An Unusual Case of Three Synchronous Tumors in a Young Woman

2005 ◽  
Vol 91 (3) ◽  
pp. 267-269 ◽  
Author(s):  
Raffaele Longo ◽  
Guido Carillio ◽  
Antonietta Torrisi ◽  
Maria Pia Tocco ◽  
Giovanni Battista Grassi ◽  
...  
Keyword(s):  
Left Lung ◽  
Wide Resection ◽  
Clear Correlation ◽  
Caucasian Woman ◽  
Synchronous Tumors ◽  
Sclerosing Hemangioma ◽  
Positron Emission ◽  
Chest X Ray ◽  
The Right

The occurrence in the same young patient of three synchronous tumors deriving from different embryogenic tissues and without a clear correlation with a common etiopathogenic factor is very unusual. We report a case of a Caucasian woman submitted to wide resection of a large retroperitoneal liposarcoma and right radical nephrectomy for suspected tumor infiltration. Histological examination of the right ureter and renal pelvis showed the presence of a multifocal urothelial carcinoma that was clinically asymptomatic. Two months later, during follow-up, chest X-ray and computed tomography documented a coin lesion of the upper left lung, confirmed by positron emission tomography. This nodule was surgically removed and examined histologically, resulting in a diagnosis of sclerosing hemangioma. The patient is alive without evidence of recurrent disease.

CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

2019 ◽  
Vol 1 (4) ◽  
Author(s):  
Yustinus Robby Budiman Gondowardojo ◽  
Tjokorda Gde Bagus Mahadewa
Keyword(s):  
Spinal Cord ◽  
Left Lung ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
High Mobility ◽  
Early Mobilization ◽  
Cord Injury ◽  
Cardiothoracic Surgeon ◽  
The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

scholarly journals SUN-932 Successful Response of Temozolomide (TMZ) in two Patients with Metastatic Pheochromocytoma/Paragangliomas (PPGLs)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Tobias Skrebsky de Almeida ◽  
Roberta P Borges ◽  
Janeczko Laís ◽  
Giovana Caroline Marx Becker ◽  
Ticiana Costa Rodrigues ◽  
...  
Keyword(s):  
Lung Metastases ◽  
Left Lung ◽  
Vena Cava ◽  
Lung Lesion ◽  
Chest Ct ◽  
Complete Regression ◽  
Lung Lesions ◽  
The Right ◽  
Urinary Metanephrines

Abstract Introduction: PPGLs are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla or their neural crest progenitors, being able to secrete catecholamines. Its treatment is primarily surgical; however, for metastatic/inoperable tumors, effective treatments are lacking. The use of TMZ, an oral alkylating agent, has been scarcely reported with variable response rates. We report 2 patients with reasonable clinical, biochemical and structural responses. Case Reports: Case 1) A 14-year old girl presented with neck pain, sweating, hypertension and tachycardia. Urinary hormonal profile revealed metanephrines 80 (up to 320 ug/24h) and normetanephrines 2983 (up to 390 ug/24h). Abdominal MRI showed a 10x6x5 cm retroperitoneal lesion in close contact with celiac trunk, superior mesenteric artery, renal arteries, aorta, left renal vein and vertebral bodies of T10, T11 and T12. A chest CT revealed multiple lung metastases. After 11 months, both the primary abdominal lesion and lung metastases increased in size.. Due to disease severity, after excluding surgical possibilities and confirming diagnosis by lesion biopsy, rescue treatment with TMZ was started for 5 days on a 28-day cycle. After 11 cycles, lung and abdominal lesions decreased more than 30% in size, and urinary metanephrines decreased 53.4%. After 21 cycles, there is no evidence of disease progression. Case 2) A 44-year old female was first diagnosed at the age of 31 with a right adrenal mass invading the kidney and the inferior vena cava associated with hypertension, sweating, headaches and palpitations. She underwent right adrenalectomy and nephrectomy. Immunohistochemistry confirmed the diagnosis of pheochromocytoma. Seven years later, follow-up CT`s showed a 3 x 2 cm liver metastasis, which was resected, and two lung lesions, one located at the right inferior lobe (1.6 cm) and the other at the left superior lobe (0.9 cm), which initially were just followed-up. At this time, a 7-month sorafenib trial was performed but the drug was stopped due to intolerable side effects. After 3 years of follow-up, the lung lesions increased in size and the right lesion was resected, but the patient refused surgery for the remainder left lung lesion. After 1 year, left lung lesion increased to 2.4 cm and mediastinal and paratracheal lymphadenomegaly developed. TMZ in the same aforementioned schedule was prescribed and after 7 cycles a new chest CT revealed complete regression of the lung and lymph node metastases.. Urinary metanephrines were 2.1 times the upper limit of normal before TMZ and decreased to normal range. Conclusion: These cases highlight the promising role of a well-tolerated single drug chemotherapy regimen in severe cases of metastatic and inoperable PPGLs. TMZ could be considered an alternative strategy for the treatment of these cases and, if possible, should be tested in adequate clinical trials.

Epithelioid Sarcoma of the Peripheral Nerve: Clinicopathologic Series of Three Cases and Literature Review

2020 ◽  
Author(s):  
Julio A Diaz-Perez ◽  
Smiljana Spasic ◽  
Jaylou M Velez-Torres ◽  
Edward F McCarthy ◽  
Andrew E Rosenberg
Keyword(s):  
Magnetic Resonance Imaging ◽  
Literature Review ◽  
Peripheral Nerve ◽  
Epithelioid Sarcoma ◽  
Emission Tomography ◽  
Wide Resection ◽  
Resonance Imaging ◽  
Positron Emission ◽  
Weighted Magnetic Resonance Imaging

Abstract Objectives Epithelioid sarcoma (ES) rarely arises in the nerve. To increase our understanding of this unusual tumor originating in the nerve, we describe the features of three cases and review the literature. Methods Clinical data, imaging, pathology, treatment, and follow-up are detailed. A systematic literature review was conducted. Results Two patients were male and one female; the median age was 24 years. The patients had neurologic symptoms, and the tumors arose in large nerves and ranged from 2.4 to 5.8 cm. The tumors were avid on positron emission tomography–computed tomography and showed increased signal intensity on T2-weighted magnetic resonance imaging. Centered in the nerve, the tumors grew with an infiltrative pattern and encased the nerve fascicles. All were treated with wide resection, and adjuvant treatment included combinations of chemotherapy and radiation. One recurred, and the limb was amputated. Metastases were documented to lymph nodes, lung, pleura, and skin. One patient died of disease after 54 months. Literature review including our cases showed that tumors stained with pancytokeratin (9/9), EMA (4/4), and CD34 (7/7); there was loss of INI1 in all six cases tested. Conclusions ES rarely arises in the peripheral nerve, and its infiltrative nature often requires morbid surgery. The differential includes a variety of benign and malignant epithelioid neoplasms.

scholarly journals Fatal congenital lobar emphysema in a puerpera: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fanyi Gan ◽  
Liang Xia ◽  
Yushang Yang ◽  
Qiang Pu ◽  
Lunxu Liu
Keyword(s):  
Left Lung ◽  
Middle Lobe ◽  
Left Hemithorax ◽  
Recurrent Pneumonia ◽  
Mediastinal Shift ◽  
Life Threatening ◽  
Right Middle Lobe ◽  
Lobar Emphysema ◽  
The Right

Abstract Background Congenital lobal emphysema (CLE) is a developmental lung abnormality usually diagnosed in the neonatal period and is rarely observed in adults. Adults with CLE are usually asymptomatic and only a small fraction may present with coughing, recurrent pneumonia and respiratory distress. In imaging studies, the most frequently affected lobe of CLE is the left upper lobe, followed by the right middle lobe. However, multilobar involvement with severe mediastinal shift is extremely rare. Case presentation We report a case of fatal CLE in a 28-year-old puerpera with postpartum respiratory failure. Chest computed tomography (CT) revealed emphysema of the right upper, middle and lower lobes resulting in adjacent atelectasis. Hyperinflation of the right upper lobe crossed the midline, leading to a deviation of the mediastinal structure to the left hemithorax and severe compression of the left lung. Conclusions Early and timely diagnosis of CLE with routine follow-up is necessary for patients. CLE, especially with multilobar involvement or mediastinal shift, could be life-threatening and should be promptly and aggressively treated to prevent severe complications.

Viral and bacterial coinfection of the respiratory tract in a 10-month-old child

2020 ◽  
Vol 13 (7) ◽  
pp. e235295
Author(s):  
Sandhya Govindarajan ◽  
Saha Bivan
Keyword(s):  
Respiratory Tract ◽  
Work Of Breathing ◽  
Acute Respiratory Tract Infection ◽  
Blood Film ◽  
History Of ◽  
Chest X Ray ◽  
Syncytial Virus ◽  
Bacterial Coinfection ◽  
The Right

A 10-month-old child, immunised appropriately for age, presented with a history of cough, vomiting, diarrhoea, increased work of breathing and eye redness for 1 week. She was treated for suspected bronchiolitis with supportive oxygen and hypertonic saline nebulisation. In view of continuing fever spikes and persistent oxygen requirement, she was evaluated further. Her inflammatory markers were raised, blood film showed neutrophils left shift with toxic granulations and chest X-ray was suggestive of the right upper lobe segmental atelectasis suggestive of a bacterial infection. Her nasopharyngeal aspirate for multiplex tandem PCR was positive for adenovirus, respiratory syncytial virus and Bordetella species. She was treated with oral clarithromycin for 5 days which improved her symptoms. She was discharged with further follow-up. Coinfection with bacteria or atypical bacteria in children with acute respiratory tract infection is common and this coinfection can induce serious illness.

scholarly journals Metastatic pulmonary adenocarcinoma to the nasopharynx at first clinical presentation: A case report and review of literature

2020 ◽  
Vol 8 ◽  
pp. 2050313X2093982
Author(s):  
Shahad Iqneibi ◽  
Jamil Nazzal ◽  
Runa Amoudi ◽  
Basma Owda ◽  
Akram Al-Ibraheem ◽  
...  
Keyword(s):  
Left Lung ◽  
Cancer Control ◽  
Metastatic Carcinoma ◽  
Pulmonary Adenocarcinoma ◽  
Review Of Literature ◽  
Thyroid Transcription Factor 1 ◽  
Positron Emission ◽  
Recurrent Epistaxis ◽  
Poorly Differentiated ◽  
The Right

Metastatic carcinomas in the nasopharynx are a rarity. We report a case of a 54-year-old male patient who presented with a history of recurrent epistaxis. On evaluation, a mass in the right Rosenmüller fossa was detected, which was biopsied and diagnosed as a poorly differentiated adenocarcinoma, immunoreactive for thyroid transcription factor-1, consistent with metastatic pulmonary adenocarcinoma. Fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) scan confirmed the presence of a mass in the upper lobe of the left lung, proven pathologically to be a poorly differentiated pulmonary adenocarcinoma, with an immunoprofile similar to the nasopharyngeal tumor. The patient underwent palliative chemotherapy, and was then shifted to immunotherapy. He is currently alive and disease free 50 months after the initial diagnosis was made. The unusual presentation of a metastatic carcinoma in the nasopharynx will be discussed, along with a review of literature. The role of immunotherapy in cancer control and greater longevity will also be presented.

scholarly journals Meningococcal Pneumonia in a Young Healthy Male

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Abdullah M. Al Alawi
Keyword(s):  
Emergency Department ◽  
Lower Lobe ◽  
Community Acquired Pneumonia ◽  
Cell Counts ◽  
History Of ◽  
Chest X Ray ◽  
White Blood Cell Counts ◽  
The Right ◽  
Local Guideline

A 23-year-old male presented to the emergency department with one-day history of right-sided pleuritic chest pain, haemoptysis, and fever. In the emergency department, the blood pressure was 140/60 mmHg, heart rate 89/min, body temperature 40°C, respiratory rates 20 breaths/min, and oxygen saturation 98% in room air. Physical examination revealed rales and bronchial breathing in the right infrascapular region. Laboratory analysis showed raised white blood cell counts and elevated inflammation markers. Chest X-ray showed right lower lobe consolidation. Intravenous(IV) ceftriaxone and doxycycline were started for the management of community-acquired pneumonia as per the local guideline. Later, on admission, blood culture was positive for Neisseria meningitidis (N. meningitidis). Ceftriaxone was continued for 4 days, and the patient was discharged while being on oral amoxicillin (1 gm TDS) for another 3 days. He remained well during the outpatient follow-up.

Quantification of regional V/Q ratios in humans by use of PET. II. Procedure and normal values

1989 ◽  
Vol 66 (4) ◽  
pp. 1905-1913 ◽  
Author(s):  
C. G. Rhodes ◽  
S. O. Valind ◽  
L. H. Brudin ◽  
P. E. Wollmer ◽  
T. Jones ◽  
...  
Keyword(s):  
Left Lung ◽  
Normal Subjects ◽  
Slice Thickness ◽  
Dependent Lung ◽  
Quiet Breathing ◽  
Mean Values ◽  
Positron Emission ◽  
Supine Posture ◽  
Quantitative Manner ◽  
The Right

Regional measurements of tissue isotope concentration, made using positron emission tomography (PET), allow tracer models to be used in a quantitative manner to provide topographic distributions of many structural and functional parameters, each derived for the same well-defined lung element. In this paper we describe a technique to measure regional ventilation-perfusion ratios (V/Q), in absolute units, by use of PET and the continuous intravenous infusion of an inert gas isotope, 13N, and report on measurements made in 12 normal subjects (4 smokers). Data were obtained from a single lung section (slice thickness, 1.7 cm full width at half-maximum response to a line source) at the level of the right ventricle in the supine posture during quiet breathing. For the 12 subjects, volume-weighted mean values of V/Q, averaged over individual right and left lung fields, ranged from 0.50 to 1.29. Analysis of these means showed no difference between lungs: right, 0.80 +/- 0.23 SD; left, 0.76 +/- 0.20 SD. Topographically, a systematic fall of V/Q in the ventrodorsal direction was observed in eight of the subjects (mean ventrodorsal difference 0.39, range 0.19–0.90), whereas two showed a clear increase toward dependent lung regions (range 0.16–0.26). Seven of the subjects with a falling ventrodorsal V/Q gradient also exhibited discrete regions of low V/Q at the dorsal lung border. We conclude that, in normal subjects, ventilation and perfusion are generally well matched in the supine posture, but isolated mismatching often occurs in dependent lung regions.

scholarly journals Recalcitrant Paecilomyces keratitis

2019 ◽  
Vol 12 (4) ◽  
pp. e229226
Author(s):  
Seetha Lakshmi ◽  
Cristina Vanessa Garcia
Keyword(s):  
Antifungal Agents ◽  
Corneal Ulcer ◽  
Surgical Intervention ◽  
Caucasian Woman ◽  
Artificial Eye ◽  
Finger Counting ◽  
Intrastromal Injection ◽  
The Right ◽  
Continue Therapy

A 54-year-old Caucasian woman presented with corneal ulcer of the right eye of 4 weeks duration after scratching her cornea while removing her contact lens and artificial eye lashes. Her visual acuity was 20/32 (left eye) and finger counting (right eye). She had a 3x3 mm epithelial defect with underlying corneal oedema and hypopyon. Right eye cultures grew Paecilomyces species. Topical and systemic antifungal agents were initiated. Due to the sight-threatening disease, the patient underwent surgical intervention with intrastromal injection of amphotericin B and a large conjunctival flap covering 75% of the right eye corneal ulcer. After 3 months of therapy, she had near-complete resolution of the corneal ulcer. Unfortunately, recurrence of the corneal ulcer occurred within 3 weeks of cessation of therapy, prompting reinitiation of ophthalmic and systemic antifungal agents. The patient was advised to continue therapy for 6 months with regular follow-up.

scholarly journals Abnormal shadow on chest radiograph: a supra – or infradiaphragmatic finding?

2021 ◽  
Vol 3 (2) ◽  
pp. 41-44
Author(s):  
Katarzyna Biernacka-Racicot ◽  
Maciej Łukaszewski ◽  
Michał Nowański ◽  
Beata Socha ◽  
Piotr Grzelak
Keyword(s):  
Left Lung ◽  
Oncological Patients ◽  
Calcified Lesion ◽  
Left Hemidiaphragm ◽  
Abnormal Shadow ◽  
Therapeutic Choice ◽  
Contrast Enhanced ◽  
Chest X Ray ◽  
The Right ◽  
Enhanced Computed Tomography

Incidental findings on chest X-ray of oncological patients need further evaluation in contrast-enhanced computed tomography (CT). We report two cases of abnormal shadows, detected on radiograph, in patients with breast cancer: the first one projected under the left hemidiaphragm and the second one obscuring the right hemidiaphragm. Both patients were asymptomatic, subjected to a surgery and to a CT. The first scan revealed a 15 mm diameter nodule in left lung with smooth margins and central calcifications. Whereas, the second exam showed a subcapsular, ring, calcified lesion in the liver. In both cases, CT was essential for staging and therapeutic choice.

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