Sacral chordoma with incidental rectal adenocarcinoma: a case report

Abstract Background We report a unique case of synchronous sacrococcygeal chordoma in association with rectal invasive adenocarcinoma. Retrorectal tumors are a rare disease caused by a variety of pathologies. To our knowledge, no prior cases of such a coincidental finding of both cancers have been reported in the literature. Case presentation This is the case of a 74-year-old white middle eastern man, with known hypertension under treatment, who presented with complaints of progressive lower back pain associated with urinary incontinence over the past 12 months. Magnetic resonance imaging (MRI) of the pelvis showed a large midline, well-defined, oval-shaped lesion replacing the sacrococcygeal portion of the spine, with extension to the presacral region. Computed tomography (CT)-guided Tru-Cut biopsy revealed features suggestive of chordoma. At surgery, we performed excision of the entire mass en bloc, sacrectomy with rectus abdominis myocutaneous flap reconstruction and end sigmoid colostomy. Surgical histopathology proved it to be sacral dedifferentiated chordoma and rectal invasive adenocarcinoma. Overall, the patient recovered well postoperatively, was discharged home with functional stoma and on permanent Foley catheter use. Conclusion To the best of our knowledge, this is the only reported case of such a presentation, and sheds light on the approach and management. We hope that reporting such a case will add value to the medical literature.

Download Full-text

Partial Sacrectomy for Resection of a Sacral Chordoma: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa024 ◽

2020 ◽

Vol 19 (4) ◽

pp. E412-E412

Author(s):

Martin Julian Gagliardi ◽

Alfredo Guiroy ◽

Alfredo Sícoli ◽

Nicolás Gonzalez Masanés ◽

Alejandro Morales Ciancio

Keyword(s):

Osteolytic Lesion ◽

En Bloc Resection ◽

Bloc Resection ◽

Wide Resection ◽

Resection Margins ◽

Low Grade ◽

En Bloc ◽

Ct Guided ◽

Sacral Chordoma ◽

Sacrococcygeal Region

Abstract Sacral chordomas are infrequent tumors that arise from remnants of the notochord. They are most often found in the sacrum and skull-base.1,2 These lesions rarely metastasize and usually have an indolent and oligosymptomatic clinical course. Chordomas show low sensitivity to standard radiation therapy and chemotherapy. Operative resection with wide resection margins offers the best long-term prognosis, including longer survival and local control.1,3 However, achieving a complete resection with oncological margins may be difficult because of the anatomic complexity of the sacrococcygeal region.4 The main complications of sacral resection include infections, wound closure defects, and anorectal and urogenital dysfunction. The rate of these complications is significantly increased when the tumor involves the S2 level or above. We report the case of a 64-yr-old male who presented with progressive sacrococcygeal pain and a feeling of incomplete evacuation. A heterogeneous, osteolytic lesion was found at the sacrococcygeal region. Full body imaging tests were negative for other lesions. A computed tomography (CT) guided biopsy was made. We usually use the midline approach in case we have to include the needle path in the resection. The pathology confirmed a sacrococcygeal, low-grade chordoma. We decided to perform an en bloc resection. A posterior, partial sacrectomy was planned distal to the S4 level.

Download Full-text

Successful surgical resection of a rare case of a giant sacral chordoma: a multidisciplinary feat

BMJ Case Reports ◽

10.1136/bcr-2020-235045 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235045

Author(s):

Safwan Omar Alomari ◽

Shadi Bsat ◽

Mohammad Khalife ◽

Ghassan Skaf

Keyword(s):

Surgical Resection ◽

Neurological Deficit ◽

Rare Case ◽

Tumour Resection ◽

Two Stage ◽

En Bloc ◽

Ct Guided ◽

Second Stage ◽

Sacral Chordoma ◽

Ct Guided Biopsy

We, here, report the case of a 72-year-old man who presented with a giant sacral chordoma without aggressive clinical and neurological course and confirmed with a CT guided biopsy. The patient underwent multidisciplinary, two-stage successful complete en bloc sacrectomy along with total gross tumour resection, followed by lumboiliac fusion and instrumentation in the second stage without any neurological deficit nor bladder or bowel-related complications.

Download Full-text

Laparoscopic surgical management of a mature presacral teratoma: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0702-x ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 1

Author(s):

Liming Wang ◽

Yasumitsu Hirano ◽

Toshimasa Ishii ◽

Hiroka Kondo ◽

Kiyoka Hara ◽

...

Keyword(s):

Laparoscopic Resection ◽

Mature Teratoma ◽

Skin Incision ◽

Histopathological Diagnosis ◽

Tailgut Cyst ◽

Resonance Imaging ◽

Presumptive Diagnosis ◽

Case Presentation ◽

Contrast Enhanced ◽

Magnetic Resonance Imaging Mri

Abstract Background Mature presacral (retrorectal) teratoma is very rare. We report a case in which a mature retrorectal teratoma in an adult was successfully treated with laparoscopic surgery. Case presentation A 44-year-old woman was diagnosed with a presacral tumor during a physical examination. Endoscopic ultrasonography (EUS) revealed a multilocular cystic lesion; the lesion was on the left side of the posterior rectum and measured approximately 30 mm in diameter on both contrast-enhanced pelvic computed tomography (CT) and magnetic resonance imaging (MRI). The presumptive diagnosis was tailgut cyst. However, the histopathological diagnosis after laparoscopic resection was mature teratoma. It is still difficult to preoperatively diagnose mature retrorectal teratomas. Conclusions Laparoscopic resection of mature retrorectal teratomas is a feasible and promising method that is less invasive and can be adapted without extending the skin incision.

Download Full-text

Uncommon manifestations of a rare disease: a case of autoimmune GFAP astrocytopathy

BMC Neurology ◽

10.1186/s12883-021-02070-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hong Di ◽

Yue Yin ◽

Ruxuan Chen ◽

Yun Zhang ◽

Jun Ni ◽

...

Keyword(s):

Rare Disease ◽

Hormone Secretion ◽

White Matter Lesions ◽

Signs And Symptoms ◽

Careful Examination ◽

Case Presentation ◽

Inappropriate Antidiuretic Hormone Secretion ◽

Contrast Enhanced ◽

The Central Nervous System ◽

Magnetic Resonance Imaging Mri

Abstract Background Manifestations of intractable hyponatremia and hypokalemia in autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy have been rarely reported. Case presentation A 75-year-old male patient presented as the case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) and intractable hypokalemia, showed fever, fatigue, and mental disorders. Signs and symptoms of meningoencephalitis, ataxia, and cognitive abnormalities. Magnetic resonance imaging (MRI) revealed multiple white matter lesions of the central nervous system. He had GFAP-IgG in the cerebrospinal fluid (CSF). After treatment with corticosteroids, his symptoms were alleviated gradually, and the level of electrolytes was normal. However, head contrast-enhanced MRI + susceptibility-weighted imaging (SWI) showed a wide afflicted region, and the serum GFAP-IgG turned positive. Considering the relapse of the disease, ha was treated with immunoglobulin and mycophenolate mofetil (MMF) to stabilize his condition. Conclusion This case showed a rare disease with uncommon manifestations, suggesting that careful examination and timely diagnosis are essential for disease management and satisfactory prognosis.

Download Full-text

Lymphangiography and focal pleurodesis treatment of chylothorax with an aberrant thoracic duct following oesophagectomy: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0709-3 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Tomoyuki Ishida ◽

Jun Kanamori ◽

Hiroyuki Daiko

Keyword(s):

Magnetic Resonance Imaging ◽

Interventional Radiology ◽

Case Report ◽

Magnetic Resonance ◽

Thoracic Duct ◽

Rare Case ◽

Resonance Imaging ◽

Case Presentation ◽

Thoracostomy Tube ◽

Magnetic Resonance Imaging Mri

Abstract Background Management of postoperative chylothorax usually consists of nutritional regimens, pharmacological therapies such as octreotide, and surgical therapies such as ligation of thoracic duct, but a clear consensus is yet to be reached. Further, the variation of the thoracic duct makes chylothorax difficult to treat. This report describes a rare case of chylothorax with an aberrant thoracic duct that was successfully treated using focal pleurodesis through interventional radiology (IVR). Case presentation The patient was a 52-year-old man with chylothorax after a thoracoscopic oesophagectomy for oesophageal cancer. With conventional therapy, such as thoracostomy tube, octreotide or fibrogammin, a decrease in the amount of chyle was not achieved. Therefore, we performed lymphangiography and pleurodesis through IVR. The patient appeared to have an aberrant thoracic duct, as revealed by magnetic resonance imaging (MRI); however, after focal pleurodesis, the leak of chyle was diminished, and the patient was discharged 66 days after admission. Conclusions Chylothorax remains a difficult complication. Focal pleurodesis through IVR can be one of the options to treat chylothorax.

Download Full-text

Severe acute myopathy following SARS-CoV-2 infection: a case report and review of recent literature

Skeletal Muscle ◽

10.1186/s13395-021-00266-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Badrul Islam ◽

Mohiuddin Ahmed ◽

Zhahirul Islam ◽

S. M. Begum

Keyword(s):

High Serum ◽

High Dose ◽

Limb Weakness ◽

Case Presentation ◽

Skeletal Myopathy ◽

Potential Marker ◽

Ventilatory Failure ◽

Muscle Magnetic Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Dose Corticosteroid

Abstract Background SARS-CoV2 virus could be potentially myopathic. Serum creatinine phosphokinase (CPK) is frequently found elevated in severe SARS-CoV2 infection, which indicates skeletal muscle damage precipitating limb weakness or even ventilatory failure. Case presentation We addressed such a patient in his forties presented with features of severe SARS-CoV2 pneumonia and high serum CPK. He developed severe sepsis and acute respiratory distress syndrome (ARDS) and received intravenous high dose corticosteroid and tocilizumab to counter SARS-CoV2 associated cytokine surge. After 10 days of mechanical ventilation (MV), weaning was unsuccessful albeit apparently clear lung fields, having additionally severe and symmetric limb muscle weakness. Ancillary investigations in addition with serum CPK, including electromyogram, muscle biopsy, and muscle magnetic resonance imaging (MRI) suggested acute myopathy possibly due to skeletal myositis. Conclusion We wish to stress that myopathogenic medication in SARS-CoV2 pneumonia should be used with caution. Additionally, serum CPK could be a potential marker to predict respiratory failure in SARS-CoV2 pneumonia as skeletal myopathy affecting chest muscles may contribute ventilatory failure on top of oxygenation failure due to SARS-CoV2 pneumonia.

Download Full-text

Concomitant hepatic tuberculosis and hepatocellular carcinoma: a case report and review of the literature

BMC Surgery ◽

10.1186/s12893-020-01021-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hind S. Alsaif ◽

Ali Hassan ◽

Osamah Refai ◽

Khaled Awary ◽

Haitham Kussaibi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Malignancy ◽

Ct Guided ◽

Case Presentation ◽

Hepatic Tuberculosis ◽

Ct Guided Biopsy ◽

History Of ◽

Abdominal Examination ◽

Peripheral Arterial ◽

High Index Of Suspicion

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy that is strongly associated with chronic liver disease. Isolated hepatic tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. Case presentation We report the case of a 47-year-old man who presented with fever and abdominal pain for 3 months prior to presentation. He reported a history of anorexia and significant weight loss. Abdominal examination revealed a tender, enlarged liver. Abdominal computed tomography (CT) demonstrated a solid heterogeneous hepatic mass with peripheral arterial enhancement, but no venous washout, conferring a radiological impression of suspected cholangiocarcinoma. However, a CT-guided biopsy of the lesion resulted in the diagnosis of concomitant HCC and isolated hepatic tuberculosis. Conclusion A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.

Download Full-text

Abdominopelvic Pain in Patient with Uterus Didelphys and Unilateral Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA Syndrome)

Frontiers in Emergency Medicine ◽

10.18502/fem.v5i3.5897 ◽

2021 ◽

Author(s):

Zahra Tavoli ◽

Ali Montazeri

Keyword(s):

Renal Agenesis ◽

Primary Diagnosis ◽

Case Presentation ◽

Uterus Didelphys ◽

Future Fertility ◽

History Of ◽

Ohvira Syndrome ◽

Obstructed Hemivagina ◽

Magnetic Resonance Imaging Mri

Introduction: Uterus didelphys with obstructed hemivagina associated with ipsilateral renal agenesis (OHVIRA syndrome) is a rare female urogenital malformation and delay in its diagnosis could lead to several complications. Case presentation: A 21-year-old virgin woman was admitted to the emergency department (ED) with severe abdominal pain, without fever and vaginal discharge. She reported a history of cyclic abdominopelvic pain and dysmenorrhea for 5 years. The primary diagnosis (OHVIRA syndrome) was made using ultrasonography, spiral computed tomography (CT) and magnetic resonance imaging (MRI). In addition, laparoscopy was performed to confirm diagnosis and drain hematosalpinx. Then, hysteroscopy was carried out for septum resection and catheter insertion. At one-month follow-up the ultrasonography showed normal left hemicavity of uterus associated with significant decrease in dysmenorrhea. Conclusion: Being aware of OHVIRA syndrome and clinical suspicion of this rare anomaly are essential for making a timely diagnosis, preventing complications, relieving symptoms, and preserving future fertility.

Download Full-text

Lateral Medullary Infarction with Contralateral Segmental Dysesthesia and Ipsilateral Headache: A Case Report

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666211117142203 ◽

2021 ◽

Vol 17 ◽

Author(s):

Renjie Wang ◽

Yankun Shao ◽

Lei Xu

Keyword(s):

Medulla Oblongata ◽

Clinical Manifestations ◽

Lateral Medullary Infarction ◽

Case Presentation ◽

Specific Sign ◽

Temperature Sense ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

The Brain ◽

Medullary Infarction

Introduction: The medulla oblongata is the lowest segment of the brain stem, located adjacent to the spinal cord, with a complex anatomical structure. Thus, a small injury to the medulla oblongata can show complex clinical manifestations. Case Presentation: A patient experienced dysesthesia, which manifested as numbness in her right lower limb and decreased temperature sense, and dizziness 20 days before admission. The numbness worsened 1 week before admission, reaching the right thoracic (T) 12 dermatomes. Her thermoception below the T12 dermatomes decreased, and the degree of dizziness increased, accompanied by nausea and vomiting. Magnetic resonance imaging (MRI) of the neck, chest, and abdomen performed at a local hospital showed no abnormalities. MRI of the brain was performed after admission. One week after admission, she experienced a severe headache in the upper left periorbital area. The numbness extended to T4, and thermoception decreased below T4. Diagnosis: Lateral medullary infarction. Interventions: Anti-platelet aggregation and mitochondrial nutritional therapies were performed along with treatments for improving circulation and establishing collateral circulation. Outcomes: The intensity of limb numbness decreased, and the symptoms of headache and dizziness resolved. Conclusion: Lesions leading to segmental sensory disorders can occur in the medulla oblongata. Ipsilateral headaches with contralateral segmental paresthesia can be a specific sign of lateral medullary infarction.

Download Full-text

Case Presentation: Unusual Association Between Possible Bilateral Intraventricular Xanthogranulomas, Postero-inferior Cerebellar Artery Aneurysm and Thrombophilia

Acta Medica Marisiensis ◽

10.2478/amma-2018-0027 ◽

2018 ◽

Vol 64 (4) ◽

pp. 173-176

Author(s):

Sebastian Razvan Andone ◽

Andreea Romaniuc ◽

Zoltan Bajko ◽

Smaranda Maier ◽

Laura Barcutean ◽

...

Keyword(s):

Choroid Plexus ◽

Metabolic Diseases ◽

Artery Aneurysm ◽

Epileptic Seizures ◽

Mthfr C677t ◽

Lower Limbs ◽

Case Presentation ◽

High Cholesterol Level ◽

Cerebellar Artery ◽

Magnetic Resonance Imaging Mri

AbstractIntroduction: Xanthogranulomas are rare, benign, usually asymptomatic, cutaneous tumors most frequently seen in children (juvenile xanthogranulomas). Some lesions can be found accidentally at randomly performed cerebral computer tomography (CT) or magnetic resonance imaging (MRI) or even on autopsy.Case report: We present the case of a 44 year-old woman, known with a thrombophilic disorder (PAI-1 gene mutation, MTHFR C677T and A1298C) on chronic anticoagulant treatment. The onset of symptoms was in 2010, when she presented paresthesia and lower limbs weakness. Two years later the patient presents with severe intermittent headache and left hemicrania and a cerebral angio-MRI is performed showing a left postero-inferior cerebellar artery aneurysm and two choroid plexus intraventricular masses in the lateral ventricles. The patient developed a new symptom, dysarthria in 2014 and in 2015 has multiple episodes of loss of consciousness, interpreted as epileptic seizures. Routine blood tests were within normal range, except for a high cholesterol level. The patient was tested for autoimmune, infectious, endocrine and metabolic diseases that were negative. Surgical treatment and biopsy from the lesion was proposed, however the patient refused both procedures.Conclusions: There is an association between xanthogranulomas localization and the choroid plexus, the most frequent CNS origin being in the trigon of the lateral ventricle. Our case does not resemble with any other case published, mostly because the unusual presentation, symptomatology and the association between xanthogranulomas, thrombophilia and postero-inferior cerebellar artery aneurysm which were never reported before in other cases of xanthogranulomas from the literature.

Download Full-text