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Background: Lymphomatoid granulomatosis (LYG) is a rare and atypical EBV induced B-cell lymphoproliferative disorder. Clinical manifestations are mainly respiratory, with nodular infiltrates, varying in number and size being responsible for respiratory distress. Cutaneous, hepatic, or neurological involvement is also possible with the disease. Lymphatic involvement is uncommon. Although pathogenesis is not clearly elucidated, quantitative or qualitative cellular immunodepression is thought to be a main factor. Here, we report a case of concomitant LYG and pulmonary tuberculosis in an elderly woman. Case presentation: An 80-year-old woman presented to the emergency unit for steadily increasing dyspnea, with a workup revealing bilateral nodules and mediastinal lymph node enlargement on chest imaging, associated with a mildly elevated C-reactive protein (CRP). She had no relevant prior medical history and no known immunodepression. Empiric antibiotic therapy was initially started with amoxicillin-clavulanate, which was later combined to azithromycin following respiratory deterioration. A CT-guided lung biopsy showed grade I lymphomatoid granulomatosis. Treatment with corticosteroids and weekly rituximab was initiated, leading to a rapid improvement of respiratory symptoms. After the second dose of rituximab, initially collected sputum cultures were found positive for Mycobacterium tuberculosis. Rituximab was suspended and antituberculous treatment was initiated. Rituximab was restarted once tuberculosis was controlled. Follow-up imaging later showed adequate control of both infectious and hematological diseases with at least a partial remission of the lymphomatoid granulomatosis. Conclusions: This case report highlights both diagnosis and therapeutic challenges in a rare but plausible situation. Lymph-node involvement in lymphomatoid granulomatosis should always be questioned in LYG as it is seldom seen in the disease. Finally, pathologic confirmation for LYG should not eliminate the need for a comprehensive workup to eliminate other differential diagnoses with management-changing potential.

Plasma membrane-derived vesicles, also referred to as large extracellular vesicles (lEVs), are implicated in several pathophysiological situations, including cancer. However, to date, no studies have evaluated the effects of lEVs isolated from patients with renal cancer on the development of their tumors. In this study, we investigated the effects of three types of lEVs on the growth and peritumoral environment of xenograft clear cell renal cell carcinoma in a mouse model. Xenograft cancer cells were derived from patients’ nephrectomy specimens. Three types of lEVs were obtained from pre-nephrectomy patient blood (cEV), the supernatant of primary cancer cell culture (sEV) and from blood from individuals with no medical history of cancer (iEV). Xenograft volume was measured after nine weeks of growth. Xenografts were then removed, and the expression of CD31 and Ki67 were evaluated. We also measured the expression of MMP2 and Ca9 in the native mouse kidney. lEVs from kidney cancer patients (cEV and sEV) tend to increase the size of xenografts, a factor that is related to an increase in vascularization and tumor cell proliferation. cEV also altered organs that were distant from the xenograft. These results suggest that lEVs in cancer patients are involved in both tumor growth and cancer progression.

ConclusionOverall, the knowledge level of cervical cancer and its prevention among women was found to be poor. Meanwhile, the screening practice was not high though women have strong intentions to screen. The main obstacles to screening were poverty and insufficient knowledge. Our findings may provide guidance on future education and training to help accelerate the prevention and control of cervical cancer in China.