scholarly journals Metastatic solitary vaginal nodule from a primary rectal tumor.

2020 ◽  
Author(s):  
Fade Alawneh ◽  
Mohamad K. Abou Chaar ◽  
Lara Rabah ◽  
Qais Shatnawi ◽  
Azza Gharaibeh ◽  
...  
Keyword(s):  
Low Anterior Resection ◽  
Colorectal Adenocarcinoma ◽  
Rectal Adenocarcinoma ◽  
Surgical Oncology ◽  
Metastatic Lesion ◽  
Rectal Tumor ◽  
Assessment Tools ◽  
Case Presentation ◽  
Vaginal Metastasis ◽  
Rule Out

Abstract Introduction: An isolated vaginal metastasis from a primary colorectal adenocarcinoma is extremely rare. Based on meticulous literature review, only seven cases were reported from 1956 – 2013. Case Presentation: We present a case of a 52-year-old female patient diagnosed with rectal adenocarcinoma, underwent low anterior resection of the primary tumor, and then was found to have an asymptomatic isolated vaginal metastasis that was completely excised. Conclusion: Isolated vaginal metastatic disease is one of the rarest entities in surgical oncology with only limited cases being reported in the literature. A diagnosis can be challenging if the metastatic lesion is small and asymptomatic even with the most advanced radiological assessment tools. A meticulous examination should be done pre-operatively in order to rule out such diagnosis.

Muscle Tone Assessment under General Anesthesia for Sjögren-Larsson Syndrome and Spasticity

2021 ◽  
Vol 56 (2) ◽  
pp. 163-165
Author(s):  
George Georgoulis ◽  
Argyrios Dinopoulos ◽  
Emmanouil Gkliatis
Keyword(s):  
General Anesthesia ◽  
Muscle Tone ◽  
Muscle Relaxants ◽  
Spastic Diplegia ◽  
Case Presentation ◽  
Neurosurgical Procedure ◽  
Dorsal Rhizotomy ◽  
Severe Spasticity ◽  
Larsson Syndrome ◽  
Rule Out

Introduction: Study of muscle tone in individuals with severe spasticity (Modified Asworth Scale – MAS:3) under general anesthesia can confirm or rule out the eventual necessity of the impending spasticity relieving ablative neurosurgery by observing the hypertonia reduction and passive range of motion expansion. Therefore, what we measure under muscle relaxants is practically a fixed deformity. Case Presentation: The study was performed on a girl with Sjögren-Larsson syndrome, presenting with icthyosis and spastic diplegia. Proposed intervention was Dorsal Rhizotomy. Under general anesthesia, with and without muscle relaxants, hypertonia was significantly reduced (MAS:1), but the angle of motion did not increase much. Conclusion: We decided not to perform such a neurosurgical procedure. In ambiguous situations, the proposed study can help in decision-making for spasticity treatment.

scholarly journals Retroperitoneal fibrous tumor recurring as lung metastases after 10 years: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kozue Matsuishi ◽  
Kojiro Eto ◽  
Atsushi Morito ◽  
Hirokazu Hamasaki ◽  
Keisuke Morita ◽  
...  
Keyword(s):  
Case Report ◽  
Solitary Fibrous Tumor ◽  
Distant Metastasis ◽  
Curative Resection ◽  
Lung Metastases ◽  
Lung Resection ◽  
Left Lung ◽  
Metastatic Lesion ◽  
Case Presentation ◽  
Fibrous Tumor

Abstract Background Solitary fibrous tumor (SFT) is a relatively rare mesenchymal tumor that mainly affects adults. Its prognosis is good after curative resection, but distant recurrences after 10 years or longer have been reported. Recurrent SFT usually arises as a local lesion; distant metastasis is rarely reported. Here, we report lung metastases that recurred a decade after excising a retroperitoneal primary SFT. Case presentation A 44-year-old woman had an SFT resected from her right retroperitoneum at our hospital. Ten years later, at age 54, she underwent a lung resection after CT showed three suspected metastases in her left lung. All three were histologically diagnosed as lung metastases from the retroperitoneal SFT. However, whereas the primary SFT had 1–2 mitotic cells/10 high power fields (HPF), the metastatic lesion increased malignancy, at 50/10 HPF. Conclusion Patients who have had resected SFTs should be carefully followed up, as malignancy may change in distant metastasis, as in this case.

Blindness paving the path to the diagnosis of metastatic prostate carcinoma: A unique case presentation

2021 ◽  
pp. 205141582110537
Author(s):  
Aadhar Jain ◽  
Anveshi Nayan ◽  
Sujata Patwardhan
Keyword(s):  
Vision Loss ◽  
Specific Antigen ◽  
Primary Source ◽  
Metastatic Lesion ◽  
Unique Case ◽  
Case Presentation ◽  
Intracranial Metastases ◽  
Appropriate Therapy ◽  
Brain Involvement ◽  
Metastatic Prostate Carcinoma

Background: Intracranial metastases from prostate adenocarcinoma are very unusual and typically occur late in the course of the disease, and initial presentation with symptomatic brain involvement, especially vision loss is very rare (with this being only the sixth such reported case to the best of our knowledge). The present case elucidates how a diagnosis was reached in such a scenario and the management provided. Case presentation: A 66-year-old gentleman presented with loss of vision and headache with no other ocular or neurological complaint. Computed tomography (CT) of his head revealed a destructive lesion involving the clivus and a space-occupying lesion (SOL) in occipito-parietal region. Detailed inquiry regarding the possible primary source of suspected the metastatic lesion revealed an increased frequency of urination, nocturia, and significant weight loss. His serum prostate-specific antigen (PSA) levels were raised. He was treated by surgical hormonal therapy and his visual symptoms improved. Conclusion: Awareness of such a presentation can lead to an accurate diagnosis. Initiation of appropriate therapy can successfully alleviate the neurologic deficits.

scholarly journals Tétanos en un preescolar de 5 años con abandono familiar: Reporte de caso

2019 ◽  
Vol 30 (3) ◽  
Author(s):  
Juan Pablo Guillermo-Durán ◽  
Salvador Gómez-Carro ◽  
Nina Mendez-Dominguez
Keyword(s):  
Foreign Body ◽  
Clinical Findings ◽  
Battered Child Syndrome ◽  
Clostridium Tetani ◽  
Case Presentation ◽  
Battered Child ◽  
Symptomatic Management ◽  
Child Syndrome ◽  
Terapia Intensiva ◽  
Rule Out

Introducción: El tétanos es una enfermedad infecciosa causada por Clostridium tetani, con un cuadro clínico grave y una elevada mortalidad. En Yucatán, la tasa de incidencia es baja (0.09 por 100,000 habitantes), reportándose únicamente dos casos en 2017, por lo que actualmente es una enfermedad de baja sospecha diagnóstica en la región. Caso clínico: Preescolar masculino de 5 años, originario de una comunidad rural de Yucatán y con esquema de inmunización incompleto, quien fue atendido por espasmos musculares generalizados, así como heridas recientes por cuerpo extraño y síndrome del niño maltratado. En la Unidad de Terapia Intensiva, se integró el diagnóstico de tétanos, por lo que recibió manejo etiológico y sintomático, logrando mejoría a su egreso. Discusión: Yucatán es una de las entidades federativas con mayor índice de maltrato infantil. Ante la presencia de dicha problemática social, es importante descartar un esquema de inmunización incompleto, mismos que con la coexistencia de hallazgos clínicos típicos y herida reciente por cuerpo extraño, se debe sospechar tétanos.Background: Tetanus is an infectious disease caused by Clostridium tetani, with severe symptoms and a high mortality rate.  In Yucatan, the incidence rate is low (0.09 per 100,000 population), reporting only two cases in 2017, so it is now a disease of low diagnostic suspicion in the region. Case presentation: A 5-year-old male preschool, from a rural community of Yucatán and with incomplete immunization scheme, who was attended by generalized muscle spasms as well as recent foreign body wounds and battered child syndrome. In the Intensive Care Unit, the diagnosis of tetanus was integrated, for which he received etiological and symptomatic management, achieving improvement at his discharge. Discussion: Yucatan is a state with high child abuse rate of. In the presence of this social problem, it is important to rule out an incomplete immunization scheme, which with the coexistence of typical clinical findings and recent foreign body wound, tetanus should be suspected. 

The Changing Landscape of Sport Concussion

2020 ◽  
Vol 9 (1) ◽  
pp. 79-85
Author(s):  
Kevin M. Guskiewicz ◽  
Samuel R. Walton
Keyword(s):  
Critical Period ◽  
Clinical Decision Making ◽  
District Of Columbia ◽  
Clinical Decision ◽  
Assessment Tools ◽  
Cognitive Tests ◽  
Youth Athletes ◽  
Sport Concussion ◽  
Neuroimaging Biomarkers ◽  
Rule Out

It was not too long ago that many people referred to concussion as a “hidden injury” and a “complex injury for which we still had much to learn.” We still have a lot to learn about these injuries, but because of the advancement of concussion research we are better informed today than we were just a decade ago. Much of this work began in the early to mid-1990s with studies aimed at equipping clinicians with better concussion-assessment tools. We needed to remove the guesswork, so more systematic and objective concussion-assessment batteries (sideline and clinic) that included symptom checklists, cognitive tests, and balance assessments were developed and validated. As a result, it became easier to detect and/or rule out concussions and to track recovery for several days postinjury. From 2009 through 2014, all 50 states and the District of Columbia passed concussion legislation requiring concussion education for high school and youth athletes, among other things. This was a critical period in which more emphasis was placed on concussion prevention, ultimately leading to increased reporting of these injuries and a reduction in the number of unreported and undiagnosed concussions. More recently, the corpus of science has evolved to identify potential blood and neuroimaging biomarkers to complement the traditional-clinical assessment tools, and newer studies are focused on treatment after concussion—challenging the notions that “rest is best” and that the effects of concussion are permanent and immutable. The research is ongoing, and several large multisite studies will yield important findings to help guide clinical decision making in the next few years.

scholarly journals Gallbladder Metastases: A Report of Two Cases

2019 ◽  
Vol 12 (1) ◽  
pp. 235-240 ◽  
Author(s):  
Mohamad Mouchli ◽  
Douglas J. Grider ◽  
Paul Yeaton
Keyword(s):  
Computed Tomography ◽  
Invasive Ductal Carcinoma ◽  
Triple Negative ◽  
Ductal Carcinoma ◽  
Primary Lung Cancer ◽  
Gallbladder Wall ◽  
Metastatic Lesion ◽  
Quadrant Pain ◽  
Case Presentation ◽  
Enhanced Computed Tomography

Introduction: Metastasis to the gallbladder is not common and usually manifests an advanced stage of malignancy. Herein, we report a case of triple negative high grade invasive ductal carcinoma of breast with a metastatic lesion to the gallbladder. Case Presentation: The patient is a 52-year-old female diagnosed with invasive ductal carcinoma treated with mastectomy and chemotherapy. After 12 months, she presented to the emergency department with right upper quadrant pain and elevated liver chemistries. Abdominal enhanced computed tomography showed periportal and gallbladder wall edema. After cholecystectomy, the resected gallbladder was histologically considered to be a metastatic lesion arising from the primary lung cancer. The second case describes a case of a 77-year-old woman with multiple co-morbidities who presented to the hospital with sepsis secondary to biliary source. Abdominal enhanced computed tomography findings were concerning for acute cholecystitis. After cholecystectomy, the pathology of the resected gallbladder demonstrated cholecystitis and plasmacytoma. Conclusion: The atypical presentation of gallbladder metastases could mislead treating providers. The diagnosis might alter management decisions and prognosis.

scholarly journals Denture Impaction Causing an Upper Esophageal Diverticulum

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Shireen Samargandy ◽  
Hani Marzouki ◽  
Talal Al-Khatib ◽  
Mazin Merdad
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
The Elderly ◽  
Barium Swallow ◽  
Diagnostic Challenge ◽  
Case Presentation ◽  
History Of ◽  
Endoscopic Diverticulotomy ◽  
Tomography Scan ◽  
Rule Out

Background. Dentures are a common cause of inadvertent foreign body ingestion particularly in the elderly. Due to their radiolucent nature, they often present a diagnostic challenge to care providing physicians. Case Presentation. A 66-year-old female presented to our otolaryngology clinic with a 2-year history of dysphagia. Her physical examination was unremarkable. Computed tomography scan of the neck and barium swallow suggested Zenker diverticulum. She was planned for endoscopic diverticulotomy; however, during surgery, a foreign body was incidentally found and retrieved, which was a partial lower denture. The diverticulum resolved thereafter, and the patient's symptoms abated. Conclusion. The authors recommend evaluating the esophagus endoscopically first in cases of upper esophageal diverticular formation, even when planning an open repair approach, to rule out any concealed foreign bodies.

scholarly journals Whole Exon Sequencing of Primary Lesion and Liver Metastatic Lesion in Pancreatic Neuroendocrine Tumor：A Case Report and Review of the Literature

2021 ◽  
Author(s):  
Yanfen Shi ◽  
Dingrong Zhong ◽  
Yuanliang Li ◽  
Huangying Tan ◽  
Zhaoqing Li ◽  
...  
Keyword(s):  
Somatic Mutations ◽  
Liver Lesion ◽  
Metastatic Lesion ◽  
Neuroendocrine Neoplasms ◽  
Case Presentation ◽  
Whole Exome ◽  
Number Variation ◽  
Pancreatic Net ◽  
Net G3 ◽  
Cell Atypia

Abstract Background: Pancreatic neuroendocrine neoplasms(p-NENs) are classified into neuroendocrine tumors (NET) G1, G2, G3, and neuroendocrine carcinoma (NEC) according to WHO classification. NET and NEC are different pathogenesis. The two kinds of tumors that occurred in the same part have not been reported. We found 4 foci of NEN G3 in a primary pancreatic NET G2. The cell atypia was obvious with Ki67 index of 50-70%, focal necrosis, there were 12 hepatic metastatic nodules with similar morphology to NEN G3, which is difficult to identify NEC and NET G3.Case presentation: A patient with pancreatic NET was selected to perform whole exome sequencing on primary pancreatic NET G2 and liver metastatic NEN G3 paraffin tissues.NET G2 had 13 somatic mutations, while NEN G3 had 72 somatic mutations and Copy number variation in 4 genes. P.S493N point mutation of TRIOBP gene was detected in NET G2 and NEN G3. 5-fold amplification of MDM4 is found in the metastatic liver lesion.Conclusion: NET G2 and NEN G3 are closely related to TRIOBP gene. Oncogene amplification (MDM4) in liver metastases may be associated with morphological malignant transformation.

scholarly journals Bee sting presumed endophthalmitis: a devastating ocular outcome

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mohammed Al Amry ◽  
Huda Al Ghadeer ◽  
Ahmed R. Al Gethami
Keyword(s):  
Ocular Injury ◽  
Microbial Culture ◽  
Rare Type ◽  
Visual Evoked Response ◽  
Case Presentation ◽  
Aeromonas Veronii ◽  
Bee Sting ◽  
Appropriate Treatment ◽  
Patient Presentation ◽  
Rule Out

Abstract Background To report a rare case of bee sting presumed endophthalmitis that resulted in a devastating ocular outcome. Case presentation A 43-year-old patient presented 24 h after bee sting ocular injury in his left eye. He had a mild inflammatory sign at presentation, and he underwent surgical exploration to rule out a scleral defect, which revealed a sealed defect. During his hospital course, he developed signs of endophthalmitis 48 h following trauma for which he received vitreous tap and intravitreal antibiotic. Microbial culture revealed gram-negative rods, Pseudomonas aeruginosa, and Aeromonas veronii. Condition escalated to reach the panophthalmitis stage and cellulitis like picture with visual acuity of no light perception. Visual evoked response (VER) demonstrated a flat response. Infection was controlled by evisceration of the globe at the end as salvage therapy against the spreading of infection Conclusions Bee sting ocular injury is an exceedingly rare type of ocular trauma. Concomitant infection can happen, and severity depends on the pathogen involved. It is crucial to have insight and start appropriate treatment based on to the patient presentation.

scholarly journals Septic Shock Predisposed by an Underlying Chronic Neutrophilic Leukemia with an Atypical Presentation; A Case Report

2018 ◽  
Vol 11 (3) ◽  
pp. 871-879
Author(s):  
Vincent Louie Mendiola ◽  
You-Wen Qian ◽  
Bagi Jana
Keyword(s):  
Septic Shock ◽  
Myeloproliferative Neoplasm ◽  
Myeloid Cell ◽  
Case Presentation ◽  
Chronic Neutrophilic Leukemia ◽  
Plasma Cell Neoplasm ◽  
Work Up ◽  
Diagnostic Criterion ◽  
Cell Clonality ◽  
Rule Out

Background: Chronic neutrophilic leukemia (CNL) is an extremely rare myeloproliferative neoplasm (MPN). Due to the difficulty in its diagnosis, the diagnostic criterion was just recently revised in 2016. CNL is defined as: A clonal disorder with sustained primary neutrophilia, with normal neutrophil maturation, that does not meet other MPN criteria, as well as no identifiable mutations of the PDGFRA, PDGFRB or FGFR1 or PCM1-JAK2 genes, and, either, the presence of a CSF3R mutation, or if absent, the presence of sustained neutrophilia (> 3 months), splenomegaly and no other identifiable cause of reactive neutrophilia including the absence of a plasma cell neoplasm, or, if present, demonstration of myeloid cell clonality by cytogenetics. Only about 200 cases have been reported. Case Presentation: We report a 61-year-old Caucasian male patient who initially presented with unexplained leukocytosis. An outpatient work-up was planned to rule out a myeloproliferative disorder but the patient was acutely admitted for MRSA septic shock. The patient was stabilized prior bone marrow work-up and was then diagnosed with an atypical type of CNL (JAK2 positive, CSF3R negative). The patient refused further treatment due to social circumstances and requested palliative care instead. Conclusion: This case aims to present atypical findings of an extremely rare MPN. Even though a recent revision has been made to help in its diagnosis, atypical findings must still be considered. This, in turn, will help to further improve the current CNL diagnostic criteria.

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