Challenges in the diagnosis and treatment of extrauterine leiomyomas: case series

Extrauterine leiomyoma is a rare disease with multiple potential metastasizing sites. Pathogenesis of this condition remains debatable with previous myomectomy a considerable risk factor. Diagnosis and treatment remain a challenge due to diverse presenting symptoms and the initial involvement of various specialties, which often cause distress in these patients. In this article, we present one case of pulmonary leiomyomas on expectant management, one case of wide-disseminated extrauterine leiomyomas including the bones, spines, soft tissues and peritoneum who underwent decompression laminectomy and biopsy of paravertebral mass and one case of retroperitoneal leiomyoma who underwent resection of the lesion.

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A case series on necrotising fasciitis of breast: a rare but debilitating disease

International Surgery Journal ◽

10.18203/2349-2902.isj20214384 ◽

2021 ◽

Vol 8 (11) ◽

pp. 3426

Author(s):

S. P. Gayathre ◽

Kudiyarasu M. ◽

Bala Brindha S. ◽

R. Kannan

Keyword(s):

Risk Factor ◽

Rare Disease ◽

Surgical Procedure ◽

Surgical Intervention ◽

Immunocompromised Patient ◽

Age Groups ◽

Case Series ◽

Necrotising Fasciitis ◽

Lactating Mothers ◽

History Of

Necrotising fasciitis of breast being a rare disease has only a meagre number of cases being reported and most commonly seen following trauma or surgical procedure to the breast. The reported cases have shown a predilection for lactating mothers with a history of surgical intervention to breast. This case series included 3 cases of necrotising fasciitis with varied etiologies in various age groups including a lactating mother, an immunocompromised patient and another patient with no other risk factor such as trauma or surgical intervention to breast and the subsequent difference in extent of surgical intervention and management in these patients. Extensive surgical debridement at the earliest was the mainstay of treatment in all three cases.

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Multidisciplinary Approach of a Very Rare Infected Verrucous Carcinoma of the Scrotum

Revista de Chimie ◽

10.37358/rc.19.4.7153 ◽

2019 ◽

Vol 70 (4) ◽

pp. 1476-1478

Author(s):

Laura Raducu ◽

Adelaida Avino ◽

Cristina-Nicoleta Cozma ◽

Sorin Nedelea ◽

Andra-Elena Balcangiu-Stroescu ◽

...

Keyword(s):

Adjuvant Therapy ◽

Rare Disease ◽

Chronic Inflammation ◽

Male Patient ◽

Multidisciplinary Approach ◽

Verrucous Carcinoma ◽

Surgical Excision ◽

Diagnosis And Treatment ◽

Wide Surgical Excision ◽

The Right

Verrucous carcinoma of the scrotum is an extremely rare disease and most cases are thought to result from poor hygiene and chronic inflammation. Currently, it has not been well characterized, the etiology, diagnosis and treatment remaining poorly understood. We present the case of a 50-year-old male patient diagnosed with verrucous carcinoma of the right hemiscrotum. Wide surgical excision was performed. Favorable outcomes can be achieved by surgery, even without any adjuvant therapy, but patients should be carefully followed up.

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Imaging Features of Primary Tumors of the Hand

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616999200817173154 ◽

2020 ◽

Vol 16 ◽

Author(s):

Filippo Boriani ◽

Edoardo Raposio ◽

Costantino Errani

Keyword(s):

Soft Tissue ◽

Soft Tissues ◽

Epithelioid Sarcoma ◽

Case Series ◽

Malignant Neoplasm ◽

Benign Tumors ◽

Imaging Features ◽

Primary Tumors ◽

Therapeutic Decisions ◽

Tumors Of The Hand

: Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis prognosis and therapy.The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.

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Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series

Journal of Medical Case Reports ◽

10.1186/s13256-021-02892-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Yuya Kato ◽

Yoshikazu Ogawa ◽

Teiji Tominaga

Keyword(s):

Pituitary Apoplexy ◽

Clinical Symptoms ◽

Case Series ◽

Optimal Timing ◽

Presenting Symptoms ◽

Pathological Evaluation ◽

Mother And Child ◽

Life Threatening ◽

In Pregnancy

Abstract Background Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. Case presentation We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. Conclusions Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.

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A national study of choanal atresia in tertiary care centers in Canada – part I: clinical presentation

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00517-x ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Josee Paradis ◽

Agnieszka Dzioba ◽

Hamdy El-Hakim ◽

Paul Hong ◽

Frederick K. Kozak ◽

...

Keyword(s):

Respiratory Distress ◽

Clinical Presentation ◽

Tertiary Care ◽

Choanal Atresia ◽

Case Series ◽

Retrospective Chart Review ◽

National Study ◽

Feeding Difficulties ◽

Presenting Symptoms ◽

Tertiary Care Centers

Abstract Background To evaluate the clinical presentation of choanal atresia (CA) in tertiary centers across Canada. Methods Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with CA at a participating center. Results The health charts of 215 patients (59.6% female) with CA were reviewed and included in this study. The mean age of patients at time of CA presentation was 0.4 months (range 0.1 to 7.2 months) for bilateral CA and 37.8 months (range 0.1 to 164.1 months) for unilateral cases. The most common presenting symptoms for bilateral CA in decreasing order were respiratory distress (96.4%), feeding difficulties (68.2%), and rhinorrhea (65.5%), and for unilateral cases in decreasing order were rhinorrhea (92.0%), feeding difficulties (24.7%), and respiratory distress (18.0%). For the majority of patients (73.2%), the obstruction comprised mixed bony and membranous tissue, with only 10.5% presenting with a purely membranous obstruction. Familial history of CA was confirmed in only 3.3% of cases. One half of patients with CA presented with one or more associated anomalies and 30.6% had a syndrome. Conclusions The present investigation is the first national multi-institutional study evaluating the clinical presentation of CA over three decades. The present cohort of CA patients presented with a breadth of co-morbidities with highly variable presentations, with bilateral cases being more severely affected than unilateral cases. Further investigation into hereditary linkages to CA development is warranted. Graphical abstract

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Oral Squamous Cell Carcinoma on Gingiva, Edentulous Ridge, and Retromolar Pad: A Case Series

Oral ◽

10.3390/oral1020016 ◽

2021 ◽

Vol 1 (2) ◽

pp. 159-167

Author(s):

Lucio Lo Russo ◽

Eleonora Lo Muzio ◽

Giuseppe Colella ◽

Maria Eleonora Bizzoca ◽

Vera Panzarella ◽

...

Keyword(s):

Case Series ◽

Medical Consultation ◽

Clinical Aspects ◽

University Hospitals ◽

Clinical Appearance ◽

Oral Cancers ◽

Presenting Symptoms ◽

Medical Evaluation ◽

Significant Incidence ◽

Advanced Stages

(1) Background: Gingival cancer has a significant incidence and is often diagnosed at advanced stages. The aim of this paper is to highlight its clinical aspects on the basis of a case series analysis in order to promote awareness and improve the diagnosis process. (2) Methods: Oral cancers diagnosed and treated at three Italian University Hospitals over ten years were retrospectively investigated. Cancer location on the gingiva, edentulous ridge, and retromolar pad was addressed. Data regarding clinical features, stage at the diagnosis, and time from presenting symptoms to first medical consultation were retrieved. (3) Results: Thirty-three cancers located on the gingiva, edentulous ridge, and retromolar pad were retrieved from 276 total oral cancer cases (11.9%). A median of 50 days (range 2–300) passed for the patient to seek for a medical evaluation. At the time of diagnosis, 63.3% were advanced stage cancers, mainly located at the mandible (91%), especially in the retromolar pad (48.5%) and the edentulous alveolar ridge (24.2%). Lesions were red (45.5%), red and white (45.4%), or white (9.1%), appearing as an ulcer (69.7%), exophytic mass (12.1%) or flat lesion (12.1%). Sixty-six percent of cancers were completely asymptomatic, regardless their clinical appearance. A statistically significant association between the time from the presentation of symptoms to the first medical consultation and the cancers stage was found. (4) Conclusions: The clinical appearance of gingival cancer is very polymorphous; its understanding may be significant to improve patient education and early medical consultation.

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Challenges in Evaluation and Management of Children with Myocardial Bridging

Cardiology ◽

10.1159/000513900 ◽

2021 ◽

pp. 1-8

Author(s):

Nurdan Erol

Keyword(s):

Congenital Anomaly ◽

Coronary Artery ◽

Case Reports ◽

Case Series ◽

Diagnosis And Treatment ◽

Myocardial Bridging ◽

Small Case Series ◽

Adults And Children ◽

Artery Branch

Myocardial bridging (MB) is a congenital anomaly where a coronary artery branch or group of branches extends inside a tunnel consisting of myocardium. Although it is mostly considered “benign,” it is reported that MB may lead to significant cardiac problems and sudden cardiac deaths. While it is a congenital anomaly, its symptoms usually arise at further ages rather than childhood. The literature on MB in children is in the form of case reports or small case series. This is why pediatric cases are assessed in the light of information obtained from adults. This review compiled the literature on MB in adults and children and compared it, as well as discussing questions arising regarding the clinic, diagnosis, and treatment of MB.

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Systemic congenital lymphangiomatosis

Sao Paulo Medical Journal ◽

10.1590/s1516-31801996000500008 ◽

1996 ◽

Vol 114 (5) ◽

pp. 1278-1281 ◽

Cited By ~ 3

Author(s):

Ligia Maria Suppo de Souza ◽

Maria Regina Bentlin ◽

Eliana Souto de Abreu ◽

Carlos Eduardo Bacchi

Keyword(s):

Young Adults ◽

Respiratory Failure ◽

Rare Disease ◽

Poor Prognosis ◽

Rare Case ◽

Soft Tissues ◽

Lymphatic Channel ◽

Autopsy Findings ◽

Children And Young Adults ◽

Cervical Area

Systemic lymphangiomatosis is a rare disease characterized by the exageration of lymphatic channel proliferation, occurring in children and young adults. We describe an extremely rare case of congenital systemic lymphangiomatosis in a newborn who had ascitis and respiratory failure develop immediately after delivery. Death occurred during the first hour of life. Autopsy findings showed numerous cysts in soft tissues of the cervical area, mediastinum and diaphragm, and several other organs including the liver, spleen, thyroid and kidneys. The severe and diffuse involvement with cysts in both lungs by lymphangiomatosis was associated with poor prognosis and death in our case.

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EXPERIENCE WITH USING RAPID MOLECULAR TESTING IN DIAGNOSING PULMONARY AND EXTRA-PULMONARY PEDIATRIC TUBERCULOSIS IN A NON-ENDEMIC SETTING - A RETROSPECTIVE CASE SERIES

Paediatrics & Child Health ◽

10.1093/pch/pxy054.114 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e44-e45 ◽

Cited By ~ 1

Author(s):

Hana Mijovic ◽

Yossef Al-Nasser ◽

Ghada Al-Rawahi ◽

Ashley Roberts

Keyword(s):

Case Series ◽

Pericardial Fluid ◽

Diagnosis And Treatment ◽

Molecular Testing ◽

Retrospective Case ◽

Detection Rates ◽

Endemic Setting ◽

Number Of Patients ◽

Small Patient Population ◽

Extra Pulmonary

Abstract BACKGROUND Tuberculosis (TB) is a rare but potentially devastating infection among Canadian children. Accurate diagnosis and initiation of treatment are limited in part by the fact that it takes 2–6 weeks for culture results to be confirmed. Xpert MTB/RIF (Xpert) is a rapid, automated molecular assay that has been validated for diagnosing pulmonary but not extra-pulmonary TB in children. OBJECTIVES This was a retrospective study of children investigated for active TB at our facility in order to: 1.Outline demographic characteristics and describe clinical presentations of children diagnosed with active TB. 2.Compare performance of molecular testing (Xpert) to stain and Mycobacterium tuberculosis culture on pulmonary and extra-pulmonary specimens. DESIGN/METHODS We conducted a retrospective chart review of all paediatric patients investigated for active TB at our facility with stain, culture and molecular (Xpert) testing between January 2015 and August 2017. Due to a small number of patients, our data analysis was limited to narrative summary and descriptive statistics. RESULTS A total of 10 children were diagnosed with active TB, including 3 cases of pulmonary, 4 extra-pulmonary and 3 disseminated disease. Age range at diagnosis was 2 months to 16 years, with 3 children younger than 1 year. Most children contracted TB while travelling to and/or being exposed to an index case from endemic areas, including East Asia/Western Pacific (5), South Asia (2) and Africa (1). All children were HIV negative. Time from symptom onset to TB diagnosis and treatment ranged from approximately 4 days to 5 months. Multi-drug resistant TB was confirmed in 1 child. Sadly, 1 child passed away from TB related complications. AFB stain was positive on at least one specimen in 4/10 cases, cultures were positive in 8/10 and molecular testing (Xpert) in 7/10 cases. Time to positive cultures ranged from 10 to 35 days, with an average of 19 days. All cases positive on Xpert were also culture positive. Xpert test diagnosed TB in 5/6 of extra-pulmonary specimens submitted, including pericardial fluid, lymph node tissues and cerebrospinal fluid. CONCLUSION Many paediatric TB patients at our facility are children who have traveled to/have contacts from TB endemic regions, emphasizing the need for obtaining thorough exposure and travel history. Culture and molecular testing demonstrated similar TB detection rates, albeit based on a small patient population. While cultures remain the most reliable diagnostic method, molecular testing may facilitate rapid diagnosis and treatment of pulmonary and extra-pulmonary paediatric TB in a non-endemic setting.

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