficial in dealing with challenging cases.

Focal segmental glomerulosclerosis (FSGS) is a conglomerate of glomerular pathological lesions unified by the segmental distribution of proliferative, sclerosing or collapsing lesions in less than 50% of glomeruli (i.e., focal distribution) in the early stages of the process and can only be diagnosed on renal biopsy. Epidemiologically, FSGS has acquired the top position among the causes of nephrotic syndrome (NS) in adults in many parts of the world and has emerged as the main cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide. Numerous approaches have been used to classify this lesion, but all have merits and demerits and no one system is entirely satisfactory. One of the popular schemes for the classification is based on morphological features and distribution of the lesions in the glomeruli, the so-called Columbia classification of FSGS. In this review, we briefly summarize the relevant epidemiology and pathology of FSGS variants in the light of our own experience with the use of this classification.

Banff classification of renal allograft pathology has evolved considerably over the past 30 years and has undergone significant changes in many of the original diagnostic categories. With this evolution, it has increased in complexity and level of difficulty in routine clinical application. To make it user friendly, this series of tutorials has been planned. In this pictorial, we aim to provide an illustrated presentation of the Banff classification categories and practical tips and tricks to identify and report the lesions. This will be useful for better understanding of renal transplant pathology for trainees and residents of nephrology and histopathology as well as for practicing pathologists and nephrologists. Banff category 4. Acute rejection (Acute/active T-cell-mediated rejection [TCMR])-Part II (Plasma cell-rich acute rejection)The main lesion of acute/active T-cell-mediated rejection (TCMR) was discussed in the previous issue of PJKD.In this issue, a special type or variant of active rejection, i.e., plasma cell-rich acute/active rejection (PCAR) is discussed. Although, it is not included as a formal category in the synoptic table of the Banff classification, it is discussed in text in Banff classifications under the TCMR category. Herein, we discuss this entity along with a few representative images and explanation of the lesions.