Dystrophic Calcification and Infraclavicular Brachial Plexopathy: Case Report

Abstract OBJECTIVE: Dystrophic calcification refers to heterotopic formation of calcium in soft tissue. There have been few reports that describe dystrophic calcification causing brachial plexopathies. We describe a unique case of dystrophic calcification that caused entrapment of the posterior cord of the brachial plexus, something not previously described in the literature. CLINICAL PRESENTATION: We report the case of a 43-year-old woman with a medical history of congenital lymphangiomas of the left chest wall and axilla, for which she had undergone multiple surgeries and radioactive seed implantation. She presented 41 years later with progressive left arm paresthesias, pain, and weakness. Neurological findings were confined to the distribution of the posterior cord of the plexus. Radiographic evaluation demonstrated a 3 × 3 × 4-cm calcified mass in the axilla and proximal arm. INTERVENTION: A careful neurolysis and mass resection was performed. At exploration, the posterior cord, proximal radial nerve, and brachial artery were found to be densely adherent to a calcified mass. Reconstruction of the brachial artery and free tissue transfer were required for healing of the severely scarred wound. Pathological examination revealed dense, calcified connective tissue consistent with dystrophic calcification. She made an excellent recovery. CONCLUSION: We describe a rare case of dystrophic calcification of the proximal arm causing symptomatic brachial plexopathy, with onset many years after surgery and radiation. Diagnostic evaluation and surgical management are discussed.

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Submucosal Colonic Lipoblastoma Presenting With Colo-colonic Intussusception in an Infant

Pediatric and Developmental Pathology ◽

10.1177/1093526617705271 ◽

2017 ◽

Vol 21 (4) ◽

pp. 401-405 ◽

Cited By ~ 1

Author(s):

Marie-Anne Brundler ◽

Kyle C Kurek ◽

Kamlesh Patel ◽

Ingo Jester

Keyword(s):

Transverse Colon ◽

Soft Tissues ◽

Submucosal Tumor ◽

Pathological Examination ◽

Lead Point ◽

Unique Case ◽

Mature Adipose Tissue ◽

Mesenchymal Tissue ◽

Spindle Cells ◽

History Of

Lipoblastoma is a benign adipose tumor typically presenting in infancy in superficial soft tissues of extremities. Intestinal complications secondary to intraabdominal or retroperitoneal involvement are exceedingly rare. We describe a unique case of a primary intestinal lipoblastoma arising from the submucosa of the transverse colon in an otherwise healthy 18-month-old boy. He presented with a history of reducible rectal prolapse, rectal bleeding, and episodic abdominal pain and was initially treated for constipation. Imaging identified a short colo-colonic intussusception, confirmed at laparotomy, and a fatty mass thought to arise from the mesentery. Pathological examination of the resected transverse colon revealed a submucosal tumor composed of a mixture of mature adipose tissue, foci of myxoid mesenchymal tissue with desmin positive, HMGA2 negative spindle cells, and scattered lipoblasts, characteristic of lipoblastoma. Lipoblastoma should be considered as a potential albeit rare cause of intussusception in young children, where a pathologic lead point is infrequently identified.

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The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences

The Heart Surgery Forum ◽

10.1532/hsf.1328 ◽

2016 ◽

Vol 19 (1) ◽

pp. 023 ◽

Cited By ~ 2

Author(s):

Mehmet Yildirim ◽

Recep Ustaalioglu ◽

Murat Erkan ◽

Bala Basak Oven Ustaalioglu ◽

Hatice Demirbag ◽

...

Keyword(s):

Pericardial Effusion ◽

Thoracoscopic Surgery ◽

Pericardial Tamponade ◽

Pericardial Fluid ◽

Pathological Examination ◽

Common Disease ◽

Pericardial Window ◽

Surgical Interventions ◽

History Of ◽

Recurrent Pericardial Effusion

Background: Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. Methods: We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. Results: Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. Conclusion: Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.

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History of an Unique Case of Adipose Tumour in the Spermatic Chord

BMJ ◽

10.1136/bmj.s1-9.26.401 ◽

1845 ◽

Vol s1-9 (26) ◽

pp. 401-404

Author(s):

D. O. Edwards

Keyword(s):

Unique Case ◽

History Of

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A rare case of cavernous hemangioma accompanied with diffuse hepatic hemangiomatosis

Surgical Case Reports ◽

10.1186/s40792-020-01023-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Takuji Ota ◽

Toshiya Kamiyama ◽

Takuya Kato ◽

Takayuki Hanamoto ◽

Kunihiro Hirose ◽

...

Keyword(s):

Oral Contraceptives ◽

Cavernous Hemangioma ◽

Contraceptive Use ◽

Careful Examination ◽

Pathological Examination ◽

Surgical Removal ◽

Adjacent Area ◽

Oral Contraceptive Use ◽

History Of ◽

Magnetic Resonance Imaging Mri

Abstract Background Hepatic cavernous hemangioma (CH) is the most common hepatic benign tumor. Most cases are solitary, asymptomatic, and found incidentally. In symptomatic cases with rapidly growing tumors and coagulopathy, surgical treatment is considered. In rare cases, diffuse hepatic hemangiomatosis (DHH) is reported as a comorbidity. The etiology of DHH is unknown. Case presentation A 29-year-old female patient had a history of endometriosis treated with oral contraceptives. Hepatic CH was incidentally detected in the segment IVa of the liver according to the Couinaud classification. Follow-up computed tomography (CT) and ultrasound sonography showed the growth of the lesion and formation of multiple new lesions near the first. Enhanced CT and magnetic resonance imaging (MRI) revealed that the new lesions were different from CH. Although oral contraceptives were stopped, all lesions grew in size. Malignancy and possibility of rupture of these tumors were considered due to the clinical course, and we opted for surgical removal of the tumors. Left liver lobectomy and cholecystectomy were performed. Surgical findings were small red spot spreading and a mass in segment IV of the liver. Pathological examination revealed a circumscribed sponge-like tumor with diffuse irregular extension to the adjacent area. Both of the lesions consisted of blood-filled dilated vascular spaces lined by flat endothelium without atypia. The diagnosis was hepatic CH with DHH. The patient was discharged on postoperative day 12 uneventfully. Conclusion We report the successful resection of CH with DHH. The case findings suggest a relationship between oral contraceptive use and enlargement of CH and DHH. Although DHH has been poorly understood, a few previously published cases reported DHH occurrence in patients using oral contraceptives. In such cases, the decision to perform surgical resection should be made after careful examination.

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Development of Tics in a Thirteen-Year-Old Male Following Atomoxetine Use

CNS Spectrums ◽

10.1017/s1092852900016412 ◽

2008 ◽

Vol 13 (4) ◽

pp. 301-303 ◽

Cited By ~ 13

Author(s):

Jessica Sears ◽

Nitin C. Patel

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Single Dose ◽

Tourette Syndrome ◽

Attention Deficit ◽

Interventional Therapy ◽

Prior History ◽

Unique Case ◽

Hyperactivity Disorder ◽

History Of ◽

Pharmacologic Therapies

ABSTRACTTics and Tourette syndrome are common comorbidities of patients diagnosed with attention-deficit/hyperactivity disorder (ADHD). One of the mainstay pharmacologic therapies for ADHD has been stimulants. However, this class of drugs has been associated with tic exacerbations, thus limiting their utility in this patients subgroup. Atomoxetine has been explored as an alternative treatment as one of the few non-stimulants available to treat ADHD. Early data identifies atomoxetine's influence on Tourette symptomatology to be not merely equivocal but potentially suppressive in the manifestation of tics. There are, however, case studies describing patients experiencing recurrences of tics following treatment with atomoxetine. We present a unique case of a patient, without any prior history of a movement disorder, who developed tics following a single dose of atomoxetine that did not improve until interventional therapy was initiated.

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Pseudoaneurisma Arteri Brakialis Pasca Kateterisasi Laporan Kasus

e-CliniC ◽

10.35790/ecl.v7i1.23109 ◽

2019 ◽

Vol 7 (1) ◽

Author(s):

Natalia Ch. Polii ◽

Janry A. Pangemanan ◽

Agnes L. Panda ◽

Ira Posangi

Keyword(s):

Brachial Artery ◽

Colour Doppler ◽

Ultrasound Guided ◽

Compression Technique ◽

Artery Pseudoaneurysm ◽

Neck Size ◽

Chief Complaints ◽

Pulsed Wave Doppler ◽

History Of ◽

The Right

Abstract: Post-catheterization PSA occurs at the site of arterial puncture followed by incomplete hemostasis. We reported a 63-year-old male visited the emergency department of Prof Dr. R. D. Kandou Hospital with chief complaints of swelling and severe pain on the right arm, occured 6 days prior to the ER visit. His right arm looked darker and felt colder than the counterpart, felt numb, and was hard to move due to pain. Three months ago, the patient had a history of percutaneous transluminal coronary angiography through brachial artery access. Examination of the right upper extremity revealed hematoma at brachial artery puncture site, edema at 1/3 distal of the brachial region, cold acral areas, strong right brachial artery pulses, yet small radial ones. Vascular Doppler examination showed a superficial hematoma above the brachial artery and a PSA pouch of 1.23 x 1.67 cm with a small neck (<0.5 cm). Colour Doppler displayed a “yin and yang” flow at pouch, while pulsed-wave Doppler showed a “to and fro” wave through the neck. Patient was diagnosed as iatrogenic brachial artery pseudoaneurysm and managed with ultrasound-guided compression technique followed by continuous compression with elastic bandage. This technique was selected due to the PSA size less than 3 cm yet symptomatic, small neck size (<1 cm), and no size progression. Patient discharged after the PSA pouch and neck shrinked. On 6 months follow-up, neither neck nor pseudoaneurysm pouch were found.Keywords: pseudoaneurysm, ultrasound-guided compression Abstrak: PSA pasca kateterisasi terjadi pada arteri yang dipungsi tetapi tidak terjadi hemostasis sempurna. Kami melaporkan seorang laki-laki berusia 63 tahun datang di Instalasi Rawat Darurat Medik RSUP Prof. Dr. R. D. Kandou dengan keluhan utama bengkak dan nyeri hebat pada lengan kanan sejak 6 hari SMRS dan memberat pada satu hari terakhir. Tangan kanan tampak lebih gelap dibandingkan tangan kiri, teraba dingin, terasa kebas dan sulit digerakkan karena nyeri. Tiga bulan sebelumnya pasien dilakukan tindakan intervensi koroner perkutan. Pada pemeriksaan ekstremitas atas kanan tampak hematoma di daerah pungksi, edema setinggi 1/3 distal regio brachialis sampai ujung jari, akral teraba dingin, pulsasi arteri brakialis teraba kuat tetapi arteri radialis teraba kecil. Pemeriksaan Doppler vascular mendapatkan gambaran hematoma superfisial dari arteri brakialis dan tampak kantong PSA berukuran 1,23x1,67 cm dengan neck berukuran kecil (<0,5 cm) Pada colour Doppler didapatkan aliran pada kantong pseudoaneurisma seperti gambaran yin dan yang. Pada pulsed-wave Doppler di saluran PSA (neck) didapatkan gelombang “to and fro”. Berdasarkan anamnesis, pemeriksaan fisik dan penunjang pasien ini didiagnosis dengan PSA arteri brakialis iatrogenik (pasca kateterisasi). Penanganan dengan ultrasound-guided compression dan dilanjutkan dengan kompresi kontinu dengan bebat elastik. Pemilihan teknik kompresi ini berdasarkan pada ukuran kantong <3 cm namun bergejala, ukuran neck kecil <1cm serta tidak didapatkan pembesaran progresif. Pasien dipulangkan setelah kantong maupun neck PSA tampak mengecil, dan 6 bulan setelahnya tidak lagi terlihat neck maupun kantong PSA.Kata kunci: pseudoaneurisma, ultrasound-guided compression

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A case of retroperitoneal tumor – clinical and therapeutic considerations

ARS Medica Tomitana ◽

10.1515/arsm-2016-0034 ◽

2016 ◽

Vol 22 (3) ◽

pp. 203-207

Author(s):

R. Osman ◽

V. Sarbu ◽

S. Osman

Keyword(s):

Rare Condition ◽

Surgical Excision ◽

Retroperitoneal Tumor ◽

Lumbar Pain ◽

Pathological Examination ◽

Nerve Sheath Tumor ◽

Abdominal Girth ◽

Computed Tomographic ◽

Appropriate Treatment ◽

History Of

Abstract Introduction: The aim of this paper is to present a case of rare retroperitoneal tumor. Material and Methods. A 72 year old man presented with six month history of abdominal girth, lumbar pain and occasional episodes of constipation was admitted in our clinic. A computed tomographic abdominal scan revealed a retroperitoneal solid mass. Surgical exploration performed later displayed solid and well delimited mass throughout retroperitoneal space followed by excision of lesion and multiple drainages. Microscopic pathological examination was benign nerve sheath tumor. Conclusion. These tumors are characteristically firm, smooth, and asymptomatic. They range in size from 1-2 mm to over 20 cm. Awareness of this indolent and rare condition is an important prerequisite for early diagnosis and appropriate treatment. Surgical excision can usually be accomplished by enucleating of the tumor without damage to the adjacent nerve.

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Prostatic Adenocarcinoma Metastatic to Pleomorphic Liposarcoma, a “Collision Phenomenon”: Report of a Case with Review of Pelvic Collision Tumors

Pathology Research International ◽

10.4061/2011/173541 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7

Author(s):

Somak Roy ◽

Ronald L. Hrebinko ◽

Kathleen M. Cieply ◽

Anil V. Parwani ◽

Uma N. M. Rao

Keyword(s):

Pelvic Mass ◽

Collision Tumor ◽

The Body ◽

Pathological Examination ◽

Prior History ◽

Pelvic Cavity ◽

Collision Tumors ◽

History Of ◽

Conclusive Diagnosis

“Collision tumor” is an uncommon phenomenon characterized by coexistence of two completely distinct and independent tumors at the same site. Collision tumors have been reported in different sites in the body; however, these are particularly uncommon in the pelvic cavity. A 70-year-old man, with prior history of urothelial and prostate cancer, presented with a large pelvic mass detected on imaging studies. Pathological examination revealed a large liposarcoma with prostatic carcinoma embedded in it. Immunohistochemistry and florescence in situ hybridization studies were performed to reach to a conclusive diagnosis. To the best of our knowledge, this is the second case reported till date. We present the challenges encountered in the diagnosis of this case and review of pelvic collision tumors.

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An Atypical Case of Catatonia, Abnormal Gait and Psychosis in an Adolescent with Chronic Cannabis Use

10.47363/jdat/2021(2)114 ◽

2021 ◽

pp. 1-3

Author(s):

Pooja Palkar ◽

◽

Sagarika Ray ◽

Keyword(s):

Cannabinoid Receptors ◽

Oral Intake ◽

Brain Regions ◽

Cannabis Use ◽

Unique Case ◽

Open Chain ◽

Walking Gait ◽

The Past ◽

Abnormal Gait ◽

History Of

An association between cannabis and psychosis is well established. Cannabis use is known to precipitate schizophrenia in vulnerable individuals and it can exacerbate existing psychosis. However, there is a paucity of knowledge about the emergence of catatonia and abnormal gait associated with cannabis use. History of cannabis use is associated with long-lasting changes in open-chain elements of walking gait. Cannabinoid receptors are located in movement-related brain regions and cannabis use is suggested to affect gait. This report is a unique case of a 16-year-old male with no known past medical history, no past psychiatric history, with family history significant for psychosis who presented to the hospital for bizarre, disorganized behavior, and decreased oral intake following heavy cannabis use over the past three months in the context of a break-up. Upon arrival, he was found to be in a catatonic state with an impaired gait. As catatonia resolved with treatment, he was able to speak and the psychosis surfaced which was addressed with antipsychotics. This case report highlights an atypical but serious clinical picture observed to be precipitated by chronic, heavy cannabis use.

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Pulmonary Infiltrates in a Patient With Advanced Melanoma

Journal of Clinical Oncology ◽

10.1200/jco.2016.69.9793 ◽

2017 ◽

Vol 35 (7) ◽

pp. 705-708 ◽

Cited By ~ 11

Author(s):

Charles A. Powell

Keyword(s):

Computed Tomography ◽

Subcutaneous Tissue ◽

Relevant Literature ◽

Pulmonary Nodules ◽

Advanced Melanoma ◽

Resection Margins ◽

Left Chest ◽

Pulmonary Infiltrates ◽

Computed Tomography Images ◽

History Of

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 60-year-old former smoker with metastatic melanoma presented with the chief complaint of pulmonary infiltrates. Five years ago, he was diagnosed with a left chest wall melanoma. He underwent surgery but received no additional therapy for an American Joint Committee on Cancer stage T3a N0 M0 tumor that was 2.7 mm in depth with no ulceration of the epidermal surface. Resection margins were free of tumor. Four years later, he underwent excision of a raised pigmented skin lesion on his left calf that proved to be melanoma with positive margins. He underwent re-excision of melanoma but 2 months later developed a new left hip soft tissue nodule. Positron emission tomography (PET) –computed tomography showed multiple hypermetabolic lesions involving subcutaneous tissue, muscle osseous structures, and bone marrow, consistent with advanced melanoma. He began systemic therapy with ipilimumab and nivolumab. After four cycles of immunotherapy, he developed a nonproductive cough and mild dyspnea on exertion (Modified Medical Research Council dyspnea scale score of 2 [ie, he had to stop for breath when walking at his own pace on level ground]). A chest x-ray showed bilateral hilar enlargement, thickening of the right paratracheal stripe, and scattered patchy increased interstitial markings bilaterally. PET and chest computed tomography images showed enlarged mediastinal adenopathy with increased [18F]fluorodeoxyglucose uptake on PET and scattered diffuse 1- to 2-mm pulmonary nodules with ground-glass opacities ( Fig 1 ). The patient was referred for pulmonary input. The patient had smoked one pack of cigarettes per day for 35 years; he quit 6 years ago. He had no history of pneumonia, childhood asthma, or tuberculosis. His mother had asthma, but there was no other family history of asthma or other lung disease.

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