Multiple-System Atrophy in Long-Term Professional Painter: A Case Report

Introduction. Multiple system atrophy (MSA) is a rare and severe adult-onset, sporadic, and progressive neurodegenerative disorder. Here, we describe an autopsy case of MSA in a long-term professional painter. Although typical glial cytoplasmic inclusion (GCI) was not observed in a routine histological examination, strong α-synuclein immunostaining in the nucleus confirmed the diagnosis of MSA.Case Presentation. A 48-year-old Japanese man with a long occupational history of professional painter was sent to the emergency room, where he died of multiple organ failure. The patient had suffered tremors and inarticulateness at age 28, developed diabetes at 42 and was diagnosed with spinocerebellar degeneration at 46. A histopathological examination showed severe neuronal loss, gliosis, and tissue rarefaction in the paleostriatum, striate body of the substantia nigra, the pons, and the olivary nucleus of the upper medulla oblongata, intermediolateral of the spinal gray matter (sacral region). α-synuclein-positive GCI in oligodendroglia was occurred in the cerebral cortex, the midbrain, the medulla oblongata, and the spinal cord. These findings confirmed the presence of multiple-system atrophy (OPCA+SDS).Conclusion. Although the pathogenesis of MSA is still unclear, prolonged, and extensive exposure to organic solvents, together with a hyperglycemic morbidity attributed to diabetes, may have contributed to the onset and clinical course of the present case.

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Primary medulla oblongata teratomas

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.6.peds1423 ◽

2014 ◽

Vol 14 (3) ◽

pp. 296-300 ◽

Cited By ~ 1

Author(s):

Da Li ◽

Shu-Yu Hao ◽

Zhen Wu ◽

Li-Wei Zhang ◽

Jun-Ting Zhang

Keyword(s):

Medulla Oblongata ◽

Histopathological Examination ◽

Mature Teratoma ◽

Radiographic Findings ◽

First Case ◽

Cystic Component ◽

Long Term Follow Up ◽

History Of

Medulla oblongata teratomas are rare. The authors report 2 new cases of teratomas that occurred exclusively in the medulla oblongata. The first case was in a 9-year-old boy who presented with a 6-month history of neck pain and repeated paroxysmal vomiting. Based on preoperative radiographic findings, the initial diagnosis was of an intraaxial medulla oblongata hemangioblastoma. Intraoperatively, the cystic component of the tumor was gray, gelatinous, and soft in consistency. The solid component was light pink, rubbery, and nodular in appearance, with an identifiable boundary. The lesion was completely removed. Histopathological investigation revealed a mature teratoma. Postoperatively, the patient was supported with ventilator assistance and received a tracheotomy, but died of intracranial infection. The second case was in a 10-year-old boy with intermittent headache for 1 month. Radiographs revealed an exophytic cystic and solid lesion with dorsal involvement of the medulla oblongata. The lesion was predominantly solid, pinkish gray, tenacious, and moderately vascularized, with clearly delineated surgical dissection planes. The histopathological examination confirmed a diagnosis of immature teratoma. Total resection was achieved, followed by postoperative chemotherapy. He was alive without recurrence of the lesion or symptoms at 59 months after surgery. Resection of medulla oblongata teratoma is challenging, with inherent surgical risks that are contingent on the tumor growth pattern. Teratomas should be considered in the differential diagnosis of brainstem lesions. Chemotherapy has been suggested for immature teratomas. Long-term follow-up and larger studies of teratomas in unusual locations are required to improve practitioners' understanding of this disease's treatment and outcomes.

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Severe Austrian Syndrome in an Immunocompromised Adult Patient – A Case Report

The Journal of Critical Care Medicine ◽

10.1515/jccm-2017-0025 ◽

2018 ◽

Vol 4 (1) ◽

pp. 17-22 ◽

Cited By ~ 2

Author(s):

Ioana Raluca Chirteș ◽

Dragos Florea ◽

Carmen Chiriac ◽

Oana Maria Mărginean ◽

Cristina Mănășturean ◽

...

Keyword(s):

Case Report ◽

Streptococcus Pneumoniae ◽

Histopathological Examination ◽

Fatal Outcome ◽

Multiple Organ ◽

Etiologic Agent ◽

Acute Meningitis ◽

History Of ◽

Valvular Lesions ◽

Formalin Fixed

AbstractBackground: Known also as Osler’s triad, Austrian syndrome is a complex pathology which consists of pneumonia, meningitis and endocarditis, all caused by the haematogenous dissemination of Streptococcus pneumoniae. The multivalvular lesions are responsible for a severe and potential lethal outcome.Case report: The case of a 51-year-old female patient, with a past medical history of splenectomy, is presented. She developed bronchopneumonia, acute meningitis and infective endocarditis as a result of Streptococcus pneumoniae infection and subsequently developed multiple organ dysfunction syndromes which led to a fatal outcome. Bacteriological tests did not reveal the etiological agent. The histopathological examination showed a severe multivalvular endocarditis, while a PCR based molecular analysis from formalin fixed valvular tissue identified Streptococcus pneumoniae as the etiologic agent.Conclusions: The presented case shows a rare syndrome with a high risk of morbidity and mortality. Following the broad-spectrum treatment and intensive therapeutic support, the patient made unfavourable progress which raised differential diagnosis problems. In this case, the post-mortem diagnosis demonstrated multiple valvular lesions occurred as a result of endocarditis.

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Giant Endometrial Polyp in a Postmenopausal Woman without Hormone/Drug Use and Vaginal Bleeding

Case Reports in Obstetrics and Gynecology ◽

10.1155/2014/518398 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Betül Ünal ◽

Selen Doğan ◽

Fatma Şeyda Karaveli ◽

Tayup Şimşek ◽

Gülgün Erdoğan ◽

...

Keyword(s):

Postmenopausal Woman ◽

Drug Use ◽

Vaginal Bleeding ◽

Clinical Presentation ◽

Histopathological Examination ◽

Uterine Cavity ◽

Endometrial Polyp ◽

Lower Back ◽

History Of

The objective of this study is to determine and discuss the causes of a giant endometrial polyp in a postmenopausal woman without hormone/drug use and to submit interesting clinical presentation. Here we report a seventy-year-old female patient who was admitted to our hospital with lower back pain. There were no other complaints from her. Physical examination was normal. For further examination, computed tomography was performed and a heterogeneous mass, with a diameter of 10×9 centimeters, was detected in the uterine cavity. Hysterectomy because of suspected endometrial cancer was performed. Histopathological examination showed us a giant endometrial polyp with edematous and focal fibrotic stroma, large thick walled blood vessels between normal sized and cystically dilated endometrial glands. To the best of our knowledge, this is the first report of a giant endometrial polyp which is unrelated to use of drugs such as tamoxifen and raloxifene; however, based on the history of the patient it may be associated with long-term consumption of thyme, which is a kind of phytoestrogen.

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Primary leiomyoma of the ureter: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02960-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Shingo Morinaga ◽

Shigeyuki Aoki ◽

Motoi Tobiume ◽

Genya Nishikawa ◽

Hiroyuki Muramatsu ◽

...

Keyword(s):

Malignant Tumors ◽

Histopathological Examination ◽

Urine Cytology ◽

Benign Tumors ◽

Case Presentation ◽

Old Japanese ◽

Retrograde Pyelogram ◽

History Of ◽

The Right ◽

Enhanced Computed Tomography

Abstract Background Only 14 cases of leiomyoma with ureteral origin have been reported previously. Such primary leiomyomas often present as hydronephrosis, making the diagnosis difficult. Radical nephroureterectomy is often performed because of the possible diagnosis of a malignant tumor. We report the 15th case of primary leiomyoma with a ureteral origin. Case presentation A 51-year-old Japanese man presented with a chief complaint of asymptomatic gross hematuria with a history of hypertension. Enhanced computed tomography showed a tumor at the upper part of the right ureter that appeared to be the cause of hydronephrosis and contracted kidney; no retroperitoneal lymphadenopathy and distal metastasis were observed. A well-defined 20-mm (diameter) defect was identified at the upper of the right ureter on retrograde pyelogram with no bladder cancer on cystoscopy. Urine cytology and right divided renal urine cytology findings were negative. Laparoscopic nephroureterectomy was performed, and the extracted tumor measured 20 × 13 mm. Histopathological examination revealed primary leiomyoma with no recurrence 16 months after the operation. Conclusions Preoperative examination with the latest available ureteroscopic technology can help preserve renal function in the case of benign tumors by enabling preoperative ureteroscopic biopsy or intraoperative rapid resection. Moreover, nephroureterectomy is recommended in the case of preoperative suspicion of ureteral malignant tumors.

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A Case of Mixed Adenoneuroendocrine Carcinoma of the Stomach With Focal Intestinal Metaplasia and Hypergastrinemia

International Surgery ◽

10.9738/intsurg-d-14-00074.1 ◽

2015 ◽

Vol 100 (3) ◽

pp. 562-567 ◽

Cited By ~ 9

Author(s):

Hayato Yamauchi ◽

Shinji Sakurai ◽

Nobuhiro Nakazawa ◽

Tomonori Yoshida ◽

Yuichi Tabe ◽

...

Keyword(s):

Intestinal Metaplasia ◽

World Health ◽

Neuroendocrine Neoplasms ◽

World Health Organization Classification ◽

Mixed Adenoneuroendocrine Carcinoma ◽

Japanese Male ◽

Old Japanese ◽

History Of ◽

Health Organization

Among neuroendocrine neoplasms, mixed exocrine and endocrine characteristics with at least 30% of each component are classified into mixed adenoneuroendocrine carcinoma (MANEC), according to the 2010 World Health Organization classification. We experienced a rare case of MANEC of the stomach with focal intestinal metaplasia and hypergastrinemia. A 76-year-old Japanese male was diagnosed as having gastric adenocarcinoma and underwent total gastrectomy. The pathologic diagnosis was MANEC of the stomach accompanied by unusual mucosal atrophy without Helicobacter pylori infection, the characteristics of which were different from both type A and type B atrophic gastritis. The patient has a history of long-term use of a proton pump inhibitor. Additional serum chemistry examination using preoperatively obtained plasma from the patient revealed hypergastrinemia. The mechanism of gastric MANEC carcinogenesis is still unclear, but that might be correlated with unusual intestinal metaplasia and hypergastrinemia in this case.

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Atypical Meningioma in the Medulla Oblongata Parenchyma

10.21203/rs.3.rs-112925/v1 ◽

2020 ◽

Author(s):

Qiushi Xu ◽

Ziang Pan ◽

Meidan Hou ◽

Fang Peng

Keyword(s):

Magnetic Resonance Imaging ◽

Medulla Oblongata ◽

Preoperative Diagnosis ◽

Histopathological Examination ◽

Atypical Meningioma ◽

Resonance Imaging ◽

Case Presentation ◽

First Case ◽

History Of ◽

Atypical Meningiomas

Abstract Background: Glioma is the most common tumor occurring in the brainstem. A primary intraparenchymal meningioma located in the brainstem without dura attachment is rare. Meanwhile, atypical meningiomas that occur in the medulla oblongata parenchyma, and without dura coverage, are extremely rare. In this study, we report the first case of atypical meningioma in the medulla oblongata parenchyma and review the existing literature.Case presentation: A 38-year-old female was admitted at our hospital with a 2-week history of progressive neck and occipital pain. Magnetic resonance imaging revealed a presence of a 1.5x0.9cm mass lesion, located in the left side of the medulla oblongata, which was hypointense on T1-weighted and hyperintense on T2-weighted images, and with inhomogeneous enhancement following gadolinium-diethylenet-riamine pentaacetic acid (Gd-DTPA) administration. The initial preoperative diagnosis was glioma or angioblastoma. The patient underwent a total surgical resection of the left medulla oblongata tumor and the histopathological examination indicated that the lesion was an atypical meningioma. The patient returned to normal life after surgery.Conclusions: Although glioma is the most common tumor occurring in the brainstem parenchyma, the possibility of meningioma cannot be ruled out in this area.

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Grinspan’s Syndrome: A Rare Case with Malignant Transformation

Case Reports in Otolaryngology ◽

10.1155/2018/9427650 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Numan Kökten ◽

Lokman Uzun ◽

Ayşe Serap Karadağ ◽

Tülay Zenginkinet ◽

M. Tayyar Kalcıoğlu

Keyword(s):

Malignant Transformation ◽

Lichen Planus ◽

Buccal Mucosa ◽

Histopathological Examination ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Exophytic Tumor ◽

History Of ◽

Stratified Squamous Epithelium

Aim. Oral lichen planus (OLP) is one of the common chronic inflammatory, noninfectious, and precancerous oral mucosal diseases that affect the stratified squamous epithelium in adults. Grinspan et al. reported an association of OLP with diabetes mellitus and vascular hypertension and called that Grinspan’s syndrome in 1966. We aim to present a case of Grinspan’s syndrome with malignant transformation. Case Presentation. A 60-year-old man who presented with a ten-year history of OLP diagnosed clinically and histologically was referred to our otolaryngology department with a painless swallowing in the left buccal mucosa for 3 months. Clinical examination revealed several plaques, striated white lesions in the buccal mucosa bilaterally, and an exophytic tumor in the left buccal mucosa. Histopathological examination showed lichen planus bilaterally and oral squamous cell carcinoma in the left buccal mucosa. The tumor had been developed on the preexisting areas of lichen planus which had been histologically proven before. The tumor was removed completely, and the tissue defect on the buccal mucosa was repaired with a split-thickness skin graft. Conclusion. Patients with OLP should be followed up periodically in a long term at close intervals for early diagnosis of malignant transformation.

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Massive juvenile ossifying fibroma arising from the middle turbinate

BMJ Case Reports ◽

10.1136/bcr-2020-234432 ◽

2020 ◽

Vol 13 (4) ◽

pp. e234432

Author(s):

Valentinos Sofokleous ◽

Konstantina Chrysouli ◽

Efthymios Kyrodimos ◽

Evangelos Giotakis

Keyword(s):

Histopathological Examination ◽

Therapeutic Option ◽

Correct Diagnosis ◽

Middle Turbinate ◽

Ossifying Fibroma ◽

Endoscopic Endonasal ◽

Juvenile Ossifying Fibroma ◽

History Of

A 19-year-old man presented with a long-standing history of nasal obstruction, which gradually became worse over the past 2 years. Nasal endoscopy revealed a sizeable rounded mass covered by a normal-looking mucosa. Imaging studies showed a mass arising from the left middle turbinate that extended throughout the expanse of the anterior skull base. The tumour was resected via an endoscopic endonasal approach. Histopathological examination revealed a psammomatoid juvenile ossifying fibroma. The patient remains free of recurrence after almost 3 years of follow-up. Only four cases of ossifying fibroma with middle turbinate localisation have been reported in the literature so far, with our case representing the fifth and most extensive case. Clinical, radiological and histological findings should all be considered for establishing the correct diagnosis. An endoscopic approach represents an excellent therapeutic option. Long-term clinical and radiological surveillance is required due to the risk of recurrence.

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Elderly-Onset Multiple System Atrophy with Lewy Body Pathology: A Case Report

Case Reports in Neurology ◽

10.1159/000515973 ◽

2021 ◽

pp. 613-619

Author(s):

Kazuhiro Fukushima ◽

Akinori Nakamura ◽

Yo-ichi Takei ◽

Kenya Oguchi ◽

Hiroko Itagaki ◽

...

Keyword(s):

Multiple System Atrophy ◽

Orthostatic Hypotension ◽

Team Approach ◽

Term Survival ◽

Lewy Body Pathology ◽

Obstructive Sleep ◽

History Of ◽

Elderly Onset ◽

Progressive Dysphagia

An 81-year-old woman presented with a 2-year history of progressive dysarthria and gait disturbance. Subsequently, she developed orthostatic hypotension, obstructive sleep apnea, right-sided resting tremor, and rigidity. Together with characteristic findings of imaging studies, she was diagnosed with multiple system atrophy (MSA). Despite progressive dysphagia and repeated choking episodes, the patient elected not to use artificial feeding or tracheostomy. She died suddenly at age 91 after 12 years of illness. The autopsy revealed neuropathological features of both MSA and of Parkinson’s disease. The peripheral autonomic ganglia revealed both pre- and postganglionic involvement by synucleinopathy, which may have underscored the sudden death of the patient. The patient survived 10 years after onset, despite the presence of multiple poor prognostic factors in MSA including the onset of old age and early appearance of orthostatic hypotension and falls, in addition to the complication of PD pathology found by autopsy. Multidisciplinary team approach and her preserved cognitive function may have been contributory to the long-term survival.

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Intra-Abdominal Bleeding during Pregnancy, Preterm Delivery, and Placental Polyp in a Long-Term Survivor of Neuroblastoma: A Case Report

Obstetrics and Gynecology International ◽

10.1155/2009/564567 ◽

2009 ◽

Vol 2009 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Noriyoshi Watanabe ◽

Junna Tsutsui ◽

Satsuki Kakiuchi ◽

Seung Chik Jwa ◽

Hironori Takahashi ◽

...

Keyword(s):

Sudden Onset ◽

Japanese Woman ◽

Adverse Outcomes ◽

Labor Pain ◽

Abdominal Bleeding ◽

Old Japanese ◽

History Of ◽

Long Term Survivors ◽

Term Survivor

Background. There are few reports of pregnancies in long-term survivors of pelvic neuroblastoma.Case. A 30-year-old Japanese woman with a history of pelvic neuroblastoma in her childhood, which was treated with surgical resection, chemotherapy, and radiation. Her pregnancy continued with conservative management, but she delivered a 510 g female infant at 23 weeks of gestation due to sudden onset of labor pain. She also had a placental polyp and developed massive postpartum bleeding.Conclusion. Cancer treatment, especially radiation therapy, in childhood may cause adverse outcomes during pregnancy in long-term survivors of neuroblastoma.

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