scholarly journals Occurrence of metastatic eccrine porocarcinoma in an immunosuppressed patient

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Mitul B. Modi ◽  
Ata S. Moshiri ◽  
Toru Shoji ◽  
Martin C. Mihm ◽  
Xiaowei Xu ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Immunosuppressive Therapy ◽  
Left Lung ◽  
Immunosuppressed Patient ◽  
Axillary Lymph ◽  
Comfort Care ◽  
History Of ◽  
The Right ◽  
Eccrine Porocarcinoma

Abstract Background Eccrine porocarcinoma is a rare malignancy accounting for 0.005 to 0.01% of all cutaneous tumors. However, its etiology is not well established. Herein we are reporting the occurrence of metastatic porocarcinoma of the back in a patient with a history of multiple cutaneous malignancies and chronic immunosuppression. Case presentation A 79-year-old male with a history of long-term immunosuppressive therapy for left lung transplantation and multiple cutaneous malignancies including melanoma, presented with an enlargening plaque on the right upper back. Biopsy demonstrated an infiltrative epithelial tumor with aggressive histology and ductal formation. Immunohistochemical stains for p63, CK-5/6, and CEA were diffusely positive, while CK-7 and CK-20 were negative. A diagnosis of eccrine porocarcinoma was made. He underwent complete wide excision with negative margins of the right upper back in January 2018. In November 2018, he was found to have a right posterior shoulder mass, positive right axillary lymph nodes, superficial right upper back soft tissue masses and lymphangitic carcinomatosis involving the left lung. He was transitioned to comfort care and subsequently passed from metastatic disease in December 2018. Conclusion The occurrence of eccrine porocarcinoma in a patient on long term immunosuppressive therapy for lung transplantation suggests a possible role for chronic immunosuppression in the induction of a subset of eccrine porocarcinomas, as in other cutaneous malignancies.

Contralateral lung transplantation: a left lung implanted in the right thorax

2001 ◽  
Vol 72 (3) ◽  
pp. 933-935 ◽  
Author(s):  
Jean-Paul Couetil ◽  
Pantelis G Argyriadis ◽  
Michael J Tolan ◽  
Antoine Achkar ◽  
Alain F Carpentier
Keyword(s):  
Lung Transplantation ◽  
Left Lung ◽  
Contralateral Lung ◽  
The Right

scholarly journals A rare anaesthetic challenge in a one-lung ventilated paediatric patient with right upper lobe tracheal bronchus

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096760
Author(s):  
Yuangui Zhang ◽  
Meiman Qin ◽  
Xiaoqian Wang ◽  
Quanzhang Yan
Keyword(s):  
Paediatric Patient ◽  
Left Lung ◽  
Recurrent Infection ◽  
Lung Ventilation ◽  
Tracheal Bronchus ◽  
One Lung Ventilation ◽  
Recurrent Pneumonia ◽  
Single Lumen ◽  
History Of ◽  
The Right

A tracheal bronchus is a rare congenital anomaly, suggesting abnormal bronchial development. The prevalence of tracheal bronchus in children who undergo bronchoscopy is estimated to be between 0.2% and 3%. When associated with recurrent infection, lobes of the lung must be removed to avoid further lung injury. In such cases, perioperative one-lung ventilation and airway management remain a huge challenge for anaesthesiologists. The case of this rare airway anatomic abnormality in a paediatric patient with two bronchial openings into the right upper lobe, and with a history of recurrent pneumonia, is reported. In addition to a normal opening, a distinct opening in the upper lobe of the right lung was observed, that originated directly from the trachea, superior to the carina. The entire right lung was deflated by left-lung ventilation using a single lumen tracheal tube, and the patient underwent right upper lobe resection. No anaesthesia complications were observed during recovery. In this case, timely identification of the tracheal bronchus and successful collapse of the right lung were key points in the anaesthesia management of this patient.

scholarly journals Oncocytic cyst of the larynx: a rare finding

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-227214 ◽  
Author(s):  
Samantha Baird ◽  
Halina Mann ◽  
Cesar M Salinas-La Rosa ◽  
Halil Ozdemir
Keyword(s):  
Social History ◽  
Granular Eosinophilic Cytoplasm ◽  
Eosinophilic Cytoplasm ◽  
Long Term Follow Up ◽  
History Of ◽  
The Right ◽  
False Vocal ◽  
Columnar Cells

A 75-year-old woman presented with an 18-month history of severe, slowly worsening dysphonia. She was a smoker and known to have multiple benign cystic thyroid lesions. She reported no associated symptoms and other medical and social history was unremarkable. Fibreoptic nasendoscopy revealed a right-sided supraglottic cyst appearing to arise from the right false vocal cord. Further bedside examination was unremarkable. She underwent microlaryngoscopy and biopsy which showed a cyst originating from the right anterior ventricle, successfully removed without rupture using cold steel. Formal histopathology revealed a 14×10×7 mm unilocular, completely excised cyst lined by oncocytic epithelium and composed of columnar cells with darkly stained nuclei and abundant granular, eosinophilic cytoplasm. Three weeks postoperatively the patient’s voice had returned to normal. To date, 11 months postoperatively, there is no evidence of recurrence, and she will continue long-term follow-up.

scholarly journals Thirteen-year follow-up of parasellar intravascular papillary endothelial hyperplasia successfully treated by surgical excision: case report

2015 ◽  
Vol 15 (4) ◽  
pp. 384-391 ◽  
Author(s):  
Sook Young Sim ◽  
Yong Cheol Lim ◽  
Keun Soo Won ◽  
Kyung Gi Cho
Keyword(s):  
Surgical Excision ◽  
Subtotal Resection ◽  
Intravascular Papillary Endothelial Hyperplasia ◽  
Long Term Follow Up ◽  
History Of ◽  
Papillary Endothelial Hyperplasia ◽  
The Right ◽  
Frontal Skull Base

Intracranial intravascular papillary endothelial hyperplasia (IPEH) is very rare, and to our knowledge long-term follow-up results have not been previously published. An 11-year-old boy presented with a 6-month history of progressive visual impairment in the right eye. Magnetic resonance imaging revealed a well-enhanced, large parasellar mass involving the cavernous sinus, right frontal skull base, and ethmoid and sphenoid sinuses. Frontotemporal craniotomy and subtotal resection were performed, and the diagnosis of IPEH was confirmed. The mass increased in size during the following 3 months. A second operation was performed via frontotemporal craniotomy combined with a transsphenoidal approach, and gross-total resection of the tumor was achieved. Adjuvant radiotherapy (5040 cGy) and chemotherapy with interferon were administered. The patient's visual symptoms improved, and there was no recurrence during a 13-year follow-up period. The results of this case indicate that intracranial IPEH can recur with subtotal resection; however, optimal resection with multimodal adjuvant treatment can control the disease for many years, if not permanently.

Parasagittal meningioma: A not so benign entity

2017 ◽  
Vol 57 (4) ◽  
pp. 175-178 ◽  
Author(s):  
Roger W Byard
Keyword(s):  
Neurofibromatosis Type ◽  
Lethal Effect ◽  
Precentral Gyrus ◽  
Unexpected Death ◽  
Comfort Care ◽  
Posterior Displacement ◽  
History Of ◽  
The Right ◽  
Parasagittal Meningioma

While the majority of intracranial meningiomas have an indolent clinical course, sudden and unexpected death may rarely occur. Two cases are reported to demonstrate rapid clinical deterioration resulting in death in individuals with large, grade I, parasagittal meningiomas. Case 1 was a 46-year-old man with a history of headaches and epilepsy who suddenly collapsed and died. A large right frontal parasagittal meningioma with haemorrhage had compressed the brain and lateral ventricle, causing tonsillar herniation. In case 2, a previously well 83-year-old woman presented with a one-week history of progressive dysphagia and dysphasia. She suffered rapid deterioration and was prescribed comfort care. A right-sided parasagittal meningioma had compressed the right superior and middle frontal gyri with posterior displacement and compression of the right precentral gyrus. If a meningioma is found at autopsy, the possibility of a lethal effect should be considered, and evidence of neurofibromatosis type 2 or other associated heritable conditions checked for.

scholarly journals Ruptured Retinal Arterial Macroaneurysm Secondary to Toxoplasmic Kyrieleis Arteriolitis: A Case Report

2017 ◽  
Vol 8 (2) ◽  
pp. 390-395
Author(s):  
Natalie Huang ◽  
W. Andrew Lee ◽  
Sean Rivera ◽  
Sandra R. Montezuma
Keyword(s):  
Fundus Photography ◽  
Systemic Hypertension ◽  
Hypertensive Retinopathy ◽  
Eye Color ◽  
Retinal Arterial Macroaneurysm ◽  
Vein Occlusion ◽  
Ocular Imaging ◽  
History Of ◽  
The Right

Purpose: The aim of this report was to describe multimodal ocular imaging findings in a patient who presented with a ruptured retinal arterial macroaneurysm (RAM) associated with toxoplasmic Kyrieleis arteriolitis. Methods: We report the case of a 64-year-old man with a history of systemic hypertension and dense amblyopia of the left eye who presented with decreased vision and new floaters in the left eye. Color fundus photography, spectral-domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography were used as diagnostic imaging tools. Results: No signs of hypertensive retinopathy were noted in the right eye. Multiple chorioretinal scars characteristic of previous toxoplasmosis were revealed in the left eye, with one covering most of the macula. Periarterial plaques or Kyrieleis arteriolitis were observed in retinal arteries surrounding the toxoplasmic retinal scars. Multiple RAMs were observed in these vessels, one of which was acutely ruptured. A perivenular plaque associated with a chronic branch retinal vein occlusion (BRVO) was noted along the same arcade at the arteriovenous crossing. Conclusion: RAM formation and BRVO can present as possible long-term complications of toxoplasmic Kyrieleis arteriolitis. This is the first reported case demonstrating an association between toxoplasmic Kyrieleis arteriolitis and RAM formation.

scholarly journals COVID-19 Pneumonia in Patients with Chronic Myocarditis (HBV-Associated with InfarctLike Debute): Specifics of the Diseases Course, the Role of the Basic Therapy (Part II)

2020 ◽  
Vol 16 (5) ◽  
pp. 730-736
Author(s):  
O. V. Blagova ◽  
N. V. Varionchik ◽  
M. M. Beraia ◽  
V. A. Zaidenov ◽  
E. A. Kogan ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Troponin T ◽  
Oral Anticoagulants ◽  
Adverse Outcomes ◽  
Interleukin 17 ◽  
Chronic Myocarditis ◽  
Life Threatening ◽  
History Of ◽  
Therapy Withdrawal

Chronic infectious-immune myocarditis of severe course can potentially be considered as a factor that aggravates the course of new coronavirus disease (COVID-19) and increases the risk of adverse outcomes. The interaction of chronic myocarditis and COVID-19 during long-term immunosuppressive therapy has not been studied. We present a description of a 35-year-old female patient with chronic infectious-immune myocarditis (morphologically confirmed, with a history of infarction-like onset and thromboembolic complications), who had continuous immunosuppressive therapy with methylprednisolone and mycophenolate mofetil. The patient also received new oral anticoagulants and tenofovir (for chronic HBV infection). COVID-19 (SARS-Cov-2 RNA+) was diagnosed in May 2020. Risk factors for the adverse course of coronavirus infection included severe obesity, heart failure, and life-threatening ventricular arrhythmias. Correction of immunosuppressive therapy (withdrawal of the cytostatic agent, administration of hydroxychloroquine) and therapy with levofloxacin, an interleukin-17 inhibitor (netakimab) were performed. The severity of pneumonia and respiratory failure was moderate despite high fever and high levels of inflammatory markers in the blood (including interleukin-6). Signs of exacerbation of myocarditis, increased levels of troponin T and anticardial antibodies (compared with the initial ones) were not found. It can be assumed that supportive immunosuppressive therapy for myocarditis has a positive effect on the course of coronavirus pneumonia and avoids exacerbation of myocarditis. Careful continuation of immunosuppressive therapy with temporary withdrawal of aggressive cytostatics can be recommended in chronic myocarditis. Further study of the features of the course of previous myocarditis and COVID-19 pneumonia is necessary.

scholarly journals Acute blue finger syndrome: a rare benign cause of acute digit discolouration

2019 ◽  
Vol 12 (1) ◽  
pp. e223365
Author(s):  
Kiran Dhaliwal ◽  
Colin Thomas Brewster ◽  
Sivarajasingham Pakeerathan
Keyword(s):  
Rapid Assessment ◽  
Middle Finger ◽  
X Rays ◽  
Benign Condition ◽  
Volar Aspect ◽  
History Of ◽  
The Right ◽  
Digital Ischaemia ◽  
First Time

Acute blue finger syndrome is a rare benign condition that mimics digital ischaemia. We discuss the case of a 32-year-old woman who presented with a 6hour history of blue discolouration of the middle finger of the right hand, associated with pain and swelling. There was no history of trauma and this was the first time that the patient had experienced these symptoms. Examination found blue discolouration of the digit primarily on the volar aspect with associated swelling. All investigations, including blood tests, X-rays and Doppler scanning, were normal. The symptoms resolved spontaneously within 48 hours. There were no recurrent episodes or long-term sequelae. Patients presenting with an acutely blue finger need rapid assessment to exclude digit ischaemia. Knowledge of this rare benign condition may prevent unnecessary distress, invasive investigations and potentially harmful treatment of a healthy patient.

scholarly journals Isolated myxoid degeneration of aortic valve: diagnostic dilemma

2019 ◽  
Vol 12 (3) ◽  
pp. e228414
Author(s):  
Htay Htay Kyi ◽  
Kewan Hamid ◽  
Luay Alkotob ◽  
Thair Dawood
Keyword(s):  
Aortic Valve ◽  
Acute Pulmonary Oedema ◽  
Diagnostic Dilemma ◽  
Positron Emission ◽  
Valve Insufficiency ◽  
History Of ◽  
History Of Epilepsy ◽  
The Right ◽  
Myxoid Degeneration

Myxoid degeneration of the aortic valve as a cause of acute aortic valve regurgitation in young age is uncommon. We report a 39-year-old African-American man with a history of epilepsy and hypertension who presented with a 1-month history of worsening shortness of breath. He was diagnosed with acute pulmonary oedema. Transoesophageal echocardiogram showed normal ejection fraction but severe aortic valve insufficiency with small masses on the ventricular side of the right and non-coronary cusps, small vegetations cannot be ruled out but other valves were normal. Subsequent cultures were negative for endocarditis. Myocardial positron emission tomography (PET) scan was strongly suggestive of cardiac sarcoidosis. However, this diagnosis was ruled out as well when he underwent aortic valve replacement with bioprosthetic valve as he did not want to take long-term anticoagulation. Histological examination of the aortic valve showed myxoid degeneration. The patient was doing very well 1 year after the surgery.

Antibody-Mediated Rejection and Lung Transplantation

2021 ◽  
Vol 42 (03) ◽  
pp. 428-435
Author(s):  
Laura P. Halverson ◽  
Ramsey R. Hachem
Keyword(s):  
Lung Transplantation ◽  
Diagnostic Criteria ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Solid Organ ◽  
Term Survival ◽  
Antibody Mediated Rejection ◽  
History Of ◽  
Active Research

AbstractAntibody-mediated rejection (AMR) is now a widely recognized form of lung allograft rejection, with mounting evidence for AMR as an important risk factor for the development of chronic lung allograft dysfunction and markedly decreased long-term survival. Despite the recent development of the consensus diagnostic criteria, it remains a challenging diagnosis of exclusion. Furthermore, even after diagnosis, treatment directed at pulmonary AMR has been nearly exclusively derived from practices with other solid-organ transplants and other areas of medicine, such that there is a significant lack of data regarding the efficacy for these in pulmonary AMR. Lastly, outcomes after AMR remain quite poor despite aggressive treatment. In this review, we revisit the history of AMR in lung transplantation, describe our current understanding of its pathophysiology, discuss the use and limitations of the consensus diagnostic criteria, review current treatment strategies, and summarize long-term outcomes. We conclude with a synopsis of our most pressing gaps in knowledge, introduce recommendations for future directions, and highlight promising areas of active research.

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