A rare case of unilateral breast filariasis mimicking chronic mastitis

Filariasis of the breast is a very rare condition. In India, largest number (around 600 million) of people live in endemic areas. Despite the huge number, it is quite rare to find microfilaria in routine smears and body fluids and it is even more rare to find it in breasts. A 40 years old female, presented with a history of lump in the right breast approximately 3x3 cm in size in the right lower quadrant. Findings were confirmed by clinical examination which did not reveal any palpable ipsilateral or contralateral axillary lymph nodes. FNAC showed it as a benign lesion. After local excision, histopathology revealed a filarial worm. Filariasis of the breast is a rare disease. The presence of microfilaria in breasts using FNAC has been reported at times but the presence of the filarial worms can only be confirmed on histopathology, hence a core biopsy or an excision biopsy is a must in all the cases. A presumptive diagnosis of filariasis can be made on sonography if the worms are alive and active, the typical presentation on USG is the filarial dance. Surgical excision of the lump followed by DEC therapy is the treatment of choice for filarial lump of the breast.

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P043 Fascinating phosphate: seek and you will find

Rheumatology ◽

10.1093/rheumatology/keab247.040 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Jyoti Bakshi ◽

Clare Batten

Keyword(s):

Back Pain ◽

Degenerative Change ◽

Nasal Bone ◽

Rare Condition ◽

Whole Body ◽

Excision Biopsy ◽

Small Lesion ◽

History Of ◽

The Right ◽

Fgf 23

Abstract Background/Aims A 62-year-old accountant was referred to the metabolic bone clinic with a 2 year history of thoracic back pain and a persistently raised ALP. There were no associated red flags for her back pain. She had a history of a gluteal lump, thought to be benign, for which she had declined excision. She has hypertension and had a previous navicular fracture. Medications included bendroflumethiazide and Adcal D3. She had restriction in neck movements and was tender to percussion in the thoracic spine. There was no proximal weakness or focal neurology. Systems and joint exam were unremarkable. Methods The case is discussed below. Results Salient abnormal results on presentation were a raised ALP of 207 and corrected calcium of 2.34. PTH was elevated at 8.2 (NR:1.6-6.9), Vitamin D 79 and a low phosphate of 0.34 (NR:0.8-1.50). Alkaline phosphatase isoenzymes showed the raised level came from bone. Protein and urine electrophoresis were normal. A bone density scan was normal, and a recent thoracic MRI showed only degenerative change. An isotope bone scan was requested and was reported to show increased activity in the nasal bone, maxilla and both orbits, raising the possibility of Paget’s disease. However, when reviewed in the Radiology meeting with a skull x-ray, the appearances were not felt to be in keeping with Paget’s. Despite physiotherapy, hydrotherapy, acupuncture and neuropathic medication the patient’s back pain continued. Her phosphate remained low and her calculated tubular reabsorption of phosphate from a 24h urine collection (TmP/GFR) was low at 0.42mmol/l (NR 0.80-1.35). She was started on phosphate replacement and calcitriol, and Adcal D3 was continued. The Fibroblast Growth Factor (FGF) 23 levels were sent and came back significantly elevated at 1380 (NR < 100). A 68Ga DOTA-TATE scan (whole body PET/CT scan), confirmed the right gluteal lump as the source of the FGF 23. The patient went on to have an excision biopsy and histology confirmed a mesenchymal tumour of the right buttock. Her phosphate replacement was gradually weaned, but on reducing the dose phosphate levels dropped and her symptoms returned. The repeat TmP/GFR was again low at 0.61, and FGF 23 levels were still raised at 204. A repeat 68Ga DOTA-TATE scan, 4 years after the first one, showed recurrence of the right gluteal lesion and a possible small lesion in the left gluteal muscle. She has been sent for further excision. Conclusion Tumour induced osteomalacia (TIO) is a rare condition and should be considered in cases of hypophosphataemia. Classical symptoms are proximal weakness and muscle and bone pain. They are typically associated with small benign tumours (most commonly mesenchymal tumours) which may be difficult to find. Excision is curative but if small amounts of tumour remain, relapses may occur. Disclosure J. Bakshi: None. C. Batten: None.

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PROMPT RECOGNITION OF STUMPAPPENDICITIS IS IMPORTANT TO AVOID SERIOUS COMPLICATIONS: A CASE REPORT

10.36106/ijar/5000889 ◽

2020 ◽

pp. 1-2

Author(s):

Anil Kumar M S ◽

D. Shiva Manohar

Keyword(s):

Psoas Abscess ◽

Rare Condition ◽

Late Complications ◽

Retroperitoneal Abscess ◽

Lower Quadrant ◽

Stump Appendicitis ◽

Histologic Evaluation ◽

History Of ◽

Appendicular Stump ◽

The Right

Retroperitoneal abscess is a rare condition which is difficult to diagnose and treat because of its insidious onset. Herein, we present a case of retroperitoneal abscess secondary to stump appendicitis. A 50-year-old female was admitted with history of abdominal pain more in the right lower quadrant for 1 week. History of fever present since week associated with chills, History of poor stream of urine for 1 week, not associated with burning micturition. Her past medical history showed a laparoscopic appendectomy operation performed 5 months ago. Computed tomography of abdomen and pelvis showed features suggestive of right psoas abscess with possible communication with the tubular structure arising from IC junction (? appendicular stump), Ill-defined peripherally enhancing collection in presacral region and bilateral ischiorectal region -? Abscess. CECT Abdomen and pelvis showed right mild Hydroureteronephrosis. Cystoscopy + DJ stenting was done post which Exploration with drainage of retroperitoneal abscess with stump appendectomy done on 15/2/19. Intraoperatively 50cc pus with caseous material was drained, psoas was bulky. 3cm appendicular stump was noted, dissected, ligated and buried. A drain was placed in the site of the operation. Post-operative course was uneventful and he was discharged 9 days after surgery. The histologic evaluation reported suppurative stump appendicitis. Residual long stump of the appendix after appendectomy might lead to persistence of infection and possibly late complications such as intraperitoneal, retroperitoneal or iliopsoas abscess. Surgical exploration may be necessary in persistent cases of Retroperitoneal abscess, to allow for recognition and treatment of the underlying pathology.

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Regional Nodal Metastasis of Humeral Chondrosarcoma in a Dog

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6198 ◽

2015 ◽

Vol 51 (5) ◽

pp. 346-351 ◽

Cited By ~ 1

Author(s):

Mandy Meindel ◽

Lisa Pohlman ◽

Brad DeBey ◽

Mary Lynn Higginbotham ◽

Rachel Moon

Keyword(s):

Lymph Nodes ◽

Histopathological Examination ◽

Bone Lesion ◽

Prognostic Indicator ◽

Needle Aspiration ◽

Nodal Metastasis ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

History Of ◽

The Right

A 6 yr old castrated male English springer spaniel was evaluated with a 1 mo history of progressive right forelimb lameness with recent swelling around the elbow joint. Physical examination findings included lameness of the right forelimb, muscle atrophy around the right shoulder, grade 2/6 heart murmur, and moderate dental disease. Results of a complete blood cell count and serum biochemical analysis were unremarkable with the exception of a mildly increased alkaline phosphatase (368 U/L; reference range, 128–328 U/L). Radiographs of the right elbow revealed a mixed lytic and proliferative osseous lesion most consistent with either neoplasia or infection. Thoracic radiographs and the echocardiogram were unremarkable. Fine-needle aspiration of the bone lesion was performed. The cytological diagnosis was chondrosarcoma. The right forelimb was amputated and the axillary lymph nodes were collected. Histopathological examination of the bone lesion and axillary lymph nodes revealed chondrosarcoma with metastasis to the lymph nodes. Lymph node metastasis of chondrosarcoma is rare and needs to be further evaluated as a prognostic indicator.

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Primary Ewing sarcoma of the larynx with distant metastasis: a case report and review of the literature

Current Oncology ◽

10.3747/co.26.5001 ◽

2019 ◽

Vol 26 (4) ◽

Cited By ~ 1

Author(s):

C. A. Maroun ◽

I. Khalifeh ◽

A. Tfayli ◽

R. V. Moukarbel

Keyword(s):

Computed Tomography ◽

Vocal Cord ◽

Ewing Sarcoma ◽

Present Report ◽

Thyroid Cartilage ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

History Of ◽

The Right ◽

Extraosseous Ewing Sarcoma

Extraosseous Ewing sarcoma is a rare, poorly differentiated round-cell tumour that is part of the Ewing sarcoma family of tumours. Here, we present an extremely rare case of primary extraosseous Ewing sarcoma arising in the larynx, with distant metastases. A 53-year-old man with a history of Hodgkin lymphoma treated 4 years earlier with 8 cycles of chemotherapy presented to our medical centre with a 2-week history of hoarseness. On physical examination, he was found to have a right supraglottic mass together with a fixed right vocal cord. Computed tomography imaging of the patient’s neck showed a heterogeneously enhancing lesion measuring 5.0×3.8×3.8 cm, centred on the right thyroid cartilage and invading the right true vocal cord. Imaging by integrated fluorodeoxyglucose positron-emission tomography and computed tomography showed active subcarinal and axillary lymph nodes, multiple scattered lung nodules, and multiple bony metastases. Needle core biopsy of the laryngeal mass was diagnostic for Ewing sarcoma. The patient received radiation to the laryngeal area and then alternating cycles of vincristine–actinomycin-D–cyclophosphamide and etoposide–ifosfamide. The patient remains in remission 1 year after completing therapy. As demonstrated in the present report, these tumours can behave very aggressively both locally and by metastasizing to distant organs. Our treatment approach provided favourable results for the patient; however, future reports are needed to further elucidate optimal management.

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Description and Trial of a Clinical Diagnostic Index for the early Diagnosis of Mammary Carcinoma.

Tumori Journal ◽

10.1177/030089167305900107 ◽

1973 ◽

Vol 59 (1) ◽

pp. 63-76 ◽

Cited By ~ 2

Author(s):

Sergio Di Pietro ◽

Alberto Re

Keyword(s):

Early Diagnosis ◽

Mammary Carcinoma ◽

Clinical Investigation ◽

Benign Lesion ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Benign Lesions ◽

Clinical Diagnostic ◽

The Right ◽

Diagnostic Index

A method of clinical investigation has been developed for the early diagnosis of mammary carcinoma based on the scoring of 10 Symptomatologie features of mammary nodules of doubtful malignancy. These features are: variations in size, consistency, form, surface, limits, mobility, protrusion, pain on pressure, presence and nature of secretion from the nipple, nature of axillary lymph nodes. Each feature is scored +2, + 1, 0, −1 or −2 according to whether it points to a malignant, doubtful or benign lesion, +2 and −2 indicating a more definite degree one way or the other. The number emerging from the algebric sum of the ten scores is rated as the complex score or clinical diagnostic index. The validity of the method was tested in 93 cases of clinically doubtful mammary nodules later subjected to histologic examination. The method yielded the right answer in 91 % (compared with 80 % for mammography) and false negatives in 2.2 % (compared with 15 %) of the 46 cases of mammary carcinoma. It yielded the right answer in 48.9 % (compared with 42.5 % for mammography) and 34 % false positives (same percentage as for mammography) of the 47 benign lesions. Thermography, used in about four-fifths of the cases, showed a much lower success rate. The combined outcome of clinical diagnostic index and mammography made it possible to avoid the preliminary classification of carcinomas as benign lesions. It was therefore concluded that the method is useful in uncertain mammary nodules, though the results of a larger trial, now in progress, must be awaited before expressing a definite verdict.

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Hepatic brucelloma: a rare complication of a common zoonotic disease

BMJ Case Reports ◽

10.1136/bcr-2020-237076 ◽

2020 ◽

Vol 13 (12) ◽

pp. e237076

Author(s):

George Vatidis ◽

Eirini I Rigopoulou ◽

Konstantinos Tepetes ◽

George N Dalekos

Keyword(s):

Rare Complication ◽

Surgical Excision ◽

Coombs Test ◽

Inflammation Markers ◽

Laboratory Findings ◽

Ct Guided ◽

Rare Manifestation ◽

Bone Marrow Cultures ◽

History Of ◽

The Right

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.

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Rheology of right ventricular outflow tract obstruction: sub-pulmonary membrane developing months after primary intervention to treat pulmonary atresia with intact interventricular septum

Cardiology in the Young ◽

10.1017/s1047951121001591 ◽

2021 ◽

pp. 1-4

Author(s):

Baher M. Hanna ◽

Wesam E. El-Mozy ◽

Sonia A. El-Saiedi

Keyword(s):

Right Ventricular ◽

Interventricular Septum ◽

Pulmonary Atresia ◽

Right Ventricular Outflow Tract ◽

Rare Condition ◽

Surgical Excision ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Ventricular Outflow Tract Obstruction ◽

The Right

Abstract Isolated sub-pulmonary membrane is a rare condition, the origin of which has been debatable. Transcatheter treatment of pulmonary valve atresia with intact interventricular septum by radiofrequency perforation and balloon dilatation to restore biventricular circulation is gaining more popularity, with improving results over time. We report in our experience of 79 cases in 10 years the development of a sub-pulmonary membrane in 4 cases: causing significant obstruction requiring surgical excision in one case that revealed a fibrous membrane on pathology; causing mild right ventricular outflow tract obstruction in another and not yet causing obstruction in 2. On cardiac MRI, the right ventricular outflow tract and the right ventricular outflow tract/pulmonary atresia angle showed no morphological abnormalities.

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Chronic Endophthalmitis Caused by Pseudomonas stutzeri

Case Reports in Ophthalmology ◽

10.1159/000510129 ◽

2020 ◽

Vol 11 (3) ◽

pp. 595-599

Author(s):

Saeed T. Alshahrani ◽

J. Fernando Arevalo

Keyword(s):

Pseudomonas Stutzeri ◽

Posterior Chamber ◽

Topical Steroids ◽

Sensitivity Testing ◽

Corneal Incision ◽

Presumptive Diagnosis ◽

Lens Extraction ◽

History Of ◽

Sudden Decrease ◽

The Right

A patient presented with complaints of a sudden decrease in vision, ocular redness, and pain in the right eye. The patient had a history of clear lens extraction with intraocular lens (IOL) implantation for myopia 2 years previously. He had been prescribed topical steroids for episodes of inflammation that occurred repeatedly every 1–2 months. With a presumptive diagnosis of chronic endophthalmitis, a 23-G transconjunctival sutureless pars plana vitrectomy (PPV) with delivery of intravitreal antibiotics was performed the next day. Culture sensitivity testing of the vitreous sample indicated <i>Pseudomonas stutzeri</i> that was sensitive to ceftazidime and gentamicin. Two weeks later, the patient presented with sudden loss of vision and all the signs of recurrent endophthalmitis. 23-G transconjunctival sutureless PPV was performed along with removal of the posterior chamber IOL through a corneal incision. Complete resolution was only achieved after removal of the IOL, resulting in excellent visual recovery. Due to its chronic and fulminating nature, <i>P. stutzeri</i> can induce endophthalmitis and should be considered in the differential diagnosis. Aseptic measures are the best prevention.

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Intravascular Glomus Tumor of the Forearm Causing Chronic Pain and Focal Tenderness

Case Reports in Orthopedics ◽

10.1155/2014/619490 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Sang Ki Lee ◽

Dae Geon Song ◽

Won Sik Choy

Keyword(s):

Chronic Pain ◽

Glomus Tumor ◽

Rare Condition ◽

Surgical Excision ◽

Vascular Tumor ◽

Glomus Tumors ◽

Contrast Magnetic Resonance ◽

History Of ◽

Subcutaneous Layer ◽

Magnetic Resonance Imaging Mri

Introduction. A glomus tumor is a benign vascular tumor derived from glomus cells and occurs mainly in the subcutaneous layer of the subungual or digital pulp. Extradigital glomus tumors have been reported within the palm, wrist, forearm, foot, bone, stomach, colon, cervix, and mesentery. Glomus tumors can originate from the intraosseous, intramuscular, periosteal, intravascular, and intraneural layers. However, a glomus tumor originating from the intravascular layer of the forearm is a rare condition.Case Report. A 44-year-old woman had a 7-year history of chronic pain and focal tenderness of the forearm. No hypersensitivity or sensory alterations were observed. Contrast magnetic resonance imaging (MRI) showed a mass measuring 5 × 3 × 2 mm leading to a vein. Surgical excision was performed, and the tumor was completely resected. Finding of gross examination revealed a dark-red, well-defined soft tissue tumor, and histologic examination confirmed that the mass was a glomus tumor. The patient’s symptoms were completely resolved postoperatively.Conclusion. Intravascular glomus tumors rarely occur in the forearm; therefore, a thorough physical exam, comprehensive medical history, in-depth imaging, and early surgical excision upon clinical suspicion may be helpful to prevent a delayed or incorrect diagnosis.

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BILATERAL PROPTOSIS - INITIAL AND RARE PRESENTATION: AML

10.36106/ijar/0610699 ◽

2021 ◽

pp. 17-18

Author(s):

Tejasvini Chandra ◽

Perwez Khan ◽

Lubna Khan ◽

Anshika Gupta

Keyword(s):

Myeloid Leukemia ◽

Blood Count ◽

Complete Blood Count ◽

Rare Condition ◽

Metastatic Tumour ◽

Blood Picture ◽

Rare Presentation ◽

Radiological Investigation ◽

Presumptive Diagnosis ◽

History Of

We report bilateral proptosis as the initial presentation of Acute Myeloid Leukemia (AML) in a child. An Eight year child presented with a history of painless proptosis in the both eyes within 10 days. Radiological investigation (CT scan) showed inltration of orbit with the metastatic tumour cell. AML was diagnosed with complete blood count, General Blood Picture (GBP) and bone marrow biopsy. The presumptive diagnosis of leukemic inltration of the orbit is made. We report this case as AML can rarely present in child as a bilateral proptosis due to leukemic inltration. Urgent treatment modality for this rare condition is radiation.

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