scholarly journals An 11-Year-Old Girl Presenting with Chronic Knee Pain: A Case Report with Diagnostic Dilemma

2010 ◽  
Vol 53 (4) ◽  
pp. 247-249
Author(s):  
Muhammad Kamal Maj ◽  
Abdul Halim Ar ◽  
Syed A. Faisal ◽  
Johan Ahmad ◽  
Srijit Das
Keyword(s):  
Lateral Meniscus ◽  
Knee Extension ◽  
Posterior Horn ◽  
Discoid Meniscus ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Chronic Knee Pain ◽  
Sport Activities ◽  
Partial Deficiency ◽  
Joint Line Tenderness

Discoid meniscus is the commonest anatomical aberration of the knee joint, among rare cases such as bilateral separated lateral meniscus, accessory lateral meniscus, partial deficiency of the lateral meniscus and double-layered lateral meniscus. An 11-year- old girl presented with history of chronic pain in her right knee for the last 6 months. The problem disturbed her involvement in the sport activities at school. Clinical examination revealed a clicking sensation on knee extension with lateral joint line tenderness. Magnetic resonance imaging (MRI) of her right knee showed torn posterior horn of lateral meniscus. Arthroscopy examination revealed a discoid meniscus with absence posterior horn. Posterior horn deficient discoid meniscus is a rare form of a congenital meniscus anomaly. We as clinicians believe that the abnormal shaped meniscus may pose a diagnostic challenge clinically and radiologically. Presentation of this case may be beneficial for orthopaedicians in their daily clinical practice.

scholarly journals Outcomes of Discoid Meniscus Repairs in Children and Adolescents

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0033
Author(s):  
Crystal A. Perkins ◽  
Michael T. Busch ◽  
Melissa A. Christino ◽  
S. Clifton Willimon
Keyword(s):  
Pediatric Patients ◽  
Lateral Meniscus ◽  
Meniscus Repair ◽  
Posterior Horn ◽  
Meniscus Tear ◽  
Inclusion Criteria ◽  
Discoid Meniscus ◽  
Tear Pattern ◽  
Meniscus Surgery

Objectives: Discoid meniscus tear patterns vary, but typically involve horizontal cleavage tears of the central discoid component with or without anterior or posterior meniscocapsular tears. Classically, the central discoid component is saucerized and meniscocapsular tears are repaired. Recent data suggests that meniscal preservation provides long-term benefits over resection1-2. However, many meniscal transplants are performed secondary to unsalvaged or unsalvageable discoid meniscus tears3. Reoperation rates after meniscus repairs vary greatly4-6, with some series reporting high rates of reinjury and reoperation, but there are no large series of pediatric discoid meniscus repairs in the literature. The purpose of this study is to describe the outcomes of meniscus repair and saucerization in pediatric patients with symptomatic discoid menisci. Methods: A single-institution retrospective review was performed of consecutive pediatric patients with surgical treatment of a discoid meniscus tear over a five-year period. Inclusion criteria were age less than 18 years, a symptomatic torn discoid meniscus treated with knee arthroscopy with meniscus repair, and minimum 4-month follow-up. A chart review was performed to describe tear location, tear pattern, and repair type (inside-out, outside-in, all-inside, and hybrid). Hybrid repair constructs were defined as those that used 2 or more repair types. The primary outcome was revision meniscus surgery. Results: Forty-four patients were identified to meet inclusion criteria. There were 23 males and 21 females with a mean age of 12.4 years (range 5 - 17 years). The right knee was affected in 61% of patients. The lateral meniscus was involved in all patients. Tear patterns included anterior meniscocapsular (19 patients, 43%), posterior meniscocapsular (14 patients, 30%), radial (7 patients, 16%), and bucket-handle (5 patients, 11%). Tears most commonly involved the posterior horn and body (21 patients, 48%) or posterior horn (16 patients, 36%) Arthroscopic meniscus repair was performed in all patients. Forty-three patients (98%) also underwent saucerization. Marrow stimulation, as a biological approach to improve repair healing, was performed in 14 patients (32%). The distribution of repair types and number of sutures for each type is listed in the table below. Mean follow-up was 19 months (range 4 - 70 months). Four patients (9%) underwent revision meniscus surgery following the primary repair, including 2 all-inside repairs and 2 partial meniscectomies. There were no statistically significant differences between patients who did or did not require a secondary surgery with respect to sex, age, tear location, tear pattern, repair type, or number of sutures. During follow-up, 9 patients (20%) had surgery for a symptomatic discoid meniscus in the contralateral knee. Conclusion: Saucerization and repair of discoid lateral meniscus tears in the pediatric population have good outcomes with low rates of reoperation. Appropriate saucerization, followed by an arthroscopic assessment of stability and tear patterns is critical to successful treatment of symptomatic discoid menisci. If tissue quality permits, meniscal preservation should be considered in all patients to avoid the consequences of subtotal meniscectomy. [Table: see text]

scholarly journals Is the present classification of discoid meniscus sufficient?

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0004
Author(s):  
Hasan Bombaci ◽  
Fatma Gökel ◽  
Emrah Geçgel ◽  
Suavi Aydoğmuş
Keyword(s):  
Lateral Meniscus ◽  
Partial Meniscectomy ◽  
Posterior Horn ◽  
Anterior Horn ◽  
Meniscus Tear ◽  
Discoid Lateral Meniscus ◽  
Popliteus Tendon ◽  
Discoid Meniscus ◽  
The Stability

Introduction: Although uncommon, the discoid meniscus is quite prone to injury due to its abnormal shape and abnormal histology. The weak or absent peripheral attachment of the discoid meniscus causes instability even after partial meniscectomy. Therefore, recently, after resection of the central part of the meniscus, in which tears develop most frequently, the remnant of the meniscus is preferred to repair. In that time, the Watanabe classification, which classifies the discoid meniscuses in three groups, is used to plan treatment. However, discoid meniscus can develop in the different forms from these three main shapes. In the present study we aimed to analyse the discoid meniscuses, which we encountered during arthroscopic procedures in the knee, according to Watanabe classification. Patients and methods: The lateral discoid meniscuses in the 36 knees of 35 patients, who were operated on because of meniscus tear of either the discoid lateral meniscus itself or the normal medial meniscus, were classified according to Watanabe classification. Results: While the lateral discoid meniscuses were classified as “complete” in 13, “incomplete” in 15 knees, the meniscuses were very thin or absent in the central (one knee) or in the postero-lateral regions (seven knees) of discoid meniscus ( Figure 1 ). In this series this opening was next to the popliteus tendon except in one case. In these cases, the continuity of the meniscus between middle and posterior horn frequently was not possible after central partial meniscectomy (CPM). On the other hand, posterior horn has stable peripheral attachment unlike the Wrisberg type discoid meniscus. Of the 36 discoid meniscuses, CPM was performed in 21 knees, CPM with anterior horn repair in three, CPM with posterior horn repair in one and anterior horn repair without meniscectomy in two patients. In nine patients the lateral discoid meniscus was left alone. [Figure: see text] Discussion and conclusion: When meniscus sparing methods are intended to perform, both to decide the amount of resection and repair of the remnant, besides the shape of meniscus tear, the stability of discoid meniscus is crucial. This study shows that the Watanabe classification cannot be sufficient to include some specific type of lateral discoid meniscus. We believe that to add the discoid meniscuses, with opening in postero-lateral region next to the popliteus tendon, to the Watanabe classification might be useful to decide the amount of resection or repair of the discoid lateral meniscus.

scholarly journals Benign Osteoblastoma Involving Maxilla: A Case Report and Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
K. Bokhari ◽  
M. S. Hameed ◽  
M. Ajmal ◽  
Rafi A. Togoo
Keyword(s):  
Case Report ◽  
Surgical Excision ◽  
Good Prognosis ◽  
Histopathological Diagnosis ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Long Term Follow Up ◽  
Rare Benign Tumor ◽  
Benign Osteoblastoma ◽  
Maxilla And Mandible

Background. Osteoblastoma is a rare benign tumor. This tumor is characterized by osteoid and bone formation with the presence of numerous osteoblasts. The lesion is more frequently seen in long bones and rarely involves maxilla and mandible. Due to its clinical and histological similarity with other bone tumors such as osteoid osteoma and fibro-osseous lesions, osteoblastoma presents a diagnostic dilemma.Case Report. Very few cases of osteoblastomas involving maxillofacial region have been reported in the literature. This case report involves osteoblastoma involving right maxilla in an 18-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, surgical excision was performed. The patient was followed up for a period of 3 years and was disease free.Summary and Conclusion. Benign osteoblastoma involving jaw bones is a rare tumor. There is a close resemblance of this tumor with other lesions such as fibro-osseous lesions and odontogenic tumors and thus faces a diagnostic challenge. Surgical excision with a long-term follow-up gives good prognosis to this lesion—Benign Osteoblastoma.

scholarly journals Tubulocystic renal cell carcinoma: Report of a rare case

2015 ◽  
Vol 9 (9-10) ◽  
pp. 654 ◽  
Author(s):  
Aanchal Kakkar ◽  
Mehar C. Sharma ◽  
Manpreet Uppal ◽  
Sunil Chumber
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Histopathological Examination ◽  
Cystic Neoplasm ◽  
Diagnostic Challenge ◽  
Elderly Male ◽  
Diagnostic Dilemma ◽  
Cystic Neoplasms ◽  
Atypical Cells

Cystic neoplasms of the kidney are rare, and present a unique diagnostic challenge. We report the case of an elderly male who presented with a large cystic neoplasm, which was a diagnostic dilemma clinically and radiologically. Histopathological examination showed a tumour composed of variably sized tubules lined by atypical cells having large round nuclei with prominent nucleoli. Hobnailing was seen at places. Tumour cells were immunopositive for pancytokeratin, vimentin, CD10, CK19 and AMACR, confirming a diagnosis of tubulocystic renal cell carcinoma (TC-RCC).

scholarly journals A Five Years Old Child with Failure To Thrive and Vomiting Presenting as a Diagnostic Dilemma: A Case Report

2020 ◽  
Vol 58 (228) ◽  
Author(s):  
Anita Lamichhane ◽  
Rupesh Sharma ◽  
Ramana Rajkarnikar ◽  
Rubee Awale ◽  
Prapti Shrestha ◽  
...  
Keyword(s):  
Failure To Thrive ◽  
Exploratory Laparotomy ◽  
Age Group ◽  
Older Children ◽  
Diagnostic Challenge ◽  
High Resolution Computed Tomography ◽  
Diagnostic Dilemma ◽  
Recurrent Vomiting ◽  
Colicky Pain ◽  
Band Failure

Vomiting with failure to thrive in older children is a diagnostic challenge due to the diversity in the diagnosis. We report a case of a five-years-old girl with failure to thrive, history of recurrent vomiting and intermittent colicky pain abdomen since 45 days of life. Intestinal malrotation with Ladd’s band was diagnosed based on clinical acumen, high- resolution computed tomography, barium follow through and intraoperative findings. Exploratory laparotomy with Ladd’s procedure was performed under general anesthesia which showed malrotation at the duodenojejunal junction with a short route of mesentery with floating caecum with Ladd’s band. Failure to thrive with malrotation of the gut in the older age group is rare in itself. As there are very few cases reported in this age group, so we undertook to report this case to increase the awareness of knowledge concerning the diagnosis and timely management to prevent the comorbidity of this condition.

scholarly journals Uterine Epithelioid Trophoblastic Tumor in a 44-Year-Old Woman: A Diagnostic Dilemma

2021 ◽  
Vol 11 (3) ◽  
pp. 631-639
Author(s):  
Maria-Gabriela Aniţei ◽  
Diana-Elena Lazăr ◽  
Raluca Alina Pleşca ◽  
Cristina Terinte ◽  
Radu Iulian ◽  
...  
Keyword(s):  
Reproductive Age ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Natural Childbirth ◽  
Trophoblastic Tumor ◽  
Epithelioid Trophoblastic Tumor ◽  
Uterine Curettage ◽  
Normal Human ◽  
Poorly Differentiated ◽  
Β Hcg

Background: Epithelioid trophoblastic tumor (ETT) is a rare and newly defined disease, which most commonly occurs in women of reproductive age and can be a sequela of any gestational event. ETT can be present in both intrauterine and extrauterine sites. Case report: A woman of reproductive age, without specific comorbidities and with a single pregnancy and natural childbirth eight years ago, was diagnosed initially with poorly differentiated pleomorphic leiomyosarcoma on the hemostatic uterine curettage. Conclusion: Our case highlights that ETT presents a diagnostic challenge due to its rarity and histologic resemblance to other pathologies. Misdiagnosis delays effective treatment and affects survival. To date, only 8 cases of ETT of the uterus without previous gestational event and normal human chorionic gonadotropin (β-HCG) levels in a 60-year literature survey have been reported.

scholarly journals Coexistent Tuberculosis of Spine and Chronic Myeloid Leukemia: Resolving the Diagnostic Dilemma and Management

2015 ◽  
Vol 49 (2) ◽  
pp. 85-87
Author(s):  
Arvind Jayaswal ◽  
Sanjay Yadav ◽  
Ankur Goswami ◽  
G Vijayraghavan
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Management Strategies ◽  
Poor Response ◽  
Diagnostic Methods ◽  
Current Standard ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Ct Guided ◽  
Tuberculosis Of Spine

ABSTRACT Tuberculosis (TB) and association with hematological malignancy is well described in literature. Lymphoid malignancies like non-Hodgkin lymphoma and chronic lymphocytic lymphoma (CLL) are documented but chronic myeloid leukemia (CML) is uncommon. The association of TB and malignancy can be sequential, concurrent or masquerading. We encountered a case posing diagnostic challenge between CML and tuberculosis. The objective to report such a clinical situation is to be aware of such rare possibilities, to analyze the diagnostic methods and subsequent management strategies. Though tuberculosis is usually the first differential diagnosis in endemic areas, it can be overstressed upon and other concurrent pathologies may be missed. Such possibilities should be kept in consideration in cases with poor response or clinical deterioration on antitubercular treatment (ATT). The importance of tissue diagnosis by CT-guided core biopsy as current standard of care is reiterated even in prevalent regions. Multidisciplinary approach is must for optimum outcome. How to cite this article Yadav S, Jayaswal A, Vijayraghavan G, Goswami A. Coexistent Tuberculosis of Spine and Chronic Myeloid Leukemia: Resolving the Diagnostic Dilemma and Management. J Postgrad Med Edu Res 2015;49(2):85-87.

Rhabdomyosarcoma in Ovary- Pathologist’s Diagnostic Dilemma

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
A C Srivastava ◽  
F Hussain ◽  
T Patel
Keyword(s):  
Soft Tissue ◽  
Ovarian Tumor ◽  
Ca 125 ◽  
Axillary Lymph ◽  
Ovarian Mass ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Epithelial Tumor ◽  
True Nature ◽  
Right Hand

Abstract Introduction/Objective Rhabdomyosarcoma is the most common pediatric soft tissue sarcoma. However, rhabdomyosarcoma in the ovary is exceptionally unusual and presents a diagnostic challenge. We report one such case and its clinical and pathological perspective. Methods/Case Report 16-year-old female presented with an enlarging pelvic mass, abdominal distension, and pain. Imaging revealed a heterogeneous left ovarian mass, right axillary lymphadenopathy, and right-hand soft tissue mass. CA-125 was 1833.0 U/ml. Patient underwent left salphingo-oophorectomy, omentectomy, peritoneal and mesenteric biopsy for ovarian staging, incidental appendectomy, and right axillary lymph node excision with suspicion of ovarian epithelial tumor. Pathological evaluation revealed a 16-cm intact ovary with multiple solid and cystic nodules with areas of hemorrhage and necrosis. Microscopic examination of ovarian tumor showed a high-grade malignant tumor consisting of sheets of small round blue cells with severe cytologic atypia, increased mitoses, and features suggestive of rhabdoid morphology. The other specimens were positive for metastases. The tumor cells were immunopositive for Myogenin and MyoD1 while immunonegative for Cytokeratin AE1/AE3, SF-1, PLAP, SALL4, MelanA, and S-100. INI-1 and BRG-1 demonstrated intact nuclear expression. FISH testing identified rearrangement of the FOX01 gene at 13q14. Based on these findings, diagnosis of alveolar rhabdomyosarcoma was rendered. Currently, the patient is receiving rhabdomyosarcoma chemotherapy treatment and has responded well. Results (if a Case Study enter NA) NA Conclusion In cases with complex and urgent clinical presentation, where the existence of a primary tumor is unknown and where symptoms attributable to primary ovarian tumor dominate the clinical picture, rhabdomyosarcoma is rarely proposed in the differential diagnoses of small round blue cell tumors of the ovary. At present, the right-hand mass is under evaluation; thus, the true nature of the ovarian mass, primary or metastatic is unknown. Our case illustrates the importance of exact diagnoses, as treatment of rhabdomyosarcoma, is different from other ovarian tumors.

scholarly journals Bilateral Facial Nerve Palsy: A Diagnostic Dilemma

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Sohil Pothiawala ◽  
Fatimah Lateef
Keyword(s):  
Differential Diagnosis ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Rare Condition ◽  
Facial Nerve Paralysis ◽  
Diagnostic Challenge ◽  
Radiological Investigation ◽  
Diagnostic Dilemma ◽  
Nerve Paralysis

Introduction. Bilateral facial nerve palsy (FNP) is a rare condition, representing less than 2% of all cases of FNP. Majority of these patients have underlying medical conditions, ranging from neurologic, infectious, neoplastic, traumatic, or metabolic disorders.Objective. The differential diagnosis of its causes is extensive and hence can present as a diagnostic challenge. Emergency physicians should be aware of these various diagnostic possibilities, some of which are potentially fatal.Case Report. We report a case of a 43-year-old female who presented to the emergency department with sequential bilateral facial nerve paralysis which could not be attributed to any particular etiology and, hence, presented a diagnostic dilemma.Conclusion. We reinforce the importance of considering the range of differential diagnosis in all cases presenting with bilateral FNP. These patients warrant admission and prompt laboratory and radiological investigation for evaluation of the underlying cause and specific further management as relevant.

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